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Preventing and Treating Alzheimer’s Disease Naturally

to speak to everybody today and to give them information related to my latest book, Natural Eye, Natural Brain Support – Your Guide to Preventing and Treating Alzheimer’s and Dementia and Other Related Diseases.

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

Hello there. Good afternoon. My name is Michael Edson. I am a licensed acupuncturist practicing over 20 years in presence of natural eyecare. And you see the website, naturaleyecare.com. I like to thank the American Acupuncture Council for the opportunity to speak to everybody today and to give them information related to my latest book, Natural Eye, Natural Brain Support – Your Guide to Preventing and Treating Alzheimer’s and Dementia and Other Related Diseases.

I am a filling in for Virginia Duran today. And I’m excited to speak with you. The book. Is was the reason I wrote the book for a number of reasons. One, because I have had relatives with Alzheimer’s who are passed away from Alzheimer’s and other forms of dementia. And one of the main book from natural eye care that Dr.

Grossman and I co-wrote he’s my partner is natural. I K you got to healthy vision in here. That book is an 800 page book and goes into how to treat eye disease naturally. And while doing a lot of the research for the book, what was really amazing to me was that the nutrients that actually support the retina and the rest of the eyes and the optic nerve when I was doing, looking at the research I kept on coming with.

Additional research related to the fact that they, these nutrients, of course, the blood brain barrier. And we’ll talk more about the blood brain barrier shortly, but it went to the brain and the brain uses these nutrients to keep the brain healthy. And the critical for preventing Alzheimer’s preventing dementia reducing brain fog and just keeping a healthy cognitive.

So I started collecting all that research and gathering it. I’m sorry. I have to find my pen here. Okay. And gathering it and accumulated over 3,200 peer reviewed research references related to how to keep the brain healthy and in the book. And we’ll go into more detail. I cover over four 50 nutrient.

And those nutrients, it gets complicated because a lot of nutrients have many different functions within the brain. So there’s a chart with over 19 19 categories of what different ways that these nutrients can help the brain. And I have an X mark in each category for each nutrient, and we’re going to go into many essential nutrients during this conversation.

Okay. I think we can start with. All right. So that is the name of the book. You’ll see. That is fruit and vegetables during critical to keeping healthy. Okay.

All right. The brain is really an amazing organ. It’s the most physiological active part of the body. As you can see it only 2% of the body rate represents 25% of the nutrients. With a hundred billion brain cells and sinaps seven to 10 synopsis per second. And we’ll talk about what a synopses in tobacco with seven to 10,000 cells a second.

We’re talking about trillions of interactions per second, and it’s really, if you think about that, how is this even possible? So there’s a lot of chemical activities that go on between neurotransmitters and hormones and. Interactions between the brain cells. But the only way that I can think of, and this is theoretical is that it’s some form of light.

Cause that’s the only thing that could travel that quickly, that can do so many transactions. And so that leads me to we’ll talk about chill all the time. So maybe that is what also what she is, and that travels that quickly in the body to help promote these types of choices or transactions that go on in.

Which is quite remarkable. And I talked about the eyes and the relationship to the eyes and the brain, the optic nerve is actually brain tissue. So it makes sense that what affects the optic nerve affects the brain. What affects the brain affects the optic nerve. The retina was created in the womb and the womb from from brain cell from brain cells.

So this correlation between. Healthy efficient and healthy brain function is very strong. As a matter of fact, from an eye exam that can often seen, they can also see early signs of Alzheimer’s, which is the beta amyloid buildup in the retina before it’s ever diagnosed as Alzheimer’s not withstanding multiple sclerosis, hypertension, diabetes, and many other conditions.

Appear on the retina often before, before it becomes obvious that it’s a health condition

it’s Alzheimer’s disease epidemic. And particularly related to the fact that people live in LA. And it’s for the most part nature related disease. In my opinion, there is a genetic aspect that we’ll talk about for sure that usually appears more people who are maybe 40, 60 years old. But the reason that these types of diseases are happening as they get older is the underlying causes of what can cause or contribute to Alzheimer’s disease.

Now, withstanding poor circulation. Inflammatory conditions, auto immune conditions, poor digestion. We don’t produce it many times in our system to break down the food. People become more sedentary. Maybe the emotional balance is not, they’re not, don’t feel as engaged in society. All these things play a part in both vision and brain health.

As you see that of 6 million people today. And it’s growing dramatically every year. It’s really an epidemic. Okay.

It’s a multi, multi neuro neurodegenerative disease, which means that there’s many parts that take place that cause dementia and Alzheimer’s and other types of improv, consents, and other types of brain illnesses. And it really needs to be looked at that. Because you can’t, it’s not a single issue problem, even though beta amyloid builds up in the brain and you also have something called tap protein in February and fibers that cause brain damage.

Why is that happening? And in order to really deal with Alzheimer’s and dementia and prevention, you have to look at the underlying visas, why that’s happening. And I mentioned a few here. Let me mention a few before, which is chronic inflammation. Blood-brain barrier, compromised blood brain barrier is what prevents unwanted materials from reaching the brain.

And that would include pathogens and metals and other types of materials that you don’t want to get to the brain. And when that gets compromised, then materials are getting to the brain that are causing brain damage as well. I mentioned nor epinephrin here, cause it’s one of those.

Hormones, essential hormones that acts as a neurotransmitter, the brain neuro-transmitters what passes information from brain cell to brain cell. And so neuro-transmitters are really critical. We’re going to go into more of that and it did mention that bit amyloid, neurofibrillary, tangles. HyperCat protein.

I was, what’s seen in the brain through MRIs when they see Alzheimer’s disease cow protein in a normal balance helps keep the micro structures of the cells to have that gets effected than the self structure start. The weekend. Beta amyloid in normal amounts is very important for motor transmission and brain function.

But when it builds. It starts damaging brain cells, also affecting mitochondrial function. And I know all of, what mitochondria is, it’s the energy cell of the body. It’s the battery of ourselves that keep the battery at the end of the cells functioning and energized. So my mitochondrial function, I was supposed to be looked at by.

And in the book I go into the nutrients that support the mitochondria support, the blood brain barrier, reduce inflammation also help reduce beta amyloid plaque and hyper phosphorylated tau protein and neural or tangles. These can be done through diet and exercise. The 40, the 3,200 plus studies in the book that are all in the, and the neuro neurological Magazines.

And then the research is in there. So it’s not, it’s medically proven, but it’s not really followed by the medical community.

Let’s start with diet and lifestyle. Cause obviously these are really critical. Eating a healthy diet is essential. What is a healthy diet? What like what the best diets having. Is to have lots of fruits and vegetables. Green leafy vegetables are really great. It’s very low in refined carbohydrates.

Obviously you’re avoiding fried foods and unhealthy oils, and we’re going to go into the fried foods and what not the foods to avoid. So you want to keep a low carbohydrate diet particularly all the white foods. What do you have? White rice, white pasta, white bread all the refined carbohydrates.

You want to keep a low sugar diet? Stevia is a good alternative if you want to sweeten something up. So there are different diets. The Mediterranean diet is good. The south street diet is good, but again, the common thing is a low refined, very low refined carbohydrates sugars. And. Some people like meat, I say eating meat, it should be as best as possible grass fed organic needs.

And and then foods to avoid avoid diabetes is, is an epidemic in society. And I think the numbers are up to 70% of people that have diabetes or have. So high sugar is one of the really severe detriments to, to the brain. What happens when we have excess sugar in the diet, the brain actually produces along with the pancreas its own insulin.

That’s how important insulin is to energy production within the brain. So when this excess sugar, that means the brain has to produce more insulin to break down the show. Insulin also keeps beta amyloid in check. So if you’re not having the insulin available to keep the in check it’s one of the reasons beta amyloid can increase and stop causing brain damage.

Insulin is also critical for other functions of the brain related to cognitive function. So avoid all sugary drinks, even juices to limit a very high in sugar aspartame and artificial sweeteners. They’re toxic to the brain. They produce as pertain produces a Spotify acid and methanol, which is toxic to brain cells.

And And it causes also hyperactivity in the brain. So you want to avoid those at all costs. Again, Stevie is a good alternative avoid generally foods that are in aluminum cans. Okay. So cause aluminum producers aldehydes and aldehydes prevent the breakdown or. Cause increases in production of protein in the brain.

And that is that would, could include amyloid plaque and tau protein and diminishes the body. The protein analysis is the body’s the brain’s ability to break down protein. It restricts the body’s ability to do that. Keep meat down to a minimum. The studies have been clear that diets, high meat.

The likelihood of the risk of Alzheimer’s disease. So meats are not withstanding, but with the hormones and the pesticides that are added and void fry foods. So five foods cause damage to the brain toxic to the brain and they also they. They increase ROS reactive oxygen species, which is a very aggressive form of free radicals that put down healthy cells.

So we all know that free radicals have a, have an extra electron at the end, and they will Quip that electron from a healthy cell causing it to be unhealthy and die. And that’s why the antioxidant is just because the antioxidants provide the extra electron to neutralize the free radicals. And we’re going to go into antioxidants and essential nutrients such as gludethyon which is a master antioxidant.

This is one of the few along with superoxide dismutase that can neutralize the full spectrum of free radicals in the body. And it’s the, actually the antioxidant. And the greatest quantity in the brain and the studies have shown that people with Alzheimer’s are significantly deficient include a thigh on the brain.

So you wonder why the doctors are telling people to minimally supplement with glutathione, but that’s only one of the many ones that are deficient, while I’m on the topic. The other ones that are deficient B complex is between. Vitamin T3. Some of the minerals such as magnesium, selenium sink these are all critical and when deficient, they can cause a brain damage because the free, radical, the cause of the free radical activity.

But also what’s really fascinating is that deficiency in somebody in these nutrients can actually mimic Alzheimer’s dementia. So in fact, for people that are that have a diminishment of. They may look like the habit and they may be being treated for it by the doctors for Alzheimer’s.

But yet, if the efficiency is just because of the nutrient deficiency, that could be the underlying cause. And not that they actually have dementia Alzheimer’s exercise cuts across all. I mentioned 19 categories. I mentioned that I have in the book, it cuts across all 19 categories. By the way curcumin does as well.

Ashwagandha’s really good. They basically a thigh on these do cut of course, most, if not all the categories of what they help to help with the brain stress. We live in a society, highest stress. We know it. And I was looking at a study this morning that said 3.2% of people in the United States are suffering with PTSD.

And that could be the trauma that can be due to the chronic stress associated work relationships, money, and stress can actually reduce the size of parts of the brain, including the Mignola, which among many other things, processes our emotional memory. Stress is important to keep that under control meditation, yoga, Qigong.

These are all taking regular walks in the words. These are all really important breathing. Remember to breathe. When we get stressed out, when we get upset, we stopped breathing. Stop, take some nice long breasts, calm down, get everything going again. Emotional balance. We know that the five elements of Chinese medicine, wood fire, earth, metal, and water.

That keeping emotions in balance are really important. Being angry and stressful cake is excess cortisol production in the brain and cortisol and causes excess hyper excitability. And that can actually be as a point of cortisone is for neurotransmission can cause destruction in brain cells as well when it’s, when there’s too much in the brain.

The colon archaic system is essential for brain functioning. And for neurotransmission is the communication between cell, the cell the brain cells a set of colon. I mentioned because that’s one of the critical, among many actually born into critical neuro-transmitters in the. Coleen is one of the underlying precursors, the acetylcholine.

And what’s interesting about set of Coleen is that’s one of the main treatments that the drugs try and address is the imbalance of a set of calling through a set of colon. Esterase so set of colon esterase and shed a calling, keep each other in balance. So what the does. Is it helps reduce acetylcholine, acetylcholine esterase to try and keep the set of calling up.

But the drugs don’t work. My, my relatives got the drugs. They just continually get worse because they’re not looking at the wider picture of what the underlying causes of the imbalances are and addressing the underlying causes which can be again, stomach them inflammation chronic stress.

Metal exposure to environmental exposures. The inability to interference with neurogenesis is the body’s ability to produce new brain cells. And we can do that up until the 1990s. I didn’t think that they thought that the brain cells that we were born with were the ones that we would die with.

The brain produces to produce new brain cells all through life until we die. And then a lot of nutrients, including ashwagandha and many others actually promote neurogenesis, new brain cells epigenetic. Epigenetics underlying is the thought that again, they thought that genetics, the way we were born, not only was the way we looked, but we were controlled the diseases we got later on, but, and they thanked the fact that epigenetics is environmentally also causes cells to turn on.

