Cystic Tumor on Cheek – Female 24

This case may look simple, it being only a cystic tumor on the cheek but the importance is the downside of what conventional treatment has to offer for such a case. What would happen to the looks and general health of this young girl if surgery left a scar and new tumors formed on her cheek or other parts of her body? That is the risk from standard medical treatment

Readers shall be benefitted from this case in understanding some features of a lesser used remedy. Please note that this case is taken in a non-standard manner, hence at many places you shall find incomplete details. I had to take this case in a casual visit to my friend’s home, and given the time and circumstances, I took what details I could and prescribed.

CASE

Miss. AB, female, 24yrs, tumor on right cheek. She works as faculty teaching computer programming and spoken English and handles accounting and enquiries at her office. She completed Dip. in Elect. and communication and is now pursuing computers. She prefers to go further in teaching and doesn’t like to work under a boss. Wants to start her own business. She never replies back to her seniors/elders. She may remain quiet for some time but suddenly may lose patience and then she bursts out. Doesn’t like to be ordered around, wants people to talk softly to her.

Figure 1: Oct. 2019 during first follow-up:

Unmarried. Her parents didn’t agree to her marriage due to horoscope/kundli issues. She decided to listen to what her parents and mother says and will not go against them. Overall, she wants to marry and settle down.

Presenting Complaints

She had dental treatment 5months back. At that time there was a large swelling on her face, but it reduced and now she has a tumor which is not going away. Mostly painless but also feels as if there is a liquid at the tip.

Inside her in mouth, the cheeks look normal, decayed teeth on both lower sides. She doesn’t take much sweets and is averse to them.

On examination, it was found to be a tumor with a hard base++, irregular contour and liquid at the top, with a feeling that if pressed hard enough, something may pop out. Cheeks being very soft tissue, this hardness was quite prominent.

PAST HISTORY:

1. In 7th std, she used braces and four teeth were removed at that time. Eight months’ later it was removed.
2. She had nail issues in childhood.
3. Left elbow had boils or pus etc. Used a lot of antibiotics at that time.
4. 2 years back she may have had tumor in breast, painful, also present now.
5. Once had food poisoning, diarrhea and vomiting – 1year back. She was travelling at that time. She was admitted in hospital.
6. Headache occasionally from sitting long in front of the computer.
7. Frequent fainting+++ during assembly in school days, standing in hot sun for more than half hour. Also fainting++ during menses, standing under sun++. She also fainted in biology lab from looking at cut cockroach.

FAMILY HISTORY:

Father: Died from liver cancer

PERSONAL HISTORY:

Appetite: Poor. Prefers warm food++.

Thirst: 2.5 glasses in whole day. Thirst for little after food. Drinks small quantities only. Earlier she used to drink warm water daily in the morning.

Desires: Spicy+++. Salt (n). Pickles (started since some time – garlic pickle++). She doesn’t eat meat, only eggs and/or mushrooms. May take gravy but not meat.

Aversion: Sweets++. Fruits++. Milk earlier she used to drink but stopped since 5yrs, yet there is no aversion).

Sleep: Always lazy+++, and sleepy++. At night she will not get sleep, but during daytime she feels sleepy all the time and no desire for work. She sleeps in night, still sleepy during day. Needs siesta very much. Fresh after siesta. She has to force herself to get up and go to work. Sleeps on sides with legs folded. Needs blanket always.

Doesn’t need fan in winters.

Urine: Normal

Bowels: Normal

Perspiration: No sweat at all.

Susceptibilities: Artificial earrings will lead to itching and redness of ear lobes. Even in watch area, itching is there, if the watch is tight. Shoe bites are common. She fainted from an ant bite 3 years ago.

MENSTRUAL HISTORY:

Menarche: 6th std.

Cycle: Regular, 4/28 days.

Ailments before:  during: earlier dysmenorrhoea was there, now only mild pains.

after:  LMP:  Sep 2019

PHYSICL GENERALS:

Dental caries. Lean, thin, marasmic.

Old x-ray report yet to be verified.

LIFE SPACE:

Anxiety about health++   More lazy than fastidious.

Not too religious. Far from superstition+++.

Silent disposition. In a group discussion, she will mostly be silent. Earlier she was very aggressive, but somehow, now she isn’t.

Believes in meditation, not God. Prefers to keep her brain pure as possible. Doesn’t believe in pooja etc.

Daydreaming++, about her present and future. Always absorbed in her own world. Always happy, takes things lightly.

Average in studies. No desire to study now as she is also doing her job.

She forgets certain things. Things told to her in office she forgets and thus now she is noting it down. Her memory may be poor for routes, especially long routes. Even difficult words in studies are not easy to remember, so she leaves it. Prefers an easy life, avoids difficult situations. Never bargains to shop, auto drivers etc. Has sympathy for such people. Even during case interview, many things about past she did not remember clearly. Poor memory definitely.

Curious+++ about many things: scientists, reads biographies, encyclopedia. loves to read such articles. Same interest for food. Reads food packets completely.

Fear: nothing specific, pet dogs. Marriage as of now.

Case-analysis

As per my understanding the following remedies seem to come up prominently in the case:

Graph: This remedy popped up on repertorising and does cover a keynote or two. It is my habit to add the pathology in Rep. sheet at the beginning of the case itself, and I do pay a lot of importance to pathology as each remedy has its own affinity for organs and the specific type of disturbance it causes in them (I’ve mentioned this point strongly in my book ‘Secrets of Case-Interview’ too).

