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Shana Turrell-Pietrzak

transcript

July 5, 2021

DANICA PIETRZAK
Can you tell me a little bit about your background? Like, where are you from? Where did you grow up?

 

SHANA TURRELL-PIETRZAK
I was born in California, my family moved to Arizona when I was three and I grew up all over Arizona. Arizona, Flagstaff, Prescott, Tucson, Phoenix, and back to Flagstaff.

 

DANICA PIETRZAK

Did you start medical school knowing that you wanted to practice naturopathic medicine?

 

Shana Turrell-Pietrzak
Actually, I was on my way to conventional medical school when I started reading Andrew Weil's books. I was in my third year of undergraduate work at the University of Arizona. And Andrew Weil had opened up his Integrative Medicine Center at the U of A med school here in Tucson, and I became very, I didn't know that there was at that time really an option to practice Hmm, a high-quality form of natural medicine other than to go to conventional medical school first, and then try to learn afterward. And at that time, I learned that the third accredited naturopathic medical school in North America had just opened in Tempe and was very interested, applied, got accepted, then wasn't quite sure, and decided to defer and finish my fourth year at UVA, and consider my decision. At that point, I decided to be young and idealistic and veered off from going to med school and went to Southwest College of naturopathic medicine. Whoa.

 

DANICA PIETRZAK

And I heard that you also practice acupuncture. How did you learn to practice acupuncture?

 

SHANA TURRELL-PIETRZAK

Well, actually, it turns out that acupuncture was one of the main reasons that I chose to go to the specific naturopathic medical school because at the time, they had by far the most, Acupuncture and Oriental medicine in the naturopathic curriculum. On the other two schools that I was considering National College in, I think they're in Oregon or Basti, or in Washington, Vesta was great with research, but both of them had very little oriental medicine and acupuncture, I would have had to go to an additional acupuncture school after completing naturopathic medical school. So I decided because I was, so I was very interested in acupuncture, because I had it used on me when I had running injuries in high school, and even though I was a teenager, and not very interested in being stuck with needles at the time, it was very effective. And so I decided that even though I complained, I was curious and went back to that doctor, and wanted to include that in the repertoire of treatments that I could offer people.

 

DANICA PIETRZAK

How do you define acupuncture? I know there's a lot of different ways, and it's not easy to fit into a sentence.

 

SHANA TURRELL-PIETRZAK

Okay. I would probably say the use of sterile acupuncture needles to puncture the skin at specific points along acupuncture meridians, and also what are called austra points, or basically points where something hurts in order to improve symptoms. And restoring health would be a very simple one. Yeah.

 

DANICA PIETRZAK

As you've practiced it longer as your understanding of it changed?

 

SHANA TURRELL-PIETRZAK

Definitely, yes. Experience has definitely changed my perspective in how I look at it. Yes. Awesome. And how long exactly did you practice acupuncture? Let's see well, sing at school, probably 1996. And continued through, let's see, I stopped practicing in 2019. That would be 23 years, but I did take three years off. At one point, I was home and so that was probably that many years that I practiced it.

 

DANICA PIETRZAK

So while you practice it, you said something about meridians. Do you know exactly which points correspond to which problems? Or is it? Is there a standard method for it? Or is it more on a case-by-case basis or from the perspective of the acupuncturist?

SHANA TURRELL-PIETRZAK

That's a great question. There are standards, yes, but one of the challenges is there are depending on which form of acupuncture or which one oriental medicine you practice and learn. I was taught TCM or traditional Chinese medicine. There's also another school of acupuncture's element theory. And so the way that the points are chosen, depends somewhat on the philosophy that you were taught, as well as your understanding of the overall health of each patient. So, most of you will tell you, in general, for this type of condition, as the acupuncturist has assessed, the condition, what meridians and what points are generally useful, then the acupuncturist will also assess the individual patient by feeling their pulses, and looking at their tongue to understand which points would be most effective for that person.