So that how well we were nurtured us children and fed and how well we take care of ourselves through our lives, actually prevent, can prevent not all time, but many of the times, certain cell genes that we don’t want turned on or turned on. mentioned some of the food sources for Coleen. The book talks about food source for different antioxidants as well.

I mentioned the culinary system is related to Alzheimer’s practices, hunting. And many other psychiatric disorders as well.

We did talk about mitochondria as being critical, to relate to all these diseases I missed. I looked this year and when beta amyloid builds up as associated with Alzheimer’s, it actually can create this function within mitochondria and quiz, a cycle effect. So the more mitochondrial dysfunction, the less energy is available for the cells to function properly in a more self-study.

As well as oxidative stress, we talked about the free radicals that need to be neutralized with with antioxidants essential antioxidants. I mentioned some of the nutrients in here that support mitochondria alpha-lipoic acid cocuten some of the B vitamins resveratrol, and this is all in the book, Shandra.

Magnesium by the way is also very important for managing and breaking down a beta amyloid plaque. So create division beta amyloid plaque. That’s another reason why you can get an increase in bid on what plaque as well. So I’m really talking about a whole body Prototron health story. That’s a whole body approach act function for doing that for 3000 years.

And in order to deal with Alzheimer’s and prevention, you have to take a step back, who is this person related to this disease and what are the underlying causes of it that may be related to that. And then dealing with that, because the drugs I mentioned Donepezil and another one Mateen which has to do with reducing GABA.

So that That it helps balance out the corner metric system and GABA can be increased through foods as well. So again, whole body approach, the body’s meant to be meant to heal is trying to heal. What can we do to help that along?

I mentioned the blood brain barrier critical it’s mentioned things here that, that caused a breakdown in the blood brain barrier. Astrocytes. Cells in the body that are cells in the brain in relative high amounts, the part of the glial system and the critical also for keeping the blood brain barrier healthier.

I mentioned aspartame and artificial sweetness. They also break down astrocytes it also prevents the excess glucose from reaching the. Some, I mentioned the vitamin, a vitamin C that help keep the blood-brain barrier already healthy. A B6 B12 baseline is in robot, obviously in resveratrol.

We already talked about this and we talk about a number of the nutrients. There’s quite a few of them that can help keep everything in balance. We talk about yin and yang. And part of it is really keeping everything in balance in the body. And a way to do that is through food diet, exercise, Chinese medicine, even I bet a medicine yolk, which Yukon gut-brain connection, very powerful. The gut represents 70% of our immune system. There’s a very strong connection in your gut, in the brain to the gut and actually produces on neurotransmitters and hormones. And communicates with the brain all the time through the Vegas nerve. It’s a big problem within society that there are gut imbalances that can lead to candidiasis and leaky gut syndrome.

And these can be caused tremendous inflammation can also cause a breakdown in the blood brain barrier and neurogenesis the diseases such as Alzheimer’s and Parkinson’s so walking causes. My microbiome microbiota break down, excess sugar, poor diet, excess dressed emotional balances medications obviously excess use of antibiotics.

So we really need to focus on that. If there’s a whole community of doctors right now called functional medicine doctors, that really start with the gut as being the basis of where disease starts from gut imbalances. Okay.

Central nutrients are making these already. That tend to be deficient. I also add here cookie 10, taurine, DHA. These all are critical for brain functioning for Alzheimer’s dementia and other, and Parkinson’s as well.

Chinese medicine practitioners out there pretty much. I understand that’s what the organization is. So the kidney Meridian overrules the the, our hormone production and endocrine system. So the home, we have a lot of hormones that reach the brain that are in the brain and act as essential.

Neuro-transmitters among. Function. So that’s willing to look at the hot Meridian. Obviously we know it has to do with spirit and Chen and all circulation, but also long-term memory. The spleen Meridian has to do with short-term memory, as well as analysis and concentration, the dual Meridian overalls, all neurological activity.

So we’re obviously looking at older meridians, but these are the four key ones. I just mentioned a couple of PA patent formulas, but there are many more out there. The Buena Juan brain tonic, or the GN now on oh, good ones to look at. But when you do your intake, we’ll figure out where you want to go with with which herbal formulas might be most helpful for your patients.

It’s different complimentary medicines. I didn’t talk much about essential oils, but they play a big role. In terms of helping support concentration reducing common symptoms of dementia and Alzheimer’s is poor sleep, anxiety, poor social skills pound community paranoia poor concentration, poor ability to make decisions, analytical functioning.

So essential. Either applied directly or in an ad, Mr. Fire can do a long way and really balancing out those imbalances associated with dementia and Alzheimer’s disease.

So stem cell research is still in progress. We don’t, I think it’s got a ways to go. If this account, my contact information, you can order the book from natural eye care.com, even from Amazon. If you want to reach me, have any questions, I’m here to answer those. You have my email address as well as my phone number.

And I thank everybody for the patients to listen to my rapid discussion today. But there’s a lot of material to cover. I want to give you a sense that we can do a lot to help people and the doctors are not doing it

and also join us next week. Bring that back up again for on Friday. Yair Maimon will be here giving a presentation as well. Thank you so much.

97140 for the Acupuncture Provider – AAC Info Network

And I always like to have a little bit of time to talk about what codes are billable, how do we build them? What do we do correctly? I think that’s often a problem, by example, what actually is manual therapy?

Click here to download the transcript.

Okay. All right. I apologize for some technical difficulties, but welcome. This is Samuel Collins, your coding and billing expert for acupuncture, and specifically the American Acupuncture Council network, your go-to place for making sure you’re coding and billing are together. And quite frankly, your business sense. So if you’ve not checked us out, come to our site, but let’s focus in on what we want to talk about today. And I always like to have a little bit of time to talk about what codes are billable, how do we build them? What do we do correctly? I think that’s often a problem, by example, what actually is manual therapy? What does that mean? And how is it different? So let’s, let’s start here. Let’s talk about what manual therapy is. Well, part of dealing with CPT codes. I’m not sure if you’ve ever watched the show, the bachelor, and I’m a little embarrassed to say.

I have seen it not very much, but I, one time looked at the CPT codes and realize CPT codes are often simply like the bachelor. What I mean by that is you ever notice how kind of ambiguous sometimes they are. So think of it this way, the bachelor like CPT codes tends to be ambiguous, overlapping, and not clear to what their intent is. So think along these lines, when you look at these two codes and you’ll see here, I have them highlighted massage 9 7 1 2 4 and manual therapy, 9 7 1 4 0. How are those different? I mean, if you think of it, isn’t massage a manual therapy, isn’t it hands-on. And so that’s one of the issues we have to kind of deal with was where’s this differentiation.

So by example, take a look at these two pictures, the picture on the left picture, on the right, which of those actually would constitute bodywork. And what I mean by that is, is the one on the left massage, or is it manual therapy or is the one on the right? And there, I think is one of the issues I think we have to address for acupuncture providers is to really differentiate between the two as to what are we doing? Why are we doing it? If you will, where we’re doing it. And all those factors come into the coding and billing. Obviously body work is something that’s integrated into the acupuncture principles and traditional medicine for that matter. So let’s take a look. What is massage? Massage says, it’s a procedure that includes Effler Rouge, you know, circular motion, petrosal lifting and squeezing to potent stroking, percussion, even needing.

So again, kind of the standard massage things we all think of. And what’s the purpose of it? Well, muscle function to an extent, but if you think of it, probably relaxation, circulation, stiffness, uh, generically, it’s used to increase circulation and promote tissue relaxation. If you think about why do people get massages to relax that can help modulate pain a little bit. So, okay. So that’s the purpose of massage and that’s the style now, conversely, let’s talk about what is manual therapy? Well, let’s first look at the code manual therapy or the service manual therapy, 9 7 1 4 0. It says specifically in the CPT manual that says they are manual therapy techniques that include by example, mobilization manipulation, manual lymphatic drainage, manual traction, and it says one or more regions. Now that’s not a very big description when you think of it. So manual therapy techniques basically are hands-on services that go beyond standard.

Just simple massage, more, I would say deep tissue, if you will kind of to break up adhesions comparative to say just simple massage notice here, it includes things like manual trigger point therapy or myofascial release. Those would certainly be considered within that. Now let’s talk about it from a standpoint, how is it defined under the standards by the American physical therapy association? Since they’re the one that commonly used it let’s look at what they say. It says manual therapy techniques are skilled hand movements and skilled passive movements of joints and soft tissues that are intended to improve tissue extensibility. Now, I want you to notice here, the difference of that two massage massage said relaxation. This notice says tissue extensibility, and it says increased range of motion, induce relaxation. So there’s some overlap, modulating pain and reduced soft tissue, swelling, inflammation, or restrictions techniques may include manual lymphatic drainage, traction, you know, massage mobilization.

So you’re kind of going, well, wait a minute. They’re just kind of saying the same thing. So really how do I differentiate? What is manual therapy, comparatively? So types of manual therapy, well, manual traction. Is that something that acupuncturists might do? I think so joint mobilization. I want to be a little bit careful there because obviously you can’t do manipulation, but mobilization of movement certainly makes sense. And then there is of course myofascial release, and I think that’s the one we focus a little bit more on. So you notice here, a myofascial release says soft tissue mobilization. One or more regions may be medically necessary for the treatment of restricted motion and the soft tissues involved in the neck and extremities. So in other words, notice the emphasis towards manual therapy to be about tissue extensibility, that there’s restricted motion.

So manual therapy, what’s the difference? The difference is more about the goal of it. Obviously you put two hands on a person like those pictures I showed earlier, which is massage or manual therapy. It’s more about what you’re attempting to accomplish. So notice here, it says the goals of manual therapy are to treat restricted motion of soft tissues in the extremities, neck or otherwise, and restore soft tissue function or muscle function, meaning a restricted area. You’re breaking up the adhesions. So there’s normal movement movement without pain and increased extensibility. So you notice the keep emphasis here on extensibility. So how would you differentiate if you’re doing a hands-on simple squeezing, I would say certainly would fit massage, but if you’re doing it to break up literally adhesions in the muscles or restricted muscle that has now been shortened, that would be the myofascial release or if you will manual therapy.

So where do we fit that though with traditional medicine statements that include things like TuiNa or Washa? So TuiNa of course is literally the meaning of pension pool refers to a wide range of traditional medicine bodywork, but it’s considered probably the oldest. In fact, I would say everyone that’s doing massage is probably a form of this to an extent anyway. So with between a fit, as manual therapy or massage, well, I will say it could fit both because it depends on the level, the depth and what you’re trying to accomplish. So think along the lines of more, what is the goal of the therapy more than just because it’s hands-on, hands-on doesn’t necessarily mean it’s massage or manual therapy, but what you’re doing, but the why you’re doing it now, what about what shadow it says to scrape? That’s what it literally means. And it says a method in traditional or in traditional Chinese medicine, which includes the skin of the neck back.

And shoulders are limbs with dis lubricated and pressured or scraped with a round edge instrument. I think much like that. You’ve seen where people do these things called fascial abrasion techniques or breast in which I think often is just really a bastardization of Washoe to an extent. Now I’ve seen wash out, include a lot of things. So I want to be careful, I’m talking about that tissue scraping. Now, what would that purpose be? It’s done manually, even though it’s with the tool, it could be with your hand. Would that be more for a release than it would be for relaxation, obviously, an area that has an adhesion. You want to break apart that scar tissue that’s going to be more the myofascial release or the manual therapy. So what I’m trying to bring back here is that what you want to look at when you’re doing hands-on therapies to distinguish whether it’s massage simple or manual therapy is more about what is the outcome that you’re looking for?

What are you looking to change? So within that, I want you to think of purpose. What is the purpose of what I’m doing? That’s going to define it more in CPT. What they say is don’t choose a code that approximate, but what says exactly? So you might be doing a manual therapy. Let me use the term broadly, but yet it could be massage or it could be the more deep tissue work which equals the code for manual fare. Remember manual therapy was a code introduced in 1999 that replaced a lot of codes. It replaced traction, it replaced myofascial release. So it’s kind of a conglomerate code, but more meaning again for our purposes, kind of the deep tissue. So what I’d like you to think of is that when you’re appropriately coding for manual therapy, what is the purpose? If it is for tissue extensibility and range of motion, manual therapy after for simple muscle relaxation and pain modulation massage, okay.

Now beyond purpose, then I’ll go back to this picture, which of these is this massage or manual therapy? Obviously, as I mentioned, you can’t tell, but I will tell you the one on the right is the manual therapy picture. And the reason why is that one is being done to break up adhesions within the gastrocnemius and soleus in order to reduce restricted movement to the Achilles tendon. Whereas the one on the left, though, you could argue, what’s going to be, could be as deep that’s clueless, just relax the trapezius area in the shoulder region, if you will. So think of if I’m going to bill for manual therapy or provide manual therapy, just make sure you’re documenting the manual therapy. It’s hands-on but more about the purpose and the goal. So within that, what do you need to document? And this is really important part.

