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.
The main rubrics of Mur-ac are:
- Industrious, Restless
- Excitement when working
- Thoughts intrude and crowd around each other while at work
- Discontent with himself; with everything
- Succeeds, never.
- Anger with indignation.
An example of my client’s being her own worst enemy is expressed by her decision to undergo tanning despite her own intolerance to sunlight, not to mention a history of Lupus in her family (succeeds never). Her industriousness amid general discontent, and numerous gastric symptoms similarly accord with a stomach acid remedy.
Rx Muriatic Acidum 200C
FOLLOW-UP ONE MONTH LATER
The rash, very red, peeling and traveling down her chest and arms. Having super vivid dreams the first two weeks on the remedy but not since. Mentions now that had been losing a lot of hair in the shower but that is now regulating.
Suddenly has energy after dinner….ENERGY IS MUCH IMPROVED FROM BEFORE FIRST CAME FOR TREATMENT. Reports having great sleep for the first few weeks. Energy level generally improved….. but the skin, very severe physical appearance.
She reports that she used to have more hand and knee pain when waking. Less stiffness now in the AM, though feels some hand pain when driving. Feels to be a bit calmer than she was. During week two had a real meltdown in her family but of late feeling more patient.
No change in the libido.
Reporting inner itching of ears and skin generally hot to the touch.
“My mother still lives with me.. Daily…she is a talker, never stops talking. Work has been busy. We are moving to a new office IT system that no one understands.”
Something new: ALWAYS FEEL TO BE IN A RUSH. A sense that there is not enough time. MORE AWARE OF HER EMOTIONS.
CAN FEEL LIKE THE WEIGHT OF THE WORLD IS ON HER SHOULDERS…if I don’t do it, no one else will. Reports that can have a hard time translating her thoughts into actions. Even when she knows exactly what she needs to do. Easily overwhelmed, as can have so much to do that it is easier to do none of it.
Continuing is dryness of mouth, dryness sensation in nose.
Reports not being able to wear contacts for the last 6 month and unusual thirst.
A much hotter, more restless acid state. Still evoking Challenge versus Anxiety but to a lesser degree as the anxiety to nurture has diminished. Shift to new remedy:
Rx Sulphuric Acidum
FOLLOW-UP ONE MONTH LATER
Face has lightened up, but the skin on the upper chest INTENSELY RED. Skin on arms has lightened up.
SKIN RAW AND BURNING, worse from where shirt was rubbing against.
Generally the skin is still changing though on her truck the redness persists. Now one big change is her indifference to anyone’s commenting on it when before would have horrified by a anyone’s mentioning it.
Reporting still more patience.
Reports the inner sense of feeling rushed though not entirely gone is far less. NO LONGER SHAKY to an extreme extent, as previously, inner tremulousness could make speaking difficult.
“I AM CALMER IN EVERYDAY SITUATIONS, EXPERIENCING CLEARER THOUGHTS WITHIN MYSELF.” Recognizing that previously had thought of herself as a ball of stress, someone who would collapse inwardly on herself but was unable to stop and ask for help since she was ”super woman”… “NOW AM ABLE TO CRY UNCLE! HELP ME!”
In response to my asking if she still has the sense of inner rushing, reports that this has changed subtly. It is now instead simply impatience with having to wait for someone to get to the point; an inner voice demanding, “Cut to the chase! I want an answer NOW!“ “Having to repeat myself to anyone stresses me out.”
“I NEED TO GET EVERYTHING DONE RIGHT NOW…. if I don’t do it who else is going to do it?”
She works in a basement office and is now reporting being averse to the moldy, dark environment. Lobbying for dehumidifier.
Reports that feet are always cold but likes the fans on. Hands and feet are icy.
EAR ITCHINESS MUCH LESS. Was also a lot of dryness in the eyes previously but she now reports is able to wear contact lenses.
