Dory Ellen Fish is a board-certified, state-licensed acupuncturist with 25 years of experience in 5 Element and Traditional Chinese Medicine acupuncture. She holds a diplomate in acupuncture from the National Commission for the Certificate of Acupuncture and Oriental Medicine. For the past 15 years, much of her continuing education has been focused on cancer care. She completed the acupuncture course in oncology for cancer patients at Memorial Sloan Kettering Hospital and the Oncology Training for Acupuncture course at MD Anderson. Dory Ellen has lectured and taught at various universities, hospitals, and organizations. Her clinical practice is in Bryn Mawr, Penn.
Listen to the podcast to hear Dory Ellen explain:
- what acupuncture is
- the benefits of acupuncture
- the risks of acupuncture, including the risk of lymphedema
- her top three recommendations for someone who wants to try acupuncture for the first time
Running time: 27:38
Show Full Transcript
Jamie DePolo: Hello, and welcome to the Breastcancer.org Podcast. Our guest today is Dory Ellen Fish, a licensed acupuncturist with 25 years of experience in 5 Element and Traditional Chinese Medicine acupuncture. She holds a diplomate in acupuncture from the National Certification Commission for Acupuncture and Oriental Medicine.
For the past 15 years, much of her continuing education has been focused on cancer care. She completed the acupuncture course in oncology for cancer patients at Memorial Sloan Kettering Hospital and the Oncology Training for Acupuncture course at MD Anderson. Dory Ellen has lectured and taught at various universities, hospitals, and organizations. Her clinical practice is in Bryn Mawr, Pennsylvania.
Dory Ellen joins us today to talk about how acupuncture can help people who have been diagnosed with breast cancer. Dory Ellen, welcome to the podcast.
Dory Ellen Fish: Thank you so much, Jamie, and thanks for having me on.
Jamie DePolo: Of course. This is a topic I think that a lot of people are interested in and maybe not everybody knows exactly what acupuncture is, so if you could sort of give us a general explanation of what it is and potentially how it works.
Dory Ellen Fish: Great. Well, acupuncture actually dates back around 3,000 years, Chinese medical historians believe, and that’s based on finding cave drawings and needles, back then, were made of stone. And the medicine, it’s one branch of Chinese medicine, and it consists of inserting very, very fine needles under the skin in specific areas of the body and along specific pathways in an attempt to regulate the movement of energy, or chi, and to bring the body into a state of balance — or I should say the body, mind, spirit into a state of balance.
So I’m going to talk about mostly how we use it for treating people with cancer, but it’s used for reducing pain, building stamina, boosting the immune system, providing profound relaxation. That’s really what it’s known for.
Jamie DePolo: Okay.
Dory Ellen Fish: Yeah, and acupuncture can also assist the body in expelling toxins from the blood or body fluids, so when we talk about detox, that’s what we mean.
And then other branches of Chinese medicine would be diet, meditation, exercise, herbal medicine, cupping, and gua sha. So most acupuncturists that you find should be versed in most of those modalities, too, and should be able to talk to you about them.
Jamie DePolo: Okay. That is helpful. I do want to focus a little bit, just in case anyone is concerned — I have had acupuncture myself, but if you could explain that the needles really are very fine, they’re almost, I guess I would think of them almost like a human hair, and there really is no pain.
Dory Ellen Fish: That’s true, and that’s always…I made a note here to talk to you to make sure we talked about pain, because everybody wants to know does it hurt. Because nobody likes needles, when you think of that, and we associate them with all kinds of medical treatments. And it is the thickness of a hair. One thing, though, I have to say is that when the needles are actually connecting to your chi you will feel something, but it’s not pain.
Jamie DePolo: Okay.
Dory Ellen Fish: And I think most acupuncturists, or many of us, should be able to work with people who have heightened sensitivity, and so we do things like breathe and blow, or we could do acupressure on a certain point if someone’s afraid or has just had a lot of things going on and are needle shy.
Jamie DePolo: Okay. That’s good to know. Now, as you mentioned when you were talking about it and in my background research I found this out, too, it sounds like acupuncture can really help ease a number of breast cancer treatment side effects. So I thought maybe it would be most helpful to sort of break it down by treatment.
Dory Ellen Fish: Great.
Jamie DePolo: So I thought maybe we could start with surgery, because most people — not all, but most people — who have been diagnosed with breast cancer have some type of surgery, whether it’s mastectomy, lumpectomy. And in some cases people have pain that comes on later or persists for a while. So what sorts of side effects from surgery can acupuncture help with? I know you mentioned pain, but are there others?
Dory Ellen Fish: Yes, and actually Sloan Kettering recommends getting acupuncture 2 days before surgery, even. People think about just after, but I find that getting it before, it basically gets people in the best shape they can be to receive the surgery. And some of Sloan Kettering’s research says that it reduces swelling and helps surgery go well. Plus that gives your acupuncturist a chance, and you a chance, you get a chance to know each other before so you’re not just coming in right after surgery.
