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Pelvic Floor and Menopause – Krystal Couture

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.

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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.

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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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Is There Value in ChatGPT for Acupuncturists? Michelle Grasek

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Hi there. My name is Michelle Grasek and I’m the host of the Acupuncture Marketing School podcast. And today we’ll be talking about how to use AI to generate content for your marketing so you can save time and just generally make your life easier. And before we dive into the slides, I’d like to thank the American Acupuncture Council for the opportunity to be here with you today.

All right, let’s get started.

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Okay, so let’s talk about using AI for your marketing content creation. How can you use it to be much more efficient? So very quickly, what will we be talking about today? First, why use AI for this? How is it helpful? Is it really helpful? And I also want to talk about this concept of content creation and whether it still matters.

I know everyone is drowning in a sea of content. The answer is yes, but we’ll talk about that in a moment. We’ll also talk about how to use AI and what to use it for. What are the things that you can ask it to do for you? And specifically, when I’m saying AI, I’m referring to the free version of ChatGPT.

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We’ll talk about how to create effective prompts. This is one of the most important things you can learn about ChatGPT. The better prompts you ask, the better your results will be. Hands down. And I’ll give you some examples. Why use AI for content generation? The easiest answer, the simplest answer is that it will cut down the amount of time it takes you to create content by about one fourth, okay?

It is, it will just make the process so much more efficient, and we live in a world where we are expected for marketing. To do a ton of content creation and it can be very overwhelming. It’s a bit of a hamster wheel I’m sure you’re familiar and I personally think that one of the best ways to Retain your sanity in digital marketing is to use chat GPT or other AI to help you either generate content ideas or generate the content itself and to repurpose content, which you can see is the last bullet on this list.

chat GPT can help you with repurposing. Okay, and repurposing content simply means taking something that you’ve already created or written for one platform, like a blog post, and copying and pasting it, making it some tweaks, breaking it down into parts so that you can use it on other platforms, instagram captions or email newsletters. Those are the most common ones that acupuncturists are repurposing content for and Facebook, of course, other social media. But there’s this idea that. To retain your sanity in digital marketing, you do not need to keep writing similar content over and over. You can just repurpose what you’ve already created.

That saves time to begin with. And then, asking ChatGPT to do that for you drastically cuts down on the amount of time that you need. And of course, on top of that, asking AI to write the content or help you with ideas. Cuts down on that time yet again. Okay, so really to make content creation Reasonable and manageable in the world that we live in I think both of those things are essential chat GPT and repurposing content Okay, and sometimes people ask me does content still matter as I said earlier everybody’s drowning in content There’s more articles on the internet than any one person could ever read in their lifetime.

Like why should I contribute to that? Why should I keep adding? So something I want you to think about is Google and the way that it works for a search. So Google’s purpose is to provide the best possible experience for its users. So if you type a query into Google, it wants to give you the most relevant, best answer that it thinks answers your question that you will like.

Because Google wants you to keep using it. Do you remember Ask Jeeves? Yeah, I’m dating myself, right? Ask. No one uses it. It doesn’t even exist anymore. Because other search engines were better, okay? So Google never wants to become irrelevant like that. Its goal is to provide a good user experience. So you can help Google do that by writing content for your website.

So people always ask me, is blogging is old school. It’s dead, isn’t it? So I always say no for two reasons. One, every time you publish a blog post on your website, that’s another page on your website. Google likes websites that are updated regularly because it shows to Google that this business is still active.

And it’s still relevant compared to a business. Maybe the acupuncturist down the street from you who opened their doors 10 years ago, publish their website and has not touched their website in a decade. Clearly Google is going to think that your website where you’re publishing monthly or maybe every two months publishing a blog post, it’s more active.

It’s probably going to be a more relevant, better user experience and answer the person’s question better. than a website that’s been ignored for a decade. Okay, so that’s one reason. And two is that when you are publishing content on your website, whether it’s a blog post or a more formal page on your website, you are naturally including keywords that your ideal patient would be searching for.

