Needle Sickness, Code Blue and Vasovagal Attack

By Gregory Ross, LAc

In school, the teacher who taught us about fainting in relationship to an acupuncture treatment always referred to it as "needle sickness" as a way of differentiation from other causes of fainting. My first experience with needle sickness came in 1987 when I was about to graduate.

A patient had come into the school clinic with a frozen shoulder, a painful and immobilizing condition. He was unable to raise his arm even to a horizontal position. The patient was assigned to a new intern, and the clinician suggested she do a through-and-through from St 36 (Zu San Li) to UB 57 (Cheng Shan), with the patient sitting in a chair so he could move the affected limb to loosen the frozen shoulder.

The new intern had never done this procedure, and the clinician asked me to help her. I made the mistake of assuming the intern had asked if the patient had eaten today, or was fatigued or nervous about the treatment. I was showing her how to thread the needle slowly and gently, but before I could ask the patient to move his arm, he said he felt faint. As I took the needle out, he passed out. We caught him and got him to the floor without harm. Pressure on Du 26 (Ren Zhong) brought him back to consciousness, at which point we found out he had been on a three-day juice fast.

It was years before I put a needle into a patient without asking if they were hungry, tired or afraid of the needles. The first time I forgot, I got a job out of the mistake. In 1993, I was doing a NADA (National Acupuncture Detoxification Association) workshop at a Criminal Justice System conference in Berkeley, Calif. I was explaining the NADA protocol to a room of about 50 judges, chief probationary officers, assistant district attorneys, sheriffs, police chiefs and substance-abuse program directors and counselors. I brought needles and offered a sample treatment to anyone who wanted to experience the calming effect of the ear points and Yin Tang. To my surprise, about half the room opted for treatment. I was moving fast; it was a good opportunity to show this crowd of powerful "stakeholders" that acupuncture was not only effective, but also quick, easy and inexpensive. In my excitement to get this all done while keeping up a running explanation of acupuncture detox, I forgot to ask the crowd about hunger, exertion and fear.

After I had needled about 15 people, someone called my name. As I turned around, I saw two people helping a woman to the floor; she was conscious, but felt weak. I ran over, removed the needles and got someone to give her some water, while assuring her and her boss they did not need to call 911.

She had not eaten breakfast. She got up, returned to her seat and said she felt well. I finished the workshop. I even had the presence of mind to point out how powerful acupuncture was. Most other recipients of the treatment reported feeling calmed by the acupuncture, but the "needle sickness" event was a much more powerful display of the movement of qi .

Two weeks later, the chief probationary officer of Alameda County, who had attended the workshop, sent someone to my office at Highland Hospital. I worked there part-time in the chemical dependency program, providing acupuncture detox, as well as acupuncture medical services to clients and staff. Over the next few weeks, we finalized a part-time job in the probation department doing acupuncture detox in the Drug Abuse Control Center (DACC), a new drug court program.

My third experience with needle sickness came in the winter of 2000. By then, the probation department grant had ended but a Ryan White Grant provided me with employment in the Adult Immunology Clinic (AICH) at Highland Hospital, working with HIV, AIDS and hepatitis patients. In the mornings, on the first floor, I worked chemical dependency. In the afternoons, on the second floor, I worked in the AICH three days a week. The rest of the week, I saw general medicine patients for a total of 40 hours a week. One of my bosses (let's call her "Marina") on the second floor had chronic neck/shoulder stiffness and pain. It took me months to convince her to try acupuncture. She was afraid.

One very busy day on the first floor, Marina walked in, ready to try acupuncture. I asked her if she had eaten. She replied, "A bowl of cereal and a cup of coffee." Well, she had eaten. I already knew she was afraid, and I also knew her job was very stressful. We discussed this, but she said she wanted to get treatment. While I was doing her intake and trying to get to the consent form, we were constantly interrupted by the chemical-dependency clients who had only a short time before going to their groups. Marina was answering pages and making phone calls between client treatments. Finally, we got to her treatment, but a lot of time had elapsed in which she could have amped up her fear.

I started with a stress-reduction ear treatment comprising Yin Tang, Du 20 (Bai Hui), ear Shen Men and one of the following ear points (this varies depending on the patient): kidney, liver or lung. She did fine. Then I did a treatment for her neck/shoulder. I got the needles in, and she reported feeling fine. I had moved on to the next patient when I heard her say, "Greg, I feel kind of funny." As I turned to ask her if she felt nauseous or faint, her eyes rolled back, her body started to shake and she began to slide out of her chair. Before I could get to her, she straightened up, opened her eyes and said, "Where am I?"

I started pulling needles as fast as I could while telling everyone else to stay in their seats. Luckily, I was using distal points ("Balance Method") and had only ear and hand points to remove. Her eyes rolled back again, and her color went to "white out" white. Du 26 (Ren Zhong) and Pericardium 9 (Zhong Chong) did nothing. I called a "code blue" (a life-threatening event).

A few minutes later, my office was filled with doctors, nurses and a crash cart (a moveable supply cart filled with all the medicines and tools needed to save a life). By now, my boss was conscious, but still very pale. To the irritated nurse who berated me with "That was not a valid code blue," I replied, "It was when I called it." The doctor in charge of the code took it very seriously. She explained what happened in Western terms.

It is called a vasovagal attack or vasodepressor syncope. Fright, trauma and pain are the most common causes, but I might add that weakness due to hunger and nervous tension before an acupuncture treatment also can cause this. The sympathetic nervous system is inhibited and there is decreased cardiac output, causing blood pressure to drop quickly and significantly and the person passes out. Death, while rare, is possible.

Later that day, my boss called to tell me she was fine and see how I was doing because, as she put it, "I was gone, but you had to deal with the whole event." She actually said she felt sorry for me.

What a place to work!

Click here for previous articles by Gregory Ross, LAc.

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