trying again - patient question

[Guest guest]

Hi all - I posted this a few days ago, and it sank like a rock. Thought I'd try

again in case it just was missed in the kerfuffle:

 

I have a new patient who has given me permission to consult with my

international advisory board to get some advice. He is a 23 yo, who was very

healthy and involved in sports. At 19 he developed severe colitis, lost a lot

of weight in 9 months. Medication (icluding flagell) was tried with no success,

and he ultimately had his colon removed, and was given a J-pouch in 9/07.

 

The J-pouch gets bacterial infections; he seems to have a few good months, then

the infection. The doctors are starting to talk about removing the J-pouch and

giving him a colostomy bag externally, which her really, really doesn't want.

He has currently been on Cipro and flagell for about 6 months, also takes a

probiotic.

 

He also has panic attacks, which seem to come on when he gets sick.

 

Stools are never fully formed, often is diarrhea (fake colon, no peristalsis -

anyone know how the stools move out?). He will have loss of appetite when the

infection starts in the J-pouch, also nausea. His energy is low, which he finds

difficult as he's trying to get a degree. He's clearly not getting much

nutrition.

 

On first visit, his tongue is a bit blue, no coat, quivering, bit of a coat in

the LI area. Damp in the heart area, dry in St/Sp (is that possible). Last

visit, the tongue was red w/red spots. His pulses are all over the place,very

low, maybe choppy. Last visit were slippery.

 

Other oddity: he has sporadic head hair loss, and spontaneous body hair growth.

 

So gentle experts: anything you can share with us (beside the obvious be very

very careful when needling abdominal points)?

 

tx so much.

karen

 

 

 

Karen R. Adams,

Lic Ac, Dipl Ac

25 - 27 Bank Row

Greenfield, MA 01301

413-768-8333

[Guest guest]

Karen:

I don't know why no one is posting on this one, let's see if I can get this

ball rolling, perhaps by raising interesting questions, and perhaps merely by

being provocative.

 

I look at the tongue and take the pulse *many* times during the visit of a

complex patient, especially the first time. I would like to know, in more detail

what the pulse and tongue show, you've given us some basics, but I don't feel it

is enough to work with in this case. With complex patients especially, and also

for the sake of case management, I view their pulses and tongue presentations in

order to create a baseline range within which they move - their most yang and

their most yin. From this dynamic I can infer much information, and also use it

to " prove " or " test " therapeutic benefit. Basically I am asking you what are his

yin tongue, and his yang tongue, what are his most deficient pulse states (as a

totality) and his most excessive pulse states (as a totality). For example, you

have already reported that his tongue can range from slightly blue to having a

red body.

 

I would also be very interested in knowing what his pattern presentation was

prior to the initial infection and operation, as well as his health history.

This, of course, allows us to see the impacts the operation had on him, further

illuminating his yin and yang (strengths and weaknesses).

 

I know you won't be able to answer much of this since you are just starting to

see him, but maybe you can get more history, more ten questions and provide us

with a clearer picture of the tongue and pulse + please link them: i.e. " his

tongue was red at the tip with a greasy coating, and, at the the time of the

tongue viewing, his upper burner pulses were soggy and bounding " .

 

Lastly, I believe it is a requirement for him to be on a strict CM diet and

herbs.

 

Hope this was of some help, or gets the convo going at least.

 

Hugo

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.middlemedicine.org

 

 

 

 

 

________________________________

turusachan <turusachan

Chinese Medicine

Tue, 9 February, 2010 3:20:12

trying again - patient question

 

 

Hi all - I posted this a few days ago, and it sank like a rock. Thought I'd try

again in case it just was missed in the kerfuffle:

 

I have a new patient who has given me permission to consult with my

international advisory board to get some advice. He is a 23 yo, who was very

healthy and involved in sports. At 19 he developed severe colitis, lost a lot

of weight in 9 months. Medication (icluding flagell) was tried with no success,

and he ultimately had his colon removed, and was given a J-pouch in 9/07.

 

The J-pouch gets bacterial infections; he seems to have a few good months, then

the infection. The doctors are starting to talk about removing the J-pouch and

giving him a colostomy bag externally, which her really, really doesn't want.

He has currently been on Cipro and flagell for about 6 months, also takes a

probiotic.

 

He also has panic attacks, which seem to come on when he gets sick.

 

Stools are never fully formed, often is diarrhea (fake colon, no peristalsis -

anyone know how the stools move out?). He will have loss of appetite when the

infection starts in the J-pouch, also nausea. His energy is low, which he finds

difficult as he's trying to get a degree. He's clearly not getting much

nutrition.

 

On first visit, his tongue is a bit blue, no coat, quivering, bit of a coat in

the LI area. Damp in the heart area, dry in St/Sp (is that possible). Last

visit, the tongue was red w/red spots. His pulses are all over the place,very

low, maybe choppy. Last visit were slippery.

 

Other oddity: he has sporadic head hair loss, and spontaneous body hair growth.

 

So gentle experts: anything you can share with us (beside the obvious be very

very careful when needling abdominal points)?

