Guest guest Posted May 17, 2009 Report Share Posted May 17, 2009 Hi all; I wonder if anybody has ideas, research, knowledge etc about the phenomenon of improved s & s, and bloodwork that overall hasn't improved, or that retains one or two values very much outside normal levels. I've always viewed it as a function of not having yet left the diseased territory and merely having established balance within the diseased territory, and so it has always been a matter of time to reverse course, as ti were, and travel back towards a territory of health, but I wonder if anyoen has a distinct viewpoint. I have a patient with a dx of rheumatoid arhtritis who embodies this for me. Her overall presentation has changed dramatically insofar as her complaint goes (moderate atrophy of the right leg, adhesion of the right hip joint with highly impaired ROM and strength, burning pains in legs (GB channel), trouble sleeping, heavy fatigue), but her overall CM assessment remains the same (qi def / liv blood-yin def), and she retains an unchanged sedimentation rate of about 70 - 100 for many years. Methotrexate and other anti-inflammatories have not affected the value. Her rheumatologists generally make the statement that she is atypical. Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue body, low gloss and a stubborn thorny area (light red) in the heart portion. Her tongue when I met her was slightly fat, flabby pale body, med to thick white coating, slightly greasy, sometimes dry and sometimes moist, pale thorniness at heart area, scalloping and med gloss. Her pulses are generally soft or soggy, weakest being at lower positions, left hand weaker than right, top left being thready at times, and pulses overall can sometimes have a bounding quality. My assessment is that, despite the dramatic relative change for the better in the last 2 years after 20 years of stability, she still has only moved about 1/5 of the distance she needs to. Thanks for any insight, Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2009 Report Share Posted May 18, 2009 Hi Hugo, I've recently treated two patients with Rheumatoid Arthritis and they both improved a lot, to the point they didn't need to take any more western medicines. Or so they thought. A check-up revealed a more active rheumatoid factor in both cases, although they were nearly symptom-free. So instead of dropping some of their medications, they had to increase them. I have no explanation for this, just that I have encountered the same thing in my practice. So what is more important? The blood work, or the MRI-scans, ...or what the patient feels. Can somebody explain the significance of the rheumatoid factor being present in the blood? Must it be eliminated at all cost? I know there are false positives, but how does one go about this in the clinical field? Thank you, Tom. Tom Verhaeghe Stationsplein 59 8770 Ingelmunster www.chinese-geneeskunde.be _____ Chinese Medicine Chinese Medicine On Behalf Of Hugo Ramiro zondag 17 mei 2009 21:20 Chinese Medicine Non-responsive bloodwork Hi all; I wonder if anybody has ideas, research, knowledge etc about the phenomenon of improved s & s, and bloodwork that overall hasn't improved, or that retains one or two values very much outside normal levels. I've always viewed it as a function of not having yet left the diseased territory and merely having established balance within the diseased territory, and so it has always been a matter of time to reverse course, as ti were, and travel back towards a territory of health, but I wonder if anyoen has a distinct viewpoint. I have a patient with a dx of rheumatoid arhtritis who embodies this for me. Her overall presentation has changed dramatically insofar as her complaint goes (moderate atrophy of the right leg, adhesion of the right hip joint with highly impaired ROM and strength, burning pains in legs (GB channel), trouble sleeping, heavy fatigue), but her overall CM assessment remains the same (qi def / liv blood-yin def), and she retains an unchanged sedimentation rate of about 70 - 100 for many years. Methotrexate and other anti-inflammatories have not affected the value. Her rheumatologists generally make the statement that she is atypical. Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue body, low gloss and a stubborn thorny area (light red) in the heart portion. Her tongue when I met her was slightly fat, flabby pale body, med to thick white coating, slightly greasy, sometimes dry and sometimes moist, pale thorniness at heart area, scalloping and med gloss. Her pulses are generally soft or soggy, weakest being at lower positions, left hand weaker than right, top left being thready at times, and pulses overall can sometimes have a bounding quality. My assessment is that, despite the dramatic relative change for the better in the last 2 years after 20 years of stability, she still has only moved about 1/5 of the distance she needs to. Thanks for any insight, Hugo ________________________________ Hugo Ramiro http://middlemedici <http://middlemedicine.wordpress.com> ne.wordpress.com http://www.chinesem <http://www.chinesemedicaltherapies.org> edicaltherapies.