So if you specialize in orthopedic acupuncture for runners, for helping them you know, recover from injuries and be able to do marathons, whatever it is, you could write a series of blog posts specific to that. Like I’m a marathon runner thinking about what are the questions that this person would put into Google if they need help, if they’ve got a knee injury, right?

How long after a knee injury can I, or before I start running again? with acupuncture. Think about what are they asking and then write blog posts about those topics so that all of those keywords are on your website and you just become so relevant to Google that it brings you up towards the top of the search because you are answering those questions and you are helping the person writing the query.

You’re the answer to that query. So I’m repeating myself, I’ll move on, but that really is why blogging and content creation is relevant for you as an individual with a brick and mortar local business. Because that’s what Google wants to send your way. But it needs you to help it do that. You have to establish your relevance on your website so that Google can crawl it and understand that relevance.

Yes, blogging and content creation are still important. And just in general creating educational content for your audience. It doesn’t matter if you only have a hundred followers on Instagram, teaching them about what you do and how acupuncture can help them is always going to be relevant. And it just falls under the name of content creation.

So one question that people always ask me about AI is they’re nervous about using it. They don’t know how to use it. They don’t know what its capabilities are, how far reaching it is, these sort of things. So I always tell people to use chat GPT to your comfort level. You could ask it to do brainstorming with you or to write you an outline for a blog post or an email newsletter.

You don’t have to ask it to write the entire content piece. You could ask it to write you the whole blog post, but you don’t have to. So use it to your comfort level. And you could also think about, AI from this perspective. I find this really helpful. And an AI professional that I met last year shared this idea with me that AI is like a really eager, enthusiastic assistant.

Imagine if you had a receptionist in your office who had free time and just loved to write and kept saying, let me help you write Instagram posts. Let me help you write blog content. What? Let me write your email newsletters. You’d have to teach that person a little bit about the tone. You want them to write the concepts that are important to include or things not to say.

And you would expect them to do an enormous amount of research, right? That is what ChatGPT is doing. It’s doing an enormous amount of research to find the answers. And when you write a prompt, that is the same as you explaining to your receptionist how you want them to put this content piece together.

You’re giving them instructions so that they write something that is relevant to your business, your community, your ideal patients, your specialty, etc. Including your tone of voice and all of the details. Okay, so Try to think about chat GPT in this really positive way where it’s a smart, enthusiastic assistant that just wants to lighten your load and make your job easier.

Okay. So what can you ask ChatGPT to help you with? Honestly, the sky’s the limit. Anything that you can think of. I would say that the major things that people tend to ask for are one, brainstorming or idea generation, two, writing outlines for content, or three, writing the content itself. So you could ask ChatGPT to write you a list of maybe Two blog posts.

Basically write me a content calendar outline for this year with two topics per month. Okay, so two blog posts. It’s just an easy place to start. Or two email newsletters per month. And what would their topics be for the whole year? So before you do this, in your prompt, It’s very important that you tell ChatGPT about your business, about your target market, about your specialty, if you have one.

Basically, give it as much information as you can so that it can give you relevant results. And we’ll talk more about things to include in your prompts in a little bit. But It helps enormously the more information you can give it. It could give you an outline for a blog post. Let’s say you really wanted to write that blog post about knee injuries and recovery with acupuncture for marathon runners.

And you just have writer’s block, and you just want to get it done so that you can repurpose it into an email newsletter and send it to your list. You could ask ChatGPT to write you an outline for this blog post, okay? And then you could write it yourself, or once you have that outline you could say, okay, this is great, please don’t include this bullet point, that’s not relevant.

But please write this blog post for me and also make sure you answer the question, how many treatments do I need and why? Okay. And then it will give you the blog post. You can also, of course you can ask it to write social media captions as well. You can also take content that you already wrote, copy and paste it into chat GPT, and then ask it to repurpose that content into other formats.

