Clinical Cases

A Case of Dermatomyositis and Sycotic Miasm

A Case of Dermatomyositis and Sycotic Miasm 1

Homeopath Molly Caliger treats a case of Dermatomyositis in a woman of 63. Long term treatment with Methylprednisolone and Methotrexate complicated this case. A deep and perceptive analysis of the patient’s history led to success in this seemingly hopeless case.

A 53-year old Russian woman, Olga, came to me in January of 2019 with the diagnosis of dermatomyositis. Her most bothersome symptoms were those of constant muscle aches and fatigue. She described her muscles as being tired. She experienced dyspnea from the slightest exertion. She does not perform any physical exercises as she complains they are too difficult and painful.

Her first symptoms of the disease manifested as redness of the skin of her hands, face and chest. Shortly after, her muscles started aching. Within a short time, it was impossible to get out of bed.

She was diagnosed at age 40 in a rheumatological center for diagnostic and treatment purposes. Shortly before admission to hospital she had become pregnant, during which time her symptoms worsened, which led her to seek a diagnosis. She was then diagnosed with dermatomyositis and she decided to have an abortion at about 10 weeks, following which her symptoms subsided somewhat.

At the time of diagnostic hospitalisation she was found to have gastritis and a pneumothorax. Upon discharge she was said to have fibrosis of a small portion of her lung. In the rheumatological center she was treated with pulse Methylprednisolone and Methotrexate (1 g/d for 3 days each).

Methylprednisolone was then given at 75 mg/day. Methotrexate was reduced to 10 mg. per week. Twice during her 3 week hospital stay she was given immunoglobulin. Her blood tests had shown some of the typical abnormalities present in dermatomyositis: highly elevated levels of creatine kinase, lactate dehydrogenase, and liver enzymes.

When we met, she had been taking Methylprednisolone daily ever since. She took Methotrexate for most of the past ten years, although owing to the fact that it caused headache, she had tried to discontinue it.

In addition to the symptoms of dermatomyositis, she suffers from absence of feeling in her pelvic region, which causes her to not sense the need to urinate. This problem developed after she was in a car accident in 2011 and had serious spinal trauma. Because she lacks feeling, she doesn’t always urinate as often as she should (her habit is to simply go to the toilet periodically and urinate), and, she reasons, due to this she is often found to have “cystitis” when she goes to the doctor (i.e. by urinalysis).

Olga’s family history shows a mother who is healthy at age 80; a father who had varicose veins, an abdominal aortic aneurism, a heart attack; he started getting serious bodily pains and then hanged himself at age 79. He had been having uncontrollable diarrhea. Her grandfathers died in the Finnish war. Grandma died of a stroke. Olga herself is a twin. Her brother is healthy.

Her childhood illnesses include chicken pox, measles, frequent tonsillitis until age 10. She had a venereal infection at age 19, the name of which she could not recall, with symptoms of burning of the urethra. She was treated with antibiotic injections. She has a uterine fibroid with no symptoms. After the car accident she had a hysterectomy because she was having very heavy periods (she was 44).

Her story

Olga is married for the second time and has a 30 year old son from her first marriage. Her husband has a son and a grandchild. When she was diagnosed she had just started living with her current husband. She weeps with a shaky voice telling how she took her current husband away from his wife, and feels anxiety of conscience regarding that. She denies ever having been depressed— only anxious.

Well-defined symptoms, whether in a patient or in a remedy, often hide their opposite. We know this is true because any symptom represents a compensation on the part of the vital force.

Compensation is expressed metaphorically as the pendulum swinging in the other direction until it reaches its nadir, or maximum swing, which is always proportionate to the original condition that gave rise to the compensation in the first place, or, as the law states: for every action there is an equal and opposite reaction. Searching for pairs of opposite symptoms in the patient is very helpful in identifying themes and finding the remedy.

Olga’s description of herself and her characteristic reactions exemplify this compensatory law of nature. She describes her character as explosive, but at the same time “calm”. In her youth she was an atheist and had multiple intimate partners, although later she became a devout Orthodox Christian, not only attending church services many days a week but finding employment there. She reports not having a sex life at all now and claims to be happy without it.

