Paradoxes within Practice

One of the patients at the assisted living facility is a gentleman of 86 years. In addition to surviving dementia he also has very high blood pressure, in the range of 180/120. What is so surprising to me about this is that we all have a very hard time finding his pulses. My ‘Western Analytical Mind’ would state if he has high blood pressure his pulses would be easier to feel. That is not the case, at all.
Yesterday when I was getting ready to give him a treatment I was feeling for his pulses, nothing detectable at all, any position, any level. Then I quieted my mind down, removed my fingers from his arm and very slowly started to reconnect my fingers to his arms. Just at the level of skin to skin contact, with the slightest amount of pressure I could contact with I could almost feel a pulse. Almost.
If I feel at his carotid artery I can definitely feel his pulse, but that is not where we palpate pulses for diagnosis. There is a Japanese form of pulse diagnosis that compares the strength of the carotid pulse to the strength of the radial pulse and based on the difference in force includes that into the diagnosis. I have been exposed to this, but I do not have enough experience in that to make a clinical diagnosis based on this information. It felt like the carotid pulse was at least 10 times as strong as the radial pulse. From what I remember my clinical supervisor, Jeff, talking about there is a 1-3 force differential that he uses. I have never heard him say anything about a ten-fold differential in pulse force. But I bet he could tell me a thing or two about this. I would also bet he would agree with my conceptual diagnosis.
One of the ways that TCM talks about death is that it is the ‘ultimate separation of Yin and Yang.’ As I have felt this man’s pulses over the last four to five months we have all felt this separation developing. He is technically a hospice patient, even though he lives in an assisted living facility. But his state of health is declining.
As a clinical supervisor I see this as an incredible teaching opportunity for the students, as well as for my own experience. We each try to feel the pulses that are ‘interesting’ or different. This gentleman’s pulses are always interesting, if we can find them. I remember one time we got him to laugh and his pulses became palpable for 15-20 seconds, then they retreated back to where they hide.
What I was originally going to write about was the dichotomy of a patient having high blood pressure, but as an acupuncturist we cannot feel his pulses. The paradoxes of one medical system seeing one thing, high blood pressure, and the other medical system not being able to detect the pulses. I still find this interesting.

Picking up the pace

It is a very rewarding experience to see my clinic growing. To be working as hard as I can to promote and develop my clinic to the point that it is self-sustaining. In all the myriad meanings of the word.

The Tui Na clinic is doing very well. The students I have been supervising have developed their skills, taught me many lessons and developed a good working relationship with the patients. In an acupuncture school it is not uncommon to have the students change clinic supervisors every quarter. I was very pleased when both students requested to return to work with the Elder's again. I was even more pleased when the Assisted Living Facility agreed to let them start practicing acupuncture on the Elders that want it starting next quarter. That tells me that the work the students are doing is well recieved and that the staff has developed a degree of trust about acupuncture and the school.

I have been asked to teach a class at the school next quarter: Immunology from a TCM perspective. This is a GREAT opportunity for me. I always learn so much when I teach. If I include the hours of preparation for the class I am probably getting paid $.50 an hour. But hey I am having fun and learning an incredible amount. It is one thing to know a subject for my personal use and understanding; it is a wholly different sense of responsibility to teach this to a group of students. To be able to teach aspiring students ways to think 'outside the box' and to intentionally look for patterns that are subtle and discrete is a humbling responsibility.

My actual clinic is growing as well. It is interesting to see that since I have taken this teaching position I have had two new teachers come into my life; of course they come in under the guise of being patient's, but I recognize them for what they are.

All in all I am enjoying my summer, relishing in watching my efforts start to bear results.

I know I have many, many hurdles to cross, many lessons to learn. But I am enjoyin' the ride...


Will write more later. Maybe about the auricular clinic for treating ADHD kids....

Respectfully,
Michael