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Acupuncture Malpractice Insurance – Neuromuscular Facial Conditions Part 1

 

 

So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name’s Michelle Gillis. I am an acupuncture physician practicing in Florida, and today I am going to be speaking to you about treating neuromuscular facial conditions. This is part one of a part two presentation. First slide, please.

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So this is just a little bit about me. I am a former faculty member of the Maryland University of Integrative Health, and I am currently on the doctoral faculty at Yo Sound University, and I. I have been teaching facial acupuncture classes internationally since 2005. Here are some publications that I have completed in the Journal of Chinese Medicine.

So today’s lecture topics are I’m going to define a neuromuscular facial condition. I’m going to talk a little bit about the theory behind a multifaceted approach, and then I will talk about submuscular needling and scalp acupuncture.

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So a neuromuscular facial condition is any group of disorders which can cause weakness or pain on one or both sides of your face, you might lose the ability to make facial expressions have . Pain, difficulty eating, drinking, speaking clearly. You can have ear pain, you can lose your sense of taste, smell, it can affect your eyes, your vision.

And you can also have the inability to sense heat or cold or be very sensitive to the heat or cold. What I have discovered over many years in practice is that using a multifaceted approach to treating these conditions, because some of them can be very difficult to treat, and using a multifaceted approach, can yield a more effective treatment than just using one of these modalities or the other.

Some examples of neuromuscular facial conditions is are Bell’s palsy, Ramsay Hunt syndrome, posis of the eyelids, and this can be one eyelid or both eyelids, synkinesis, which is when you’re trying to move one. Part of your face, but another part moves involuntarily. The side effects of a stroke TMJ Trigeminal Neuralgia multiple sclerosis, and there are many others I.

Part one and two of this presentation represents about an hour of what is usually a two-day class that I teach on treating neuromuscular facial conditions.

So the interesting thing about our face is that our face is the only part of our body where the skin is connected directly to the muscles, which is what gives the. Our ability to move the skin on our face without having to move any bones or ligaments or tendons. So here we have an example. We have skin, and then we have muscle.

And as you can see it, the skin is connected directly to the muscle and then down to the bone.

For example, here is a cross section of a part of the cheek, and you can see the skin and then the fat, and then the fascia and invested inside of this fascial layer is the muscle, and then there is deeper fascia and there is the facial nerve.

When treating the face, there are several things that’s, that are important and you wanna make sure you are increasing the blood flow to the area. I. Increasing the qi to the area and also if there’s any fossil adhesions that exist, that you can break these up because all of this can affect how the face moves and the sensations that we feel.

By using a technique called submuscular needling. In some instances it’s intramuscular needling, but submuscular needling can increase the flow of blood and QI to the area can help to break up any fascial adhesions. And if you are thinking in terms of . Cosmetic benefits. It can also stimulate collagen production to the area.

There are several muscles on the face, head and neck that are really conducive to this submuscular needling approach. And they are the auricular muscles, the temporalis muscle, the platysma, the masseter, the anterior digastric. The frontal, the proces, the corrugator, and the levator muscle. We are only gonna speak about a couple of those today.

And the using submuscular needling is part of this. Multifaceted approach. So in addition to Submuscular needling, we’re also going to talk today about scalp acupuncture, and then next time facial motor points, facial cupping and guha and derma rolling.

So here is another cross section of the face. And as you can see, the facial nerve is invested in this it’s called the SMA layer. It is the superficial muscular AERA system, and the nerve can become entrapped. And when that happens the signal that gets to the muscle, which in turn goes out to the skin, which moves the skin on our face, moves, the muscles in our face can become compromised.

So the first muscle I wanna talk about for Submuscular needling is the frontals and. The frontals muscle goes on either side of the eyebrows. There’s one head on one side of the eyebrow and one on the other. And what you would do is you would take, typically I do half inch needles and I would needle underneath the muscle.

And this is what it looks like here.

So when needling the frontals muscle, the way that you isolate the muscle is you ask your patient to raise their eyebrows. Go ahead and raise your eyebrows, okay? And then relax and you can find the border of the frontals muscle and the way that you needle. Is you’re going to go from the origin to the insertion.

So the origin is up here and the insertion is here.

And typically what I do is I will put in. Usually three needles

on the lateral edge, and I will put in two needles. On the medial side, and when you’re needling, what’s important is that the angle of the tube is the angle that the needle’s gonna go in. So if you go like this, it’s going to go too deep. If you go this is going to be too shallow, I use. My thumb or a finger to help to guide the needle.

So you wanna keep your fingers out of the way when you’re actually inserting. That way you can get to the correct depth right underneath the muscle. That’s the lateral side. Then you’re going to do the medial side, and usually two needles. Will suffice and I do the one side and then I do the other side and I’m using half inch needles.

You can use one inch needles depending on how big your patience forehead is.

The next muscle group. That I’m going to demonstrate for submuscular needling is the temporalis. So the frontalis is used to raise the eyebrows, and it’s also indirectly involved in raising the eyelids, the temporalis muscle, which is a large. Very thin, fan shaped muscle that’s on either side of the skull and it also goes in front of the ear.

It helps us with our chewing and it helps to, so it helps to elevate the jaw and it can be involved with conditions like TMJ. It can also cause head. Pain. If it is too tight, it can be involved in trigeminal neuralgia because nerves can become entrapped underneath the temporalis. I. And this is what this looks like.

So here’s the temporalis muscle, and what you would do is take needles and put them all around the outside of the temporalis. And I have a video for that as well.

So for the temporalis muscle. The idea is to find the outline of the muscle and it tends to be a very large muscle. It runs all the way from the back of the skull all the way around the front of the face. And you’re literally going to take the needles and you are just gonna work your way around.

The entire line of the muscle, and depending on how tolerant your patient is you can use, you can really thread like 20 of these into this area. I’m just doing a little demonstration here I want you guys to get an idea of what this looks like. And it doesn’t really matter which direction you’re going in.

What matters is that you’re getting, again, underneath the muscle and that you’re working your way all around the perimeter of the muscle in order to relax it. And they should have a nice little circle around. A muscle when you’re done, and this will really help to relax the temporalis muscle if they have TMJ.

Pretty much anything that affects the face. The temporalis muscle helps to pull the face up. I use this technique sometimes and facial rejuvenation when I teach my facial rejuvenation classes because the temporalis muscle can really lift up the face. I’m just gonna do one more again. I’m using serum one inch.

Needles. So that’s what that looks like.

So for the temper, the next. Technique that I use when I’m treating neuromuscular facial conditions is scalp acupuncture. Now, scalp acupuncture can be used and it is used traditionally to treat a multitude of. Conditions, everything from phantom pain to speech issues, to inability to move a body part.

But when I use and teach scalp acupuncture, it involves issues concerning the face. So when we when we would incorporate scalp acupuncture. We could use this in conjunction with submuscular needling or as a standalone technique, so any conditions that involve the face scalp, acupuncture can be very effective.

I. Especially when you’re dealing with a condition like trigeminal neuralgia where it’s very painful to needle directly onto someone’s face, you can use scalp acupuncture and this will treat the face without having to directly put needles in the person’s face. So here we have a cross section of the scalp.

We have the skin, we have the close connective tissue, and this is very heavily vascularized with lots of nerves. Then we have the aosis. Right below that is the loose connective tissue, and this is where you would want to insert the needle. Right below that is the perran and that is the skull. The good news is that when you’re trying to find the right depth to needle, if you just go down as deep as you can along the bone.

Then ’cause it, you, it is impossible to put an acupuncture needle through someone’s skull bone. You can needle right along the bone and if you get into the loose connective tissue, it will not be painful. If you go into the close connective tissue, you’re going through vessels and nerves, and it can be very painful.

So the thing that can be the most important thing to learn when you’re learning scalp acupuncture is how to measure. So the, you’re basically going to, these are not acupuncture points. These are areas of the. Scalp that affect different areas of the brain. And the way you measure is you’re going to get your horizontal and vertical planes, and then you will find the area of treatment based on that.

So the first landmark is from the glabella to the occipital protuberance, and the glabella is at the midpoint. Of you’re gonna get to the glabella is between the eyebrows and you’re gonna measure back to the occipital perturbance. And this will give you your line this way. And then you are going to find the midpoint, and that is the midpoint of the midline.

