Courtesy of The Victorian College of Classical Homeopathy http://vcch.org/ 
First visit – April and May 2010
S. is an 18 yr old woman with a two year history of anemia  from heavy menses and metrorrhagia that started soon after a move with her family in the late spring of 2009. The move caused her some stress and sadness from leaving behind friends, though she understands the need to move because her father became the new minister of a parish in another state.In July of 2009, she was admitted to the hospital because she was pale, dizzy and faint from heavy bleeding. Testing showed that she was severely anemic, requiring two units of blood. Iron pills (325 mg/3x/day from Sept. 2009 to July 2010) were prescribed for her low iron level, that later caused constipation. She continued to have heavy, irregular menses with bleeding between menses and a birth control pill was prescribed (Cryselle). Her menses became painful with abdominal cramping and backache after starting on birth control.
S. is a slender young woman who displayed a quiet and reserved demeanor in the interview with her mom. She is polite, well-mannered and speaks in a quiet voice with some nervousness. In a later interview without the mom, she answers all my questions but is reluctant to say much about her life or family, though she is able to answer the ’head to toe’ questions. Fashion design, music and art are what she likes best. As a young teen she was very active in competitive sports like track and field and pole vaulting. She is the oldest of 6 children. The family has relocated numerous times due to her father’s military and religious work. She has always been home-schooled by her mother, as are all her siblings. Mom says she has lots of friends and is self confident at home. They are a very tight knit family and have a large extended family in the area where they live.
Overview of Case:
Fear of snakes, heights
Sensitive to noise-headache
Fear and dislike of doctors; uncomfortable with questions
Moaned in sleep as child
Sadness from relocating in summer 2009
Heavy menses, protracted-7 days, <3rd day, some clots, red. Onset 13 or 14.
Anemia-low iron and RBC, chronic for past 2 yrs from menorrhagia , menses
H/o spotting between menses and bleeding
Iron pills for anemia
Birth control for bleeding and heavy menses
Painful menses with backache, cramps in abdomen, since starting BC- none prior
Aversion to fat (meat, pork, bacon), shellfish
Desires chocolate, daily
Nausea riding in car all her life
Sleeps well, takes 1 hr to fall asleep at times. Sleepy on rainy days, lazy
Recurring dream as child of farmyard scene with horse that looked like painting or photo
Prefers warm weather, not extremes, chilly in general
Worse in winter. Likes spring and summer best
Grinds teeth in sleep
Acne on cheeks, chronic, red pimples; worse with menses
Backache with menses on BC. None prior to BC with menses
Headache at temples-pressing, aching, constricting from noise, choir practice
Menses- irregular, heavy, protracted; suppressed from birth control. Metrorrhagia. Anemia (low iron and red blood cells). Painful menses since on birth control with backache and cramps in abdomen.
Nausea riding in the car, chronic
Aversion to fats, fish
Sadness after move and loss of friends. Metrorrhagia and heavy menses result.
Chilly in general
Mind, Grief, ailments from, agg. ( 845)
Stomach, Nausea (845)
Female, Menses, protracted, prolonged (240)
Female, Menses, suppressed (358)
Blood, Anemia (285)
Back, Pain, menses, during (165)
Generals, Heat, vital, lack of (284)
Generals, Food and drinks, fat and rich food, aversion (89)
Generals, Riding on cars or wagons, during (186)
Because the problems with menses began shortly after the family move to a different state, this seems to be the cause of hemorrhaging, with S. saying she experienced feelings of sadness and loss at this time. The rubric ‘ailments from grief’ is chosen to represent this etiology. The rubric ‘suppressed menses’ is chosen because her menses became painful with cramping and backache after starting on birth control- prior to this she never experienced any pain. We don’t know when the anemia actually started and it could have been an issue long before she required hospitalization. Her anemia could be the result of gradual blood loss from menses over time, exacerbated by the hemorrhaging episode in the summer requiring the blood transfusions.
|Yellow – 1||Red – 5-7||Blue – 3-4|
|Hairline- crowdedHairline arc|
Teeth- top even ?
|Forehead- curvedBridge- indented|
A/s- eyes, nose
The facial features show that this patient is dominant in red (sycosis) and requires a remedy that is dominant in red (sycotic) energy.
