A Case of COVID-19 Related Anxiety. Date of initial consultation: November 2020
A 65-year-old housewife, has been referred to me by another patient in summer 2020. Due to the COVID-19 shut downs, the initial consultation took place on Skype. Her chief complaint was anxiety and sleep issues since the spring when COVID-19 started.
Other complaints are acid reflux, weather related headaches, post-climacteric dryness, chronic rhinitis with sneezing (possibly of allergic nature). She had not used homeopathic remedies before. She was not on any medications at the time of initial appointment. She is using Vagifem (estrogen replacement cream) to deal with the symptoms of vaginal dryness (only told this on the 2nd visit).
During the consultation she was reserved, could not fully finish her thought before jumping to another subject and was communicating in short sentences. Her story was focused on physical complaints, and it was difficult for her to describe her symptoms in detail.
She often used the expression ‘bothers me’ when talking about external or internal disturbances. E.g. ‘acid reflux bothers me, my throat bothers me, my ear bothers me, my knee bothers me, milk bothers me’. Another theme that ran through the conversation is her sensitivity to everything. She used phrases such as ‘I am very sensitive’, ‘My body is very sensitive’, ‘My system is very sensitive’.
When asked to describe the sensitivity, she said that she could not take any medications even vitamins or supplements, as it makes her feel queasy. GI symptoms <coffee, <alcohol, <milk, <cheese, <fatty food. She has a history of headaches which she experiences before any change of weather. This runs in the family as both her daughters and her sister have the same weather-related headaches.
She loves to exert herself in the gym (weights) or long walks, does exercise 5 times a week. Excessive physical exertion <pain in her knee joints and muscle pains. Doing weights or walk sometimes helps her abort the headache when it just starts. Exercising gives energy (2). If not exercising <stiffness of her joints, < headaches. When asked if she really enjoys exercising, she says ‘No, but it makes me feel better physically and emotionally’. She sweats profusely during exercising (1), more than other people.
Sleep issues and anxiety. This is the chief complaint and affects the energy of the patient. Waking up between 2-3 am and restless for 1-2 hours before falling back asleep. Toss and turn for an hour in the morning. Wake up unrefreshed and tired. Anxiety and stress cause the restlessness during the day (can’t stand or sit) and desire to move > walking (3), > physical exercise (2).
During anxiety episode feels like the heart is racing and shortness of breath (1), acid reflux < (1). Thinks anxiety is COVID related, worries about family wellbeing, about getting sick with COVID. Waking 3-4 times at night to urinate, due to dryness of vagina since menopause. Sleep issue on a scale 7/10.
Dryness of vagina and sensation of dryness in the mouth, also dry skin. Have to drink due to dryness in the mouth. Do not feel thirsty, but drink due to feeling of dryness. Desire warm drinks. Frequent urination at night and vaginal dryness. >estrogen replacement cream, used approximately once a week. Without it wakes up 6-7 times a night and experiences extreme dryness and burning pain deep in the vagina. Patient told me that the frequent urination at night is due to vaginal dryness only during the second consultation.
Weather related headaches. < Before any weather change (3), > as soon as it changes. Depending on the weather could happen couple times a week, but mild. The intensity was much worth before menopause. Sometimes HA >physical exertion (2), >sage roll (1), >sleep (2), >coffee (sometimes). Location: in temples, both sides, changes from one side to another, not consistent, every headache is different. Never wake up with a HA but within an hour can start. Concomitants: sometimes slight nausea during headache (1), eyes will be sore, sensitive to light (1), > darker room, > quiet.
Other ailments: History of acid reflux , right now does not bother that much. Started 2-3 years ago due to stress. With sensation of rawness in the larynx and accompanied by cough. <acid food, < coffee, < alcohol, < hard cheese, <emotional stress, > warm drinks. Fainting (2) due to low blood pressure when getting up from sitting to standing, > eating salt during the day (3), salty snacks. Frequency? every few months.
Cold extremities (mostly feet) (2), even in summer, but warm up in bed and need to stick them out of the blanket. Was told by the doctor that she has a geographic tongue (1). Varicose veins (1), one in the back of right leg. Granuloma annulare (1) on hands- started 3 years ago (around the time when diagnosed with pancreatic cyst)- on and off, right now much better. Pancreatic cyst (1), did not increase in size over the last 2 years. Teeth grinding day and night and jaw stiffness during the day (3), < anxiety (3). Even when wearing night guard, managed to crack my tooth.
Anxiety due to pandemic. If my family or I get sick. Worry about their health, and wellbeing. Feel like my heart is racing, + acid reflux. Shortness of breath (during the day). Happens out of the blue. 6-7/10. Weeping? Don’t cry. Built a wall around my emotions due to my husband volatile temper. Consolation? < worse (3). Lately feeling a bit depressed (1).
