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Grief and Fertility Challenges: Part 2



So we’re going to continue with grief and fertility challenges, and let’s go to the slides. Then there are the women who are diagnosed with secondary infertility.

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, this is Dr. Martha Lucas, and we are going to today continue with the presentation on grief and fertility challenges. So if you didn’t get to see the last presentation, the first part of this, make sure you go back and watch it. I want to thank the American Acupuncture Council for hosting this webinar and remind you that.

I have a private practice in Denver, Colorado, and Littleton, Colorado, and I am happy for you to contact me if you have any questions about this presentation. So we’re going to continue with grief and fertility challenges, and let’s go to the slides. Then there are the women who are diagnosed with secondary infertility.

Now, this is a little bit of a nebulous term, and it means these women have had a successful pregnancy. They’ve given birth, but they are struggling to get pregnant. I. The second time, and it’s interesting to them because they’re like shocked. What happened? I had a baby already. I, and statistics show that once you have a pregnancy, once you give, have a successful birth, that your chances of getting pregnant are higher.

The second time, but there is this thing called secondary infertility where women have a little bit of a hard time getting pregnant that second time. Now why? Did they get, have some scarring on the fallopian tubes? Did they have a previous C-section that led to some scarring? The causes can be varied.

And grief can also become a factor in grieving the idea that their child doesn’t have a sibling. Because again, I’ve worked with many women who only have one child. They, for some health reason or whatever, they couldn’t have another child, and so they have a layer of grief about I wanted to have more than one child.

My whole life, all I thought about was being a mother and having a . Whole slew of kids around. I want my child to have a playmate. Some people feel sorry for their only child. They feel like maybe they’re lonely. They don’t have anybody to walk to school with. They have to play by themselves, and all of that can increase their grief.

They can grieve who they used to. To be before their diagnosis. Now, it seems that everything is about appointments that you have to set up, you have to show up for, you have to infuse all your energy into all of these processes and procedures, and sometimes all of this. Grief, just even generalized grief, not even fertility.

Challenge grief can take away the comfort that we used to get in the little things like taking a walk or meeting a friend for lunch or reading, going to a coffee shop, or going to a park and reading. And then even the bigger things, not being happy at family gatherings in with grief sometimes, especially longstanding grief.

It. It just takes away the satisfaction or joy that you get in what used to be joyful experiences. Sometimes women who used to pursue hobbies or their passions are now too tired, too distracted, or too sad to do those things that used to bring them joy. They feel like they used to be a generally happy, optimistic, hopeful person, but now they feel like a shell over their formal.

Former selves, they say they watch those things in life happen. Like they’re watching them on a TV screen, they’re not really experiencing them. They’re in the room, they’re in the family event, but inside they are not experiencing the happiness of the event. They want to engage in life the way they used to before they had to start their infertility treatment, but they just can’t do it.

They just long for their pre. Diagnosis self, but the grief just takes over. Now what about the woman who suffers through recurrent pregnancy losses? This includes what is called a chemical pregnancy, which the pregnancy test results get lighter over time. I. Hormone levels go down and then, and sometimes unfortunately, that first promising ultrasound ends in a loss, losing a child and deciding to continue with pregnancy treatments can be the most excruciating emotional experience that a woman or a couple can have.

They for them. It seems like the losses go on and on. The things to grieve go on and on. So this is partly what we need to support people through when they’re going through this in their fertility treatment. And unfortunately, infertility is lonely. Even though you have a million appointments and you seem to have a support system, all of that does not take away that grief of trying to have or grow a family.

The wonderful support does not inherently change the circumstances of the woman plus the woman. You know it, we all want support, right? But. Part of the problem with the support is the person feeling like she’s constantly explaining what part of the process are you in right now? Or feel the myriad of responses of people saying, oh how did that go for you?

How did that last treatment turn out? Constant answering questions about what’s going on with your treatment. Where are you in the process? Are you going to do it again? There’s all of that, that even though support is good, having a support system is good. Part of a support system is having to talk about it.

And then of course the drugs, a lots of them cause powerful treatment effects, which is a good thing. But they also have strong side effects. For example, oral birth control pills. Can have very powerful side effects. And the rate of depression in women taking birth control pills is five to 50% being more common, most common in the progesterone dominant formulas.

So what does it mean in Chinese medicine? How are the organs involved? The liver is known to regulate the flow of chi and emotions. We all know that the commander of qi, it stores blood and regulates substances. Emotions cause physical disease. How? Through stagnation. Through stagnation, that causes deficiency through stagnation that causes excess.

Through the deficiency of blood. For example, the liver, blood, heart, blood, the heart governs blood and stores the she emotional stress can make heart, blood and yin deficients. See, thereby of course, there we find the shen is disturbed. The emotions are disturbed and important for fertility challenges.

Blood flow to the uterus becomes compromised. Spleen helps make digestion work well. We need the digestion to make good blood in order for us to have a successful pregnancy because digestion, that doesn’t work well and worry. Remember, in a previous , Presentation I was talking about how worry makes the digestive pulses go backwards.

All of that disrupts the flow of chi in the earth, in the center, in the spleen and stomach pulses, and that is again going to negatively affect blood flow to the uterus. Worries effect on the spleen also can lead to poor appetite, fatigue, sleeplessness, brain fog. And again, all of those are gonna be a negative effect on the woman who’s trying to get pregnant.

Grief gets stuck in the lungs so the immune system is affected and the flow of Q throughout the body can be compromised because that is part of the lungs. Job right now, you’ll recall that spleen and stomach, earth and metal lung, large intestine are the immune system. So that’s why if the lung pulse is stagnated or short because of grief, then the whole immune system can be compromised.

And again, if the lungs can’t manage the flow of Q and blood, then you’re gonna have a negative effect in the uterus. The lungs are about taping in the new and letting go of the old, but old grief and continuing grief can get stuck in the lung pulses. Some people lose the ability to connect their inside world with the outside world, and metal is about that communication.

The release of grief is essential to allowing the body to heal and get the communication with the inside and outside going again. Otherwise, the person is what we call armored. They become very heavy because of their heavy emotional burden. Grief can be separating, isolating, and it can be cutting them off from their

Relationships with the rest of the world and an important message for people who are experiencing grief is it’s okay to feel your grief. You don’t have to hold it in, as I said, and any one of you have taken a class from me, know that I tell people emotions have to be expressed. You must let them out.

You can’t leave them in ’cause they’re gonna mess up your chi. Mess up the flow of oxygen and blood in your body. And I tell them it’s okay to use your voice while you’re crying. The frontal lobe, our San Jou area will go round and round and round and round and round when you cry in silence with the same message over and over and over and over again.

But when you use your voice, when you’re grieving and crying, that . Cuts off that San Jal frontal lobe running around in a circle. So it is okay to feel your grief and it is okay to use your voice in your grief. So here’s in a, here’s a little bit of a picture of what the lung large intestine pulse might feel like.

You, it might feel like . The lung large intestine, pulse is short, it doesn’t flow. You’ll notice at the top of the picture there is the sine wave. That’s how the normal pulse would feel. Yang and yin yang and yin flowing through all of the positions. But the lung pulse in grief may feel like it’s a shorter pulse, or that little dot indicates like a naughtiness, almost like a little ball stuck in the pulse.

A spinning bean pulse, if you will. Plus the trauma of the fertility challenge and experience can leave the earth position empty. Remember, if the energy can’t flow through the lung large intestine, again, you can see it’s a flow yang and yin yang and yin all connected. But if one that’s the normal pulse on the top there.

But if the normal pulse that flow is. Stopped or stagnated by the lung pulse, then the spleen stomach isn’t going to be getting any . Energy either, and that’s the trauma pulse, that deep emptiness in the spleen stomach. And this person, believe me, if they’ve had past trauma, then this whole fertility challenge experience can key into that.

And then they’ve got a. A double problem. They’re not making good quality oxygen in blood. It’s not being floated around by the lung large intestine. And then of course, that leads to a negative effect on the flow of uterine blood. I. The patient’s experiences may also reignite, as I said, old patterns of trauma, grief from childhood, the feeling that your life is outta control.

Because believe me, as lots of women going through all of these challenges feel like their life is outta control and that their body is outta control. Their body just will not do what they want it to do, which is get pregnant and have a successful birth. So all of that can lead to that empty spleen pulse from old trauma.

Now this is what we want the normal pulse to look like. We want the left and the right to connect with each other, the kidneys, to connect with the left side and the right side. And again, if in that large intestine lung position there’s a knot or it’s short and it’s not flowing, then you’re not going to get the flow of energy through all of the organ systems.