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 18, 2009 Report Share Posted May 18, 2009 Tom - I have started to explore this with a couple of patients. I think its very complex and ultimately requires a high level of interaction between you and the rheumatologist/physician. I think there is a lot of dynamism at play and precisely when the blood tests were taken in relationship to when (a) they got their acupuncture, (b) they got any major dosages of medication and © any other highly punctuated events took place - all is important to really get a picture of what is going on. I have been working with an RA patient this year and even though her pain level was going way down and she was looking better than ever with regular acupuncture, a few blood tests suggested markers in the blood were worsening - but when I considered the blood tests in relationship to when she got hit with major dosages of some intense meds, I became suspicious. I was lucky to find her family practitioner was amenable to having her blood checked precisely three days after three consecutive acupuncture teratments (its my suspicion that 2-3 days after acupuncture represents the peak effect) - and sure enough at those points in time, her blood markers were remarkably reduced - I think with these patients its a highly dynamic picture and ultimately, we need a very good relationship with the docs, regular blood tests strategically scheduled over several months to really get a handle on what is taking place and how the body is responding to acupuncture, meds and other inputs and events. A couple of random blood tests is, I suspect, mostly noise and little of value. Regards Daniel -- In Chinese Medicine , " Tom Verhaeghe " <tom.verhaeghe wrote: > > Hi Hugo, > > > > I've recently treated two patients with Rheumatoid Arthritis and they both > improved a lot, to the point they didn't need to take any more western > medicines. Or so they thought. A check-up revealed a more active rheumatoid > factor in both cases, although they were nearly symptom-free. So instead of > dropping some of their medications, they had to increase them. > > > > I have no explanation for this, just that I have encountered the same thing > in my practice. So what is more important? The blood work, or the MRI-scans, > ..or what the patient feels. Can somebody explain the significance of the > rheumatoid factor being present in the blood? Must it be eliminated at all > cost? I know there are false positives, but how does one go about this in > the clinical field? > > > > Thank you, > > > > Tom. > > > > Tom Verhaeghe > > Stationsplein 59 > > 8770 Ingelmunster > > www.chinese-geneeskunde.be > > _____ > > Chinese Medicine > Chinese Medicine On Behalf Of Hugo > Ramiro > zondag 17 mei 2009 21:20 > Chinese Medicine > Non-responsive bloodwork > > Hi all; > > I wonder if anybody has ideas, research, knowledge etc about the phenomenon > of improved s & s, and bloodwork that overall hasn't improved, or that retains > one or two values very much outside normal levels. > > I've always viewed it as a function of not having yet left the diseased > territory and merely having established balance within the diseased > territory, and so it has always been a matter of time to reverse course, as > ti were, and travel back towards a territory of health, but I wonder if > anyoen has a distinct viewpoint. > > I have a patient with a dx of rheumatoid arhtritis who embodies this for me. > Her overall presentation has changed dramatically insofar as her complaint > goes (moderate atrophy of the right leg, adhesion of the right hip joint > with highly impaired ROM and strength, burning pains in legs (GB channel), > trouble sleeping, heavy fatigue), but her overall CM assessment remains the > same (qi def / liv blood-yin def), and she retains an unchanged > sedimentation rate of about 70 - 100 for many years. Methotrexate and other > anti-inflammatories have not affected the value. Her rheumatologists > generally make the statement that she is atypical. > > Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue > body, low gloss and a stubborn thorny area (light red) in the heart portion. > Her tongue when I met her was slightly fat, flabby pale body, med to thick > white coating, slightly greasy, sometimes dry and sometimes moist, pale > thorniness at heart area, scalloping and med gloss. > Her pulses are generally soft or soggy, weakest being at lower positions, > left hand weaker than right, top left being thready at times, and pulses > overall can sometimes have a bounding quality. > My assessment is that, despite the dramatic relative change for the better > in the last 2 years after 20 years of stability, she still has only moved > about 1/5 of the distance she needs to. > > Thanks for any insight, > > Hugo > > ________________________________ > Hugo Ramiro > http://middlemedici <http://middlemedicine.wordpress.com> ne.wordpress.com > http://www.chinesem <http://www.chinesemedicaltherapies.org> > edicaltherapies.