Taking Charge (11)

Eleven
Acupuncture
Taken from the book Taking Charge: a journey of recovery. Available for purchase (post and download) from http://www.familyconcernpublishing.com.au
My interest in acupuncture goes back a long way, but I never suspected it would end up being so important in my own recovery. 
The initial interest stemmed from Kirlian photography , . Semyon Kirlian had originally caused some excitement in the late 1930s when he showed that an object on a photographic plate connected to a source of high voltage gives off a small corona of discharges. He caused controversy when, from his experiments with a dying leaf, he suggested that the discharge represented some life force which gradually extinguished with death. This has been debunked, and the effect may simply be the gradual loss of water from the leaf as it dies, rather than anything else. However, to a medical student of everything, the thought that the body put out energy that might be seen or measured was an intriguing one.
Later, there was a science show on the BBC in the UK, maybe in the 70s, led by a very enthusiastic and well-respected interviewer (and I can no longer find a reference to it in the BBC Archives or elsewhere and, embarrassingly, I can no longer remember his name (maybe James Burke)). Essentially, there was early discussion about the Kirlian phenomenon, and then they darkened the theatre, and demonstrated what looked like electron discharge from all sorts of places on the body, finally referencing this to Acupuncture meridians and points on ancient charts. Having been switched off by the arguments about, and ultimately refutation of, the Kirlian phenomenon, I was definitely switched back on. 
Some years later, both Jan and I struggled with painful conditions that needed medication and care. She had a period of rather frequent and severe migraines; I had shoulder pain and other muscular pain from overdoing it at Karate (too much youthful enthusiasm, too much force, too little technique!). Recently come onto the market was a self-help electronic, battery driven, acupuncture machine (the Acuhealth) devised at the University of Adelaide. It was hand held, simple to use, and the instruction manual was detailed and clear with sequences of points to be ‘needled’ (that is buzzed) either ‘positively’ or ‘negatively’, for a wide range of common conditions for which all the sequences of points were carefully detailed. There was some introduction to Chinese medicine thinking, but we moved swiftly through this to the practicality of maintaining our own health when necessary. We just followed the instructions to the letter, and it worked - mostly. There were times when the migraines were not helped, but really we were both impressed. The machine still works, 20 years later.
So, we got used to the idea of acupuncture points, meridians, and sequencing of treatment, and I became quite adept at using acupressure on those same points – after all fingers and thumbs are even more portable than a hand-held machine. There was no question that it worked; theory as to why seemed irrelevant.
My early training in Karate did not include much about pressure points, or points to be struck. It was an oversimplified version that taught stances, punches, blocks and kicks through a system of physical practice, repetition, and correction; to be honest, it was mostly about strength and power rather than finesse and deep knowledge. The same with Kata, it was simply about learning the movements from seeing and doing, and then lots of practice, lots of repetition, and lots of correction. Over 9 years getting to my first black belt I became fit and strong, reasonably quick, could defend myself (mostly) in the Kumite (fighting), and actually won some awards in Kata competitions (forms or sequences of dance-like movement –OK it was in the Veterans division). After a while the somewhat meaningless rote of training twice or three times a week can get boring, and even though I was teaching over the last few years, on moving to Queensland I gave up for a while.
I picked it up again when my son returned from the UK to live in Brisbane and started a new style of Karate which was more about the fluidity of movement (Goju Ryu), and less about being some sort of human tank (Shotokan). He has a depth of understanding about the why and how of Karate I found fascinating and, with his encouragement, I began to collect videos of various masters, other styles, and technique. I was constantly introduced to new books explaining what a specific Kata or a sequence of moves was supposed to do to the opponent’s body, and of course much of it relates to Acupuncture points. You can think of Karate as self-defence. There is a basic rule that there is no first strike; in other words, you don’t start it! Within this, and as part of a response to the recognised (and surprisingly limited) variety of habitual acts of human violence, in defending, you can think about attacking muscles and weakening them, damaging superficial arteries or nerves to reduce the control over key muscles and movements, or you can think about joint locks or even breaking bones.
But our style of Karate is in some ways much more subtle than that and targets points on the body that are poorly understood in Western thinking. One issue is that you can cause considerable pain by hitting or pressing on a particular point that coincides with an Acupuncture point in Eastern medical practice. More than that, a defined sequence of strikes can cause temporary paralysis, weakness or even unconsciousness . I have read and re-read many core books (for instance The Bubishi – known as ‘The Bible of Karate’ and translated by Patrick McCarthy ) that describe and explain these, I have attended many specific seminars on how to do this, and I have practiced. So to my half-baked knowledge of medical acupuncture, I have added some depth of knowledge about acupuncture points that are relevant to the art of Karate. This is complex stuff, and I still have a long way to go to reach a full understanding and an ability to use the knowledge appropriately and skilfully.
