Intake of case June 15th 2021
T.M. is a 51-year-old female patient who presented to the clinic with symptoms of what she termed spells or episodes. These spells would last from 1 to 30 minutes during which time she would experience tightness, sweating, balled up tension in her epigastrium and intense pain.
She would have to curl up in a ball during the spell until it was over and would be left with the feeling of being weak, exhausted and sweaty.
Medical History:
Family history of bowel cancer, cataracts, corneal separation, senility.
Personal history of traumatic birth of second child, history of trauma on sailboat capsizing when 7 years old. Hemorrhaging following second child from piece of placenta not removed after delivery.
Vaccinations: fully vaccinated following Ontario schedule when younger, no reactions known.
T.M. presented with the menopausal symptoms as her chief complaint. A stiff neck and shoulders was also added to her list and occasional headaches from running. She described her hot flashes as occasional now and further between describing them as 10 times per month. When they come at night they wake her up and that is annoying. Her pattern of sweating with the hot flashes is pelvis, chest, back and shoulders.
Practitioner: Can you tell me about the spells you mentioned on your intake form?
T.M.: They are weird, they start as a grabbing feeling in my upper abdomen, it was tied to my cycle but now they are not as regular. They are a tightening, causing me to feel anxious and start sweating, they can last up to an hour.
They are painful but I cannot control it, cannot stop it or get away from it. The symptoms get worse and worse then they just stop. I feel exhausted afterwards and sweaty. I am white in the face. Of the one I had last month, my husband said I had fear in my face and I was pale. I don’t like pain at all. I am afraid of it especially when I don’t know what it is from.
When I know what is causing it I can calm down. I bend forward for relief but it does not help much. Lying on my side is best bent up in fetal position. It is tight I cannot breathe well it feels like, hot, like a fever, heat all over but mostly in chest and back, head, forehead.
Practitioner: Have you tried anything to help with these attacks?
T.M.: Yes I saw a Naturopath and she gave me Cheliplex which worked for 3-4 months to ease them when they started but did not do anything to stop them. Then I was given Sepia for 2 months but it did nothing to change the symptoms.
I try to stretch out when they start and to open up my breathing but then flex forward afterwards for relief. My bowel movements are related to it, like something must move through there for it to go away (she pointed at her stomach area in the epigastrium). It settles if I can have a bowel movement.
Practitioner: Does anything trigger them?
T.M.: I have had them after a run, while doing groceries, at work, at home, so no pattern has shown itself, no.
Practitioner: Can you tell me about menopause when did it start and when was your last period?
T.M.: Last one was July 2020 but they were erratic prior to that for 5 years. The hot flashes have been for those 5 years and the cramping started about 2 years ago. My menstruation prior to that was bright red, some clotting on the first day, the day before had a feeling of having to empty my bowels completely, had a lot of aching but no cramping with them, 3 days of heavy flow and 2 days light. My sex drive is quite low since menopause started.
Practitioner: Can you tell me more about the panic or anxious feeling?
T.M.: I used to panic because I had no idea what was happening before I had figured out that it is related to hot flashes and my bowel movements. It hurt so much it panicked me.
Practitioner: Can you tell me about the headaches?
T.M. They are related to the neck tension, I get a stiff neck then pressure in my head, behind my eyes, and nose, it is worse with running, I get tighter and tighter during a run and when I get home, I have a headache. When I turn my head to the right the headache goes from my neck up into my head. Always in that direction. It is a restricted feeling, sleeping can aggravate, make it worse, especially with deep sleep, I will wake up with a headache after a deep sleep. I don’t seem to guard my neck during a deep sleep.
The intake continued but further details did not arise about the chief complaints. The questions then shifted to more general in nature.
Practitioner: How are your bowel movements and digestion in general?
T.M. Good, I go at least once a day most days twice. But lately they have been shorter and more like little balls. For about a year now. No pain or constipation at all but this cramping seems related to the movement of stool through my colon.
Practitioner: Tell me about your energy?
T.M. it is very good, I get lots done, I sleep very deeply and sometimes I can take a nap in the afternoon. I am most energized in the morning, and I get motivated by things that make me happy. If there is a negative energy about something it wears me down. Sadness makes me slow down, but I think that is normal.
