Case Study: Adelaide MCase Study: Adelaide M--W.W.

Karen ElardeKaren Elarde--McCuaigMcCuaigLejla FazlicicLejla Fazlicic

Natasha NusinovaNatasha NusinovaNatasha NusinovaNatasha NusinovaGloria Van DellenGloria Van Dellen

Patient InformationPatient InformationPatient InformationPatient InformationAdelaide is a retired dancer who lost her husband Adelaide is a retired dancer who lost her husband

and home approximately 9 months ago. She and home approximately 9 months ago. She currently lives with her son, daughtercurrently lives with her son, daughter--inin--law and law and grandson.grandson.grandson. grandson.

Ethnicity: Caucasian Ethnicity: Caucasian Age: 89Age: 89Blood pressure: 130/80Blood pressure: 130/80Pulse: 62Pulse: 62Temperature: 97 2Temperature: 97 2Temperature: 97.2Temperature: 97.2Height: 5’3”Height: 5’3”Weight: 130 lbsWeight: 130 lbsWeight: 130 lbs.Weight: 130 lbs.

Chief ComplaintChief ComplaintChief ComplaintChief Complaint

Chief complaint is rightChief complaint is right--sided weaknesssided weakness Chief complaint is rightChief complaint is right sided weakness sided weakness post TIA (Liver Wind) with occasional post TIA (Liver Wind) with occasional slurred speech and intermittent voiceslurred speech and intermittent voiceslurred speech and intermittent voice slurred speech and intermittent voice breaks. breaks.

TIA occurred October 2009TIA occurred October 2009 TIA occurred October 2009TIA occurred October 2009 Currently being treated with physical, Currently being treated with physical,

ti l d h th iti l d h th ioccupational, and speech therapiesoccupational, and speech therapies Has not had acupunctureHas not had acupuncture

SubjectiveSubjectiveSubjectiveSubjective

Spirit: Cheerful & joking but answers all questions Spirit: Cheerful & joking but answers all questions p j g qp j g qappropriatelyappropriately

Complexion: Pale with slight flush over cheeks and Complexion: Pale with slight flush over cheeks and f h df h dforehead.forehead.

Posture/ Stance: Slightly Kyphotic, walks with walker, Posture/ Stance: Slightly Kyphotic, walks with walker, drags right foot slightly.drags right foot slightly.drags right foot slightly. drags right foot slightly.

AudioAudio--olfactory exam: Slurred, slow speech, slight urine olfactory exam: Slurred, slow speech, slight urine smell noted. smell noted.

Social history: Never smoked, alcohol consumption more Social history: Never smoked, alcohol consumption more than occasional, first husband physically and mentally than occasional, first husband physically and mentally abusive.abusive.abusive.abusive.

Medications & SupplementsMedications & SupplementsMedications & SupplementsMedications & Supplements Glimerperide: DiabetesGlimerperide: Diabetes

A l di i H t iA l di i H t i Supplements: Supplements:

C l i Vit i DC l i Vit i D Amlodipine: HypertensionAmlodipine: Hypertension Hysaar: HypertensionHysaar: Hypertension Clonidine: HypertensionClonidine: Hypertension

Calcium + Vitamin D: Calcium + Vitamin D: Osteoporisis, ArthritisOsteoporisis, Arthritis

CoCo--Q10: HeartQ10: Heart Clonidine: HypertensionClonidine: Hypertension Simvastin: CholesterolSimvastin: Cholesterol Plaavix: AnticoagulantPlaavix: Anticoagulant

CoCo--Q10: Heart, Q10: Heart, HypertensionHypertension

aa t coagu a taa t coagu a t Aspirin: AnticoagulantAspirin: Anticoagulant Cerefolin: MemoryCerefolin: Memory Aricept: MemoryAricept: Memory Ropinirole: Restless Leg Ropinirole: Restless Leg