She got pregnant at a young age and got married but was not happy, and the marriage soon ended. When she met her future second husband she was still atheist. Having participated in the breakup of his marriage and then living with the reality of her second marriage in which she was less than satisfied, she became very religious.

Her religiousness looks like a compensation for feelings of guilt about what she now sees as her former licentious way of life. When asked what is the most important thing in her life, she says she wishes her family believed in God. Her husband is “not much of a believer in God”, and at first he criticized her for her beliefs. Her husband drinks alcohol sometimes excessively— a source of anxiety and disappointment for Olga, especially in light of her religious values. They live in a communal apartment, one of the remnants of Soviet-era life.[1]  Her son lives in one room of the apartment and they in another.

Olga claims to not having any fears (she says “Without God, of course, there are a lot of fears”). She does not like conflict and does not argue. She claims to not be easily offended and says she “never got offended in her life”. She rarely weeps and says, “When you live with God, you don’t weep any more,” although she admits to having wept “out of self pity” when her husband drinks too much.

Olga works in a charity residence for old women founded by her church. The women who work there receive the title of “Sister of Charity” after they have gained ample experience and received the blessing of the head priest. Before the Communist Revolution there were many Sisters of Charity and many charity residences. Under Soviet rule this philanthropic institution disappeared together with churches. Since the 1990s they have once again started appearing.

Generals

She likes shellfish and fish.

Adores sweets in any amount! (A year ago, she decided to eat them less.)

Loves fruits, all.

Vegetables (tries to eat cabbage for her stool)

Likes tea.

Doesn’t drink coffee (averse).

Drinks little water.

She perspires moderately.

Has heat flushes but not severe.

Neither extra hot nor extra cold. Does not like stuffy rooms.

Lately she gets headaches in temples, aggravated by cloudy weather.

Discussion

It is important to explain the cultural and historical context in order to better understand the person and the case. Olga’s story is characteristic of many people who grew up in the Soviet Union and lived through its collapse and restructuring.

She was in her 20’s when the coup occurred that led to the breakup of the USSR and she lived through the turbulent, troubled 90’s as a young woman. For most of Russia’s youth, that decade represented an identity crisis: university graduates found themselves without any chance of finding employment as the “intellectual” specialities disappeared.

Science, industry, engineering, the arts — all came to a virtual standstill as the country was occupied with the transference from a communist to a capitalist economy. Organised crime and corruption blossomed in an atmosphere of chaos and greed, during which the majority of citizens were underpaid, hungry and hopeless, while a tiny minority grabbed the country’s natural resources and formed a class of oligarchs, some of which went on to gain political control. For the average young adult, Russia in the 1990’s held no prospects for personal development. Many people abandoned their careers and took up simple sales jobs.

The Orthodox Church began making its renaissance in the early 90’s. The spiritual soil was ripe for people — the great majority of whom had grown up atheists as had been mandated by the State — to turn to God in their hopelessness. Russia, and Russians, were enduring an identity crisis. It involved, all too often, a painful rejection of much with which people had identified themselves, to be replaced with new, unfamiliar values and beliefs (beliefs which had heretofore been taught as unethical). Olga is a characteristic example of this historical and cultural phenomenon.

The context of Russia in the 1990s and into the new millennium can be characterized first and foremost by the word survival. In this regard it can be interpreted as being a wholly psoric period in Russian history: people were concerned with finding work, keeping a job, supporting themselves, exploring independence as they began to break away from a position of dependence on the government to dependence on one’s own resources. People sought predictability, reliability, stability.

Dermatomyositis

Dermatomyositis (DM) is a systemic inflammatory myopathy that develops primarily during childhood between the ages of 5-15 and in adulthood between 40–60 years of age, involving the heart, gastrointestinal tract, lungs, and skin. DM is a vasculopathy, characterized by the deposition of immune complexes within blood vessels. It is also characterized by symmetric proximal muscle weakness and elevated serum skeletal muscle enzyme levels.

