Celebrating Asian American/Pacific Islander (AAPI) Heritage Month 2023
Interview with Siyun "Sisi" Xie, MD
Interview with Ed Mariano, MD, MAS, FASA
What is Acupuncture?
Interview with Siyun "Sisi" Xie, MD and Uchenna Umeh, MD
Dr. Umeh: Dr. Xie, can you tell us where you work and your current roles at your home institution, other societies, and within ASRA Pain Medicine?
Dr. Xie: I was born in China, immigrated to the United States at age 2, and now I’m a CA-3 at The University of Texas Medical Branch and an incoming pain fellow at Stanford University. I serve as Chair of ASRA Pain Medicine’s
Resident Section Committee and DEI Officer of the North American Neuromodulation Society Residents & Fellows Section. I also co-founded the Medical Student Component of over 100 medical students for Women in Anesthesiology in 2022 and am
currently developing their resident component.
Dr. Umeh: How do you celebrate AAPI Heritage Month?
Dr. Xie: By supporting my younger brother! He is a freelance film editor in Los Angeles with dreams of directing his own feature films. In his personal film projects, he creates content with emphasis on AAPI culture and features AAPI actors to increase
our representation. I admire him for his courage and perseverance to pursue his dream career, which goes against the grain of our cultural pressure to pursue STEM careers. I think his work is important since AAPI are underrepresented in the film
industry, and our stories and perspectives are often untold or misrepresented.
Dr. Umeh: Why do you think AAPI Heritage Month is important to recognize?
Dr. Xie: This recognition brings positive awareness for AAPI culture and our contributions to American history. It also gives Asian Americans a formal opportunity to reconnect with our roots and find pride in celebrating our culture. Overall, this can positively contribute to the mental health of our community especially with the recent rise in anti-AAPI violence since the COVID-19 pandemic, including the mass shootings in California and Atlanta.
Dr. Xie (front row, third from left) and the Resident Section Committee coordinate the activity for trainees, including developing resident/fellow program content at both annual meetings.
Dr. Umeh: Who has served as an inspiration in your life? Who inspired you to be a leader and why?
Dr. Xie: It’s hard to pinpoint one person since I find inspiration from many leaders, especially those from underrepresented backgrounds, because of what they’ve had to overcome. It’s incredible to see an increasing number of women physicians in our field take on multiple leadership positions while juggling a busy work schedule and raising kids. I was fortunate to have strong female attendings at my institution and see them champion and empower residents to rise to their potential. I am deeply grateful for their support and mentorship, and because of them, I’m inspired to champion others in a similar fashion.
Dr. Umeh: What motivated you to step up and become a leader in ASRA Pain Medicine, especially since you are still a trainee?
Dr. Xie: It’s simply that I find being involved fun and fulfilling, and it helps me stay connected with my passion to serve others amidst the grind of residency. I get the opportunity
to be creative by brainstorming ways to contribute to the organization, and it brings me joy to positively impact others.
Dr. Umeh: What factors impact one’s ability to lead others?
Dr. Xie:
1. The motivation or intention for leading will impact the way you lead.
2. The ability to listen and discover the needs of the group/individuals you are leading will impact whether you can create an empowering environment for the group.
3. Finally, having leadership experience contributes to your ability to navigate the challenges you’ll encounter as a leader.
Dr. Umeh: What advice would you give other residents, fellows, and medical students as they navigate their careers?
Dr. Xie: Get involved early - you never know what doors you’ll open for yourself, what mentors you’ll encounter, and, most importantly, what growth you’ll experience from putting yourself out there. Because you’ll never stop feeling busy, it’s worth figuring out early how to set aside time for activities that bring you joy/purpose/fulfillment and strengthen your sense of self.
Dr. Umeh: Is there anything else you would like to note?
Dr. Xie: Stay hungry - continue actively participating in your personal and professional development, as it is a lifelong journey.
Interview with Ed Mariano, MD, MAS, FASA and Uchenna Umeh, MD
Dr. Umeh: Dr. Mariano, can you tell us where you work and your current leadership roles at your home institution, other societies and within ASRA Pain Medicine?
Dr. Mariano: I'm a professor and the senior vice chair in the department of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine. I am also chief of the anesthesiology and perioperative care service at the Veterans Affairs Palo Alto Health Care System. I have previously served on the Board of Directors for ASRA Pain Medicine, where I also chaired communications and membership, the 2013 spring annual meeting, and served as editor of the newsletter.
