Intern Reflection 3: J.S. 8/19/15

                 

J.S. was a male in his mid-60s. His wife and he came in together weekly but I only treated him this one time. They had just returned from vacation to find their AC and fridge were both broken. He had felt stressed about this but was now reporting it was much less. He mainly wanted to work on his tight shoulders and upper back. I could tell that he seemed worn out and somewhat tense. I got the sense that he had transferred his stress into his upper back and shoulders and had not realized it. His differentiation was “Qi and Xue Yu, Qi and Yin Xu and LV Qi Yu.” I felt that Tuina was best primary modality for this patient but I also incorporated  some local points, GB 20 and 21, 4 gates, SP6 and Ren4, 6, 17. While I was treating him I felt a little disappointed in myself for not having “done more.” I was thinking that maybe the treatment wasn’t going far enough, or that it was too simple. At the end of the session as he was walking out he stopped me and hugged me, telling me, “Thank you so much! I’ve never felt so good after a treatment.” I was surprised and humbled by this. Though I never got to treat him again, that interaction has stuck with me. It made me see how sometimes a simple treatment is the best and also how powerful touch can be. After that treatment I started using Tuina in almost all my treatments.

Set of 3 Intern Reflection 2: E.M. 3/26/15, 4/2/15, 5/14/15

           

E.M. was a woman in her mid to late 80s. She had been coming in to the AOMA clinic once a week for many years. When I first saw her she was suffering from fatigue, low back pain and a recently torn rotator cuff. She was the sole caregiver for her adult paraplegic son and this was one of the only times during the week she was able to focus on herself. My initial assessment was “Local Qi and Xue Yu in the GB channel and LV and KD yin Xu.” She had about 30 degrees range of motion on her left arm with pain ranging from 7-8/10. I first treated her in Mandy Marrows clinic so we started with a Japanese style Hara treatment as well as tuina on the low back and some local points around her left arm. I continued to see her every week and we formed a positive bond. Despite all her hard work taking care of her son alone E.M. had an inspiring attitude and was always smiling and excited to see me. We got to a point a few months into treating where I realized the treatments for her energy were not working and in fact her energy level was worse. I encouraged her to get some bloodwork done and she was compliant. E.M. was the perfect example of a good compliant patient. Even when it seemed nothing was helping, she continued to return with the same positive outlook. She was flexible and open to trying new things but was also honest when something hadn’t worked.

            On the April 2^nd treatment I reported to Mandy that I was concerned the treatments for her fatigue were not working and asked what else we could do. Mandy showed me a technique where you do direct rice moxa on Du20 and Ren6. I told E.M. about the technique and knew because of the amount of time she had been coming and her willingness to try new things that she would be open to the idea, and indeed she was. She next time I saw her she reported her fatigue to be almost completely resolved. After that it would dip down here and there but as long as I kept doing that moxa technique her fatigue never dropped back down so low.

            At this point we had moved into the next term and I was treating under Dr. Luo. While her fatigue was well managed her should pain was unrelenting. We had had small successes with e.stem but ultimately the benefits only lasted a few days. I was in the same opposition as before with her fatigue, not knowing what to do next. I mentioned to Dr. Luo my success with the moxa on Du20 and that gave him the idea to try warm needling pai-ci on her shoulder. He felt that because she had responded so well to the direct moxa it meant that she was the type of person who can see great success with moxa. I did the warm needle pai-ci and within 3 treatments the pain was completely gone. Though she would never regain her range of motion, as the cuff was torn and she had turned down surgery, our treatment was a success.

            Over the months of knowing E.M. and treating her I became quite fond of her and felt very much like a care-taker to her. I had never felt that way about a patient before. I would think about her outside of clinic and even though I haven’t seen her in many months I still think fondly of her and wonder how she’s doing. Having this experience with such a compliant patient who is undergoing recurring symptoms helped me to remember never to give up or just keep doing the same thing over and over if it’s not working. It also taught me that learning what type of techniques work best for specific patients can lead to more success with them in the future.

