Qiological Community

Calling on the Brain Trust_Ramsey Hunt in 30F

This is a new patient, I saw her yesterday. She is coming in for the next five days, so I have time to work on her.

Personal Note: I have to constantly remind myself not to "Eat all of my meals on Monday morning.

Female: 30, Symetrical and Athletic

About a week ago she started feeling tingling on the L side of face. Went to MD and was told that she had Ramsey Hunt. They couldn’t see anything that was definitive on ear drum, either wax or a nodule. She also has two small bumps on the outer ear that are painful, but the MD thought they could be a pimple. She was given Valtrex and started taking it right away. She developed severe stomach pain, thought it was because of meds on an empty stomach so she ate dinner. During dinner she started to feel her mouth moving funny. She could feel the lower jaw move but the upper jaw was not moving. The side of her face was locked and drooping and her eye wouldn’t close. This happened on Thanksgiving, she continued to get worse up until today. Tuesday Dec 1

Work: Traveling nurse, moved to COVID unit about two weeks ago. This was against her contract and infuriated her. She is treated poorly by management at work, staff are great, her boss is “awful.”. Made her very angry. When she was younger she used to have a hot temper, but now talks out her anger. Doesn’t feel like she buries it, just needs to work it out and process through it.

The night before this all started she drank a bottle of wine, she is not a big drinker, but had a too much.

She went through a bad breakup about a month before this.

She also set the oven on fire the night before this and had to put it out with an extinguisher, was very stressed about this.

Body Temp:
Temp fluctuates, has for as long as she can remember.
Hands and feet get cold.
She can go from hot to very cold quickly.

Gyn:
Periods were always heavy flow before she got on birth control. Now they are more regular, but sometimes fluctuate between light and heavy, sometimes clots.

Psychoemotional: The patient frequently feels worrisome and anxious.
Does not feel stress, she works in a high stress job, but doesn’t feel the stress of her work. She has always “just dealt with it”.

Gi:
Has ST pains that are sharp and come on quickly, only recently. Just before the face started these came on.

Urine: Amount is normal.

Stool: Presentation: normal bowels.

Sleep: behavior: can not enter sleep and not rested after sleep.

Skin: Normal
Eyes: Dull (4)

TGITR: (10) Face, came in with tape over eye to keep it closed, Entire ST ch of face on L. does not move.

Pulse, middle pos both sides was superficial, rapid and hard.

Other notes: When she mentioned the breakup she started to tear up, she also started to tear up when she discussed the face. When she first called she was told she needed “alot of acupuncture.” So she had called every acupuncturist in town and was shceduled with 6 different acupuncturists over 6 different days and sometimes twice a day. I cleared some space and got her in for 5 straight days and had her cancel the other appoitnments so she could ahve some consistency.

Chs I am considering: GB/PC; BL/Ht; ST/LU

First Sesssion: I started with a GB drain, Full moon was the night before and she kept bringing up how angry she was with the work situation before this started. I typically would not start with a drain, but this seemed gross and she is very robust.

Her pulses immediately calmed down and were even across all positions, she also started to look brighter in the face. Eyes stil dull.

After 15min, I added a SJ+, she immediately said she felt a shift in her face. She got very emotional and said she felt like her face was mvoing better. She said she felt hope for the first time since this started.

However, after the session when she looked at her face in the mirror she said she didn’t see a change in the eye of or the movment in the face.

I see her again today: I am going to se ehow she presents, but today I was thinking of PC or ST/LU.

Any thoughts or suggestions would be helpful.

Thanks
Darren

Clinic is hard! And you just made it that much harder with your over-the-top treatment choices. You aren’t going to know what did what when she returns tomorrow.

This patient came to you in a sea of chaos and you just added to the maelstrom with the flagrant misuse of your tools. I am absolutely shocked that you drained GB on the first visit and further appalled that you added another channel treatment on top of that. This shows disrespect for the teachings and utter lack of concern for your patient. You learned in the advanced class how to responsibly use draining. Please review your notes to prevent further injury to your patients.

You will need to carefully reevaluate her when you see her tomorrow and bring on as much P and SJ energy you can muster in yourself. To help with that I recommend going through her case very carefully tonight, analyzing all of symptoms/findings according to the 12 channels. Definitely include all the physical findings used in Saam, thenar eminence, medial heel, midline of Ren15-8, ruq/luq, quality of flesh, etc. The thread below shows you how. Case Study Format

Ground yourself thoroughly before seeing her. Make sure you give her as much time as you need to reevaluate and come to a fresh diagnosis. Watch her response on the table like a hawk and act accordingly. You owe her your best possible self.

1 Like

Thanks Kristen for your response, it was the first time I have had a public tongue lashing in almost 20 years. The last time was when I messed up a coffee order on a film set. Both were equally unpleasant and unprofessional.

To clarify. My decisions were not made as reckless or acting out of disrespect for the patient or the medicine. I spent an hour on my intake with this patient before i placed any needles in her. My treatment was based on what presented clinically in front of me and my concern for my patient and her well being were what lead me to use drianing.

No, it is not recommended to use a drianing and I fully undersand that the basic principles of Sa’am are to supplement.

However, when reviewing my notes before I treated her, OUR teacher Toby, said draining is to be used when there are three R’s: Recalcitrance of the disease, Robutness of the constitution and (REALLY) acute disease. All three of those were present in this situation and we were a day after the Full Moon, when blood and qi are replete. All of these went into my decision. I drained responsibly.

All of the other areas of Saam diagnosis were normal and that is why they were not mentioned.

Clinical Update:
Patient slept last ngiht for the first time since this happened and felt rested and relieved after her session. Her eye did not close yet, but it is the best she has felt in a week. Her stomach pain has reduced, but still comes on in waves.

