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A Case of Bell’s Palsy

The subject is a 29 years old male with dark complexion. He is a chemical engineer working for a multinational company. He comes from a religious and traditional Hindu family. He was a diagnosed case of Bell’s Palsy involving the right side of his face since more than 18 months. He wanted to try Homeopathic medicines after getting no result with conventional medicine, herbal treatment and 15 sittings of physiotherapy.

His case as given on May 12, 2007:

“I have this right sided facial palsy since November 2006. The right side of my face is totally paralyzed. I cannot close my right eye completely nor can blink it. I also have difficulty in raising right eyebrow. Because I cannot close the eye, it does not get protected from air or dust. So off and on it looks red and I get lachrymation frequently. I also have difficulty in eating and drinking. Water drops down from mouth while drinking. I can feel the stiffness in whole right side of the face. This facial palsy has left me with distorted look and distorted smile. Sleeping on right lateral side is difficult as the paralyzed side is painful if I sleep on that side.”

“I rushed to the physician and started treatment immediately on the day when I came to know that my face has got paralyzed. The physician told me that usually Bell’s palsy recovers completely in a month or so. I received steroid treatment to enhance the cure. I also completed about 15 sittings with physiotherapist. But it was of no help. I also received herbal treatment but there is no change in my condition in spite of all this. I also get weakness off and on. My stamina to work has reduced since this illness. I get numbness in my legs if I sit on the floor for a long time. ”

When questioned about the onset of the facial palsy, he gave the following history: “It was a month of November. Previous night we had a party. I returned late night. It was very cold and windy outside when I returned.  When I got up in the morning, I could notice some weakness in right side of my face. I ignored it thinking it must be because of cold outside. Weakness gradually increased by the next day. I thought of consulting our family physician. But I had a lot work in the office on the same day. So I could not see our physician on that day. By the next day morning the right side of my face was paralyzed.”

“I had cough for several days few months before I developed this facial palsy. Apart from that the only major illness that I have suffered is jaundice in my childhood. My father is diabetic and my mother is suffering from hypothyroidism. My appetite is good. I feel thirsty several times in a day. Our family is traditionally vegetarian. But I like non vegetarian food. I enjoy both spicy and sweet taste equally. I have habit of smoking cigarettes daily and I take alcohol occasionally with my friends. I keep awake till late night. Even though I go to bed by 11.30pm, I don’t get sleep till 2.30-3 am. I sleep till late morning. I get dreams but they are hard to recollect in the morning when I get up. My bowel habits are regular. I sweat moderately in summer. My perspiration stinks moderately but it does not leave any stains on clothes.”

“I never like to follow the routines set by the society. I like to live in my own way, as per my own wish. I don’t like to follow the rules and regulations set by my parents or by society. Because of this thinking, my parents always called me a problem child. I never obey them. They say that I always contradicted their wish and discipline. My parents wanted me to follow the religious path in our family and be vegetarian as per customs. But I started eating non vegetarian food. I left my home for the same reason. I don’t like anyone to force their thinking on me even though my parents. I have right to think in my own way. I have right to live my life as per my wish. Nobody likes my habit of smoking and drinking alcohol. But I don’t care. I don’t want to stop smoking and drinking just because somebody wants me to do so. Now my parents want me to marry. They say it’s a proper age to think of marriage. But I don’t want to marry just because it’s a custom. Is marriage necessary to live a life? I have a girlfriend. But I don’t want to marry now. What’s the problem to the society or to my relatives if I don’t marry till age of 60?”

“I like to be with my friends. I am enjoying my life with my friends. We do parties, eat whatever we want, and do whatever we want to….no restrictions.  I like to spend money. I spend every penny that I earn.  I visit my parents once in a month. My parents called me squanderer for my habit of spending so much of money. But I don’t care. My friends call me straight forward person because I speak straight without hiding anything or without caring for anything. I like to help people a lot. I cannot see anybody’s suffering”

Initial assessment:

This man has come for the relief from right sided facial palsy (Bell’s palsy). He gives the history of exposure to cold, windy weather 2 days before he developed palsy. This information points to exposure to cold wind as a possible causative factor in developing palsy. He also said that he had weakness of the right side of his face for about two days before the signs of palsy were visible. This indicates the gradual onset of paralysis. He describes himself as a man with contradictory disposition since his childhood. He says he does not like to follow the routines set by society and gives examples of resisting defiantly to such situations. As per the information provided by him, he likes to squander money, he is addicted to alcohol and tobacco and he also likes to freak out in parties. Though he has a girlfriend, he does not want to marry just because it is the custom. Deduced from this information, I thought it’s the anarchism aspect of his nature which makes him to break the norms set by the society.