So if you wrote an email newsletter, you could. put it into chat GPT and say, please repurpose this as a blog post incorporating these important keywords for my website, or please take this email newsletter and break it down into two Instagram captions. Okay. So you can ask it to do. or help you create ideas for just about anything.

You can also talk with ChatGPT. This this class is really for beginners, people who don’t have a ton of experience or maybe you’ve dipped your toe in and you didn’t get great results from ChatGPT, so we’ll talk about how to improve your prompts so you get better results. But I just want you to know, if you don’t have a lot of experience with ChatGPT, you talk to it like a person.

You ask for revisions, you can say, I like this part, but this part’s not relevant, and here’s why. And if you stay signed in, it will remember, okay, most of the things that you’re telling it. Sometimes you have to repeat, but that’s okay. For the most part, it’s going to remember important things.

If you are just dipping your toe in and you’ve never used it before, I would recommend beginning with repurposing content. So find a piece of content that you wrote that really represents your business, your ideal patient, your specialty, and copy and paste it into ChatGPT and ask it to use that as the basis for creating other kinds of content.

So if it was For example, a really great Instagram post caption that got a lot of engagement with your audience, got people asking questions, maybe you got new patients because people were asking you questions about it, and you felt like it really represented you know who you are and what you’re doing in your practice.

That’s a great place to start. So you could put it into chat GPT and say, can you please write up like repurpose this as a blog post and or as an email newsletter or based on this information, can you suggest other Instagram post topics or other topics that I could write about for my blog? So if you are new, Begin with repurposing content.

And I put that little note in the first bullet that says repurposing content can go in any direction because I often talk about starting with a blog post and then breaking that down and repurposing it into email newsletters and multiple Instagram or Facebook posts, et cetera. But you can go in the other direction.

As I just mentioned, if you have a great Instagram post or email newsletter that could become a blog post or a new page on your website. etc. So as I’ve been saying, the way that you ask ChatGPT for something is very important, and that’s called the prompt. So the more descriptive and specific you can be in your request, in your prompt, the better results you’ll need and the fewer revisions you’ll need to ask for.

Now, If you ask ChatGPT to write a whole piece of content for you, a blog post from start to finish, it’s normal to expect that you will need it, you will need it to do some revisions. And, you’ll probably still have to do some tweaks and edits, even after the revision, just to make sure it sounds like you, that it feels authentic, that you think it is really going to resonate with your ideal patients.

And that’s normal. Okay? But the better prompts you write, the less of that you will have to do. So what can you include in a prompt? Let’s go with the blog post example. That’s clearly my favorite. So you can tell first, tell chat GPT about your business, describe your ideal patient and your target market and your specialty, and then tell it.

Why you need this piece of content. What are you going to use it for? What’s its purpose? That’s important for chat GPT to know and then you can ask it to write this piece of content in a specific tone of voice for example warm, but professional or you could say friendly and warm and So let’s say you ask for professional.

Please write this blog post about XYZ in a professional tone of voice, and then you add all the other information about your business, your target market, and the purpose of the piece, and maybe it produces something that is very formal, way too professional, and you realize, oh, this is not the tone that I use on my website.

All you have to say is, actually, this is too formal in tone. Can you please write it in a more warm and friendly tone? Or you might have to use a the, excuse me, thesaurus, to figure out what are the descriptive words that you want to use until you hit on the right tone. Now, let’s say you finally land on tone that feels appropriate, right?

Like you nailed it. Write down those descriptive words that you put in your prompt so that if needed, you can ask for them again in the future. So you get a consistent tone. Okay. And you can also say to ChatGPT anything you definitely want it to include or not, okay? You can tell it how long you want something to be.

If you want an 800 word blog post, then say that. You can Take a piece of content you’ve already written. Let’s say you wrote something about acupuncture for fertility and you feel like it really represents, again, your specialty and your target market. And you can copy and paste that in there, but then give it instructions to write a different piece of content, maybe about acupuncture for PMS, and you can ask it to use that content example as a formatting.

