Introduction
Which is the remedy? This is the question most homeopathic doctors ask themselves during a consultation. I think a better question would be: Which is the most appropriate remedy, potency, frequency and dose for this patient?
This case of laryngeal papillomatosis aims to show the benefits of asking the second question to achieve progress in the patient’s healing. The case also demonstrates the great flexibility of the LM (1) (2) (3) (4) (5) (6) (7) potencies to adapt to changes during the healing process and the use of Polarity Analysis (8) (9) in a chronic case.
This case is a transcription of my notes taken during the nine consultations, from 2015 to 2020, and the emails exchanged with the patient.
The patient (P) is a 22 years old college student of English literature. He is a slim and attractive young man, but I am shocked by his voice, which reminds me of a puppet’s voice.
First consultation 16 June 2015.
P: The main reason for the consultation is my voice, my throat. The hoarseness started in March 2014 for a few weeks. Then it started again in January 2015. It started when I was in college. I had been at a rugby match. There was cold weather. I spoke louder. The GP has referred me to the ENT consultant for a fiberscope. Recently I have been trying to get a job for the summer. When I phone or I hand a CV my voice gets worse.
Which previous illnesses have you had?
P: I had asthma when younger, but I haven’t used an inhaler for 10 years.
I had psoriasis in my right elbow when stressed in secondary school. It looked like red dots in a small circle. It was treated with Fucibet. It came back several times.
Last summer I worked in Malta and I had a skin rash for a month, and it went away. It was in the right side of my groin. It went away with a cream and a powder that I got in a chemist. I wasn’t seen by a doctor.
I have an overly curved spine. Six years ago, I had back muscle problems for a year. I couldn’t do sports. At the sports clinic they said that my back was curved because of rugby. It was more a muscle problem. I had pains in my legs.
Tell me about your body temperature and your perspiration.
P: I am more inclined to wear more layers. I don’t perspire too much.
Which are your food cravings, aversions and which foods do not agree with you?
P: I eat a lot of meat. I prefer savoury. I drink a lot of milk and tea. I used not to eat cheese and eggs. Now I am eating them. I used to think I was allergic.
How do you sleep? Tell me about your dreams.
P: I sleep pretty well. I sleep on my side. When I was small, I had a dream that I was going up a hill and it was too steep. Then I was falling down the hill. The street in real life is flat but in the dream is steep.
What do you worry about? Which are your fears?
P: If I am doing exams, I will be thinking about that. I am going to America, to college, next year, as part of my degree. I am not too anxious. When I was small, I had a fear of having an operation and being knocked out. This doesn’t bother me anymore.
How was your childhood?
P: I thought it was great. I have good memories of the different schools I went to.
What would your friends say about you?
P: They would say that I am quite social. I like to go out, but I am quite reserved at times.
Tell me about you.
P: I am optimistic but very careful. I am poor at taking decisions. My bedroom is messy but when I do something there is a right way to do it.
P replies to the Polarity Analysis questionnaire. Below there is the repertorization:
Graphites appears at the top of the ranking. Hering’s Guiding Symptoms (10) seems to confirm the choice: Voice: impaired; not clear, in singing; cracked, in singing. Hoarseness in evening. Chronic hoarseness. In addition, the patient has a history of suppressed skin conditions. I prescribed Graphites 1 LM, 1 globule in 200 ml bottle, 10 shakes, 1 coffee spoon a day for 3 days.
On 26 June 2005, the mother of the patient, who is also one of my patients, informed me that he has taken the Graphites and a small patch of psoriasis came up on his arm for a few hours and then went away. No other reaction. The mother added that the ENT consultant found 2 growths on the vocal cords and surgery was scheduled for 23 July.
I suggested increasing the Graphites 1 LM to 1 coffee spoon twice a day immediately. Then changing to Graphites 6 LM, 1 coffee spoon twice daily.
