Jason: October 15, 2020, 6:32pm
A Sa’am Alaykum!
After catching up on the advanced class recording I wanted to get in the habit of writing up case studies, and I’d be
grateful for any input before doing my second treatment for this patient tomorrow. I don’t know that it’s especially
difficult, but I have some trepidation due to his age.
94 yo male, CC: bilateral LBP, bilateral leg pain affecting GB/UB and inner thighs, S/P removal of 2 tumors from
bladder 1 year ago.
Numbness in lower legs, especially GB channel, and bottoms of feet.
Whole body cold
Body type: Thin
Skin: unremarkable
Urination: 2x/day, 4x/night (retained during day)
BM: 1x/day, soft
Hearing loss (age related)
Talkative +8
Emotion: Admits only to experiencing joy, but a little cranky during treatment
Tongue: Red, cracked, scanty coat
Pulse: Leathery, rapid, somewhat forceful
The GTITR is probably his shuffling gait, or it could be his singular character. He gets a big kick out of telling
everyone how old he is, how great his sense of humor his, and how great his health is. His talkativeness was
entertaining at first, but after a while became an obstacle, then a drain, then diagnostic.
I have done one treatment for him. I eliminated SI+ due to age and focused on channels. He said the most painful
area was the GB area of both hips, so I supplemented PC on left. After 5 minutes he didn’t settle. I removed the
needles, but supplementing GB didn’t seem indicated. Instead, I supplemented UB on right because of the low
back pain, talkativeness, red dry tongue, and rapid forceful pulse. I spoke to him after a few days and he said there
was “no change,” although I will have to wait until tomorrow to see if that includes urinary symptoms. I am
considering HT+, due to whole body cold and UB channel involvement. Thoughts?19/01/2024, 10:5994, Male, LBP, radiculopathy and numbness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/94-male-lbp-radiculopathy-and-numbness/1333/print2/7
KristinWisgirda: October 15, 2020, 10:18pm
as-salamu alaykum wa-ra?matu -llahi wa-barakatuhu
(Peace be upon you, as well as the mercy of God and God’s blessings.)
Based on the leg symptoms, any channel is called for except SI+ because of age concerns. Theoretically I might
consider it way, way down the road and only after K+. I would also ask Toby before doing it as well.
Jason:
I am considering HT+, due to whole body cold and UB channel involvement.
H+ concerns me in someone who has significant H excess signs and some dryness. Retained urine + double fire is
a dangerous combo. I am more worried about the retained urine than the other symptoms for him.
How dry is he? Are the cracks in his tongue shallow or like deep sharp edged fissures? How thin is he?
Is the numbness frank numbness or paresthesias or both?
It would help to know the level of his LBP, how good is resources are, if he has a belly or is bloated, how good is
grooming is.
Jason:
Skin: unremarkable
He has perfect skin tone and moisture with no varicosities? This certainly is worth remarking on if it is true.
Jason: October 15, 2020, 11:15pm
Hi Kristin, thanks for your comments.
Based on the leg symptoms, any channel is called for except SI+ because of age concerns.
Yeah, I eliminated SI, tried PC and UB. I would also tend to hold off on KD+ with pain based on Toby’s
comments, but maybe there are exceptions? (I haven’t seen his MRI report yet, but I’m sure there is spinal
degeneration, and probably stenosis. His lumbar spine is visibly deformed.) So, for treating the yang channels, not
a lot of options. Still hesitant about GB, but I’ll give it another look.
Resources: He has money, good insurance from his career at the UN in “disarmament,” he has 3 or 4 sons who are
doctors, but did complain about having to pay a $20 copay several times. Would LU+ benefit this kind of pain? It
occurred to me for the numbness, but he said he didn’t mind that too much. He slapped the sole of his foot and said
he didn’t feel anything.
