kellykd: December 5, 2019, 6:52pm
While I have been having some great results with Sa’am, I have a couple of examples where it did not go well.
Here is one. I will be seeing her again later today.
This is a 34 year old female patient who I was seeing all through her pregnancy. Now she has a 3 month old.
During her pregnancy she was having high blood pressure whenever she was in the doctor’s office and there was
concern of pre-eclampsia. She did great with the acupuncture and herbs: no swelling, felt good but there was a little
protein in her urine and blood pressure continued to be high at the doctor’s office. The doctors were worried and
induced her at 37 weeks which ended up being a bit of a shit show and she ended up with a C-section.
So she came in two weeks ago – she is 3 months post partum and feeling pretty good but feeling unmotivated and
tired, craving junk food/carbs and hating the cold dark Vermont weather,. She just returned to work part time,
which she loves – teaching art – but was feeling overwhelmed with everything, including now having two kids.
T: pale edges, pale purple-blue color, twc
P: xu overall, esp chi. L guan was strongest – moderate.
Nov 18 – In the heat of the clinical moment I treated Heart+. She had a (as Amy Jenner put it) zippy feeling in her
chest. I decided to mellow it out with Liv+ and she was feeling ok and the feeling in her chest was a little less but
didn’t feel bad. She relaxed on the table etc.
Next day she felt off – foggy, disconnected, not thinking clearly, thirsty, irregular harder stools. A few days later she
had cramping and spotting (still nursing, no periods yet), and felt “fast” energy in her mid-up abdomen. Then
intense panicky feeling and a little dizzy/lightheaded.
Dec 3 she was feeling particularly overwhelmed and then during teaching she felt woozy, lightheaded and almost
fainted – had to stop teaching. She had loose stools. Again she couldn’t think clearly and she thinks it was an
anxiety/panic attack. Jittery like she had too much caffeine, too. Going outside in the cold air did not help.
Dec 4 I saw her again (she was away, hence the gap in time). I know that UB+ would balance the H+ but I was
apprehensive to do UB+ with how very cold it is here in VT now and how she was hating cold. So I did P+,
thinking it would be calming. She also had a little sinus congestion and ear popping (older daughter is sick) and
queasiness and not great appetite coming into the treatment.
She felt very relaxed during and after the treatment. The queasiness went away and she got hungry but had a little
more sinus pressure.
Dec 5 – this morning she said that after work yesterday she felt jittery like she was over caffeinated, distracted/hard
to concentrate, nauseous and on the edge of fainting/lightheaded.
I am seeing her again today at 4:00. My top two for today are UB+, SI+
Maybe for the first treatment I should have done SJ+ or SI+ – probably SI+24/01/2024, 12:10Case where H+ and Liv+ did not work well at all – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-where-h-and-liv-did-not-work-well-at-all/774/print2/4
I am looking for feedback about what to do today. If you look at her history below, you can see why I thought of
H+ and Liv+ but I think my timing was off and now she is really “off” – OY!
more details on her in case you are interested. This is from her original first visit:
KM female 34 DATE OF INITIAL INTAKE: 22 March 2019
She originally came in in March when she was 15 weeks pregnant with nausea. Bloating after eating – after lunch
and dinner in pregnancy.
Protein in urine was high.
High blood pressure at end of last pregnancy.
Anxiety high and blood pressure high past two visits (136/85) then 116/70 after Reiki (usually 110/65)
average build, looks healthy, engaged, flesh feels resilient, supple, good complexion. Skin on the dry side. Nails a
bit brittle.
Flushes easily, not overly sensitive to wind on neck, but doesn’t love wind.
BODY TEMPERATURE Runs cold, likes a warm bath, often cold hands and felt – more fingers and toes.
Sometimes white and stiff, even at the beach in summer. Toes white/stiff when a kid. Dx: Reynaulds
Even in pregnancy, still likes warmth (warm bath)
PERSPIRATION normal
SKIN, HAIR & NAILS: dry skin and hair – itchy, cracks on hands (works in pottery studio)
Thirstier with pregnancy – normal otherwise
Tends toward constipation, but also can be loose (esp when not pregnant) with stress. History of nausea, stomach
aches and GI turmoil with stress since childhood – worse with anxiety.
