First Consultation – September 2014
75 year old female, married. Her main problem is confusion, dullness of mind. After days of anxiety and worrying about some family matters she developed for the first time confusion of mind (3). She describes it like a fog in her head and difficulty in concentration (2) which prevents her from finding solutions to important issues.
She also has vertigo in th evening when turning while lying in bed (1) and in the morning on getting up from bed (2), sometimes is accompanied with nausea. It’s a feeling as if the room is turning around. Whenever she gets upset she has a feeling of constriction or pressure behind the sternum (2) which goes away after a few sips of water. Perspires intensely in axillas (2) with offensive odor(2). Her right hand sometimes feels numb (2) and she has swelling in fingers (1), mostly in the morning. Pain it the left shoulder (2), in the right heel (1) and swelling of the right ankle (1). Almost all day has noise in ears (2), like a fly, especially when it’s quiet in the room.
When she moves her head she has a feeling of sand in her neck (1). Almost every night when lying in bed she has a very annoying dry cough (2) which after about 10 minutes goes away. Her eyebrows are falling out (2) and also the hair on her head (1). Has pain in the back in lumbar region while standing (2), ameliorated when lying down. She avoids doing anything standing, lying is her best position. Sometimes has dull pain in right hypochondria (1).The ultrasound showed gallbladder stones. Has Hashimoto hypothyroidism (1).
She tolerates cold and warmth. Has dry skin (2) with slight itching now and then (1). Desires fruits (3), vegetables (3), sweets (3), soups (1), fish (1). Aversion olives (2) and eggs (1).
Sleeps sometimes on her back, usually with her hands above her head (1), sometimes on her sides (1). Snores a lot when lying on back (2). Easily falls asleep and wakes well-rested. Her dreams sometimes are intense.
She is a very optimistic person, very independent, open, communicative, likes to go out very much with every opportunity. She is open and intrigued by anything new. Her house is never tidy, she calls it a creative mess and admits her laziness (3). Her husband believes her incapable of keeping the house tidy and says she’s irritable when doing housekeeping (2). Her appearance is sloppy. She is critical to others (2). Reports no fears.
She has had for a long time difficulty in concentration (1), in remembering names (1) and finding the correct words (1). Sometimes forgets her purchases in the shop (1).
PERSONAL MEDICAL HISTORY
At age of 16-17 had pleurisy cured with antibiotics. In the age of 44 had purulent ovaritis and was hospitalized for two weeks. Twelve years ago had herpes zoster under her left mamma, cured with allopathic therapy. Can’t remember ever having an acute with high fever. The only high fever she ever had was from a flu,7 years ago, which passed away by itself, without help of medication. For the last 4-5 years every winter, has a dry cough for one month, which passes on its own. Otherwise she’s never been ill, except for the diseases mentioned above.
FAMILIAR MEDICAL HISTORY
Both of her parents were over 90 when they died of old age. Her father was healthy all of his life, was operated only for gallbladder stones and her mother had arthritis for 10 years before she died. All of her siblings are healthy.
PROGNOSIS OF THE FIRST CONSULTATION – DEPTH OF THE DISTURBANCE
Her problem is mostly on the physical and mental level. On the mental level she has had for years absent-mindedness, forgetfulness and lack of concentration which are on the superficial level of the mental plane. Now she has a confusion of mind which is deeper than the previous symptoms. On the emotional level except for the irritability on doing housekeeping she’s quite healthy. Her physical symptoms of vertigo could be on the nervous or vascular system. She has endocrine ailments and some symptoms on more superficial levels of respiratory and tendons and muscles.
PERSONAL MEDICAL HISTORY
The patient shows a good constitution, since she has been ill only three times in her entire life. Vertigo, difficulty in concentration. The dry, itchy skin of the patient give us an idea of the psoric miasm and her joint complaints of the sycotic miasm.
