Case Quizes Clinical Cases

Revisiting: Stomach Disaster Needs 2 Remedies

Elaine gives and explains the answer to last month’s quiz.

How many of you remember last month’s quiz?  Okay, here it is again with the answer at the bottom:


Mom, are we having another “completely different” quiz this month?

No way, Shana, forget about it!

Why, what happened?

Last month’s quiz?  Very disappointing.


Well, Shana, apparently people don’t know what our remedies “say”!  Only five people voted. 

I had nooooooo ideeeeeeeeea!  Well, what do we do now?

Not to worry!  I have a real doozy of a quiz this month!  People are really going to have to put on their thinking caps because this acute case requires two remedies!

Whose case is it?

“Sponge Bop”.

Mom, don’t you mean “SpongeBob”?

No, absolutely not, that would be trademark infringement.  This is a perfectly original name, like “Homer Stimpson.”


or “Bullwinkle J. Mooze”!


I see……..

So here it is folks, the case of Sponge Bop, as told by his mother, Mrs. Bop

Good grief.


Sun, Oct 10, 2010 at 12:04 PM

Acute Case Questionnaire

1. Describe the complaint. 

Came on Suddenly—Stomach pains started around 11:30 pm Friday–cramp like or like a knot in his lower abdomen—hurt on both sides and the middle.  Pain was constant!  His brother said Sponge Bop was so restless that the younger brother couldn’t sleep.  Says he was moaning during the night. No sleep during the night because of the pain.  Cramps in upper right leg during the night.  Pulling knees up to chest started the cramps.

Are you saying he had cramps in right leg and thought pulling up his leg would help; but, instead, it caused cramps in the stomach?

No, no, he already had cramps in the stomach—he first noticed stomach pain around 11 pm.  During the night he pulled up the right leg thinking that would help the stomach cramps.  Pulling up the leg started the cramps in the right leg.  Had to push leg down with hand to straighten it.

Yeesh!  So, you’re saying that “straightening out” is a way of coping with the stomach cramps?

He wanted to straighten the leg to ease the leg cramps–only he couldn’t straighten the leg so he used his hand to push the leg back down from where he had pulled it up.  He has been sluggish in answering questions.  Hard to get him to answer questions.

Is it like answering is just too much trouble, or answering makes the pain worse?

It just takes energy.  It does not make the pain worse to talk or answer.  Says he is so tired.  Threw up Saturday morning early around 4 or so.  Said it hurt horribly while vomiting.  Said it smelled like stool and vomit was brown.  His brother said it smelled foul.  Usually when he is sick, his first symptom is soreness so he took an Arnica Saturday morning around 8 am. 2 pellets in bottle of spring water.  He told me it didn’t help.  Sister said he looked pale and sick and seemed worse in the morning.  A friend said he looked green.  Says he felt better for a bit then (after vomiting) and told his sister he felt OK, not bad but OK and went on a 1.5 hour walk with everyone.  Fresh air and sun made him feel better.

Drank coffee for breakfast.  Ate nothing.  Drank 2-3 16 oz bottles of water.  Drank one on the way home around 11:30 Saturday morning.

Why did he drink so much, was he thirsty or was it just that he thought it was the right thing to do? What temperature water was it?

He said he was thirsty.  The water was cold, very cold as the bottles had been in the vehicle all night.

Friday after trip home, he can’t keep even a sip of water down.  Said maybe he felt a bit better after vomiting.  Gave him a bit of cold apple juice and it came back up–said vomit looked like water. Asked for cold water with no ice.  When asked what makes it better or worse answer is Nothing.

1:25 pm Sat.  Gave him Nux vomica, 30C, 3 pellets in a bottle of spring water.  I think I gave it to him after he vomited at home.

Went to bed–lying on side–doesn’t want to lie on back.  Said he felt a bit chilly.  Lies very still wrapped up in a blanket up to his chin.

Slept.  Said remedy helped a bit.  Threw up about 3 times over course of afternoon and evening. Would throw up 15-20 min after even a sip of water.  Asked to lie down on the front porch Friday evening to see if it would help.  Says it did.

7 pm Fever is 100 F.  Pains in abdomen are worse again.

Gave Nux again 7:30 pm after succussing bottle 10 times.

At 5 am Sunday–vomit was green.

Sunday morning–said clothing at waist bothers him.  Wants to have a stool but can’t.  Just crumbs.

Repeated Nux 8:15 Sunday morning after succussing 10 times, then as he swallows the remedy, he told me he feels bloated.