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 Thank you for your observation, Danie. I will keep that in mind. Tom Verhaeghe Stationsplein 59 8770 Ingelmunster www.chinese-geneeskunde.be _____ Chinese Medicine Chinese Medicine On Behalf Of Daniel Schulman maandag 18 mei 2009 21:17 Chinese Medicine Re: Non-responsive bloodwork Tom - I have started to explore this with a couple of patients. I think its very complex and ultimately requires a high level of interaction between you and the rheumatologist/physician. I think there is a lot of dynamism at play and precisely when the blood tests were taken in relationship to when (a) they got their acupuncture, (b) they got any major dosages of medication and © any other highly punctuated events took place - all is important to really get a picture of what is going on. I have been working with an RA patient this year and even though her pain level was going way down and she was looking better than ever with regular acupuncture, a few blood tests suggested markers in the blood were worsening - but when I considered the blood tests in relationship to when she got hit with major dosages of some intense meds, I became suspicious. I was lucky to find her family practitioner was amenable to having her blood checked precisely three days after three consecutive acupuncture teratments (its my suspicion that 2-3 days after acupuncture represents the peak effect) - and sure enough at those points in time, her blood markers were remarkably reduced - I think with these patients its a highly dynamic picture and ultimately, we need a very good relationship with the docs, regular blood tests strategically scheduled over several months to really get a handle on what is taking place and how the body is responding to acupuncture, meds and other inputs and events. A couple of random blood tests is, I suspect, mostly noise and little of value. Regards Daniel -- In Traditional_ <Chinese Medicine%40> Chinese_Medicine , " Tom Verhaeghe " <tom.verhaeghe wrote: > > Hi Hugo, > > > > I've recently treated two patients with Rheumatoid Arthritis and they both > improved a lot, to the point they didn't need to take any more western > medicines. Or so they thought. A check-up revealed a more active rheumatoid > factor in both cases, although they were nearly symptom-free. So instead of > dropping some of their medications, they had to increase them. > > > > I have no explanation for this, just that I have encountered the same thing > in my practice. So what is more important? The blood work, or the MRI-scans, > ..or what the patient feels. Can somebody explain the significance of the > rheumatoid factor being present in the blood? Must it be eliminated at all > cost? I know there are false positives, but how does one go about this in > the clinical field? > > > > Thank you, > > > > Tom. > > > > Tom Verhaeghe > > Stationsplein 59 > > 8770 Ingelmunster > > www.chinese-geneeskunde.be > > _____ > > Traditional_ <Chinese Medicine%40> Chinese_Medicine > [Traditional_ <Chinese Medicine%40> Chinese_Medicine ] On Behalf Of Hugo > Ramiro > zondag 17 mei 2009 21:20 > Traditional_ <Chinese Medicine%40> Chinese_Medicine > Non-responsive bloodwork > > Hi all; > > I wonder if anybody has ideas, research, knowledge etc about the phenomenon > of improved s & s, and bloodwork that overall hasn't improved, or that retains > one or two values very much outside normal levels. > > I've always viewed it as a function of not having yet left the diseased > territory and merely having established balance within the diseased > territory, and so it has always been a matter of time to reverse course, as > ti were, and travel back towards a territory of health, but I wonder if > anyoen has a distinct viewpoint. > > I have a patient with a dx of rheumatoid arhtritis who embodies this for me. > Her overall presentation has changed dramatically insofar as her complaint > goes (moderate atrophy of the right leg, adhesion of the right hip joint > with highly impaired ROM and strength, burning pains in legs (GB channel), > trouble sleeping, heavy fatigue), but her overall CM assessment remains the > same (qi def / liv blood-yin def), and she retains an unchanged > sedimentation rate of about 70 - 100 for many years. Methotrexate and other > anti-inflammatories have not affected the value. Her rheumatologists > generally make the statement that she is atypical. > > Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue > body, low gloss and a stubborn thorny area (light red) in the heart portion. > Her tongue when I met her was slightly fat, flabby pale body, med to thick > white coating, slightly greasy, sometimes dry and sometimes moist, pale > thorniness at heart area, scalloping and med gloss. > Her pulses are generally soft or soggy, weakest being at lower positions, > left hand weaker than right, top left being thready at times, and pulses > overall can sometimes have a bounding quality. > My assessment is that, despite the dramatic relative change for the better > in the last 2 years after 20 years of stability, she still has only moved > about 1/5 of the distance she needs to. > > Thanks for any insight, > > Hugo > > ________________________________ > Hugo Ramiro > http://middlemedici <http://middlemedici <http://middlemedicine.wordpress.com> ne.wordpress.com> ne.wordpress.com > http://www.chinesem <http://www.chinesem <http://www.chinesemedicaltherapies.org> edicaltherapies.org> > edicaltherapies.org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 Tom Usually the blood test is not important. RF can positive or negative in RA patients. If the sed rate is going up then you may be dealing with increased inflammation, i would pay attention. 400 29th St. Suite 419 Oakland Ca 94609 alonmarcus Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 what about hyperthyroid/graves dz? I have a patient who I have been treating for about 6 months whose symptoms have turned around/resolved (though I wouldn't think of stopping treatments) but the blood work does not reflect this and we're wondering whether or not to proceed... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 Hi Tom, thank you for your informative posts. My understanding is that the presence of the Rheumatoid Factor does not lead to a definitive diagnosis of RA. RA can be dx w or w/o RF in the blood. I sometimes think (certainly some cases seem to fit this well) that an increase in RF during treatment may be a sign of increased metabolism (Qi/heat) which will regulate in the long term. I am also not at all sure that your patients should be upping their meds. A good question to ask rheumatologists is whether treatment for a particular condition (in this case RA) is justified based on: 1. presenting s & s 2. bloodwork 3. presenting s & s and bloodwork I am pretty sure that treatment is not justified based on 2. alone. I don't believe that that is the standard of practice, because, as you say, this test not only has false positives and negatives associated with it, but also a lot of other conditions that are *associated* with an elevated RF. It is also important to note, as a colleague of mine reminds me, that Rheumatologists often like to treat aggressively and early, and often are not well justified in their treatments. I.e. " What evidence is there for pursuing the treatment of a patient with isolated elevations of RF? " Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ Tom Verhaeghe <tom.verhaeghe Chinese Medicine Monday, 18 May, 2009 14:56:52 RE: Non-responsive bloodwork Hi Hugo, I've recently treated two patients with Rheumatoid Arthritis and they both improved a lot, to the point they didn't need to take any more western medicines. Or so they thought. A check-up revealed a more active rheumatoid factor in both cases, although they were nearly symptom-free. So instead of dropping some of their medications, they had to increase them. I have no explanation for this, just that I have encountered the same thing in my practice. So what is more important? The blood work, or the MRI-scans, ...or what the patient feels. Can somebody explain the significance of the rheumatoid factor being present in the blood? Must it be eliminated at all cost? I know there are false positives, but how does one go about this in the clinical field? Thank you, Tom. Tom Verhaeghe Stationsplein 59 8770 Ingelmunster www.chinese- geneeskunde. be _____ Traditional_ Chinese_Medicine [Traditional_ Chinese_Medicine ] On Behalf Of Hugo Ramiro zondag 17 mei 2009 21:20 Non-responsive bloodwork Hi all; I wonder if anybody has ideas, research, knowledge etc about the phenomenon of improved s & s, and bloodwork that overall hasn't improved, or that retains one or two values very much outside normal levels. I've always viewed it as a function of not having yet left the diseased territory and merely having established balance within the diseased territory, and so it has always been a matter of time to reverse course, as ti were, and travel back towards a territory of health, but I wonder if anyoen has a distinct viewpoint. I have a patient with a dx of rheumatoid arhtritis who embodies this for me. Her overall presentation has changed dramatically insofar as her complaint goes (moderate atrophy of the right leg, adhesion of the right hip joint with highly impaired ROM and strength, burning pains in legs (GB channel), trouble sleeping, heavy fatigue), but her overall CM assessment remains the same (qi def / liv blood-yin def), and she retains an unchanged sedimentation rate of about 70 - 100 for many years. Methotrexate and other anti-inflammatories have not affected the value. Her rheumatologists generally make the statement that she is atypical. Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue body, low gloss and a stubborn thorny area (light red) in the heart portion. Her tongue when I met her was slightly fat, flabby pale body, med to thick white coating, slightly greasy, sometimes dry and sometimes moist, pale thorniness at heart area, scalloping and med gloss. Her pulses are generally soft or soggy, weakest being at lower positions, left hand weaker than right, top left being thready at times, and pulses overall can sometimes have a bounding quality. My assessment is that, despite the dramatic relative change for the better in the last 2 years after 20 years of stability, she still has only moved about 1/5 of the distance she needs to. Thanks for any insight, Hugo ____________ _________ _________ __ Hugo Ramiro http://middlemedici <http://middlemedici ne.wordpress. com> ne.wordpress. com http://www.chinesem <http://www.chinesem edicaltherapies. org> edicaltherapies. org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 Hi Alon: Woops, I see you beat me to the punch. I do have a question since you bring up sedimentation rate though: I may have mentioend a patient I am working with who is experiencing a constantly elevated sed rate (about 100 in the past year, was 70 for many years) in absence of any other RA markers. She has more and more mobility in her hip joint and no longer experiences any burning pains and so on w/ acu + herbs. She was on methotrexate for years without it demonstrating any type of effect, subjective, R.O.M. or in the bloodwork. Comments? Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ alon marcus <alonmarcus Chinese Medicine Tuesday, 19 May, 2009 14:33:03 Re: Non-responsive bloodwork Tom Usually the blood test is not important. RF can positive or negative in RA patients. If the sed rate is going up then you may be dealing with increased inflammation, i would pay attention. 400 29th St. Suite 419 Oakland Ca 94609 www.integrativeheal thmedicine. com alonmarcus (AT) wans (DOT) net Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 Hi Sami: I am of the opinion that generally bloodwork should inform us, but not direct us. Daniel brought up a very good point: we forget that bloodtests are little more than random snapshots of some blood values and can be very misleading in this way. He used an example of different values taken 3 days after acupuncture versus blood tests being performed directly after receiving strong dosages of meds. Very different results. I have tried to find responsible ways of continuing to work with patients who respond well despite bloodwork that seems to indicate the opposite. Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ Sami Rank LAc <herbsnacupnxr Chinese Medicine Tuesday, 19 May, 2009 14:54:42 Re: Non-responsive bloodwork what about hyperthyroid/ graves dz? I have a patient who I have been treating for about 6 months whose symptoms have turned around/resolved (though I wouldn't think of stopping treatments) but the blood work does not reflect this and we're wondering whether or not to proceed... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2009 Report Share Posted May 19, 2009 I have a similar situation with a patient that has nephrotic syndrome. Her symptoms of swelling, puffyness, fatigue, stomach pain and dizziness have all resolved. Her current pulses and tongue do not indicate any strong tcm pathology. Yet her creatinine level is going up and her blood albumen is very low. In the past this has correlated with her having a lot of symptoms. Now she is virtually asymptomatic but her nephrologist is understandibly very concerned. I find it difficult to ask her nephrologist to let her be for a while and see if the numbers change. Any suggestions. Ken Cherman, L.Ac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2009 Report Share Posted May 20, 2009 Hello all, Has anyone had any experience treating diabetes insipidus with acupuncture and herbs? I have a client that came in to address knee pain from trauma but asked if acupuncture can address diabetes insipidus. She has a hard time staying hydrated even when she drink a large amount of water. Any help would be greatly appreciated? Dan Clark Chinese Medicine subincor Tue, 19 May 2009 19:32:51 +0000 Re: Non-responsive bloodwork Hi Tom, thank you for your informative posts. My understanding is that the presence of the Rheumatoid Factor does not lead to a definitive diagnosis of RA. RA can be dx w or w/o RF in the blood. I sometimes think (certainly some cases seem to fit this well) that an increase in RF during treatment may be a sign of increased metabolism (Qi/heat) which will regulate in the long term. I am also not at all sure that your patients should be upping their meds. A good question to ask rheumatologists is whether treatment for a particular condition (in this case RA) is justified based on: 1. presenting s & s 2. bloodwork 3. presenting s & s and bloodwork I am pretty sure that treatment is not justified based on 2. alone. I don't believe that that is the standard of practice, because, as you say, this test not only has false positives and negatives associated with it, but also a lot of other conditions that are *associated* with an elevated RF. It is also important to note, as a colleague of mine reminds me, that Rheumatologists often like to treat aggressively and early, and often are not well justified in their treatments. I.e. " What evidence is there for pursuing the treatment of a patient with isolated elevations of RF? " Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ Tom Verhaeghe <tom.verhaeghe Chinese Medicine Monday, 18 May, 2009 14:56:52 RE: Non-responsive bloodwork Hi Hugo, I've recently treated two patients with Rheumatoid Arthritis and they both improved a lot, to the point they didn't need to take any more western medicines. Or so they thought. A check-up revealed a more active rheumatoid factor in both cases, although they were nearly symptom-free. So instead of dropping some of their medications, they had to increase them. I have no explanation for this, just that I have encountered the same thing in my practice. So what is more important? The blood work, or the MRI-scans, ...or what the patient feels. Can somebody explain the significance of the rheumatoid factor being present in the blood? Must it be eliminated at all cost? I know there are false positives, but how does one go about this in the clinical field? Thank you, Tom. Tom Verhaeghe Stationsplein 59 8770 Ingelmunster www.chinese- geneeskunde. be _____ Traditional_ Chinese_Medicine [Traditional_ Chinese_Medicine ] On Behalf Of Hugo Ramiro zondag 17 mei 2009 21:20 Non-responsive bloodwork Hi all; I wonder if anybody has ideas, research, knowledge etc about the phenomenon of improved s & s, and bloodwork that overall hasn't improved, or that retains one or two values very much outside normal levels. I've always viewed it as a function of not having yet left the diseased