Aches, Pains, Sprains, and Strains: Acupuncture for Back Pain

senior man with back pain

Do you know the #1 reason why patients visit an acupuncturist? Pain. Specifically, back pain.

Low back pain affects 80% of adults in the U.S. This includes everything from minor sprains and strains to degenerative disc disease and sciatica. If you are over 70 years old, spinal discomfort can become a daily problem.

So what can acupuncture do for back pain? A lot.

Acupuncture is excellent at relaxing tight muscles around the spine. It can offer significant pain relief, even if the issue is structural, such as in the case of scoliosis. In fact, I often see patients after conventional medical intervention to help them manage lingering pain that is not controlled through other forms of treatment. 

In situations of severe back pain, such as in the case of fusions, traumatic injury, and chronic degeneration, I focus on providing systemic pain control. Because acupuncture encourages the body to release its own endorphins, this form of treatment is excellent for patients who are looking for a drug-free alternative to medication.

Here’s another bit of good news: the Centers for Medicare and Medicaid Services is covering acupuncture services used in research on the efficacy of acupuncture in the treatment of chronic low back pain. It’s a good first step. If CMS sees the potential of acupuncture in addressing this wide-spread condition, the next move could be Medicare coverage. Our profession is very excited about this possibility. You can read more about this project from our national professional certification commission, NCCAOM.

If back pain is causing you daily discomfort, consider acupuncture. During your first treatment we’ll discuss your condition, as well as any Western medical diagnoses from your doctor. Then I will develop a treatment plan based on your specific condition, which will work with your medical, exercise, and physical therapy programs. 

Want to learn a few more specifics about low back pain? See the National Institutes of Health Low Back Pain Fact Sheet for details.

Know someone who suffers from back pain? Have them call me at (720) 668-6638 to discuss possible treatment options. Most back pain sufferers see changes after just a few sessions of acupuncture, which is always a welcome relief.  

Autumn Immune Boost

autumn leaves

After a long, hot summer, we have finally reached the cool months of autumn, my favorite time of year.

In Chinese medicine, fall is associated with the respiratory system. As the days grow colder and the air turns dry, the lungs must work harder to defend the body against airborne pathogenic influences. Although ancient Chinese medical doctors had no concept of germ theory, acupuncturists and herbalists have long understood the importance of protecting the lungs during this vulnerable time of year.

Let’s look at a few simple ways to support your respiratory health during the autumn season.

Bundle up

In Chinese medicine environmental cold can enter the body through the pores in the skin, weakening the lungs and creating opportunities for illness to take root. The best way to prevent cold damage is to bundle up against the elements. Scarves, gloves, warm socks, hats, and extra layers go a long way in preventing illness during cold weather. Be especially conscious of covering your neck and the backs of your shoulders. Also, don’t forget to be careful around drafts from air ducts or fans, which mimic the forced quality of a cold wind.

Eat well

Immunity is directly linked to digestive health. In fact, in acupuncture, the lung is closely connected with the large intestine, stomach, and spleen organs. If you feel you’re catching a bug, avoid refined sugar completely. Sugar taxes your immune system, feeds bacteria and viruses, and compromises your ability to fight infection should you catch something. During the autumn months, stick with warm, cooked foods, and avoid ice-cold beverages. Don’t skimp on water though; staying hydrated with room-temperature drinks will keep you healthy year-round.

Sleep deeply

Sleep is essential for fighting infection, repairing achy joints and muscles, and calming the mind. In fact, most healing is conducted while we are asleep. Now that the weather is turning cold, many people find sleeping is easier than during the summer. Adequate rest will boost your immune system much more than taking supplements. Take advantage of the longer, cooler nights and allow your body the simple medicine of sleep.

When it comes to immunity, there are no true substitutes for proper nutrition, hydration, and sleep. That being said, if your respiratory system is habitually prone to catching colds and flus, now is the time to boost your system with herbs and acupuncture.

