The Acus team warmly congratulates the first cohort of U.S. Air Force physicians who graduated from our “Medical Acupuncture for Military Physicians” course at Nellis Air Force Base on Monday, June 13, 2016!
These residents completed 300 hours of medical acupuncture training, and they will use their acupuncture skills both on the battlefield and in garrison. In the photo below, Acus Founder and President, Dr. Joseph Helms, at the center of the graduating cohort.
On May 30, 2016 by Acus Admin
Acus Acting Executive Director Brad Erickson, PhD, interviews Acus graduate Nacchal Nachiappan, MD, about her experience using acupuncture to treat veterans.
Where do you practice medicine, what kinds of patients do you care for, and what are their particular challenges?
I’m at the Phoenix VA. My specialty is general internal medicine and I see a lot of patients with chronic pain and mental health issues. The patients are more vocal in expressing their feelings and can be more aggressive in their demands than the general population. I try to explain things and show that I’m offering something different. I demonstrate that I’m not ignoring them, and that I’m giving them different options as I provide comprehensive care. I do this so that they feel they’re being heard and in order to build a relationship of trust with them that will carry forward into the future.
How did you come to integrate acupuncture into your clinical practice?
Taking the course with Dr. Helms opened up a variety of therapies and modalities, including electrostimulation for patients who didn’t want me to use needles. The patients really like it. You usually don’t get to cure people before your eyes but these practices can produce results on the spot. Only a few minutes of treatment can have a huge impact.
How does the option of acupuncture change your treatment approach?
I don’t have to wait to give a referral or wait to see how patients respond to treatment. Some patients experiencing pain are already taking as much narcotics as we can give them. Acupuncture is a great option that helps these patients. Many of them respond immediately while others respond over time.
What do you see as the obstacles and opportunities for the expanded use of acupuncture in the VA?
Currently, we have to get a consent form signed before we can administer acupuncture but that requirement will end soon. We’ll have one less barrier to using acupuncture. In common care we have many things to accomplish. My nurses and secretaries help advertise acupuncture to patients, so there is more demand. We’ve established a weekly acupuncture clinic so that I can see more patients.
In the military they do the battlefield acupuncture protocol on 30 to 40 patients together with just one doctor and a couple of assistants. They all get the same protocol and it’s very efficient. I thought I could try that but many patients want to discuss other problems, and record keeping is a challenge that tends to slow things down. However it’s still better than separate appointments.
Have you seen any patients achieve dramatically improved health incomes that you can attribute to acupuncture? Can you tell me about any patients in particular?
Yes, I had one patient experiencing level 8 pain on a 1-10 scale and with just two acupuncture points he felt much better. He came in on a wheelchair and walked out with a walker. Other patients come in every six to eight weeks for a treatment and they say it helps them sleep better and the treatment lasts a long time. I had another patient taking a huge amount of methadone, 180 5mg pills per month. After a series of acupuncture treatments he’s down to 40 pills a month and the goal is to get him off it completely.
Much of the public attention on acupuncture in the military has focused on the benefits for active duty soldiers and recent veterans of Iraq and Afghanistan. Yet medical clinics at military bases serve a large population of retired military personnel and their families. As medical providers at these facilities incorporate acupuncture into their practice, the benefits for senior health show signs of being even more dramatic than those for younger patients. In this interview with pioneering military physician-acupuncturist, retired Colonel Heather Pickett, Brad Erickson asks how acupuncture is helping military seniors in Las Vegas to achieve better health outcomes and improved quality of life.
Brad Erickson interviews Dr. Heather Pickett
BE: I understand that many retired military personnel live in the Las Vegas area. How many seniors are served by the hospital and clinics at Nellis Air Force Base?
HP: There are now as many as 30,000 retired military personnel and their dependents in Las Vegas. The majority of them receive medical treatment at Nellis while the rest make use of the Las Vegas VA Medical Center. New retired vets continue to move to Vegas in large numbers as well.
