post-op ankle pain

[Guest guest]

I'd very much appreciate any insight from my esteemed colleagues:

My patient is a 41 year-old female suffering from post-op ankle pain

since this past winter. She had sprained her ankle about four years

ago & due to the pain she underwent surgery this year to " release a

pinched nerve. " She thinks the doctor snipped a tendon to release

the pressure in the area but is not sure. Scarring is present along

the kidney channel on the medial portion of the foot toward the

medial malleolus. I've treated her three times to not much success.

I just recently used e-stim.

 

She describes the pain as achy & sore, especially upon palpation &

definitely worse at the end of the day. ROM is normal. Most painful

area is around KI2. Her diagnosis: local Qi & blood stag w/

constitutional SP Qi xu with damp & wind stirring. She is moderately

overweight, a solid, stocky woman but no puffiness or edema. She

suffers from chronic migraines which she wakes up with. I'm

suggesting a modified Ban xia bai zhu tian ma tang after we see some

progress w/ the foot. She comes in once/week.

 

It's been a little frustrating not having seen even the slightest

change in the foot so I hope some of you may have a different

approach you could suggest. In fact, any insight would be most

welcome.

 

Many thanks,

Ehanu

[Guest guest]

Ehanu,

I feel very much for you and your case here, I have had a similar thing before

in my clinic. I won't comment on your diagnosis at all, just the ankle pain.

Stick some moxa on it! A lot! And things do take time.

 

ehanula <resonanthand wrote: I'd

very much appreciate any insight from my esteemed colleagues:

My patient is a 41 year-old female suffering from post-op ankle pain

since this past winter. She had sprained her ankle about four years

ago & due to the pain she underwent surgery this year to " release a

pinched nerve. " She thinks the doctor snipped a tendon to release

the pressure in the area but is not sure. Scarring is present along

the kidney channel on the medial portion of the foot toward the

medial malleolus. I've treated her three times to not much success.

I just recently used e-stim.

 

She describes the pain as achy & sore, especially upon palpation &

definitely worse at the end of the day. ROM is normal. Most painful

area is around KI2. Her diagnosis: local Qi & blood stag w/

constitutional SP Qi xu with damp & wind stirring. She is moderately

overweight, a solid, stocky woman but no puffiness or edema. She

suffers from chronic migraines which she wakes up with. I'm

suggesting a modified Ban xia bai zhu tian ma tang after we see some

progress w/ the foot. She comes in once/week.

 

It's been a little frustrating not having seen even the slightest

change in the foot so I hope some of you may have a different

approach you could suggest. In fact, any insight would be most

welcome.

 

Many thanks,

Ehanu

 

 

 

 

 

 

 

Building a website is a piece of cake.

Small Business gives you all the tools to get online.

 

 

[Guest guest]

Dear Ehanu,

1) what points have you used thus far? which points did you connect to

e-stim?

 

2) it is hard to make assessment without understanding what the surgery

entailed. is there a post-op MRI report? this will help to confirm your

patient's suspicions about the tendon damage.

 

3) also once a week acupuncture is not very much if that is her only source

of pain management. perhaps offer her a 2nd shorter treatment free, or give

her some topical herbal liniment like " Zheng Gu Shui " or " Yun Nan Bai Yao "

topical spray to apply daily, or give her some ear balls. Some way to keep

the therapy going in between her weekly acupuncture sessions.

 

4) in my experience, acupuncture tends to provide some temporary pain relief

and speed up healing, but tui-na massage and bonesetting is what gives the

most profound effect for a majority of orthopedic conditions. In this case,

it may be necessary to do a little gua sha to break down the scar tissue. It

is quite likely that her ankle joint needs manual adjustment. So if you're

not trained in this, it would be wise to send her to a manual therapist like

D.C., D.O., or a massage therapist with special training in injuries or

post-op pain. if you can get her to schedule acupuncture and manual therapy

appointments back-to-back, of course that would be ideal.

 

5) also is she undergoing physical therapy? achey/soreness may be related to

joint instability or weakness.

 

just some ideas to consider...

 

~edith

 

--

Edith Chan, L.Ac.