And if you go a half a centimeter. Behind the midpoint, that is where you’re going to be drawing a line. Right here. So you’re going to find the midpoint of the eyebrow and also go back to the occipital protuberance. And when you go back 0.5 centimeters, you’re gonna draw a line that intersects just like this, and you’re gonna break this up into three sections.

So the lower two fifths. Is this is where you would needle for concerns of the face? The upper extremities is the . Middle two fifths and then the upper one. Fifth is the lower extremities. So the lower extremities are the legs, the spine, the trunk, and the neck. And the upper extremities is just the arms and the hands.

And this bottom two fifths is the face. So this is the area that we would want to needle.

The technique for needling looks like this.

When you’re needling the scalp, it’s important to angle the needle properly so that it goes into the loose connective tissue. I like using a tube. You can freehand if you’d like, but I find that the tube helps me to guide the needle to the correct depth. I tap the needle in, remove the tube, and then I use my free hand to guide the needle

if the needle is improperly. Your patient should not feel any pain. So you’ll know that you’re into the loose connective tissue. If your patient doesn’t have any pain, when you needle, once the needle is in, you stimulate it gently for 30 seconds just like this. Or you can use electricity.

So that concludes our lecture today. So we covered Submuscular needling and we covered scalp acupuncture. Next time we are going to talk about facial motor points, facial cupping, GU Shaw, and derma rolling, and then some protocols for specific conditions. And I look forward to seeing you next time.

 

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Acupuncture Malpractice Insurance – An Associateship vs. Starting a Private Practice

 

And so we’re gonna go over the idea of employment versus private practice. And so I don’t mean just employment as employment in a hospital.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello, and welcome to another episode of To The Point. I am Dr. Nell with American Acupuncture Council. Let’s go to the slides.

So today we’re gonna go over a topic that, again, every time I bring these to you guys, there seems to be a theme where many people are coming to me with these same questions. And so we’re gonna go over the idea of employment versus private practice. And so I don’t mean just employment as employment in a hospital.

We could talk about . Contract work synonymously. Really the idea we wanna dive into is the idea of growing your own business versus being a part of someone else’s business. And what are some of the pros and cons there? What are some of the considerations and things we need to go over? Why this is such an important topic to me is I have done all of these different variations of this.

I’ve done the cash practice, the insurance practice, I’ve done contract work worked in a medical facility, been part of a group practice, . There’s many different ways that you can build your career in this profession, in the clinical space, if maybe this’ll be a future one that we do. Talking about all the other different revenue streams you could potentially have, and ways that you could make impact or be employed in this industry beyond the clinical space.

But today we’re really going to hone into the clinical aspect of this. So with that, what are we thinking about today? What’s the considerations that we wanna have? We wanna talk about the risk reward ratio. . There’s nuances with that. If you’re on your own versus working for somebody else, same thing with costs.

The costs are gonna be drastically different. And even within those two different options, they’re gonna be different cost considerations, and then the benefits comparison, because of course, whatever decision we make, we always wanna be coming from. A really informed place and making decisions out of having substantial information rather than making a decision based on, oh, insurance feels complicated.

I don’t wanna deal with that. Or, I don’t know anything about owning my business, so I’m just not gonna do that. So we wanna look at what’s the benefit for us but also what are those risks, those costs, really the overall considerations that we need to have when making this informed decision. So let’s look at the risks and the rewards of both of these options.

Like I said, in that employment independent contractor piece . First and foremost, you wanna have malpractice insurance. Whether you’re working for yourself or you’re working for somebody else. You are gonna have the flexibility of how you manage risk when it comes to your own private practice.

You’re gonna have a lot of autonomy when it comes to deciding what is your environment going to look like? How am I going to control all these different variables around me? You’re not worried about, . Potentially other providers causing issues or sharing patients. If it’s you get to make the rules, right?

You also get to make decisions around what type of malpractice coverage you’re going to have. The limits. If you are working for somebody else, they are going to make a lot of these decisions. So that environment, if it’s a shared environment, you are not an autonomous entity there. I’ll give you an example.

When I first started my practice in Beverly Hills, I was sharing a medical space. So it was amazing for a new practitioner because I was in an environment with a neurologist, a chiropractor, massage therapy, Ayurvedic care nurse practitioners. Really loved that multidisciplinary approach. However, . We shared a waiting room.

We shared office staff, and even though we were all running our own businesses . When Covid happened, there were certain risks and, rules that were in place. And I got really concerned that, okay, what if these other providers aren’t following the rules? Could I get fined? Could I get in trouble?

And so there is an additional risk at having this multidisciplinary kind of space and not having that autonomy over your own space. Also, if you’re working for someone else let’s say you work at Modern Acupuncture. . They are going to determine what your limits of liability need to be. The the type of policy that you need to have.

They are going to have the setup of their physical space, right? So you are not going to have a lot of decision making power when you are working for somebody else. There are things you can do. Of course, you’re gonna be practicing clean needle technique. . You’re gonna make sure that you keep your risk as low as possible.

But at the same time, there’s only certain things that you can control when it is not your space. The rewards of that though, we’re gonna get into, and some of that has to do with the cost. So let’s look at that. It’s very interesting to me that, over 90% of acupuncturists are sole proprietors.

So running our own businesses going out on our own functioning as entrepreneurs. And yet, like 2% of our education is focused on business training and most small businesses fail within their first few years. . There is something really interesting about how that is set up and certain realities that we need to be aware of with that.

And cost is really one of those. So when you’re looking at the cost of starting your own business now, yes, we are in an industry that has pretty low overhead. We don’t need a lot of expensive equipment to get really dramatic results for patients. We need our needles, we need our basic tools. For CNT, we need a treatment table.

If you’re doing community acupuncture, you might not even need a table. You might need chairs. So there are ways to offset a lot of this cost. You can share space when you’re first practicing. You can rent a room, so you are operating as an autonomous entity, but you’re minimizing the cost of your initial investment in your practice and how that looks.

Obviously if you’re working for someone else, a lot of that might even be taken care of, that already low overhead could get even lower. So I had done an employment agreement with another acupuncturist when I was first starting, and I worked with him two days a week, but. He paid for all of the supplies.

He was, doing all of the insurance billing. He had a scheduling software that he was paying for. He had office staff, so all I was doing was showing up and treating. And so when we think about cost, we also wanna think about what does that mean? For what it’s potentially costing us as well, right?

So if you are operating in your own business, you get to determine what that fee schedule is. You get to determine what your take home from your business is going to be. Whereas if you’re working for someone else, you’ll see a lot of these jobs advertised online and sometimes it is nowhere near what you could make in private practice.

And that’s because. This entity that is employing you or contracting you is taking on not only a lot of that risk, but the cost as well. And so they have to offset that in some way. But I do really wanna talk about the benefits because this is going to look a little bit different depending on not only like what your risk tolerance is, what your interests are, what you genuinely want to spend your time doing.

So like I mentioned with private practice. You get to determine what your fee schedule is. Nobody is making that decision for you. You can do your own market research. You can say, I’m going to have a relationship based practice and I’m going to go out and make friends with other healthcare providers and make sure that I have a ton of referrals coming in and I keep my patients really happy.

You could have a FI high volume insurance practice where you are in network with a lot of companies that are essentially . Pre-qualifying people for you who are on those websites looking and saying, oh, hey, I’m interested in acupuncture. Where is there an acupuncturist in my area? So that flexibility and the autonomy that you will have in private practice is really your major benefit.

You get to make. All of the decisions that for some cannot feel like a benefit at all. Some people, and I would venture to say a lot of people in our industry did not get into this medicine to run a business. They are not interested in being entrepreneurs. That is not, top of mind. It’s that they wanna be incredibly cli, clinically competent, which most acupuncturists are who are licensed and they want to deliver incredible patient results.

And that’s what we like to do, right? The benefit of working for someone else, when you give up some of that autonomy, you get back a lot of that focus on being a clinician. So I loved at that point in my career, when I was first starting out for two days a week to be able to show up in an office and just treat and have a full schedule and never worry about recruiting patients or what the overhead was, or was my, business license renewed.

Did I pay my taxes, did I get my articles of incorporation in ? All of those things were taken off my plate as an employee as a contractor as well. Like I’m not worried about those things. I get to show up and do what I wanna do best. So when we are looking at . The benefit analysis here that is going to be highly individualized depending on who is looking at this.

I personally see so much benefit in running your own business and getting to determine what your marketing strategy’s gonna be. Who are those partners you’re going to bring in? . But a lot of people might not feel that way. I have a provider who works for me in my practice, and she is incredible.