In Brisbane, Rod began a four-year graduate course in Acupuncture and Eastern Medicine, and I listened with fascination to his synthesis of lectures and concepts. Central to the whole idea is that we have something in us called Chi. This is an energy which flows down certain meridians (mapped thousands of years ago in China), and up other meridians. Chi needs to be in balance between Yin and Yang, and imbalance can lead to ill-health. That is really the limit to my knowledge. I have listened (I promise), but there is so much that just doesn’t seem to fit with the conceptual frame of my 40 odd years of Western Medical practice. I know what I do know, and have experienced, and I just accept the dissonance or conflicts. A senior psychiatric colleague of mine once said many years ago that the essence of a being a good psychiatrist was the ability to tolerate uncertainty. So that is what I do; I accept both, and tolerate the fact that I have difficulty reconciling them. There are many times, though, when I have mused that perhaps eastern ideas might have something very special to offer in psychiatric practice that is just not available in western thinking, and I muse about all the knots that we have got ourselves into with diagnosis and the medical model, so-called scientific method, and pharmaceuticals. Ah well, that is all another story…
I have seen some very odd but convincing demonstrations regarding Chi, which are often seemingly party tricks, but also seem to be so much more. I actually came across it when I first arrived in Brisbane. I was still keen to do martial arts, but looking for something a bit more elegant than what I had been doing, and thought I might try Aikido. This style is very focussed on energy (Chi or Ki), and in my very short career I did get a sense of respect for the ability to move Chi in another person, and disempower them.
The party trick end of this was to rub your hand on your chest in one sideways direction a couple of times, and then point a finger at distance of a centimetre from a $5 note bent slightly and standing on its side. The note moves as if in a very light breeze. Static electricity? I don’t think so. If you rub the other way across your chest you get nothing. Inexplicable…
Another ‘party trick’ is to ‘strip Chi’ from an arm held strongly horizontally from the chest. You demonstrate that you cannot lower that arm very far against resistance by pushing downward somewhere around the wrist. Then you simply very lightly rub your hand somewhat quickly down the top of the arm from shoulder to the back of the hand. After a brief pause you press down on the arm, at the wrist, and find you now ‘have the strength’ to lower it even where previously you did not. Or perhaps your friend has ‘lost the power’ to restrain you from lowering the arm. Simple distraction, or some trick of hypnosis? Apparently not! If you rub upward from the back of the hand to the top of the shoulder, it does not work. Inexplicable…
One final (and much more dramatic example) occurred last time I was in Japan. We had been on a coach journey to train under a waterfall, and were returning home. Along the way we stopped for an evening snack at a roadhouse. The wait for the food seemed interminable, and we all sat around talking Karate (of course). We got onto Chi, and whether it actually existed, and one of the Canadians decided to give us a demonstration. He invited a young woman karateka (of perhaps 50 kilograms) to sit on an ordinary chair, and then invited 4 males to stand at the corners of the chair. One had to put an index finger behind the left knee, another put his index finger behind the right knee. The two others had to put an index finger under each armpit. The young woman was asked to hold herself rigid, and the four males were asked to attempt to lift her! To no avail, not surprisingly. Then all the males were asked to rub their right and left hands together, and focus their Chi through deep breathing at the Hara (an area just below the belly button, called Tanden in Chinese). Our subjects were then invited to hold their hands in sequence 1L, 2L, 3L, 4L, 1R, 2R, 3R, 4R in a line centrally above the woman’s head – not touching her head or each other’s hands. After 30 seconds they removed their hands carefully without touching, again were asked to focus their Chi, and resumed their index fingers where they had been. Once again they lifted – this time to a height of a clear 20 cms above the seat of the chair for about 20 seconds with no effort - before everyone got a bit anxious and lowered her gently back to the chair. I was there, I saw it, and I was gobsmacked. I still cannot explain what happened.
Well, all of this is a long-winded lead up to discussing the place of acupuncture in the treatment of my paralysis.