Phone: 415.298.5324

www.EdithChanAcupuncture.com

 

On 10/10/07, ehanula <resonanthand wrote:

>

> I'd very much appreciate any insight from my esteemed colleagues:

> My patient is a 41 year-old female suffering from post-op ankle pain

> since this past winter. She had sprained her ankle about four years

> ago & due to the pain she underwent surgery this year to " release a

> pinched nerve. " She thinks the doctor snipped a tendon to release

> the pressure in the area but is not sure. Scarring is present along

> the kidney channel on the medial portion of the foot toward the

> medial malleolus. I've treated her three times to not much success.

> I just recently used e-stim.

>

> She describes the pain as achy & sore, especially upon palpation &

> definitely worse at the end of the day. ROM is normal. Most painful

> area is around KI2. Her diagnosis: local Qi & blood stag w/

> constitutional SP Qi xu with damp & wind stirring. She is moderately

> overweight, a solid, stocky woman but no puffiness or edema. She

> suffers from chronic migraines which she wakes up with. I'm

> suggesting a modified Ban xia bai zhu tian ma tang after we see some

> progress w/ the foot. She comes in once/week.

>

> It's been a little frustrating not having seen even the slightest

> change in the foot so I hope some of you may have a different

> approach you could suggest. In fact, any insight would be most

> welcome.

>

> Many thanks,

> Ehanu

>

>

>

 

 

 

[Guest guest]

Hi Ehanu!

Some thoughts:

I don't get a clear feeling as to your diagnosis being one of excess or

deficiency. Some more info there would be useful. I know you said sp qi xu, but

how does that fit in with everything?

This is at least a four year condition. Why you would expect results after

three treatments is beyond me . I would also be interested to know know what

happened directly following the surgery - did she get any better? What got

better? What stayed the same? Did anything get worse? What changed?

If the pain is worse at K2, did you think of treating according to point

functions? i.e. Moxa to tonify Kidney Yang is what jumped out at me.

 

Hugo

 

 

ehanula <resonanthand

Chinese Medicine

Wednesday, 10 October, 2007 11:50:25 AM

post-op ankle pain

 

 

 

 

 

 

 

 

 

 

 

 

 

I'd very much appreciate any insight from my esteemed colleagues:

 

My patient is a 41 year-old female suffering from post-op ankle pain

 

since this past winter. She had sprained her ankle about four years

 

ago & due to the pain she underwent surgery this year to " release a

 

pinched nerve. " She thinks the doctor snipped a tendon to release

 

the pressure in the area but is not sure. Scarring is present along

 

the kidney channel on the medial portion of the foot toward the

 

medial malleolus. I've treated her three times to not much success.

 

I just recently used e-stim.

 

 

 

She describes the pain as achy & sore, especially upon palpation &

 

definitely worse at the end of the day. ROM is normal. Most painful

 

area is around KI2. Her diagnosis: local Qi & blood stag w/

 

constitutional SP Qi xu with damp & wind stirring. She is moderately

 

overweight, a solid, stocky woman but no puffiness or edema. She

 

suffers from chronic migraines which she wakes up with. I'm

 

suggesting a modified Ban xia bai zhu tian ma tang after we see some

 

progress w/ the foot. She comes in once/week.

 

 

 

It's been a little frustrating not having seen even the slightest

 

change in the foot so I hope some of you may have a different

 

approach you could suggest. In fact, any insight would be most

 

welcome.

 

 

 

Many thanks,

 

Ehanu

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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[Guest guest]

Not sure I understand why you state she has spleen xu with damp but then

have no edema (maybe she has other damp signs, no?) Have you considered the

kidney as a possible or for that matter maybe a tendino-muscular channel as

being the primary? If possible I would lightly press on kid 2 or maybe she

already has pain there and look for kid 7 and 10 to reduce it by at least

half. Then needle these locations at the same depth as you applied

pressure. You might also check out the possibility of blood stasis.