She’s been licensed for 12 years and she, the entire time has only been interested in employment opportunities or contract work because she is very clear that she wants to spend every hour possible in her day. Focusing on patient care and treating patients, and she has absolutely no interest in running a business.

So looking at benefits that is highly individualized. There are certain things that you’re gonna say, oh hey that sounds really good to me. That will not sound good to somebody else. So just like our medicine is so highly personalized, this decision is as well. But I think the important things with this to remember are you have tons of flexibility.

. You get to decide if you want to only run your own business, if you want to work for someone else, if you wanna work with someone part-time. If you wanna have multiple locations, that is a really beautiful thing about not only the personalized aspect of care that we have, but the personalized aspect we can have with our clinical setup and the way we deliver that care.

It’s very important though to know your state laws. So for example in California it is very difficult to contract people. A lot of those laws were built around trying to protect independent contractors like Uber drivers that type of thing. And. The side effects of that have permeated into the healthcare delivery system.

And so you need to be knowledgeable about, okay, am I even allowed to have independent contractors? Am I allowed to be an independent contractor? If I’m an employee, who do I need to be employed by? Another California example you need to be employed by a professional corporation. So if you don’t, your employer doesn’t fall into that category.

They’re not supposed to be employing you as an acupuncturist in that state. So there is nuance there and workarounds for all that too. That’s where the flexibility comes in. That’s where talking to an attorney comes in. That’s where talking to me, letting me guide you and send you to the right people to help with this setup.

And the last thing I wanna end with is that. As a, not only a medical provider, but a provider of acupuncture and traditional medicine who is working in such a highly specialized area of healthcare. yoU are your business. So whether you are, presenting yourself and saying, Hey, like I have my private practice, but I also work here and I work here and I work here many times, we become the brand for our own entity.

People are drawn to you a lot of times, even more so than the medicine. People get very attached to their providers, and so while that provides a lot of . Flexibility. There’s also a ton of responsibility that goes along with that, and I think that’s, I wanna link that back to the risk management piece at the beginning that we really need to be mindful of.

Because even if we’re out there, we’re, posting on our own personal social media, we’re still representing ourselves and our business, whether we are employed or whether we are practicing independently. I love talking about these different options. I’ve been able to help a lot of providers navigate that landscape that’s my happy place.

So please feel free to reach out. We definitely have the risk management piece covered, and don’t forget to tune in next week for another episode of To The Point. Thanks for tuning in. .

 

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Acupuncture Malpractice Insurance – Weight Loss and Menopause Part 2

 

 

this is part two of Menopause and Weight Loss

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Tsao-Lin Moy, and this is part two of Menopause and Weight Loss. This is a really important thing and what makes Chinese medicine practitioners acupuncturists different from a Western model is we’re not looking to fix them. We’re gonna help them . To get a better grasp on how their body actually works.

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We can help them understand from that perspective of how to get themselves into a place of balance. For, again identifying the constitutional type, the yin and yang within the body constitution plus . What else is going on? How are they eating their environmental stressors? We can’t be there all the time.

So these are things that they’re gonna have to identify and then work with. So body and fluids are really . Believed to be derived from food and drink, and they serve to nourish and warm the muscles and the skin and lubricate our joints, right? And they also surround our brain. This is really like something to not just address with herbs, but really incorporate dietary recommendations.

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So I just wanna give like an example of one of my patients she’s 52. I actually treated her 20 years ago. So I really know what her constitution was when she was younger. Was a very, let’s say lung, large intestine, stomach, spleen type. She had chronic constipation, a lot of weight on below, right?

She was and why I say lung, large intestine is she emotionally was dealing with like trauma from her childhood, like grief, loss of a parent. And then also like holding on to. Things that weren’t really true, but as a child she believed them and she was also very damp ’cause she had a lot of squishy fluid.

So recently she came to see me and after, having kids and then she had moved to the south very damp and hot where she was which was not great for her constitution. So this is also, we look at . Seasonally, you can figure out someone’s constitution also, like how they are seasonally, what do they prefer?

How are they’re a lot better. Some people are perfectly fine in a hundred degree weather and 90% humidity. I’m not one of them. But some people even will need a sweater. They’re very dry and they are always cold and they, so the heat and the moisture they love so working.

So she’s been working a lot and stressing, her main complaint was this weight gain and swelling, right? That she was starting to swell. She was having frequent urination, but she was still . Gaining all of the water. So she, was working a lot high cortisol overall not getting enough sleep.

And especially at night, this is this circadian rhythm. And again, going back to women have a cycle, men too, right? If men don’t sleep. At night, it’s actually really affects their fertility and their sperm production. So we are creatures that need to be much closer to nature.

So when someone’s not sleeping, then we know that’s also, they’re off balance. And so strategy, because she’s in menopause, I was looking, both her yin and yang were diminishing though, not at the same rate. So lots of water. In her body. Am I thinking kidney? Yes. Because of her adrenals.

And also that the jing is depleting and her constitution. But also from a five elements perspective. The water is not nourishing the wood, so she was . Had this liver defic deficiency, right? Because liver is involved with the blood, it’s involved with the uterus reproduction, it’s responsible for the smooth flow of qi and blood and our emotions.

So really, the strategy was like, okay, how can we address this simply, right? Because when the body is in a state of fluctuation, you wanna have a clear direction. To the body. So the more complex a person’s symptoms, then the more simple you want the the treatment to be. The first order is how can I bring this person into balance?

How can I help them so that then their body is going to heal, they’ll balance out, and then they’ll get stronger and they can at the same time make adjustments. So in terms of let’s say the strategy . With acupuncture. So this is where you’re, we’re looking at what methods do we have? We have food, we have acupuncture, we have herbs, we’ve got some cupping.

We’re doing a, we’re checking constitutionally and where the person is, we have teas as well. Okay. So in terms of . The strategy for this person, and I think this is something that is no matter what you can you’re not gonna do any harm with somebody is to look at source points and also shoe points.

So for this patient really my focus was, spleen, spleen three, liver three, large intestine, four combination, like kind of move, get things moving adding in spleen nine or seven for all the dampness. CV nine for that fluid. So fluid accumulation. Also dimmi because a lot of the fluid was below.

So like sitting in water. Kidney seven. Which actually goes to Dai. So really, and then according to Kiko, Matsumoto style, really like looking at stomach chi, which is, finding the points. And that’s around stomach, 36, 37, 39. So really looking at the stomach, the large intestine, small intestine, because we are looking at digestion right now in terms of food.

Warm foods, . For someone who has the damp, we want warm and like gentle dispersing. So I always think of something like a little bit of cinnamon. So that actually increases a little bit of the peripheral circulation and it’s actually warm. It’s also great for someone who might be, have a difficulty with sugar metabolism and maybe even pre-diabetic is, that’s actually something that can be incorporated, in addition. Looking at excellent probiotic with your patients. You also want to look at dietary adjustments. These are absolutely a must and a kind of detoxification support, whether it’s lymphatic. Some different kinds of foods to clear out to help the system release metabolic waste, let’s say.

And also, oftentimes in menopause with lower estrogen, there’s an increase of what is known as the non-alcoholic fatty liver, which is an means that there is this weight gain because the liver is not able to process, right? So everything gets backed up. In terms of formulas, basic formulas, I like ones that are less than 10 ingredients.

And again, because we’re looking at . The perimenopause menopausal state is in fluctuation, so it’s not that stable. So you start adding a lot into the mix. Then what happens is that you’re sending mixed messages. So better to go simple. I love like jwe shaan, right? The shaan for someone who has a spleen, like kinda worrying.

Type of personality Ong or Swan again for yin and blood deficiency. And this is this recent research with Iwe to and Shan Ma Huang, which are very close was actually used for premature ovarian failure they’re looking at. So it also gently nourishes the yin and the blood, and so

Nothing wrong with, possibly adding those formulas if you know your patient and you also know herbs, right? So we don’t wanna just give herbs based on formula based on a protocol only, right? We need to do a good diagnosis. Okay? So in terms of food and diet I cannot, emphasize more.

This is where the gold is. Your patients absolutely must make changes. It’s really if they’re not willing to do that, then it, it be, it’s you’re constantly battling, right? . So things like eating fresh and organic, primarily plant-based, ’cause it’s a lot cooler and nourishing. I didn’t put it in the list, but in season.

