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Case Studies

Maggie's Complete Case Study

Case Study: Maggie

Diagnosis:

Mastoiditis in left ear
Severe TMJ disorder caused by disk displacement (right) and fluid on left joint
Cervical muscle spasms due to spinal surgery for disk rupture with spinal cord compression
Myofacial pain and headaches

Description of limitations/ problems:
Dizziness and ringing in left ear (continuous); fullness and pressure in left ear; head and neck pain; inability to chew for one year; inability to sit or stand for long periods of time; loss of concentration frequently and loss of balance occasionally. Insomnia.

Treatment starting June of 2002 included: Physical therapy manipulation of TMJ joints, ultrasound, TENS unit, accupuncture, Trigger Point injections in face, head, neck and back, BOTOX injection in face and head, Biofeedback.

TMJ Surgery on 4-15 and 6-19 - Arthrocentesis. (Arthrocentesis involves establishing inlet and outlet portals in the upper joint space with hypodermic needles, irrigation of the joint with lactated Ringer's solution, and lysis of adhesions by hydraulic distention of the joint and manual manipulation.)

Prescription drugs: Valium, Bextra, Soma, Flexural, Robaxin, Darvocet, Vivactil, Pamelor, Zanaflex, Naproxen, Effexor, Vicodin, Antivert. Antibiotics for inner ear disease: Augmentin, Prednisone, Levaquin

Note from Maggie: The only lasting relief I have come up with so far has been from physical therapy joint manipulation and massage/reiki therapy.

Medical Treatments 2002-03


4-11-02
- C-6-7 Level Cervical Spine Fusion
Surgery goes well, hospitalized for two days. Two weeks following surgery I wake unable to open jaw. Developed severe TMJ disorder.

6-02 - Was given a TMJ splint in attempt to reposition disks to wear day and night for one month and stop chewing food. Put on a soft/blended food diet and sent to physical therapy.

6-02 - Start Physical Therapy for TMJ. Ultrasound, manual manipulation, massage,ice and heat. Given jaw exercises to do daily.

8-02 - Sent to Cedars Siani Pain Center to combat daily migraines associated with the TMJ and the TMJ pain. Given Pamelor and Flexural.

9-02 - Trigger Point injections in face and head for TMJ and in the trapezes muscle. Continue physical therapy. Given Effexor.

10-02 Continue PT, now getting trigger point injections every 10 days for TMJ, still unable to chew foods or hold a conversation without myo-facial pain.

1-17-03 - MRI of TMJ joints reveals some disk displacement of the right disk (it is forward) and fluid on the left joint. Continuing PT. Slight ringing in ears begins. Some slight dizziness but still able to function.

3-03 - Blue Cross cuts me off from PT on 3/6. By 3/27 the pain in my ears was intense, the dizziness had increased to the point I could barley drive.

4-1-03 - MRI of brain and head shows fluid in the left mastoid, told I have Mastioditis. Doctors attribute my ear pain to TMJ. Put on Augmentin (antibiotic) and Prednisone.

4-4-03 - Go to Emergency Room at Midway Hospital for severe pain in right side of neck and numbness in my right hand. Given Vicodin.

4-12-03
- Go to Midway Emergency Room with extreme dizziness and ear pain. Given a shot of Morphine and sent home that night at 3am.

4-15-03 - Arthrosintsis TMJ surgery at UCLA Dental and Oral Surgery. Ringing in ears is getting worse.

4-20-03 - Go to Cedars Emergency Room with extreme dizziness after trying to go to the grocery store by myself. Put on IV. Given Antivert 25mg the following day and sent home.

5-1-03
- Botox given in TMJ trigger points and head. Some relief of myo-facial pain. Dizziness persists.

5-12-03 - Fluid in inner ear remains, pain is intense. Have pulsitial ringing. Dizziness is severe, cannot drive. Put on Leviquin (antibiotic) as second attempt to get rid of inner ear mastioditis.
Resume Physical Therapy for TMJ. Evaluated for Arthroscopy TMJ surgery. Surgeon decides against.

5-29-03
- Visit new ENT told again that my ear problems are caused by TMJ. Given Valium.

