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A Patient’s Journey: East Meets West in Stress Management

This is a patient’s progression through suffering from the damaging influence of stress, to the intervention she received under the integrative East-West medicine model of care and ultimately, regaining health. We invite you to follow this patient along the journey as a way to learn the various basic concepts about integrative East-West medicine.

In This Article:

 I. Case Description

II. Intake Interview

III. Treatment Plan

IV. Patient Outcome

V. Comment

Background

Patient SP sought help at the Center for East-West Medicine clinic after having suffered for ninth months from her gastroesophageal reflux symptoms. Upon review of her history, the physician discovered a tangled network of problems far beyond gastroesophageal reflux. She is middle-aged, divorced, appeared overweight, and was pre-hypertensive. A registered nurse, she has worked night shifts in various high-stress Intensive Care Units for ten years. Heartburn and bloating sensations often disrupt her sleep. Over-the counter anti-acid drugs, have only provided temporary relief. She also takes non-steroidal anti-inflammatory drugs (NSAIDs) to help deal with tension headaches, migraines, and environmental allergies.

 

Intake Interview

At the initial history intake, the clinician made note of the following on the patient’s background:

  • Medications currently taken: NSAIDs, Triptan, nasal steroid sprays, anti-acid drugs, and antihistamine agents
  • Supplements currently taken: vitamin D, calcium, multivitamins, gingko, and green tea extract
  • Current diet:
    • meals – mainly cold salads and Asian-dishes, such as fried rice and stirred fried noodles with chicken and vegetables
    • snacks – power bars, chips, string cheese, yogurt, and baked-goods
    • high dependence on coffee and other caffeinated beverages
  • Exercise: cardio and weight lifting for half-an-hour once or twice a week
  • Medical history: chronic low back pain, allergic rhinosinusitis, osteoarthritis of the knee, degenerative disc disease of the cervical spine, migraine headaches, dysthymia, Hashimoto’s thyroditis, and frequent urination and constipation
  • Surgical history: tonsillectomy, septoplasty, and ACL reconstruction of the left knee

 

Enumeration of Stressors

The provider identified the following stressors:

  • Pharmacological stressors: non-steroidal anti-inflammatory drugs have placed a major burden on the gastrointestinal tract; nasal steroid sprays and antihistamine agents may increase drowsiness, rebounding congestion, and dry mucosal layers
  • Psychosocial stressors: divorced, work-related stress incurred by dealing with patients, patients’ families, and doctors
  • Emotional stressors: loneliness, anxiety, and dysthymia
  • Environmental stressors: cold hospital environment results in contracted and tense muscles; hypersensitivity to environmental allergens and patient germs, discharges, and drainages
  • Mechanical stressors: strain on the body from lifting and transferring patients and excessive hours working on the computer
  • Hormonal stressors: perimenopausal symptoms, including hot flashes and night sweats, which disturb her sleep at night
  • Dietary stressors: excessive intake of coffee/caffeinated beverage, cold foods (salad), spicy foods
  • Pain stressors: migraines, lower back problems, heartburns
  • Metabolic stressors: overweight and pre-hypertension; risk factors for cardiac and endocrine diseases

 

Treatment Approach

In this initial visit, the provider began to develop a partnership with the patient by identifying the underlying stressors that trigger her symptoms, and initiated a jointly developed comprehensive treatment regimen that includes acupuncture, acupressure, Chinese nutrition advice, and a stress management strategy beginning with lifestyle modifications. In addition, the clinician analyzed the long list of medications and made plans to gradually reduce her dependence upon them. The patient returned for weekly visits. She was further instructed to perform self-massage on the essential acupressure points and how to use a tennis ball to massage her back. She reviewed the recommended dietary modifications with the clinician, and was taught the techniques to enhance her quality and quantity of sleep. During each return visit the provider reviewed the skills, checked the patient’s progress, and verified the outcomes with the patient.

 

Outcome

After five weekly treatments, she reported that the heartburns, allergic rhinitis, and tension headache have significantly decreased, and no episode of migraines have presented treatment began. She also recognized that to prevent the reoccurrence of her symptoms, she needed to maintain the dietary modifications and continue to practice self-acupressure.

After ten weekly treatments, she reported that she rarely takes anti-acid drugs and pain medicine for her headaches and back pain any more. Other chronic conditions that she had for many years, including constipation, nasal congestion, and insomnia, had improved considerably. No longer suffering from sleep deprivation from heartburns and night sweats, she could enjoy improved mood. Overall, she felt more relaxed and energized.

 

Comment

This patient case illustrates the East-West approach to a wide range of stressors and a complex array of associated health consequences. Practitioners trained in the integrative East-West medicine model of care examine the persons’ background history in detail to first understand the patients, extract essential information in understanding the patients’ illness in the context of their lives, and then derive plans for lifestyle changes in order to achieve overall wellness.

By Shannon Wongvibulsin, BS Candidate, UCLA 2014
UCLA Center East-West Medicine, Staff Writer


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