kellykd: October 17, 2020, 9:47pm
Hi all.
I am working up a case and I’m stumped on a few symptoms.
This 65 year old female who is not terribly robust, more introverted with slightly sunken facial features. She has
had right low back and hip pain that is worse at night while lying down and she will have sensations in her thigh
that makes her want to get up and move around at night. I was thinking this was K XS/SI+ and it responded well to
SI+
She also gets migraines that often come on at night and wake her up between 2:00-4:00 am. I would think this
might also be K XS/SI+, but could it also be SI XS/K+?
I can tell you that it did not respond well to SI+ but the migraines got worse! more intense, more frequent, more
widespread – was on R side of head, now also in forehead.
She does have some SJ XS symptoms generally and related to her migraines and I was thinking Liv+ for next
treatment. I did consider K+ but I know to be cautious with pain, so I don’t think I will do that.
What do you think about migraines or headaches that come on at night, without seeing the whole case? This the my
main question here.
thank you!
Kelly
KristinWisgirda: October 18, 2020, 10:12am
Hi Kelly,
kellykd:
I can tell you that it did not respond well to SI+ but the migraines got worse! more intense, more frequent,
more widespread – was on R side of head, now also in forehead.
The absolute clearest indicator of which treatment the patient needs most is given to us when the patient has an
adverse reaction to treatment. You must treat the counterbalancer every single time. Forget everything else you
think you know about the patient and about Saam. Toby clearly teaches this in the intro class but so many students
seem to forget it. Mistreating with Saam means you have injured the patient. Treating the counterbalancer is the
practice that allows you to undo the damage you have done to the patient.
Please treat K+ at the next visit.
kellykd:19/01/2024, 10:52Back/hip/leg pain and migraines worse lying down at night – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/back-hip-leg-pain-and-migraines-worse-lying-down-at-night/1339/print2/6
slightly sunken facial features.
Sunken facial features is a SI excess sign as it is a deep depletion sign such that you would see in a deeply
exhausted patient, the end of their life or after years of cancer treatments.
kellykd:
I did consider K+ but I know to be cautious with pain,
Another misunderstanding that many students have is what you have stated above. While SI+ is commonly the
right treatment for pain from blood stasis, this doesn’t mean that K+ can’t be used for pain. I have used it many
times for pain with great results.
Did you ever try it for your post partum foot pain that you mentioned in a previous post?
kellykd:
What do you think about migraines or headaches that come on at night, without seeing the whole case?
You have to look at the case and repeat the mantra sometimes channel, sometimes quality. For Saam, coming on at
night doesn’t say anything. You have to make sense of it with the bigger picture.
kellykd: October 18, 2020, 5:00pm
Thanks for helping me clarify this, Kristin.
I do understand K+ can be used for pain, but I understand that the pain would probably be worse with movement or
exertion. This is partly why I was confused. Even though she has some clear K xu signs, her pain symptoms (low
back/hip and migraines) seems more K XS, even the migraines, which come on while she is sleeping, not while
moving, but also, worse with massage, which I hadn’t mentioned above.
So, even though she had the adverse reaction of more migraines in the two weeks after the treatment with SI+, she
initially feeling really good, joyful even, and I was nervous to use K+ for fear of causing more pain. Yet my gut
was also telling me she needed K+ and now you have given me more confidence to try it. I’ll bump the Liv+ idea
to the next treatment, if needed.
I guess I haven’t yet tried K+ on myself. I guess I might have to do that tonight! thanks for the reminder, Kristin.
thanks again!
Kelly
KristinWisgirda: October 18, 2020, 5:30pm
19/01/2024, 10:52Back/hip/leg pain and migraines worse lying down at night – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/back-hip-leg-pain-and-migraines-worse-lying-down-at-night/1339/print3/6
94, Male, LBP, radiculopathy and numbness
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.
Worse with movement or exertion can be SI excess pain but it can also be just a local problem meaning any
channel could be used to treat. The real dynamic of SI excess is that symptoms arise because the patient can’t hold
themselves together.
kellykd:
she had the adverse reaction of more migraines in the two weeks after the treatment with SI+, she initially
feeling really good, joyful even,
How did she settle on the table with SI+? Did the migraines get worse after using SI+ more than once? So with the
improvement of the lbp, SI+ had a mixed effect of benefiting and aggravating. Even so, if there is a clear
aggravation of anything after treatment, you must must must use the counterbalancer, even if it doesn’t make sense
to you on paper. This case demonstrates just this point.
Is There a Point at Which You’d Consider a Strong Gem to be a Contraindication?
I recently had a new patient with interstitial cystitis consisting of inhibited urination with burning in her
urethra, pelvic pain, and nocturia 3-4x/night. Dry skin 6+, modestly overweight, great resources, full distended
belly with marked resistance and pain on pressure in the whole right upper quadrant, non-aggressively loud
voice, plump thenars. She didn’t settle wonderfully with ST+ but I was so conflicted about other treatment
options I let her ride it. The day after treatment was horrible for her- increased frequency of urination and pain.
The next treatment, she sunk right in with Lung+ and had a good response. What was it that I missed?
