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| Hpathy Ezine - February, 2009 | |||||||||||||||||
Depression, Nausea and Suicidal Thoughts-- Leanne Satherley |
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| This case has been briefly edited for conciseness and duration but displays the total case as taken by a fourth year student. All names and places are represented by ”Patient and “Student”. Although longer than the other cases, it is a reminder of how we only need parts of the whole case to get the totality. Many patients (in particular this one) cannot vocalise their emotions very clearly and that combined with the judgement of the practitioner can lead to an incorrect mental analysis. This case displays the use of circumstance to choose rubrics – an accurate and objective way of finding a remedy that suits the patient. This case also reminds us of the following
When a case is presented in this format we can clearly see when a leading question during a biography or emotional expression closes down the flow of information or worse, leads to the patient “agreeing” with our interpretation; however conversely a lack of leading questions during the physical case taking can bring about a lack of generals and specifically modalities – so vital to the totality of symptoms.
CASE Student: Ok, as you know I am a homoeopathic student and I have to present a written transcript, an audio tape and 5 photos of the case to my lecturer. This is all private and confidential, is that okay with you? Patient: Yes that’s fine. Student: As a student, I need to present this case to my supervisor. I won't be able to provide any remedy without their supervision – as I need to make sure I’ve got the remedy correct as well as things that are relevant to the case. Homoeopathy is where we look for patterns that are recurring in your life. We all have different type of stresses, and they will represent themselves in different patterns in your life. We are looking at how those stressors affect you both emotionally and physically. Homoeopathy treats you by choosing a substance that is found in nature that is known to help people with these illnesses and patterns. Homoeopathic remedies are completely natural and have been proven to assist in many different types of illness over the last 200 years. We'll be doing an analysis, including your history up to now and situations or events that have been stressful for you have and how they have affected you. At the end we also look at your facial features and take some photos. Student: So how can I help you today? Patient: I basically suffer from nausea. Student: Ah ha Patient: Which is it, it happens every day. And any time of the day so it doesn’t have to be anything in particular that sets it off. It could happen at 3 o’clock in the morning where it gets to the extent where I want to vomit. But I can’t, I don’t and it’s been getting bad. Student: Mm Patient: It’s been going on for at least six months at least Student: Ok, so what was happening around six months ago - can you think of anything that was happening? Patient: I think my stress levels, my mum got really sick. Student: Mm Patient: So I think you know I think it’s more stress related than anything else. Like I’ve got um, more work to do at work and like I got more responsibility now, then with my mum getting really sick… Student: Ah ha Patient: I think it’s all just sort of turned into you know, into that. Student: Ok, when you say that your stress levels with your mum being sick what was happening to you, how do you relate that stress to you, what did you feel? Patient: Sad, hurt, worried. I was just so worried about her and still am worried about her. Student: Ah ha Patient: Cause no-one knows what’s wrong with her and she’s just someone else for you to look to, cause there’s no one else, no-one knows what’s wrong. And that plays on me. You know. Cause she’s just my mum. My best friend. Student: Absolutely, yea. That’s understandable Patient: Like I think I’m depressed, I’m trying to give up smokes, I can’t, I’ve put on so much weight, I’ve never been this big before in my life. Student: Ah ha Patient: And I think that everything has just got on top of me. Student: Ok, um, now long have you been smoking for? Patient: Oh, since I was 15 and I’m 37 now. Student: Ok, How do you find it stressful, what are the physical symptoms of your stress? Patient: Um, I don’t Student: Don’t know? That’s OK. You were saying that you were having more to do with work. Patient: Yes, I’ve got, like I was just doing Hire , like I’ve got glass now, I look after two glaziers as well, so now I’m looking after two as well. Student: Ah ha Patient: Um, you know I did get a pay increase to do that but it is more, you know, responsibility, you know, which I don’t think it plays on my mind but obviously these things do, must play on the back of your mind, I’m obviously thinking of stuff, you know what I mean, you know I’m guessing, that’s what is making me sick Student: Ok, what is the physical stuff, how is your sleep going? Patient: Well, to be honest, I’ve been taking tablets that is making me go to sleep, um, before that I would be waking up at least three, three times a night. Um, yea, feeling ill so that would wake me up. But I’m sleeping a lot more to, I’m tired all the time. Student: Yea Patient: So, and it’s because I’m a beached whale now, I’ve got no energy, you know, like I feel tired, like before coming here I said to my partner about 6 o’clock, I could go to sleep know. Like that’s ridiculous I’m 37, I should be able to stay up, I’m in bed by 9.30 every night, every night. If I stay up to 10.30 that’s a late night, wow that’s a late night. Student: When you say that you wake up three times a night, roughly what times were they? Was there a pattern to them? Patient: Yea, I would, I would say 11, 1 and about 4 Student: Would you get back to sleep reasonably early? Patient: Yes, I would say if I didn’t feel nauseous I could easily go back to sleep. Student: Ok was it the nausea that was making you wake up? Patient: No, not always. Student: No? But you would feel nauseated when you woke up? Patient: Yea Student: Ok, were you having problems getting to sleep? Patient: No, because I’m that tired that I want to go to sleep and I think that well, I feel sick that I would want to go to sleep to get over it. Try and get over cause if I’m …. Student: Ah ha Patient: If I’m asleep then I can’t feel it Student: Yea, would you have problems when you wake up or to wake up? Patient: No, that was pretty good, I was pretty good at waking up Student: Ok, were you feeling that it was a refreshing sleep? Patient: No Student: Ok Patient: I still felt tired Student: You still felt tired, when you woke up. So what time do you roughly wake up? Patient: I wake up every morning a ¼ to 6. Student: Ok so its 9.30 to ¼ to 6 is your …. Patient: Yea, 9.30 to ¼ to 6 is my sleep. Like 9.30 is late I usually go to bed at 8.30. 