A sick builiding case

[Guest guest]

Hi everybody,

 

I have a new case that confounds me more than usual.

56 y.o female

 

Chief complaints: 4 years ago she started working in an old courthouse

that had a leaky roof and animals rotting in the insulation. At this time she

was working 2 jobs and raising 3 kids as a single mom. Soon after she started

getting migraines, fatigued and respiratory distress that culminated in a

“pneumonia like “ illness(2 years ago) that she doesn’t feel that she has

recovered from. The following complaints date from this illness.

 

Fatigue-

She says that she is unrested on waking even after sleeping 10-14 hours.

She has started to fall asleep without any warning during yoga classes and

sit down events. However, she works out 5 times a week aerobically and

with weights for 45 minutes. These 

work outs leave her temporarily more tired but feeling better

overall.

Headaches:

no more migraines. Headaches are frontal, occipital or involve the whole

head. They will be every day for a few weeks then stop for a few weeks.

Headaches are throbbing in nature, always involve photosensitivity, and

occasionally involve mild nausea. No auras. No redness to the face or eyes

during headaches.

Left sided

back pain located below the scapula. Was sharp when

started during illness. Now it is a constant dull pain. Not affected by

breathing. Limits left arm reaching forward. Chest xrays/MRI are negative

except for “black spot” left over from sarcoidosis.

 

 

Systems overview

Respiratory: Diagnosed with

sarcoidosis at age 27- hasn’t had any relapses. Now diagnosed with emphysema

and copd. Since the illness 2 years ago has had shortness of breath constantly,

which when it gets severe creates chest pain that can radiate down left arm and

up to her jaw- this happens 2 x week. EKGs show no problems with her heart. Her

breathing during the interview sounded labored. When this happens she uses an

albuterol inhaler. She uses flovent and serevent daily. Wheezes on damp days.

Barely ever coughs. Has stuffy nose in the morning but no nasal discharge or

sinus problems. Has always had a poor sense of smell.

GI:Gets acid reflux when is having a

bad breathing day. Eats 3 meals but is never hungry in the morning. Bowel

movements come every other day- they are sometimes sticky. Has frequent

flatulence. Eats lots of salads.

Sleep: Has weeks where she sleeps

well and then weeks where she has a hard time falling and a hard time staying.

Doesn’t wake to urinate.

Gyn: Went through menopause 3 years

ago. Up until then she had 28 day cycles with no problems. Did have a fibroid.

General: Very dry scaly skin.

Occasional low back pain with long periods of standing.

Gets “fevers” in cycles that last for weeks. When they happen the

fevers happen in the late morning, the early afternoon and in the middle of the

night. The fevers last for ½ hour and involve her whole body feeling hot

without any up flushing feeling. She can sweat profusely when they happen at

night.

Since the illness, she has a hard time concentrating. Feels like her

head is in a fog and that she can’t retain new material.

She comes across as a feisty woman.

 

Tongue: slightly swollen overall,

slightly more swollen on the left side front; purplish with slightly orange

sides; mild red pts at the tip; thin yellow coating, thicker in the back; a

deep crack on the left side anterior 1/3rd, smaller cracks on the

right side anterior 1/3; underneath- thin purple veins to the tip with little

varicosities over the whole underneath surface

 

Pulse:   very deep, barely there chi position,

bilateral

            R cun- thin and wiry

            L guan- soft and

shapeless

 

Abdomen: upper ren- tender

            Middle ren- bloated

            Lower ren- weak

            Tight flanks, tender

Liv14/Gb24

            Palpating K16 sends

chills down her legs

 

Patterns and Principles: I see Lung

qi and yin vacuity with some phlegm/dampness in the lungs, Liver depression

with blood/yin vacuity, Spleen vacuity with some dampheat accumulation, blood

stasis. Since so many symptoms originated with working in the sick building or

with pneumonia like illness, have a damp/dampheat element, and come and go, I

suspect some lingering pathogen. Also she was temporarily left with a bitter

taste in the back of her throat after her first acupuncture treatment which

makes me think that some hidden pathogen is being expressed.

I can’t figure out how to prioritize my formula, if I should focus more

on clearing dampness/dampheat while supporting qi, blood and yin and coursing

the liver.

 

If you have gotten this far reading the case, thanks for your

perseverance.

Any suggestions.

 

Thanks,

Kristin

[Guest guest]

Kristin

I have written an article about a similar case . It could give you

some insight into your case. Todd has put it up somewhere for access

for members.

