This lady walked in to the office this afternoon... WWYD?

[Dee]

We know her from one of our groups. She has a seriously drooping eyelid, and a general "I feel like cr@p!" look about her. She has a severe underbite, serious TMJ, mild fibromyalgia, tension everywhere possible, the recent spring weather has been wreaking havoc on her sinuses and ears, and she has recently begun to experience extreme dizziness-- to the point of having fallen down three times yesterday. She also had her precious 2yo little boy with her (single mom), and stress was written all over her. She said she feels like her energy is "dead".

She asked if we might be able to help her. My first question (in my head) was WHY is she so dizzy she's falling down?

DH had a client show up right then, so we waited until he got him into the room before continuing with our discussion. I know that he (DH) had spoken with her some about energy/Qigong stuff at some of the meetings, and she is interested in seeing if we/he can help her "fill back up". She also wants help from the constant pain she is in. She said that she has been told that she have joint replacement surgery on her jaws, both sides. She's bone-against-bone, and the slightest hit could cause serious damage (she has a rambunctious 2yo boy! For anyone not familiar with 2yo boys, they love to head-butt, lol!).

I had her sit in our nice comfy rocker and lean back, then I did some hair-pulling for her. She was so tender, I couldn't even do the lightest lymphatic drainage I know how to do on her face. The hair-pulling seemed to help her some-- she said it felt like I was releasing tension around her jaws as I did it in certain spots.

I told her that personally, I was not comfortable touching her any further than that until/unless she got clearance from a doctor that massage wouldn't cause any harm. I told her that I am not qualified to even begin to try to help "diagnose" what is going on with her (though I do suspect that it is a combination of things, though I don't really know WHAT things other than the obvious TMJ, sinuses, and serious emotional and physical tension.) I gave her the name of a local "wellness doctor" (quotes are not sarcastic, they're to indicate "lack of a better term") who is a combination chiropractor/nutritionist/acupuncturist/massage therapist and probably a whole lot more.

The biggest question for me is, no matter what individual issues she's dealing with, that dizziness/falling thing worries me. I don't know that there's not something going on inside that I could somehow examassageplanetate if I were to work on her. I'm worried that there could be an underlying CNS thing... or something. I asked her to at least give the chiro/doc a call and see what she has to say. I doubt she'll be able to talk her out of/offer her a viable alternative to the surgery (I don't know if there IS a viable option to it, for her situation. That's not for me to say!), but I'm hoping that she'll at least be able to give her/me some understanding of whether massage might be contra-indicated or not.

I'm pretty sure the hair-pulling and simple breathing exercise I did with her couldn't harm her, but I'm not sure about much else. Did I do right? Would you have booked her an appointment anyway, or what? If so, what would you offer her? (Even if it's something I/we probably don't offer, I'd like to know anyway.) What do y'all think of this client's situation?

 

[P4wn4g3]

This lady walked in to the office this afternoon... WWYD?

I forgot to add, she told me that she's been on pain medication since August (the dizziness started in the past 2 weeks or so). She's now taking "Oxy-cotton" (?); she said it's one step down from morphine.

 

[joshieboya]

This lady walked in to the office this afternoon... WWYD?

I would absolutely work on her. I would recommend her to a physician to check for vertigo, or other possible inner ear disturbances, perhaps correlated with her TMJ. I would actually not work much on her head or neck, because I have a vertigo client who has been affected by work around the ears. I might do general relaxation on her feet especially, some foot massage and/or reflexology might be a great way to treat problems in her head that you wouldn't want to treat directly, and some great stress relief paired with some swedish on the legs. Gentle, of course.

I would simply avoid deep tissue or any structural work, or work around her head or neck without doctor's clearance. I think the hair pulling was probably fine, especially since it felt good to her. Normally I'd be all over her head and neck, but with the vertigo symptoms, and knowing how terrible that afflication can be, I wouldn't want to trigger it without a clear diagnosis against it.

I truly believe that gentle, loving touch is good is almost every case. She sounds like she needs some stress relief and gentle touch on places far from her trouble spots would help her relax.

