Asthma in a Woman of 41

Initial appointment – January 1^st, 2020

Carol is a 41 years old female. She came to me because of asthma attacks that returned after a long period of recession. In her intake form she mentioned also PCOS (Polycystic Ovarian Syndrome) and headaches. The two latter complaints were very old though. The initial consultation was conducted via Viber.

Family history

• Maternal grandmother : Died at 93 natural causes
• Maternal grandfather : Died at 63 heart attack
• Paternal grandmother : Died at 50 cancer
• Paternal grandfather : Died at 86 natural causes

Observations

In general Carol is robust, dark hair, green eyes and a healthy 41 year old, caucasian woman. She got married at a relatively young age and she is a mother of two children. Her daughter is 18 years old and her son is 16 years old. She is a teacher of the German language and instructor of Yoga. Very busy in her everyday life.  The way she speaks reveals that she is a highly intellectual person, too.

Carol is complaining about asthma and a moderate tendency for bronchitis. The complaint exists since the beginning of November 2019. The whole situation starts with paroxysmal sneezing. At the end of the fifth sneezing there is a wheezing.

This has happened three times since November. When she feels that the paroxysm is about to start she uses puffer (Aerolyn) preventively, otherwise she believes she will not be able to sleep. It happens clearly only in the night. She says it is because of stress but she notices that it is an exaggerated reaction to stress. Asthma attack comes with lachrymation and palpitations.

In 2017 there was a severe asthma attack and she had to go to the ER. She was given cortisone. She was told she had allergic rhinitis. During the crisis she feels suffocating and hypoxic.

The feeling she has after every asthma attack is described as an “angry sorrow”. She is angry with herself because she let this happen. During the fits she feels pressure in her sinuses, and there is thin and clear mucus running from her nose (like water). In general, those asthma attacks annoy her.

She says it is not something that makes her suffer, just bothers her. After every attack she sleeps. She gets better when lying in fetal position, on left side, under heavy blankets, regardless if the room is warm.

In general, she feels some pressure at the end of the day, as her schedule is quite heavy. Very often, in night time, a conversation with her daughter leads to a fight.

She considers that this annoying situation generated in the family at the end of the day comes from suppressed emotions from her side. If a good friend called her at the moment of explosion or if she had someone to quieten her, she would feel much better.

She is very concerned about her role in life after the kids grow up and move out of the house. “Who will I be?”, “What my role will be?”, “Will I be a mother, a companion…?”. When she thinks about all that she sighs.

In 1994 she had an ultrasound test which revealed cysts in both ovaries. At the time of the consultation there was nothing pathological with her ovaries. She feels hot during the day and cold in the night before sleep. Actually when she starts feeling cold in the night, this is an indication that she has to go to bed.

Her extremities are steadily colder than her core, especially her fingers. She likes summer more than winter. Her health is better during the summer. She can tolerate cold but if she feels chilly she aggravates. When she feels cold, she shrinks with a tendency to cover first of all her hands (put them in the pockets).

She has to wear sunglasses when there’s sunshine otherwise her eyes tear. The heat of the sun is beneficial for her but she is sensitive to the direct exposure of her head under the sun.  She feels better when she is close to the sea. Weather changes do not affect her.

She must have breakfast. She is very hungry in the morning. She may get a little sleepy after lunch. Her dinner is light; usually the last meal is at 8:00 pm. If breakfast is skipped, she is trembling (10:00 am). Skipping lunch does not affect her so much but if this happens, she’s having a sweet desert around 5:00 pm. Dinner is maybe the less important meal for her. She can go to sleep with empty stomach.

She craves cashew nuts and sunflower seeds; plain not salted. She dislikes okra because it’s slimy. She also doesn’t like green peas but not to the point of aversion. She cannot eat pork chops if she hasn’t removed the fatty crust first.  Milk consumption causes a discomfort; she has abdominal bloating and slow digestion. She prefers her food hot, not warm. She has fruits maybe once a week, just for the taste.

In general, she is not a thirsty person. She is sensitive to caffeine; it causes  tachycardia. Her sleep is very good. She falls asleep easily and her sleep cannot be disturbed easily. Usually she sleeps in the fetal position, on her left side. She prefers the room to be cool and she likes to cover herself. She will not perspire even if the room temperature is 25^oC and she is covered with blankets.

