Hi all! Sa’am newbie here. Any insights on this case wuld be much appreciated!
27 year old transgender individual (transitioning from male to female; pronouns they/them)
Chief complaint: anxiety and depression
- Largely related to ongoing pushback from family about sexual orientation
- History of trauma: childhood attachment trauma, sexual assault, various physical traumas (bike and soccer accidents)
- Meds: Vyvanse (stimulant for ADHD), Estradiol (estrogen) x 1 year
Secondary complaint: pain along psoas, hip, IT band (left side painful, right side tight) 5/10
Tertiary complaint: tightness and pain in hands, forearms, elbows 4/10 (right hand more painful and slightly larger than left, palms look unusually red). Aggravated by use, particularly motion/vibration of chipping ice.
Appearance and demeanor: facial symmetry/beauty +8; bright eyes +6; polite +5; sloppy hair/clothes +7; shy and soft voice +7 (noticeably nervous when talking with me)
Lifestyle: Personal care worker in group home (reports high stress). Strongly values environmental sustainability - does permaculture landscaping during summer, and practices a “freegan” lifestyle (dumpster dives for food, for “moral reasons”). Sets many food rules for self, but then craves and binges on high fat/sugar foods. Was living with 5 roommates but recently moved out with partner. Smokes a lot of weed to manage anxiety and pain (goes to addictions counselling).
Body Morphology/Flesh: strong build, good muscle tone
Skin: normal moistness but very sweaty hands/feet during needling
Body Temp: warm body +5; cool extremities +2
GI: tightness in left hypochondriac region +6, alternating constipation/diarrhea, suspected hiatal hernia (bike accident a couple year ago – handlebars dug into stomach/ribcage area)
Sleep: poor, difficulty falling asleep +8. Irregular sleep schedule due to 2 night shifts a week. Usual bed time is 1-8am.
Emotions: Anxiety started in teenage years – had to “walk on eggshells” around family of “narcissists and sociopaths”. Manifests as sense of urgency, rapid thoughts, forgets to breathe, tightness in hip and gut, wanting things to be good/right. Tends to keep everything to self. Depression manifests as a sense of being frozen, wanting to withdraw and stay in bed all day (but taking Vyvanse helps get them out of bed).
Urination: forgot to ask
Pulse: wiry left, soggy right
Tongue: pinkish red body, multiple deep cracks in centre, thin yellow coat
BL: history of sexual assault may have diminished love for others? sense of feeling “frozen” when depressed?
GB: insomnia +8, pain along GB channel +6
PC: lack of self-assertiveness/weak boundaries +5, pain along GB channel +6
SJ: bright eyes+6, polite +5, social anxiety +6, anger directed at self +7, tight left hypochondrium +5, left-sided pain +5
ST: lacks resources (multiple payment cards declined, no car) +8, acid reflux in childhood (gone now) +1, suspected hiatal hernia +2
SI: diminished self-love +7
KI: lots of pain +8, good symmetry/beauty +8
Grossest things in the room: lack of calm rootedness, lots of pain
Treatments: Only one so far. +PC on right side to address anxiety, insomnia and left-sided pain along GB channel
- Response: patient was sensitive to needles and became very anxious during needling (hands and feet dripping with sweat, faster breathing, increased heartrate). Aside from the increased anxiety, I didn’t observe other adverse effects so I left the needles in. They took a long time to settle, and just started to get comfortable about 20-25 minutes into needle retention so I retained for 40 minutes (too long?). After needles were removed, patient reported feeling more relaxed, had a rosier complexion and appeared more at ease when interacting with me. However, pain was unchanged at the time. I checked in with them a few days after the treatment and they said they were “less tense/in pain, able to fall asleep 05.-1h earlier than before, and had good sleep 3/5 past nights”.
Other treatment ideas:
- +LR on right to provide shielding and address left-sided pain
- +SI on left to address pain in general
- +KI on left to cultivate self-love
- Any thoughts on whether to prioritize +LR or +SI (or something else) for the next treatment? The patient seems fairly SJ excess but perhaps I need to start by reducing pain and stagnation?
- I am wondering which side to needle when working with transgender patients. I think Toby mentioned in the on-demand course to examine where they are along the spectrum of masculine to feminine? At the moment I perceive my patient to be more on the masculine side so I am thinking to needle the left side in general.
- Any thoughts on compelling findings for opposite channels, such as diminished self-love (SI excess) but also lots of pain (KI excess), or insomnia (GB excess) prsenting with lack of assertion/boundaries (PC excess)? Potential for a “toggle” situation?
- I am debating whether to use thinner needles on this patient next time. They are quite needle-sensitive so I want to avoid triggering more anxiety, but I’m hearing that thicker gauge needles tend to get better results. Currently I am using 0.30-0.35 mm.
Thank you so much for reading through this case! I have found it a useful exercise to lay out and categorize all the information gathered.