 

[Nintendude]

This lady walked in to the office this afternoon... WWYD?

Over the past several years I have seen a LOT of people develop vertigo.
In most cases the health care providers that they see, seem to be stumped as far as helping the client.
(I know this sounds weird but I am suspecting that maybe there is some energetic/planetary thing going on )

This person is seeing someone that knows how to prescribe meds and do surgery - so those are the options that she has been given.

Personally - given the various conditions present, I would refer out to an advanced cranio-sacral practitioner.
CST can address the tmj/jaw issues and probably the vertigo issues. The droopy eyelid in a young person sounds neurological (I have a droopy eyelid but since I am over 50 it's really an aging/gravity issue), and given the tmj issues there may be some nerve impingement going on.
Many people with fibro get physically and emotionally worn down and overwhelmed. I believe that CST work could also assist her with her over-all wellness.

But I don't feel that "regular" massage in this case would be of any more benefit that a bit of generalized stress relief.
Which can't hurt...but would not be enough IMO.

 

[tehabwa]

This lady walked in to the office this afternoon... WWYD?

I would absolutely work on her. I would recommend her to a physician to check for vertigo, or other possible inner ear disturbances, perhaps correlated with her TMJ. I would actually not work much on her head or neck, because I have a vertigo client who has been affected by work around the ears. I might do general relaxation on her feet especially, some foot massage and/or reflexology might be a great way to treat problems in her head that you wouldn't want to treat directly, and some great stress relief paired with some swedish on the legs. Gentle, of course.

I would simply avoid deep tissue or any structural work, or work around her head or neck without doctor's clearance. I think the hair pulling was probably fine, especially since it felt good to her. Normally I'd be all over her head and neck, but with the vertigo symptoms, and knowing how terrible that afflication can be, I wouldn't want to trigger it without a clear diagnosis against it.

I truly believe that gentle, loving touch is good is almost every case. She sounds like she needs some stress relief and gentle touch on places far from her trouble spots would help her relax.

Shivashiva, Thanks for you reply. I didn't think of working on her FEET to affect her HEAD. She did mention that she feels tight all over, but indicated upeforum.xxxody more with her gestures. I'd have to prop her up, though-- with her extreme tenderness in her face, she couldn't handle lying prone, at least. And I know that when I'm dizzy I don't like lying flat on my back. I do have a wedge.

SHE thinks the vertigo is due to her ears. I think it may be due to her hears, in conjunction with whatever is going on with her jaws (I have a feeling that it is examassageplanetating the "normal seasonal/barometric pressure" reaction that many folks get when the weather does what it has been doing here lately). I am just concerned to make sure that there isn't a nerve being impaired somewhere, that we might accidentally trigger or make worse, kwim?

 

[Mz. Lovely Maddie]

This lady walked in to the office this afternoon... WWYD?

Over the past several years I have seen a LOT of people develop vertigo.
In most cases the health care providers that they see, seem to be stumped as far as helping the client.
(I know this sounds weird but I am suspecting that maybe there is some energetic/planetary thing going on )

This person is seeing someone that knows how to prescribe meds and do surgery - so those are the options that she has been given.

Personally - given the various conditions present, I would refer out to an advanced cranio-sacral practitioner.
CST can address the tmj/jaw issues and probably the vertigo issues. The droopy eyelid in a young person sounds neurological (I have a droopy eyelid but since I am over 50 it's really an aging/gravity issue), and given the tmj issues there may be some nerve impingement going on.
Many people with fibro get physically and emotionally worn down and overwhelmed. I believe that CST work could also assist her with her over-all wellness.

But I don't feel that "regular" massage in this case would be of any more benefit that a bit of generalized stress relief.
Which can't hurt...but would not be enough IMO.

Squashy, DH and I both agree that she has some serious energy stuff going on. Or, NOT going on-- she's very "blocked". She knows it too ("feeling like her energy is dead"). Given all the symptoms MINUS the dizziness and/or drooping eye, I'd feel more comfortable-- even with the vertigo. It's that both are presenting at the same time.

