Subject: Penka Slavova
Age: 31
Fatigue Factors: Keeping up with housework, yard work, two young children, and let's not forget the new puppy.

Penka is a mother on the move, often spotted on neighborhood sidewalks with 4-year-old daughter Lilliana in a stroller, baby Isabella in a backpack, and new puppy Solomon on a leash. If Penka is not playing with the kids, she is cleaning or cooking or gardening or crossing items off her to-do list in rapid fire (with the exception of item number one, getting enough sleep). Her husband teaches during the day, and so evenings combine kid time with couple time. If she had more energy, she says, "I would just do everything better. I'd have more memory. I'd have more patience with my kids and be more creative with them when we do projects. I'd have more peace of mind."

For years Penka has been curious about acupuncture, a more than 3,000-year-old Chinese practice in which thin metal needles are inserted under the skin to unblock and stimulate energy flow in the body. "Bring it on," she says gamely upon meeting Ian Cyrus, an Eastern-medicine practitioner who serves as the staff acupuncturist for Philadelphia's Thomas Jefferson University Hospital Center for Integrative Medicine. Cyrus explains that acupuncture is only one of eight Asian healing arts he offers, including herbal formulas and bodywork.

"Calling me an acupuncturist is like calling a mechanic a wrench-ist," says Cyrus, who explains that Eastern medicine helps put the body back into balance, and that acupuncture is particularly useful for people with chronic conditions—ranging from fibromyalgia to depression, infertility, and allergies—but not acute illness. "I wouldn't want to go to somebody like me if I had a ruptured appendix," he says.

Cyrus examines Penka's tongue color (unusually purple, he determines, possibly indicating compromised liver function) and texture (normal). Then he checks the rhythm of her pulse and takes her temperature. He questions her about circulation ("Do your feet and hands get cold?"), illnesses in her family, and what she eats. Penka takes no vitamins or supplements, and her diet leans heavily toward bread and cheese. "That's a big staple in Bulgaria, where I'm from," she explains. She's rarely able to sleep through the night because she is breastfeeding her 18-month-old, and she hasn't yet resumed her menstrual cycle. These last two facts draw Cyrus's attention as potential contributors to fatigue.

"She's probably running on E," he says. "Tired and wired."

"Exactly," Penka responds. Cyrus chooses to address what he sees as possible compromised liver function. Penka definitely needs to take vitamins, he says, especially while breastfeeding; he suggests a multivitamin with iron and a few other supplements, including milk thistle, some of which will require taking several pills several times a day. Then Penka lies on the treatment table so Cyrus can place the needles into her ears, wrists, feet, and ankles. She feels buzzing in her right foot and slight discomfort at her extremities but nothing more. Needles can stay in up to 60 minutes, but Cyrus usually leaves them in for 10 to 15. That's sufficient time, he thinks, for the needles to stimulate the nervous system and help open up energy and circulation pathways. According to Eastern medicine, proper flow of both is necessary to keep the body and spirit in balance, and one symptom of being out of balance—or blocked—is fatigue.

End Result: Penka says there's no way she can keep up the supplements regimen of 20 pills a day, so she'll drop all but the multivitamin with iron (for breastfeeding) and B12 with folic acid (which helps in the maturation of red blood cells). Penka did feel her energy levels shift after each treatment. "They relaxed me, so I could relax more," she says. Penka had been trying to cope through hypervigilance—doing everything she thought of as soon as she thought of it. But the taste of relaxation changed her priorities, and now she'll opt for recharging over relentlessly accomplishing: "Anything I can put off, I put off. One more phone call, loading the dishwasher, doing whatever—I put it off just so I can be with the kids or read a book."

"Most of us are so used to being on edge and stressed," Cyrus says, "we don't know what it's like to achieve a baseline of deep relaxation. After a few treatments, patients' systems learn to develop a different frame of reference. They know the difference between what they've grown accustomed to and what they should feel like."

Try It Yourself: Eastern-medicine treatments generally range from $100 to $200 for an initial visit. Follow-up appointments cost between $50 and $100, and a typical treatment cycle will include eight to 10 visits. Supplements are additional. Cyrus advises that the practitioner you choose be certified by either the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) or by the state in which he or she practices.

How nutrition works to cure fatigue

As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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