Ayurveda and Yoga Therapy in Treatment of Traumatic Injuries - A Case Study

Introduction

I believe that if we combine the life saving measures of allopathic medicine with the life sustaining and lifestyle improvement measures of Ayurvedic and Yoga Therapies, the acceleration of healing from traumatic injuries will increase dramatically and reduce re-hospitalizations for traumatically injured clients.

The progress of technology in allopathic medicine is quite impressive.  However, in this evidenced based paper I will be reviewing how allopathic medicine, however great it is in life saving emergency measures, falls short when it comes to treating traumatic injuries post hospitalization.  The reason for this is simply that allopathic medicine only recognizes and treats the client’s physical symptoms and not the psychological and spiritual symptoms that manifest as a result of the traumatic injury.  For instance, anxiety, depression and PTSD is a common occurrence with traumatic injured patients yet these emotional issues are frequently overlooked in allopathic treatment.

Initial reactions to trauma can include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, and blunted affect. Most responses are normal in that they affect most survivors and are socially acceptable, psychologically effective, and self-limited. Indicators of more severe responses include continuous distress without periods of relative calm or rest, severe disassociation symptoms, and intense intrusive recollections that continue despite a return to safety. Delayed responses to trauma can include persistent fatigue, sleep disorders, nightmares, fear of reoccurrence, anxiety focused on flashbacks, depression, and avoidance of emotions, sensations, or activities that are associated with the trauma.  (Substance Abuse and Mental Health Services Administration, 2014).

The universality of Ayurveda is reflected in its search for balance; its goal is the equilibrium of the doshas, dhatus, agni and malas, just as the nature of all biological systems is homeostasis.  Both Ayurveda and modern physiology recognize that health is achieved through balance and regulation of the internal systems.  Ayurveda describes this regulation via the humoral concepts of vata, pitta and kapha while modern medicine determines it through chemical pathways and feedback mechanisms.  Each has its place; however, knowing how to utilize each particular paradigm is the important question. (Pole, 2013).

The goal of this case study is to integrate these two healing modalities, Allopathic and Ayurveda, and educate the reader on the effectiveness of client treatment by using modern allopathic methods and ancient Ayurvedic wisdom to treat the client/patient as a tri-parte whole being.   The measures I used while client was still in hospital was the Subjective, Objective, Assessment and Plan tool.

Client Info and Injury

On September 30, 2016 at approximately 7:30PM Client, a 54-year-old female riding a motorcycle was hit head on by a Honda CRV, SUV who crossed the center line.  Client took the brunt of injuries to left side of body.  Client was wearing a helmet and riding leathers with protective arm shields.  Client was taken via ambulance to rural hospital and due to severity of injuries was transferred to a trauma hospital in Springfield Missouri and admitted to Neuro Trauma ICU with goal of stabilizing client to prepare for multiple surgeries.  Clients prior health before accident is excellent.

List of injuries sustained: Left lip laceration (complete), partial de-gloving of left lip and cheek, pulmonary contusion, left rib fractures, spleen laceration, left distal humorous fractures (crushing injury), left radial head fracture (crushing), left fifth metacarpal fracture, left distal ulnar fractures, left third and fourth metatarsal fractures, left one through fifth phalanx fractures (all crushing injuries) left patellar fracture, left knee instability and undiagnosed at time of injury, left thigh fluid accumulation and separation of fascia.

Side note: Client happens to be my identical twin sister.

Modern Medicine (allopathic) and Traumatic Injuries

The goal of allopathic treatment was to stabilize client for surgery and prevent infection.  Client was placed on multiple rounds of antibiotics and endured multiple surgeries where multiple hardware was placed in left arm and hand to stabilize the crushed bone and preserve as much function as possible to left hand and arm.

Ayurveda and Traumatic Injuries

My plan as Ayurvedic clinician was to address client as a whole tri-partite being, bringing doshas back into balance as much as possible, addressing physical and emotional symptoms and helping to assist client to gently change her relationship to and identification with her current condition through lifestyle, dietary, herbal and yogic therapies.