On 19 August 2015, the mother informed me that the surgery went well but the consultant could only completely take out the growth on one side. He will have surgery again on the 27 of August. The ENT consultant considered the growths to be papillomas and they will not become malignant, but they could come back. She mentions that she would like that his son takes homeopathy to prevent recurrence.
Second consultation 31 August 2015
P: The last surgery went well. The consultant is very happy with it. I am going to college in America. I have to vaccinate for whooping cough, diphtheria and polio, meningococcal disease, typhoid and hepatitis A. Can I take homeopathy for recovering quicker from the surgery and to avoid side effects from the vaccination?
Rx: Arnica 10 M, stat. One week after Staphysagria 200c. Thuja 1 LM, after all vaccinations.
The mother phones on 16 October 2015: The results of the biopsy are neither dysplasia nor malignancy, squamous papilloma, wart atypia only.
The mother phones again on 9 February 2016: My son has hoarseness again. The ENT consultant said not to worry. He can get surgery again. I am worried he would need surgery twice a year. He is doing well at the university in the USA. He got 98% in his exams. I was happy to see him at Christmas.
Advice from Dr. Clapers. Dr Clapers is the current president of the Barcelona Medical Homeopathic Academy. He has been using LMs for more than 30 years. I sent him an email asking for advice on the case. This is his reply: I had a case of laryngeal papillomatosis with many recurrences and several surgeries. He recovered completely taking the remedy several times a day in high potencies. He started with LM 30 twice a day. After one potency he immediately started another. The fiberscope showed that after more than one year of homeopathic treatment the papillomatosis had completely disappeared.
Third consultation 25 July 2016
P: My throat again is giving me trouble since Christmas. I had the second surgery last August. The consultant said that better wait because the papillomas are very small. I will have a control in 4 months. It is not sore and not uncomfortable. More people are asking what is going on.
P: In the last 2 months I got a lot of phlegm and problems with my ears, that have been blocking and popping. Only the left was painful. The consultant said that there is a drip in the back of my throat. My left ear blocked for a while and I couldn’t hear. I would blow my nose and I could feel my ear. I will be coughing and hawking mucous a lot every day, green or clear but thick. The voice will be clearer after the hawking and coughing.
P: I would have stayed in the US. I have one year left in college. I need to decide what I am going to do after.
P replies to the Polarity Analysis questionnaire and I repertorize again:
Hering Guiding Symptoms (10) confirms Stannum metallicum: Voice husky, deep, hoarse, hollow; clearer or higher after hawking up mucus. Roughness and hoarseness, momentarily amel by coughing. Shrieking noise in ear when blowing nose. Cough with copious, green, salty sputum, most profuse in morning. Sputum: like white of an egg; yellow green pus.
Rx: Stannum metallicum 30 LM, 1 granule in a 200 ml bottle, 10 shakes, 1 coffee spoon twice a day, for two weeks. Follow with Stannum metallicum 33 LM.
Fourth consultation 23 August 2016
P: The voice is much better, and the ears have completely cleared out. I have a lot of phlegm. It can be green sometimes. I just finished a course of 10 days antibiotics. I did a chest X ray this morning. The GP auscultated my chest and said it was getting crackling. I got the flu after the antibiotics. My limbs were a bit tired. I am not still 100% back to normal. I am back to the ENT consultant in mid-November.
P: I got a pain in my penis with the antibiotic. The GP gave me a single tablet of Fluconazole actavis 250 mg hard capsule. After urination it felt like if there is urine trapped. Now it is through the day. It is a pain inside and feels like a knot. The pain is throbbing, sore, gnawing, milder but constant.
The repertorization of the pain in the penis and the Hering Guiding Symptoms (10) suggest Pulsatilla which I give as an intercurrent remedy. Rx: Pulsatilla 200 c, 1 globule in 50 ml bottle, 10 shakes, 1 coffee spoon, once, to be repeated if necessary. I indicate to continue, after the disappearance of the pain in the penis, with Stannum metalicum 36, 39, 42, 45 LM, 1 granule in 200 ml bottle, 10 shakes, 1 coffee spoon, twice a day, two weeks each potency. I also prescribe probiotics and omega 3, 6 and 9 capsules.
