Update #2 from Chip

Dear Friends, September 27, 2018

First and foremost, thank you for your kind and healing communications. There is no way I can respond to all these but please know how much I appreciate the love and support that has been expressed to me.

I left the hospital on Monday Sept 24 and came home. This is a much better environment for me and I have a core team of friends and loved ones taking care of me. The pain is generally under control and the side effects of the opiates are improved but still need work. But I am in good spirits.

One of the many challenges is dealing with all of the communications that are still coming in by email, text, and voice. We have more than 300 people from all over the world on our contact list and it’s very draining for me to process this, so I have a communications team receiving everything and making decisions about when to reply and what I need to see. Please direct all communications to: Iamchipspancreas at gmail.com.

Now that I’m settled in I can begin attending to a few things that I would like to complete in the time I have left. This means that I need space and energy in my life to complete these goals, and sadly I have very little of either. It is a difficult decision to make but with the exception of a few members of my extended family who will be flying in during the next month or so, I will not be receiving visitors. As Monika and I have specific support needs, we will reach out to any of you who may be willing and able to help us out.

Deep thanks for your support.

Love, Chip

Chip’s Saga 2018 September

Chip Chace’s Saga, 2018 September

Greetings friends,
Sorry for taking so long to respond to your missives.
As you may have heard, I’ve had a rather challenging summer culminating in a diagnosis of adenocarcinoma of the pancreas.

Those of you uninterested in the following back-story can skip this bit.
Back in April 2018, I trapped a testicle in my climbing harness and experienced a mild strain injury. The pain persisted and did not seem to improve. In late May, I had a colonoscopy, which was normal. Shortly thereafter, I developed symptoms of gastritis while teaching in Europe. I was unable to consume wine or eat like normal. I experienced persistent gastric upset accompanied by pain radiating between the left flank and both testicles.

I saw my Primary Care Doc at the end of June and we decided to treat for H. Pylori with a berberine-based formula and an iteration of Wen Dan Tang, a Chinese herbal formula. Things improved considerably on this regimen.

I left for Canada on July 8th on a return tip to Baffin Island, while continuing on my gut meds. I flew for two days followed by a one-day boat ride, then a two-day walk, including two sketchy river crossings only to discover that my gear cache had been stolen and that an attempt to solo Mt. Asgard would not be possible.

I made my way back to Boulder by July 20-21. I sought solace in the Wind River range in Wyoming. I’ve been soloing there for the past 40 years and its my home range. Ten miles west of Rollins, I was rear-ended by a semi trailer that was going 40 miles per hour faster than I was. I totaled my Toyota FJ, but was miraculously unscathed otherwise. Monika came up and got me so that I could regroup back in Boulder. I returned to the Winds with a rental car and spent another two weeks climbing. I still had to be very careful about caloric intake and continued on my meds. I did have a 17-hour moment of grace during which I soloed the 1800 west face of Mt. Helen. All the while, I was juggling the gut and testicular discomfort as best as I could.

Upon returning home the upper GI symptoms began to diminish, although the left flank pain persisted, as did the radiating pain into the pelvic floor. I continued working, but was doing very little else. The flank pain became increasingly prevalent and unresponsive to anything that I tried.

I was admitted to Boulder Community Hospital on Saturday 9/8 at midnight with left-sided flank pain that was unresponsive to pain relievers. They ruled out the possibility of a kidney stone via CT scan. This they followed with a CT scan with contrast dye, which identified pancreatic adenocarcinoma and hydronephrosis.

Presumably the tumor or an adjacent lymph node is compressing my left ureter and this is causing the pain.

I continued to have a difficult time with adequate pain control. I received morphine and dilaudid via IV every hour, plus oxycodone every two to three hours and atavan every three hours, which helped with sleep. They also put on a fentanyl patch since I was still getting inadequate pain control. This helped a great deal with the pain. They put in a nephrostomy tube on the left, which helped to decrease pain from the ureter. At some point, I developed intractable hiccoughs, which persisted for 5 days. None of the drugs for this were especially helpful.