And you’ll notice those are sign waves. The infinity symbol is a sine wave yang and yin, and then a sine wave yang and yin. So we need for the kidneys to be able to support all of the other systems. Gallbladder liver to small intestine, heart, and then back to the other side, a continuous flow of sine waves.

That is the goal of every acupuncture treatment. So that’s why if grief is negatively impacting , The one position or more than one position? It is impacting more than one position because it’s stagnated. So it’s not allowing the energy to flow over to the other side. So this is the importance of figuring out how we can release the grief in that position.

Now, one way to do it is to use. Low points, right? Maybe you open the lung and the large intestine low, or you open the spleen, stomach, low points, anything that’s going to allow you to start relieving that stagnation in the lungs. I love liver. 14 lung one, liver 14 lung one pointed out. That’s an entry, exit point, treatment, and it will take some of the pressure off of the lungs.

Plus for grief, lung two is a very important point for lifting the clouds releasing the clouds or . Releasing grief, so you know, us thinking about how can I open the lungs? Sometimes I’ll do liver 14 lung one, also kidney 27 pointed out just to really open, physically open the flow of.

The chest, allowing the person to feel more. Sometimes we need to use sky points because again, the person’s energy is stagnated. They’re not in touch with their spirit anymore. I enjoy the idea of using something like Pericardium three, heart five, heart seven. That way again, I am opening up the heart protector because

Longstanding grief can definitely start to affect the pericardium because its job is to protect the shen. So sometimes going straight for the heart pulses, going straight for the heart channel with people isn’t the best choice because their shen is tender. So approaching it from the pericardium and then moving into the heart sometimes is a better

Option but the main goal is getting the lung and large intestine channel open so that it will flow over to the other kidney side. So again, you might open kidney four, the low point on the kidneys to get that energy flowing, and the kidney is more likely to accept it and get consolidated and strong to help the woman through this fertility challenge.

As I said, we can use the low points kidney four. The, at this time the person and the kidneys might be in a . Protective mode. So opening up the kidney pulse is very good for that. I want to thank you for watching. I also want to thank the American Acupuncture Council again.

Also you can see my teaching website is lucas teachings.com and my private practice site, which as I said is my . Clinics are located in Denver and Littleton Colorado is acupuncture woman.com and feel free to contact me if you have any questions. .


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Are You Setting Yourself Up for an Audit?



Obviously, no one wants to be audited for anything. Let’s face it. No one wants to go to the I R S and be audited, but what I will say is, often the people who try to bring this up often do it in a way that they’re ultimately just trying to scare you..

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 there everyone. This is Sam Collins, the coding and billing expert for acupuncture for you and of course with the American Acupuncture Council. We’re gonna talk today a little bit about something. I know many of you hate to hear the word. In fact, it’s considered the a word audit. I’m in trouble.

What’s happening. Obviously, no one wants to be audited for anything. Let’s face it. No one wants to go to the I R S and be audited, but what I will say is, often the people who try to bring this up often do it in a way that they’re ultimately just trying to scare you and trying to elicit a response of fear so that you do something that they have like they’re the magic.

Clearly. I. Audits can be a problem, but I wanna talk about it from a standpoint. Is it really as much as people say, and are there some things that may make you more vulnerable, less vulnerable? Let’s get into that part of it. Obviously what occurs is many times an insurance company is simply looking at what you have billed and whether or not it was documented.

This doesn’t have to be insurance though. This is where people often have some misgivings. Quite frankly. If you’re doing a cash patient, there’s a complaint. They’re gonna look at your notes to see did what you say you did happen in the notes. And really, that’s all it comes down to. I’ve not really seen a lot of audits for their coming back for medical necessity, and I’ll never say that doesn’t happen.

But most often for Accu is, Hey, you build out something. Did you do it? And you have to think of what causes this? Why are they looking? I will tell you, in many instances, UnitedHealthcare recently seems to be the one that’s doing this the most, and I’m finding that often, to me, it appears they’re doing it because unfortunately, acupuncturists generically have some pretty poor documentation habits, and as a consequence, it’s low hanging fruit.

If they look at your notes. It’s not documented well, and I wanna make sure that we prevent that ’cause what triggers them to look at it, why? And often there’s these little triggers that happen. But let’s talk about it from this standpoint. Who protects you? You’re protecting yourself to start, but then you may have someone else behind you.

Like obviously I’m an expert and if you work with me in the network, I would wanna audit your notes myself to make sure they’re okay before even someone looked. But let’s talk about malpractice coverage. Obviously you all have malpractice coverage and the main reason you have it is just for that malpractice.

Frankly, there’s not a lot of malpractice, and I’m not saying it never happens, but it’s actually pretty rare. That’s why for the most part, your coverage is so low. But one of the things I want you to think of is do you have coverage for other than just malpractice by example, the most common thing I see an acupuncturist looked at for are gonna be either from the board.

Or it could be from an agency including an insurance on the documentation of your services that we call an audit. If you’re with American Acupuncture counsel for insurance, do you know it’s included up to $30,000 of defense, meaning they bring in attorneys of people to protect. You realize, invariably when I see an office audited and an insurance company has said that it’s not proper, most often it is.

Once we can work with it, or even if it isn’t, I wanna work with you to make sure, is it, and that’s how I’m gonna focus today, a little bit on that part of it, how to make sure that if you are audited, what do you need to do, but what things can trigger it. So let’s talk about the first thing that triggers someone to maybe want to look.

And frankly, it comes up when you bill something that’s unusual or out of the ordinary. In other words, if you’re floating in the middle of the stream, you’re okay. But if you get to the outsides, things can get a little bit trickier. Probably one of the big areas is your exam codes or evaluation and management codes.

What code are you choosing? Acupuncturists often will choose high level codes, which can be appropriate in many instances, but we wanna be careful if your style. Is to spend an hour with every new patient, meaning you’re billing a 9 9 2 0 5 every time. That’s a little unusual, and that’s not to say you wouldn’t have some, but to spend an hour with every patient seems a little bit odd.

Clearly, as an acupuncturist might you have a patient you spend more time with on average, simply because maybe they’ve been to two or three other providers, they have a long-term chronic condition. That history of evaluation may take longer, so certainly could be appropriate, but not everyone think of it simply.

If someone has chronic low back pain, surgical candidates been to a chio, a pt, medical doctrine, all of those things, I would bet that exam takes longer ’cause just the history of information they need to give you. Comparatively though, if someone has a hangnail, I wouldn’t expect that same type of exam.

So be conscientious. What triggers an audit or someone requesting records is when something is unusual. If you are billing a high level e and m code on a regular basis, you have a greater tendency for someone to look. Now, if you are doing that exam and can justified, I’m all in, but realize you become vulnerable.

So if you’re billing with that pattern, your documentation may be better in order. Because chances of someone looking at it means they wanna see and does it fit by example? Have you ever audited your own records? Like when you bill a 9 9 2 0 5, have you ever looked at the notes and said, do these notes meet that level of coding?

Did I have the medical decision making? Which is probably not, we don’t see things that severe Or do I have the time that justifies it? And often I found it doesn’t. So I want you to start to look and go, let’s make sure if I’m coding it, lemme make sure I know why. I’m picking that e and m code, and I would say that even applies with a 9 9 2 0 4 2 0 5.

The other place that runs into a problem is just the frequency of an exam by example. A lot of people come to me and say, Hey, Sam, how often should you bill for re-exams? And this is across the board. Really, even if you’re not an acupuncturist, a chiropractor, a medical doctor, is expected that re-exams are about every 30 days for recurring care of a patient’s condition.

If it’s sooner than 30 days, that’d be a little bit like why now? Could there be reasons for it being sooner than 30 days? Of course. What if you’re seeing someone for headaches and neck pain and then they come in on the next visit and say, Hey, last night I tried to list something. I twisted my low back, I felt a pop, and they have low back pain.

Sure an exam is appropriate ’cause it’s a new condition or new complaint. But if it’s to deal with the same area, chances are not until every 30 days. So be conscientious. What insurance companies do and what everyone does is just look at an algorithm. How often is something being billed and where do you fit with your peers?

If you fit outside the norm, someone’s gonna think we’re gonna take a look by example. Blue Cross sent out letters. Blue Cross Blue Shield sent out letters to many providers last year. On that factor about the frequency of the codes for E and s, but also the frequency of acupuncture. In the letter, it doesn’t say that you’re doing anything wrong, but it says your numbers are above the norm.

