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Case Study: Working with the Elderly

by Warren Cargal, L. Ac.

Working with elderly patients in the Clinic can be challenging. Often they will be taking several different medications as well as having limited mobility which makes it difficult for them to receive acupuncture or take Chinese herbal formulas.

With that said, finding a way to work with them becomes the challenge because the results can be very profound. Let me share a patient with you.

She is 82 years old and living by herself in a retirement community. She is diabetic and has high blood pressure. Her medications are norvasc and lisenopril to treat the high blood pressure and 50 units of humolin for diabetic control.

Even with the medications her blood pressure and blood sugar are not controlled. Average daily blood pressure (bp) is 172/78 and blood sugar (bs)is 180. Due to the elevated bp and bs she has been having transient ischemic attacks (mini strokes) which is effecting her short term memory.

She would be considered a non compliant patient, as she does not want to take herbs or supplements (says it upsets her stomach), is on/off with taking her medications and does not want to change her eating habits. (eats a lot of carbohydrates and drinks daily milk which is hyperinsulamatic).

She came to the Clinic via her children who were very concerned about her deteriorating conditions and feeling they had exhausted what Western medicine had to offer.

On their first visit the patient was confused and had difficulty in remembering words associated with the name of objects. I made two recommendations to the children:

1.      They were to get a nurse tech in twice/day to monitor the Mothers bp/bs and to make sure she was compliant with her medications and supplements

2.      Recommended the following supplements for her to start:

a.       Omega 3/ 2x/day, inflammation, reduce triglycerides, control bs

b.      Coptis 500mg/3x/day diabetic control, bp control

c.       Vit C w/ magnesium 1000mg/2x/day control inflammation, strengthen immune

d.      Blood Pressure support to reduce bp. 3/2x/day

Additionally a dietary therapy was introduced to the patient (with nurse tech assisting), making sure she was eating frequent meals with more protein and vegetable content and reducing carbohydrate consumption.

After 3 days on this protocol, I received a call from one of the children wanting to take the mother off the protocol because she was complaining of upset stomach. His comment was he did not want to cause his mother any additional suffering. I had previously explained to the children that initially there may be some stomach discomfort, however it would pass. I reminded the patient’s son of our conversation and suggested we give the protocol two weeks before we make a decision to change anything.

Coptis the herb being used to reduce blood sugar can cause stomach upset or constipation, so it does take time for the body to get used to it. Laboratory studies suggest that Coptis may have at least two functions in relation to reducing blood sugar: inhibiting absorption of sugars from the intestine and enhancing production of insulin.

Three days later I received another call, this time from the daughter, who said the nurse tech just called to inform them the Mother’s morning blood sugar was 130 (down from an average of 180). A big improvement!

Over the next month the patients bs and bp continued to improve. However more surprisingly, her cognitive functions begin to return with an ability to carry on on-going conversations and to recall the names of common objects.

What was the reasoning for the recommended treatment protocol? The patient was starving herself with a nutritional deficient diet consisting of refined foods, sugars, carbohydrates and dairy. Also she was non compliant around scheduling her meals to control her diabetic condition. Both of these contributed to her prescription medications not being effective. Chronically elevated blood sugar will drive hypertension, high cholesterol and cognitive decline.

I used the Vitamin C, magnesium and Omega3 Oils to help begin to improve her nutritionally deficient condition. Vitamin C acts as an antioxidant required for 300 metabolic functions in the body, which includes tissue growth and repair, adrenal gland function and healthy gums. Ascorbic acid is related to carbohydrate metabolism. Deficiency production of insulin takes place in ascorbic acid deficiency. This vitamin also decreased the level of low-density lipoproteins (LDL which are considered harmful for our body) and increases the levels of high-density lipoproteins (HDL or good cholesterol). It also helps in lowering the blood pressure and helping to prevent atherosclerosis. It is not manufactured by our body therefore, it must be obtained through the diet or in the form of supplements. Most of the vitamin C is lost in the urine.

Magnesium is essential for the proper functioning of many tissues in the body, including the brain. In rats studies it was found that elevation of brain magnesium led to significant enhancement of spatial and associative memory in both young and aged rats. This finding suggests that elevating brain magnesium content via increasing magnesium intake might be a useful new strategy to enhance cognitive abilities.

