Passive Case Witnessing Problem

It’s a case of a 6 year old girl who consulted me on 18/12/08.

The very first peculiar thing we observe about the child is …she enters the consulting room holding mothers hand tightly.

M: She has made a drawing for you.

(Child’s sibling is also our patient. Every time when this child used to accompany her sister, she would draw and now also she has got the following drawings. This itself shows us the child’s intense connection with her subconscious through this form of art.)

M: She does not have any health problem as such but I wanted to start treatment for her overall development.

PASSIVE CASE WITNESSING PROCESS

D:        Tell me what’s happening to you..? Can I send your mother out?

P: No.

OBSERVATION: Clings tightly to her mother.

D:        Okay, tell me what’s your name?

P: OBSERVATION: Sitting in mothers lap with her hands around mother’s neck. N……P……

D:        Tell me more about you?

P: PAUSE

OBSERVATION: Smiles and clings more to the mother.

D:        Tell me what are your interest and hobbies? What you like to do?

P: I like to swim, like to draw, I like running…playing.

D:        Wow! What else?

P: I like to play on the computer, like to watch TV.

OBSERVATION: Now she removes her hand from the mother’s neck and sits leaning on the table, yet she is in her mothers lap.

D:        What else you like to do?

P: Like to go to school.

D:        Very nice, very nice you are talking?

M: You sit on the chair and talk to the doctor.

P: OBSERVATION; child sits on a chair next to the mother but still holding her arm.

As the mother starts to leave the room, the child jumps off the chair, starts crying and goes and hugs the mother, and goes out with her.)

(The mother comes in with her after some time but now the child sits on the chair and mother on the sofa behind her.)

D:        OK, so tell me what else you like to do?

P: I’ll like to play – go on a slide. Like to read books.

D:        Very nice. You are speaking so well. What else you like to do?

P: Like to dance… then I like to play, then I do homework.

OBSERVATION: Looks behind towards the  mother.

ACTIVE CASE WITNESSING PROCESS

D:        And what are you scared of?

P: Scared of lions, tigers…

D:        What else?

P: Bhoot.

The mother had some work and she had to go out of the room. Immediately the child said no.

D:        You are speaking so well. Just talk with me and your mother will come in 2 minutes.

P: No…no…(OBSERVATION: She gets up and clings to mother and starts crying)

D:        OK you don’t talk, but can you draw till your mom comes back?

(She sits on the chair and starts drawing.)

(Since she was not ready to communicate even after so much of encouragement and the fact that at the beginning she had brought drawings, we ask her to draw.)

OBSERVATION: She covers the paper with the hand and also draws at one lower section of the page.)

D:        Wow! What is this?

P: This is my sister & me, & this is my father and my brother.

D:        And what is this?

P: A heart.

ACTIVE – ACTIVE CASE WITNESSING PROCESS…

D:        What is this heart doing here?

P: I love heart so I drew it.

D:        Earlier also you drew hearts. What about this heart you love?

P: I love heart like that only.

D:        Heart with arrows what does this mean?

P: Looking into the drawing. (PAUSE)

D:        What are you all doing?

P: We all are looking at the heart and thinking what is it.

D:        What does the heart mean?

P: I don’t know.

D:        You like drawing heart huh. When do you draw it?

P: In school. In my drawing class. I draw heart and stars and one day I drew heart and star in the Christmas tree.

D:        In this drawing who is having the flower? (We spotted a flower in the drawing she had made.)

P: My sister- she is just holding it.

D:        She is going to give it to someone or what?

P: Me.

D:        And heart will go to whom.

P: To my brother and father.

D:        Why?

P: Like that only.

D:        Like that only. OK… Would you like to draw something more for me?

D:        Wow! What is this?

P: A drawing.

D:        Of what?

P: Drawing of a garden. This is me and my brother.

D:        What are you both doing here?

P: We have come here to play.

D:        What are you playing?

P: Running and catching.

D:        What is this?

