Learning is supposed to be difficult
It's not you, it's the subject. We are all baby birds learning to fly.
I’ve decided at the moment, I’m going to alternate between posts for the beginner veterinary acupuncturists and posts for the more advanced veterinary acupuncturists so that no one gets too frustrated with material above or below their skill level.
Heaven knows that learning this form of medicine with a western mind is hard enough. We don’t need to be making it more frustrating than it already can be.
This essay? Substack? I’m not sure what to call it. This one is on the effort that we naturally put in to learn something. This is to help those of us with the anxiety that comes from growing up and having most of your school work be easy; then you get introduced to Organic Chemistry.
The universe has decided I’m going to dwell on this for a moment because there were several sessions at ACVIM talking about helping people learn things, and then when I got home, the Qiological podcast was discussing a similar subject.(Qiological #413)
Another aside: If you haven’t yet found Qiological, I highly recommend it. This is a human acupuncture podcast hosted by Michael Max that as he says, gets into the weeds of East Asian Medicine. He also covers development of acupuncture businesses and so this translates very well to what we do. You can find Qiological on the web and wherever you find your podcasts. Here’s a link to their about page on the web Qiological
Learning is hard but playing with the material can be helpful
Think about watching babies learn to drive their bodies, and young children learning how to hold a crayon or a pencil and learn to write and color within the lines. Look at their faces. It’s usually a picture of intense concentration. How hard was it to master your physical exam for conventional medicine? Are you still working to make it better? How hard did you work on your first surgical attempts?
So now, I’m going to help you with a medicine form that comes from a completely different direction, in a different diagnostic paradigm, and with a different set of tools. Of course this is hard. Like the other skills mentioned above though, it can also be rewarding.
When you learn to speak a new language, you can play on the apps all you want. If you don’t practice speaking to other people in that language (which is HARD!) you will not become fluent. If you do practice, you are introduced to a new world, and sometimes a new way of thinking. This can be very rewarding. Your hard work pays off. What can help is practicing the discipline of learning a new thing. This is equivalent to scales for the musician and learning verb tenses and vocabulary for the language learner. The more we practice thinking in the new diagnostic paradigm, the easier it will be to use it in your every day life.
First let’s start with what doesn’t work so you can stop doing that.
From vet school, everyone probably has some study habits that worked when you needed something in short to medium term memory to pass the test. This doesn’t help if you can’t remember what MCH is on your CBC six months later. Cramming, and reading things over is great to get things into short term memory but you need to actively engage with the subject to get it into medium to long term memory. If you don’t use it, you’re going to lose it.
This is how you put things into your memory so you can use them. Please bear with me re: the diagram. I’m learning adobe.
Yeah, this image kind of sucks, but what it says, is that we have to engage and retrieve information continuously to put it into our brain and then be able to get it out to use it. It also says that I’m not afraid to suck at Adobe. Don’t be afraid to suck at acupuncture or any other skill. You’re still better at it than someone who didn’t take the basic course.
So how do we do this with TCVM/Acupuncture/Chinese Medicine? I hear you say. You immerse yourself as you can. Listen to podcasts on Chinese Medicine like Qiological that I mentioned above , join vet acupuncture groups on social media like Every Day Acupuncture For Veterinarians.
Integrating your conventional brain and your TCVM brain
All of that is reading is important. You also need to engage with the medicine. An easy way to do this is through your conventional patient physical exam. Think of how many of those you do every day. You can engage your TCVM brain during each and every one of them and not add significantly more time to your exam. Waaaaay back, in the dark ages, when I did conventional medicine and was learning TCVM, I added a second section to my notes labeled TCVM findings. I just threw in stuff I noticed and if possible attributed TCVM values to them. Nobody ever complained about more information in your notes, so don’t be shy. If one of your colleagues asks you what you mean, do your best to describe it in conventional medical terms. That will help you be able to describe how things are linked and help them know what you mean by that statement.
Most of us start with a meet and greet to the patient. Petting them, observing how they behave (how’s their Shen?)? How did they do walking into the room? Do they appear neurologically normal? If your tech is putting them in the room, simply look at their faces and watch how they navigate the table or the floor. Strength? Symmetry? Any signs of them dragging toes? Do they know where their feet are? If they’re there for a problem is the problem on the Dorsum (Yang aspect) or the Ventrum (Yin aspect)? Are they the same temperature all over their body, or is there a temperature differential between front and back or up and down or the lateral aspect and the medial aspect? How’s their skin and hair? Do they have any strange smells emanating from them?
Pulse everyone quickly. Learn the difference between what an apparently healthy dog or cat pulse feels like. Then there are the pulses that feel “wrong” in some way. You don’t need to know how they feel wrong, just take a guess and put it in your notes. Pulse feels deep. Pulse feels superficial and is larger than expected. Pulse is tight. You put your attention on the pulse.
You can also do this with the tongue. I remember in vet school all of the tongue variations I saw and the conventional doctors teaching me said they were all normal variations. Really? You mean it’s perfectly normal for that tongue to be pale lavender, and that other tongue to be brick red, and that tongue to be purple. That tongue has a yellow sticky coating. That’s all normal? Of course it isn’t, but it’s only relevant on your TCVM exam.
When you do abdominal palpation, do a superficial palpation before you go deep. Look for reactive alarm points, look for tensing in the abdomen. Note where it is on your record. You may not actually use this information until you learn more. For now, what you’re doing is engaging your East Asian medical brain and improving your palpation skills. Are any of the ventral Alarm (Mu) points painful? Note that. Pay attention.
As you do your musculoskeletal exam, where is the pain? Which meridians are involved? Is it regional, local, or global? What is tight and what is loose? Problems extending the front limbs, can be tightness in the diaphragm or problems in a Yang Ming meridian. Pain in the Gall Bladder meridian is common in older dogs. Are there Shu points lighting up? Do you think this is related to an internal medical problem or a pain problem in the back or limbs? I once found kidney stones in a patient that didn’t look right because BL-23 was a gaping depression and we decided to do a radiograph along side the usual CBC/UA/CHEM panels. Note what you see in a separate section. It may be helpful to you at this visit or a later visit of this patient.
The other advantage of noting these things in your physical exam is that now that your TCVM brain is engaged, you will see things that you can help with acupuncture. Now you are reminded to offer it to the client. There should be no IVDD case or joint pain case in your clinic that doesn’t get offered acupuncture as a potential treatment. Clients can refuse. You can tell them you don’t have time now, but you are happy to schedule a follow up to treat them later. Overall, the number one complaint about conventional medicine I get in my exam room is that no one ever told me this could be treated with acupuncture. Don’t be that person. You can treat that patient if the client so desires. Don’t wait until all of the conventional treatments have failed. Do them together. You offer all of your conventional tools to help a patient, now you can offer this too.
As you train your brain to think in both languages, don’t expect perfection. Expect to do better over time. Every time you interact with your TCVM physical exam you get better at doing TCVM exams. Encode the data then retrieve the data then encode and then retrieve. This is how we get things into long term memory and how we can get them out again easily. Looking for things makes them easier to find.
