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 Gellis. I am an acupuncture physician, and today I am going to be presenting on microneedling for Aging Hands, neck and Chest. So a little bit about me. I have recently published a hardcover 500 page book on treating the face. So you might wanna check that out. And currently I’m on the doctoral faculty at Yoan University, former faculty member and clinic supervisor.
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At the Maryland University of Integrative Health for about 18 years. I’ve been published several times in the Journal of Chinese Medicine, regular columnist at acupuncture today, and I’ve been teaching facial acupuncture classes internationally for about 20 years. So today I’m talking about a couple of specific topics within the general heading of microneedling.
So I’m gonna be talking about microneedling for the neck, chest, and hands. So I’m gonna go over the benefits of microneedling, how it works, contraindications, some special considerations when you’re microneedling the hands, neck and chest. And then some technique techniques. So why would we do microneedling?
Microneedling is a great alternative to injectables, things like Botox and fillers and surgery to address things like fine lines, acne scars, loose skin, large pores, crow’s feet, lip wrinkles. Skin discoloration, like dark spots, stretch marks, and even hair restoration. So what does it do exactly?
How does it work? Microneedling stimulates your body’s own collagen production, the micro. Stimulate your body to produce collagen, and it also increases the absorption of any product that you will put on your skin by up to a thousand percent. And in my book, I have pages and pages of references to studies and white papers that have been done on microneedling and how it affects the skin.
I. So the benefits are, there’s very little downtime. It’s very low risk, highly effective, and the collagen that’s produced is your own collagen. So it’s very natural. It’s. Relatively comfortable. There’s very little pain and the results can last up to five years from a series of treatments. There are some indication contraindications.
You don’t want to do microneedling on people that are on blood thinners. People that are undergoing chemotherapy or radiation, people that have really any kind of moderate to severe conditions that are open or oozing that might require medical care, psoriasis, eczema, active acne, that’s pu warts, other things like that.
If you’re not sure, look it up. Speak to your patient’s doctor. Have them speak to their doctor before you start microneedling over any skin condition if your patient has keloids or if they are pregnant. These are all contraindications. So real quick education of the skin. This right here is the stratum corneum.
And so this hole piece right here is the dermal layer and the epidermis. And right at the base of the epidermis is this layer called the stratum basal, and this is where the stem cells. That produce new keratinocytes are formed. So you really don’t even need to get down into this dermal layer, which is where the blood vessels are.
So just by staying in the epidermis, you can stimulate the growth of. New fibroblasts and collagen. So the way the fibroblast stimulation works is these needles puncture. This would be like the head of a microneedle pad, puncture little holes into the skin. They heal very quickly, but they damage the epidermis, and the epidermis heals itself with new healthy skin.
So when we’re doing microneedling, we are going to use different depths for different parts of the face and the neck. And the neck and the chest are very sensitive. The skin on the neck in particular is very thin on the chest. It’s a little thicker. But you really wanna dial it down when you’re working on the neck itself.
So when you’re microneedling, you want to take into consideration the depth of the. Skin, the thickness of the skin that you’re needling and how deep you want those needles to go. Because on a microneedle pen, the needles go up and down and they’re going to penetrate into the skin, and there is a dial on microneedle pens showing you how deep the needles are going to go.
As I mentioned, skin on the neck and the chest can be very sensitive and thin. It can be crepey on the chest. There can be a lot of dark spots on the chest. On the neck, you can get loose and wrinkled skin. So here is an example of an aging neck, and you can see how thin and delicate the skin is here, and then when you’re working on the chest, you get these deeper wrinkles and folds and a lot of sun damage because the sun, when we’re out, the sun is going to hit our chest.
A lot of times we put sunscreen on our face, we put on our hat, but our chest is exposed. So this is an example of what a patient might look like before microneedling and then after, just so you can get an idea, they’re going to be red, but they, there shouldn’t be any bleeding when we’re talking about the hands.
The hands as people’s. Hands get older, they can get very bony veiny, and the veins can be right up at the surface. Their hands can be very sensitive. The skin can be very thin, and because the hands and the feet are so far away from the heart. The healing capacity, there’s the blood flow to the hands and the feet isn’t as good as the rest of the body.
So you can have some reduced healing capacity. So you wanna be very careful not to go too deep. So for a patient like this, when you’re working, you wanna make certain to avoid any prominent veins and to pay attention to any dark spots. I. This was a patient of mine came to me for three or four microneedling treatments, and this is what they looked like before and this is what they looked like after their third treatment.
I had just. Treated them. And I had dabbed at this spot right here, but you can see this spot here is almost completely gone. And just overall the skin on the hand looks much healthier. Little bit about the protocol. You wanna make sure if you’re working on their hands, that the patient washes their hands.
And if you’re working on the chest, you can use a neck. You can use a makeup remover wipe with some rubbing alcohol on it to get that clean. You wanna make sure you put gloves on. And if they would like numbing cream, you can put numbing cream on. I usually recommend like a 5% lidocaine cream, and then you’re going to let that sit for about 20 minutes.
You remove that either with a cotton pad or a makeup remover, white and. Then whatever area you’re working on, you wanna make sure to spray it or wipe it with alcohol, and then you’re going to apply your serum. I recommend hyaluronic acid serum. The product that I use is made by. A company called AccuLift.
It has vitamin C, hyaluronic acid, and collagen. And then you’re going to adjust the depth of the pen and the needle lengths and the speed of the pen according to how deep you’re going to go, depending on the thickness of. The patient’s skin. You’re going to use an up and down technique, and if you’re working on the hands, you’re going to go up and down.
So you’ll be going like this, you are not gonna go across the hand this way. And then if they have any spots, you would use a stamping technique and again, avoiding any prominent veins. For the neck, you’ll be working up and down and on the chest you can go up and down and left to right and use a stamping technique.
When you’re setting up expectations for your patients the results can take. Up to two weeks to see any sort of improvement. And I recommend four to six weekly sessions and the appointments are one month apart. So I’m sorry, not weekly sessions, four to six monthly sessions, and if they wanted to come in for some nano needling, which is a much more superficial.
Needling. It’s more of an exfoliation. They can do that after their skin is healed. So usually within a week. And they do need to know if they’re using any prescription products that they will absorb more quickly. When you’re setting up expectations for your patients, you wanna take into account their skin type, their age, lifestyle, diet.
How much sleep they’re getting. Water, they’re consuming what their skincare routine is, their genetics. Talk to them about their family and how they aged. Of course, your TCM diagnosis, I always include, I. And acupuncture treatment with my microneedling. And any blood, she yin deficiencies, excesses, stagnations, things of that nature.
Some of the possible side effects could be some pinpoint bleeding, redness, itching, burning, a little skin irritation or some pigmentation that should say changes. You also wanna send your patient home with some take home instructions. Let them know they could be red Peel flake for about 24 out 12 to 24 hours and schedule their next appointment for a month out. Soothe their skin with either aloe and Orica blend again. AccuLift has a calm spray. It has green tea.
And aloe and tica and CBD and some other things that are very calming to the skin. They shouldn’t put any makeup on the day of, stay out of the sun. No exercise because sweat can irritate the area, use very mild soap. And after the treatment they should start on a skincare routine. So this is what a microneedle pen looks like.
