Intake of case June 15th 2021
T.M. is a 51-year-old female patient who presented to the clinic with symptoms of what she termed spells or episodes. These spells would last from 1 to 30 minutes during which time she would experience tightness, sweating, balled up tension in her epigastrium and intense pain.
She would have to curl up in a ball during the spell until it was over and would be left with the feeling of being weak, exhausted and sweaty.
Medical History:
Family history of bowel cancer, cataracts, corneal separation, senility.
Personal history of traumatic birth of second child, history of trauma on sailboat capsizing when 7 years old. Hemorrhaging following second child from piece of placenta not removed after delivery.
Vaccinations: fully vaccinated following Ontario schedule when younger, no reactions known.
T.M. presented with the menopausal symptoms as her chief complaint. A stiff neck and shoulders was also added to her list and occasional headaches from running. She described her hot flashes as occasional now and further between describing them as 10 times per month. When they come at night they wake her up and that is annoying. Her pattern of sweating with the hot flashes is pelvis, chest, back and shoulders.
Practitioner: Can you tell me about the spells you mentioned on your intake form?
T.M.: They are weird, they start as a grabbing feeling in my upper abdomen, it was tied to my cycle but now they are not as regular. They are a tightening, causing me to feel anxious and start sweating, they can last up to an hour.
They are painful but I cannot control it, cannot stop it or get away from it. The symptoms get worse and worse then they just stop. I feel exhausted afterwards and sweaty. I am white in the face. Of the one I had last month, my husband said I had fear in my face and I was pale. I don’t like pain at all. I am afraid of it especially when I don’t know what it is from.
When I know what is causing it I can calm down. I bend forward for relief but it does not help much. Lying on my side is best bent up in fetal position. It is tight I cannot breathe well it feels like, hot, like a fever, heat all over but mostly in chest and back, head, forehead.
Practitioner: Have you tried anything to help with these attacks?
T.M.: Yes I saw a Naturopath and she gave me Cheliplex which worked for 3-4 months to ease them when they started but did not do anything to stop them. Then I was given Sepia for 2 months but it did nothing to change the symptoms.
I try to stretch out when they start and to open up my breathing but then flex forward afterwards for relief. My bowel movements are related to it, like something must move through there for it to go away (she pointed at her stomach area in the epigastrium). It settles if I can have a bowel movement.
Practitioner: Does anything trigger them?
T.M.: I have had them after a run, while doing groceries, at work, at home, so no pattern has shown itself, no.
Practitioner: Can you tell me about menopause when did it start and when was your last period?
T.M.: Last one was July 2020 but they were erratic prior to that for 5 years. The hot flashes have been for those 5 years and the cramping started about 2 years ago. My menstruation prior to that was bright red, some clotting on the first day, the day before had a feeling of having to empty my bowels completely, had a lot of aching but no cramping with them, 3 days of heavy flow and 2 days light. My sex drive is quite low since menopause started.
Practitioner: Can you tell me more about the panic or anxious feeling?
T.M.: I used to panic because I had no idea what was happening before I had figured out that it is related to hot flashes and my bowel movements. It hurt so much it panicked me.
Practitioner: Can you tell me about the headaches?
T.M. They are related to the neck tension, I get a stiff neck then pressure in my head, behind my eyes, and nose, it is worse with running, I get tighter and tighter during a run and when I get home, I have a headache. When I turn my head to the right the headache goes from my neck up into my head. Always in that direction. It is a restricted feeling, sleeping can aggravate, make it worse, especially with deep sleep, I will wake up with a headache after a deep sleep. I don’t seem to guard my neck during a deep sleep.
The intake continued but further details did not arise about the chief complaints. The questions then shifted to more general in nature.
Practitioner: How are your bowel movements and digestion in general?
T.M. Good, I go at least once a day most days twice. But lately they have been shorter and more like little balls. For about a year now. No pain or constipation at all but this cramping seems related to the movement of stool through my colon.
Practitioner: Tell me about your energy?
T.M. it is very good, I get lots done, I sleep very deeply and sometimes I can take a nap in the afternoon. I am most energized in the morning, and I get motivated by things that make me happy. If there is a negative energy about something it wears me down. Sadness makes me slow down, but I think that is normal.
I sleep about 7-8 hours and can fall asleep in a few minutes. I don’t move much when I sleep. I am woken by the hot flashes, and they drive me out of bed to cool off. I am agitated when they come. I like the room cool but not cold or I cannot fall asleep.
I like the windows open only if raining and I need a blanket but not too thick. I will stick my right leg out if I get too hot and I snore when on my back. I sleep on my side mostly and I can according to my husband talk when I am sleeping and not remember what the conversation was about in the morning.
