Forum Replies Created

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  • Yvonne Farrell

    Instructor
    March 22, 2024 at 10:10 pm in reply to: Pre- and post-surgery considerations

    Do you have pre- surgery treatments for someone like her or general practices for the many patients you have treated in similar circumstances? Boosting Qi and blood seems reasonable. I don’t have protocols for pre and post surgery. Everyone is different. If a patient is depleted then yes you want to try to access resources. Some patients have a ton of stagnation so you need to work on circulation. Your patient seems to have a lot of issues.

    If surgery was not imminent, I wondered if a divergent might help because of the basically one-sided chronic condition of pain, and her fear of the unknown. I don’t think impending surgery is a reason not to do a divergent. I wouldn’t think the fear of the unknown the way you describe it is not a reason but the unilateral (worse on one side) plus the kidney & bladder disease certainly is.

    The fear of the unknown is at the yuan level so it shows up everyhwere in the patient’s life.

    I would be interested to hear your thoughts on what to weigh regarding holding latency or releasing it before a surgery, which will demand resources from her to heal from surgery and recuperation. I would not make the decision based on the impending surgery. I would base it on what is best for the patient. Not enough resources maintain latency. Lots of stagnation release latency. If both, then horseshoe. If her resources are depleted to help her recover from surgery, is this in essence going to also be a release of latency for her, or will the shock of surgery add latency? There is no way to know. it depends very much on the whole picture. How much resource does she have and how well does the surgery go? Also, in this patients case what is the nature of the surgery and will they try to do both at the same time. Are they opening her up or doing a laproscopic procedure? Too many questions to give you an answer. If a release of latency is done BEFORE surgery, would that be beneficial to the patient (or you can suggest the parameters where the answer would be yes or no if you don’t want to comment on this particular case). Releasing the latency would be beneficial if the patient had enough time and resources prior to the surgery. This is because releasing latency stops the burden of using resources to maintain it. So more resources for healing. But you can only do that if she has enough resources to release in the first place.

    I wonder if the surgeons will combine surgeries so that she gets her leaking breast implants replaced at the same time as her bladder or kidney surgery? I hope not. The healing time from that would be awful if the bladder/ kidney surgery is extensive. Is there another line of thought that you would be more inclined to do in the 2 appointments remaining before her scheduled surgery? Based on the fact that you only have 2 visits, if you choose divergents, I would be inclined to maintain the latency. As for another direction, I do not have enough info to even begin to guess what else you might do other than support resources and circulation. That is assuming she wants you to help her prep for surgery. If she wants to treat her low back pain then the divergent seems resonable as do several of the 8 EV depending on the picture. The thing is, anything you do to help her low back pain will not interfere with the surgery. So basically, we come back to the idea of what she wants you to treat. If she wants you to prep her for surgery AND treat her low back pain it gets a little trickier. In a case like that I would first decide what channel/ system would be best for the low back and then within that system try to also address resources and circulation.

    Also, as an aside, what benchmarks do you set for patients returning for acupuncture after surgeries? I mainly base that decision based on the type of surgery and whether the patient can make it to the office while managing pain. Sometimes that’s a week after surgery, some times that’s 3-4. In the case of abdominal surgery the time is shorter if its laproscopic, longer if they have to open her up. I have heard practitioners advise yunnan bai yao to stop internal bleeding after surgeries. Yunna Bai yao is very good post-surgery but I do not recommend it to everyone. It depends on the patients constitution, the medications they take, their age, if they have bleeding tendencies and once again how extensive the surgery is.

    I know each person responds differently in terms of how ambulatory they are, their pain levels, strength, etc. She is extremely thin. I am imagining that it might be 4 weeks for her if they do both surgeries for her. I hope they don’t do both surgeries at once. Of course since I don’t know what kind of surgery we are talking about, hard to tell.

    How long would they let her leak silicone in her body? Some leaks are very slow so they may risk delay but once again without all the info, hard to tell.

  • Yvonne Farrell

    Instructor
    March 20, 2024 at 5:12 pm in reply to: I can’t make tonight’s class on March 20, 7pm PST

    Thanks for the heads up Daryl. It is thoughful but unnecessary. We don’t take attendance and these hours are totally voluntary. You can come and go as you please. The recording will be available for you to listen to, so you won’t miss the discussion.