 

tx so much.

karen

 

Karen R. Adams,

Lic Ac, Dipl Ac

25 - 27 Bank Row

Greenfield, MA 01301

413-768-8333

 

 

 

 

 

 

 

 

[Guest guest]

Thanks, Hugo - I always enjoy your input. I will try to get more information

for you. The tongue change I found a bit alarming since he's prone to infection

of his j-pouch (hence the long term flagell). I'm also interested in what was

going on when all this first hit the fan; I expect it's going to take some time

to get ht information. Right now it's as tho everything was fine and wham!

severe colitis. I suppose that's possible, and maybe it's my bias, but it seems

unlikely that it was a 'wham' kinda thing.

 

 

I've done some research on the operation, and essentially he's working w/o a

large intestine, small intestine only. So far more fluid loss than normal, less

nutrient uptake possible - and I wonder about the strain on the small

intestine's sorting ability, body mind spirit. Also, losing a physical organ

impairs but doesn't 'disappear' the function of that system w/in the system (I

mean, he still has a LI channel) and am wondering about how that works. E.g. I

know patients who have lost their gall bladders who have a terrible time making

decisions.

 

I'll do my best to get you more information; we both may need to translate, as I

am Five Element trained. ;-). If no one else chips in, I'd like to keep the

dialog going with you, off list?

tx

k

 

 

Karen R. Adams,

Lic Ac, Dipl Ac

25 - 27 Bank Row

Greenfield, MA 01301

413-768-8333

 

 

 

All shall be well

and all shall be well

and all manner of thing shall be well

Julian of Norwich, 14th century

British mystic

 

 

 

 

 

 

 

________________________________

Hugo Ramiro <subincor

Chinese Medicine

Wed, February 10, 2010 12:17:15 PM

Re: trying again - patient question

 

 

Karen:

I don't know why no one is posting on this one, let's see if I can get this ball

rolling, perhaps by raising interesting questions, and perhaps merely by being

provocative.

 

I look at the tongue and take the pulse *many* times during the visit of a

complex patient, especially the first time. I would like to know, in more detail

what the pulse and tongue show, you've given us some basics, but I don't feel it

is enough to work with in this case. With complex patients especially, and also

for the sake of case management, I view their pulses and tongue presentations in

order to create a baseline range within which they move - their most yang and

their most yin. From this dynamic I can infer much information, and also use it

to " prove " or " test " therapeutic benefit. Basically I am asking you what are his

yin tongue, and his yang tongue, what are his most deficient pulse states (as a

totality) and his most excessive pulse states (as a totality). For example, you

have already reported that his tongue can range from slightly blue to having a

red body.

 

I would also be very interested in knowing what his pattern presentation was

prior to the initial infection and operation, as well as his health history.

This, of course, allows us to see the impacts the operation had on him, further

illuminating his yin and yang (strengths and weaknesses).

 

I know you won't be able to answer much of this since you are just starting to

see him, but maybe you can get more history, more ten questions and provide us

with a clearer picture of the tongue and pulse + please link them: i.e. " his

tongue was red at the tip with a greasy coating, and, at the the time of the

tongue viewing, his upper burner pulses were soggy and bounding " .

 

Lastly, I believe it is a requirement for him to be on a strict CM diet and

herbs.

 

Hope this was of some help, or gets the convo going at least.

 

Hugo

 

____________ _________ _________ __

Hugo Ramiro

http://middlemedici ne.wordpress. com

http://www.middlemedicine.org

 

____________ _________ _________ __

turusachan <turusachan >

 

Tue, 9 February, 2010 3:20:12

trying again - patient question

 

Hi all - I posted this a few days ago, and it sank like a rock. Thought I'd try

again in case it just was missed in the kerfuffle:

 

I have a new patient who has given me permission to consult with my

international advisory board to get some advice. He is a 23 yo, who was very

healthy and involved in sports. At 19 he developed severe colitis, lost a lot

of weight in 9 months. Medication (icluding flagell) was tried with no success,

and he ultimately had his colon removed, and was given a J-pouch in 9/07.

 

The J-pouch gets bacterial infections; he seems to have a few good months, then

the infection. The doctors are starting to talk about removing the J-pouch and

giving him a colostomy bag externally, which her really, really doesn't want.

He has currently been on Cipro and flagell for about 6 months, also takes a

probiotic.

 

He also has panic attacks, which seem to come on when he gets sick.

 

Stools are never fully formed, often is diarrhea (fake colon, no peristalsis -

anyone know how the stools move out?). He will have loss of appetite when the

infection starts in the J-pouch, also nausea. His energy is low, which he finds

difficult as he's trying to get a degree. He's clearly not getting much

nutrition.

 

On first visit, his tongue is a bit blue, no coat, quivering, bit of a coat in

the LI area. Damp in the heart area, dry in St/Sp (is that possible). Last

visit, the tongue was red w/red spots. His pulses are all over the place,very

low, maybe choppy. Last visit were slippery.

 

Other oddity: he has sporadic head hair loss, and spontaneous body hair growth.

 

So gentle experts: anything you can share with us (beside the obvious be very

very careful when needling abdominal points)?

 

tx so much.

karen

 

Karen R. Adams,

Lic Ac, Dipl Ac

25 - 27 Bank Row

Greenfield, MA 01301

413-768-8333