by Malia Kirby

Emma (not her real name) has been a friend to my father's side of the family for as long as I can remember. She's your typical feisty Southern belle: she had her hair and nails done in the salon two to three times per week, she's eternally conscious of her etiquette, she enjoys a mixed drink every evening, and she has absolutely no problem telling you exactly how she sees things. She's a tough old bird, making her one of my favorite people. She's also my most stubborn, non-compliant patient, so I try to make sure she's booked at the end of the day in the event she's a no-show.

One afternoon, Emma arrives in my office looking like she's been hit by a train. She's moving more slowly than usual and I notice she's pale. "How are we feeling today, Miss Emma?" I ask her.

...

"Not well, Sugar," she replies.

"What's going on?"

"Well, I think I might be coming down with that flu that's been going around. All my quilting friends have come down with it, so I'm guessing that's all it is. Could you treat me for that today instead of my knee, please?"

"Sure, Emma," I reply. "Let's take your pulses and I'd like to ask a few questions so I can determine the best formula for you, ok?"

"Now, Sugar, you know I'm not going to drink those horrible teas you make," she tells me.

"I know, Emma, but I'd like to give you options so you can be back to your regular shenanigans and keeping this town on its toes," I tell her in response as I check her pulses...which, for some reason, are abnormally racing and tight for an elderly woman who normally has a fine and faint pulse. She's also clammy to the touch, making warning bells go off in my head.

"Emma," I ask, "tell me what you're feeling specifically. Are we talking respiratory flu or stomach flu?"

"Definitely stomach flu. I'm exhausted, I'm nauseous, and I have a headache right here," as she motions to her forehead. "My neck and shoulders are killing me, too."

"Shoulders?" I inquire.

"Yep. Right between my shoulder blades."

"Hmmm. I suppose it's possible you've picked up the bug that's been going around, but I want to check one quick thing first before I ask you any other questions," I tell her as I reach for my blood pressure cuff.

"That old thing again?" she says as she watches me tighten the cuff around her arm. You know my blood pressure has been under control since that new good-looking doctor moved into town and switched out my medications. I don't know why you bother anymore."

"You know it's simply a safety precaution and that everyone has their blood pressure taken here. It isn't just you," I tell her as I listen for beats...but wait. That...can't be...right. I take the blood pressure cuff off of her arm and switch to the other side, this time tightening the cuff up to 300 mm Hg.

"Emma," I ask, "did you take your meds this morning?"

She pauses for a moment before responding. "I don't remember. I think so. I don't know. Maybe not. But, it's ok because they work over time."

"Not exactly," I tell her. "Prescriptions affecting your heart, particularly what you're taking, must be taken at the same time every day, otherwise they can cause spikes in your blood pressure. From what I'm seeing, I'm guessing you didn't take them this morning, because your BP is 264/152. We need to call you an ambulance to take you to the emergency room."

"I don't want to go to the hospital," she groans.

"Well, I didn't give you that as an option, Emma. I think you're at risk of a heart attack or a stroke. I'm not going to allow you to go home only for someone in the family to find you later on, partially paralyzed. And let's face it, you can't quilt, paint, or raise your normal level of ruckus if you don't have the use of both arms."

She glares at me for a moment before grunting, "Fine. Call an ambulance."

I call the hospital and I make a few calls to her surviving family members to let them know what's happening. A less than an hour later, she had a heart attack.
_________________________________

Howard (not his real name) is an athlete in every sense of the word. He's a triathlete and avid rock climber with ambitions of being an Ironman. He's one of the few people who I'll see outside running in sub-zero temperatures here in Boulder, I've regularly seen him cycling in the foothills, and I'm sure that if I were out climbing Fourteeners here in Colorado, I'd probably see him there also. In the outdoor sporting world, Howard is ubiquitous.

One would assume that he first sought treatment for some sort of trauma or to improve his performance, but instead I first saw him for extreme fatigue, which kept him from his training. As I discussed what he was experiencing over the phone with him before his first appointment, I requested that he bring in a list of his medications and the bottles of every supplement he was taking.

"I really believe in Chinese medicine," he told me over the phone. "I've experimented with a number of herbal prescriptions that were recommended to me at the health food store and I've even cured myself of my insomnia, so I've been studying a little on my own. It's really interesting!"

"I'm glad you're pleased with your experience so far. And if you don't mind, would you please be sure to bring the bottles of the Chinese herbs you've been taking as well? Different companies will often modify their formulas from the classics and I'm not always familiar with those modifications if I don't use their products."

"No problem. I'll see you soon," he replied as he hung up the phone.

When Howard's appointment finally rolled around, I could easily see that he was exhausted as it appeared that he could barely carry in the shoebox full of supplements and he was slightly dragging his feet as he took each step. I greeted him at the door, took the box out of his hands, and helped him to my table.

"Wow, you weren't kidding, Howard! Your exhaustion is almost dripping off of you! Let's see if we can't get you feeling better sooner rather than later. First things first, though. Let's take your blood pressure."

"What the...? Well, that explains the exhaustion," I thought to myself.

"Howard," I asked, "do you ever keep track of your blood pressure?"

"No, I don't see much point. I've always had rock-steady blood pressure at 90/60 at every doctor's appointment. Why do you ask?"

"Today, you're at 65/40, which is abnormally low. I don't really see much in your medical history suggesting why that would have happened, so I'm fairly concerned with this. I'll go ahead and give you a treatment today, but I also want you to see your primary care physician as well to ensure that nothing is wrong physiologically, ok? Now, I'm going to start with some moxa to help build you back up, which will..."

As I continued on my usual moxa spiel I give to my first-timers, I wondered to myself how something like this could have happened. I supposed that, theoretically, he could have been burning up his yin and blood through his training or that perhaps his spleen was so vacuous that he wasn't able to take in post-heaven qi from his diet. I also wondered if he might be a possible case of anorexia, but considering his build, I figured that at that point I was severely reaching for an answer. After I inserted his needles, I sat down at a desk and began to look over his supplements, where I was soon to discover the problem.

Howard wasn't exaggerating when he told me over the phone he had been experimenting with Chinese medicine. He had well over fifteen formulas that he'd brought in with him, most of which redirected qi downward or invigorated the blood, with the overruling majority including (Huai) Niu Xi* as an ingredient.

"Ok, it's time to pull your needles and I think I might have discovered where your low blood pressure is coming from, so I'd like to ask one last question that could confirm or deny my suspicions. Regarding the Chinese herbs you've been taking, which are you currently using and how often are you taking them?"

"I've been taking them all, three times per day, just like the clerk at the store suggested."

Bingo.

"Here's what we're going to do. I'm going to fill you a formula to help combat the effects you've been feeling and I want you to stop taking everything in that shoebox. You can keep it for another time, but for right now, don't take anything you've brought in with you. In the meantime, I want you to salt it up. Chips, popcorn...anything your heart desires. Don't worry about keeping your training diet. Right now, I want you to eat anything that will help build up your blood pressure. Everything you've been told not to eat because they aren't "healthy," I want you to eat for the next three days. I'll check up on you then. If I'm wrong and you aren't feeling better when I call, I want you to make an appointment with your MD."

In three days' time, I called Howard to see how he was feeling and I left a message on his voicemail to return my call when he got the chance. The next morning, I started my day listening to a message from him telling me all about how he had missed my call because he felt good enough to go out rock climbing with his buddies.
_________________
*Chen, John K & Tina T. Chen. Chinese Medical Herbology and Pharmacology. Pgs 650-651. Art of Medicine Press. City of Industry, CA. 2004.