This is a case of a lean, sickly looking 40 year-old I treated a few months ago. He was very anxious about the possibility of counter reactions and aggravations from the Homeopathic remedies; As soon as he arrives, he asks if the homeopathic treatment will cause any aggravations. He also expressed the same concerns about remedy reactions over the phone while taking an appointment. On arriving, he goes through the patient disclosure form in detail and questions me about my qualifications. Anxious expression on his face throughout.
Case presented in the patient’s own words:
You have CCH degree from here, how is it different from India? Started around a month ago. That day morning had lemon juice, lay down after that. Was on a diet plan for 7-8 months, very light breakfast of bread, mostly heavy lunch, light dinner, doing yoga. Maybe the body was under stress from all that, don’t know what brought it on? I was feeling a little weird the previous night, felt nauseous, didn’t know why, ate some sunflower seeds. That morning had my breakfast, lime juice, didn’t know lime is acidic. Lay down in the afternoon, had tea in the afternoon, feeling a little nauseous and it increased in the evening. I felt a block in my chest, felt like an asthmatic, called my friend who is a resident, he suggested antacid, Zantac, it helped a bit but there was a lot of anxiety. I didn’t know if it was heart related or digestive. Next morning went to the ER. In this area especially in the epigastrium, pit of the stomach I feel tightness, not in the chest. I feel it affects my breathing. Fat tends to trigger it, I put very little ghee (clarified butter) on rice. I avoid acidic foods since then, less spicy. I stopped caffeine for 2-3 weeks but that causes headaches so have little tea. (Going into everything in detail. In depth explanation about what foods he eats, in what quantity etc. Had to practically cut him short to make the conversation move ahead). Once the tightness comes on, it triggers breathing, I focus on the area. Nowadays I try to focus on it.
I take Omez 20 mg, once a day, they told me to take it for one month. Zantac when I have flare ups. If I feel too much of a block, Zantac. Sometimes I feel a burp and slight liquid coming up to the throat. Then my throat became sore, I take warm water and salt for 2-3 days and it helps with the soreness. Sometimes I feel heartburn in my chest, sometimes I feel some sound in the chest on lying down, have a raised pillow. Main thing is a block in the epigastrium. When I take a deep breath, it feels like you are not free, it feels like something is kept there. They checked the oxygen levels, all is fine. I was anxious about it, now don’t pay much attention to it, as long as I control the food. (Sighs often while describing all this, seems very anxious). It brings thoughts of maybe it is something serious going on, that you could die, mild sadness. Various philosophical thoughts on it. Either you still persist beyond death, maybe there is rebirth, you have to die to find out, don’t know. Other possibility is you could suffer and die. I do think about death, what is around it, what goes on after it, these thoughts more recently. About 4 months ago one of my close friends died of cancer, since then think about it. That could be a stressor to this, maybe? I was also doing the head stand in yoga since a few months, and the diet, these were also stressors in the body. I commute to work about 3 hours everyday. I was on an empty stomach for long periods, was having one big meal. I went on this diet just like that. I was doing yoga, pranayama, felt lighter on that diet. My body was fine at that time, was doing other asanas. I dropped weight. I did the head stand just for health and energy. Got interested to just have energy, felt more energy. What yoga recommends, so thought let me try these asanas, some meditation, breathing exercises.
I am interested in spirituality, not religious in terms of rituals. You need discipline even when you are doing yoga, I light the lamp twice a day. I was shocked when my friend died, I didn’t know about it, he had it for about 2 years. I flew for his funeral, then felt a bit sad. He was just 40, he has a wife and daughter. When the GERD happened, I would think is it cancer? Nobody knows what it is, even the doctors. You have a cough, it could be something more serious or just a cold, nobody knows? When doctors check it, they do blood tests, chest x ray, ekg, you never know, not that I feel satisfied, then they have to do more tests, endoscopy, colonoscopy, one of my friends with GERD had to go through all this. They will keep prodding if you keep going to them. Today I was reading there is gene therapy for a rare disease, they don’t know everything. I am satisfied enough when they say it for now, I like to get things checked. There is value in conventional meds, like vaccines. Beyond a certain point you can’t do anything, in the worst case you could die, just do your due diligence. (Sighs and looks sad) I don’t keep worrying, if something becomes acute, you can either take meds, control your diet, what can you do?