  • Yvonne Farrell

    Instructor
    March 7, 2024 at 6:38 am in reply to: Are trigger points a Wei treatment?

    Hi You Again,

    You can use trigger points in TMM treatments. These fall into the same category as “ashi” points. They do not have the same impact on Wei Qi as the superficial modalities ( Guasha, massage, etc.) If the trigger point is not on the pathway of the TMM you can still use it just don’t use too many. You don’t want to move the attention away from the particular sinew you are treating.

    Also, it is important that the trigger point doesn’t produce a sensation so strong it distracts from the treatment. So if it is keeping all the patient’s attention you will need to back it out a bit.

  • Yvonne Farrell

    Instructor
    March 7, 2024 at 6:30 am in reply to: Joint Replacement (Hip and Knee) Questions

    Hi Elaine,

    I would still be asking general questions that connect the knee to the way she lives her life. “Have you been able to figure out what made you vulnerable to the knee surgery?” “How is your overall joint health?” ” Any other pain in the body?” You can also ask her how the surgery has changed her life. Questions like these may lead to curiosity or further discussion….or not.

    You also have a wonderful opportunity to educate. You can talk about resources, about circulation, about diet for joint health. You talk about stress, both physical and emotional, and its impact on joint health. You can speak about the difference between acute injury and chronic pain.

  • Yvonne Farrell

    Instructor
    March 5, 2024 at 11:54 am in reply to: 4 things

    Hi Vibeke,

    1) One of the reasons for not doing 8 extra on children you mention is that they cannot give consent. Then I wonder about consent and how to ask consent form adults. I mean: what do you say to people to make them understand what the 8 extra are about…? Can you give some examples on how I could do that, please? Adults can tell you they are willing to work at a deeper level or that they recognize that there current state is connected to their past, a trauma, emotions or stress. They can also recognize when something chronic has become a habit and they need to change things in their lives.

    2) And this leads me into my second question – about me as a acupuncturist not having the agenda of «fixing people with acupuncture» – and that I should be giving patiens choices and options and let them choose and let them have their sovereignty. I wonder what that looks like. That can look like a lot of different things but most important is the idea that you do not decide for the patient. “There are several ways we can approach this.” Most of the patients that come to me just want to feel better with the complaints that they have, and they are willing to try this strange acupuncture-thing a few times that someone they trust told them was a good idea to do and see if that could help them. Then that is what you do. You treat what they want you to treat. But you also educate along the way. When people have acute pain that is simple and easy. When they have chronic problems, more is involved and much of that involves lifestyle choices and how they deal with stress. Help them to understand. So I wonder if you would comment in where they are then regarding sovereignty and how to meet the patient there. Many patients who are suffering will have maintained their sovereignty. Those patients will take your advice and treatment and do what they need to do to get better. The patients who have lost their sovereignty want someone else to fix them or they feel lost and victimized by their lives. They may be living through the lens of trauma or addiction.

    3) I also wonder if you have any input on the pathology with sleep apnea. I am pretty blank here…Most patterns of apnea have a spleen qi deficieny or spleen qi sinking compnenet with either damp or phlegm. Sometimes Spleen yang xu.

    4) And: the Yin Qiao is indicated when the arch of the feet is fallen. I understand that this metaphorically has to do with the stance in life an being aligned with true self – but would you involve that if you were to treat someone with pain in the foot (like plantar fasciitis) due to a fallen arch, or is that more of a TMM ting – or how would you treat that? if its acute use TMMs. If chronic or recurring, lingering use Yin Qiao.

  • Yvonne Farrell

    Instructor
    March 5, 2024 at 10:35 am in reply to: Maybe patient break thru?

    Such and interesting case Dona.

    Finally, I asked what probably should have been ask a long time ago. What is causing you the most suffering in your life? Tears, fear that her husband (now age 75), might die before her and she would be left with sons who would treat her badly. I know it may sound a little crazy but it some ways it feels like she is doing everything to avoid caring for herself in maybe some unconscious kind of way to speed up her own death. She has pre-emptive sadness over the idea of being left/abandoned.