We want you to look to make sure it’s justified. To me, that’s a warning that an audit is impending. Now, I don’t care about an audit so long as we’ve documented and have the reasons, but I prefer not have to go through it. So high level e and m codes are just a very great frequency, is definitely one trigger.

So keep that in mind. If you have exams done every 30 days for ongoing care, you’re billing oh threes with an occasional oh 4 0 5, I think you’re gonna have no issue. The other area is just the sheer number of services you provide. Now for acupuncture, as I’m sure many of you are aware, you can bill up to three sets that are payable, and I haven’t found too much of an issue billing up to that number, however, Keep in mind if you bill everyone three sets, no matter what, that may be your style or technique, but be conscientious.

That shouldn’t. Some people have less or more. Now, I’ll never take away if that’s the style, but keep in mind when that number is higher, it’s gonna afford someone to look. Now, I do not care if you build three sets, two sets, whatever. Just make sure it’s documented. The problem I find is that many acupuncturists are never taught properly.

The documentation. And remember, documentation of Accu Acupuncture requires two things. You have to document the time. This is the time with the patient, and realize that time is soon as you walk in the room and say, Hey, Mrs. Jones, how are you feeling? That starts the time. It includes also tongue and pulse and evaluation, day to day-to-day, but also sterilizing your hands, preparing the points, choosing marking, inserting needles, all of those things.

So document that along with what points you have done. If you have that, we’re okay. Unfortunately, I’ve seen a lot of offices that don’t document that they may document one way off the other. So if you’re going to document acupuncture, remember it has two things, time and the points of each set, and they must be separate.

The time a person resting on needles without any active part to acupuncture does not count, but the active part of it and realize that takes a lot more time than people realize. It’s not just the point of inserting the needles. But all the things that lead up to, into, and the removal. So make sure that’s documented.

But again, if it’s more than three, so be it. There are, most plans won’t cover more than three, so if you do more, that’s fine. It doesn’t really matter. Just make sure what’s there is documented. The other trigger, of course, is just the sheer number of visits that the patient has. If you have a patient with an uncomplicated condition that you treat for a very long time.

The chances are someone’s gonna eventually look and go, is this care working? Why is this person continuing? Are they getting better or not? And again, it doesn’t mean it’s wrong, but they’re gonna start to question the efficacy. I would say start thinking of when you say someone has a stagnation or a chief stagnation, think of that as a functional deficit.

As they get better, the she improves, which means the function improves. And if we’re demonstrating that, I think medical necessity becomes a lot easier, but length of care can be a factor. But what about length of care? Depending on the condition, simple, low back pain, I would expect not to take too long.

But what about some of that’s had chronic recurring low back pain? That’s a little different. Maybe they have more complicated conditions. Maybe they have a disc injury. So there could be factors that are involved within that. So keep in mind, all I wanna make sure is that if anyone ever looks at your notes, they’re justified.

Let’s face it, people think all the time that’s only gonna happen with insurance. No, it doesn’t. If a patient makes a complaint to the board or has an issue, the board is always gonna want your records, and the board has certain standards that must be met regardless of insurance billing. So please be careful.

Don’t think because I’m billing cash or getting paid by cash, my documentation can be sloppy. No. You still have to have the same detail to indicate what services were provided. You can’t just do, I did acupuncture and it was $75. So give me a little bit more. The other factor is just number of services, and I’m talking generally, I talked a little bit about acupuncture, but what about additional services?

If you’re doing twin on gu sha cupping, those are all fine, but what if you have a person, you’re doing eight things on a visit? Does that not seem maybe just a little excessive? I’m not saying it absolutely is, but that would be unusual. Unusual things get looked at. Now, unusual on an occasional basis.

Everyone gets that unusual on a consistent basis means what’s going on in your office. That’s different. What I prefer to do is flow in the middle and when you get outside of it, if someone looks no big deal. One of the things I do with our network members when you join is I audit you. One of the requirements is I wanna see a sample of two or three claims from you, whether cash or otherwise to see are the things you billed for.

In the notes, because here’s what I found. I had an office once that had an audit, and the notes they requested, quite frankly weren’t very good. The insurance company was coming down on them, but because they’re with American Acupuncture Council Plus with me, we went back and said, yes, actually, we did an audit of this office six months prior and we found certain deficiencies and we have them correct them.

To include all the things they needed. Do you know they didn’t have to pay anything back in that audit because they showed there was compliance that, yeah, that older claim had that. But take a look at a newer claim where you can see that it was fully documented. Realize sometimes you’re just not doing things because you didn’t understand what was necessary.

If you show that correction can probably make all the difference in the world, and I see that happen way too often for you to not feel panicked oh my God, I’m gonna get in a lot of trouble. Most often, they’re just looking for you to be compliant. We see it with the VA and other plans, they just wanna make sure if they’re paying for something, that the person got it.

So if you’re doing a lot of services, great, document it, but also give me a reason why it can’t just be that’s what I do with everyone. No, it might be, that’s what I do with everyone with this particular condition. But not one that has a hangnail and a disc injury. You get my differences there. So thinking this way, don’t overly panic about an audit, but realize anytime anyone looks at your notes, they’re being audited, they’re looking, let’s make sure they’re in place.

So here’s some things that I wanna make sure that you’re doing. So let’s go to the slides, let’s talk about them so you can get a little visual of it as far as what’s happening. And you’re gonna look at what things are gonna trigger. So let’s get to the slides. I’m hoping my slide person is there to bring those up.

I’m not seeing them yet, but we’ll start there. I’ll wait for them to come in. But one of the triggers, as I mentioned, is gonna be high level evaluation and management codes. So keep in mind if you’re billing oh fours or oh fives, you have a greater chance of someone looking at you, which I do not care.

Just make sure they’re documented. So if you’re billing a 9 9 2 0 4. Or 2 0 5. What are the main things you’re gonna need to have? Remember exam codes are based on medical decision making or the time now medical decision making. I don’t think an acupuncturist is probably gonna see a condition that meets the medical decision making for a 9 9 2 0 5.

I’m not gonna say never, but very unlikely. ’cause you don’t see life or death things. However, what do you meet Time there could be a patient, let’s face it. That’s been to all these doctors that I mentioned. It could literally take a 45 minute interview plus an exam that takes an hour, so that certainly makes sense.

The same with the 2 0 4. Remember, that’s 45 to 59 minutes. Now, as an experienced acupuncturist, often once you’ve been around a while, do you really require that you spend an hour? I think in many instances, not don’t be overly concerned of, I don’t meet the medical decision making, but the time is there, which means document time.

Tell me how much time did you spend on this exam? If you’ve done that, you’re covered. Now be careful if you have an exam that you said you spent an hour and I see a half a page of information, I would go, how did that take an hour? That would seem unusual, but keep in mind, what if that person was hard of hearing?

There could be other factors, part of it. So high level e and m codes, and I’m hoping can someone go to the slides for me? The next factor is just simply evaluation and management frequency. Are you billing exams too frequently? I’ve had acupuncturists that mistakenly would bill an exam every visit. That is not appropriate an exam.

Every visit is not, it’s about every 30 days. So a lot of people think I can bill one ’cause I have to evaluate. Of course you do have to evaluate a patient each time, but the evaluation you do on a day-to-day visit is part of the acupuncture. . When you bill an e and m code or an exam, that’s when you do the big full thing.

So think of every 30 days. If it’s any sooner. Always do this check if I’m doing it than sooner than 30 days. Do I have the reasons behind it? In other words, do I have new condition, significant complaint, or change without that rethink and go why am I doing that? The next factor is greater than three sets of acupuncture.

I am all in and I have some acupuncturists that are mad and say people shouldn’t even do more than one set. I will never get into that argument. You do what you feel is necessary. Just bear in mind when you do more sets, someone’s gonna look and go, why is this always doing more sets? Nothing wrong with that.

But if you’re doing three sets of acupuncture, let’s remember what is the minimum you have to have documented? You must have 53 minutes of face-to-face time and no single set because there’s three is less than eight minutes. . So make sure the time matches and you have documentation of time and points for each set, and that’s the face-to-face time doing the acupuncture.

The other thing is just plain acupuncture documentation. Please take a moment to look at your notes and see that you have those two elements. That’s not really that hard. I wish the schools did a better job of teaching it, but this should just basically tell you from the start, always tell me time and the points.