About you? Family would describe as calm. Don’t like big group of friends, happy to be alone. Very good friend. Have about 10 good friends. Confrontation? Not good with it. Will usually back away. Grudge? Takes me a long time to forgive, but I don’t forget if someone did something to me. Impatient with technology (e.g. can’t learn a new app). Irritable (3) from people talking around me -in public transport, in a mall (recent), irritable with customer service.
History: Had menopause at 48. Had hot flashes a lot every day for 12-15 years. No ME issues. Had eczema when was very young. In her 30th had severe migraines, after menopause >, just mild headaches now weather related. Had frozen shoulder a few years ago. Food and drink: Cravings: for 30-40 years craved popcorn (salted), stopped 2 years ago. Crave salty (3). Don’t like anything sweet (only dark chocolate).
Craves coffee in the morning, but < acid reflux, now take cortado only 2-3 times a week. Get thirsty at the evening before bedtime. A couple sips at a time > (2). Generally warm drinks (2), herbal tea. Stomach < rich, fat à queasy (1). Excessive coffee or alcohol would give a hot flash at night. Generals: Like to have something on the neck to keep it warm, wears a lot of scarves and hats. Always feel cold (3). Cold humidity < joints stiffness (1)
The following rubrics were considered during case analysis:
Mind, anxiety, family, about, his
Mind, fear, of, contagious, epidemic, infection
Mind, restlessness, nervousness, move, must, drives from place to place
Teeth, clinching, clenching together
Mind; consolation, sympathy; ailments from, agg.
Generalities, food and drink, warm, drinks, desire
Mind; irritability; talk of others, from
Generalities; food and drinks; salt or salty food; desires
Generalities, dryness, of, usually, moist, internal parts
Mouth, dryness, sensation, of
Sleep, waking, urinate, with desire to
Female, dryness, vagina
Female, pain, burning, smarting, vagina
Extremities, coldness, chilliness, daytime
Generalities; faintness, fainting; rising, on or after
Head, pain, headache, weather, change, of, agg
Generalities, exercise, exertion, amel
Mouth, mapped tongue
Initial treatment plan assessment
The patient is healthy for her age, has a strong vital force and good lifestyle habits and hygiene. She is rather reserved and answers in short sentences. I suspect that the picture that she shared is rather not complete. She seems to be affected most by emotional stress due to worries about her family, which manifests on a physical level as acid reflux and on a mental level as anxiety and sleep disturbances.
Natrum mur showed up strong taking totality of symptoms related to the whole person, as well as Sepia, but Ars Alb is high up if focused on rubrics related to the most recent complains of anxiety, which I wanted to address first and once they ease up, treat on a deeper level with a constitutional remedy (potentially Nat-m or Sepia).
The chief complaint was anxiety with restlessness which is a characteristic feature of Ars Alb. Anxiety about health, about contagious disease. The reason for anxiety is fear of contagious disease and fear of germs, and Ars Alb is well indicated for this type of fear and in COVID related anxiety.
Anxiety for family and their health and wellbeing. Chilly and > by warm drinks and warmth in general. The special focus of pathology in Ars Alb is in the GI tract incl. liver, stomach and intestines. Ars Alb has dryness of mouth, lips and vagina and thirst for sips of warm water, could also have HA before storm or change of weather; have affections of digestive tract with heartburn; many food aversions and sensitivities incl. loathing or desire of fat.
The remedy for the first prescription was Arsenicum Alb 30c one liquid dose and quick check-in in 3 days. If no aggravation, liquid dose once a week. The 30c was chosen as the patient highlighted her extreme sensitivity.
Dec 3rd 2020 quick follow up on day 3 after the 1st dose of Arsenicum Alb 30c
The patient reported immediate relieve of anxiety after the first dose, she described it “I felt as if the cloud has lifted”.
Dec 18th 2020 quick follow up on the phone requested by the patient
After the 2nd dose, she experienced some nausea and sleeplessness the first night, loose stools for a few days. After the 3nd dose started to have pain in the spleen area, on and off. Experienced similar type of pain briefly before when went to energy healer.
Anxiety today through the roof. Last time took the remedy 5 days ago (3rd dose). Concerned about the pain and what she should do, continue or not, what is the remedy made of, is it possible that it will make her feel worse. Advised to take a break with the remedy until the pain subsides. Do not repeat the remedy and wait.