Hope this helps. Mike W. Bowser, L Ac

 

 

:

resonanthand: Wed, 10 Oct 2007 18:50:25 +0000TCM -

post-op ankle pain

 

 

 

 

I'd very much appreciate any insight from my esteemed colleagues:My patient is a

41 year-old female suffering from post-op ankle pain since this past winter. She

had sprained her ankle about four years ago & due to the pain she underwent

surgery this year to " release a pinched nerve. " She thinks the doctor snipped a

tendon to release the pressure in the area but is not sure. Scarring is present

along the kidney channel on the medial portion of the foot toward the medial

malleolus. I've treated her three times to not much success. I just recently

used e-stim.She describes the pain as achy & sore, especially upon palpation &

definitely worse at the end of the day. ROM is normal. Most painful area is

around KI2. Her diagnosis: local Qi & blood stag w/ constitutional SP Qi xu with

damp & wind stirring. She is moderately overweight, a solid, stocky woman but no

puffiness or edema. She suffers from chronic migraines which she wakes up with.

I'm suggesting a modified Ban xia bai zhu tian ma tang after we see some

progress w/ the foot. She comes in once/week.It's been a little frustrating not

having seen even the slightest change in the foot so I hope some of you may have

a different approach you could suggest. In fact, any insight would be most

welcome.Many thanks,Ehanu

 

 

_______________

Boo! Scare away worms, viruses and so much more! Try Windows Live OneCare!

http://onecare.live.com/standard/en-us/purchase/trial.aspx?s_cid=wl_hotmailnews

 

 

[Guest guest]

I see you have quite a few responses with different ideas. One more country

heard from - the balance method of Dr. Tan's. The ankle and the wrist are

mirrors for one another. If the incision was on the Ki channel and there is

pain at KI 2, needle the HT channel on the opposite wrist. Use Ashi points to

determine the most sensitive areas on the channel. Use thin needles - may need

guide tube, if you are on the palm. You can also use TH on either side, BL on

opposite side, Colon on either side and PC on opposite side. I would start with

HT and PC on opposite side. Have one intention at a time. I use the other

channels when I am creating an yin yang balance.

 

Just stay simple with the opposite wrist first. Touch the ankle before you put

the needles in and get a level of pain and exactly where it is. Then after you

put a few needles in sensitive Ashi points, recheck the level of pain. You can

do this shortly after you put the needles in. If you are in the right place, she

should feel some relief immediately. You can always keep trying Ashi's on those

HT and PC channels. If nothing is moving try the TH and Colon, then Bladder.

You may find it moves with the first set - then I would leave well enough alone,

twirl the needles some during the treatment. Ask if the pain moved - and it

might have - again do Ashi to get to it.

 

Oh, I know it is cookbook sounding. There is some real theory behind it, but

that is classes deep. If it works to get her out of pain now, then go for it.

 

Also pursure everyone else's coments.

 

Scar treatments on the side of the scar can also be very good . I would do it

in a separte tx from the one above. I agree to use yunnan baiyao in between.

The patches are great for pain relief. Also twice a week would be good if she

can get in.

 

Good luck,

 

Anne

 

-------------- Original message ----------------------

" ehanula " <resonanthand

> I'd very much appreciate any insight from my esteemed colleagues:

> My patient is a 41 year-old female suffering from post-op ankle pain

> since this past winter. She had sprained her ankle about four years

> ago & due to the pain she underwent surgery this year to " release a

> pinched nerve. " She thinks the doctor snipped a tendon to release

> the pressure in the area but is not sure. Scarring is present along

> the kidney channel on the medial portion of the foot toward the

> medial malleolus. I've treated her three times to not much success.

> I just recently used e-stim.

>

> She describes the pain as achy & sore, especially upon palpation &

> definitely worse at the end of the day. ROM is normal. Most painful

> area is around KI2. Her diagnosis: local Qi & blood stag w/

> constitutional SP Qi xu with damp & wind stirring. She is moderately

> overweight, a solid, stocky woman but no puffiness or edema. She

> suffers from chronic migraines which she wakes up with. I'm

> suggesting a modified Ban xia bai zhu tian ma tang after we see some

> progress w/ the foot. She comes in once/week.

>

> It's been a little frustrating not having seen even the slightest

> change in the foot so I hope some of you may have a different

> approach you could suggest. In fact, any insight would be most

> welcome.