Several studies have indicated an inverse relationship between the consumption of fish containing the omega-3 fatty acids as eicosapentaenoic acid (EPA, 20:5n-3) plus docosahexaenoic acid (DHA, 22:6n-3) and the risk of cardiovascular disease (CVD) and cardiac death. Numerous intervention trials indicated that higher intakes of DHA plus EPA can favorably influence several risk factors for CVD and fatal heart attacks including reductions in fasting triglyceride levels in the circulation, lowering of the triglyceride:HDL-cholesterol ratio, lowering of blood viscosity, reduction in blood platelet reactivity and other thrombogenic risk factors, plus effects on numerous non-conventional risk factors which are not routinely measured in the public health care system. The latter include a favorable influence of omega-3 fatty acid intakes (as DHA plus EPA) on postprandial lipemia (carbohydrate-induced blood fat surges after a meal), heart rate variability, arterial compliance, lowering of the resting heart rate, as well as anti-arrhythmic affects.

Omega 3 like Vitamin C, is not manufactured by the body and must be obtained from food sources or supplementation.

To begin to get some immediate reduction in bs, I selected Coptis  as it has been shown that Coptis may be helpful in maintaining healthy blood sugar and cholesterol levels in those with type 2 diabetes.

Dr. Guang Ning, of Shanghai Jiao Tong University School of Medicine in Shanghai and colleagues randomized 116 diabetes patients to receive one gram of Coptis daily or placebo for 3 months. Average hemoglobin A1C -- a measure of long-term blood sugar control -- dropped from 7.5 percent to 6.6 percent in those taking Coptis supplements. Patients taking Coptis also showed significant reductions in total and "bad" LDL cholesterol. Blood pressure also fell in patients taking Coptis. Patients on Coptis lost 2.3 kilograms (5.1 pounds), on average, compared to 1.3 kilograms (2.9 pounds) for the placebo group. Patients taking Coptis were more likely to have a side effect of constipation, and two patients in the Coptis group had their dosage reduced for this reason. Journal of Clinical Endocrinology and Metabolism, July 2008

The Best Blood Pressure Support used to help reduce blood pressure draws upon the Materia Medica of Traditional Chinese Medicine (TCM). 

Cassia tora seed and Baikal skullcap: Cassia tora has a cooling quality similar to Baikal skullcap. Both expels excess heat, with an added beneficial soothing effect on the eyes.

Ligusticum chuaxiong: Ligusticum has a warming effect that promotes healthy circulation of blood and Qi. Sometimes conceptualized as the body's vital energy, Qi refers to the entire spectrum of bio-energetic and bio-chemical functions that maintain life on both the physical/material and non-physical levels. In good health, Qi circulates freely. If the flow of Qi is blocked or stagnant, negative functional imbalances may manifest.

White peony root: Another cooling herb used by TCM herbalists to counteract ascending liver yang and harmonize stagnant Qi, white peony is said to tonify the blood, which correlates to a nourishing effect on the body.

Turmeric rhizome: Turmeric, popular all over the world as the spice used in curry, is a warming herb. It has an invigorating action on circulation of blood and Qi. Turmeric contains natural constituents called curcuminoids (collectively curcumin), that have beneficial effects stemming from their ability to neutralize free radicals and promote tissue comfort.

Nardostachys chinensis: Another warm herb, Nardostachys chinensis regulates Qi and disperses excess cold. Belonging to the same family of herbs as valerian, which is well known to western herbalists for its relaxing benefits, Nardostachys chinensis has a similar calming effect on the nervous system.

Individual all six of the herbs have extensive pharmological studies supporting their anti hypertensive effects. Combining them releases a powerful synergistic effect on the body to help reduce blood pressure.

I enjoy sharing these patient stories with you and I hope it is of interest to you as well.. It is a great opportunity to share the diagnostic logic, and the use of Chinese medicine for today’s illnesses. I encourage you to share your comments on our facebook page.

 

This article was published on Wednesday September 15, 2010.
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