Search for tag: "acupuncture"

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Troy: You've got to say something like, "Troy puts the stud in studies," or something like that. Something good. I'm just kidding.

Scot: I will never say that.

Troy: I was just trying to think of something better than "Troy's articles" or whatever you called it.

Scot: That's us. It's a "Sideshow" episode. That's what we like to call a soft start. You caught us in the middle of a little prepping trying to decide what we're calling this segment, where Troy scans the medical journals so you don't have to and then shares an article that hopefully is of some interest.

Troy: Hopefully.

Scot: Yeah, this is "Who Cares About Men's Health," a "Sideshow" episode. My name is Scot. With me, as always, the MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: And Producer Mitch.

Mitch: Hey there.

Scot: All right, Troy. Let's take a look at your articles, hear what you've got. Go ahead and put those articles on display.

Troy: Look at the articles.

Scot: Yeah. Go ahead and put those articles out on display for us. We're going to pick one.

Troy: Oh, we're picking?

Scot: Oh, yeah. I mean, unless you just decided you had one that you . . .

Troy: I decided.

Scot: Oh, okay.

Troy: This title is so good that I knew even if I gave you my list of five, including the one on green urine that I keep trying to get you to pick, I know you'd pick this one.

Scot: All right.

Troy: And I'm just going to read it to you and if you don't like it, if you're just like, "No, we would not have picked that one," let me know and I'll pull up some other ones.

Scot: Okay.

Troy: The title of this article from the "Journal of Emergency Medicine," the title is "Battlefield Acupuncture Versus Standard Pharmacologic Treatment of Low Back Pain in the Emergency Department: A Randomized Controlled Trial."

Mitch: Oh, Troy, I did a bunch of interviews about this. Keep going.

Troy: Yeah. Tell me I have not piqued your interest.

Scot: So when you say battlefield, you mean like a war battlefield?

Troy: That's a good question.

Scot: Oh, okay. Well, I guess, Troy . . .

Troy: I'm hoping I piqued your interest enough that I can . . . I'll explain what battlefield acupuncture is. I didn't know before this article.

Scot: Move forward with this one. Go for it.

Troy: Okay, we got it. So battlefield acupuncture, to your question, is a technique using acupuncture. So you're familiar with acupuncture? You use these little needles in different spots. Ideally, the way this is designed, it's supposed to then relieve pain or lead to different effects.

Acupuncture, of course, is considered an alternative therapy, and it's one of those things where it has gained more mainstream acceptance as these types of studies have come out. But it's been considered a traditional therapy, an alternative therapy. It is not something I have ever done or have ever practiced. I did spend a day shadowing, spending time with an acupuncturist during med school, which was really cool, to kind of see what she did and hear her philosophy and see her approach and see the patient's response.

But battlefield acupuncture is a technique where there are certain little needles that look more like little tiny darts that are placed in specific places in either one or both ears.

The idea behind this is that these spots are said to influence the central nervous system pain response. And by putting these little needles in these different spots in the ear, they then decrease pain that is coming from other sites in the body. I mean, that's the theory. Again, I'm not a traditional practitioner, but I'm just kind of reading what I found on it.

Scot: Time out. In the ear, or in the part around the ear, or the earlobe?

Troy: In various parts. So yeah, let me clarify that. Not in the tympanic membrane. You're not going in the ear hole. These are different spots . . .

Scot: Okay.

Troy: Yeah, these are different spots on the auricle of the ear. You do not want to puncture the eardrum. These are spots . . .

If you just do a Google search for this, you can see photos of where these spots are. They're basically at the very top of the auricle of the ear, so the very top of the ear, and then kind of maybe half an inch down from there. And there's another spot half an inch down from there. There's a spot on the earlobe. There's a spot just on the very front part of the earlobe.

So they're like little tiny darts, and they actually have a tool that you use to place these. They just stay in place until they fall out. So it's usually three or four days. You put these in there, you leave them in, and you just send people home with these in place.

Scot: Wow.

Troy: Yeah, it's fascinating. Again, I have never done this. I've never been trained on this. This is the first article I've seen looking at treatment of low back pain.

And then you might ask, "Why would I even care about this? Because surely I have some great treatment for low back pain." I can tell you that when you see a patient come to the ER, the first thing you'll see is their name and a chief complaint and that's what shows up. And when the chief complaint is low back pain, that to me is one of the most frustrating things to go and see because there is so little that I can offer.

It used to be these patients would come in and everyone would just get opioids, like, "Okay, here's your script for Norco or Lortab." That's a horrible way to approach it and that's what's led to the current opioid epidemic.