Obviously, if you’re billing for manual therapy, the big issue is that we have to show it. So documentation must be include that area. You’re doing the service also though, the or technique you’re using. And again, there could be a wide variety. Don’t be afraid of describing things like muscle, energy, PNF, things of that nature would fit certainly statements of myofascial release. What I want you to be careful of is don’t simply say I did manual therapy, identify what the styler technique was also indicate there, the start and stop times, or frankly, just the time. Remember this is a time service, much like is acupuncture. And so you do have to document time. Now you can document time. A couple of ways. You can just tell me how many minutes you spent, or you can do from into, if you say, Hey, I started at 10 and I ended at 10 20 of the 20 minutes either way, tell me how much time you spent because it’s time derivative.

And then along with that, the expected goals, and this is probably the more important factor to make sure you distinguish it from massage. I did myofascial release to the right shoulder to increase range of motion due to restrictions about the, you know, the clavicle area or the deltoid, something of that nature. Subscapularis you name it? Any of those would certainly be fit, but just tell me what the goal is. It’s more about the outcome then the service, could there be a mixture? What if you did some deep tissue work, but it also included a little bit of massage? Well, that certainly is fine. Just remember the bulk of the work would be the manual therapy. Therefore that would be the more appropriate code to bill. Now it is a 15 minute service and I’m sure you’re all aware. Does it require the full 15 minutes to bill for one unit just like acupuncture.

You do not have to spend a full 15 minutes face-to-face but at least eight minutes. So remember the eight minute rule does apply with this code as it would with massage for that matter. Now what it was billable here though. So here’s something I want to bring up about the eight minute rule. That’s often confusing. In fact, I did a program this weekend at the Florida state Oriental medical association. And one of the questions that came up was about timing. So I’m going to give you a little quiz here. Let’s see if you can pass. What is billable here? What if I do tend to 10 minutes, face-to-face doing acupuncture. You know, I insert some needles manual. And in addition to that, I do another 10 minutes of massage or manual therapy, either one don’t care. So I’ve spent 10 minutes on one, 10 minutes on it, the other, what can I, bill?

What will you bill for this visit? Can I bill for both codes? I’ll give you a moment to think about it, which is appropriate. Well, what is going to be appropriate? We have to do the eight minute rule. The time you spent with the patient, if you recall was 20 minutes total, remember 10 minutes in 10 minutes. Therefore, how many units is 10 minutes? We’ll look at this little chart and you’ll notice one unit is eight to 22 minutes. So if you only spent 20 minutes, can you bill for two units? And this is what’s important to remember, even though you’re doing two separate services, the time is cumulative. So if you’ve only seen, I spent 20 minutes, you cannot build both codes. Now you get to build one of them. Of course. And you always get to build the one that has a higher value, but you can’t build both.

So do make it important to always document time. Now, keep in mind. That’s because you spend 20 minutes. What if you actually spent, say 13 minutes on acupuncture and 10 minutes on the manual therapy would both be billable. Well, they would because you’ll notice two units is 23 minutes. So it becomes very imperative that you document the time properly in your file because frankly, that’s all someone’s ever going to look at. They’re not going to question so much the service as much as did you document it. What did you do? Where did you do it? And how much time did you spend?

So what about modifiers though? And this is a confusing area for acupuncturist because I’ve seen many of you say, Hey, do I need to have a modifier 59? When I bill this therapy? And the Frank answer is you do not. No modifier is typical on a claim for an acupuncturist when it comes to physical medicine codes for most plans. Now, bear in mind. Some people will think, oh, I have to put modifier 59. That is necessary for chiropractic providers, but it is not necessary for you. Chiropractors have to demonstrate a separate from manipulation, but not for acupuncture. So a 59 is not necessary on this code because it doesn’t have to be distinguished from something else. There’s no correlation of manual therapy to acupuncture. However, what but you want to make sure is is that though I don’t need to distinguish it from acupuncture. Are there some things we might have to do?

And this is something I want to make clear to not have anyone confused. We’ve done a program on this. You’ve been to a seminar with me. You’ve heard me talk about it as well. How about plans like United health care, Optum health, Anthem blue. Those companies require that when you build a physical medicine code, which includes manual therapy, you have to include modifier 59 or excuse me, modifier, GP, excuse me. So that true for all physical medicine codes. So if you’re billing a physical medicine code to United Optum Anthem, put a GP. Now notice, I didn’t say Aetna, I didn’t say Cigna. So don’t automatically add those in just because you’re billing, but to those carers only, but distinctively doesn’t acupuncturist need to put a 59 on manual therapy. You do not. There’s no need to distinguish it as a separate distinct service. So keep it simple, provide the manual therapy, why to reduce adhesions, increase range of motion.

If you’re doing it more for relaxation, likely massage bottom line is let’s make sure we’ve documented and build for it. Ultimately, if you’re providing a service, I want us to be reimbursed for it. I don’t think you should have a free clinic. No one has free clinics or at least at least no one. That’s trying to make a profit off of it. So I want you to keep in mind though. What about your state now? Of course, this is going across the whole United States. Now do most states have licensure for acupuncturists where they can do manual therapy or therapies? They do. By example, I’ll give one New Jersey has a very broad scope of practice, which clearly allows the service, but New York does not states like Florida do. And most states do so make sure you know, your state and what you’re allowed to do. But I will say generically, most states do allow adjunctive therapies and this can be within scope, but always check within your state to make sure am I practicing within my scope because some states do not.

So I don’t want to make this a blanket that everyone can do it because it may not be within your scope. Ultimately, what we want to be able to do is to make sure your practice can continue to thrive and enhance the care of your patients. I want you to do the services that are necessary for your patients to recover and get the best outcomes. Manual therapy certainly can be part of that. Let’s make sure we bill it right by documenting what we’re doing, where we’re doing it and the purpose. And of course time, ultimately we are your resource. If you’ve not taken a moment, come to our site, the American Acupuncture Council Network, AAC info network. We’ve got a new section there that is free to all of you. Don’t even have to be a member. We normally have a membership where I become part of your office.

I help you on a day-to-day basis with all types of issues, but we post a new section. So if you’ve not seen that, I would suggest take a look there. Cause we’ve got a lot of updated information on requirements for vaccines, whether it is or is not what’s going on with other issues regarding the ADA and other issues for acupuncture offices. So with that, I’m going to say thank you all very much. I’m glad to always spend time with you. Next week will be Virginia Doran and as always the American Acupuncture Council is always your resource as am I come and take a look, go to my Facebook page as well. And I welcome any questions from you. Thank you everyone. See you next time.

Motor Points and Trigger Points: A Compare and Contrast Discussion

We want to talk about the compare and contrast of what is a motor point, what is a trigger point, which is a very, very common question and also how to use them clinically.

Click here to download the transcript.

Hello everyone. Thank you very much for attending our Sports Acupuncture Webinars sponsored by the American Acupuncture Council. My name is Matt Callison. I’m here with my colleague and good friend,

Brian Lau. So

Last month we had Josh Lerner as a guest. I was not able to make it last month, but Brian and Josh talked about trigger points quite a bit, and the pathophysiology and also different clinical uses. We wanted to this month to discuss and build upon last months, a narrative. We want to talk about the compare and contrast of what is a motor point, what is a trigger point, which is a very, very common question and also how to use them clinically. So before we actually start going into, let me talk about Josh a little bit here on the reason why we have him is he’s like Brian, who is, uh, not only just an excellent clinician, but a true academic. So that’s a pretty rare combination to have, uh, Josh graduated from the north west Institute of acupuncture and Oriental medicine in 2001. And he’s currently on faculty of the Seattle Institute of east Asian medicine, or he’s teaching orthopedic medicine trigger point theory, muscle-skeletal amp and also points and channels. Now he’s studied with Tom Bizzio and Frank Butler for quite a while. Starting in 2006, he also started taking trigger point release, uh, acupuncture trigger point release in 2007, and started dry needling classes in 2016, which he has become certified in dry needling in 2019. Now being an overachiever that Josh is, he also took the smack program at the same time and graduated from the sports medicine acupuncture certification program in 2017. So Josh is welcome. Thank you very much for coming Josh and help us out with this podcast webinar. Really appreciate it.

Thanks for having so you appreciate being asked back for this.

Yeah, absolutely. Well fun. All right. So we only have 30 minutes, so let’s jump right into what is the motor point? Well, you didn’t get into the trigger point, then start talking a little bit about case studies and how to be able to use them. Uh, first things first, the motor point when I first started studying them, this would be before I was an acupuncturist when I was going in and, uh, physical education and athletic training school at San Diego state university. I graduated from SDSU in 1986. Now in the training room, we were taught to use one inch by one inch or two inch by two inch could be even four inch by four inch electrical pads to place them over the central aspect of the muscle in order to influence the muscle belly or the motor point region. Now, it was common to be able to use these pads on agonist and antagonist muscles, for example, hamstrings and quadriceps, or even on hamstrings and then to a distal tendon or a proximal tendon in order to influence the electrical energy of that particular muscle.

Now, when I became an acupuncturist graduating from Pacific college Oriental medicine, which is now called Pacific college of health sciences, graduated from Pacific college in 1992, always was curious about the motor point and wondered as an acupuncturist. What would it be like to take a highly conductive electrical material, a stainless steel needle, and put it into this region as defined as having the lowest resistance to electrical conductivity. So therefore we, you have a region that has the lowest resistance to electrical electrical conductivity. That means that there is a enormous amount of cheap potential to manipulate. Now, of course, an acupuncture needle is much thinner than a one by one or a two by two pad. So therefore I started my journey and researching motor points. Where are they located at that time? Nobody was really talking about motor points, trigger points was the big thing.

Um, it was still under a lot of influence of Janet Chevelles and Dr. Simon’s enormous work and trigger point theory and their books as well. Um, and at that time, I, like I was saying, motor points really weren’t discussed very much. They were mentioned in the Shanghai text of acupuncture, which is an interesting read with that. And then going online and trying to find who was actually doing acupuncture on motor points, um, was Dr. Chan Gunn. Now he was up in Canada and he was also researching on motor points, but she’s got some incredible research if you guys wanted to go and check that out on Google scholar, um, being more of the dry dealer, um, he was really staying quite a bit away from traditional Chinese medicine and taking it more toward the dry needling aspect of it. And so we’ll finish that story at another time.

So what I found was taking acupuncture to the Motorpoint region was changing range of motion, changing muscle strength, decreasing pain. And this was really very, very exciting. Um, but trying to find where those motor points are at that time was very difficult because there really weren’t that many maps available. It was more of a line drawing with just like a black dot on it. So gathering a number of different research articles. I think it was in the forties or fifties, and today it’s well over 300 research articles that I have on motor points in their locations. But back then, there wasn’t very much so collecting that information and then also electrocuting a triathlete friend of mine with the surface surface electrode, trying to find exactly where these motor points are. Then I would map them and then locate them according to bony landmarks and acupuncture points for the acupuncturist.

Now this was way back in the early 1990s. And that was when the motor point manual came out, which I even have a copy of that anymore, but also the motor point chart came out and I’ll since then, it’s also has been updated the motor point chart. And this just came out in 2019. The original came out in the year 2000. Also some of the work that I was doing back then in the year 2000, I actually collected a whole lot of notes and started writing quite a bit and then published this treatment of orthopedic disorders manual, which came out, like I said, in the year 2000 or actually 1998, it came out and it’s been used at all three Pacific college campuses since then now in 2007, then my research came out and published the motor point index in 2007. So long story short, my work has been out there for a long, long time and has actually influenced quite a few people over the years.

Um, this has a lot of accountability and a lot of responsibility to it because even as today, Motorpoint locations have changed a little bit. The definition of the motor point has changed. Um, motor points. Now over these last 15 years are talked a lot about you’ll see research articles all over the place. It has infiltrated our field pulled a lot from the work that I have created, but then also what other people are also doing with motor points. So it’s, it’s something that is needing some discussion about what is a trigger point and what is a motor point. Now, the definition of the motor point in the 1940s, fifties, and sixties was basically an umbrella term for where the motor nerve inserts into the muscle belly and where the motor nerve inserts at the intramuscular junction, the neuromuscular junction. So both of those locations, which can actually be far away from one another in a muscle was the umbrella term called motor point.

