by Pamela Newhouse, RDH
In August 2001, I was diagnosed with calcific tendinitis in both shoulders. The orthopedic surgeon, Dr. Mark Colville, reported that both shoulders were involved but as my pain indicated, the left was more severe than the right. He further reported that neither shoulder had enough deposit to warrant surgery ... yet. Furthermore, he said the previously prescribed twice-a-week physical therapy sessions and my daily home strengthening program were not beneficial and should be discontinued. And, finally, the condition was not caused by my occupation, dental hygiene. Thus it could no longer be considered an occupational injury.
What about my main complaint, the pain? The doctor said to bend over at the waist, let the arm hang, and rotate it in small circles. He was so serious; I didn't laugh.
I've been practicing hygiene since 1990 — four days a week initially and three days a week since the 1992 birth of my first child. The pain in my left shoulder began in spring 1997. I ignored the pain while performing my hygiene duties and, until 2000, found it to be only a mild discomfort at work. The pain experienced while sitting or lying down finally sent me seeking answers in summer 2000.
I believed that the pain was due to my shoulder being elevated and unsupported while performing hygiene. I reluctantly filed a worker's compensation claim. The case physician believed I was too loose, which allowed the ball of the shoulder to basically fall out of the socket. The separation caused the pain. This condition he labeled a "sprain" and prescribed strengthening the shoulder region muscles through physical therapy.
For several months, I visited a physical therapist twice weekly. At these appointments, therapeutic ultrasound with anti-inflammatory gel would be administered followed by an ice pack. At home, seven days a week, I performed my assigned exercises with my rubber resistance tubing. During this time, I tracked how I was doing based on my daily ibuprofen intake. I averaged 800 to 1,200mg of ibuprofen daily — at least 600mg prior to bed. I began taking glucosimine, 1,750mg daily. I propped my arm up while sitting or lying down. At work, I continued to ignore the pain.
My worker's compensation manager now wanted concrete results from the physical therapy - something I couldn't supply. I couldn't say that the shoulder was better; it simply didn't seem to be any worse. I couldn't report any pain-free days, but the pain was something I could live with. Since there didn't appear to be resolution with the therapy, the manager directed me to consult with a specialist. That was Dr. Colville. With his diagnosis, physical therapy ended and the worker's compensation case was closed.
For four months, I dealt with my growing discomfort by increasing my ibuprofen intake. I now averaged 1,200mg to 2,000mg daily. Usually half of these were taken right before bed in the hope that I might sleep longer. But each time I changed positions, I would have to move my left arm with the right. This was a teeth-clenching pain that would awaken me with each change of position. Sometimes I could slide back into sleep and sometimes not. At least once each week I would tearfully finish the night in a chair, the left arm supported, an ice pack applied, and still more ibuprofen taken.
I was missing out on life. I wasn't getting enough sleep and was exhausted. I had no energy for anything; the pain absorbed it all. I told myself that I was too young to feel this old and that I had to do something.
So, I did.
In the last week of 2001, I began twice weekly massage therapy, signed up for yoga classes, increased my glucosimine dosage, and attended a continuing education class on musculoskeletal disorders.
Initially, massage provided a great deal of relief but, all too quickly, became less and less effective. I dropped the yoga class after nine weeks as my shoulder lost all of its strength. The intensifying pain prevented me from performing the exercises that had been taught in the continuing education class.
It was the middle of March and I was actually in more pain and less mobile than when I had made my year-end resolution to find answers. I had moved from a slippery slope to a rapid freefall of pain. I was becoming very frightened.
Easter weekend found my family and I visiting the beautiful Oregon coast. I iced my shoulder constantly, ate ibuprofen indiscriminately, and carried my left arm with my right. I again resolved to do something. So, upon my return home to Vancouver, Wash., I made an appointment with an acupuncturist for the following Wednesday.
I confess. I didn't know much about the practice of acupuncture other than it originated in China and needles are poked in you. I was more curious than fearful. But at this stage of the pain, I was willing to try anything.
My first visit with the acupuncturist, Paul Rosen, began in his office where I was surprised to learn that he had been an attorney prior to becoming an acupuncturist. Now in his early fifties, he has been practicing acupuncture for nine years.