For writing this new piece of content, okay? So that can substitute for giving it all these specific instructions about like tone of voice etc. So that it basically tries to write something like your previous piece. So you have that consistency. You can also give it specific numbers. If you have a blog post and you want Instagram to give you three, sorry if you have a blog post and you want chat GPT to give you three Instagram posts, then say so.

Okay. If you want it to give you six ideas for a subject line for an email, Ask for six. And again, don’t be afraid to ask for revisions because once chat GPT produces something for you, it will typically say, I hope this is what you’re looking for. Let me know if you need changes. And if you want changes, just say so it will do it.

instantly. And if you don’t like the changes, you can always go back and use the initial for further revisions. Okay. And lastly, I’ll say that you can use chat. You can ask chat GPT questions about itself so that you can learn how to use it better. For example, when I first started using chat GPT and I’m using the free version, so I’m not sure if this is possible in the paid version, but I had asked it, if I give you the, Web the hyperlink for a website.

Can you then read the webpage and summarize the page for me and it answered and said, no, I can’t do that from you giving me the link. But if you want to copy and paste the text on the page, then I can give you a summary. Okay? So you can basically ask chat GPT or tell it, here’s what I want, and then ask it.

What information do you need to create this for me? Okay, so you can really engage with it so that basically you’re going to learn to use it more effectively and efficiently so that it takes up less of your time and you get a better result and then you have to spend way less time on your marketing.

That’s our goal. So I really hope all of this is helpful. It’s definitely a crash course in using ChatGPT for marketing and content. I hope it inspires you just to dip your toe in if you’ve never used ChatGPT before. Try repurposing a piece of content and, if you used it in the past and got like weird or mediocre results, really practice.

your prompts and give it a lot more information and play around with it. And I think you’ll see that you get even better results. Okay. So as always, it’s a pleasure to be here with you. If you have questions about marketing, you are more than welcome to send me an email, michelle at michelleGrasek.

com. I clearly love talking about and teaching marketing. So I am more than happy to chat with you. Mhm. Mhm.

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Acupuncture for Sports-Related Injuries in Athletes

What does research have to say about the use of acupuncture for the treatment of sports-related injuries in athletes?

A review of clinical case reports confirmed acupuncture can help relieve short-term pain and recovery from dysfunction and has been used as a useful, non-invasive, and conservative modality for managing sports injuries.

Some of the sports injury cases included lateral meniscus rupture, femoral acetabular impingement, ganglion cysts, and sports hernia.

These cases showed the potential of acupuncture in the treatment of various types of sports injuries beyond pain control in musculoskeletal disorders.

Healthcare continues evolving to less-invasive, natural, and drug-free methods, with acupuncture now being a first-line complementary healthcare choice.

Remember, the American Acupuncture Council (AAC) offers an unparalleled track record in acupuncture risk management.

There is a reason acupuncturists have trusted AAC with their business for 50 years.

Not an American Acupuncture Council member? Get a Quick Quote and find out how much you will save! Click here!

You’re Undercharging & What To Do About It – Sam Collins

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Greetings, everyone. This is Sam Collins, the coding and billing expert for acupuncture for you, for the profession, for the American Acupuncture Council, and of course, for my AAC network members. Let’s talk about, have you really decided, how do I determine

Have you ever thought of what the costs are? As most acupuncturists, you’ve probably dealt mostly with cash and you’re charging one fee no matter what you’re doing. I want to start to do something that allows you to make more money in your practice by identifying your services and creating a true value to them.

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I can’t tell you how often I’ve had acupuncturists come to me and say, Charging a fee that is well below what people will accept. By example, if someone is willing to pay you 70 for a service, but you only charge 35, how much are they going to pay? 35 is what you charge. And I say this really from an insurance standpoint, because if an insurance is willing to pay you 70, but you only charge 30, they’re going to pay you 30.

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So have you ever really taken some time to look through your fee schedule to understand the value and what we’re going to focus in on what’s called relative value units. So let’s go to the slides. Let’s talk about that. Every single service. In CPT, any service you can provide as a licensed acupuncturist to a patient, that service has a value.