So now when people come in, I say, "Well, you can try ibuprofen or Tylenol." "Well, I've already been trying that."

"Well, you could try some lidocaine, some numbing cream on there." "Well, I've tried that."

"Well, you could try physical therapy." And we actually had a physical therapy in our emergency department and did a study on it, and that was great. But that person was only there 30 hours a week and the emergency department is open 24/7, so that's not something I can offer that often.

So if there was something I could actually do and say, "There's evidence behind this and this is going to help you," and people actually did it and said, "Wow, it helped me," that would be really cool.

So this study, essentially what they did is they took patients who came into the emergency department . . . It's a fairly small study, more of a pilot study we would call it, where it's kind of like, "Hey, let's try to see if it works. If it works, let's do a bigger study."

So they only had 52 patients. Twenty-six of these were randomized either to getting this battlefield acupuncture done or to just standard treatment, which would be the stuff I talked about where it's just like, "Hey, do whatever you normally do."

The patients with the battlefield acupuncture had a significant decrease in their pain score when compared to the patients who just had standard treatment.

And they then contacted these patients two to three days after they were there and found that the patients who had the battlefield acupuncture continued to have a significant improvement in their pain scores compared to those who were sent home either with a prescription or with just standard stuff we would do for low back pain.

Of course, there were no difference in any adverse effects. It's not like these patients were getting a lot of infections, they were complaining of a lot of pain or bleeding, or anything like that.

So their conclusion was that this potentially shows some promise. I can tell you please don't come to the ER right now and ask for battlefield acupuncture, because we don't have the tools there. It is not something we're doing. But maybe a study like this and some subsequent studies, if they continue to show this works, maybe it's something we're going to learn to do. I would love to be able to offer something better than what I can realistically offer in the ER.

So kind of a cool study. A pretty simple thing, it looks like, to do. It's just something we're not doing now, but maybe we'll see more of this in the future.

Mitch: I have to chime in because I've done it.

Troy: So when you say you've done it, have you performed this on people?

Mitch: Yes, I have.

Troy: Wow. This is cool.

Mitch: Okay, so 2011, it was my old life as a documentary filmmaker. We were working on a project called "The Painful Truth," and we were traveling all over the country investigating chronic pain patients and how they are treating their different conditions and how it impacts their family. And I got to actually go to this big medical conference. And one of the rooms where they were doing a breakout session was all about battlefield acupuncture.

You go in there and up on front, there's like this cute small woman who's been studying it and she published the paper. And then there are these military guys in full uniform with all their awards and medals and everything, talking about how they were using acupuncture in the ears and the tragus and all these different parts to stop people from going into shock on the battlefield.

Troy: Wow. So that's where it got the name then. I had no idea before this.

Mitch: So I was actually able to get one of them to be interviewed with us. And when we were talking about the interview, he pulls out first an orange and he's like, "Here's the tool. I want to show you how easy it is here. Here, why don't you go ahead and put some of these little brads in." And it's like a little gun and it's just, "Pew, pew, pew." So I bedazzled an orange.

And then he's like, "Do you want to see what it feels like?" And I'm like, "Absolutely, yes, a thousand times." And so he clips my ear. I'm trying to find some photos of it right now. But he clips my ears, and I didn't feel anything because I wasn't going into shock. But I'm like, "Wow."

And then he asked if I would feel comfortable doing it with my cameraman, and I said, "For real?" And the guy was not sure, but I'm like, "Oh, come on. It'll be fun." So yeah, I got to basically bedazzle my cameraman's ear with this tool. And it was just . . .

Troy: Did they draw the spots on there for you to shoot this little gun into, or did you just see it and you're just like, "Okay, there, there, there"?

Mitch: So they had a little printout and they were like, "Here's where you're going to do it." And then when I was doing it, he took his little Sharpie and did little dots on the guy's ear to be like, "Here's where you're going to shoot it."

Troy: Make sure you hit the right spots, yeah.

Mitch: And so the big part of it is that this for them at that time was . . . This was not necessarily something that a battlefield medic would need to have special training for. They can train anyone to do it, right?

Troy: Yeah. It's sounds so simple.

Mitch: So it was really kind of cool to . . . And especially for him, the guy who was giving me the interview and everything, he was like, "These for so long have been treated as 'alternative medicine.'" Big quotation fingers there. But they're starting to find real applications. And so it's kind of exciting to hear that you also found a study about it.

Troy: Yeah, that is fascinating. Again, it's not something I've ever been trained on. And there probably are other emergency-department-based studies that have done this kind of thing, but there are not a lot. And maybe there are some others with low back pain, but this is the first time I've seen this.

