Post-surgical plantar numbness and tingling

[Guest guest]

I have a new case that I think is rather interesting and would like

comments from anyone, especially those who have treated a similar

case.

 

 

64-year-old male,one pack-a-day-smoker who after emergency surgery

for a ruptured abdominal aortic embolism, suffered from loss of

balance, difficulty walking, cramping of the calves and numbness and

tingling in the feet. He currently only suffers from numbness and

tingling on the bottom of his feet. The feet are warm on palpation,

but he reports feelings of cold in the feet especially in the

wintertime. The feet are slightly reddish purple with some spider

veins around KID-3. Nothing seems to ameliorate the condition but

extended walking on hard services exacerbates the condition.

Since the surgery , 18 months ago, while still reporting fully

functional taste,he states that he has no real desire to eat and

that nothing tastes good. 2 of his 3 meals a day are protein shake

high in dairy content. Patient is 5'10 " and at the time of

surgery weighed 160 lbs. After three weeks in the hospital , he

weighed only 125 lbs. and has since returned to 145 lbs.

He has a 30-year history of Crohn's disease , from which he was on

prednisone , 10 mg for 25 years. he states that he has no

osteoporosis from medication, but he has lost many of his teeth due

to the side effects. He stopped taking prednisone five years ago.

His only symptom of the Crohn's today is loose stools and diarrhea.

He is currently taking , Accupril(anti-hypertensive) and Nexium(to

control acid reflux).

Patient complains of headaches occipitaly normally related to

stress. He states that his life, although retired, is

stressful.Patient does not feel hot or cold in general. Patient

states that he is usually thirsty , although he drinks a lot of

water.He states that his overall energy level is eight out of 10.

Patient looks approximately 10 years older than his age with

slightly wrinkled skin and pale gray complexion.

tongue: slightly red body, thick dry pervasive slightly

yellow coat, sublingual veins thick swollen dark purple

pulse: weak overall, left middle pulse wiry and excess

right distal pulse superficial and surging

 

My preliminary diagnosis is blood and phlegm stagnation in the lower

limbs, spleen deficiency and phlegm heat in the upper jiao.

It seems that there was underlying spleen deficiency prior to the

operation. The operation , not only further damaged his spleen ,

but the large amount of blood loss involved in such an injury led to

blood deficiency and stasis in the lower limbs. It seems that the

three major organs involved in fluid metabolism are all involved in

the case. He has phlegm heat in the lungs due to his long-term

smoking, a weak spleen and the chronic nature of his Crohn's

disease , as well as the prednisone treatment leads me to think that

there's some kidney deficiency is well. Denies lower back or knee

pain.

 

during his first visit . I treated him with the following

acupuncture protocol: KID2, Ba Feng w/estim, ST40, Ren12, Ren6, LIV3

herbal formula: Shen Ling Bai Zhu San + Dan Shen, Mu Gua, Chuan Niu

Xi, Gui Zhi, Tian Hua Fen

Diet mod: Cut out " protein shakes " (ice cream, milk, yogurt, whey

protein powder, raw egg)!!!! Replacements suggested.

 

In his next treatment I plan to add KID-1 to the acupuncture

protocol and to attack the phlegm more vigorously with herbs , as

well as adding Di Long and Jiang Can.

 

Any ideas or analysis would be appreciated.

 

Rich Blitstein

[Guest guest]

Hi Rich,

 

Thank you for submitting this case.

 

IMHO I feel you may be missing the liver as possibly another underlying culprit.

 

Going by cookbook medicine the warm feet is part of 5-center heat, aged look,

wrinkles/greyness/ hyptn./ ↑ thirst/teeth issues>> Kid. Yin deficiency

with the internal coldness Liver stagnation [sublingual veins

respective/stress/prednisone/plantar px./Crohns dx./other Rx., {HA &

hyptn.}(Liver heat & Yang disorder-GB?)]

 

Liver>St., lack of appetite... Sounds like the cold, wet food hasn't helped his

Spleen.

 

Smoker hx. and 'heartburn'>>St. & Lu. Yin deficiency.

 

Is there ever constipation/hemorrhoids on his off-Crohn's days??

Night sweats, vivid dreaming/nightmares, emotional hx.??

Incontinence/output/edema/frequency???

Family hx.? Eyes?

 

Some important questions that I would like to know the answers to.

 

Hope this helps.