Acupuncture for Hospice and Palliative Care

This spring I completed training to become a Certified Hospice and Palliative Care Acupuncturist. My goal of providing comprehensive acupuncture services to older adults includes end-of-life care for patients approaching death and those who choose to forego ongoing medical intervention.

Acupuncture is an effective support for easing anxiety, fear, and emotional distress surrounding long-term illness, as well as the dying process. By calming the mind, acupuncture helps patients preserve their energy for connecting with loved ones, engaging in spiritual practice, and approaching their final days with a sense of peace.

This work also assists in managing pain, helps patients sleep, increases appetite, and boosts mental clarity. Because it is so versatile, it can be administered to clients in hospital beds or wheelchairs at home or in skilled nursing facilities. It is a truly remarkable support that can even be offered simultaneously to family and primary caregivers, strengthening the wellbeing of all involved.

If you have questions about how acupuncture can help ease the dying process for yourself or a loved one, please reach out. It is an honor for me to be a part of your support network now and in the future.

 

Acupuncture for Hot Flashes

hot flash

Now that it’s summer in Boulder, let’s talk about those overwhelming hot flashes you’ve been having and how acupuncture and Chinese herbs can help.

Many women suffer from hot flashes related to menopause. For some women, these temperature fluctuations let up quickly after menstruation officially stops. Other women live with hot flashes and night sweats for years after menopause. This condition is, in many cases, treatable with Chinese medicine.

Unfortunately, Western medication for hot flashes is often anti-depressants. Since many patients don’t want to be on mood-altering medications, women are left with few options for managing this uncomfortable symptom. Acupuncture and Chinese herbs, on the other hand, really work to cool you down, regulate your hormones, and help you sleep. In fact, Chinese medicine has been used to help women through menopause for centuries.

Let’s look at what a course of treatment could include.

Warm, Hot, or Raging?

Hot flashes—and their nighttime counterpart, night sweats—usually begin as mild episodes of discomfort in perimenopause. During this time, the period becomes irregular. Blood flow may change, and you may experience a shift in frequency, duration of your period, or premenstrual symptoms. The perimenopausal transition can last for a number of years, and hot flashes and night sweats may start well before a woman is officially in menopause.

Menopause occurs once a woman has naturally gone six months without having a period or has had her ovaries removed. This hormonal shift can instigate stronger hot flashes and night sweating, although all women are different. For some women, hot flashes are never a problem; others report living with this condition for years after menopause.

The first question I ask hot flash sufferers is how frequently their episodes occur. Once a day? Twelve times a day? Only at night…but all night? Frequency is important to determine, as it will help us chart whether your treatment is working.

Next I want to know how hot a patient feels. Just uncomfortably warm? Briefly hot, but then chilled to the bone? Or are you soaking your sheets at night? Severity of the episodes is also an important point. This will steer me toward whether I recommend acupuncture, Chinese herbs, or both.

Finally, how long a patient has suffered from hot flashes is critical. Is it a new symptom, or have you had them for years? Typically, newer symptoms are easier to treat, whereas older problems take more time to unravel.

Acupuncture, Herbs, or Both?

Patients with mild hot flashes—often women in perimenopause—can usually expect great results with acupuncture alone. I recommend weekly treatments with sessions spaced further apart once symptoms significantly diminish. During that time I will have you track how often you have hot flashes and their severity.

If your hot flashes and night sweats are not managed by acupuncture alone, we should consider a customized Chinese herbal formula. Taking Chinese herbs every day is like getting a daily treatment. For women with strong symptoms, or for those who don’t want acupuncture, herbs are a promising solution.

Finally, some patients benefit most by using both acupuncture and herbs. Women who have had hot flashes a long time, or who have hot flashes with a complex overall health picture, should consider using both.

In all cases, the most important thing to remember is this: come in early. The longer the problem lingers, the harder it can be to treat. That being said, even if you’ve had symptoms for years, Chinese medicine may really be able to help. Most patients can expect changes in the first few sessions.