Session 2:
Lu+ was used.

I am relieved to hear that your patient is feeling better after your high risk treatment. You may not be so lucky in the future. If the treatment didn’t go so well, you likely would have needed not 1, but multiple additional treatments to undo the damage.

Adverse reactions to Saam treatment can be severe. One patient ended up in the ER. Another had panic attacks for weeks. Our first responsibility to our patients is that we do not harm them. Toby has said that he is unsure if inappropriate draining can be fully counterbalanced because draining is truly pulling the plug on that particular quality. For this reason draining is to be used with extreme caution.

You had never treated her before this visit so how can you say that her condition was recalcitrant to treatment? Recalcitrance means that you have repeatedly supplemented with some benefit but the gap between the channel pairs is too big. Recalcitrance doesn’t mean recalcitrant to Valtrex. The safe and responsible treatment would have been to start with P+.

I can’t speak to her robustness.

For the really severe disease indication for draining, her condition wasn’t imperiling her in such a way that safety needed to be sacrificed. Unilateral supplementing treatments can make radical changes much more safely.

The harsher tones of my post came from my responsibility to emphasize in no uncertain terms that your use of draining and a 2 channel treatment was unsafe. Even if you disagree, I have to point this out for the benefit of other students and their patients.

1 Like

Kristin,

I didn’t post to get into a argument with you. I was looking for help.

I was hoping that some of the amazing minds that I sat with (virtually) in a room over the Advanced weekend would be able to offer some thoughts on this case.

When I reach out to my SMAC and EAM colleagues we have an open discourse and collaborate with respect for one another. We don’t attack or lecture eachother. How do we learn if we don’t make mistakes and have the ability to discuss them in a respectful way?

In the past two years I have only done around 3,000 SAAM treatments, well under the 10,000 some would say I need to fully understand the medicine. I do not claim to be an expert. One of my mentors once said, “On your death bed what you are meant to know of Chinese Medicine is what you will know of Chinese Medicine.” I don’ t expect to know everything and I know there will always be more for me to discover.

I was looking for help.

How do we look at an acute herpes outbreak in SAAM?

Has anyone had success treating shingles, especialy in the face with SAAM?

How do we calm the body when a virus is openly attacking the CNs VII and VIII?

As I said I was looking for help.

Hi Darren,

I would like to apologize to you and the forum. I whole heartedly accept your criticism of unprofessionalism with regard to my tone. In the future I will work on finding ways to communicate without harshness. For sure the world needs less of that.
I still stand by the content of my previous posts. My harshness came out of frustration that certain teachings are not being followed. My first concern is the safe practice of Saam.

Of course the answer is going to be a diagnosis based on excellent Saam based observation and case analysis. We ask that cases to be presented in a way that we can most easily see your patient. We need to be sure that you are looking at and sharing as much information as possible. We can’t assume that the Saam physical findings are normal unless you tell us so. You say she has ST pains but I don’t know where those are- epigastric area, luq?. You haven’t mentioned where her face pain and/or tingling is. I need more information.

I have successfully treated a number of cases of shingles including on the face and head. Treatment has been individualized and always supplementing. No draining needed for results.

I hope your patient continues to improve.

1 Like

Hi @Maynardacu
Sorry I did not reply sooner. I managed to lock myself out of the forum during the migration process. Just not worked my way back in. Weird when you have to hack your own website.

Often I feel like I’m hacking my patient’s health as well. Things are murky and often what looks like an open path is a dead end.

Thanks for sharing this patient with us. I have a few thoughts.

First, as I’ve highlighted above, when a patient comes in with this level of anxiety (and frankly I’d say this is a very aggressive stance) I’m super cautious. In my experience people like this are looking for a hero to save them, and if a practitioner can do that they will love them, but if not they will burn them down. Six acu’s multiple treatments a day?? You got balls brother, I’d avoid that kind of patient myself. Not because I don’t think I could help, but because if they are going to get multiple treatments in a short time then it will make very hard for me to help as they are having their body pulled eight ways to Sunday. And that makes it really hard to help them. Sometimes people really do get in their own way.

For me this is diagnostic and I think you really nailed with Shaoyang excess.

For patients like this I set the expectation that “more is not gooder” and tell them I’m going to do something that might disappointment them because it’s so simple, four needles one side. The reason I tell them is I want to be sure we are moving in the right direction with the right treatment. Too many needles or treatments will muddy the water. Really, I’m looking to as Samuel L Jackson would say… Calm them the f*ck down.

The patient of yours clearly has fire going upwards and outwards. From the outset of your description I was thinking Shingles or Bell’s palsy. And we can use our basic Saam parameters to work with this, of course.

Also. while she has tremendous excess in her presentation there is underlying deficiency. A broken heart with sadness, a feeling of being out of control of her life and job situation. The beauty of tonifying first is that it is like holding a frightened child. they will settle if held and given a sense of safety and comfort.

I understand the desire to help, but draining on the first treatment is ill advised as you don’t really know her yet. And clearly you are an experience and skilled practitioner, as you nailed the diagnosis and so there was not an ill affect.

Still, I’d highly (and this is from my own experienced painfully gained) recommend when draining only drain. and just one side and do not do anything else. It really muddies the water to do more. You’re already asking a lot of the organism with the draining. It is enough. Again, I’ve learned this hard way.

I get it that this patient has a lot of anxiety, but our patient’s anxiety does not mean we need to do more. Again my own awful experience is when I try to do more for people like this it can make them worse. First settle the waters. Then see what is there.

Again, thanks for sharing this challenging and interesting case and please keep us posted.

Onward.