A Case of Crotalus cascavella

D.M., a 33 year old woman, first consulted me on August 1993. She was simply dressed in practical clothing, quite obese, intelligent, direct and cheerful.

‘I have renal failure. I have a mental illness, and I was taking Lithium for three and a half years when they noticed that my blood pressure went up. By March my creatinine had gone up to 1.8 (normal to 1.6). When I was on the table for an angio, they had to cancel it when they found out my creatinine had gone up to 2.7. I saw a nephrologist who diagnosed that I have Lithium-induced renal failure, which is unfortunately irreversible, progressive, and extremely rare. I got a second opinion which was exactly the same.’

‘I am depressed, my life is short. This stuff wasn’t supposed to hurt me. I have been mentally ill all my life. I was sexually and physically abused until I was thirteen years old. I seemed fine until January 1988 when they took out my gallbladder, then in April I went into a severe depression, which happened once before when I was twenty five, due to birth control pills. I was suicidal, I just didn’t want to live, I kept thinking of different ways of suicide, shooting myself, driving off a cliff. It is worse when I haven’t slept for a while.

I get violent (3), angry, my mind races (2). I feel pretty good without sleep for a few days then I get depressed and crash into a deep black hole. I was hospitalised to get me to sleep, then some jerk of a nurse woke me up. I promise you, if you ever wake me up, I’ll hit you (2). I punched the refrigerator (2), I throw things (2), I pound nails, I have to do something physical.’

‘Sometimes I cannot eat. Or I cannot get clean enough. I take showers all the time. I hate the noise in my head (3), it gets much worse if people are around (2). I hear a white noise, or conversations I wish I would have. I don’t want more memories to come.

My parents divorced when I was three years old, my mother remarried when I was five. Both of my stepparents are assholes. My stepfather’s father raped me when I was five, and told me not to tell. I remember my stepfather’s abuse, it was brutal, he used objects (she later recalled that it was bunches of broken sticks inserted into the vagina). He once left us in the care of some transient who raped me also. I hate Christmas, I was raped then. I’ve asked myself if I’m nuts. My stepfather hit me in the eye, nobody asked, nobody cared. I learned to play baseball and was good at it. My grandmother swears I would have killed my oldest brother if I had been allowed to. I would fight back to his teasing by strangling him. I was also responsible, like a surrogate mother, for my younger half-siblings.’

Viral pericarditis at the age of twelve. Severe chest pain (2). Pneumonia’s as an infant. ‘I almost died.’ Ear infections and pneumonia at the age of twenty three. My gallbladder gave me chest pain too. There was a sharp constant pain. ‘I get palpitations when I have any kind of pain, worse from being nervous and from stress.

I work as a respiratory therapist in a hospital. I always knew I wanted to do something medical. It’s not too bad except when kids die. My opinion is that we are here to protect children (2).

I’m a mean, horrible person inside, otherwise pretty gentle. I scare myself with what I am capable of. I’m violent, or capable of violence, but I take anger in and don’t project it out, most people don’t have any idea of the feelings inside. I believe I have to do everything for myself (2), if something is not right, it is my fault (2). I don’t trust anyone. I love water, the ocean is calming, any water, the sound of water.’

Warm, worse from hot weather. Sinus trouble especially shooting pain in right ear (3). Foods desires: ice cream (2), meat (2), milk, fruit, cheese (1), spicy (2). Foods aversions: fish (2), salt, eggs (3), tomatoes (3), squash (2). Thirsty for cold water (2). Some gas (2), also some reflux, probably from all the drugs. Sexuality: I tried it once with a boyfriend, but could not do it. Masturbates for sexual release. Blood Pressure: 180/120 previous to medication. Medications: Vasotec and Tenormin for hypertension secondary to renal failure. Tegretol and Doxepin for ‘bipolar disorder’, Restoril for sleep, Iron for anaemia, also due to the renal failure. Laboratory Values in 1993: Creatinine 4.2 (0.6-1.2), Creatinine Clearance 15.7 ml/min (88-128) Hgb. 10.4 (12-16), Hct 31.9 (37-48) with normal indices. Uric acid 12.1 (2.6-6.0)

Impression Mental/emotional illness, bipolar. Post-traumatic stress, complicated by a sleep disorder, in association with iatrogenic renal failure with secondary anaemia and hypertension.

Prognosis: I was naive about her prognosis, underestimating the degree to which she had been and could once again be a danger to herself. At her first visit, her symptoms were well-controlled on medication, she was mild-mannered and pleasant, and we both focused on the degree to which she had suppressed her memories and her anger. The remedy chosen started us on a mutual path of challenge and discovery, as it unleashed her pain and anger.

Note There are two humbling and instructive reasons why I did not find the right remedy initially. First, I didn’t know the remedy at the time. More importantly, I believe all the clues were there, but I did not heed her clear message about the depth of her pathology. Her story confirms for me the instruction that the prescription must be based on the most serious pathology that is clearly seen, even if she appears to be coping well, as if she has recovered from that pathology. In retrospect, I believe the remedy could be seen from the start.

Plan: Based on a history of abuse, the tendency to internalise anger, and her serious sense of self-reliance, Staphysagria 1MK once was given.