5-26-03 – Began Massage Therapy and Reiki Therapy with Laura Sadler

Note from Laura: The Tinnitus and any pain will be gauged on a scale of 1-10, 10 being highest. The following are my notes and updates I get from Maggie unless otherwise noted.

5-26-03

Treatment:
Massage Therapy on upper back and neck and jaw on the right side at site of pain. Reiki Therapy on the right side of the jaw at site of pain and on both ears. Maggie is on muscle relaxers, Robaxin and occasionally Soma, anti-inflammatories – Bextra and antibiotics – Levaquin.

45 minutes massage – at least 15 devoted to jaw massage
15 minutes reiki on both jaw and ears.

Results:
Tinnitus almost gone on right side. Jaw didn’t lock for a week.

Maggie’s Notes:
Visit Laura Sadler for Massage and Reiki. After treatment am able to drive all the way downtown for the first time since 3-27. Head feels more clear.

6-4-03 Physical Therapy

6-10-03
Myringotomy ear procedure at the House Ear Institute

6-12-03

Client had to have a small hole drilled in left eardrum due to pressure caused by a buildup of fluid.
30 minutes massage - at least 15 devoted to jaw massage
15 minutes reiki – jaw
15 minutes reiki – ears
used Stillpoint method

Results:
Jaw locked after 4 days due to an attempt at eating solid food. Tinnitus in right ear disappeared completely. Infection developed in left ear from having the hole drilled in the eardrum. Client received cortisone shots in her jaw at the joint and had antibiotics placed on the left eardrum. Heartbeat sound disappeared from left ear.

Maggie’s Notes:

Second surgery is painful. The ringing is more intense than ever in my ears. I see Laura again and it is calmed down to pre-surgery levels of ringing. I am able to go to Sav-On by my self twice in the week without major distress and confusion of driving.

6-15-03 Follow-up where they put Cypro on a swab in her ear to relieve the pain.
Maggie: it really made it worse cause they left the cotton thing in there I found out from a later doctor who removed it.

6-16-03 Trigger point injections in TMJ and head muscles at Cedars Pain Center

6-4-03
Physical Therapy

6-24-03

15 minutes massage back and neck
20 minutes reiki on jaw
15 minutes reiki on both ears
3 mintues reiki on top of head (for stress)
used Stillpoint method

Results:

Ringing in left ear volume is 9. Tinnitus went from a constant ring to a woosh sound during treatment and went to a 4 out of 10. It lasted until 10pm that night and then went to a 6 out of 10. Jaw and neck pain continue to decrease, dizziness is also decreasing.

6-27-03
45 minutes massage upper back, neck, scalp, face and jaw
20 minutes reiki on ears
15 minutes reiki on jaw
used Stillpoint method
added visualizations to reiki treatment

Results:
Volume of ringing went down in left ear during treatment.
Maggie was able to go to a Spinning class for the first time since her surgery. After class the pressure in her left ear increased. The volume of the ring in her left ear has decreased and only increases when she’s tired. Her headaches have decreased from all day to only a portion of the day and are much more manageable. She is able to carry on a lengthy conversation on the phone for the first time since her surgery.

Maggies Notes:

6-29 Friends come into town from Maryland. I am nervous as I don't know if I can hold conversations and focus for more than an hour at a time. Not only am I able to make it through weekend I actually enjoy the company and am able to talk and ignore the ringing in my ears.

7-2-03

30 minutes massage upper back, neck, scalp, face and jaw
25 minutes reiki on ears
15 minutes reiki on jaw
used Stillpoint method
used visualizations with reiki treatment

Results:
Condition stabilizing, but she had a setback from sitting in a moist sauna which aggravated her left ear. Ringing in left ear volume is 7.

7-8-03
Maggies is only taking Anitbiotics at this point. Ringing in left ear is volume 7 at start of treatment. Ringing went to a 5 at the end of treatment. Maggie is only taking antibiotics for the fluid buildup in her left ear.
50 minutes massage upper back, neck, scalp, face, jaw and pressure points on hips
20 minutes reiki on ears
10 minutes reiki on jaw
used Stillpoint method
used visualizations with reiki treatment

Results:

Ringing was down to a 5, but went up to a 6, and then after experiencing extreme stress it went up to an 8. Myofacial pain is at a 6.