If you have that, you’re fine. Where I think we run into a problem is people forget that and all you have to do is document it invariably, and I’ve been around acupuncture for 25 years as a patient, partly, but also as an expert on the coding and billing. And I invariably find acupuncturists generally will always tell us they see patients longer than the average provider.

I agree. I agree. I see that too. However, what do you need to do? Tell me the time. Tell me the points of each one. If you have those in place, we’re gonna be okay. And then just about therapies. If you are doing therapies in addition to acupuncture, I’m all in. But let’s be careful of not having eight or nine units of therapies.

Try to stick with four or less. If you’re doing three units of acupuncture, I would stick with maybe no more than one or two things that are therapies outside of it. Not to say never ever. But again, on a regular basis, we are not trying to do everything plus the kitchen sink. Keep it in mind. But if you’re doing more than that, what do you have to have documented the services?

If you’ve done more than four units or services, good documented. But if I did four units a time service, remember now my time has to equal 53 minutes. In addition to that, if I’m doing even more than that, I might have to as much as an hour and 15. Keep in mind, I had an offices a few weeks ago that they’re being questioned.

That they were billing for more times than their office was open. They were billing out, 20 hours of services and you’re thinking, how can you bill 20 hours of service in one day? For this office actually was quite simple. There was more than one acupuncturist working in the office. And part of it, they weren’t showing which acupuncturists were doing the care.

So they always thought it was just one when there actually were three acupuncturists. That makes sense, but it was looked at. Now, once they figured that out, they were fine. But remember, you can’t do more than one hour of acupuncture in one hour. So you can do four units, whether you’re gonna do four units on one patient or divided up among two or three or four depending.

So keep that in mind. And then just remember, always look at long-term care. If you’re doing long-term care, I get it. . But if it’s an uncomplicated condition, why? Realize there’s gonna be a point of, is the care really helpful? Now, I’m a believer in palliative care. I think it’s important, but let’s remember that isn’t always what an insurance will cover.

And this is where with insurance, it’s a bit different. If a person’s paying cash, you do palliative care all you want. Just make sure they’re aware of what it’s doing. So keep in mind here will be the point document. If you’re doing an , make sure it meets the amount of time or medical decision making, either one.

I think it’s probably more, mostly time. If you’re doing acupuncture, document the face-to-face time and the points of each set. Not a big deal. Not very hard. Once you learn that your life will be easy. In fact, I would say for acupuncturist, your documentation is quite easy, but it’s not something that you’re doing if you’ve never learned it in that way.

So time and points, and just make sure the care plan matches complexity. Simple pain or simple problems shouldn’t take as long, but things can take longer. But there’d be reasons behind it. And that’s not always documented or reflected in the diagnosis because often you’re limited to just the symptom.

But realize in the notes, don’t be afraid to include all of the complicating factors. Even the VA talks about this. What if you have a patient that’s diabetic, they’re very overweight, they’re very deconditioned. I don’t care what you’re treating ’em for. With those three things on board, it’s gonna take longer.

Even though you’re not treating the obesity, not treating the diabetes, it’s still gonna complicate it. Not to think that maybe some of those things might get better if they’re in less pain. Maybe they can be more active, lose a little weight, and all those things. But keep in mind, there’s reasoning. All I want from you is simply when you’ve billed it, make sure it’s there.

I’m your advocate. Make sure that if someone looks at your notes, they can see what you’ve done. It’s documented properly. No issue at all. I don’t care if you’re audited, just document the services. No one can ever come back and say you should have only done two sets. Who says you should do what you do?

Based upon your experience and expertise as a provider, you might wanna say, what do I ever get a chance to have that looked at? Our network service does that. I would say definitely take a look. That’s what we do. We offer you a way of looking at that beforehand, and it’s just part of the overall service.

I have a vested interest in you. . If you’re not successful, you wouldn’t need continuing education. Therefore, why would I exist? Your practice is not surviving. I’m not surviving. So we’re gonna be your advocate. The American Acupuncture Council is always gonna be your resource. Give us a call, make sure if you need help, we’re here to do that.

Until I see you next time, document. But take care of your patients and do well, my friends.


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Grief and Fertility Challenges Part 1



Grief and fertility challenges. So even when the end is having a healthy baby for many couples, there is a long struggle to conceive, and it can take a really brutal toll on people emotionally and physically. Women who are undergoing assisted reproduction treatment.

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, this is Dr. Martha Lucas, and I want to thank the American Acupuncture Council for sponsoring this. Webinar on grief and fertility challenges, and we’re gonna talk about how grief can negatively affect fertility and how to help people. In my practice, this is one of my specialties. I have practices in Denver, Colorado, and Littleton, Colorado, and teach online also, and love to teach.

So I’m so happy to be here. So let’s go to the slides. Grief and fertility challenges. So even when the end is having a healthy baby for many couples, there is a long struggle to conceive, and it can take a really brutal toll on people emotionally and physically. Women who are undergoing assisted reproduction treatment.

Have so many emotions during this time, and many of them don’t become pregnant anyway, so there’s the grief about that. And then there are many who experience a pregnancy loss after their treatment. So all of this can lead to prolonged grief and mourning. Women may live with melancholy mourning throughout their fertility treatment.

So from start to finish because they start out with a little grief that they have tried to do natural ways to try to get pregnant and haven’t been able to do it. They desire their lost time as a pregnant. Woman, which interestingly enough can even happen to the women who have a baby because lots of I V F or assisted reproductive technology babies aren’t full term.

Some are born . Much more early as a preemie. And I have treated women who perhaps have to have an emergency C-section at 27 weeks, 29 weeks, 30 weeks, and they literally do mourn not having to have that whole 40 weeks as a pregnant woman. And it’s very interesting to treat them through that grief because

Even though they have a healthy baby, they bore a baby. They really do regret or grieve that they didn’t get to have that full term as a pregnant woman. If they don’t get pregnant, they miss what they call the lost love of a child. They mourn what they think of as a lost future, and some of them just as a lost role as a mother, they go through what

Can be described as an agonizing exertion of mourning because it’s hard mourning. Experiencing grief is a very hard emotion that sometimes you feel like you are never ever going to get over. Sadness can manifest in various ways. It can be just a mood that sometimes you have and sometimes you don’t.

It can be more severe sadness. It can be paralyzed thinking the person has a hard time even getting out of bed in the morning. It can be even. In extreme cases be delusional, but the common denominator for grief and fertility challenges is loss. The loss of having a baby, the loss of having the love of a child, the loss of the future that maybe you have thought about.

I. Since you were a younger woman, Freud’s description would be a state of desperate longing for reconciliation with an object or a person that is lost. Again, there’s that common theme of they have lost something I. Such women are not diagnosed with major depression. It’s not like they, oh, you have major depression and here’s your antidepressant.

It is more like a non, what we call a non ailing, productive and culturally accepted reaction to loss, or the fear of loss. Because remember I said some women go through this kind of sadness or grief throughout the whole . Fertility challenge throughout all of their work that they’re doing and all the procedures that they’re having.

So that’s the fear of loss. Now, we’ve discussed before in a webinar how fear scatters kidney energy, and we never wanna see that. We have, we must, in order to get pregnant, we need to have good, secure, solid, consolidated kidney energy. So this fear of loss that’s along with the grief also can affect the kidneys.

and then these women are constantly reconstructing their self-image as a woman, as a mother, or potential mother, and even as a partner because their partners are very affected by their emotions. Again, as I said earlier, some women who are receiving fertility treatments experience consecutive pregnancy losses.

For some, they never have a pregnancy loss or a miscarriage For others, there may even be more than one. I think we’ve all treated women who’ve had . Two miscarriages, three miscarriages. I’ve treated women that have had four or five, or even six miscarriages, and this also can lead to prolonged grief in both the woman and the partner.

Deep sadness, depressed mood, irritability, worry, anxiety, they can have changes in eating, changes in sleeping patterns. All of those are part of the normal grief response, but they can all be very disruptive to your regular life. Now, although grief is a natural non-pathological phenomenon, it can lead to complicated, more complicated grief reactions where the symptoms are more disruptive or pervasive or long lasting than what we call normal grief.

And as a practitioner, we need to realize that prolonged grief can interfere with the healing process so it’s can therefore interfere with the fertility. Process with all of the treatments and it’s going to affect their general quality of life. Could lead to substance abuse and increased risk of suicide.