I sleep about 7-8 hours and can fall asleep in a few minutes. I don’t move much when I sleep. I am woken by the hot flashes, and they drive me out of bed to cool off. I am agitated when they come. I like the room cool but not cold or I cannot fall asleep.
I like the windows open only if raining and I need a blanket but not too thick. I will stick my right leg out if I get too hot and I snore when on my back. I sleep on my side mostly and I can according to my husband talk when I am sleeping and not remember what the conversation was about in the morning.
Practitioner: What is your body temperature like?
T.M.: I am not hot nor cold really, I don’t like to be cold, my feet are cold a lot, I also don’t like to be too hot, in the summer if it is more then 35 degrees, I must get out of the heat in an hour or so. I like the cold weather to do things in but I don’t like to get cold. Rainy weather takes away my motivation.
Practitioner: Can you tell me about any fears that you have?
T.M.: I am very afraid of heights, but I love being in the mountains. I have a fear of ladders too as they are not stable. I am afraid of anything happening to my family. I am also afraid of large bodies of water and drowning. I had a bad experience when I was younger almost drowned on a capsized sailboat in Lake Ontario with my family in a very bad wind and rainstorm.
Questions were asked about dreams but there was no memory of any dreams of significance.
Practitioner: Can you tell me about your perspiration, when, how much and where on your body?
T.M.: I sweat all over, head, armpits, neck and throat mostly, my underwear is soaked with exercise, so my entire pelvis must sweat. No odor, other than normal sweat, no real strong smell.
Practitioner: Any food cravings or dislikes?
T.M.: I have a desire for breads, chewy bread, sweets, chocolate, and vegetables. I don’t like pork or bacon anymore since menopause started. I like fish but hate the smell of fish, so I don’t cook it much. I don’t like brussel sprouts.
Practitioner: What about your thirst?
T.M.: I used to be thirsty and drink lots of water but lately I have noticed that I am not thirsty, for about 5 years now. If I drink water it has to be cold with ice, and I don’t like hot drinks.
Practitioner: Can you describe yourself to me, who are you deep down inside?
T.M.: I am a mother of two. A wife, daughter, I run two businesses, I am a nice person, loving, creative, smart, (not sure if I am smart) (laughs), a dreamer, fixer of things, connector. I love my family, my dog, being creative, people appreciating her creativity.
I don’t like meanness, people who take advantage of other people. I would change how much she cares about what other people think. I do have anger, but I push it off to a point then it explodes out of me, then it is hone mostly. Yelling feels good during but not after.
I feel if I keep any anger inside it will go somewhere else. It pops out at the top. I do hold grudges with some people. If someone hurts my family, I cannot forgive that. I don’t like confrontation, arguments, they make me anxious and and sweaty in the face. I don’t like criticism, I take it poorly, it makes me feel like I have done something bad, something wrong. It brings sadness.
Practitioner: What are the biggest traumas you have had in your life?
T.M.: The sailboat incident for sure, and the birth of my second child my daughter. She got caught inside my pelvis and her heart stopped they had to extract her with some force and it caused a nerve palsy that gave her permanent nerve damage.
Then in the haste of saving her they did not clean my placenta properly and I had hemorrhaging about 2 weeks after alone in my house. A friend had to drive me to the hospital to be looked at as I bled all over his car seat. I really have not been the same since then, but menopause has created the recent changes.
In recent history T.M. was given Sepia 30 CH OID for her symptoms by another practitioner. It did not make any change at all to the case or her cramping, her thermals did not change nor did her hot flashes. There was no change to bowel movements or her digestion. She continued this therapy for 2 months and then stopped taking Sepia. Her conclusion was that it did not help.
Assessment:
When looking at the totality of the case it became clear that this is not only a factor of menopausal changes in her body. The cramping seems to be directly related to her bowel and the fears are more deeply and earlier rooted in her history then the recent menopause.
Since she came to the office with a history of Sepia use with no effect, this removed one remedy for us to differentiate in the case. The amount of heat released before the cramping and the fear associated with the cramping are striking elements of the case. Menopause while a factor, will not be the only key in the case.