Threw up maybe 30 min after remedy — watery, bits of mucus, brown and bits of brown crumbs.

Has kept no liquid down since the bottle of water around 11 a.m. or so on Friday.

2. Etiology-

Sponge Bop, who is 18, worked 1/2 the day Friday (mowing and yard work), ate a late lunch around 4pm .  Then left for a camping trip and ate supper on the way maybe around 5:30 pm, he was really pushing himself as they were running about an hour late.

Ran and played hard with lots of little kids for 5-6 hours til 11 pm.  Was sweating a little bit.

Fell on rocks and landed on his front.  Bruised his shins.

Day was hot to begin with (80’s) and turned very cold (low 40’s).  Also, he ate a snack that night–maybe 8-8:30, organic granola bar, grapes and part of a s’more (roasted marshmallow with chocolate and crackers).

It was very cold–kids stayed around the campfire til about midnight trying to get warm then went to bed.  He said he didn’t sleep AT ALL Friday night.

Sunday morning—feels down and somewhat dejected/upset.  Brother and his wife are here from Florida and he is missing out on the visit.  More loved ones due to come to supper tonight and he won’t get to see them as he is sick.  Grandma is in from out of town and more family due to arrive Wednesday.  He is very sociable and so is dejected at not seeing these people or the thought of them cancelling their visits because of his illness.

3. Sensation-

Friday during the night. –Pain from bottom of ribcage all the way down to groin yesterday like his gut had been knotted.  Felt like somebody kept tightening it.

Saturday–After vomiting early in the morning, still painful but not as much and only in lower abdomen.

Sunday morning—Lower abdomen is better, knot-like pain is gone.  Abdominal muscles feel like they have been overworked and stretched.  Pain is from below ribcage to belly button.  Before vomiting Sunday morning, little to no nausea.  Had really bad hiccups.  Says hiccups hurt.  (Usually is not very susceptible at all to pain—is one of those kids who gets a splinter and never tells me till it is quite infected.)  Throat had a bit coming up like indigestion.  Felt kinda scratchy and then threw up.

Sunday morning: Feels bloated and hurts all over.

10:15 Sunday morning–Hiccups again–Retching but nothing is coming up

4. Appearance-

Looks and acts miserable, feels quite down and somewhat upset.  Skin is a bit warm but cooler than last night.  Temp is 99 F.

Looks bleary eyed.  Eyes have a pinkish cast.

Lies very still, hardly moving.  Right now is on side and knees pulled up a bit.

Sometimes, hard to even hear his answers to my questions.

5. Location-

Abdomen.  Says he would feel better if he threw up even though it hurts the whole time he is throwing up.

6. Modalities-

Better for—fresh air with a slight wind.  Slightly better for vomiting.  Wants to be in sun near window.  Better for sleeping with fan on low both because of air moving and background noise it gave.

Generally better for sleep.  Acted like he was chilly yesterday (Saturday) as he kept rolled up in his fleece blanket.  A few times he pulled one arm out of the covers but today he doesn’t want a blanket.

Worse for lying on back or stomach, sitting up.  (Even wants to lie down while vomiting.)

He can only lie on his side?

Yes, to be comfortable.

Either side?


Why is sitting up worse, is it because of dizziness?  Pain?

Takes more energy.  No dizziness or pain.

Worse for hic-cupping.

To what degree is hiccupping part of the case—is he doing it often?

He was not hiccupping at all yesterday.  He says he has hiccups when he moves around, either moving around on sofa or getting up to go to the bathroom.  Says the hiccups cause him to vomit sometimes.

He is not hiccupping often.  I would have said yesterday the stomach cramps/pain were his biggest complaint.  Today it seems like the thirst is worse than the hiccups–he says he can get rid of the hiccups if he holds his breath long enough.  He is hiccupping from time to time–it is not constant, just irritating when it happens.  Lying still helps with the hiccups.

Didn’t mind the noises last night—felt like he could hear what was going on with company here—didn’t feel so left out.

This morning: Footsteps overhead were annoying—his bedroom is in the basement under the kitchen.

7. Concomitants

Pain with moaning and sometimes hiccups before vomiting.

Is this the only time there’s hic-cupping?

No.  Also hiccups when he moves around.

Something that you could call indigestion (hasn’t eaten since Friday evening.)

If not in the sunshine, wants to be covered, sometimes he is chilly but not necessarily.  Just wants to be covered.