SyndromeSyndromeSyndromeSyndrome Mirtazapine: AgitationMirtazapine: Agitation

10 Questions / Medical History10 Questions / Medical HistoryQ yQ y

Hot/Cold: Cold over all extremitiesHot/Cold: Cold over all extremities

Perspiration: NeverPerspiration: Never

Head/Body: Occasional headaches (does not have a Head/Body: Occasional headaches (does not have a pattern), dizziness (sporadic), rightpattern), dizziness (sporadic), right--sided weakness, sided weakness, fine motor to right hand poor fine motor to right hand poor –– unable to grasp and unable to grasp and

ll d ff l ll h dll d ff l ll h dwrite well, some difficulty swallowing, states right side write well, some difficulty swallowing, states right side of mouth drooped but almost resolved, drags right foot of mouth drooped but almost resolved, drags right foot –– walks with walker. Denies any pain. walks with walker. Denies any pain. PMH b i TIA’ ( i i t k )PMH b i TIA’ ( i i t k )PMH: brain aneurysm, TIA’s (mini strokes), PMH: brain aneurysm, TIA’s (mini strokes), osteoarthritis. osteoarthritis.

10 Questions (con’t)10 Questions (con’t)

Chest/Abdomen: Denies chest pain, passes gas Chest/Abdomen: Denies chest pain, passes gas frequently. Abdomen is soft and nonfrequently. Abdomen is soft and non--tender.tender.PMH H t i f 50+ t i l fib ill tiPMH H t i f 50+ t i l fib ill tiPMH: Hypertensive for 50+ years, atrial fibrillation PMH: Hypertensive for 50+ years, atrial fibrillation (arrhythmia), Epigastric pain (GERD) past 25 years (does (arrhythmia), Epigastric pain (GERD) past 25 years (does not have currently)not have currently)

Appetite/Thirst: Eats small, frequent meals, craves Appetite/Thirst: Eats small, frequent meals, craves sweets, ice cream, dairy products, drinks decaf coffee, sweets, ice cream, dairy products, drinks decaf coffee, water diabeticwater diabetic WHAT ABOUT ALCOHOL???WHAT ABOUT ALCOHOL???water, diabetic water, diabetic -- WHAT ABOUT ALCOHOL???WHAT ABOUT ALCOHOL???PMH: Diabetic past 2 yearsPMH: Diabetic past 2 years

Vision/Hearing: Wears glasses, dry eyes for many years Vision/Hearing: Wears glasses, dry eyes for many years (uses eye drops), hard of hearing (especially when there (uses eye drops), hard of hearing (especially when there is background noise), no tinnitusis background noise), no tinnitusPMH Ch i Bl h iti (i f ti d th lid)PMH Ch i Bl h iti (i f ti d th lid)PMH: Chronic Blepharitis (infection under the eyelid) PMH: Chronic Blepharitis (infection under the eyelid) ––has had for 3+ years, cataracts (were removed)has had for 3+ years, cataracts (were removed)

10 Questions (con’t)10 Questions (con’t)10 Questions (con t)10 Questions (con t) Urine/Stools: Urine color is YellowUrine/Stools: Urine color is Yellow--Clear, experiences Clear, experiences // , p, p

stress urinary incontinence, has frequent urinary stress urinary incontinence, has frequent urinary infections, wears diapers, has constipation (uses stool infections, wears diapers, has constipation (uses stool softener)softener)))

Sleep: Has experienced sleep apnea and restless leg Sleep: Has experienced sleep apnea and restless leg syndrome for most of life; sleeps 2syndrome for most of life; sleeps 2 3 hours/night3 hours/nightsyndrome for most of life; sleeps 2syndrome for most of life; sleeps 2--3 hours/night, 3 hours/night, snores, and talks a lot in sleep. Naps often during the snores, and talks a lot in sleep. Naps often during the day. Uses alcohol to sleep.day. Uses alcohol to sleep.

Constitution, mental, emotional: Poor energy, Constitution, mental, emotional: Poor energy, depression and anxietydepression and anxietyp yp y

Pulse & TonguePulse & TonguePulse & TonguePulse & Tongue PulsePulse

–– left left –– full, surging and wiry throughoutfull, surging and wiry throughout–– right right –– full, surging, wiry, slipperyfull, surging, wiry, slippery

TongueTongue–– red colorred color–– thick, dry yellow coat in lower jiaothick, dry yellow coat in lower jiao–– light to no coat in upper and middle jiaolight to no coat in upper and middle jiao–– body is full and thick, no teeth marksbody is full and thick, no teeth marksbody is full and thick, no teeth marksbody is full and thick, no teeth marks–– horizontal/vertical cracks over whole tonguehorizontal/vertical cracks over whole tongue–– medium sublingualsmedium sublinguals

