Final Reflection

   I have so many emotions and thoughts about my time at AOMA. I could talk about all different aspects of it but I'll stick to the idea of professionalism. I feel I started off in the clinic with a bit of an advantage, I used to be in the service industry. This afforded me a level of comfort and ease in dealing with patients, supervisors and other interns. Though I had this great foundation to start off with, being a waitress and being a health care provider involve very different relationships with your patrons. Watching other student interns interact with patients was probably the most educational in learning about patient-practitioner relations.
   The other way in which I grew my professionalism was during my time with the ASA. Learning from someone like Tara was such a special gift. She showed me how to work in a community with so many complex and ever changing relationships and somehow stay on every one's good side. I don't know if I've reached her level of success in doing this yet, but I always think of her as a guide.
   My other great lesson came from being the president of the ASA. Having a cabinet full of good people who struggled to get along, failed, succeeded and struggled some more was a great challenge. Having to supervise, delegate, mediate, support and discipline was hard at times, but overall felt satisfying and strengthening.
   I could go on even more, but I also greatly respect and admire you, Lesley, and know how hard you work, so I'll leave it at that!

Self-reflection and Learning Goals 5: Level 3

     From the first tuina clinic with Dr. Fan he kept the feeling of the clinic very calm and relaxed, but as the weeks went on he started requesting more and more physical assessments. I never felt like I was fully committed or confident in my physical assessments during acupuncture rotations simply because it seemed like my findings often wouldn't change the treatment plan anyway. While in tuina, it felt more acutely important to the treatment. On reflection, it would have been a good idea if I had treated those musculo-skeletal acupuncture treatments more like a tuina treatment. I think perhaps part of why they seemed different in my mind was the lack or addition of physical contact with the patient. In a tuina treatment you start touching the patient right away, feeling for ropey, sore or knotted muscles and you don't have to ask very many questions. While in an acupuncture treatment you start with talk only, and it can be easy to forget to use palpation or alternatively difficult to transition from one to the other.
   I think the most important lesson I've learned in reflecting on this, and also my goal for the future, is to always remember touch. Get that patient permission from the beginning so you can easily move from questioning to palpation and incorporate physical assessments that way as well.

Self-reflection and Learning Goals 4: Level 3

   I had to make up one Herbal shift today after having finished the rest of my clinic hours about a month ago. Since that time I have taken the herbal board (and passed it!). When I had my last day of my herbal shift from last term I felt moderately comfortable with herbs. I still felt like I couldn't recall formulas or single herbs on the spot  most of the time. I wished I had taken one more herbal rotation and almost thought about signing up for an extra one this summer.
   Reflecting on how I feel at this moment about herbs, I feel more than moderately comfortable. This has made me fully realize the importance of simple repetition which I did so much of while studying for the herbal board. It's also inspired me going forward to always keep practicing and reading about formulas and herbs. I remember once Dr. Shen saying it took him 10 years to feel completely confident with herbs. That's not the kind of timeline a person can rush.
   Even though I feel my progress is moving slowly, I feel confident that it IS moving and that it is going at the right type of pace. My goal for the future is to simply keep the pace and continue to learn and love herbs no matter what.

Intern Reflection 5: K.G. 6/22/16

 

This was the first time I had treated a friend in clinic and I was curious to see how I would feel about it. I had heard from many differing opinions on how it felt treating family and friends. Some people were specifically getting into TCM in order to care for sick family members while others swore they would never treat a friend or family member.
  The actual treatment went well. I think K.G. was a good first candidate to do this with because she isn't shy or uncomfortable about sharing information about her personal health in general. We have an easy report but didn't take up too much time with personal conversation.
   The most difficult part came later when we were at a dinner party a couple weeks later. In front of the whole group she brought up the treatment and how well it went and how well the herbs were working. It started a conversation about TCM, which I was excited about. Someone asked me about what types of conditions TCM is "good for" and as I started listing things I had to bite my tongue because I almost stated what K.G. had come in for. Later in the conversation K.G. brought it up herself but I realized at that moment just how dangerous to HIPPA treating family and friends can be. It was a good lesson to have early on, though it didn't scare me away from wanting to treat family and friends. It just served as a reminder of how careful one must be in social situations (especially if you've had a glass of wine!).