Jamie DePolo: Okay. Very interesting. I had not heard that but it makes sense.
Dory Ellen Fish: Yeah. And then if there’s pain reduction, that potentially reduces the need for medication, which causes constipation and a variety of other incidences. And then after the surgery, there is a treatment that I like to use for clearing effects of the anesthesia and pain medications that somebody was given for the surgery. So it’s important for that.
We also use needles around the incision after. That’s not right on top of it, and at first I would start very far away, but it starts sending blood and chi to the incision site, to the surgical site, and helps it heal. There are things we can do to help with adhesions, with scar tissue. And we use ear points, head points, body points that are used to help reduce pain but also help sleep.
Jamie DePolo: Oh, nice.
Dory Ellen Fish: And help the bowels, too, after surgery. Helps the body functions come back quicker from trauma of surgery.
Jamie DePolo: Okay. Now I know sometimes if nerves have been cut or moved around, especially if lymph nodes are removed or — I should say during reconstruction — people might have peripheral neuropathy. Can acupuncture help with that?
Dory Ellen Fish: Yes. That’s something that we treat, peripheral neuropathy, also obviously from certain types of chemo. So we treat peripheral neuropathy.
Your acupuncturist should be informed that there is very slight, but still there is risk for lymphedema from anything invasive, even obviously an arm… you know, getting a manicure can be considered invasive. And so we’re really careful not to use needles on a limb or possibly quadrant where there has been lymph node biopsy or removal.
And I actually have some patients, I’ve had somebody wear like a little band on the arm so I don’t forget I’m not supposed to needle there, and that is a really smart thing to do. But you need to let your practitioner know, and if they say it doesn’t matter, that it’s fine, then you probably want a different acupuncturist. And remind us, too, because we can forget.
Jamie DePolo: Right. So the idea is — just to make sure that I’m clear and everybody listening is clear — that acupuncture obviously is invasive, and if somebody has lymphedema or potentially has a very high risk of lymphedema, putting needles in that area is not a good idea.
Dory Ellen Fish: Nope.
Jamie DePolo: Okay. Okay. Excellent. Now what about radiation therapy? I know that sometimes can cause fatigue and stiffness of the pectoral muscles. Can acupuncture help with some of that?
Dory Ellen Fish: Yes. First of all, yeah, fatigue, dry mouth is a big thing, and sometimes I’ve experienced people who’ve had esophageal pain or nausea, vomiting from radiation. It’s also a very hot treatment, and so there are things that we do energetically to cool the body off and help the body get rid of what it doesn’t need that’s left over from the radiation.
Jamie DePolo: Okay. Wow. Now I also know, this is probably a little bit more commonly known, that people use acupuncture to help ease hot flashes and joint pain, which are a big side effect of hormonal therapies, either tamoxifen or the aromatase inhibitors. Are there other ways that acupuncture can help people who are being treated with hormonal therapy or even, I know immunotherapy is relatively new for breast cancer, but in your practice have you seen anybody come in with some side effects from that, and how can acupuncture help?
Dory Ellen Fish: A lot. A lot of women who’ve had breast cancer or any kind of hormonal cancer do find themselves with menopausal symptoms, and acupuncture is really helpful for treating that.
One of the things also that’s important is that we don’t just do acupuncture, and so there are nutritional recommendations that we can make, lifestyle recommendations, some of the hormonal treatments. I do see a lot of shoulder pain, different kinds of migrating joint pain, and what I’ve done with that where I get really good results also is cupping therapy. I don’t use fire cups, but I use suction cups, and those really help shoulder pain.
Jamie DePolo: Okay. Now just can you sort of briefly explain that, too, just in case somebody isn’t familiar with that?
Dory Ellen Fish: Okay. Yes. It’s a therapy where you create suction on the body, and it basically separates the skin from the fascia, from the muscle, and really increases circulation. And if there’s a little bit of frozen shoulder or rotator cuff inflammation, it’s very effective with acupuncture.
I mean, I’ve had people come in and say, “I do not want you to cup me,” and then I say, “Terrific, we’ll do needle and some liniments.” So that’s something that would be up to the person and their practitioner to decide.
Jamie DePolo: Okay. Okay, good to know, and I will say perhaps if anyone has watched the Olympics or other sporting events and they see people with the ring circles on their backs, that’s the result of cupping.
Dory Ellen Fish: Right. But that’s really extreme.
Jamie DePolo: Yes. Yes. Absolutely.
Dory Ellen Fish: You will not — I can’t swear that would never happen — but you’re not going to leave here looking like Michael Phelps.
