1st visit, 18. 11. 2016
A woman, 37 years old. The main problem is the inability to get pregnant naturally. Whenever she got pregnant through IVF (5 times in the past), she always miscarried at week 6. The cause of the difficulty is unknown, all the tests are fine.
From the age of 18 to 26 years, she was taking hormonal contraceptives, to which she was very responsive. She suffered from generalized swellings all over her body (2), had mood swings, and when she got out in the sun in the summer, she had acute psychotic states that manifested by screaming, great anger, feelings of strong aggression, and weeping.
These states were frequent after exposure to the sun and after a few minutes, when it had subsided, she did not remember what exactly she had done. These problems disappeared after discontinuing hormonal contraceptives.
All her life, her blood pressure has been low. Her period is regular (28-32 days). On the first day of menses, she typically has abdominal crampings (2) without any other modalities.
Observation: She has red spots on her face. When I asked her about it, she confirmed that these red spots appear whenever she is emotionally upset or after physical exertion. She has been observing this since an in vitro fertilization in 2012.
When they appear, she feels strong (burning) heat in her cheeks (3). When such a rush of heat to her face occurs, she feels strong anger (3). Similarly, when he gets angry, red spots appear on her face.
In the past, she has tried homeopathic treatment for difficulties in conceiving and carrying. She has taken Aur-m-n., Nat-m., Folic., Sil., Thuja, and Phos-ac. in the past without any visible effect.
A year ago, on examination, she was found to have a 5 cm ovarian cyst on her left ovary (3). For the last 5 years, she keeps feeling non-specific bladder pains before her period.
From the age of 26 to 30, she suffered from severe dysmenorrhea with terrible pains as if someone was ripping pieces of meat out of her uterus. The cramps were coming in waves.
The course of the miscarriages: They always came in the 6th week; they began with marked chills all over the body in the evening with chattering of teeth, which was followed by bleeding of bright red blood with dark clots.
Since the last abortion, she has been much more sensitive to cold than in the past and often has cold feet (2-3); nevertheless, never sleeps with socks on. For a long time now, she cannot tolerate anything tight around her neck (3).
The prominent red spots on her face were the first thing I noticed about the woman before she sat down and told me the reason for her visit. In addition, she was slightly out of breath (I had an office on the 1st floor and she climbed the stairs). However, the panting was not especially pronounced while the red spots on her face were.
Once she told me that the recurrent miscarriages and difficulty getting pregnant naturally were the main problem. I began to consider remedies combining recurrent miscarriages and easy flushing of the face. Ferrum metallicum, Pulsatilla, and Belladonna are among the main remedies of which both these aspects are characteristic.
The flushes of heat felt in the cheeks, chest, or upper half of the body are very typical of Amylenum nitrosum, which also blushes easily from agitation and is very sensitive to anything tight around the neck. But when a flush occurs in an Amylenum nitrosum patient, this condition is accompanied by anxiety “that something bad is going to happen,” whereas here, we see strong irritability during the flush, which is characteristic of Belladonna.
In Belladonna, we see not only blushing during agitation but also irritability during congestion of the head, e.g., in the sun or during fever (in which Belladonna has an extremely congested head).
When analyzing any case, it is of utmost importance to ascertain and recognize the whole picture of the disease and not to focus on only one part, such as miscarriages or the inability to conceive. Indeed, if we started doing that (in this case, if we consider only remedies that have miscarriages as a keynote symptom), we would tend to “fit” the patient into the picture of one of the remedies of which these problems are typical.
Similarly, we must avoid trying to “prescribe for miscarriage and miscarriage symptoms”. Now, if we were to select a drug based on the symptoms present during abortions and give her a drug based on those symptoms alone, the drug would have a very superficial effect.
The tendency to miscarriages is a chronic problem, and unless the remedy affects the general health of the patient, homeopathic treatment will not have any major effect. Still, looking at the symptoms during abortions, we see bright red bleeding with dark clots, which is a keynote of only 2 remedies, namely Sabina and Belladonna.
Both of these drugs are very important for miscarriages in the first weeks of pregnancy, similar to Kali carbonicum, Apis, Cimicifuga, and Viburnum, all of which are characterized also by extreme cramping pains during menses, similar to those the patient suffered from while taking hormonal contraceptives.