Fifth consultation 8 November 2016
P: I’m pretty good. I feel the voice has improved. I’m going to the consultant in a fortnight. I took antibiotics for my throat a couple of weeks ago. I had a sore throat and a cough with phlegm. It is fine now. I had a mouth ulcer for a few days. I used to get them when younger but not anymore now. I still have it now. On the sole of my foot, I had a small rash. It was itchy at the beginning not so much anymore. I am still taking the probiotics. My general health has been pretty good. My energy was good for most of the time. When I had the sore throat, I was feeling a bit tired.
Rx: Stannum metalicum LM 48, 51, 54, 57, 1 granule in 200 ml bottle, 10 shakes, 1 coffee spoon, twice a day, 1 month each potency. Avoid dairy, inhalations with sage or eucalyptus essential oils. Oats’ cream for foot rash. Continue with probiotics and omega 3, 6 and 9 capsules.
Mail from P 24 January 2017
I just wanted to give you a quick update to let you know how my voice is doing. I have recently started my third monthly bottle of Stannum and have another one to take afterwards. I am still also taking the probiotic and the omega 3, 6 and 9 every day.
Yesterday, I visited the consultant for an update on my vocal cords. He said that there is a small papilloma on one side only. Consequently, we have decided not to pursue further surgery for the moment unless the voice gets considerably worse in the coming months.
Since I spoke to you last, the voice was very good for a while. However, it was somewhat worse in the lead up to Christmas. I noticed it particularly when trying to sing Christmas carols! In the last week or two my voice has also been quite hoarse. The sound has been quite harsh, particularly when I have to project my voice, such as when speaking in class.
Reply to P email 24 January 2017
Thank you for your feedback. Please, change bottle every two weeks, as we did before, continue taking the remedy twice a day and take each time one teaspoon instead of one coffee spoon. You could send me an email in two weeks to let me know how your voice is.
There is an interruption in the healing process. Therefore, potency, frequency and dose should be increased.
Mail from P 8 February 2017
I have been taking one teaspoon of Stannum twice a day for the past fortnight as directed and have started the final bottle also. My voice is in much better condition now. I haven’t been having any trouble with hoarseness lately and the voice feels stronger again.
Sixth consultation 3 March 2017
My voice has been a bit mixed. It got better when I increased to 2 teaspoons a day. It got worse 2 weeks ago. The last bottle I took it for 25 days. I have started to get mouth ulcers in the right side. I was wondering if it was something different in the diet or I have bitten myself.
I had a lot of them in the past. I had not had them for quite a while. I tend to get them at home. It could be because when I am at home there is something important to work at. Now applications.
I twisted my ankle quite badly. Probably 3-4 weeks ago. Mum gave me some Arnica. It is pretty good. Not at 100% but I feel confident. There is a lot going at the moment applying for a Master. It could be the stress the cause of the ulcers. I didn’t do exercise because of my ankle. Usually, I go to the gym and I do yoga once a week. I am still taking the probiotics and the omega 3, 6 and 9. I am sleeping well.
Rx: Stannum 60, 63 and 66 LM, 1 granule in 200 ml bottle, 10 shakes, 2 teaspoons a day, 2 weeks each potency.
Probably the voice has worsened lately because the patient took the last potency for 25 days instead of 15, as prescribed.
Mail from P 20 March 2017
My voice has been good since we last met. I haven’t noticed any hoarseness and it hasn’t been on my mind, which is usually a pretty sure sign that it is in good shape. As it is approaching essay season here in college, I am increasingly finding myself in the library, so I am using my voice less, which can only help.
It hasn’t been under much pressure lately as I haven’t been in loud environments. The mouth ulcers which were bothering me when we last spoke have since passed. I have also been able to get back into exercise fully which will certainly help avoiding stress and improving my general well-being. I have moved on from the first to the second bottle, Stannum 63 LM.