BE: As practitioners at The Mike O’Callaghan Federal Medical Center at Nellis increasingly integrate acupuncture into their practice, have senior patients gained access to acupuncture?
HP: Yes. I started the acupuncture referral clinic as part of the newest Air Force Family Medicine residency in 2008. It was our goal from the beginning to use acupuncture in our traditional outpatient family medicine residency clinic for all patients as part of the full-spectrum of integrative family medicine. I have found over the years that aging people respond very well to even a little acupuncture that I can quickly incorporate during a clinic visit and the effects can be long lasting.
Each family medicine resident needs to have a diverse panel of patients including all age groups and must include at least 10% of patients that are 65 and older.
They must also have literally hundreds of hours of care of the adult patient in numerous settings such as the emergency room, inpatient units, specialty care clinics, nursing homes, hospice and intensive care units. This means if all residents are trained in some acupuncture, many of the seniors served by Nellis will have access to acupuncture treatment.
BE: What are the particular medical needs of the senior population served by Nellis? Does acupuncture offer any special benefits that improve senior health outcomes and quality of life?
HP: I would say that the biggest problem is pain management and psycho-emotional problems associated with chronic disease. There is always a risk factor in prescribing medications for pain, anxiety and or depression and the risks increase for older patients. Medications for chronic disease also lead to unwanted side-effects. Cognitive problems are one side effect in older people that can lead to accidents and injury. Apart from prescription drugs, over-the-counter anti-inflammatory analgesics can damage kidney and liver function. Kidney function already declines with age while the risk of diabetes and high blood pressure increase that even more; you don’t want to exacerbate that with Tylenol or anti-inflammatories. I have also seen acupuncture reduce opiate use among the elderly with much success. Using acupuncture can reduce these medications to very low doses and may reduce these risks improving their mental state and overall quality of life.
BE: How willing are your senior patients to try therapeutic acupuncture? Could you tell me about a particular patient who was helped?
HP: Very willing! They seem to be much more open than the general population. They’ve been through it all and are willing to try anything. In my practice I would say I see a 90% response rate and the benefits may last longer than with younger patients. I have a post-stroke patient with post-traumatic stress who comes in once a month with his wife for auricular trauma protocol (ATP). He (and his wife!) is beside himself because his mood and mobility is so much better. I also add a few scalp needles and this quick treatment provides 90% improvement in his symptoms.
BE: What would it take to provide the option of acupuncture to more of the seniors served by Nellis?
HP: Using it daily for all health services, which is what we’re starting to do. It began with the family medicine residency clinic then expanded to the ER, in-patient and then to out-patient specialty services as the residents would see their patients in all settings of a community hospital. Our goal is to get every resident trained in acupuncture and encourage them to use it every day. The next stage is to train our specialists in rheumatology, neurology, orthopedics, and internal medicine. They see a majority of patients who are over 55.
Early on, I trained a rheumatologist in battlefield auricular acupuncture, the only kind I had taught others in before Dr. Helms provided the comprehensive training now used at Nellis. The rheumatologist was very skeptical but everyone he treated responded well to acupuncture and the patients started asking for it. One of our neurologists used it extensively as an adjunct in his clinic as well.
BE: Is there anything you’d like to add to what you’ve said?
HP: Seniors have multiple medical problems in the majority of cases. Some practitioners don’t want to try acupuncture because these cases seem so complicated, yet more doctors need to put it at the top of their list because even a little acupuncture can help. If seniors can reduce their meds, or sleep better, that can lead to better health and quality of life overall. Doctors don’t need to be intimidated by the complexity of senior health challenges. After all, acupuncture is a relatively low-risk therapy. The 2015 American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (http://onlinelibrary.wiley.com/doi/10.1111/jgs.13702/full) is an evidence-based list of select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug–drug interactions documented to be associated with harms in older adults. When I look at that list, I see many of those medications and the problems they are supposed to treat can possibly be addressed by acupuncture. I really want to add that as we continue to see these successes in our senior veteran population, I hope we can transfer this knowledge to Medicare recipients as there is such a huge need in the civilian senior population for medical acupuncture to be reimbursed and current guidelines do not provide for acupuncture reimbursement.