You have needle cartridges wall charger, batteries, extra batteries, and that way you can plug it in. It should come with instructions and a nice long cord. I recommend a minimum of 18,000 RPMs on the speed for the needles to go up and down for it to be effective and that you should purchase a medical grade pen.
The less expensive pens that are sold online usually are for home use for single person use. Professional pens have anti backflow technology and they are meant the pen is meant to be used for long-term use on many patients. And then the needle cartridges go in the sharps container afterwards.
So this little snippet I just showed you was a little piece of a much bigger class. I teach a four hour microneedle in class and a bunch of other classes live and recorded. You can check them out@facialacupunctureclasses.com. And any of the products I’ve talked about today, you can find@uluskincare.com.
Thank you so much, and thank you to the American Acupuncture Council for this opportunity
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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 there. My name is Michelle Grasek. I am the host of the Acupuncture Marketing School podcast and a practicing acupuncturist. And today we’ll be talking about how to optimize your Google Business profile so that you rank higher in a Google search and can get more patients. And before we dive in, I’d like to take a moment to thank the American Acupuncture Council for the opportunity to be here with you today.
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Alright, let’s get into the slides. Okay. So today we’re going to talk about, first, how does your Google business profile actually impact your search engine optimization? And for the sake of brevity, I’m just gonna call the Google Business profile your profile from here on out, instead of saying the whole phrase.
We’ll talk about why it matters, and then we’ll talk about how important it’s to complete every section and make it keyword dense with the keywords that your ideal patients are looking for, the kind of people that you wanna treat more of. And then we’ll talk about some very specific steps to increase your visibility.
Basically to get Google to pay more attention to your business and your profile. So let’s make sure we’re all on the same page. Many of you are familiar with this already, but a Google Business profile is essentially a free resource provided by Google where you can fill out all of the. Important, relevant information about your business to help people decide if they wanna work with you, if they feel like you’re a good fit.
And I like to think of your profile as having two main purposes. One is so that potential patients. Can learn about you, as I just said, and decide if they wanna keep researching. Are they interested? Do they wanna click through to your website? Maybe they decide they are interested and they can just click through and make an appointment from your profile without even making an appointment, or, sorry, without even going to your website first.
But that first function is. For the potential patients, it’s information for them to make a decision. And then the second function of your profile is really to let Google understand what your business is all about and what you like to treat and who you like to treat so that it knows when your business.
Is the relevant answer to a question that someone has typed into Google. So let’s think about the purpose of Google or their goal for a moment. So we’ll take a tiny tangent here. Google’s goal is to provide the best possible user experience, which means providing the most helpful and relevant and correct answer to whatever question someone types into a Google search.
And. Your Google business profile, obviously because it is owned by Google, is a direct line for Google to better understand. Who you are and who you want to treat, so that when someone types in a question, for example, acupuncture near me, or natural pain management near me natural fertility remedies, et cetera, then Google understands whether or not your business is the answer to that question.
And really what we’re doing in. Filling out your profile as completely as possible and packing it with keywords is you are helping Google help you, right? Because if your business, if you are a fertility specialist, if your business is the best answer to a question such as natural fertility remedies, you are me or acupuncture for fertility near me, then Google wants to know that it wants to help you.
It wants to rank you higher in a search because it cares. About that user experience. Do you remember? Ask Jevs, I’m really dating myself right? No one uses Ask j Eves anymore. I don’t even know if it exists because it did not provide the most helpful and relevant answers to a search query the way that Google did.
And Google does not want that to happen, right? It doesn’t want to become like Ask j. Eves. So it really actually wants to provide the best answer. So again, what we’re doing in filling out your profile as well as we possibly can is helping Google to help you find the patients who are a good fit for you.
Okay? And it’s important to remember that, I think it’s 77% of people when they’re picking a new healthcare provider, they are Googling first, they’re doing an internet search to learn what they can about different healthcare providers in the area, and they’re really looking for reviews, right?
And so the reviews are just one portion of your profile that really matters to potential patients. But. We really, we can’t underestimate how important your Google business profile is for people who are in the market for a new acupuncturist. Okay? It makes a big difference in whether or not they’re going to pick you.
And because your business profile is so integrated with Google and helps Google to understand your business in a big way, that means that your profile can really impact where you show up in an organic search, where you show up in the map pack. And I’ll exit the slides really quickly and show you what I mean when I say that.
I googled acupuncture near Cana, which is a town close to where I live. And the first thing that comes up is called this part is the map pack. Okay. So you can see there’s. A sponsored this person paid for ads, right? And then it’s the same person right here happens to have the most Google reviews.
That’s probably one of the reasons that they’re ranked at the top of the map pack, not just that they pay for advertising, but this here is really the map pack, the top three. That were chosen as the most relevant for this search query. And then you have the map. And then of course, as you scroll down, you have the organic search results in a list.
So your Google business profile can really impact where you show up on these pages. And I will click right here. And this is the Google Business profile. Okay. Just to make sure we’re all on the same page, you could see all the different sections and we’ll talk about the ones that are the most important.
But really you want to fill out every section. So if you pardon me, I’ll come back to the slides here. If you take only one thing away from this talk, it’s that the more complete. Active your profile is the more likely you are to rank above your competitors. And active simply means that you are regularly adding things to your profile.
And that could be new images or videos. It could be updating your office hours to make sure they’re correct. If you change them, and it would also be adding what are called updates. Sometimes they’re called posts to your Google business profile. Basically, Google prefers accounts. They prefer profiles, they prefer websites, social media, et cetera.
When they’re creating your search engine optimization score and deciding where you rank, they prefer profiles that are updated regularly instead of. Stagnant or abandoned, right? So if you set up your Google Business profile, when you set up your business, I don’t know, five or six years ago, and you haven’t touched it since then, Google’s going to consider your business to be less active and less relevant than the people who are updating their profiles regularly because Google, again, really wants to provide the best answer to someone’s question and.
Businesses that are regularly updated simply look more relevant. Google can trust that business is active. It’s running maybe it’s busier. Basically someone’s paying attention to it, and so it is going to prefer to show that business compared to a profile that has not been updated in a long time.
Okay. So before we dive into all these tips, I would say that if you already have a Google business profile, which is probably 90% of people watching this, maybe 95 remember also that Google, any software, anything on the internet is constantly being updated. They’re always adding features and sections.
So I would really recommend using this opportunity to go back into your. Profile and scroll through every step. Let Google walk you through and see if there’s any sections that have been added that did not exist when you first set it up and fill those in completely. I would also recommend adding some new photos and making sure that you start posting updates, which we’ll talk about in a moment regularly.
But even if your profile’s all set up, just go back through and make sure it’s complete. And I have some recommendations for using keywords in different sections. So let’s get into that now. So when we talk about your profile being complete. You also want to make sure that you are incorporating keywords that your ideal patients might be searching for, because again, you are pretty much teaching Google when you are the right answer to a person’s question.
Okay? So think of it this way, if you are a fertility specialist, but your Google profile doesn’t say anything about fertility, and someone types in fertility, acupuncture near me, and you have a competitor who’s. Profile talks about how they mostly treat fertility patients. Obviously Google is going to rank that person higher in the search because it’s more relevant to the particular question at hand.
Okay. So if you know that you have a niche and you want more of a specific kind of person, you have got to talk about that person, their symptoms, their goals in your Google business profile. When I’m talking about keywords, I am talking about, what are the things that people are searching for in relation to fertility, right?
