The Transformative Role of East Asian Medicine & Acupuncture in Palliative and End of Life Care
Previously published in the 2022 issue of The Journal of Acupuncture and Integrative Medicine
An undeniable reality of working with cancer patients is that some patients will not survive their diagnosis. Chinese medicine and acupuncture has the ability to significantly improve the quality of life of terminal patients. Many barriers exist that block the use and acceptance of acupuncture as a tool for end of life care, including lack of awareness of the modality, funding and insurance coverage. In addition to the ability to treat side effects of medication and disease along with the pain associated with death, acupuncture helps reduce anxiety, stress and helps patients find peace in the dying process. As practitioners working with patients with potentially terminal diseases, it is critical to place focus on our ability to hold space for the healing process through death as it is for the healing process through the curing of disease.
An undeniable reality of working with cancer patients is that some patients will not survive their diagnosis. The role of Chinese medicine and acupuncture in palliative and end of life care is by no means as researched or studied as the care and treatment of disease and illnesses like cancer, but it’s role is powerful, impactful and has the ability to significantly improve the quality of life of terminal patients up until their transition. Many barriers exist that block the use and acceptance of acupuncture as a beneficial tool for end of life care, including lack of awareness of the modality, funding and insurance coverage. In addition to the ability to treat side effects of medication and disease along with the pain associated with death, acupuncture is an excellent modality to help patients reduce anxiety, stress and find peace in the dying process, to ultimately, die a good death. Inherent within acupuncture elemental theory is the process of the transition from birth to death and the cycle of life, associated emotional states and opportunity for healing. By deepening our understanding of the connection this medicine has with not only the physical body but the mind and spirit we have a unique opportunity to help our patients not only experience relief of pain and suffering, but also an impactful and meaningful transition. As practitioners of acupuncture and Chinese medicine working with patients with potentially terminal diseases, it is just as critical to place focus on our ability to hold space for the healing process through death as it is for the healing process through the curing of disease.
Having anxiety can be a debilitating experience, it can come on out of nowhere, but even when we have awareness of the triggers, it can still catch us off guard, stop us in our tracks and really put a halt to anything we wanted to do. Having tools and coping mechanisms to help guide us through an anxiety or panic attack can be crucial to our ability to feel like we can release the anxiety and live our lives. While medications can be extremely helpful, they also come with side effects and can cause considerable drowsiness which isn’t always desirable. I’ve found acupuncture treatments on a regular basis to be particularly powerful for helping my patients move through anxiety, stress and other tough emotions. But if you aren’t near your Acupuncturist’s office the following acupressure points can help you become more grounded, present and calm in a matter of minutes.
I recommend you go through all of the points mentioned here, treat one side then the other and use the treatment time as a time to slow down, to gather your thoughts and release them as you move through the protocol. You may notice you start yawning, or your eyes water, maybe even cry a bit - these are all good signs that your body is releasing that energy and emotion which will allow you to carry on in a more calm space when you are finished.
While my clinic is not seeing active COVID-19 patients in person, one demographic we’ve been seeing and having a lot of success with have been COVID long haulers. A ‘COVID long hauler’, ‘long COVID’ or ‘chronic COVID’ is when symptoms persist beyond the active infection time, these symptoms can persist for weeks to months and risk for long term permanent effects seems to be likely. This presentation has been likened to Lyme’s Disease in that the precipitating factor is a viral infection followed by a chronic presentation of symptoms that range in severity from mild to severely disabling.
Long COVID patients are typically burdened with shortness of breath, difficulty with exertion, dizziness, fatigue that can be extreme, continuation of loss of smell and taste, brain fog and much more. It’s a disheartening condition to watch, because of so many unknown factors there isn’t a lot of help from modern medicine and many patients are simply told to wait it out. Patients go from active healthy individuals to barely being able to get out of bed, this type of condition takes its toll not only on the body but particularly the mind, emotions and spirit. Our work with Long Haulers is to help encourage healing in the body, benefit the Qi - the vital life force of the patient and help patients find their center again in the midst of sometimes devastating circumstances. By helping bring peace and hope back into the healing process we have seen many patients make great strides in their healing.
Women’s health, fertility and conception are some of the concerns that my patients will come in for, I think this aspect of acupuncture and herbal medicine is actually a bit more well known, second to pain treatments, and there’s a reason for this: it works. If you were ever a fan of the HBO show Sex and the City you might remember Charlotte’s experience with Dr Mao the acupuncturist who helped her learn how to tune back into her inner peace and eventually get pregnant for the first time. This side of acupuncture often gets talked about in a kind of whimsical miraculous type of way, where people hear about one person who had success and tout acupuncture as the ‘miracle cure’ for all fertility woes. And while yes, for some people acupuncture might just be the missing link to having a healthy happy baby, it’s often a piece of a multi-pronged approach. We’ve seen through scientific study that acupuncture improves the success of IVF treatments, so it’s not just an old wives tale, it really does work.
