Client with upper right quadrant pain


Debra Foley
 

On June 8th I had a client who complained of high mid to right sided abdominal pain that spread to the scapula. She was experiencing a higher level of pain recently and had a history of high liver enzymes 10 years ago which resolved by diet change.

GL: U RQ
LL:  liver, gallbladder, pylorus, sphincter of oddi, dj


Mobility test of the liver seemed harder to move from right to left. Worked in a seated position on the liver which improved mobility. The gallbladder seemed difficult to feel with a lack of motility. Working with the sphincters initiated a relaxing and gurgling response. After the session she initially felt better with decreased pain and she went home and slept for 2 hours. The pain resumed and she made an appointment with her dr for the next day. The labs and ultrasound revealed a large amount of stones, inflammation, infection and scar tissue in the gallbladder. She was scheduled for surgery the next morning to remove the gallbladder. The surgeon found the gallbladder "stuck" to the colon and duodenum and it was so inflamed they stopped the surgery, closed her up and transferred her to a larger hospital where they placed a drainage tube into her gallbladder. The intent is to wait for surgery until infection and inflammation subside. At the present she feels better and only minimal pain where the tube was placed. She is drinking apple juice and taking supplements to calm her gallbladder. Her first question for me was "How soon can you work on me?" I realize infection is a contradiction for VM. She was placed on antibiotics and has finished taking them.
I would like any thoughts and advice on this case.

Thank you.
Deb Foley VM1 LT1 CS1 LMT


Dagmar
 

Hi Deb,
The first thing that comes to my mind is as visceral therapist we work "in the realm of the subacute". So the question is when will your patient be subacute. Is the infection gone? Are the doctors still planning on removal of gallbladder? I would give it at least 4 weeks after surgery, and then start with a short appointment, mainly motility. See how she does with that, and take it from there. I would also require a doctor's ok to cover my you-know-what. 
I have allowed myself to be pushed into early treatments by eager patients a couple of times, and it did not go well. So most importantly, if you don't feel good about treating her, if you feel a listening that seems to push you "out" of the gallbladder - do not let yourself be swayed against your better judgement!
I don't think there is a clear cut answer, but I hope it helps some.

Dagmar Growe, LMT
VM 1-6, NM 1-4, LT1, VVM 1 & 2


Debra Foley
 

Thank you for responding. I appreciate it. Some good points. Always a learning experience.  She definitely has to have the gallbladder removed and has an appointment with surgeon beginning of July. 
Thanks again.
Deb



On Jun 24, 2022, at 4:18 PM, Dagmar via groups.io <dagmar@...> wrote:

Hi Deb,
The first thing that comes to my mind is as visceral therapist we work "in the realm of the subacute". So the question is when will your patient be subacute. Is the infection gone? Are the doctors still planning on removal of gallbladder? I would give it at least 4 weeks after surgery, and then start with a short appointment, mainly motility. See how she does with that, and take it from there. I would also require a doctor's ok to cover my you-know-what. 
I have allowed myself to be pushed into early treatments by eager patients a couple of times, and it did not go well. So most importantly, if you don't feel good about treating her, if you feel a listening that seems to push you "out" of the gallbladder - do not let yourself be swayed against your better judgement!
I don't think there is a clear cut answer, but I hope it helps some.

Dagmar Growe, LMT
VM 1-6, NM 1-4, LT1, VVM 1 & 2


Heather McWilliams
 

I just wanted to chime in and thank you Dagmar for your post.  I found it very helpful.
Heather McWilliams, MSPT
Quantum Leap Physical Therapy
360-990-6627

*Please note that the information contained within this email is intended for the recipient indicated in the salutation.  If you have received this email in error, please notify the sender and delete any copies of this email.  


On Sat, Jun 25, 2022 at 4:22 PM Debra Foley <foley.deb1960@...> wrote:
Thank you for responding. I appreciate it. Some good points. Always a learning experience.  She definitely has to have the gallbladder removed and has an appointment with surgeon beginning of July. 
Thanks again.
Deb



On Jun 24, 2022, at 4:18 PM, Dagmar via groups.io <dagmar=scattercreek.com@groups.io> wrote:

Hi Deb,
The first thing that comes to my mind is as visceral therapist we work "in the realm of the subacute". So the question is when will your patient be subacute. Is the infection gone? Are the doctors still planning on removal of gallbladder? I would give it at least 4 weeks after surgery, and then start with a short appointment, mainly motility. See how she does with that, and take it from there. I would also require a doctor's ok to cover my you-know-what. 
I have allowed myself to be pushed into early treatments by eager patients a couple of times, and it did not go well. So most importantly, if you don't feel good about treating her, if you feel a listening that seems to push you "out" of the gallbladder - do not let yourself be swayed against your better judgement!
I don't think there is a clear cut answer, but I hope it helps some.