The other thing that’s nice about acupuncture is in terms of radiation, in terms of risk for lymphedema, in terms of other things, is that we don’t have to treat the site exactly. So let’s say that you had lymph nodes removed in your right arm and you had your right breast treated. We can treat the other side and get just as good results, or we could treat your leg, or we could do aromatherapy if you wanted, or we could do acupressure.
So it’s not like we just have to leave that body part out of the loop or we would go and stick needles where you’ve just had a burn or an operation.
Jamie DePolo: Right, and that’s because of the way the meridians run through the body, like you can treat other areas and still affect the energy in the part that had surgery or other treatment.
Dory Ellen Fish: Exactly, and I think that that’s something that people who haven’t had it don’t know, and you would imagine going to an acupuncturist having needles put in your breast. That wouldn’t happen.
Jamie DePolo: Right. Okay. Okay.
Dory Ellen Fish: Yeah, and most of us do ear acupuncture, too, which is really effective and treats the whole body.
Jamie DePolo: Okay. Okay. So we talked a lot about the benefits of acupuncture, and there are many. Are there any risks that people should know about?
Dory Ellen Fish: So I think the risk of lymphedema, risk of an infection every once in a while. I mean, I’ve never seen anybody get an infection from acupuncture and I’ve been doing this 25 years, but it still would be a risk, or if you saw somebody who wasn’t properly trained. The thing is, for acupuncturists, our training is extensive. I mean, I had to do 4,000 hours of study after a college degree to even sit for my Boards, so there’s a lot of regulation in our field. And we need to do a lot of continuing [education].
But once in a while, like for me probably once or twice a year, somebody might feel a little bit dizzy, or if they’re not hydrated they could have a mild headache for an hour or two, but these are not things that I see.
I think that one of the important things about acupuncture, is it’s good to sit with your practitioner, and somebody who really wants to partner with you and not somebody just doing something to you. This is collaborative medicine, and it should be working with the comfort level of the person receiving it. So if you’re with an acupuncturist, you want to have the right person working with you because it’s really an intimate relationship.
Jamie DePolo: Sure, and that kind of goes along with what happens during a typical appointment, especially the first appointment, it’s not that you walk into an acupuncturist office and lay down and the person starts putting needles in you. There’s usually a very thorough health history discussion and goal talking and “What do you want to do, how can I help,” so it’s really almost like a 2-hour appointment.
Dory Ellen Fish: That’s right. It sounds like you’ve had really good acupuncturists, because that’s correct. At my practice we see one person an hour, which is a lot of attention and different parts to the treatment, and sometimes the person wants a lot of conversation. And your acupuncturist is — we’re not doctors, so we don’t have that type of clinical mindset in the statistics about what you have, and we’re not therapists and we’re not treating, “What’s wrong with you.” We’re actually partnering and treating you and supporting you in getting through something really challenging, and it’s a special relationship.
Jamie DePolo: Yes. I wholeheartedly agree with that. It has to be a very good fit. Now, if someone wants to try acupuncture and hasn’t before, what should they look for in a practitioner? I know you, for example, have completed continuing ed courses on acupuncture for people diagnosed with cancer. Is that something that’s important for, say, somebody who’s been diagnosed with breast cancer, is it important to have somebody who’s taken those extra courses on working with people with cancer?
Dory Ellen Fish: Well, it’s nice if they have. One of the reasons it’s nice, like in terms of finding an acupuncturist. I help a lot of people find acupuncturists. It really should be convenient. You don’t want to find somebody who is an hour away, or somebody who’s in the right price range for you, too. And there are a number of different options that way. But the first thing that I look for is their specialties, and your specialties are what you really care about. So if you really care about oncology it would be nice if you took the good courses out there that focus on cancer care. But that’s not essential.
But having said that, if I went on somebody’s website and I see that they specialize in sports medicine, I probably don’t want to go there with cancer, or somebody who has a big section on facial rejuvenation. I mean, they might be wonderful acupuncturists, but you want to see somebody at least who specializes in internal medicine. When we were in school we were told that we should not be working with people with cancer until we had been practicing for 5 years.
Jamie DePolo: Oh, wow.
Dory Ellen Fish: That might be silly, but when I started learning, that’s what we were told. And there are really good courses. The Sloan Kettering course is fantastic.
Jamie DePolo: Okay. Well, that’s great, and it sounds like Sloan Kettering is doing a lot of research on how acupuncture can help people with cancer, which I guess from my viewpoint is important because you can have the anecdotal evidence of perhaps some of your clients and how it’s helped, but a clinical trial is really the gold standard, especially when you start talking about getting insurance companies to pay for it or things like that. So that’s really exciting to me to see that they’re doing that research.