You can brainstorm what are all the questions that your ideal patient might put into Google that could potentially indicate that they’re a good fit for you and lead them to acupuncture and your website. Okay? And of course, if you’re an orthopedic specialist, you or you only treat runners, whatever it is, you would wanna think about those keywords instead.
So let’s talk about your profile briefly. Some of these things will be obvious. Again this is also for people who are just filling out their business, Google business profile. So when you are. Initially setting this up, and you can go back and change this if you’ve already set it up, as I mentioned, and some things don’t match up like they should, but you have to make sure that your business name, address, and phone, what’s called the nap or the NAP, are identical across all different platforms on the web.
So if you’ve got your Google Business profile, you’ve got your website, maybe you have a Yelp account, maybe you’re on, I don’t know, MapQuest your. Business name, address, and phone number have to be identical. An identical address. Means literally identical, right? However you write like suite one or like room 400 has to be the same on each one.
Why? Because this consistency again indicates to Google that your business is reliable and trustworthy and professional. Okay? If you’ve got a different address, for example, if you moved and you never updated those. Other platforms like Yelp, where if you changed your office hours and they’re different across every platform, it’s confusing and it doesn’t seem as the inconsistency isn’t as professional for Google.
It’s going to rank other businesses higher who have that consistency, right? Because it’s all about that user experience. It wants to feel confident it’s providing the right answer to a person’s question. Okay? So make sure that your name, address, phone, and I personally think office hours as well are identical when.
When you’re filling out your profile to all the other places where they’re found on the web, okay? And then the category you wanna choose is acupuncturist. I know this seems obvious, but some people choose wellness like a wellness center because they’re not sure. But if you are not a legit wellness center, and what you want is more acupuncture patients than choose acupuncturists.
Remember we’re teaching Google what kind of people to send us. We’re teaching Google about our business. So if you’re an acupuncturist, choose acupuncturist. Okay. And then for services or treatments, this is a great opportunity to incorporate those keywords that we were talking about earlier. You have the chance on your profile to put in each kind of service that you offer.
So I would list them out all individually. Include everything that you offer. So you could say initial treatment, follow-up treatment. You maybe you have cosmetic acupuncture. You offer cupping separately. Guha facial separately. Okay. And then for each of those, you have a description area. So really maximize that descriptive area with those keywords that your ideal patient might be searching for.
So you could say initial treatment, and then you could expand upon that. So of course you would say 90 minutes, $150 initial intake and treatment for, and think about your specialty or your niche or the things you love to treat, right? For example, for pain management, digestion, and anxiety, et cetera.
Okay? So take the opportunity to put some of those keywords in the description for your services. And then of course, in your business description, this is a space where you can. Absolutely maximize on those keywords. So you have 750 words in this space. I would max it out. That’s my recommendation. Make sure that you say your business name and your location and mention the.
Treatments or the services that you offer, but also be sure to talk about the symptoms that you treat symptoms, conditions. And you can even describe your target market if you like. Again, if you have a niche, you could say, treating marathon runners, helping them recover from injury so they can perform at their best or so that they can, run their, continue their training while they’re recovering from injury.
Feel free to describe your ideal patient in your business description, and if you have any awards or PR like media that you were featured on, all of that is social proof. I recommend putting that in the business description as well. I. Okay. The next thing of course is, and this is obvious, you definitely wanna put your website and your booking link on your Google business page.
Photos and videos are very important and I mentioned earlier I adding new ones. This is helpful again, because Google likes to see that your business is fresh. It’s relevant, it’s active. Someone’s paying attention to it, so you don’t have to, have new professional photos taken. Just take a picture of a new corner of your office that looks attractive on your phone and pop it onto your, profile. Okay. And put a caption, use keywords in the caption, ageless acupuncture treatment room where we help patients have babies, we help them improve their fertility naturally. Something like that. Okay. And you can now add videos to your profile 30 seconds or less. And remember.
Google loves rich content like photos and videos, so you definitely wanna add a video and it can be very simple. Just do an office tour where you walk from the outside of your building into your treatment or into your reception area. Show your treatment rooms, okay? You can put a little text on top of the video if you know how that just says, office tour.
Okay. I wouldn’t use audio. I don’t think people are listening to audio on these videos on your profile. You can add captions if they’re speaking but make sure you add lots of rich content like photos and videos and add new ones. I would say once a month. So the next suggestion I have is that there is a section on the Google Business profile where you can ask and answer your own questions, and I highly recommend doing this.
You can ask a question as the business owner, but it will show up as a anonymous, and then you can answer that same question and that the answer will show that you are answering as the business owner. So let me show you what this looks like.
Okay, so on this profile you see you’ve got the Google Business profile over here on the right. So if we scroll down, you’ll see this question that says section that says questions and answers, see all questions, and then there’s a button to ask a question. So what you really wanna do in this section is ask the questions that your ideal patients might be putting into Google and ask the frequently asked questions that you truly get all the time from your patients.
See, for example, can acupuncture help with IBS? Oops, that’s not what I meant to do. And then the person answered and there was a bunch of keywords in the answer. Okay. So really think about what are the questions that your ideal patients might have like that. Let me go back a minute. Think about the questions that are helpful for people to make a decision to come see you, right?
Like to help them know if you’re the right fit for them. And so that’s one category of q and a. And then the other is what are the questions that they might be putting into Google that you wanna show up for? Okay, so again, if you’re a fertility specialist, you could ask, how many treatments do I need for fertility?
And then answer the question with lots of keywords. How does it work for fertility? And answer the questions can you help with this specific thing? I’m dealing with this, et cetera, et cetera, et cetera. Okay. Again, you’re just teaching Google about your business so it knows when you are the answer to a question that someone puts in.
The next idea that is really important is adding regular updates on your Google Business profile. And I’ll exit and show you what that means. So sometimes these updates are referred to as posts. So you can see here they are in this section. And if you scroll through, you can see previous posts. Okay.
And if you click, you can see that. You get a little bit of text, whoops, sorry. But not a ton. And then there’s a call to action button with a link that you can choose what to link it to. But these are not really blog posts and they’re not really social media posts. You could think of them as just updates or announcements.
I do think that if you are writing blog posts sharing them in the Google Business profile as an update and. With just a couple sentences saying, Hey, are you struggling with IBS? I recently wrote this article about acupuncture for IBS. Click here to read more. Or if you already know you wanna try acupuncture for the symptom, click here to make an appointment.
But the idea here is that you are including keywords. That description of the update and that you are posting updates regularly. So most experts say, Ooh, once a week. If you could do once a month, I’d be really happy with that. Twice a month is super. I think every week is if if you’re feeling super organized and motivated, but just try to be regular about it again, because Google prefers when your profile is active.
Okay. We talked about images already, and then the last thing, which I’m sure does not surprise you at all, is an emphasis on collecting reviews because this is also a way to show Google that your business is active. When you are regularly getting new reviews and think about these reviews, what people write, especially if they share about their symptoms, is going to be filled with keywords that your other patients are going to be searching for.
Okay? The way that I tell my marketing students and marketing clients to think about reviews is to make it a strategy. Have a strategy where once every four to eight weeks and put it on your calendar once every four to eight weeks you are reviewing. The people that you’ve seen in that timeframe, look for people who you’ve seen like four to eight times who are consistently happy with their results.