Repertorization using the complete repertory:

Face, paralysis, right

Face, paralysis, cold from

Mind, contradict disposition to

Mind, anarchist

Mind, squanders

The other rubric that was also referred was from Phatak (A-Z) repertory:

Paralysis, gradual: Causticum and Syphilinum are the only two remedies listed under this rubric.

The remedies seriously considered based on this repertorization were Causticum and Merc Sol.

Causticum was the only remedy that covered all the mental as well as physical symptoms of the case. It is predominantly a right sided remedy. Great weakness and paralysis characterizes this anti-psoric remedy. The weakness of Causticum progresses until gradually appearing paralysis develops. Causticum is indicated for local paralysis; as for instance, of vocal organs, muscles of deglutition, of tongue, eyelids, face, bladder and extremities. It is indicated in paralysis that is post diphtheritic, or caused by exposure to cold, or from lead.

The usual mental picture of Causticum is hopeless, sad and despondent. The Causticum patient is over-sympathetic. He can also be suspicious, mistrustful, anarchist and one who looks on the dark side of everything. He cannot support  injustice.

Weakness followed by gradual development of paralysis, right sided facial paralysis and paralysis developed after exposure to cold weather are three characteristic symptoms presented in the case, that are covered by Causticum.  Causticum is also a good match for the mental symptoms viz: anarchist, contradictory nature and looking on the dark side of everything and at the same time sympathetic also. After repertorization and confirmation from materia medica, I selected Causticum as the constitutional remedy for this person.

Merc sol is the remedy I was thinking of while taking the case. Mentally, mercury is also anarchist, revolutionary. It is predominantly a syphilitic remedy frequently indicated in ulcers, destructive inflammations, abscesses, necrosis and other destructive pathologies. Paralysis is not a usual indication of Mercury. Also, the profuse perspiration without relief, moist tongue with intense thirst, slimy acrid discharges and night aggravation characteristic of this remedy, are not present in the given case. So, Merc Sol is a good match for the mental symptoms only. Since it does not match the physical symptoms, nor is it miasmatically similar, it was ruled out from final selection.

 

Based on my evaluation, Causticum was selected. It was given in 200c potency. The fellow was generally in good health, his symptom picture was clear and he had no limiting conditions that would have led me to choose a low potency. This is the potency I generally start a case with unless there is a reason to go higher or lower. He took a single dose of Causticum 200c on May 12, 2007.

Follow up June 10, 2007.

He reports: “One week after receiving the remedy, redness of the right eye started reducing. Drooping of right eyelid reduced. Now my both eyes look of same size. Stiffness of facial muscles is less, though there is not much change in looks. My sleep is better. Now I don’t remain awake for hours after going to bed. And I am also feeling energetic and fresh.”

In response to questioning he indicated that his feelings for his parents are still the same and he also reacts against the regulations set by the society in the same way.

My assessment based on this information was that Causticum was acting. Drooping of the eyelid had improved to a great degree and both his eyes looked of equal size. The right eye was no longer getting red. The stiffness of right sided facial muscles was less. The effective action of Causticum was also seen through an increase in energy level and improvement in sleep. Mentally there was no change, but that was not surprising because the mental symptoms were quite deep. No action was taken as the action of the remedy was still in progress. Follow up was scheduled.

Follow up July 20, 2007.

He reports: “I can notice a lot of improvement in facial palsy. Now I can close my right eye properly. Shape of face is getting to normal. Now I am able to drink properly. My sleep is normal. I feel more energetic than ever before. Appetite, thirst, bowel habits everything is normal. But now I am getting pimples like eruptions all over my body. It’s everywhere on face, scalp, back and chest also. I am also having dandruff since 3 weeks.”