I became less responsive to all the pain meds. At some point last night on Friday, 9/14, Monika worked on me while I was in the midst of my barely conscious delirium and this seems have mitigated the hiccoughs significantly but not entirely. The fentanyl made me delirious and I rapidly improved after the removal of the fentanyl patch. By Saturday afternoon, 9/15, I was alert and the pain briefly abated Though by the next day I was again began experiencing nocturnal pain that was off the charts. Two days ago that shifted to nearly severe pain accompanied by intensive wrenching and vomiting fatigue, weakness, and mental fogginess.

The Intensity Scale

Pain is often graded on a scale of 1-10 with 10 being unbearable. For me it’s useful to grade other experiences based on their raw intensity using a similar scale. Uncontrollable vomiting, retching, chills, weakness and muscle twitching may rate a 9 or even a 10 even though actual pain involved. In Baffin last year, I embodied the wild in the midst of a level-10 intensity experience and catalyzed a lasting moment of transformational grace. My death deserves no less than that.

Current Status

My diagnosis is adenocarcinoma of the pancreas and hydronephrosis in the left kidney. There is currently a tube draining that kidney. My biggest medical issue is extreme pain, followed by vomiting, nausea, and mental fogginess. They have not yet staged this extent of the cancer as this requires a PET scan, an outpatient procedure. I still need IV meds for the pain, which requires me to be inpatient. Catch-22. On the other hand, no one is in much of a hurry for me to get the PET scan as all other signs point to significant metastases.

Prognosis is poor. The immediate goal is palliative care - get me home and functional on oral pain meds. Now that I’m marginally lucid, I’ve begun doing Chinese medicine, acupuncture and osteopathy to help me recover whatever strength I can.

Goals

First and foremost, I want my death to be an act of creative transformation, that is to say, I want to die well. I’ve been training for this my entire life and I’m well prepared. I would have preferred to die in the mountains, and that is indeed what Monika and I had envisioned for me. I got this instead. Yet, here is precisely where I want to be. I cry from the raw wonder and intensity of the experience but never because I’m sad or afraid.

I’m grateful for every second of I’ve lived so far and for whatever moments I have left. When I’m writhing in pain I scream thank you. When I’m puking my guts out I retch thank you...and sometimes FUCK!!!!!. I’ve been practicing more or less this way for a long time.

I want to optimize my time with Monika and Djinni.
I also want to nudge my students along as best I can.
If possible, I want to finish up a couple of writing projects,

To achieve these goals, I need to ration my time carefully. We’ve set up this gmail email account: IamChipsPancreas at gmail dot com so that we can keep you updated in a manner that creates the least amount of hassle for everyone.

I’m not seeing visitors just now, but if you want to get together or talk on the phone then please email us back at this email address and we will contact you with information (but DO NOT REPLY ALL because there are about 300 people on this list). That way we can have meaningful conversation with as few interruptions as possible. Please do not just stop by, as virtually every hour of my day is schedule. I know many of you have already expressed interest in getting together. We’re just getting organized here so please write again now if you’re still interested.

A thousand thanks for your love and support Love, Power, Grace and Gratitude to you all.

Chip

An EV Case from Jennifer Spain in Raleigh, NC.

A few months ago, a friend, who is also an acupuncturist, reached out to me for help with a year-old neck injury.  He had been treating himself with adequate success over the past year, but recently had an unexplainable flare up that involved both the right side of his neck and his right shoulder.  The neck pain was tight and achy—similar to what he had been experiencing for the past year, though more severe, and the shoulder pain was a new, deep squeezing pressure inside the joint capsule. He hadn’t had much luck getting the pain to shift with the treatments he’d been giving himself. 