And this is also a way to be in the cycle of the season and also have the body go with the season, right? And also the food is much more nutritious because you’re gonna it because it is actually gonna have a higher nutritional value to it, right? No diet drinks or artificial sweeteners.

One of the traps for women that are trying to like they’re trying to lose weight is that they start looking for diet foods and things that are zero calories or fat free and things. But that actually is very problematic because we do need fats and in fact, because. We are becoming yin and blood deficient, that it’s really important that we have fats and eating foods like a bone broth, right?

Or even marrow stews. That are gonna be nourishing. We can add in even the the dots out, the jujube beads. Really looking at more of like kind of medicinal soups and we really. Getting about it too, right? Gluten and dairy can be very inflammatory. And even when my patients say I’m not I’m fine with gluten I really encourage them to maybe

Try to limit certain foods or to do something called food combining. And that’s a strategy where if you’re gonna have a starch, then you eat it with like leafy green or leafy green with an animal protein, but you don’t eat like animal protein with a starch because that changes the absorption and the sugars the way we digest.

Alcohol. And so these are things to look into and I would actually encourage you to try them yourself, right? The best is if you’ve experience, you can also share it. The other thing too is you can decide, Hey, for all of my . Patients that are in their forties, fifties, and going through a change.

Let’s do it together. Let’s do a sleep work on our sleep, let’s work on eating more vegetables and fruits and stuff and really, come up with recipes and stuff to get involved. I think if you’re involved with your patients and you’re excited about it, that you’re gonna have a better outcome for them.

And always the idea is to teach them, right? Alcohol, preferably none. Alcohol is not. Good . It reduces the immune system. It causes inflammation. Actually, yeah. I know there’s maybe some, that’s something that people will have to make a, make decide to do that, right?

There’s plenty of evidence that it’s not really great and can cause inflammation. So why do that? And again, oh, and I mentioned the food combining. Okay. And let’s see where we are. Yes, here’s some wonderful food. One of the things that is really useful is to certain kinds of foods are can help with hormonal health, so things like seeds. One of the strategies for, for the menstrual cycle is something called seed cycling. And then using the four phases of the menstrual cycle to then have flax seeds, pumpkin seeds, sesame seeds.

So these are things that you can actually. And encourage. I would encourage, because again, even though like I showed in the very beginning of the slides that the . Period is ending, the cycle is still going on underneath. And so being able to look at the cycle and nourish according to where the cycle is going to make a difference.

So once you find, it’s like when you find the wave, then you can ride the wave. If you don’t know where you are on a wave, you’re gonna be tumbling and be pulled in the current. Okay. And then, okay, so this last of heart, and this is teaching your patient self-care. Now here’s the thing, consistency and commitment is gonna get a result.

And so I know oftentimes patients say how many times do I need to do it or how long before it will happen? And really everybody is different, but one thing is certain they need to commit to make that commitment and have the consistency and really look at like when do they give up? Sometimes they just give up or it’s too hard, right?

But the thing is you know, that’s where we can help and coach them through and encourage them so little wins. Let’s say they, stop drinking diet. stuff we need to say great, how long are you doing it? Helping with a mindfulness practice, this is a really big thing because stress is going to increase cortisol.

It’s gonna cause sleep problems, it’s gonna cause more problems with weight. It’s gonna interfere with hormonal balancing and emotional stability. And so having a mindfulness practice, . I encourage doing breath work. I do it every morning. I do Wim Hof breathing and I’ve done GR technique. And really what does breath work do?

It helps you with your nervous system but also when you do breath work, it actually pumps your lymph, right? It actually supports your organs, and this is important to get. Of the inflammation and move the fluids. Sleep hygiene again making sure to go to bed at night. Really important is get off of the phones.

Stop with the Netflix and the videos and the Instagram and the Facebook, even though we’re . On Facebook to really stop that because it actually interrupts our brain patterns. It also creates a lot of anxiety and a lot of worry. And then on top of that, we’ve got cortisol and the stress, and that creates more of this like cycle of doom and gloom.

Exercise and movement again to move the chi in the blood. Not overdoing it, but really looking at what is the purpose is to increase the blood flow, tone the muscles. And it could be used as a practice drainage, again with the breath work. But also I encourage teaching your patients how to actually do a little lymphatic massage on themselves or even to get some body work for that.

And then again making the dietary adjustments such as preparing food themselves. And this is something that. You can offer to your patients in your newsletter or in your posts, some healthy recipes. Again, you can decide to do, a campaign maybe in January as we’re coming up on the people making resolutions or even maybe before start, before, since we’re heading into Thanksgiving and Christmas and all the cookies, et cetera, et cetera, to really start creating things as tools for them.

This is the end of the presentation. If you have any questions, please, to put them in the chat and we can get back to you. Thank you.

 

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Acupuncture Malpractice Insurance – Using the ICD10 Updates for 2024

 

 

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Greetings, everyone. The coding and billing expert is here. Sam Collins, the American Acupuncture Council is your partner in success. The network is the other step of that. How do we help you? We make sure you’re getting paid for what you’re doing, and I don’t care if it’s insurance, cash or otherwise. One of the things to get updated on, of course, is diagnosis.

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As you’re well aware, diagnosis actually update every year, but here’s a riddle for you. When do the 2024 diagnosis codes update? You’re thinking, actually they already did diagnosis codes always update on October 1st, the year prior. So really the answer to the riddle is the 2024 diagnosis began October 21st.

Of 2023. What’s important to note though, is yes codes update, but do the codes update that are important to us, meaning the ones that you use regularly. So let’s talk about that. Let’s go to the slides. Let’s talk about what is going on for 2024. In fact, right now, what’s happening with ICD 10? ICD 10 is our coding system.

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It’s what we use to communicate what’s wrong with our patients. Now, you might say, SI, I don’t bill insurance. I don’t need to know a code. You better know a diagnosis. Whether you’re putting the code down or the diagnosis, it should be accurate. So by example, if I were to say someone has neck pain, that would be okay.

What’s another way of communicating that, whether it be a super bill or a 1500 claim form is AM 54 2. realize every code is universal. That I don’t care if you’re in China, if you put M 54 2, they know you mean neck pain. So we always have to use coding to make sure we have the best and most appropriate coding for what is wrong with our patient.

Diagnosis matters. It really is. What is wrong with your patient? Now, some of you might say Sam, I can’t diagnose in my state. If that’s true, although I’ll say some of that’s not quite, someone comes in with pain. You can say they have pain. You’re not differentiating it, you’re just saying pain.

But what diagnosis is what’s wrong with the patient? Why are they there? Now, what I love about acupuncture is the simplicity, but the genius of the simplicity of acupuncture. What does the body always communicate when something is wrong? It always tells us one simple thing, I’m hurting. I’m in pain. I don’t care what you have.

Pain is always gonna be part of that, so keep it simple. Pain is gonna be fine. For the most part though, we can go beyond that. That’s not all what man? Acupuncturists treat lots of things. Like by example, if you’re treating with someone under the insurance eviCore, they’ll pay for strokes. They’ll pay for menopause, they’ll pay for anxiety, depression, anorexia.

So there’s a lot more beyond. Acupuncture now is being recognized to do much more than just pain management, though. Pain management is a very popular thing to do. It’s not all that you do. So have to remember when we’re talking about coverage. Coverage for some insurances may be limited to pain. But it can be, go beyond that.

Here’s a couple of offices that just put up signs in front, and here would be a thing I’d have for you is do people know what you do? Like I drive by an office that says acupuncture. Great. So when you just put that up, what are you expecting? That I know Something that no one’s ever taught me. I. You’re hoping.

So here’s two offices that let people know what they treat. Notice this one is fatigue, stress, tension, anxiety, depression, so on it goes all these conditions. The other one even indicating like Bell’s palsy, start to think of, we’ve gotta educate people what you do, regardless of how you’re getting paid, whether cash or otherwise.

We have to tell them what we do. And every one of these things has a diagnosis. So that way, even if you’re in all cash office, can I give them a Super Bowl with a diagnosis to make sure we can potentially get the best possible payment by example? Here’s for Aetna. This is Aetna current. This is gonna change after first of the year a little bit, but right now you can see this is what Aetna covers.

Now what’s really interesting here, you’ll notice it says these are the codes that Aetna covers if the selection criteria is met. But then it says, not all inclusive. You know what that’s really saying? These are the codes we pay for sure. There’s others, but we’re not gonna tell you. But I would say, look at this and start to pick up.

