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.