As one patient shared, “…following just a few treatments with Norah, my hot flashes are now what I would consider ‘micro-flashes’ and are few and far between.” (For more details see Testimonials.)

If hot flashes and night sweats are causing you to dread the summer months in Boulder, call us today to talk about acupuncture and herbal treatment options.

Care for the Caregiver

Caregiving is one of the most socially important roles we can provide for others. Over the course of our lifetime, we will likely move through a variety of caregiving roles, from parenting small children to providing support to an ailing spouse. As we age, the people we love will age, too. For many of us, the strength of our caregiving capacities will be challenged by our own physical and mental limitations.

As an acupuncturist specializing in treating elders and caregivers, I am here to help.

In my work with elders, I am reminded every day of the need for skilled, compassionate caregivers in aging services. We live in a time when children often live far away from their parents, complicating the ability to provide one-on-one care. For some older adults, the network of caregivers they can rely on is very thin—considerate friends or sometimes only paid employees. Aging can create unforeseen vulnerabilities, such as dementia or compromised mobility, situations that require the kindness of a caregiver’s patient support and watchful eye.

Because of the challenges of aging, the difficulties for caregivers can be immense. Primary caregivers, or care partners, as some prefer to be called, shoulder physical, mental, and spiritual worries that often go unshared. In a caregiving relationship, the person with fewer hindrances may feel unable to complain, vent, cry, or express anger about their position. After all, they may think, I’m not the one with Parkinson’s. Or, Who else will take care of all of the work if I don’t?

The pressure to be super-human can take its toll on even the most resourceful caregiver.

At Boulder Acupuncture and Herbs, I am focused on elder health. Implicit in that vision is a commitment to the wellbeing of caregivers, too. After all, without a vital caregiving community, how can we provide the necessary help elders need to stay safe, healthy, active, and engaged through their senior years? Caregivers are a critical piece of this social puzzle.

Unfortunately, caregivers are at a greater risk of developing depression, physical burnout, and long-term health issues. The impacts of extensive caregiving are becoming much more publicized, as shown by the Family Caregiver Alliance of San Francisco, California. According to FCA, the choice to place a family member in a long-term care facility is usually linked to the caregiver’s health, not necessarily the elder’s health. This means we have a lot to do, as a community, to keep our caregivers, and our seniors, well.

What, then, can acupuncture do to help care for the caregiver? So much.

Here are 7 ways acupuncture can benefit caregivers:

  1. Your job is physically demanding. Acupuncture is proven to relieve pain.
  2. You go home tired but still can’t sleep. Acupuncture treats insomnia.
  3. You eat on the run. Acupuncture optimizes digestion.
  4. You work with many people, every day. Acupuncture boosts your immunity.
  5. You help others age well. Acupuncture keeps you active.
  6. You are human. Acupuncture reduces stress, anxiety & depression.
  7. You care for everyone else. Your acupuncturist is your ally in health.

Caregivers need to be reminded that their wellbeing is as important as that of their care partner’s. By shifting the conversation on caregiving toward the needs of caregivers, we build strength, resiliency, and compassion into our community. This leads to a win-win for elders and the people who care for them every day.

If you are doing the super-human work of caregiving, please reach out for a little support. The Boulder County Area Agency on Aging has many resources for caregivers, including respite care, classes, a lending library, and so much more. Boulder Acupuncture and Herbs is here for you, too.

Most of all, thank you for all that you do.

How Does Acupuncture Work? Part II

acupuncture meridiansIn Part I of How Does Acupuncture Work? we discovered how qi, blood, yin, and yang interact. Let’s take a deeper look at the way these forces merge to create the major organs of the body.

The Organs in Chinese Medicine

The primary organs in Chinese medicine include the Liver, Heart, Spleen, Lungs, and Kidneys. Each of these organs has a “sphere of influence,” meaning it impacts the function of other aspects of the body and can offer diagnostic clues leading to treatment possibilities based on deep-seated relationships.