Now recently, I would say within the last five to seven years, you start to see articles talking about motor entry points. And this is actually a better way of describing where my work has actually been taken is I’ve been looking for the motor point where it goes actually into the muscle belly itself. And the reason why is because it has the largest diameter of the motor nerve, then going into that motor point and has the lowest resistance to electrical conductivity, I’m taking that acupuncture needle and inserting it into that spot is where we can actually change quite a few things within that muscle, not only within the muscle itself, but also how the central nervous system views what’s happening within that muscle.

So the interesting, interesting thing about this is with motor points, like I said, that’s more of an umbrella term for what’s now being clearly defined as a motor entry point or where the motor nerve inserts into the neuromuscular junction would be the intermuscular motor point. So again, as the motor nerve comes in and inserts into the muscle itself has the largest diameter that goes into the motor into the muscle. Then it usually will bifurcate and go into a proximal part of the tissue. And also the distal part of the tissue sometimes close within an inch sometimes far away, six to eight inches, depending on the length of the muscle. So these collateral branches from the motor nerve travel within the muscle tissue and then insert into the actual muscle itself back can be called the intramuscular motor point. So we have motor entry points. We have intermuscular motor points, VM umbrella term would be motor points.

So I hopefully that actually helps. Um, you don’t really see motor entry point too much discussed in our field, but I’m sure it will start to spread over this next five or 10 years. Just, just because that gives us a little bit more clear definition of what exactly we’re trying to be able to treat. Now, the motor entry point is where the green triangles are on the sports medicine, acupuncture textbook, and also on the motor point chart, that’s where the motor entry point is located. Okay. So then now the intramuscular motor points themselves, um, those can actually be turning into trigger points with Josh and Brian and I are going to go ahead and discuss that in just a little bit or a trigger point can also develop, uh, at the location of the motor entry point. So from here, why don’t we now start to compare and contrast with the trigger point? Josh, do you want to take it away or Brian, do you want to add anything?

Yeah, I’ll, uh, I’ll step in here. And so Matt and I have had lots and Brian, Matt and Brian, and I have all had lots of discussions about, um, comparing and contrasting, um, trigger point phenomenon with motor points. And so there are a few different, um, dimensions within which we can kind of talk about these both contrasting differences and comparing areas that are similar. So one of the things to keep in mind, especially once we start talking a little bit more clinically, is that as helpful as it is to really talk about the, the differences between ideas about motor points versus trigger points to a large degree, especially clinically there’s a huge amount of overlap. And it’s a, if you really like Venn diagrams, there’s like a big circle about trigger point phenomenon and a big circle about Motorpoint phenomenon. There’s a huge gray area of overlap between the two of them.

So I’m going to try and keep that in mind as I’m discussing this, but it might sound at times like I’m being a little bit arbitrarily black and white about differences between them when that’s really not the case. So, um, one of the, one of the areas of contrast is that the motor points are basically a, a normal physiological phenomenon. Everybody has motor points. It’s just how the body works. Whereas trigger points are very specifically a pathological phenomenon. I’m not going to talk too much about the details about trigger point physiology, Brian and I spent an hour actually last time talking about a lot of that stuff. And so if you want to brush up on that, you can kind of go watch the previous podcast that Brian and I did. I think there are also going to be some links to some other discussions that Brian and I and a few others have had about trigger point stuff.

So you can refer back to that. Um, so that’s the first contrast is just normal physiology versus a pathological condition, right? Trigger points. Are they form due to some kind of muscle damage, right there, a small contracture in a muscle fiber that is the response to either like an excessive eccentric load or, uh, a low level contraction that goes on a long time and kind of wears out the fiber. Uh, another, another type of contrast between them is that motor points in a lot of ways are more like acupuncture points in that not only everybody has them, but the, the locations tend to be somewhat predictable, even though there can be quite a bit of variety of from person to person, whereas trigger points can really form just about anywhere in a muscle. So when you’re looking to treat trigger points, you really have to palpate the entire length of a muscle.

Whereas when you are treating motor points, um, you’re generally starting from a somewhat relatively defined position. Like it’s, uh, say, you know, in the middle, like the middle part of a muscle, or like in the case of say the rectus femoris, one of the common motor points is going to be halfway between like stomach 31 and hunting, right. You still have to palpate locally and the actual location you’re going to be looking for like a kind of an usher point. It might be, you know, one up to sooner, so away from that point, but you’re starting roughly from [inaudible].

Um, another, another area of contrast, uh, that I think will probably open up interesting discussion because Matt and I have talked about this quite a bit is how you use them clinically and what muscles you choose to treat, whether if you’re thinking about a trigger point versus a, um, a motor point. And so I’ll just kind of talk just very briefly about my take on this and then maybe, uh, Brian and Matt, if you guys want to pop in and, uh, contradict what I’m saying. Awesome, nice and heated, spicy debate going. So motor points in my practice, I tend to use very, uh, very kind of more generally to really overall improve the functioning of the muscle and to treat in the sense of the little skeletal homeostasis, what I’m really focusing a lot on biomechanical issues, where there’s a joint dysfunction in gallons of muscle pull across a joint, or are treating, uh, a muscle in one area of the body.

And I want to treat the entire senior channel. I might need other muscles more display or more proximally in that CGU channel. I’m 10 years motor points is in those locations, more commonly, um, and for trigger points, I tend to overall use the more specifically to treat the referral patterns when there’s pain or some other like parasthesia, that might be part of the referral, but even having said that there’s a huge amount of overlap between them. And so I also very commonly will use trigger points to treat more general biomechanical issues and old very often also use motor points to treat painful conditions. Um, and there’s a more subtle distinction to be made. And how I diagnose personally between the use of those two things. Um, it has to do with the fact that when you have pain, sometimes the pain is coming from a motor point, but you can have pain due to a muscle dysfunction that isn’t sorry, a trigger point.

Um, you can have pain from muscle dysfunction that is not from a trigger point pain, but just you can have pain because the muscle itself isn’t firing correctly, which can send signals to the central nervous system, kind of a warning signal. That just something isn’t right. We’re going to just give you some pain. So you stop using the muscle. Um, so you can have cases of pain that are in a muscle that are not to the trigger point, but they can be helped a lot by motor points. Um, so there are just kind of muddied the whole discussion a little bit with that. So I I’ll, uh, let’s open this up, Matt, Brian, uh, what do you guys want to talk about in terms of that?

Uh, Brian, I’ve got a few things to say, but why don’t you go ahead and start? Uh,

Well, I just say something simple and that’s, uh, you, both of you guys painted an ice clear picture of, uh, a difference between a motor point in a, in a trigger point. But if you look at a lot of the discussion and sometimes even the research out there, it’s not always so clear cut as, as Josh kind of alluded to it, the Venn diagram of how they overlap in terms of, um, comparisons, but even in terms of discussion like Matt was mentioning, sometimes they use the term motor entry points, sometimes motor point to encompass all of that. It’s not always very, um, consistent sometimes there’s discussions of trigger points that talk about, like, I saw several research articles that talked about an anatomical basis for trigger points. And they were basically looking at the motor entry point as the site of where trigger points tend to form.

Um, so the it’s not so clear how we’re going to try to discuss it from a, um, you know, compare and contrast and as if they’re different, but there’s a lot of overlap out there. So if you’ve looked into this at all, sometimes it’s easy to get confused because it’s confusing cause there’s a lot of different, different people saying different things about it that aren’t always consistent. Um, and I know this isn’t the case with the newer edition at Trevell and Simon’s book, but, um, in the previous additions, you know, they had Xs on sort of the frequent location of where a trigger points tend to form. And there was numbers, you know, like trigger point number one, upper traps trigger point number two, and in a different regions and different kinds of common sites. Now, of course, within that common site, you’d have to palpate and find the exact location.

Um, uh, and it’s going to be very variable, but there were sort of go-to sites, so to speak. And, um, if you look at those go-to sites, you’ll see that those go-to sites tend to be at the motor point, the motor, uh, close to the motor entry point location, um, where the muscle is getting the innovation. So, uh, the reality is that motor points are at the location of where common trigger points form, and both of them share one similar thing in their description and their language is that a motor point is the highest concentration of motor in plates. It’s a motor in plates or the cite on muscles that are, uh, have receptors for acetylcholine. So a motor point is the highest concentration of motor end points, a boater, um, in plates. I think that’s more of the classical definition of, of a motor points. Now with motor entry points, that’s more about the entry side of the nerve, but the classic definition going a little farther back as the highest concentration of motor in plates and trigger point in the language is often described as forming at the site of the highest concentration of motor in plates. So there’s a lot of parallel and there’s a lot of overlap and it’s not always clear to differentiate one from the other, my turn.

All right. Thanks Brian. Um, Josh Brian, that was awesome. That was good. Uh, in, in my mind, the motor implants are going to be where the intramuscular motor points are a little kid at, um, where the motor nerve enters into the muscle. There can be collateral branches that go into the motor end plates, but not always. So let’s now take this information and see if we can be able to bring it into some kind of clinical sense, for example, let’s I remember before we get into clinical sense, let’s remember that motor points also can be used as empirical points that will take pain away from a distance site. And that pain from a distance site has nothing to do with the trigger point referrals. Like for example, a flexor carpi ulnaris motor entry point is pre magnificent and taking pain away from the levator scapula attachment.

And that lateral posterior side of the neck or the piriformis motor entry point takes pain away from a urinary bladder 10 region. So there’s a number of different ways of looking at the motor entry point. And also what the trigger point is. Let’s say that tomorrow a patient comes in with sciatica, you use slump tests, you use straight leg, raise tests, a neural tension test, and they’re negative. So it doesn’t seem like it’s true sciatica. So what could be causing the sciatica like sensations? There’s a number of things that can, for example, a Fossette joint can cause referral pain, a sick really act joint can cause referral pain trigger points can cause the sciatica like referral pain. So let’s say that with this patient that you’ve done slump test and straight leg raise, and you’ve ruled out sacred iliacs joint dysfunction or Fossette joint dysfunction.

And you’re palpating along the iliac crest where the gluten minimis attaches and you find with palpation, it reproduces that patient’s sciatica likes sensations. This is just in the hypothetical example. So you’re looking at the glute minimus at its attachment side, or maybe the muscular tenant is junction site that you’re palpating around that area. And it’s a way from the motor point, which would be the muscle belly halfway between the superior border of the greater show canter and the iliac crest. That point definitely needs to be treated because it was causing this person sciatica or sciatic, like sensation definitely needs to be treated and TCM. We look at it as being either as an access or deficient, is it cold? Is it damp? And we are treated according to how we know how to get rid of and resolve damp or treat cold, reduce access, reinforce the deficiency.

It’s all going to be predicated on your palpation. Now, from my experience, if we treated the motor points of the gluteus minimus, first that trigger point that was located two or three inches away would be difficult to find it’s not going to be reproducing that same type of parasthesia. So from my experience, I would like to treat the trigger point. First, what I’ll do clinically is treat the trigger point first because that’s what’s causing it. And they’re like what Josh was talking about before let’s treat the motor entry point, cause that’s going to be then communicating quite a bit, the central nervous system about where that muscle is in space. You guys want to comment on that? Yeah. So

I think, um, another really great aspect to think about motor points is that in that particular case that you’re talking about, the motor points are also going to be incredibly useful to then treat the other muscles that might be involved in why that glute minimus develop trigger points in the first place. Right? So there may be, uh, there may be some, you know, if there’s like a pelvic imbalance where you have to look at the balance between the, the hip, uh, AB doctors like the glute medius and minimus plus with the add doctors plus with like the QL, um, that there may be this larger muscle imbalance issue between keeping the pelvis level in the, in the frontal plane, right? So it could be that treating the motor points of the adductor longus and brevis the quadratus lumborum and even using the motor points more in a TCM sense of looking at excess and deficiency to try and balance.

A lot of that is going to be a really important part of the treatment to keep that one gluteus minimus that’s causing referral pattern to keep that from developing further trigger points, right? Cause the trigger points could just be the end result, like the last symptom of a dysfunction that has been going on from these other areas, right. Um, where you might need to treat motor points, uh, down in the, in the cap for any of the motor points for the muscles that control the foot of the ankle. Cause maybe the glute minimus is developing trigger points because of its being overloaded because of an ankle dysfunction. Right? So I think that’s another aspect to the balance between looking at trigger points versus motor points that can be really helpful clinically. Awesome. Brian, anything you wanna say?