 

Your tongue in oriental medicine actually provides a lot of information about the health of the patient. It's just a fascinating way to get additional information about the person, the color of the tongue, the shape of the tongue. What does the shape of the tongue tell you? Well, if it didn't tell you things, both in oriental medicine as well as conventional medicine, the shape of the tongue as far as long and thin, short and fat, does it have scallops on the edge? Like, for example, like teeth marks? Also, does it have the color yellow fur? Is it shiny and red and glossy? And the interesting thing is, that can tell you is there a lot of Is there a deep crack in the center? Are there cracks all along it? All this gives actually very interesting information. I mean, even conventional medicine can give you information about hydration status, infection, irritation, all that. There you are.

 

DANICA PIETRZAK

So has your style of acupuncture changed with respect to time?

 

SHANA TURRELL-PIETRZAK

I'm sure it has. I'm sure it has. Interesting, I'm wondering what exactly my style of acupuncture is. Um, one of the things is, as naturopathic medicine, I both use acupuncture as a standalone therapy like patients will come and see me specific work before acupuncture treatments for specific conditions. But I also will use it in conjunction with other therapies. And, for example, if someone comes in with, you know, sinusitis, I find it very effective to begin with an acupuncture treatment, while we also talk about diet and herbs and hydration, nutrition, all of that type of thing. And but if I use the neti pot, if I start out with the acupuncture, I find that it gets the symptom improvement moving much more quickly than without it. So there, but then again, there are people who are not interested in changing their diet and just want me to do some. Exactly. And so at that point, in that kind of case, we can schedule several acupuncture treatments and see if we can get them taken care of that way. And because basically, my approach is, whatever will be safe and effective for people that they will actually follow through with.

DANICA PIETRZAK

Absolutely. I heard that you started your own practice. Tell me a little bit about that.

 

SHANA TURRELL-PIETRZAK

Haha, well, actually, that was fascinating. And, in a lot of ways, quite an enjoyable endeavor. And, of course, an incredible amount of work. I really liked my own practice, because everything could be exactly organized the way that I really liked it, which was, which was wonderful. I had a great, great practice with two other naturopathic physicians for I think about 15 years before that, and really wonderful. But of course, whenever you work with other people, they have different ideas. And I had some ideas that I wanted to try and as far as the organization of the Office of my time, I wanted to do quite a few things and so I found it to be very efficient. And it worked. Actually, I was quite pleased it worked quite, quite well. What are you interested in? Are you interested in any specific areas about that? Or?

 

DANICA PIETRZAK

Where did you get your herbs from? What it was like to run a practice instead of just working with other people? And you still work with other physicians, correct?

 

SHANA TURRELL-PIETRZAK

Well, actually, no, I was in it as a solo practice. So there by myself, and one of the things I did like was that we had an office where I had a separate room. I did like having a consultation room and a separate room for acupuncture. That was very convenient. So I didn't have to put up and down the table each time I ordered from the same places that we had before but just was able to use the ones that were my preferences. I really liked using companies that had good third-party validation of equality, all of that type of focus there, I learned that I love seeing patients, but that managing office staff wasn't my favorite part of practice, but it's part of the practice. And so that's something you have to do. And learned a lot more about deciding which types of electronic health record systems to use. And you know, what I liked. So when you would see patients, what are some of the common applications for acupuncture? acupuncture, acupuncture can be one of the fantastic things. It can be used for many so many different applications because since it's focused on improving the health and functioning of the body, it's can be used for a vast array of symptoms and conditions, I found that I used it quite a bit for upper respiratory conditions, or pain, digestive even mental, emotional, sometimes I found it very helpful for anxiety, not as much for depression.

 

But then again, that may have been my applications are the people I was using it with, I found that certain people are seen to be acupuncture, like so many other therapies is not a panacea or doesn't work the same way for everyone seemed that certain, attempted to come to a perception that acupuncture in a way worked, there was maybe 10% of extremely excellent responders, 10% of people who maybe didn't respond at all, and everyone else was in between. And so part of it was figuring out which types of therapies worked best for which people. So again, I used it for a wide range of applications, and I often used it to enhance treatment protocols that included other options as well as acupuncture. So if I'm not, wasn't I just an acupuncture acupuncturist who only did acupuncture that perhaps models that a little bit for you?