And as I said, it’s can, especially according to our medicine, where we’re looking at the pulses and we’re looking at all, all the organ systems communicate with each other. Prolonged grief can interfere with the conception process. And they’re coming to us to help them create what I call a warm, fertile environment so that they can conceive.

These women may also feel like life is meaningless. They doubt their own identity or role in life again, because part of their role in life was to be a mother, and now they are having to look at that differently. And then when we’re looking at the woman, we need to look at the intensity and the duration of her grief symptoms.

A very common social factor that contributes to the grief is when the loss is not talked about. For some reason, this particular type of grief is sometimes invalidated. It’s like . Doesn’t count. Oh, you had this procedure, maybe it’s not gonna work, and then it didn’t work. So it’s just a part of the process.

That’s not the experience of the woman or the couple going through the process. To them, it’s a great loss to them. It’s, we’re trying this procedure. Oh good. We had a conception. And then of course they’re gonna be excited. Their excitement is still attenuated by worry and anxiety, but it’s. Still something that looks like it was successful, and then when it’s not successful, they’re going to have grief about it.

But as I said, sometimes this loss is something that people just take for granted, Hey, it can work, it might not work. And then the woman feels like she can’t talk about it. And then you have internalized grief. And as we know from Chinese medicine, the masters used to say that emotions caused all physical disease.

And when I first heard that . Over 20 years ago, I thought emotions cause all physical disease, but then as I started to take more and more pulses and listen to people, I realized that yes, absolutely what they meant was the emotions. Cause . Patterns in the pulses in the energetic system that then leads to physical disease because of blockages or deficiencies or excesses that the emotions cause like excess heart fire.

So it’s. Interest. When I was in graduate school and my school had two arms in the psychology department, research or clinical, I was like, oh, I don’t wanna be a clinical psychologist. I don’t wanna spend eight hours a day talking to people about their emotions. And now that’s what I do. So it’s interesting how the world turns.

So for some women, treatment can be apparently an infinite . Cycle of these things like try one, it didn’t work. Try another one. It didn’t work. Oh, first we’re gonna try the . Ai. Okay, that didn’t work. So we need to move up to something that’s a little more technological and move up and move up.

And remember this is involuntary absence of motherhood on their part. They thought, women get pregnant. I’m going to, wanna have a baby. It’s gonna be easy. And they’re, this is involuntary for them. A lot of women feel like they don’t have any control over this Also, interestingly enough, cognitive and emotional impacts of all this, like sadness and fertility treatment are linked to the maternal fetal attachment.

That’s the emotional bond that an expected mother develops with her unborn baby. And this is another reason why it’s important for us to diagnose. Pathological grief quickly. I have had women who’ve had a struggle getting pregnant, managed to, had a successful birth, then get pregnant again, and they go right back into this cycle.

And I’ve explained to them, you are creating an anxiety. Commitment connection with your unborn child instead of the emotional bond of being calm. I love you. You’re my child. If you continue to be anxious and sad worrying that you might have a miscarriage, when at this point you’re not having any symptoms of a miscarriage, And the development of this grief can be over a number of factors.

They get sometimes, depending on the bedside manner of their medical professionals, they can get . Messages that are really a little bit overwhelming. Your ovaries don’t work. Your partner’s sperm aren’t good swimmers, or they’re poor swimmers. What’s they get these diagnosis, like I say, fertility challenges because I feel like infertility is a damning.

Diagnosis. It’s like you’re infertile. That’s why I say fertility challenge. You’re experiencing a challenge. They have to go through the tests, the procedures, the waiting. There’s so many things for them to obsess about. Like any grieving process. And the five stages of grief that are mentioned by Kubler Ross.

Grief over infertility can have those same stages. Denial. That must be the wrong diagnosis. The doctors can’t be right about that. It must be my partner. Some people even blame the tests. We all know that there are, there have been lab tests before that didn’t have the right result. They, it must be a defective test.

Anger, I see this a lot too. She didn’t even wanna get pregnant and she is. Oh, I’ve been trying so hard to have a baby and why is it so easy for everybody else to get pregnant or everybody else seems to be pregnant, bla, being angry that you didn’t start earlier. Like, why did we wait for our careers to have a baby?

Then there’s the bargaining that they’ll do anything to get pregnant. There’s the depression stage. Nothing is going right. I’ll never get pregnant. My best friend is pregnant and I can’t even be happy for her, or I was invited to a baby shower, but I can’t go because it’s just . Too sad for me. And then acceptance.

It is what it is. We’ll just keep trying. I’m sure we’ve all treated women who’ve gone through cycles and cycles of treatments, and then finally just say, you know what? Whatever I’m done. I’m going to take a rest. We’ll see what happens. Now I have to say, I wish I had time to do a retrospective study of those women because

There’s a certain percent that get pregnant after that. And now from a Chinese medicine perspective, why would that happen? It would happen because they relax about it. So liver cheese stagnation gets resolved, their blood can flow better to the uterus, their bowel eye isn’t blocked anymore because they’re not so anxious, and their body literally opens up to the idea of pregnancy. And I think from a Chinese medicine perspective, it’s because they just give up and their body goes back to feeling more normal. Couples might experience loss after an unsuccessful treatment cycle, and then they are faced with the decision of, do we do the same thing?

Should we continue the same procedure, do a more complex procedure, or just move beyond ? Again, move on to the acceptance. We’re probably not gonna get pregnant stage. And then speaking of couples, infertility treatment is taking a toll on both partners. It’s not only a bunch of invasive procedures for the woman, it’s an emotional roller coaster for both of them.

Some people, some women do report that the couple are doing it together. Like I see the couple in my practice, I don’t only see the woman, I see the man and the woman because, I believe that they are doing it together for one thing. What if the male’s dmai is blocked? Then he might not be a great conception partner, so you do need to see the man also to make certain that his systems are all working well.

But unfortunately, some women do report that. And men, they have more fighting. They get a little estranged from each other, and that the treatments are having a negative effect on their sex lives, which is another loss for them. So they have the side effects of the hormone therapy, decrease in libido, mood swings, body changes like dry vagina and sensitive breasts.

All of this makes the intercourse experience less pleasant to the point where some women . don’t have sex anymore after they have the baby, just from the trauma of the pre-pregnancy. Challenges with that. And then they have another thing to mourn. They have grief about their pre infertility sex life, the emotional stability that they used to have with their partner and the harmony that they used to have with their partner.

One woman told me that she had just lost too much. Through the whole procedure, her loving husband, because their relationship was negative, affected her healthy body. She felt like her body just was completely destroyed by all the treatments. She says she had a great life before all this, and now after she had her i b F, she had a, has a daughter.

But her grief about her pre infertility, what she calls her pre infertility life, still continued. We’re gonna end here for today. . And I wanna again, thank the American Acupuncture Council for this presentation, for hosting this presentation. And next time we’re going to start with talking about the woman who has had a successful birth, but still is suffering from some grief.

And we’ll go over how you can help her using Chinese medicine. .



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3 Things to Keep Your Practice on Track



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.

Hello, and welcome to another episode of To The Point. I’m Dr. Nell with American Acupuncture Council. Thanks everybody for being here, and let’s go to the slides today. We are going to go over . Three really simple, effective, very quick things that you can be doing to keep your practice on track. Played with the title a little bit of this because I wanted to tell you they can be done in less than five minutes.

So I think we go through a lot of misconceptions when we’re running a business. It’s hard to stay on track with things we think that. We have to analyze everything that we have to, have this whole system in place that’s gonna take us way too long, every day. And so what ends up happening is we end up having reasons that are silly, that we don’t keep our practice on track.

And it doesn’t have to be that complicated. But the reasons we’re not doing this, it really is that paralysis by analysis. We don’t know what we need to look at. We’re looking at too many things, trying to make this way too complicated of a. Or we’re not prioritizing. One of my coaches once told me that if you have more than three priorities, you don’t have any priorities.

So we have a hard time narrowing that down sometimes, and sometimes there’s a very real reality to this of capacity. So we’re focused on our day to day. Sole proprietor, small corporation, trying to make sure that the absolute necessities get done in our business. And so if we’re not focused on some of these just anchor practices that don’t take us very long, but can be really helpful, really effective for staying on track with growth, we don’t get to the point where we can enjoy scaling or enjoy taking some admin off of our plate.

And so today we’re looking at three really simple things that you can do. They take less than five minutes each, so we’re looking at less than 15 minutes a day to make sure that we stay on track with this. So the first one is highs and lows. Sometimes you may have heard this referred to as roses and thorns of your day.