FAMILIAR MEDICAL HISTORY AND HEREDITARY PREDISPOSITION
Her mother’s arthritis gives an indication of sycotic miasm. The fact that both of her parents died of old age with no health problems during their lives shows a very good hereditary predisposition.
Her complaint most probably was triggered by the worries and anxiety she’s been experiencing lately. Pathology-wise there are no deep problems and the prognosis is good from that point of view. Homeopathically, the fact that her main problem is on a mental plane and has a tendency to move deeper, from absent-mindedness, forgetfulness and lack of concentration to dullness are not favorable, because any complaint that is accompanied by mind disturbances is more difficult to cure. Fortunately on emotional level she’s quite healthy, has no fears, is an independent, optimistic, open person. Her hereditary and the fact that she was ill only three times in her life, and except for those health problems she had younger, hadn’t use any other allopathic drug, are favorable for the prognosis.
People who have never had an acute belong to the group of very healthy people in level 1 or of the very sick, levels 9-12. The fact that she had reached the age of 76, being relatively healthy in spite of her everyday problems and never had an acute, except once, seven years ago leads us to the conclusion that she must have been in a group A, level 1, all of her life. The acute with high fever 7 years ago confirms it. If she were in levels 9-12 she couldn’t have develop a high fever which would pass by itself. The clearness of the remedy and her reaction to it will show us what level of health she is on.
SELECTION OF SYMPTOMS OF THE FIRST CONSULTATION
-Irritability on doing housekeeping
-Anxiety-tension in the chest
-Dry cough on going to sleep
-Vertigo on turning in bed
-Vertigo, morning on rising
-Snoring lying on back
-Pain in lumbar region on standing
-Numbness of the right hand
-Swelling of the fingers in the morning
-Fruits, sweets and vegetables desire
INTENSE SYMPTOMS: Independent , Laziness
REPERTORISATION AND REMEDY SELECTION OF THE FIRST CONSULTATION
I didn’t use too large rubrics like buzzing noise in ears, concentration difficult, confusion of mind, vertigo with nausea, falling of hair, dry skin with itching, pain in right hypochondria nor the rubric with only one remedy- Aversion to olives. I can always use them in differential diagnosis. The symptom- Tension, constriction in chest behind sternum, from getting upset and drinking water amel. I couldn’t find as it was described. I found Constriction, tension, tightness-heart-drinking water amel, but I didn’t use it because the patient didn’t specify that thedescribed feeling is from the heart, which she would have accentuated. She just showed the middle of her chest a little bit higher of the heart. Also this rubric doesn’t have the modality- on anxiety. So the closest rubric I found and used is Mind-anxiety-pressure-on the chest.
DIFERENTIATION OF THE REMEDIES
SULPHUR has as keynotes standing agg, aversion olives and eggs, desire sweets, critical, lazy, untidy, itching of the skin, agg from standing, amel from lying. There are no contraindications.
LYCOPODIUM is open, has gall bladder affection, is right sided remedy,(in the case all the extremities symptoms are right sided except the shoulder). Contraindication is desire for olives. The essence cannot be confirmed.
PHOSPHORUS is open and has desire for sweets and fish. There are no contraindications.
RHUS TOXICODENDRON as key notes has stiffness in muscles and joints, agg on beginning to move after rest.
PHOSPHORICUM ACIDUM doesn’t have any key note and doesn’t fit the m-e picture.
BELLADONNA is right sided like Lyc (but as said in Lyc the patient’s physical symptoms are not all right sided), no other key notes, nor fits the m-e picture.
NATRUM MURIATICUM has only desire for fish as key note which is only in the first degree in the case.
MAGNESIA MURIATICA, LACHESIS and ARSENICUM have no key notes.
Sulphur is the most prominent remedy in the totality of symptoms and the patient fits in its mental-emotional description with laziness, irritability on doing housekeeping, independent, critical, being sloppy. She has keynotes like pain in the back on standing being her worse position, pain in left shoulder, aversion olives, desire sweets. Also, all the rubrics I didn’t use have Sulph. In this case we can prescribe on the totality of symptoms. The essence and some key-notes prove the correctness of the remedy choice.