Here are a few examples of internal imbalances leading to external signs and symptoms:

The Liver impacts the eyes in Chinese medicine. Virtually all eye symptoms can be traced back to Liver disharmonies. This may sound absurd in Western medicine, but we know that by treating the Liver in Chinese medicine, we can impact eye health.

The same is true for the Lungs. In Chinese medicine, the Lungs are responsible for the skin. Unlike the example of the Liver, the relationship between lung health and skin health is well-documented in allopathic medicine. For example, we know patients with asthma and allergies are more likely to develop eczema.

Through questioning patients about subjective symptoms, the acupuncturist is able to work backward to diagnose imbalances deeper in the body.

Investigating in this way yields many clinical benefits. For one, acupuncturists pay attention to signs and symptoms that may be overlooked by other practitioners. In fact, many acupuncture patients are surprised by the specificity of our diagnostic approach. We often ask questions other healthcare practitioners do not ask.

The next time your acupuncturist rattles off a list of strange questions, know they are gathering important information that will result in a customized treatment strategy designed specifically for your condition.

The relationship between all these disparate signs and symptoms can be confusing to Western patients. But rest assured, it’s the acupuncturist’s job to discover these relationships, not yours.

 

Seeing the Bigger Picture

Acupuncturists also gather objective information on a patient’s health by examining the body.

One of the primary ways we get information about what is happening internally is by feeling the radial pulse in your wrists.

Each wrist offers a window into your internal environment. I feel the pulse bilaterally at a superficial level and deeper, closer to the bone. This technique tells me about the state of each of the organ systems mentioned above, as well as the vitality of qi, blood, yin, and yang.

Acupuncturists also investigate the tongue. Believe it or not, your tongue tells a story about your inner climate. Do you run hot or cold? Do you have phlegm in your intestines or lungs? The tongue will often reveal these conditions. (If you are curious about tongue diagnosis, check out Why Does My Acupuncturist Look at My Tongue?)

We also physically examine the body. We may feel for changes in skin texture, how pain responds to pressure, or if the area is hot or cold. All of these signs and symptoms give us clues to what is happening internally. Once we decide on a diagnosis, we treat these imbalances by influencing the meridian system.

 

Qi and the Meridians

In Chinese medicine the human body is a connected system of relationships. Electrical and metabolic information is sent through the body via a network of invisible channels called meridians.

Meridians connect all parts of the body in a continuous network of impulses. This is why we can insert an acupuncture needle in the foot to affect the hip or one in the hand to halt sneezing. In fact, qi moving through the meridian system is the real “secret” to how acupuncture works. It is how information is conveyed.

When this system of communication is disrupted or blocked, we experience pain and dysfunction. Also, when the body is weak, the signals being sent through the meridians become weak. Acupuncture revives this signal by stimulating the qi and blood. It also directs the qi to correct the flow of these impulses so that the body functions in a healthy way.

Without the meridian system, and the theories of qi, blood, yin, yang, and the organs, there would be no Chinese medicine as we know it. If we ignore the idea of qi, throw out the theory of the organs, and simply stick a needle in a muscle, we will not be able to address truly complex health issues. Patients may experience temporary pain relief, and even a sense of relaxation, but to unravel deeper problems, such as asthma and heart arrhythmias, the ancient Chinese theories are indispensable.

As an acupuncturist and an acupuncture patient, the theoretical scaffolding beneath acupuncture has always made sense to me. It is what differentiates it from practices like dry needling or trigger point therapy, techniques that employ acupuncture needles but abandon Chinese medical theory.

As acupuncture treatment evolves in the United States, it is important that we not forget the importance of balancing qi, blood, yin, and yang, which are the basis of health. Acupuncture helps thousands of people every day all across the world because of its foundational theories, not in spite of them. Ancient Chinese doctors understood this.