Upon examination, I found the yang rhythm at his left hip to be lowest, and channel listening guided me to the Urinary Bladder channel. Manual thermal diagnosis on his left leg indicated UB58 to be an active point, and the yang rhythm increased as I applied pressure to that point with my fingertip. His pulse was bilaterally deep, thin, and slippery; and he had very strong bilateral oketsu (blood stasis) signs. This pulse indicated hot fluids stagnating in the lower burner, and specifically to the use of a formula like Polyporus Decoction (zhū líng tāng). I inquired about any urinary symptoms, thirst, or dryness. He replied that he had been having some urinary difficulty, along with dry mouth and lips, and thirst since the onset of the flare up. This was interesting! I had an active bladder point, urinary symptoms, and a pulse that indicated a formula that moves hot, stagnant fluids out of the bladder. The strong oketsu signs also made sense in this context since blood will often heat up and become stagnant when the fluids become hot and stagnant. Additionally, this all seemed to relate very well to pain inside the shoulder joint which is full of synovial fluid, and the well-understood premise that blood stagnation can cause pain. 

Using acupuncture, I treated the left hip with left UB58, treated oketsu with Lv4 bilaterally, and treated the shoulder and neck with right LI11, and left GB41 and TB5. I also gave him Polyporus Decoction (zhū líng tāng) to take for a couple of weeks. Upon follow up, my friend reported that the squeezing pain in the shoulder joint completely resolved after a couple of days, and his neck pain returned to his prior baseline.  The urinary symptoms also completely cleared up, as well as the dryness and thirst.  

    The Engaging Vitality approach is all about listening to the body to see what’s showing up first, and then using Chinese medical theory to understand and make sense of it. There are so many theoretical relationships that this case made tangible for me, that I thought it might be interesting to share it. There is the contralateral relationship between the left hip and the right shoulder, the relationship between the fluids in the bladder and all the fluids in the body, the bladder organ and taiyang bladder channel relationship, and the relationship of interior blood disharmony and exterior pain along the taiyang areas of the body. 

One thing the EV instructors have repeated many times is that it’s more clinically useful to try to be helpful rather than be right. It would have been so easy to have given my friend an acupuncture treatment that used local points in the painful areas to release local stagnation, and then given him a formula like Cinnamon Twig Decoction plus Kudzu (guì zhī jiā gé gēn tāng) that theoretically addresses painful conditions in the neck. That might have seemed more right based on a symptomatic approach to treatment. Actually I found out later that my friend had taken a formula based on that approach with no effect. Polyporus Decoction (zhū líng tāng is actually a perfect fit in this context: it contains Alismatis Rhizoma (zé xiè), Poria (fú líng), and Polyporus (zhū líng) to move congested fluids, Asini Corii Colla (ē jiāo) to address the blood, and Talcum (huá shí) to cool. By listening first to my friend’s body, and then making sense of all the combined diagnostic information from the palpatory findings and the pulse, I was able to administer a treatment that was actually helpful and that also made sense within the context of Chinese medical theory.

Chip on Palpation as Practice

Palpation as Practice: Part I

Learning to palpate is a lot like learning to meditate. The two skills are similar enough that the road signs commonly used to navigate the meditation landscape are also useful on the path to palpatory competency.  I want to talk about palpation from this perspective. We should be clear at the beginning that they are different things, although there is most probably some cross over benefit in practicing both meditation and palpatory awareness. Most importantly you don’t have to be in a deep meditative state to palpate effectively.

Perhaps the most significant commonality between meditation, palpation and for that matter, medicine is that they are all practices. At the beginning, the expectation is not so much that we will be good at these disciplines as that we know how to practice them. They are skills that are cultivated over time. At least in terms of meditation and palpation, we don’t really know the limit to what it is possible for us to experience. 

In learning to meditate, sooner or later we will have a fleeting experience of open awareness. At this point, we can’t really say anything about it. Even acknowledging that it is happening, “hey, look at that, my mind is quiet,” is enough to derail the experience. The early stages of cultivating any form of palpatory awareness can be very much like this as well. It too, may be very fleeting, and just as you think you’ve caught it, it may be gone. Even once you are consistently feeling something, the experience will initially be pre-verbal. It is new and vague enough we have no words for it. Nevertheless, the process of progressively fine-grained articulation builds from this fundamental binary apprehension. I feel something or I don’t. 