territory and merely having established balance within the diseased territory, and so it has always been a matter of time to reverse course, as ti were, and travel back towards a territory of health, but I wonder if anyoen has a distinct viewpoint. I have a patient with a dx of rheumatoid arhtritis who embodies this for me. Her overall presentation has changed dramatically insofar as her complaint goes (moderate atrophy of the right leg, adhesion of the right hip joint with highly impaired ROM and strength, burning pains in legs (GB channel), trouble sleeping, heavy fatigue), but her overall CM assessment remains the same (qi def / liv blood-yin def), and she retains an unchanged sedimentation rate of about 70 - 100 for many years. Methotrexate and other anti-inflammatories have not affected the value. Her rheumatologists generally make the statement that she is atypical. Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue body, low gloss and a stubborn thorny area (light red) in the heart portion. Her tongue when I met her was slightly fat, flabby pale body, med to thick white coating, slightly greasy, sometimes dry and sometimes moist, pale thorniness at heart area, scalloping and med gloss. Her pulses are generally soft or soggy, weakest being at lower positions, left hand weaker than right, top left being thready at times, and pulses overall can sometimes have a bounding quality. My assessment is that, despite the dramatic relative change for the better in the last 2 years after 20 years of stability, she still has only moved about 1/5 of the distance she needs to. Thanks for any insight, Hugo ____________ _________ _________ __ Hugo Ramiro http://middlemedici <http://middlemedici ne.wordpress. com> ne.wordpress. com http://www.chinesem <http://www.chinesem edicaltherapies. org> edicaltherapies. org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2009 Report Share Posted May 20, 2009 Hi Ken: Thanks for your participation; as our profession has interfaced more and mroe with MDs, this sort of issue has become more central. My first suggestion is preventative: nurture good relationships with MDs so that you have some clout when you have to ask for consideration like this. Other than that, I have only been able to come up with a bit of a confrontational challenge: ask what the *justification* for a treatment is. This is important terminology in WM: justification. Once you get an answer as to what is *justifying* the treatment, you can look it up. i.e. " Only blood values are necessary in order to *justify* treating for nephrotic syndrome " . Then look up what the standard of practice is for the justification of treatment for nephrotic syndrome. *Then* ask or look up whether there is *evidence* justifying the treatment. I have found this useful in many ways, although it's not a complete approach, I think. Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ " kncherman " <kncherman Chinese Medicine Tuesday, 19 May, 2009 17:44:47 Re: Non-responsive bloodwork I have a similar situation with a patient that has nephrotic syndrome. Her symptoms of swelling, puffyness, fatigue, stomach pain and dizziness have all resolved. Her current pulses and tongue do not indicate any strong tcm pathology. Yet her creatinine level is going up and her blood albumen is very low. In the past this has correlated with her having a lot of symptoms. Now she is virtually asymptomatic but her nephrologist is understandibly very concerned. I find it difficult to ask her nephrologist to let her be for a while and see if the numbers change. Any suggestions. Ken Cherman, L.Ac. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2009 Report Share Posted May 20, 2009 Hugo the first question i would ask about your patient is there something else going on. Its uncommon for large joints to be the main joints affected in RA so is there something else going on. Certainly the hip pain may be unrelated and she can have more than one condition. As far as treating physical signs or tests in RA, it not simple since we don't really know what can prevent joint destruction in the long run. Some of the so-called disease modifying medicines are claimed to have long term positive disease changing effects. I never studied these claims so i am not sure how strong the evidence. I definitely know we do not know what the true long term effects of CM except that i would THINK that if acute symptoms are controlled the long term outcome would probably be ok. But again i cant be sure and therefor its not an easy issue. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2009 Report Share Posted May 20, 2009 Ken call her Dr and talk to him/her Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2009 Report Share Posted May 21, 2009 Dan, Investigate Dr Chong's yu xiao san. Mark Zaranski Chinese Medicine , Daniel Clark <eckdclark wrote: > > > Hello all, > > > > Has anyone had any experience treating diabetes insipidus with acupuncture and herbs? I have a client that came in to address knee pain from trauma but asked if acupuncture can address diabetes insipidus. She has a hard time staying hydrated even when she drink a large amount of water. Any help would be greatly appreciated? > > > > Dan Clark > > > > Chinese Medicine > subincor > Tue, 19 May 2009 19:32:51 +0000 > Re: Non-responsive bloodwork > Hi Tom, thank you for your informative