Herbal Intern Reflection 1: J.B. 9/23/15

J.B. was a male patient in his late 50s. He had been coming into the AOMA clinic for treatment of his Scleroderma for about one year. Though the Scleroderma was diagnosed as systemic, it presented locally from his elbows to his fingertips bilaterally. The skin was extremely tough and when he first came to clinic he had no mobility in his hands at all. At the point I started seeing him as an herbal intern the skin from his elbows down to just above his wrists was vastly improved. He also had about 75% mobility back in his hands. His differentiation was “Local Qi and Xue Yu, LV and KD Yin Xu and SP Qi Xu.” He was also trying to gain some weight back that he had lost during the worst part of his symptoms. He had gas, bloating, loose stools, low appetite and also chronic sinus congestion. He had been prescribed Fu Zi Li Zhong Wan previously but upon inspection of his tongue we found it to have a thick yellow coating while his pulse was long and wiry. We came to the decision that the Fu Zi Li Zhong Wan was too warm for the time being and it was his damp(-heat) symptoms that needed to be addressed. We decided to switch him to Liu Jun Zi Tang and give him some dampness reducing dietary recommendations.

            About a month later his digestive symptoms were almost completely resolved. His appetite was good, he had gained 4lbs and he had no more gas, bloating or loose stools. The only thing was that his tongue had remained unchanged. I was perplexed by this and asked my supervisor, Dr. Song, if that meant our formula choice was wrong or not. I was curious to understand how to gauge the outcome of this formula choice, by the tongue or by the symptoms. Dr. Song informed me that this is a common outcome for the type of formula we chose, as it is meant to be taken long term and it can take a little while to see the full results, but the fact that there was symptom improvement did in fact attest to our correct formula choice.

Intern Reflection 2: R.G. 3/12/15

R.G. was a male in his 60s with a history of Hashimotoes. This Autoimmune disease had caused eye pain and bulging. R.G. had received surgery on his left eye which contributed to blurry double vision, scar tissue formation and restricted eye movement. His official diagnosis was Graves’ Opthamalopathy. When I first saw R.G. he had been coming to the AOMA clinic once a week or so for about 6 months. He had been receiving electrical stimulation on GB 1 at 20Hz for 15 minutes each treatment and reported left lateral muscle strength improvement. R.G. had a positive attitude toward his treatment and prognosis and the environment of the treatment room was light and friendly.

            I was glad to report in my SOAP notes his opinion of lateral muscle improvement and his overall feeling that the treatments were effective. On reflection of this case what I find interesting is the absence of any objective treatment outcome assessments. This is disappointing because R.G.’s is an interesting case that I would have appreciated having information about how well the electrical stimulation was work. It would have been useful to know for future treatments if the voltage was correct, if the length of time it was administered was enough etc. I feel in a case the best objective assessment tool would be photographic and video evidence. Not every patient is as positive and trusting towards alternative treatments and in a private clinic these tools could be beneficial to patient retention.

Self-reflection and Learning Goals 2: Level 2

Weakness: Remembering to do and performing the correct physical assessments. I find this especially difficult when the supervisor doesn’t have any specific requirements for doing them. It is also especially hard to remember to do the assessments when they are not needed for musculoskeletal issues but rather for internal organ issues.

Strength: A good rapport with patients. Good communication skills, honesty and empathy. Knowing how to communicate with patients about things at their speed. Needling technique, point location, diagnosis and differentiation. I believe I improved greatly in my intake, asking the correct questions in the most logical order. I feel I’ve also improved in my presentation to the supervisor.

Self-identification of learning goals and learning plan: My learning goals in level 3 are to watch closely and listen attentively to the instructors. I don’t want to let the fact that I have a comfortable base to work from let me rest on that. I want to keep asking questions and attempting to push my skills and knowledge.

Self-reflection of goal achievement: In my first "Self-Reflection and Learning Goals” from term 2 of Level 1, I sited my weakness as my ability to ask the correct differentiating questions during intake. I feel I have definitely accomplished this goal. Of course there are always times when you forget something specific, but I feel my perception of patterns has improved greatly.