Nurses Conference 2013 - Kimberly Smith-Niezgoda, M.Ac., L.Ac, Dipl.nccaom
Acupuncture - what is acupuncture? And how does inserting thin, sterile needles at specific places on the body reduce pain and promote healing? And why would I solicit a treatment that uses sharp, pointy things while I am awake? Because it works - acupuncture works.
Good afternoon, my name is Kimberly Smith-Niezgoda. I am a board certified licensed acupuncturist. I also have a degree in nutrition and I extensively use both western and eastern dietary therapies with my patients. I would like to thank Tracey and the Foundation for having me and all of you for having me here today to share hopefully some insights into this amazing medicine and some other modalities that may help. And especially after hearing some of the presentations this morning I certainly have learned a lot. I believe I am also here to share some hope. For either any of us that are suffering from endometriosis or from some of our patients that we may be interfacing with.
Can I ask who here has ever experienced acupuncture? Okay, so maybe a third, maybe a third. So for any of you that have had acupuncture treatments hopefully you will have some new information and for people that have not, hopefully you will have some things that you will learn.
I will be covering what is acupuncture, how does it work to relieve pain and reduce symptoms, why is it appropriate to use with our endometriosis patients. If that is not enough to cram into a half hour what role does nutrition play in healing and in managing the menstrual cycle and potentially endometriosis?
What is acupuncture? According to Webster's, this is straight out of Webster's dictionary, "Acupuncture, an originally Chinese practice of inserting fine needles through the skin at specific points, especially to cure disease or relieve pain", a very broad, generalized theory to explain. Its facts include stimulation of release of natural opiates, blockage of pain signal transmission, and a placebo effect. It is a medicine that has been used for over 3000 years. It continues to be used for not only pain relief but also for internal medicine. Today more and more western medical institutions are recognizing the effectiveness of acupuncture for a number of conditions.
So how does it work? There are several modes of action that have been identified for acupuncture and the mechanisms can get quite complex and probably not really appropriate, but ultimately acupuncture is a remarkably simple medicine that depends upon the stimulation of the peripheral nervous system. So what does that stimulation at the periphery do? It promotes blood flow. This is significant because everything the body needs to heal is in the blood. It includes oxygen, the nutrients that we absorb from food, the immune substances, hormones, analgesics and anti-inflammatories and restoring proper blood flow. As we all know many of us if any of you have been nurses it is vital to promoting and maintaining health.
Acupuncture stimulates the body's built-in healing mechanisms, extremely important. Acupuncture creates micro traumas that stimulate the body's ability to spontaneously heal injuries, to the tissue through the nervous, the immune and the endocrine systems.
Acupuncture releases natural pain killers, again, extremely important when we are talking abut something like endometriosis. Inserting a needle sends a signal through the nervous system to the brain where chemicals such as endorphins, norepinephrines and enkephalins are released. Some of these substances are ten to 200 times stronger than morphine. That is pretty significant when we are talking about a population of people that are suffering from debilitating pain. Ten to 200 times stronger than morphine.
Acupuncture reduces both the intensity and the perception of chronic pain, again, very, very applicable in the scenario of endometriosis. In hearing Dr. Seckin speak occasionally you have a highly successful surgery or from the surgeon's standpoint the surgery is successful and yet the patient is still suffering with pain. Acupuncture can be a modality that helps to interrupt and interface with that perception, the ongoing perception, the muscle memory the body is having of chronic pain or debilitating the intensity of it.
Acupuncture relaxes shortened muscles. This in turn releases pressure on joint structures and nerves, and again, it promotes blood flow. When you relax the muscle, when we are in pain we contract and constrict and that creates more pain. If you can relax the shortened muscles you can then have less pain.
And perhaps one of the most important systemic effects is that acupuncture reduces stress. Or, what I often times say to my patients, "We may not be able to eliminate or reduce the actual stressors that we have in our daily life but it affects how we interface with the stressors". So many times patients will say, "You know, I, nothing has changed necessarily. I still have the same job or I still have the same scenario going on but I am handling it better. I'm not yelling as much, I'm not flipping out at my kids. I'm not, you know, blowing up at work, at my employees". It changes how we interface with the stressors that we do come in contact with. And this is achieved by creating a balance between the sympathetic and the parasympathetic nervous systems. We get locked in that fight or flight. Our systemic nervous system, which is designed to respond to stressors in a way that allows us to, you all know this, fight or flight. How many times are we being subjected to a stressor where we cannot fight or flight? It is a phone call from our boss or a phone call from a family member, some trauma. We cannot fight or flight. We are fortunate if we can. Oh you are 15 late for that appointment, great, let me run down three blocks and get there. That we have completed the circuit, we actually have done what the body initiates, the stress response, the sympathetic nervous system to do. We are flighting but so many times we are not fighting or flighting, we are bathed in the cortisol hormones, we just continually bathed in the body and we stay locked in that fight or flight mechanism. Acupuncture in spite of ourselves, we put you on a table, bring you out of that fight or flight modality - it reduces stress, it reduces our perception of stressors and how we interface with it.
