Patient: female, age 36, of Indian decent
Consultation: January 18th & 22nd, 2020 (Seen at work, after hours in private boardroom)
Occupation: Lease Analyst
Presenting complaint: Lack of energy due to stress
I met with Marie1 for an initial consultation on the evening of January 18th after working hours. Since we both work for the same company it was easy to book a private boardroom for our chat. However, due to Marie becoming emotional we had to break and resume on the evening of January 22nd, 2019.
Marie works as a Leasing Analyst for a very big global asset management company with a rich portfolio in real estate throughout Canada, US and around the globe. A job in Corporate Accounting is deadline and report driven which creates a lot of stress.
Q: What was happening in 2017?
“Work was so stressful, and still is. We were preparing for a mass system conversion. There were a lot of logistical nightmares, a great deal of testing and never-ending meetings. I was working long hours to accommodate our people on the west coast. On top of that there was overtime, because we still had to get our regular job done. No one was allowed to take vacation till after ‘go live’ day which was aimed for January 01, 2018. I ended up getting really sick, lots of coughing and congestion and I ended up with an ear infection which required antibiotics.”
Q: Tell me about the cough?
“I was ‘an old man’s cough’. I had clear to yellow phlegm and I remember that I had to continue coughing in order to get rid of phlegm. I am so tired and fed up, we’re still so busy that I still can’t take any vacation.
Oh, I had chronic bronchitis when I was 25 and I was on antibiotics which did not help. A friend suggested oil of oregano which helped. I was put on an inhaler and was told to use it for emergencies. If I get any wheezing now, it comes on around quarter-end. But I have not used the inhaler since getting sick at 25.”
Q: Tell me about your sleep?
“It could be better. The stress from work is interfering with it. It’s been like this since 2017. I go in and out of sleep throughout the night. I wake up to either pee or to have a drink of water but it’s not a constant thing. It takes a while to get back to sleep afterwards, it is like the wheels in my brain are constantly turning. I go to bed at 10:30 but it takes about an hour to fall asleep.
I have a lot of thoughts about different aspects of life. I don’t know how to relax. On top of that I wake up in the middle of the night with leg cramps; even my toes cramp up and there’s pain on the right side of my hip.
I have an ovarian cyst. I sleep in the fetal position, on my right side. I can’t sleep on the left side at all, not even when I’m sick. On average I get about 5-6 hours of sleep a night. I wake up tired. I just don’t want to get up in the mornings.”
Q: Tell me about the acne?
“I’ve been breaking out for the past month. I get boils that hurt when touched. I use rubbing alcohol to get rid of them. The boils appear and disappear on their own, mainly on the chin, on the right side.”
On observation of Marie’s face, I did see a boil on the right side of her chin along with several pimples scattered about the right cheek.
We went over other physical generals, and Marie indicated that she does not have any issues with her eyes, vision nor with her hearing. She does get headaches, mostly on the weekend. They are better with sleep.
She attributes the headaches to inactivity as she has not been able to keep up with exercise. She has no issues with food. She evacuates once a day at either 10am or 2pm. If it doesn’t happen at 10am it will happen at 2pm; it is very consistent. If and when there is a smell, she attributes it to what she has eaten the night before. Pee is normal, no dark colour nor smell to it.
Q: Do you have any cravings?
“I crave chocolate when stressed and I crave meat, I’m a carnivore. On a typical day, I don’t eat breakfast, but I constantly eat throughout the day. I am constantly nibbling once I get to work. I will snack on anything, chocolates of any type. I don’t crave salt nor pastries nor cakes, just chocolate. I like spices, hey I’m Indian but I have cut down on them just to be healthy. My spice tolerance is at about an 8 level for heat and I don’t sweat when eating spicy food.”
Q: Any food Intolerances?
“Yes, I am allergic to nuts. My throat will tighten up and will have to throw up, once I do that I feel better. I don’t get a rash, nor a fever. I don’t use an epi-pen, I just avoid them. After I throw up, I feel fine again.”
Q: What are your periods like?
“I normally have cramps in lower abdominal area but this time, I’m on my period right now, I have pain in the upper abdominal area. The first 2 days are heavy, and the rest of days are light. I do see the odd blood- clot but everything is a good shade of red. I’m not on birth control.
I have noticed that I do have discharge even when I am on my period. There is a smell but I can’t describe it. I have no history of yeast infections. But I do have an ovarian cyst on my right side so not sure if they can be related. On a scale of 1 to 10, the pain is at a 5 or 6.”
Q: How is the libido?
“Yeah, I have a very healthy libido. I have sex about 3 to 4 times a week. My current boyfriend has the same amount of interest, so there are no issues there. But I am finding sex uncomfortable because of the ovarian cyst. I don’t bleed but it feels like ‘it’ is hitting a wall inside.”