We are lucky to have inherited such a profound vision of human health, one that is both applicable to modern illness and flexible enough to accommodate new knowledge. Even as we seek to explain how acupuncture works in contemporary language, we can appreciate its roots in the dynamic balance between yin and yang.

How Does Acupuncture Work? Part I

During graduate school I was part of an acupuncture education outreach effort. When I told our program director the topic of our presentation—how does acupuncture work—she laughed.

“Good luck figuring that out!”

She was right. Acupuncture is not easy to explain—and I watch it in action every day.

Despite this challenge, I’ve learned that educating people about how acupuncture works is important. We are curious beings, after all. Also, patients and practitioners, not to mention insurance providers and medical doctors, all want to understand how acupuncture provides relief.

In this post I hope to shed some light on this difficult question by giving you a short-and-sweet primer on the theory behind this powerful medicine.

 

The Roots of Acupuncture

The answer to “how does acupuncture work?” is embedded in a cultural perspective that is different from Western medical science. While Chinese medicine is based on observation of nature—with humans being an inextricable part of their environment—the ancient Chinese were not conducting double-blind placebo-controlled studies. Nor did they have the concept of germ theory or the endocrine system.

Even still, Chinese medicine is highly empirical, meaning it developed based on visible changes in wellbeing after implementing certain therapeutic techniques. Acupuncture and herbal medicine are not just theoretical—or superstitious—forms of medicine. In fact, Chinese medicine is the oldest and most contiguous body of textual medicine in the world, meaning what we use today has been refined through clinical practice and passed down in books over millennia.

Chinese medicine is also highly adaptable to modern illness, which is why it remains so clinically relevant and important to modern healthcare. Many theories and treatment methods used in the contemporary clinic were discovered over 2,000 years ago and are still applicable to patients with iPhones and Facebook accounts.

So just what was in these ancient texts?

The history of Chinese medicine began with the first herbal medicine text, the Shennong BencaoThe Divine Husbandman’s Classic of Materia Medica. This book was compiled 2,500 years ago and includes many well-known herbs that are still in use today, including ginseng and ginger.

The first acupuncture text was the Huang Di Nei JingThe Yellow Emperor’s Classic of Medicine, compiled 2,200 years ago during the Warring States Period in China. This manuscript introduced the ideas of yin and yang into medicine, concepts that could already by found in the religious philosophy of Taoism.

These ideas were flexible in that they could be applied to broad scenarios, such as weather and climate, or minute workings in the body, like growth and development, death and decay. The flexibility of Chinese medical theory is really what keeps it clinically effective even today.

 

Qi, Blood, Yin and Yang: Navigating the Inner Ecosystem

Much like an ecosystem, Chinese medicine is based on patterns and relationships that are visible in the natural environment.

We think of the outside world as a complex system of elemental interactions: water, soil, wind, sunlight. Similarly, the body is its own ecosystem. However, the primary relationships in your body occur between qi, blood, yin and yang.

Yin and yang are opposites, yin being dark, moist, heavy, cool, and receptive, and yang being light, warm, expansive, and generative. An important thing to remember about yin and yang is that these terms only have meaning in relationship to one another; they are inextricably connected. If we say a person who is cold lacks yang, we can only determine this by weighing it against the yin qualities present in their body.

Qi and blood have a similar relationship. Qi is life-force energy in Chinese medicine. It permeates and animates everything. I like to think of it as the electrical impulse that is always present in living organisms. Blood, like yin, is dense and nutritive. It moves all over the body, feeding the cells of the muscles, brain, and all the internal organs. The qi carries the blood around the body, pulling it forward with a magnetic force.

When qi, blood, yin and yang are in a state of balance, people feel good. When these forces are out of whack, disease comes about. The job of an acupuncturist is to determine what is imbalanced and adjust it through sending a corrective message through the needles.

 

Diagnosing Imbalances of Qi, Blood, Yin and Yang

But just how does an acupuncturist diagnose disease? First, we need to know how the yin, yang, blood and qi are interacting.