Yeah, I would just add into that some distal channel points do it. Now we have a pretty comprehensive picture. You know, we, we use this one a lot with the glute medius and minimus minimus in this case. Cause it’s clearly on the gallbladder sinew channel ma uh, Josh mentioned the quadratus lumborum and the add doctors, which we on time to go into it now, but the QL is, uh, part of the liver send you a channel as the ad doctors are. So you could also include points, um, to affect the relationship between those channels like sourced and low combination gallbladder, 40 liver five would be a really good combination that we use quite easily in the program. So you do, maybe we have this one point, that’s creating a referral, but it’s linked, uh, functionally with other muscular structures. So glute minimus in this case, linked with quadratus, lumborum add doctors in terms of how they’re in dysfunction together. So we can use motor points and trigger points and combinations of those muscles along with distal channel points. And that’s a to create a good local distal and point combination from a TCM standpoint.

Oh, awesome. Yeah, that’s good. Let’s go farther into that. So remember you guys, Osher points have been treated for thousands of years. So trigger points and tender motor points have been observed and treated with traditional techniques. And in some of the discussions that Josh and Brian have had is that when a trigger point is located in a different location than the motor entry point, it’s really common to find a tight palpable band linking the two. So for example, from the motor entry point, if you cross fibered toward the trigger point, many times you’ll actually find that type palpable ban linking the two, which maybe is why punk’s a needle technique was developed, which is really quite common in myofascial acupuncture by kneeling three or four needles in a row within that tight palpable bag. One of the needles would be at the motor entry point.

One of the needles are two of the needles might be the trigger point. So you’re covering those bases. And then as Brian was talking about linking that particular channel with points that will open up the channels in the collateral Xi, cleft Lubo points and such, and let’s also remember this patient, what’s their internal balance. What’s happening with them? How well can they handle inflammation because it’s on the gallbladder channel. Well, how is their liver and gallbladder functioning in their life? Could the liver and the gallbladder be contributing to part of this clinical picture? Always something for us to be able to consider is people are not just coming in as meat suits. We treat the entire patient. Great discussion. You guys.

Yeah. Another really interesting aspect to, uh, bringing TCM theory into this is also looking at, uh, general, like we get into TCM basic constitutions, right? There’s I very often find an element of spleen Xi deficiency with certain types of people who tend to develop a lot of trigger points because of the, the spleen’s ability to supply energy to muscles. Right? Cause the trigger point formation is in a sense of problem with energy supply to the muscle after it gets damaged, right? There’s a, there’s a very strong case to be made for looking at the importance of blood status and using herb formulas to treat a lot of blood status. Um, I think I mentioned maybe in a previous discussion that Brian and I had, I’m a big fan of the drew Yutang family of formulas for treating various types of musculoskeletal pain for that, uh, for that purpose. So I think that that’s, that could be a whole other podcast. We could talk about like a TC woman also talking about like postural distortions and TCM constitutional diagnoses, and then talking about muscular relationships between postural distortions and TCM stuffs. That could be a whole other thing we can get. Right, right.

That would be hours and hours and hours or people would just go to the smack program. Right. Well, this has been a great conversation, you guys, and I think there’s a lot of clarity that was added to this. Um, we are right approaching that 30 minute mark right now. Is there any closing comments that you guys want to be able to say?

Uh, I’ll just say, well first, um, Matt and Brian, thanks again for inviting me to do this. I really appreciate it. And uh, I just want to put it out there for everybody listening that the, the, the smack program, the sports medicine acupuncture program was one of the real turning points in my career. It kind of brought together, even though I’ve done a lot of work with trigger points and some orthopedic stuff before then, um, it really brought together, uh, so many different elements of what I was trying to get at when I was doing, um, orthopedic work with my patients that it’s probably saved me 15 or 20 years of studying on my own, trying to do a lot of this together. So I just wanted to say, thank you, Matt and Brian for, uh, giving people this opportunity. Great.

Well, thanks for that, Josh really appreciate that. And that’s good. Um, yeah, it’s always welcome. And no, Josh, you didn’t bug me with your questions during the smack program where you sat down as a no, no, you just have very inquisitive mind. And the thing is, is that kind of dialogue is so welcome to because other people are stimulated by that kind of conversation. So it’s always welcomed. So thank you, Josh, for that also for more, let me finish this one real quick, Brian, for more information about Josh in the comments section, there’s, uh, three different links that, um, he’s talking about trigger points for anybody who’s interested in a motor point chart or motor point book. There’s also, there’s going to be links for that as well. Go for what Brian.

Yeah. On the topic of, uh, messages coming up, there was a question which we could go into a lot of detail and we don’t have time, but it was about osteoarthritis of the hip. Um, and I just want to quickly say that the same discussion we were just having about balancing the pelvis, um, by using motor points, uh, in terms of like, if there’s a, uh, elevated Lem, QL, glute medius, and minimus, and the combination of motor points, plus distal points, that’ll help balance the hip joint would be really a great idea for osteoarthritis, but you could also look at, uh, what trigger point referrals are referring to that region of pain. The hip joint itself can refer pain and can be, can be the pain source. Sure. But since we’re talking about trigger points and motor points, looking at the trigger points that are part of that referral, uh, it could be that the trigger point is causing 20, 30, 40, 50, 60% of that pain. Um, so also treating the, the, uh, looking for trigger points in those, um, regions that could be referring to that area would be a, it would be a good idea to start with

Joshua say something, I’ve got something to add.

Um, uh, the only thing I would add to that is if you’re not used to looking up trigger point referral patterns, it not is going to not just be the muscles locally to the hip, right? One of the muscles that might recreate something like osteoarthritis of the hip could be like the lung just amiss muscles up around the thoracolumbar junction around T 12, right. That can refer pain down to the truck hacker. So there’s a lot that has that a lot of, um, resources out there to allow you to look up for pain in one particular area of the body, what is the list of different muscles that can all refer to that area? And it’s really helpful looking, you can find those online it’s in Trevell um, uh, yeah, very useful resource.

Um, just to add some clarity with this one, cause I don’t know what kind of diagnostics were made with the osteoarthritis. So the patient may actually have confirmed osteoarthritis, but now these comments that we’re making is that, um, there also could be, uh, pain contributors, which would be trigger points. So as we know, uh, trigger points can also live not only in muscle tissue that we’ve been addressing over these last couple of hours is also can live in joint capsules, tendons, ligaments. So needling the joint capsule itself may also help in this particular case as well.

All right. Anything else, gentlemen? I think we, uh, we covered most of the stuff we wanted to cover.

All right. Well thank you very much. Really, really appreciate it. And so stay tuned for next week, come in, check in, check out Jeffrey Grossman for next week. And Brian is, was nice hanging out with you, Josh. Thank you so much. Really, really appreciate it. Thanks you guys. Bye now. Bye-bye

Anxiety Is Not Fear – Yair Maimon

…the lecture today will be on, uh, I think a very relevant topic about anxiety, and there is a lot of misconception that links, anxiety and fear, and in Chinese medicine, and we’ll say fear, we’ll link it with the kidney in the essence of the kidney

Click here to download the transcript.

Hello everybody. And welcome. I would like first of all, to thank the American Acupuncture Council for, uh, putting up this lecture and, uh, arranging everything around it. So thank you very much. Uh, the lecture today will be on, uh, I think a very relevant topic about anxiety, and there is a lot of misconception that links, anxiety and fear, and in Chinese medicine, and we’ll say fear, we’ll link it with the kidney in the essence of the kidney, but as you will see, anxiety is actually in some cases may be related to kidneys, but in most cases it is not. So I will start with some slides now, so we’ll follow my lecture. Um, so the lecture, as I say, it will be also based on the clinical and clinical experience, because I always like to teach from the clinic from the clinic and from the thing, the most important information we gather from patients.

And we see actually the effectiveness of our daily acupuncture when we are in the clinic. Next slide, the prevalence of anxiety is actually quite wide. I mean, according to the American psychiatric association, they’ll say 10% of people are affected by anxiety disorder, but really 30%. And I think more will experience it in the life. If you ask me now, after Corolla should be updated thing, then the numbers are much higher and it’s twice often women than men. And it makes sense. I think women just, the more sensitive in men are better in maybe negating or not allowing their emotions to out in America. They’ll say it’s about 40 million people suffering from anxiety disorders and it’s the most common mental illness. So, so it’s a kind of major issue. Next slide please.

And, uh, if you look at the, the way it is described, so anxiety refers to anticipation of future concerns. So there is some concern about something bad that will happen. Actually it can be many things is when you unfold the case in the clinic, it can be a very vague thing, or it can be very real in sometimes very surprising and it may create this avoidance behavior. So people will not do something like they’re afraid to drive the car because there is some fear related to losing control in the car or that something will happen in the car. I have very strange cases like people will drive in the car, but not in bridges or not to pass tracks. Usually it relates to something that we will see later on as a, as a kind of trauma-based things. It, but fear is very different. Fear is in emotional response to some real threat, immediate threat it’s more associated in, in Western medicine was the flight and fright reaction that the body chooses. The sympathetic SIM system becomes very active and it’s either fight or try to escape from danger. Next slide.

So when we look at the pathology, we see the things, it is not the same as fear. And, uh, this one is real and this one is a bit unreal and it’s always something, you anticipate something in the future. And when we look at the symptoms, you will see, it’s not really kidney symptoms that you see in the clinic, which if anxiety will be fear, it’s much more the palpitations, the chest pain, chest oppression. I think almost 50% of people who got come to emergency room with like a threatened heart attack, or they think they have heart attack. It’s actually panic disorder or anxiety disorders. So it’s a very common that all the symptoms more relate to the fire into the heart next line. So you see it’s not the kidneys and, uh, if we can look for the next line. So, um, one of the things that anxiety very much refers to is this kind of, uh, um, being rooted in some trauma, in some memory and, uh, this memory that’s the interesting part can be a root of the memory can be known, can relate to a certain situation, but even more interesting.

It can be unknown next time when it is known, it’s very well, I won’t say easier to treat, but like we use different strategy and, uh, it can be, you know, death, it can be an accident. It can be any event, you know, events in the army like, uh, uh, PTSD. Then usually I, I feel that it’s good to combine acupuncture with some other strategy, with some other kind of behavior modifications like a behavior, psychology, MDR, be a feedback. So when you can pinpoint to is some very specific event, like if somebody got stuck in an elevator for a long time, now he’s afraid to go through an elevator is and anxiety and panic attacks about it. Then maybe, you know, it can be, the acupuncture will be amazing and creating a change, but maybe we’ll need another intervention. It’s more interesting when we go to the unknown area, when there is no real reference, uh, to the, the beginning of this anxiety attack.

And then also it can be prenatal or postnatal next slide. And this differentiation of postnatal and prenatal is, is also important in the clinic. I find it many times the postnatal, uh, if the root is already in the postnatal life, we’ll see more of this heart symptoms, palpitations, arrhythmias, chest oppression, different things around the heart. And even people will be concerned that they have something wrong with the heart. When it’s a prenatal, obviously there is no memory and it will relate to some issue maybe that starts very already at the pregnancy time and maybe even earlier, but I mean, it, some things are running in the family. I can good example if the mother, especially the mother, because the mother and the fetus are very connected through their PO. If the mother has anxiety, she can pass it to the child. Obviously, if there was some traumatic event to the mother and I’ve had many cases that I’ve seen that I can route to, sometimes during pregnancy, like the mother went through an accident or the mother, I know different cases where the mother wanted to do an abortion and then regret it.

So in a way it was traumatic to the child. So then there’ll be a certain anxiety and uncertainty issues around death. And that’s whenever there’ll be, I know a patient of mine, if there’d be some death in the movie, you will go into this anxiety attack. So the prenatal roots are very interesting to watch. And then the symptoms also may shift. You will see more like to do also with breathing difficulty, waking up with difficult breathing, being afraid. There’ll be not enough oxygen, uh, eh, even claustrophobia, strange dreams, fear of losing control. You’ll see a lot of different, weird symptoms, which are initiating the anxiety or coming with the anxiety next slide. So it will be very different, uh, when the root is known or unknown. And also to me, the treatment will be different. And I’ll, I’ll talk a little bit about treatment also of unknown roots.

Exactly. I think it can be really, uh, kind of, uh, beginning of, or the root of many symptoms in the clinic. And this is also symptoms you will find when you look at what symptoms anxiety can provoke. So it can be neurological, digestive, respiratory cardiac, muscular. So you have patients actually coming to you with a chronic fatigue syndrome is fibromyalgia was different abdominal, the disturbances, but actually it is anxiety. And you may treat for a long time, the physical symptoms with very little success. And till you change the strategy and the focus of treatment on the anxiety and the root of the anxiety, and then suddenly all the symptoms will disappear. All will get better. Next slide. So this is very common to me to kind of shift my attention from a physical cause to something which is deeper to a real root of disease, which is deeper.