930 is a late night. Student: Ok so you. Ok Patient: I would be sleeping a lot, I would be having my eight hours and still feel tired Student: Ok, did you be feeling tired throughout the day where you would go and have a cat nap? Patient: No, yea, yea I would, I’ve done a few at work, lunch time I would go into my car Student: Ah ha Patient: Feeling, when I would be feeling sick I would curl up and go to sleep and then I would be drinking a lot of those V drinks (energy drink) thus the weight gain. Student: Ok Patient: Cause I would be drinking those energy drinks to keep me awake. Student: Ah ha, Ok, how many of those would you take a day? Patient: Two, not every day, but I haven’t had any today but yesterday I had two. Student: Mm, would it be like a Monday to Friday thing? Patient: Yea when I’m at work. Student: Just for that pick me up? Patient: Yep Student: Ok, now the nausea you are corresponding to six months ago, a lot of stress with your mum in hospital, what was happening at work, what was happening around you? Obviously mum being in hospital was very stressful. Patient: Mm, and um, I can’t remember what was happening, so many things were happening. That does happen you know what I mean, um, I just know, I don’t know. As I’ve said I’ve tried in the last six months I’ve tried to give up smoking. Student: Ah ha Patient: And that makes you depressed because you can’t do it. You know, you do it for three hours and then you have a smoke. And so that thing that then that depresses me, and I think that there are so many factors that I’m just depressed. Student: Ok, when you are saying that you are depressed what are you feeling emotionally? Patient: Um, sometimes I feel like I could just cry. Student: Mm Patient: Just at nothing. Student: Ah ha Patient: Um, but yea just, emotionally I’m just feeling drained just, that’s the main thing. Just tired, feeling sick. Student: Ok, some people when they are talking about depression feel like they are in a black hole. Patient: Yea, I feel like I’m in a hole and can’t get above it. Student: Mm, ok Patient: Doesn’t matter what I do, like some positive thing happens then two negative things happen and it sort of, you know, drags you down. Student: Ah ha Patient: So I’ve got …….’s mum wanting to living with us, she’s there for six weeks to try it. Student: And how’s that going? Patient: Well, she’s only been there a week at the moment, so, ok, she’s a lovely lady but she’s incapacitated, so she’s not the healthiest of woman, so I sort of, this week I’ve sort of come home from work, cooking a meal and putting it on the table for her and taking the plate away, and it’s sort of like, hello, I don’t think I need this in my life you know, but I don’t know how to say that. Student: Mm Patient: You know, but I’m not going to, but I will say something but I will wait until the end then I will say to ……., no. For her to live with us full time in our house we don’t have a separate area, she will be just there. Student: Mm Patient: So that’s something else that’s playing on my mind, as well you know. Student: Mm, there’s a lot of pressure when you have other people live with, come into the family, you know live there 24/7. Patient: That’s what I just asked ……., how he felt you know with his daughter living with him. Student: Mm Patient: You know, and I said be honest, he said it was alright but he didn’t like …., you know. But you know I did mean. Student: People react to any situation so. Patient: It’s not like a holiday. Student: What I trying to find out how you are reacting to situations that you have got going on now. One your mum not that well, she was in hospital 6 months ago and recently, she’s home now isn’t she? Patient: Yea came home last week. Student: Yep, you know they can’t find out what’s wrong with her, you’re feeling depressed, you’ve got a young babe, what he’s 18 months? Patient: No he’s three Student: Where did that three years go. (Laughter) Student: You know, you’ve got a three year old, your working, you’ve got your mother-in-law. Patient: Over-weight Student: Over-weight, these things impact on your health and what Homoeopathy does is, we try and even out the scales, the more pressure that you have and the more stress, your energy goes down. And we’re trying to even out those scales with more energy for you. Patient: That would be wonderful if you could even out those scales. (Laughter) Student: So, ok you’ve had, the last six months have been pretty stressful with your mum, what’s happened, let me go back to your childhood and we will work through everything up until now ok. Patient: Yep Student: So how was your childhood? Patient: I had an alcoholic father Student: Ah ha Patient: Um, I had my Nanna used to live with us. Student: Ah ha Patient: Full time, um, my brothers would fight a lot. Student: Mm Patient: Punch me up. Student: On a regular basis? Patient: Yea, once a week Student: How did you cope with that? Patient: ….. was violent, my younger brother was violent, very violent especially when he got to sixteen. Um, he was, he was bad, he would hit me over the head with a cricket bat, broke my nose. He was shocking. I dealt with it, I was put on antidepressants to help calm me down, cause, yea, I was nervous I suppose, yea, around him. Student: Ok, obviously that would cause people to react differently but when you say nervous what do you mean? Patient: Um, on edge all the time, you know, just edgy you know, if someone comes, any noise, even now, if some-one is fighting, I’m under the table, I’m hiding. Student: Ah ha Patient: I’m not, just don’t want to be there. Student: Ah ha Patient: And that’s just stemmed back from …. Student: Ok Patient: From then I think Student: What else was happening, what was your primary school like? Patient: Primary school was good. Student: Yea, Patient: Had um, good friends, I think my live changed when I met a boy in high school, um and I was, a real long story but to cut it short, we split up and he went out with another girl, we were at my mum’s place one night me and my friends, and a girl friend came up and said they were on