P: Flowers.

D:        Which flower are they?

P: This is flower, this rose and…this …this is pink flower.

D:        Draw one more thing for me?

P: OBSERVATION:  She draws human figures and then joins all of them together.

D:        Wow! What is this? I don’t know what it is.

P: My family.

D:        What’s your family doing here?

P: Ring-a-ring-a-roses.

D:        Ring-a-ring-a-roses. What’s that?

P: I don’t know.

D:        Whom you like the most in your family?

P: My mom.

D:        What about mom you like the most.

P: (PAUSE)

D:        You like or your sister likes?

P: I like more.

D:        What else?

P: (PAUSE)

ACTIVE – ACTIVE IN DIFFERENT AREA – FEAR

D:        What are you scared the most.

P: Lion and tiger.

D:        What about them scares you the most?

P: Because lion crawls and eat us.

D:        What else do they do.

P: Smiles.

D:        You said previously that you are also scared of ghost. What about them scares you?

P: (PAUSE) … I saw the movie called Road side Romeo. (This is a bollywood movie)

(Here when we ask her about fears, she herself goes to the area of movies, so we become active- active to explore this area.)

ACTIVE – ACTIVE IN DIFFERENT AREA -MOVIES

D:        What is there in that movie?

P: There’s a dog, many dogs but 1 dog’s name is Romeo.

D:        Go on?

P: There is a girl called Leila and she loved…. and that dog he loved Leila..

D:        I don’t know what they do? Love means what?

P: I don’t know.

D:        What about the movie do you like the most?

P: I like Leila.

D:        What about Leila you like?

P: (PAUSE)

OBSERVATION: leans on the table and hides mouth behind both palms.

D:        Which other movies you like?

P: Romeo & Jaane tu… (It’s a Bollywood romantic movie.)

D:        And what is there in that movie Jaane tu…?

P: I forget.

D:        Anything else about you.

P: Nods no.

D:        So you like all movies with love/

P: Nods Yes.

D:        What about it you like?

P: I don’t know… because nice things happen.

D:        What?

P: Like they don’t shout, they don’t hit and all.

D:        Anything else.

P: No.

Child goes out and comes back with another drawing along with the mother.

MOTHER’S OBSERVATION OF THE CHILD

She is very affectionate child.  She will go and give big hugs even to strangers. She is very fond of her younger brother and she will make him understand things by saying you can win this or that and she lets him win. Actually she is friendly with anybody and everybody.

END OF THE CASE

—————————————————

UNDERSTANDING OF THE CASE

OU OF PLACE/ OUT OF ORDER

Passive case witnessing process

Verbally the child didn’t speak anything peculiar but our observations regarding the child were very peculiar…

• Her clinging.
• Sitting in the mother’s lap.
• Holding mother tightly.
• Holding her hand while talking.
• Hugging the mother.

Active case witnessing process

• Clings to mother as she tries to go out of the room.
• Covering the paper with hand while drawing.
• A heart.

Active-Active case witnessing process

• I love heart .
• I drew heart and star in the Christmas tree.
• Drawing of a garden
• Flowers.
• Draws human figures and then joins all of them together.
• Too much family attachment.
• Ring-a-ring-a-roses.
• That dog he loved Laila Leila
• Like they don’t shout, they don’t hit and all.

WHAT IS THE FOCUS/CENTRE/ESSENCE OF THE CASE

• Love, attachment and togetherness.
• Love for heart.

This is very evident from her body language and all her drawings. Also this further gets confirmed from the mother’s observation of the child.

WHICH KINGDOM?

• Pure sensitivity seen.
• Drawings of garden, flowers.

This clearly points to the PLANT KINGDOM.

WHICH FAMILY?

This tremendous attachment to the mother, togetherness of the family, hugging and clinginess, love for hearts is very suggestive of the MALVALES family.

WHICH MIASM?

We observed that whenever she draws she covers the paper with her hand. This gives a hint of the SYCOTIC MIASM.