Paul listened attentively as I told my story and my search for answers. Upon relating my diagnoses of calcific tendonitis he said that many people have calcium deposits but that was not what was causing my pain. He directed me to a treatment room that resembles a typical doctor examination room except the exam table is more softly cushioned and comfortable than a physician's. It's similar to what you would find a massage therapist using. There are several drawn posters on the walls, renderings of the front and back sides of Oriental men. Each figure is covered in red dots, which, I learned later, represent an acupuncture point.
I stood with my back to Paul as he poked and prodded several areas in my arm, shoulder, and neck. With each invasion, I verbalized the degree of pain felt. He had me lay on my back on the table. He then placed five extremely thin needles, not in my shoulder to my surprise, but in my right foot and ankle area! Prior to each placement he would manipulate the area with his fingers until I indicated it hurt. The needle would then be placed and, after approximately three to five seconds, I would feel a slight cramp at the placement point. After the fifth needle, I felt a rush of warmth to my shoulder. This, Paul explained, were the muscles relaxing, the veins being released from their constricted state, and the healing blood was flowing.
Upon this first visit, Paul placed a total of six needles in my right foot and ankle area. Gradually, the appointments consisted of a series of 12 needles placed in both feet and ankles with the last three placed in my hands. The routine was the same each time — the manipulation of the area, the pain found, the needle placed, the slight delayed cramp. With each needle placement, a hot point of pain in my shoulder disappeared. Paul would then turn down the lights and leave the room for about 40 minutes.
At the end of our first session, Paul removed the blunt Chinese needles and advised me not to touch my shoulder. "Don't manipulate it with your fingers and don't use it anymore than absolutely necessary." He explained that the acupuncture sessions would relax the muscles so that the blood could keep flowing. That meant the arm would be in a very vulnerable state especially in the beginning of therapy. "That's one sick shoulder," he said.
Paul requested that I quit hygiene for two weeks, place my arm in a sling, and see him three days a week. A compromise was reached. Since I worked in hygiene only three days weekly, I would take Monday's off and see him on that day plus my normal Wednesday and Friday off for the next two weeks, a total of eight planned sessions. I vetoed the sling but promised to be very careful. At this point Paul emphasized again, the shoulder would be very vulnerable to injury, perhaps to a degree that would never allow it to come back should I injure it further. He emphasized that I was to be cognizant of that at all times.
I saw Paul two days later on Friday when he again stressed that I take care and when again, I assured him I would. I was already feeling some relief in my shoulder, the pain intensity down slightly.
Upon waking Monday morning the luxury of knowing that I had a free day ahead made me a little slow, a little lazy. As I rolled to my right side from my back position, I dismissed the thought of bringing my left arm over with the right. My shoulder felt better, it felt like it could do it's own work, so I forced it. This instantly became apparent that I had just made a painful mistake. Paul had warned me that I would know if I had pushed my arm too far and he was right. A small sharp scream escaped me involuntarily. Should I have been standing rather that lying down, I'm sure I would have collapsed. At my appointment later that morning, with the pain level still up, I related to Paul what I had done. He expressed dismay but less than I had already expressed at myself. That experience, thankfully, didn't cause any permanent damage. I became very diligent in protecting my shoulder and after the eighth acupuncture session, I was totally free of all shoulder pain! Now, only my neck continued to present with a low-grade discomfort that had been overshadowed by the severity of the shoulder pain. What we learned from this was that my neck had transferred its pain to the shoulder area. I had asked too much of the neck muscles from my less than ideal hygiene posture. The neck muscles then put strain on the shoulder muscles. My shoulder eventually became so overtaxed, it couldn't even carry my arm anymore. Basically, there wasn't anything wrong with my shoulder(s) and never had been.
I suffered chronic pain with increasing intensity for five years. Depression had been creeping in. Fear had taken root. Just exactly how do you earn a living, have a career, without a shoulder? How do you raise children when you're weak with pain? I shudder to think of all of the ibuprofen I took and what the next step may have been. Possibly pain pills and muscle relaxants while waiting for surgery. Possibly an unnecessary surgery that wouldn't have brought relief because there wasn't anything wrong with my shoulder(s), and never had been.
Being pain-free is so different from what I had grown accustomed to that it's in my conscious thought throughout my day. I'm pain- and medication-free. I sleep all night and awake refreshed. My energy has returned, and I'm living again. Through his skill as an acupuncturist, Paul Rosen saved my life. I have never dealt with a health care professional who is so finely tuned with the concept of how the knee bone is indeed connected to the thigh bone asPaul is.
