RE: lymphedema case--update

[Guest guest]

Thanks to everyone who expressed concern, provided advice or insights,

and in general helped to maximize this learning experience for me.

 

On Monday I had another lymphatic drainage treatment. I did not feel

better afterward; in fact, I felt intense pain and was very discouraged.

However, by later that evening I felt a significant decrease in pain,

and by this morning I felt a great improvement and felt that somehow the

worst was behind me. Oh, also on Monday I modified my formula to add

some Mu Dan Pi, Chi Shao, and Ye Jiao Teng among others. But I only got

one dose in Monday after the modification, so I feel like the

improvement was more related to the massage.

 

Even though I felt better, I decided to see an MD anyway this morning.

Several people contacted me off-list and implored me to seek Western

medical care. The family members whom I told of my condition (who do

not believe in Oriental medicine) thought I was crazy. So, I decided to

go not because people said I should or out of fear (which I will not

deny could have been a motivator the evening before when I was in so

much pain), but out of a desire to make the learning experience as

complete as possible. Part of me also wanted to have the result of the

visit somehow vindicate me, my decisions, and Oriental medicine (this

would be the part of me that is the furthest away from enlightenment).

 

So, the doctor said it wasn't a bite at all, but MRSA

(Methicillin-Resistant Staph Aureus) that had caused my problem--he sees

at least 5 infections a day. But, he said that I was " over the hump "

because my wound is almost totally healed (scab fell off today), so

whatever I was doing to treat it was right (after my appointment, I did

some research online and found that garlic has been shown to kill

MRSA--recall that the wound ceased to be red, raised and active after I

put those thin slices of garlic on it. [Antibacterial activity of a new,

stable, aqueous extract of allicin against methicillin-resistant

Staphylococcus aureus. Author(s): Cutler

<javascript:__doLinkPostBack('detail','ss%257E%257EAU%2520%252522Cutler%

2520RR%252522%257C%257Csl%257E%257Erl','');> RR; Wilson

<javascript:__doLinkPostBack('detail','ss%257E%257EAU%2520%252522Wilson%

2520P%252522%257C%257Csl%257E%257Erl','');> P; British Journal Of

Biomedical Science 2004; Vol. 61 (2), pp. 71-4]. The doctor felt that

the lymph problem was a back-up in the system. He estimated that it

would take 2 weeks to get rid of the lymphedema. He said I would get

better more quickly with an antibiotic, but that I would still get

better without it (I did not take it). He said, " Whatever you're doing,

keep doing it. " He said that if the infection had gotten into my blood

(where it would show up on a blood test), I would " have a high fever and

be really sick, " but that it seemed whatever I had done had taken care

of it.

 

I saw another herbalist today whom I greatly respect (he's one of my

former teachers). He always has a very Daoist approach in his formulas,

and I often think there is no way they will work, but then they do (and

very gently, yet completely). He prescribed the following formula

(powder dosages, taking 5 grams, 2x/day):

 

Ze Xie 5

Fu ling 9

Ren Dong Teng 6

Che Qian Zi 5

Huai Niu Xi 5

Zhi Zi 3

Gui Zhi 1

Xiang Fu 5

Huang Lian 2

Huang Qi 6

Mu Dan Pi 5

Mu Tong 2

Zi Su Ye 3

Fang Feng 5.

 

Finally, I also used my arm a lot today (almost as fully as normally)

and did not experience the flare-ups of the past few days in which the

skin over my cubital lymph node got red and hot, with lots of pain

(though by the end of the day I was feeling a slight increase in pain

and knew it was time to stop). Though my arm still looks quite swollen,

I feel the swelling has gone down some because I can fully bend and

straighten my arm without pain or a feeling of pressure. I will have

another lymphatic drainage massage tomorrow. Overall, I believe I am on

the way to a complete recovery.

 

Thanks again,

Julie

 

 

 

 

 

 

On Behalf Of j_c_sp23

Sunday, August 24, 2008 3:40 PM

 

lymphedema case

 

 

 

I find I am having a difficult time thinking clearly about this case,

partly because I am a very new practitioner (I graduated 6 weeks ago,

and got licensed 2 weeks ago) and never saw anything like this in my

clinicals (nor in my 10 years of being an Occupational Therapist/ Hand

Therapist), but mostly because the patient is me, and it's tough to be

objective when experiencing the physical and emotional aspects of

disease. So, I am turning to you all, both so that I may learn and

become a better practitioner and so that I can get clearer on the best

way to treat myself herbally and return to health.

 

I apologize in advance for how long this is, but I figure the more you

know, the more you can help.

