I’ve decided to share a case that was complicated for me and from which I learned a lot. I am publishing this particular case to demonstrate the consequences of getting lost in the patient’s stories. To further complicate the case the story includes multiple homeopathic care givers, long term remedy use, and treatments that ostensibly are congruent with the indications presented.
I am presenting this in two formats: interview style and narrative. Interview style presents an overview of proper case taking. The point narrative gives a small glimpse of the amount of information collected in the case. The College I attended taught me to take a lengthy initial consultation with complete history, and consults are 2 hours or longer. You can imagine that in 2 hours there is a lot to talk about and I know that I can only hold your interest, my dear readers, for a limited amount of time and editorial space.
Let’s us begin:
Gentleman, 60 years old. He is robust, average height with dark hair. He is very jovial and VERY talkative.
He has brought me back the completed intake form which I emailed him at the time of booking. I ask him if he read through the homeopathic information brochure which was attached to that email and if he had any questions about it. He said that he had read it. He tells me that he is very familiar with homeopathy, having gone to a homeopath since childhood who prescribed Nux-v and he has taken it periodically since then and it has helped him.
He tells me, “You will give me Nux vomica because it’s a good remedy for me and has worked so well in the past.”
I offer him a cup of tea, and we both have some, while I review the intake form with him.
The patient wrote this on the intake form:
Major Complaint, and in order of importance for you:
- very poor blood circulation since 1 year
- stiffness in legs since 1 year
- very painful leg cramps since 1 – 5 years
- gas in stomach/ headaches since 2 years
- very low energy levels since 3 – 5 years
- APO Ramipril
He has been diagnosed with:
- High blood pressure
- High cholesterol
- Colitis / Crohn’s disease. ( He uses these words interchangeably)
He had typhoid when he was a small child.
History of stroke and heart failure in the family.
I had asked the patient to bring in any blood test results that he had taken when we had spoken on the phone. I asked him if he had brought them in with him. He told me that he did not get a chance to ask the doctor for them. Throughout treatment the patient never did give me test results.
Homeopath: Out of all this that you have made note of on the intake form, tell me what bothers you the most?
Patient: Apathy. I feel that I have lost incentive in life. I have a lack of energy. I’ve got joint pains and muscular cramps. I’ve got a poor memory. I suffer from diarrhea. I think for sure I suffer from depression. I’m also very excitable.
Homeopath: From these issues what troubles you the most?
Patient: What bothers me the most? My leg on the left side is very painful, like cement. Getting up in the morning I usually have a huge cramp which is very painful.
Homeopath: Since when?
Patient: Since 6 or 8 months
Homeopath: What makes it worse?
Patient: Don’t know.
Homeopath: What makes it better?
Patient: Lying down on my back, with no pressure. My calf is like cement. I have a pain on top of the foot, on the back over then ankle. See, here the swelling on top of the ankle?
Physical exam: I ask the patient if I can perform a physical exam by touching his legs. He said yes. I ask him if he feels pain in his leg now. He said, “No, not now”. I observe that there is indeed minimal swelling on the top of the left ankle, no swelling on the right leg. Palpation confirms the visual. I palpate both left and right extremities, starting from the toes up to the thighs, asking if he felt pain. He did not. His feet felt neither extremely warm, nor extremely cold.
The patient then proceeds to tell me about his troubles with pain in the shoulder while on a motivational seminar cruise. He tells me about the celebrities in the seminar run by a famous self help guru type, how much he learned, and how much he enjoyed it. He talked about being hospitalized with Crohn’s a couple of times.
He tells me that his sexual organ is not as hard as it used to be, and his sex drive has gone down.
We stop so that he can pour another cup of tea.
Homeopath: Tell me more.
The patient then proceeded to tell me about his life:
It was full of love and disappointment.
Flash and opulence.
His young child, his wife, and his mother, all died within months of each other.
His second wife took him to the cleaners. (He is talking about the money cleaners.)
This man knew how to tell a story, and he effortlessly went from one to another.
He told me that he came from a political family and that he was involved with many political figures and could walk into high official offices whenever he wanted. He had lost a lot of money in a business venture from which he never recovered. He lives with a girlfriend now.
Patient: I’m a people person, not shy. I can walk into a room and talk to anybody. There were people in our house all the time…….I used to be a good singer. I don’t sing anymore. I choke up and start crying if I read something, even if it’s very nice I cry. For instance if I read poetry where the words are significant. I can’t watch movies in public anymore, if anything nice happens I cry. It’s embarrassing…..I have lost that mental strength, of being positive, of being 100% right. I was very arrogant. I can drop the arrogance now.
Homeopath: How is your digestion?
Patient: I’m good. No heartburn. No indigestion.
I asked him what he ate on a daily basis. He told me he likes spare ribs, steak, pasta, garlic bread, Indian food, Italian food. (You know, all the right kind of foods to feed his condition.) Does not care for vegetables. He eats out at restaurants frequently with clients.
I asked him again, “How is it possible that you suffer from this colitis condition and yet you don’t ever have heartburn or indigestion?” He said to me, a little sheepishly, “Well, I don’t anymore since I take antacids right away.
Homeopath: Any sensitivities?
Patient: Light and noise affect me very badly. I pass a lot of wind. I get diarrhea if you or anyone else upsets me. I get diarrhea with a lot of milk or cakes. Milkshakes and pizza.
The patient’s narratives presented certain roadblocks that had to be overcome. The basic road block was that there was too much information The other roadblock for me was that the patient wanted Nux-v and, on the surface, it seemed to be the right remedy for him. Yet, if it was the right remedy I couldn’t understand why he was still suffering with the same things and taking the same remedy for so many years. I wanted to make sure to do a thorough and proper job. It was a case that needed extensive evaluation, and research, and with that, time.
Since there was a history of typhoid I made a note for myself that I would look at the remedies that were under the Typhoid miasm, identified and classified by Dr. Rajan Sankaran to see if any fit.
I thought of causa occasionalis (footnote 7a, aphorism 7 *). I view the patient’s eating habits to be the exciting cause, as well as the maintaining cause. Based on the type of food he likes to eat, some of the symptoms this patient is experiencing might be alleviated by a change in diet.
As I needed the time to do some research I started the patient off with Gemmotherapy, Oligotherapy and Tissue Salts. These remedies were to address the skeletal, mental and generalized energy levels, giving me time to come up with a homeopathic remedy and help him feel better right away. I gave Pinus Montana, Manganese Copper, Lithium, and 5 Phos Tissue Salts.
Recommended dietary and lifestyle changes:
I had asked the patient if he had ever had diet counseling and he said no. I asked him if he was amenable to change his diet in order to help himself alleviate the problems he was having with gas and diarrhea. “NO WAY!” He exclaimed, while throwing his arms in the air as he leaned back on his chair. Just like that. I explained that if he does not want to change his diet to help himself that he would suffer like this for the rest of his life, and so on, until his face softened and I could see that he was at least listening to me. I asked him to avoid eating beef, and rich foods and to add vegetables to his diet. He reluctantly agreed to try.