Patient: A. I.
Date of Initial Consultation: July 14, 2018
1st Follow up: Oct. 2, 2018
2nd Follow up: Dec. 5, 2018
3rd Follow up: Feb. 25, 2019
Abstract
A.I. presented with childhood anxiety for several years. Her anxiety changed throughout time and she went on two different homeopathic remedies before seeing me. She was originally successfully treated with Arsenicum Album, then some time later with Phosphorus. Arsenicum Album initially worked then failed, and Phosphorus only partially removed some symptoms. Upon treating A.I.’s current presentation of anxiety with panic attacks was off of a homeopathic remedy for several months. Careful case taking and analysis of lead me to conclude that the patient was presenting chronic anxiety with acute
exacerbations of panic attacks characterized by Lachesis symptoms.
Keywords; anxiety, panic attack, hot flushes, throat constriction.
Introduction
Generalized Anxiety is defined as a condition related to anxiety, anxious thoughts, worries, and other cognitive processes and behaviours that may lead a person into a perpetual state of anxiety. It can occur in association with panic disorder; which is distinguished by episodes of severe panic. These may often have triggers. Anxiety is often common in childhood and environmental and social conditions may lead to this disorder.2
Patient Information – First consultation -July 2018
A.I is an eleven year old girl whose anxiety started with a panic attack. It first occurred when she was 8 years old while shopping with her family. The panic was characterized by a choking and constricting sensation felt in her throat. She was crying, pulling at her throat, and very fearful. This episode was the first sign of anxiety, as this later developed into a fear of vomiting and becoming sick. Upon a further investigation into the etiology it was found that she had be ill and vomiting at school just prior to this episode of panic. She originally benefited from the prescription of Arsenicum Album dry doses 2 pellets for four consecutive days. About a year later she had relapsed with a slightly different presentation of anxiety, however it still revolved around the fear of becoming sick and vomiting. She was treated with several doses of Phosphorus in various potencies (wet and dry). However, this served only to alleviate partial symptoms, and she was becoming increasingly tired and suddenly hot. After several months without a homeopathic remedy, the symptoms of prostration and hot flushes persisted.
I started treating A.I. on July 14, 2018. Upon taking her case I found that she had consistently suffered from a hot flushed in the evening, which lead her to undress in order to cool down. She also presented with frequent sudden prostration where she felt the need to lie down. She had a fear of vomiting (or getting sick), and dreams of vomiting which would wake her in the middle of the night into a panic attack state. In her attacks of panicked state, she would wake her up leave her bedroom and seek consolation from her parents. Her panic attacks were characterized by a sudden fear, cramping (which felt like a knot) in the lower abdomen, her breasts, and a knot or choking constriction in the throat, trembling in the whole body, clammy hands and feet, as well as extreme fear of vomiting. She would feel like she starts to get hot in the head and her palms and feet started sweating. In response she would start fidgeting with her hands and pulling at her fingers. She would sit in a knee to chest position and repeatedly ask if she was ‘going to throw up’. The panic attacks were most frequently at night upon waking. Thought they could also start randomly when she was calm, or when she started to think about the past or about the future, as well as when her body started to cramped up.
Homeopathic Diagnosis
The symptoms were episodes of panic characterized by heat, constriction of the throat, fear of vomiting upon waking at night. Also, general disposition to daily hot flushes, and sudden episodes of weakness.
Selected Rubrics
Discussion
Initial thoughts about this case was that the patient was presenting extreme fear with cramping in various locations, heat, and episodes of heat and weakness in general. After the differential I thought perhaps Lycopodium would be a good fit. Upon consulting with my externship supervisor (Sarah Hutchinson), and further discussions of the most morbid symptoms to look at, I decided to proceed with Lachesis muta instead.
Taking a closer look at the case I came to the conclusion that the most reliable symptoms that persisted in frequency and intensity were the almost daily hot flushes around twilight which caused the patient to undress and the random weakness spells which caused her to need to lie down. The relative morbidity of these symptoms for an 11 year old child together with a sense of constriction in the throat as well as in various parts of the body, and a fear of vomiting all pointed to Lachesis muta.
Lachesis muta most characteristically covers the general tightness or constriction of the throat as well as other areas of the body, sleeping into an aggravation, and is a remedy commonly used for hot flushes.
Prescription
Lachesis muta 200C was prescribed in a water dose. 2 Pellets were diluted in a tincture 25 ml. A.I. was to take 1 drop 1x week with succussion in between doses.
Follow-up and Outcomes – First follow up – Oct 2, 2018.
A.I. has overall shown significant improvements in her overall anxiety and panic attacks. After the first follow up (Oct 2, 2018), the frequency, duration, and intensity of the anxiety attacks decreased. She also reported sleeping better and had a growing appetite. He frequency of hot flushes and sudden prostration have also decreased. She is not as hot when they the flushes occur and they don’t occur very often. Her sudden attacks of prostration are still occurring from time to time, but not as intensely. Specifically, since the initial consultation (July 2018) and taking the remedy she has had 5-10 panic attacks in total. She feels overall less anxious. She is also able to manage them better and says she feels more overwhelmed rather than panicked. The attacks are similar in nature, but a few things have changed. She says that she now starts to feel trembling in her hands/fingers. They start with a tension/tightness in her hands/fingers and she starts to pull at her fingers to draw attention/pain to them and away from her panicked state of mind. She feels like she wants to tighten up into a ball (sits still w/ knees drawn in). She also feels a vibrating/shaking sensation in her legs. Her panic attacks are caused by emotions, bad thoughts, nightmares about throwing up and about bad memories. She says that when they are intense, she feels heat/burning in the forehead and dryness in her throat.