Acupuncture can have an effect on every major system of the body including the cardiac, the gastrointestinal, the genitourinary, the circulatory, the cerebral, the endocrine and the immune system, all the systems of the body. Broadly speaking acupuncture has three primary effects: it relieves pain, it reduces inflammation and restores homeostasis.
Homeostasis is the body's ability to regulate its environment and maintain an internal balance. If we realized that all diseases involve a disturbance of homeostasis and nearly all diseases involve some degree of pain and inflammation, if we understand that most diseases are characterized by pain, inflammation and a disturbance of homeostasis we can begin to understand why this medicine could be utilized not only for endometriosis but broadly for so many conditions.
I would like to say to please keep in mind that the pain research is constantly evolving, putting this medicine into the western modality of double blind placebo. The study has been very challenging and many of the studies are not really able to stand up to the protocols that we put them to in the west. More and more is being learned about it and so much is empirical evidence that the patients are healing. The patients are getting relief. It will be on the forefront, it is happening.
I would like to discuss, just being I think a room full of health care professionals, the actual mechanism of the ability of acupuncture to relieve pain. There are two types of nerves involved in the perception of pain, and again, many of you know this, the sensory nerves are the nociceptors and the positional nerves are the proprioceptors. So the sensory nerve is saying there is pain and the proprioceptors are saying it is in my abdomen, or it is in my hand. If it all functions correctly that is fine, the body continues on. But if the signal strength of that position nerve is where it is supposed to be the brain releases powerful natural pain relieving substances called the enkephalins. The enkephalins then are transferred to the brain, the spine and the capillary beds where it reduces or eliminates the pain. That is fine but unfortunately that is not what is happening in the scenario of chronic pain. Why? The current explanation is that the position nerve signal going up to the brain becomes too weak. So the brain cannot figure out where the pain is coming from and enkephalins do not get released. Because the brain is not getting the message the nerves keep firing and they keep firing and the nerves become inflamed. This in turn further weakens the signal. If we can set signals, the ability to jump the threshold, this in turn gets the message to the brain. So we are having this pain, the body is not aware of where it is coming from so it keeps firing. That is a problem.
Inserting a needle into the skin at a peripheral site jumps that neural threshold on the position nerve pathway so that the signal can reach the brain, "Ahhhh". Relief. Once the signal reaches the brain all of what we just talked about kicks in. The brain recognizes there is pain, recognizes where it is coming from, it releases the enkephalins which are the pain killers and the pain is reduced or eliminated. This initial response is very fast and oftentimes patients get out of pain on the table. It is oftentimes perceived almost instantaneously.
After needling therapy, after an acupuncture treatment the patient goes home. Sometimes the pain comes back. The old habit of the nerves firing chronically below threshold re-establishes itself. And the body, just like the mind, has a hard time breaking bad habits. But if the patient returns in a few days or in a week for another treatment the neural threshold is jumped again and if you keep jumping the neural threshold eventually the central and the peripheral nervous systems gets the figures out that it is better to operate in the non-pain state than in a pain state. The technical term for this is called re-establishment of neurological homeostasis. Again, you are controlling your environment and re-establishing balance.
So that description is how acupuncture relieves pain via the peripheral and the central nervous system. There is another pain relief mechanism that actually involves activating the immune system, very important when you are having any disease scenario.
Acupuncture needles are seen as foreign invaders to the body. Inserting a needle into the skin creates a micro-trauma, which in turn stimulates the body, the activity of the immune cells that control inflammation. There are millions of immune cells along the dermis of the skin and these cells are like water balloons filled with fatty molecules called leukotrienes and prostaglandins. When a needle is inserted into the skin it pops the mass cells releasing the leukotrienes and the prostaglandins. Leukotrienes are the strongest anti-inflammatory substances the body can produce. Again, it is amazing. Our body already has the ability to reduce and eliminate pain and to reduce inflammation. The micro-trauma caused by the needle starts a systemic immune response and it promotes healing of the soft tissue throughout the body, not just at the needling site. After the needles are removed the lesions continue to stimulate the immune system for potentially two to three days, sometimes a week. You have an actual, noticeable, effective where inflammation is reduced.