I am currently president of the California Society of Anesthesiologists and previously served as speaker, vice-speaker, district director, Ddlegate and Program Chair for the annual educational meeting and Hawaiian conference. Within American Society of Anesthesiologists (ASA), I am currently Section Chair for Education and Research, a Board position, and I am the CPT Advisor for ASA and part of the ASA delegation to the American Medical Association. I am also the immediate past Chair of the ASA Committee on Regional Anesthesia and Acute Pain Medicine.
Dr. Umeh: How do you celebrate AAPI Heritage Month?
Dr. Mariano: My family is from the Philippines. My parents were immigrants, and I was the first in my family to be born in the United States. Filipino culture is full of music, dancing, family, and food. For AAPI month, we try to visit AAPI-owned businesses and restaurants. Our boys love the Filipino bakeries we have in the Northern California Bay Area, and we regularly stock up on baked treats filled with ube - not just this month! We talk about our family's history, how my grandfather joined the United States Navy in the Philippines and served during World War II, which made it possible for our family to come here.
Dr. Umeh: Why do you think AAPI Heritage Month is important to recognize?
Dr. Mariano: It is important to celebrate diversity and the value that comes from teams made up of people from differing backgrounds. People of AAPI heritage have been a critical workforce that has supported many forms of industry across the US. As immigrants, AAPI people have taken any jobs offered to them. AAPI immigrants are credited with the completion of the transcontinental railroad. Filipinos in California were critical to the rise of our state's farming industry and were an important part of the farm worker movement led by Cesar Chavez. People of AAPI descent are typically stereotyped as hard workers but not leaders.
Dr. Umeh: Who has served as an inspiration in your life? Who inspired you to be a leader and why?
Dr. Mariano: My parents have been an inspiration to me. I can't imagine making the decision to leave your home country and family and start over in the US thousands of miles away. Going back to the Philippines as an adult really puts this in perspective. After having three kids, my parents moved our family from New Jersey to a small town in Northern California where we were an obvious minority. They made hard choices and faced setbacks but persisted.
ASRA Pain Medicine Immediate Past-President, Samer Narouze, MD, PhD, presenting the Distinguished Service Award to Ed Mariano, MD, MAS, FASA, during the 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting.
Dr. Umeh: What motivated you to step up and become a leader in ASRA Pain Medicine?
Dr. Mariano: I have been blessed with great mentors and sponsors in ASRA Pain Medicine. Icons in our field made me feel like I belonged, and this motivated me to want to serve. I have never had a plan to become a leader. I've always just wanted to be useful, which is why I have accepted opportunities to serve when they have been offered.
Dr. Umeh: What factors impact one’s ability to lead others?
Dr. Mariano: Leading people is not for everyone, and leading physicians has some unique challenges. To lead doctors, you have to be a good doctor. You have to be open to opportunity even when it means more work. You have to be authentic, loyal, and fair. You have to be willing to do what is right even when the decision isn't always popular. Here are a few more of my thoughts about leadership https://www.kevinmd.com/2015/12/6-tips-great-physician-leader.html.
Dr. Umeh: What career accomplishment makes you most proud?
Dr. Mariano: This isn't an award or leadership position for me. It was the first time I took my son on a visiting professor trip. My oldest son was only 4 years old, and he accompanied me to Penn State Hershey. I had never seen a visiting professor do this before, and the department of anesthesiology at Penn State was so supportive. This set the precedent in our household that the minimum age to be a junior visitor professor is 4 years, and now all three of our boys have joined me for one-on-one work-related trips where I've been a guest speaker.
Dr. Umeh: What advice would you give to young physicians as they navigate their careers?
Dr. Mariano: Besides the other leadership advice shared already, I think it's important to be open-minded. A career as a physician can be 30 or more years. You may want to explore different paths or even switch paths a few times. Remember that there are no shortcuts to success. Be ready to fail and keep going. You may be the first person to do something - someone has to be. I spoke about this at the recent ASRA Pain Medicine meeting. You may find yourself the first person who looks like you to get to a certain level. When that happens, when you get into that room, hold the door open for someone else.
