Patient Emotion Tests Case Study

Section 1 – Introduction

Valkyrie (Valk) is a 44 year old patient with Polycystic Kidney Disease (PKD), severe anxiety recently diagnosed as Post-Traumatic Stress Disorder (PTSD), and Chronic Fatigue Syndrome (CFS). In some respects, this was probably not a wise choice of FTD, (due to biting off more than one can chew as it were), but in others a great development opportunity. Valk is a computer games designer and also an author. Standing at over 6 feet, Valk is tall, slightly thin, with a large protruding belly owing to the PKD. I noticed instantly the blue-black around the eyes, and the groaning voice. His eyes showed brief moments of been wide open, which to me looked life fear leaking out. He smelt putrid. Due to these factors, I was already suspecting that Valkyrie was a Water CF. I must comment this was a challenging FTD, but fascinating on many different levels.

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Emotion Test 1
Content	Gave personal congruent warmth (PCW)
Structure Requirements Met	Have known Valk for a while, and expressed PCW
Element and which test	Fire Test  – Personal Congruent Warmth
My words	“Great to see you Valk, you’re looking well!” [Said joyfully, in a laughing voice]
My judgement	Appropriate, normal, healthy flow of joy
Evidence	“Great to see you too!” [Said with a broad smile, the eyes shining, and then he gave me a hug]

Section 2 – Health

Main Complaint

• What is it?

Valks´ main complaint is chronic pain, caused by the PKD, which puts pressure on the internal organs and abdominal area. PKD is congenital, and he was diagnosed properly at age 11 with the condition, inherited from his mother. However, it did not cause physical problems for a number of years. “It causes me a lot of pain, which I have to live with, day to day.” Valk stated this, looking slightly emotional.

Emotion Test 2
Content	Inner Wound – living with chronic pain and PKD
Structure Requirements Met	Continually suffering from chronic pain and PKD, which clearly does affect him emotionally
Element and which test	Earth Test 7 – give sympathy
My words	“It must be really hard for you, living with this kind of pain and condition day to day.” [Looked with sympathetic eyes, gently moving head to the left.]
My judgement	Accepted sympathy appropriately
Evidence	“Thank you. Yes although its difficult, I feel I’m just about able to cope. .” [Accepted well, showing some emotion in eyes as he stated it, eyes looking down slightly]

• Duration

Valk has had this since his 30s, but most importantly he stated that “I wasn’t really consciously aware of it until after I had my breakdown in 2011, but I think it had been there for a number of years but had been ignoring it.”. So in essence, noticeably for 6 years.

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• Location

Location is the abdominal area, below the ribcage, encompassing the Middle Jiao, not lying on any particular points on channels.

• Quality

Varies between a dull ache and been almost stabbing at times, but is constantly there

• Intensity

It can be very intense, and sometimes very dull, varying between 2-9 on the pain scale

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• Frequency

Constant

• Worse / Better

Generally it is worse at night, gets better during the day. Movement can exacerbate, sometimes help. Worse with pressure.

• Can / Can’t do

Unable to walk very far, have sex, bend over easily, so it is creating restrictions in his life.

• Accompanying Symptoms

No other accompanying symptoms.

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• Other Treatments

Occasional Massage and Pilates.

• What is it?

Anxiety, classed as PTSD by a Doctor recently.

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• Duration

Valk feels the anxiety has been with him most of his life, at some kind of low level, literally since as a toddler. His earlier memory was of him been almost killed by a knifeman as a toddler. As shocking and unbelievable as this sounds, it is I believe true. His mother fought off the intruder before he could be attacked, and this is his earliest memory as a human being. The intruder was an escaped prisoner who had just murdered two people in the same building. This knowledge, as well as the event, must of had an impact in the formation of this anxiety.

There were also other events after, such as been in close proximity to a riot as a child, and witnessing the storming of the Iranian Embassy in London in the 80s. Genuinely, all this did happen to Valk. Finally, his father constantly created an atmosphere of uncertainty, “I couldn’t trust him – he would say ‘oh we’re going to go for a drive’ and suddenly we’d be in Wales for a week.”

Valk, perhaps without surprise, had a nervous breakdown in March 2011, and since then has been diagnosed with PTSD. The breakdown was brought on by overwork, partly running a successful computer games company and working too hard. So in essence, around 35-40 years.

• Location

No particular physical sensation, although chest can tighten during one of his panic attacks.