Notice it says Migraines. So it covers migraines, but if you notice, you dropped out other types of headaches as well. Then back pain, hip pain. In other words, I’ll tell you, they cover pain, but more than beyond that. So it’s a matter of knowing do I have the right code? Here’s what’s happening with ICD 10.

We have to know that diagnosis code has to reflect what we’re seeing. I would say the most common codes, pain symptoms and signs, they’re acceptable. Probably the best payable codes often, but we have to know. Wait a minute, Sam, you’re talking about an update. I know. I. So let’s talk about the updates. Every year there’s an update and as noted, the ones change for this year, October 1st.

Now, frankly, I will tell you I’m very acupunc centric when it comes to this. I really don’t care about things that acupuncturists don’t manage, treat or get paid for. So if you told me something about nephrology, I go that may be an issue, but I’m not gonna worry about that change ’cause it’s not a code I’m probably going to be using.

So this year there were a lot of updates. You’re thinking, wow. We have 73,000 diagnosis codes. Think about that. There’s that many conditions. Yep. Now, let’s be mindful though. How many do you commonly do? I’m gonna say most acupunctures probably code 10 to 15 things. And it’s because we see a lot of the same things, or you specialize.

So we have to make sure are the things that I treat changing. So there are 395 additions, 25 deletions. What has changed that I can see that might affect you? Here’s one. Migraine. It was first on the list for notice. Now we have codes that indicate chronic migraine. And I know you might be thinking, Sam, there’s always been a code for a chronic migraine.

No, there hasn’t. There actually has not. There’s been codes for migraines, never identified as chronic. Now, what does chronic.

Chronic mean. Honestly, from a pure coding standpoint, chronic means a condition that is lasting longer than you would expect for it normally to be gone, or probably in simplest terms, 12 weeks. So a person that’s had migraines off and on for 12 weeks or more. It’s probably chronic. In fact, I would make an argument that most people that get migraines, they’re probably recurrent.

So I’m gonna jump in and say maybe most migraines, unless this is the first time the person ever had it, is probably chronic to an extent. What I’m pointing out there is just a way of coding it. Are you paid for migraines? You bet you are. Now, can you code headache? Instead of migraine? No, I guess you could, but I want you to think for a moment.

Let’s talk about insurances like an As, H or others. If you’re requesting 12 visits for headache, I doubt they’re gonna give it to you. They’re gonna think, come on, it’s a regular headache. Treat ’em a few times. But what if you code a chronic migraine? Does that set up something a little different? Think of a person with simple back pain.

That’s how you say it’s back pain. But they actually have . Disc bulging with radiculopathy. That is painful, but is disc. Disc with radiculopathy more serious? That’s a patient probably gonna treat for months. Here’s the idea. Give me the code that best describes what’s going on with the patient. So is this a big deal?

No, but it’s one to add to your arsenal. How many of you have a common code list? How many of you have been to American Acupuncture Council? Our network seminars, we provide you with a list. Of all the codes that are payable by insurance and in fact that list is further divided into which insurances do pay for some, which ones don’t pay for some, a good way to look.

But nonetheless, this is added to the list. They’re definitely covered. What else has changed for this year? Remember last year, not any big changes, but the year before, remember the back pain code change and you had all that back and forth. I’m gonna give you a quick tip. If you are billing a Medicare Advantage plan.

And your coding back pain, which of course that’s what they cover. It must be M 54 51 or M 54 59. Do not ever use M 54 50 for back pain. When it comes to anything related to Medicare, and I’m not talking just regular Medicare Part B, but I’m talking the advantage plans that pay you directly. This year migraine codes changed, but notice this code for Parkinson’s.

You’re thinking, oh, come on Sam, Parkinson’s. I won’t say acupuncture treats Parkinson’s directly, but what do Parkinson’s patients often have? Painful and stiff joints. Back pain. So I would look at this as being a comorbidity. I’m not treating it directly, but a Parkinson with Parkinson’s may have more need for care.

I’m not saying treating Parkinson’s at all, and I’m not saying I’m really worried about this coach, but should you be aware, will a Parkinson’s patients have some different issues if you’re dealing with an ASH and you’re requesting extra visits. These type of comorbidities are actually what they pay attention to that, oh, I see why this person needs a little bit more.

What about osteoporosis? M 54 51 is a code that indicates back pain. That’s vert, progenic. Might a person with vertebral genic or osteoporosis be part of that? Here’s some new codes for that are gonna be related to the pelvis. Now, again, I’m pointing out, you’re going, Sam. Do I really care about these?

Probably not in the sense of directly, but indirectly. Think of you’re treating the human condition. If it’s manifesting with some pain. There’s always a way to do that. What I’m concerned about though is what were the changes this year? Migraine. So if you don’t have an UpToDate list, you may want to get one.

Come to the American Acupuncture Council, the network. If you’re part of our network, if you come to our seminars, you get it if you have malpractice through us. Thank you. Malpractice is separate. If you come to my seminar, it doesn’t give you malpractice coverage, so we wanna make sure you have the right codes.

In an up-to-date list of information this year, are there any earth shattering changes? No, I would say not, because it doesn’t change codes that you’re already existing, that you’re doing. It’s adding some. So make sure, do I have the right and proper ones to identify what’s going on and what if they’re coming in from someone else and bringing that diagnosis.

I gotta make sure I have an accurate diagnosis and one that’s payable by example. Cigna has a different list in Aetna, which is different from United, which is different from progressive or other types. So keep in mind, know your coding, know where your payment’s coming from, the AC, the network. We’re always here to help you, but here’s one that’s interesting.

This one may not help you much, but this will be a fun one. At parties, there’s a diagnosis for everything. Do you know there’s a diagnosis for being a bad parent? The parent that’s hovers over the person too much that’s always there and always interferes in their life. That’s actually AZ 62.1. I.

A parent who is never there is AZ 62.0. So you can in a way give a person a really bad, or I won’t say a compliment, say something bad about them without them knowing it. But here’s an interesting, whenever you ever have a friend or family member that works in a hospital and they come home and can be like, oh my God, in the emergency room last night, this person came in, you’re not gonna believe what they put inside their body.

There are diagnosis codes for foreign bodies entering a natural orifice. These are all new ones. They’re in the W section. I want everyone to just give me a moment to think. We have a code that talks about you’re putting a battery or a button bat. So a decel or a button battery. A plastic object, A bead, a coin, a toy, jewelry.

And here’s what I find interesting. There’s bottles. But here’s the, I just find glass or sharp glass. And I guess there is a difference. There could be, nons, sharpp, glass. Here’s my point. Coding can be fun. You ever wanna say something bad about someone? There’s a way of coding it. What I’ll point out is there’s codes for everything.

So if you’re seeing something, trust me, there’s a way to code it. What I’m concerned about, is it something that is under acupuncture’s purview? Is it something we get paid for? And if it is, we wanna know it. The American Acupuncture Council, as I said, is your partner. The network is always here to help with that.

I hope to see you at a future seminar. Come January or at any time, become a member. Let me be part of your staff. Go out and do well. I’m wishing you the best. Code changes for this year. Don’t start in 2024. They started in October. Make sure you update your list, everyone. Until next time, take care.

 

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Acupuncture Malpractice Insurance – Weight Loss and Menopause Part 1

 

 

So today I’m gonna be talking about menopause and weight loss. And this is really menopause is, we have a 50% of our population is female, and we’re, heading into a larger . Portion of a population is gonna be over 40, over 50, moving into this phase of life.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Tsao-Lin Moy and I’m a licensed acupuncturist and herbalist with a brick and mortar practice in New York City at Union Square. so I’d like to first thank the American Acupuncture Council for having these opportunities to speak about topics of health that are very important to us as practitioners.

And also to our patients. So today I’m gonna be talking about menopause and weight loss. And this is really menopause is, we have a 50% of our population is female, and we’re, heading into a larger portion of a population is gonna be over 40, over 50, moving into this phase of life.

We’ll go to the slides. Okay. So this is weight loss and menopause, like how to help your patients with the menopausal weight game. Lemme go here. Okay, so the key topics that I’m gonna be talking about is we’re gonna do a little review of yin and yang. Really what’s happening. I’m gonna talk about constitution.