Dory Ellen Fish: Well, we have the benefit of it because they’re very generous sharing their information. And if they’ve done a big study on how to boost white blood clot count, then I want to use that in my treatments, in addition to really customizing for the person that I’m seeing. Because I see people going through chemo and they’re not nauseous at all, and maybe their primary side effect that’s bothering them is brain fog.
Jamie DePolo: Okay.
Dory Ellen Fish: So you just never know what that’s going to be, and they have very specific protocols, and you can totally gear it to the person that you’re working with.
Jamie DePolo: Yeah. And you talked a little bit about pricing. So is acupuncture typically covered by insurance?
Dory Ellen Fish: I wouldn’t say typically, I would say sometimes.
Jamie DePolo: Okay.
Dory Ellen Fish: It’s still developing, and I think one of the things — we have people who will call here and just say, “Do you take insurance,” and if we say we don’t accept insurance, they say goodbye. But if you find just having somebody have insurance, you want to make sure that you’re getting the same thing or you want to make sure that you’re getting what you need.
So I know some people for example, have several — up to five — treatment rooms going at the same time and they take insurance, but you’re not getting exactly the same thing. Or maybe they wouldn’t do full body treatments or they wouldn’t do cupping or gua sha, but maybe you don’t want those things and you don’t need a lot of personal time and you don’t want to pay for something out of pocket that you don’t need or you’re not interested in.
So I would just make sure you know how much time you’re going to be getting.
Jamie DePolo: Okay. Okay, and it sounds like, too, people need to check with their insurance carriers to find out if the services are covered.
Dory Ellen Fish: Definitely.
Jamie DePolo: Yeah. Okay.
Dory Ellen Fish: I mean, at least somebody should be willing to give you an itemized bill that you can send to your insurance company. So we give super bills with codes and things like that. I do not take insurance because I just see one person at a time and that wouldn’t work for me. Typically it works well if you have a few treatment rooms, and then you can afford to accept insurance.
Jamie DePolo: Okay. Well, that’s good to know. And then to sort of wrap up, what would be your top three recommendations for a person who wants to try acupuncture for the first time, a person who’s been diagnosed with cancer, I should specify, what things would you recommend they consider or to think about before they go ahead and make an appointment?
Dory Ellen Fish: Well, the first thing is I said before, finding the right person. So put the time in. If you have a friend who has a recommendation, those tend to be the best referrals because you already know the person and they know you, and you have a good chance of a good fit. I think that it’s definitely worth a try. I tell people usually the worst thing that’s going to happen is you might still have your chief complaint, but you’re going to be really relaxed and well, because acupuncture doesn’t only work on the thing that you’re treating. We treat the whole person, and so when you bring the system into balance a lot of things come into balance so there are often benefits that people never expected.
So it really is worth a try. If you go and you don’t like the person but you’re interested in acupuncture, please try somebody else. It’s like saying I went to the doctor once and I didn’t like him so I never went back. I mean, we’re all so different, this is thousands of years of medicine from all kinds of Asian countries, right? So we’re all very different.
Jamie DePolo: Sure.
Dory Ellen Fish: The other thing is, sometimes people come expecting one session to make everything go away, all kinds of ailments, and you really want to give it a couple tries. I usually tell people, “Come three to four times, and if it feels like nothing’s happening it probably isn’t.” Thank goodness that’s very, very rare, but you should trust yourself and not just think, “Well, it’s supposed to be good for me so I’m going to keep going even though really I don’t like it or it doesn’t seem like anything’s happening.” You would be better off getting a referral for some other healing modality that you were a better fit with.
There’s a distinction. Part of what acupuncture does, it’s the distinction between healing and curing and that ties into what I was talking about before, that maybe all your symptoms don’t go away but they don’t have the same negative effect on you or your life as they did before. Like maybe you’re still having a couple hot flashes, but it doesn’t seem like that big of a deal in the context of your life and other good things that are going on. So I think that we do curing, but this is a place for a lot of healing to happen.
Jamie DePolo: Excellent. That’s all really good advice, and I really like that last point you made because I think sometimes in our society today we want the quick fix, like we want to take a pill or we want to do this thing and then I’m going to feel great, and I’m glad you pointed out that sometimes with acupuncture, you need to give it two, three, four times to let it work everywhere.
Dory Ellen Fish: Yeah.
Jamie DePolo: Because obviously, too — correct me if I’m wrong — as an acupuncturist, you can’t hit every single energy meridian in somebody’s body in one treatment, you kind of have to focus on certain things and once those are kind of in line then you move on to something else, right?
Dory Ellen Fish: Exactly. Exactly.
Jamie DePolo: Okay. Okay. Well, Dory Ellen, thank you so much. This has been so helpful. I’m so glad you could join us.
Dory Ellen Fish: Well, thank you so much for this opportunity, and I also appreciate how much you know about acupuncture, so thank you.
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