As an acupuncturist, I use many methods of investigation to determine what is out of balance in my patients. Some imbalances are temporary, acute, surface-level disease states, such as a cold, flu, or injury.

Other problems run deeper and become a part of a patient’s constitutional makeup. They grow from the little things we do, or that happen to us, over months or years. Sometimes they are even with us from childhood. I often think of these imbalances as “body habits.” They are harder to interrupt and often require maintenance support, including acupuncture treatment or herbal medicine, over a longer period of time.

Your body’s symptoms are subjective messages sent to alert you that something is off. My role is to question you about these symptoms so that a pattern emerges.

Through interpreting the relationship between symptoms (subjective) and signs (objective), I then reach a diagnosis designed to address the imbalances of qi, blood, yin and yang.

Next time, in How Does Acupuncture Work Part II, we’ll look at the role the internal organs play in diagnosing and treating disease. We’ll also learn the theory behind why acupuncture needles impact the health of qi, blood, yin, and yang.

The mystery continues…

The Healing Benefits of a Long Winter’s Nap

I just love winter in Colorado. Even though our snowy season has been quite mild this year, I adore the cozy comforts of winter. In my house, cold weather means lap blankets, doubled-up socks, never-ending mugs of tea, homemade soup, and, my favorite cold weather pastime, sleeping.

Over the last few years, sleep has become my primary medicine for everything from headaches to emotional distress to digestive issues. Although I rarely sleep late into the morning, I am happy to head to bed at 7:30 p.m. if I feel ready for a long winter’s nap.

I’ve learned that indulging my sleep habit makes my waking hours more productive and fulfilling. I need less caffeine to get my brain working, and my stress remains manageable when I get enough rest. My life feels noticeably easier when I’ve slept well. Like drinking plenty of water, sleep really is a miracle drug.

During the holiday season, I took two weeks off to rest and go within. As part of my time off, I incorporated a few of what I call Healing Naps. On the surface, these just look like plain old naps. (Maybe you’ve taken one of those already today.) To make my naps even more wonderful, I include a simple addition: before falling asleep, I imagine myself bathed in warm light as I lay in bed.

This loving, gentle blanket of light feels very similar to the way I feel when I receive an acupuncture treatment. I’ve even begun using this light-awareness technique before going to bed in the evening. I encourage you to try it, especially if you have insomnia or fitful sleep. The healing benefit of consciously directing warm, loving thoughts toward yourself before bed translates into a deeper sense of safety, which we need in order to let go into sleep. This safety resembles being “tucked in” as a child.

Sleep is a time of letting go, slowing down, and opening up. Why rush it? Give yourself an extra hour. Take a nap if you have the time on a Saturdayafternoon. Allow yourself to experience the regenerative peace of a temporary hibernation.

Like the sweet red fox pictured above, may you have the healing benefits of restful winter sleep. And if your sleep is not so restful, let’s talk about how acupuncture can help.

Sage Advice: Wisdom from My Grandmother

girl on the edge

As a child, I was very close to my maternal grandmother. A former Navy WAVE and an airplane mechanic during WWII, my grandmother was unlike most of the other older women I knew. For one, she didn’t cook. My grandmother’s idea of a home-cooked meal was sliced potatoes and onions fried in butter, a reminder of her Polish-Russian childhood in Chicago. She was also fine with eating M&Ms for dinner or cracking pistachios while watching TV and smoking cigarettes at the kitchen table.

Hailing from the Windy City, she was a Cubs fan, but she’d root for the White Sox, too. As long as Chicago baseball was on TV, she had a favorite. Always embarrassed of her thinning hair, she wore a wig my whole life and only changed out of her slacks for a skirt when someone graduated or passed away.