I think we often forget to look at our patient’s constitution look at some treatment strategies a little bit about acupuncture, herbs and supplements, and diet, which is gonna be really important. And . Self-care, right? So if your patients are not involved in their health and taking care of themselves when they’re not seeing you or they don’t have homework or something to do, then oftentimes they end up quitting or giving up or just deciding they’re gonna take, drugs or, go on some crazy weight loss diet.

Yin and yang again, is something that is a dynamic balance. It’s not yin or yang. It’s really yin and yang. And women are relatively more yin, right? And in this, picture, it’s, it is the four stages of a menstrual cycle. So women’s biology is actually very cyclical, with, it’s known as a moon phase.

And so even when women stop bleeding, they still have a cycle. And so it’s really important to recognize that women’s biology, . Their cycle is very different from a man’s. It’s not the same. It’s always going through, um, a a blood phase, a yin phase, a chief phase, and then again, into the yang phase, right?

And so even though the bleeding may stop, there is still this phase. And so what often happens is this is a slide that looks at . What is happening with the hormones? So if we look at, pre menopause and we look at post menopause, in the end, both the estrogen and progesterone are going to end up being like the relatively in the same position except for less, right?

So women are relatively more yin, and this is because . It’s part of our physiology is making blood and being able to hold onto life, right? So always as we head towards menopause, we’re looking at, we’re losing the yin part. And so when we have the hot flashes, this is relative yang, but overall both yin and yang are starting to decline.

So the hormonal fluctuations actually cause . The hot and cold flashes, interruption of the circadian rhythm, like sleep interruption of the result of yin and yang kind of trying to stabilize uh, blood deficiency results in more yang excess, but it’s really relative excess. But not like from abundant young, right?

So you can have someone . Who’s hot? A woman will hot flash, but she always gets cold, hands and feet. So we’re really like looking at this kind of circulation. So this is just a little bit of a review. So what happens is this. The dynamic balance becomes a little bit unstable. And so what we can observe is that when this yin declines, it can’t balance the yang.

And that’s that experience, the hot flashes, right? And the night sweats. So losing more of the yin. And eventually though, as you can see in the slide, that the hormones, the yin and yang kind of balance out. But before that, it can be extremely uncomfortable. Now, for menopause complaints, what I’d say hot flashes really at the top.

Weight gain, skin and hair insomnia, usually from the hot flashes. And the ups and downs are also showing. But for the most, what I’ve found, and I’m guessing that. Because there’s the media, because there’s this aspect of we always have to be thin, that when women start to gain weight it’s very upsetting.

wOmen are always trying to lose weight, stay fit, look good, and then as we enter into this particular phase and our body starts to feel a little bit out of sorts, and then all of a sudden what’s happening is this weight gain, and especially around the middle. Weight gain is in general, I would say a sign that there’s something systemically getting blocked or backed up.

There’s also going to be inflammation in the body as weight gain is office excess fluid. It’s often that and fat that will store waste. So when we have metabolic waste or a lot of chemicals, what’ll happen is our body will try, will store it, convert it into fat, and oftentimes it’s going and especially hormonally.

So if as with women are doing fertility treatments and they’re injecting themselves with all kinds of hormones that they tend to gain a lot of weight around the middle. . This is also due to stress, but it’s also due to the fluctuations of hormones. And then there’s this metabolic waste, or we can call it like turbidity, right?

That’s in the system. So one of the things is that you can also be a endocrine problem, such as thyroid. Or fatty liver, which is also metabolic. But for sure we know that this is part of the digestion because this is postnatal, the digestion is gonna be involved, right? So it’s not just diet, but it’s also

The ability to absorb food nutrients and then make the hormones and make the blood, and make the fluids so for the skin and the hair, right? So all of these things, so we’re looking at. We have our jing, or our Jing that we’re born with which is kinda like a blueprint for life.

And then as we develop, our environment is very much a part of affecting, how we develop, right? So we got a blueprint, and then we have the environment, which will give us a range of how tall we’re gonna be. How healthy, like all of those things. But also we’ve got our, genetic makeup that’s there.

And so once we’re born really environmentally, we’re looking at that postnatal cheese. So environment, and then what are we bringing into our body not just food and nutrients, but also, energetically, emotionally, what else is happening for us? And stress is a big issue, right? Because that’s gonna actually affect our our nervous system.

Okay, so a quick overview. Constitutional body types, right? We’ve got yang, we’ve got yin type, damp phlegm, dry, and then we have neutral, so women are gonna be more in the yin and the damp phlegm, and then also neutral. As menopause, like perimenopause starts to come, this is going to show up and be more exacerbated.

In terms of the characteristics. So if we look at, a young body type is gonna be really like sturdy, energetic, that red complexion to. Tend towards like heat preferring cold drinks. So this is they, if somebody who’s tends towards young starts eating a lot of spicy foods, it’s gonna be problematic.

So looking at the constitution of the person. Is gonna be really important because that’s really like that kind of underlying blueprint that they’re born with, right? Something that their constitution. And so always we’re gonna be looking at constitutionally, how is this pattern emerging?

So it’s not just the signs and symptoms where we can say, oh it’s a yin deficiency, it’s blood deficiency. It’s really, we’re like, oh, in a young person or in a yin person, what is that gonna look like? Because that’s gonna, I, that is actually going to direct you towards like how you’re gonna treat that person, right?

Someone who’s very damp and Fleming is gonna be like more watery. But water is inflammation. Even if it’s not hot. We’re looking at, the body is retaining fluid to dilute some kind of inflammation, and over time it can actually get hot. So in, in terms of a strategy, you wanna be careful, someone is cool and damp.

If you heat them up too much, it can actually turn into that damp heat and phlegm, right? And inflammatory conditions. So that’s why going back to the basics and looking at what is their constitutional body type. And from there we’re looking at what is that pattern? It’s emerging for them, not just their, oh, they’re blood deficient.

Yes. But blood deficiency in a particular body type has a different pattern. Although we can still use the same treatments, we might even use the same herbal formulas. We still have to recognize what is the underlying pattern and not just rely on protocols or, or. Really using herbal formulas, like a supplement.

A lot of, practitioners, I would say forget they that they’re, they may have their western mind cap on and or patients think of them as, oh, give me that herb formula again. I really liked it. I felt really good. Which is great. But then we’re looking at

What else can be done? Because maybe they’re not changing their diet, maybe they’re not doing other things unless somebody’s really ill they don’t necessarily need to be on formulas for a really long time. And that’s the determination of what’s a long time. And as we know, it’s very hard to get people to make changes and especially with their diet and lifestyle, but.

This is a really important thing and what makes Chinese medicine practitioners acupuncturists different from a Western model is we’re not looking to fix them. We’re gonna help them to get a better grasp on how their body actually works. I’m gonna stop here and next time there’s gonna be part two where I’m gonna talk about simple methods on how you can treat your patients that are suffering from weight gain and menopause.

 

 

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Acupuncture Malpractice Insurance – Hyaluronic Acid: The Key to Hydrated Youthful Skin

 

Acupuncture Malpractice Insurance – Hyaluronic Acid: The Key to Hydrated Youthful Skin

Hyaluronic acid is a natural. Substance found in the body. It’s present in large concentrations in the skin where it helps keep complexion hydrated. And plumped, we hear about hyaluronic acid a lot in our social media and regular world today.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi, my name is Dr. Shellie Goldstein. I am here today from Florida. We are going to talk about hyaluronic acid and I wanna thank the American Acupuncture Council for allowing me to give this very exciting presentation today. So let’s go to the slides. Hyaluronic acid, the KE to hydrated youthful skin.

And for those of us in Florida, this is very important, but it’s also important for everybody as you’re about to see, what is hyaluronic acid? Hyaluronic acid is a natural. Substance found in the body. It’s present in large concentrations in the skin where it helps keep complexion hydrated. And plumped, we hear about hyaluronic acid a lot in our social media and regular world today.

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What you may or may not know about hyaluronic acid is it’s a humectant. And what is a humectant hum? A humectant is a protein or a substance that actually draws moisture from the environment, whether it’s from the air or from the water or wherever you are. So it takes it in from the environment and through the skin into the deeper layers of the tissue, what we call the dermal layer and below.

And a , like I said, is a substance that has the ability to attract and retain moisture. Similar to a sponge. Just you put a sponge in water, it just soaks it up and it holds onto it, and that’s what hyaluronic acid does. As we age our body, like other substances in our body, we begin to produce less and less of it.

