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Interesting Case with success but need more clarity

Hi,
This is the first time I am actually writing in. I have been more of an observer as I feel like such a kindergartner.

This patient is a 45 year old male with a rarer form of dwarfism. He had surgery on his legs to straighten them at age 5 and rods put in his back around age 9. He was skeptical at first to try acupuncture for his chronic hip pain but felt he had nothing to lose since it is “inevitable” he will need hip surgery due to his stature issues. I first tried +SI due to surgeries and pain with mild success. Then I tried + LV due to his intense observational skills. Also, mild success. The 3rd visit I did +UB because of location and that although he doesn’t say he feels warm he moves and talks fast. He got up from the table feeling remarkable. I saw him 2 weeks later and he asked for +UB again which I did with again great results. Now I see him regularly and feel I can do 2 +UB but change it up in between. My questions are: What do you think of this? How often should I do +UB? I have not done +UB bilaterally yet. Thank you for your input!

Hi @ldkrecu,

Thanks for your case. It is impossible to give you much feedback without a full case study. Here is the preferred format for case studies here: Case Study Format

Yes, in most every case you don’t want to repeat a channel more than twice in a row. It is also riskier repeating a treatment when someone’s channel excess doesn’t present strongly. You say he doesn’t feel warm. Does he have a full red face, fast pulse, a loving temperament besides pain location and fast talking/moving?

Big relief also means his system has undergone a big change. Reevaluation at every session is key.

Writing up the case and matching all aspects of the presentation to channel excess will help you (and us) see your patient better.

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Thank you Kristin. Here is the workup:

45 yr Man with dwarfism
CC: chronic hip pain probably due to body stature ergonomics. He had surgery on his legs to straighten them at age 5 and rods put in his back around age 9. Pain level varies from 0 to 8.

Appearance and demeanor : symmetrical; appropriately dressed, initially standoffish but has warmed up and very congenial, funny, dry sense of humor, polite +5, fast talker+6 bright eyes 5; slight ruddy/red face +4;

Lifestyle: works in tech; has resources, Very busy at work. Only took 2 days off work last year but normally goes on nice vacations. Because of lockdown felt no reason to take days off. Has 2 children, happily married. Usually is on phone during treatment but not always. (Treatments are at a medical clinic at his workplace)

Body morphology and flesh quality: has a rare form of dwarfism, fleshy hands and feet, not overweight but as a small person it may look like he has a larger belly due to proportion. Flesh firm, no veins or discoloration in legs, amazingly nimble.

Skin Quality: normal skin moisture +5

Body Temp: reports feeling normal body temperature, feels slightly warm

GI: no problems reported

Respiratory: rhinitis controlled by claritin; occasional sinus infections

Sleep: reports normal sleep

Emotions: slightly cynical yet funny. cares about family but frustrated with extended family due to different beliefs. +7

Urination: normal

Other Body: no varicosities; scars from surgeries on back and legs

Excess Presentations:

Heart: slightly rapid pulse, ab soft/warm +6, moves quickly

UB: some political fear frustration +5

GB: when you get him on a passionate subject his sarcastic humor comes out and can feel slightly aggressive +5

P: likes research and to stay on top of things +5

SJ: observant +7

Liver: initially hard to make eye contact +3

Lung: has resources, normal moisture in and out, fleshy thenar but could be due to stature

Stomach: none

LI: project oriented +6; physically strong +6

Spleen: none

SI: none

K: symmetrical, fleshy heels but could be due to stature +6

The Grossest Thing(s) in the Room: sense of humor, dwarfism, nimbleness

Main treatment ideas: +SI, +LV, +UB

Treatments 1 +SI on left
mild improvement with hip pain

Treatment 2 +LV due to observation skills
mild improvement with hip pain

Treatment 3 and 4 +UB location and that he moves and talks quickly, soft ab
reported feeling great (requested +UB for Tx 4)

I am learning - with HUMILITY, the importance of this a LOT lately! :joy:

That whole ‘do that treatment again, it was so good’ thing is just so often the wrong place to go (not necessarily - even sometimes just the right thing to do - just so often not). I have even learned that clearly in myself. I remember once many months ago, doing a PC+ treatment on myself and it was SO INTENSELY remarkable, it was almost a spiritual experience - and of course, I have tried PC+ treatments on myself since then, so desiring of that same or a similar experience (who wouldn’t?!?) - and it has never ever happened since.