Heather Pickett Biography
Heather Pickett is a recently retired Air Force Family Physician/Flight surgeon who served for 22 years stationed throughout the world. She graduated from the United States Air Force Academy in 1988 and the Chicago College of Osteopathic Medicine in 1992. She completed a General Surgery internship at Wright State University in 1993 and then a Family Medicine residency at the University of Nebraska Medical Center in 2001. Dr. Pickett started out in rural medicine for a year, as the lone doctor on a 2X4 mile island in the middle of the Aleutian Islands in Alaska! She was then sent to Edwards Air Force Base in California as a flight surgeon where not only did she work with the US Air Force Test Pilot School and flew in numerous aircraft, but she also was the Commander of the Space Shuttle Medical Recovery Team. Her progressive program in occupational medicine at Edwards AFB, won her the prestigious “Air Force Flight Surgeon of the Year” award in 1998. After her family medicine residency, she moved to Germany where she practiced full scope family medicine and aviation medicine. The last 10 years of her career were spent teaching as full time faculty for the St. Louis University/Scott AFB Family Medicine Residency and the Nellis Air Force Base Family Medicine Residency in Las Vegas. She has been an Assistant Professor with the Uniformed Services University of Health Sciences in Bethesda, Maryland, St. Louis University School of Medicine and Touro University College of Osteopathic Medicine in Las Vegas. She also completed a Primary Care Faculty Development Fellowship at the University of North Carolina, Chapel Hill in 2008. As an osteopathic physician who has been using her manual medicine skills throughout her career, she was chosen in 2005 as one of the first Air Force Physicians to be trained in Medical Acupuncture through the renowned Helms Medical Institute Physician Acupuncture Program. Since then, as a full-time Family Medicine professor, she launched acupuncture teaching clinics at the Scott Air Force Base/St. Louis University School of Medicine Family Medicine residency and the Nellis Air Force Base Family Medicine residency in Las Vegas, NV exposing hundreds of medical students and residents to the art of medical acupuncture in all aspects of patient care. She was the first military family physician to teach auricular acupuncture at the Uniformed Services Academy of Family Physicians national conference in 2007 and has taught auricular acupuncture techniques across the country and in the UK to both military and civilian practitioners. While in the Air Force she received the ‘Academic Grand Master’ special experience identifier for her years of acupuncture experience and teaching. With numerous publications, presentations and research related to family and integrative medicine, she currently works in the Pain Management clinic through the Department of Physical Medicine and Rehabilitation at the Veterans Affairs Southern Nevada Medical Center. There she performs medical acupuncture and osteopathic manipulative medicine to a wide range of patients with pain and mental health issues.
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Acus Preceptor Dr. Freda Dreher explains how acupuncture influences the neurological and physiological processes that perpetuate PTS among military service members in this interview with Acus Acting Executive Director Brad Erickson.
Dr. Freda Dreher is a Physical Medicine & Rehabilitation physician who has been in practice for 22 years. After several years of practice, looking for a healthier approach to pain management, she took the Helms Medical Institute course for acupuncture for physicians. Since that time she has been so impressed with the benefits of acupuncture for general health conditions that she continued with the HMI training for primary care. She has also received Board Certification in Medical Acupuncture based on extensive attention to continuing medical education and continuous ongoing acupuncture practice in both inpatient and outpatient settings. Her ongoing education has not only focused on acupuncture, but has included yoga, Qi Gong and Tai Chi, positive coaching, Motivational Interviewing, and most recently hypnosis. As a clinical preceptor for Helms Medical Institute and Acus Foundation, she finds the balance of eastern and western medical approaches for the care of patients with trauma, pain and disabling conditions to be very satisfying.