 

David Akrish

Heaven and Earth CMHC

White Snake Choy Li Fut & Tai Chi Chuan

2100 E. Union Street suite-B

Seattle, WA 98122

www.HeavenEarthCMHC.com

206-320-1041

 

 

 

richblit [richblit]

Friday, July 30, 2004 7:47 AM

 

Post-surgical plantar numbness and tingling

 

I have a new case that I think is rather interesting and would like

comments from anyone, especially those who have treated a similar

case.

 

 

64-year-old male,one pack-a-day-smoker who after emergency surgery

for a ruptured abdominal aortic embolism, suffered from loss of

balance, difficulty walking, cramping of the calves and numbness and

tingling in the feet. He currently only suffers from numbness and

tingling on the bottom of his feet. The feet are warm on palpation,

but he reports feelings of cold in the feet especially in the

wintertime. The feet are slightly reddish purple with some spider

veins around KID-3. Nothing seems to ameliorate the condition but

extended walking on hard services exacerbates the condition.

Since the surgery , 18 months ago, while still reporting fully

functional taste,he states that he has no real desire to eat and

that nothing tastes good. 2 of his 3 meals a day are protein shake

high in dairy content. Patient is 5'10 " and at the time of

surgery weighed 160 lbs. After three weeks in the hospital , he

weighed only 125 lbs. and has since returned to 145 lbs.

He has a 30-year history of Crohn's disease , from which he was on

prednisone , 10 mg for 25 years. he states that he has no

osteoporosis from medication, but he has lost many of his teeth due

to the side effects. He stopped taking prednisone five years ago.

His only symptom of the Crohn's today is loose stools and diarrhea.

He is currently taking , Accupril(anti-hypertensive) and Nexium(to

control acid reflux).

Patient complains of headaches occipitaly normally related to

stress. He states that his life, although retired, is

stressful.Patient does not feel hot or cold in general. Patient

states that he is usually thirsty , although he drinks a lot of

water.He states that his overall energy level is eight out of 10.

Patient looks approximately 10 years older than his age with

slightly wrinkled skin and pale gray complexion.

tongue: slightly red body, thick dry pervasive slightly

yellow coat, sublingual veins thick swollen dark purple

pulse: weak overall, left middle pulse wiry and excess

right distal pulse superficial and surging

 

My preliminary diagnosis is blood and phlegm stagnation in the lower

limbs, spleen deficiency and phlegm heat in the upper jiao.

It seems that there was underlying spleen deficiency prior to the

operation. The operation , not only further damaged his spleen ,

but the large amount of blood loss involved in such an injury led to

blood deficiency and stasis in the lower limbs. It seems that the

three major organs involved in fluid metabolism are all involved in

the case. He has phlegm heat in the lungs due to his long-term

smoking, a weak spleen and the chronic nature of his Crohn's

disease , as well as the prednisone treatment leads me to think that

there's some kidney deficiency is well. Denies lower back or knee

pain.

 

during his first visit . I treated him with the following

acupuncture protocol: KID2, Ba Feng w/estim, ST40, Ren12, Ren6, LIV3

herbal formula: Shen Ling Bai Zhu San + Dan Shen, Mu Gua, Chuan Niu

Xi, Gui Zhi, Tian Hua Fen

Diet mod: Cut out " protein shakes " (ice cream, milk, yogurt, whey

protein powder, raw egg)!!!! Replacements suggested.

 

In his next treatment I plan to add KID-1 to the acupuncture

protocol and to attack the phlegm more vigorously with herbs , as

well as adding Di Long and Jiang Can.

 

Any ideas or analysis would be appreciated.

 

Rich Blitstein

 

 

 

 

 

 

 

 

 

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[Guest guest]

Thanks for the response on this case. HEre are some answers to your

questions

Is there ever constipation/hemorrhoids on his off-Crohn's days??

No

Night sweats, vivid dreaming/nightmares, emotional hx.??

In general an " up tight " kind of guy but no dx mental history

 

Incontinence/output/edema/frequency???

Urination WNL, no edema

Eyes

yellowish crusting at inner and outer canthus-has had since childhood

 

I did find out that he has restless leg which does not bother his

sleep but his wife complains.

He also takes immodium daily!!

 

I believe that in general there is blood def which is effecting the

liver and some liver qi stagnation for sure but the liver still does

not seem to be the main issue.

As far as the KID is concerned of course there are some yin def

signs but the hot feet do not feel hot to him. He has no sleep prob

or night sweats.

 

I will tonify blood using bai shao-dang gui probably which will

address the liver which has stag due to def. I feel that by moving

blood qi will also be moved and attacking the phlegm is of greater

priority.

I have to be careful with blood movers due to his hx but network

vessel ones like lu lu tong and phlegm can be attacked strongly.