Let’s go through a simple, not simple like case from the clinic. And then I can explain, um, it’s a patient 29 years old is quite a quiet person. Uh, first I introduced him a little bit, like what I see in the clinic. Um, he kind of, kind of rude himself is very shy and, uh, but it can be also engaging. I mean, if you talk with him, he will look at you. So pat is timid, shy, quiet. He will not initiate a discussion. And when you look in his eyes and maybe you can also see through this, there is something a bit lost and a bit sad and a bit lacking there. Next slide. So, uh, this is like, what do you see in the clinic and how the anxiety manifested in him? Uh, any, when you say since the day I remember myself, I have anxiety and anxiety attacks.

I was very shy as a child and almost not seen in this is something also interesting, like this feeling of not being seen by friends. Although he, he, you know, it looks good is very active, but he always, this has stayed. You know, one of the deepest thing that I can say about myself, I always feel alone. Even that he’s surrounded with people, uh, he has this feeling of being alone and he’s when he is with people, easily feels offended and gets insulted, especially in the group, you know, things that maybe people don’t like him or say something about him and he will immediately withdrawn next slide. So this is like very shy and inward person. And if I asked him about the sentence for the anxiety, he says, I have this tension in the upper part of the abdomen around rent 15 and a, and it says like, when I get this kind of anxiety attack or anxiety feeling, I feel everything is going up to the head very often lately I will have insomnia, especially during time that there is more anxiety and this tendency for short breasts let’s time.

So, uh, you can see that there’s like many symptoms and his, his life is very much kind of the quality of life is extremely reduced. My oldest feelings. So I asked him also what makes him better? That’s a very key question to ask people. And a lot of time we’ll give you actually an insight of, um, both the root of the disease, but also for the path of healing. It’s a very simple question. Uh, but sometimes actually the most important. So he says when I feel loved, which was a very surprising, you know, because it was very honest and, uh, you know, titled as patients, you almost feel like you want to hug him suddenly, you know, cause it’s like bringing this honest pain, but also this there’s something about him and not being seen in any meaning law, which is also very much calling for lab to, to ask.

It’s almost the path of the diagnosis. And he says, when I have a new relationship with when he is in relationship with somebody that he loves and feels connected to enclose, there’s less anxiety and then asked him what it is related to. And I find questions that are one of the most important part in really understanding a case, the answers to two good questions, a good, they can be very simple, are extremely revealing. So he says it’s connected to a fear very kind of deep and morphic theory says the feel of being alone, the kind of feeling of being alone gain related to some kind of, you know, it’s not a fear from something, but it has this kind of being alone and this kind of being lost in this being alone as a key, a feature in his internal life, next slide. So you can see that, that he’s very, um, Inwood person, but in the same times is seeking and yawning for, for, for this love and connection.

And I say, when did it start this kind of fear in itself, it started at a very early age. So probably the root is prenatal, as you will see later, asked him if he in yet other fears, he says, don’t not really fierce, but difficulty in relationship, difficulty in start relationship in intimacy. And, um, it says it doesn’t stay long in relationship and he doesn’t understand why, like you said, only feel close, even if the relationship are good for him. So again, it’s a kind of already hinting as towards something deeper, which is the root of the anxiety, next slide. So, uh, the pals and the tank, so the pulse was on the heart and pericardium, uh, some will call it kidney and very deep and weak. So basically I put it. There’s no fire. The fire pulse is very weak. There’s no fire there.

The tongue is normal. Next slide. So you can see that the gain, another issue, uh, we’ll go now to the diagnosis. Next slide. So the diagnosis in general, there is a weakness and it’s important to see access or weaknesses, always the beginning of diagnosis. And there’s a weak fire, weak meekness, 12 fire, some weakness in the kidney. And I put it as a general tendency feeling of not protected because the treatment will reflect the diagnosis, the treatments we want to bring back this ability to feel more protected, next slide. And, um, so again, and when we look at the diagnosis, so you can see this shyness, this ministerial fire pericarp fire, which very much relates to relationship is very weak and very weak Shan and eyes. And if that is kind of a bit lost as Shen is a bit weak, next slide. So you seek instance deficiency overall of firing and weakness.

Uh, since it’s a day, he remembers itself is a prenatal and this feeling of not seeing again, this points to this week fire. So we want to strengthen tonify this fire in a very deep way into treated this prenatal root of this weakness. And as this easily feel offended, it’s another part of CARICOM and it’s a drain. So it’s a pericardial lever. A lot of time can relate to is next time, next time. So, uh, also the symptoms, you know, very much the divergent channel and divergent channels are a lot of times keen treating anxiety as the divergent channel of the pericarp relates to this area and goes up to the head. So it explains this kind of feeling that he has an insomnia shortness of breath, again, relates to the pericardia, this tightness in the chest and this lack of Dwayne stagnation, next slide. So, um, and again is relates to love relationship. So, um, I it’s very clear like where the case is going to end if this weakness of pedicab, but also relate to the gene level next line.

So this, um, prenatal root is one of the key routes that we want to address here. And we want, that’s where I find it, that the kind of usual acupuncture and send the straight forward, doesn’t bring this deep transformation effect unless we go to some kind of a different usage of acupuncture and next slide. So, um, and the pulse on the tongue, again, re reflect the same thing. So next slide, and we can finalize the diagnosis that there’s this fire, especially pericardial, uh, weakness, and some DJing and kidney essence weakness. Next slide. So the treatment I, I, I used for him was sometimes pericardium, which I will not discussing in this lecture, but it’s the fire of the pericarp very interesting point. And I’ll lose it just on its own, just to one point treatment. And one point needling sometimes create very dramatic effect. And then it was very cut one and do 11, which I want to discuss next time.

Um, this is a picture of the DOMA. It’s part of a project that I’m doing with two colleagues, bottles, Kaminski from Poland, then Rania ya’ll from Israel and took together with the painter from Poland and Matina Yankee. And so we kind of paint and portray them Perigon in a various more special way, but basically in this project, looking deeper into the effect of, by the effect of points and the mechanism and the names of points. So do 11 Shen doubts, look at the name, they do it the way of the Shen, the Dow of the Shan, next slide. So here you can see the picture, uh, from our, uh, book, which will be hopefully ready in a year. You’re already working seven years on itself. I’m still optimistic, but it takes long. We already went through all the points twice and we’ll need more time to finalize it all.

So first of all, this point is located on the level of their heart. And you can see here this, this kind of this pathway, this path of the Shen next slide and the path of the Shen is this path, uh, that, uh, the, the road, which the emperor used to travel in the, to the Imperial too. So it means it’s like to go to this ancestral energy. And when we talk about prenatal, uh, effects, we’re talking about really, uh, ancestral or, or things that are passing in the lineage. And I find in the clinic that many strange symptoms can be related to lineage to, to the parents and to the whole lineage. And then that’s why the patient cannot understand the root, or why has this symptoms? So this point is a very special name. Next slide. This Shen down this way to the clear way of the Dow.

And this is the way the emperor used to go to this ancestral through tubes and all the, the points by two on the upper chest and upper back, uh, relate to this dynamic of the gene, going up to the heart to be transformed into shape, to this deep transformation of water and fire. So if you look at the location of the point, it’s on the level of his bladder, 15, which relates to the heart and bladder 44 also, which relates to the heart. So the location also explain us the dynamic of this deep changes of the heart. Next slide.

So we can use this points to establish this back communication with self, the established, a communication with your own downs, your own inner path, which is special for you, you know, which is special for the patient, which is dependent very much on his individuality he’s authenticity, which I can say, like the background noise of sometimes ancestral noise, different traumas are just taking the person of his own path of his own authentic feeling and path. And when person is connected to this place, then the Shen comes out and then nothing really can disturb you. And this point can be used for anxiety distinction for, uh, for flight and next slide for timidity, and also for shortness of breath. The other point, which is interesting is card one, just use it today. Actually in yesterday, it’s called celestial pool and you see this beautiful drawing that we are a painting.

It’s a drawing of this pericarp channel. And this point is on the pericarp. You can see it’s quite high, it’s on the mountain. So it’s on the chest area, you know, just by the nipple next slide. And the name celestial pool is very special. Next slide it’s to do with this place of, uh, the pre heaven and post heaven meeting, meaning of, of really the root of life, which is heavenly. At this point, there is internal trajectory which are connected to rent 17. So it’s also very good to a lot of chest oppressions and, but even eye disorders. I mean, it’s part of the windows of heaven and windows of heaven are very much related to, um, the divergent meridians, which are balanced deep balancing our emotional life, that the Virgin Meridian, the extremely important in treating emotions and especially deep rooted emotional problems and emotional conflict, it’s also meeting point was liver and gallbladder. So when you see things more related, uh, on the, on the drain level, this point again, has another treated actually was this point, the person who is a glacier who has difficulty of swallowing, uh, next slide.

So, uh, as I said, its name is very special. Heavenly pawn is a place of, of this connection. This is this ascend, early pond is, you know, in all the places and all the classic life are starting from water from this essential poem, which everything is timing for next line. So just to kind of finish up this short lecture. So in his case, it is it, is it fear? No, it is more this weakness of this weakness of fire, this deep deed for love and being in and feeling loved and feeling protected, which is, that’s why the CARICOM is sometimes translated as the heart protector. So there is this weakness of also wood and water, which is not supporting the fire, but the fire is the core in his case next line. And using this kind of points really create a transformation. If you’re interested to hear more about kind of how to use transformation points, I put a whole series actually, during COVID about the different, eh, anxiety disorders. I call it creating the cloud series because it’s to do with anxiety and depression and other, uh, more emotional rooted and understanding better the emotions. And now we can treat them with acupuncture next line.

So as a final note, you know, I it’s, I, I call it by the way, clearing the cloud, because sometimes when you use this, especially windows of heaven point, it’s like you open the window. It’s like the, the image is like, you know, suddenly there is light in the room, or if you walk during the day and there is clouds and suddenly they’re clear and the sky is open. So the whole internal feeling is changing. And to me, the most magical part of acupuncture is this ability to transform, to touch heaven in the patient. And to me, having in the patient is, is a very real thing. It’s the real deep inspiration of being connected to something which is greater than, than you. It’s difficult to put it in words, but it’s a very known feeling when you feel in a place when your heart is at peace, when you feel connected, it’s then it’s when you’re alleviating suffering and clearing this clouds and allowing this real deep healing and change. So next time. So, um, I hope it was helpful for you. And, uh, thank you all for joining, joining in, and thanks again, the American Acupuncture Council for providing this show. Be healthy, feel well. And from Shanta Shan, thank you so much and all the best.

How to Get Past the Gatekeepers for MD Referrals – Chen Yen

You like the idea of attracting more patients through medical doctor referrals, but you’re not really sure how to get past the gatekeepers,

Click here to download the transcript.

You like the idea of attracting more patients through medical doctor referrals, but you’re not really sure how to get past the gatekeepers. So this is Chen Yen your six and seven figure practice make-over mentor at introvertedvisionary.com and welcome to my show today on AAC live. So, uh, you might have been thinking about getting referrals from medical doctors, but, um, let’s talk about, well, how do you actually connect with them? Because some of the most common challenges that I hear are having trouble getting past the gatekeepers, or, you know, how do you approach them so that they actually do take you seriously? And then what if they’re saying things to you? Like the, you’re not a part of my insurance network and, or they might seem skeptical. And the truth is that as far as I’m days go, it is true. Not every medical doctor will refer, but did you know that medical doctors have thousands of patients in their practices and many would be actually happy to tell their patients about you, if they knew about you and how you can help their patients.

So, um, as we get into this, I w I want to share, uh, uh, let me just, let me just think about this, what I want to share. Okay. So, so then is it worth it to you to develop that relationship with, with a medical doctor? And it just, you just only need, like, you don’t need a ton of medical doctors referring. You just, you know, a handful of medical doctors who are your biggest champions. And remember, they don’t always have to be medical doctors either. They could also be other kinds of conventional medicine practitioners or holistic health practitioners too. So whether it be nurse practitioners or nurses or PAs, I have clients who are nurse practitioners also, and they say, Hey, don’t forget about us. It’s actually easier to get in with us then, then medical doctors as well. And then you could also look at like making connections with other holistic health practitioners, for example, chiropractors and naturopathic doctors, too, to mutually collaborate on helping you’re working as a team or to collaborate more on, on getting better outcomes for your patients.

So specifically, let me give you three hot tips related to connecting with MDs. And, uh, this comes from my experience of having worked in different settings in the hospital setting as a pharmacist, as in the outpatient setting. Also, I’ve been in the insides of the FDA and at Merck, and having seen what actually gets medical doctors to refer and what doesn’t and giving you the shortcut to that. So, and by the way, I, I have, um, okay. So as far as, uh, the, the, the, the, uh, the tips that I was going to share with you, so the number one tip of connecting and getting in with MDs is to actually go around the gatekeepers, because if you’re just facing the gatekeepers, what are they doing there? They’re there to screen you out. One of the most common mistakes is, is I actually also sending things like letters, but what happens to, to a letter, just think about the kinds of mail you get in your office.