Lies perfectly still almost as if dead.

Why is this?  Is it because moving brings on nausea, or because moving causes a draft of air, or because moving is just too much trouble, etc.?

Moving takes energy and also causes hiccups.  He is not nauseous now.  Though he was nauseous yesterday before he vomited.

Hiccups are “annoying, they are killing me.”  (Direct quote)

Is it because they cause pain?

Yes.  Hiccups cause pain all across his stomach because of the sore muscles from vomiting.

8. Discharges-

Vomit—Brown on Saturday morning—foul smell, thick, chunks of apple recognizable

Like water Saturday afternoon

Green tinged water later Saturday

Sunday morning—bright green, thin

Sunday midmorning—dark brown liquid with mucus and brown crumbs.  I don’t notice any odor.

The odor is gone?  No odor in the case now, even bad breath or any other sort of odor?

Odor is gone—no body odor nor odor to vomit.  I don’t notice any bad breath odor either.

9. Generals-

“Can I have some more ice chips?  I want a sea salt bath.”

Why, because he heard this might be good for him?  Or he has a desire for salt?

Wanted a sea salt bath because he thought he might get hydrated that way through the skin and also thought it might relax his sore stomach muscles.  He is still asking to soak in a sea salt bath but I told him no as I didn’t know if it would draw more moisture from his body.  He said he is not desiring salt.

“I’m hungry but warm food sounds repulsive.  I guess I could be considered sad.  I’m thirsty.”

10:45  “I feel so dehydrated.”

10. The mentals–

Slow to answer questions, indifferent and sluggish, but says he doesn’t feel that way.

Has felt a little irritable since midday Saturday when he got really tired.

No confusion or cheerfulness.

11. What have you been saying?

“Just come check on me periodically.”  Last night—“Please leave my remedy here in case I need it.”  I (Mom) slept on sofa so I was available but he didn’t come get me or call.

12. What are you doing?

see above–mouth is really dry–doesn’t want to answer anymore questions.

Not talkative–only answers questions when I press him.  A lot of this info I am giving you I just learned for the first time this morning.  Right now is lying dead still and quiet.  A few minutes ago was making little noises (like groans or little sounds of pain) each time he hic-cupped.

13. Describe your thirst and appetite-

Getting thirstier, feels dehydrated, wants cold water, ice chips, wants regular drinks, whole glasses of water except then knows he will throw up.  Wants to take a walk but has no energy.

14. Fever?


15. Sweating?


16. Odors?

Not anymore

17. What is most striking or peculiar about your condition?

Says nothing is striking.  When asked what is bothering you the most—“hiccups, my stomach, getting nothing to drink and being unable to keep water down…”

18. Is there a diagnosis?

No, a doctor along on the camping trip mentioned it could be dehydration when he heard that Sponge Bop vomited Saturday after strenuous exercise on Friday.

19. Describe your energy-

Says has no energy, keeps asking–are you done?

Mrs. Bop, it is tempting to give ____________ but, I’m going to go with _____________.

Give ______________ 30 in water, one swallow or sip and let me know what happens

On Sun, Oct 10, 2010 at 9:24 PM

Hi Elaine,

1:30 pm

Before the _________________ Sponge Bop didn’t want to get out of bed to come upstairs .

30 min. after the remedy, he got out of bed and went upstairs to shower.  This was his idea, not mine, really surprised me.

Said the shower helped, relaxed him a bit.

But nonetheless, he said there was no change after the remedy.

Moving around did make him hiccup which made his stomach hurt.  He said he felt rotten.

He moved out to lie down on the porch furniture after a while.  Was still very dejected over being sick around an hour ago.

3 pm

I asked if there has been any change better or worse since the ________ remedy.  His answer, no.

Has continued with small spoonfuls of water every 5-10 min or so–no more vomiting.

Hiccups seem to have stopped, he was able to roll over and lie on his back a few minutes ago.  He said only lying on his side was making his back hurt, but it is OK now.

When I asked again a couple minutes later, he said maybe he was a bit better.  (I really wanted a more specific answer.)

How, I said.  He said,

–not so bloated feeling

–stomach muscles not so sore

–not so dehydrated feeling

I think he looks more relaxed, peaceful

That’s what I wanted to hear!!!!!

(Didn’t express dejection this time over being sick) and he seems very still & quiet and maybe sleepy. Very slow to answer questions.  Wanted to be in the living room or on the porch.  Windows are open today and family is playing cards on this floor.  The talking and noise don’t seem to bother him.