I don't think that the one wellness doc I referred her to does CST, but perhaps she can give us more insight into what's going on with her. I care more about helping her feel better than I do about "keeping her as a client"; she seems the type that if we couldn't help her directly, she'd come see us when she was feeling better, if she could. But I'm not even worried about that. She's come to us for help. I'd like to help her, even if that means sending her to others. I don't KNOW any qualified CST therapists around here. I guess it's time to get to looking for one!

 

[Stef Elke]

This lady walked in to the office this afternoon... WWYD?

Wow. Bless her heart.

I would also consider adding a chiropractic neurologist to the arsenal. Droopy eyelid(s) is/are typically a Cranial Nerve 3 lesion and vertigo is typically either an otolithiasis (loose otolith that floats through the endolymph in the ear, sending all the sensory hairs crazy and producing the feeling of vertigo) or an autoimmune process against the sensors or vestibular nuclei. All this mis-firing of the various parts of the nervous system can cause other parts to "ramp up", causing hypertonicity of certain muscles, and unbalanced at that. This will usually cause constricture of the pterygoids, causing the TMJ to start deviating off track. So, lots of neuro stuff going on there - which is *exactly* what these chiro-neuro docs help with. Phenomenal stuff. Just Google "chiropractic neurologist + [your city]" and you should find several.

Meds will help this patient with the vertigo (providing they diagnosed the cause correctly - antivertigo meds are of limited success when the problem is actually destruction of the vestibular nuclei due to an underlying, undetected autoimmune disorder), and surgery will probably not be of much help, but it's good to explore all options just in case.

Other than that, I see absolutely nothing wrong with seeing her for massage therapy. If nothing else, you can effect positive change and balance at the central nervous system level by inducing a parasympathetic state, which may indeed help re-coordinate some of that mis-firing.

Good luck!

 

[edwardlova101]

This lady walked in to the office this afternoon... WWYD?

Thanks, Jyoti. I am not positive, but I *think* the chiropractor/wellness doc I referred her to can at least get her started with the neuro stuff. If she can't, she'll know who can. But she can't get in to see her for another couple of weeks. In the meantime, she went and got a clearance for massage from her regular doc. She was super-excited about that when she left her message to let us know about that. Then we saw her he next day at a local kids' event, and she mentioned it again. She even *looks* better, just having that hope. How wonderful-- her won self-healing has begun.

 

[Kool Shelby]

This lady walked in to the office this afternoon... WWYD?

I found a great CST practitioner by using the Upledger site...
I had wanted a session before taking CST 1
Best bet for this person would be someone who has advanced training (a LOT more than just CSTI or 2 ).

http://www.iahp.com/pages/search/index.php

 

[TERRY S]

This lady walked in to the office this afternoon... WWYD?

Thanks, Squashy. I found a couple of more advanced CST therapists within about 10 miles of here (the client lives w/in walking distance to our office, so 10 miles to us is also 10 miles to her). I don't know if she'll be able to *afford* the advanced treatments-- I guess that's not my problem. I hope to give these people a call and find out more about what they do after my tooth issue heals up. Not just for this client-- I want to know too! It would be great to get to know more therapists around here; people we can refer out to where appropriate, and to maybe trade off with and get to experience what they do too!

 

[blahh 90210 is on]

This lady walked in to the office this afternoon... WWYD?

Here's a visual of the Epley Maneuver: http://video.google.com/videoplay?docid=3511475079304232482# - but I'm not sure where it falls in your scope of practice.

Just one thing that I would suggest, find and become friends with a good vestibular specialist in your area/region. They can be very valuable as a colleague and for referrals.

I don't like it that the client wants you to "fill her up" energetically. You may help and be a catalyst, but please make sure to inspire the clients to understand that they need to start to "fill themselves up" with the proper QiGong exercises, if you know them. If not, consider contacting a friend (scroll to bottom of the page) http://www.tcmspecialists.com/taichi.htm .

