Clinical Cases

We present some cases to illustrate what can be done using integrative medicine intervention to help alleviate the illness of patients. In most of these cases, patients had multiple studies done to establish the diagnosis and western medicine interventions were rendered but were not effective.  All of the following sample cases are well documented in the charts and consents for publication are obtained.

Lumber disc herniation with sciatic pain

The patient is a 17 year old who has L4-5 disc herniation with pain level 8 of 10 radiating to his right thigh.  He failed months of physical therapy.  After Dr. Penn offered her integrative therapy, combining scientific Chinese medicine and hand manipulation, his pain was resolved to 0 of 10 and he continues to be pain free 10 months after the completion of treatments.  This case will be submitted for publication.

details coming soon...

Irregular menstruation, dysmenorrhea

This case is published by British Medical Journal Case Report. Acupuncture treatment for dysfunctional uterine bleeding in an adolescent’. There are more treatment details in the publication.  Please feel free to read, download and distribute.

The patient is a 16 year old girl who has never had regular menstruation ever since the beginning of her period at age 12.  For more than 2 years she has had 3 periods per month, which were heavy and painful each time.  The longest time in between period was about 3 days.  She is ‘constantly’ on.  Her cramps are severe and she often had to miss school because of her cramps.  She does not sleep well because of the pain.  She was seen by gynecologist and has tried different modalities to control her period.  She has had devices, injections and birth control pills.  At the time of presentation, she was on her birth control pill in the middle of the pill pack and she’s also on her period.  She reports she never skips her pills.

She was offered to get acupuncture treatment to have 3 times weekly treatment and continue her birth control pills and her gynecological appointment. In the first month of the treatment, she had 1 breakthrough bleeding of 6 days, she later had a regular period at the end of the month.  She continued her birth control pills daily.  The following period was 30 days after the previous period which was not in sync with her pills. Her birth control pill was then discontinued for lack of effectiveness. 

She continued her treatment 2 times per week, 38 days after the last period without taking any medication, she had another period with normal volume and duration.  She does not have dysmenorrhea anymore.  She missed her gynecologist follow up appointments a couple of times since the beginning of acupuncture treatment.  After 2 ½ months acupuncture treatment, she went back to her gynecologist for follow up and indicated her birth control pill was discontinued, her gynecologist agreed and scheduled follow up appointment in 6 months if needed.  She is not stressed anymore with normal sleep.  Her energy is good and starts working 70 hours per week during summer time and still in good mood.  Her periods have continued to be regular 1 year after the completion of her treatments.

Case Comments:

 Traditional Chinese medicine (TCM) has been used for menstruation, infertility with many successful cases and studies documented.  This case illustrates the importance and benefit of adjunct therapy using acupuncture to treat menstruation issues especially for child bearing age females. For patients in this age group, after ruling out any organic causes and especially when conventional therapy is not effective, it should be worthwhile for a trial of TCM therapy which has no side effect when properly performed.   The goal is to establish normal menstruation and maintain fertility.

Femoral Patella syndrome, bilateral knee pain

The patient is a 15 year old girl who has pain on both knees for more than 2 years. The pain comes on when she walks or runs and there’s no pain at rest.  She denies she had any injuries to the knees and reports her knee pain has gotten worse over time.  She has been seen multiple times for her knee pain but her condition did not improve and reports pain after walking 2-3 minutes with pain level 8 of 10. 

Her knee x-ray was normal.  She was seen by rheumatologist and all laboratories for inflammatory process were negative.  She was diagnosed with Femoral Patella syndrome and was recommended to have physical therapy and exercise to strengthen her quadriceps.  She wants to have acupuncture treatment for her knees because she was treated briefly the year before and felt the treatment helped her. 

The patient was started the treatment plan to have acupuncture +/- hand manipulation 3 times a week for 2 weeks, then 2 times per week, then once per week, anticipating 2 months treatment.  A day after the 2nd treatment, she reports the pain has decreased, with pain level 2 of 10 after walking 10-15 minutes. After the 3rd treatment, she had no pain after walking 15 minutes, the treatment was then decreased to once per week.  After the 4th treatment, she had no pain after walking 45 minutes and did not pay attention to her knees anymore. 

Case Comments:

Femoral patella syndrome is frequently seen in teen age girls.  The treatment usually involves physical therapy and exercise to strengthen the quadriceps muscles.  As demonstrated in this case, acupuncture treatment with Dr. Penn's hand manipulation can be very effective in alleviate patient’s pain, her recommendations on posture adjustment can help prevent the recurrence of the symptoms.

Lumbar sacral disc protrusion

The patient is a 14 year old with lower back pain for 3 months while banding or walking with a pain level 8 of 10. Usually doing chores like vacuuming makes the pain worse.  The pain shoots from her back down to her knee and sometimes to her right calf, there is mild tingling sensation but no muscle weakness.  Her MRI showed L4-5 disc bulging.  She wants acupuncture treatment because the treatment helped her sister who also has lower back pain with disc herniation. 