>

> Many thanks,

> Ehanu

>

>

 

 

 

 

 

[Guest guest]

How recent was the surgery? If there's scarring I will assume is

been some time ago. Have you tried Tui Na? If not, you might want

to consider it. It will probably be uncomfortable while its being

applied, but then again, that's Tui Na. While doing it, I would

recommend unit a liniment or Tiger Balm, and I would pay attention to

the area on the sole of the foot, between SP4 and KD2. Chances are

you'll find a ball of stagnation that will be quite ashi. Work it

and the whole foot. It will hurt, but also feel good, and after you

finish have your patient walk on it. You and she might be pleasantly

surprised. Don't forget to rectify the toes, releasing the jing-well

points.

 

Chinese Medicine , Dan Redfern

<corotcm wrote:

>

> Ehanu,

> I feel very much for you and your case here, I have had a similar

thing before in my clinic. I won't comment on your diagnosis at all,

just the ankle pain.

> Stick some moxa on it! A lot! And things do take time.

>

> ehanula <resonanthand wrote:

I'd very much appreciate any insight from my esteemed colleagues:

> My patient is a 41 year-old female suffering from post-op ankle

pain

> since this past winter. She had sprained her ankle about four

years

> ago & due to the pain she underwent surgery this year to " release

a

> pinched nerve. " She thinks the doctor snipped a tendon to release

> the pressure in the area but is not sure. Scarring is present

along

> the kidney channel on the medial portion of the foot toward the

> medial malleolus. I've treated her three times to not much

success.

> I just recently used e-stim.

>

> She describes the pain as achy & sore, especially upon palpation &

> definitely worse at the end of the day. ROM is normal. Most

painful

> area is around KI2. Her diagnosis: local Qi & blood stag w/

> constitutional SP Qi xu with damp & wind stirring. She is

moderately

> overweight, a solid, stocky woman but no puffiness or edema. She

> suffers from chronic migraines which she wakes up with. I'm

> suggesting a modified Ban xia bai zhu tian ma tang after we see

some

> progress w/ the foot. She comes in once/week.

>

> It's been a little frustrating not having seen even the slightest

> change in the foot so I hope some of you may have a different

> approach you could suggest. In fact, any insight would be most

> welcome.

>

> Many thanks,

> Ehanu

 

> Building a website is a piece of cake.

> Small Business gives you all the tools to get online.

>

>

[Guest guest]

I agree with all of the questions posted thusfar and would add that i

would use external liniments as well. One of the factors that was not

posted was how long ago the surgery was and what improvement was derived.

I have seen Traumeel work well in post-op cases, this reduces

inflammation and appears to stimulate a healing response.

Also, Zheng Gu Shui to treat the scar tissue with cross friction

manual work, this should help as well.

Lastly, she can soak her feet in magnesium (epsom salt), this can be

rather miraculous with some patients, the water should be pretty hot

to open the pores, but is useful as it can be done while watching TV,

reading, etc.

Regards, Tymothy

[Guest guest]

Ehanu,

A female age 41 complains her ankle pain and went through surgery.

Pain , achy and sore upon palpation. ROM is normal, most painful is

around K2. Diagnosis is Qi and blood stagnation with Sp def with damp

and wind. Chronic migraine headache was prescribed with Modified

BanXia BaiZhu Tian Ma Tang with some progress w/ foot.

This is a strange diagnosis.

My questions : How did she get the pain that she was considered as

sprained ankle? Did she get X-ray? After the sprained, the pain came

in soon or after a long time ? Did it swell up ? What kind of

treatments were given after that ? Did it get better or worse after

treatment? What did her doc say it was before he suggested surgery ?

After surgery the pain remain the same or worse ??? and Why ? Any

medication is taking for subdue the pain ? How long does it last ?