They like acupuncture, they like you. Basically, you’re looking for people who feel like a slam dunk to write you a five star review, and then email them your request, and I suggest emailing. You can ask them verbally, but also follow up with an email because you must send them the link that goes directly to your.
Review page on your Google business profile. Do not expect people, if you say, Hey, will you write me a review? And they’re like, yeah, I’d love to. They’ll probably won’t do it because they won’t remember. Even if they have good intentions and they have to figure it out for themselves. They have to Google your business.
They have to find your profile. Then they have to figure out, where do I leave this review? What do I click on? It’s not gonna happen. If you wanna actually. Get reviews, you have to send them the link. And so when you sign into your Google Business profile as the owner of the profile, there’s a section that says Get more reviews.
If you click on that, it will give you the short link that goes directly to the page where all they have to do is click the number of stars, type the review, and hit submit. Okay, so that’s gonna make a huge difference in the number of reviews you actually get is sharing that direct link. Okay? And I put on here consistency wins this game because I.
If you are regularly asking patients for reviews, you are over time going to accumulate way more reviews than people who are passively waiting for their patients to do it for them because they won’t do not expect your patients to do this work for you. Even the ones that are very happy, very few people are thinking to themselves.
I should write this business a review, especially if they’re not business owners. It is not top of mind. You have to be the one who asks them to write a review. Okay this is like a crash course in Google business profile and I’ve given you a bit of homework, some things to think about, but really, again, if you take nothing away from this, just remember.
Nothing away from this except this concept that the more complete and active your profile is, the higher you’ll rank in a search. Okay. So I do hope this was very helpful and you are always more than welcome to ask me questions. Feel free to send me an email. Oops.
Feel free to send me an email, michelle@michelleGrasek.com. I love answering your marketing questions and yeah, thank you so much for being here. I’d like to thank the American Acupuncture Council. One more time for the opportunity to be here with you.
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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.
Good morning. Good afternoon, everybody. Welcome to Fearless Acupuncturists. This is Dr. Perry Barnhill, and today we’re gonna talk about Google reviews and how to respond to them properly. Properly go to slides.
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Again, this is Dr. Perry Barnhill and I wanna welcome to the webinar on how to respond to Google reviews in a HIPAA compliant way, such that you keep yourselves outta trouble. That’s the goal. We wanna respond to reviews properly and legally in a positive way, and at the same time keeping ourselves out of trouble with any kind of HIPAA violations.
All right, here we go. So why do Google Reviews matter? We know these reviews impact our online reputation. They’re very important. We know it builds positive engagement with potential patients, even existing patients we know patients check reviews out all the time. As a matter of fact, we check reviews out and Google reviews on primary, people we go to see, doctors we go to see.
So it’s really important. It builds. Engagement with the SEOs and compliance with HIPAA is very crucial, as we all know in all patient communications, especially public facing communications such as Google reviews. So understanding HIPAA in online interactions, and let me just go over a little bit of HIPAA overview.
As we know, HIPAA protects. Patient health information, just the acronym PHI Protected Health Information and PHI includes all kinds of things that can identify the patients. Things such as their name. We know that’s pretty basic. Their IP address, their face. There’s so many things that it can be related back to the patient.
It is protected health information and violations. I know you hear about this a lot, but this is true. Violations can result in big fines and it can damage your reputation. Okay, so here’s what we want to do. We want the dos and the don’ts and responding to reviews. Now the dos, we want to keep our responses generic and professional.
We wanna focus on customer service, not their acupuncture care. Now, the don’ts, we never want to confirm or imply that the reviewer is a patient in our office. We don’t wanna mention any details about their care, including anything regarding about their family members. Like just be very safe about it and just don’t do anything like that.
Alright, so creating a safe response to positive reviews. And here’s an example. Dr. Joe and his team are fantastic. They always make me feel comfortable. Here would be a sample response. Thank you so much for your kind words. We strive to provide a comfortable and welcoming experience for everyone who visits our office.
Now, how do we handle negative reviews? Let me give you an example here. I had a disappointing experience with the wait time at Dr. Sally’s office, and here’s a good response. We always appreciate any feedback. We take concerns like this seriously and would like to learn more. Please contact our office directly so we can address this issue.
So one thing to notice is we’re not referring back to you or any way that can imply that this patient even came to our office. These are very generic responses, but these are the responses that we need to have in order to stay compliant, navigating complex reviews. Here’s an example of a review. The whole family.
Love seeing Dr. Steve. Here’s an example. Response. We love taking care of families. Here’s the key. I didn’t directly say we take care of your family. We love taking care of families as just a generic response as compared to I. We love taking care of your family. So that’s the distinction there. And again, this response is safe.
’cause it doesn’t reveal or directly imply that we’re taking care of their family. We just love taking care of families. So here’s some common mistakes to avoid. Just re going over the skin, acknowledging that the patient or their family members in any way confirms their status in our office, providing any additional information about their care, even if they mention it first.
Don’t, just don’t respond to it in that way at least. And here’s another thing, and I see this often, don’t engage in back and forth discussions that might inadvertently disclose more details. And where I see a lot of providers getting themselves in or potentially hot water, they have this back and forth almost argument about the care or the wait time or whatever it was in the office.
So don’t even go there. Alright, HIPAA compliance and best practices. Always thank the reviewer without confirming any details. Keep your responses focused on general customer service. Encourage offline communications for specific concerns. Where we said, Hey, please contact our office. Don’t go there online and in front of everybody.
Train your team. Also, this is so important. Train your team and how to handle reviews in a compliant MA manner. I would suggest that if you have team members responding, make sure before they respond. They get back with you and you approve that response before it goes out. Handling potential HIPAA violations.
This is what we don’t want to have to deal with, but if we accidentally disclose PHI take that review offline immediately, get rid of the trail. Consult with your compliance officer for guidance. Ask to see what you should do from there. Report the incident to necessary authorities If required, however, ask first.
Don’t just start reporting things to hipaa. If you don’t know for sure if it was a violation, ask someone like myself. Ask someone like Dr. Julie. Find out first before you go reporting things. So here’s some final tips for success. You wanna respond promptly. Thoughtfully and you want to regularly review your HIPAA policies related to online interactions, and this is where I say you need to train the staff.
It’s part of the training, it’s part of the requirements we have for hipaa. We have to train the staff on how to respond to situations like this, for example, and encourage our satisfied patients to leave positive reviews and then bury the bad reviews with good reviews. Remember protecting patient privacy.
It’s not just a legal requirement, it’s commitment to the trust your patient’s place in you. So some next steps here, you can all go to and download this HIPAA compliance checklist. You can go to this, the website here, or you can scan the QR code, check out this list. If you go through this list and you can’t safely mark all those boxes, you’re not in compliance with hipaa and we don’t wanna be there.
You don’t have to be there. It doesn’t have to be complicated, it doesn’t have to be confusing, but it’s a process. So make sure you are, because if you’re not, the consequences are what we don’t wanna talk about. You don’t have to be in that boat. If you want, you can schedule a demo with us. You can go to fearless acupuncture.com.
There’s a demo there. You can scan the QR code. You can go to our website@ww.fearlessacupunctures.com or always feel free to contact me at Dr. perry@betterhipaablueprint.com. And again, thank you so much, the American Council acupuncture Council. It’s a mouthful. A CN. How’s that for allowing us to provide you with this webinar?