7-11-03


Treatment:
55 minutes massage upper back, neck, scalp, face, jaw and pressure points on hips
25 minutes reiki on ears
10 minutes reiki on jaw
used Stillpoint method
used visualizations with reiki treatment

Results:

Ringing reduced during treatment, no number to specify the reduction. Maggie was able to go to the mall for the first time. She spent an hour there with no dizziness. Her Tinnitis rose due to lack of sleep. Maggie saw her surgeon and he said that she looked so good, he thinks she should be able to eat. When she tried her jaw locked again and it took her 4 hours to unlock it.

7-16-03
When Maggie arrived her Tinnitis was at an 8. Her myofacial pain was a 4. The Tinnitis went down to a 4 at the end of treatment. I used a towel and created traction in her head and neck before massaging her face and jaw.

Treatment:
55 minutes massage upper back, neck, scalp, face, jaw and pressure points on hips
25 minutes reiki on ears
10 minutes reiki on jaw
used Stillpoint method
used visualizations with reiki treatment
neck stretch and traction using a towel

Results:

The volume stayed at a 4 for 24 hours and then went back up to a 7. Maggie saw her doctor and he checked the hole in her ear. He told her that it had completely healed up, and he was amazed at how quickly it had healed. Her myofacial pain has continued to decrease.

7-18-03
Maggie got stuck in traffic for 45 minutes. She did not experience any dizziness; this is the longest she’s spent driving since the mastoiditis kicked in. She is almost finished with taking the antibiotics. Maggies’ volume went from a 7 to a 5 during treatment.

Treatment:
55 minutes massage upper back, neck, scalp, face, jaw and pressure points on hips
20 minutes reiki on ears
10 minutes reiki on jaw
used Stillpoint method
used visualizations with reiki treatment
neck stretch and traction using a towel

Results:
At this point in her treatment, I have decided to summarize Maggie's case. We've been seeing a definite pattern of relapse occurring due to stress. The main source of Maggies stress is her dealings with her insurance companies and with some doctors that want to give her pills and send her on her way. She is often accused of being depressed or having anxiety, and some of her doctors have refered her to psychotherapists.

Maggie is not suffering from anxiety or depression, her pain is real. She recently saw a neuro-muscular dentist and the dentist told her that her case is the worst she's seen in 17 years. The dentist also told Maggie that she went into medicine because she had suffered from TMJ and many doctors had accused her of being crazy too. The dentist recommended that Maggie continue her massage/reiki treatments and is going to arrange for her to have a tens unit to use on her own. If Maggie doesn't get recover in a month or so, the doctor recommends that Maggie have another surgery.

Overall, Maggie has had the best results for her pain management with massage therapy and reiki treatments. She has been closest to returning to a normal lifestyle since she's been receiving these therapies along the care she's been receiving from her doctors. Although, she has relapses, she has never has pain or dizzyness that even come close to what she experienced before she saught out alternative treatment. She has confirmed that some of her problems are related to nerve damage that took place before her operation on her spine. As we go forward, I am hoping that the therapy I provide and the treatment she is seeking from the neuromuscular surgeon and osteopath will eventually cure her so that she can avoid further surgery.

I will continue to comment on Maggie's progress as I treat her, but I will just give occasional updates rather than details of each visit.

August 25, 2003:
The treatment that Maggie is receiving from her dentist is going well. The main problem she faces is that they insist on using the tens unit on Maggies neck and when she comes to me for treatment her neck is extremely tense. She has been having stronger headaches from this and some neck pain. Maggie's new splint is working out well and the clicking in her jaw has ceased. We are mainly focusing Maggie's treatment on her neck and on the Tinnitis in her left ear. Since she has been seeing the dentist, the volume seems to have increased and the fluid is also building up again in that ear which is making her dizzy again. I suspect the neck strain may be related to these symptoms.

 

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Laura Sadler,
LMT CMT
818-562-7764

Located in Burbank