As a result, the following rubrics where chosen: Using Schroyens Synthesis Repertory 2009 in the Radar Opus version 3.0 software program.
Stomach contraction (104)
Abdomen Pain hypochondria (253)
Female Genitalia/Sex Menopause (119)
Mind ailments from mental shock (45)
Mind Fear pain of the pain (21)
Mind fear sudden (51)
Fever Stool before (9)
Fever heat accompanied by complaints other (104)
Mind fear high places of (120)
Neck pain stitching pain (42)
The Mind Ailments from mental shock was chosen to represent the strong mental issues from her daughter’s birth, they were sudden emergency based and quick. She is still dealing with them today as the topic still brings tears when discussed.
The stomach epigastrium squeezed as if, is the closest rubric to the exact words used by T.M. but it was too small a rubric to use in this case, therefore Stomach Contraction was used instead.
The Mind fear pain of the pain was chosen as it very closely represents her description of the pains in her abdomen but pains in general, she is afraid of pain in her life in general.
The following chart was made using Radar Opus Version 3.0
The following remedies where then looked at for comparison and choice: Pulsatilla, Phosphorous and Mercurius.
Pulsatilla – this remedy repertorized well. The emotions of this patient and Pulsatilla match well, she is sympathetic, amel by consolation, fear of heights, yielding, hormonal disturbances match. The food desires match, the aversions match. (Allen, 1889) The sexual desire does not match. Puls are mild, gentle, yielding in nature. T.M. is all of these. Her family comes first, and she gives in to others often. Pulsatilla is thirstlessness, but do not exhibit epigastric pains, even though it scored highly (the MM does not have a match for her epigastric squeezing that she complains of. The cervical pain does seem to be a highlight of Pulsatilla (Hering, 1879)
Phosphorous – this remedy also repertorized well, Phos tends to be related to heat and burning pains. They tend to be open and lively people; they have a desire for company and an anxiety for others. They are sensitive to external impressions, and they are creative and artistic. (Hering, 1879), these all matches T.M. and her personality.
Phos has food desires that closely matched T.M with the chocolate, and cold drinks. (Allen, 1889) It is usually a thirsty remedy. In the epigastric region it can be very sensitive, painful to pressure, griping, sharp pressure. (Hering, 1879) Sudden heat before stool. (Hering, 1879) Her sexual diminishment did not match under Phos but this was not a complaint by her just an observation when asked. Stiffness in nape of neck matches exactly with the complaints of T.M. (Hering, 1879)
Mercurius Solubilus– this remedy repertorized with the highest score on the rep chart. It however did not match her personality nor her mentals. Mercurius tends to have difficulty expressing her emotions and ideas. They have delusions often. (Allen, 1889).
They tend towards depression, slowness and dullness and they are closed. (Allen, 1889) They are aggravated by perspiration and heat of bed (Allen, 1889) They do have a desire for bread. They are usually thirsty. Mercurius is usually restless, something that T.M. never mentioned (Hering, 1879) Mercurius can have the tightness in the neck and in the shoulders. (Hering, 1879) It does exhibit burning pains in the stomach but not the pressing and tightening of Phos. (Hering, 1879) The pressing cramping pains of Mercurius are found in the area of the liver and gall bladder. (Hering, 1879)
With the number of symptoms that related to Phosphorous it was clear that a better look at other phosphorous remedies might be relevant and indicated. When looking at Nat Phos, it was too nervous and T.M. did not have the qualities of Natrium in her personality or pathology.
She did not exhibit weakness. (Allen, 1889) Calc Phos had the anxiety about others, but T.M. did not have any slowness, irritability or moaning associated with this remedy. (Allen, 1889) T.M. was not indifferent, excitable, or especially talkative as would be found in Ferrum Phos. (Allen, 1889)
Phosphorous was selected and given at 30 CH OID for 1 month and then follow up.
Follow up July 16th 2021
T.M. was feeling better and it was clear on her face and in her mood when she entered the clinic. She reported “sleeping deeper in general and not waking anymore with the hot flashes. She did have another episode of cramping this month which was quite strong and lasted a long time.