WHICH REMEDY?

The remedy from the Malvales family with Sycotic miasm running in the centre is TILIA EUROPA. BUT in the case we observed that along with the general theme of the Malvales family, the child’s focus was “Heart”. So when a further inquisitive search was made keeping focus on the “Heart” interestingly we found out a remedy TILIA CORDATA which also belongs to the same family where the leaves of the tree are heart shaped.
Thus the remedy given was TILIA CORDATA.

WHICH POTENCY?

At the end of Passive case witnessing process, verbally the child seemed to be at the ‘Name and Fact’ level but the peculiar body language which we didn’t understand initially and which got connected later on with the whole phenomenon, represented the child’s complete altered energy pattern. Thus the child (non-verbally) vibrated at the Delusion level. Therefore the potency given was 1M, single dose.

A follow up drawing

END OF THE CASE

Anosmia



Hpathy Ezine, September, 2011 | Print This Post |

The term anosmia derives from the Greek an (without) and osme (odor); it refers to the absence or impairment of the sense of smell.The most common cause of anosmia is a several head cold or respiratory infection, which intranasal swelling blocks the nasal passages, preventing odors from reaching the olfactory region.

The term anosmia derives from the Greek an (without) and osme (odor); it refers to the absence or impairment of the sense of smell. Hyposmia refers to diminished olfactory functioning. Synonyms for this condition include anosmia, anosphrasia, and olfactory anesthesia. Organic forms of anosmia are categorized as afferent (related to impaired conductivity of the olfactory nerve), central (due to cerebral disease), obstructive (related to obstruction of the nasal fossa), and peripheral (due to diseases of peripheral olfactory nerves).

The most common cause of anosmia is a several head cold or respiratory infection, which intranasal swelling blocks the nasal passages, preventing odors from reaching the olfactory region. This type of anosmia is temporary. Other organic causes of this condition include neoplasms (tumors), head injuries, or chronic rhinitis associated with granulomatous disease.

Anosmia also is a characteristic of olfactogenital dysplasia, also known as Kallman’s syndrome or anosmia eunuchoidism. This condition, more prevalent in males, is associated with lack of development of secondary sexual characterized and anosmia.

The apparently X-linked autosomal dominant or recessive inheritable condition is associated with dysfunction of the hypothalamus and the pituitary. Anosmia with these etiologies typically is a permanent condition. Decreased sense of smell, microsmia, is also common with aging and among smokers.

Psychological forms of anosmia, while less common, may occur. Phobias or fears have been identified as precipitating such forms of anosmia. Specific types of anosmia include anosmia gustatoria (loss of the ability to smell foods) and preferential anosmia (loss of the ability to smell certain odors), provides a detailed description of conditions associated with a disturbance of olfaction and excellent clinical analyses with children.

Anosmia Causes

  • A. Allergic and vasomotor rhinitis
  • N. Nasal obstruction: deviated nasal septum
  • O. Olfactory nerve affections
  • S. Sub-arachnoid hemorrhage
  • M. Meningitis and neurosyphilis
  • I. Idiopathic

Intracranial lesions e.g. absences, tumor, infection, etc.

  • A. atrophic rhinitis

Differential Diagnosis

Head or facial trauma

  • Probably the second common cause of anosmia
  • May result in permanent anosmia
  • CNS rhinorrhea may occur

Post upper respiratory viral infection

  • Accounts for 20%-30% of causes of anosmia

Nasal and sinus disease

  • The most common cause of anosmia
  • Allergic or vasomotor rhinitis and sinusitis result in temporary anosmia.
  • Intranasal polyps may result in obstruction of nasal passages with temporary anosmia.

