First Impressions and Observations:
Anna is a tall, thin, attractive woman of 29 who is quite open in answering questions. When she comes in from work she is tired. She is affectionate with her baby who is about 17 months and with her husband who is there briefly before the interview.
Her Crohn’s began five years ago in October 1999 when she was visiting Mexico. Two months before she had had a “nasty break up” with her boyfriend in Spain and she was feeling depressed. At the onset of the diarrhea, she lost a lot of weight, was crying for no reason and couldn’t eat much. She would feel full after a few bites. She was diagnosed with depression and given some medication which helped. During this period she also met her husband.
A year later in Canada she was still suffering episodes of diarrhea. She was checked out by a tropical disease specialist who ruled out parasites. A colonoscopy in February of 2001 showed that she had left-sided ulceration and she was diagnosed with Crohn’s. She had one serious flare up in October of 2001, for which she took prednisone until January 2002. She now takes an anti-inflammatory Salafalle, every day. She was experiencing symptoms before the flare up and was also feeling stressed because her in-laws were visiting and she was moving.
During the flare up she experienced vomiting, diarrhea and bleeding. She was so exhausted she spent most of her time in bed. The more she worried, the sicker she felt. To feel better she went on the internet and found a chat group through a website devoted to Crohn’s. When she found people were sicker than she was, she felt better. Every day she feels some abdominal discomfort in the form of mild cramps. About every 10 days she has one episode of diarrhea, but can’t predict when in the day this will happen. The diarrhea is extremely loose, mustard yellow and oily. The cramps feel as though her intestines are squeezing together really hard. She feels extremely weak after the diarrhea. When she is about to have diarrhea she has a sudden urgent desire to go. Hot or cold applications do not help the cramping much, but rubbing her abdomen does. Sitting down also helps. The cramping is relieved after the diarrhea. Occasionally she is constipated, some times for 2-3 days and recently up to a week.
Spicy food will bring on the diarrhea. Fried food, leeks, eggplant and garbanzo beans also aggravate her. She is not fond of milk, but likes cold fruit juice. She says she has to have her food and drinks cold. She likes salads, seafood, and sweets. However, she wants water at room temperature. She can’t stand the taste of anything bitter. Tonic water makes her ill and carbonation bothers her stomach. She is not very thirsty and has to remind herself to drink. She often experiences burning in her stomach and heartburn after eating.
She has regained the weight she lost when she was first ill, but she loses weight quickly when under stress.
Her first month of pregnancy was normal, but after that until the sixth month she was nauseous 24 hours. The thought of food made her ill, although she also craved salt and sour things. Odors really bothered her, particularly perfume. The odour of perfume still bothers her. She had a very quick labour and delivery, 5 hours total.
Anna gets one or two headaches a month. Her eyes are bothered by bright light. She is also very sensitive to sound. She can’t go to sleep if there is any sound in the apartment. She feels as though she constantly has echoes in her ears. Her own voice sounds loud to her and she can hear her own breath.
She has a tendency to asthma as she is allergic to cats. She feels a tightness in the throat and in the upper chest. It is always worse at night. Occasionally she will take Ventolin for it. She likes fresh air and likes the windows open at night, even in winter.
She says she is somewhat chilly since the baby was born. Changes in weather bother her.
Anna describes herself as a “people person” She likes being with people, although she is also a private person who keeps some things to herself. Her biggest fear is that something will happen to the baby. She has a fear of falling. She says she dreams a lot and can remember her dreams. Anna always feels better in the morning after sleep.
Anna revealed the following symptoms:
-physical sensitivity-to light, sound, smell
-Recurrent diarrhea, yellow in colour
-sudden urgency with diarrhea
-great exhaustion after diarrhea
-cramping relieved by diarrhea
-better for sitting
-better for rubbing
-aggravation from spicy food
-desire for cold food
-lack of thirst
-burning in stomach after eating
-echoing in ears
-desire for company
-ailments from grief
-left sided aggravation
-desire for fresh air
-aggravation from change of weather
-feels better in morning
Abdominal Discomfort and Diarrhea
The cramping, colour, frequency, and exhaustion accompanying her diarrhea are all important.
