vomiting feces case study

July 29, 2005

Vomiting Feces - Case Study

It was requested by another CHA member that I post the details of this case

study. Sorry for the delay, but here it is.

Patient is age 51, female, with a lifelong history of “putrid” vomiting with

ejection of material that she says looks and smells like feces. Bowel movements

can occur as infrequently as every 2 weeks with hard, bound stool, although

occasionally there is thin, sudden, watery diarrhea. She takes a daily laxative

under her doctor’s recommendation, which “usually” will allow her to have a

daily bowel movement.

Severe bloating and fullness occur with small intake of food. She also has

heartburn and frequent nausea and vomiting, sometimes noticeably with undigested

food.

Her biomedical diagnosis for this condition is gastroparesis, which means the

peristaltic waves in her stomach are only half as rapid as normal. This causes

food to stagnate and create bezoars, which are the congealed masses she is

vomiting. Bezoars can wreak havoc of they pass into the small intestine and

block the normal passage of digestive by-products. The most common cause of

gastroparesis is diabetes, which she does not have. Second most common cause is

gastric surgery, which she also has not had. 40% of cases have unknown causes.

It is treated medically with avoidance of fiber, because it aggravates all

symptoms severely. Her intake of actual food is quite limited: cooked green

beans and carrots, canned pears and peaches, cottage cheese, cereals, white

bread. Occasionally she can only handle a liquid diet, and under her doctor’s

recommendation she uses the liquid Cambridge diet both as her nutritional basis

and to supplement what food she can eat. Any foods other than these

cause rapid and severe aggravation of all her digestive symptoms, especially

the nausea and vomiting.

Other biomedical diagnoses: She is diagnosed with GERD. She was hospitalized

twice in 2003 for chronic pancreatitis. In 1997 she had her gallbladder removed,

but now she produces stones in her liver. A one-sided parathyroid tumor was

removed in 1990. She also had a hysterectomy in 1987 for stage 4 cervical cancer

and endometriosis. Still more diagnoses include a heart murmur and leaky valve,

osteoarthritis, depression (since childhood) and fibromyalgia. Occasionally her

liver and pancreatic enzymes are elevated, with no attributable cause. She had

rheumatic fever as a child. She mentioned that she needs to take special care of

her skin after surgeries, as she is prone to contracting severe infections which

heal slowly and poorly. She participated in a sleep study this year, which

revealed that she does not cycle into REM sleep. She also has been diagnosed

with Obsessive-Compulsive Disorder.

She is on many prescription medications: Percoset or Vicodin for pain (her

choice), and she is allergic to both of these, so she takes Benadryl with them.

Flexeril to relax tight muscles. Coridicin for allergies. Ambien for sleep.

Daily prescription laxative. Klonopin and Cymbalta for depression. Recently she

took Bactrin for a urinary tract infection.

In her initial visit, her chief complaint was chronic headaches, dull and achy

in character though occasionally (on this visit) sharp and throbbing. Headaches

originate in the occipital region and migrate forward to the frontal region. Her

headaches appear to stem from chronic muscular tension in her upper back,

shoulders and neck. Several times per year, she has epidurals for these

headaches, and on the first visit she had already had 2 out of a series of 3,

with no benefit. She was in a car accident in 1993 in which there were disc

herniations at C4-C5 and also in the lumbar area. She attributes her headaches

to this accident. Headaches are worse in late afternoon/evening, and when she is

out in hot weather. They are better in winter. Alternating applications of heat

and ice helps. She lists the following areas of pain: neck, shoulders, feet,

sternum from the xyphoid process up towards her throat.

Her demeanor is interesting. She is very clear about details, but appears

dulled, absent of emotional expression, and very far away. She describes her OCD

as being unable to stop processing the words she hears, reads, and thinks - as

if she is typing them over and over in her head, and seeing them as patterns,

and she says this causes a delay in her ability to respond in conversation.

Physically, she is obese, weighing 209 at 5‘ 3“. She describes having low energy

all day, with particular weakness in her arms. Her wrists are unusually,

tremendously thick and her ankles are puffy. Her sensation of temperature is

that she is usually on the cold side, with cold hands, legs and feet. She likes

hot weather and rarely sweats.

Eyes and ears are itchy, with the eyes also being dry. She is allergic to

pollen. Nose is typically stuffy and she sometimes has sinus pain. No dizziness.

Occasional sore throat from Gastro Esophageal Reflux. Profuse post-nasal drip of

clear, watery phlegm.

She claims blood pressure is typically low. Occasionally she has heart

palpitations.

No complaints about her lung (organ) function, other than nasal allergies and

sinus headaches.