Pros and cons of your day. You can take less than five minutes a day, and sometimes you’re gonna have to search for something because we have a tendency to overgeneralize when it comes to our day or when it comes to themes that we had throughout the day in our practice with patients. So we might say, oh, it was a really challenging day, or, wow, I killed it today.

But to really drill. Scroll down into that in a short period of time and just say what was really one high of the day and one low of the day. And that’s going to allow us to then take data from that and say, all right, if my high from the day was I stayed on track with timing, then we can look at what things did I do differently?

To stay on track with timing that made that really successful, or if the lowest today was like I was always running behind. Are there ways that we could have accountability in that and could tweak that a little bit? So it can be something just as simple as what’s one really positive one area of improvement that we can make, but just a quick check-in with that on your highs and lows every single day that you’re practicing.

And then you can implement this weekly as well, right? You’re gonna create two lists as your second thing so fine. Two can have an A and a B. So maybe this ends up being four things total, but you’re gonna have two lists that are gonna help keep you really on track. And this says, who owes me and who I owe.

This is not favors or anything like that. This is your task list. Things that you said you would get to people. Maybe it’s a list of therapeutic exercises that you were supposed to get to a patient. Maybe it’s that a patient was supposed to send you lab work and they didn’t, so you’re gonna have two running lists at all times.

That’s going to be who owes me something that I need to check in with, and who do I owe something to? And so this keeps you accountable every single day for that quick check-in. And with the who owes me something that could be as simple as shooting something through your patient portal. Oh, I wanted to check in, make sure nothing fell through the cracks on this end, because I’m seeing that your labs didn’t come through.

That quick check-in with a patient does so much. It allows them to know that you’re thinking about them, that they’re still a priority in your mind, even though they’re not in the office at that moment. That can have a huge ripple effect. Just that quick check-in and it helps you keep on track because you were probably needing to do something.

When you get that, who owes me something? The who I owe. Same thing. Go through your list and what can you knock out at end of day or first thing in the morning, however you choose to implement these three things throughout your day, whether it’s at the very beginning or at close of day. I like doing both.

You’ll get to that point taking that five minutes on either side, but this helps you have that running list so you know really what your priorities are for the day. And you can look in order of magnitude, who do I need to reach out to first? Who’s owed a status update from me? Who do I need to send things to?

This really helps you stay on track and allows things to not fall through the cracks. And the last thing is one person to outreach to. And I wanna challenge you to make this a different person from someone who was on those two previous lists. So if it’s someone that you were owing something to, or they were owing something to you, I want you to try to think outside of that.

I want you to try to think about someone who you can add value to, someone who could be a good . person to add to your care plan for a patient, another provider that you wanna keep in better contact with a colleague that you could send a quick article to. So again, thinking about it in these five minute brackets, one person you’re gonna outreach to help in that day.

And that might be by sending them content. It might be just checking in with them and see how they’re doing. . It might be, you can have a running list for this too. One of my leadership instructors calls it a drip list. So people that you wanna continuously keep in contact with and make sure that you stay updated with them.

So really, those are the three things that are going to, in less than 15 minutes a day, allow you to stay on track. It’s nothing complicated whatsoever, and it’s simply. What are my highs and lows for the day? Not thinking in general terms. Get really specific with this, and then you can take action items from that for improvement or things that you wanna keep doing because they’re going really well.

The second thing, being those two lists, who do I need to get things to and who needs to get things to me? And make sure that we’re constantly working those lists every day. So things. Don’t fall through the cracks. And that last thing being who am I adding value to today? Who am I staying in contact with today?

Who am I continuously cultivating a relationship with? And pick that one person to outreach to that is not gonna fall into one of those other lists that you needed to keep track of those three things. Help you stay on track in less than 15 minutes a day If you have further questions. You all know I love efficiency hacks, simple and effective ways to keep practice on track.

I hope this has been enjoyable for you. Feel free to reach out to me with any questions at a c and don’t forget to tune in next week for another episode of To the Point. .


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3 Tips to Boost Your Practice in the Summer



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.

Has it been slow in your practice this summer, or maybe this month tends to be a slow month for you and you would like to get ahead of that, so because you’ve been experiencing a dip in your practice or concerned about it being slow, typically this time of the year Today I’m gonna share with you three hot tips to boost your practice in the summer.

This is Chen Yen six and seven Figure Practice Makeover Mentor, an introverted visionary where we help introverted visionary acupuncturists and other holistic health practitioners with growing their practices to be really fulfilling and consistent as well. So that way they could just focus on helping people instead of and also changing the face of our healthcare system.

Instead of worrying about where to find patients. And then for our our clients who are at a stage or practice where they’re already busy, then we help ’em get to a place where the practice runs more without them or bring in another few income. So I’m your host for the a c show today, and I’m super excited to share with you these three hot tips.

So what do you, what have you noticed is. People just end up not coming in. What could you actually do? So the first hot tip is to send out an email that or more than just one email. ’cause have you ever had the . Experience of where even some of your patients come in for one thing, but they don’t even realize you can help them with other things.

So how could you educate your patients on how you can help ’em with different kinds of health issues? Or perhaps you have other kinds of service offerings within the practice that they may not really know about or be as aware of. And how can you educate them more about those other offerings or how acupuncture or Chinese medicine can help with certain health issues?

So what do you actually come up with to send and. Many times I, what I often hear from a lot of acupuncturists as well I end up racking my brain or I feel like I don’t really have time to come up with things and, or I’m, I don’t have any a email software thing, so then I just don’t.

Don’t do it right because that’s just ends up getting tables as a on the back burner and never ends up getting done. But if you are slower in your practice or if you would just love to have something automated. ’cause imagine if whenever you were slow, you just had certain emails that were automated that you could.

End up using to educate your patients for potential patients, perhaps those who have inquired about your services, but then they didn’t end up coming in. And I’ll share a little hot sip related to that. Like how do you actually get their email address right? You’ll share that with you here in a moment.

So as far as the email that you send out a couple of hot tips related to what to think about with, what to send out that I’m gonna share with you from our new patients from email system that our clients use. Is that one. Ideally vary the length of whatever you send out. Have you ever felt oh my gosh, I get so many emails , and do you ever notice that you don’t open every single one of ’em, but if they are your patients, likely they will open like you’ll have a decent kind of an open rate because

You are their practitioner, you’re their, your health a healthcare provider. For them, it’s very different than them just getting some random kinds of emails from all kinds of different things. So first of all, your emails are more likely to be open anyway, but. Just because there are a lot of people who get a lot of emails, how could you end up being an email that people look forward to getting?

So one hot tip is to vary the length of your email. So sometimes super, super short. It might just be a couple sentences. So one type of email you could look at sending might be a very more personal ish feel, an email. And and checking in on how things are going for them and with their, what they had come in for from before.

And then bring up that, that, whether it’s time to schedule and another visit, or in case they come across a, someone they who’s dealing with, x, y, z kind of health issues. Then in case they come across one or two people who are dealing with X, Y, Z kind of health issues, feel free to. To also share with them, to let them know about the practice.

So that’s one kind of an email you could look at sending to help increase patient flow into the practice. Another kind of an email you could consider sending. Is what I talked about earlier, which is specific to a health issue. And maybe one, kind of one email you talk about at certain Like digestive kinds of issues or another email you talk about a different kind of of pain issue, like injury.

And some people may not realize the extent of how acupuncture can help with other things. When there might be a. A first aid type of trauma related things happening or or maybe supporting with pregnancy. Some people may not know about those things and yet you might help them with that.

Think about the different topics that you can educate your patients on. And then, so that’s one. One hot tip is sending out emails and I’ll, I promise to share with you what to do to also be getting emails from of people who maybe call your practice, but then they never end up booking. So what happens with those people?

Because maybe they, they call and they ask around and then they decide to do something else, but something else might change down the road and they could have a need for your services. And again, so it’s if you’re able to stay more top of mind awareness and continue to educate them until they understand the benefits of working with you, and also see if they resonate with you or not, then they’re more likely to come in.

So one thing that you can do, It’s before every single person who calls and doesn’t end up booking before, hang up the phone with them to say something like let me send you something that can be of help to you and with your, your X, y, Z health issue. And ideally if you had a good way of navigating the conversation with them, whether you’re having it yourself or your front desk person is having it, that conversation, then you would Have found out what they might be dealing with that made them decide to call you in the first place so that way you can end up staying connected and send them something that could be helpful for their issue right now.

