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A Case of a Young Boy with Bronchiolitis

1st consultation: 2/8/2013

The boy was born by emergency C-section because the mother did not dilate enough. He was full term. After birth he was not breathing+++. Doctors told the mother to pray for the baby as he was in critical condition and all blue. He recovered from that but his mother was shocked and it took her a while to recover. He had been breastfed for 5 months without problems. At 3 months old he experienced his first episode of bronchiolitis. He has been hospitalised frequently over the past few years when his breathing got really bad.

“Lungs are full of mucus”+++, very fine rattle, wheezing and whistle+++ little expectoration+++.

On examination- very fine rattling on both inspiration and expiration deep in the chest. The boy tried to cough it out but it just stays there. Mother says that nothing really makes it better.

Mother reports: In the past it would get really bad < night that he could hardly catch a breath. He would breathe really fast, pale in the face, would express pain in the chest and it looked constricted, use of accessory muscles, “ fighting for breath” as mother says, and would ask to drink water.

Doctors have also said he may have asthma. In the past he had several courses of antibiotics, Ventolin and had been fully vaccinated.

History of ear infections, ongoing water in the ear <R –side, hearing < on R- side as well.

Generals:

Appetite: good appetite, prefers warm food and loves his warm milk+++ (has to have the milk!)

Sleep: interrupted by cough occasionally, no expectoration, hasn’t slept a night through; sleeps on the side.

Temperature: more warmish but can have cold feet; likes to wear socks at home

Perspiration: sweats a lot on his head <night during sleep++, can have sweaty/clammy palms.

Stool / Urine: good

Energy: changes depending on his condition, can be very low on energy, ‘just not right’ as mother says.

Mind: A happy boy, who likes to play quietly and can play on his own with toys, cars, motorcycles. He seems to be more independent compared to his sibling (F,8). He can be shy with new people but only for the first 5 minutes and then he is OK.

Observation: he was hiding behind his mother but still looking at me and seeking contact. Playful.

Milestones: mother says that he started walking late at 15 months. He liked to be carried a lot, talking at 6-7 months, teeth at 5 months old.

Family History:

Father: psoriasis

Mother: Hypothyroidism (from shock after the boys’ birth), PCOS

Fathers’ mother: Asthma

Father’s father: Hay fever

 

Thoughts: looking for a remedy with a propensity to cause mucus overload in the lungs particularly in the tiny bronchioles, with panting, rattling, gasping for air and very little expectoration.

Rubrics: (from Synthesis, Dr Frederik Schroyens)

Respiration, panting (p. 1110)

Respiration, gasping (p. 1108)

Respiration, accelerated (p.1095)

Respiration, asthmatic (p.1096)

Respiration, whistling (p. 1113)

Respiration, rattling, expectoration, without (p. 1111)

Expectoration, difficult (p. 1151)

Expectoration, scanty (p. 1154)

 

Differential:

I thought of several remedies including Antimonium tartaricum, Arsenicum album, Kali carb, Ipecac, Lycopodium. However, only one remedy stood out:

Antimonium tartaricum – produces rattling of mucus with little expectoration, chest full of mucus yet less and less is expectorated. Respiration is rapid, short, difficult , seems as if he would suffocate. Suffocative shortness of breath, gasping for breath and thirsty for cold water; history of neonatal asphyxia.

Note: Ant tart has a major therapeutic application in respiratory diseases, and affects the mucus membranes (bronchi, respiration, lungs, circulation).

Prescription: Antimonium tartaricum 200c – take 2 pills once a day for 3 days and call me back.

I also gave two other remedies to take home but to wait for further instructions.

Calc carb 30c – The constitutional remedy, as the child is of a more calm and placid nature, delayed walking, liked being carried, can play on his own, profuse perspiration of the head during sleep, chronic otitis media with defective hearing, cervical glands enlarged, strong craving for milk, propensity to wheezing, whistling respiration, cold feet and clammy hands.

Bacilinum 200c – antimiasmatic remedy – catarrhal chest and bronchiolitis (bacterial infection), expectoration minimal, more suffocation, preferably used in children, family history of COPD, hay fever, asthma (mainly sycotic background).

Note: I can imagine that the triangle of Calc carb- Lycopodium- Sulphur may well come into use later on, as there are many aspects of all three remedies in the child, with Calc being the most predominant at this stage.

 

The mother called 3 days later to report significant improvement in wheezing. The boy appeared to be more happy and lively.

Instructions: Take Ant tart 200c once daily until clear improvement. Once the improvement is very good (80% better) – wait for 2 days and start with constitutional and anti-miasmatic remedy on a weekly basis with remedies taken 3 days apart (example: one every Monday, the other every Thursday).

Follow up : 4 weeks later 30/08/2013

The boy has taken Ant tart 200c for 7 days during which time he expectorated a lot of mucus. He had a lot of yellow/green discharge from his nose as well. He has more energy and has been sleeping better. He has been asking for a lot of milk. There is still mucus coming out occasionally from his chest but he is much better. No wheezing in the chest.

Note: I see this elimination of mucus as a positive sign, his energy, mood and sleep have improved, which all points in the right direction.

Recommendation: Continue only with weekly Calc Carb and Bac.

 

September 2013: Mother has come back 3 weeks later for herself to treat her thyroid problem. Reported that the boy is so much better that she is not concerned any more.

November 2013: The mother is coming for herself 2 months later. She has given the boy his constitutional remedy with anti-miasmatic remedy on a weekly basis (for 2 months) and after that she stopped giving him anything else. She is happy with how bright and healthy he is.

January 2014: The mother is coming only for herself. She reported that the boy is doing really well and no issues with his chest or breathing. She was delighted with boy’s improvement.

 

References:

Barvalia, Praful. Bacilinum vs Tuberculinum, Indian Journal of Homeopathic Medicine. viewed http://homeoint.org/hompath/articles/1731.html

Hahnemann S, 1997, Organon of Medicine. B. Jain Publishers, New Delhi.

Master FJ, 2006, Clinical Observations of Children’s Remedies, 3rd Edn, Rene Otter, Lutra Services BV, Eindhoven – Netherlands.

Schroyens F. 2004, Synthesys- Repertorium Homeopathicum Syntheticum, 9.1 Edn, Homeopathic Book Publishers, London.