Mail from P’s mother 19th August 2017
My son was with the ENT consultant last week. He was very happy with the condition of his vocal cords. There is still a tiny papilloma remaining but nothing that would require surgery. My son is flying to England for his master on September 28th.
Seventh consultation 24 May 2019
P: The last check-up of the papillomas was 2 years ago. The consultant said that there was no need to do any surgery. For me 99% of the time is not in my mind. My voice is back to normal, but I cannot sing. I used to be in a choir.
I have mouth ulcers. I have been getting them all my life. They tend to come in stressful times. I was in England for 2 weeks and back at home I got 2 mouth ulcers. I have a common wart in the second finger of my left hand and one mosaic verruca in the sole of my right foot. I had a cryotherapy session for both. I will have 4 more cryotherapy sessions for the foot one.
P: I have stress and fatigue. The whole system getting round down. I feel tiredness a lot of the time. I don’t see clearly my situation. I feel confused. I feel ups and downs. Maybe 4 days every month I can feel sad. I may be very tired, go to bed and start overthinking but not often. Sometimes I have problems falling sleep. I could be waking 3 times during the night twice a month. When I am confused, I feel the need to be understood. I am not harbouring much anger. I tend to avoid conflict. I disengage. If I have a conflict at home it is with my father.
The repertorization and P’s narrative suggest Magnesia carbonica. Hering Guiding Symptoms (10) confirm this choice: Anxious, sad mood, with indisposition to talk, restless sleep with frequent waking, aphthae. The rubric Skin, warts in the Synthesis repertory includes Magnesia carbonica but does not have Magnesia muriatica.
Rx: Magnesia carbonica 30 LM, 1 granule in 50 ml bottle, 10 shakes, half a teaspoon, one day, repeat after 3 weeks, repeat twice. Then Magnesia carbonica 33 LM, same pattern. 2LVERU, 1 capsule daily, 2 months. Probiotics every day for 3 months. I give him a leaflet on stress management techniques.
Mail from P 10 June 2019
The wart on my finger seems to be gone as of today. It had turned black after the cryotherapy but fell off in the shower this morning. The nurse has suggested that in another week I should know whether it has fully healed, once the new skin has grown back completely after the cryotherapy.
The mosaic verruca on my foot is also much improved. I had my second cryotherapy session this afternoon. The nurse scraped off the outer layer of the verruca before treating it with the liquid nitrogen. She has suggested that if hard skin forms, I treat it with an emery board and return for another session in four weeks. I have also been taking the probiotics each morning. I am due to take the second dose of the homeopathic medicine this coming weekend.
P: On Saturday afternoon I met a friend. I had a couple of drinks and was speaking loudly as I was in a busy bar/restaurant environment. That night, I was extremely hoarse when I got home. It helps to drink water and my voice is almost back to normal now, but evidently my vocal cords are not fully recovered yet.
I don’t know whether this is because the papilloma virus is still present, because my vocal cords are weak or damaged after the surgeries a few years ago or because of some other related reason. For the past two weeks I have also been completing some work experience in a solicitor’s office.
Getting up and out each day has definitely helped with my mood and feelings of anxiety. The major source of upset in recent months has been related to figuring out next steps/a job/career plans. It now looks like I have a new job almost secure, which should start in the coming months, and I am a lot clearer on future plans, so that is a massive help. I have been sleeping well, though still some tiredness on certain days.
P: One thing that I failed to mention when we spoke, but that I thought of subsequently, is that when I do feel upset that is usually accompanied by a tightness in my throat and a need to drink lots of water. I noticed this sensation recently and once I was aware of it, I realised that this has been an ongoing factor.