    With that information, I thought about several things, self sabotage in many areas, thinking Yang Wei. Also, I became aware of how often she ask others, including me, to make decisions for her. She has visited many authority figures to get answers, cranio-sacral, psychiatrists, psychics, shamans. I didn’t think about this until as she was leaving, “what do you think I should do about this—” . Also lack of resources, I did Chong, first trajectory, and Ren this time, plus SP10. She said she felt very calm, But I think I need to think differently, and I do think she needs to apply for medical aid, although “doesn’t trust doctors”, ( which I did mention). And I need to suggest, maybe, making some small decisions of your own. Authority? I think you are on the right track with the Ren Mai. I can see why you would examine the Yang Wei but it seems like her acts of self-sabotage are all around self-care. All these authority figures she is seeing are an attempt to get someone to take care of her (like a mom). It’s like she needs someone to tell her everything is going to be ok and then give her a cookie. I don’t say that jokingly or judging. She needs nourishment and needs to see herself worthy of that. Her sons treating her badly is also a form of abandonment. She cannot count on them to takes care of her which is why she is worried about her husband dying first. The Ren will help her to take responsibility for her life through the heart & kidney axis, especially if you use Ren-15. Also if I were to add additional points, I would be thinking about the Stomach channel.

  • Yvonne Farrell

    Instructor
    March 4, 2024 at 12:24 pm in reply to: Suicide risk patients

    Thanks for pointing out that I was treating him for what he presented to me. I make my own diagnosis, and treat accordingly. I am just rattled by this alert and trying to do the right thing if he returns as scheduled for a second treatment. If the patient has triggers for his PTSD, and I learn this from the person who created the alert, then I can avoid bringing it up inadvertently. I would like to hear why the alert was issued and what they are doing to help him or if it has subsided recently, but will that taint my perception of the patient? Is there any value to discussing things with the provider who issued the alert….is it negligence on my part if I don’t? I don’t expect you to have the answers, Yvonne. I am just thinking out loud so that you can see my thought process. I hear and appreciate the deep concern you have for this patient’s well-being. I believe that is in your nature. Because you have that nature I also believe that you would notice in the treatment of this patient if they were at risk when you see them. I think if you personally need to know the history behind that alert then you should do what you can to get that info. Personally I think it has already tainted your perception of the patient. So maybe seeing it through and getting the answers you need will help you create some context around your perception. I think it is not helpful to anticipate problems if the evidence is not clear or based on someone elses opinion.

    I have to imagine that the risk is still imminent three weeks out and I wonder if I should request that he is the only patient I see in that hour, to be certain that he is safe in the room. Can I leave him unattended? Did you have any problems leaving him unattended on the first visit? Does he have a bell he can ring if he is uncomfortable? If you think you need more time, you should get it. I will have to make that assessment when he is back. Is it ethical to tell the patient of the alert and gently inquire? <b style=”font-family: inherit; font-size: inherit; color: var(–bb-body-text-color);”>I would think that bringing it up with the patient is unwise until you have the info and maybe not even then. I think it is likely ok to ask a general question like, “tell me a little about your history”. It seems like you have already done that and that he was pretty forthcoming in sharing with you his trauma. Are such alerts done routinely or with some discreet understanding provider to provider that it is not mentioned to the patient? I think it is pretty common to put alerts in mental health files especially if there is a team. Whether the patient knows about that varies depending on whether the patient has actually discussed suicide with the doctor. One is a risk assessment based on the docs experience and one is documentation of a patient’s intent. You at this point do not know which is which. So it really comes back to you having the information that will make you more comfortable treating the patient.

    I keep coming back to the fact that you treated a patient with a traumatic history quite well on the first visit without having that info.

  • Hi Annette,

    That is a really good question. I find the sinew channels are actually quite good for herpetic breakouts, especially in the acute phase. They help the venting process and shorten the course of the breakout. Once the skin lesions are gone and you are left with lingering nerve pain, I find them less effective. I think at that you point you need to deal with blood. So yes you could focus on the PC loop, the Luos, the Yin wei, with appropriate presentations.