 

[Universal]

This lady walked in to the office this afternoon... WWYD?

Here's a visual of the Epley Maneuver: http://video.google.com/videoplay?docid=3511475079304232482# - but I'm not sure where it falls in your scope of practice.

Just one thing that I would suggest, find and become friends with a good vestibular specialist in your area/region. They can be very valuable as a colleague and for referrals.

I don't like it that the client wants you to "fill her up" energetically. You may help and be a catalyst, but please make sure to inspire the clients to understand that they need to start to "fill themselves up" with the proper QiGong exercises, if you know them. If not, consider contacting a friend (scroll to bottom of the page) http://www.tcmspecialists.com/taichi.htm .

pueppi,. thanks for the video-- I'll watch it tomorrow.

I probably said what I said about the clients' intentions regarding energy work improperly. She knows Hubby teaches Qigong, and wants to learn it, in addition to him doing energy work on her. *I* won't be doing anything other than possibly observing, at that point. He does teach how to do that....

Aaaand, I'm afraid I'll have to look up what a vestibular specialist is/does, before I can start seeking one out.

 

[Pompal 09.]

This lady walked in to the office this afternoon... WWYD?

Aaaand, I'm afraid I'll have to look up what a vestibular specialist is/does, before I can start seeking one out.

Your vestibular specialist may be a PT (physical therapist) or OT (occupational therapist), not necessarily an MD. This link should help: http://vestibular.org/vestibular-disorders/treatment/vestibular-rehab.php

Over the years I've had 3 clients who I have had to refer. It's nice to know who to refer them to.

 

[asiank]

This lady walked in to the office this afternoon... WWYD?

Aaaand, I'm afraid I'll have to look up what a vestibular specialist is/does, before I can start seeking one out.

Your vestibular specialist may be a PT (physical therapist) or OT (occupational therapist), not necessarily an MD. This link should help: http://vestibular.org/vestibular-disorders/treatment/vestibular-rehab.php

Over the years I've had 3 clients who I have had to refer. It's nice to know who to refer them to.

very cool, pueppi. thanks. i think this particular lady's dizziness was due to weather/allergies (that's what she thought), and when we saw her that few days later she didn't seem to be having that same problem, but i'll keep this info handy in case she or someone else does need it.

 

[Pompal 09.]

This lady walked in to the office this afternoon... WWYD?

I would still have to work on her and would suggest to visit a specialist and have her vertigo checked.

Maybe she has a problem with the balance fluid in her ears causing her not to be able to balance properly. Some foor massage might do it and treat her problems with just gentle touches of course. I would not go to deep tissue or any bone work as that might be a bad idea without proper word from the doctor.

 

[bluePumpkin]

This lady walked in to the office this afternoon... WWYD?

A little late on this, but for what it's worth...

I'm just starting to study trigger points, and it appears that ones in the SCM can lead to vertigo/dizziness due to the SCM's role in keeping the head oriented properly in space.

Any update(s) on the client? I hope so, and I hope they are good ones!

 

[Sleepy]

This lady walked in to the office this afternoon... WWYD?

Absolutely refer this woman for medical evaluation and treatment. She should be evaluated for neurological issues before they have a chance to progress. Some are the result of bacterial or viral infections that can be reversed very quickly once proper treatment is applied. Other times there is a neurological issue, some of which can be treated efficiently with a simple sequence of gentle head/neck positioning and/or movements.

Fiddling about with energy work and trigger points may provide some symptomatic relief but never address the underlying cause. There is little harm in doing such work as adjunct therapy, but DO NOT ASSUME that that is all she'll need. If this happens to be a symptom of undiagnosed Lyme disease or MS, she will be best helped by having the condition identified as quickly as possible.

These are my opinions based on seeing many cases of vertigo caused by a wide variety of issues. Few were treatable within the limits of my skills and scope of practice, though I might provide some temporary relief. The happiest outcomes followed referral to medical professionals capable of proper diagnosis and treatment.