their way to get you, and they are going to beat the hell out of you, um, she was completely smashed up and these other people came to my parents house and started kicking it in, and yea, from then on it just sort of my life was just, you know, it was just on this roller coaster. Student: Ah ha Patient: Cause then ….. went around to their place and with my dad and punched them up and it was, you know, then they broke into my mum’s house and stole her handbag, and it just kept going on for, you know, a year. Student: Ah ha Patient: You know, there was just, knives were found out the front of my bedroom window where they had slashed the flyscreen to come and get me, and it was shocking. Student: Mm Patient: You know, that was, that was scary I reckon. Student: Mm, how did you cope through all that? Patient: Um, my mum sent me to Queensland. Student: For the whole year? Patient: No, sent me to Queensland just for the initial bit of it, um, but once again I would be siting in the corner in the foetal position. Student: Mm Patient: I think, yea, but my mum is a highly strung person. Student: Mm Patient: So, I think that I’m inheriting her highly strung thing. I wish I didn’t, I don’t want to be worrying about two flies on the wall that might break a wing. But I seem to worry about, I know cause my partner would be saying to me in the car, you know, I would be saying we are going to be late for work, we are going to be late for work, and we are not going to be late, but I just, and he would be saying, well, Patient you can’t do anything about it, if you’re going to be late, your late for work. You know but, there’s nothing you can do you know but I will worry about everything. Other people, some people cannot just worry about it go on with live but I worry about money, you know, just being late for work, or what the boss, is the boss going to be in a good mood today, is he going to be in a bad mood today, is …… going to be settled at crèche, and which school am I going to put him into, just everything you know and I don’t think I’m coping with it. Student: Ok, when you are saying that you are feeling worried about all these things, what is happening physically? Patient: I think, that’s when I know that I’m getting really stressed, I know that’s when I’m starting to feel sick. Student: The nausea and the vomiting? Patient: Yea it is, it’s that and its, you know, I can feel it coming on, you know, I know when it’s coming on, you know, I know that’s when I’m something, fizz, that’s not even a word, I can’t, 10 to 15 minutes later I’m lying in the back seat of my car at work feeling like I want to vomit. Student: Mm do you when you feel like I want to vomit do you actually bring anything up? (Should have but didn’t enquire about if lying down made her feel better) Patient: No Student: Do you dry retch? Patient: No Student: Nothing? Patient: No it just sits there, I just really want to but it just doesn’t, it gets to the stage when I think oh no I’m going to get gastro or something, cause, cause you are that sick, but, you know, should I leave work you know cause I’m going to vomit, you know, cause it’s an hour trip home you know, but I never am sick, I just want to, so I don’t know you start to wonder if its in my head, you know, but I am sick, I can tell, people can tell at work, I go from this bubbly you know, happy person to this sort of quiet person and when I and they can see it you know, but I slide down. Student: When you say it sits here, you are indicating to your chest. Patient: Yep, I found out recently through a camera that I have a hiatus hernia. Student: Ah ha, Patient: Um, but nothing else was found, and that doesn’t, you know, cause anything. Student: Mm, what’s the feeling that you feel? Patient: No it’s just feels like the sick, sick is just sitting there and it wants to come but it just doesn’t. Student: Is it a pressure, is it an ache, is it a sharp pain? Patient: No, it’s just more like an achy sort of feel. Student: Ok, now you’ve, going back to your high school years. Patient: Ah ha Student: Apart from that year, was there any other really stressful incidences? Patient: Mm, I got hit by a car but um, that was about it really. Student: When was that. Patient: Um, I was probably in about form one, took the girl next door roller skating in ……… and we were crossing the road with the green light and a car came around the corner and hit me. And I just hit the bonnet, hit the roof and the boot and fell in the gutter and it was pouring with rain. And I hopped up and I could remember him saying do you want me to call an ambulance, and I said my parents can’t afford an ambulance because that they were broke, so I still took ……. to roller skating cause I promised her I would, after being hit by a car, and um, we didn’t stay very long cause as the adrenaline passed the actual pain set in. Student: So, did you have any actual injuries? Patient: Um, no I don’t think I did, I think, I think I survived. Student: Ok, I’m glad about that. Patient: But yea, I’ve got injuries from ……. throwing a stone at me, from riding the bike with my girlfriend on the handle bars at high school we tried, we were stealing his bike as he kept pulling my bike apart so I stole his bike, had my friend peddling her little heart out down the road and ….. throws a rock, she’s gone flying and I’ve gone flying and my dad came down and I said I’m going to kill him and I must have swore and my dad got me, belted me across the bum, had he said don’t you swear, and my mum said don’t you thinks she’s hurt enough and bleeding everywhere, don’t you think she’s in enough pain. So I’ve had good brothers. Been there supporting me all my life. Student: Ok so they weren’t that supportive during your growing up years, what we, ah was it easy to make friends at school? Patient: Yea, I had really close friends, Student: Yea, are you still in contact with them today? Patient: No, oh, I still ring her up occasionally, you sort of drift apart when, cause she has, um, I think she has four kids now, and they are all primary school age, so she started a lot younger than what I did. So she had her kids and so I just thought, well I was single so whatever, so I still went out. But like I still ring her and say hello and that sort of stuff. Student: Yea, so, what year did you finish school? Patient: Year 10, I started year 11 but because my girl friend, my best friend had finished year 10 and I thought it wasn’t the same without her so I left. Student: Ok, then what did you do? Patient: Um, I think