Sjogrens and sinusitis case

[Guest guest]

I wait wait for the new clinically oriented discussion group to start to

share this case. Even if folks are interested in other things, it's a good

exercise for me to try to regurgitate a case out to you in some more easily

assimilable form than that in which I first received it.

A 50 y.o. woman, a financial counselor by trade. Chief complaints are

sinusitis and chronic cough of 4 years duration. The cough actually started

after a few months after being prescribed Prilosec for reflux. Even though

she has long gone off Prilosec because she no longer experiences reflux to

her knowledge; one of her M.D.s continues to call her condition reflux

induced asthma. She has been seeing a pulmonologist, a GI doc and a

rheumatoloigist for her Sjogrens.

I'll try to keep my narrative as clear as possible. Everything seems so

interrelated; it may be hard to keep my categories straight.

The cough: She's been on antibiotics for 5 weeks and is scheduled for a 6th.

The sputum is still yellow and gluey, before antibiotics it was green. It is

worse early in the morning, with cold air and after eating. It sounds like

there is a great deal of sputum rattling around in her lungs and she feels

like it is coming from deep in her lungs and not just her throat. She uses an

inhaler every day.

The sinuses: She has had sinusitis for many years more than she has had the

cough. She has a long history of allergies to pollens and also underwent 5

years of allergy shots for her allergies to yellowjackets and hornets. She

has a long history of sinus related headaches, infections and antibiotics. On

theory of her cough is that it is the result of post nasal drip. She had

sinus surgery 3 years ago and since she no longer gets headaches but

otherwise not much change.

The Sjogrens: She had knee surgery on her left knee in 1993 which seemed to

go well. After doing a month of PT both of her knees swelled up all of a

sudden and were very stiff. The docs thought it was the PT. They have her

cortisone shots and now there is very little inflammation. But soon after

this knee situation she started getting conjuctivitis like symptoms in both

of her eyes. The redness and the discharge soon gave way to grittiness and

now dryness. After a year of going to eye doctors they realized she has

Sjogrens (dx:1994). She also has little saliva production and has a great

difficulty swallowing becuase of the dryness but also becuase of constant

phlegm in her throat. She feels that there is a pocket in her throat where

food sticks. When she tries to cough the food out there is always a great

deal of phlegm. Occasionally she gets yeast infections on the back of her

tongue. Also on the autoimmune front, she has begun getting Reynaud like

symptoms in her hands and feet.

Is any of this clear?

Systems review:

Digestion: Not much appetite but still eats 3 meals a day. She often doesn't

finsih meals because of the implications of her swallowing difficulty. Loss

of taste. often feels bloated after meals. A history of reflux and ulcers but

none now.

Bowel movements: One every other day. No difficulty. Well formed, not dry.

Urine: No problems. Doesn't wake to urinate.

Sleep: Occassionally wakes with warm flashes. Rare nightsweats. Sleeps well,

7-8 hours.

Gyn: 2 pregnancies, 2 live births. Her period became irregular 2 years ago

and stopped last October. She has some yellow vaginal discharge with itching

a few days a month. Some cyclical breast tenderness. Low sex drive.

General: sensitive to cool and damp weather. Cold hands and feet (Reynauds).

Little spots of eczema but otherwise no dry skin. She enjoys her warm flashes

because before they started a year ago she was cold all of the time. She

says her energy is pretty good. She works fulltime and is also the sole care

taker for her husband who has late stage MS. She is very present and matter

of fact. She is very appropriate and warm. Very strong Heart qi.

Tongue:Dusky. Puffy with teethmarks and very tender. More swollen in Lung

area. Geographical coat-no coat in center, thick yellow in back, patchy dirty

coat in lung area. Sticky slimy coat- it doesn't look that dry. White lines

that look like scars criss cross her tongue. She denies any injuries. Does

anybody know what to make of these?

Pulse: very weak, very thin, and deep except in the Heart position which

fuller and stronger.

Analysis: I am wondering if the dryness of the eyes and mouth is not more

from or as much from phlegm obstruction ( or yang not moving the fluids) than

from yin xu. The phlegm could be from Lung/ K yin xu or Sp/K/Lung qi/yang xu.

Its probably a little bit of everything. Or is it?

Definitely Phlegm heat in the Lungs. Spleen qi/yang xu with damp/phlegm

accumulation. Stomach yin xu but with no real St yin xu heat signs? Dampheat

in the lower jiao. Kidney yin not nourishing Liver yin(eyes) and not securing

yang.

I don't have my formula with me but it was on the idea of Clearing the phlegm

heat from the lungs while supplementing the spleen: huang qi, bai zhu, zhe

bei mu, huang qin, yu xing cao, sang bai pi, xing ren and a few other guys.

With this she's coughing more stuff up and clearing out more deep seated

phlegm from her lungs. I also have her using a grapefruit seed extract nasal

spray and doing saline sinus washes. I'm afraid that putting any drying sinus

herbs would dry her out more. I'm wondering if my formula shouldn't be more

based on 6 gents of metal and water(er chen tang + dang gui and sheng di)

plus regular 6 gents plus phlegm heat herbs. This would make it more oriented

toward Spleen tranformation while also addressing the yin.

What do y'all think?

Thanks for plowing through this with me.

Kristin Wisgirda, Lic.Ac., MTOM

[Guest guest]

please be clear. cases should still be presented to this list; the new

list is for those who belive clinical practice should be separated from

these other related issues. I offer the new list as a service, though

I personally believe the existing forum is more appropriate for actually

understanding cases in context. I beleive most of the senior px on this

list share this position, so I do not expect the new list to be well

represented. However, I may be wrong about this bias and thus the new

list will be offered to see what the truth is here..

 

 

 

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