CHOICE OF POTENCY
Since the patient hasn’t got severe physical pathology and the clearness of the remedy picture shows that she is in group A, we can use any potency. But since she is an elderly person, we should avoid going higher than 200. If necessary, we can always raise the potency.
Rp. Sulphur 200C
REACTION TO THE FIRST PRESCRIPTION
The first three days after the remedy she had an aggravation of the main symptoms-confusion and “fog” and couldn’t concentrate. After the initial aggravation she had gradual but constant amelioration on mentals and especially in energy level. She even started to do more housekeeping and wasn’t irritated while doing it. Also she began to do exercises every morning after waking. She is in excellent mood and feels that she is able to confront her every day problems in a more determined way. She said her brain was working as if she was 40 years younger. She feels now more stiffness and numbness in her hands and fingers in the morning on waking. The middle finger of her right hand is swollen all the time. Pain in the right heel is worse.
The patient’s reaction to the remedy, immediate initial agg with amel, confirms that she belongs to group A of levels of health. There’s a great improvement, as is expected in patients in group A, with amelioration on deeper level and moving the problem to the peripheral level. It clearly shows the direction of cure from inside-out, clearing the mental level and bringing all the disturbance on the physical level. Now we must wait and permit the remedy to do as much as it can for the organism.
SECOND CONSULTATION, FOLLOW UP after 7 months
The patient is complaining of more intense vertigo and pain and numbness in her hands. Now has vertigo on bending the head backwards(2),on rising from the bed (2), worse lying on the left side(2), better on closing eyes(2). When turning in bed from right to the left side the whole room is turning around and is nauseated (2).
Also every morning on waking her fingers are numb (2) and swollen(2), has tension or stiffness(3) and numbness (2) in both, but mostly in the left hand. The pain is in tendons in the middle and on the exterior part of the palms. She cannot close her fingers into a fist and needs to make constant movements of them to make it feel better. Numbness of finger tips (1). Pain in upper arms (2), cutting pain in right shoulder (2) and tension in ankle (1). Coldness of knees (1) and feet (1). The skin on the tips of the thumb and index finger of the right hand is peeling off (2).
Also, there are two symptoms she had had during the first consultation and before that, but forgot to mention it. One of them is the sensation of sand in her eyes (2). The other one wasn’t difficult for me to notice-Twitching of her eyelids (2). Her back in lumbar region is even more painful from standing (3). Her generals are still the same, only desire for fruits and sweets are less intense.
SELECTION OF SYMPTOMS OF THE SECOND CONSULTATION
PECULIAR SYMPTOMS: -Vertigo on bending head backwards
-Vertigo on rising from the bed
-Vertigo, lying on the left side agg
-Vertigo, closing eyes amel
-Vertigo turning in bed
-Vertigo with nausea
-Cutting pain in right shoulder
-Fingers numbness morning on waking
-Fingers swollen morning on waking
-Hands numbness morning on waking
-Finger tips numbness
-Upper arm pain
-Sensation of sand in eyes
-Twitching of eyelids
INTENSE SYMPTOMS: -Tension in hands in the morning on waking
-Stiffness in hands in the morning on waking
-Back pain in lumbar region on standing
REPERTORISATION AND REMEDY SELECTION OF THE SECOND CONSULTATION
I didn’t use rubric Vertigo-bending head backwards, because it has only 2 remedies which don’t fit the patient’s picture, nor the too large rubric Coldness of feet. As I understood stiffness is a rigidity of the hand due to tension of muscles, so I used both, stiffness and tension with the modality in the morning on waking where it was possible to find.
DIFFERENTIATION OF THE REMEDIES
SULPHUR has keynotes, sensation of sand in the eyes, aversion eggs, olives, agg left side. Contraindication is coldness of feet.