Does the pain get worse when she wear some special shoes? or with

barefoot ? Does it get worse when you twist or turn her anknle ? Does

it get worse when you apply pressure from her toes inward, lightly and

hardly ? Does it get worse when she stand up with tiptoes? or when she

lying with her foot raised, turned ? And if any pain or any tender

either localized or radiated we must no where it starts and where it

ends ? When we know where it starts we can apply our finger pressure

to find where it is " on surface or in deep tissue " . When such

pressure is applied does it radiate ? At the end of radiating site we

can applied fingure pressure again and move up and down to see if it

continue further? REMEMBER ABOUT THE MERIDIAN ! DO NOT LOSE SIGHT.

If this has not been operated , our chance of success is favorable.

Otherwise, it depends. For TCM, we should bear this in mind. The

extremities root in the body trunk. Find a meridian, choose a point

within a trunk is a key for needle stimualtion, a site of pain should

be massaged in deep or on surface according to the bearable of pain

level. If successful is too slow, tonify S36 or moxa Du4. I believe

good judgment, diagnosis and treatment here will relieve the pain

immediately.

The needle stimulation from the trunk to active Qi and move it to

the site of pain, but in order for this Qi to follow your command you

must massage the site, twist and turn to make it return to it proper

place............... ANYHOW , Do not forget to ask about her shoes or

what kinds or device that makes her pain worse. Get rid of it.

I do not see SP xu, beside, it does not have to do with Organ

deficiency here as it stated that from sprained ankle. If this

statement was made with our patient, she would look at us as an alien

for she knew it was a sprained.

For migraines you TCM can claim whatever you want for she, a

aptient, does not know a thing what you are saying... Beside, you can

tell us TCM that her Liver Blood deficiency, Liver Yin deficiency,

Liver Wind, Liver Fire uprising, damp and phlegm we will not argue

with you either because we do not understand what you are saying for

the symptoms are not sufficient here.

Ban Xia BaiZhu Tian Ma Tang is a formular for clearing damp ,

phlegm and wind... Will this formula deplete your patient's Qi ?

BECAREFUL !!! She may feel better, but look forward to see millions of

other symptoms arise. When Qi is depleted, infinitive of problems

arise depend upon how bad it is..... Why are we not choosing a formula

that may help activating Qi and tonifying Qi such as Chai Hu, Bai

Shao, San Qi with Dang Gui, Huang Qi, Ge Gen ?

Are we undestanding that Baizhu, Ren Shen, Gan Cao tonify Qi and

resolve damp and phlegm, ignoring them use Ban Xia and Tian Ma is a

risky business.

 

GOOD LUCK Ehanu,

 

Nam Nguyen

[Guest guest]

Thank you all for your ideas. I diagnosed her w/ constitutional SP xu

& damp based on various s/s... pale, puffy tongue (esp. down

midline), w/teethmarks, white coat, sl. greasy mid-back. She suffers

from fatigue, some mental fogginess & mild digestive issues such as

bloating & occ. soft BMs.

 

I used estim locally on Kd2 (just lateral to the scar) to Kd3, and

UB60 to UB59. At the time I wasn't able to use moxa so I used a

liquid moxa liniment with heat. The Kd2 sensitivity reflecting yang

xu has me intrigued so I will investigate that further. She didn't

present with any typical yang s/s so I ruled it out.

 

Unfortunately no imaging has been done since the surgery so I'm still

not entirely sure what the procedure entailed. She is bringing in

some pre-op paperwork so hopefully that will shed some light on the

picture.

 

Regards,

e

 

 

Chinese Medicine , anne.crowley

wrote:

>

> I see you have quite a few responses with different ideas. One

more country heard from - the balance method of Dr. Tan's. The ankle

and the wrist are mirrors for one another. If the incision was on

the Ki channel and there is pain at KI 2, needle the HT channel on

the opposite wrist. Use Ashi points to determine the most sensitive

areas on the channel. Use thin needles - may need guide tube, if you

are on the palm. You can also use TH on either side, BL on opposite

side, Colon on either side and PC on opposite side. I would start

with HT and PC on opposite side. Have one intention at a time. I

use the other channels when I am creating an yin yang balance.