I just started working just jobs um, where, I worked at ….. night shift with her. Student: Ah ha, and how was that? Patient: Yea that was good. Student: Ah ha Patient: Until I stuck my finger in the embroidery machine, and in where they make the shoes. Student: Yea Patient: And they’ve got a big bar and I lent down to clean the needle and I’ve grabbed the machine to start it, it started embroidering in my finger, I’ve had a good life, when I actually write all this down I’m going to be more depressed than when I’ve started. (Laughter) Student: Ok Patient: So that needed surgery, cause the needles was stuck in my finger Student: Ok, so it actually need surgery? Patient: Yea, I had to have a plastic surgeon, I’ve still got the scar across there. (Indicating a scar in the inside of the index finger of left hand) as the needle got stuck. Student: Ok, so Patient: Your lecturer is going to think that I’m a twit, he will think that that girl needs a lot of medication. Student: Have you had any other injuries? Patient: No I think that’s enough, I didn’t, I was only there for a year. Student: Ok, so after …… what did you do then? Patient: I think I just worked , I can’t remember, oh you’re going to laugh again .cause, I worked as a receptionist in …….., and my mum had to drive me to work cause I didn’t have my licence. Student: Yep Patient: And my mum had a bad accident on the roundabout, and my dad, my mum, mum, had to call my dad, to come and save us, and my dad had to come down and was blaming my mum in front of everyone, and my dad being as supportive as he should be, which went to court and we won by the way. Student: Ok, but any injury Patient: So that didn’t last long that job cause I couldn’t get there cause mum didn’t have a car. Student: Any injuries sustained in that accident? Patient: No Student: No? Ok so it was quite a minor one and no-one had to go to hospital. Patient: No, no we didn’t have to go to hospital . Student: Ok, after that job what happened? Patient: I can’t really remember then cause I had a few little jobs, I had a job in ….., job in ……. and um, every time there’s a job right, and I had this boss that um, that came on to me. Student: Ah ha Patient: And um, yea, he in the tea room, it was and I was the only receptionist, it was a panel beaters, it was no-one else there, and he came on to me and throws me to the ground and, and my dad went around there and sorted him out. Student: Ok, you are taking this very well. Patient: No just that I look, when you look at all this no wonder that I’m depressed. Student: Ok, so your dad sorted out that assault. Patient: Yep Student: Did it get reported to the police or anything? Patient: No Student: Did it go any further? Patient: No Student: Any injuries sustained? Patient: No Student: Ok Patient: But then, I suppose the next year I was knifed. Student: Ok, hang on, where about’s is this, was it in that job? Patient: No, it wasn’t to do with this job, it was a at a milk bar, it was Queen’s birthday long weekend and I went to buy a packet of cigarettes in …… and I had just finished buying them and I was just walking to my car and a bloke asked for my money, and I said … you’re not getting my money and then I looked down and he had stabbed, slashed me four times up my arm so I handed him my 10 dollars that I had and for a thank-you gift for the 10 dollars he stabbed me in the neck and he ran off. Student: He stabbed you in the neck as well? Patient: Yep, yea, right, just, it was a millimetre away from the main artery thing or whatever it is. Student: Mm Patient: Once I got to hospital they said I was very lucky but no I didn’t go straight to hospital, I went straight home to pick up my boyfriend to go looking for him with a baseball bat. Student: Mm Patient: Then I went to the police station and they said l think I should call an ambulance. Student: Ok, so you didn’t think it was this bad or? Patient: No, I just think it was the adrenaline and I wanted to catch this guy. You know, that it nearly killed me. Student: Um, ok, so you had this fixed up, any stitches in your arm. Patient: No, no it was all butterflies . Student: No? Patient: No Student: Ok so you. Patient: That one was just a puncture, it was just like straight in and out. Student: Yea, ok, after the milk bar what happened in the next year? Patient: Um, I was still living with ….. at the time. Student: Ah ha Patient: In ……, in his house in ……., I was unemployed and that’s when I started working in the career of Hire, I started at …….. in hire and you know that’s where I’ve stayed. Student: Ah ha, ok you’ve mentioned …… and that’s obviously a previous relationship. Patient: Yea, I’ve had, obviously my partner, my husband of now, then I had ….. I was with eight years and then there was ….. Student: Ok, and those relationships were ok? Patient: Yea, yea, they were, like they weren’t violent or abusive or anything like that, I don’t know maybe I should mention that I saw a lady commit suicide, in front of me. Student: Ah ha Patient: Um, it’s really bad isn’t it, my life’s crap (became tearful at this stage) um, at a railway line, I was the first one at the railway line when I saw her running and she was wearing bright coloured clothes that stood out it was a cold winter’s morning and she just lied straight across the tracks and just covered her face and the train just hit her and she just exploded. And then I can still remember this stupid woman, cause I was right at the front, telling me to go up and talk to the police and I said no I’m not going over there, and she dragged me over and I could still see the ambulance people and that putting little bits of towel down over the bits of her from her remains from here to ……., and it was so cold, you know, that the steam was coming off cause they were hot you know and it was so cold, and I, to this day remember that she was Chinese and she was wearing a beanie, bright coloured, and that was oh, I recon I would have been about 20 . Student: Mm Patient: So a long time ago, I can still remember which railway line and what time of the day it was, and that, that plays a lot on me too. Student: It still affects you? Patient: Mm, like sometimes if I sit at a railway like I don’t like to be the first one. Student: Mm Patient: And you know, and if I am sometimes I’ll talk and make jokes, sit and talk cause I’ve seen people, and I’ve seen kids trying to beat a train and, you know, I just feel physically like I want to kill them, like, you know, if they are going to trip over they will die in front