Where my work comes with fertility patients is less focused on direct hormone and menstrual cycle support, although this is definitely a part of the treatment protocol, but more focused on what we think in Chinese medicine as ‘cultivating the baby’s first home.’ The womb and the mother are essentially your baby’s first home, and we need to make this place a calm, nourishing, warm and supportive environment for the baby to thrive and develop in before birth. Part of this often revolves around cultivating new stress management practices, accessing our inner peace and learning how to truly listen to our body. If our outer world is highly stressed, our body also takes on this energy and it can make a pregnancy become difficult, particularly if we are wanting to call in an intentional pregnancy.
The Branch, Root and the Soil - A Chinese Medicine Perspective on Pandemic Denial and Anger
We live in a world where, for all of our lives - beauty and status have been paramount: we crave it, we seek it, we spend our extra money on attaining it, seek out jobs that can provide for it, it’s ‘necessary’ for assimilating into social culture or being ‘seen’ … It. Is. So. Important. But… is it?
When we first experienced our ‘lockdown’ in the Spring I was aghast at the level of denial and flat out refusal of some people to follow safety guidelines. It made no sense… Why are people so readily willing to throw common sense out the window for a haircut? Are eyelash extensions really that important? Who benefits from outright denying this pandemic actually exists? Why is there so much hostility over a tiny piece of fabric? As time has passed the deniers and rebels against protocols became louder and more polarized, likely due to the politicization of the entire process. And while doing a little self-care to pump up our self esteem and confidence is an absolutely valid process, it always seemed like something much, much deeper was at play.
In Chinese medicine one of the first diagnostic principles we learn is to differentiate the root from the branch. The branch might be the presenting symptoms a patient walks in with, knee pain, insomnia, headaches, stress, anxiety, you name it - it’s the first thing that the patient complains about when you ask what they would like to work on today. The root is that underlying cause that created the environment for the current symptoms to arise in the first place. We often think of this as a constitutional imbalance, meaning that everyone has their own predisposed weaknesses and strengths, perhaps this is passed on from our parents and ancestors, maybe a result of early childhood illness or trauma or other underlying issues. The root is often extremely complex, and can sometimes be difficult to diagnose, but once we can get to it, or pointed in the right direction we often will see transformative shifts occur in the patient. The knee pain that hardly responded to direct treatment now can begin to release because we’ve found the root of the issue in a deficiency of the Water element and Kidneys due to some repressed fear. As we begin to unpack this root cause, the physical or emotional symptoms start to give way to the healing that is present. I also like to look another step deeper, to the soil, this is the deepest layer, this unseen and usually unnameable force that sets us up to create and experience certain things in our lives, perhaps another name for this is fate or predisposition. Dr David Hawkins, PhD calls it the ‘attractor pattern’, it’s the unseeable pattern that sets up the visible and nameable string of events that eventually leads to the presentation we are looking at in our office.
How’s life going for you?
Do you feel like something is missing? A lack of inspiration perhaps? Feeling closed off from others or even yourself? A sense of despair or an absence of the ‘heart and soul’ of life? Maybe you’ve been having trouble sleeping? Feeling anxious? Restless? Difficulty concentrating?
If this sounds a little too familiar read on… it might be a disruption or disturbance of your Shen.
Let me explain…
In traditional Chinese medicine (TCM) the way we look at our mental, emotional and spiritual health is by looking at the Five Spirits - these spirits are aspects of our complete animation as a human on Earth from our Divine spiritual nature to our animal instincts to the connection with the collective unconscious. These spirits all serve different aspects of the self and our interaction and experience on Earth, as such we can address issues that arise in the psyche by addressing these spirits. As goes with all illness and disorder in TCM these issues with the spirits can be experienced in a range of severity and intensity and also duration - meaning we can have a mild and brief Shen disturbance that lasts a day or two or we can have a more severe and chronic presentation that lasts for months, years or a lifetime, there are many causes and reasons why which I’ll get into later on.
I love chocolate, I just… love it; it’s delicious, it’s gorgeous, it’s fun to work with and create from, it makes you feel good, what’s not to love? As an artist I also love working with chocolate as a medium - there is so much more than just the visual nature of it - there’s the art of flavors and combinations of textures, it’s a full spectrum sensory experience if you ask me, and this is just a part of why I love it. As an Acupuncturist and Doctor of Acupuncture and Chinese Medicine I also know that chocolate isn’t only a love affair for the senses either, it actually has some medicinal and therapeutic qualities that can help balance and nourish the body and mind. In Chinese Medicine we think of all food as medicine, all foods have certain properties and qualities that affect the body in specific ways, when we bring more awareness to these properties we can turn our entire diet into a nourishing experience directed at what parts of us need direct healing. It’s this love affair with chocolate and Chinese medicine that brought me to the intersection of combining the two - making high quality chocolates that are flavored to work with the spirit, elements and organs of the body.