posts. > > My understanding is that the presence of the Rheumatoid Factor does not lead to a definitive diagnosis of RA. RA can be dx w or w/o RF in the blood. > I sometimes think (certainly some cases seem to fit this well) that an increase in RF during treatment may be a sign of increased metabolism (Qi/heat) which will regulate in the long term. > > I am also not at all sure that your patients should be upping their meds. A good question to ask rheumatologists is whether treatment for a particular condition (in this case RA) is justified based on: > 1. presenting s & s > 2. bloodwork > 3. presenting s & s and bloodwork > > I am pretty sure that treatment is not justified based on 2. alone. I don't believe that that is the standard of practice, because, as you say, this test not only has false positives and negatives associated with it, but also a lot of other conditions that are *associated* with an elevated RF. It is also important to note, as a colleague of mine reminds me, that Rheumatologists often like to treat aggressively and early, and often are not well justified in their treatments. I.e. " What evidence is there for pursuing the treatment of a patient with isolated elevations of RF? " > > Hugo > > ________________________________ > Hugo Ramiro > http://middlemedicine.wordpress.com > http://www.chinesemedicaltherapies.org > > ________________________________ > Tom Verhaeghe <tom.verhaeghe > Chinese Medicine > Monday, 18 May, 2009 14:56:52 > RE: Non-responsive bloodwork > > Hi Hugo, > > I've recently treated two patients with Rheumatoid Arthritis and they both > improved a lot, to the point they didn't need to take any more western > medicines. Or so they thought. A check-up revealed a more active rheumatoid > factor in both cases, although they were nearly symptom-free. So instead of > dropping some of their medications, they had to increase them. > > I have no explanation for this, just that I have encountered the same thing > in my practice. So what is more important? The blood work, or the MRI-scans, > ..or what the patient feels. Can somebody explain the significance of the > rheumatoid factor being present in the blood? Must it be eliminated at all > cost? I know there are false positives, but how does one go about this in > the clinical field? > > Thank you, > > Tom. > > Tom Verhaeghe > > Stationsplein 59 > > 8770 Ingelmunster > > www.chinese- geneeskunde. be > > _____ > > Traditional_ Chinese_Medicine > [Traditional_ Chinese_Medicine ] On Behalf Of Hugo > Ramiro > zondag 17 mei 2009 21:20 > > Non-responsive bloodwork > > Hi all; > > I wonder if anybody has ideas, research, knowledge etc about the phenomenon > of improved s & s, and bloodwork that overall hasn't improved, or that retains > one or two values very much outside normal levels. > > I've always viewed it as a function of not having yet left the diseased > territory and merely having established balance within the diseased > territory, and so it has always been a matter of time to reverse course, as > ti were, and travel back towards a territory of health, but I wonder if > anyoen has a distinct viewpoint. > > I have a patient with a dx of rheumatoid arhtritis who embodies this for me. > Her overall presentation has changed dramatically insofar as her complaint > goes (moderate atrophy of the right leg, adhesion of the right hip joint > with highly impaired ROM and strength, burning pains in legs (GB channel), > trouble sleeping, heavy fatigue), but her overall CM assessment remains the > same (qi def / liv blood-yin def), and she retains an unchanged > sedimentation rate of about 70 - 100 for many years. Methotrexate and other > anti-inflammatories have not affected the value. Her rheumatologists > generally make the statement that she is atypical. > > Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue > body, low gloss and a stubborn thorny area (light red) in the heart portion. > Her tongue when I met her was slightly fat, flabby pale body, med to thick > white coating, slightly greasy, sometimes dry and sometimes moist, pale > thorniness at heart area, scalloping and med gloss. > Her pulses are generally soft or soggy, weakest being at lower positions, > left hand weaker than right, top left being thready at times, and pulses > overall can sometimes have a bounding quality. > My assessment is that, despite the dramatic relative change for the better > in the last 2 years after 20 years of stability, she still has only moved > about 1/5 of the distance she needs to. > > Thanks for any insight, > > Hugo > > ____________ _________ _________ __ > Hugo Ramiro > http://middlemedici <http://middlemedici ne.wordpress. com> ne.wordpress. com > http://www.chinesem <http://www.chinesem edicaltherapies. org> > edicaltherapies. org > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2009 Report Share Posted May 21, 2009 Mark, re: Yu Xiao San, is there a brand you use or recommend? Hugo ________________________________ Hugo Ramiro http://middlemedicine.wordpress.com http://www.chinesemedicaltherapies.org ________________________________ zedbowls <zaranski Chinese Medicine Thursday, 21 May, 2009 8:12:30 Re: Non-responsive bloodwork Dan, Investigate Dr Chong's yu xiao san. Mark Zaranski Traditional_ Chinese_Medicine , Daniel Clark <eckdclark@. ..