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Acupuncture Today
June, 2009, Vol. 10, Issue 06
 
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When Patients Stop Coming

By Kaleb Montgomery, DTCM

In my last article, I mentioned that I find it interesting when patients stop coming for treatment when they start getting better. I want to clarify and explore this more. I don't mean patients that get a 70 to 80 percent improvement then stop coming for treatment instead of sticking it out.

That's very common and natural. We all have different thresholds of tolerance. Once a problem is eased to a certain degree with which we can live, it's no longer worth the time and/or the money spent on treatment.

What I am talking about is chronic problems that patients spend years trying to fix and once they start to finally see some improvement, they stop treatment. My patient with the chronic urinary tract infections was the example I mentioned in my last article: "Urinary Tract Infections and the Heart."  I have a couple of other patients that clearly illustrate this point as well.

One is a man that came to me because of urinary difficulty. He had almost complete incontinence, and was impotent and unable to achieve a full erection. He had tried numerous other complementary and allopathic treatments to no avail. He was referred to me by another health care provider.

I saw him for only a few treatments. After each treatment, he showed improvement. After only one treatment, he was able to hold his urine for about an hour. He also had been able to get his first good erection in a long time. He was unable to sustain it, but we were both very happy with his progress. I was surprised and happy that such a chronic stubborn problem had improved so quickly. He kept expressing to me over and over again how happy his girlfriend was with his newfound erection. It was easy to see the joy in his demeanor and eyes. My next surprise happened when he cancelled his next treatment and did not rebook again.

This story would normally end there, with me wondering why he stopped coming in, except that I told the story to the health care provider who referred him to me in the first place. They told me that this patient had a history of sexual abuse and that he was the abuser. Now his story made sense on a few different levels. Firstly the nature of his symptoms was clearer. The body location and organ system involved in an illness do not happen randomly. I have spoken about this in earlier articles, but it is important enough that I want to mention it again here.

Illness is not random. When we get sick, our bodies are speaking to us. They are telling us that something is askew. This imbalance almost always starts on an emotional and/or mental level. In TCM, this is called the shen; the subtlest and most refined level or manifestation of qi. The qi flow is interrupted first on the shen level and then other levels are affected afterward. This is just like how a blood stagnation can develop from a qi stagnation. "Qi is the commander of blood," meaning the qi movement propels the blood flow. This is the same relationship that is happening with qi and blood, except with shen being a more level instead of qi, and qi being the coarser, denser substance instead of blood. Our spirits "talk" to us through the affects of the emotional disturbance by altering the flow of qi in the body part or organ system about which we are "worried." In my patient's case, the original disruption of qi occurred in his reproductive organs with the abuse, hence the urinary and sexual performance issues he was experiencing. It was like the guilt he was feeling over what he had done had so severely disrupted the qi flow in the area that his penis no longer functioned at all. Both of the jobs that his penis was built to do, urinate and have sex, were affected. Fair enough, sexual abuse is a horrible crime that echoes down through the generations. It is important to point our that my guess at his feelings are just conjecture. I did not speak to him about how he felt. However if what we know about the cycle of abuse holds true, in this case most likely the original disruption and damage to his qi flow probably first occurred in my patient when he was abused.

In another case, a woman with fibromyalgia and chronic fatigue was referred to me because she was not progressing. This woman had so much pain in her jaw and teeth that she was unable to eat solid food. For the last six years, she had only eaten steamed vegetables and tofu pureed in a blender and slurped through a straw. I am not sure why she limited herself to just steamed veggies and tofu, I know that if pain limited my diet to liquid, those two foods would not be my first choice of sustenance. As we will see, more likely her outrageously limited food choice was probably a reflection of the mental/emotional root of her illness.

Like the first example, we got great results in just a few treatments. After one treatment, her teeth felt so much better that she was able to eat fresh crispy lettuce for the first time in six years. In our next treatment, she told me that she asked her dentist if acupuncture could help tooth pain and he said no, so she was going to stop treatment even though she had continued to improve this week as well. Needless to say, I was frustrated and tried to convince my patient that the dentist was wrong because she actually had improved. However she would not change her mind and I did not see her again.

Again, the story would have ended there except that I spoke to the health care provider that referred her to me in the first place. This time the health care provider called me because he was mystified by our patient's behavior. This patient had come back to them for continued treatment. When he asked why she had stopped seeing me even though it was the only thing that worked, she insisted that she did not want to talk about it. Every treatment she came in and asked, "What can I do to get better," and he would say "Why don't you go back to see Kaleb?" She would refuse to talk about it and of course did not call me for more treatment.

For me the most interesting part of this story is not that she stopped coming for a treatment that was working. I eventually came to the conclusion that she was not ready to heal yet. We all have gotten advice from friends, maybe about a bad relationship, that we dismiss to the eye-rolling dismay of our friends or family. Later on, when the situation plays out exactly as predicted by our friends, we say "Why didn't you tell me!"

This patient could not yet let go of her disease. The fascinating bit for me is that she continued to spend her time and money to get a treatment that was not working and that she knew would probably not work. If she had just discontinued treatment and not gone back for more, then I would have still been frustrated but could have chalked it up to tight finances or her not being ready to heal thus far. However, the baffling part was that she still spent good money on ineffectual treatment. Why?

My guess is that like many fibromyalgia/chronic-fatigue patients, she used her illness to get attention, love and support from friends and family. She had forgotten how to get attention in a normal healthy way. I hypothesized that her support network would quickly get fed up with her if she stopped seeking treatment all together, so to keep up appearances and be able to play the "I am doing everything I can" card, she had to keep "trying" to get better.

Nothing is quite as irritating as someone who is sick but is unwilling to try to help themselves. People stuck in that rut quickly find themselves alone and friendless. Being alone and friendless is not what my patient wanted. She wanted the attention, but needed to get/stay sick because it provider her an excuse for something. I did not find out what this something was for her, but I have found it out in other patients. I find this pattern very common in fibromyalgia/chronic-fatigue patients. So common in fact that I will cut this off now and continue this train of thought in my next article by exploring fibromyalgia/chronic-fatigue more.


Click here for previous articles by Kaleb Montgomery, DTCM.

 

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