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Acupuncture Effectively Treats Overactive Bladder without Surgery, Medication or Side Effects
I hear it often from my patients: ‘sometimes I pee a little when I laugh,’ ‘I wouldn’t dare try to do jumping jacks or it would be a mess,’ and ‘I just know that I have to use the bathroom before I leave to go anywhere or I might pee my pants.’ Overactive bladder, leakage and incontinence aren’t anything new, but in my practice I’ve gotten the impression that patients think that having these conditions is just a part of getting older, from giving birth or prostate enlargement and it’s something you just have to live with. Treatments for overactive bladder (OAB) leave a lot to be desired, patients don’t want to undergo invasive surgery, but medications have high rates of undesirable side effects which leaves most patients thinking there isn’t a viable treatment option and that urinary leakage is just something they’ll tolerate. While kegel exercises may provide some relief and help for many patients, not everyone notices a difference with doing them, pressing the point home again that OAB is just something we live with, untreated.
Overactive bladder (OAB) is a condition that affects adults and children worldwide and can be caused by numerous underlying factors or traumas like childbirth, prostate enlargement, poor pelvic floor muscle control, bladder prolapse and more. It goes without saying that this condition can create a significant psychological burden on patients and symptoms range from urinary urgency to incontinence, while this condition can be incredibly bothersome, surgery often seems a drastic approach and medications may have limited effect and side effects (de Wall, L. L., & Heesakkers, J. P. (2017.) So what’s the good news? Acupuncture is actually an incredibly effective treatment for OAB, working better than most medications with fewer side effects, it is so effective in fact, that medical doctors use acupuncture and electrostimulation in order to address the tibial nerve and improve its functionality which addresses the innervation of the bladder and helps with OAB, they call it Percutaneous Tibial Nerve Stimulation (PTNS). Studies on PTNS have shown improvement in bladder symptoms of over 50% improvement and up to 80% improvement in quality of life studies, this therapy is also minimally invasive and does not pose traditional risks or side effects associated with medications and surgeries (de Wall, L. L., & Heesakkers, J. P., 2017).
In my acupuncture practice in San Rafael, California I provide patients PTNS treatments with acupuncture for with overactive bladder it is a simple adjusted acupuncture treatment to address the innervation of the bladder and improve the regulation of information from the brain to the bladder called Percutaneous Tibial Nerve Stimulation and Sacral Nerve Stimulation. While for some patients, the cause of OAB lies in the musculature of the pelvic floor, for many it can be an issue with the nerves that bring information from the bladder to the brain and vice versa, and no amount of kegel exercises will provide relief, for most it’s a combination of both! In addition to treating the issues of the bladder directly, as an Acupuncturist my aim is to always get to the root of an issue, and that doesn’t mean just what’s going on in the body as a cause of an issue, it also means the bigger picture in the body - mind - spirit connection. Acupuncture treatments for OAB will consist of a direct treatment to address the symptoms of overactive bladder and leakage, but also addressing the patient as a unique individual and their constitution so that they can embody more strength and health throughout all aspects of their life, not just the symptoms at hand.
Published in Acupuncture Today February 2020 Vol 21, Issue 2
What do we think of when we hear the word ‘healing’? For many, the first conclusion is that healing means to get better, or to heal from a disease. But what if this belief and concept about healing isn’t the whole picture? If healing doesn’t just mean to get better, then what does it mean? And how can this help us help our patients?
Merriam Webster’s dictionary defines healing as:
heal - transitive verb
1a: to make free from injury or disease : to make sound or whole // heal a wound
B: to make well again : to restore to health // heal the sick
2a: to cause (an undesirable condition) to be overcome // MEND the troubles … had not been forgotten, but they had been healed — William Power
b: to patch up or correct (a breach or division) // heal a breach between friends
3: to restore to original purity or integrity // healed of sin
Our approach in healthcare focuses on the first 3-4 aspects of this definition - to heal a wound, the sick or overcome an undesirable situation. While it is important to help our patients find recovery from the ailments that bring them into our office, in some cases, this isn’t always possible. Chronic disease, terminal illness or life situations that are permanent are not so simply overcome in the sense that we can erase them from reality entirely. It’s in this case where we have to focus on the last definition of the world healing - to restore to original purity or integrity. And while the sample of being ‘healed of sin’ takes on a different tone, what I believe this definition to point to is simply: to return to our original intention.
Dr. Kim Peirano, DACM, LAc is the Owner and Acupuncturist at Lion's Heart Wellness, the San Francisco Bay Area and Marin's #1 Cosmetic Acupuncturist and #1 Holistic Healer.
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