I arrived to the patient’s hospital room two days post traumatic injury.  Client was in neuro trauma ICU and was not stable enough to move into surgery due to blood loss and extent of injuries.  Diagnostic testing was still being completed to obtain baseline of complete injuries.  I had one week to work with client in hospital.  Disclosure; I have a bit of an advantage here in working with client as I had worked as an RN in neuro trauma ICU and was familiar with this environment.

Subjective: Client reported feelings of anger, fear and pain.  Her pain, on a scale of 1-10 was rated a 7 and was mostly controlled during the day.  Patient stated that her pain escalated at night to a 10 and her heart rate increased.  She also vomited when pain got that high.  Client was upset with the confusion that seemed to be centered around what Doctors were going to do with her injuries.  At that time, client reported that her arm had not been unwrapped since night of injury.

Imbalanced vata affects the other doshas, creating pain.  This sensory and emotional experience is associated with psychosomatic response to actual or potential tissue damage.  In all pains, vata is the causative factor.  (Lad, Vasant D, BAM&S, MASc, Ayurvedic Perspectives on Selected Pathologies pg 39.)

Objective:  Clients left arm was wrapped and wrappings were soaked with serosanguinous fluids and nurses had to continue to remove the pillow and wrappings under clients arm and replace with fresh linens.  Client’s hair was dirty and had bits of glass in her scalp.  Client at times became flushed, sweaty and breathless when the pain increased.  I did observe while in room the confusion from the providers as to what the treatment plan and surgeries were going to be.

Assessment:  Client presented with multiple injuries and was in neuro trauma ICU, some of which had not been addressed.  Client verbalized anxiety and fear with what surgeries she was going to have and I observed a large divot in client’s left thigh just above the knee.

Plan:  The hospital environment was very vata provoking.  The plan was to decrease vata and help client get clarity on treatment plan by contacting head of surgery and get clarification on plan and prepare client emotionally and psychologically for impending surgeries and therapies.  Request a bath for client to help feel cleaner and apply vata pacifying abhyanga oil to areas that are not injured.  At night, apply oil to right foot (left was bandaged) to help client feel more grounded.  Client was NPO (nothing by mouth) due to impending surgeries.  Warm water was the only sustenance client could have.

After I requested to have clarification of treatment plan, head of surgery came in and discussed extent of injuries, addressed divot in left thigh above knee, reviewed cat scans and x-rays and anticipated surgeries with myself and client.  Client felt a little better after this consult and was able to start planning for what was ahead for her. Because I am also a nurse and the clients twin, and they were short staffed, the staff allowed me to bath client, wash her hair, and apply abhyanga oil with massage to uninjured areas – this is atypical and would not be available to Ayurvedic practitioners. Client states that she could not believe how much better this simple act made her feel.  Client had surgery two days later and again on the fourth day.  Client had extensive hardware installed in left hand, and left arm.   Pins were inserted in her left foot which were left exposed. See below figure 1, 2 and 3 for hardware installed.

Client was later moved to neuro trauma floor where she was able to get up and sit in chair.  Client was able to begin to eat.  I gave her bone broth to promote healing and she handled this very well.  At this time, I was unable to be with client for the remainder of hospitalization and client was instructed on ways that she can help keep herself grounded by drinking bone broths, consuming warm, oily, unctuous soups.  Additionally, oiling her feet was helpful, if she was going to be in bed.  The importance of trying to keep a schedule was emphasized, and she was taught nadi shodhana pranayama to help assist her with pain and anxiety.  Lavender essential oil was used to help scent her pillow to assist calming and sleep.  I had to leave client to travel back home to Florida.

3 months later.

Samprapti (Pathogenesis of Condition) and Rupa (clinical signs/symptoms) after Allopathic Treatment

December 9, 2016 (69 days post-accident) Client presented with clostridium difficile  that caused severe, cramping and debilitating diarrhea, malnourishment (client had 20 lb. weight loss since accident).  She also experienced severe pain from multiple fracture healing, extreme fatigue and exhaustion, feelings of hopelessness, anger, sleep disturbance with nightmares and incessant thoughts of accident.

Clostridium difficile is the most common cause of nosocomial infectious diarrhea. The frequency of colonization in hospitalized patients varies between 10 and 43%.

