CCs: anxiety, sleeplessness, warts and dry cracked skin
Initial Consultations 02.11.2021 + 02.16.21 (with mom)
Age 15 at initial consult; 16 for follow ups
03.23.21 , 04.21.21, 06.17.21, 07.29.21 , 01.24.22
Case Summary and Conversation
Initital consultation 02.11.2021
Bradley was a 15 year old boy at our initial consultation. He was my first externship case as a student at CCHM and I had known him and his family for 2 years prior. He came to me for help with his anxiety, sleeplessness, warts and dry skin.
He also awoke feeing very unrefreshed and he was having difficulty concentrating with school. He is anxious in crowds and physical activity makes him feel better. In the five months prior to seeing me he had moved for the second time in 4 years (2016 and 2020) thus leaving friends and starting over again at a new school.
His grandfather also passed away late 2020 and he broke up with his first love in September 2020. Prior to this recent succession of griefs, Bradley had also suffered from the death of a close friend’s mom and the loss of that friendship as well as moving and going to a new school where he knew no one (2015/ 2016).
Bradley was polite and composed in our interview. He is of fair complexion and I observed large red acne spots on his face. He was clean and presentable with freshly cut hair. He sat upright and was very composed. He said his room is messy. He worked hard to answer my questions.
He described himself as an introvert and that he has become even more so making it harder to meet new people after his latest move. He said his sadness has morphed into being anxious and nervous. Over the course of seeing him Bradley was also attending school in person and doing online school at home due to changing Covid-19 restrictions. I’ve included a few excerpts of our conversation to show the level of our conversation and to highlight the symptoms I used in my reportisation.
Me: What should we talk about first?
Bradley: The past couple of years I’ve had 3 or more warts. One was really bad for months, took awhile to treat. The others more minor because I got them early. This is my biggest physical reoccurring issue. The other issue is dry skin since moving back here.
Me: What is the location of the warts?
Bradley: A lot on my hands. One on knuckle of forefinger, first knuckle, R hand. Came after a cut that split open. Due to dry skin too.
Me: Dry skin right now?
Bradley: Yes, terrible if I don’t use lotion. It’s worse since moving back. Mainly on the knuckles of my hands.
Bradley’s dry skin is worse in the dry cold climate he is now living in. Nothing striking about this so I focused on the location of the dry skin and warts and any sensations but again found nothing striking with the sensations. He has had warts on his feet in the past but currently they only show up on his hands.
I did think it was somewhat striking the warts come after a crack in the skin or a cut in that location. He did say his feet have been cold since moving back which is a new symptom and yet he doesn’t like to wear socks because of the feeling., I noted this contradiction.
He had his largest wart burned off with liquid nitrogen and he kept saying’ I wanted them to cut it out.’ I wondered if he was also talking about his feelings of grief when he was saying this so I made a mental note to see what came up when we got around to discussing his emotional symptoms.
After discussing his physical complaints of dry skin and warts Bradley said he was having a hard time falling asleep since their latest move.
Me: What should we talk about next?
Bradley: That’s it for physical things that bother me. I try to stay pretty healthy, workout every day, eat well. Oh sleep. I don’t have a problem staying asleep, a hard time falling asleep. Sometimes I wake up really early for no reason, 5am, and not able to go back to sleep.
Me: Tell me more about that?
Bradley: I never had trouble with sleep until we moved back here. Nightly. Only time I can fall asleep is if I stay up really late.
Me: Tell me more about falling asleep, what’s preventing it.
Bradley: Weird, sometimes anxious about school. Lot of time can’t link to anything. Thought comes in that’s not good, often about school because I’m behind, I fell behind in quarantine. Stuff I forget about pops into my head right at sleep. It’s why I wake up at 5am too, thinking of school, remembering something I forgot about. I have alot of thoughts in my head at night and can’t fall asleep.
Me: Tell me more about the thoughts when you are falling asleep.