Marie was unable to describe pain when asked.
Q: How you are with temperature, what is your ideal temperature?
“I’m a warm person. I sleep with only a comforter, but no other layers and I keep the temp in my condo at 22 degrees Celsius.”
Q: Let’s talk about what happened 10 years ago, what happened back then?
“I had just moved back home and transferred from Waterloo University to Ryerson so I did not graduate when I was supposed to. I graduated a year later. After graduating I noticed that my self-confidence was low, everything I had worked so hard for at Waterloo went down-hill. But then I started working for this company and I began to get some confidence back and I met you.”
Q: Tell me about your childhood, what was it like growing up?
“In high school I was teased, every girl in school was, so I was not alone, we were all made fun of. I complained to teachers about the bullying. No one came forward and no one got blamed so this was very hard on me. I became emotional, I would cry. I wanted to stay home. I didn’t want to go to school. I told my parents about bullying at school, but they didn’t know how to deal with it. I did not have the greatest relationship with my parents after that.”
We became more real with each other after I moved out 3 years ago. But I am not emotionally connected with parents. My father is stern, and my mother is too accommodating. They’re always butting heads, there is a lot of arguing. As a teen I always stayed in my room. I felt a lot of anger towards them.
My brother and I would get hit by our dad. It wasn’t a constant thing and my brother would get hit more than me. My brother and dad don’t get along at all. It was because of my family dynamics that I moved out. I felt sad because I would compare them to other people’s parents, they weren’t like other people’s parents.
My dad has the upper hand and makes all the decisions. He never listens to what mom has to say. There has always been verbal abuse and some physical abuse at home. When I was getting ready to move out dad made me feel that I’d be incompetent and would not be able to make it out on my own.
But despite that, I’m blessed that I have a grounded extensive family, lots of aunts, uncles and cousins. They take care of me. I am learning to not hold anything back any more, it was the reason why I moved out in the first place.”
Q: Tell me what happens if you see bullying taking place now?
“I see it at work, but I don’t step in. I will be pissed off about the situation, but I don’t relate it to what I experienced as a kid. I don’t linger on past bullying experiences.”
Q: Let’s talk about your current relationship. What’s it like?
“The man I am dating is not divorced yet. He’s been separated for about 4 years but not divorced. We hang out. He has expressed that he wants more of a relationship lately, but I don’t want the same. I’m not sure what I want.
The idea of marriage frightens me, maybe that’s the reason I can’t say ‘I love you’, maybe it’s because of what I was raised in. Maybe this is why my past relationships have not worked out. There is pressure from family about getting married.
All my cousins are married, and many have kids. I’m sad and annoyed, I get that my parents are looking out for my well-being, but they do not understand what I want. I don’t understand what I want.”
Q: Tell me, who are you?
“I’m a kind-hearted person. To my friends I am like a sister, I am the ‘go to’ person because I am non- judgmental. People can open up to me. I have a good set of friends. Marie is someone who could have done better.”
At this point Marie began getting palpitations and was near tears so I changed the subject. She mentioned that she gets heart palpitations when she is feeling very anxious. I decided to give her a few minutes to calm down then decided to change to an easier topic, one that I knew she could easily discuss.
Q: Do you like dancing or exercising?
“I love to dance, free-styling, not structure dancing. I don’t like structured gym classes either, I prefer to be a free spirit and dance in whatever way and mood I want. I love Zumba and running marathons but I haven’t been able to go for a run in so long. No time.”
We ended there for the night but I left her with a bit of homework, I want her to think about who she is and to think about everything we had already discussed so far to see if she has more information to add to help with the case taking.
Second half of initial consultation was conducted after business hours on January 22, 2019 in a private conference room.
Marie began the consultation by telling me that she had thought about everything we had discussed so far and thanked me for having taken the time to listen and for allowing her to voice her thoughts. She indicated that our conversation actually made her feel better, “like a weight was lifted”.
Q: Where would you like to start?
She whispers to me, though we are in a soundproof boardroom and it is after hours and 98% of our coworkers have gone for the day.
“I don’t get wet when I have sex. But I am still very into it and it just takes longer to get moist and get aroused. I noticed this started in the past year, during end of Q3 of 2017 and has not changed since then. Now I think about the issue which makes having sex more difficult.”
Q: Who is Marie?
“I am honest and kind. I don’t have huge passions. I like to try new things. Commitment scares me. The possibility of it failing frightens me. I have not been in too many relationships but I’d break them off; I’d find their stupidity or faults and just end things. I have the tendency to attract the wrong guy. Guys who are not in a good place in their lives or guys who are unsure of themselves. As for my current boyfriend, we’ve been together for about 4 years. I am used to the arrangement.”
Q: Do you have any fears?