The windows have to be hermetically closed.

Her dreams are nice and vivid. She remembers 7 out of 10 of them. If there is a dream that reoccurs is a dream of flight. It happens once every 2-3 months. Her perspiration is normal.

She doesn’t like wearing bra. Even when she goes for teaching she wears a sports bra. She doesn’t tolerate any tight clothes on her. Yoga tights are an exception because they are super comfy.

Her period is quite regular. It comes every 28 – 30 days.  She knows very well when her period is about to come because the sequence of the concomitant symptoms is much defined. She feels relief upon the flow. There is constipation during the ovulation.

Carol says that her libido is somewhere between normal and a little increased.

Her energy is at peak in the morning (“I feel as if I am turbo boosted”). There is a drop of energy at 12-1 pm. Then there is an increase in her energy at 2-3 pm and a drop again at 3-4 pm. Her energy stabilizes at a good level in the afternoon and it keeps like that until she goes to sleep. Before sleep it’s like her body switches off. She likes that feeling.

She likes Yoga (she is at a very good level), literature, poetry, translation and discussion with friends. She likes very much traveling but only when it is scheduled. She is very sensitive to disagreement. She gets very angry when someone rescinds his agreement with her.

She wishes she was more patient sometimes. She is not jealous. She is not familiar with that feeling.  She has also a tendency to be critical against others. There is no active fear at the moment.

She is tidy with her staff and she puts them in an order of her own way.

The biggest trauma of her life was her sister’s sickness (anorexia nervosa) in 1997 during their puberty. She told me she has been treated homeopathically in the past. She has taken several remedies since her puberty.

• Ignatia (16 years old)
• Medorrhinum (26 years old)
• Phosphorus
• Platina muriatica Natronata (31 years old)
• Sepia
• Palladium (32 years old)
• Natrum Muriaticum

Occasionally she uses an Albuterol puffer (aerolin) for managing the mild asthma attacks and naphazoline nitrate (Septobore) for the lachrymation.

Initial assessment

It seems that the asthma attacks the patient suffers from have an emotional base. Sh looks healthy, vigorous, very active, and intelligent. The problems with her respiration are triggered after she has arguments with her daughter.

She had asthma attacks in the past but they were under control. Now it seems there is a slight relapse.  It is more likely the asthma attacks to have an emotional origin.

From the miasmatic perspective the case points toward sycosis. In the physical plane we see ovarian cysts, warts, appendicitis, asthma attacks, lachrymation and catarrh.

There is also cancer history in the family. The heart attack of the grandfather resulted from the hypercoagulability of his blood.  In the emotional plane there is hypersexuality. In the mental plane we see the hyper activity of the mind.

Repertorization

(Using Vithoulkas Compass)

1. Rubric: RESPIRATION – ASTHMATIC- night
2. Rubric: MIND – ANGER, irascibility – ailments after anger, vexation, etc. anxiety, with
3. Rubric: EXTREMITIES – COLDNESS – fingers
4. Rubric: GENERALITIES – LYING – on side – amel
5. Rubric: GENERALITIES – COLD – becoming – agg
6. Rubric: GENERALITIES – FOOD and DRINKS – slimy food, aversion
7. Rubric: MIND – CENSORIOUS, critical
8. Rubric: MIND – REPROACHES – himself
9. Rubric: EYE-LACHRYMATION – light, from – of sun
10. Rubric: MIND – CONSOLATION – amel
11. Rubric: MIND – FASTIDIOUS

The rubrics :
RESPIRATION – ASTHMATIC- night
EXTREMITIES – COLDNESS – fingers
GENERALITIES – LYING – on side – amel
GENERALITIES – COLD – becoming – agg
EYE-LACHRYMATION – light, from – of sun

The rubric “MIND – ANGER, irascibility – ailments after anger, vexation, etc. anxiety, with” connects efficiently the etiology and the result of the patient’s problem. She is very worried about her daughter’s future. That makes her being over concerned some times.