The patient’s history shows that she was very sensitive to hormonal contraceptives. Her description of acute psychotic states, which were aggravated by exposure to the sun and which appeared shortly after she started taking contraceptives (and disappeared shortly after that was stopped), shows several other symptoms which are very unusual and which can be used to confirm the remedy needed at present, should the current symptoms not be sufficiently complex and clearly pointing to a single remedy.
Should the current symptoms point to a single remedy, which, at the same time, covers the past symptoms (i.e., those that occurred while on contraceptives), this would greatly improve the prognosis of the case as it would mean that the patient remains in the picture of a single remedy for a long time.
Of remedies I considered, i.e., Ferrum metallicum, Belladonna, and Pulsatilla, there is just one that has a specific relation to ovarian cysts – Belladonna. However, this drug is typically associated with right-sided cysts. We also have to consider a remedy of which left-sided ovarian cysts are keynote – Lachesis.
In addition to the left-sided cysts, this patient has one of the main keynotes of that remedy – a strong aversion to anything tight around the neck. Also, “pain comes in waves”, a symptom that appeared when the woman was on hormonal contraceptives, is another of its keynotes.
Let’s select the most important symptoms of the case now and perform repertorization to look at all the remedies that come into consideration.
- Miscarriages at 6 weeks of pregnancy
- Red spots in the face
- Heat/burning in the cheeks
- Anger associated with facial flushing
- Left-sided ovarian cyst
- Aversion to anything tight around the neck
Repertorization in RADAR software with the Synthesis 9.1 repertory
Repertorization is performed using the technique of sum of symptoms with respect to the intensity of symptoms (for RADAR users: Sum of symptoms and degrees – Intensity is considered)
Lachesis very well covers the totality of symptoms and can be confirmed by several keynotes, such as left-sided ovarian cyst and aggravation by tight clothes around the neck. However, one of the newest symptoms – red spots in the face in association with agitation and anger – is not typical of this remedy.
Belladonna counts among important remedies in women who are prone to miscarriage. Although it cannot be found in the rubric “abortion at 6 weeks”, it is a drug that is very closely related to miscarriages and should be differentiated with Sabina.
In addition to that, several other symptoms of this patient are also keynotes of this remedy, such as the link between facial congestion and strong feelings of anger, red spots in the face, feelings of heat in the cheeks, as well as (although to a minor degree compared to Lachesis) the sensitivity to tight clothes around the neck.
Belladonna is also an important remedy for ovarian cysts, although right-sided cysts are more typical of Belladonna. However, if the other symptoms agree, laterality cannot be considered a contraindication. We must also consider the acute psychotic episodes caused by overheating of the head that have occurred in this patient while on contraceptives – these count among the pivotal keynotes of Belladonna.
Phosphorus covers some of the symptoms of this case, but none of this woman’s symptoms are central to this remedy. The same applies to Sanguinaria, Pulsatilla, Bryonia, Nux vomica, Calcarea carbonica, and Kali bichromicum.
Kali carbonicum is a very important remedy in women who tend to miscarry in the first trimester but we can see no additional symptoms that would confirm this remedy.
Selection of the remedy, potency. and dosage:
Belladonna is the only remedy that can be confirmed on the basis of both the totality of symptoms and keynotes, thus covering the case better and more comprehensively than Lachesis. Since many of the most recent symptoms are keynotes to Belladonna and the remedy can, therefore, be confirmed very well, I recommend its administration in a single split dose at a potency of 200C.
Prescription: Belladonna 200C in a single split dose
1st follow-up, 27. 1. 2017 (6 weeks after the remedy)
The patient took the remedy on 12. 12. 2017. After that, she had changeable moods and she was more irritable than usual. Now, she has almost no flushes of heat; the cramping during her period disappeared, too. The cyst size has not changed (5cm).
In the last 2 weeks, red spots on her face and flushes started again, but only in a very mild form. Her PMS has disappeared and she had no spotting before her period nor pain during it.
She no longer has cold feet and she sometimes walks barefoot around the house. This changed right after taking Belladonna. A minor rash has appeared on her face (the last time she had it was six months ago). During ovulation, she feels twitching in her left ovary. Overall, she feels better than before the drug.