I would love to be able to do this. Again, I would love to also maybe see some larger studies just saying, "Yeah, this panned out and we are seeing an improvement and this works."

Again, Mitch, like you said, it sounds super simple to do. As I've looked at pictures of it, it's like, "Okay, just hit these five spots." It's not rocket science, and you just need that tool, the same tool you had, which we don't have. But that's so cool you were doing that.

So if we can do this, I'm going to bring you in to teach us all how to do it, Mitch. Apparently, you're the expert now. You have more experience with this probably than any physician in our emergency department. So you're coming in.

Mitch: Okay. All right.

Troy: I love it.

Scot: Can we get you one of these guns on eBay?

Mitch: I don't know.

Troy: They have them on eBay?

Scot: What do they cost? What does one of these things cost?

Troy: I don't know. I've never looked into it.

Mitch: It was like a handheld staple gun. It was between a hole-punch, like one of those single handheld hold-punches. It was kind of like that plus a staple gun. It didn't feel too technical.

Troy: Yeah. We should probably clarify. Don't do this at home with a staple gun. It would be unwise and unsterile. But yeah, it seems like if you have the proper tools and a sterile device that's designed for this, it doesn't sound difficult.

Scot: Troy is a physician, right? Mitch mentioned something that resonated with me. Alternative medicines, right? There's a lot of stuff out there that people swear by. But as a physician, or at least many physicians I've talked to, until they can see some hard evidence that it actually makes a difference, they don't really accept it as a treatment. But it sounds like you would be in all the way on this because of this study?

Troy: I would like to see at least a couple more studies that replicate the results. At the same time, I don't want to just do something just to do it. It would be nice to see something that helps. I would be open to doing this if a patient . . . if I talk to them about options and I said, "Hey, there's been a small study. It seems to make a difference."

The big thing for me is, "Is there a big downside to this? Am I going to be causing harm?" And if I'm not going to be causing harm, and they did not report significant adverse effects with this, if I'm not going to be causing infections in their ear, or a lot of bleeding or things like that, and there's reasonable evidence to support it, I would offer it to a patient specifically that way. I would say, "This is something . . . there's been a small study." I'd say, "We can try it if you're interested."

Scot: And if this really did work, that sounds like it would change your life. It would make you go from seeing name and back pain to name and I can help this person. Name and back pain, going, "Oh, geez," to name and back pain and, "I have something I could probably do."

Troy: I would love to have that. If anyone asks me, "What is the most frustrating thing you deal with in the emergency department?" it is back pain, because people come there wanting answers and wanting a quick fix and it's a 15-minute discussion often of saying, "Hey, this is what you need to do. It's going to be a long process. You're going to have to do physical therapy. I'm not going to prescribe opioids for this. I do not want to do that. I do not want to create potential for addiction." And then I'll offer them the Lidocaine, things like that, and say, "Well, maybe this will help."

But yeah, to be able to just be like, "Yeah, I can try this. We can do this and there's evidence to support it," would be wonderful.

So we'll see what happens. Again, it's one of those articles where you see it like, "Oh, that's really cool." I can't say it changes my practice right now where I'm going to start doing this. Obviously, I don't have the tools to do it right now or the training. But it's one of those that maybe we're going to see more on this. It takes a while for these things to come into practice, but maybe in five years, this will be a standard approach in the emergency department. Who knows?

Scot: All right. You made it to the end. Good for you. Be sure to check out some of our other "Who Cares About Men's Health" episodes.

What you just heard is what we call a "Sideshow." It's where sometimes we talk about health topics that aren't necessarily directly related to what we normally would talk about, which is the core four plus one more. That is to be healthy now and in the future, you should concentrate on your nutrition, your activity, your sleep, your emotional health, and you've got to know your genetics.

Plus, we also have episodes that are dedicated just to men's health issues. So check out some of those episodes as well.

And if you know somebody that would find any of them useful, please go ahead and let them know about the podcast. It's the best way that you can help us grow the podcast.

If you want to reach out, lots of ways to do that. You can call us at 601-55SCOPE and leave a voicemail, you can email us at hello@thescoperadio.com, or you can check out our Facebook page. That's facebook.com/whocaresmenshealth.

Thanks for listening, and thanks for caring about men's health.

Dr. Jones: For some women, menopause is tough. We have this hormone thing going on, but we're also aging, and our joints hurt. And our teens are trouble, and that makes us cranky. So what are the options and therapy for the menopausal transition? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Although hot flashes are the signature symptom of menopause, there are a number of other physical and emotional symptoms that are common for women in their 50s. Insomnia, anxiety, joint aches, and headaches come to mind. Some of these are clearly related to the loss of estrogens, but some are not so clearly related to hormones. Whatever we think the biological cause might be, women don't feel well.