Food Preferences, Aversions, and Sensitivities
Anna’s preference for cold food and drink, her dislike of milk and her sensitivity to spicy food in particular are important in considering her digestive difficulties. Burning in her stomach after eating and heartburn are also important.
Her asthma is not extremely serious, but requires occasional medication. It is always worse at night and affects her throat and upper chest.
Echoing in Ears
This is a constant problem. Her voice sounds too loud to her and she is aware of her own breathing.
Ailments from Grief
Anna’s Crohn’s came on after an emotional upheaval and during a time she was depressed.
Themes and Evaluation
Centre of Gravity
The centre of gravity of the illness is emotional. Even though the original upset is in the past and Anna has moved on with her life, her body remembers her upset. She has been given a diagnosis of Crohn’s and certainly her symptoms support it. It seems quite well controlled as she does not experience diarrhea every day. Crohn’s does not run in her family and she was older at onset than most people.
Anna shows great sensitivity to physical stimuli, particularly sound, light, and odors. She also is emotionally sensitive as she has become ill as a result of depression.
Both her sciatica and the ulceration in her bowel are left-sided.
Desire for Company
Anna describes herself as a “people person”. When she was very ill, she immediately sought out a group of people with a similar illness.
Hierarchy of Symptoms/Themes
-ailments from grief
-desire for company
-exhaustion from diarrhea
-desire for cold food
-sensitivity to spicy food
-echoing in ears
-desire for fresh air
-sensitivity to physical stimuli
-better for rubbing
-better for sitting
-reaction to changes in weather
Themes, Symptoms, Rubrics
Keynotes from the Case with Corresponding Remedies
Totality of Remedies
|Nux vomica||Causticum||Phosphorus Ac.||Natrum carb.|
Essence –Remedies That Reflect Themes and Symptoms
Sensitivity- Phosphorus Nux vomica Lycopodium Causticum Lachesis Ph. Ac.
Abdominal Inflammation –Phosphorus Nux.-v. Zinc Lycopodium
Ear Discomfort – Phosphorus Lycopodium Causticum Acid nitricum
Miasmatic Analysis: We see psora here with the diarrhea, but also the syphilitic miasm with the bowel ulceration.
Analysis of Remedies
- Emotional Distress
Anna said that her ailment came on a couple of months after she had a nasty break up. She also said that when she had her flare up she immediately went to the internet to find fellow sufferers.
Phosphorus addresses this symptom most closely.
- Abdominal Pain
Anna was diagnosed with Crohn’s disease after experiencing cramping and diarrhea. She has some ulceration in her colon. About every 10 days she has an episode of diarrhea that is yellow and leaves her feeling weak. She feels better when she sits down and the cramps are better when she rubs her abdomen. She also experiences burning in her stomach when she eats.
PHOS affects “MUCOUS MEMBRANES (STOMACH; BOWELS)”. It has stools “yellow, watery”. It has “pains in stomach always commence with eating and last as long as he continues to eat. Oppression and burning in stomach”. It has “burning in gullet< eating”. It is also better for rubbing and for sitting.6
ZINC has “Stool; involuntary, thin, in morning on waking”; “Burning in stomach, heartburn after sweet things”, “pain in abdomen after a light meal”. It is worse for “EXHAUSTION; mental or physical” and better for “rubbing”8
Again Phosphorus most closely fits the patient’s abdominal symptoms.
- Ear Discomfort
Anna complained of constant echoing in her ears. She said her own voice sounded too loud to her and that she could hear her breathing.
NUX has “hyperaesthesia of auditory nerves; loud sounds are painful and anger him”
Phosphorus exactly matches the patient’s description.
- Desire for Cold Food
Anna said she has to eat cold food and have cold drinks, although she prefers water at room temperature. She is aggravated by spicy food, fried food, garbanzo beans and eggplant. She prefers salads, fish and seafood and she loves sweets.
NUX. is > hot drinks. It loves “fats” and tolerates them well. It is listed as a 2 in Synthesis for cold food ameliorates.
Phosphorus most closely addresses the patient’s food desires.
