Chief complaint: left-sided arm and leg weakness for 10 days
I have been invited to treat stroke patient in St. David’s Medical Center (SDMC) since 2016. I would like to report the first case of a 70-year-old female patient with 10 days of acute ischemic stroke. I did neurological physical exam carefully. Her vital signs on 03/03/2016: Temperature 95 degree; Pulse rate 80 beats/min; Respiration rate 20/min BP 165/95 mmHg, Since stroke patient was not stable at the acute stage and could have multiple strokes within days or weeks, I started to treat her once a week with a very safe acupuncture technique which I usually used in ICU. One Sunday at 5 pm, I went to SDMC for the third treatment. While stepping out of the elevator, I heard unexpected acclamation from my patient's ward. Usually it was very quiet in the hospital. I was curious about what happened. When I walked into the ward, the patient was having dinner, surrounded by her daughter, son, and grandchildren. Her whole family could not help cheering since they noticed the patient could feed herself with affected hand for the first time after the stroke.
(Please note: All names, dates, and symptoms in the clinical case report section have been modified to protect the patient's privacy.)
Chief complaint: right-sided hand, arm and leg weakness and slurred speech for 15 days
15 days before coming to my clinic, Mr. J. suddenly felt right-sided hand weakness and numbness at 10 pm right before bedtime. He noticed he could not hold the glass of water and his right arm and leg felt weakness too. When he tried to talk to his wife, his wife noticed his speech was unclear and broken. He went to emergency room within one hour and admitted to Dell Seton Medical Center at The University of Texas for 7 days. He started rehabilitation therapy in the hospital. At the same time, they found me online. Mr. J. was very interested in the combination of both western medicine and acupuncture. This was very unusual since most patients in the United States didn’t know acupuncture was very helpful to stroke patient, not to mention in the acute stage. Even if I started to treat stroke patients in ICU in China, most stroke patients in America came to see me 2 or 3 months after stroke. Furthermore, I believe it was very hard for Mr. J. to make this decision since he never had any acupuncture treatment before.
I was very pleased to see Mr. J. and gave careful physical assessment for him. His vital signs on 06/05/2018: Temperature 96.5 degree; Pulse rate 90 beats/min; Respiration rate 22 /min; BP 158/90 mmHg. I noticed Mr. J.'s fingers in right-side hand were swollen and difficult to move on June 5. He could not hold a pen or write anything. The muscle strength of right arm was rated on a scale of 2/5 which meant difficulty of raising the right arm. The muscle strength of right leg was 3/5 which meant he could only walk slowly with significant heaviness and difficulty. He came to my clinic with a walker. On the first day to my clinic, Mr. J. tried to express himself but he could even speak in a full sentence. His wife had to help him to explain what happened. I served him once a week with acupuncture treatment. After the first treatment, he and his wife both could tell that his speech was clearer. Mr. J. also noticed his arm and hand were stronger. Right after the first treatment, when he tried to make another appointment at the front desk, the receptionist could tell the obvious improvement of Mr. J.’s speech ! After 4 weeks of treatment, Mr. J. could move his right-sided fingers, arm and leg much better. He could do quite a few activities which he could not perform after stroke including writing and raising his arm. After 6 weeks of treatment, he walked normally only with a cane. Mr. J. wanted to quit using the cane since he felt he could walk faster and faster. I insisted that he continued to use his cane since stroke patient could fall with fracture which would delay the recovery. I need to think of this possibility for my patient ahead of time.
Chief complaint: right-sided arm weakness for 14 days and slurred speech for 13 days
14 days ago, Mr. C. suddenly had blurred vision and felt numb, weak and heavy in the right arm after dinner. The symptoms were partly resolved after 30 minutes. The next morning, his wife noticed he could not speak clearly. He made an appointment with his primary care physician (PCP). His PCP prescribed Aspirin for him and suggested him to have CT or MRI. Mr. C. had not done that yet.
After careful neurological physical assessment, I realized the urgency and complexity of his condition. Mr. C.’s vital signs: Temperature 96 degree; Pulse rate 64 beats/min; Respiration rate 20 /min; BP 127/77 mmHg. He had decreased muscle strength in the right-sided arm on a scale of 3+/5. He also had imbalance during walking, mild headache, fatigue, shortness of breath, and slurred speech. His wife helped him describe what happened after sickness. His breath sound of right lung was decreased.
Since his physical exams findings could not be explained by one common stroke and only stroke with multiple focuses could have these symptoms which was not common in clinic, I strongly suggested Mr. C. to have emergent brain CT or MRI. At the same time, I started to treat him with acupuncture twice a week. The muscle strength of Mr. C.’s right arm and his speech were improved significantly after first treatment. After 2 weeks’ treatment, Mr. C.’s muscle strength of right arm increased to 5-/5, which meant his muscle strength was almost normal. The MRI result came out in two weeks which indicated lung cancer with brain metastasis. The most common cause of stroke is hypertension, but for Mr. C., his stroke symptoms came from the brain compression.
Mr. C. was very grateful to me for guiding him to discover the disease in real time. He asked me why he had lung cancer without any smoking history. I explained to him there were various types of lung cancer. Some of them were not related to smoking. Mr. C. had brain cancer removed by an excellent surgeon and started chemotherapy, and radiotherapy under the guidance of his oncologist.