And in the meantime, everybody have an amazing day.
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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.
Hey, guess who? It’s acupuncture time. It’s Sam Collins, the coding and billing expert for chiro, for acupuncture for you, if you will, the profession as well as the American Acupuncture Council. I’m gonna speak to you directly as a network service today because a lot of you, and this means those of you who are network members with me, have gotten some letters recently that said, Hey.
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We paid you money for the va, we want it back. This is very similar to what went on last year. So I wanna talk about how we can go to dispute this, ’cause I’m getting several of you with some really big requests for recoupment. So let’s go to the slides and let’s talk about what is going on. And this is coming directly from the va, which is VA Community Care.
And again, it’s the care for veterans. You have to be enrolled. And remember, if you’re on the East coast, you will be enrolled through Optum Health. If you are in the West Coast, and now when I say West Coast, let me say Texas and west of Texas, you’re gonna be through Tri West. But it’s happening in both areas.
And what it’s relating to is you’re getting letters that are coming to you saying, Hey, we paid you money. We shouldn’t have. We want it back, pay us back. And if you don’t, we’re gonna take it out of future payments. So we wanna talk about how do you really respond to this, what’s gone on and what we need to do.
Part of it I’m gonna say to you is, this is why I hope that many of you are network members with me, because you would’ve avoided this whole thing had you known. Been part of that. We did go through that last year a bit. So many of you’re getting letters similar to this one. Try West. I’ll leave this one small.
But what this does is it’s just saying the purpose of this letter is to inform you that pricing information, allowable reimbursement on claims previously paid you has been adjusted, given the correct payment is lower. We want some money back in this case, $388. Now that’s not very much, but I don’t like paying anything back.
When I do not have to. So let’s talk about what has gone on specifically and what is the issue that’s happening. How do you overpay it? Let’s face it, fees paid for the VA pay at your state, Medicare allowable. So how could to be wrong? I had someone that sent me a letter and said, Hey, Sam. I went through all my pricing and this is what they paid me before.
How could this be possibly overpaid? There could be two issues here. One of them is called the multi procedure payment reduction, and what this refers to is that secondary services on a claim now I’m not talking acupuncture exams, but therapies by example. If you’re billing a therapy, the first therapy is paid at a hundred percent of its normal rate.
But then each subsequent therapy on the same day is reduced what’s called the practice expense ratio. And what this refers to as the practice expense of a service goes this way by example, let’s say I’m gonna do massage for an hour. I have to do a certain amount of setup for that room. That’s the practice expense.
That practice expense doesn’t have to be done. If you think of it, if I set it up for the first 15, do I reset it up for the next? We don’t. So what they’re doing is reducing that portion of it. Now that practice expense comes out to about 15%, 20%. So it’s not a big amount. Let’s say the code is worth 30.
The multi procedure prov reduction would be that it would be paid probably at about 26 or roughly about 15, 20% difference. So not a big difference, but nonetheless a difference. Now, that’s something they should have been doing and they didn’t, so that’s really on them. My pushback is gonna be at least parsing on that.
However, for acupuncture, the biggest issue is not that, because those would be small potatoes. We’re talking three, $4. It is the use of 9 7 0 3 9 and 9 7 1 3 9. So when you get this letter, what you wanna do is verify with them, how are you indicating it’s overpaid? Is it overpaid because of the procedure reduction portion or is it being overpaid because I use 9 7 0 3 9 and 9 7 1 3 9 for cupping.
Please be aware. Since February of last year of 20 24 9 7 0 3 9 and 9 7 1 3 9, were no longer part of the standard episode of Care for Acupuncture, which meant you could no longer use it. I’m hoping some of you go, oh yeah, I remember when that happened, and you were no longer to use that code. Now, of course, if they were allowing it and they were.
Prior to this change 2024, they were allowing you to bill 9 7 0 3 9 for cupping. And frankly, many of you were getting paid 45 to $50 for it. So if someone’s willing to do that, I’m willing to take it. However, let’s keep in mind, let’s think about that logically for a second. Cupping is a much simpler service than acupuncture.
Yet you are getting paid more for cupping than acupuncture. So you can look and go that doesn’t make sense. However, because they allowed it, I’d say, go ahead. Technically, you should have not been using it after last year. Realize here is the newest list of codes I. Allowed for acupuncture with the standard episode of care since February of last year, and you’ll notice immediately none of the 9 7 0 or 9 7 1 3 9 7 0 3 9 or 9 7 1 3 9 is included.
They were removed. Now the pushback that I have, if you’re getting a request for a refund, that was prior to February of 23 for the date of service, the standard episode of care, up to that point. Did include it. Therefore, it would be appropriate for them to pay, and the pushback would be, hey, it was allowed at that point.
Now, if you are getting requests after February 23rd, now that’s a whole nother issue. That’s one that, oh, shucks, we should have known. Now, network members with me, you should have well known because I sent out a lot of information. This is why I’m sending this all directly to you as well, not to mention just for everyone, let’s make sure you understand.
If you’re billing the va, these are the codes they allow. They do not allow 9 7 0 3 9 if you are wanting to do a service that is not on this list. You must specifically get authorization from the VA to provide it, or it’s automatically non-paid. Now I will have you notice. Notice the last two codes in each one, the 0 5 5 2 T, and S 89, or excuse me, 0 5 5 2 T is the code for laser.
So they do cover laser. Don’t get excited. It doesn’t pay that much, but it is covered. So bottom line is do not use for cupping any further. If you have been. 9 7 0 3 9 or 9 7 1 3 9. Do not use them. They’re gonna be a problem. And if you get paid, you’re thinking I got paid. They’re gonna come back and take it back.
I. We’re gonna push back on that a little bit, but again, after February of last year, it’s gonna be a little bit harder. So for cupping, what should you do? I’m not saying not to bill for cupping, I’m saying for the va, however, it is only under 9 7 0 1 6, and that code, frankly, is worth between 11 and $15, which truthfully makes much more sense to me.
I don’t think cupping should have the same value as acupuncture. Not to say that cupping doesn’t have value, but is it as much as doing the needling? I think not. So therefore, yes, it’s still payable, but just under that code. Now, if you’re getting issues on the price reductions, that’s what I would still push back on, depending on when they’re implementing.
But remember, that’s gonna be a pretty small amount. If it’s a big amount, I’m almost certain it’s going to be cupping. So make sure you’re pushing back. How can I dispute it? The number one dispute I have, and this is the starting point, but I want always there to be two disputes, is just plain statute of limitations.
Let’s face it, we have only 180 days to bill the va. Does that give them infinite time to recoup, years later? No. Under federal statutes it’s 365 days or one year. Therefore, if they’re making a request to recoup money from you, that is over 365 days or one year. That’s the number one pushback. If you’re a network member with me, please contact me.
We have a dispute letter to that fact for you already formatted that you can send. Hopefully this is encouraging. Some of you, oh, this is why that network is so good anyway. If you’re not a network member, you’re just gonna have to go back and say, Hey, that’s statute of limitations. I would also push back though on this issue case law, there’s case law that’s been around since the nineties that says when an insurance pays something improper and the provider has not done anything.
To make that payment improper. The carrier is the one responsible under federal rules. They may push back on that, but if you recall last year, we were able to dispute that, but I’m expecting the same. So my hope is that given in another month or so, we should see some pushback where they’re going to no longer seek these recoupments, at least the ones prior to 23 or over a year.