Other phenomena associated with the disease include not only skin lesions typical for DM but also myopathic changes noted on electromyography (EMG), evidence of muscle degeneration, regeneration abnormalities, necrosis, phagocytosis, and the presence of an interstitial mononuclear infiltrate; all of which may be noted on muscle biopsy. Interstitial lung disease (ILD) is a negative prognostic factor associated with increased morbidity and mortality in patients with DM.[2]

Dermatomyositis’ leading symptom is a skin rash that precedes, accompanies, or follows progressive muscle weakness. The rash looks patchy, with purple or red discolorations, and characteristically develops on the eyelids and on muscles used to extend or straighten joints, including knuckles, elbows, knees, and toes.

Red rashes may also occur on the face, neck, shoulders, upper chest, back, and other locations, and there may be swelling in the affected areas. The rash sometimes occurs without obvious muscle involvement.

Adults with dermatomyositis may experience weight loss, a low-grade fever, inflamed lungs, and be sensitive to light such that the rash or muscle disease gets worse. Children and adults with dermatomyositis may develop calcium deposits, which appear as hard bumps under the skin or in the muscle (called calcinosis).

Calcinosis most often occurs 1-3 years after the disease begins. These deposits are seen more often in children with dermatomyositis than in adults. In some cases of dermatomyositis, distal muscles (muscles located away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses. Dermatomyositis may be associated with collagen-vascular or other autoimmune diseases, such as lupus. DM patients are more likely to have an underlying malignancy.

Understanding the condition from the homeopathic point of view

Analyzing an autoimmune condition is a challenge for the homeopath. In seeking the largest common denominator, we try to determine the miasm first and foremost. The autoimmune classification immediately leads us to think about the cancer miasm.

If we lack evidence in either the patient or the disease for cancer miasm being dominant, we tend to look to the syphilitic miasm, since autoimmunity implies self-destruction. These generalisations however do not always lead us to the correct miasmatic diagnosis.

Dermatomyostitis displays the elements of chronic inflammation, fibrosis and sclerosis. Interstitial lung disease is a group of diseases that affect the tissue and spaces (interstitial) around the air sacs (alveoli) in the lung. When these spaces are obstructed by inflammation, the oxygen-carbon dioxide exchange is impaired.

When inflammation is untreated for too long, it can result in pulmonary fibrosis, in which the lungs are scarred causing serious breathing problems. Except in inclusion body myositis, interstitial lung disease is the most common and serious complication of the inflammatory muscle diseases. Researchers estimate that 30-40% of myositis patients have some form of lung disease.[3]

Approximately one fifth of dermatomyositis hospitalizations in the US were associated with an atherosclerotic cardiovascular diagnosis or procedure. These patients have double the risk of in-hospital death in comparison with controls and with dermatomyositis patients without a cardiovascular diagnosis. Cardiac manifestations in patients with dermatomyositis include congestive heart failure, arrhythmias, myocardial fibrosis, and myocardial infarction.[4]

The sycotic miasm is characterized by chronic inflammation that leads to reduced function, hardening, fibrosis, and sclerosis on the level of the physical body. This tendency can be seen as a general rigidity and lack of elasticity due to the hardening and overgrowth of tissues. On the local level it leads to organ weakness and dysfunction.

In the blood vessels it leads to sclerosis, circulation problems, impaired nutrient exchange. In the patient we see stiffness, a tendency toward obesity, and an overall impression of “heaviness” and slowness. The rigidity of the physical body is reflected in the psyche as fixed ideas, extreme religiousness, and a closed reserve, as compensation for licentiousness, hypersexuality and uncontrollable feelings.

Olga’s feelings of guilt and shame create a foundation of what comes across as a conservative, shy personality, a person now dedicated to serving others. The sycotic miasm seeks approval and praise.

Sycosis sets in after the inflammation stage has not been successful in reaching critical mass and bringing about homeostasis; when fibrosis, hardening of tissue and a tendency toward overgrowth appear.

The sycotic personality strives to acquire— whether material or spiritual desirables— to compensate for a sense of internal emptiness. The symptom of religiousness as manifested through the sycotic expression is usually narrow and strict, placing emphasis on the rules of the Church.

Sycotic faith is more legalistic than mystical. God’s love is interpreted as something one earns through proper behavior and attitude and following the law to the letter. One can never be good enough, however, in the sycotic state. Accepting God’s love (and the love of people) is a challenge because the unspoken conviction is “I am not worthy”.