I am also realising that another cause of upset, in addition to job concerns, has been to do with my relationship with my girlfriend and that that is something that I have been bottling up rather than speaking about with her or a friend/family member. In identifying this cause and noticing that it is exacerbated by not speaking about it, I can perhaps now start to work it out. I am also wondering if there is relevance to the fact that not speaking about these issues manifests as a tightness in the throat. Hopefully some of this is useful – I’ve tried to be as thorough as possible in giving a rundown of how I’m doing now.
The patient has become aware of his psychological conflicts.
Eight consultation 24 August 2019
P: I started a new job. I moved into temporary accommodation. I am moving into a new apartment. I broke up with my girlfriend 48 hours ago. This relationship was taking a toll on me. I would be a bit tired, but this could be adjusting to new environment. I am better in many ways. Last time I saw you I was still at home.
I am in a better place emotionally. My throat has not been in my mind. A couple of people have asked me to join a choir and I said I couldn’t because of my vocal cords. I am sleeping better. The anxiety is good. I am busy in a healthy sense. I harboured a bit of anger towards my father. Now it is better. I am going for cryotherapy. It will be my 5th session.
Rx: Mag carb 36 LM, 1 granule in 50 ml bottle, 10 shakes, 1/2 teaspoon, once, repeat after 3 weeks, repeat twice. After Magnesia carbonica 39 LM, 42 LM, 45 LM, same as Mag carb 36 LM. Continue with probiotics and 2LVERU. We discussed the adverse effects from cryotherapy and Hering’s law.
The patient has taken action to resolve his psychological conflicts.
Mail from P 22 May 2020
It has been a strange time with the Covid outbreak and all of the restrictions that have followed. I hope you haven’t been too badly affected. Overall, my health has been very good since I saw you last.
I am currently finishing the last bottle (potency 45) of Magnesia Carbonica, which I started several months ago, taking each bottle 3 times and 3 weeks apart. I am also taking the probiotics each morning. I am also taking Source of Life Gold in liquid form at the moment as I shake off the remnants of a cold.
For the last 5-6 weeks I have been getting some pretty bad mouth ulcers. A new one seems to arrive just as the previous one is going. I have gotten mouth ulcers on an intermittent basis for many years but the current ones have been for a more sustained period and have been more severe.
My voice is significantly better – I have been learning guitar, which has encouraged me to start singing again and my voice is getting stronger and stronger. My foot healed really well after the verruca. I have had quite a bit of dry skin on the foot for a while, which I have been treating with fresh aloe vera, Sudocream and heel balm. While I am fairly confident that this is just dry skin I am also conscious of not wanting the verruca to return.
In terms of wellbeing more generally, I have been doing very well. I am working at my parents’ home at the moment – I thought it best to get out of the city centre and a small apartment while lockdown continues. While my job continues 9-5, I now have much more time to work on developing a PhD application.
I might have struggled to make this time otherwise, so I am happy about this. And I have good access to the outdoors here which is very helpful at this time and makes it very easy to be self-contained. I am keeping up a routine including exercise, time outdoors and hobbies, so all told the past 2 months or so have been nice. Hopefully this gives a good overview of how I have been doing and thanks for all of your help. It has been brilliant to have the bottles to take while my foot and throat recovered.
Reply to P email 22 May 2020
You can take the three bottles of Magnesia carbonica LM 48, 51 and 54 the same way as the previous ones, except that instead of shaking the bottle 10 times, please, do it only twice. You may also consider extending the 3 weeks periods to 4 weeks periods, if you feel that you are feeling well enough. Regarding the mouth ulcers, you may want to consider increasing your zinc intake.
I decide to decrease the shaking and the frequency to prevent the recurrence of the aphthae.
Ninth consultation 1 July 2020
P: The verruca in my foot is gone completely. I have dry skin for quite a while. No pain, sometimes a little itch. Regular athlete’s foot between toes on both feet. My voice has been good. No need for a check-up for a few years. I am playing guitar and singing. It is good for my confidence. The mouth ulcers are gone.