My concern for you though, is make sure you understand, do not bill. 9 7 0 3 9. I know you’re thinking they paid me. They can recoup it. We wanna push back. Let’s make sure the claims are correct. If you’re not a network member with me, this is a great time to understand what we do. This is something we’re trying to get you ahead of the curve and not chasing after it.
VA patients are still very good patients. Remember, we got about a 20% increase in the Medicare fees for the first set this year, so that’s a good patient. Just understand the rules. Again, no use of cupping. If you’re not a network member, please take a look. If you’re a network member, please contact me.
Let’s go through. We can do a one-on-one zoom if we need to, but let’s make sure we’ve got some fire to push back on this. Until next time, my friends, I wish you the best.
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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 everybody. This is Dr. Perry Barnhill with a Fearless Acupuncturist, and today we are gonna talk about something that is so important. There’s some new HIPAA changes that are coming down the pipe regarding reproductive healthcare. A lot of you are very much involved with fertility and reproduction and pregnancy and things like that, so make sure you stay tuned for this.
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Also big thanks to the American Acupuncture Council for having us here. We are pleased to give you the information that you need to have now Slideshow please. Okay, here we go. This is all about strengthening reproductive healthcare under the privacy and the new HIPAA privacy rule. So there’s new requirements.
Just like I said, there are forms, and when I talk about attestation, I am specifically referring to a form that we’re gonna need to have and send out before we send out any information. We’ll get in some details on that and some action steps so you know exactly what it is you need to do. Let’s talk about some of these new changes.
Now, if you’ll remember, maybe you don’t know, but you need to know they are, there are seven new laws for HIPAA in 2025. We’re not gonna get any of these, but they’ve actually added to that, believe it or not. So they have talked about some modifications to the privacy rule. Specifically to better protect reproductive healthcare privacy.
We’re gonna define what this reproductive healthcare privacy is, and a lot of you are involved with this. What it does is this, it prohibits use or disclosure of PHI protected health information. Remember, these are the records we have on our patients, including our intake forms. All righty? So even if some of you may not be involved with this, which I know a lot of you are.
Still, a lot of this information is actually on the intake forms that the patients fill out when they come to the office. So what it does is this prohibits user or disclosure, PHI, solely to investigate or penalize lawful reproductive healthcare. It requires this form I’m talking about, so it requires and obtaining written attestations before we disclose this reproductive healthcare.
Information or records in certain circumstances, or I’ll talk about certain scenarios that you, we will go over and covered entities, which is all of us have to update our notice of patient privacy practices accordingly. What is reproductive healthcare? This reproductive healthcare is a very broad definition, and federal registry. This is some of the stuff that comes from the Federal Registry to help better define what reproductive healthcare is, and it’s a exclusive list. What I’m going to do is, I’m just gonna go through the main things here. You can read all the details behind it, but it’s contraception, it’s management of pre pregnancy, which a lot of your doing.
It’s fertility and infertility again and family planning. It’s still sterilization issues. And sexual health to include many things there. So make sure you understand what this is. Who is affected? Guess what? All of us as healthcare providers are affected. All of us are healthcare clearinghouses are affected, affected health plans.
So all insurance companies are business associates. You know the people that have access to your records, they’re affected. So you need to make sure they’re aware of these things. Also, through your business associate agreements. Here are the situations that require attestation. So I’ll just summarize a little bit.
Reproductive healthcare, if these scenarios occur, meaning these folks ask for records from your patients or from you that you have on your patients and your records re have. Any of that reproductive healthcare definitions on it, or in it, including intake forms. You’re gonna have to send out the form, the attestation form.
So here are the scenarios, or here are some examples of if these people ask for records that contain that reproductive healthcare, you’ll have to send out one of those attestations Health oversight activities. Again, you’re gonna validate that the disclosures are not. Used for punishing lawful care.
That’s how You do it through the attestation statement. Judicial administrative proceedings confirm that the request is not investigative or punitive in nature. The way you do this is through that form, which we’ll talk about here in a second, and also law enforce enforcement requests. So law enforcement, you have to also use this attestation form before you release any of this information, or at least information that has reproductive healthcare in it.
Coroners medical examiners here, again, you’ll have to use this form as well before you release the information. We have a form I should say we, I’m referring to the government. I’m obviously not the government, but we’re talking about a form, they call it the model attestation form. So why not use the form that they actually say we can use, and this is the requirement, it’s the required step we have to do before we disclose reproductive healthcare information or records, and it ensures that whoever’s asking for it.
So those scenarios I just showed you, like the law enforcement, coroners, medical examiners. We send this form to them, they gotta fill it out and send it back to us, and basically saying they’re not gonna do anything or punish them by law for doing the things in the reproductive definitions that I showed you.
Here’s the form, and basically what this form is this, and I know you probably can’t see this on the slides, but the next slide, I’ll have a link for you so you can download this form for yourself, for your offices, and for your staff. But basically, this is the form that we would send out. So let’s say law enforcement, here’s a scenario.
Law enforcement, like I said, in those scenarios, they ask for protected health information from what on. That you have in record of one of your patients. And those records happen to include some of those reproductive definitions in there. So before we send them any information, we have to send this form out and they have to fill it out.
And basically it says that they’re not gonna use any of the information that they acquire from your patient records to punish the patient. Alrighty. Here is the link so you can get this form. I’ll bring the sync up again here a little bit later, but you can just scan it and then I’ll get you right to the link.
Lots of things you gotta do here. So let’s go over some of the main ones. You have to document everything, as always, as you always know, with everything we do in our offices. Hipaa, reproductive healthcare obviously is a big one. In fact, it’s mandatory. We have to keep records of our policy updates, so make sure you keep a record of this.
In fact, keep a record of this for your training log. This could be something you can show your staff, the test station, that form that we have to have. You gotta keep that on file disclosures. And what I mean by disclosures is, believe it or not, every single time that we release information on a patient, we have to record that because patients have a right to come back and say, Hey, I want to see everybody that you ever sent my information to.
So we gotta have that readily accessible. We have to train, we have to educate the staff, and here’s what this looks like. Identifying protected health information that Reque requests or PHI requests that will trigger the use of that form. Kinda like we talked about the reproductive healthcare. Talk to your staff.
Distinguish lawful reproductive healthcare from investigating request. So when those people are asking, and I say those people, the people that I was talking about in those scenarios, ask for reproductive healthcare, PHI on your patients. A testation form goes out, so you have to know how to locate and use the form and document the disclosures, and of course, you have to retain the testation forms to keep copies of everything.
Make sure you train your staff on this. In fact, a lot of officers are deciding and telling the staff. If you have any requests for protected health information from any of those people, let me know so you all can check it over and make sure that attestation form is sent out and then sent back to you before you release any of that information.
You have to update your notice of patient privacy practices. That form the big old packet that we’re supposed to have in our office for all the patient’s rights. Those things have to be readily available for patients. And again, it must reflect. So there’s gonna be changes in there if you had those forms, which you all need to have those prior to 2025.
Guess what? Those forms are no longer good. So you have to get a new, you have to get new notice of patient privacy policies to provide patients with clear and updated information about their rights and how their information is protected. All to align with the updates of the final rule guidelines.