of me, you know. You know, so.. Student: Mm Patient: So I’ve had a fair bit that’s happened when you actually but it down on paper. Student: Mm, did you get Counseling for it? Patient: I did, over the phone I did, I went for counseling when I was attacked that’s why I didn’t go for it I saw them. So, that’s why when I went for counseling and I didn’t really like him, he made me sit in a chair like this and they have two chairs and then I had to be the attacker and then I had to … then I had to jump in that chair and be me and then, I had to be two parts and I thought this guy is really messing me up here. So I never went back. Student: Ok Patient: And that’s why they, the train people rang me up and they gave me the counselor that deals with the train people they spoke over the phone and gave me their number and I just kept ringing them up and talking to them I was lucky cause I had people that I could talk to, my mum, and all that, I could talk about it 50 times a day and they would not say we’ve heard it, shut up, they just let me vent so. Student: Ah ha, so what were you venting? Patient: Just how could she do that, how could some-one just do that, how selfish is she, I still feel that now, how selfish that’s well and how could she just want to end it. What about people like me and the train driver that, that had a bird’s eye view of what she did, you know, like, has to be other ways of doing it if you what to do it, you know. I know that people when they are feeling like committing suicide don’t think of that sort of stuff, you know, it makes it hard when. Student: Yea, it does make it hard. Patient: That’s basically, you know, why I can’t understand how she could have done it and I hate her for it and I hope she’s in hell. For leaving me that scar in you know, and for me having to live with it for the rest of my life. You know, just driving my partner to work and I’ve had to watch that. Student: Mm Patient: But, then on the other hand I feel sorry for her that she’s had to feel that bad that she actually had to go and do that, you know, it’s sad that someone is feeling that sad, bad about their life that they actually, you know, do it. Student: Ok, moving from that time what happened in the next year or two? Patient: Nothing, I think everything was quite smooth, um, I met ….. so I had to leave ….., um, to be with ….. and that was a very laid back relationship, like we sort of lived together for probably one year out of the nine years together, and I was living at home, he was living at his mum’s we were more like friends, we would go fishing, go to the football, and I wanted a bit more, he never gave me more. Student: Mm Patient: So, it was like a real laid back relationship really. Student: And, family wise around that time how was that? Patient: Um, no I think that was, think that was fine, like, yea, cause all, everyone had moved out, there was no, …….. and everyone had moved out and on with their lives, it was quite good really, I had the house to myself. Student: Ah ha, ok, then that relationship broke up? Patient: Ah ha, I met, I met, ….., my husband now, um, um and then I sort of was still seeing …… and then I thought no, um then I, then I chose ….., you know, by then and ….. decided to propose to me after I said I wanted to split up with him. He gave me an engagement ring, um, which I turned down, kept the ring, turned him down. I deserved it, nine years, he didn’t believe in jewelry, um yea so, but I couldn’t, I’ve found the best partner now, I’m happy with who, you know, like I’ve got a supportive, who is great with me being sick all the time, you know, putting me down all the time, with me putting on weight all the time, he doesn’t say, you know, you’re frumpy, um, you know, he’s great with ….., he’s a great dad, he’s a great husband, so I’m lucky I’ve got, finally found a perfect man but then I don’t like the other family. Student: Ok, so this is his second marriage? Patient: Yea, he’s, yea, ….., got an, wife, ex wife and two children who are 11 and eight and his ex wife is a pill, doesn’t give anything, just takes everything. Student: Ok Patient: And I feel like I’m working my butt off, to support the other family and that plays on me too. Student: Ok, when you are saying you feel she’s are taking everything, um, the kids don’t live with you? Patient: No, no, we have the kids every second weekend, where we have to drive to ……..to pick them up. Student: Ah ha Patient: And drop them back and that’s because we had, we moved, made it our chose to move out to …….., she reckons, but that’s only because that’s the only place we could afford, um, you know, who can live inner city, cause who could possibly afford to live inner city, um, but yea so, she, she makes sure that she won’t, like give an inch, like with the payments and all that, like ….. has never missed a payment, or he doesn’t, he feels, he knows he has to support, you know, but we’ve asked, well, look instead of making it the hundred, do you want to make it seventy cause our mortgage has just gone up and you’re now living with someone else, you know, you’re are doing it easier, oh no can’t do that, so.. Student: Mm Patient: Those sort of things Student: How is that affecting you how are you feeling about that? Patient: Angry, angry and pissed off that she gets to work 20 hours a week and gets to live the high life and she gets to have her children at home the whole childhood when my son’s been in care since he was eight weeks old. Student: Mm, Patient: And like, you know, that plays on me and ….., you know, ….. can’t support us, me and ….., because basically by the time he pays his 22% or whatever it is to his ex wife, and then, then it’s every fortnight $50 to pick them up with e tag, and bring them back so that’s another $100 a month and then, then you’ve got to entertain them, feed them, and clothe them, cause she won’t provide clothes either we have to provide our own clothes, um that’s all an expense, so all ….. pays for them plus a personal loan that he’s paying off, from his debt before he met me um and his ex wife, there’s not a hell of a lot left over. Student: Mm Patient: You know, without me being the main bread winner. We would have nothing, but you won’t let …… hear any of this will you? Student: No Patient: Cause I would hate for him to know how I really felt. Student: What, I’m trying to find is, with everybody, everybody feels about different situations and this is how you feel about this situation, and what I’m trying to connect is, what I can find out what