Tough case!

[Armin]

Hi all,

I have a client who was in a car accident almost two years ago. She was rear ended and for the first year, no one managed to do any proper assessment on her case or she was continuously misdiagnosed and mis-treated, making her condition worse. Finally a phsyiotherapist managed to properly diagnose her with an alar tear (a deep tendon or ligament which stabilizes the neck deep to the shoulder muscles, my basic understanding). It was finally decided that the best approach was to have surgery to stop the constant intense nerve pain which basically covers the trigeminal nerve, the vagus nerve (constant nausea) as well as other nerves in the general area. Her whole left side is badly messed up. Her left arm is weak and cold. She has brain fluid pooling near the cerebellum and the brain stem and has constant dripping from left nostril.

I started working with her about six months ago and for the fist time in a year and a half she was able to sleep for 7-8 hrs, reduce pain killers, more energy and all the other good things that acupuncture brings about. But, her neck and shoulder on left continued to be super locked up and impossible to touch. I had given her regular acupuncture, and sinew treatments but could never go above the shoulder level. Any local needling or work would give her lots of pain, nausea, and even trembling. So, I kept away form the area and managed to support her.

She was waiting for her surgery when corona hit and now on hold. She continues to be in pain on a daily basis and I have only been able to give her relief for 3 days at a time, so she’s been coming twice weekly. It doesn’t help that she is not a very compliant client and keeps doing crazy physical activities that she shouldn’t be doing. Her argument is that it’s either that or she would lose her mind after all this time of pain and restrictions in her life.

I am wondering if any one has any other ideas for this case. I was thinking of 8ev’s like yin Wei to support and for resources but am concerned about driving the pathogen deeper to the yuan. Given that the pain is constant, divergents don’t seem to apply but perhaps can be used to boost mediumship.

Anyway, would love your insights.

Thank you.

[Elizabeth Evans]

Hi Armin- I was also on the Divergents zoom call… we “met” there. 🙂

I’m very “beginner” so hopefully someone with more experience will offer thoughts but I thought I’d get the ball running.

I was listening to one of Jeffreys talks yesterday and your case description took me back to the theme of rigidity- both physical (which you describe as locked) and emotional (not complying). I’m wondering if a focus on emotional might be in order. From my fledgling understanding both sinews and luo are in the realm of emotional. But maybe just gently presenting the idea.

I had a tennis elbow patient who also had a similar rigidity in his ability to comply. He’d leave pain free, but continue as normal (like your paitient- quite a brutal exercise regime for “sanity” in an intense job, family life). Personally, I felt all I could do was plant the seed of change and understanding that living a less depleting lifestyle might help a condition like his. Ultimately, he needed to give the idea a chance to grow. At that time, he wanted the pain to go so he could continue with his life. Having the pain go was the only change he would engage with. It took a lot of careful wording before I even felt he left with a carefully planted seed of thought. But I had to concede that, at that time, that was the appropriate treatment. Maybe someone else could have done better. Afterall, I’m still learning. 🙂

Another thought, from Jeffreys gallbladder talk, was that there are several points on the gallbladder channel on the scalp indicated for trauma. Im also thinking how GB crisscrosses the scalp and “talks” to the brain. I’m just wondering if a it might allow access to allow the change needed. Maybe even as a “take home” for self massage??? (Thinking and typing here [???]). There was a lovely concept I heard on one of Jeffries lectures that to embrace change there is a process of grief as you need to let go of something. And, from what you described, there seems to be some letting go, or unlocking that needs to occur.

I do wonder, with her resistance to treatment of the area- how you’d know whether the nausea and shaking are a sign of “stop back up” or a sign that you should just be with that and allow for her to process it. I’d love someone’s thoughts on whether sitting with her through that discomfort would help.

Anyway, these are just ideas which I’m sure you’ve already thought of. But sometimes, even if an idea isn’t valid, it can lead to a new idea. Hopefully others with more insight will jump in.