This worry is expressed to her daughter. Her daughter does not accept her mother’s behavior and reacts. Now the patient besides her anxiety, she feels also angry because her daughter does not share her worry.   Asthma attack follows.

The rubric “ MIND – CENSORIOUS, critical” was selected because the patient said spontaneously she tends to be critical to others.

The rubric “MIND – REPROACHES – himself” was selected because the anger the patient feels actually turns to herself. She accuses herself for that. She would like to be more calm and less explosive.

The rubric “MIND – CONSOLATION – amel” was selected because  a phone call from a friend could reverse her quarrelsome state of mind.

Finally, the rubric “MIND – FASTIDIOUS” was selected because the patient wants order in her life in general. She keeps her schedule. Her life is well organized. She likes traveling but only when it is well prepared. Surprise trips are out question. The way she communicated with me, the way she filled her intake form and in general the way she organizes her life reveals a person who wants everything to be in order.

Analysis

The three remedies I took into consideration were Arsenicum album, Nux Vomica and Pulsatilla.

Arsenicum is the remedy that covers most of the symptoms. It is a remedy that fits well to chilly patients, to patients that get worse when becoming cold.  It has also the characteristic aggravation during the night. In Arsenicum we find the criticism against others and against one’s self. Another feature of Arsenicum that matches to the patient is the fastidiousness. Of course we have to mention as well the anxiety that characterizes Arsenicum patients. However, there are some striking features I would like to see in a patient that needs Arsenicum which are not present in this case. There is no restlessness, no anxiety for health issues, no “burning sensation” ailments such as pain or any kind of “burning” discharges. Additionally, the patient is very vital. I don’t see in her any prostration or weakness. Finally, the patient does not present any kind of insecurity which is the main mental characteristic of Arsenicum.

Pulsatilla is another remedy that caught my attention. I thought of Pulsatilla mainly because of the irritability of the patient. Pulsatilla is also well indicated for asthmatic attacks in the evening and in the night. The quality of the asthma attacks is more likely to be hysterical. Pulsatilla has the key note of getting better with consolation. This agrees with the patient statement that any fit of anger would stop if that moment a good friend called. Pulsatilla has a tendency to reproach her self. However, the self reproaching of pulsatilla targets to attract the attention and the pity of other people. Pulsatilla tries to make people feel sorry for her which is not what the patient is trying to achieve. The self reproaching in our case contains a type of self criticism. The patient likes to sleep with the windows hermetically closed which is far away from Pulasatilla’s desire for open air.  Additionally, in the mental level, the patient cannot be described in any way as yielding or malleable as a Pulsatilla patient should be. Finally, in order to choose Pulsatilla I would like to see more  “changeability”. The patient though, presents a well defined stability in all three levels. There is no mood swings, no irregular menses or any kind of deviations in her mental activity.

Nux vomica covers the same number of symptoms as Arsenicum does. In the mental plane Nux – v matches better to the irritability and anger of the patient. The Nux – v personality has this quarrelsome quality which is confirmed by the patient’s interview. The patient gets in arguments with her daughter because she believes she does not study effectively to achieve her goal. The patient believes that her way of studying is better. She has been through the same procedure by her self as a student and she knows. Besides that, we can see through  the interview  a tendency to perfectionism that the patient presents. Another feature of Nux – v is the fastidiousness. In Nux v. this desire for order derives from the tendency to perfectionism and not from the insecurity, as it happens with Arsenicum. In the physical plane Nux – v is chilly but without the lack of vitality as it happens with Arsenicum. The mental state of the patient was the major factor that weighed in my decision. I could describe her as an “alpha – female”.

Modalities such as “worse when becoming cold” and “better when lying” enhance the choice of Nux – v as the appropriate remedy for this case.

February 11^th, 2021 one dose of Nux – v, 30C, in the form of dry pellet.

Follow Up #01 – March 28^th , 2020

Carol took the remedy (Nux-V) on 11^th Of February 2020, at night (Tuesday), before going to bed. In the morning she could not wake up. She didn’t care though. It was not a bad feeling of fatigue. She was feeling this sweet sleepiness at school, too.

When she arrived at school she didn’t want to get out of the car. She wanted to go back to sleep. She didn’t want to do anything. She liked it though. (Wednesday).

