A Case of Discoid Lupus Erythematosus Secondary to Sjogren’s Syndrome
Note: This case was solved using Sense Dimensional Analysis
Discoid lupus erythematosus (DLE) is a subcategory of Chronic cutaneous lupus erythematosus (CCLE). DLE classically presents with erythematous-to-violaceous, scaly plaques with prominent follicular plugging that often results in scarring and atrophy. DLE may occur in the absence of systemic disease, or it may occur in association with Systemic lupus erythematosus (SLE).
Sjögren’s is a chronic autoimmune disease in which people’s white blood cells attack their moisture-producing glands. Although the hallmark symptoms are dry eyes, dry mouth, fatigue and joint pain, Sjögren’s may also cause dysfunction of other organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system. Patients may also experience extreme fatigue and joint pain and have a higher risk of developing lymphoma. Nine out of 10 patients are women. About half of Sjögren’s occurs in the presence of another autoimmune connective tissue disease such as rheumatoid arthritis, lupus, or scleroderma. Its onset can be insidious. On average, it takes nearly 3.9 years to receive a diagnosis of Sjögren’s.
The majority of patients with Sjogren’s syndrome experience those symptoms in conjunction with another autoimmune disease, which is considered secondary Sjogren’s. Antibodies are tags in your body that mark material (usually foreign) that your immune system will then attack. However, in the case of autoimmune diseases such as Sjogren’s and lupus, the antibodies tag your own cells. The antibodies Anti-SSA (Ro) and Anti-SSB (La) are present in 70-80% of individuals with Sjogren’s syndrome, and about 30% of people living with lupus show markers for these antibodies as well.
The client’s issue that she is her own worst enemy could not more perfectly express the autoimmunity problem. As her complaint that waxes and wanes in intensity throughout her treatment a Sense Dimensional theme is consistently evoked: Inability to resolve the core Challenge versus Anxiety conundrum embedded within the Sense Dimension of Taste. (related to what Traditional Chinese Medicine refers to as the Earth Element or Phase) The remedies selected in the client’s treatment, namely Muriatic Acidum, Sulphuric Acidum, Nux Vomica and Bryonia each express a variation on the Challenge versus Anxiety theme.
(Over a sixteen-month period commencing in October 2014)
Thirty-seven year old Caucasian woman. Lightly freckled complexion
Arrived bearing a diagnosis of Discoid lupus erythematosus (DLE) secondary to Sjogrens Syndrome. She recalls that ten years earlier, after having gone through a regimen of tanning she experienced the flaring up of a longtime rash across her forehead. This was followed by eruption of bright red circles under the eyes. A red rash accompanied by the sensation of dryness and burning extending down the face and around the ears also erupted.
(Note: Sunlight is known to hasten skin cell apoptosis in Lupus with a generally aggravating effect. Since, as it turns out there exists a history of Lupus in her family it would have been best had she avoided any unusual sunlight, ultra violent ray exposure and tanning in particular. Ten years earlier at the age of 27 she understandably had other concerns.)
Following a scalp biopsy with an inconclusive result she was diagnosed with discoid, and systemic lupus. Prescribed Plaquenil (Hydroxychloroquine chiefly used to treat rheumatoid arthritis) with little effect.
As a teenager, history of red, cystic acne, treated with Acutane. Allergic response when the skin comes into contact with nickel or gold. Had an abdominoplasty (tummy tuck) in June of 2004. Prior to that, a history of red cystic acne on her back. treated with Acutane. Developed a stomach issue: gas, bloating…could not figure out what was bothering the stomach. One hundred pound weight loss. One doctor thought she had an eating disorder. She was found to have small intestinal bacterial overgrowth but as she is allergic to Bacitracin successfully addressed it with an online regime combining apple cider vinegar and gelatin. She reports that having been influenced by an independent minded grandmother who never went to the doctor, she tends to refuse antibiotics. In general seeks to self-treat.
Continues to live in the suburb where she was born and is her mother’s only child. The biological father has a few children separately. The parents were never married but knew each when they were younger. They are now on good terms. Mother is alcoholic and a prescription drug abuser. Stepfather, an important person in her life, was an alcoholic but managed to quit drinking. Both mother and stepfather are smokers.
She was an outstanding student, making National Honor Society. At the state university studied Child Psychology but got pregnant there. She’s been with that same man since she was fifteen.
Says: “I kind of raised myself. My parents had limited educations. I was the little mother of the house.” “When I was pregnant, I thought my life is over. My mom is one of eleven children, no one of whom ever broke away from having low expectations. None of my aunts for example, could hold onto a job. Making a living, just getting by, that is it…that has to be your focus.”
Currently works as a secretary.
Suddenly becomes emotional telling about her childhood. “Literally, my mother would move into my bedroom with me. And yet, months could go by when we did not talk to one another.”
“I was a very nervous child, nervous over everything, sounds, people drinking. My mother and my biological father would have a fistfight. I could smell the alcohol on my mother early in the day and know it would be a bad day. My stepfather became my grounding support. Fortunately, not an emotionally over-reactive man, so s kind of safety net for me.”
“I remember always thinking: that when I have a family of my own there will be no chaos. My mom counted on me for everything, keeping up the house, everything. Every week she would wash the apartment walls and I had to do that with her. I could not leave my mom alone. Had to be there with her always.”
“Losing my grandmother was tough. She did a lot to help raise me.”
“I get dizzy spells, and also very tired. I can work but when am done, my body suddenly feels like all of a sudden I weigh three hundred pounds. Am really down for the count.”
“My sleep: I wake to go the bathroom at least twice a night. I toss and turn. I do not wake refreshed. But I do fall asleep quickly until waking two hours later.”
“The sun bothers me a lot….from an early age. At the playground or beach I burn and blister.”
“When I drive I grip the wheel tightly. I can get restless. I like to know what is going to happen. When I do not know, then I get restless. My whole body can shake.”
“I had what turned out to be gangrenous appendix. Surgically removed out just before it could rupture.
“Food cravings are ordinary though find meat to be satisfying.”
“Over past year menses not as regular as now. The second day of my period is my worst Can get internal pressure pains when have my period.”
“Feel half dead, zero sex drive.”
“The marriage…known him since was 13…. some cheating going on, on his part. I count on him for everything. He provides me with stability.”
“My mom with whom I still live, a few times has tried to commit suicide. Though she has a big heart., just cannot fend or care for herself. My mom is very talkative. An in your face woman, this mother of mine.”
“I would love to have internal peace, not be so tired, not have these exhausting dealings. A hot button for example, is when my kids talk back to me. Also, my mom talking to me and my not being able to get a single word in.“
“Everything seems unattainable. I would love to deliver babies. In fact, my husband and I adopted by brother’s baby, but that is another story. My dream is to help others. I had such academic success (weeps) and cannot make anything of myself, am just a secretary.
“I AM MY OWN WORST ENEMY.”
Whenever I engage a client whose self-antagonism leaves me wanting to ask, “What’s eating you?” the likelihood of an acid remedy comes to mind. Where the relationship to one’s mother is especially inflamed, evidence of significant grief is found (the death of a beloved grandmother) and powerful compensation in the direction of nurturing appears, one naturally thinks of a muriaticum. The overlapping of these themes produces Muriatic Acidum whose remedy state reflects anxiety lest she not nurture others. This is dysfunctional excess of Anxiety. Strenuous effort eventually prompting discouragement and exhaustion expresses dimensional failure to meet Challenge. Her history of abdominal flab, bloating, gassiness, bacterial overgrowth in the stomach and weight loss disorder reflects the metabolic and gastro-enterological purview of the Sense Dimension of Taste.