Tongue PicturesTongue Pictures

Palpatory FindingsPalpatory FindingsPalpatory FindingsPalpatory Findings

Mu/Shu:Mu/Shu: Mu/Shu:Mu/Shu:Hara: negative findingsHara: negative findings

Tendinomuscular/Cutaneous Regions:Tendinomuscular/Cutaneous Regions:Finger deformity with arthritic nodules, Finger deformity with arthritic nodules, slightly kyphotic drags right footslightly kyphotic drags right footslightly kyphotic, drags right foot slightly kyphotic, drags right foot slightly slightly

AssessmentAssessmentAssessmentAssessment

Working Diagnosis & Treatment PrincipleWorking Diagnosis & Treatment Principleo g ag os s & eat e t c p eo g ag os s & eat e t c p e

Root: Root: Liver Yang Rising with Internal Wind and Kidney Liver Yang Rising with Internal Wind and Kidney Yin/Yang Deficiency Yin/Yang Deficiency

Branch: Branch: Spleen Qi Deficiency and Spleen Failing to Hold UrineSpleen Qi Deficiency and Spleen Failing to Hold UrineL Qi D fi iL Qi D fi iLung Qi DeficiencyLung Qi DeficiencyPhlegm Misting the HeartPhlegm Misting the HeartLiver Invading Spleen/StomachLiver Invading Spleen/StomachLiver Invading Spleen/StomachLiver Invading Spleen/Stomach

Kidney ImbalanceKidney Imbalance

Metal fails to generate water Metal fails to generate water and water fails to control fire and water fails to control fire

According to the patient history, According to the patient history, she was living in an abusive she was living in an abusive marriage for almost 20 years with marriage for almost 20 years with

This caused weakness of the Kidney meridian (theThis caused weakness of the Kidney meridian (the

g yg yfear for her own safety and safety fear for her own safety and safety of her children. of her children.

This caused weakness of the Kidney meridian (the This caused weakness of the Kidney meridian (the emotion of fear, hearing loss is related to the Kidney)emotion of fear, hearing loss is related to the Kidney)

Yang provides Fire for Spleen and strength for HeartYang provides Fire for Spleen and strength for Heart Untreated Kidney imbalance leads to Loiver Yang Rising Untreated Kidney imbalance leads to Loiver Yang Rising

and Liver Attacking Spleen and Stomachand Liver Attacking Spleen and Stomach Also, Kidney imbalances lead to the formaiton of Heat inAlso, Kidney imbalances lead to the formaiton of Heat in Also, Kidney imbalances lead to the formaiton of Heat in Also, Kidney imbalances lead to the formaiton of Heat in

the Heart and Small Intestin meridians. the Heart and Small Intestin meridians.

Liver ImbalanceLiver ImbalanceWater fails to generate Wood and Water fails to generate Wood and Wood fails to control EarthWood fails to control Earth

llbl dd dllbl dd dLiver & Gallbladder meridians were Liver & Gallbladder meridians were already weak and imbalanced and already weak and imbalanced and created Liver Yang Rising created Liver Yang Rising (Hypertension) and Liver Attacking(Hypertension) and Liver Attacking(Hypertension) and Liver Attacking (Hypertension) and Liver Attacking Spleen and Stomach (GERD, eye Spleen and Stomach (GERD, eye problems, restless leg syndrome)problems, restless leg syndrome)

At the same time she had formation of Internal Wind At the same time she had formation of Internal Wind (Stroke)(Stroke)

Patient also full of anger (emotion related to Liver) thatPatient also full of anger (emotion related to Liver) that Patient also full of anger (emotion related to Liver) that Patient also full of anger (emotion related to Liver) that was not expressed (socially unacceptable behavior for was not expressed (socially unacceptable behavior for Southern lady)Southern lady)

Starts to drink alcohol on regular basis (socially Starts to drink alcohol on regular basis (socially acceptable behavior becomes an addiction)acceptable behavior becomes an addiction)