    If you want to impact the pc loop through the sinews, then you would indeed treat 3 arm yin. Bleed PC-9 needle GB-22 or something on the flank.

  • Yvonne Farrell

    Instructor
    March 1, 2024 at 4:31 pm in reply to: Suicide risk patients

    I want to share that I am seeing patients with VA insurance. They come in with ICD-10 codes for chronic pain issues. I can peruse their EHR to see reports from the VA for medications, other providers they are seeing through the VA system, and maybe an idea of their authorization for massage or chiropractic from the other providers in my wellness center. As I related to you recently, I was checking to see who was on my upcoming schedule when I saw a system flag for “high risk of suicide” on one of my new patients. I saw this AFTER I had my initial session with him, even though the letter/note stating this was dated about three weeks before our first session. Don’t know why EHR alert wasn’t there before his appointment with me, or if the note was even in his EHR before our appointment. I did not see it if it was. Would I have treated him differently with this foreknowledge? Hi Tamra. I have read your post several times now and I also went back and reread the original email you sent me and I still can’t figure out if this is a post about what to do with “high risk” patients or your relationship to your employer. So for the sake of this post I am going to focus on the patient and not the system. I think if you really want to talk about the VA and your employer we will need more clarity and it may be a little too personal for the forum.

    I do know that you like to treat what you see Yvonne, and let the patient themselves be what you work with rather than chart notes. I felt the sadness and emptiness in his HT and LU pulses.<b class=””> When I mentioned in my response to your email to “treat what you see” that was actually in relationship to how much info you didn’t have. You do not need to know everything about a patient in order to treat them. You focus on why the patient came in the first place and you gather what info you can in the moment and then you treat. I am not opposed to reading a patient’s chart notes but they are someone elses perspective and although they can be useful they can also be biased. For instance based on you original email, I thought the patient was suicidal but maybe that is not his current state or someone’s assessment several weeks ago. If you treat him as if he is suicidal and he is not then you risk treating something that isn’t there. You need to make your own diagnosis. That chart info is just a small part of it. You need to be careful because it can be like when a family member tells you something about your patient. Accurate? Biased? or perhaps they want you to focus on something that the patient isn’t interested in engaging. You need to do your own investigation. What does this patient wnat to work on rioght now? Also when we have spoken about charts in the past, it is usally about the fact that I do not look at MY charts before I see the patient because I don’t want to be predisposed. I do however check those charts before I needle.

    I have questions; first what were you worried about when you saw that “high risk” after fact that you weren’t worried about when you treated him? And how are you feeling about the patient now and your ability to help him?

    Pt was mid-50s and candidly told me about his combat TBI incident and subsequent medical care events. His eyes moistened when he mentioned that he was the only guy to survive. I felt those inner goosebumps that you get when really listening to a person’s pain or experience. His posture was rounded shoulders, but he had blast wounds and the chemicals from the blast seared his lung tissues. He had tinnitus and migraine headache as his chief complaints. He spoke with equanimity and I imagined that his medications had something to do with that, but he was pleasant and we laughed at times during the conversation as we became acquainted. It was “Yes, Ma’am” and very polite, very coherent introduction of himself. He spoke of a future fun family event. It doesn’t sound like he mentioned anything about having suicidal ideation. Since his chief complaints are tinnitus and migraines that is what you treat and that looks very much like a Yang Qiao issue. You mentioned he had TBI, that is also often a yang qiao issue. This may be a way to begin treating his chief complaints and his nervous system (brain) at the same time. He may be “high risk” because of his history but it doesn’t sound like that is why he is seeing you.