So what happens? We start to dry out. Our skin looks dry, our tissues get dry. We get fine lines and we can get skin wrinkles. When we think of the body, let’s start with the anatomy of the face. You have the bone, which is your solid core structure of your face, layered and horizontally. On top of that is our layer of muscles.

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Then we have fat and we have skin, and what keeps everything together, it both separates, but it also joins all of the horizontal tissues of the face and the rest of the body is connective tissue or fascia. It’s like a web, as you can see in, in the image. It’s just this woven web that holds everything together in place, but it also holds the individual tissues in place as well.

The primary components of fascia are collagen. So collagen is the integrity and the support system of this tissue. It’s like the mattress. It’s gives you the support, gives you the volume of that you need and see in your skin tissue. Whereas the next in protein is elastin. Elastin isn’t so much volume, but.

It allows that snapback. So if you take your skin and you lift it, and you drop it, elastin is what you need in order like that rubber to snap back into place once you lift and let it go. And then there are fibroblast cells, or small protein. That when stimulated is what produces collagen or what stimulates the production of collagen in the fascia.

It also affects many immune and inflammatory responses, and it’s very important for wound healing as we’re gonna learn in a few minutes. And then there’s hyaluronic acid. It’s the moisture this . Substance that bathes all of the other proteins, the collagen, the elastin, the fibroblasts, and other cells that are in this area, what we call the extracellular matrix.

Hyaluronic acid is in the image, is this a little red line and it has a surrounding it, what we call protio glycans and protio gly cancer. What attracted those water molecules to the hyaluronic acid? It is so effective that hyaluronic acid molecule can hold up to 10 a thousand times of its molecular weight and water, which makes it responsible for th up to 30% of the skin’s national natural moisture retaining ability it has.

So here’s . Hyaluronic acid strand and then attached to what are bound to the hyaluronic acid are protio, glycans, and protio. Glycans are what the water molecules attach to, and you can see it in this area. In the lower image, you can see the hyaluronic acid and green, the protio glycans are those little

Feathers that stick out from the hyaluronic acid. In red, elastin and collagen that woven matrix of different colors of blue. So all of these are in fascia and in the what we call the extra cellular. Matrix in the face, hyaluronic acid is primarily located in the dermal layer of the skin, which is the second layer of the skin.

And we’ll look at this for a minute, and it’s found throughout. This matrix is found throughout loose connective tissue of the superficial layer of the skin. Below the deep layer of fascia, and it’s generally found in places aside from the skin, in places that are moist, like the oral cavity, the cartilage of the nasal structure and blood vessels, and in the mucosa membranes of the face here, although the structure of fascia layers varies across different areas of the phase.

Here we see it where the stars are. So the very top layer of skin is the epidermis. It’s what we see when we look at someone else, when we look in the mirror. And then just below the epidermis is the derma layer, and this is the true health of the skin. So the surface is the surface layer, the epidermis, and just below it is what we call the dermis.

And this is where we see most of the hyaluronic acid, the extracellular matrix, and all of the nutrients and proteins that keep cells nice and healthy. And then underneath that we have the superficial Retin Macular Cuts fibrous. And those are not horizontal. They’re vertical structures like ligaments that hold those horizontal structures in place.

I. Below that, we have a fat layer, which gives our skin plumpness. And then below that we have the superficial fascial membrane. And this membrane actually attaches the above layers to the below layers, another layer of ligaments. And then we have another layer of fascial membranes, which don’t have as much hyaluronic acid, but because of that, underneath it as an entire layer of hyaluronic acid or extracellular matrix.

And then we have the lining of the muscles epimysium and then the muscles themselves. So this is lining, you can see multiple layers of hyaluronic acid, which keeps this entire tissue layering nice and hydrated, nice and wet, so that things slip around and slide more effectively. So in acids, the benefits of hyaluronic acid are that keeps skin nice and plump.

When skin is nice and plump and hydrated, it minimizes wrinkles and fine lines. There are many different types of wrinkles. I’m talking about wrinkles at this. Moment that are related to skin dehydration, it increases skin elasticity and slide remembering that the elasticity is the elastin or the snap back in our skin tissue, and that all of those, that proteins need to stay wet.

In order to work effectively. And then also remembering that wetness allows those horizontal planes to slide back and forth. When we don’t have enough hyaluronic acid in our skin, we get dry. It gets irritated and then you start to see facial redness, irritation, even to the point where you have skin breakouts and dryness.

Like eczema and psoriasis. And then also remembering that we have fibroblasts in that extracellular matrix. And so without that wetness or moisture we have difficulty having our wounds heal. So hyaluronic acid and providing that moist environment helps the fibroblasts development and assisting assist in wound healing.

And here’s an example of this. So in terms of the integrity of hyaluronic acid, you see the image on top. You have tissues that need hyaluronic acid to lubricate and enhance the movement of those adjacent cells. That slide that we were talking about and then without. Hyaluronic acids are changes in that production from either age or other trauma, that type of thing.

We start to lose the production of hyaluronic acid, which leads to skin dehydration, loss of firmness and elasticity, wrinkling, and then again those horizontal planes. What happens if . You don’t have moisture. They get sticky and tight and so things, the lows, layers just can’t move independently of one another.

And that’s when you start to get fascial binding. And there are many ways to improve hyaluronic acid. One is acupuncture. When we are needling to improve the skin layer, so it’s very superficial layers of the tissue we’re not gonna place the needle perpendicular. Why? Because then you go towards the bone area.

We need to go into that superficial tissue. So we’re gonna angle the needles at a 15 to 20 degrees. Relative to the surface of the skin. So for us as facial acupuncturists, we tend to use intramurals more because you can slide them at an angle as opposed to going deeper in, into the tissue and missing it heading into the muscle layers.

So we will use very superficial needling to stimulate the skin to produce more collagen, in which case the, and the hyaluronic acid elastin all of the proteins that are found in that extracellular matrix in order to improve skin elasticity, plumpness, and texture. And then also we use needling.

Anytime you roll or create a, an, and a little channel by puncturing the skin. It allows product or whatever it is on top of the skin to move into those deeper layers of the skin. So we use it. Same microneedling is a very popular treatment that we use. And facial acupuncture. So it’s a number, like a plum blossom, a lot of superficial needles in one small area, and then you rub product into the surface of the skin.

So by superficial needling, we’re creating tiny little channels in the skin that make it easier for topical products, including hyaluronic acid, serums, or creams. To penetrate into the deeper layers through the epidermis, into the germal layer and below, and this will enhance the absorption and the effectiveness of whatever product we’re using.

And then that combination of superficial needling and hyaluronic acid, whether it’s in the form of a serum or a cream, can enhance the skin, make nice and plumb, make it smoother, more even toned with reduced fine lines, wrinkles, and even scarring it at ate layers. When we think about hyaluronic acid and topical products we think of it either as a serum or a cream or a mask. Another conversation, at another time, which I promise I will deliver here. And so we’ll use these products that contain dosages of hyaluronic acid and they go into the surface of the skin and directly moisturize the, those deeper layers and superficial layers.

Their job is to retain water. So again, the protio glycans on the hyaluronic acid proteins bring water into the tissue or wherever the hyaluronic acid sits to improve the skin plumpness and reduce the appearance of fine line and wrinkles. So it’s immediate hydration. You put the product on the moisture, it attracts the moisture and plumps the surface of the skin.

Depending upon the product and depending upon the depth of penetration, if it’s sitting on the surface of the skin, this product, then it’s gonna bring moisture to the surface of the skin, and if you can press it through the deeper layers. Say with the addition of superficial needling, then it actually goes into the tissue below the germal layer, and then it has longer lasting results.

Hyaluronic acid, because it’s naturally produced in the body, in its pure form, it’s very safe to use. Sometimes people will get a reaction to a product and any product which could result in irritation or redness or itching. In most cases, it’s not the hyaluronic acid that’s actually causing the irritation.

I. But it’s other ingredients in the product. Products are made of multiple ingredients. Sometimes an ingredient doesn’t agree with your skin, particularly if you have very sensitive or sensitized skin, and so you may develop some redness. It’s usually not the hyaluronic acid, although if you discontinue it and try a different product with a different formation, it may or not.

When we think of derivatives of hyaluronic acid, we think of them in terms of molecular weight. So all proteins, all ingredients, particularly in the skincare world, are have a certain weight and that’s measured in dass. So a compound. So in its raw form, say hyaluronic acid in its raw form, because it’s raw, it has a very high molecular weight.

