[Robert.Mears]

Hey Dave, I have a 68 yo female s/p surgical excision of a benign neoplasm T4-T7 (second surgery in about 6-7 years as it reoccurred). She has a history of a DVT (R) proximal calf (most affected leg), (B) LE weakness, altered/diminished sensation, decreased proprioception (R) LE, (B) LE swelling notable in lower legs especially. She is blind and struggles with an extensor tone pattern (R) LE which acts on the adductors particularly. I placed six 3” needles perpendicularly to the leg last week (R) LE Iliotibial homeostatic point (tends to have discomfort / feelings of tightness there) with one above and below and 3 in the adductor longus similar distribution. She reported experiencing tingling in her foot where she normally has no sensation, tickling in the (R) buttock where she is completely numb and some burning on the heel the later of which was associated with 18. None of this was distressing to her. The adductor tone relaxed significantly and she had a much improved stride in gait. She stated her (R) hip felt freer. She had hoped it would change how the leg feels though it did not. My initial concern was for the DVT, but I remembered you treated Jill (just had surgery on her hip last week) and she had the DVT history which is not listed as a contraindication. Any thoughts or concerns would be welcomed. I also wanted to know when varicosities would not allow for safe treatment and if that only means avoiding them or that portion of the leg or the entire leg. Thanks Go Cavs!
Rob

[Robert.Mears]

Follow up: Patient reported some relief of abnormal tone for up to 3 days. Had aching posterior thigh the day of treatment which resolved. Patient is also a diabetic.

[Nick]

In response to the DVT. While not a contraindication it is always advisable to check with the patients physician to ensure it is appropriate to needle.

It sounds like a typical nerve referral in the saphenous nerve distribution into the medial foot. Intense obviously, was this her first time needling? It good to hear there was a positive lasting effect.

As far as vericosities if the veins have an abnormal appearance I would choose to go proximal or distal to that area to avoid needling the structure itself.

Let me know if that helps and any follow ups.

[Robert.Mears]

Thank you for your response Nicholas. The Saphenous could definitely tie in with some of her plantar symptoms though I have not needled it directly due to concern over her lower leg swelling. Interestingly enough, I needled a second time in 2 weeks and followed my original points (Iliotibial homeostatic point and Adductors with three 2″ needles along each), and she noted mild increases in lateral knee and proximal thigh sensation as well as a minimal decrease in the abnormal walking on a high heel sensation in her foot. She also feels out of control with the leg, but I attribute that to the tone changes. I should add that her DVT history is remote (’80s) and they were in the calf. Also, she has no clear varicosities just congestion lower legs and worse on the right which likely relates to decreased muscle activity and arch collapse. I am contemplating putting her in compression garments to try to control the swelling and then considering needling lower.

[Nick]

Interesting case for sure. Why do they think she has he swelling?

Is it cardiac, lymphatic, or local vascular/tone issues?

Also, out of curiosity have you needled her paravertebrals at all?

[Nick]

Interesting case for sure. Why do they think she has he swelling?

Is it cardiac, lymphatic, or local vascular/tone issues?

Also, out of curiosity have you needled her paravertebrals at all?

[Robert.Mears]

I have been able to achieve decreases in abnormal tone with this patient with needling. I have not attempted paravertebral needling due to the presence of a dormant tumor in the region and the reward versus risk doesn’t look favorable. I believe her swelling is likely related to decreased muscle tone and activity as well as extra weight. Her lack of proprioception in the extremity and fear are her greatest challenges.

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