Acupotomy – Radical Dry Needling

The unexpected visit to the acupotomy hospital at the end of my stay in Korea was not something I would have ever signed up for. BUT – I am very glad I went.

At VIII ICTAM in Korea, 2013, I sat in on 3 of the 4 sessions in the acupotomy panel, to see what it was. I was suitably horrified – as every western trained acupuncturist I spoke to, was also.

Few non Koreans attended this panel. The translation was not wonderful – but the general idea and the videos were enough to portray what was happening.
I was reminded by a question from the floor about what I had done in my past using gold and silver needles – very fine – and spent some time in discussion with this participant – so I felt my morning was not totally wasted.
I would have been happy to have never heard of it again. Barbaric!! It is amazing how we all carry perceptions about with us.
I kept wondering why they did not do all sorts of other things . . . that we might do in clinic
when back surgery has failed – often many times. What we don’t know we don’t know. . .

This was until my much anticipated post conference medical acupuncture clinic turned out to be the acupotomy – that I had never wanted to deal with again!! This is until I heard their cases. I then saw the point – what do you do when all else has failed? This may not seem to be so outrageous . .

I was forced to re evaluate what was ‘real’.

If we look at what Dr Lee does from the position of a person whose horrendous back pain or numbness, pins and needles and/or permanent restriction of movement and hence life, that is not relieved by standard care – AND they have had several rounds of surgery, and what they have now is apparently the best their body and their life will ever be, acupotomy can be perhaps less judged as being radical dry needling – and more life saving for those who need it.

Seen as an acupuncturist who attends First World people, who have very First World problems, and who have access to a smorgasbord of interventions – it was still amazing to see people get up after the hospital procedure and wander about after what he does inside them moments before!!!

I had hoped that there was some amazing way he saw in real time what he was doing – but was quickly set straight. I watched people sitting at a chair, local anaesthetic inserted and three minutes later – they were jabbed, messed with and off the couch, back to their hospital beds!!! Neck fixed.

The equipment


Sterilised – awaiting use	Betadine & forceps used to paint the body first

The larger blunt gadgets.	The smaller one with the clear plastic handle that he starts with.
	I watched Dr Lee throw the used in with the clean, whilst he is working. We can get horrified, but apparently he has done over 7,500 (another 15 whilst we watched this Saturday morning) and has had 5 cases of infections– which stacks up as ridiculous next to modern surgery infection likelihood.

The process (What is he doing?)


Finding sore spots, marking them for the local

Injecting local, waiting for it to work, then attacking in the facet joints to break up and to physically separate whatever is in the way.The crunching sensation must be totally alarming for the patient.When I felt the instrument inside the person hitting up against everything that was to move – it was both understandable and outrageous.And apparently works instantly, as you can well imagine.Blockage gone!


When we were just in his ‘rooms’ we were not gowned up and he, and we had no gloves on to be touching the implements.

Patients were next to each other.	A far amount of pressure is used.

What he is planning to do

Showing us what he will do in the theatre with the other failed back surgery people – the man waiting lying on the bed in previous picture, was a simple case so he did not need to be in with the nurse, etc.

The context

All have their scans/X rays with them and he refers to this to start the process.

He then has the patient in position and marks out (much like Prolotherapy) where it hurts most. He then comes back with local anesthetic, having injected that in, sets the timer for 3 minutes, moving onto someone else who is waiting and prepped. In the theatre there were three beds and all were in various stages awaiting his ministrations.




It appears to be very gross and feels it also(I was gloved up to have my hand on the instrument he was rummaging around under the failed laminectomy – and there are no words to explain the feelings).


Everyone’s scans are referred to before he starts and he checks where they have problems and he may stop and ask what is happening for them then

What you do not see here is how deep these go in.Or the sensation of FEELING the crunching through – Dr Lee got me to glove up and to hold the handle of his tool whilst he was inside and attacking the facet joints or whatever it was he was releasing. Then it is clear – just like that!!!!No idea how to describe the brutality of it.

Occasionally someone elects to undergo general anesthetic, and I think all are also on Valium. It still seems to not be pleasant.

In the 4th shot below, the patient is explaining what has happened so far, and what he is left, with once Dr Lee has done the first movements. He is explaining how the sensations are in his toes by way of his fingers and he that is very relieved and happy – although not comfortable – for Dr Lee to return and get stuck in again . .

Dr Lee is grateful he as instant feedback unlike usual operating conditions. Dr Lee is trained as an acupuncturist/Korean medicine practitioner.

This is obviously highly unpleasant – he has only local anaesthetic and Valium on board.

Dr Lee is very attentive and totally present all through this – he seems to have everything in hand.

He does a bit more and then asks more questions – this happened many times for this man.



As with all, he walked off a few minutes later, vacating the couch for the next person.There were about 12 altogether in this segment.

Shoulder

Yellow package standing up on the monitors is the Valium.Betadine is the brown liquid in the tray – about to paint him with it, then drape him ready to work on the problems in the joint.

Standard operating measures taken

There is a lot of force used.It does not sound on the outside, but must be heard internally as well as being felt – the local would only dull the pain sensations – and often I wondered if it even did that very well.I was surprised that there seemed to be considered no neck involvement . .


The scans are consulted and all is on computer at the touch of buttons.

There is some blood split – but far less now that he uses blunt instruments!!!

The participants

We first toured the rounds to see those who were scheduled for the day and saw a few who had been worked on the day before and who were awaiting home release. All looked fine . .

	Dr Lee explaining via X rays what is to happen with what is there and how they feel based on his remarkable working knowledge of the back and how sensations are blocked and what it feels like.Dr Lee also showed us how the patients were not able to get their legs up and how much pain it gave them – and how it would all be gone when the blockages were released.

Neckwork

One of the participants, an Indian doctor, decided on the spot (as we walked in and he heard what we were to be watching) that he would like them to do it to him, as his neck referred intense pain into his scapula and down his arm. As he had not been at the lectures, I thought he was being very adventurous. I guess no one would imagine that this could ever be under the name of ‘acupuncture’.

He became upset whilst watching the intensity of the acupotomy on the failed back surgeries – I explained many times that that was much less brutal on the necks he missed out on, at the start whilst he was being X rayed, blood taken and being gowned up. Thus he finally agreed to undergo the procedure – which I thought was still very brave, as the patients were very vocal during the events he had just watched.

Possibly due to this he was very tense. I am not sure that they offered him Valium either. Just putting the anesthetic in, he was begging Dr Lee to stop. After much midwiving from myself and a nurse, (she was wonderful – s it looks a s though this is a very hands off/brave face forwards culture) we got him through it – holding onto his hands and reassuring him.

Maybe not very stoic, but afterwards, he literally kissed Dr Lee’s feet – in front of all of us – the difference in his body was unbelievable to him.

The outcome

Apparently usually requires a few goes – as the body is not fully healed with one traumatic procedure. I wondered – and could not get translated – what they did for pre and post care. As a clinician, having been in the presentation a few days before I wondered still – what about sorts of things I do in clinic to assist those in this mess.

Several people we saw prior to his working in them were in for their second or third attempt. He sees this as normal, as there is so much scar tissue, adhesions and general cleanup needed after many laminectomies etc. There is almost no haematomas as he no longer uses sharp ends to the ‘needles’.

The man in the picture was in for his second time, and he was very happy to be up with straight body, no wrong sensations.