If we realized that genetically the body is not designed to be in chronic pain it will do everything it can do to get us out of pain. Acupuncture reminds the body how to do what it already knows how to do. Talking about utilizing something like Lupron for patients - and I do not know - maybe this my new path but to begin to see can acupuncture reduce the kind of lesions that Dr. Regard had pointed out in the woman that she worked with that was overweight. It may. If we are reminding the body to do what it knows how to do already it will heal, potentially can, potentially heal some of the things that have gone awry.
When we remind the body how to do what it already knows how to do it is a bit like jump starting a car. We are not changing how the car works we are not even adding anything to the engine. We are just giving that battery a little jolt. And then the engine and the car can do what it is already designed, already knows how to do, right? That is an amazing thing. It is important to understand the neurochemical mechanism not only provides pain relief but it also promotes the homeostasis, the tissue healing, it regulates the immune, the endocrine, the cardiac and the digestive systems. Again, it is why explaining how getting acupuncture treatments for endometriosis can also address other issues that our patients are dealing with; the depression, the fear, the fatigue, the bloating, difficult urination potentially. You know sometimes there are physiological blockages here but it may help reduce some of that - bowel irregularities. Acupuncture is not directed towards a particular disease or condition it works instead by activating the body's self healing ability. Again, it is why it can address things from asthma to back pain, the side effects of chemotherapy to endometriosis.
I would also like to address a well documented research treatment for addiction that could specifically be utilized to help with patients that could be suffering from dysmenorrhea or from smoking or potentially trying to reduce or eliminate some of the narcotic usages that you have been utilizing for pain control. It is called the NADA protocol. It stands for the National Acupuncture Detoxification Association. It initially was researched in the prisons to help addicts going through withdrawal. It has been extensively utilized in a group setting. It is five needles in each ear it is called the auricular treatment. It is extremely powerful to help with smoking cessation, weight loss and addiction control. It helps to assist in quickly returning the body to pre-usage hormonal levels as well as reducing stress and eliminate cravings. It is a phenomenal treatment.
That leads me to those that may not have been exposed to acupuncture and to talk about they are sharp pointy things, needles are sharp and pointy, "Ow, doesn't it hurt?" They are fine, they are oftentimes the width of the hair. The needles are solid so they are not like that which we use for blood draws or putting something into the body with an injection. We are not putting in or taking anything out of the body so they are solid and they are very thin. Sometimes there is a sensation to it but often times it is extremely minimal, especially for anybody who is - any women in the room and things that we endure and have gone through. It is not described as painful and once you interface with it even the patients that are most terrified of needles come in and, "Okay, go ahead, go ahead" and by the second treatment or the third treatment they are just, "Oh please, please, I'm here, I'm here".
Acupuncture treatments can be in an individual setting where you are on a massage table. It can be extremely beneficial for so many people that live in this culture of go, go, go all the time to have a half hour or an hour or an hour and a half to lay on table in a quiet, relaxed setting and be tended to. You can get to different areas for endometriosis patients or for people suffering with menstrual scenarios. It is nice to be able to eventually, if not initially, get to the abdomen, to get to the low back, to get to areas where you are really suffering from some symptoms. But you can access treatment and more and more treatments are becoming very accessible in seated scenarios in group situations. Sometimes you hear it described as community treatments or group treatments. A lot of the younger population likes to have treatment this way. They can come in groups. Girls like to be in groups and when you are younger you can communicate and be in more of a social situation, or you can be quiet and fall asleep but there are many, many different ways to access actual treatments.
That being said, how do we bridge the gap between treatment of a condition and nutrition that is best for a person suffering from a condition? The answer is we do not. There is not a gap. The treatment for endometriosis or any state of disease and understanding that we are what we eat, and what we eat influences our state of health is absolutely paramount. Relieving pain, reducing inflammation, bolstering the immune system, assisting in hormonal balance and lessening stress is intimately and inseparably achieved by providing nutritional support that the body is fuelled on. Nutrition is the foundation for wellness and often can be the pivotal character in re-initiating the healing process. We could spend entire days on nutrition it is that important but obviously we will not. In Chinese medicine and in acupuncture regulating diet is the first line of defense in correcting imbalance. Traditionally you did not treat with needles until you regulated a person's diet. In this country I have found it is one of the reasons I transitioned from nutrition into working with acupuncture because it is often so difficult to change our diets. We live in the land of plenty and we have got a lot going on often.