Follow-up September 1993: ‘I’m not sleeping (2), I have new memories (2), I feel suicidal (2), worthless (3). I was not supposed to get this bad. I want to shoot myself, or I could take pills. I want to cut myself with a knife, drive off a cliff. And my heart is going crazy with palpitations (2). I am pissed (2), life is not worth living like this. I want to beat the sh*t out of the people who hurt me and then got away with it (3). I don’t know what is harder: going through all this the first time or the second time. I want to chop my stepfather up with a knife, no – beat him to death with a bat. Death would be a relief (2), it would be better for me (3), for my family, my friends. I’m not sleeping at all (3), people at work are tired of me. Voices in my head telling me I am bad, telling me to hurt myself. I get angry at my cat for sleeping. I want to throttle her. I get restless, especially my feet in bed. I do not know if I want to die so much as I just do not want to live (2). I think I am insane. I have smashed some of my furniture to bits.’

Observation Her manner had changed to sullen and sarcastic, with her arms folded. On this occasion and always, she intermittently cracked a genuinely funny joke or laughed at someone else’s humour.

Impression: Suicidal depression with strong anger component. Plan: Aurum 10MK, C12 daily at bedtime.

Over the next few months her despair shifted to anger, which seemed an improvement, but did not hold. Her hypertension improved so much that we had to discontinue one of her anti-hypertensives. She began to re-experience some of the physical symptoms she had experienced before, beginning with her heart pain and including her pneumonia and cholecystitis. She was hospitalised overnight for cardiac evaluation which was negative. She continued to show ill effects of any suppression. (She was given antibiotics for her pneumonia which sent her into a deep despair.) She also had temporary periods where she could sleep without medication, and a few good dreams.

During these months she continued to give significant details which indicated the correct remedy, had I been aware of the remedy. The clues are in the way in which she responds to abuse. The history of abuse does not indicate a particular remedy or even a particular rubric, but is only the stage on which our patient sings her or his own particular song. This patient had started to sing her song, but I was not familiar with the tune. Her response to abuse was one of incredibly violent impulses, directed against herself and those who threatened her. I looked in the rubric: MIND; Violent, vehement; deeds of, rage leading to. She revealed that she had fears of snakes (2), fire (2), rodents (2), car wrecks.

Plan: Hepar sulphuricum 1MK, which seemed to help her physical and sleep symptoms, but her despair and hallucinations continued to relapse.

In 1994 she deteriorated with completely inability to sleep and active suicidal ideation. At this point, I questioned my wisdom in taking on such a difficult case or in practising medicine at all! My patience was challenged with once or twice daily telephone calls, two hospitalisations with frequent rounding, frequent calls to my own consultants, and a deep fear for the safety of my patient. Thankfully, she had tremendous courage to work through the challenges of acute emotional crises.

I gave her Lachesis, Cenchris contortrix (particular for snakes who attack with open mouths, fangs bared), and Lyssin with no significant help. She was hospitalised briefly in a psychiatric unit, and discharged on multiple medications.

At this point I was talking frequently with her psychiatrists, who assured me that her pathology was severe and would require medication on a life-long basis. I adjusted the allopathic medications over the next few months and only treated with remedies if I saw a clear picture. Every respite was temporary and her black moods returned with voices in her head, visions of snakes and horrible dreams. She developed a severe pneumonitis which responded well to Antimonium tartaricum, followed by a worsening of her mental symptoms, reminding me that homeopathic medications can also be suppressive.

One year later she gave me the final clue, which was that she was seeing insects as well as snakes during her aggravations, crawling on her and on the walls . There is one remedy that covers hallucinations of snakes and insects: Crot. cascavella.

In ‘Substance of Homeopathy’, Sankaran describes a cured case in which his patient reported that she ‘would get into a violent rage at the least provocation’, causing actual destruction and injury to those around her. The rattlesnake can sit quietly or be mild-mannered, perhaps only warning of imminent danger. But once activated, they strike to kill. Important rubrics in her case:

*Mind; Dreams; spiders *Mind; Dreams; spiders; enormous hairy, which tried to climb on him *Mind; Dreams; vermin; spiders *Mind; Anxiety; chest, in; Heart, region of *Mind; Death; thoughts of; alone, when *Mind; Dreams; fights *Mind; Dreams; frightful *Mind; Laughing; alternating with; groaning *Mind; Magnetic state, feeling of personal power increased; hears voices and follows them *Mind; Mental symptoms alternating with; physical; menses *Mind; Starting, startled; sleep; during *Mind; Suicidal disposition; throwing himself from; windows

Additionally, Crot. cascavella should be added to the rubric: Mind; Violent; deeds of, rage leading to.

Plan: Crot. cascavella C200 once, C12 daily She is still on numerous medications: as listed above, and because of all the absences from work, she was prevailed upon to apply for disability which was readily granted on an indefinite basis.

Follow-up August 1995 : ‘Right after the remedy the snakes got much worse, I was seeing them in most of my dreams and in the daytime. Also had a lot of flashbacks of abuse. The psychiatrist had me increase one of my drugs for a while but that is back down again.’

