Compiled by Kathryn Ann Caudell, Ph.D., R.N., A.O.C.N., Assistant Professor, The University of New Mexico College of Nursing
Two patients from Dr. Sollins’ internal medicine practice entered a Bridges In Medicine™ T.E.A.M. protocol in 1997. Each T.E.A.M. protocol lasted for two months. One patient suffered from fibromyalgia; the other from chronic sinusitis.

1. FIBROMYALGIA T.E.A.M. CASE STUDY



1. History and Background :


M.N. was a 48-year-old female with a 13-year history of fatigue, neck pain, and lack of energy. Her current medical history was significant for fibromyalgia, headaches, fatigue, insomnia, hypertension, chronic constipation, and neck and upper back pain with stiffness. Her current medications included Amitriptyline for sleep, Lotensin for hypertension, Kava Kava for sleep, Ginko Biloba, Accutane, Fiorinal for headaches, a multiple vitamin, and calcium. Due to her low energy levels, she was unable to exercise regularly on her aerobic rider, hiking, skiing or biking. She required ten hours of sleep daily, including naps. Her presenting complaints were lack of energy, waking up exhausted daily, difficulty sleeping, frequent dull headaches, and pain in the C-7 to T-1 area and neck between the scapulae, both of which were rated on a scale of 1-10 as 10 and 9, respectively (0 being pain-free).

M.N. recalls first not having energy in the fourth grade. Her mother was reportedly an overachiever and expected her daughter to continue activities despite low energy levels. M.N. reports having an unhappy childhood. The fibromyalgia onset occurred around age 35, during a time of intense personal stress caused by multiple family situations. She felt pulled in all directions and had to depend solely on herself for support. M.N. also reported having been treated for anxiety in the past.


2. Treatment :


The T.E.A.M. for M.N. consisted of a rheumatologist M.D., a Doctor of Oriental Medicine (D.O.M.), a licensed social worker, a yoga instructor, and a physical therapist and Feldenkrais practitioner. After being evaluated by the rheumatologist, and a group T.E.A.M. consultation, the alternative practitioners began to treat M.N.


• The D.O.M.’s examination revealed wiry, tight pulses of 64. The tongue appeared swollen and quivering with slight deviation to the left. The center of the tongue was peeled. The body was pale and covered with red rough bumps and a light white coating. The right shoulder and scapula were slightly dropped and a trigger points was noted in the trapezius with a strain and pull on the muscles in the neck.
  
  The pulse characteristics manifest in her system as one who represses emotions, a tendency for anger or, as in M.N.’s case, depression. The pale tongue demonstrated that blood was not nourishing the ligaments, tendons and muscles, thereby becoming dry and light. The quiver in her tongue was due to her very weak chi, which is frequently observed in chronic fatigue and fibromyalgia patients. The swollen tongue indicated a spleen chi deficiency. The dry tongue was due to a deficiency of fluid in the body, while the pale color of the tongue was secondary to a blood deficiency, which was also noted as the reason for her sleep disturbances. The treatment recommended by the D.O.M. was acupuncture twice a week to build the chi, smooth the liver energy, build and move blood, and relax the muscles. The patient was also advised to avoid sugar, dairy, wheat, and preservatives.



• The licensed social worker saw M.N. five times in two months for psychotherapy. M.N. initially presented as anxious, depressed, and fearful. She had protected her family from her health problems and discomfort which eventually led to an increased sense of loneliness and helplessness. During therapy she explored a theme of self care versus self exploitation, a feeling that she frequently felt during her childhood. The goals for self care included diet, exercise, self esteem, visualization, rest, and setting limits and boundaries with her husband and sons. M.N. was also encouraged to allow more emotional expression.



• The Feldenkrais practitioner’s goals were to help M.N. become aware of her patterns of organization in her life and her physical movement to guide her development of an enjoyable and sustainable movement program. M.N.’s patterns of organizing included frequent holding of her breath while being engaged in activities. Since exhaustion was a major complaint, this breath pattern could have contributed to her low energy levels. M.N. also braced her chest and neck when reaching from a sitting posture, moving forward to reach while the chest was moving backward. This reach-while-pulling pattern requires increased energy expenditure. Both the breath holding and the chest bracing make it difficult to find neutrality while in action. M.N.’s postural habits while sitting and standing also greatly contributed to her neck and shoulder discomfort. Her center of gravity while sitting fell behind her pelvis causing her pelvis to roll backward, thereby creating a “C” curve in her spine that places her head forward. This led to the neck and shoulder muscles working overtime to carry the weight of the head. M.N. also over-isolated her neck when sitting and turning, and when looking up and down, all of which led to additional muscular stress.
  
  The Feldenkrais practitioner recommended restorative yoga, Feldenkrais hands-on and movement lessons, and aerobic activity. While supporting the body, the restorative yoga leads to a passive release of tension. While learning yoga, M.N. was also instructed in breathing techniques for increasing energy and relaxation. Both the breath work and the restorative yoga were given as meditation techniques to quiet the mind. In addition, M.N.’s exercise program consisted of biking or walking for twenty minutes, three times a week.
  
  
• The certified yoga practitioner discovered that M.N. had experienced long-term stress, which results in subsequent, chronic “holding” patterns of muscular stiffness. The primary areas in which M.N. was affected included loss of muscle tone in the arms and legs, tightness in the hips and shoulders, and a gripping in the diaphragm and intercostals. To begin releasing the tightness in the hips and shoulder, M.N. was instructed in a variety of ways to support passively the body to allow an effortless release of tension. Non-supported postures such as standing were also used to begin restoring muscle tone. Various props were used to help ensure accurate alignment so that her energy could move in a balanced way.



3. Treatment Outcomes :


M.N. responded very favorably to her integrated treatment approach. At the completion of two months, she no longer required afternoon naps. She was beginning to sleep through the night and awoke more easily and feeling more refreshed. Her activity level increased considerably and she was able to maintain increased aerobic exercise. She also gained a keen awareness of how she organizes herself in her movements. She was more sensitive to when she needed to stop and rest, and how she should pace her activities. She also has participated in activities that are joyful and fulfilling, which has contributed to feeling less depressed. Five months after treatment, M.N. continued to maintain her increased activity level, biking for several miles an hour at a time. Her discomfort and pain is considerably less, rated as a ˝ and 1 on a scale of 1 to 10 (0 being painfree). Her appearance was more relaxed and animated. Dr. Sollins saw M.N. six months after the conclusion of the T.E.A.M. protocol. Although personal stress was increased secondary to an anticipated move out of the state, she continued to manage her pain and maintain a more active and energetic lifestyle with continued positive emotional stability.



2. SINUS INFECTIONS AND SINUSITIS T.E.A.M. CASE STUDY



1. History and Background :


J.H. was a 48-year-old male who presented with a 35-year history of chronic intermittent sinus infections and sinusitis. Related surgical history included a tonsillectomy, a nasal polypectomy, and a submucous resection. J.H. had allergy skin testing while in college and received injections with no improvement. He had no hayfever-type symptoms, and never wheezes or is short of breath. He experienced sinus infections intermittently during adulthood, which became more frequent and severe since 1995–96. A CT scan of the paranasal sinuses revealed a whitened area at the base of the lower frontal sinuses bilaterally, indicating that this may be residue from prior infections and could provide the proper environment for future infections. Additional history includes two broken metacarpals, kidney stone extractions, and alcohol treatment.

J.H. is a corporate executive, a high-stress position. For stress relief, he exercises strenuously for 50–75 minutes three to five times per week. He is married and has two children.


2. Treatment :


J.H.’s treatment T.E.A.M. consisted of an internal medicine M.D., a D.O.M., a nutritionist, a Healing Touch practitioner, an allergist M.D., and a chiropractor.


• The D.O.M.’s treatment plan was to balance J.H.’s body, mind, spirit and emotions, to disburse the chi stagnation, to clear heat, and reduce phlegm. The D.O.M. used acupuncture needles, tuina massage, moxibustion, herbal therapy, diet therapy, cupping, and auricular therapy.



• The allergist M.D. performed skin testing and pulmonary function testing (PFT). The PFT was normal. There was no evidence of asthma. Skin testing showed a positive reaction to grasses and weeds, cats, peanuts, and a slight reaction to wheat and corn. The allergist offered a nasal spray for a drippy nose, and two puffs per day of a corticosteroid.



• The chiropractor noted some elevation of the right shoulder, and significant left trapezial tension with a mild trigger point in the left trapezius. Flexion and extension of various spinal locations were accomplished without pain or difficulty. The treatment plan involved spinal manipulation to improve integrity of spine and help his body function better. Cranial manipulation in the sinus region was performed to facilitate sinus drainage.



• The Healing Touch practitioner’s assessment of the seven chakras revealed diffuse achy energy. The Root and Crown chakras were open and spinning clockwise. The others were energetically compromised, feeling diffused and flattened. A buzz was noted in the energy field over the area of the right jaw and face area. The treatment approach included healing touch of the whole body and symptomatic complaints accompanied by soothing music. Specific interventions for subsequent treatments included an opening spiral meditation, mind clearing, pain drain, ultrasound and laser to sinuses, full body connection, attention to the solar plexus and heart chakras, full body magnetic unruffling, pyramid balance connecting the higher and lower centers, self-chakra connection, bridging technique for the heart and back of throat, and a closing spiral meditation.



• The nutritionist was seen three times during the first four weeks of treatment. She took a dietary history and habits, and recommended that the patient restrict his intake of wheat, sugar, and dairy products. She suggested he take vitamin B and C, as well as Bromeline and liquid flax for mucous.



3. Treatment Outcomes :


During the first week into the T.E.A.M. treatment, J.H. experienced the onset of one of his acute sinus infections. He did not seek traditional allopathic therapy during this time from the internist (Dr. Sollins, M.D.). The symptoms became severe, but subsided after one week. He felt that the integrated care he was receiving helped give him the support to withstand the pain and pressure from the infection. After completing the T.E.A.M. treatment, his sinus symptoms dropped from 9 to 2 on a pain scale of 1 to 10 (0 being pain-free). J.H. reported that after running he now no longer experienced green, yellow or bloody discharges from his mucus, nor had he felt burning pressure in his sinuses. His sinuses felt stronger and more elastic. Sinusitis was a major concern in his life that had been put in its place, not in the foreground. J.H. also noted that he felt a renewed spirituality and growth. He reported that the acupuncture and healing touch therapy furthered, and perhaps accelerated, this development. Dr. Sollins has not seen J.H. for a sinus infection since the conclusion of his T.E.A.M. treatment.



3. DISCUSSION


These two case studies demonstrate the effectiveness of an integrated medical approach to reduce symptom distress and improve patients’ well-being in two distinctly different, longstanding illnesses. These treatments did not control for extraneous variables that could have influenced these patients’ outcomes. These treatments also did not systematically introduce the different practitioners into the treatment schedule to determine which treatment modalities had the greatest effect. Nevertheless the intent of the integrated T.E.A.M. approach was to try to improve the health of two patients will illnesses that had not adequately responded to traditional medicine.