A very interesting case- thanks for sharing!

Best wishes

Liz

[Armin]

Hi Liz,

Yes, I do remember you. I have been on a divergent mode since;)

Thank so much for your input. Everything you said makes perfect sense. When I first started seeing her, she started making a lot of progress all around, even her range of motion, though not as much as other departments. Shortly after and as she continued with medical assessments, X-rays, and MRI’s, it was decided that surgery would be the best option for her given the extent of damage and that it had been a year and half since the accident already. The surgery is so specialized that the last six months her medical team has been trying to find someone to do it. There are only a handful in the world who do this type of surgery.

The upshot of that was that she resigned herself to the surgery as the only solution and then stated regarding our work simply as palliative, I guess on a subconscious level. Interestingly enough when her pain gets really bad, I don’t even treat the pain and simply help her emotionally with the treatments and she responds nicely. So you are absolutely right in the emotional component of things. Gallbladder has been a focus throughout but not on the head, so I may work with that, on the opposite side!!!

There are times that I think the whole left side is locked up as it’s protecting and stabilizing the neck given the extensive damage to alar ligament deep inside.

And ya, maybe I just need to be more present and really hold the space for her and give the local area a go. She’s probably locked up as a guarding from when the accident happened and has not been able to let go. This is a type A personality we are talking about here; go go go all the time. We have discussed how the accident happened for a reason and she has accepted that if the accident had not happened she probably would have been dead due to some kind of crazy health issues. She had had two close calls with septecimia and going into anaphylactic shock due to basically not listening to her body’s signs. So she knows what she is doing to herself but I guess she is just wired to be that way. Oh and she is like a full on professional athlete who has basically had to cut back on everything.

Anyway, I will try to work with that for now. Still open to others’ insights.

Cheers:)

[Antoine Mulpas]

Hello Armin,

A difficult case indeed ! I would have been lost seing this patient.
From the divergent point of view, I would think of the Bladder and Kidney Divergent. They both go to the area locked up. But the main difficult here is to needle BL-10. Maybe you can try to work on them with essential oils ? It would be a good alternative, one she can carry home. And if the area is loosening up after your treatments, maybe you can try with needles.
Maybe Yang Qiao Mai can be useful, to release the “stance” in which she is locked up. To release the tension with the outside world, to be able to open to it again after the car accident.
Hope that can help you, and I think your approach and the one suggested by Elizabeth are and can be really helpful for her.
Cheers
Antoine

[Armin]

Thanks Antoine! Great ideas. My challenge with the divergent and 8evs has been with the concern of driving the pathology deeper into the yuan level. When I take her pulse, generally right side is soft and weak, and left side is tight/wiry and superficial. I recall Ann saying once about this pulse presentation as not being a good one. We want to have the left side pulses deeper than the right side. I think Ann said that it means severe loss of mediumship, but am not certain. Makes sense given that the left is more about blood and yin. So when it’s more superficial and tight, it’s trying to hold on to what’s left of the mediumship.

Next week I’ll try to get a bit bolder and try some of the ideas presented here and very cautiously!!! It makes sense to boost her mediumship if nothing else through either divergents or 8evs depending on pulse.

She came in yesterday and was very emotional as her grandmother had passed away. She was very close to her and so had cried a lot which meant her pain levels were over the roof. Crying, coughing, sneezing and even chewing are all pretty painful in general. I didn’t want to try any new stuff with her and just supported her more on the emotional level.

Thanks again we’ll keep you guys posted.

Armin

[Mònica Martín]

Hi Armin and everyone,

It is often the case with these sort of “accidents” that the person “hit” experiences a sort of misalignment between head (mind), and body (emotion) in the area that connects them both, the neck. This tends to happen when the person is undergoing a period of stress, or when the person feels overwhelmed for many reasons that may lead her to feel that she can’t stop (so life does so for you). Sometimes is the drive to do, to achieve, to accumulate….whatever that is, the accident is a “call” to stop. I’ve had patients who clearly understood the “message” and they improve a great deal with simple sinew treatments after an accident. They usually report there being a before and after the accident. And they tend to regard the accident as a turning point in their lives.