you are feeling whether it, obviously affecting you physically cause you have got the nausea and the sleep problems. Patient: Yep Student: Ok, so what I’m trying to find, is what you are feeling. You are feeling angry and feeling pissed off, (poor use of words) you’ve had a lot of violence in the past, whether it’s you or those around you that’s still affecting you. Patient: Yep Student: Um, when you are saying you feel like you are wanting to hide away with any violence now. Patient: Yep Student: What I would really like to know is what you are feeling emotionally, what is the upper most emotion that you are feeling at that time. Patient: Scared. Student: You are scared, Ok Patient: Yep, I’m scared that I am going to get hurt. Student: Ah ha, and that’s an understandable emotion. Patient: Yea, I’m just scared that, I remember that a big broad, at work a bloke was angry and threw a chair and I was that scared, not in my recent job, um, I was that scared that I hopped under my desk in a foetal position crying cause I thought oh my God, he’s, he’s going to hurt me, you know. Student: Ah ha, ok that’s why I’m asking, you can tell me as much as you like or as little as you like. Patient: No, well there’s heaps, I was living in ….. with …., I was the first time we decided that we would try and live together, I was attacked, cause walking in the park across the road from Safeway. Student: Ah ha Patient: Um in broad daylight a man jumped on me, tried to rape me, um, lucky he didn’t I got away from him, um, and that you know, so, you know, that’s something else, like, there are just so many things, you know a lot. Student: Ah ha Patient: A lot really Student: Yea, and it is a lot and sometimes, you know we deal with a lot of Patient: My mum’s is such a stress head and you know like, you know she’s like that sort of breed, you know, maybe I’m bringing it all on to me, saying ok come on I can handle this and I can’t handle it you know, cause. Student: Yea, we all have genetic tendencies and I will delve into that a little bit later, but those influences still affect you, they affect everybody, and whether you know, they are in the positive or the negative I don’t know, I’m not the one to comment on it, but what I want to know how these situations are affecting you. Then I can. Patient: Yep Student: Help, ok, you were feeling angry. Patient: Yep Student: Ok, the next couple of years? Patient: No that was fine, everything sort of, when I got with ….., I was fine, fell pregnant more or less straight away. Student: Ah ha Patient: Had ……., Student: How’s that? Patient: Um, like the birth was an emergency caesarean. Student: Ok Patient: 27 hours of labour and then they had to, um, and then I was upset cause I wanted to have a caesarean and I wanted a natural birth cause ……. two other kids were caesarean and I wanted to give him the natural birth and I couldn’t. So, um, but yea, no, um perfect, you know the happy family. Student: Ah ha Patient: You know, got a wonderful child, a loving child, which I’m and healthy, except for his younger years where he had pneumonia three times and had to be hospitalized. But apart from that he’s a healthy kid. Student: Ok, so you got pregnant had ….. Patient: Got my new job, been working where I am now for a year last week, um, and that’s good, you know, it’s a family business, they look after you, you know, they are friendly and that sort of stuff, so. Student: Ok, so that’s going well? Patient: Yea, that’s going really well. Student: That’s great and anything that’s been happening out side in the last few years? Patient: No, no, not, I had the funeral last week of ….. and he’s been a friend of the family for as long as I can remember and that’s going to hurt my dad and then I will worry about my dad cause he’s lost his best mate, so it’s another thing that I can’t control but I will just worry about it, so, but yea, the last year has been quite good except for my mum being, like, this time last year she nearly died, Student: Mm Patient: It’s when they told me she’s lucky she’s made it and she’s gone downhill ever since then but she has her days, like I took her shopping today Student: Mm Patient: She couldn’t walk because the thing was falling out but she was happy to be out Student: Mm, Yea Patient: So everything’s fine now. Student: Ok, when you were saying you were depressed, how long have you been feeling like that for? Patient: I would probably say that I was feeling like that for a 5 months, but I, I know that I feel depressed but I didn’t, I guessing that I was depressed but I never ever said that I was, you know, I never sort of put my finger on it. Student: Mm Patient: The only reason why I took antidepressants and it’s sort of like wow I feel better Student: Are you on antidepressants or have you been on them in the past? Patient: No I’m on them know, um, Serepax. Student: Ok Patient: Um, I’ve been on them for a week, but within that week, the nausea is still there. Student: Ah ha Patient: But nowhere near as bad or as often, um, so that’s why I’m guessing that it’s more to do with you know like more feeling depressed than actually, cause I’ve had so many tests to find out what’s wrong with me but they can’t find anything. Student: Ok, so what tests have you had? Patient: I’ve had colonoscopy, gastroscopy, I’ve had my gall bladder removed cause they thought that, was what was making me sick, this is all after having ……., um, and I can’t remember, I had a ECP. Student: An ECG? Patient: No they put up um, a camera down your throat and they were checking for stones in my bile duct. Which wouldn’t be there anymore because it would be removed with the gall, gall oh I don’t know. Student: Your gall bladder yea Patient: I had something to see if I still had gall stones in my stomach. Student: Ah ha Patient: Um what other, I’ve had blood test to check whether I had hyper, hyper, thyroid. Student: Ah ha, and that’s all come back ok has it? Patient: Yea, that’s probably what I’ve had done to find out the nausea, but nothing, except for like, two weeks ago when I had the camera down my throat, throat, they’ve said that I’ve got a hiatus hernia, and that’s, else looked fine. Student: Are you on any antacids or anything else like that? Patient: I take Nexium Student: Nexium, how often do you take that? Patient: Cause I have reflux, I take one a day and I take 20mgs, Student: Ah ha. How much Serepax do you take? Patient: One and it’s 30mgs Student: 30mgs, um, you saying, that they say you have reflux. Patient: Well, that’s yea