I recently attended a continuing education class sponsored by the Institute for Natural Resources.The speaker, Dr. Laura Pawlak, stated at one point that the only mistake made with acupuncture therapy was that it too often was used only as a last resort and, in many cases, it should be considered first.That, so briefly and concisely stated, is my entire point.
Performed by a properly trained practitioner, acupuncture is a fairly safe and forgiving discipline but it is not without the possible risks and complications that can occur when penetrating the body with a sharp instrument. Risks can include syncope, puncture of an organ, infection, contact dermatitis to stainless steel, even a retained needle. As with choosing any care provider, research and references prior to the first appointment can often save time, money, and help you avoid receiving less than ideal treatment.
The World Health Organization has set guidelines on basic training for both physicians and nonphysician practitioners. The minimum hours are 2,500 for nonphysician acupuncturists and 200 for physicians. The guidelines include standards for safe practice and clinical indications for treatment.
Unfortunately, there is a great disparity from state to state regarding the practice of acupuncture and the number of practitioners in a particular state. For example, Massachusetts has almost 600 licensed acupuncturists and Iowa has only eight. Iowa is particularly interesting in that MDs, DOs (doctors of osteopathy), podiatrists, and dentists are allowed to practice acupuncture without any additional training. In New York, there are 500 licensed acupuncturists and 712 certified physicians. In North Dakota and Oklahoma, only MDs and DOs are allowed to perform acupuncture with no additional training. In Wyoming, acupuncture in not regulated at all by the state.
Titles vary from state to state for an acupuncturist who may be "licensed," "registered," or "certified." These titles don't necessarily reflect the individual state's educational requirements, although most accredited schools of acupuncture require 2,500 hours of training. Besides the hours of training, other important variables of an individual practitioner are their level of skill and talent, and even their philosophy and approach. These factors often determine whether the treatment received is effective. An individual may find symptom relief with one practitioner and not another.
There are currently over 10,000 practicing acupuncturists in the United States. To obtain certification, an applicant must pass a national standardized exam. This exam tests both theoretical and practical acupuncture knowledge and is administered by The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). All states except California and Nevada (which license nonphysician acupuncturists) recognize the NCCAOM exam. To retain certification, continuing education requirements must be met.
To see if a particular practitioner has graduated from an accredited school and has received NCCAOM certification, you can contact NCCAOM at www.nccaom.org or phone (202) 232-1404. Additionally, www.medicalacupuncture.org can be accessed for additional information, your individual states credentialing requirements, and names of acupuncturists in your area.
Acupuncture originated in China anywhere from 2,500 to 5,000 years ago and is presently being practiced in 40 countries. The earliest acupuncture needles were sharp flat stones called bian stones. They were used to prick a certain part of the body for the treatment of diseases. Archeological finds in Inner Mongolia and the Hebie Province show that metal needles replaced the stones and were being used at least 2,000 years ago.
Traditional Chinese medicine theorizes that the more than 2,000 acupuncture points on the human body connect with 12 main and 8 secondary circulatory channels, called meridians. The Chinese believe these meridians conduct vital energy, or qi, between internal organs and the surface of the body. Qi originates from the major organs, and flows along the meridians. When the energy flow is smooth and balanced, you're healthy. If the balance becomes disturbed, then you feel ill or pain.
There are specific points along the meridians called acupuncture points where the energy flow can be stimulated and the function of related organs can be regulated. The concept of qi moving through the vessels (meridians) has been difficult for western medicine to accept, but researchers have verified specific physiological changes during and following acupuncture.
According to an expert panel convened in 1997 by the National Institutes of Health, scientific studies have shown evidence that acupuncture is effective in relieving pain after dental surgery, reducing nausea and vomiting associated with morning sickness and chemotherapy, and providing anesthesia. Additional research suggests that acupuncture may be useful for asthma, carpal tunnel syndrome, fibromyalgia, headaches, lower back pain, menstrual cramps, osteoarthritis, and other conditions that may cause chronic pain.
Pam Newhouse, RDH,received her dental hygiene degree from Lane Community College, Eugene, Oregonin 1990.Pam currently practices three days a weekwith Dr. Dennis Cummings of Salmon Creek Dental Center in Vancouver, Wash.After one year post-acupuncture therapy, her shoulder remains free of pain.You may reach Pam by e-mail at new [email protected].