And you, you look at one and you really don’t know, uh, you don’t really recognize it. What do you do? Right? It’s like, and this is what the gatekeeper might be doing like, right. So, so then, um, how, how do you actually, I approached them, get them going around the gatekeepers one hot tip is to, to actually, I message the doctor on a platform like LinkedIn. So this is a, an Avenue that our clients right now are getting really good results from. And we had a client of ours. Who’s been doing this, and then he’s been getting zoom meetings with the medical doctor. He also, um, offers up to, to meet in person too, but isn’t it nice to have that opportunity where you don’t have to leave your, your, um, house, you don’t have to leave your clinic. And then you could just do a zoom with a medical doctor and start to, to help them be more aware of how you can help their patients.

So that is one hot tip, and then you just need to know what exactly to be messaging them. And then I went to do, if they don’t, don’t actually, um, get back to you, right? So, but that’s, that’s one thing that’s working really well for, for, um, our clients. And then the, um, the second hot tip is, um, and these are tips that I’m teaching you from the doctor referral success roadmap in the, uh, in our consistent patients, make-over, uh, mentorship for introverts. And so it’s to actually go, go through your existing patients, see this is instead of sending letters instead of calling the office. And then they’re like, who are you? Um, some of the most low hanging fruit is, is think about the, the patients you’ve, you’ve had good results with and, or who have been very appreciative of your care. And how can you actually, um, ask, they’re even ask the patients more about the, their primary care doctor, if they have one or other kinds of practitioners they see, and then, then you can ask them, um, do you, do you like them?

Right? Cause it’s also important to, to get a sense of what that practitioner is like, you’re the people who, who will likely refer most to you. And also the people you’ll enjoy working with the most are ones who are most with you value wise. So you need, it’s not just about reaching out to any kind of provider. It’s also helpful to be discerning too, about who you develop these relationships with. And then, so then how do you go about this? So once you, after you have, have, uh, have a better sense of whether he wants to connect with that, that doctor or not, then you could always suggest that the patient bring it up to, to the medical doctor about how they’ve been coming to your practice and essentially putting a word in for you. Right. Just saying, tell your, your doctor, how, how it’s been for you coming here.

And I would love to, um, connect with your doctor because, uh, I would love to too, I’m developing my network of referrals and in the area and wanted to connect with, you know, would like to talk to them and understand their, their practice philosophy better as there might be the ne uh, opportunity for mutual referrals or, uh, when, when the need arises. So, so that is something that you could bring up to your patient. And then what happens when I’m after that? How do you actually approach the, the doctor, uh, when you, you know, doctor’s office and Dr. So we actually have a template for this that I want to make sure you have, because that we could just, just, uh, use it right away already to help you with, with getting into the next step of this. And, um, you can go to, I’ll give you the website link.

So it’s at introverted visionary.com forward slash get M D referrals. So it’s introverted, visionary.com forward slash get M D referrals. And there you can download a template, um, that will be instantly, and you could use that to help you with what, what do you actually, uh, how do you go about, you know, what do you say to that doctor once you actually have that opportunity to connect with, with that doctor so that you start getting referrals, you’re more likely to start getting referrals sooner rather than later. So the third hot tip of what you can do to go around the gatekeepers instead of just, just, you know, talking to the gatekeepers and then them screening you out is, uh, to, uh, educate the doctors through, uh, and a talk or a webinar where you’re in front of the providers. So why is this it’s because many times when, when, um, you might not be getting referrals, it’s because of, of one, three reasons, and let’s have a look at the slides here.

So let’s hop into the second slide here. So, so, you know, and, and also in terms of the, Oh, and go ahead and go to the second slide. So this is, this first one is just that most people often quit, right? When they’re looking at getting referrals from doctors, they’re just like, well, they try a little bit, and then they quit. And they’re like, well, this thing doesn’t work. Whereas it might be that it’s just because you haven’t, uh, haven’t had a system in place that works to have it happen because we have clients. Imagine if you actually had three providers sending you one or two referrals a week, what would that do for your practice? It’ll get filled up pretty quickly. Right? So, so in order to increase the number of referrals, for example, if, uh, whether you’re not getting any or whether you’re already getting some, let’s look at the three reasons why you may not be getting referrals as much right now, one.

And then, and then we’ll talk about why, you know, the, the webinar also doing your talk and then how you know, that kind of thing, um, can help speed, speed up this referral referral thing happening. So one reason why they may not be referring or not referring as much yet is because there’s not trust in you as the practitioner. So this, this is also in you personally, you know, that, that personal connection with you just think about it, the people that you might connect with the most, or the people you might refer to the most, you like them, like chances are, there’s some, you know, they either like them for who they are personally, uh, or they, they, they’re just really great with their patients, right. But there’s still some kind of a personal connection. Otherwise you could, you could choose to refer to someone else also.

So, uh, so their connection with you as a person can also play, play a role. The second reason why you may not be getting as many referrals as you could be, or any at all yet is they might be, they might not trust in your modality. Now, when we talk about modality, I don’t just mean that they think acupuncture can help it. It’s also beyond that, it’s like, what do they actually understand the scope of what acupuncture can help with? Or do they just think that it’s just used for musculoskeletal pain and that’s about it, right? So to what extent do they actually under skid stand the scope of how you can really help their patients? Also, they need to know and understand if it’s safe and effective. If it’s not safe, they’re not going to refer. Even if they think it’s going to be effective, but if they’re kind of scared about safety or, or, um, or like, if you’re, you know, if you’re you offer Chinese herbs and then they’re all concerned about drug interaction, then they won’t be referring.

So how can you help, help them feel safer? And also there are many of them are concerned about lawsuits these days. And so that’s a, um, an of consideration whenever they, they, um, they refer, they don’t want to get in trouble for referring to someone who ends up screwing up on their patients because they can, that’s not a good thing, is it? So, so then how are you communicating your, um, the safety and efficacy of your approach? The third reason why you may not be getting as many referrals as you could be get is because they’re not necessarily, you’re not necessarily top of mind awareness for them. So they’re busy and they might be going about their day with so much happening. Seeing patients day in and day out, are they having nurses have get their attention vendors are trying to get their attention. Drug reps are stopping by people.

They’re getting calls and requests all the time throughout the day. They’re really busy. And so what we want, and if you’re not top of mind awareness for them, they’re not gonna refer. So because today they might have thought about you. And then two days later, they already forgot about you. This is why drug companies think about this. Why do drug companies spend so much money sending drug reps to eye, to doctor’s offices? They know they have statistics to back it up that every single time when a drug rep goes and educates the doctor more, there’s this spike in prescribing, I’ve seen this because I’ve been in the inside of a pharmaceutical industry company, right? So this is the sort of thing that, that I, if you are able to get to the point where, where when doctors are, are seeing patients during the day, and I think thinking anything, meaning I remember I should refer to this person, that’s when you will be getting more referrals from medical doctors.

And so, um, uh, and so thank you for showing the slides for my help with this. Like the, so then, um, the, as far as an Ellen, if you could switch back to me, that’d be great. So as far as the, the, um, in, in terms of what can you do is to actually educate, um, the doctors further, right? Remember we talked about the, the, even if they realize that, uh, or understanding, Oh, acupuncture can help with pain, but if, if there are certain scenarios where they’re not as, as, um, well, an understanding about related to whether it’s safe, or if it makes sense for this particular situation that can think, then they’re not going to refer for that situation. So one way, how are you going to actually, um, help the doctors understand better? So one great way is to educate them. And, and then, uh, but then how do you educate them when, when they’re really busy seeing patients all times.

So if you’re able to have the, have the doctor hop on a zoom, or if you’re, if you want to stop by, and then, then also be sharing a couple of key things, you know, then, uh, or if you’re speaking in front of a more for like at a conference or something, um, where there are providers there, for example, we had a client of ours who spoke to a room full of 50, um, medical doctors and other kinds of conventional medicine practitioners. So she got 10 patients herself, as far as those doctors coming in to see her. And then she got referrals. In addition to that, now some of you might be thinking well, but I don’t know about speaking in front of such a large audience. I feel a little intimidated for one and another. I just don’t want to be speaking at a large audience.

Don’t worry. You don’t actually have to, you could literally just be talking to one, one, a medical doctor, one person’s not feeling more comfortable. So, um, yeah, but for those of you who want leverage, cause imagine if you, you actually just, I, again, you know, you do one, one webinar or one talk and then you’re, you’re done for a long time. The doctors are referring, you’re getting three patients a week. You’re getting five patients a week consistently for a while. Then you don’t actually have to be doing marketing for a long time. This is one of the few approaches where, where, um, you can literally be putting it in place once and you could be getting referrals three months from now, six months from now, even a year longer from now, and not have to be constantly marketing other approaches. Typically you need to be constantly marketing.

Would you agree? And that can get exhausting. You would just like to be focusing on helping your patients and treating patients. So, so then you just need to have a system that brings in doctor referrals quickly and consistently as well. That works. And so, as far as I promise to also share with you the what to do, uh, when the doctor is not in your insurance network too, so, um, or the ones that you seem to my top, it might seem skeptical. So, so as far as the, the, the w if there, you’re not a part of their insurance network, it’s just a matter of two things. One is what if instead you reached out more to medical doctors who had cash based practices, or who had concierge based medical practices, because there are medical doctors like that out there, and they would be there.

Patients already used to that kind of a culture of pink cash. And so that’s one possibility. Second possibility is, um, just because a patient has insurance doesn’t always mean that they won’t pay cash for it, for example, um, there, I mean, I can think of two instances, have you ever, uh, perhaps maybe you have insurance, right. But have you ever paid out of pocket ever happily? So if you have, then, then that’s an example of, of someone, even though they would much, but would you also rather prefer to, to, um, have your insurance? We accept that. Of course, most people, if they are paying for insurance, they want insurance to be accepted, but you still in the end still also paid out of pocket. Right? Why that it’s because you really saw the value. And, and so the second possibility is that, you know, again, we can’t really judge people for, um, whether they will pay or not.

For example, I actually had a client who, who, um, who told, who suggested her patient, this patient actually got on a train one hour each way to go see her. And she said to her one day, she’s like, well, why don’t you see someone closer to you? You know? Um, and she’s like, and this person was on Medicaid. Right. And I, because also my client was going to be moving to another location. And it might’ve been a little bit further away from this person. So, but she said, well, why don’t, why don’t you just, just let me, let me refer you to a different provider who be closer to you. And she said, no, I save up my money every month to come and see you. And it just really hit her. And it really hit me too. Right. And as it should hit all of you that it’s, who are we to judge, whether someone can afford it or not, or choose to save up their money to come and see you, even if indication is, are maybe they, they quote unquote can afford it.

Right. Um, and so, so it’s not fair for us as practitioners who judged that it’s fair for us as practitioners to, to let people know about their options. So if, if a medical doctor actually says that to you while you’re not in our insurance network, and you’re say that’s true. And, um, I believe, you know, one of the most powerful, one of the most helpful things for patient is for them to know their options. And then you could tell that story that I just shared with you, you could say, you know, for example, there a practitioner who, who actually had a patient who, who had Medicaid and, uh, and she said, you know, so you could just tell that exact same story to this metal, whoever medical doctor you’re talking to, who might be concerned, you’re not in their insurance network. So if you’re finding this helpful, go ahead and, and like this, or typing the chat, uh, what’s been one valuable tip so far.

And if you want the script that I promised you in terms of a, an exact, um, script that you can use to help you approach, uh, medical doctors for whom you have mutual patients with so that you can get the ball rolling more, to be getting more referrals from medical doctors, then you can go to introverted visionary.com forward slash get M D referrals. And then you just need to know, see one of the most common mistakes. A lot of acupuncturists end up making with this when wanting referrals from medical doctors is, um, not really having a strategy. It’s just like, Oh, let me, let me go ahead and reach out to these doctors. And, Oh, I had a good conversation. Oh, they should start referring now because they said they would let me know if they had any, anyone who could refer you, but, but, um, how’s that worked for you before it, and if you haven’t tried it before, let me just share with you this, that typically, that doesn’t work very well.