and that’s one of the symptoms of the hiatus hernia is the reflux. Student: How long have you had the reflux for? Patient: I’ve been on not Nexium but Somac and Zantac like basically since I was 20 so for about a good 10 years I’ve been on something for my stomach. Student: Ok, you’re say that’s when you are 20 I’m just trying to connect things here. Patient: Well that’s probably when, when the girl committed suicide, um 20 I was probably knifed then, yea so it was all around about that time. Student: Ah ha, ok, and it’s been a problem ever since, ok what does the reflux feel like, is it a burning or? Patient: Yea, it’s like a burning, I was getting it before and I could feel it rising up, and it was just burning and you can feel it coming up your throat. Student: Ok, what childhood diseases did you have? Patient: I had hepatitis when I was a child, I was yellow and I was about three Student: Ok Patient: I was just limp like a doll. Yea, I was limp, and they kept saying that to my mum that I was ok and mum kept saying that this is not my child so I was just like a rag doll apparently Student: Ah ha Patient: Um, I can’t think of anything else when I was a baby Student: Yep, any recurring illness in the teenage years? Patient: I had my appendix out Student: Ok, um, anything twenty onwards till now? Patient: No, I think we have covered everything that has happened in my life Student: Ok, no I mean illness, are you prone to chest infections, asthma? Patient: No, I used to get really bad eczema between my thighs when I was a kid Student: Mm Patient: Walk like a cowboy and bright red um, but I don’t suffer that anymore Student: Ok, ok, I’m just going to go through your symptoms top to toe. Anything headaches, migraines anything there? Patient: No, I’ve got black spots in my eyes that look like sperm, look like, like a dot and a little tail Student: Ok, ears? Patient: No fine Student: Nose? Patient: No Student: Mouth, teeth? Patient: Teeth are crap, sensitive, Student: Sensitive? Patient: Yep, very sensitive the other night, I had to go and buy Sensadine yesterday, at 10 bucks a tube Student: Ah ha, ok, have you had bad teeth throughout your life? Patient: Yep, yep, it’s not through not looking after them, I think like ….. we have got the bad teeth of the family Student: Ok, um, fillings, teeth out? Patient: Lots, lots of fillings, probably a filling in every back tooth, and probably no back teeth, yea, probably one there and one there on the bottom. (Indicating to each side of the jaw) Student: Ok, any problems with your tongue or your gums? Patient: No Student: Throat Patient: No Student: Ah, chest, asthma, bronchitis Patient: No Student: Ah, apart from you reflux and your hiatus hernia anything else? Patient: No but I had Irritable Bowel I think for the last four days, where tonight, it’s the first tonight, just being here hasn’t hurt, like, to hurt, like ah, na if I press it really, really hurts in my bowel, Student: Ah ha Patient: I’m guessing that it’s my bowel, cause like I’ve had the runs for the last four days which is normal that’s a normal thing as well Student: What sort of pain is it? Patient: Um, like a cramp, it feels like, ah, yea, I don’t know, it’s like I want to pass wind or something Student: Ah ha Patient: Um, yea, it’s like it knots up, like a knotting pain Student: And have you had irritable bowel syndrome before? Patient: Yea, I’m never normal to go to the toilet Student: Ok, can you describe me a pattern? Patient: Ok, at the moment, in the last six months it’s actually now it’s like’s like I’ve got gastro, it’s like water. I could be four times a day, you know, and that’s what could happen and that’s why I get this pain, from the toilet like a bug that I’ve got and then. Then I will get constipated. Student: Ok. How often would you have the diarrhoea, what sort of cycle are you having, is it diarrhoea then constipation? Patient: No, I have diarrhoea for probably two days than hard Student: Yea Patient: And diarrhoea again Student: What colour is the diarrhoea? Patient: Um, like a greenie, Student: Ah ha is there any smell? Patient: No not really Student: Anything that makes it worse? Patient: No, like it could happen if I have eaten or not eaten Student: Ok, anything that makes it better? Patient: No Student: Ok with the hiatus hernia did you have any symptoms, of, or pressure or pain around that area? Patient: Well, two last year, was it last year, before I got my gall bladder out Student: Mm Patient: I use to get this pain around here that was crippling and like I’ve had an ambulance to my house three times, the emergency department four times, um doubled over in pain cause the pain was that bad, worse than labour pains, that’s why they took the gall bladder out but now I’m wondering if it was actually the hiatus hernia popping out, cause it’s like a spasm it would just get you and then it would, it would eventually go. Sometimes I would call an ambulance, by the time the ambulance actually got there the pain had actually subsided, it was like a spasm sort of thing Student: Ok, how often would these attacks occur? Patient: Um, probably once every two, once every two to three weeks I would probably be in the emergency department on Morphine Student: That’s pretty bad pain Patient: Yea Student: What was the pain like? Patient: Like, I tried as I said it was like a spasm, it was like, unbearable it was terrible, I would be hyperventilating through the pain, where they would tell me to slow my breathing down, the pain was that bad Student: So they thought it was your gall bladder Patient: Yea, so they removed that. I did get the pain after the gall bladder was taken out but to this day, I could feel a little bit of a tingle, um, and then when I feel it coming on, now I could feel it, when I know that the pain is coming I will have something to eat and it will help it Student: So it is slightly better with you eating Patient: Yes Student: So what sort of stuff are you eating? Patient: Um, well I don’t have breakfast, for morning tea I might have a vegemite sandwich, Student: Ah ha Patient: For lunch I will have what everybody else is having, you know a sandwich or Singapore noodles and dinner I would have like what everybody sort of, you know you meat and three veggies, stew or lasagna. Student: Any problems with your urine, or urinary? Patient: No but as of last month, I had my period then got my period again then got my period two weeks later again and then I got my period on the date that I was meant to get it. Student: Ah ha