Its a difficult lesson to learn (in my experience . . . even now, I STILL falter in this regard regularly) - to somehow BOTH hold the history of your treatments of a patient AND at the same time, view them freshly and reevaluate them freshly on every visit - I have come to consider this - after getting to a certain level with the Sa’Am basics - to be truly the most transformative and developmental step for us as pracitioners - it challenges our clinical egos to the core!

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Thanks for the write up. It sounds like you have gotten to know him and have a good deal of information. Now the trick is to take what you know and try to understand it in Saam terms. As well, it is helpful to separate the patient’s story and your preconceived notions from what actually happened and how things are.

My recommendation is to give his thenars, heels, and belly clinical weight even if you think his dwarfism is the reason why they are so. With his belly, even a little extra flesh or overly ful presentation can point to internal dampness even if not extreme. I am interested in his Lung/St balance given the good resources and thenars, maybe fuller belly, tendency to rhinitis/sinus even though you say his skin has normal moisture. Knowing it takes time to develop observation skills, I encourage new Saam practitioners to keep looking at their patients and asking “is that skin really normal? is it drier/more moist than my previous patient?”

We need to know more about his hip pain. Is it bilateral? Where exactly does he experience it? Any other channels besides UB? When did it start and what was going on when it started? Anything make it better or worse? Palpating the hip/hips? do you notice anything about the quality of the area?

Is this dense?

Does this seem like like SJ excess lightness on one’s feet to you?

What do you think the impulse behind the sense of humor is? Does he like to be on stage (K excess?)? Is he trying to smooth things over and make a nice experience for you (SJ excess?) Does he love to connect (H excess)?

Is this an all over redness or a patchy redness? Full red belongs to H excess, blotchy red belongs to SJ excess.

Is this rudeness or does he have a legit reason for needing to take his attention away or is he attempting to please someone else? So many possibilities.

Take another look and let us know.

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Thank you Kristin for this feedback! Very helpful.

We need to know more about his hip pain. Is it bilateral? Where exactly does he experience it? Any other channels besides UB? When did it start and what was going on when it started? Anything make it better or worse? Palpating the hip/hips? do you notice anything about the quality of the area?

The pain is bilateral. He feels it deep, mostly along UB and GB channels. He has had this pain for years. Nothing of note has helped in the past but sitting aggravates it so he moves around a lot. While palpating the lower back and glutes can be tight but easily relax with massage. The rods in his back go to about UB 23 and below that he is very flexible, able to arch and bend easily.

His flesh is firm but not dense.

Maybe SJ excess light? When he walks he sways from side to side but not heavy footed.

What do you think the impulse behind the sense of humor is? Does he like to be on stage (K excess?)? Is he trying to smooth things over and make a nice experience for you (SJ excess?) Does he love to connect (H excess)?

I think the sense of humor has been a defense mechanism maybe due to the fact that he looks different than others? He is not trying to smooth things over, he is pretty real with his assessment. I think he is indifferent to connecting so not H excess.

Is this an all over redness or a patchy redness? Full red belongs to H excess, blotchy red belongs to SJ excess.

He is more blotchy red so SJ excess.

Is this rudeness or does he have a legit reason for needing to take his attention away or is he attempting to please someone else? So many possibilities.

I don’t think it is rudeness I think it is because he is so focused on work that he doesn’t want to miss something in combination with not knowing what to do with himself or give himself permission to do “nothing”.

Great. It would be helpful to go through the list of channel excesses again and add the signs and symptoms discussed above… When you start to see signs/symptoms pile up behind a particular channel and its counterbalancer has few to none, then you know you have clear direction.

Given that his pain is also on the GB channel, you definitely should look more closely at his P/GB balance. Refer to the intro powerpoint notes to refresh your memory. It is helpful to look beyond how much someone likes research and get a sense of rooted and deliberate vs impulsive to act and erratic, concave/convex, etc.

Even though he seems to have more SJ excess signs, the phone thing suggests an inner orientation more in line with Liver excess. Unless you think it is an extreme awkwardness that he is hiding behind.

Let us know what you do and how it works out.

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