So you need to have, do you actually have a strategy that works? Do you actually have systems in place or even certain things that are automated that support getting doctor frills? And these are the things that our clients come to us for in our consistent patients make over mentorship for, for introverts, um, as well. So you’re welcome to go to our website at introvertedvisionary.com. And if you’re, if you’re tired of being at a plateau and, uh, would like to be busier consistently with patients, or if you’re already busy and would like to be able to free up your time and, um, be able to still help more people without having to, to feel so burnt out, then, uh, feel free to reach out to us as we help our clients. We’ve helped our clients. We’ve ushered our clients into six figures and seven figures the introverted way. So stay tuned next week for a year. Yair Maimon, uh, who will be your host for AAC show next week, till next time

Continuing Education Issues in the World of Covid

…the Kongress is so well organized and so fun, you know, I think, Oh, they’re just going to be listening to lectures all day, but there are, but there’s great teachers from around the world. And there’s also wonderful social events…

Click here to download the transcript.

Hi, I’m Virginia Duran. And this week’s host for another edition of, to the point, very generously, really produced by the American Acupuncture Council. And, uh, today we’re going to be talking about issues around continuing education in this new COVID world and where we might be going in the future and the pros and cons of online learning and issues that are specific to our field when it comes to continuing education. And so I thought who would have more experience with this then? Julia Stier, uh, Julia is the Kongress chair, woman of the international TCM Congress in Rosenberg, Germany, uh, which has been running for 52 years. And I think of it as the, the largest and most prestigious acupuncture conference in the world or in the Western world. I should say. I don’t, I’m not sure what’s done in the East, but, um, she’s very, very capable and has had to pivot last year, uh, in, in, in a couple of weeks time to putting everything online. And so she’s been dealing with these larger issues around the new continuing education sphere. And so I would like to introduce you to Julia and, um, have her tell us about, uh, how we might, um, proceed and solve some of these. So, Julia, thank you so much for taking time to be here. Cause I know you have another Congress coming up in a few weeks and uh, time is already precious.

So thank you. Can you tell us how

You, how you got into the field?

Um, yeah. Yeah. Oh, well, um, my mother is from Taiwan, I’m half Taiwanese. So, um, in my family or no family, the some Chinese doctors already. And so, um, I sort of grew up with Chinese medicine and it was normal and, um, at all plays and, um, when I was, um, um, a young girl at 17 or 18, I, um, had some, um, chronical condition that came up and up again and I had to take a lot of antibiotics and then I went to see a Chinese doctor and she treated me a couple of times and it sort of, it never occurred again. So, um, I was completely convinced and I, um, started learning, um, uh, Chinese medicine. Um, a couple of years later I have, um, studied, um, medicine also. And, um, also I have been working in, um, um, I’ve been, uh, an event manager, um, lots of years. So, um, when this position at the Congress, um, was free, um, I, it sort of everything came together. Everything just fell into place. And so, um, it was, um, sort of, it was supposed to be, I guess, especially well

Having, you know, knowledge of both worlds, uh, you know, some people don’t have the organizational skills to do something like this, but the, the Kongress is so well organized and so fun, you know, I think, Oh, they’re just going to be listening to lectures all day, but there are, but there’s great teachers from around the world. And there’s also wonderful social events where you’re dancing with your, your heroes or your DCM heroes thing. It’s it’s um, it’s and it’s so well balanced with you have things on nutrition, she gung and tie cheese sessions, uh, herbs, a little, you know, there’s some Western, uh, style acupuncture. There’s classical, there’s Japanese, Korean. I don’t know about Taiwanese, but we should have it if we don’t, you don’t, there’s just, it’s so well balanced to really reflect all the aspects of the medicine that I’m, uh, you know, I feel so fortunate to have, uh, presented there a few times and to just even attend. Um, so we do want to know though how you’ve managed to bridge this gap, uh, or, you know, uh, pivot on, you know, how you’ve been doing it and how you have to do it now and love to hear your thoughts about what it might be like in the future. Yeah.

Oh, well, um, last year it was, um, sort of a surprise in Europe. Um, racial, um, became real, um, in, in March I think. And, um, we had the first, um, lockdown light in Germany from middle of March and the Congress was only two months later. So, um, we really didn’t have a lot of time to think, um, or to make plans. So, um, we just decided to take everything online, um, because we thought this was the only possibility something could happen and, you know, tickets were sold already. Everything was booked, everything was planned. And so, um, yeah, we just went straight ahead. We found, um, a partner in net of knowledge. Um, they are a Canadian company, they have this educational platform already and they program, they set us up, um, um, well, um, a site in there on their educational platform. And so, uh, we could start from there and actually most of our speakers, um, were really, really, um, brave too.

They just, and then said, yeah, let’s go. And we try. And, um, some courses, of course, some lectures, um, some workshops, especially the practical clinical workshops. We couldn’t take online. Um, like the palpation based work. It was, we couldn’t really think of any way at that time. And, um, but most of my questions is how do you, how do you accommodate the, these challenges with the, uh, clinical style workshop? Yeah, well, um, what really worked out well is, um, we had, for example, we had, um, this, uh, Japanese speaker, um, he is, um, in his practice in, um, in Japan and he had, we had two lays with them and the translator, um, with him in the translator and, um, he had patients coming in and, um, so, um, all participants, they could watch online. Um, it was all live. Um, they could watch online.

Um, they had a view directly in the practice. Um, the speaker, um, he quit, um, talk to them directly and he could, you know, treat the patient and, um, do the theoretical part before. And then, um, we could just, um, what should him, how he handles things and he could tell, you know, he could demonstrate a lot on the patients and participants always had the possibility to ask questions. And so it was a really interactive, um, way of teaching. Um, although it was only online. Um, but, um, it was not, it was not only, you know, sitting in front of the screen and watching for seven hours a day and not really being able to do something other than just listening. Um, but you could, uh, really actively taking parts, um, and the demonstration of learning. So, um, that was really good. Um, and also, uh, there was this, um, speaker from Italy and she had, um, trainer, baby, um, uh, workshop. So the participants, um, the babies, um, enter the class and, um, they could, um, turn on the cameras. And so, um, the speaker could, uh, you know, uh, the extra, she could watch them the treat their babies and, um, still comment on how they, how they were treating and how they were, you know, doing what they were taught to. So, um, this was, this was really, um, this was really good way of bridging this gap for us.

Yeah. I think it’s very clever your solution. Yeah. One question I had was, uh, how do you manage, um, intellectual property issues? Because it seems to be a kind of epidemic in the field, at least in the U S and, uh, but I shouldn’t say cause every country I teach in within six months, somebody’s teaching my stuff. So it’s not unique to the U S it may be worse here, but, um, it, it, it’s hard with something where a lot of what we’re teaching is in the public domain, but, you know, material or, uh, you know, with an online platform, how do you protect it with this protector on that issue?

Yeah, well, of course, um, we have, uh, um, w we have them, well, we have not, everybody can just come in, you have to, we have only the participants who could, who get the code, um, uh, to get into the workshops. And, uh, we have people actually watching closely and controlling that, not nobody’s in there who doesn’t belong there. And, um, so it’s, it’s, um, similar to, to a live event really. Um, and there’s these controls. And then of course we mock all the, all the slides, all the slides are being marked from the speakers. Um, Mark does theirs and then, um, well in the end, um, it’s really like an, a live course. You also, you will also always have participants there who take photos or, um, make audios or, um, or video recordings. And, um, we have an eye on that and, uh, of course there are certain rules which people have to follow.

And, um, actually of course, um, some of our speakers put their handouts up, uh, upload the handouts before. So participants can, you know, prepare and Donald before, but some of us, because I’m also, uh, you know, fear that the slides or the material, um, will be taken. So, um, they only provide the material to the participants who leave their email address, and maybe they, um, send out the slides after the, um, after the lecture backs. Um, there will always be a small gap. You can’t close at the end. You can’t really well, um, be a hundred percent safe. Um, but we, and what we can all do is, um, have an eye on everything that is going on. And so, um, in Germany that is not, that’s not re re a lot if someone teaches us what, um, uh, material that is known from somewhere else that has been already taught by somewhere else by somebody else, or is really somebody else’s method that they involved. Um, somebody will see it as somebody will always realize.

Yeah, yeah, no, I’m always so impressed how you have such wonderful teachers and, you know, from all over the world, I mean, from Japan and China and Korea and Australia, North America, all over Europe, and probably some places I’m missing, how, how do you there’s, so there’s so much talent, but how do you choose? Um, and, you know, do you have, you have themes, I think yearly themes for the Congress that have a certain topic you want to promote then, then, um, and then you have, you know, people teaching other things too, but it must be a tough decision.

Oh, yes, yes. Oh, there’s so many really good teachers out there. And of course we have, um, we have a lot teachers who, uh, were already, um, um, part of the Congress many, many times, and you know, who we can really rely on and who always, who we, who we know will be sort of a Garand to, you know, um, to, to do a really, really good lecture that is entertaining and still, you know, really well, they have a lot to say. And, um, and then, um, I’m reading a lot of journalists and I’m visiting other congresses. And then of course, I always have an open ear to suggestions such as sun shins. So, um, many people, um, keep, um, send in their proposals and many people have some, you know, some teachers that they propose to us that they say what you might like, and then there’s, um, there’s also a thing of online learning.

Um, there’s this, um, a lot of material on YouTube and other channels, um, nowadays, so I can get a better impression of, um, what the speaker has already been doing. Um, it’s, um, it’s not, um, it’s not taught to find new speakers that are really a lot new challenges. Um, it’s just, yeah, but it’s hard to decide because we only have, you know, we have like, uh, sometimes some years we have 60 speakers, which is a lot, but, um, there are a lot more who we, who couldn’t speak. So yes, it’s a tough to show

Or, and, and with, you know, uh, if you’re, um, also providing the videos afterwards where people who couldn’t attend or people who just, you know, want to, you know, get it all, then you don’t have to worry about like missing, you know, your favorite speaker cause they were at the same time. So there, there are some advantages to the online viewing of the class.

Yes, yes, yes they are. I mean, nothing can, you know, there’s, uh, that the personal it’s it’s missing, of course I’m the person I’m meeting and the dancing, the, you know, social, but, um, what really is a plus a big plus is that you, you buy a day ticket and you don’t only get to see one workshop. Um, you can, and this is something that actually a lot, a lot of people did last year. You can, during the day you can jump between the lectures and you know, what, you don’t have to stay in one lecture all day. And, um, uh, we upload the recordings of the days, um, for a couple of months afterwards. And so, and until the 1st of September, September of this year, you have time. Um, what if you booked? So, um, at 10 days we will get the chance to see 10 courses, 10 lectures, instead of one.

Can you tell us, um, a little bit about the theme and some of the speakers this year and how they can help people can find out more information about it?

Oh yes. Do you find, um, the whole program on a TCM hyphen Congress for the key dot and D E is also an English language, of course. And, um, uh, the thing, well, this year it’s, um, expressions of the metal element. Can you see this? Yeah, very appropriate because of the metal element and it’s about a physical and mental manifestations of skin and respiratory diseases. Um, we have, um, a lot about topic, but also really, um, on, on any other topic you can imagine. And, um, we have learned a lot from last year things that worked really well and we left out things that maybe didn’t work out so well. And, um, all for example, this year we have, um, a live cooking class. So, um, there’s in the handout and there’s a sort of a stopping list and you can go and, um, do your groceries before. And then, um, on the day, um, you can, you can be actually cooking with our teacher. She does this. And then, um, and this is also something we couldn’t do live in an, in an actual kitchen because you can’t put hundred cooks into a kitchen, especially

Okay.

When everybody can do this from their homes and they’re connected.

Well, that’s a great idea. Yeah. Yeah. We’ll miss some of the interacting with your colleagues from all over the world, but you know, that’ll come in the future. And of course it’s really about the, uh, the content of the Kongress. So, um, is there anything else you wanted to say before we close? Yeah.

Um, because you mentioned the, like the interaction we have, um, we have some social gathering, um, um, also online, like, um, um, the fantastic finale, for example, it’s always on, it’s a concert on Saturday nights, um, which is, um, done mostly by us because, and, uh, we did that last year and we have that this year too. Um, it was really nice, you know, it’s, it’s sort of, uh, the same feeling

Yeah. Whoever wants to can turn on the cameras. And we had a long, long chat after the concert and it was hot woman, really, it was nice to see everyone and, you know, at least that for a while. So, um, yes, everyone who was interested can just check out the program and be sure, um, it will, there will be a social interaction to not only, you know, learning on a high level, but also, um, meeting each other in some way.

So everything, but the 2:00 AM drinking with your teachers. We try, maybe that goes lunch. Okay. Well, thank you so much for, uh, being part of the show and we’re so grateful and next week for those that can tune in, we have Matt Callison and Brian Lau as hosts. So, um, really, uh, again,

This is Virginia Duran of luminous beauty.com signing off and thanks to the American Acupuncture Council again, see you soon.