Jan 6th 2021 quick follow up on the phone
Pain in spleen area lasted a few days, been feeling fine since then. The past 1-2 weeks anxiety level definitely went down. Patient reported that even her friend commented that she seemed calmer. Sleep not great. I advised to stop with the remedy for two weeks and see if the anxiety levels maintained to be low and let me know if started getting worse.
Feb 8th 2021 long follow up on the phone
Still no anxiety issues since the 3rd dose 2 months ago. Sleeping isn’t so great. Still getting up 2-4 times at night to urinate, but can go back to sleep. Still using estrogen cream 1-2 times a week. Old symptom not reported before: Nose runny, dripping during the day, had it for years. Clear color, < in the house. Blow it more in the cold. With sneezing < inside, < in the city. No sneezing when in the cottage. Suspect allergy. Ear bothers, very dull pain on and off, not intense, radiating from face to ear
(2). Clench and grind teeth even during the day, so chipped a bit of a crown. Dryness of mouth is still there (2), need to drink, stop drinking at 4pm to prevent waking at night to urinate. Skin is dry. Acid reflux under control. Headaches started in mid-20th, had lots of them before menopause, very intense.
Still weather related but less intense. Exercise used to keep them at bay, now does not help. Like to challenge myself, complete with myself, not competitive with others. Excessive personality, feel that have to do lots, but now realizing that need to cut back. Like to push myself with exercises.
Describe headache? Like head is in a vice around temples (2). Low BP, but can function, no fainting, >salty snack (3), >pickle (2). When feel like eating a lot, means the HA coming (3). With HA sometimes stomach does not feel well, stomach is upset, little nauseous (1). This month had HA 6-8 times, lasts one day, >sleep (2). Hands are cold but not as cold as my feet (2). Granuloma annulare better now after laser treatment.
Updated the chart with the following rubrics:
Nose, discharge, clear
Stomach; appetite; increased, hunger in general; headache; before
Assessment: The patient is doing well. Anxiety >, acid reflux >, energy >, headaches no change, dryness no change. Do not repeat the remedy, wait.
Feb 22nd 2021 short follow up on the phone requested by the patient
Anxiety is up again, not near where it was in the beginning before taking the remedy, but definitely up, sister said she can feel it in my voice. Started just before had to go to hospital for an MRI, the visit was very stressful (got stuck in the elevator, they messed up my card, was not clean there).
Describe anxiety? I feel the best in my house, safest in the house (3). Fear of seeing people (3). All related to COVID, scared of new strain (3). Have pain in the face daily, think it’s related to clenching (3). Dull pain constantly on left side of the face (2), it moves, right now upper part of cheekbone. Could relate to crack in the tooth, but scared to go to dentist. Headaches? Think it’s worse, but it’s due to volatile weather. Feeling cold? Yes, right now hands and feet are frozen. Cravings? just feel like eating salty food (3). New: sometimes I shiver (1), my whole body for a few seconds, don’t know where exactly.
Observation: patient is abrupt, talks in a very short sentences, says ‘I don’t know’ instead of finishing the sentence when describing symptoms. Very reserved, does not talk about emotions, just physical symptoms and very concise, uses ‘bothers me’ a lot. Had difficulty describing what anxiety means for her. Does not describe anything in detail. New rubric added to repertory chart: Face; pain; extending to; ears
Assessment: The anxiety is back again but less intensity than before the remedy, triggered by the visit to the hospital and the news of the new strain. Repeat Arsenicum Alb in 5 cups water one dose and wait.
March 1st 2021 quick follow up on the phone
Took Arsenicum 30c in 5 cups of water on 6 days ago. First night after taking did not sleep well, woke up at 2 am and could not fall asleep. After taking remedy noticed that wasn’t clenching teeth the next day. Energy a bit increased, 20-30% more. Anxiety 30-40% less.
Face pain is better for sure, think it related to clenching, which is related to anxiety. Pain in the ear a few days ago, but resolved itself. Everything else is good. When was the last time you had headache? Last time had it a couple days ago due to the change of weather. Estrogen gel used about once a week. Without it there is a burning pain deep inside the vagina and urination at night 6-7 times. Craving coffee only in the morning, but only take it 2-3 times a week.
Assessment: Arsenicum Alb 30C still works and helped to reduce the anxiety, not as strong effect as the first dose, but possibly also because this dose was in a 5 cups method. Advised not to repeat unless the anxiety starts to get worth again.
In the meantime, advised to start taking Nat-m tissue salt once daily indicated for patient’s dryness of mucous membranes and other chronic complaints such as hay fever symptoms, recurrent headaches, coldness of extremities. I believe the patient will need Nat-m remedy, but due to high sensitivity wanted to introduce it slowly starting with a tissue salt form and see what effect we can get from it first before moving to the higher potencies.