Guest guest Posted March 18, 2000 Report Share Posted March 18, 2000 - kwisgirda Wednesday, March 15, 2000 12:50 PM MS case I've got another case for y'all. A 40 y.o. woman. She has had vertigo since August of 98. It came on all of a sudden in a huge episode that kept her in bed for 3 days.She has had the vertigo ever since. It comes on with rising or turning over and is accompanied by nausea. A year ago she went to a neurologist who dx her with right positional vertigo and proceeded to perform the Epley's maneuver which consists of the patient extending her neck and then having her neck adjusted. After this manuever the patient was required to wear a neck collar for 2 days and then for the next 5 days to sleep only on her left side. On the first night of sleeping on her left side she woke with excruciating pain in her left forearm and hand. She has had this pain ever since and very little seems to affect it. She has been on Neurontin, Tegretol, Motrin; she has worn braces and used heat and cold. The only thing that makes a difference is if she keeps her arm still; the pain is less noticable then. She characterizes the pain as dull and achy most of the time with day long bouts of sharp stabbing pain every 7-10 days. She also has numness and tingling in her fingers and hand. She feels that she is losing strength in her hand as well. The neurologist initially gave her a dx of carpal tunnel which an EMG then ruled out.An MRI showed 2 demyelinated lesions in her brain and 2 in her spine. Currently she is on no medications. She is a short statured, slightly overweight woman. Her flesh feels firm and full; there is no visible wasting in her left arm. She has very bright white areas around her eyes; otherwise her face is reddish and slightly puffy. She seems sluggish and her voice is soft. She seems guarded and afraid. A review of the systems: The patient was not very forthcoming. She didn't check anything off on my symptoms survey. This is what I was able to get out of her. Intestines: bowel movement every 1-2 days. Occasional problems with dryness. UB: has always urinated frequently, 10 times a day or more. Doesn't know what color. Feels like she empties every time. No problems w/ dribbling. Musculoskeletal:No weakness except in her left arm. Legs feel stiff when standing in the same position. Sciatic pain down the back of her right leg on long car trips, 2-3x/week. Sleep: works nights, gets 6-7 hours, doesn't feel rested on waking, arm sometimes disturbs sleep GYN: Cycle is 24-25 days long with 3-4 days of bleeding. Cramping in lower back, abdomen and legs during 1st day of bleeding. The flow is dark the first day and light all others; no clots. 2 pregnacies and 2 children, ages 10 and 14. PMS: moodiness and pain in back of legs and lower back. Breast tenderness during ovulation.Has watery cysts in right breast which have been aspirated 2ce in the last year. Emotions: very moody all of the time; cries easily; lots of anxiety about dx; not telling her family about her dx. General: usually has cold hands and feet; frontal headaches associated with anxiety about her dx; low energy; stopped smoking a few years ago Tongue:very pale, dusky, red rashiness in the H and some of the Lung region ; size-normal; pinched teethmarks on right edge; central crack in St region with slight swelling on right; dry; thick dirty coat in center; an indentation in the edge of the left lung region; thin dark veins underneath Pulse:hidden on the left(responds well to acupuncture); soft and slippery on the right but still pretty weak Diagnosis: Damp/phlegm blocking the channels of the left arm;Sp qi xu; internal phlegm/damp accumulation; Liver blood xu and qi depression; underlying K xu Rx:ban xia bai zhu tian ma tang, modified ban xia, 9 bai zhu, 9 tian ma, 6 chen pi, 6 fu ling, 6 sheng jiang, 6 huang qi, 15 dang gui, 9 bai shao, 9 chuan xiong, 9 ye jiao teng, 6 tu si zi, 9 di long, 6 gui zhi, 6 I have seen her twice and have administered this rx on the last visit so I have no feedback yet. I feel that both phlegm/damp stagnation and blood xu are contributing to her arm pain and parethesias but I am having a hard time figuring out which I should give more attention to. Her case is also unusual in that she has had continuous symptoms for a year without any remissions. I read that usually exacerbations on last 1-3 months. Next time I am also going to recommend a flax and primrose oil supplement. So far acupuncture hasn't given her much relief from the pain. I plan on doing some scalp points once she gets more used to the idea of needles. Any feedback or experiences? I am getting some pretty tricky cases for a new practitioner and I appreciate your support and criticism. Thanks. Kristin Wisgirda, MTOM, Lic.Ac. Bridgewater, MA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 19, 2000 Report Share Posted March 19, 2000 Kristin, Take a look at " thoracic outlet syndrome " as a contributor to her arm sxs. Palpate her scalene muscles on that side. If they seem pretty tight, needle each one, ie: juan bi extra points. I realize the arm sxs may be due to demyelination but this could give her some relief by relieving any muscular pressure on what is left of the nerve conduction to that arm. Your formula looks like a pretty good starting point. You might consider doubling or tripling your dose of ye jiao teng for it's dual function of calming shen/nourishing blood and helping with pain in the extremities. Mark Quote Link to comment Share on other sites More sharing options...
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