When I was about ten years old, my grandma was diagnosed with bladder cancer. After her surgery she spent the rest of her life emptying a catheter bag every few hours. It was a good thing my grandma had such a robust sense of humor because her catheter schedule was unforgiving. Whenever she stood up from a game of cards to excuse herself so that she could empty her bag, she told us it was “Howdy Doody time,” a reference to the old black and white children’s television show. Her non-existent bladder was calling.

My grandmother always spoke to me as if I were an adult. She accepted that I was capable of understanding life experiences beyond my age. In keeping with her faith in my ability to comprehend the bigger things in life, she told me one truly amazing story.

During her cancer surgery, she’d gone through a near-death experience on the operating table. When I asked her what it was like, she folded her hands—she had the most lovely, slender fingers—and said, “All I can say is that you have nothing to be afraid of.”

“You mean of dying?” I said.

“Right. Of dying.”

What a gift to give a little girl.

 

Since starting my work with elders, I’ve discovered that the vulnerability of childhood can mirror the vulnerability of old age. Whereas childhood is imbued with the hope that accompanies a bolt of growth, development, and physical transformation, in our culture, the breakdown of the physical body is often seen as a tragedy.

There is not a clear social role for elders in the United States, especially if they are not a part of traditional family units, such as LGBTQ seniors or elders who live in isolation. As a culture, we have a lot of work to do when it comes to embracing our seniors as sources of wisdom and guidance, in matters both big and small.

I often ask myself how different our society would be if we respected our elders as living treasures. How much healthier would we be if we examined what it means to have a long life—even with its many triumphs and failures? What if we regarded old age as an honorable stepping-stone toward our transition from this world into death?

The sheer mass of knowledge our elders carry in their life experiences is deeply moving for me. And yet sometimes, even without our knowing it, we prevent older adults from having a voice. Or we diminish the power of their experiences by reducing them to being “cute” or “sweet.” Sometimes, I think, we are actually afraid of what they want to say to us.

It is becoming more and more important that we fight our tendency to ignore or shy away from the challenges of old age. After all, America is aging; we hear that announcement everywhere. As caregivers, we are in a position to learn so much from the people we serve. Also, in more plain language, our elders are going where we are going before us. They are pioneers of the human body and the human spirit. To mistakenly believe they are moving backward because they cannot participate in our fast-paced, hyper-driven culture is an insult to the journey they are walking. They are clued into some other rhythm of life that runs beneath the surface of all our lives if we are brave enough to examine it.

Many of the clients I work with live in what I would characterize as physically small orbits: they may rarely leave their homes, and their contact with the outside world is often very limited. No doubt, some elders prefer it this way. Plenty of my patients are happy being solitary. Others, however, long for community connection, conversations, and a chance to feel involved. Like many people, they want to contribute.

It is my experience that many elders long to care for us, to guide us younger folks toward living positive, healthy lives. Even though I am hired to take care of my patients, my patients also nourish me. They tell me to slow down. They advise me not to work too hard. And they are genuinely happy for me when I take time off or visit my family. They care about me.

One of my favorite pieces of advice came from an elder in her 90s. “You think you have a lot of pep, but you don’t! Don’t overdo it.” This kind of insight is commonly called “sage advice,” meaning it is earned through the wisdom of time and experience. Elders are living repositories of this hard-earned knowledge—intelligence that cannot be bought. If we listen, our grandmothers and grandfathers, our fathers and mothers, have so much love to give us. Sometimes that love comes from having learned something the hard way, maybe in a way they are not so proud of but are willing to share with us so that our paths become easier. What a blessing.

My grandmother died fifteen years ago but, thankfully, not before she told me about her experience on that operating table. What a gift to ease the heart and mind of a little girl who, like all of us, is worried about what death will bring. How could I ever repay her for sharing that insight with me, that amazing wisdom she garnered through her own body and mind? I will carry her words with me all my life.

Now, as I work with elders who are approaching death, I am reminded of my grandmother’s sage advice: don’t be afraid. What better gift can we give one another than the mercy of solace? And what better source of comfort and confidence than a kind soul who has walked the path before us?