His grooming was pretty good considering his age. Baggy clothes. He wears extra layers to keep warm, including a
headband thing for his ears. I would say cold +7 or 8.19/01/2024, 10:5994, Male, LBP, radiculopathy and numbness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/94-male-lbp-radiculopathy-and-numbness/1333/print3/7
Tongue cracks are not severe. The redness was more impressive. That gave me confidence in UB+.
He denies bloating and all other digestive symptoms, other than the soft stool. Vegetarian diet. He has a tiny bit of a
belly, visible when he strips down to his undershirt, but not with clothing on.
He has perfect skin tone and moisture with no varicosities?
No, it’s just unremarkable. Not particularly dry. I guess that is impressive at 94. I didn’t check for varicosities since
I had set aside SI and KD.
So I have GB, LU, possibly KD (?) to consider for tomorrow.
Jason: October 16, 2020, 2:20pm
Jason:
I would also tend to hold off on KD+ with pain based on Toby’s comments, but maybe there are exceptions?
I searched the forum for clarification, and found this in another case discussion:
Kristin:
Pain by itself can be Kidney excess. Worse with movement is SI excess. They are separate entities.
This is incredibly helpful! So, I’m thinking KD+ is the way to go now as he definitely has more pain with walking
to the point where he has avoided it altogether lately.
KristinWisgirda: October 16, 2020, 6:03pm
Jason:
Worse with movement is SI excess.
I think this can be misleading and I apologize for not fleshing this out adequately.Worse with movement suggests
any kind of movement and we know that not all pain with movement can be treated by K+.
Pain can can happen when there is lack of consolidation. This is SI excess pain.
I’m not really connecting with his picture beyond his age, personality, whole body cold with H excess signs, thin
body and ok skin. I don’t feel I can give direction with confidence especially in the complicated areas of H/UB and
K/SI. However, I wouldn’t rule out SJ+ or Liv+, though SJ+ sounds better; or Sp+/ST+.
1 Like19/01/2024, 10:5994, Male, LBP, radiculopathy and numbness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/94-male-lbp-radiculopathy-and-numbness/1333/print4/7
Back/hip/leg pain and migraines worse lying down at night
Jason: October 16, 2020, 7:10pm
So you don’t see the visible spinal degeneration as indicative for KD? There is also the hearing loss, and I’m
noticing now some shakiness in short-term memory, i.e. he forgets what he was saying.
KristinWisgirda:
I’m not really connecting with his picture beyond his age, personality, whole body cold with H excess signs,
thin body and ok skin.
Yes, he is remarkably healthy, which is a mixed blessing for us diagnosticians. There seems to be no change after
the first treatment, other than the pulses are less leathery and forceful, and I have a general sense that he is less
overwhelming from my POV.
I would have shied away from SP and ST due to the numbness. I didn’t think about SJ or LV either. The inner thigh
pain seems to be secondary. Sorry if that was unclear.
After examining him a second time I see that his legs are rather dry, and there are no apparent varicosities.
He’s committed to 3 more treatments, so I’ll let you know how it goes. Thanks again for your help, and I’ll let you
know how it goes.
allyson_nevard: October 16, 2020, 7:06pm
I haven’t been on the forum in a while – but why can’t we do SI+ on an older person who has pain and numbness? I
have done this several times with great success. It’s often the 1st time treating an older person with a stronger
constitution with pain. I wouldn’t do it on a frail or really weak elderly person but I find that there circulation really
needs moving the 1st time seeing them. The next time I do something different – sometimes KD+. Granted, I have
never done it on someone quite so old. I think 88 is the oldest.
1 Like19/01/2024, 10:5994, Male, LBP, radiculopathy and numbness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/94-male-lbp-radiculopathy-and-numbness/1333/print5/7
KristinWisgirda: October 16, 2020, 7:11pm
I’ve had similar experiences @allyson_nevard. 94 is definitely over the line for me. I am wanting to be even more
cautious after Daniel’s elderly patient had a stroke very soon after an SI+ treatment that relieved the patient’s chief
complaint.