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Chief complaint: right-sided hand, arm, and leg weakness for 15 months after birth.
15 months ago, Mr. E. was born in a hospital in Austin with right-sided body paralysis. During the pregnancy, both brain ultrasound and MRI indicated the enlargement of his left ventricle.
When he came to my clinic on 03/23/2017, his vital signs were within normal limits.
The muscle strengths of his right-sided hand, arm, and leg were decreased on the scales of 2+/5. He could not walk or stand. He could not reach his right-sided arm. His right hand could not grab any toys. His right-sided facial muscles were weaker than the other side. Moreover, he could not keep balance during exercise due to his poor torso coordination.
I started acupuncture treatment for him once a week. Each treatment lasted one hour which was not easy for a 15-month-old patient. His parents did very good job to calm him down and held him from begin to end. After the first treatment, his parents were very excited since his fingers could move better. 3 weeks later, Mr. E. could use his right hand to grab toys. 6 weeks later, his right-sided hand, arm, and leg were stronger and his parents could help him do more exercises much easier than before. Mr. E. started to stepped out to stairs with assistance after 2 months’ treatment. Ever since then, the recovery is easier since Mr. E. could perform many activities which he had never done before. The more Mr. E. exercises, the faster he recoveries.
Pediatric patients had the different characteristics from adults. In order to keep them safe, I adjusted my acupuncture technique to match their ages and watched carefully during the whole therapy. I knew any improvements at this stage would change their lives in the future.
Chief complaint: global muscle weakness for 5 months.
Mr. P. was born at 37 weeks gestation. When he was 6 months old, his parents found that he could not hold his head steady. Furthermore, he could not sit still and his body would tilt in either direction while sitting. It was till 8 months old, he started to roll and crawl. His parents brought him to a pediatrician. Brain MRI at 6 months old was normal. He was diagnosed global developmental delay, dysphagia/feeding difficulty, and speech delay.
When he came to my clinic on 08/04/2018, his vital signs were within normal limits. After careful physical assessment, I noticed, as a 11-month-old child, Mr. P. could not sit or stand, raise his arms, and swallow properly. He could not use his hands and fingers to grab anything.
I explained my findings to his parents and set up an acupuncture plan which was safe and practical to children. I gave two treatments per week. Each treatment lasted for 1 hour. After the first two treatments, his parents noticed he could move his fingers better swallow easily. After three treatments, he still tilted to either directions but he started to use his arms to support himself. On month later, he can crawl with head elevated easily. He could reach one his arm out and grab objects with his fingers. Two months later, Mr. P.'s parents were very excited since their son could sit still without assistance, stand with some assistance, reach out and grab toys with both hands since his global muscle strength increased significantly. After three months, he could sit and stand much better and swallow much better. Based on his mom, his appetite was improved too since he could swallow easier than before. He started to practice walking with assistance which his parents thought it could never happen before.
Chief complaint: mouth deviation and inability to close left eye for 10 days.
Ms. F. worked outdoors and was exposed to cold weather daily. She started to feel tongue numbness on Dec 28, 2018. The next morning her mouth was deviated associated with left nasolabial groove and front wrinkle disappearing.
Since both central facial paralysis (stroke) and peripheral facial paralysis (Bell’s palsy) could have mouth deviation, It was important to make a differential diagnosis between these two diseases. When she came to my clinic on 01/07/2019, I gave a careful neurological physical assessment to rule out any possible signs of stroke. Her vital signs: Temperature 96.5 degree; Pulse rate 72 beats/min; Respiration rate 18 /min; BP 128/82 mmHg. There was 0.4 inches’ gap between upper and lower eyelids while closing her left eye. At the end of first acupuncture treatment, she felt mouth was not as tight as before and her affected eye could close tighter. After the second treatment on Jan 9, her mouth deviation was improved further and left nasolabial groove was deeper than before.
Due to her busy work, Ms. F. could not come to clinic until Jan 15 for the third treatment. After this treatment, her left nasolabial groove and forehead wrinkles deepened and forehead muscles started to move. Moreover, her left eye could close much tighter. She was very excited about the improvement after those three treatments. Since she kept on working outdoors in cold weather every day, I asked her to wear a mask covering her face, ears and neck. I will give another two treatments in next two days and reevaluate her facial paralysis.
On Jan. 16, Ms. F. came back to clinic and her mouth deviation and eye closure were better than yesterday. Her left eyelid could close much faster. There was 0.1 inches‘ gap between upper and lower eyelids while closing her left eye. She was excited to show me that she could intentionally move her mouth to the left side while smiling. Furthermore, her forehead muscles moved more extensively which could life her left eyebrow much higher than before. One third of her forehead muscles participated in eyebrow movement. I will keep on reevaluating her symptoms tomorrow.
On Jan. 17, Ms. F.'s left nasolabial groove deepened further. She could close her mouth better. When she blew her mouth, there was no air leaking from the left corner of her mouth. Her left eyelid could close even better. She could lift her left eyebrow higher than yesterday. Two-thirds of her forehead muscles participated in eyebrow movement.
(To be continued )
Copyright © 2019 Dr. Song Luo, Chinese Neurologist and Licensed Acupuncturist - All Rights Reserved.