Heart ImbalanceHeart Imbalance

d f ld f lWood fails to generate Fire, Wood fails to generate Fire, Fire fails to control MetalFire fails to control Metal

Heart and Small Intestine meridians were imbalanced Heart and Small Intestine meridians were imbalanced from Wood failing to generate Fire (emotions of from Wood failing to generate Fire (emotions of anxiety/depression are related to Heart meridian)anxiety/depression are related to Heart meridian)anxiety/depression are related to Heart meridian)anxiety/depression are related to Heart meridian)

This leads to the formation of Damp and Phlegm in This leads to the formation of Damp and Phlegm in these me idians and ca ses constipation di inessthese me idians and ca ses constipation di inessthese meridians and causes constipation, dizziness, these meridians and causes constipation, dizziness, arrhythmias, and insomniaarrhythmias, and insomnia

Spleen ImbalanceSpleen Imbalance

Fire fails to generate Earth and Fire fails to generate Earth and Earth fails to control WaterEarth fails to control Water

Spleen/Stomach meridians were Spleen/Stomach meridians were imbalanced from previousimbalanced from previous

Di t th t i h ith d i ( h ilk i )Di t th t i h ith d i ( h ilk i )

imbalanced from previous imbalanced from previous pathologypathology

Diet that was rich with dairy (cheese, milk, ice cream)Diet that was rich with dairy (cheese, milk, ice cream)forming Damp (Diabetes)forming Damp (Diabetes)

Excessive drinking of alcohol damages the Spleen andExcessive drinking of alcohol damages the Spleen and Excessive drinking of alcohol damages the Spleen and Excessive drinking of alcohol damages the Spleen and since alcohol is hot in nature, it caused the “cooking” of since alcohol is hot in nature, it caused the “cooking” of Damp and formed PhlegmDamp and formed Phlegm

Also Spleen Qi Deficiency caused failure of Qi to holdAlso Spleen Qi Deficiency caused failure of Qi to hold Also, Spleen Qi Deficiency caused failure of Qi to hold Also, Spleen Qi Deficiency caused failure of Qi to hold the organs and resulted in urinary incontinencethe organs and resulted in urinary incontinence

Lung ImbalanceLung Imbalance

Earth fails to generate Metal, Earth fails to generate Metal, Metal fails to control WoodMetal fails to control Wood

Lung / Large Intestine meridians were imbalanced and Lung / Large Intestine meridians were imbalanced and caused Lung Qi Xucaused Lung Qi Xu

Shallow breathing, difficulty speaking, and compromised Shallow breathing, difficulty speaking, and compromised immune system are the result of Lung Qi Xuimmune system are the result of Lung Qi Xuimmune system are the result of Lung Qi Xuimmune system are the result of Lung Qi Xu

Plan Plan –– Root TreatmentRoot Treatment

Treatment Principle: Treatment Principle: TonifyTonify Kidney Yang and Yin, Descend Liver YangKidney Yang and Yin, Descend Liver Yang

GB 39 GB 39 -- Influential Point of Marrow (Brain and Bone) in Influential Point of Marrow (Brain and Bone) in elderlyelderly

Du 20Du 20 Four seas point Sea of Marrow (Brain and KidneyFour seas point Sea of Marrow (Brain and KidneyDu 20 Du 20 -- Four seas point, Sea of Marrow (Brain and Kidney, Four seas point, Sea of Marrow (Brain and Kidney, cognitive, and central nervous system disorders) cognitive, and central nervous system disorders)

SishencongSishencong –– Cognitive and central nervous systemCognitive and central nervous systemgg g yg ySJ 5, GB 41 SJ 5, GB 41 -- Dai Mai Dai Mai -- connect upper and lower parts of connect upper and lower parts of

bodybodyS 3 62S 3 62 QiQi G i di d (G i di d ( ii f i )f i )SI3, UB62 SI3, UB62 -- Yang Yang QiaoQiao -- Gait disorders (Gait disorders (eversioneversion of gait) of gait)

PlanPlan –– Root Treatment con’tRoot Treatment con’tPlan Plan Root Treatment con tRoot Treatment con t