Surprisingly I found this the only remedy to cover the rubric FACE-Tumors-cystic tumor of cheek!! It was a single remedy rubric and thus from beginning of the case I was paying much attention to the essence of this remedy but she started to talk about aversion to meat and frequent fainting spells, poor energy level, aversion to work etc. By the end of the case, I decided to move away from this remedy and concluded that this rubric needs more additions.

Lyco: As I began taking the case and she expressed her desire of not working under a boss, and that she never replies back to seniors in an argument; this remedy seemed like a strong contender. Hence throughout the case, I also tried to confirm keynotes of Lycopodium in other areas, e.g. fear of dark, egotism, stage fright or fear in a crowd, fear of marriage/opposite sex, strong desire/aversion for sweets etc.

Nux-m: I first started to think of this remedy when the patient described her thirstlessness. I wonder if you paid attention to that when reading the case or if this feature was overlooked. If you paid attention to it, well and good, but did you think of this remedy? And of course, like the above mentioned remedies I too was on the lookout for keynotes.

Staph: The way she described her anger bursts led me to think of this remedy and then again, during case-interview I looked out for any of its keynotes – strong aversion to milk, submissive nature, sleepy during day and sleepless at night, agg. from siesta, head lice, strong emotional/anger suppression, dental troubles and of course tumors. In my personal experience, Staph. is a prominent remedy in teenagers for tumors especially related to sexual parts.

You can use repertory sheet to study which remedies cover which symptoms.

Repertorial Sheet:

Vithoulkas Compass analysis:

PRESCRIPTIONS:

7-SEP-2019: Nux-moschata 1M/1dose. PL x BD x 1month. She was advised to take the dose on 4^th day of her menses.

11-10-2019 : (Kindly refer to the image at beginning of the case).

She hasn’t taken medicine as she still hasn’t got periods. She got cough since 2 days. Her mother also has it and maybe thus she developed it. Yesterday mild chilliness was there, nothing else. Mild change of voice is there. Today it is less. Nose block is also there. No idea about color of discharge. Her whole handkerchief was wet.

Rx: PL x 3doses.

15-10-2019:  Last menstrual period (LMP): 11/10/2019. She took the first dose tonight.

16-11-2019 : She had coryza once but it disappeared on its own. Surprisingly she is now taking sweets in good quantity. LMP: 11th Nov, 2019.   Twice pus came from eruption on chin and was yellow color, thin, watery. Peeling of skin is there over the eruption. The centre part is clear, edges are raised and red. graphites onintment also prescribed locally.

16-12-2019 : LMP: 12/Dec/2019. No pus this time but blackish discoloration on once applying Graphites ointment. Then she stopped applying. The eruption is now totally flat but reddish in color. Maximum drinking 2 glasses per day and rarely some days one glass on waking in morning whence she feels very thirsty. Now she is planning to try fish. She takes eggs though.  Indolence is reduced by 30 – 40%. She doesn’t feel fear on seeing blood anymore.

20-01-2020 : LMP: 15/Jan/2020. Thirst is again reduced, she has come down to two glasses per day. Tiredness is also back now. Now, itching is there in the tumor, which is completely flat but on palpation, irregular striae can be felt inside the cheek. Pain in tooth is more now, < eating, brushing: mild pain only. Rx: Nux-mos 1M/1dose.

16-02-2020 : May now drink up to 3 glasses per day. LMP: 16/Feb/2020. No more tiredness. tumor is completely flat and light now.

Sadly, after the national lockdown occurred on account of CoViD she never came for any follow-ups. But, I met her again after a few months at my friends home and she allowed me to take a picture of her cheek.

As can be seen in the image, the tumor is almost healed and she was happy with the results, so she decided not to give any follow ups. I did not insist further and hoped that she shall visit for treatment when she feels the need for it.

Fig 2.  Picture taken in June 2020. Tumor is almost healed

CONCLUSION:

I could confirm the following symptoms/key-notes in this case, though I did not choose all for Repertorisation.

NUX-MOSCHATA
MENTAL/SPIRITUAL	EMOTIONAL	PHYSICAL	CLINICAL*
Indolence+++	Anger++	Dental caries++	Cystic tumor++
Aversion to work		Fainting, standing+++	Aversion sweets++
Anxiety about health+		Fainting, sun++	Tumor, mammae
Religious, want of feeling		Fainting, menses during+++	Desire, garlic+++ (in pickle form+++)
Silent disposition		Fainting, blood+++	Aversion, fruits
Day dreaming+++		Desire, warm food++	Sleepiness+++ during day, sleepless at night
Memory, poor+++		Desire, warm drinks++	Fresh after siesta
Mind; recognize; does not; surroundings; streets, well known++		Thirstless++++, only drink enough to moisten mouth	Fainting, insect bites+
Desires easy life, avoids difficult situation		Desires, Spices+++	Sympathetic+
Fear of dogs/animals		Aversion, meat++	Curious+++
Day dreaming+++		Sleepiness+++
		Chilly++
		Allergy, metals
		Dysmenorrhea
		Marasmus

* These are the symptoms which were not found to be covered by Nux-m in repertory but some were cured by it and others were not. The patient did not take treatment long enough for more observation as her main complaint was resolved. 

** The symptoms highlighted in blue cells are the main keynotes one should try to confirm in a case before prescribing this remedy. 

Comments, queries and suggestions are most welcome.

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