And that value is just to compare one service to another. By example, if one service has a value of 1 and another service has a value of 1. 5, It tells you the one that’s 1. 5 would be 50 percent higher than the other. So what I want you to do with this is start to really use just your fee for acupuncture.

If you tell me what you’re charging for your first set, I will tell you what the relative price should be for everything else you should do. And I’m going to implore my network members, in particular those that are viewing this, Make sure if you haven’t reached out to me this year to do so we can go through with you on a one on one Zoom on Establishing and understanding a fee schedule that’s specific to your area.

There isn’t generic across the United States It depends on your area. So I’d like to start this though with all of you taking a look at what is your current charge? Have you ever really thought what do I charge for stuff? I want you to write this down. What is your charge? For the first set, an additional set of acupuncture.

We’ll just choose manual for now. Keep it simple. What is your charge for a 99203? A simple mid level new patient exam. As well as 97124. Just simple massage. Nothing fancy. So acupuncture. mid level new patient exam and massage. How did you choose the fees? How do you know what one should be to another? What we’re going to focus in on is the relationship of one to the other.

Now, what we’re going to start with is what is your fee for 97810? Now you may think how do I come up with that? There’s things to do there. And again, network members can contact me about that, but I’m going to just keep it simple. What do you currently charge? If you tell me what you charge for a 97810, I will tell you what the other fees will be and what an insurance will pay.

Give me what an insurance pays for one code, and I’ll tell you what they’ll pay for any. Now I want to keep in mind, a lot of your managed care contracts don’t necessarily follow this. But, this is one of the reasons I don’t like managed care, but things that don’t. By example, workers comp, personal injury.

Even the VA follows this because I will tell you the VA and Medicare rates are much higher than what you would get from American Specialty Health in a lot of these. So I want something that’s going to make sense. So what this is about though is understanding the value of services. So on this page I’ve given some examples of the relative value units for common codes and you’ll see right in the middle I’ve included the acupuncture codes.

And you’ll notice 97810, 97811 all have relative values from one to the other. To make this the simplest way to think of it, if you charge 138 for the first set, I’m just making it an obvious example, what should be the cost of a second set? 80. Now you may think, wow, that’s a big, yeah, there is more than a 50 percent difference.

between the first set and the additional set. The first set includes more of the initial part of the visit, all the exam part. That’s why it’s a little bit more. And I’m going to warn everyone, this has gone up 20 percent this year. If you’re not aware, and you’ve probably seen it within the VA for those that are billing, there is a 20 percent increase in the relative value.

RVU’s updated substantially because I think they really looked at the cost. and value of acupuncture in relation to other services. So 97810 and 97813 both increased 20%. So if you have not increased your value of 97810, I’m going to let you know you’re losing money. Now, the value differences of 11 and 97814 did not change, but those two increased substantially.

By example, on a Medicare slash VA patient, That is literally 10 to $15 more per code. And remember that’s based on a $40 rate. The $40 rate for 9 8 9 4 0, which was fairly common, is now 50 plus in most areas. So start to look at that. But what this also does though, is give the relative values of other services by example.

Notice simple heat, infrared heat, 9 7 0 2 6. It has a value of 0.2. So if you think in relation to a 9, 7, 8, 1 0, you’re gonna think my goodness. That’s literally around 15 percent of that. So if you want to know the relative value of a heat lamp, it’s about 15 percent of the price of your acupuncture, which means that’s why it’s worth like 10.

I, in addition here, though, I have other codes, 99203, 3. 37. Now here’s something to look at notice 97810 is 1. 38. 99203 is 3. 37. Now, this is not exact, but what we all see here, that’s close to, if not quite, three times that rate. I’d say about 2. 6. What you want to start to think of is, what should be my price of a mid level new patient exam?