Hi Elaine,

Sponge Bop asked if I was going to give his remedy again tonight?  Would you advise me what to do?

Here is an update on how he is doing.

He doesn’t feel as good as he did an hour ago–due to bloating & hiccups though hiccups are not as painful as earlier today.

He does look livelier than this morning though is still tired and weak.

He still hasn’t had a stool.


has drunk a bit less than 1 pint of water in the last 1 1/2 hours plus about 1/2 cup earlier this afternoon.

This is good as it is more than he had in the previous 24 hours or so.

He says he wants more ice cold water (2-3 glasses he said) as he is still thirsty and lips, mouth and throat feel dry.

But he can’t drink anymore as his stomach feels bloated again–feels full and a little uncomfortable like a tight feeling.

Has not had a stool.

Has not vomited since taking ___________.

Sore muscles in stomach/abdomen are better.

Lower abdomen better but still a bit tight.

Upper abdomen below rib cage is tighter—he said maybe due to water he drank?—than this afternoon.

Has been sitting up last 1.5 hours to watch a movie.

Hiccups got worse.  Before that hiccups had been a bit better, less frequent and easier to get rid of by holding his breath.

Decided to lie down again a few minutes ago to see if it eases hiccups.  (I just asked and he hasn’t hiccupped since he lay back down about 10 minutes ago.)

I have seen slow but steady improvement in him all afternoon–his voice earlier this afternoon was faint, but now is stronger, more normal volume and tone.  He seems perkier to me but says he is still weak and tired but not as weak as before _______ dose.

Should I repeat the ________remedy or wait?


Hi Elaine,

After repeating ____________at 8:30 pm, he still felt miserable from the hiccups and the stomach pain it caused.

Then he threw up repeatedly around 10 pm and is still spitting out mucus which he thinks is tinged with blood as it is pinkish brown.  The vomit was thin consistency, dark brown with bits of mucus and no odor.  It was pretty tough on him vomiting so much (maybe a quart or more?) and he was totally weak afterwards.  Wanted to lie down on the floor and then couldn’t stand and had to be all but carried to bed.

After vomiting, the cramp, knot-like pains in his lower abdomen returned.  They have eased up for the moment.  He is again lying on his side very still and quiet.

Plus the bottle.  The potency isn’t high enough.  Ideally, we should have a 200C for this case but since all we have is the 30C, we have to plus it to at least 33C.  Let me know what happens.

Hiccups better, he said.

Still has desire for ice cold drinks, cold things.

Now he has desire for company, asked a couple times this morning for me to rub his back, not nearly so weak, looks better in the face this morning, apparently no knot like pains this morning in his stomach; raw, chewed up stomach pain not bothering him either.


Mrs. Bop, I want you now to switch remedies to ____________30C.  One dose, let me know what happens.

Hi Elaine,

Sponge Bop fell asleep fairly quickly last night after I gave him ___________.

Slept all night–got up once to use the bathroom.  Urinating now.

No vomiting.  Stomach not as bloated feeling, hiccups better, he said, still has desire for ice cold drinks, cold things, still has desire for company, asked a couple times this morning for me to rub his back, not nearly so weak.  Looks better in the face this morning, apparently no knot-like pains in his stomach; raw, chewed-up stomach pain not there either.


Mrs. Pants


Well, that’s it, everybody!  Were you able to figure it out?  What were remedies #1 and #2?  Write to me at [email protected] and let me know!  The answers will be in the November ezine.  See ya then!



Rhus tox/Bryonia

Bryonia/Carbo veg.




Hi everybody!  Are all of you back?  How did we do?
Let’s begin by talking to avid quiz-participant and winner, Dr. Diderik Finne
of New York:

The leading remedies are Phosphorus and Bryonia.
You probably gave Bry  first, then Phosphorus  I would have begun with Phosphorus.

Yes, I gave Bryonia first.  Why would you give Phosphorus first when he didn’t want company and was lying perfectly still, two keynotes of Bryonia?  Movement made everything worse and he was disinclined to answer questions; then, as soon as he got Bryonia, he got up and took a shower.  You know, Bryonia and Phosphorus are both very thirsty; but, did you notice the dryness in the case, including constipation?  That goes more for Bryonia.  When I saw the mentals change (asking for company) and the amelioration from rubbing, I went for Phosphorus.