 

DANICA PIETRZAK

And how So you said that there were 10% on one side, 10% on the other, and the rest in the middle. How effective Do you really think acupuncture is as a treatment?

 

SHANA TURRELL-PIETRZAK

And a good question. And those numbers were just my general thoughts, certainly, how effective it is. That's part of one of the big questions everyone is trying to figure out. There's no simple answer to that. I think it's definitely enough pain and discomfort in the world, that we have challenges treating in ways that are safe and effective, that having another treatment that we do know is very safe when done by well trained, licensed professionals, that does have some evidence of some effectiveness. And I know that's vague, but that's what we're still trying to figure out. And there are so many ways that we have to treat pain that you have to be very cautious with having a way that can be very helpful, and very safe is certainly advantageous. So I'm really hoping that over time, we get more information about this. But for me, in my experience, certainly people responded well enough that it was absolutely something I was going to continue to do while I was practicing.

 

DANICA PIETRZAK

One of the things that I wanted to discuss today was some of the inconclusive evidence brought or brought forth by research journals. Do you think that that is because of the acupuncture itself, or the methodology?

 

SHANA TURRELL-PIETRZAK

Great question. I wouldn't be surprised if there's some of both. But we know that methodology is a big issue with acupuncture research, for quite a number of reasons, certainly. And again, I'm certainly not a researcher myself, but I do love to read the research. And I'm very interested in how acupuncture researchers put it together because basically, you can't double-blind acupuncture. But in order for it to be safe, the practitioner has to know what they're doing. And they have to know that they are practicing acupuncture, there are, there are options that are tried like sham acupuncture, as well as where people put needles into the body, but not at acupuncture points. The challenge with that one, of course, is that the body has very predictable physiological responses to being having a needle inserted in into through the skin, no changes in circulation, white blood cell migration to the area, you know, your pain responses, even if you're just putting it through the skin, all of these things. And then of course, when any type of basic procedure. And acupuncture putting a needle into the skin would be considered invasive in that way, there is a significant mental-emotional response, whether or not that needle is being inserted into an acupuncture point.

 

Also whether they have other types of acupuncture, they're not called sham acupuncture, where the skin is your push with a dull needle, but it doesn't actually puncture the skin. So you're trying to reduce the physiological responses while still trying to elicit the mental emotion to some degree. So those two both have pros and cons but certainly are not a way that again, that it could be winded exactly from the patient. And then, of course, there are the issues of diagnosis. Because when we're looking at studies, you're wanting to study in western medicine, usually a specific diagnosis with specific criteria. And if you take something as simple as, say sinusitis, that's a single diagnosis in western medicine, but in Chinese medicine, someone with sinusitis could have it when they could have a cold. And then depending upon what the practitioner reads in the pulses in the tongue, they could end up with the same Western diagnosis could end up with different treatment protocols through acupuncture. And those different treatment protocols may be more or less effective for people with different types of Oriental medical diagnoses.

 

So the challenge is to say, if you wanted to study, you know, a large number of people with sinusitis, and Western medicine, who says, well, let's treat everyone with the same protocol so that we can assess how this protocol works. That may be more or less effective for those people because it may or may not be associated with their random medical diagnoses. So that certainly complicates some of the study design. And then of course, one of the biggest issues that I've seen with acupuncture research is just the low number of people who are studying. Oftentimes you're like, Okay, well, this looks very good until you discovered that one of the biggest pieces I see with research, one of the biggest challenges with a lot of acupuncture research is just the low power of the research as far as the few oftentimes there are too few people, number of people in order of good statistics. So you'll think, "Oh, this study looks great, until you realize that there are only 11 people in the study," you know? And it's like, well, there's, you can't get any statistical significance out of that, or it doesn't really mean much. Now, if you could have 1,100, or better yet, 11,000 that would be a lot more interesting. So those are some of the things that I think about then also to, you know, was there adequate blinding, did the, you know, the study where there was randomized, you know, there's a lot of, I think there are ways that we could really, you know, improve and get better, better at what research that could be more helpful and applicable, or working professionals to take in. But I think we, a lot of it, have really well-designed studies with good randomization and blinding and enough people in them. So the results are more meaningful and interesting. Or that's what I would love to see.