What is Acupuncture?An Introduction to the Traditional Chinese Medicine Technique for AAPI Heritage Month
Written by: Chris Li, MD
Written by: Chris Li, MD
I am a regional anesthesiologist at the Hospital for Special Surgery (HSS) in New York. I also specialize in integrative medicine techniques to improve perioperative orthopedic care. I was raised in a yoga-meditation group, Ananda Marga, and have practiced both since childhood. During fellowship at HSS, I followed in the footsteps of my mentor, Dr. Stephanie Cheng, and became a medical acupuncturist, performing intraoperative acupuncture for perioperative stress, anxiety, nausea, and pain for joint arthroplasty patients.
My personal relationship with acupuncture comes from my parents – as a child, they would first seek out traditional Chinese methods of care for me when ill or injured. While rare, when I had a cold, I would receive herbal teas and homeopathic medicines. When my hand was bitten by a dog or for my ongoing lower back pain, I was sent to an acupuncturist. I always bounced back quickly and efficiently and grew to learn the strength of these treatments.
Acupuncture has a rich history in Chinese culture, rife with treatments for nearly any ailment, be it physical, mental, or spiritual. However, it didn’t gain popularity in the United States until the 1970s, when a New York Times reporter, James Reston, (in Peking for President Nixon’s visit), underwent perioperative acupuncture for analgesia after an appendectomy in Peking. Nixon observed the successful care that Reston would then return to write about in the New York Times as an obituary to his removed appendix. The National Institutes of Health began funding research into acupuncture in the same decade and eventually the evidence culminated to support the efficacy of this technique. Eventually, the Affordable Care Act and many forms of insurance started to cover acupuncture procedures.
So, what exactly is acupuncture? It is a medical treatment based on the theory that the human body has a natural flow of energy, or Qi, that when obstructed, causes illness or pain. Acupuncture utilizes thin needles inserted at points on the body to relieve blockages, thereby restoring balance to the natural flow of Qi with the subsequent improvement of illness or alleviation of pain.
Dr. Li demonstrating a scar deactivation acupuncture for an old burn scar during an acupuncture workshop for residents and fellows.
There are multiple forms of Qi that an acupuncturist assesses a patient for excess or deficiency in, which then guides their treatment plan. Two significant types are Yin Qi, a slow and steady energy that is responsible for the body’s nourishment and growth and Yang Qi, a dynamic, active, warming energy important for movement and transformation of the body. Qi flows through energy pathways known as meridians that travel from the tips of the fingers to the ends of the toes. There are twelve meridians, named after organ systems and associated with specific parts of the body. They include Lung, Large Intestine, Stomach, Small Intestine, Spleen, Heart, Bladder, Kidney, Master of the Heart, Triple Heater, Gallbladder, and Liver Meridians.
The acupuncturist chooses which points on specific meridians to target via an interview with the patient as well as a physical exam. Questions relate to a patient’s past medical history but differ from allopathic lines of inquiry in that the goal is to determine where a patient’s Qi excesses, or deficiencies lie. Discovering a patient’s favorite season, flavor of food, color, emotional tendencies, responses to stress, and psychological characteristics will change an acupuncturists’ diagnosis for a patient. Points are chosen, needles inserted, and treatments typically last under half an hour.
While not fully elucidated, there are a few theories into the mechanism of action for acupuncture treatments. The neurohormonal theory that needling activates nerve pathways leading to hormone and neurotransmitter release, therefore regulating various bodily functions. The vascular-interstitial theory suggests that acupuncture increases blood flow and oxygenation to tissues, reducing inflammation and promoting healing. Finally, the gate control theory is based on the idea that needles activate nerve circuits that block pain signals to the brain and stimulate production of pain-relieving endorphins.
Indications for acupuncture range from physical to mental/spiritual, including chronic pain (lower back, neck, osteoarthritis), headaches, hot flashes, addiction (smoking, alcohol, substance abuse), and depression/anxiety. Previous systematic reviews and clinical trials have shown the effectiveness of acupuncture in each of these realms while more recently at HSS, Dr. Cheng has published on the effect of intraoperative acupuncture on postoperative pain control in total knee arthroplasty patients.
While further studies are needed on acupuncture protocols as well as its mechanism of action, it is a promising, non-pharmacologic alternative for those seeking integrative complements to allopathic medical care. Acupuncture has been performed by traditional Chinese practitioners for thousands of years and it is exciting for me to continue to investigate this underutilized modality as a novel technique in the care of perioperative patients.