Around 2011 used to take antidepressants, got off it. From 2001- 2010 had some stress in college, during engineering. I had a professor who was trying to flunk me in some practical. I was joking something with some friend, and he heard his name, he thought oh he is saying something about me, so he started flunking me in those subjects. That caused stress, and anxiety in my mind. I went to yoga center and they gave me some pills, then went to a psychiatrist. He could just keep flunking me, it was not in my control. I didn’t know it initially, only after 6 months to a year I found out from another professor. I was in my 4th year by then, had some suspicion, how is it possible I failed, I was doing well. Then took antianxiety meds and continued on it, tried to stop them, then would come back the feelings of hopelessness.
First when I took it was hopelessness. Then it was like I can’t do my job, can’t handle it, it was artificial and uncomfortable. Let me think, something of fear, if someone says you are going to die in 10 days how would you feel? Fear is the root of all this. Then you feel sadness for your family. If you are 40 and someone says you are going to die, how would you feel. When you are 90 it’s a different fear. In college the fear was I don’t have control, I could be stuck for ever if I keep flunking. After college switched to antidepressants from antianxiety medications. I came to the US for my masters, felt depressed, one was getting adjusted to the new country, I was 21 then. I had homesickness. I tapered it slowly, didn’t want to be on them long term.
Family dynamics also affect, I guess. My mom was always anxious, she would want to do something if someone falls sick, so that goes into let’s try to do something. I had a good childhood, relationship with parents was fine.
You read the news, health related stuff, like germs, sensible things like I will take the flu shot. Not a hypochondriac. If I see my son cough, think is it the mattress, try to modify the food a bit, general stuff, I don’t worry too much. If he is coughing, then I will try to see what we can do, sensible things, only if there are some symptoms otherwise don’t. I will try home remedies, if it’s going on for a while will get it checked. I am not perfection clean, not everything is kept perfectly clean. It’s phases, one day I will keep everything clean. Even at work, will tend to a lot in a spurt, work in bursts and then go to relaxation. I am a software engineer, I am by myself, loner, don’t follow too much instructions nor lead people. I have a small circle of friends who are very close, otherwise I am low profile.
Nothing to describe about myself. I don’t like to talk about myself, it’s your ego if you talk about yourself, the less the better.
Not much temper, do get angry. At home, it could be health related. Eg, when my son was 2 years old, he was watching videos for too long, I told my wife not to allow it too much, some new recommendation on how much is okay, raised my voice and said don’t do that. Then later I apologized to my wife for raising my voice. At work, if somebody is trying to boss over me then I get angry, I like to be independent, I try to resist that, I will raise my voice. I will try to avoid that person, or that situation, if its unavoidable, I will tell them straightaway even if it’s my boss.
Both my parents were very good, had a very nice childhood. I usually don’t feel guilty, I like to experiment, don’t feel guilty about having done yoga. I would feel guilty if something could have been avoided easily and that caused some damage, it hasn’t happened, that is a possibility, there are so many hypothetical things, You can’t control too many things.
Not very thirsty. Now I drink out of habit, just to keep hydrated, drink as it’s good for health. I can drink one bottle once in 6 hours or so and get by.
I feel cold now because I lost weight. Not too extreme. I used to be 180-200 pounds when I was on the antidepressants. Now I am around 137 pounds, due to GERD.
No skin problems recently. As a child has some patches here and there, ringworm. I have a small cyst on my left cheek.I am losing weight because of this issue.
I don’t hold grudges, would probably avoid them, don’t want to harm people who did wrong to me. I don’t think about it too much. If they are constantly sitting on my head then I think about it. I will ignore them. If it’s in a meeting and they are pushing my buttons then I will raise my voice, I am quite outspoken that way, I will blast and forget it, I won’t ruminate, will give it to them straightway even if they are very senior or the president. It happens occasionally. Usually when that has happened it has never mended, if they are aloof then I don’t take steps to rectify the situation. I have good sleep usually, only recently due to orthopnea have to raise my pillow.
D/D of Remedies
What really stood out in this case taking were the following factors:
- Extreme anxiety about one’s own health, fear of death with a sense of hopelessness that nothing can be done.
- Need to control one’s environment, like the quantity and nature of food, exercise regimen etc.