Dagmar Growe, LMT
VM 1-6, NM 1-4, LT1, VVM 1 & 2


Winnie Tsu
 

When all settles down, consider the phrenic nerve as infection can affect it and it runs from C3-5 to pleura, capsule of liver, mediatinum, right upper abdominal peritoneum, diaphragm, capsule of gall bladder and adrenal glands.  Also helpful to release things related to C3-5 and thoracic outlet....subclavius, dorsal scapular nerve, subscapularis serratus ant, long thoracic nerve, nerve to levator and levator scap, rhomboids

Winnie

On Sun, Jun 26, 2022 at 2:53 PM Heather McWilliams <quantumleappt@...> wrote:
I just wanted to chime in and thank you Dagmar for your post.  I found it very helpful.
Heather McWilliams, MSPT
Quantum Leap Physical Therapy
360-990-6627

*Please note that the information contained within this email is intended for the recipient indicated in the salutation.  If you have received this email in error, please notify the sender and delete any copies of this email.  


On Sat, Jun 25, 2022 at 4:22 PM Debra Foley <foley.deb1960@...> wrote:
Thank you for responding. I appreciate it. Some good points. Always a learning experience.  She definitely has to have the gallbladder removed and has an appointment with surgeon beginning of July. 
Thanks again.
Deb



On Jun 24, 2022, at 4:18 PM, Dagmar via groups.io <dagmar=scattercreek.com@groups.io> wrote:

Hi Deb,
The first thing that comes to my mind is as visceral therapist we work "in the realm of the subacute". So the question is when will your patient be subacute. Is the infection gone? Are the doctors still planning on removal of gallbladder? I would give it at least 4 weeks after surgery, and then start with a short appointment, mainly motility. See how she does with that, and take it from there. I would also require a doctor's ok to cover my you-know-what. 
I have allowed myself to be pushed into early treatments by eager patients a couple of times, and it did not go well. So most importantly, if you don't feel good about treating her, if you feel a listening that seems to push you "out" of the gallbladder - do not let yourself be swayed against your better judgement!
I don't think there is a clear cut answer, but I hope it helps some.

Dagmar Growe, LMT
VM 1-6, NM 1-4, LT1, VVM 1 & 2


Debra Foley
 

Thank u for the great information!


On Jun 27, 2022, at 10:01 AM, Winnie Tsu <winnie.valencia@...> wrote:


When all settles down, consider the phrenic nerve as infection can affect it and it runs from C3-5 to pleura, capsule of liver, mediatinum, right upper abdominal peritoneum, diaphragm, capsule of gall bladder and adrenal glands.  Also helpful to release things related to C3-5 and thoracic outlet....subclavius, dorsal scapular nerve, subscapularis serratus ant, long thoracic nerve, nerve to levator and levator scap, rhomboids

Winnie

On Sun, Jun 26, 2022 at 2:53 PM Heather McWilliams <quantumleappt@...> wrote:
I just wanted to chime in and thank you Dagmar for your post.  I found it very helpful.
Heather McWilliams, MSPT
Quantum Leap Physical Therapy
360-990-6627

*Please note that the information contained within this email is intended for the recipient indicated in the salutation.  If you have received this email in error, please notify the sender and delete any copies of this email.  


On Sat, Jun 25, 2022 at 4:22 PM Debra Foley <foley.deb1960@...> wrote:
Thank you for responding. I appreciate it. Some good points. Always a learning experience.  She definitely has to have the gallbladder removed and has an appointment with surgeon beginning of July. 
Thanks again.
Deb



On Jun 24, 2022, at 4:18 PM, Dagmar via groups.io <dagmar=scattercreek.com@groups.io> wrote:

Hi Deb,
The first thing that comes to my mind is as visceral therapist we work "in the realm of the subacute". So the question is when will your patient be subacute. Is the infection gone? Are the doctors still planning on removal of gallbladder? I would give it at least 4 weeks after surgery, and then start with a short appointment, mainly motility. See how she does with that, and take it from there. I would also require a doctor's ok to cover my you-know-what. 
I have allowed myself to be pushed into early treatments by eager patients a couple of times, and it did not go well. So most importantly, if you don't feel good about treating her, if you feel a listening that seems to push you "out" of the gallbladder - do not let yourself be swayed against your better judgement!
I don't think there is a clear cut answer, but I hope it helps some.

Dagmar Growe, LMT
VM 1-6, NM 1-4, LT1, VVM 1 & 2