Rod began work on my body on about Day 3. We had been told a bit about what might be happening to my spinal cord, and had been given the results of all the tests including the early MRIs and CT scans. There was a ‘shadow’ from about the level of T6 down to T9 more on the right. There were arguments about what might have caused it – perhaps a little bleed, perhaps an embolus, perhaps a form of multiple sclerosis. But nobody knew for sure. Without a definitive cause, how could there be a definitive treatment?
And no-one could tell me what the course of recovery might be. I had been started on a moderately large dose of Dexamethasone and some preventative heparin to ensure I did not get deep vein thrombosis but, as noted elsewhere, there was no other treatment offered until I began physiotherapy about 10 days or so later. My muscles were not massaged, nor was my skin soothed where I had pain. I guess medical staff were just waiting to see how much recovery my body could make; sort of passive observation. As I have said elsewhere, nobody could tell me what I might have done to myself (if that was a possible cause), and therefore they could not tell me what not to do in the future!
With permission, but obviously some resistance and concern from staff, Rod came in about 5 evenings a week after a full day at work (poor bloke!). In fact, no medical person wanted to listen to anything I said over the next few weeks with regard to sensation or returned function. They just looked perplexed, or slightly embarrassed. 
Behind closed doors (or curtains), and mostly with me laying face down, I got needles inserted locally around where I thought my spine had been damaged around my spinal cord. I don’t know or understand the pattern of insertion, so I cannot explain that. There were also needles placed down my legs in a variety of patterns. Finally there were sometimes needles placed in the crown of my head, or around my upper neck. My very superficial understanding was that the ones in my back were mostly to help local recovery, the ones in my legs to revitalise my legs (literally, given they were so dead), and the ones elsewhere were to help my body regain (or perhaps rebalance) my general health. Occasionally Rod would place needles around my upper chest in the pattern of referred pain from my T7 damage. Did the needles hurt? Mostly not! There were some spots that did appear to be sensitive. One in particular about two-thirds down my inner calf/shin has always given a reaction, made me jump, or at least made my leg jump. Occasionally, needles in the dorsum (top) of my foot would make me jump or at least twitch. Interestingly, the only response I can get from Rod when this happens is “Good, that was a good one…. So where did it travel to (radiate to)?” This is not because he is some sort of sadist getting back at his poor old father. Rather there is a belief, that the stronger the reaction, the more likely the needle is to be exactly in the right place, and the more likely it is to do provide some improvement. 
The response to his question was always a positive “Well, down toward the spot between the big and second toe” or “Up to a point on the knee”. What is interesting about these radiations, is that there is no relationship with any piece of my western medical logic. There is no nerve pathway that provides the way that the reaction travels! But if you read about Meridians in the old Chinese or Japanese texts (and I have a bit… before I got overwhelmed by possibilities), they have known about these pathways for thousands of years.
The results were (and remain) fascinating. From the first treatment in hospital, I began to get sensations going down both legs. It felt like warm deep pulses travelling down; like a steamroller driving down inside of my legs. From no sensation to these powerful sensations was just miraculous. Within half an hour, I would be dead to the world in the deepest of sleeps, waking some hours later, slightly uncomfortable from laying in the same position for a long time and with dribble on the pillow. There was a deep sense of comfort or satisfaction, a sort of total body buzz I have only got at other times from meditation. The warm bulldozer waves would have ceased, but what was left were wonderful pins and needles all down through my legs and into my toes. I could not describe the joy and hope those sensations left, when before there had only been deadness.
Within a couple of days, those pins and needles made me determined to try and move what I could so that I did not lose too much muscle, and therefore my strength and control. I began to move my feet a couple of inches up and down, the left and last damaged foot better than the right and first paralysed. Each day I would proudly demonstrate my most recent ‘trick’ to any visitors who had time and patience to watch (most of them, bless them!). Each day there was an improvement with both little and large muscles responding to the efforts. From about the second week, I would wake at 5.30am, and do a whole hour of any exercise I could think of, twisting to the side, gradually drawing up my knees further toward me, holding my knees up while I did work on my abs (such as they are). I swear that if I went two days with no acupuncture, then progress would slow perceptibly, but after one of those deep sleeps, the next day there would be little advances.