Simply put and for brevity's sake for all of us we certainly know so much. Nutrition is about minimizing toxins and maximizing nutrients. What does that mean in everyday life? Eat less or ultimately no processed foods. That can oftentimes be accomplished by beginning to work towards eating foods in their most whole form possible; an apple, an egg, a green pepper, a sweet potato. Apple sauce is more processed than an apple, but applesauce is better than pudding. Eat with the seasons. This is something that studying Chinese dietary therapy taught me is that eating with the seasons. We are especially living in a place where we do experience the four seasons, this is somewhat different if you are living in a tropic environment where temperatures are maintained at 80° year round. Eat with the seasons, what would be growing outside? In February eating a fresh tomato probably is not the best nutrients that we could fuel our body on. Eating a root vegetable something that could be put in a root cellar is much better, sweet potato, turnip, a beet. What is growing at the time of year where you live? Doing that allows the body to achieve, to be in rhythm with the harmony of the seasons. It can be really, really profoundly eye-opening for so many people when they begin to think about their diet like that and begin to eat like that. It can be a huge, huge shift for many, many people, and I see it happen with my patients. Eat more vegetables, more vegetables, more vegetables, especially green, leafy vegetables - and the lunch out there is perfect, perfect example. More green leafy vegetables, there are just so many nutrients.
Some fruit, some fruit. Find what sources of protein work best for you. This again is where having somebody who has training or insight into nutrition can be really helpful because sources of protein whether it is animal or plant protein it can be very individual, very individual. Again, it depends on your previous habits and your current state of health. It can be very different and that, again, that is where studying eastern dietary therapy was very different for me than western nutrition.
Begin to develop an awareness of how you feel after you have eaten something. Have you had this great meal that was so good and then all of a sudden like, "I have got to go to sleep. Oh my God, if I don't go to sleep now..." There is something there that you might want to think about. If you have to go to sleep right after you eat - now a siesta, there is a lot to be said for that - but think about how you feel. Do you feel really bloated after you eat your lunch? "But it's a salad and I'm eating a salad and water for lunch but I'm bloated". Well, that may not be the best lunch for you. It may not be the right food. If you begin to think about how you feel and make that connection sometimes that is great insight for - I am generalizing to us because it could be helpful for any of us but really about our patients that we come in contact with.
Find, potentially, an acupuncturist with a passion in nutrition and a background in nutrition. That connection there is part and parcel to our training. I never treat without talking about your dietary intake because it is one and the same for me.
So specifically for endometriosis patients you want to think about decreasing or eliminating inflammatory foods. What are inflammatory foods? Sugars, sugar, white sugar should not, it is - it should not be in any of our diets. I know it tastes really good but really it is highly inflammatory. Dairy is very, very inflammatory. It is not necessarily the best source of calcium nor the best source of protein that we can get. And it is a challenge for many of us to get off dairy. Cheese is great. Cheese is great. And again, when you are in a healthy, balanced state having cheese, having dairy, having some sugar is not going to tip the scale. But if you are, and for our patients in endometriosis or any disease condition, you sometimes have to go back to square one and you have to rework it. You have got to clear the slate. And then when you are healthy again and your body functions properly some of those things are not going to be a problem.
Common cooking oils are extremely inflammatory. Trans fats, deep fried foods - so many of the younger patients so many younger population deep fried or fast foods and processed foods. Feed lot raised meats, you hear more and more about locally grown, organic grass fed pastured protein. It is available, get a freezer. Go in on a third or an eighth if you are going to eat animal proteins. But the investment in it oftentimes when you are eating quality products you are eating less of them so it does not necessarily have to be that much of a hike in your food bill.
Red meat and processed meats are highly inflammatory. Alcohol is inflammatory, hopefully our high school patients are not drinking alcohol but they might be.
Refined grains and all grains can be very, very inflammatory. I could spend the whole afternoon taking about wheat and traditionally farmed wheat. Organic wheat could be different. But wheat is a problem for so many of us. And even if we are not diagnosed with celiac disease or some disease, most of us are having a problem with wheat.