Two and a half to maybe 2. 75? Of the value of the acupuncture code. So if I’m charging, say 60 for a 97810, my price for a 99203 is going to be 160, 170, somewhere in that range. What I find often is a great deal of undervaluing. of the services. So here’s how we’re going to do this. Let’s talk about what you charge.

Let’s just make it simple. What if we were to charge 75 for a first set of acupuncture? I’m just using this as a random number, so that’s what your fee is. Great. I take 75 and I divide it by its relative value. So I take 75, divide by 1. 38, and it gives me this conversion, which is 54. This conversion number then is what we multiply any other code by.

To tell me it’s relative price. So if my first set of acupuncture is 75, notice the additional set 5434 times 0. 79 means 42. Now I’d probably round that up to probably 43, but needless to say, you can see here. Oh, okay. It’s not going to be the same price. I’ll give an example. I had an office that was charging 60 for every set, and they were paying in full for each one.

They’re thinking, this is great, Sam. You know what that told me? If they’re willing to pay you 60 for an additional set, do you think you have undervalued the primary set? You bet you have. So I want you realizing that this swings both ways, that you really want to start to have a reason behind the fees.

And again, with network members, I want to push you that. Let’s start to set this up, because here’s what I’ve learned. Most acupuncturists bill roughly 8 to maybe 10 codes on a regular basis. Exam codes, acupuncture codes, a handful of therapies. I find of that, usually more than half are undervalued. Which means Half of the codes you bill, you’re getting less money than you should.

So by example, look at the exam price. Now again, remember I said it’s about 2 point whatever above, but notice 54. 34, 183. So again, not quite three times, but you can see the range. But notice for massage. Massage has a higher value than the additional cent. Hence why that one is going to be 49. 99 or again I’d round up to 50.

Now to show you how this works, here is the fee schedule for Arizona. And I just picked Arizona. Obviously this is going across the U. S. and I have network members everywhere. Network members contact me, we’ll go over what’s in your state. But this is always a good starting place. This is the Medicare rates.

for the state of Arizona. And every state has this same breakdown. Now what I’m showing here though is the Medicare rates notice for the acupuncture codes, exam codes, but let’s do the math here to show you how RVUs work. Notice the value in Arizona Medicare is 43. 86. By the way, last year that was like 35.

It’s gone up substantially. So I take 43. 86, I divide by 1. 38. It gives me a conversion of 31. 78. I then take that number, 31. 78, multiplied by any other codes RVU to give me the price. Now notice how this works. 31. 78 times 79 is 25. 10. Do you notice the fee for 97810? 25. 17. I know it’s off a few pennies, but you get it’s in that range.

Notice 3178 times 3. 37 for 99203, 10710. Notice 99203, 10695. Again, within 15 cents. 3178 times 0. 92, the value of a massage, 2923. Notice the value of massage. So you may want to start to realize that, oh, this is exactly how insurances do look at fees, particularly when it comes to personal injury and non managed care.

Now here’s what’s further interesting. My general rule is An office probably wants to be maybe twice the Medicare rates as a typical fee. Now, I’m not saying necessarily that high But that’s a starting point. I would say maybe even 1. 5 But here’s where I bring this up in Arizona for workers compensation and let’s face it.

Would anyone say? Oh, yes, the workers compensation fee the mandated fee is the highest fee in the state No, it’s not but notice the conversion in Arizona is 68 So instead of being 3178, it’s 68. So think of it 97810 has a value of 1. 19. If 68 is your first, or you’re going to use 68 conversion, the worker’s comp rate is going to be, oh wait, 68 times 1.

19 is about 120 percent of that. You’re thinking that first set then is going to be around 80. Yeah, what would the additional set be? 68 times 79 or 80 percent of that take off about 13. Again, right about 52 or 53. Please be careful of undervaluing. If you are billing 50, And a carrier is willing to pay 80, but you bill 50, you’re going to get 50.

So be mindful that if someone ever says, how did you come up with a fee schedule? Have a real reason Not based on what my friends have been doing. We don’t know what your friends are doing. We’re right. Your mom told you that Did you ever get away with it when you said that’s what Johnny did, mom.