The lungs are associated with the air element in ancient medicine systems and air is associated with what we call, in the modern age, mental processes. Although we now associate mental processes with intellect function, the ancient Greeks — and the theologians of the modern Eastern Orthodox Church — have a very different understanding of this realm of human existence.

The mental sphere is more closely associated with the concept of “spirit”, or cognition: interpretation of the world. The created world having its source in the divine, it is imbued with God’s grace. Taking in this grace from the external world is the source of our inspiration, that which gives us a feeling of connectedness with all of creation — love — and purpose for life.

Expiration is the act of giving back to creation, expressed through our individual totalities, the grace we have accepted and in-spired. Breathing then becomes a continual process of taking-in and giving-out. The air element, then, reflects our relationship to and difficulties with our ability (or willingness) to receive divine inspiration and return this inspiration to others. In the context of the homeopathic consultation, the mental symptoms of the patient (i.e. the cognitive interpretation of the world) represent this air element.

Dermatomyositis therefore is a strong sycotic condition. In planning Olga’s treatment, I chose to begin with the remedy that covered her totality of symptoms at the present time:

Religious affections

Remorse, repentance

Respiration, difficult, from slightest exertion

Gen. desire for shellfish

Gen, desire for sweets

Gen. inflammation, muscles, myositis

Since she would be continuing to take prednisolone for an undetermined period of time, I anticipated that once her general condition improved on the “surface” remedy, she would be able to wean herself off the prednisolone and then we could address the sycosis. I often use this approach with cases that have been suppressed severely for a long period of time.

The question always is: do we begin with a backhoe, or a shovel? Sometimes it’s necessary to begin with the shovel, even when you know that the backhoe will have its day!

Therefore I prescribed Calcarea carbonicum 30c to be taken 7 days using the “plussing” method, followed by 7 days of no remedy, then to repeat in the same way week after week until our second consultation in 3 months.

“Plussing” meant that she made an initial solution of 3 pellets to 500 ml. Water kept in a bottle in the refrigerator, and after taking one teaspoonful each morning, she was to add another teaspoonful of water to the solution. She was to shake the bottle 20 times before each dose.

I chose a medium potency since the remedy would need to be repeated (with plussing) for a relatively long time, and also because the case had been and continues to be suppressed by allopathic drugs. In addition, I felt that Olga’s basic nature was psoric, that she had come of age in an intensely psoric time period during which many people’s vital force “moved them into” sycosis as a survival response. The very psoric Calcarea carbonicum, I reasoned, would give her foundational support of body and soul as she weaned herself off the medication.

Second visit

Olga came to see me three months later. She reported that when she took the remedy the first week, she felt a rush of energy. The second week she felt not quite as much energy. By the third week her body pain became less.

She had been to see her rheumatologist recently and while there was examined and told she again has cystitis. She has no symptoms (normally she could tell by the odor of her urine but this time there was no odor). I told her not to take anything. She is gradually lowering her dose of Prednisolone and now takes 7.5 mg. We agreed she would stay at that dosage level for now. She had headaches in her temples very bad, twice, since starting the remedy. She feels the remedy is helping her.

Now she gets dyspnea only if running to catch a bus. I prescribed another four months of the remedy to be taken in the same fashion. My reasoning behind this was based in the observation that it’s never worth it to hurry a patient through weaning off a hormonal drug he or she has been taking for many years. I have also observed that it takes many years of practice to begin to “feel” the pace of healing, which is always unique to the individual and should never be forced.

Third visit       

Another 4 months went by. Olga reported having had an acute illness in May for which she took Paracetamol. She last saw me in March and now it is October. She did not have a headache the entire late spring and summer but recently they have come back. Since late August they have been once a month, during the first 10 days of the month and only at night.

She has not had cystitis the whole time, although the bad odor returned together with her headaches in September.  Her dyspnea has much improved and she hardly notices it any more. Her body pain is much less. Because her symptoms had improved but then the improvement had stopped, I prescribed Calcarea carbonicum 200c one dose.