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• Quality

Intense bouts of anxiety, panic attacks, triggered by movies, world events, etc. Any movie which he knew from before the breakdown does not trigger a reaction, i.e. he knows what will happen so therefore there is nothing to fear. If it’s a movie he doesn’t know, it triggers a panic attack. For me this was quite fascinating. I enquired, “So why does a movie you don’t know trigger you do you think?” He answered: “It’s because of the uncertainty – it seems to shock me, whereas if I know whats going to happen, it is no consequence – I feel safe.”

Emotion Test 3
Content	Fears around watching certain films
Structure Requirements Met	Valk expressed that watching a film he didn’t know would scare him, creating possibly a panic attack
Element and which test	Water Test 3
My words	[Future-Fantasied Violation] “So if I took you to see an action film in the cinema, it could make you really scared right?” [Stated with eyes wide, mouth wide open]
My judgement	Showed inappropriate fear
Evidence	“It could terrify me. I mean, I just don’t know what would happen.” [Said in a very monotone voice, shifted uncomfortably, eyes wide]

I thought this was fascinating, as it almost described the anxiety of the water element so well. By knowing the outcome, there is nothing to fear. But any kind of uncertainty, instantly triggers a strong fear reaction. “I also find it really irritating – I can’t just live a normal life, you know?” Valks eyes hardened, his voice became more shouty, arms crossed.

• Intensity

The intensity of the experience of the PTSD is debilitating – he is unable to function when it occurs.

• Frequency

There is no necessary pattern, apart from movies and world events. Sometimes it can happen unexpectedly. Driving interestingly, does not faze him. Not even using a scooter, or fast vehicle in general. He commented “When I’m driving, I know exactly what everyone is going to do – I anticipate everyone’s actions, what could happen, so I don’t feel generally scared when I drive.”. As he spoke, he looked very cool and calm, but fear did leak from his wide open eyes.

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It is worth noting this is certainly a typical reaction from a Water CF, anticipating danger, etc.

• Worse / Better

Better when avoiding certain triggers etc, like movies, news, etc. Interestingly playing computer games, even violent ones, do not provoke a reaction. “Computer games do not trigger the anxiety, because I always feel in control – I know that I can’t be harmed, but I’m still able to get a thrill.”.

• Can / Can’t do

Avoiding new films, tv shows, which haven’t been seen before 2011, news, world events.

• Accompanying Symptoms

None.

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• Other Treatments

Cognitive Behavioural Therapy, Counselling.

 

Chronic Fatigue Syndrome

• What is it?

CFS.

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• Duration

Since the breakdown in March 2011, he has suffered from CFS.

• Location

Everywhere, noticing that the muscles in general feel weak, both the arms and legs.

• Quality

The quality is that he feels general weakness, exhaustion, particularly in the legs.

• Intensity

Fairly intense. Sometimes has dull, aching pain in his arms and legs.

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• Frequency

Sometimes it will come randomly, and he will lose several days where he cannot do anything around the house.

• Worse / Better

In general rest makes it better, and not doing too much in general. Massage can help, but more on the gentle side.

• Can / Can’t do

Has to limit various activities (walking, DIY, etc). Sometimes it can be so severe he cannot write, so it even effects his ability as an author.

• Accompanying Symptoms

None.

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• Other Treatments

Rest

Health History

• Birth

Birth was straightforward, no issues at all.

• Early Childhood

Was breastfed.

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• Childhood Illnesses

Generally healthy child, had measles and other normal childhood pathogens.

• Injuries / Accidents

1. Was once stabbed in the left thigh.
2. Had necrosis of the right forearm, nearly requiring surgery.
3. Abscess on front tooth requiring surgery.
   • Operations

Aside from tooth, no others.

• Other past Illnesses

None.

• Drugs

Smoked cannabis 3-4 times, magic mushrooms once.

• Smoking

Once smoked two packets in a night and that was it.

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• Drink

Drinks one pint of beer a week on average.

Family Health History and Relationships

• Parents

Valk has a good relationship with his mother, and would describe her as a friend. She has PKD aswell, but is in good health following a Kidney transplant. However with his father, it is quite the different story.

His father worked in the music industry, working with famous artists such as Tom Jones and David Bowie. Sadly, his father was sexually abused as a child, and in Valks opinion this lead him to being “A f***ed up individual”. His father has no sense of boundaries, and no awareness for others feelings. When Valk was 15 for example, his father started engaging in coitus with a lady in front of him. As Valk spoke of this, I noticed a slight tremor in his voice, and a slight hardening of the eyes.

In this case, although some emotion present, it was not anger seemingly. He then continued, “I still have a difficult relationship with my Father – its tough, he isn’t an easy man.” As Valk spoke, I noticed his eyes began to look down slightly, with some emotion in the eyes.

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Emotion Test 4
Content	Inner Wound – coping with Father
Structure Requirements Met	Difficult, trying relationship with Father.
Element and which test	Earth Test 7 – give sympathy
My words	“It must be very difficult dealing with your father – you must find it hard, with everything that happens and continues to happen.” [Cocked head to side in sympathy, with a sympathetic expression, speaking in a singing tone]
My judgement	Accepted sympathy appropriately
Evidence	“Yes its hard, but I’m able to cope with it now much better, thank you.” [Accepted well, said in a calm voice, showing less emotion than expected]

Noticing that he took the sympathy well, I wondered if perhaps there was any current anger towards him, with everything that has happened:

Emotion Test 5
Content	Father
Structure Requirements Met	Anger relating to his Fathers continuing difficulties, almost feeling ‘abused’ by him, relating to Fathers’ inappropriate behaviour as well in general
Element and which test	Anger Test 2.2
My words	“So you still have a difficult relationship with your Father, I mean, does he ever make you angry?” [said forcefully, with a hint of anger in the voice]
My judgement	Appropriate – no anger actually present at this time – appropriate anger at time.
Evidence	“I get angry when he does do these things, but I’m also quick to let it go – I don’t hold on to it, and also aren’t afraid to tell him.” [Stated in a relaxed manner, no hardening of voice or face]

He continued: “I was actually pleased when my parents broke up – I wasn’t sad or upset at all! I was happy!”. When he said this his face actually lit up, and there was a display of some joy.

• Siblings

Valk has 2 siblings, one half brother and one half sister. He is not particularly close with either, and displayed few emotions around the subject.

Personal History

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• Childhood

As stated earlier one of Valks earliest memories was of been nearly murdered as a toddler. Generally, his childhood was defined as feeling unsettled, unsafe, insecure, mostly due to this Fathers behaviour.

• School

Valk interestingly had few difficulties at school in general.

• Friends

Makes friends easily, and feels he has constructed his own family via his friends.

• Relationships

He has been happily married since 2004 to his wife, which “…was a very happy day for me. Aria is wonderful.” As he said this, his face lit up, and joy seemed to flow, red flushed into his cheeks. I took an opportunity:

Emotion Test 6
Content	Relationship with wife
Structure Requirements Met	Happily married, had already displayed some joy around discussing her
Element and which test	Fire Test 1 – eliciting joy
My words	“You sound so happy talking about getting married!” [Said joyfully, in a laughing voice]
My judgement	Appropriate, normal, healthy flow of joy
Evidence	“Best. Decision. Ever.” [Said with a broad smile, the eyes shining, the cheeks flushing]

• Jobs

Valk, due to PKD, has always been, “An overachiever – that’s how I would describe myself.” I asked ‘Why was this?’. He stated, “I thought my life would be over by 25 due to PKD. Its why I burned out. I was always fighting.”.

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Emotion Test 7
Content	Overachiever
Structure Requirements Met	Showed lots of determination, being within the shadow of PKD
Element and which test	Metal Test 6 – PIQ
My words	“Wow – so you showed a lot of determination in the face of this?” [Said in a slightly weeping voice]
My judgement	Accepted PIQ
Evidence	“Yes I’ve always been a very resilient person.” [He said smiling, holding his head slightly higher]

Valk has had a variety of jobs, and is currently an author.

• Children

None.

• Emotional Stresses and Strains

Valk, as mentioned earlier, has a variety of stresses and strains, relating to the chronic pain, PKD, PTSD and CFS. However, apart from this, he seems to cope remarkably well, and generally comes across as quite happy, enjoying spending time with friends and playing computer games.

• Traumas

Aside from some of the aforementioned traumas, it is worth talking about when he had his breakdown in 2011. This was an extremely traumatic time. He had been working long hours, jetting around the world, raising funds for the computer games company whilst trying to also manage it HR and various other divisions. He was in the middle of a meeting, and suddenly almost went into a ‘fugue’ state, and went straight home to bed, barely speaking to anyone. He then didn’t leave the bed for several days. It was the last time he went to the company. He saw a doctor, who told him that if he continued working the way he was, he would be dead in a few weeks, due to his blood pressure and other indicators. Valk said, “When the doctor told me, I have to be honest, I was relieved. Because it was a way out of this place I was in.”. He said calmly, showing no fear at all.

Emotion Test 8
Content	Fear of death around situation
Structure Requirements Met	When met with the prospect of death, he didn’t find it scary, but almost relieving
Element and which test	Water Test 3
My words	[Future-Fantasied Violation] “So you didn’t feel scared? With PKD, I would be scared about could be coming – does it scare you?” [Said in a groaning voice, eyes wide]
My judgement	Showed no fear – inappropriate, as some fear would be normally expected.
Evidence	“No, not really. I don’t really fear it.” [Said with literally no fear leaking, eyes and body language calm]

He said before this time, he had had moments where he felt like he was losing his mind. He would feel confused, disconnected.

These two things were extremely revealing. Normally, someone would display some kind of fear in these situations, but none was displayed at all to my surprise. My beliefs about Valk been a Water CF were almost certain at this point. But, I did continue to test on other CFs to be sure.

He continued, “After all this happened, I was filled with such rage. Utter rage. Rage that my business partner had treated me so badly, thinking I was just a little tired and not taking seriously how messed up I was. Felt exploited. This was going on until the earlier part of this year, this issue with the business partner.” He stated this, remaining quite calm.

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Emotion Test 9
Content	Feeling ‘abused’ by business partner
Structure Requirements Met	Yes – described feeling angry about the situation
Element and which test	Anger Test 2.2
My words	“I can see how you’d be angry about that – I’d be furious! [said forcefully, with a hint of anger in the voice, eyes hardened]
My judgement	Appropriate – no longer angry about situation
Evidence	“Yes I was, but once I sorted things out with business partner, I was able to let it go.” [Stated in a calm voice, eyes still, no real movement in body language]

Present Situation

• Living Situation

No financial stresses – has a lodger who helps pay the bills.

• Housing – damp/ cold etc

Damp patches in house, but not too cold.

• Work / Jobs

Loves his work as a successful science fiction author, and also designs board games and role playing games as well.

• Relationships

Married since 2003, as stated earlier. Very happy.

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1. Sleep – Quality, Quantity, Insomnia, Drugs, Dreams
   • Generally poor quality sleep, due to restless legs and chronic pain.
   • Mostly 7 hours, but a very disturbed sleep.
   • Wakes up a lot, but does not fret. Will get up, watch some TV, then go back to bed.
   • Will go to toilet to pee several times in night.
   • Sometimes will take a nightol, but rarely.
   • Has always had very vivid dreams, and has nightmares 50-60% of the time, which he says are pain induced generally.
2. Food & Taste – Appetite, Digestion, Likes/ Dislikes, Taste, Diet
   • Generally eats 2 meals a day, enjoys food, and has a healthy appetite he feels.
   • Digestion is complex, due to PKD putting pressure on abdominal area. He can’t eat anything big or heavy, as Kidneys literally feel crushed against his stomach. He will vomit occasionally if he eats too much, and will have acid reflux, especially when nervous, and nausea. However he believes the reflux is also a consequence of the drugs he is on for his PKD (a later section will cover the drugs and side effects he has).
   • Likes most foods, occasionally craves lots of fish. Loves cheese. Doesn’t crave much red meat, but will crave chicken and eggs after exercising.
   • Likes strong tastes, savoury flavours, and very much salty things.
   • Eats a lot of bread, ham, cheese, crisps, and eats two pieces of fruit with every meal.

3. Thirst and drink
   • Quantity:
     • Will drink 8 litres a day due to the drugs he is on.
   • Thirst:
     • Mostly thirsty.
   • Type of fluid:
     • Mostly water, 2-3 cups of tea, 1 coffee.
   • Alcohol:
     • 1 pint a week normally of beer.
4. Bowels
   • When
     • 1-6 times a day, first in the morning then randomly during day.
   • Consistency:
     • Mostly solid, with occasional loose stools. Was suffering from constipation, but pilates has helped with peristalsis.
     •  No blood or mucus.
     • Has pain in coccyx and perineum region when going to the toilet. Pain is dull.
5. Urine
   • Quantity:
     • Once to twice an hour, averaging 12-20 times a day.
   • Colour
     • Light to being very dark. Sometimes green, due to presence of infection (although rare).
   • Odour
     • No smell, unless not drinking enough water.
   • Pain
     • None.
   • Enuresis
     • None.

6. Sweating & Temperature
   • Sweating
     • How Much
       • Does not sweat much, with no smell.
     • When
       • When exerting, and at night time (night sweats).
   • Temperature
     • Hot or cold?
       • Generally hot. Cold temperatures do not bother him.
     • Area
       • Generally hot.
     • Time
       • At night, in the afternoon and evening.

7. Head and Body
   • Headaches
     • Yes, but most were related to shoulder tension. Since doing Pilates, headaches have stopped.
     • Sense of muzziness in the head.
   • Dizziness
     • Sometimes, and occasionally very severe. Happens sometimes when standing up quickly, and in general.
   • Numbness
     • None.

 

8. Eyes and Ears
   • Eyes
     • Floaters, and sometimes has patches of vision missing in his eyes.
   • Ears
     • Hearing is excellent – can hear high pitched noises other people can’t. Tinnitus on occasions, high pitched.

 

9. Numbness
   • Numbness
     • Occasionally in penis.

 

10. Thorax and Abdomen
    • General
      • Has chronic pain as mentioned in abdomen. Pilates seems to help.
    • Chest
      • No pain or distention at this time, or in general.
    • Flanks
      • No pain or distention at this time, or in general.
    • Epigastrium
      • No pain or distention at this time, or in general.
    • Hypochondrium
      • No pain or distention at this time, or in general.
    • Abdomen
      • Chronic pain as mentioned, with significant distention.
11. Pain

Abdomen

• Description
  • Pain varying in intensity around the abdomen.
• Where
  • Approximately around the mid-belly, Middle Jiao.
• When Comes on
  • Generally at night, but is constantly present in varying intensities.
• Full or Empty
  • Mixed.
• Fixed or Moving
  • Moving around the abdomen.
• Better/ Worse
  • Better with exercise, worse with lack of movement.
• Cold and Heat
  • Uses heat to help.

 

12. Current Drug Prescriptions
    • Tolvaptan
      • Usage: For extending life of Kidneys. Every 3 years of use extends life of Kidney by 1 year.
      • Common Side Effects: Polyuria (Frequent Urination, reported by Valk), increased thirst, and dry mouth.
      • Dosage: Once a day every day at this time.
    • Lisinopril ACE Inhibitor
      • Usage: For blood pressure, to keep it low. Although Valk does not have hypertension, his pressure is slightly high.
      • Common Side Effects: Dizziness, Diarrhoea, Stomach pain, Drowsiness, Headache.
      • Dosage: Once a day every day at this time.
    • Tramadol
      • Usage: Pain reliever for chronic pain.
      • Common Side Effects: Tiredness, drowsiness, headaches, dizziness, nausea, vomiting, constipation, diarrhoea, stomach pain, nervousness, anxiety.
      • Dosage: Occasional, only when in pain.
    • Sertraline
      • Usage: Antidepressant (SSRI)
      • Common Side Effects: Tiredness, drowsiness, anxiety, diarrhoea, nausea, indigestion, lack of appetite, excess sweating, insomnia, impotence, decreased libido, difficulty achieving orgasm.
      • Dosage: Occasional, when Valk feels he needs it.

Section 3 – Physical Diagnosis, Pulses and Tongue

Physical examination

1. Observation
   • CF Colour
     • Blue/ Black at edge of eyes.
   • Complexion
     • Generally light complexion.
   • Skin
     • Slightly dry.
   • Hair
     • Slight dry.
   • Shen in the eyes
     • Shen relatively sparkly.
   • Shape
     • Tall, thin, not muscular.

• Weight
  • 12 stone.
• Movement
  • Moves slightly jerkily.
• Nails (Colour, Strength, ridges)
  • Pale nails, some ridges, slightly weak

 

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Palpation

• Skin Temperature, Moisture & Texture
  • Hot skin temperature, slightly dry, soft texture.
• Front Mu Points
  • Kidney Mu Points on chest were sore, no other Mu points were.
• Lower Back
  • Definitely tension present within the Quadratus Lumborum muscles
• Shoulders
  • Shoulders slightly tense, particularly within the posterior and superior aspects of the trapezius muscle

Upper Jiao	Middle Jiao	Lower Jiao
√	+	–

Pulse and Tongue

BPM: 62