KristinWisgirda: October 17, 2020, 10:27am
Jason:
he is remarkably healthy,
This view is going to limit your ability to help him.
As we are going on this conversation you are gradually adding in more observations that help flesh out his picture.
No varicosities, shaky short term memory, etc. This is great. I suspect you have even more information about him
that would be helpful. As always, my suggestion is to go through each of the 12 channels and consider how each
channel quality is manifesting in his system, or not. Don’t jump over any of the 12 channels because of an apparent
contraindication, for instance LI excess and numbness.
Our Saam observation skills are in their infancy. We are limited by our lack of opportunities to spend time with
Toby or his teacher to show us what they see. Hopefully, we will get such opportunities soon.
Jason: October 17, 2020, 9:21pm
I just meant that he admits to few symptoms. Of course, I see more each visit.
He came for the third time today – highly motivated. He says maybe 5% improvement, which I would normally
interpret as zero, but he seems to be moving better. He didn’t have a hat on today, even outside, whereas before he
kept it on in the office (72 degrees). His eyes were brighter too. The biggest thing I learned from the second visit is
that when he settles, it is very subtle – just a little softening of the eyes, and even then he asked for his phone during
treatment. So I questioned him more about being busy. He says he is texting with friends around the world all day,
and went on about his illustrious career as a diplomat, etc. So, I supplemented spleen. He didn’t settle deeply as I
had hoped, but the pulse is improving steadily. I think I will return to treating channels when I see him again on
Tuesday.
Jason: October 17, 2020, 9:24pm
19/01/2024, 10:5994, Male, LBP, radiculopathy and numbness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/94-male-lbp-radiculopathy-and-numbness/1333/print6/7
KristinWisgirda:
We are limited by our lack of opportunities to spend time with Toby or his teacher to show us what they see.
Hopefully, we will get such opportunities soon.
Zoom could be great for this!
KristinWisgirda: October 18, 2020, 1:33pm
Jason:
The biggest thing I learned from the second visit is that when he settles, it is very subtle –
It may not be that subtle when he really settles deeply. Don’t convince yourself that subtle is all there is. His
symptoms haven’t changed much yet.
Jason:
His eyes were brighter too.
You notice this because they were dull before? In your initial description of him I wondered about Liver excess as
it sounds like he is on automatic pilot with his schtick.
Jason:
Zoom could be great for this!
Until then with every patient we should be asking how much we see
dry/damp on the inside/outside
bright light warmth open to the outside/dark dull cool closed inward
hot/cold, outward love/cold fear
assertive up and out/calm down and in
consolidated self love or dynamically moving/falling apart
Jason: October 18, 2020, 4:59pm
I think we’ve all experienced elderly patients who take a lot longer to do basic things and are not always helpful
interviewees. I wanted to keep a concurrent record of treatment in real time, but maybe it would be better to post
after several treatments. That seems more common.19/01/2024, 10:5994, Male, LBP, radiculopathy and numbness – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/94-male-lbp-radiculopathy-and-numbness/1333/print7/7
His MRI shows “severe spinal canal stenosis.” Would you normally expect quick results in a case like this?
KristinWisgirda: October 18, 2020, 5:08pm
Jason:
elderly patients who take a lot longer to do basic things and are not always helpful interviewees.
Totally diagnostic if you look at the qualities of their interactions- muddled dampness, shielded in their own world,
anxiously vigilant, etc- as well as the qualities of their movements- combinations of unstable, slow and deliberate,
loss of upright integrity, etc.
Jason:
His MRI shows “severe spinal canal stenosis.” Would you normally expect quick results in a case like this?
You wrote that some of his symptoms are s/p surgery on his UB meaning they aren’t all attributable to stenosis.
The vigor of the constitution and the complexity of the pathology all have to be taken into consideration when
determining prognosis. You are aiming to see some clear improvement with each treatment if you are making the
right diagnosis.