Remedy Choice: Phosphorus
I looked at the treatment of Crohn’s disease in Dr. R.A.F. Jack’s book , Homeopathy in General Practice. In some cases he will use a bowel nosode where the symptoms agree. In the case of a Phosphorus constitution, the nosode Gaertner (Bach) may be used to good effect. I also looked at the symptom picture of this nosode in Allen’s Keynotes. In other cases of serious daily diarrhea or where the constitution is not completely clear, he will treat the diarrhea acutely. Podophyllum seems to be used quite frequently. In this case, Anna’s diarrhea, while bothersome, is not really severe. Her constitution just needs a little tweaking which Phosphorus should do.
I am also going to suggest strongly that she continue to use the acidophilus and the fish oils prescribed to her by her naturopath.
1. The strength of the vital force: Strong – Anna is basically a healthy young woman. She is busy and stressed as she works full time and has a baby.
2. Centre of Illness: Emotional
3.Sensitivity of the Person: Very high
4. Family Miasmatic History: psora/ syphilitic –Anna shows signs of both. Her extended family is mostly psoric with eczema, heart disease and high cholesterol.
5.Medicines the patient is currently taking: Salafalle (?) an anti-inflammatory
6.Confidence in prescription: Strong
7. Potency: 200c
8.Response of Symptoms: Anna’s cramping, diarrhea and ear symptoms should alleviate.
9.Prognosis: Anna will begin to feel quite well.
10.Follow Up: 4 weeks
Follow Up #1
November 22, 2004
Anna took a dose of Phosphorus 200c three weeks ago. She is now experiencing less cramping than she had and she has not had an episode of diarrhea. Going to the bathroom is not so urgent as it was. However, she feels she is a little more constipated than she was and she can constipate herself by not going when she needs to. Altogether she rated the improvement a 6/10 as she had experienced a little more cramping the day before I saw her.
The echoing in her ears disappeared for a short while. Now it is less frequent than before but it seems to be coming back. Her left ear does not feel normal. It is sensitive and “echoey” particularly in the morning.
Anna’s basic energy is still low as her baby continues to wake her up several times a night.
Her face is breaking out more. The break out does not seem associated with her period. Maria thinks it may be due to stress, as she and her family have just moved into a new condominium building that is unfinished.
The remedy addressed Anna’s problems; however, she has had two major stresses during this period: an ongoing lack of sleep and a move to a new home. She may not become completely well until her baby begins to sleep through the night.
Anna’s prospects for recovery are excellent, once her life settles down. She may need a higher potency of the remedy to effect a cure.
Prescription: Re-dose with Phosphorus 200c
Follow Up #2
December 28, 2004
Anna took another dose of Phosphorus 200c on November 24 just before she left for a vacation in Mexico. In general, she has experienced much improvement in her health. The echoing in her ears has completely disappeared. The daily cramping has gone.
She did experience one bout of diarrhea in Mexico, but felt that she had been drinking too much coffee to which she is sensitive.
However, in the last two weeks she has been feeling really irritable and sensitive emotionally. She lacks patience, is frustrated and feels like crying. She is really out of sorts. She apologizes to her husband for her behaviour which is unlike her. She has been stressed by finances and by Christmas.
She has been experiencing spotting for the last week and has felt a heaviness in her stomach. She also had a severe attack of diarrhea and cramping in the morning of the day I saw her. She felt very weak and faint afterward. She also feels bloated. She thinks she is either premenstrual or possibly pregnant as she had a similar feeling of heaviness when she was first pregnant. Her period is due next week.
Her allergies and asthma have gotten worse as she is living in a new, unfinished condo building which is very dusty.
Anna’s current symptoms are consistent with a Phosphorus picture. She should have another dose of Phosphorus 200c.
Follow Up: 4 weeks
Follow Up #3
February 21, 2005
Although Anna’s cramps had disappeared when I saw her in late December, she had experienced another attack the morning I saw her ( December 28). She suspected that she was pregnant. She received another dose of Phosphorus 200c in early January. Five days later she phoned me and said she had noticed a real shift and that she was starting to feel nauseous all the time. She felt hungry all the time as well and was better for eating and better for sugar. She was worse when she didn’t eat, was very thirsty and was reacting to smells. She didn’t think about her nausea so much when she was distracted by work. I consulted with my supervisor and gave her Sepia 200c. She called me the day afterward to say she was feeling worse. I told her to give it a couple of days. She did not call back, so I assumed she was O.K.