Bradley: Hard because I know it’s happening but in the am I don’t recall. I don’t remember dreams either. Thoughts about school and what I need to do. About our move back. Random things too like music and F1 car racing. Can’t put it to one thing, that’s the time when my brain is relaxed. When I go to school really tense. At school tense and stressed and anxious and affects ability to work. Stressed and can’t think clearly.
Me: Stressed and anxious at school, tell me all about that.
Bradley: Never felt a tonne of anxiety before, ok first day of school. Alot of the sadness and grief of moving back here and not having friends. Affected my work alot at beginning months. Then quarantine and got behind, being off school and at home where more comfortable, less stressful. So then when I went back to school had a knot in stomach, felt sick, barely ate, didn’t feel like eating. Gradually got a bit better but I didn’t feel comfortable at school. Felt cloudy at school and hard to focus.
Bradley was experiencing difficulty falling asleep due to racing thoughts and waking at 5am. At his new large school he is stressed, tense, anxious and now experiencing difficulty focusing and cloudy feeling. His appetite has also dropped off. His vital force is being impacted on all levels.
The dry skin and warts were the first physical symptoms to be expressed and with the addition of further griefs it appears the advancing mistunement was now manifesting with loss of appetite, cold feet, anxiety, mental fog and difficulty sleeping.
Me: Make me feel one of those attacks.
Bradley: Huge amount of energy I felt, I can’t breathe, breathing too much, confusing, don’t know what’s going on, acting crazy, so much energy walking around the room fast, breathing heavily then not breathing much. Then I’m tired after.
Me: Anxious, where in the body
Bradley: chest, stomach the most.
Me: Make me feel this in my stomach
Bradley: Tight, squeezing feeling, a knot in my stomach (he’s pointing to his diaphragm).
Me: This knot in your stomach, is there a temperature, a sensation, a colour.
Bradley: Contracted, twisted, uncomfortable position (he’s making a ball with his hands). Squished feeling. Feels smaller. Squished, crumpled, twisted while squishing it. Achy pain, not sharp. Feels smaller.
Me: When in life do you feel squished, twisted, smaller
Bradley: Alot of time when doing school work. About the move. About friends. Those are the two biggest things. Most days I get those feelings.
I was pleased with the sensations Bradley was giving but due to my inexperience I wasn’t sure how to go deeper into these sensations and to see if there was a sensation that ran through his other symptoms as well.
Bradley told me he feels like an outsider and with what I was seeing so far and knew of him I was wondering if this was a mineral case, and perhaps in the first phases of the periodic table where the individual is not in the group but wants to be. Again, I was and still am a beginner at these concepts but it was interesting to begin to apply this thinking to the case.
The remainder of the intake was spent gathering as much as I could about Bradley’s general symptoms and to complete his chief complaint symptoms. He is better with movement and outside, worse consolation, worse milk, he’s very hard on himself, he likes salty food, he gets headaches before thunderstorms and he internalizes his anger.
He also said he’s been feeling nothing when he should be feeling something, for example did great on an exam and he felt nothing, no satisfaction. He also said he won’t get sad when things happen, he gets an empty numb feeling.
It’s also hard for him to get excited and he hadn’t cried in three years until his recent move and he’s shocked that he’s crying when he’s anxious and can’t control it. He likes to listen to music when he’s anxious. He lacks in confidence and dislikes crowds. He doesn’t like to be hot in the sun and he’s often thirsty.
I spoke with the Mom the next day to see if she wanted to add anything. She said Bradley took a few doses of Ignatia the month prior to seeing me and there was some improvement. She had also been giving him some Aconite when he was particularly stressed about going to school.
His eating, sleeping and fear of going to school improved with Ignatia and he wasn’t isolating quite so much. His appetite improved a bit as well. She said as a child he was very sensitive to sounds.
Case Analysis and Differential
I made an initial rep chart based on what I thought most needed curing. Based on my inexperience the rubrics were quite simple and they are the first 12 rubrics in the chart. I considered using Mind, ailments from grief but decided to focus on the symptoms his body was expressing and to take this into account in the differential.