 

Here's the background: I think I got bit by a bug (during sleep?) on

the posterior part of my forearm, about an inch-and-a-half distal to

the olecranon, just over 3 weeks ago. I first noticed it on August 1,

2008. I was on vacation at the time. I thought it was a pimple (it

wad a whitehead), so just figured my body would take care of it and

didn't think any more about it for almost 2 weeks (it was out of my

consciousness because I couldn't see it without effort, and it didn't

hurt when bathing/running a wash cloth over it). Then I noticed that

the area hurt if I set my arm on a table, and I realized it was red

and raised (about 1.25 inches in diameter). I started taking Lian

Qiao Pai Tu Pian, which cut it down by over a half within the first

day. That was August 13. I took the herbs for another day, but then

life happened and I didn't take them again (I'm a better practitioner

than patient).

 

So, on August 17, I noticed that the inside of my elbow was tender to

touch, and I realized my cubital lymph node was slightly swollen. I

started taking the herbs again, which helped the area where the bite

(?) was (as it was still raised and red), but not the lymph node. I

felt I needed something that went deeper, so asked one of my former

clinical supervisors for help (on August 19). He told me that I

should just keep taking the same herbal formula, but also put very

thin slices of garlic on the bite area, changing it as the garlic

dried, for the rest of the day and also to sleep with it. My gut said

the Lian Qiao Pai Tu Pian was no longer appropriate, but I figured he

had so much more experience than I did that he must be correct. So, I

did as he said. I knew the garlic would make the area under it

blister, and it did, but it also completely got rid of the redness and

swelling. That area is now healing well. However, my lymph node got

worse (more swollen and more tender), and it progressed to the next

proximal lymph node. My arm was painful (deep ache) from the level of

Lu-3 to about the level of Li-10 with occasional numbness in my hand.

 

So, on August 20, I consulted with another practitioner and shifted

the focus of my herbs (mostly clear heat, relieve toxicity; some clear

heat, cool blood and clear heat, dry damp, with some move qi and

blood, plus herbs to balance all that cold stuff). I also started

taking ibuprofen (which I hate doing, but the pain was making it

impossible to sleep), and that--combined with the herbs--seemed to

help the ache and the progression. It seemed to " pull back " to that

cubital lymph node (the one proximal to it was still swollen, but not

so tender). Then, 3 weeks after I initially noticed the " pimple "

(i.e., August 22) I woke up with lymphedema around my inner elbow (the

first time I had noticed it), despite the fact that the pain has

pulled back to that cubital lymph node. So, I had an acupuncture

treatment, and then saw my chiropractor who put on some kinesiotape,

which I took off after about 5 hours because it made the lymphedema

increase and pool about a third of the way down my medial-posterior

forearm. My cubital lymph node also seemed really angry--the skin

around it got hot and red for the first time and the node swelled even

more, becoming very hard. I should mention that at no time during all

of this have I had any red streaks up my arm, any fever, or any

pitting edema. In addition, I continued to take the herbs.

 

After sleeping with my arm elevated, the " pool " of edema went away,

but the general lymphedema remained. My arm continued to be be warm

in the area of the cubital lymph node at rest, but if I used my arm at

all, it would quickly get hot and red, and it ached greatly (I'm sure

because everything was being strangled by the swelling). I avoided

using my arm because of the pain.

 

Yesterday (August 23), I had a lymphatic drainage massage which helped

a lot (80% reduction in pain within an hour). Her impression was that

the lymph system was just backed up and the lymph was gelling so it

couldn't flow, but it was more fluid after the treatment, and she

expected it to continue to improve. I felt so good that I spent 2

hours re-filling raw herb jars and ordering raw, powder, and patent

herbs. Within that time, my arm returned to the swollen, painful

state it was in prior to my treatment, with the skin over the node

being red and hot. I also developed a low-grade fever. The redness

and heat mostly went away after I did some lymphatic self-massage, and

the area got less taut and painful, though the node was still very

swollen and hard and there was still pain. The fever went away with a

dose of ibuprofen. I will see the massage therapist again tomorrow.

 

Today I am unable to use my right arm for anything without flaring it

up (tough, as I am right-handed). I have typed all of this with only

my left hand except for one paragraph (and after that I had to stop to

do the self-massage to calm it down).

 

Through all of this, my tongue has been unchanged (swollen,

teethmarks, light red, thin white coat, red prickles at the tip; my

tongue has looked like this for over a year). My pulse on the right

is thin, deep in the 1st and 3rd, and wiry. It feels constrained (not

surprising). On the left it is thin and wiry.

 

I have not seen a medical doctor, as I know all he will do is put me

on a broad-spectrum antibiotic (which I feel I am taking the herbal

equivalent of, plus anti-viral).

 

Here are my questions:

 

1.) How does view the lymph system? This was never

discussed in my schooling, and I cannot find anything about it in my

books (even Fluid Physiology and Pathology in TCM). Is lymph fluid

considered jin, ye, or something else?

 

2.) Does anyone have any experience treating lymphedema of the upper

extremity? If so, can you please share insights?

 

3.) Herbally, what is best to treat this? The classic formulas for

edema which I have looked at seem not to apply.

 

As I said, I am not able to think clearly about this case because of

how involved I am physically and emotionally. I greatly appreciate

any help anyone can give.

 

Thank you for taking the time to read all of this.

 

Julie Espy