And then you could end up, asking for permission to continue to keep them in the loop about updates within the clinic or other helpful tips related to different kinds of health issues they might, they or their family might encounter. So the second hot tip to giving your practice a boost when it’s slow in the summer is to think about how can you communicate.

Why now is an important time to come into the practice. So one reason why people may not be coming in is they go on vacation, they fall off the bandwagon, or they just are feeling, maybe they’re feeling Fine. And maybe feeling fine is okay for them to not come into your practice if that’s a part of your philosophy, but maybe what you’re treating them for, maybe they’re feeling fine, but they’re not making as much progress with the core health issues they’re having if they’re not getting consistent treatment or care.

So how can you convey and communicate to them why now is an important time and to come in to get that taken care of, whether it’s from a clinical perspective or. Overall with it should be from a clinical perspective anyway. And some, something to think about with this is, have you ever thought about how retail stores, they often have these different sales throughout the whole year?

I. Next time you, you see maybe a brand that you love and you end up buying things from them. Notice how often they do sales and what times of the year they do sales and what do they say about why they have the sales, right? So they’re all kinds of different holidays and all of a sudden, every, those kinds of places end up having sales.

And why do people buy? Because . The, those stores or companies are mentioning why now is a great time to buy because you’re going to be getting a significant savings or because it’s Mother’s Day and it’s, it’s a great time to buy a gift for your mom, or it’s for, upcoming. It might be labor Day.

And it’s, it is time to really give yourself a breather and and reset as you get into the fall. And it’s great time to come in for acupuncture and also bring your family for To, to get them back in the swing of things or back to school. It, so there’s so many things that you could think about why now is a great time to come in.

So think about that and communicate that in an effective way so that people are presence to how important it is to come in now, or or are inspired to come in. One for clinical reasons. Another could be also for, stress, relaxation and resetting or helping with other things tied into the season.

One of our clients actually brought in five figures in a month from supplement herb sales and using, like being strategic about how he was doing . Sales. And that, that can happen when, if you would love to share more about something you offer within the practice and also experience a boost in the practice.

And part of what worked well for him was highlighting why now is a good time too to be getting those supplements or herbs. The third tip. Oh, and another thing I’ll just give you a tip that you could use right away as well, is that if you’re experiencing a slow week or slow day, one thing you can do is to either post this up in, in your social media or email it to, or text your patients.

Something about how you’ve got a few open spots on x. Such date and such date. So you might say a few spots. I have a few openings on Thursday and on Friday. And you could give a couple spots. You can say, I have a couple spots opened up for Thursday and Friday. Such and such day and times.

You can give a couple of those times. And if you wanted to come in today, make give me a call and I can work you in. So then that way it presences people to the the idea that you do have open spots. ’cause have you ever had patients who have told someone else, they told you, oh, I told someone else about you, but then that person didn’t come in yet?

Sometimes it takes more than one time letting their friend know or someone they care about, know about your services because have you ever been to a. Have you ever had the experience of where a friend told you about a restaurant? They were all excited about it and you thought, oh, wow.

I should check that out. But what did you do? Maybe you didn’t check it out quite yet, right? But then you, your friend brought up again and then you ended up going. Or you heard about it another time and then you ended up going, so that can totally happen even if you have been told by your patients that they’ve referred, but then that person hasn’t come in yet, they could still totally come in.

So if you are letting your patients know about open spots, you could also bring up how they could let their, if they or a friend of theirs had wanted to come in, they can come in. And so that can also. Remind them of how they could mention it to their friend again, and that you have spots this week.

So that has also helped our clients, our acupuncturist clients, and other holistic health practitioners, clients with getting more patients coming in the door when it’s slow. A third hot tip to boost your practice when it’s slow in the summer is to be clearing out. The non-supportive belief that, oh, this time tends to be slow for me, and this is something that I often hear from acupuncturists and other holistic health practitioners is that comment.

It’s August tends to be slow for me. Everyone goes on vacation and. And in my first business, the one, I had grown to seven figures in less than five years. So in, I remember someone on my team, so she had owned her own business for, in the same field that, that my business was in for over 20 years.

And she would always say to me, December is usually really slow because everyone goes on vacation. And I remember saying to her one year, I said, , What if December was our busiest month? And what if other people who think that, they it’s really slow. What if we actually ended up helping those people who weren’t able to be helped by other people because, They’ve, , they had this mindset that it’s gonna be a slow month.

Let’s help those people. Shifting that belief and what happened that year, we had our biggest month in December. So just because other people are having slow months doesn’t mean that you need to have a slow month either. Part of it is energetically your underlying belief about what you What’s possible for you and what’s possible for other people as well, so other people can be slow and you could be the busiest you’ve ever been this month.

I hope these three hot tips have helped you and for more six and seven figure. Practice makeover tips. Go to introverted visionary.com and start putting in place just even one of these hot tips within the practice. I shared with you several possibilities and you can even just one thing put in place, can bring in a boost in your practice even when it’s slow.

Till next time. .


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Facial Cupping & GuaSha for Cosmetic and Neuromuscular Concerns



And I would like to thank the American Acupuncture Council for this opportunity to speak to you today about facial cupping and GuaSha for neuromuscular facial conditions.

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 Gellis and I am a board certified acupuncture physician. And I would like to thank the American Acupuncture Council for this opportunity to speak to you today about facial cupping and GuaSha for neuromuscular facial conditions. Can you go to the first slide please?

So a little bit about me. I am a former faculty member and clinic supervisor at the Maryland University of Integrative Health, and I was there for almost 20 years. And I’m currently on faculty, on the doctoral faculty at Yoan University in Los Angeles, California. And I teach facial and cosmetic

Acupuncture continuing education classes and have been for almost 20 years as well. So the, I wanna start out today by giving a definition for a neuromuscular facial condition. So what a neuromuscular facial condition refers. To is any group of disorders that affects the nerves and the muscles that are responsible for moving the face, our facial expressions, and also any sort of pain or neuropathy, any sort of dysfunction or abnormality that affects the neuromuscular system.

Which involves the communication between the facial nerves and the muscles that control the face. And our face is the only place on our body where the. Muscles are directly connected to the skin and as a result, we can move the skin on our face without having to move a joint or any other part of the body.

And this brings with it some very unique . Issues such as particular conditions, which can affect either one or both sides of our face and some of the more common . Common neuromuscular facial conditions that I’ve seen in my practice over the years are Bell’s Palsy and also any sort of facial nerve paralysis.

You’ll see this frequently, people who’ve had facial surgery or an injury, myasthenia gravis, which is a degenerative condition. Involving the muscles and it is almost always noticeable on the face as well. Hemi facial spasm, which is any sort of twitching or spasming of part of the face, T M J, which involves the temporal mandibular joint.

Trigeminal neuralgia, which is a very painful neurological condition involving the trigeminal nerve and posis, which when we’re talking about the face, typically involves one or both of the eyelids. So today I’m not going to go into depth about . Different modalities for treating these diseases or about the diseases themselves.

But I am going to talk about facial cupping and gua and how and why these two modalities can be a wonderful compliment to other . Things that you might be doing, your body points, perhaps some facial motor points, submuscular needling, scalp acupuncture, things that you might be doing to help the face to get back to normal functioning.

So here is just a couple of photos from some of my classes me teaching facial gu Shaw and facial cupping. So first I’m gonna talk about facial cupping and the benefits of facial cupping. Facial cupping helps to bring blood just like . Cupping on the body helps to bring blood and cheese circulation to the muscles.

Facial cupping helps to bring blood and cheese circulation to the muscles and therefore to the skin, which means that when the extra blood circulation comes up to the skin, it . Increases the fibroblast activity, and this will stimulate collagen and elastin production. So this is more of a cosmetic benefit.

I. But having that extra collagen can be beneficial. Also, if someone has had long-term paralysis and they’ve lost collagen in their skin and their wrinkling of the skin, doing the cupping can help with that. It also relaxes any tight fascial. . Fascia fascial tissue that is on the face. And by releasing and relaxing the fascia, the face can move more smoothly and function better.

Facial cupping and gua can release nerves that have become entrapped on the face sometimes. . Wi woven within the nerve, the muscle sometimes within the fascia. Cupping helps to move stagnant lymph out of the face, which can take toxins with it and helps the. Reduce inflammation, which can help the nervous system of the face.

It also helps with inflammation on the exterior of the skin. If your patient has redness, heat signs, rosacea, eczema can help with that. And also, just like with any cupping that you would do on a patient facial cupping helps to strengthen the vascular integrity of the face.