> wrote: > > > Hello all, > > > > Has anyone had any experience treating diabetes insipidus with acupuncture and herbs? I have a client that came in to address knee pain from trauma but asked if acupuncture can address diabetes insipidus. She has a hard time staying hydrated even when she drink a large amount of water. Any help would be greatly appreciated? > > > > Dan Clark > > > > > subincor > Tue, 19 May 2009 19:32:51 +0000 > Re: Non-responsive bloodwork > Hi Tom, thank you for your informative posts. > > My understanding is that the presence of the Rheumatoid Factor does not lead to a definitive diagnosis of RA. RA can be dx w or w/o RF in the blood. > I sometimes think (certainly some cases seem to fit this well) that an increase in RF during treatment may be a sign of increased metabolism (Qi/heat) which will regulate in the long term. > > I am also not at all sure that your patients should be upping their meds. A good question to ask rheumatologists is whether treatment for a particular condition (in this case RA) is justified based on: > 1. presenting s & s > 2. bloodwork > 3. presenting s & s and bloodwork > > I am pretty sure that treatment is not justified based on 2. alone. I don't believe that that is the standard of practice, because, as you say, this test not only has false positives and negatives associated with it, but also a lot of other conditions that are *associated* with an elevated RF. It is also important to note, as a colleague of mine reminds me, that Rheumatologists often like to treat aggressively and early, and often are not well justified in their treatments. I.e. " What evidence is there for pursuing the treatment of a patient with isolated elevations of RF? " > > Hugo > > ____________ _________ _________ __ > Hugo Ramiro > http://middlemedici ne.wordpress. com > http://www.chinesem edicaltherapies. org > > ____________ _________ _________ __ > Tom Verhaeghe <tom.verhaeghe@ ...> > > Monday, 18 May, 2009 14:56:52 > RE: Non-responsive bloodwork > > Hi Hugo, > > I've recently treated two patients with Rheumatoid Arthritis and they both > improved a lot, to the point they didn't need to take any more western > medicines. Or so they thought. A check-up revealed a more active rheumatoid > factor in both cases, although they were nearly symptom-free. So instead of > dropping some of their medications, they had to increase them. > > I have no explanation for this, just that I have encountered the same thing > in my practice. So what is more important? The blood work, or the MRI-scans, > ..or what the patient feels. Can somebody explain the significance of the > rheumatoid factor being present in the blood? Must it be eliminated at all > cost? I know there are false positives, but how does one go about this in > the clinical field? > > Thank you, > > Tom. > > Tom Verhaeghe > > Stationsplein 59 > > 8770 Ingelmunster > > www.chinese- geneeskunde. be > > _____ > > Traditional_ Chinese_Medicine > [Traditional _ Chinese_Medicine ] On Behalf Of Hugo > Ramiro > zondag 17 mei 2009 21:20 > > Non-responsive bloodwork > > Hi all; > > I wonder if anybody has ideas, research, knowledge etc about the phenomenon > of improved s & s, and bloodwork that overall hasn't improved, or that retains > one or two values very much outside normal levels. > > I've always viewed it as a function of not having yet left the diseased > territory and merely having established balance within the diseased > territory, and so it has always been a matter of time to reverse course, as > ti were, and travel back towards a territory of health, but I wonder if > anyoen has a distinct viewpoint. > > I have a patient with a dx of rheumatoid arhtritis who embodies this for me. > Her overall presentation has changed dramatically insofar as her complaint > goes (moderate atrophy of the right leg, adhesion of the right hip joint > with highly impaired ROM and strength, burning pains in legs (GB channel), > trouble sleeping, heavy fatigue), but her overall CM assessment remains the > same (qi def / liv blood-yin def), and she retains an unchanged > sedimentation rate of about 70 - 100 for many years. Methotrexate and other > anti-inflammatories have not affected the value. Her rheumatologists > generally make the statement that she is atypical. > > Her tongue is slightly fat, has a white coating, slightly dry, a pink tongue > body, low gloss and a stubborn thorny area (light red) in the heart portion. > Her tongue when I met her was slightly fat, flabby pale body, med to thick > white coating, slightly greasy, sometimes dry and sometimes moist, pale > thorniness at heart area, scalloping and med gloss. > Her pulses are generally soft or soggy, weakest being at lower positions, > left hand weaker than right, top left being thready at times, and pulses > overall can sometimes have a bounding quality. > My assessment is that, despite the dramatic relative change for the better > in the last 2 years after 20 years of stability, she still has only moved > about 1/5 of the distance she needs to. > > Thanks for any insight, > > Hugo > > ____________ _________ _________ __ > Hugo Ramiro > http://middlemedici <http://middlemedici ne.wordpress. com> ne.wordpress. com > http://www.chinesem <http://www.chinesem edicaltherapies. org> > edicaltherapies. org > > Quote Link to comment Share on other sites More sharing options...
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