Basically all to align with everything that’s come down the pipe with these new laws. Here’s some next steps for you. Here’s another. Opportunity to download that QR code if you’d like to, so you can go right to it and get that model attestation form, which you have to have. You need to have this in your manuals.
One of the things that we’ve done is we’ve put together a HIPAA compliance checklist. So you can go through, look at this checklist. ’cause a lot of people, they think, oh, I think I’m compliant, or I, maybe I have this form, I have that form, but maybe you’re not really sure. Maybe you didn’t know. You need to do a bunch of assessments and analysises throughout the year.
So we’ve created this form here, just this checklist. You can go through it, check it out, and if you can’t answer these questions or if you’re not doing the things on this form, then guess what? You’re not compliant and you do not wanna be in that position. Believe me, don’t be in that position. Get it dialed in.
Protect yourself. If you’d like to, you can schedule a demo or you can just get started. You can go to this website here. You can schedule demo, go dot fearless provider.com/demo. Of course, you can scan the QR code there to your right. If you just wanna get started with the HIPAA program, we have everything you need for hipaa, all the forms, all the trainings.
We have ’em in videos, we have downloads, we have closed caption, we have transcripts. We have. Everything in there to make it learn as easily as possible for you and your staff, or I’m more than happy to talk to you. You can contact me at Dr. perry@betterhipaablueprint.com. Again, thank you all so much for being here.
We hope you hope the best for all of you. In spite of all these changes. Just make sure you go out there, get the process going, and make sure you have this in play. In the meantime, have an amazing day, everybody.
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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.
Hey everyone, and welcome! I’m Dr. Crystal Lynn Couture. The pelvic acu and I want to thank the American Acupuncture Council for supporting this flock. If you don’t already know this, the American Acupuncture Council has amazing vlogs hosted on their website almost every week. And within these vlogs are absolute gold.
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Michelle Gellis, Michelle Grasick, myself, and some other amazing practitioners have all shared lots and lots of vlogs. And trust me. They’re worth seeing. Today, we are going to be talking about the pelvic floor and menopause. Shall we get into it? In today’s chat, we’re going to define menopause. We’re going to reframe the menopause definition, which is going to help us and our clients.
We’re going to talk about production. of hormones. We’re going to talk about follicles. We’re going to have a little bit of a chat about Jing. We’ll talk about kidney deficiency and we’ll talk specifically about menopause and the pelvic floor. So let’s get into it. All right. The Western definition of menopause is as such.
Menopause describes the stage of a woman’s life when her menstrual periods stop permanently and she can no longer get pregnant. The Siwen describes this as at the age of 49, the Ren Mai becomes deficient, the Chang Mai is depleted, and the Tian Gui dries up. Menstruation stops, she becomes weak, and can no longer conceive.
There’s a little bit of overlay between the two definitions, but there’s a different understanding between the two definitions, of course, and we know that as Chinese medicine practitioners. If we look further, Western medicine refers to the decline of hormones and the ovaries producing less and less estrogen and progesterone.
In TCM, we talk about the decline of the kidney gene and the body becoming deficient of yin and fluids. So clients are going through this. We ourselves might be going through this as practitioners, right? Women around the globe have been and will continue to go through menopause. And there is a stigma associated with menopause.
And that stigma is almost, even in the Siouan, it’s almost like a little bit of a death, right? And so I think it’s our job as acupuncturists to look beyond that and help our clients see that this is a second spring, a second bloom. A rebirth. And we see this in clients already. We see that at 50, I hear this so often from practitioners that I’m talking about.
I went back to acupuncture school at 50. I went back to whatever marketing school at 50. I wanted something new at this age, right? Because it’s a rebirth for their body. Everything is changing. Everything is transforming. And what an opportunity to look inside. And for clients to decide what they really want to experience through this second phase of life, how they want to live, how they want to access their relationships, their dreams their spirit within them.
So I think if we paint this as an opportunity, we have a beautiful way. To empower our clients and help them embody this transition that might not make it less uncomfortable. But the good news is we have tools in our toolkit to help make it less uncomfortable. So we have this unique opportunity as women.
To intentionally shift into this phase of our lives with grace, gratitude, desire, and passion for life. And as practitioners, if we can support this mindset and witness our clients flourish, that’s really where the magic happens. So let’s talk production of hormones because I think it’s important for under us to understand the Western science as well as the Eastern, right?
So estrogen, of course, is going to be produced by the ovaries. It’s also produced by the placenta. A small amount is produced by the adrenal glands on the kidneys and a small amount is produced by the adipose cells throughout the body. Now progesterone progesterone is produced by the o ovaries, by the placenta, a small amount by those adrenal glands.
And then in males, a small amount is produced within the testes. Okay. So we start to see that as the ovaries and the placenta are no longer involved in the picture. The big producers of estrogen and progesterone are on the bench. They are no longer on the forefront. They’re out of the game.
So what this means is there is going to be a decrease in estrogen and progesterone. Now, estrogen is most of the circulating estrogen in the premenopausal women is produced by the ovaries, largely as a result of secretion from the granulosa cells of developing follicles. And estrogen peaks, as we know, right before ovulation.
We talk about progesterone. Once the egg has been released at ovulation, that empty follicle that remains becomes the corpus luteum. The corpus luteum produces progesterone in higher amounts and estrogen in smaller amounts. So physiologically, scientifically, there’s a major change going on within the hormones at that menopause phase.
Let’s talk about the follicles for a moment. The ovary establishes several million non growing follicles at five months of gestational age. That’s huge, followed by a decline to menopause when approximately only 1, 000 remain. We have an average of 450 menstrual cycles in a reproductive lifespan. All of this to say that the decline in follicles is going to be, as well as hormones, thus, is going to be progressive due to the follicle death by apoptosis.
Now, Jing is the basis for follicle development. Menopause is a progressive decline of Jing over time. So hopefully this is starting to illuminate the overlay between the Western and the Eastern medicine here. The progressive nature means a couple of really important things for us. That lifestyle can improve or inhibit one’s menopause experience.
Over stress. Emotional stress. Overwork. Tobacco use. Irregular eating habits. Eating to excess. Coffee consumption, alcohol consumption, drug use just to name a few, can all contribute to one’s menopause experience. The great news about this is that if we are seeing clients before they are going into the phase of menopause or perimenopause, we have the opportunity to help them impact their menstrual health through the phases of their life so that their menopause can potentially change their life.
be a better experience. Now, a lot of Chinese texts that are out there in particular, Seven Times a Woman talks really about this nature of starting to prepare for menopause at age 35 that references by Leah Andrews. Sorry, I forgot the name for a sec. It’s a great book, one that you should definitely have in your clinic.
So starting to have this conversation with clients at age 35, one is going to really help their menstruation journey from 35 to let’s say 50, but it’s also going to really help prepare them for the menopause experience as well. Now a decrease in kidney jing. Kidney means that kidney yang and kidney yin or both can become deficient.
So the kidneys are the root of the original water and fire, right? They’re that origination of the Tian gui, which comes from the kidneys with the minister fire acting upon it and creating the menstrual blood, right? They are interdependent and inseparable. The minister fire is part of this experience, the formless, there’s a connection between heaven where as emperor fire heart and form is human.
Now kidney deficiency is Yin deficiency, right? We’re going to see, with Yin deficiency, we’re going to see night sweats, we’ll see hot flushes, we’ll see the feeling of heat, we might see those cold feet, and frequency of urination. The tongue generally here is going to have no coat, and redness may be present.