Urination is without complaints, 4-6x daily, with a recent UTI treated with

antibiotics.

Complexion is sallow and pale with a pink overtone (very hot weather here

recently), and her facial skin is dry and dull. On palpation of her back, the

skin is very cool and extremely clammy to the point of being wet.

Her voice is soft, and she speaks in a slow monotone. She readily shares

everything I ask of her in great detail and with a sense of concern that feels

like wanting to “get it right“.

Her childhood history is revealing. She suffered severe child abuse, which she

calls “love abuse”, and which she mentioned included enemas as punishment. She

has been working with a therapist for 7 years on these issues. Prior to this

time, she was working as a nurse. Currently, she is too overwhelmed to keep any

job she takes. She is on Medicare and supplements her income with beadwork.

Tongue: pale and slightly dusky with a red tip. It is stiff, deeply scalloped

and surprisingly small for her large body size. Sides of the tongue are bare and

tender. The coat is dry, thick, greasy, and slightly yellow. Sublingual veins

are small and slightly blue.

Pulse: 70 beats/minute.

Right side: deep, regular rhythm, weak strength, tiny size, thready quality. The

pulse is almost imperceptible distally.

Left side: middle depth, regular rhythm, weak strength, small size, thin

quality. In the middle position, it is slightly slippery.

My diagnosis for her vomiting and constipation is food accumulation due to poor

spleen transformation and transportation. I believe there is a strong emotional

component that could explain the etiology of most, if not all of her internal

health woes, which I believe shows itself in stagnation on all levels: blood,

phlegm, food, cold, and dampness. She asked me on her second visit yesterday to

prescribe herbs and modify them as needed by monitoring her progress by phone on

a 6-month RV trip she and her partner planned to take next week! I told her I

could not do this responsibly, and she has since decided to postpone the trip

for a while.

I am looking at her digestion and elimination as the most important aspects of

her health to address first. Due to her difficulty in metabolizing foods and

fiber, I have decided to recommend herbs in liquid extract form for easiest

assimilation. The 2 formulas I have selected to start with are both by Chinese

Modular Solutions: Meal Mover (a modified Bao He Wan with Da Huang and Bing

Lang), for food accumulation, and Strengthen Spleen (a modified Liu Jun Zi Tang)

for, obviously, strengthening her spleen. I do not feel confident that I can

address all of her concerns, but at least I see a starting point.

This client has a long road ahead of her. Any comments would be welcome, on-line

or off.

Thank you,

July 29, 2005

Andrea,

Thank you for sharing the details of this very interesting case study.

She sounds very similar in many ways to a patient I saw for a quarter

while in school (cc: migraines). Similar body type and tongue. That

patient had some clear Liver involvement, though, and in fact though she

described life situations which made her seem insufficiently assertive

(i.e. not sticking up for herself), and though she seemed similarly cold

and flabby, she reacted very strongly to needling, often angrily, in

fact. I wonder what your patient's reactions are to needling - is it

hard to find the qi? A couple other thoughts/questions:

What are her menses like? Menstrual history? Any pregnancy history?

Does she get any exercise at all? Sounds like beading and RVing involve

lots of sitting...could she be convinced to take walks, to help move the

bowels?

Would she, could she, prepare and eat congee? (I am surprised about the

green beans - they are certainly full of fiber, as are carrots; Paul

Pitchford says " string beans can worsen constipation, " and can be used

for diarrhea - in my experience I definitely find them " firming " or

binding.) I wonder what " anything else " means in terms of food; can she

really not eat any, say, cooked greens?

In general sounds like you're taking the approach I would take, though I

also wonder about her Heart...but you're right, sounds like a long road.

Good luck,

Nora

>

July 29, 2005

I would be very concerned with this one. Has there been any mention of

stool frequency at all? If not, has she had any lower GI tests (possibly

for parasites)? Some types of worms can block the ileo-cecal valve

preventing movement thru the bowels. Just another thought.

Mike W. Bowser, L Ac

>Nora <nora

>

>Re: vomiting feces case study

>Fri, 29 Jul 2005 09:52:11 -0700

>

>Andrea,

>

>Thank you for sharing the details of this very interesting case study.

>She sounds very similar in many ways to a patient I saw for a quarter

>while in school (cc: migraines). Similar body type and tongue. That

>patient had some clear Liver involvement, though, and in fact though she

>described life situations which made her seem insufficiently assertive

>(i.e. not sticking up for herself), and though she seemed similarly cold

>and flabby, she reacted very strongly to needling, often angrily, in

>fact. I wonder what your patient's reactions are to needling - is it

>hard to find the qi? A couple other thoughts/questions:

>

>What are her menses like? Menstrual history? Any pregnancy history?