The doctors did not seem to be impressed at all. They would go through their daily routine of checking power in all directions for the various muscle groups, reflexes (always, and still, very brisk), all forms of sensation, joint position sense, and response to vibration at each leg joint. I would say that I thought such and such a movement seemed stronger, they would cast doubt with furrowed brow. The senior registrar had one of those impassive faces, not giving away a thing. She was ever doubtful. I guess she did not want me to have too much in the way of expectation, did not want me to be disappointed with the final result. I used to get furious after she left; I was just certain there was progress. After a while, I realised it was her problem (not mine), and that the medical examination is so much of a blunt instrument, that it is (probably genuinely) hard to perceive small changes. I am ultimately grateful to her, surprisingly. Her blank looks and lack of encouragement drove me to do better and better. I would have liked her to be a bit encouraging, particularly in those bleak early days when you believe you will be confined to a wheelchair. Perhaps she understood reverse psychology; but on the other hand, I know she did not.
The consultant was probably worse in some ways. He had a way of smiling a little smile: “What would you know, you are only a patient” was my interpretation, but then I have always been overly sensitive and a touch paranoid. He always looked uncomfortable, and my (?overly sensitive) thoughts were that he really wanted to avoid me, because there was no medicine that was going to work for me, and he could offer nothing to help (perhaps that should be ‘nothing to help a colleague’). After several weeks he did sort of accept my academic status and offer a couple of very good published papers on small series of patients with similar problems. I was grateful, and very interested in what was being said. Mostly he seemed to have some sort of internal dialogue going on, and was always in a hurry. I think the smile was (perhaps) defensive. The other irritant was that his internal dialogue always interrupted what I wanted to say in the way of changes I was noticing, or questions I needed to ask. You could see his eyes glaze over, as he turned to the junior registrar to demand another test. I learned very early on not to complain about physical symptoms, because the result was always another test, another uncomfortable examination.
None of the doctors ever wanted to talk about Acupuncture, and this ultimately included the people later at the specialist Spinal Unit. They did not understand it, had maybe never experienced it, could not find proper rigorous scientific studies on it, just knew there would be never be any Cochrane Collaboration meta-analyses of randomised controlled studies (and actually they are wrong! ). On several occasions, if one of the junior medical or nursing staff came in while I was having one of my treatments, they would bluster and promise to come back later, or the next day. Even the staff and a couple of ex-patients from my mental health service did better than that. Although, there is a funny story here.
One early evening, several staff visited from a group called ‘Beautiful Minds’ – essentially a group of young adults mostly recovered from mental illness and now part of a group helping other young people. None of them had ever been directly my patient. There were two of them with a full-time staff member, and my son arrived to do my acupuncture. They asked if they could watch, having never seen it before, and I agreed (call me odd, call me unethical, and possibly several other names). As each needle went in, they squirmed and said “Ewe…!” One of them is a young woman who has self-injured over the years (very badly and repeatedly), and is now a consumer consultant for several of my professional and research projects on self-injury. Her facial expressions were just the most extreme, and she asked how I could allow my son to do this to me? (She who had repeatedly taken a knife or a razor blade to herself). Towards the end, given my repeated assurances that it was not painful, she asked if she could try? My son put one needle into a point between her thumb and forefinger, much to her (and everyone else’s) amusement. She had to admit that it did not hurt, and then came a string of questions as to whether it would work for chronic self-injury. None of us know (yet).
I feel somewhat strange telling you these things, now. It feels a bit like I am being a traitor to my own training. I am a doctor, I have gained the most wonderful skills and experiences from being a doctor, and I treasure being a doctor. I can’t help that I am western trained and struggle to understand what has happened to me. I know for sure that if I had done nothing in those first few weeks after I was paralysed, I would have mouldered and deteriorated. I know I would have deteriorated emotionally and mentally as much as physically. The acupuncture made significant physical changes. It gave me hope for the future, and this has continued to the present (with the occasional bad day). It has sustained me emotionally. If you like, it has provided a holistic wellness allowing me to challenge the residual paralysis every day of my life.
I still get acupuncture every two weeks or so, sometimes just for the sense of wellness, sometimes targeted at particular aspects like the neurogenic bowel, or the fact that I get swollen legs from time to time. I can go into a session with that old memory of the deadness in my legs, a feeling that the ataxia has increased and I am not as steady, despite the fact that I walk every day, and am on an exercise bike two or three times a week. After a session, within 24 hours, the wonderful pins and needles are back, my feet feel more flexible, more alive. My ataxia settles down, I feel more like agreeing to go for a walk, and (to top it off), my performance on the bike improves dramatically.
I know, it is only one person’s experience… And of course Rod, being the lovely human being he is, just says: “Mmm, it’s probably all coincidence”.
A word to the wise: “If western medicine appears unable to assist you to get rid of irritating problems, give serious consideration to at least trying some acupuncture.”