“Yes, of being cheated on. I am attracted to men with issues and because of that my trust in people has diminished and end up losing trust in people closest to me.”
Q: Tell me about the hives?
“I have been getting them for the past month. They are red circular welts that appear in random places on my body. They’re not extremely itchy but I will scratch off and on. I can’t attribute it to anything. I have not changed my detergent, nor perfume or any other cleaner at home.
I thought it could have been a result of laser hair removal on my arms and legs but I have gotten the circular welt on my back. The spots are random, and usually appear one at a time, and they are about the size of a nickel. They appear one about once a week.”
On observation Marie showed me one that she had on the back of her neck near the base of the neck on the right side. After our second chat, I felt comfortable that I had a good set of symptoms to use in order to select and prescribe a remedy.
Rubrics Identified2
Mind; ANXIETY; agg., ailments from (327) Sleep; UNREFRESHING; morning (77) Sleep; DISTURBED; thoughts, by (52) Mind; ANXIETY, palpitations; with (201)
Mind; SUSPICIOUSNESS, mistrustfulness (180) Female; DRYNESS; va-gina (45)
Female; TUMORS; cysts; ovaries (59) Extremities; CRAMPS; bed, in (59)
Skin; ERUPTIONS; urticaria, nettle-rash (326)
Remedy Choice: Lycopodium
Lycopodium fits Marie’s symptom picture well, in particular with the anxiety about career, history of bullying, problems with self-esteem and confidence and her right sided problems such as her ovarian cyst, acne, and the confirmation that she can only sleep on her right side and lastly waking up unrefreshed in the morning.
Morrison3 said that “the Lycopodium patient fears forming long-term relationships”. Marie indicated that commitment scares her and that she would find faults in her partner and then breakup.
Prescription: Lycopodium 200C, water dose, once every 3 days.
First follow up: May 2020 (approx. 3 months later)
Marie was very happy to tell me that she did not get sick this past first quarter. To help manage the anxiety and stress she’s managed to take one day off a week, on a weekly basis as well; she has been working too late. Other notable improvements include:
- No palpitations with anxiety and worked through Q1 without getting sick
- In general, has more energy but not enough to get back to exercising or running
- Less headaches
- Still wakes up at night but is able to fall right back asleep within a few minutes
- Urticaria (red circular rash) completely gone
- Leg cramps and toe cramps are gone
- Right abdominal / hip pain remains but less intense
- Waking up better in the mornings, but did also indicate that she is going to bed earlier (9-10pm)
- Vaginal dryness during intercourse has improved
- Marie indicated that with her romantic relationship, she is feeling less insecure
- She has not developed any further boils since starting the remedy; has the occasional pimple only
Notable new symptom, Marie does not like being home alone. She prefers to be social and out and about. When at home alone she is restless. After repertorizing this new symptom, [mind, ALONE, agg (136)], and after reading Boericke4, (Lycopodium has a fear of being alone), I concluded that Lycopodium still fits the whole symptom picture.
Prescription: Lycopodium, 200C, but increase the frequency to a daily dose.
Second follow up: June 2020
- Marie has not been sick since taking the remedy despite the stress at work
- The headaches are completely gone, has not had one since taking the remedy daily
- Continues to wake up in the middle of the night but is able to fall back asleep (no change)
- Vaginal dryness during intercourse is much improved, if had to rate it on scale of one (not dry) to ten (severely dry), she is at a 2
- Is waking up better but not fully refreshed despite going to bed relatively early (9-10pm)
- Right abdominal/hip pain is at a 3 (where 1 is no pain and 10 is severe pain)
- Face has cleared up, the boils have not returned and pimples are gone
Still does not like being home alone. We discussed perhaps taking an interest course at a local College or University, sand he confirmed that it was something that she’d been thinking about too
Marie mentioned that a week after starting on the daily dose, she developed red spots on her legs which lasted for about 2 days. She spoke to her mom and mom confirmed that as a child Marie did have spots all over but does not remember how they were treated.
I was very happy to hear this revelation as it clearly demonstrates a return of old symptoms and provides further proof that Lycopodium is the best indicated remedy. This is a clear example of Hering’s Law of Cure5, “we heal in reverse order as the symptoms have appeared or been suppressed”.
Prescription: Lycopodium, 200C, but increase the dose frequency to twice daily.
Third follow up: August 2019
Marie was very happy to report that her relationship with her parents and brother are improving and she is spending time visiting them. As well her romantic relationship is going well, she worries less and less about her insecurities and is able to give more to the relationship.
The headaches are a 100% gone and have not returned. She is sleeping through the night and is waking up in the morning refreshed 9 out of 10 times. She is very happy about this improvement. The vaginal dryness is gone and she no longer has issues becoming aroused and having intercourse. More importantly she reported that she had gone for an ultrasound and the cyst she had been living with for so long is gone.