In response to questioning he said, “I still feel angry about the rules and regulations set by the society. But now I don’t feel anger for my parents. I want to take care of my old parents. I feel more responsible for them. My mom was not well last week. I really felt sad for her. I am planning to stay with them so that I can take better care of them.”

My assessment was that he was continuing to improve. With continuous improvement in facial palsy, now mental symptoms were also improving. He was developing a bond of affection with his parents. He was feeling care for them. His anarchist nature is innate and so very deep. But he was showing change in his attitude towards his parents. Getting eruptions on body and dandruff were nothing but the exteriorization of the disease force on the level of skin. Now the disease force was moving from the more important organ (nerve) to a less important organ (skin). So getting skin eruptions and dandruff was a good sign indicating that the case still had a forward momentum and was still progressing. So no action was taken and follow up was scheduled.

Follow up September 12, 2007.

He reports: “Till last month the improvement was persistent but there is no further improvement in last 2-3 weeks. I can shut my right eye properly. I have regained the shape of face. If I blow air in my mouth, I have a good strength in cheeks to hold it back for few seconds. Skin eruptions are getting less. Still few eruptions are there on legs. Also I am feeling less energetic compared to last month.”

In response to questioning he said, “My mother was hospitalized 3 weeks back. She had fever and she was not responding to the treatment. So I was worried for her. Only after 3 days of hospitalization she felt better. After this incidence I am not able to notice any further improvement in facial palsy.”

My assessment at this point:  There was no further improvement in his condition since a month, and also he was felling less energetic. These two things indicate that the remedy has exhausted its action. Anxiety and worries due to mother’s illness may have acted as an obstacle to exhaust the remedy action. Since he was in status quo since one month, I felt it was a proper time to repeat the remedy. So a single dose of Causticum 200 was given to him which he took on the same day.

Follow up November 15, 2007.

He reports: “I am feeling better. There is no complaint about facial palsy now. The face is looking normal. The strength in facial muscles has also increased since last dose of the remedy. I can just notice mild twitching in facial muscles if I get exposed to cold air. But it lasts only for few minutes. I used to get twitching even before getting Bell’s palsy. My stamina to work has also increased. Skin eruptions are less. I can see very few of them on legs. Since my looks are normal, I asked my girlfriend to marry me and she agreed. We are getting married in January.”

When he was asked how he changed his thoughts about marriage, he said, “I have changed my mind. Previously I used to get obsessed by the idea of marriage. But now I think that the right things should take place on right time. I am happy with my girlfriend. She understands me well, she cares for me. Instead of spending time and money in parties, I like to spend time with her. I think she is the perfect match for me.”

My assessment was that recognizing his love and the decision of marriage show a drastic change in his constitution. It is in stark contrast to reckless thinking, irresponsible behavior and obsession about marriage. Twitching of facial muscles after exposure to cold is the recurrence of the old symptom, which indicates that the process of cure was still in progress. No action was taken and follow up was scheduled.

Follow up January 5, 2008:

He reported: “I am perfectly ok now. I don’t have any complaints. I think I have regained strength in facial muscles. I haven’t experienced twitching in right facial muscles since a month. Skin eruptions have subsided completely. I am getting married after 2 weeks. My parents are very happy for me.”

In response to questioning he said, “I still have anger about the customs and traditions that are forced on by society. But now I recognize that all the traditions are not bad. And regulations bring the discipline. So we should have a flexible approach toward them.”

My assessment was that he was physically and mentally stable. With 2 doses of Causticum 200c his facial palsy improved completely and it was followed by Hearing’s law of Cure. His mental state changed drastically in the last few months. He was a person with reckless thinking, irresponsible behavior, a careless attitude, and a bad habit of squandering all his money. He developed a greater sense of responsibility. The one who was obsessed by the idea of marriage was getting married. He had been cross, contradictory and irresponsible towards his parents.  Now he was showing care and affection for them. He still feels angry about rules set by the society, but he has developed a more responsible and milder approach in  reacting to his anger. I thought that no action was needed. He was asked to call if he had problems in the future.