Mom’s not going for that. We don’t care what Johnny does, what we do at my house. So network members, I’m mom right now. I want to know, what are you charging? We can go through it. Make sure you set up a zoom for that. I want you to really start to realize, make a competent fee schedule, not a guessing fee schedule.

And that’s what too many of you do. And that’s why a lot of acupuncture struggle. I want to end that struggle. By setting up a good sound fee schedule now bear in mind when you sign a contract With an insurance company you’re accepting the pay less. That’s why they like you to sign up By example, if you sign up with UnitedHealthcare, what do you get?

About 60 a visit. What if you don’t sign up with UnitedHealthcare, what do you get generally? About 100. Same might apply with Cigna. Now ones that are HMOs, maybe we want to, but others you may want to rethink it. So to help you do that, what I’d like you to do is take a moment, and this is, this is not just for my network members, obviously this is for everyone, Use this QR code.

Go in here. You’re going to send us some information of what is your fee for 97810, where they’re going to send you back the calculations of the codes that we just showed you based on your fee for 97810. See if it makes sense, but I’m going to warn everyone. Be careful if you have not increased the value of your 97810 this year, you have flat out lost money because it went up 20%.

That doesn’t mean all managed care, but for everything else. As always, we want to make sure that your practice does well. Network members especially, I’m going to emphasize, if we haven’t done our meeting this year on fee schedules, get in contact with me. Let’s get moving. For everyone else, make this a good starting point.

Maybe I’ll see you in the fall for a seminar to make sure you really can make sense of it. Or how about this? Join the network. Make me part of your staff. Let’s work one on one. As always, everyone, I’m going to say thank you for taking some time with me. We always want you to be successful because your strength is ours.

Take care all.

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Treating TMJ with a Multifaceted Approach Part 2 – Michelle Gellis

And today I am doing part two of a two part lecture on treating TMJ with motor points, scalp acupuncture, and submuscular needling.

Click here to download the transcript.

Hi, my name is Michelle Gellis. I’m an acupuncture physician and I teach cosmetic and facial acupuncture classes internationally. And today I am doing part two of a two part lecture on treating TMJ with motor points, scalp acupuncture, and submuscular needling. So if you can go to the first slide,

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I previously was a former, I’m a former faculty member and clinic supervisor at the University, Maryland University of Integrative Health. I was there for almost 20 years and I’m currently on the doctoral faculty at Yoson University. I’ve writtenly written. I’ve recently written a book on treating the face.

It is a comprehensive guide, covering everything from the five element treatment of the face to cosmetic acupuncture, treating neuromuscular facial conditions, facial cupping, gua sha, microneedling, red light therapy, and many other. So you might want to check that out. So last time I spoke about TMJ and its etiology, its symptoms, treatments.

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As far as some Western medicine theory and TCM theory, and today I am going to go over a multifaceted approach to treating TMJ because it is a very common condition that we will see in our patients. The underlying theory in my treatment protocol is that neuromuscular facial conditions such as Bell’s palsy, TMJ, myasthenia gravis, and others can best be treated using a multifaceted approach.

So today we are going to talk about three of those. Scalp acupuncture, Facial motor points and submuscular needling. Scalp acupuncture is actually a fairly modern technique in our medicine. It’s only been around since the 1950s and really became popular in the 1970s. And we use our needles to stimulate different areas of the scalp, which stimulate different areas of the brain, which control different parts of our body.

And it is not based on acupuncture points. It is based on neuroanatomy and it makes it Very beneficial for treating the face because frequently when people have certain conditions that are very painful, it’s hard to do localized treatment. But by treating the scalp, we can affect. the face. So there’s three main areas that we would look at when thinking about treating, using scalp acupuncture to treat the face.

And that would be the motor area, the sensory area, and the foot motor sensory area. And depending on the condition, whether it’s more motor function or sensory meaning pain or neuropathy, you would choose the particular area. So again, it’s based on neuroanatomy. Basically, on the homunculus.

