A Case of Vertigo

February 22, 2007

A man of middle age, no unusual or striking physical presentation.  “I have trouble with vertigo.  It started 6-7-years ago when a cold wind hit the back of my head.  This past year has become more troublesome. I get imbalanced when I lay back and close my eyes. It is so much worse tipping my head back. The room moves, not me, and I get nauseated. My whole head feels cobwebby. I have no strength.  It is exhausting to manage it. I feel like I have a lead weight on the right side of my head. An episode can last 2-4 weeks, suddenly clearing up.  I work installing overhead construction parts, on high ladders, so this vertigo can cause dangerous situations for me.”

“I have had off and on bladder infections as an adult, and a constant desire to pee, since 6^th grade; constant post nasal drip that is better outdoors.  I can smell a deer pissing on the hill—you have to use the wind.”

“I have difficulty concentrating, and I forget names.  I have dreams of falling. I fear heights.  I love being alone.  When I am hunting I connect with the outdoors. If I miss a target, it is just the human factor. I target practice obsessively (20-30 hours per weekend) to eliminate the human factor. I have a coach for this.  I want my reactions to be automatic.  The human factor is humiliating.”

I was in a car accident as a young child. It doesn’t haunt me. I have lots of close calls at work—I could die from a fall.  I always make it a point to learn lessons from failure.  I don’t get mad easy. I get hostile of I’m pushed too far. I can take it (stress on the job) but other guys can’t. I don’t really socialize with anyone but family occasionally.  I have never had a long-term relationship with anyone—never dated, never wanted to, really.  I live with my parents, when I have a job near them.

Initial Assessment

This man has come to obtain relief primarily from vertigo. Constant urge to urinate and post nasal drip are his secondary concerns.  Several mental/emotional patterns are described in opposites: Inability to remember names/concentration problems and learning a lesson from everything and fearing heights and working on heights. He identifies being obsessive and avoiding humiliation as well as being slow to anger but able to be pushed and then becoming hostile.  He mentions the lack of extra-family relationships very matter- of- factly, but it is clear to me that much of the case revolves around relationships being either not intimate or hostile.

I am concerned by the interaction between the precision shooting and the vertigo. There is a sense of wanting a rigidity/predictability and the body not being balanced or controllable which puts him in potential physical danger on his job and seems to express itself also in a lack of intimate relationships.

Repertorization using Van Zordvoort, R  Complete Repertory 2003

Generalities, Cobweb sensation

Smell- sensitive to odor of- strong odors

Bladder- urination-frequent-small quantities at once, but

Vertigo, nausea with

Vertigo, Motion from head, of- backward

Mind, mortification, humiliation, chagrin agg.

Mind, senses acute

Mind- memory- weakness, loss of

Quarrlesome, alternating with silent depression

The remedies seriously considered based on this analysis were Sulphur, Ignatia and Conium

Sulphur:

A remedy that I considered while listening to the case, as he talked about “learning lessons” I was reminded of Sulphur’s well-known ability to therorize.  However, there weren’t skin concerns: burning, itching or throbbing congestions/swellings. I did not observe any emaciation.  However, it does cover the “worse looking down”, sensitivity to atmospheric changes (wind), loss of memory and sudden urination.  It covers the mental and physical symptoms only partially.

Ignatia:

This is a well-known remedy for ailments from mortification.   However, the general symptomology of rapid changes, (including twitching) is not present in this case. It doesn’t come up strongly in the analysis, but the client’s strong emphasis on humiliation and high standards in shooting in the case prompted me to look at this remedy.

Conium:

This remedy came strongest in the analysis, and the only remedy in the rubric Vertigo, motion from head of, – backward.  In addition, Conium is well known for ailments from lack of sexual relationships.  It affects nerves and muscles, with a sudden lack of strength. The convulsions that Phatak  mentions combined with the fear  progressive debility (It is exhausting to manage this) are represented in this case of this vertigo. Trifles are important (target shooting).  It also covers the urinary, post-nasal drip physical symptoms, and the emotional symptoms of being sad and disappointed in oneself and gradually withdrawing from relationships. This person did not have the glandular induration that conium is so well known for, but the balance of the case made this the strongest remedy for the case at this time.

Potency

I chose to give him Conium 200c, single dose, dry pellets.   I often use this dose when I am confident that there is no fulminating disease at work.  He moves living locations frequently with his work, so a daily dose was less convenient

He took the dose February 24, 2007.

Follow-up March 30, 2007

Patient states:  I am doing VERY well.  My head cleared up by 75%. It used to feel like tunnel vision.  My energy is way up. I am spending more time with my nieces and nephews. Relationships on the job are much better. I am not as crabby. I have less urinary urgency.  There is no change in the post nasal drip.The change was instant.  Then, last Friday (1 month after remedy dose) the vertigo came back by 10%. I didn’t take another dose, just waited till this appointment, and it got better after two days.

Assessment :  Remedy has acted well.  Don’t redose at this time.  Call when you experience symptoms again.

Follow up August 3, 2007

Vertigo is coming and going again. Last week it was NASTY. Slowly I feel myself going down.  My post nasal drip is worse, and I have to chew gum all night to get relief from it.  My shooting skill is ok—I have to quiet my mind more.  Distractable. I want to quit my job.  Leave everyone behind.

Assessment:  Mental/emotional and physical states are the same, so there is no need to change prescriptions.  Remedy needs to be repeated. Conium 200c, dry single dose.

Follow-up February 28, 2008

I am amazed at how fast the remedy acted last August.  Winter is a bad time of year for me. Now, I am fighting  a cold. I am run down. I took the remedy on my own. It sort of helped.  My inner ears are off.  I have had sore throats, coughs, chest colds for three weeks. The whole job site has pneunomia.  I am irritable. Don’t want to see anybody. Heights are bad. The vertigo isn’t as bad as when I came a year ago, but it is back, the same way.

Assessment:

Remedy adjustment is needed. The case is still the same, so it is a potency issue. I chose to go up to a 1M, plussed for three doses, each dose 12 hours apart, to address the acute respiratory illness. I requested that he call to check in with me in 4 days, to assess the status of the respiratory illness—either to change the remedy to an acute prescription or to refer him to a doctor.  He called in, and was 75% better, both in the acute illness, vertigo and irritability.

Follow-up February 6, 2009

Bad time of year again—the vertigo is coming back slightly, but otherwise I am doing well.  Urinary and post-nasal drip symptoms are fine as well.  I am doing well at work and with my extended family.

Assessment:  Mild recurrence of the primary complaint after 1 year. Redose with Conium, 1M, single, dry dose.

Conium has been very helpful to this man over the past 8 years. His primary complaints of vertigo, post nasal drip and urinary urgency have significantly decreased, so that they don’t impede his life at all. Emotionally he is much more friendly and at ease with people. His target practicing has continued with the change that he has made friends at the target range.  His assessment of the remedy is that it ‘has changed my life!  Thank you!”  He continues to come in, about every 3 years, to check in with me.