How do we take the women as a whole person and not just the sum of her symptoms? And what are some of the options? Today in The Scope studio we're talking with Dr. Lisa Taylor-Swanson. She's an assistant professor in the College of Nursing and an expert in acupuncture. Lisa, thank you for joining us to help us think this through.

So give us some thoughts about the care of women in menopausal transition thinking about all of these symptoms. You know, women certainly can wander their way through the traditional health care system. They can get estrogen for their hot flashes, they can get a triptan for their migraine, they can get sleeping pills for their insomnia, they can get Ibuprofen for their joints, they can get Prozac for their anxiety. But women don't want to think of themselves like that. They don't see themselves siloed in so many pill prescriptions. So what do we do?

Dr. Taylor-Swanson: That's something I've thought a lot about. And I know as a clinician practicing traditional East Asian medicine including acupuncture and Chinese herbal medicine, I've always been drawn to thinking about the whole person. And in that tradition the way we diagnose, for example, a hot flash in woman A would really depend on how her sleep is, her bowels, her mood, and depending upon compared to say woman B who has no problem sleeping but does have hypertension, I would use different acu-points and different herbal prescriptions to treat the same, say primary concern of hot flashes, because we have to understand the whole person.

So that whole person view is literally at the theoretical foundation of East Asian medicine. And that's why I study that. It's really very interesting.

Dr. Jones: So I would say coming from the church of Harvard medicine, that although I want to know about a woman's hypertension and the way her bowels work, the dose that I would give for her hot flashes would be more just to her hot flashes and not to her guts I'd say?

Dr. Taylor-Swanson: Absolutely. And that's exactly not how East Asian medicine is practiced. And so those symptoms really inform one another, and then, of course, we look at the tongue and feel the pulse as well to have additional signs that we look at.

Dr. Jones: Look at the tongue?

Dr. Taylor-Swanson: Yeah, absolutely. Top and bottom.

Dr. Jones: Okay, ladies you're going to have to wash your mouth out and brush your teeth before you go.

Dr. Taylor-Swanson: But don't brush your tongue.

Dr. Jones: Don't brush your tongue, okay, okay. So what are some of the options in the field of alternative and complementary medicine that women might choose to pursue? I know women are already making these choices, because when they come to see me, they've got bottles of supplements. They've got dong quai. They've got some Chinese herbal medicines, I say I don't know that they . . . these Chinese herbal medicines may not actually have estrogen in them, so I'm always worried about what they're taking with these bags that they're going through.

But I can't stop them. You know, and I probably shouldn't, and I shouldn't negate their efforts to make themselves feel better through options other than my office. So what should we be thinking about and what are the choices?

Dr. Taylor-Swanson: There are many choices. Definitely, acupuncture is one to consider again for the whole person perspective. And what's interesting is that not only kind of clinically or intuitively we can imagine, say if someone receives acupuncture and her hot flashes are better, and then her sleep is a little better, and then her moods a little better that makes sense certainly.

But the fascinating thing as a researcher is that we have basic science, types of data that demonstrate how that happens. So we have changes in our serotonin production and re-uptake. We have changes in our muscles, changes in the connective tissue around the muscles, other changes in the central nervous system, peripheral nervous system changes, etc. And those all happen simultaneously. And so I think it's fascinating to consider. I know you asked what are the various options. But one is acupuncture, and that we know all those symptoms are affected simultaneously and we know more about why.

There's other good options too. There's definitely Ayurvedic medicine, traditional medicine from India that treats the whole person much in the same sort of way. Definitely massage therapy can be helpful for those joint aches and pains, and it's very relaxing and might help a woman sleep better. Reiki healing touch. I mean there are so many options nowadays, and most of them have been investigated to try to find out really do they work. But I think another really important message for our listeners is that acupuncture I can say for sure is safe. It doesn't hurt. It's very relaxing.

Dr. Jones: It doesn't hurt.

Dr. Taylor-Swanson: I know, right? Who would think that?

Dr. Jones: Well, I'm not needle phobic, and you mentioned that you started as an acupuncturist. I'm not needle phobic, but I know perfectly well when I have needles put in my skin, because I'm also a seamstress, so I poke myself with little needles and it's usually my finger, the most sensitive place to poke. But it hurts.

Dr. Taylor-Swanson: So these are different. One they're tiny. They're literally the size of about two hairs, 40 gauge, 36 gauge, for those of you clinicians out in the audience. And they're solid and the interesting thing is blind acupuncturist several hundred years ago figured out if they had a tube around the acupuncture needle, one, to help them locate the points and be safe clinicians because they couldn't see, but two, it was less painful.