PC 6, SP 4 PC 6, SP 4 –– Yin Wei Mai (stagnation in Heart ,chest, Yin Wei Mai (stagnation in Heart ,chest, throat, anterior trunk, Spleen throat, anterior trunk, Spleen QiQi deficiency, deficiency, ShenShen, , p, , p QQ y,y,disorders especially involving will and self control, disorders especially involving will and self control, phlegm conditions)phlegm conditions)

ST 36 GB 34ST 36 GB 34 –– FreecourseFreecourse Liver ChannelLiver ChannelST 36, GB 34 ST 36, GB 34 FreecourseFreecourse Liver Channel Liver Channel KD 3 KD 3 -- TonifyTonify and nourish Kidney and nourish Kidney LV 13 LV 13 -- TonifyTonify Liver and Spleen Liver and Spleen -- Influential point of Influential point of ZangZang

organsorgansREN 4 REN 4 -- Intersection point of LV, KD, SP, for all Kidney Intersection point of LV, KD, SP, for all Kidney

issuesissues

Plan Plan –– Symptomatic TreatmentSymptomatic Treatment

Treatment Principle:Treatment Principle:Treatment Principle: Treatment Principle: TonifyTonify Spleen and Lung Spleen and Lung QiQi, Disperse Phlegm, , Disperse Phlegm, Support Spleen to Hold Urine Support Spleen to Hold Urine

HT 7, HT 7, RenRen 17 17 -- Sea of Sea of QiQi for LU and HT patterns,for LU and HT patterns,HT 7 for osteoarthritisHT 7 for osteoarthritisHT 7 for osteoarthritisHT 7 for osteoarthritis

Blurring of vision Blurring of vision –– Liver pointsLiver pointsLV 3LV 3 -- Hypertension Restless Leg SyndromeHypertension Restless Leg SyndromeLV 3 LV 3 Hypertension, Restless Leg SyndromeHypertension, Restless Leg SyndromeLU 9 LU 9 -- Yuan Source, Influential Point of Vessels Yuan Source, Influential Point of Vessels -- for for

disorders of pulse and arrhythmiasdisorders of pulse and arrhythmias

Symptomatic TreatmentSymptomatic Treatment con’tcon’tSymptomatic Treatment Symptomatic Treatment con tcon tPoints for symptoms already included in Root Points for symptoms already included in Root Treatment Plan:Treatment Plan:Treatment Plan:Treatment Plan:

GB 41 GB 41 -- Hearing loss, Hearing loss, BlepharitisBlepharitis -- disorders of eyesdisorders of eyesKD 3KD 3 -- OsteoarthritisOsteoarthritisKD 3 KD 3 -- OsteoarthritisOsteoarthritisST 36 ST 36 -- Type II Diabetes, Type II Diabetes, FlatulanceFlatulance, Hypertension, HypertensionSJ 5 SJ 5 -- ConstipationConstipationGB 34 GB 34 -- Restless Leg SyndromeRestless Leg SyndromeSishencongSishencong -- InsomniaInsomniaREN 4REN 4 Urinary IncontinenceUrinary IncontinenceREN 4 REN 4 -- Urinary IncontinenceUrinary Incontinence

Alternate Alternate right and left points after 4 weeks of treatmentright and left points after 4 weeks of treatmentg pg pOffer herb supplements to Offer herb supplements to tonifytonify KidneyKidney

Post Treatment Care Post Treatment Care d id iRecommendations Recommendations

Education on diet breathing exercises andEducation on diet breathing exercises and Education on diet, breathing exercises and Education on diet, breathing exercises and Tai Chi Tai Chi

Clinical Issues or ConcernsClinical Issues or ConcernsClinical Issues or Concerns Clinical Issues or Concerns

Why would this case be interesting to health Why would this case be interesting to health y ou d t s case be te est g to ea ty ou d t s case be te est g to ea tcare professionals? care professionals?

Strokes are one of the leading causes of death Strokes are one of the leading causes of death and the leading cause of debilitating disease in and the leading cause of debilitating disease in this country As the population gets older andthis country As the population gets older andthis country. As the population gets older and this country. As the population gets older and lives longer, we will have to care for more lives longer, we will have to care for more people with this illness and its devastating people with this illness and its devastating disabilities that impact the whole body’s disabilities that impact the whole body’s energetic balance.energetic balance.