So this is a cross section of the cheek. And you can see here we have the skin and then some subcutaneous fat. And then below that is this . S what is called the SMA layer. It is the superficial muscular aporetic system, and this mimetic muscle helps to get the signals from the nerve into the muscle, out to the skin, and it is what allows the skin on our face to move below that.

We have and it’s invested in various tissue and surrounded by fat, and then below that we have a facial nerve. Then in some areas of the face, on the fattier parts of the face, we’re gonna have more fat and then more muscle. This is a picture of a fass of fascia. If you’ve ever taken let’s say chicken and you’ve pulled it apart, that really tough fibrous stuff that you have to cut with a scissor to get the meat off of.

That is fascia and what can happen, especially if there’s paralysis. But sometimes just with aging, the fascia can become very stiff. It can get moved into a place where it really shouldn’t be. It can pull down and . Nerves can get trapped in there by doing facial cupping and facial guha. You can help to break up some of these adhesions and allow for more free movement in the face.

The cups, when you’re doing facial cupping there’s certainly a lot of options for cups out there. The ones that I like are glass cups. They’re much smaller. You could see the size. I use these two sizes depending on where I’m working on the face. But the cups are . Glass. And the reason why I like glass over silicone or any of the other materials, plastic is one of the most important things when you’re doing cupping, is that the cups can glide.

You don’t wanna leave marks on the person’s face. You don’t wanna leave cupping marks. So it’s not like cupping other places in the body where the person is gonna be left with cupping marks. The cups have gotta be able to move and they have to be able to grab enough of the tissue to make a difference.

So they have to be large enough to actually get in there and get that blood and tissue moving, but not so big that they’re too big for the face. So these are the two sizes that I like. And then the rubber part of these . Cups. It fits well in a hand and is easy to squeeze if you’re doing a lot of facial cupping during the day.

If the cup is too hard to squeeze, then it could be very difficult. Your hands can get sore and no one wants an acupuncturist with sore hands, . The Guha tools that I like are made out of Jade and they have different edges on ’em. And when I talk about Guha in a second, I’ll go over that, but there’s like a use shaped section.

There’s a little nobby section on the tops, and then the sides are flat for working on other parts of the face. , there are some contraindications with facial cupping and gua. You do wanna be cautious if your patient has very high blood pressure that’s not controlled well. It can bring a lot of blood and she and energy up to the face and the head.

If the person is on anticoagulants or just has a condition where they. Bruise easily. This could be an issue because even though you’re trying not to make any marks on the face, I. When you’re dealing with the face, the skin is thinner, the tissues are more delicate, the vessels are thinner and more delicate.

So this is something you need to note. If the patient suffers from frequent severe migraines, then facial cupping and gu. Again, brings a lot of energy up to the face and head. It can be an issue if they have a pustule acne. You don’t wanna be running the cups over that. If they’ve had any sort, I. Of treatment done on their face, microdermabrasion, lace, or Botox fillers.

This is a big conversation and I go through, in, in my classes, I go through all the contraindications and all the different types of fillers, but basically in a nutshell, for the purposes of today, if they’ve had any sort of treatment done on their face. , their skin and their face has to be healed.

And in order for you to start doing cupping and you never wanna do cupping over an area where there’s been a neurotoxin like Botox ’cause it can make it wear off or move it. The, for facial herpes, I have never personally had . A person breakout, but it’s certainly a possibility. And then if they’ve had recent dental work or any sort of facial surgery, you want to be gentle maybe some light cupping, but definitely not using guha tools over the area.

So the symbols that I use in my cupping instruction for the slides that you’ll see, I have an X that I use for suction and release, and O if you’re just suctioning and then a line if you’re dragging the cup. So in this example, when you start out, and I’m not going to go through all the steps of facial cupping, but I’m going to give a few examples.

So the first thing you do is you’re going to do a lymphatic drainage. So you would take the cup and you would suction and release down the neck. When you get to around kidney 27 under the clavicle, then you’re gonna drag the cup. Over to the lymph node, which is right around lung two, and you would do this like three times and then you would move to the next area.

I always work on one side of the face and then the other when I’m doing facial cupping. The next would be a suctioning, and then dragging the cup over different parts of the face that have been affected by the paralysis. Now, if the person is having facial pain, like trigeminal neuralgia, you would not want to be doing cupping over the areas that are tender.

In this example, , If the person had Bell’s Palsy, you would be working the cups along the stomach line to help with any facial movement in those areas. In this picture I’m showing you can suction and release and you can drag the cups around the lips, stopping at different acupuncture points and stimulating them, and this is good.

For patients who have any sort of disharmony around the mouth, whether it’s neuropathy or any sort of tension in the mouth, and this can help to release. The orbicularis oris muscle for issues with the eye, things like ptosis, any sort of drooping with the eye, or any sort of inability to open or close the eyes.

You can work gently inside the orbital rim. You don’t wanna point the cup at the eyeball, but gently working around. The orbital rim in order to bring energy into this part of the face. And the orbicularis oculi if the person can’t raise their eyebrows or if the person has a lot of tension in their eyebrow, in their forehead, if they’re having any sort of

Twitching in this area. Then you can go to yin to and suction and then drag the cup up to do 24. Do the same with you Y up to gallbladder 15 and then San Joo 23 up to stomach ache. Next is facial gu sha for facial Gu Shaw. The benefits are that by doing the gu sha on the face, it helps to clear wind, which is part of the metal element and can help with the skin metal and skin, and can also clear the wind, which

Is involved with facial ticks. Also, it helps to expel fire and invigorates the blood. Harmonizes the blood. The Jade gu sha tools are wonderful. They are very much a part of Chinese medicine. I. Only use Jade on the face for this reason. Works with stagnant blood and also helps with microcirculation and does this by causing some microtrauma, which again helps with collagen production.

So here is that tool I was talking about. This is a Jade guha tool and has different corners, this U shape and then flat sides, and then these massage corners. For specific acupuncture points, the technique that you’re going to use are very large scraping strokes, so you’re going to do it gently, evenly, and steady.

I tell my students, you go for the gu, but not the Shah. You don’t wanna bring up all that redness. They’re not going to look like they’ve had Guha, but it will . If you work in one direction other than in between the eyebrows, you can go a little more vigorously, but you are going to release some of those fascial adhesions, really get into the muscles, stimulate acupuncture points, and this is wonderful for young.

Younger patients, needle phobic patients, people who really need to be treated on their face, but are a little reluctant to have needles put in their face. So here’s an example of what it might look like if you were doing gu guha. Now, when I do facial guha, I use two tools and you’re going to put, for the cupping and guha, you’re going to put

Oil. The oil that I use that I like is all organic and vegan. It has C, B, D and Arnica in it, and it allows the tools to glide well without clogging pores. So you’re going to start at l i 20 and you can. Massage there, and then you’re going to move the tools along the sides of the face, and this will break up any sort of stagnation or disharmony that’s going on within the muscles.

And really invigorate the blood and the chi in that area. Same for the eyes. You can massage a bladder two and then use the U part of the tool around the orbital rim and around the braille. I really like, especially for wrinkles between the eyebrows, but . Even if your patient is just having a lot of tension in between their eyebrows, really getting in there with the in tongue, can I.

Relax, the corrugator muscle, the procerus muscle. It allows everything to ease up. It’s great for your patient’s mental health and my patients that have come to me with various sorts of neuromuscular facial conditions from Ms. Myasthenia gravis Bells. Even ptosis, this really can allow the face to relax and when the face is relaxed, it can function better.

I. One of the last steps that I do is I take the flat sides of the Guha tools and I work all along the temporalis muscle and the trigeminal nerve, the facial nerve they can all . Have some disharmony and dysfunction if the temporalis muscle is tight or tense, if someone has T M J or if they have trigeminal neuralgia and you really can’t get in there and work on their face, you can still work on the temporalis.

Relax the temporalis and this will relax their face and their jaw. The very last step that I do is I turn my patient’s head to the side. I start at the base of the Oput and I work all the way down right to the shoulder, right down the trapezius, pressing fairly hard in one direction, and this will release the back of the neck, which releases the occipital frontals, releases the face, and it really is a very relaxing way.

To end treatment for your patients.

If you have any questions about anything that I talked about today, you can put them below and you can also go to facial acupuncture classes.com. My classes are listed there and there’s also a Contact us button, which you can use. So I want to thank the American Acupuncture Council again today, and if you missed any part of today’s recording, you can go to the link and catch us there. .