‘I feel kind of fearful as if something will happen to me (2), I am afraid I am going to be attacked (3), that someone will hurt me. Maybe I should have a gun. I am always thinking someone is in my house (2). I don’t remember anything nice about my childhood, do not recall fairy tales or being read to. I remember praying as a child that I wished I would die.’

Over the next few months she had ups and downs, decided to terminate therapy, had urges to run away and times of temper and times of fear. She had numerous acute illnesses, primarily sinus infections, which did not respond to changes in the Crot. cascavella, and for which she received Nux vomica, Kali bichromicum and Sulphur, with mixed results. Throughout, however, she was free of hallucinations and suicidal impulses.

January 1996 she once again, after a suppression of an acute illness, had a full blown deterioration with auditory hallucinations, visions of snakes, other noises in her head, and her particular pattern of feeling hurt, or sad and responding with sudden anger and the urge to kill. Her psychiatrist adjusted her medications and I repeated the Crot. cascavella C200, and she responded well.

By May 1996 she returned to work on a limited basis. She developed intermittent and painless rectal bleeding and blood in her urine. She reported that she had lost her fear of snakes, found herself able to watch them without problem.

Impression Clearly the bleeding in this case is a curative discharge, but because of the seriousness of her past pathology both physical and mental, I gave her Crot. cascavella 1MK.

Her bleeding resolved. Her blood pressure continued to fall on medication, and after several episodes of light-headedness we decreased her Vasotec. In December she developed severe nausea and elevated liver enzymes, presumably related to the Tegretol, which we discontinued.

By December 1996, since coming off of the Tegretol, sleep disorder returned. She had no effect from repeating or increasing Crot. cascavella, was this a good sign or bad?

‘Last night I was really pissed off when I couldn’t sleep. This isn’t right. My mind starts to go, and I just try to get it to shut up. I read like crazy to try to wear my mind out, but we’re just not tired. I don’t have time to sleep, my brother is visiting. I think of what I want to do with the house, all sorts of projects. I have been working really hard and enjoying it, I have been in a good mood (3), I am just pissed that I cannot sleep. And cold (3), I do not like to be cold. In every way I want to go fast, to get everything done (2). I am even eating fast. I am always hungry.’

Impression Sleepless, hurried, chilled, irritable. And despite the return of her sleeplessness, this is not at all the hallucinatory or self-destructive state which previously accompanied her insomnia. She reveals that she has really changed her state.

Plan: Nux Vomica 1MK, with C12 daily. Resume Tegretol if no better within 3 days.

January 1997: (Excited!) ‘I am off the Tegretol, and sleeping! even through ten straight days of working, it was really a killer at work, but I did it. We had one dead baby at a Caesarean-section, but we fixed it!’ Medications: Paxil 20 mg and Vasotec 2.5 mg.

March 1997: hypotension due to Vasotec. Feeling great. We agreed that she could stop her last medication (Paxil) on the Spring Equinox. She brought flowers to the office as she had always promised she would when she was off all medications!

Comment There are many instructive points within this case, not the least of which is the dramatic pathology covered by Crot. cascavella. Her state clearly changed and a complete layer of psychotic depression was gently and rapidly removed with the remedy. With the healing of a deep mental and emotional illness, her vital force clearly demonstrates what we expect: serious pathology on the physical level. Her particular complaints of pneumonia, chest pain and indigestion beautifully mirror the complaints which were suppressed in her history. The final expression of gastro-intestinal bleeding signalled the end and the resolution of a cycle for her. Additionally, although the patient never drank coffee, she was clearly treated homeopathically amidst a whirlwind of allopathic symptom control. The prescription medications at times were suppressive, but never suppressed for long. At other times, they palliated the most painful and life-threatening of her symptoms, e.g., protracted sleeplessness, while we searched for the correct remedy. Once given the correct remedy, her allopathic drugs did not seem to interfere with the action of the remedy. Her body merely became strong enough to develop symptoms so that the drugs had to be discontinued. They were then shed as easily as a snake sheds its skin!! I also find it interesting that once the deeper pathology was resolved with the Crot. cascavella, Nux vomica has been effective where it was not helpful before.

May 1997, Annual examination: Blood pressure 122/78 No complaints, menses regular. No medications!! Exam normal, except for obesity. Laboratory values: Creatinine 2.2 (0.6-1.2) Uric Acid 5.6 (normal) Hgb = 12.9Hct = 38.0

She has extensively improved her house, landscaped her yard, and had a fence installed. She has increased her work to full-time, and remains in good spirits. Her nephrologist considers her renal function ‘a miracle’.

On her original history form she wrote in her correct birth date, but wrote 1993 for the year: In retrospect this was an optimistic mistake which slowly proved to be true. The courage of this patient and the strength and clarity of her vital force make this case one of my most valuable teaching experiences about life in general, as well as an eloquent confirmation of the beauty and power of the homeopathic process.

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Deborah Gordon, M.D., is a Family Physician who studied at the Hahnemann College of Homeopathy where she is now an instructor.

Deborah Gordon, 1605 Siskiyou Blvd Ashland OR 97520 USA