11/29/2015
Ok, here's the long awaited case study of my little Tourette's patient. She was diagnosed at age 5 1/2 at which time her tics (mostly physical such as eye rolling, head tossing, lip pursing, hand sniffing, etc. with only throat clearing as a vocalization tic) were happening at a rate of 55 tics per minute! Yes, you read that right, almost one a second. She was in constant motion and feeling distressingly out of control. Her Westen Drs told her parents that it was just going to get worse and that she would end up unable to go to school or have a normal life and they should prepare themselves to care for her for the rest of her life. They said that they could try seizure meds (some of the most toxic out there) on her to see if it might help, but otherwise had no other therapeutic suggestions. Her parents didn't like that option and decided to see what could be done fore her with alternative medicine. Her mother had read an article about a cheerleader who attributed her recovery from TS to acupuncture so they found and acupuncturist and tried it. Unfortunately that acupuncturist really wasn't very good with pediatrics and my little patient had a really scary first treatment and didn't want to go back. So her mother decided to try naturopathic medicine. She found one of my lovely colleagues here in town and with diet changes and supplements was able to get her tics down to a rate of about 100 a day! She and her parents were thrilled. She was able to go to school and was (and still is) a top student. However, her improvements seemed to plateau at about 100 tics a day and while it was a huge improvement from 55 per minute her mother was determined to see if more could be done. They decided to try acupuncture again and their ND referred them to me as a pediatric specialist (there's a big difference between acupuncturists who will treat children and those of us who have actually been trained in pediatric acupuncture). When my little patient first started seeing me at the age of barely 7, she was like a little blazing inferno! Her tongue was scarlet and her system was boiling and like boiling water she had no choice but to move (water must be cool enough to have the option to be still). She had both excess heat and yin deficiency manifesting as tics, inability to control her temper and behavior particularly when anxious or excited and secondarily when angry. She was exhausted especially first thing in the morning and in the afternoons but was unable to fall asleep until the wee hours. She had also developed some OCD tenancies such as needing to touch things a certain amount of times and trying to keep everything balanced. I told her parents that her system was like a house that had caught fire and that her treatment would be in 2 phases, first put out the fire, second rebuild her house from the ashes. We started by simply draining heat out of her system as much as possible with a combination of cupping, acupuncture, and take home ear seeds on body points. We also did a little tweaking to her already much improved diet (emphasizing no sugars and increasing cooling foods) and had her walk in ankle deep cold water before bed. Initially her parents didn't want to put her on herbs as she was already on a lot of supplements so we left herbs for our back up plan. She responded dramatically to the treatments and her tics quickly dropped both in frequency and type. Her sleep started improving as well. We had started treatment in early winter and by the time we were approaching Chinese New Year (the beginning of the spring/wood element qi season) she was able to go 2 weeks between treatments and was virtually tic free. I told her parents that it was likely that when the spring qi hit her symptoms might ramp up again and even more so when summer hit (fire season, her pattern was heart fire predominant with liver fire secondary) but not to worry as we would just keep plugging away at it. I gave her mother the dates of the qi changes and sure enough like clockwork my patient's symptoms flared right on que (it only brought her tics up to a handful a day so nothing alarming just a noticeable change). We went back to weekly treatments for a while and cooled her system down more. She then finally got to the point where her excess heat had dropped enough to show the extreme yin deficiency underneath (aka we'd put out enough of the fire that we could start rebuilding her house but at the moment had a pile of ashes). I had seen that she was close to that shift so had told her parents ahead of time that when she made that shift she was suddenly going to be exhausted (it's always a good idea to give parents a heads up when you expect symptom changes because then they can relate to it as an expected progression of improvement rather than worrying that it is a new symptom). We discussed adding herbs (yin nourishing) when she made that shift and they were fine with that. When the shift happened her poor little body was so exhausted that she started sleeping like the dead. In fact she began sleeping so soundly that she was unable to wake herself at night to p*e and so for a while had some trouble with bed wetting. Gradually her energy improved again and she started waking up refreshed. During the summer season we had trouble completely subduing the tics but her treatments were also more irregular with vacations and such. Again like clock work the day the seasonal qi shifted to fall her symptoms dropped back down. During the fall and winter we continued to drain heat and nourish her yin and was even able to start carefully rebuilding her qi. Her OCD symptoms stopped, she recovered from the bed wetting and her sleep became consistently good. Her tics dropped down to a couple extra blinks every few weeks. Initially as her system cooled enough for her body to be capable of stillness the fire in her system would show up in her emotions and self/impulse control (or rather lack there of). Eventually even her emotions and self control were nice and reliable. She was able to reduce many of her supplements and herbs. By spring the qi change was a minor flare and by late spring she was doing so well her parents decided to let her have a break from regular treatments and go to as needed so she could feel normal for a while. She did great! She was tic free all summer and went a solid 6 months between treatments. Gradually by the end of summer and beginning of fall she had built back up enough heat to start having trouble with impulse control. A few weeks ago she started having a little eye rolling and throat clearing. We started doing treatments again but with just acupuncture and gua sha and it has made an immediate difference. Our plan is to do a few weeks of intensive treatments and then set up occasional maintenance. It's been less than 2 years since I first met her and she is well on her way to being balanced. As I told her mother, we can get her to the point where her system is neutral but what's more is we can teach her what her warning signs are as far as her system heating up so that she can get it cooled back down long before it gets all the way back to boiling. I'm very happy with her case. She is not yet all the way to where I want her but she is well on the way and what's more is that she has the tools, support, and self awareness to get her there and now the quality of life to be comfortable on that journey.
A couple notes, every case of TS I've seen thus far has had the characteristic of extreme heat (the whole boiling water can't stay still phenomena), some are heart fire dominant with liver fire secondary others are liver fire dominant with heart fire secondary. Each has its own particularities but so far they all have the extreme heat. The full Chinese diagnosis I gave for the case above is:
1) heart fire igniting liver fire
2) extreme yin xu predominantly of the kidney, heart, and liver
3) underlying spleen and kidney qi xu.
I hope this case is helpful. If you would like to discuss/brainstorm on any similar cases message me. Someday I think it would be nice to do a study on treating TS with Chinese medicine. It's a condition that makes sense to us because of how we diagnose but remains mysterious to Westen medicine as they don't yet have the concepts of constitutional heat. I've explained it to receptive Western medical practitioners as being kinda like a febrile convulsion on slow mo. Imagine that instead of the concentrated heat of a fever causing the concentrated movement of a convulsion, TS is like stretching the heat out until it becomes undetectable as heat to a thermometer and the convulsions slow down to tics.
Thank you to my patient and her parents for giving me permission to share her case and to my colleague for the referral in the first place as well as the awesome tandem work. I love integrative medicine!