>

> Just stay simple with the opposite wrist first. Touch the ankle

before you put the needles in and get a level of pain and exactly

where it is. Then after you put a few needles in sensitive Ashi

points, recheck the level of pain. You can do this shortly after you

put the needles in. If you are in the right place, she should feel

some relief immediately. You can always keep trying Ashi's on those

HT and PC channels. If nothing is moving try the TH and Colon, then

Bladder. You may find it moves with the first set - then I would

leave well enough alone, twirl the needles some during the

treatment. Ask if the pain moved - and it might have - again do Ashi

to get to it.

>

> Oh, I know it is cookbook sounding. There is some real theory

behind it, but that is classes deep. If it works to get her out of

pain now, then go for it.

>

> Also pursure everyone else's coments.

>

> Scar treatments on the side of the scar can also be very good . I

would do it in a separte tx from the one above. I agree to use

yunnan baiyao in between. The patches are great for pain relief.

Also twice a week would be good if she can get in.

>

> Good luck,

>

> Anne

>

> -------------- Original message ----------------------

> " ehanula " <resonanthand

> > I'd very much appreciate any insight from my esteemed colleagues:

> > My patient is a 41 year-old female suffering from post-op ankle

pain

> > since this past winter. She had sprained her ankle about four

years

> > ago & due to the pain she underwent surgery this year to " release

a

> > pinched nerve. " She thinks the doctor snipped a tendon to release

> > the pressure in the area but is not sure. Scarring is present

along

> > the kidney channel on the medial portion of the foot toward the

> > medial malleolus. I've treated her three times to not much

success.

> > I just recently used e-stim.

> >

> > She describes the pain as achy & sore, especially upon palpation

&

> > definitely worse at the end of the day. ROM is normal. Most

painful

> > area is around KI2. Her diagnosis: local Qi & blood stag w/

> > constitutional SP Qi xu with damp & wind stirring. She is

moderately

> > overweight, a solid, stocky woman but no puffiness or edema. She

> > suffers from chronic migraines which she wakes up with. I'm

> > suggesting a modified Ban xia bai zhu tian ma tang after we see

some

> > progress w/ the foot. She comes in once/week.

> >

> > It's been a little frustrating not having seen even the slightest

> > change in the foot so I hope some of you may have a different

> > approach you could suggest. In fact, any insight would be most

> > welcome.

> >

> > Many thanks,

> > Ehanu

> >

> >

>

>

>

>

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[Guest guest]

Debbie Shapiro's new Cd on what your body health or dis ease is trying to tell

you, refers to pain and ankle injuries,bone vs soft tissue and even the location

and severity and repeatability.I believe, as this was only by first listen

through, that the ankles were about the grounding and the direction your life

was going in.I know this answer is not strictly TCM but in actuality it

is.Emotions trapped in the body cause the physical manifestation of the dis ease

or harmony imbalance.So since this woman had this problem even before, the

root......................of the problem is the suppressed,oppressed,or dnied

biological/emotional conflict.Sincerely,Patricia Jordan DVM,CVA,CTCVM &

Herbology

 

 

:

resonanthand: Wed, 10 Oct 2007 18:50:25 +0000TCM -

post-op ankle pain

 

 

 

 

I'd very much appreciate any insight from my esteemed colleagues:My patient is a

41 year-old female suffering from post-op ankle pain since this past winter. She

had sprained her ankle about four years ago & due to the pain she underwent

surgery this year to " release a pinched nerve. " She thinks the doctor snipped a

tendon to release the pressure in the area but is not sure. Scarring is present

along the kidney channel on the medial portion of the foot toward the medial

malleolus. I've treated her three times to not much success. I just recently

used e-stim.She describes the pain as achy & sore, especially upon palpation &

definitely worse at the end of the day. ROM is normal. Most painful area is

around KI2. Her diagnosis: local Qi & blood stag w/ constitutional SP Qi xu with

damp & wind stirring. She is moderately overweight, a solid, stocky woman but no

puffiness or edema. She suffers from chronic migraines which she wakes up with.

I'm suggesting a modified Ban xia bai zhu tian ma tang after we see some

progress w/ the foot. She comes in once/week.It's been a little frustrating not

having seen even the slightest change in the foot so I hope some of you may have

a different approach you could suggest. In fact, any insight would be most

welcome.Many thanks,Ehanu

 

 

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