“With such a history of my mom being a huge factor in my life, my husband almost felt married to my mom and not to me. Now as am gaining separation from her, feeling in touch with my own separate needs, and this is good for my marriage.”
“FEELING PIG HEADED AND WANT YOU TO SEE IT MY WAY.”
Reflecting how after birth of her son, “When my beautiful self got so fat and no one any longer looked at me as someone attractive, and I dropped out of college and gradually lost myself.”
Shift into a junior version of “inner rushing” seen in Sulphuric Acid (impatience and need to control) but also, away from the self-destructiveness of an acid state. The workaholic Nux state, also featuring a “succeeds never” mindset is yet another, typical Sense Dimension of Taste remedy. Given her stronger ego, the new remedy is prescribed:
Rx Nux Vomica 30, 200 one week later (and 1M to hold)
FOLLOW-UP ONE MONTH LATER
Skin initially had gotten terribly inflamed on the Nux. Today looking so good! Feels like she is growing new skin.
Noticing that in one of the locations where she works, she gets allergic reaction. Perceives that upon leaving her ears pop, and congestion in her throat clears.
Remembering…how her condition at one time had started to flare in the month of February when there was little sun. But also, “I am feeling more clear; able to articulate my feelings better, no longer losing words (head was so cloudy), secure with the feelings I have. Am okay saying hey, this is just me now, thus able to debate with doctors, happy to challenge their opinions and findings. FEEL LIKE I KNOW WHAT I AM TALKING ABOUT, not feeling like others are so far above me. Have much better energy.”
“So as to test out the sick building notion have petitioned to move to another building starting in a few weeks.”
Is committing to visiting an environmental medicine physician.
Reports: “I wake between 1 and 4 so get interrupted sleep but am patient in traffic now, even if am going to be late. EVERY THING NEEDS TO BE DONE! I AM A WORKER…MY FEELING IS DONT LEAVE ANYTHING FOR SOMEONE ELSE…PEOPLE WHO CANNOT GET OUT OF THEIR OWN WAY BOTHER ME. I stress about the ladies who have to take my place when am leaving. Am anxious that when you come in to replace me at the next shift there will be nothing left over from me for you to do.”
She cries easily. If someone makes a comment takes it personally.
Some itchiness but nothing inflamed.
ALWAYS WORRIED ABOUT TOMORROW. “Get ready today so that am ready for tomorrow.”
“Allergic to my glasses again it seems…. super dry… Cannot put in my contacts.”
(The following is elicited in response to my questions confirming a shift into a Bryonia state):
“Am easily homesick. Every vacation. I come home a day early.”
CANNOT TOLERATE BEER. Thirsty but hates to drink.
JK: How are you generally improved?”
Client: “Am able to listen to my body now.”
A further change as per eating, elicits the response, “I am a gourmand now, no longer an epicure.”
We find a prevalence into general dryness. Also an all work no play orientation (excess of Challenge), anxiety lest she not get everything done (dysfunctional Anxiety) and tendency to homesickness. These all indicate a shift into the vine that climbs as it clings, Bryonia.
Rx Bryonia 30 C and 200 combined
As the client was pleased with her improvement, had impressively gained control of her life and was focused on remedying her environmental situation homeopathic treatment was concluded. What I heard from her eight months later verified that she is no longer her own worst enemy:
“I went to see an environmental who found two mycotoxins in my urine from toxic mold. I’m currently being treated and the rash is improving weekly (now that I know what’s causing that) but I am a different person since I’ve met and been treated by you. Throughout this process of figuring out what’s going on I have been clear minded, confident, assertive and calm. There have been several times since seeing you that I have been faced with difficult issues that in the past I would have been very timid, have body shakes (from nerves) and let my husband take care of the situation. Not now! I am so sure of who I am and what I deserve and what I’m capable of. I just can’t thank you enough for helping me become the woman I am today. I am strong, very capable, clear headed and finally feeling like a worthy important human being.”