My patient didn’t have any obvious signs of internal dryness that might have been the aggravating factor. I remain
stumped but she is getting better because I prioritized her body’s reactions over my ideas. Reality wins always.
kellykd: October 18, 2020, 7:48pm
Just back from a run and I realized that I was my thinking about migraines worse with massage might be K XS
doesn’t make sense. It makes more sense that that would be SI XS. K XS would probably like the movement of
massage, so there’s one more check mark for SI XS.
Unfortunately, I had mistakenly done SI+ two weeks in a row. I have a new system with EHR and I hadn’t printed
out the last week’s chart note, so I didn’t see SI+ treatment and came up with the same idea. It was only once I got
the needles in that I realized my mistake so I paid a lot of attention that second time.19/01/2024, 10:52Back/hip/leg pain and migraines worse lying down at night – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/back-hip-leg-pain-and-migraines-worse-lying-down-at-night/1339/print4/6
I didn’t write down how she settled on the table, but after the first treatment: After the first time she felt good
overall. feeling of joy while hiking that she hadn’t felt in a while.
The second time she initially felt activated. Her right thigh discomfort came up and then went away completely.
She settle in and almost fell asleep. Felt warm , then at the end cool. I wasn’t sure if her face was paler, she is
already slightly pale and I wasn’t sure. I also called her the next day – she felt fine. tired that night, slept well, pain
was not bad.
she then cancelled her next appointment when she started getting more headaches later in the week. We talked and
I am seeing her tomorrow.
KristinWisgirda: October 18, 2020, 10:25pm
Even if you can be sure of the quality of the massage, I wouldn’t put a huge amount of weight on it. Rather I would
look more at the channels involved in her migraines, the balance of the overall K/SI presentation, other aspects of
her big picture as well as her response to treatment.
With her weaker constitution, it is likely always a bad idea to repeat treatments on her.
At the start of every clinic day, I make a cheat sheet with the last 6 visits and responses. It is really easy to get busy
and lose sight of what you have done.
kellykd: October 19, 2020, 4:17pm
Great idea, Kristin.
I have been developing my system and I now write in next to the treatment how the person felt during and after the
treatment. I also double check that I am looking at their most recent treatment : / Live and learn!
I did K+ to myself last night. I ran a 10K yesterday – my first in quite a while – and my feet are pretty good today.
thanks again for you help, Kristin!
1 Like19/01/2024, 10:52Back/hip/leg pain and migraines worse lying down at night – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/back-hip-leg-pain-and-migraines-worse-lying-down-at-night/1339/print5/6
amyjenner #8October 19, 2020, 7:27pm
I started keeping a little box on the side of my SOAP note that has Last 2 tx, Today’s Tx, and Next Tx.
it is my practice to make sure the part about the previous is filled out before I start for the day. If I can, I like to
make that note and ideas with rationale for the next time I see someone. Doesn’t always happen, but when it does,
it helps with stress for sure.
kellykd: November 10, 2020, 5:28pm
Update – on my patient with the migraines – and also me since doing K+.
My patient with the migraines that were worse since doing SI+ twice. I did K+ for her (2.5 weeks after the second
SI+) and she was deeply relaxed. She ended up with a headache the next evening and ok the rest of the week.
The next week (last week) I did Liv+ and she was very relaxed during and after the session. She felt a headache
coming on that night and the next morning it was stronger so she took 1 ibu and it helped (after SI+ her headaches
were less responsive to ibu). Since then then she has been fine as far as I know. But has been having headaches 1x
week, but now not as intense as they had been for a bit there. I haven’t heard from her since last week, so I am not
sure about this week. She was happy that she was doing well leading up to the election. She was supposed to come
in this week (2 weeks since her last session), but her schedule changed so we will see. I’ll add a note when I hear
from her.
An interesting thing with her is that if she gets massage anywhere on her body, it will trigger a headache.
Question: How much moving is happening with Liv+ would you say? A little moving with a lot of nourishing of
the blood?
Me. I did K+ a couple weeks ago and woke the next night at 2:30 am with a headache. I rarely get headaches. Then
I had visual disturbances in the morning – left peripheral vision was dark/missing. then I had some iridescent lines
in my vision for a bit. both went away within an hour. Since then 2-3 x i had to stop reading (studying Dr Yu)
because the iridescent lines came back and made it not possible to read. It happened last night and then again today
with a very mild headache, loss of peripheral vision on the right and iridescent lines that made it hard to read. I do
get floaters regularly and have a bunch of SJ XS signs, not a lot of K XS signs. Today I did Liv+ and then added
SI+.
Does it make any sense that K+ would lead to such visual issues? My feet are about the same.
kellykd: November 10, 2020, 5:44pm
PS My visual stuff was clearing up before the treatment but has been quite clear since (only 30 minutes).19/01/2024, 10:52Back/hip/leg pain and migraines worse lying down at night – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/back-hip-leg-pain-and-migraines-worse-lying-down-at-night/1339/print6/6
For the above patient I’m considering giving her Wu Zhu Yu Tang. She doesn’t vomit, but has a water glomus. Too
much water makes her feel uncomfortable in the stomach and can trigger headaches.