So the Japanese tradition of acupuncture and that we've pretty much adopted in the U.S. is to use these guide tubes. So first the patient will feel the pressure of the tube, and what's happening is it sets up those little [node receptors 00:06:21], so they perceive pressure, and then you pop in the needle and you hardly even notice it for the most part.

Dr. Jones: Kind of like when you're giving a horse a shot, if you slap them three times on their skin and then you give them a shot, they don't feel a shot. Okay, okay. Well, I'm feeling better already. I'm feeling more calm about having needles put in my skin.

Dr. Taylor-Swanson: Most people do fall asleep. Or they go to this . . . a colleague of mine calls it acu land. And you just kind of drift off to this really mellow, quiet, relaxing place. Usually, the clinician will turn the lights down and have some nice music, and you're cozy with the needles in place. So it's really a very surprisingly comfortable experience.

Dr. Jones: Well, it sounds like it's a total time out from your week experience. It's not just hopping up on a table and getting poked a couple places. You're actually having some little time out. I can't say . . . well, sometimes the doctor's office, I get to look at magazines I would never ever buy at the store, but if people in the doctor's office are upset, I kind of, you know, while I'm waiting and wanting to say I'm not in a clinic and, you know, I'm just having a quiet time. But other people's moods while I'm waiting affect me. When I get in the room as much as I love my doctors, there's this third patient in the room called the computer that seems to get all my doctor's attention.

Dr. Taylor-Swanson: Well, and I think for women going through the menopausal transition and for midlife women overall there's this sandwich generation phenomenon where often women are working, taking care of kids, like you said in your intro, taking care of parents sometimes, and so to have that little time out just an hour once a week, once every couple weeks it can make a world of difference.

Dr. Jones: Well and when we talked before the interview, we talked about the fact that in medicine sometimes we silo women's symptoms so they get this for this problem, and this for that problem, and that prescription for that. But you talked about the spider web. Can you talk a little bit about that?

Dr. Taylor-Swanson: Absolutely. It's my favorite metaphor for how, again the theory and also the intervention of acupuncture in East Asian medicine works. If you were to imagine a woman as a spider web and say for example, that spider web includes her symptoms, it includes all of her body systems, so the endocrine system, all of your hormones, your digestive system, etc. And also includes your social life, so caring for kids, your friends, your church, your work, etc.

And so if there's a tug on one end of the web, say you're caring for an aged parent and she or he falls, then that's going to affect your whole spider web, your whole person. It's not just that, "Oh, gosh I have to schedule my time differently." But you're probably going to be worrying, and [perseverating 00:09:03], and scheduling appointments, and not sleeping as well.

So I think to really consider a woman as her whole self, not only all of the symptoms, it's great that science is moving that way. We talk about symptom clusters now instead of only a single symptom. But it's a real whole person phenomenon that includes her social life, her work life, her body as well, and not only the symptoms.

Dr. Jones: Well, we're just making you the poster child of our Seven Domains of Health. Because here, The Scope radio we believe in the seven domains, meaning there are many parts of us that have to be well for us to feel well. But I like the Native American, particularly Navajo tradition of the Spider Woman who weaves the web of life into this sense of wholeness. So who should a woman go to if she wants this particular approach?

Dr. Taylor-Swanson: Well, the good news is nowadays acupuncture is regulated by state departments of health in all but just a handful of states in the country, so you can just go to the website for your local Department of Health, look up an acupuncturist in your area. They're absolutely going to be board certified nationally, and they're absolutely going to have a master's degree. They might also have a doctoral degree either in acupuncture or something else. So you can be confident they'll be well trained and properly licensed.

Dr. Jones: Do you go and see if they're a good fit, or do you ask your friends because some might be really good for sports therapy and joint problems, but they don't get women.

Dr. Taylor-Swanson: Right. Well, and modern life definitely most of my patients when I practiced in Tacoma, Washington, where I just moved from most of my patients were either referred from their primary care or other specialty care practitioners or from their friends, and that's always a good way to find an acupuncturist. And modern life most acupuncturist have websites too. So you can check the web and get a sense of who they are from their website.

Dr. Jones: And see if they put midlife women transition kind of stuff.

Dr. Taylor-Swanson: Yeah.

Dr. Jones: Well, we're waiting for you to hang out your shingle now that you're here in town and for you continue your research in the area of midlife women now that you're here at this College of Nursing. And we're here because getting old isn't for sissies. And 50 isn't even old. Many of us want to take an approach to our midlife concerns that helps our body and our mind. And we're grateful for Lisa for coming to help us think about it. And thanks everybody for listening on The Scope.

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