China Trip Reflection

    Spending every day in Chengdu University Hospital changed so much of how I think about Chinese Medicine. The most obvious thing you notice about CUH was how many people were there. Thousands, every day. Not different people either, often the same people came back every single day to be treated. The herbal counter was like a bus terminal, constantly swarmed with patients waiting to get their raw herbs.    Before I went to China other China trip alums told me the medicine seems to work better in China, like magic. I saw that right away, but I also saw it wasn't like magic at all. Patients not only came to be treated every day or every other day, but they all truly followed their doctors orders. It was fascinating to see what a world where TCM is trusted and respected, as much as western medicine is back in America, is like.
    The other thing that really stuck with me was the repetition. One doctor, in a specific department would use the same basic herbs that he or she likes best and then modify that formula based on the patients other symptoms. When they did acupuncture or tuina it was the same routine every time, the same "formula" every time. Lumbar disc herniation? Lumbar Jaiji with BL40. With Sciatica? Add GB30, BL53 or 54. Finish off with tuina on the lower back for 15 minutes, some spine twisting and a hot wax compress (used in place of moxa, since there was a separate building for moxa only).
    This repetition was surprising and yet made perfect sense to me. TCM is so complex and yet when you boil it down to basics, it's so simple. Humans are the same. We're all unique and yet so simple. It was incredibly encouraging to experience this well oiled machine that was Chengdu University Hospital. It made me feel so much more assured in my abilities, ideas and plans. In the future I'm sure I'll encounter moments in my practic where I feel overwhelmed by the possibilities or the symptoms. Having had this experience I can now reflect on this time and remember treatments don't always have to be original, complex or confusing. Trust the medicine and results will follow.

Intern Reflection 4: J.B. 8/9/16

J.B. was a 34 year old woman. She came in on one of my lasts days treating at AOMA. Her chief complaints were stress and insomnia. She reported owning a small soap making business, which she loved and had good success in, but the better the business went the more stress she felt. She also had two small children, 4 and 6. She felt her insomnia, as well as her other symptoms, such as irritability, low libido, alternating loose and constipated stools, stemmed from the stress.
     This was an interesting patient for me because it felt as if I was looking at myself in the future. My hope is to own my own small successful business and maybe have a kid or two. I also suffer from insomnia triggered especially by stress as well as all the other symptoms she reported. When I looked at her tongue it was like looking into the mirror.
    What I took away from this patient was a reminder of how vitally important self-care is. It's so easy for me to have sleepless night after sleepless night before I'll ever do anything about it. These things age you, they wear you down, they lead to an imbalance of systems and can take a great fulfilling life and career and turn them into a hardship. So right after she left the treatment room I went over to the White Crane and made myself some powder. 

Set of 3 Intern Reflection 3: L.E.H. 3/16/15, 4/30/15, 6/4/15

     I started treating L.E.H, a woman in her mid-70s in late 2014. She had a long history of injuries and surgeries on her left knee. She had been a runner as a young women and had previously had reconstructive surgery on her knee. She was given the initial diagnosis of of chondromalacia patella and had undergone an arthroscopy and most recently a realignment surgery.
   Immediately before and for three months post-surgery I treated her systemically. Her wounds were still healing and it would have been far too painful and dangerous to start needling her scar area before that time.
    Once the three months had passed, acupuncture and e.stem were provided weekly to the local area and continued for 6 months. Points were chosen surrounding each scar on a 45 degree angle going toward the center of the scar. If possible the needles were inserted into the interior of the scar as well. E.stem was set between 30Hz-60Hz depending on the pain tolerance of the patient on each specific treatment day. Additional non-e.stem Ashi points were inserted as well. Distal points were chosen based on the differential and from week to week on specific systemic symptoms. Points which were commonly used include: KD3, SP6, LV8, GB34, ST36. Points and e.stem were left in for 20-25 mins and on occasion e.stem Hz were increased after patient reported electrical sensation had dissipated.
     Directly following her surgery L.E.H. reported waking up at night due to pain between 4 and 6 times. By the end of six months she reported only waking 2 times. During this time she was also practicing physical therapy 2 times a week and low impact water aerobics 3 times a week.
    Patient’s scars both reduced in size by close to half and thickness was reduced by more than half. Pain on palpation around scars was reduced and scar tissue was softer. L.E.H. reported that her orthopedic surgeon commented on multiple visits how “amazed” she was by the accelerated healing of the scar tissue.
     This case serves as a perfect example of how staying the course and keeping consistent can be the best course of action. It also shows how a combination of acupuncture, PT and water aerobics can greatly accelerate healing from major joint surgery. Treating L.E.H. showed me that finding a specific symptom to track over time (number of times woken by pain) can assist in showing a practitioner, a patient and the patient's other doctors how things are progressing.