Snakeoil (Ann) could you email him the edited version please if you

read this.

heiko

kwisgirda wrote:

 

 

Hi

everybody,

 

I

have a new case that confounds me more than usual.

56

y.o female

 

Chief

complaints: 4 years ago she started working in an old courthouse that had

a leaky roof and animals rotting in the insulation. At this time she was

working 2 jobs and raising 3 kids as a single mom. Soon after she started

getting migraines, fatigued and respiratory distress that culminated in

a “pneumonia like “ illness(2 years ago) that she doesn’t feel that she

has recovered from. The following complaints date from this illness.

 

 

Fatigue-

She says that she is unrested on waking even after sleeping 10-14 hours.

She has started to fall asleep without any warning during yoga classes

and sit down events. However, she works out 5 times a week aerobically

and with weights for 45 minutes. These work

outs leave her temporarily more tired but feeling better overall.

 

Headaches:

no more migraines. Headaches are frontal, occipital or involve the whole

head. They will be every day for a few weeks then stop for a few weeks.

Headaches are throbbing in nature, always involve photosensitivity, and

occasionally involve mild nausea. No auras. No redness to the face or eyes

during headaches.

 

Left

sided back pain located below the scapula. Was

sharp when started during illness. Now it is a constant dull pain. Not

affected by breathing. Limits left arm reaching forward. Chest xrays/MRI

are negative except for “black spot” left over from sarcoidosis.

 

 

Systems

overview

Respiratory:

Diagnosed with sarcoidosis at age 27- hasn’t had any relapses. Now diagnosed

with emphysema and copd. Since the illness 2 years ago has had shortness

of breath constantly, which when it gets severe creates chest pain that

can radiate down left arm and up to her jaw- this happens 2 x week. EKGs

show no problems with her heart. Her breathing during the interview sounded

labored. When this happens she uses an albuterol inhaler. She uses flovent

and serevent daily. Wheezes on damp days. Barely ever coughs. Has stuffy

nose in the morning but no nasal discharge or sinus problems. Has always

had a poor sense of smell.

GI:Gets

acid reflux when is having a bad breathing day. Eats 3 meals but is never

hungry in the morning. Bowel movements come every other day- they are sometimes

sticky. Has frequent flatulence. Eats lots of salads.

Sleep: Has

weeks where she sleeps well and then weeks where she has a hard time falling

and a hard time staying. Doesn’t wake to urinate.

Gyn: Went

through menopause 3 years ago. Up until then she had 28 day cycles with

no problems. Did have a fibroid.

General:

Very dry scaly skin.

Occasional

low back pain with long periods of standing.

Gets

“fevers” in cycles that last for weeks. When they happen the fevers happen

in the late morning, the early afternoon and in the middle of the night.

The fevers last for ½ hour and involve her whole body feeling hot

without any up flushing feeling. She can sweat profusely when they happen

at night.

Since

the illness, she has a hard time concentrating. Feels like her head is

in a fog and that she can’t retain new material.

She

comes across as a feisty woman.

 

Tongue:

slightly swollen overall, slightly more swollen on the left side front;

purplish with slightly orange sides; mild red pts at the tip; thin yellow

coating, thicker in the back; a deep crack on the left side anterior 1/3rd,

smaller cracks on the right side anterior 1/3; underneath- thin purple

veins to the tip with little varicosities over the whole underneath surface

 

Pulse: very

deep, barely there chi position, bilateral

R

cun- thin and wiry

L

guan- soft and shapeless

 

Abdomen: upper

ren- tender

Middle

ren- bloated

Lower

ren- weak

Tight

flanks, tender Liv14/Gb24

Palpating

K16 sends chills down her legs

 

Patterns

and Principles: I see Lung qi and yin vacuity

with some phlegm/dampness in the lungs, Liver depression with blood/yin

vacuity, Spleen vacuity with some dampheat accumulation, blood stasis.

Since so many symptoms originated with working in the sick building or

with pneumonia like illness, have a damp/dampheat element, and come and

go, I suspect some lingering pathogen. Also she was temporarily left with

a bitter taste in the back of her throat after her first acupuncture treatment

which makes me think that some hidden pathogen is being expressed.

I

can’t figure out how to prioritize my formula, if I should focus more on

clearing dampness/dampheat while supporting qi, blood and yin and coursing

the liver.

 

If

you have gotten this far reading the case, thanks for your perseverance.

Any

suggestions.

 

Thanks,

Kristin

 

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