I think it was Phos from the start.  He wanted to lie still, yes, but you have to ask yourself why.  In my understanding, it was not an aggravation from movement, or from being disturbed, but lack of energy, the same reason he did not want company.  Phos is bold type under Indifference.  The rapid dehydration and desire for ice cubes were clear Phos keynotes.

I’m not remembering all the things that were worse movement but hiccups was definitely one of them; then, like I said, there was the dryness, dry mucus membranes.  Now, half an hour after Bryonia, he gets up and takes a shower!  Nothing has happened within half an hour to restore his energy other than taking Bryonia!

Now, speaking of “no energy”, who has less energy than the famously weak Arsenicum; but, do they lie still?  Noooooooo!  They toss and turn and move from here to there and back again…..

You make some good points, Elaine.  In truth all we can do is speculate.

Remember when I said, “It’s very tempting to give ______________”?  I was referring to Phosphorus!!!!!  But, you know, when your acute case has mental concomitants, they become your first consideration—unless the etiology is compelling and overwhelming!

He does not want company.

He does not want to answer questions.

He wants to lie perfectly still and not move for anything, he doesn’t even want to sit up to throw up!  The materia medica even says, “worse rising up” and he surely demonstrated that!

Between the mentals and the keynotes, I don’t know how you can ignore Bryonia.

Now, I know, you’re saying, “Oh, he was just too weak to ask for company and too weak to move, etc.”  But why then, after he’s given Bryonia, is he suddenly able to ask for company and get up and take a shower?  He suddenly got the energy!  Isn’t that what we want to see after the right remedy?  Patient all of a sudden gets energized?  The other important thing to look for after a remedy is the return of a calm and relaxed nature.  (“I think he looks more relaxed, peaceful,” Mrs. Bop said, after Bryonia.)

So, all I’m saying is, we can’t ignore the mentals–which I’m sure you already knew; but, you were trying to talk yourself out of them!  Sure, maybe Phosphorus would have worked–we can’t go back and try it and see what would have happened, as you’ve said; though I sure wish such a thing were possible sometimes.

Do I win a T-shirt or something?



Let’s hear from Maryam from Pakistan:

Hi Elaine! how are you?

I am well, thanks!

This case is too much messy and took a lot of my time and I am not sure of 2nd remedy.

Well, then, let’s just forget it!

I think the very first remedy needed by the child was Rhus tox…

Yes, yes!  I totally agree!  Too bad he didn’t get it.

… due to striking symptom (extreme restlessness so brother could not sleep) and the etiology– i.e. over-playing and change of temperature (day was hot to begin and turned very cold) but unfortunately he has not gotten the right remedy Rhus Tox in time so symptoms had changed, right?

Yes, absolutely, and the ailments going from hot to freezing cold weather.

So I sum up all the general and characteristic symptoms and repertorized the case, and the remedy who is getting the highest marks and cover almost all the symptoms is Phosphorus!

Wait a minute….  You’re Dr. Diderik Finne in a wig and high-heels!

No, Elaine, wait!  I think in this case some very striking symptoms go towards Bryonia!

Oh!  Well, that’s different; never mind!

I thoroughly read both phos and bry in materia medica and my final decision is to give bryonia first because of key symptoms:  Does not want to move (thus we have the well known Bryonia aggravation from motion, runs throughout the remedy).  Does not want to answer questions.  Desire to keep perfectly still.  Amelioration by cool air.  Great thirst for large quantities of water, especially
cold water.

Bryonia patient is subjected to hiccough, to belching, to nausea and vomiting, so that disordered stomach is the general term Bryonia patient with such inflammatory condition of stomach and abdomen be seen lying perfectly quiet in bed with the knees drawn up.

And for the second remedy, Phosphorus was already in my mind because of previous repertorization and gotten the highest score.  So in this case, after partial cure by Bryonia, Sponge Bop showed two more symptoms i.e. desire for company and ask for rubbing the back.

Yes, my thoughts exactly!

So here I have 3 symptoms for repertorization i.e.

Appetite, desires cold drinks.

Back, rubbing, amel.

Mind, company, desires for

and yessss!!!  Phos. is getting highest marks again (Plumbum too) so I again read materia medica and I think I am not wrong, but not sure.



Maryam from Pakistan

Yay!!!!  Let’s hear it for Maryam from Pakistan!!!!!

Dr. B, it’s time to congratulate our winner:
Maryam from Pakistan!

See all of you back here in December!


Elaine Lewis, DHom, CHom

[email protected]


About the author

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at [email protected]
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at: and


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