After talking with my supervisor, he suggested homesickness and aversion to change were strong qualities that needed to be reportorised. He also guided me to include Mind, dullness, studying after, affected by music and headache before storms. He also said I needed to look for more specific rubrics for the warts on the hands and add these as well. Here is the chart with these additions to my original rubrics:
Based on my initial chart I did a differential between Natrium muriaticum, Lycopodium and Kali carbonicum and I chose Nat mur as his remedy. However after including the rubrics as suggested by my supervisor and our discussion I then added Natrium carbonicum to the differential. This was an interesting concept to me as both Nat mur and Kali carb were well indicated, so to find a remedy that was a combination of the two was a great point of learning.
I decided to choose Natrium carbonicum for Bradley as it more specifically covered (Hering’s Guiding Symptoms):
- location of the warts on the back of the hands
- dryness in the cracks of the hands and joints
- specific time modality of waking at 5am (tho not in the rubric I chose it is in MM’s)
- feeling unrefreshed in the morning.
Further, Nat carb covered all key symptoms in the case as well as generals:
- < mental exertion,
- < before thunderstorms
- sensitivity to noise as a child (provided by the mom)
- sensitivity to music and
- < milk
- mental indifference
- refined appearance
- cutting, drawing, pressing stomach pain experienced with anxiety
- Freckles on face
- Pimples on lower face and lips
- Very cold feet
- Falls asleep late at night
- Awakes too early in the morning
- Natrium carbonicum 30c.
- 2 pellets every 48 hours for a max of 3 doses.
- Stop sooner if changes felt or observed.
Follow up 1: 03.23.21
Initially Bradley said nothing changed with his 5 doses of the remedy (I had told him max of 3 doses), however as I went through his symptoms there was improvement. Specifically with the feelings of anxiety in his stomach, he was no longer waking at 5am, his appetite had increased, the dry cracked knuckles were slightly better.
He was still feeling mentally anxious thinking about school, having a hard time falling asleep and waking feeling tired and his hands and feet were still cold. I felt his vital force needed a more consistent yet gentle stimulation to address the stresses of school and still adjusting to the move he was experiencing on a daily basis.
My supervisor was in agreement. Later that night Bradley’s mom sent me a message to say she had seen an improvement with the remedy and in fact Bradly had left his basement for the first time after school to go out and play basketball in the street with kids. I was encouraged to hear this improvement.
- Stay with Nat carb 30c
- 2 pellets in water, shake 10 times and take a sip twice a day until he noticed a change.
Follow up 2: 04.08.21
Bradley said he’d taken Nat carb 30c in a cup of water two times a day until it ran out. He said the biggest thing he’d noticed was the physical anxiety feelings have very much decreased, noticeably. He’s falling asleep better and no longer waking at 5am.
However he’s been more tired in the mornings and has had some cracking on his knuckles. No warts. His mental fog and difficulty concentrating is slightly better. He’s no longer crying and he’s stopped thinking about the move so much and what he left behind. His stomach twisting up has severely decreased he said. He still does not want consolation and he loves to exercise.
My observation was he’s seen an improvement in several areas but still has more healing to go. No panic attacks since starting on the remedy. Physical and general improvement but more healing on the deepest mental plane still needed. He has not taken any remedy for 2 weeks.
- Increase potency to Nat carb 200c
- 2 pellets in cup of water
- Sip of remedy before bed once weekly until improvement noticed then stop
- If no change then consider switching to Nat mur
Follow up 3: 06.17.21
Bradley ended up taking 2 doses of nat carb 200 in water once weekly. He noticed little changes of getting to sleep better, his skin was a lot better, no cracks on hands. He noticed it takes a lot more for him to feel anxious now, whereas before it was small things that would set him off.
He said he notices the effect of the remedy working more and more as time has gone on since he stopped taking it. No warts, no waking early, improvement with mental fog and difficulty concentrating. He said the biggest improvement is not feeling anxious thinking ahead to his day. Stomach twisting has continued to improve. No new symptoms.