>

>Does she get any exercise at all? Sounds like beading and RVing involve

>lots of sitting...could she be convinced to take walks, to help move the

>bowels?

>

>Would she, could she, prepare and eat congee? (I am surprised about the

>green beans - they are certainly full of fiber, as are carrots; Paul

>Pitchford says " string beans can worsen constipation, " and can be used

>for diarrhea - in my experience I definitely find them " firming " or

>binding.) I wonder what " anything else " means in terms of food; can she

>really not eat any, say, cooked greens?

>

>In general sounds like you're taking the approach I would take, though I

>also wonder about her Heart...but you're right, sounds like a long road.

>

>Good luck,

>Nora

>

> >

>

July 29, 2005

Andrea,

Thanks for a more complete picture of this person's health history. I see

several concepts related to acupuncture that might be important

considerations. These could be found in Kiiko Matsumoto's Clinical

Strategies vol 1. They include diag and treatment points for blood

pressure, pain related to auto (Gb 40 and SJ 9 opposite to pressure pain

near Gb 20). I have found this very helpful for releasing tension related

to post trauma (upper cervical area) as well as migraines. It also allows

for better chiro adjustment if things are out of whack. The issues of

immunity can also be addressed by this work. Check out the book and let me

know if I can be of more help. I highly recommend this book.

Mike W. Bowser, L Ac

> <

>

> vomiting feces case study

>Fri, 29 Jul 2005 00:14:58 -0700 (PDT)

>

>Vomiting Feces - Case Study

>

>It was requested by another CHA member that I post the details of this case

>study. Sorry for the delay, but here it is.

>

>Patient is age 51, female, with a lifelong history of “putrid” vomiting

>with ejection of material that she says looks and smells like feces. Bowel

>movements can occur as infrequently as every 2 weeks with hard, bound

>stool, although occasionally there is thin, sudden, watery diarrhea. She

>takes a daily laxative under her doctor’s recommendation, which “usually”

>will allow her to have a daily bowel movement.

>

>Severe bloating and fullness occur with small intake of food. She also has

>heartburn and frequent nausea and vomiting, sometimes noticeably with

>undigested food.

>

>Her biomedical diagnosis for this condition is gastroparesis, which means

>the peristaltic waves in her stomach are only half as rapid as normal. This

>causes food to stagnate and create bezoars, which are the congealed masses

>she is vomiting. Bezoars can wreak havoc of they pass into the small

>intestine and block the normal passage of digestive by-products. The most

>common cause of gastroparesis is diabetes, which she does not have. Second

>most common cause is gastric surgery, which she also has not had. 40% of

>cases have unknown causes. It is treated medically with avoidance of fiber,

>because it aggravates all symptoms severely. Her intake of actual food is

>quite limited: cooked green beans and carrots, canned pears and peaches,

>cottage cheese, cereals, white bread. Occasionally she can only handle a

>liquid diet, and under her doctor’s recommendation she uses the liquid

>Cambridge diet both as her nutritional basis and to supplement what food

>she can eat. Any foods other than these

> cause rapid and severe aggravation of all her digestive symptoms,

>especially the nausea and vomiting.

>

>Other biomedical diagnoses: She is diagnosed with GERD. She was

>hospitalized twice in 2003 for chronic pancreatitis. In 1997 she had her

>gallbladder removed, but now she produces stones in her liver. A one-sided

>parathyroid tumor was removed in 1990. She also had a hysterectomy in 1987

>for stage 4 cervical cancer and endometriosis. Still more diagnoses include

>a heart murmur and leaky valve, osteoarthritis, depression (since

>childhood) and fibromyalgia. Occasionally her liver and pancreatic enzymes

>are elevated, with no attributable cause. She had rheumatic fever as a

>child. She mentioned that she needs to take special care of her skin after

>surgeries, as she is prone to contracting severe infections which heal

>slowly and poorly. She participated in a sleep study this year, which

>revealed that she does not cycle into REM sleep. She also has been

>diagnosed with Obsessive-Compulsive Disorder.

>

>She is on many prescription medications: Percoset or Vicodin for pain (her

>choice), and she is allergic to both of these, so she takes Benadryl with

>them. Flexeril to relax tight muscles. Coridicin for allergies. Ambien for

>sleep. Daily prescription laxative. Klonopin and Cymbalta for depression.

>Recently she took Bactrin for a urinary tract infection.

>

>In her initial visit, her chief complaint was chronic headaches, dull and

>achy in character though occasionally (on this visit) sharp and throbbing.