(Dehtt/2007) (Department of Gastroenterology, Eriyces School of Medicine, Gursoy, S.,; Guven, K; Arikin, T; Yurci, A; Torun, E; Baskol, M; Osbakir, O; Yucisoy, M;, 2007).

I was able to work with client for 10 straight days before she traveled back home to Missouri to resume allopathic treatment.

Darshanam (visual Exam)

Client appeared tired, malnourished with 20 lb. weight loss.  Current weight 103 lbs.  Skin pale with eyebrows thinning near outer edges.  Client is 5’1” in height.  Her tongue was pink with white thick coating and deep cracks in stomach area.  Eyes are gray with yellow sclera with dark brownish/red spots in right eye on lung and stomach areas and dark brownish red spots in stomach and spleen area.  Left Vikriti pulse presents as V3, P3, K0. Energy and force is good and temperature is warm.  Attention drawn at level 5 to vata in prana finger and vata in Tejas finger.

Clients current vikriti is V3P3K0 her prakriti is V2P3K1

Treatment Principle

  • Emotional /psychological – address PTSD and effects of trauma with yoga therapy
  • Balance the digestive fire to normalize digestion and absorption and clear c-diff with herbs, healing diet with focus on bone broth and digestive spices and rest
  • Stop diarrhea and heal gut with herbal remedies
  • Reduce acidity and ama with sattvic diet and daily routine
  • Reduce pitta with herbs, yoga, meditation, pranayama
  • Vata reducing modalities and sattvic diet
  • Reduce pain and anxiety using yoga, herbs, lifestyle, meditation and pranayama techniques
  • Improve quality of life

Chikitsa

Doshas: Prakriti: V2P3K1   Vikriti: V3P3K0

Systems addressed: Integumentary, skeletal, muscular, nervous, circulatory, respiratory, digestive

Dhatus: Rasa, Meda, Mamsa, Asthi, Majja

Chakras: Muladhara (root), Sacral (svadhisthana), Navel (manipura), Heart (anahata)

Sub-Doshas: Samana, Apana, Vyana, Pachaka, Ranjaka, Kledaka, Avalambaka, Shleshaka

Yoga Therapy: A full range of motion assessment was completed with client to obtain baseline of physical abilities.  Then client was placed in a comfortable seated position in front of mirror.  Client was then asked to perform range of motion with extremities while watching herself in a full-length mirror.  Client has a strong sense of self, but despite this, even though she had had approximately 3 weeks of allopathic physical and occupational therapy, client was very surprised at her current physical limitations.  The idea behind this was to allow client to fully come to terms with her current status and change her relationship to and identification with her current physical condition so that progress in yoga therapy could be better utilized in moving forward from this state.  Client was taught how to modify Suryanamaskara A, Plank, seated position.  Due to client’s unstable left knee I focused more on stretching, opening and aligning the body. Client reported feeling like her hips had been  “physically knocked out of kilter” so focus was given to using blocks to assist in gentle seated hip openers and lying twists and hip flexor postures.  Client’s home yoga exercise program was:  Modified Suryanamaskara A, Child’s pose, Paschimottanasana, Janusursana A with support of block under bent knee and small rolled towel under left leg when straight to prevent hyper flexion of weakened left knee, Bound lotus with support of both knees with blocks holding for 10 breaths slowly moving blocks away when hips start to relax.  Focus while seated is engaging muhla and udihana bhandas and lifting/lengthening spine out of pelvic bowl.  Cat/cow 5-10 breaths with padding under knees, supported plank (client to place straightened legs with bolster under upper thigh/knee area and blanket under forearms (client cannot straighten left arm due to hardware in arm and client was taught to modify by placing upper body on forearms with padding under forearms).  Focus was to engage shoulder girdle and abdomen area to increase upper body and core strength hold for 10-20 breaths.  Client was then to bring knees to chest and hold, then progress to happy baby.  Savasana with concentration on gratitude to the body for its ability to perform activities.

Meditation:  guided meditations with focus on ‘all is as it should be’ and ‘acceptance’ and ‘dealing with anger’ themes.

Mantra: Aum – repeated daily and at night before bedtime.

Ayurvedic Diet, lifestyle, treatments:  Client to spend 30 minutes daily outside in sunshine.  In this particular case client took afternoon naps in hammock under shade tree daily for 7 days.  Although naps are not generally recommended in Ayurveda I made an exception due to client’s depleted and exhausted state, rest was a priority to allow the bodies healing processes to ignite.

Client was placed on a sattvic diet and focused on vata reducing foods. Dincharya included tongue scraping daily, garshana dry brushing to stimulate lymph, abhyanga oil with sunflower base and sandalwood, rose, lavender and mint essential oils.  Neti was not prescribed at this time due to healing sinus fractures.  Nasya oil applied with q-tip to nostrils in a.m.  Pranayama recommended was nadi shodhana  (alternate nostril breath) daily and when feelings of anxiety started to arise.

Client was advised to journal her experience and feelings, take long walks on the beach bare footed to exercise and manipulate foot and hear the sound of the waves and massages with abhyanga oil on a weekly basis.

Daily plan:

AM

  • Coffee with raw milk and digestive spices of nutmeg, cinnamon, cardamom and ginger) – client loves coffee and this is her modification to continue coffee
  • Powdered wheatgrass, spirulina, moringa with 2 Tablespoons collagen, 1/4th teaspoon of personal herbal blend (see below) mixed with apple juice
  • 2 Cups warm water with lemon and 1/4th inch fresh ginger
  • 1 cup bone broth
  • 1 hour of yoga therapy
  • Apply Rosemary-Peppermint soaked cloths to left arm, hand and foot then wrap with heating pad for 20-30 minutes - Alternate with ice

Noon

  • Personal herbal blend (see below) taken with 1 teaspoon ghee and ½ teaspoon raw local honey
  • Bone broth veggie soup: bone broth with chopped veggies in season
  • Kitchari
  • 2 C warm water with lemon and 1/4th inch fresh ginger
  • Walk in nature/beach & rest - observing beauty

Snack

  • Tea: Fresh tulsi leaves, spearmint, fresh ginger root and lemon grass steeped for 5 minutes. Drink 3-4 Cups daily

PM

  • 1 Cup Bone Broth
  • 1 Cup warm water with lemon and 1/4th inch fresh ginger root
  • Diet to focus on fresh juices, bone broth added to soups, kitchari, raw milk and roasted vegetables
  • Personal Herbal Blend taken w/1 teaspoon ghee and ½ teaspoon raw local honey
  • Apply Rosemary-Peppermint soaked cloths to left arm, hand and foot then wrap with heating pad for 20-30 minutes - Alternate with ice

 

Before Bed

Magnesium Citrate, 2 Tablespoons collagen, Blissful sleep herbal blend (as needed), sleepy milk, triphala 2-4 tabs

 

Herbal Chikitsa:

  • Personal Herbal formulation: Chamomile, Gotu kola, St. John’s Wort, Skull Cap, Marshmallow, Gokshura, Ashwagandha, Ginseng, Guggul, Manjishta, Jatamansi. Goal is to reduce swelling, increase healing, nerve regeneration, rejuvenate and calm.
  • Sleep Herbal formulation: Jatamansi, Shankhapushpi, Ashwagandha, Nutmeg, Gotu kola, Valerian
  • Digestive herbs: coriander, cumin, fennel, fenugreek, ginger – taken as a tea
  • Triphala 2-4 Capsules before bedtime
  • Personal Tea blend with fresh tulsi, ginger root, lemon grass and spearmint - drink 3-4 Cups daily.
  • Rosemary-Peppermint tincture soaked cloth applied to left arm, hand and foot then wrap with heating pad leave on for 20-30 minutes- apply in am and pm. Alternate with ice.

Client Reported Results

Within 3 days of client’s arrival, client’s C-diff was completely cleared without the use of allopathic medicine.  Her bowel movements were within normal limits one time a day, which was client’s pre-accident norm.  To this date of report, client continues with normal digestive functioning.

Client’s strength started improving greatly upon the 3rd day of implementing chikitsa and started participating in daily activities with increased vigor.  Client reports feeling 100% better than she had since the day of her accident.

Client reported that she had been greatly disappointed with her progress in allopathic physical and occupational therapy and was in fact, “shocked” by her limitations when I placed her in front of the mirror and asked her to perform simple range of motion exercises. The physical and occupational therapist had not performed any of the exercises in front of a mirror.  She felt like that although initially the shock of the mirror ‘depressed’ her, she reports that she believes it was the turning point since her accident that she was able to come to terms with where she was at and then work through the process of accepting her limitations and then move forward.   Client reports that allopathic therapies had been very painful for her and was surprised at her progress with yoga therapy and the painless way in which she was able to accelerate her physical abilities.  She was very pleased with her progress during her stay and continues upon date of this writing to do yoga and increase her physical activities to a lot of the activities that she had done pre-accident status.

Client has gained all of her weight back and states that although she still has set backs with dealing with her emotional state and PTSD she continues to utilize her yoga, meditation, mantra and pranayama tools to help her in dealing with this and then continue to move forward.

Closing

I believe if we combine the life saving measures of allopathic medicine with the life sustaining and lifestyle improvement measures of Ayurvedic and Yoga Therapies, the acceleration of healing, physically, emotionally and spiritually from traumatic injuries will increase dramatically and reduce re-hospitalizations for traumatic injured clients.  If we could incorporate Ayurvedic principles while the client is still in the hospital and educate the client regarding Ayurvedic and yogic principles that they could utilize upon discharge, that the increase in healing, satisfaction and overall wellbeing would greatly improve client’s quality of life.  It would also incorporate a sense of empowerment to the client to better enable them to feel that they have some control over their current situation and that they do not have to be a victim to their current circumstances.

It is my life mission, to share the wonderful benefits of Ayurveda and Yoga Therapy with clients while also educating my allopathic colleagues on the beauty of integrating these three (Ayurveda, Yoga and Allopathic) healing sciences so that together we can incorporate a holistic and sustaining healing modality that will not only save lives, but greatly improve the quality of life for post traumatic and/or catastrophically injured clients.

References

  1. Department of Gastroenterology, Eriyces School of Medicine, Gursoy, S.,; Guven, K; Arikin, T; Yurci, A; Torun, E; Baskol, M; Osbakir, O; Yucisoy, M;, 2007
  2. Pole, 2013
  3. Substance Abuse and Mental Health Services Administration, 2014
  4. Lad, Vasant D, BAM&S, MASc, Ayurvedic Perspectives on Selected Pathologies pg 39.
  5. McCall, Timothy, MD, Yoga as Medicine
  6. Payne, Gold, Goldman, Yoga Therapy & Integrative Medicine
  7. Ginger Garner, Medical Therapeutic Yoga
  8. Khalsa, Cohen, McCall, Telles, The Principles and Practice of Yoga in Health Care
  9. Frawley, The Yoga of Herbs
  10. Dass, Ayurvedic Herbology, East and West

Author :

Annette Broy, RN, CCM, RYT-500, E-RYT200, C-IAYT, AHC, AP

Dragonfly Ayurveda and Yoga

439 Tamiami Trail #202

Venice Florida 34285

941-222-0777

dragonflyayurvedayoga.com

At Dragonfly Ayurveda and Yoga, located in beautiful Venice, Florida, we specialize in Ayurveda and Yoga Therapy.  We value what we do and take pride in having only C-IAYT Yoga Therapists and Certified Yoga Alliance Instructors working with our clients.

Our yoga therapy clients come from all over Sarasota County including Sarasota, Siesta Key, Osprey, Nokomis, Longboat Key, North Port, Englewood, Port Charlotte and beyond.  Therapy can also be done virtual.  If you would like to learn more or participate in our yoga therapy call 941-222-0777 or click HERE to schedule your consult.

*Annette Broy is co-owner of Dragonfly Ayurveda and Yoga Studio in Venice FL.  She has been a Registered Nurse since 1994, and a Certified Case Manager since 2000.  Annette is a Yoga Alliance Certified E-RYT200, RYT500, (Registered Yoga Teacher), and a Certified Yoga Therapist with International Association of Yoga Therapists (IAYT).   She also holds credentials with National Ayurvedic Medical Association, (NAMA) as a Certified Ayurvedic Health Counselor and Certified Ayurvedic Practitioner.