Miasm: Red remedies are in bold
Remedies: The following remedies are in all rubrics:
Sep 34/9 puls 33/9 sulph 32/9 ars 31/9 bell 31/9 calc 31/9 nux-v 31/9 phos 31/9 bry 30/9 kali-c 30/9 lyc 30/9 nit-ac 27/9 cycl 27/9 nat-c 24/9 rhus-t 24/9
Remedy and Dose: Sepia 30c daily dose
June – August 2010
Mom says she is fine with email or phone calls. Menses normal, no bleeding between menses. They have been traveling all summer and S. will have blood work in July for anemia and iron level. Her doctor says she may stop birth control and iron in June or July if she continues to do well.
September 22, 2010
She has had a normal period. No pain or backache with menses. She stopped taking the birth control pill and iron supplement in July. Off fiber supplements for constipation. Her ferritin and hemoglobin levels are in the normal range (July 2010 blood work), but RBC is still below normal though it has improved. Acne on face is much improved- 90% better. She reports that her face cleared up after only one week on the remedy. No nausea riding in car. No headaches. Sleep is good. No grinding teeth or moaning in sleep. Energy is good. Less chilly. No colds or flu in spite of exposure from family members. She and mom are very happy with the results! Rx: Continue on Sepia 30c daily.
October 22, 2010
She’s doing well. Just a few small pimples on forehead. Acne was on forehead and jaw line, both sides. She had one cold, as did other family members, for only three days, and is clear now. Rx: Continue on Sepia 30c daily.
November 17, 2010
In early November, she was a bridesmaid at her best friend’s wedding. She designed and made all the gowns and suits for the wedding party. Her facial acne is worse for past 2 weeks. She is feeling tired and chilly. No bleeding between menses or pain with menses. Rx: Continue on Sepia 30c, daily dose.
December 29, 2010
She is spotting, dark color, in evening, after having her normal period 2 weeks ago. Mom says she has been overdoing it with daily sleepovers at friends, (not taking remedy every day), her job as music teacher, and Christmas charity work. Mom says all this is much more activity and stress than she has been used to in the past and insists on complete bed rest until spotting stops.
Rx: Resume Sepia 30c, 2-3 times daily until bleeding stops, then reduce to a daily dose. Mom is instructed to try Arnica 30c if Sepia fails by morning and to go to ER if bleeding becomes worse, or if she thinks it is necessary now. Sepia works- spotting slows, then stops completely within 1-2 days.
January 24, 2011
Her doctor at the cancer center dismissed her in January 2011 since her test results were all in the normal range. He requested she have a blood count done by her primary care doctor annually. She is doing well, no complaints. Planning on starting college for fashion design in the fall at a university in another state where she will be away from her family for the first time.
Rx: Stop remedy and see how she feels. Resume Sepia if needed and keep in touch on progress.
Her blood work shows her iron (ferritin), hemoglobin, and red blood cell count as follows:
Bloodwork: July 2009 – January 2010
July of 2009
Ferritin was 8 (normal is 23- 70); hemoglobin was 10.9 (normal is 12.0-17.0); RBC was 4.05 (normal is 4.50- 5.30).
November of 2009
Ferritin was 14; hemoglobin was 12.9; RBC was 4.31 (Hemoglobin is normal)
January of 2010
Ferritin was 18; hemoglobin was 12.2; RBC was 4.01. ( Hemoglobin is normal)
July of 2010
Ferritin was 28; hemoglobin was 12.4; RBC was 4.12
(She has been on Sepia 30c since May 29, 2010. Ferritin and hemoglobin are normal, RBC is still below normal. Iron and birth control discontinued.)
January of 2011
Hemoglobin was 13.5; RBC was 4.32 ( Hemoglobin and RBC are normal. Ferritin was not tested.)
*Her doctor at the cancer center dismissed her in January 2011. Test results were all in normal range. He requested she have an annual blood count done by her primary care doctor.
S. started Sepia 30c on May 29, 2010. Eight months later all blood work is normal.