For the last 6 months rash on right side of abdomen and belly button. This one is a little bit itchy and warm. Psychologically I have been good. I enjoyed being at my parents’ and working from home. My familial relations are good. I still feel a bit of under the surface tension with my father. Different ways of seeing the world. It is very relaxed.
I am ready to move again. The whole thing is very sedentary. My left knee is clicking but no pain. On Sunday when I got out of the car it clicked. Yesterday I was doing push up I felt a clicking. Then I didn’t want to do much more. The leg wasn’t sore, but I could feel a little click. I do 5 minutes of dynamic workshop and 20 minutes of high intensity and 5 minutes of static stretching, 4-5 days a week. I am sitting a lot and carrying more tension in the body.
P: I am in a transition. I am applying for a PhD. I am feeling a kind of blockage. Eager to get moving to the next step. A normal environment would be to relax in the evening. I am trying to unblock and make progress.
P: The stress through the body could cause the haemorrhoids. Recently I have had some issues with haemorrhoids. Initially I had one internally, which I believe was brought on by constipation. This was quite sore during bowel movements and was treated with suppositories (Scheriproct), taking about 10 days to heal. Towards the end of this 10 day period, I developed one small external pile, which was treated with a gel (Preparation H) and has since receded almost completely. This was mildly uncomfortable and was something that mentally I was more eager to be rid of than something that was physically painful.
Normally, I drink lots of water and would have a reasonably high-fibre diet. Since the onset of the haemorrhoids, I have been trying to cut down on things like white bread and pasta, while eating more high-fibre foods and especially prunes.
I have also been trying to incorporate more movement breaks as during the working day I would be quite sedentary. With the dietary adjustments and suppositories, the constipation went away. I had a similar difficulty with an internal haemorrhoid roughly 3 years ago that was treated in the same with Scheriproct and with prunes and more water for constipation. To deal with stress I do exercise, walk, talk to people. I am in a very different headspace from before, quite relaxed. I have taken the Magnesia carbonica 45 LM.
Rx: Magnesia carbonica 48 LM, 51 LM and 54 LM, 30 ml, 2 shakes, half a teaspoon one day, repeat after 3 or 4 weeks, repeat each potency twice. Aloe vera gel for skin, avoid soaps and garments that may produce eczema. Given leaflet on haemorrhoids. Advise on diet. Given leaflet on stress management. Given advice on athlete’s foot. Hering’s law explained again. I refer P to an osteopath to assess knee complaints.
Afterthoughts
- The LM liquid potencies allow great flexibility to respond to changes during the healing process. The potency, the frequency of the repetition of the remedy, the dose of the remedy and even the number of succussions allow to adjust the treatment to the changes that take place during the healing process.
- Another advantage of LMs potencies seems to be their capacity to overcome suppressions (11). Many patients seek homeopathy after receiving suppressive treatments and during homeopathic treatment may decide to continue with these treatments.
- Patient education is central to the healing process. The goal should be to empower the patients to increase their autonomy in relation to their health and thus be able to make the decisions they deem appropriate. The physician must avoid paternalistic and authoritarian attitudes and respect the patient’s autonomy (12).
- Information from relatives and friends is sometimes critical to resolving a case. The fact that the patient’s mother and sister were also my patients allowed me to know the family dynamics and their impact on the patient.
- Progress in the healing process needs to be assessed. In this sense, Hering’s law and the degree of awareness of the patient’s internal conflicts are very useful tools for evaluating the healing process.
- The physician should provide information to the patients that supports their healing process. Thus, hygienic, and dietary advice can be incorporated into the consultation through brochures and / or material accessible on the Internet.
- Teamwork allows us to be better homeopathic doctors. I want to thank Dr. Josep Maria Clapers and my colleagues of the Hydra study group for his advice on this case. I also want to thank Dr Russell Malcolm for having introduced me to Polarity Analysis.
References
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- Flores Villalba, Fernando. Escala L.M. Teoria e Pratica. Piracaia : Robe Editorial, 1997. ISBN 85.7363.003-5.
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