Artificial food additives or any foods that cause an allergic reaction, gluten foods, coloring that again can be a very individual thing.
So you want to increase anti-inflammatory foods. Any berries, especially blueberries, go organic if you can. Again, that is a whole other subject - go organic. Pineapple and papaya are anti-inflammatory. If you are eating with the seasons we are not in a tropical environment so gearing toward the fall and winter we probably would go away from pineapple and papaya at this time. Broccoli and cauliflower, sweet potatoes - one of life's greatest foods. Extra virgin olive oil, coconut oil; shitake mushrooms, wild-caught salmon. Turmeric, research on turmeric is astounding on how it decreases inflammation, and green tea.
To kind of generalize, again, it is a very individual thing when you have a patient suffering with menstrual irregularities and/or endometriosis. What would be a specific dietary intake that is optimal for them is very individual but it is a broad brushstroke.
Things you would want to avoid during the menstrual cycle or if somebody is having painful dysmenorrhea or having trouble and you do not know if it is endometriosis it has not been conclusively diagnosed yet. Alcohol, of course myriad of problems, tobacco, coffee, cold fruits, refined sugars, hydrogenated fats, cold temperature and raw foods. Some of the foods that can be beneficial to this population and to all of us are what we call blood nourishing foods. Dark, green leafy vegetables, there they are again. Beets, sprouts, grains, legumes like lentils, dark berries, things that resemble what you would think of as really a dark rich blood, things that have dark, deep colors. Dates, figs, apricots, black strap molasses. Again, organic meats can be very nourishing. For some people that are vegetarians or vegans you know sometimes they - if it is not a philosophical thing - and they are willing to opt for some meats if they are very blood deficient. Eggs, go organic in your eggs you will never go back if you go organic with eggs, they are completely different, and liver.
A few other things - this could be deemed controversial, but a few other things to think about - fluoridated water may suppress thyroid activity. Find out if your water is fluoridated. If you are having problems, you know people who are having problems with menstrual cycles, find out, it is easy enough to find out. Find out if you have a filter on your own water. Is it removing the fluoride in there? It can upset the hormone system in general. Chlorinated water destroys vitamin E and vitamin E is very important for ease in menstrual cycle. Have a filter that removes the chlorine. We should also be removing the chlorine from the shower as well. When chlorine goes into gas it is not the best thing for us to be breathing in. Commercial meats may have residues of steroids which interfere with cycle regulation.
During the menstrual cycle some things that can be really helpful and kind of intrinsically we know this; avoid heavy physical work. It would be great to have a pass not to have to do the stuff we do, hike the grocery bags up three floors in a third floor walk up or something. Emotional stress; avoid emotional stress during your menstrual cycle. There is a pass. Over-exposure to cold and damp; this is hugely important with the younger population. I know with my own daughter it is - they do not necessarily feel the cold that I notice, I feel the cold more. Sometimes the fashions, the low rise fashions for those pants and skirts and crop tops. You are exposing that back part of our kidneys to the cold and they do not feel it. I have been out skiing and I have seen their whole back is exposed. They do not care, they fall in the snow. But if you are having difficulty with your menstrual cycle keeping your low back, your legs and your feet warm can be extremely helpful. And being able to have a pass not to get in if they have a swimming cycle in their school, if they do not have to get into the cold water or if they are an athlete swimming, if they are able to train some way other than getting in the water it can really help, and/or keeping our hands out of cold water during our cycle. Getting plenty of rest and something else that may not be popular to talk about but abstaining from sex during menstruation.
So nutrition goes hand in hand with our state of mind and the functioning of our bodies. Investing the time and the effort to discover the abundant health promoting foods and what type your body or their bodies are optimally fuelled on will serve our patients as well as all of us long into our elder years, hopefully, God willing.
Acupuncture can be a significant asset for a myriad of females struggling with menstrual pain or discomfort. It has the ability of keeping things balanced and functioning properly to potentially avoid complications. I do not know. I do not have the research to say if we get to them early when they have difficulty could we prevent some of the stories like Padma's? Could we prevent some of us from suffering for so long? Potentially we may if we remind the body to do what it knows how to do and for cells to go back into apoptosis and die off instead of adhering themselves to the cell walls where they do not belong, potentially. It also has great potential to relieve and perhaps eliminate many of the symptoms of someone who is actively and already dealing with endometriosis.