BE: How did you find your way to acupuncture?
FD: During residency training and in my first few years out in practice, I had several family members with health problems, and then I myself had some serious health issues to address. Although I found my doctors and my colleagues to be bright and compassionate, I felt that personal and individualized care was sometimes missing. I sought out acupuncture treatments for my own health. My first few treatments were not terribly effective, but they were personal and most definitely individualized. Intrigued, I started reading books on Chinese medicine. After speaking with several colleagues who had taken the Helms Medical Institute training, I decided to take the plunge. The course was rigorous and it was fun. For the first year in practice I only used acupuncture for pain management, but felt that I was not a complete physician if I could not treat sinusitis, menstrual difficulties, and other such assorted common complaints. In my second time through the HMI course, this time focusing on primary care, I learned even more than I did the first time. My appetite was properly whetted for a lifetime pursuit of education in acupuncture as well as related arts and practices such as Qi Gong and Tai Chi.
BE: What can you tell us about the challenges and rewards of training military physicians?
FD: I have found that there are more rewards than challenges in training military physicians. As a whole, the students who are active duty and are treating active duty military service patients and their families are a very well prepared group. I have found that they take assignments seriously and approach the work in an enthusiastic fashion. The physical fitness level of most military physicians is higher than average and this matters in acupuncture training. Students practice on each other, and thus we have easy models for teaching acupoints locations. Even when the studying is difficult and the material is rigorous, military physicians tend to not complain. I suspect that this is related to the unique perspectives that they have gleaned during their service duties. It is rewarding to know that when they train in acupuncture, they will invariably have ready, willing and deserving military service members upon whom they can practice. The only challenge that I feel is that I have not served in the military, thus I cannot walk in their shoes. Overall, I feel that is an honor and a privilege to teach those who serve our country.
BE: Could you describe an acupuncture technique that you find particularly well suited to military applications?
FD: During my time working in the Veterans Affairs medical system, I found that I was not only able to treat Veterans, but I often saw active duty soldiers from the Vermont Army National Guard. As I was primarily seeing patients for traumatic brain injury, spinal cord injury, and amputation, I had plenty of work to do. From showing up to appointments early, to readily expressing gratitude for their care, this patient population has been about the easiest I have ever worked with. For the patients in my clinic, I found that scalp acupuncture was the most effective for immediate reduction of pain and pain related symptoms. Invariably patients in my clinic had PTS and/or ongoing high levels of stress and sleep disruption. For those problems, I have turned to basic body points. It has seemed amazing at times that a stress treatment would resolve the pain complaint. In turn, pain management acupuncture on body points can help patients to sleep better, thus in turn reducing their stress and improving their healing. I have often explained to a patient: “This acupuncture treatment neither removed nor added anything to your body. Thus, the healing is within you. I am helping by doing acupuncture, but ultimately you can learn to heal on your own.” I look at Veterans as individuals who often used to be extremely fit, capable and proud individuals. Acupuncture, as part of the medical system, can help them to rediscover those features within themselves.
BE: In a national address, President Obama referred to the “demons” that follow veterans home from war. In our military history, we’ve used terms such as “shell shock,” “battle fatigue,” and “war neurosis.” During the Civil War, this condition was called “soldier’s heart” and Germans once used the term Seelenbelastung or “burdening of the soul.” Now this is called Post Traumatic Stress (PTS) and it seriously impacts many returning soldiers. How can acupuncture help these men and women?