Patient: I ended up with it in the middle of the month, of the cycle. Student: Ah ha Patient: Um, but it hasn’t happened to me again I don’t feel, it happened about two months ago that cycle, I wasn’t sure what was going on. But usually I get stomach cramps, period cramps which I have always had since I’ve had my period and I’ve had that since I was 11. Just down here (indicating to the lower abdomen) where just ohh, you know, just your normal every day, I think most girls get a cramp. I get back pain. Student: Ah ha Patient: Um but yea, a lot of girls at work will walk around with those heat bean bag things, but I don’t do that I just put up with it, it will eventually go away, it’s just. Student: Ok, what’s the flow like? Patient: Good, but um, it’s usually very heavy the first day, um, the second day is light, you know, I’m only usually heavy for one day, and then it’s dying off, by day three or four it’s gone altogether. Student: And it’s not excessively long? Patient: No, no I think I’m coming to the end of my time of being a woman, thank God. Student: And it’s quite regular? Patient: Yea, every, on the dot it’s28 days. That’s when I got it in the middle of the month I thought oh my God may be I’m pregnant like, it was just so unusually. Student: Any problems with your arms, legs? Patient: No everything’s fine . Student: Your back? Patient: No everything is fine. Student: Feet, joints? Patient: No Student: Skin? Patient: No Mother – emphysema from smoking Father – diabetes untreated, high blood pressure Mother’s mother - heart Mother’s father – emphysema Father’s mother – diabetes Father’s father – cancer? Student: Do you have any dreams, or remember any dreams? Patient: No, I had a dream last night that ….. went off with a couple of prostitute’s what the insecurity coming in. But, yea no, just no, I can’t really know, I can’t really remember them anyway. Student: What’s your greatest fears? Patient: Um, I don’t know, what am I really scared of? I can’t think, I’m not, I wouldn’t say I was scared of heights, um, probably scared of my mum dying, can that be my greatest fear? Student: Yea Patient: Cause that’s my greatest fear of my mum dying and leaving me alone, um, yea and oh I don’t know, not really that scared of that much really. Like I’m scared of being knifed or, you know, attacked or something you know. I’ve got fears but yea, I’m not really scared of stuff. Student: Dietary preferences? Patient: Um, I’m not really that fussy, I will eat anything, um, I’m actually a savoury person over a sweet person. So I would rather have chips or something over chocolate. Um, but yea I’m not really a fussy sort of person, like I don’t like sushi or that sort of stuff. I’m not into the gourmet food, I’m not into olives or the sun dried tomatoes, I’m more into your bangers and mash your ocker style food. Student: Ok, um, I can’t, I think that’s about it. Patient: That’s it Summary of case
Miasm: Green Rubrics chosen (Macrepertory complete) MIND; VIOLENCE, vehemence (124) MIND; SUICIDAL* disposition (136) MIND; STARTING, (267) MIND; ANXIETY (511) STOOL; COLOR; green (121) STOMACH; HEARTBURN (233) STOMACH; NAUSEA (492) SLEEP; SLEEPLESSNESS (542) *This rubric is an example of using circumstance to represent a mental symptom. The impact of another person suiciding was so distinctive to this patient. Rather than interpreting her emotional state (grief, shock, anger etc) the event itself holds the energy of the remedy. Ars, Nux, Bell, Sulph, Chin, N Mur, Sep, Phos, Calc, Lyc, Verat, Merc, Plb, Aur, Acon, Alum Green remedies – Chin, Phos, Calc, Acon Aconite 200 single dose – 23 June 2007
Follow up Six days after initial dose given on request from patient. For the first 3 or 4 days felt “fantastic” after waking up the next morning after taking the remedy.
However the symptoms started to return after 4 days with the nausea coming back but not to the level that it was, feeling more fatigued again but again not to the level that she was on the initial consultation. Also had a sore throat which was worse on swallowing with a sharp pain and some chest pain which was checked out by the GP who did an ECG and everything was normal. Repeat Aconite 200c single dose
7th July 2007 Again felt fantastic the next day on waking after taking the remedy.
However the symptoms then started to return about 5 days after taking the remedy although not to the same extent as the last follow up. Due to the dramatic effect of the remedy within a very short time (overnight) I decided to continue the remedy but increase the dosage to maintain the improvement for a longer period of time. Aconite 1m single dose Phone call received from patient about 3 weeks after last dose of remedy given. Everything has been steadily improving and will contact me if she needs to. No repeat given. 27 July 2007 Improved after last dose but slipping again – Aconite 1m single dose The effect of the remedy was absolutely incredible. However the length of the improvement was not sustained until the last dose given. It was because of the incredible improvement each time the remedy was given that the remedy was not changed but additional and higher dose’s given. January 2009 follow up – (no more doses given after July 07) · No nausea at all during the day · No abdom cramps or pain during the day but will have discomfort about 3am in the morning but can cope with this and it is not bothering her · Appetite good · No fatigue and has maintained her energy levels throughout the day · Sleeping more at night although still will wake up once about 3am, continues to feel refreshed on waking · Bowels –diarrhoea has not returned · Has stopped smoking which she has found difficult but again is coping with it · Coryza has gone · Not as worried about everything and continues to feel less anxious · Lost her job about 6 months ago and was out of work for about 4 months has now found another job in the same industry and is enjoying it. Her family had to move in with her parents as were close to loosing their house (which they have rented out while living with the parents) this is working well as they are able to get into a better financial position and her mother is able to look after her son while she is at work (therefore cutting down on childcare fees). Her son starts school this year · Does not feel depressed or sad · Feels as if she is carrying a lot of fluid at the moment especially around the abdom area and ankles
Leanne Satherley (4th year student 2007) Ad Dip Hom |
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