Fourth visit

Olga came to see me after another 2.5 months. She stopped taking prednisolone at the end of November and her whole body started hurting, and it hurt for 2 weeks. Her pain is worse from physical exertion. She developed a skin eruption on her hands.

Her urinary condition is the same (no feeling) and she has not had cystitis. Her mood is good. She feels pain lying down – shoulder hurts. I asked her again about her general disease history to see whether she had recalled anything.  She said she had Chlamydia and was treated with antibiotics 15 years ago, and she still was found to have it after 10 years.  She remembered her infection from age 19 as having been gonorrhea.

I prescribed Medorrhinum 200, in water, one teaspoonful, once a week for four weeks.

Fifth visit

Olga came to see me after another 2 months. After the first dose of Med. she got an aggravation of body aches that lasted one day, which then resolved and she felt better. After the third and fourth doses the length of aggravation was shorter each time.

She reported that although the pain intensity is less than it was when she began treatment, it is still there almost all the time. If she sleeps on side her shoulder joint hurts. If she is sitting, nothing hurts. At home, lying in bed she has no pain. It is painful to MOVE. Her food preferences have not changed. Her mood is normal.

I prescribed Arnica 200c once a week one dose, for four weeks.

Sixth visit

When Olga came to see me five weeks later, she was feeling MUCH BETTER. She is now able to do exercises which cause some pain which is very tolerable. If she doesn’t exercise, she feels normal. She got a new pain under her left ribcage after eating that came and went. She had a headache in her temples once like she used to have (used to always have them once a month), but she waited and did not have another one.

I prescribed continuation of Arnica 200c every 10 days for a month.

Seventh visit

When Olga came to see me the last time, she was feeling even better. She compares her current condition to being similar to what it was when she took Prednisolone:  no pain except for after exercising. Even her knees stopped hurting. She has not had any dyspnea. Her mood is good. She feels that she has been cured.

Conclusion

Olga is a wonderful example of how homeopathy can help people suffering from what are believed to be incurable, autoimmune conditions. Cases of this nature need to be followed up regularly, with regular “tune-ups” to prevent relapse. The patient needs to be well informed about potential triggers, including the avoidance of all suppressive medication (and indeed medication of any kind not prescribed by the homeopath), herbs, procedures (it has been my observation that many homeopathy patients experience antidoting of the remedy after an osteopathic or chiropractic session, for example).

In this particular case I foresee continuing to work with Olga on her miasmatic issues that keep her from living a full and satisfying life in every way. While her spiritual life is quite developed, her emotional and interpersonal life remain quite suppressed.

Moving into menopause will be both a challenge and an opportunity for her to heal these problems and blossom into a middle-aged woman who is able to receive and give love without restriction.

[1] Communal apartments were common in the Soviet Union. They were usually large city apartments which had been confiscated during the bolshevik revolution from the well-to-do and turned into communal dwellings that housed numerous families. The apartments have many rooms, one kitchen, one bathroom, one lavatory, and a long corridor: rather like a dormitory. The kitchen, bathroom and lavatory are generally shared. It was very common for an entire family to live in one room of about 20-24 square meters. After the fall of the Soviet Union and the beginning of privatization, occupants could purchase their rooms.

[2] https://www.journalagent.com/eurasianjpulmonol/pdfs/EJP_18_1_50_54.pdf

[3] https://www.myositis.org/about-myositis/complications/interstitial-lung-disease/

[4] Lundberg IE. The heart in dermatomyositis and polymyositis. Rheumatology (Oxford) 2006;45(Suppl 4):iv18–21.

About the author

Molly Caliger

Molly Caliger

Molly Caliger (BA, Certified Professional Midwife, DHom) became a midwife about 30 years ago, and it was through midwifery practice that she was led into homeopathy. In 1997 she graduated from The School of Homeopathy. Having lived most of the last 25 years in Russia, Molly ran The Russian Birth Project (an internship program for foreign midwives based in Russian maternity hospitals) from 1992-2005. In 2006 she founded Tropos School of Classical Homeopathy and Midwifery in St. Petersburg (Russia). The school offers distance and semi-distance learning courses (courses are taught in Russian), including a full 5-year course in homeopathy and a 3-year course in midwifery.

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