Analysis of the 1st follow-up:
There was an aggravation of her condition followed by an improvement in long-term symptoms after the remedy. The appearance of a rash after taking the remedy (especially when combined with initial worsening and subsequent overall improvement) is one of the most reliable signs that the remedy was correct and that we should wait.
2nd follow-up 19. 2. 2020 (3 weeks since the last follow-up) – phone call
5 days ago she started having depression at times and severe mood swings, which she had been suffering from previously. It was very intense; she says she felt unable to get to work, was apathetic, could not concentrate on anything, kept forgetting what she wanted. This went on for nearly a week, and she said she was “like crazy”. She is a little better now but still significantly worse than at her last follow-up.
Observation: She speaks in a very anxious, almost panicky, manner. She is physically very exhausted and says she cannot do anything, not even mentally.
Analysis of the 2nd follow-up:
The first thing that struck me was the level of anxiety with which she spoke. I had read the minutes of the last follow-up and seen that she had a good reaction after Belladonna and felt generally better, which was preceded by an initial aggravation and during which the keynotes of Belladonna were greatly reduced. I first needed to find out what had happened and how she got into this state.
The moment I realized that she was extremely exhausted physically and mentally while saying that she “felt crazy”, Calcarea carbonica came to my mind as it is complementary to Belladonna and the fear of going mad (which was evoked in me by her statement about “feeling crazy”) is its keynote. I asked her if she was afraid of anything since this condition has started, and without hesitation, she replied, “I’m afraid of going crazy.”
Although this confirmed one keynote symptom of Calcarea carbonica, I still didn’t understand how she got into this state. But I figured that if she really needed Calcarea carbonica, overworking was the most likely reason for her partial relapse (the most common etiology in Calcarea carbonica).
My next question, then, was whether there was anything preceding her condition. She replied that she has been working in place of three people for the past three weeks because of the extreme amount of work that has piled up.
The etiology of overworking, the fear that she was going crazy, the general exhaustion, and the fact that Calcarea carbonica was complementary to Belladonna (which was working properly; this complementarity has the value of one keynote symptom) led me to the prescription of Calcarea carbonica 200C in a single split dose.
Prescription: Calcarea carbonica 200C in a single split dose
3rd follow-up, 3. 4. 2017 (6 weeks after taking Calcarea Carbonica)
She cannot remember any aggravation but within a day of taking Calcarea Carbonica, she started to feel much better. She began to concentrate better, stopped being anxious and her fear of going crazy disappeared completely. For a month, she was significantly better in all respects; the original problems that had disappeared after Belladonna did not return.
In the last 2 weeks, she has had very severe headaches, which she says she suffered from about 10 years ago when she had them daily. In addition, she has developed a strong downward pulling sensation in the uterine area which she never had before, and she has started to have very cold feet, especially in the evenings.
Analysis of the 3rd follow-up:
The overall marked improvement and the return of the old symptoms (in this case headaches) indicate that the treatment is proceeding in accordance with Hering’s Laws. If the old symptoms return, it is usually necessary to wait, except in situations where these symptoms are very strong and, together with other symptoms, form a clear picture of the remedy.
In this case, we can see that the headaches are accompanied by a strong downward pulling sensation in the uterine region combined with cold feet in the evening, which are two keynotes of Sepia. For this reason, I prescribed Sepia 200C in a single split dose at this stage of treatment.
Prescription: Sepia 200C in a single split dose
4th follow-up 20. 4. 2020 (2 weeks after taking Sepia)
Within a day after Sepia, a great relief accompanied by the disappearance of headaches as well as of the downward pressure in the uterine area came. Today, she had a positive pregnancy test.
Analysis of the 4th follow-up:
A significant relief from headaches and of the downward pulling sensation and, especially, the confirmation of a pregnancy that was, for the first time in her life, natural, are all extremely good news in this case. Given the overall improvement, the disappearance of the keynotes of Sepia, and the confirmation of pregnancy, it is necessary to wait.
9 months later, she gave birth to a healthy boy. The pregnancy was free of any complications and no conventional drugs were necessary.
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