PHOSPHORUS has key note agg sleeping on the right side, left sided, feet and knees cold, open personality, desires fish. No contraindications.
CAUSTICUM has no keynotes. Desire for sweets is contraindication.
ARSENICUM has no keynotes. Sloppiness is contraindication.
LACHESIS is left sided. Contraindication is that symptoms may go from left to right (the patient’s symptoms were on both sides, but more on the right side in the beginning and now are more on the left side).
PULSATILA has no key notes. Contraindication is desire for eggs.
FERRUM METALICUM as key notes has desire soup, aversion eggs, rheumatic pain of upper limbs.
BELLADONNA has no key notes. Contraindication is right sidedness.
CONIUM MACULATUM has vertigo on turning in bed. No contraindications.
RHUS TOXICODENDRON as key notes has stiffness in muscles, joints, agg on beginning to move after rest. No contraindications.
Phosphorus and Sulphur cover the most symptoms. The most intense symptoms, stiffness and tension of hands in the morning on waking are not represented by Phos. After the first prescription she said that her generals didn’t change except of desire for fruits and sweets that are less intense and that she became more prone to do housekeeping. There are, also, no changes in the m-e picture. Also she belongs in the uppermost layer of group A of levels of health. The patients from that group don’t change the remedies easily. So Sulphur should be considered before Phosphorus.
CHOICE OF THE POTENCY
The patient’s defense mechanism was strengthened after the first prescription. There are no more m-e symptoms. Since she reacted well on 200so I shall repeat Sulphur in the same potency.
Rp. Sulphur 200 C
REACTION TO THE SECOND REMEDY
After Sulphur 200C, all the symptoms were gradually decreasing without an initial aggravation. About 1 week after the remedy the cough she has had every winter for the last 5 years occurred but in lesser intensity and it lasted for about a week instead of a month and passed by itself. The patient feels very good in all levels.
EVALUATION OF THE FIRST AND THE SECOND REMEDY PRESCRIPTION
An initial agg of the main complaint followed with an amel on a deepest level is a very good reaction. All the force of the defense mechanism from the m-e level went to the physical level and developed some new or made more intense some existing physical symptoms. After the second prescription she didn’t develop an initial agg, most probably because after the repetition of the same remedy in the same potency the organism was used to the stimulus, so it gave a milder initial reaction. After this prescription we could expect that, unless there’s a strong antidotal influence, she would remain healthy for many years.
THIRD CONSULTATION after 4 months, September 2015
After sitting in an air draft, although it was summer and very hot, the same night developed a feeling of a strong constriction in the whole thorax as if it was in a vice. Her respiration was very painful. The whole night she was putting compresses with alcohol to help herself till the morning. Her temperature was 37,2 C. The next day she was breathing with no pain.In the hospital she did detailed examinations and they found the CRP 104 and was TBC positive. She was prescribed antibiotics which I recommended not to take, because when they were prescribed two days later. All the symptoms were already gone and she was feeling as if she was completely healthy. She was physically, mentally and emotionally strong. After 10 days she did the blood test again and CRP was 5. Of course there’s always a possibility of a laboratory mistake. The patient herself noticed that the feeling she had that night was somewhat like back then when she was ill from pleurisy only in a much lesser degree. So we could consider it as a good sign of an old symptom coming back and passing on its own without further help. Since she was well in general and had no more physical symptoms I didn’t prescribe her any remedy nor she took the allopathic medication.
FOURTH CONSULTATION after 4 months, January 2016
The patient still feels good in general, strong physically and mentally and emotionally calm. The only symptom now is a fluid discharge from rhagade under her left breast that has been discharging discontinuously for about 1 month. It’s interesting to notice that at this area she had herpes zoster 13 years ago. So I can assume that it’s an old symptom coming back in a less severe form which is a very good sign. Since this symptom is not bothering the patient and there’s no other complaint, the patient feels healthy on all levels, I decided not to prescribe.