SLEEP ok – nocturia, up recently at 4:00 a few times.
ENERGY Afternoon slump even before pregnancy. Not right after eating.
EYES AND VISION poor night vision, even with glasses. No floaters.
EARS AND HEARING ok
CHEST & BREATHING occasionally/rarely palpitations – skips a beat.
HEAD & BODY tense back of neck
OBGYN & LIBIDO Cramps – mild to moderate, occasionally take ibu, heat helps.
PMS – irritable and sl bloated.
EMOTIONS – ELEMENTAL PHYSICAL Anxiety, a little sensitive, type A
HARA pregnant24/01/2024, 12:10Case where H+ and Liv+ did not work well at all – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-where-h-and-liv-did-not-work-well-at-all/774/print3/4
TONGUE red tip, slight purple hue – later visits pale purple, puffy, toothmarks
PULSE moderate, sometimes a bit wiry and/or fuller in guan (esp L)
Note: Feb 8 (first trimester) HCT 34.9 then in June (end of 2nd trimester) HCT 33.9 and she had swelling of
fingers and face April 17. At that time I gave her Dang Gui and Peony Decoction that she took through her second
and third trimester and she did great with that formula.
KristinWisgirda: December 6, 2019, 12:48am
Thanks for sharing the case @kellykd
Have you seen this: Case Study Format ?
It has a couple of tools that can really sharpen your Saam observation and diagnosis, as well as help all of us see
your patient better. The first tool is listing all of the channels and assigning all of the symptoms to a
channel/channels. Grading the symptoms on a 1-10+ scale helps to. 10+ is extreme, 1+ is mild. Listing all of the
channel hopefully inspires you to consider all of the channels. In this case, I am really interested in the SI/K axis,
especially since she is postpartum and the delivery process was a shit show. How pretty is she? Is she into herself?
How fertile? Any blood stasis signs- varicosities, significant history of menstrual irregularities/pain/pms? Status of
the medial heel?
As well adding her presentation during pregnancy makes it more confusing, unless it is standout information like
the csection.
The second tool is noting what is the grossest part of the presentation that day. What is the biggest thing in the
room? This may or may not be the chief complaint.
I know it took lots of time to write up such a detailed case. Completing these 2 tasks likely will help you see your
patient better and will enable the group to give you better feedback.
kellykd: December 6, 2019, 12:57am
thanks Kristin
Yes, I have seen the case study format and have started using it, but started after this patient’s initial intake. It’s
harder to covert an old one than to do it on a new person. I’m working on it Sorry that my intake was not clear.
I just saw her again this afternoon and I can give you a quick update. Then maybe I can try to redo her intake next
week.
I decided to try UB+. She did not feel good – anxious – and I immediately took them out. I then did SI+ and she
immediately felt good – her thinking was clear, vision was clear, speech was easy and she was relaxed. OK great!
Then she had a rush of anxiety, but then it went away. Then she became flushed and hot in the face, anxious energy
was going up and very nauseous. This time she mentioned fear. She went to the bathroom and had loose stools. Oy
vey!24/01/2024, 12:10Case where H+ and Liv+ did not work well at all – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-where-h-and-liv-did-not-work-well-at-all/774/print4/4
So, I am now thinking about K+ as a possibility but will do as you suggested with her intake before deciding for
sure.
a few notes to fill in – she is pretty but not drop dead gorgeous. I think quite fertile – no problem getting pregnant
2x. No noticeable varicose veins. I would not say she is overly into herself – but I haven’t seen any lack of love for
herself either.
KristinWisgirda #4December 6, 2019, 1:26pm
kellykd:
It’s harder to covert an old one than to do it on a new person.
For sure! With my long term patients, too much history and my habitual way of perceiving them can cloud the
picture.
kellykd:
will do as you suggested with her intake before deciding for sure.
Great! Given the power of Saam and her reactions to treatment, it would be good to slow things down and even use
another system until you have sorted out her presentation.
At each treatment ask yourself what channel qualities would really benefit her system at this moment.
Clinic is hard!