As there is great general improvement in the specific symptom picture and the general vitality of the patient has improved, Lachesis muta 200C is continued as above. 2 Pellets were diluted in a tincture 25 ml. A.I. was to take 1 drop 1x week with succussion in between doses.
In the 2nd follow up (Dec. 5, 2018) she states that she is doing much better. Over the past few weeks, she has noticed that when she forgot to take the remedy, she would take it a few days later than the 7th day, because she felt she needed it. Overall, the frequency, duration, and intensity of the anxiety and attacks have decreased. She feels she is 80% better. She has 3-4 panic attacks overall all. When they occur, they are of the same character, starting with the heat in the forehead which spreads down her body. However, they only last about 5 minutes. She also noticed that she is overall less anxious and that when she starts to feel anxious, she is better able to deescalate the situation on her own. Her appetite has grown and she is eating more and finishing her whole lunch at school.
She feels less tired, and she is also more thirsty. Lachesis 200c is continue 1x week as above. 2 Pellets were diluted in a tincture 25 ml. A.I. was to take 1 drop 1x week with succussion in between doses.
In the 3rd follow up (Feb. 25, 2019) she again confirms progress. However, she has noticed that she is experiencing an aggravation approximately 48 hours after taking the remedy (a mild panic attack of the same character. A further dilution of the remedy; 1 tsp of 1 drop diluted in 4 ounces of water helped with the aggravation. She still feels she is 80% better. Interestingly there seems to be new symptoms developing. She says that for the last few weeks she has noticed a minor headache on the vertex of her head occurring at the same time every day after school between 4-5pm. She is asked to pay attention to any further aggravations, and new emerging symptoms.
As the remedy continues to help, her Lachesis Muta 200 C in continued. 2 Pellets were diluted in a tincture 25 ml. A.I. was to take 1 drop, dilute in 4 ounces of water and take 1 tsp a week or as needed with succussion in between doses.
Discussion
The presentation of this type of anxiety with sudden heat flushes and episodes of sudden weakness along with a general constricting sensation clearly pointed to Lachesis muta. The re-evaluation of the relative morbidity of the symptom heat flushes in an 11 year old child, leads to the confirmation that Lachesis muta was indeed the right remedy. This speaks to the fact that symptom evaluation and analysis is imperative in getting to the right prescription. We need to always ask ourselves what is the most morbid symptom of the case, and what best characterizes the way a patient is experiencing their symptoms.
Lachesis muta fit the chronic presentation of anxiety as well as the acute exacerbations of the chronic condition. The discussion of the follow ups and the progress of the patient clearly demonstrates Hering’s Law of Cure.3 The patient shows a progressive alleviation of symptoms, along with the movement of a tension and tightness that was prominent in her core and throat and moved outwards toward her hands and fingers. She feels a dryness in hear throat instead of constriction, and mentally emotionally feels more overwhelmed rather than anxious and panicked.
As the patient is progressively getting better, the posology is altered (further diluted) to attend to any aggravations. The frequency of the dose is altered as per the patient’s needs, as she has become very tuned into when the remedy is required. She is told to watch and report back, as well as to continuously watch any new emerging symptoms.
Unpublished Material
AJHM Authors Guidelines – 2013.pdf – CCHM
JOURNALS REFERENCED:
- Severe Suicidal Depression in a 28-Year-Old Woman. A Homeopathic Case Report.
Fleisher, Mitchell A., MD, DHt, DABFM. American Journal of Homeopathic Medicine. Volume 110. No. 2 / Summer 2017 e-issue., pg. 22-25.
- A case of Adjustment Disorder with Anxiety. A Homeopathic Clinical Snapshot. Guess, George, MD, DHt. American Journal of Homeopathic Medicine. Volume 110 / Spring
2017 e-issue., pg. 30-32.
- Bipolar Disorder, a Presentation of 3 Cases. Merizalde, Bernardo, MD. American Journal of Homeopathic Medicine. Volume 96, No. 4, / Winter 2003-4. pg. 309-315
- Day to Day management of anxiety and depression. Spence, David. MB, BS, MRCS, LRCP, DObstRCOG, FFHOM. British Homeopathic Journal.January 1990, volume 79, pg. 34-39.
2 Website; https://www.psychologytoday.com/ca/basics/anxiety. Accessed Mar. 2, 2019.
3Website; http://www.homeoint.org/cazalet/schmidt/lawofcure.htm (accessed Mar. 15, 2019).
Electronic Material
- https://homeopathybooks.in/principles-homoeopathy-students-medicine/evaluation-of-sy mptoms/
- https://escipub.com/Articles/JSR/Vol1/JSR-2017-0229
- http://www.encognitive.com/files/Bipolar%20Disorders–A%20Presentation%20of%
- https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0038-1633340
- https://www.psychologytoday.com/ca/basics/anxiety
- http://www.homeoint.org/cazalet/schmidt/lawofcure.htm
Awknowledgements
- Sarah Hutchinson, HOM, Student Supervisor (CCHM)