 

DANICA PIETRZAK

So do you think that randomized control trials are still effective for acupuncture? And if not, what methodology would you suggest?

 

SHANA TURRELL-PIETRZAK

Well, certainly, gosh, being educated in a more Western scientific approach, I do really enjoy. And like randomized control trials, I think they're probably certainly not perfect for acupuncture. But they are much better than other options that I'm aware of at the moment, such as non randomized control trials. No, I don't have any other options that I think are better, because they're certainly better than trials with too few people that are not blinded that don't have good consistent methodologies and have conclusions that are not supported by the results.

 

DANICA PIETRZAK

But if you were to improve on randomized control trials, and their current methodology, assuming everything's done correctly, what would you suggest

 

SHANA TURRELL-PIETRZAK

What I would, what I would be very interested to see would be randomized controlled trials, where patients were categorized by their oriental medical diagnoses, in addition to their conventional Western diagnoses, because I have to admit I, you know, as a naturopath, I am very interested in both in conventional diagnoses and treatments, natural treatments, as well as oriental medical diagnoses and treatments. So I would really like to see those patients who in the randomized controlled trials operated in that way, and treated as per their oriental medical diagnoses. And I would be curious to see if that changed the results when you're when they were categorized in that fashion? I think that that would be wonderful. I do too. And also, of course, in those trials, I would like to see large numbers of people so we can get good statistical data. So that's what I would like to see. Awesome.

 

DANICA PIETRZAK

And what do you think about the relationship between acupuncture and anatomy, their organs, but also researchers are trying to find new organs like capillary clusters, nerve clusters, to explain the effects of acupuncture? Or are any of these issues interesting to you?

 

SHANA TURRELL-PIETRZAK

Oh, absolutely interesting. To me, I would be very, very curious to see whether in the future they're able to find a good correlation between anatomical structures and acupuncture points and meridians. I know that and this was from a long time ago, I know that there was evidence there was that point where there were acupuncture points, there were supposed to be areas of increased electrical conductivity through the skin. What does that mean? Who knows? It's interesting to increase electrical conductivity using your metal needles. Does that mean anything? I don't know either. But as long as the patients feel better, that's what's important to me. Answer. Have you heard about bonghan ducts? I have not heard of bonghan ducts. That wasn't certainly wasn't part of my training. And I had not heard of them until they were mentioned earlier this morning. And I'm very curious to look into that a little bit more. So no, unfortunately, I don't have any information on that.

 

DANICA PIETRZAK

Well, I don't have any further questions. Do you have anything that you would like to add about acupuncture, your experience, or future research?

 

SHANA TURRELL-PIETRZAK

Let's see. I really do think that acupuncture is can be a very helpful tool, especially for musculoskeletal issues, or relaxation, which is, I still think is somewhat on given that putting needles into somebody can be relaxing, but certainly, I think that that was a major way that I dealt with the stress of medical school, was getting acupuncture and found it helpful for a lot of other people as well. And so I think it's a wonderful tool that is very safe to use, again by qualified professionals, and can be a great addition to a course I did. I was working in general family practice, but I found it very helpful in that area. And I loved knowing that it wouldn't interact with any medication. It was again, safe and as long as the patient was comfortable, was very helpful. So that's the main thing. Awesome. Well, thank you for the questions.

Dr. Turrell is a licensed naturopathic physician in the state of Arizona. She began her studies at the University of Arizona, and attended Southwest College of Naturopathic Medicine and Health Sciences. There, she studied conventional medical sciences, nutrition, herbal medicine, counseling, hydrotherapy, oriental medicine, acupuncture, and more. She joined a group practice in Flagstaff, AZ where she practiced general family medicine for 20 years. She frequently used acupuncture to treat a range of conditions, including pain, upper respiratory symptoms, and GI symptoms.