FD: The neurobiology of Post Traumatic Stress is fascinating. For the person experiencing such stress, it is devastating. I was first able to witness PTS at the VA where I trained as a medical student and resident, and have more recently seen PTS patients at the VA Medical Center in Vermont. Acupuncture can very much influence the neurological and physiological processes that perpetuate stress response emotions and behaviors. Research is only beginning to help us understand how and why, but it is apparent that there are very real and measurable changes in the deep brain structures when acupuncture is provided. Some of the response is related to the personal setting of care, the safe environment, and a compassionate acupuncturist. But there is definitely more to it than that. I recently treated a Veteran who spent two years serving with the United States Marine Corps in Vietnam. He came to me hoping that I could relieve a little of his back pain. Knowing that he’d had several inpatient admissions and a multitude of approaches for PTS, I chose to do a PTS treatment first. He woke the next day with no back pain and having had no nightmares. He explained to me at his next appointment that he had a renewed sense of hope. As a physician, the rewards do not get any better than that.
In this post, Brad Erickson, Acting Executive Director of Acus Foundation, interviews Dr. Helms about the innovative use of acupuncture in the military.
BE: What can you tell me about the particular medical needs of military patients?
JH: The leading reasons military patients seek treatment are 1) back pain, 2) neck pain, 3) headache, 4) stress, including insomnia, anxiety, focus, and all the forms of post-traumatic stress, and 5) all other forms of pain.
BE: People might be surprised that back and neck pain are the top problems. Why is that?
JH: Soldiers carry 75 pound kits plus special gear such as medical equipment, communications gear, and weapons. While carrying these heavy kits they are climbing, crawling, being shot at, and medics are carrying injured bodies. Flyers are in constant vigilance, looking backwards-and-forwards and side-to-side, which results in what they call “cobra neck.” All of these factors place a tremendous amount of stress on the backs and necks of service members.
BE: What are the opportunities for medical personnel to use acupuncture in the military and why do you advocate a “think acupuncture first” approach?
JH: I’ll take you through the opportunities for acupuncture in the military but I also want to say that I don’t advocate that military medical practitioners think acupuncture first in every instance. In a battle emergency situation, the first priority is to get the wounded to safety and carry out life-saving interventions. Clearly, in such cases I would not advise acupuncture first.
BE: What about when the wounded person and field medics are no longer under fire?
JH: While they are waiting for medevac, they can use auricular acupuncture to control pain without the complications of administering high doses of pain killers. Then, when at the base camp, and the patient is reassessed, and, if appropriate, acupuncture can be used to reduce pain and stress, restoring a sense of calm following the trauma of injury. When stabilized at an intermediate facility in Kuwait or Germany, acupuncture can be combined with conventional therapy to treat pain, concussion symptoms, and to restore function. You can’t always perform complex surgery at these facilities and some wounded personnel are flown to Walter Reed or another US facility. While there, they may be subject to a series of surgeries in a process that can be very demoralizing. At this stage acupuncture can be used to keep pain at a minimum and also provide relief from stress and psychological trauma.
BE: Do opportunities to use acupuncture end at the hospital?
JH: No, once patients are in a rehabilitation or Veterans Health Administration center, we are dealing with chronic pain, functional rehabilitation and recovery from psychological trauma. All three of these conditions respond positively to acupuncture. In garrison, the everyday traumas that bring patients to urgent care or follow-up visits is also fertile ground for the integration of acupuncture into overall treatment strategies. It is beneficial to be able to offer acupuncture as a potential unique intervention or to complement conventional health management.
BE: Now that the Acus team is carrying out acupuncture training for physicians at Nellis Air Force Base, how is that changing military patient care?
JH: Our experience to date at Nellis has been very promising because there is a growing corps of practitioners that allow acupuncture to be offered at any appointment without waiting for a referral to an outside acupuncture clinic. This means that acupuncture can be part of the first line of treatment options rather than used as a last resort. This is what we mean by Think Acupuncture First.
BE: But you aren’t claiming that acupuncture is a cure-all?
JH: No. What I am saying is that a skilled acupuncturist will find many creative opportunities to assist whatever processes are being undertaken in ways that complement other interventions and therapies to enhance patient comfort and wellbeing and improve health outcomes.