Her bowels felt the same during that episode and there was the same sweating happening during the episode. Her hot flashes are better in general, they do not wake her at all. There were not new symptoms noticed. Her head felt clearer, and her thirst has returned.
She is noticing that she must guzzle water occasionally to satiate the thirst. No new cravings were noticed. Her bowel movements in general where longer and better formed for at least 3 weeks now. No changes in thermals noticed.”
Phosphorous was working well, it has stimulated the vital force to work in the correct direction. While it would be good to see a change in the episodes in this first month, no change in remedy at this time is indicated. A change to 200 CH OID was chosen. Since the vital force had been stimulated but not enough to change the chief complaint, an increase in potency is indicated. It is also indicated by Kent for chronic cases. (De Shepper, 2001)
Follow Up August 5th 2021
T.M. reported in the first week her neck getting stiff and sore, then it moved to her right arm and then it erupted in a pustule that oozed and leaked for 2 full weeks. The liquid was yellow then it changed to clear yesterday. (the location of the pustule was over her vaccination scar on her right deltoid tubercle).
Her head is clearer then before and she has had no episodes at all this month. Still the odd hot flashes but during the day only. Had some soreness in left knee with running but then it disappeared. The thirst changes continued but did not increase.
Sleep continued to be good and no changes noticed in bowels or cravings. The Phos is working very well, the posology does not need to be changed so redosing was suggested for one week and then observe. Since the chief complaint was being addressed and the vital force showed no evidence of proving symptoms the posology was continued. (De Shepper, 2001)
Follow up October 15th 2021.
T.M. reported that the oozing in the arm has cleared up and she is left with a red raised scar there, but it seems to be healing. There have been no spells in 3 months at all. She is still sleeping through the night and the night sweats are all but gone, maybe one this month.
Thirst is the same and her bowel movements are the same. The headaches from running have not come back since July. The remedy is working very well and in order to be sure the cure becomes complete a change in posology to 1M once and then wait and see is recommended. (De Shepper, 2001) T.M. was given one dose of 1M Phos and then told to report if any of the symptoms returned.
Follow up January 4th 2022
T.M. called the office to report that she had one episode very mild and very short lived that day. It was the first one since July and it did not come with the sweating nor the fear nor the heat production. I asked her if she took the remedy and she said, “it did not cross her mind to”. She then took one dose as recommended before.
Conclusions:
Phosphorous worked very efficiently and thoroughly in this case. It worked by stimulating the direction of cure (Kent, 1911) from Hering, as the vital force irritation travelled from her neck to her right arm then burst through the skin at an old vaccination site and then removed volumes of liquid from her body.
It also worked on the epigastric pain and cramping after moving up through the potencies as described by De Shepper (De Shepper, 2001) and Hahnemann. (Hahnemann, 1833) under Aphorism 287. Phos seems to have removed all of the symptoms, but it will remain to be seen if they stay away with a few more doses or if the remedy needs to be increased one or a few more times.
Bibliography
Allen, H. C. (1889). Keynotes and Characteristics with Comparisons. Philadelphia: Homeopathic Publishers.
De Shepper, L. (2001). Hahnemann Revisited. Sante Fe: Full of Life publishing.
Gerachny, P. (2022). Physiology of Menopause. Zurich: Springer.
Hahnemann, S. (1833). Organon of Medicine. Kothen: Hahnemann.
Hering. (1879). The Guiding Symptoms of Our Materia Medica. Philadelphia: Globe Printing.
Kent, T. (1911). Lectures of Homeopathic Materia Medica. Chicago: Kent.
NASH. (2022, Jan 22). NASH Journal submision guidelines. Retrieved from NASH Homeopathy.org: https://homeopathy.org/the-american-homeopath-journal/journal-submissions/
Nwabudike, L. (2016). Impetigo and Homeopathy. The publishing house of the Romanian Academy, 89-93.
Nwabudike, L. (2020). Palmar and Plantar Psoriasis and Homeopathy. Our Dermatology online, 66-69.
Patel. (2021). Menopause Review: Emerging treatments for Menopausal symptoms. Clinical Obstetrics and Gynecology, 10-15.
Sadowsky, V. (2020). A Case of Belladonna. NASH Homeopath, 10-15.