So looking at this, the face takes up a really large section of the brain area. So this is motor and this is sensory. And you are going to be needling horizontally through this loose connective tissue. So we have the scalp, the clo, the skin rather, the close connective tissue, the aponeurosis. And then we have the loose connective tissue, which is where we would be.

needling. So the landmarks that we’re going to be looking for are the glabella and the occipital protuberance. So we need to measure the scalp and we usually do that with two hands. And so you would look at the glabella and the occipital protuberance, and then you would draw an imaginary line between the two, and when you find the midpoint, you go back 0.

5 centimeters, and that is going to give you your your vertical line this way, and When you’re deciding on your horizontal line, you want to start at the midpoint of the eyebrow. So you are going from the midpoint of the eyebrow to the occipital protuberance. That is going to be you’re starting here 0.

5 centimeters back and you go right to the hairline when you measure from the midpoint of the eyebrow to the occipital protuberance. So this is the motor area and the bottom two fifths. So we have five fifths. The top one fifth is your lower extremities. So we’re not concerned about that middle two fifth, the upper extremities.

And so that would be the hands and the arms, and then the face and the head would be the right here, this section right here. That is the bottom two steps.

Another technique that we can use is submuscular needling. Submuscular needling is a technique that we use when we need to or want to relax an atrophied muscle or overly tense muscle and it is really beneficial for long term paralysis or if someone has a lot of tension in an area and there are several muscles on the face and head that we can use submuscular needling for, but TMJ, the ones that we’re going to focus on are the temporalis and the masseter.

So here you can see the temporalis and the masseter. And what you would do is you would take. half inch acupuncture needles and you would thread them around the edge of the temporalis and underneath or through, if you can’t get underneath the masseteer. And by doing this, it brings blood and qi flow to this area.

So here’s another close up of what that might look like. It doesn’t really matter what direction the needles are going. As long as you stay right on the edge of the muscle and the easiest way to find the border is you bite down and where you have your patient bite down and you can feel the front of the edge.

of the temporalis, and then you are just going to, once you find the front edge, then you can follow it around on the temporal fossa, and this will go all the way back behind the ear, and you would just thread the needles all around horizontally along the edge of the muscle. And it looks something like this.

And then for the masseter, the easiest way to find it is ask your patient to bite down and it will pop out. And then you are going to place needles right underneath from the origin to the insertion. Right underneath the muscle and some people the muscles very thick and you might be going right through the muscle and it looks like this

some additional ancillary treatments that you could add in are to use some points to help relax your patient like Shen Men, you can also In the auricular area there’s a TMJ point that you can use and lower jaw, so you would look those up on an auricular acupuncture chart and for if they’re having sensory issues like pain, you would do both sides for scalp acupuncture.

And if it’s just one side, if it’s motor issues, you would just do one side and then cupping and Gua Sha can also be very beneficial. and submuscular needling of the massetere, temporalis and there’s also some auricular muscles that you can see right here in this picture. These are the auricular muscles.

You could also needle under those and in some individuals that is very beneficial. Why does it keep doing this

and also the motor points for the masseteer and the temporalis. So the facial motor points, the motor point for the temporalis is just anterior to gallbladder a. Okay. And it is on the temporalis muscle and you would just go anterior to that and you can needle that and stimulate it a little bit. And then there are two motor points for the masseter and one is stomach six is a motor point.

And then just below stomach seven, in line with the earlobe, there is another motor point. And you could needle both of those on the affected side or on both sides and stimulate those. And all of these used in combination can really be very beneficial to helping to relax the face, relax the jaw, relax your patient.

If they have TMJI cover this in great detail in my classes and there is my website, facial acupuncture classes.com. And you can also follow me on Facebook, Instagram, TikTok. I have I have a Facebook group with over 8,000 acupuncturists in it. There’s always a lot of conversation going on and I. Teach classes internationally so you can check out my schedule.

Thank you so much.