When there’s yang deficiency, we can still see the hot flashes, we’ll see the low back pain, the feeling of coldness, the cold feet, and that frequency of urination as well. But in this case, the tongue can be pale. Now, when we see some combination of kidney yang deficiency and kidney in deficiency, we’ll see all of these symptoms concomitantly existing.
And the person really having this dig dysregulation of temperature and this dysregulation of temperature is going to be annoying and uncomfortable for them and something that they can’t quite, put their finger on. So that’s really important for us. to be aware of and to utilize our good diagnostic skills as Chinese medicine practitioners to find out what’s happening in the system.
Let’s talk about menopause and the pelvic floor specifically. We know because we’ve talked about it in previous chats that estrogen is going to preserve muscle mass. It’s going to support muscle repair. It’ll help generate muscle force. It increases the collagen content. It plays a role in muscle metabolism and it protects against muscle apoptosis, right?
Apoptosis. So when estrogen is decreased, The muscle is at a disadvantage, which means there can be less muscle suppleness, less strength, less power and function of the muscles within the body and the muscles of the pelvic floor, right? So you can see that there’s a lot of research that comes out for women at the menopausal age that encourage strengthening exercise, especially weight bearing or resistance exercise, right?
And this is because those muscles are at a disadvantage. You can also very commonly hear the complaint that women that are going through the menopause phase are feeling weakness in their bodies. I want to take just a moment to point out that we know that estrogen also comes from the adipose cells, right?
And so we can also see some weight gain. There’s a number of reasons that we can see weight gain through the process of menopause. But one of them is going to be that those adipose cells may be trying to produce estrogen for the body. So it’s important to consider that as well. And that’s, I think, one of the reasons that a lot of women go on the hormone replacement therapy to try to really help their bodies for weight gain, for muscle balance, and to just feel better because the symptomology is real.
Everything is changing in the body without good muscle contraction. Without that muscle suppleness as well, we can a lot of times see strain on the fascia and those fascial chains that exist within the body can produce pain for clients. So it’s probably pain that was latent. It’s probably pain that was there and it was being held by the suppleness of the tissues.
And then all of a sudden as the suppleness decreases, it starts to really pick up because the body is holding itself up. on those fascial chains because the musculature is not having good contraction. So what do we know about progesterone? Progesterone is going to support muscle relaxation.
It’s also going to support protein synthesis within the muscles, and it’s going to help maintain connective tissue elasticity. So if we think about estrogen and progesterone, what they do is they are strength and flexibility in harmony, which we can liken a little bit to what’s happening in menopause with the wood element, right?
There’s this decrease in progesterone and that can contribute to the muscle weakness. It can contribute to muscle tightness. It can contribute to proprioceptive confusion within the body and stiffness within the tissues. Now, if you’ve seen my pregnancy, Workshop. We talked a lot about what is proprioceptive confusion.
Proprioceptive confusion with pregnancy, we can see, right? We see rebellious chi. We see the acid reflux. We see this kind of energy going up when it needs to be going down. And all of those changes that occur. During menopause, that can happen as well because there are changes deep within the system that are Allowing the meridians to be resourced in a different way than they might have been resourced before.
And so it’s important to consider that. Now, what does that mean for the pelvic floor? If there’s proprioceptive confusion within the pelvic floor, that generally means that the body is not relaxing and contracting the pelvic floor when it’s meant to. Now, what does this mean? If, for instance, on the exhale, the pelvic floor is relaxed, What are we going to have?
We’re going to have leakage because those tissues are relaxed when they’re meant to be contracted. That could be of the bowel. It could also be of the bladder. And what’s happening is that we are relaxing the tissues. When we are exhaling. So that’s a sneeze, a cough, a breath, a push breath out all of those things.
And what our pelvic floor is supposed to be doing during the exhale is going up and in. That goes the opposite too. On the inhale, the pelvic floor is meant to be relaxed, right? We’re filling the body with breath when we inhale. So that’s a relaxation of the pelvic floor. That’s that pelvic floor ballooning and relaxing, taking the chi, taking the breath of the heavens.
in and then on the exhale pulling up and in, releasing out, right? So proprioceptive confusion in the pelvic floor is one of the number one things that we want to work on with our clients that are having issues with leakage. Now, progesterone in particular with reduction in the connective tissue elasticity and that sort of decrease in muscle relaxation, what we can end up with is actually excessive tightening of the pelvic floor.
Now with excessive tightening, And reduced yin and fluids, what we’re going to end up with is over contraction that leads to pain, particularly could be pain, spontaneous pain, but it also could be pain with sex and intercourse, right? Even pain with the, with very shallow penetrate penetration or very narrow penetration of a finger can be very painful because these muscles are over tightened and over contracted because there is a reduction in the elasticity.
So this is something for us to be very aware of with our clients and to be good investigators as we’re evaluating our clients and find out what’s happening and having a basis of understanding of what’s happening with the hormones helps us to understand why this is happening and also give us information and insight into the connections between what we’re finding within the meridians and our TCM.
Diagnostics, right?
There’s more to this estrogen and progesterone business within menopause, right? It is actually that the receptors for estrogen and progesterone are present on the pelvic floor. So when the body is producing less estrogen and progesterone, the receptors begin to decrease because they’re not used. If we don’t, if we don’t use it, we lose it, right?
And those tissues can weaken. So this is another contributing factor. to what’s happening within the pelvic floor is a reduction in receptors. Let’s go menopause and beyond, right? Progesterone and the mood. Okay, so progesterone controls overall mood. and sense of well being. Estrogen low estrogen in particular can increase susceptibility to stress and anxiety.
Estrogen and serotonin are linked, they are interconnected. Which means that when estrogen drops, So does serotonin, which is linked to an increased risk of depression. Now, as we know, serotonin and melatonin are also linked. So this is where we can see these interruptions in sleep cycle. So we’ve got physiological changes going on.
On top of those physiological changes, we have emotional changes that are going on. There is nothing that we can do as acupuncturists to stop these changes from happening, because there is a transitionary period. in the body that is physically proven that is proven through Chinese medicine through the energetics.
Jing changes right at this phase. So the only thing that we can do is help our clients to be prepared and then help our clients to go through the transition in the smoothest way as possible. We can clearly understand if we’re looking at this if we have not been through menopause ourselves. If we are looking at this data right now, we are We can clearly see why, as women are going through menopause, they can feel like they are drowning.
They can feel like the world is coming up against them. They can feel like they are so disconnected from their bodies, and it is because they are in a whole new experience. Which is why that reframe of the rebirth, that discomfort, that vulnerability of a rebirth, can be really helpful in helping them to come into their power.
During the menopause phase, so I really hope you enjoyed our time today If you’ve been with me before, you know I’ve presented a pelvic floor intro, menstruation, fertility, pregnancy, and postpartum, all in relation to the pelvic floor. And these workshops were all sponsored by the American Acupuncture Council.
And here’s some references. I just want to once again thank you so much for spending this 20 minutes or so with me today sharing in information about menopause and the pelvic floor. I really hope that this is something, there are little nuggets here that you can take back to your practice that are going to help you to support your clients.
In the best way possible. So I want to thank you for, from the bottom of my heart. I also want to thank the American Acupuncture Council for sponsoring this vlog. Thank you so much, and I’ll see you next time.
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