Burning Peripheral Neuropathy in Little Toe

I am new to practice and one of my first patients is a complicated patient with a myriad of symptoms.  I was hoping to get some suggestions on treatment.

My patient is a 54 year old woman whose main complaint is a neuropathy in her right 5th toe.  She's had 3 operations on her toe, including one to remove a bone spur and one to remove the toe nail.  She states that the burning pain in her toe was exacerbated by the operations and is now a constant pain that she rates as a 9 out of 10.  She says her next step, if I am not able to help her, is to have her toe surgically removed.  Tests have not shown any cause for the neuropathy.  My patient is not diabetic.

In addition to the peripheral neuropathy in the toe, she also suffers from major back pain between the scapulas and in the lower back around UB23 to UB27.  Tests have confirmed that she has arthritis in her cervical, thoracic, and lumbar spine.  She also suffers from bipolar disorder, insomnia, dry mouth, migraine headaches, and depression.  She is taking at least 5 different perscription medications, including Wellbutrin and Estrogen (I can't recall the others).

My patient has a rapid and thready pulse with a reddish tongue with very little coat.  She has floaters, sips small amounts of water throughout the day, tinnitus, dry eyes, constipation, and vaginal dryness with a recurrence of UTIs.  I have diagnosed her with KD Yin Deficiency, LV Blood Deficiency, and LV Qi Stagnation.

So far, I have treated her 3 times.  Although she says she feels more relaxed after her treatment, there has not been any alleviation of symtoms.  The points I have been using are DU20, DU14, UB18, UB23, UB27, KD3 (left), SP6 (left), UB40, UB58 (right), UB60 (right), UB65 (right), SI3 (left).  Additionally, I use electro stim with microcurrent on UB60 to UB65.  I finish with cupping on her upper and lower back.  I have also tried blood letting on UB40 bilaterally.

I know that a case like this will take time to see marked improvement, but my patient is desparate for relief.  Any suggestions anyone could provide on this complex case would be greatly appreciated.  Thank you.

Ang


Comments

misty's picture

Dear Ang,  Try CV10,12

Dear Ang,

 

 Try CV10,12 13

and then Stomach Chiu

then GB 22,23

 

These are for RSD and worked on me

 

Kiko Masumoto did these on me 5 times with 85% improvement. Please tell me if it works

 

Bill// Misty

 

 

misty's picture

Dear Ang,  Did either

Dear Ang,

 

 Did either approach work????

 

Bill/Misty

Chad Dupuis's picture

Mixed presentations like

Mixed presentations like these are often very difficult to treat and if you were trying to treat her whole range of symptoms looking for the root pattern would be the place to start.  You are, however, only treating her for the neuropathy - although the bipolar, insomnia, etc. would be good to treat as well.  In cases, like this, however, you need to take one step at a time - particularly when the conditions are not directly related.  In her case, her bi-polar disorder is not the issue, nor is the arthritis, etc. - it seems to be a reaction to the surgery, which is common.

Treatment wise, then, I would focus on the matter at hand - and when it resolves you can focus on the other broader conditions should the patient want to pursue that route.  Trying to do all of them at one time, particularly when the conditions will take at least 3-10 treatments before a strong response is felt, will most likely lead to patient frustration at least, and outright failure at most.

Your general point selections look fine, but I would narrow things down a bit and focus on more cupping and tuina in the area.  I would recommend something along the lines of SI 3 w/UB 62, HT 7, GV 20, GB 20, huatuo of T1, T7, L2, L5, UB 40, GB 34, GB 39, UB 57, (all bilateral) and UB 65 (right only).  These can all be performed with the person lying face down - afterwards some cupping in the T7 to L5 area to facilitate the circulation down to the legs and then fairly strong tuina (to the patient's tolerance, of course) through the whole calf and down into the foot - massage the whole bottom of the foot and then in and around the toe joints.  I would use some sort of cream like tiger balm to stimulate the blood circulation in the area.

With the history of surgery you don't really know what the condition is within the foot - but conditions of this nature should improve to at least some degree within the first 4-7 treatments.  If there is no change and you are comfortable with what you have tried there may be damage from the surgery that is difficult to heal and you shouldn't feel bad for not being able to help her entirely.  Unfortunately for the patient, many of these conditions are easier to treat if people were to try acupuncture first, instead of as a last resort which is somewhat common as peoples understanding of acupuncture is still growing.

ang67's picture

Thanks for the

Thanks for the suggestions.  Taking a more focused approach makes sense.  I will give it a shot and see what happens.

ang67's picture

Unfortunately, my patient

Unfortunately, my patient quit on me before I had the chance to try either of these suggestions.  I guess she was desperate for some immediate relief, and when she didn't get it, she decided to try something else.  I did explain to her that chronic conditions like these take time to treat, but she felt that she couldn't wait.  Maybe if I had taken a more targeted approach from the beginning, we would have seen faster results.  A lesson learned.  Thanks for the suggestions.

misty's picture

You are most welcome Bill

You are most welcome

 

Bill

Feng Mei's picture

my suggestion

try salonpas patches suround stick on little toe. 8 hours a day ,change everyday, 7 days a term.