The patient was started the treatment to have acupuncture +/- hand manipulation 3 times a week for 2 weeks, then 2 times per week, then once per week, anticipating 2 months treatment. After 2 treatments, patient did not have radiation pain to knee anymore. Her back is straight without any gluteal cleft deviation.   After 4th treatment, the patient has no more pain while bending or walking. The treatment is to be continue a few more times to reduce the chance of pain recurrence.

Case Comments:

This case demonstrates the concept of ‘build your reserves’ in my view.  Lower back pain and disc herniation is very commonly seen in adult population. Although not scientifically studied, without traumatic injury, we can anticipate many disc herniations in adults are in fact the result of gradual worsening of previous conditions such as bulging disc. If we can stop or even reverse the process of deterioration, the patient is less likely to have debilitating symptoms later in life, and less likely to require strong or habit forming pain medication.

 

Chronic Abdominal pain

The patient is a 17 year old girl who has abdominal pain for more than 2 years.  Her pain is constant, lasts 7-8 hours during the day, for 5-6 days per week.  She had multiple laboratories done and the results were all normal.  She was seen by gastroenterologist and had multiple studies including scope done, all studies were negative.  She was started medication for reflux but it was not effective and she had weight loss from poor appetite and continuous pain.  She was scheduled for biopsy to further evaluate her chronic abdominal pain.

While waiting for her biopsy appointment, she was offered acupuncture treatment for twice per week, anticipating 4-6 weeks.  She missed some of her appointment.  After 3 weeks with 3 treatments, the patient states she feels better and her appetite starts coming back.  She is pain free with normal activities after 5 treatments with some weight gain and does not care for more treatments anymore. She returned to her gastroenterology appointment follow up and did not need her biopsy.

Case Comments:

Acupuncture often is effective on some functional disorders when no organic causes can be found.  This patient has a treatable TCM diagnosis ("phlegm"), and the treatment plan is derived from this diagnosis. This case demonstrates the potential benefit of acupuncture when the patient is with functional disorder.  

Obsessive Compulsive Disorder

The patient is a 14 year old boy who is depressive, anxious and started having suicidal thoughts. He was referred to emergency room evaluation because of his suicidal thoughts.  He was evaluated by the psychiatrist and diagnosed with obsessive compulsive disorder.  He was suggested that medication may be needed for his condition.  He and his mother both want to try acupuncture treatment for his condition and hopefully not to take any medication.  He is otherwise a good student at school who likes sports.

He was started on acupuncture treatment once per week for 2 months. He reports that the treatment helps him and after 5 treatments, the frequency was weaned to twice per month.  After another 3 treatments, the patient feels well enough and no more treatment was needed.

Case Comments:

Mental stress is one of the most treatable conditions by acupuncture. From many studies stress has been related to many illnesses and is a health condition we should pay much attention to.  This case show that acupuncture can relax our mind, with proper counseling, we can reduce patient’s stress, improve his/her functioning.

Eczema

The patient is a 3 month baby boy with extensive severe eczema covering his face, body, arms and legs.  Other than his eczema, he is growing well.  Because of the concern of the need of repetitive use of high strength steroid on a very young baby, he was offered to use adjunct TCM treatment with topical steroid to control his eczema.

The baby was started twice weekly acupuncture treatment with no needle retention.  After 2 months, the frequency was reduced to once weekly for another month.  In the first 2 weeks of treatment, he required intermittent high strength of topical steroid to control his condition, afterwards, he used lower strength steroid cream intermittently at most twice weekly to the most severe areas of rash. At the end of 3 months, his skin is clear with occasional local mild flare up at the wrists and ankles without any skin thickening frequently seen with chronic eczema.  Of note, the baby has never cried during the during the acupuncture treatment.

Case Comments:

Using medication only when it’s indicated is important for all patients but especially in young infants.  This case shows that even though it may take some time and patience to treat potentially chronic illness, the acupuncture treatment can be used as adjunct therapy to minimize the use of potential side effect of medication or the long term dependence on medications.

Ankle sprain

This patient is a 14 year old with ankle sprain 4 months prior to presentation.  He continues to have ankle discomfort which keeps him from playing soccer and wants to know what can be done.  His ankle exam is normal with full range of motion.  He was offered acupuncture treatment for his ankle pain once per week.  He was completely pain free after 3 treatments.

Case Comments:

This boy’s pain is relatively mild by exam yet it hinders his function.  For total of 4 treatments, each time using 1-3 small needles , he regained the strength of his ankle and becomes symptoms free.  This case indicates we can use acupuncture to alleviate some mild yet debilitating symptoms quickly with total body function restoration.  He is not likely to injury his ankle easily with a strong ankle verse a weak ankle; that is, if his ankle is borderline functioning he’s more likely to have injury to his ankle while playing soccer.