After a while perception stabilizes, and we start to be able to look around. As we more consciously experience our experience, we are increasingly able to say things about what we are experiencing. In meditation we may simply witness the moment- to-moment play of our emotions. A common observation for palpators at a similar stage is “well definitely I feel something, but is that me or my patient?”  In more general terms, we might ask whether this input is self or other. Meditators spend a lot of time on the cushion trying to break down the bounds of self and other, just as we are cultivating a capacity to appreciate qi beyond the perimeter of our own skin. Yet, in both cases, no matter how effectively we extend our perception into our environment, we cannot really function without simultaneously being able to distinguish between what is outside and what is inside. 

Mindfulness meditation practices concern themselves with an examination of our internal environment and our responses to external stimuli of one sort or another. 

In learning any new palpatory technique, it similarly helpful to identify that phenomena in oneself. If you know what it feels like in your own body, it is easier to identify it someone else. It is also easier to tell whether that palpatory information is coming from you or your patient. For instance, what does your own yang rhythm feel like? Knowing that will help you to differentiate it from your patient’s yang rhythm.  You can also palpate an inanimate object. If you find that the treatment table has a yang rhythm then you either have a very special treatment table or you are feeling your own qi?” All this can take some time and experimentation to sort out for oneself.  The good news is that the difficulty in distinguishing between self and other fades with experience and generally becomes less of an issue with every new palpation technique you learn. 

Meditation is about learning how our mind in particular works and in using that insight to exert some productive control over that process. Although we all share a human nervous system, each of us is wired a little differently. No one’s palpatory antenna is without a few unique bends and kinks. Learning the quirks of our particular apparatus is an essential part of learning to appreciate qi. For instance, is one hand more sensitive than the other when listening to the yang rhythm or doing channel listening? Does it help cross-reference your findings by switching hands? Which hand is best for manual thermal evaluation and which for local listening. Our own acute or chronic injuries may influence the accuracy of our listening. Even problems in our ankle may influence how we stand, subtly influencing the way our hands receive information.  

Some days we may be able to sustain our attention and awareness on the cushion better than others. Its best not to label our meditation sessions as good or bad, we just practice. Just as it is counterproductive to beat yourself up when you catch your mind wandering, it is also unhelpful to fret over the fact that you’re not feeling anything. Just move on and keep practicing. 

Most experienced clinicians will acknowledge that their palpatory capacities vary from day to day, and even over the course of a single day. In meditation, pulse diagnosis, yang rhythm or general listening, our baseline competencies generally improve as we gain experience. We gradually get to the point where our palpatory input is clinically useful even on our off days. Some days we may be more confident in our local listening than in our channel listening. At other times the opposite may be true. We simply do our best to make use of whatever information we can glean at any given moment. Our receptivity is inherently variable for reasons including but by no means limited to our own competency. Sometimes our patients are just not communicating with us on a particular palpatory wavelength.  Cultivating our comfort in working with whatever information we have is a skill in itself. A key to all of this is to try with just the right amount of effort. If we don’t try seriously enough or often enough, we will never learn the skill. Yet working too hard will just as surely subvert the learning process. 

Once we are reasonably confident that we are feeling something, and that what we are feeling is coming from the patient and not ourselves, the issue is no longer whether we can feel qi but what specifically we should be filtering for. 

We will pick up this thread in a subsequent blog. 

Dan Bensky interviewed on Heavenly Qi podcast

CLICK here to hear Dan's interview on Heavenly Qi podcast

Go to our Resources page for more information about EV. 

Chip Chace interviewed on Qiological podcast

CLICK here to hear Chip's interview on Qiological podcast

Go to our Resources page for more information about EV.