For patients like the one you describe I would consider the fact that she probably was bearing a high degree of tension in the neck prior to the accident (she was not listening to her body). Damage to tendons in the deepest level may suggest that the most superficial layer was not fit enough (probably too tight) to “guard” her from damage due to the shock. This prior tension could have been the result of fear (BL) or indecision (GB) or inaction (St). In any case what could have been “liberating” (the hit) in her case worsened the condition because instead of inducing “change” created “resistance” (has she changed anything in her life after the accident? or has life changed for her after the accident?).

Possible treatment avenues could be Yang Wei Mai to restore the balance and integration of Yang in the neck particularly if it’s all driven by fear of change and more even so if the fear is due to not being present in the present moment or having difficulties embracing a new phase in life.

Within the Divergent context, it could be useful to find out what emotion is she holding at an UNCONSCIOUS level (Wei / Yuan being about unconscious emotions). If you encounter too much fear, indecision or bearing, you could use BL DC, GB DC or St DC respectively making sure to guasha the corresponding areas properly prior to needling. Correlating the state of Yin through the pulses might yield more info on what confluence to pick. Window to Heaven points are extremely useful in these cases, and particularly TH16 Tianyou 天牖 Window of Heaven (master point of this series of points) to restore the communication between mind and body. It is clinically interesting to see this very lack of communication which lies behind the original tension as the reason for a whiplash injury to become intractable (resistance). The fact that she responds “nicely” to treatments when you when you address her emotions seems to point to that.

All the best with this patient, Armin. Keep us posted.

Monica

[Armin]

Hi Monica,

Thanks so much for your input and insights; very helpful.

She is definitely in the category of resisting the change rather than accepting it, and I can see it very clearly that she is suffering for it. But, it is really her choice. She does pay lip service to the idea that the accident happened for a reason but I know for fact and she knows it as well that the moment she will feel a bit better after surgery, she’s going to go back to her old ways. Well, I should not say for sure; there is still hope that something might click and she will see things a bit more clearly, perhaps after I have cleared the connection between head and the body through the window to heaven points, as you have suggested.

Since my last post, not much has changed with her condition, well things are a bit worse. I will keep you posted.

Cheers

[Mònica Martín]

Hi Armin,

If she keeps coming to see you, there must be something in her that feels attracted to the idea of change and she intuitively knows that you can help her in that regard.

Sometimes finding what that “holy grail”, change in this case, looks like for your patient might be useful. What change means for her, what it looks like, in what way she projects it, how she perceives change and how she has experienced it in the past. Sometimes this information along pulse-taking allows visualizing within the complete channel system where the blockage lies. And even so, because no treatment is ever the same as the same patient is never the same in each session, even at different times during the session, every move in every session requires continuous reassessment and re-evaluation of your treatment strategy. And that includes your own expectations and “hopes”. Luckily life is bigger than the outcome that our minds can ever imagine for that one patient. In that sense, every patient becomes an invitation to keep our mental door wide open to endless possibilities.

In this way, every moment becomes an opportunity for a profound change, not only for our patients, but also for ourselves as practitioners. And it is in those patients that represent more challenge for us that we encounter the best lessons for us to learn.

Keep us posted with those changes, Armin

Cheers

[Armin]

Thanks again Monica. Nicely put and it all makes sense. The unique thing about this case is that all her treatment expenses are paid by her insurance company so in a way she is not as invested in the treatments and the result. She’s coming in for “pain relief” until surgery day, which is now finally set for mid-September, though she has to travel to India for it. The best surgeon for this highly specialized procedure is there.

Of course, that doesn’t change the picture for me; I will still try to do thing session by session until then.

Cheers:)

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