Iatrogenic

  • Amphetamines
  • Certain antibiotics (e.g., amikacin, doxycycline, amoxicillin, clarithromycin)
  • Nasal steroids
  • Antithyroid agents
  • Radiation

Poisoning

  • Chemical pollutants
  • Heavy metals (e.g., lead)
  • Volatile organic compounds
  • Inorganic compounds (e.g., vanadium, chromates, cadmium)

Iiicit drugs

  • Intranasal cocaine

Granulomatous disease with destruction of the olfactory nerve

  • Wegener’s granulomatosis
  • Sarcoidosis

CNS disorders

  • Alzheimer’s disease
  • Parkinson’s disease
  • Anxiety disorders

Neoplasms

  • Meningioma of the olfactory groove
  • Nasal cavity tumors
  • Brain tumors

Endocrine disorders

  • Diabetes mellitus
  • Hypothyroidism
  • Adrenal insufficiency

Congenial disorders

  • Kallman’s syndrome
  • Turner’s syndrome

Vitamin deficiencies

  • Malnutrition
  • Vitamin B12 deficiency (pernicious anemia)
  • Niacin deficiency (pellagra)
  • Zinc deficiency

Diagnostic Workup & Initial Management

History and physical examination

  • Assess onset and duration, associated symptoms (e.g., allergic symptoms), recent head trauma, exposure (particularly to intranasal zinc), medications, and past medical and surgical history.

°    Rhinitis and sinusitis may be associated with chronic nasal congestion, rhinorrhea, postnasal drip, pale or boggy nasal mucosa, sinus swelling and tenderness, and headaches.

°   Upper or lower respiratory symptoms and renal involvement suggest Wegner’s granulomatosis.

  • Include a complete head and neck exam and a full neurologic exam.

°   Enlarged nasal turbinates suggest sinusitis (turbinates are pale and boggy in chronic allergic sinusitis and erythematous in non-allergic sinusitis)

°      Assess for septal disease (midline granulomas) and polyps

Initial diagnostic workup

  • Several types of smell tests are available:

–      Olfactory threshold and odor identification test

–      University of Pennsylvania scratch and sniff test

–      Alcohol sniff test

  • Initial laboratory testing may include CBC, electrolyte, glucose, BUN and creatinine, calcium, ESR, thyroid profile, liver function tests, and vitamin B12 level.
  • Blood and/or urine toxicology screen if suspect drug use or poisoning.
  • Nasal discharge testing for ?-transferrin in CSF
  • Head CT may be indicated to evaluate skull base, brain, nasal cavity, and sinuses.
  • MRI may be indicated to evaluate brain and soft facial tissues.
  • Antibodies to Ro/SSA and LA/SSB are positive in Sjogren’s syndrome.

Initial patient management

  • Temporary anosmia because of nasal and/or sinus disease is usually successfully treated medically with systemic and/or intranasal corticosteroids, antibiotics if coexisting bacterial infection is present, antihistamines and avoidance measure if an allergic component exists, or decongestants and/or saline lavage for nasal congestion.

–    Polypectomy and sinus surgery may be necessary if initial therapy is ineffective.

  • No cure is available for permanent anosmia (e.g., from post viral infections, trauma, congenital disorders); however, regeneration of neural elements may occur over a period of days to years.
  • Anosmia caused by CNS and endocrine disease requires treatment of the underlying illness.
  • Vitamin and mineral supplementation in cases of deficiency.

Homeopathic treatment of Anosmia symptoms – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat Anosmia symptoms but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure Anosmia symptoms that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of Anosmia symptoms:

Alumina, Anacardium, Hepar Sulph, Kali Bi, Mag Mur, Natrum Mur, Pulsatilla, Belladonna, Aurum Met, Calcaria Carb, Ignatia, Iodum and many other medicines.

References:

Cecil R. Reynolds, Elaine Fletcher Janzen; Encyclopedia of Special Education: A-D; 2007; 135

Scott Kahan, Redonda Miller, Ellen G. Smith; in a page: Signs and symptoms; 2008; 24

Parmar HB; Mnemonics in Internal Medicine & Pediatrics; 2002; 08

Ashish Sharma

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