Which means that it has difficulty pressing into the surface of the skin. So it remains on the surface to pre and remembering that the hyaluronic acid is, and the proteoglycans are actually gonna pull the water to the place of the hyaluronic acid. So if it’s a high molecular weight, it’s just gonna sit on top of the skin.

It can’t get through the skin, so it’s gonna remain on the surface. And where does the water go on the surface? So it’s going to create a protective film that prevents water from actually evaporating. So it’s gonna keep the moisture that’s in the skin in, and it’s going to put water on the top. So it’s actually going to give you a tightening effect because it’s a locking moisture in.

So it’s gonna look plump, but it’s gonna feel a little tight. For deeper penetration, particularly in skincare world, we look at different forms, say the hydrolyzed, which actually breaks it down a little bit and allows the hyaluronic acid to split into smaller fragments, and that’s usually less than a thousand to 1800.

Das. And so this allows that product to penetrate a little bit deeper into the surface of the skin. So again, drawing that water a little deeper through those tissues. There’s another form, sodium hyaluronic, and this is the salt of the hyaluronic acid that’s used and it’s good for stability when you think of cells.

And molecules that penetrate through the cell wall. Salt is one that actually go, is small enough to go back and forth and back and forth through the cell walls, which is where you want the moisture. And so another form the form of the alkaline foreign sodium hyaluronate is oftentimes used in cosmetic formulas, allowing it to penetrate a little bit deeper into and through the epidermis into this.

Skin area, the deeper layers. And this is actually a, gives you a visible effect of plumpness from underneath the skin surface as opposed to on top of the surface. There are two new forms of hyaluronic acid that are being used right now, sodium hyaluronic cross polymer, and this is even a lower molecular weight than the salt version, and it’s crosslinked to form.

A molecule that is a little bit higher molecular weight, but passes through that barrier quickly. And it’s it’s very interesting because it’s gives you the stability of a hyaluronic salt acid but also the humectant properties of a more superficial, so it’s covering both the surface and a little bit deeper and then to go most deeply or the deepest into the skin.

Is the the new sodium ated Hyaluronate and acetyl hyaluronate is it’s new. And what’s fascinating about this form is that this ingredient or this formulation of hyaluronic acid actually can penetrate into the skin three times. Much deeper, which allows for three times more water and absorption than ordinary hyaluronic acid.

And it keeps it in, it locks it in so that it stays longer. So it’s great for aging skin, dehydrated skin, or people say who live in the desert or in dry climates or even in the winter when you tend to lose a lot of moisture on the surface over your skin from cold. It also inhibits the release of MMP one, which is a degradation of collagen, immature skin.

Skin and it’s also used to help protect the skin from the UV rays and environmental pollution. So it’s lookout for that one. It’s new. It’s coming up and I think it’s gonna. Be really popular. It’s used to reduce crows free and the nasal labial fold of the skin, the wrinkles that run from the corner of the nose to the corner of the mouth.

And keep an eye out. I think it’s gonna be very popular in upcoming formulations of skincare. What’s interesting is this research study, it’s a randomized control trial of the efficacy of cream-based hyaluronic acid at different molecular weights. And this. They’re using water bound hyaluronic acid at a weight, a molecular weight.

So three different weights, 51, 3300, 802,000. That’s more than three, isn’t it? It’s five. And so they applied it around the eyes. 76 female patients between the ages of 30 and 60 years for 60 days. So they measured at 30 and 60 days. And what they, so one eye, they used this cream and then the other at different molecular weights.

And they used placebo on the other side. And then they were taking objective measurements. So they used a semi-automatic morph photometry meter in order to demonstrate the changes, the objective changes. What they did is the measurements were wrinkled depth. They, and then they also compared the size or the amount of change that occurred at 360 days.

And the 60 day measurement, what they concluded was the application of a 0.1% hyaluronic formulation was made significant changes in both skin hydration and elasticity, but they also found that the lower the molecular weight. The more effective it was. So again, going back to those cross pollinations or breakdowns of combined hyaluronic acid products that are coming up, they’re designed to both break down the acid, the hyaluronic acid, into very small, low molecular weights in order for it to penetrate through the skin more effect effectively and efficiently.

The other, another very important way to get hyaluronic acid into your skin is through your diet. So a diet rich in nutrients that support hyaluronic acid production can help improve the health and appearance of your skin. Key factors related to improving hyaluronic acid or getting hyaluronic acid through your food and diet.

A water. Drink as much water as you can. And that will help keep hyaluronic acid functioning properly. And then nutrients to consume are foods high in vitamin c, e, and magnesium to help produce and support the synthesis of hyaluronic acid. So these vitamins help synthesize it, water helps to keep it functioning.

And then antioxidants, such as fruits and vegetables. They actually protect that hyaluronic acid from breaking down. And then collagen rich foods and supplements can support hyaluronic acid by promoting skin elasticity and hydration. So you will need to have nutrients like vitamins C and magnesium to build or synthesize it.

You need antioxidants to help it from breaking down. And then drink plenty of water in order to support or maintain the functioning properties of hyaluronic acid. And then you want to promote, help, promote and support that hyaluronic acid by promoting skin elasticity and hydration by taking collagen rich foods or supplements.

And then here’s a research study. This is a 12 week double blinded placebo study, and 12 weeks is about right because when we talked about the epidermis and the dermis, skin cells start at the base of the dermis and make their way up to the epidermis so that you, what you visibly see. It takes about 30 days to, to migrate up from the cells, from the base of the dermis all the way up to the surface.

So 12 weeks is three rounds of improved production of hyaluronic acid in that germal layer in order to visibly see a difference in the epidermis. After 12. So in this study, this double-blind placebo controlled study, they were using daily hyaluronic acid, 120 milligrams, and it was from High Best.

It’s a company in Tokyo. Taken daily for 12 weeks in 40 healthy Asian men and women ranging in the age of 35 to 64, and they evaluated objective measurements of wrinkles and the stratum cornea water content. That’s the surface of the skin. The amount of transepidermal water loss, that’s through the tissues.

Elasticity and they looked at imaging analysis so that they were objective measurements rather than just asking the people. How do you feel? So this was actually a measurable controlled study. I. After 12 weeks, they noted that skin condition was significantly improved in terms of wrinkle assessment, stratum, cornium, water contact, transepidermal, water loss, and elasticity.

So they concluded that. It makes a difference. What’s very interesting is remembering that when you were applying hyaluronic acid to the surface of the skin, you wanted a low molecular weight. In this one, what’s interesting is another 12 week period they were looking at the benefits of hyaluronic acid.

Applied orally. They did a similar study, 60 Japanese male and females aging, 22 to 59 years old, presenting with crows free and wrinkles. And then they were assigned hyaluronic acid at a me molecular weight of two 300 and 300. Again, 120 milligrams of hyaluronic acid. Now what was so interesting about this.

Is again measuring the skin wrinkling by imaging analysis and skin condition, and that was from a questionnaire survey. Here’s what they found is during that study period, what they found is that the higher molecular weight at 300 K group showed significant, a higher significant. Change in terms of diminishing wrinkles and compared with the placebo group.

So both worked at two and at 300, but the conclusion is that the 300, the higher molecular weight. Worked better. Why? Now? This is a good question. So think about this. If you are applying it to your skin, then those molecular, then the hyaluronic acid molecules have to get through the skin. However, if you’re eating them or ingesting them orally, it has to get through the digestive tract and get absorbed in the digestive.

To track. So when you break them down, a higher molecular weight has more of it. So you actually get a higher delivery of the product as opposed to topically when you can’t a higher molecular weight, it’s not gonna get through. So it’s just gonna sit on the top. So situation, you want a lower one. So I hyaluronic acid is great and.

It just depends how you do it. Whether you stimulate it with acupuncture, you ingest it, or you apply it topically. And so the benefits are really not just the hyaluronic acid but the delivery system. Low molecular weight for application on the surface of the skin topical application, and a higher molecular weight.

When you ingest it, so read your ingredients, read the package you want around a 300 molecular weight of 300 k if you’re gonna consume it, and you’re gonna want a smaller, safe five to 50 if you are going to apply it topically. So if you want more information about hyaluronic acid, I actually will be giving a presentation about tissue and DA fascia at the upcoming Pacific Symposium.

Here’s more information about it, and that’s it. So thank you very much. I appreciate your time here, and I hope you enjoyed this and learned a lot. Again. Thank you American Acupuncture Council for allowing me to present today. .

 

 

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