Thursday: She decided not going to school. She didn’t go. She was sleeping almost all day long. Then there was some sore throat and catarrh. That lasted for two and a half days. After the third day the sleepiness subsided gradually, in a smooth way. She still has the “essence” of this sleepiness. She likes it.

That weekend her period came. She was sleepy. During her next period she had a slightly more painful headache than usual. She experienced less nervousness during the first days though.

She likes a little bit this situation regarding the COVID19 because she had the chance to rest. Now she has time for everything.  She had a hysterical reaction after the lock down was announced (due to the virus) which lasted 3 hours. Then she relaxed. She said she has the feeling that without the Nux-V that reaction would have lasted for three days.

She noticed that when she has some kind of dispute she follows a more defensive stance which has benefited her. She feels more relaxed. Sometimes it’s like she doesn’t care. Other times is like she projects the dispute in the future and she realizes that it is something she will not deal with it again, so it doesn’t worth it to spend any energy even in the present. Finally, there are times she faces the disputes with humor.

In her sleep there was a change. She started sleeping on her right side soon after she took the remedy. Now it’s half on the right half on the left side. She is still better with consolation. Still on the chilly side of body temperature.

Her sleep , which was already good,  has become divine. Now she has more patience in negotiating the “misunderstandings”. Before it was black or white.

After the remedy she noticed that she could forgive herself for not completing a task; she was not pressing herself to do it. She would leave it for the next day. Her energy has become good and effective.

On March the 20^th she woke up with stuffed nose. She was breathing from her mouth. If she wakes up suddenly from a warm bed or if she moves from a cold place in to a warm place suddenly, she sneezes for 4-5 times. It’s like the first sneeze feeds the next one. There is a peak of this situation in the spring (allergy). less intense in the summer and in  the fall. There is a sensitivity in the climate changes in general.

Assessment

After the patient received the single dry dose of  Nux 30C changes started to happen. For some days she was feeling drowsy but she liked it. This indicates that the remedy made her nervous system slow down in order for the heal to take place.

It is true that the patient was extremely active and she needed to take a break.

The catarrh with sore throat on the third day could be a possible slight aggravation.

The overall state of the patient has improved. Asthma attacks are completely gone. The patient does not refer at all to asthma attacks. It is as if she has forgotten about that.

Her sleep has become divine, as she says. Now her reactions when something bothers her are less snappish. She gives time to herself to think over a conflict before she reacts. The relationship with her daughter has improved and in general she feels more relaxed.

Her moodiness and some pain she was experiencing before and during her period are much better. She mentioned for the first time that every spring she has an allergy that gets better in the summer and in the fall.  From all the above I have to

consider that the first prescribing was correct.

Plan

Wait and watch. The patient has improved after a single dry dose of Nux – v 30 C. There is no reason for the moment to disturb this situation. No further dosing needed.

Follow up #02 – May 17^th, 2020

The first thing mentioned by Carol was the dramatic improvement pertain to her allergy. Every May she had copious catarrh and lachrymation. This year the improvement is 95%. As a result of the improvement in her allergy her mood has uplifted, too. She is very happy about that. When something concerns her she has the tendency to express it and talk about that. She is not quarrelsome anymore.

No signs of asthma attacks.

Assessment

Carol’s improvement is still developing.  Her asthma has disappeared completely and her allergy is 95% better than previous years. Her mood in general is very well.

I wouldn’t prescribe anything since I don’t see any reason for doing so. It seems that Nux Vomica was a successful prescription. No action needs to be taken.

It is remarkable that just a single dose of homeopathic remedy, not only resolved the patient’s major complaint (asthma) but it acted beneficially for her overall health. This is proved by the dramatic improvement of her allergy during the spring of 2020.

The result of the first prescribing and the “wait and watch” strategy after the first follow up seems to work very well for the patient, I decided that there is no need for a third follow up. I encouraged the patient to call me when she would think that it is necessary.

There were some times in those nine months after the first prescribing that Carol texted me just to tell me how satisfied she is with the homeopathic treatment. I consider the fact she never called me for a follow up very encouraging.