When I called her to set up a follow up she was in a bad state. She had had to take a leave from work because she was so nauseous she couldn’t think about anything. At the interview, she told me mental exertion, in fact, makes the nausea worse. She is worse at night, but also in the mornings. Often she vomits before she has anything to eat. There is always a little bit of blood (pinkish colour) with the vomitus. She doesn’t salivate except when she is throwing up. She has a ravenous hunger which makes her sick, but she wants to eat all the time. She only wants to eat cool things like fruit, lettuce, salads. She is also very thirsty for ice water.
She is worse for smells, particularly from the kitchen. She is also worse for motion. Getting up and moving will make her nauseous. She is better resting as she can keep food down. She feels better rubbing her stomach, although she can’t stand the pressure of a waist band. Deep breathing through her mouth also helps to control the nausea. Getting up will make her dizzy, as will standing up longer than she should. She may see black or dots and feel unstable. The vertigo is like a band around her head over her eyes and moving back.
She told me that since she’s been sick, none of her friends have come by and she really misses them.
It is clear that Anna is in a Phosphorus state; however Phosphorus 200c did not help her nausea initially. I would like to give her Phosphorus in a different potency.
Prescription: Phosphorus LM 1, 5 drops, twice a day.
Monitor at weekly intervals over the telephone and adjust as needed.
Follow Up: 4 weeks
Follow Up #4
Anna began taking Phosphorus LM1, 5 drops twice a day on March 1. She had been extremely nauseous with her pregnancy. I called her every 4 or 5 days to see how she was doing. At the first call her nausea and vomiting were less. At the second call the nausea and vomiting were gone, but her energy was still low. She was worried about a visit to her gastroenterologist (March 11) because she had to fast for 8 hours before the appointment. She was sick for 2 days after that, but by March 14 she felt her energy returning. She also complained of left-sided sciatica. I thought perhaps she was getting too much remedy and suggested she cut back the number of drops she was taking to 6 in a split dose. Her nausea and vomiting returned. She herself moved back up to 8 drops and then back to 10 split dose. By March 23 her energy was returning, although she still had some slight nausea. The sciatica also went away.
The following week the nausea and vomiting were completely gone, but she noticed the return of an old symptom: her own voice sounding very loudly in her head. This was happening 2-3 times a day on the worst days. She tried cutting the remedy back to 8 drops split dose on her own. The loudness in her head cleared up, but the nausea and vomiting returned. She put herself back on 10 drops split dose.
When I saw her on April 4, the nausea and vomiting were completely gone and she was feeling like she wanted to go back to work. She said that she still had a lot of stomach acidity and craved fruit, but was avoiding it because it aggravated her. She said she could live with the loudness in her head if it meant she wasn’t nauseous.
I’m thinking that she should try taking her remedy (10 drops LM1) once a day. She seems to need 10 drops to control the nausea; however, reducing the frequency may control the ear problem. I’d like her to try this and to call me in a couple of days to report how she is feeling.
April 08/05 – Everything is O.K. Her ears have cleared up. Her stomach is better taking 10 drops in the morning. She asks if she can take 3-4 drops at night to tide her over until the next day. I agree she can try this. I tell her to cut back if she notices old symptoms returning.
I saw Anna once more in October 2005. Her Crohn’s symptoms had returned.
She had stopped taking the LM1 about a month before her baby was born in September.
I prescribed one dose of Phosphorus 200c. I did not hear from Anna again.
Allen, H.C. Allen’s Keynotes. New Delhi,B. Jain Publishers, 2000 (reprint edition)
Jack, R.A.F. Homeopathy in General Practice. Beaconsfield, Beaconsfield Publishers,2001
Morrison, Roger. Desktop Guide to Keynotes and Confirmatory Symptoms. Grass Valley: Hahnemann Clinic Publishing, 1993
Vermeulen, Frans. Concordant Materia Medica. Haarlem: Emryss Publishing, 2000