>Headaches originate in the occipital region and migrate forward to the

>frontal region. Her headaches appear to stem from chronic muscular tension

>in her upper back, shoulders and neck. Several times per year, she has

>epidurals for these headaches, and on the first visit she had already had 2

>out of a series of 3, with no benefit. She was in a car accident in 1993 in

>which there were disc herniations at C4-C5 and also in the lumbar area. She

>attributes her headaches to this accident. Headaches are worse in late

>afternoon/evening, and when she is out in hot weather. They are better in

>winter. Alternating applications of heat and ice helps. She lists the

>following areas of pain: neck, shoulders, feet, sternum from the xyphoid

>process up towards her throat.

>

>Her demeanor is interesting. She is very clear about details, but appears

>dulled, absent of emotional expression, and very far away. She describes

>her OCD as being unable to stop processing the words she hears, reads, and

>thinks - as if she is typing them over and over in her head, and seeing

>them as patterns, and she says this causes a delay in her ability to

>respond in conversation.

>

>Physically, she is obese, weighing 209 at 5‘ 3“. She describes having low

>energy all day, with particular weakness in her arms. Her wrists are

>unusually, tremendously thick and her ankles are puffy. Her sensation of

>temperature is that she is usually on the cold side, with cold hands, legs

>and feet. She likes hot weather and rarely sweats.

>

>Eyes and ears are itchy, with the eyes also being dry. She is allergic to

>pollen. Nose is typically stuffy and she sometimes has sinus pain. No

>dizziness. Occasional sore throat from Gastro Esophageal Reflux. Profuse

>post-nasal drip of clear, watery phlegm.

>

>She claims blood pressure is typically low. Occasionally she has heart

>palpitations.

>

>No complaints about her lung (organ) function, other than nasal allergies

>and sinus headaches.

>

>Urination is without complaints, 4-6x daily, with a recent UTI treated with

>antibiotics.

>

>Complexion is sallow and pale with a pink overtone (very hot weather here

>recently), and her facial skin is dry and dull. On palpation of her back,

>the skin is very cool and extremely clammy to the point of being wet.

>

>Her voice is soft, and she speaks in a slow monotone. She readily shares

>everything I ask of her in great detail and with a sense of concern that

>feels like wanting to “get it right“.

>

>Her childhood history is revealing. She suffered severe child abuse, which

>she calls “love abuse”, and which she mentioned included enemas as

>punishment. She has been working with a therapist for 7 years on these

>issues. Prior to this time, she was working as a nurse. Currently, she is

>too overwhelmed to keep any job she takes. She is on Medicare and

>supplements her income with beadwork.

>

>Tongue: pale and slightly dusky with a red tip. It is stiff, deeply

>scalloped and surprisingly small for her large body size. Sides of the

>tongue are bare and tender. The coat is dry, thick, greasy, and slightly

>yellow. Sublingual veins are small and slightly blue.

>

>Pulse: 70 beats/minute.

>

>Right side: deep, regular rhythm, weak strength, tiny size, thready

>quality. The pulse is almost imperceptible distally.

>

>Left side: middle depth, regular rhythm, weak strength, small size, thin

>quality. In the middle position, it is slightly slippery.

>

>My diagnosis for her vomiting and constipation is food accumulation due to

>poor spleen transformation and transportation. I believe there is a strong

>emotional component that could explain the etiology of most, if not all of

>her internal health woes, which I believe shows itself in stagnation on all

>levels: blood, phlegm, food, cold, and dampness. She asked me on her second

>visit yesterday to prescribe herbs and modify them as needed by monitoring

>her progress by phone on a 6-month RV trip she and her partner planned to

>take next week! I told her I could not do this responsibly, and she has

>since decided to postpone the trip for a while.

>

>I am looking at her digestion and elimination as the most important aspects

>of her health to address first. Due to her difficulty in metabolizing foods

>and fiber, I have decided to recommend herbs in liquid extract form for

>easiest assimilation. The 2 formulas I have selected to start with are both

>by Chinese Modular Solutions: Meal Mover (a modified Bao He Wan with Da

>Huang and Bing Lang), for food accumulation, and Strengthen Spleen (a

>modified Liu Jun Zi Tang) for, obviously, strengthening her spleen. I do

>not feel confident that I can address all of her concerns, but at least I

>see a starting point.

>

>This client has a long road ahead of her. Any comments would be welcome,

>on-line or off.

>

>Thank you,

>

July 29, 2005

Thank you, Mike. I appreciate your suggestion. I will look into this book.

Andrea Beth

mike Bowser <naturaldoc1 wrote: