Am I Getting Better? Part II. Clinical Example

Daniel Schulman

/ 2 min read

Monday, 24 September, 2012

This is a followup to the previous blog post, ‘Am I Getting Better?’

A present case from my clinic serves well to highlight many of the finer aspects of determining progress during treatment.  A mother recently brought her 9-year old son to my clinic for help with bedwetting.  He was wetting his bed every night.  I used a non-insertive pediatric acupuncture approach from Japan, called Shonishin.  His initial response was quick and obvious to both him and his mother.  For the first three treatment sessions, they returned for the following appointment reporting that he had a dry bed for either the night or two nights following treatment (first dry bed in a very long time).  So, clearly he was responding to treatment.  Then the school year started and the next treatment did not yield the same result – they reported on the following visit that he had wet his bed every night since the last treatment.  I didn’t probe any further.  We all assumed this was reflecting the temporary heightened stress / excitement associated with the beginning of the school year.

When his response to the second treatment after the start of school yielded the same report from his mother (“this is no longer working”), I inquired further.  It took a few different questioning angles, but within minutes, it became clear that while he was not having any dry nights, his sheets in the morning were very significantly less soaked every night of the week between treatment sessions.  To use his mother’s words, “his bedsheets used to weigh a good 5 pounds every morning, now they are just damp and weigh much less”.

The culture we live in is so steeped in the expectation of instant and complete response to our demands, people often have an initial all-or-nothing expectation of a medical intervention.  We shouldn’t be surprised.  Food, Entertainment, the Internet, even modern biomedicine are all very much designed to feed the expectation of instant and dramatic response.  I find very often that patients are not well equipped to navigate the very real complexities of response to an intervention like acupuncture.  So, it takes some coaching on my part to help identify if, in fact, response is taking place.

When a 9-year old boy has been soaking his bedsheets nightly for years and, after only a few acupuncture treatments, is, in fact, still wetting the bed nightly, but to a significantly less degree (damp versus drenched), this is quite a signficant, even remarkably good response.  Teasing it out requires careful attention to all the dimensions of monitoring discussed in the previous blog post.  You should be considering not just frequency (how often is the symptom present or absent?), but also intensity (in this case, amount of urine).  And you should also be engaging yourself, your practitioner and also any third person (in this case, the boy’s mother) who has been observing and knows the subtleties of the situation intimately (in this case, how wet the bedsheets were every morning).  When all of these dimensions and sources of awareness are put to work, a rich understanding of response to treatment often