- Do nothing and follow up again to see if improvements continuing. His healing is following Hering’s law of cure with improvement going from physical cure first to now a healing on the deeper mental and emotional levels. Wonderful to hear he’s noticing improvement continuing even tho no longer taking the remedy. The vital force has taken over from the stimulus of the remedy.
Follow up 4: 07.29.21
Bradley had a hard fall on his road bike and had multiple deep contusions on his right palm, forearm and leg. I prescribed Arnica 200c, 3 pellets in water, shake and take TID for a week then as needed for pain thereafter. Also Calendula 200c, 2 pellets dry dose first then in water TID for a week.
Bradley said he felt the remedies helped as he healed up pretty quickly. Less than a week for the wounds on his arm and leg and just some surface scabs with the palm taking the longest as it was the deepest. Some wrist pain as well from the fall that healed well.
Bradley had not taken Nat carb 200c since the end of April. He was feeling good. He had a cut on his pinky finger from the bike accident and he would in the past always then get a wart but he did not this time. His difficulty falling asleep with racing thoughts was starting to return. He had no stomach twisting with anxiety. No panic attacks. No dry skin.
- Re dose Nat carb 200c one dose to stop return of symptoms and give another stimulus to the vital force in light of the bike accident most likely being an obstacle to cure.
- Stop Arnica 200c and Calendula 200c
Quick check in 09.10.21
Bradley said he’s doing great all around since the re-dose of Nat carb 200c at the end of July/21.
Follow up 5: 01.24.22
I observed large red acne spots around Bradley’s mouth and lower cheeks. He was much more relaxed than in past appointments and had slightly dishevelled hair. He was smiling and seemed very much at ease. It has been very close to a year since we began treatment.
I asked how he’d been since taking the last dose of the remedy at the end of July 2021. He said nothing’s really come back of his symptoms except for a bit of dry skin during the very cold spell they had the month prior. No warts appeared on the cracked skin.
He’s falling asleep well and staying asleep. He said maybe 10% left of difficulty falling asleep. He’s still feeling a bit tired in the mornings on waking. No issues with anxiety anymore, no acute attacks. His concentration with studying has improved another 40% from where it was last time.
His appetite is now very high. He’s had no physical symptoms of anxiety. He’s exercising and training even more and loving it. He has a lot of energy. His mind is very good he said, much happier. No more emotional indifference, no new symptoms of any kind have appeared. Overall he said he is 80-90% better from when we started.
We agreed he could use a bit more healing with the dry skin on his hands, the acne on his face, the remaining difficulty concentrating and feeling tired in the mornings.
- Increase potency of Nat carb to 1m
- Remedy prepared in water and alcohol
- 3-5 drops every 48 hours for a max of 3 doses. Stop as soon as changes observed
- Felt Bradley needs a higher potency to push his vital force a bit more to heal the remaining symptoms
As I worked through the case I could see that Bradley’s vital force was affected on his physical, emotional and mental levels with the leading edge of his disease manifesting in cracked knuckles, dry skin, cold feet, loss of appetite, difficulty falling asleep and waking early, difficulty concentrating, feeling indifferent and both acute and generalized anxiety.
There was a strong etiology of multiple griefs. Based on my initial reportisation I chose Natrium muriaticum. However with guidance from my supervisor to add in some key rubrics that captured the patient’s symptoms more characteristically and based on his suggestion to add Natrium carbonicum to my differential analysis, it was clear Nat carb appeared to be the similliumum.
After nearly a year on the remedy and five follow ups, Bradley has regained his happiness with life. He’s much more relaxed and his ability to function at school and in the world is much improved and he is now thriving on all levels. He’s doing excellent at school, working and enjoying it, training hard physically and having no anxiety. He plans to race in the mountain bike circuit this summer.
I look forward to seeing how a few doses of Nat carb in a 1M potency engages with Bradley’s vital force to ideally heal the small percentage that remains of his symptoms. There is no doubt the direction of this case of teenage anxiety, most likely due to multiple griefs is toward cure.