- Mistrustful of others. Great suspicion on doctor’s ability to help him
- Emaciation and inability to gain body weight
Arsenicum album- A characteristic trait of this remedy is they are so anxious that they can be absolute control freaks and try to control everything around them, including their eating habits, lifestyle, thought processes. Just like how our patient tries to control all the foods he is eating, right up to how many spoonful’s he consumes, to his exercise routine. They are hypochondriacal about their health and also suspicious of other authorities. Our patient clearly describes it when he says that beyond a certain point doctors cannot do anything and also in the way he prods me initially about my qualifications as a practitioner. They tend to be hyper vigilant about their health and try to control their condition promptly on the slightest hint of their symptoms resurfacing again. Great mental restlessness associated with physical prostration. Arsenicum is well known for emaciation and gradual loss of weight. Chilly.
Nitric acid- Can come across as selfish and suspicious. Bothered by everything with a tendency to be complaining all the time. They can be loners, sulky and gloomy. Unforgiving nature with a tendency to hold grudges. Difficult family relations, seem emotionally uninvolved but the patient himself can feel misunderstood in his own family, holds a lot of anger within self. Nit acid is one of the well known remedies in our Materia medica with a great anxiety about their own health, fear of death. Symptoms < when they think of them. Need for company when anxious, clinging and demanding by nature. They tend to be chilly and like the Acid remedies have tendency to lose weight, emaciation, with digestive problems. Desire for fat with aggravation from fatty food.
Argentum nitricum- It is a remedy used often for digestive issues. They tend to be flatulent (which the patient did not seem to complain about), crave sweets and are < by heat. Mentally they tend to be creative, impulsive and anxious of their health. Our patient came across as anxious and suspicious whereas Arg nit are usually more extroverted by nature.
Kali arsenciosum- Anxiety about one’s health with fear of dying. Many of the symptoms including the fears get < at night, insomnia, tossing and turning in bed, panic attacks. Conservative nature and a stickler for rules like the Kali’s. Tendency to many skin complaints. Digestive issues. Extreme chilliness.
Based on my understanding of the case, my main contender remedies were Ars alb and Nit acid. It was a difficult choice to choose one over the other. I decided to select Nitric acid, as I felt my patient expressed a lot of discontentment and had great anxiety. I kept Ars alb as my back up choice if Nit acid failed to produce the desired result.
Remedy: Nitric acid LM1 OD for 3 weeks.
1.5 months later
(He looks heathier. Seems to have gained some weight)
I stopped Omez after taking it for a month, about 2 weeks into starting with Homeopathy. It was easy to stop it, didn’t experience much withdrawal symptoms from weaning the Omez. Been okay. If I eat more, I still feel stiffness in the abdomen. If I control the diet and exercise it’s fine. Sometimes I feel hungry, then you get the stiffness. As of now it feels it is there in the background. Take fenugreek seeds sometimes. Definitely there is around 50% improvement.
Minor flare ups, < eating late at night, < fat foods. I was very regimented when it first came on, like taking 8 spoons of rice. What I am seeing is if I eat small amounts spread out, and maintain exercise, like swimming and walking, it seems okay. 2 days ago, felt a slight trigger, like at late at night. No big flare ups. Tightness mildly affecting the breath and feeling uneasy in the epigastrium, can’t take a full breath. Very rarely a heartburn. Feel more congestion in the epigastrium, when I have flare ups, then I have to take a deep breath. Now once it starts I adjust the next few meals and exercise. I am able to eat a regular diet. I have an idea, like I have one egg, if I have 2 eggs, it can get bad. I try to be more careful on diet.
I have put on some weight cos I increased the diet. 6-8 pounds. It’s always good to put on some more weight so you have some fat reserves if you lose weight again. As long as it is controlled. Energy levels are definitely better I have to keep some restrictions, after some time you tend to relax it, especially fat does it. The amount of fat, I have a rough idea of how much I can take with each meal. I avoid citrus foods. Emotionally I feel fine. Only mental change is okay I am fine, I am not worrying that I have to take Omez. I am mostly normal as long as I am watching my diet. No worry as such, I am worrying less about family members too.
I had one flare up, 2-3 days back, it’s just that once it comes it reminds you. I again kind of adjusted and reduced the diet. I had a sprain in my knee going on for 2 weeks or so, I took one dose for it. It might have to do with walking, comes on sometimes if I walk too much. I am able to sleep without having to raise myself now, but still use a wedge pillow to be on the safer side.
(Very focused on how he controls his diet, right to the number of spoonful’s he eats. I advise him to relax his restrictions and be mindful of eating a healthy moderate diet instead).
Remedy: No change. Wait.
2 months after first follow up:
Email from patient that he is doing well and doesn’t feel a need for an appointment now, wants to cancel the scheduled follow up. Will get in touch in the future if required.