    After receiving your support and support from another practitioner, I have a clearer vision of how to treat him, should he return for his next appointment. I was alarmed that since the alert appeared after our treatment day, that something that happened because of my treatment. He has managed to survive his pain for those three weeks since the alert was issued, by the suicide care team with the VA or his psychiatrist. I hope that our next session(s) help to walk this patient back from the edge if possible, but let me ask you some technical questions:

    Is it appropriate for me to reach out to the VA team and ask for a provider update on this alert? If I was a solo practitioner, I can make my own policies, but I am a 1099 employee; I don’t know if my employer has any objections since the VA is his bread and butter. When I called the VA scheduling team within the center, they said this was the first alert they have received, and they had notified the office manager. When, I don’t know. She actually gave notice so she wasn’t in the office this week, but I treated him last week. I have funneled all questions for the owner through her. She would reach him by phone as needed to answer any questions that I had. The wellness owner (my boss) has told me that the patients are his patients, not mine. I had to take some time off work recently, and wanted to assure that my patients were not going to feel abandoned by my absence, so I asked if I could write or call “my” patients. My license requires this of me, but he said that all of my patients were offered options to see other providers within the center. So continuity of care was offered to “his” patients. He then instructed me that he doesn’t want providers (i.e. me) making calls to his patients. Perhaps he also doesn’t want me calling the VA about this. I likely need to try to have him call me (most of our communication is via gmail, which as we all know, is not that secure.) I have found proton.me that a friend recommended for better encryption and less email snooping, but I don’t know if the EHR platform (Chirofusionlive) allows for HIPAA communication between providers. He is a chiropractor. This whole thing is something we should talk about at a separate time. I have questions. What I can say for sure is if he was referred to you for acupuncture by the VA then you entitled to his history.

    I am going to send my boss a “call me” email now, as I think through this as I write. Just imagining that any new practitioners might benefit from this post.

  • Yvonne Farrell

    Instructor
    March 24, 2024 at 10:23 am in reply to: Welcome

    Dona,

    No matter how quiet you are, your presence is inspiring. Thanks for sharing a bit of yourself with Cohort 3. xo

  • Yvonne Farrell

    Instructor
    March 7, 2024 at 7:49 pm in reply to: Joint Replacement (Hip and Knee) Questions

    Hi Heather,

    Healthy joints basically need 2 things; minerals & lubrication. So foods high in Vit. D , Calcium & magnesium and healthy fats. Leafy green are good, salmon, avacado, coconut oil.

    If someone already has joint pain that is inflammatory in nature then you would need to take the foods out the diet that cause inflammation. Highly processed foods (esp. ones that have lot of sugar), overly spicy or hot natured foods, caffeine, fried foods, sodas (esp. diet). Some people swear that removing nightshades from the diet can help joint pain. I haven’t found it particularly helpful.

  • Yvonne Farrell

    Instructor
    March 4, 2024 at 12:31 pm in reply to: Pregnancy Contraindications

    Hi Vibeke,

    The Golden needle treatment is done between the 1st and 2nd trimester and then again between the 2nd and 3rd trimesters. A gold-plated needle is used at Ki-9. Sometimes I do it on its own and sometimes I combine it with other things if the patient has symptoms. Jeffrey says that because it is the xi-cleft point of the Yin Wei it clears blood toxicity and since the baby and mother share blood it can be used to separate the karma between babies and moms.

  • Yvonne Farrell

    Instructor
    March 4, 2024 at 12:25 pm in reply to: 16 year old boy with chronic cough

    And thus the Yang Qiao. Thank you Vibeke.

  • Yvonne Farrell

    Instructor
    March 1, 2024 at 3:58 pm in reply to: Welcome

    Thrilled to hear this and I am looking forward to your participation.

  • Yvonne Farrell

    Instructor
    February 26, 2024 at 8:01 am in reply to: Welcome

    Hi Daryl (she/her),

    We will do our very best to help you to feel safe and confortable. I recognise that people join the mentorship with varying degrees of experience and and they all have different expectations . You can be sure that you will never be judged for whatever level of participation you bring. I have many people who rarely ask questions but learn from the questions of others and just as many who are willing/able to share their deepest challenges. All are welcome.

    I have no expectations that participants will have prior knowledge or expertise. I love when we have a good mix of clinical experience. The newbees often ask questions that change the perspective of seasoned practitioners and vice versa.

    I have a pretty broad teaching history so I am open to exploring anything from the basic knowledge of our first training to the deeper and more esoteric thoughts this medicine can address. Just so you know, this medicine is so vast that there will be times when I cannot answer a question but even then we will ponder the possibilities.

    Welcome.

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