Sjogrens Syndrome

15th August 2007

Consultation with a 50 year old female who had been diagnosed with Sjogren’s Syndrome 2 years previously following a sudden loss of weight, sporadic diarrhea and the emergence of a palpable lump on the left side of her face which proved to be a cyst in the parotid gland. Symptoms currently being experienced were mouth dryness – she needed to constantly chew gum to increase the production of saliva – and sore, gritty eyes. She expressed a lot of anxiety regarding her health saying that she felt like a ticking time bomb and that she was at high risk of developing lymphoma. Her condition was being medically monitored on an annual basis.

The patient worked 5 days a week as a nurse for children with disabilities and found the work to be extremely stressful. She said that she just cannot get enough done in the day as she was so exhausted. She needed to retire to bed very early in the evening on week days and had to have a sleep during the afternoon on weekends. She felt that she could not function if she did not do this. She has been married since her early twenties but had not had any children – both she and her husband had decided to travel and enjoy the world instead. Eight years ago her mother to whom she was extremely close, passed away suddenly and she was still very upset when relating this experience. Her father was in the early stages of dementia and had just moved in with her and her husband.

She had also suffered from Raynaud’s disease for years. Worse when going from warm to cold and needed to wear gloves when she went shopping for frozen foods, Twelve months ago she was diagnosed with mild hyper thyroidism – current thyroid function had returned to within normal parameters. Over the past 4-5 years her periods had become very heavy with severe clotting. She also had a history of a left sided migraine followed by nausea and vomiting associated with her period, and severe cystic acne. She was using the pill to control these symptoms and she also contracted a number of colds every year and was very slow to recover – a cold could last a month and she would just get over it and then come down with another.

FACIAL ANALYSIS

There were an equal number of yellow and blue features – so the patient was assessed as belonging to the green miasm (tubercular).

Repertorisation. (MacRep for Windows)

RUBRICS CHOSEN

FEMALE: MENSES: clotted, coagulated (123)
GENERALITIES: MENSES: agg, during (122)
GLANDS in general, affections of (46)
MIND: ANXIETY: health, about (88)
MIND: GRIEF (103)
EYE, DRYNESS (125)
MOUTH, DRYNESS (334)
EXTREMITIES: RAYNAUD disease (28)

Remedies that came up for consideration from the repertorisation were Calc Carb, Phos and China (being “green” remedies). Initially I did not include the rubric for Raynaud’s disease and was having difficulty deciding between Calc Carb and Phosphorus Decided to see if anything came up in this area to distinguish between the 2 remedies. Although the rubric was a bit smaller than I would have liked, decided to include it which meant that Calc covered all rubrics and Phos was missing from this last addition.

Calc Carb 30C daily.

12th August 2007: Doing well. Developed a cold about a week ago but seems to be recovering faster than she would normally expect to. Feels she has more energy and waking with more “spark”. Has used no eye drops at all and using a lot less chewing gum.

Continue Calc Carb 30C daily

3rd October 2007: Cold resolved quickly. No longer needs to sleep on the weekends. Very rarely using gum. Eyes good. Planning a 5 week holiday to Morocco and expressed concern regarding carrying the remedy into a foreign country. Decided to give 1 dose Calc Carb 200C and follow up appointment in December on returning.

18th December 2007: Not using chewing gum or eye drops. Under a lot of pressure regarding her father, but surprised how well she is coping. Has decided to cut her work load to 3 days a week. Picked up a bowel condition whilst away – Guardia??? “Everyone else is really sick – all I am getting is a sudden foul smelling, watery, brown bout of diarrhea every 1-2 weeks immediately after a meal” – no other ill effects.

At this point I was very happy with her response to the remedy but was also concerned that if the diarrhea continued this would result in a slow fall in energy level and a return of symptoms. I particularly did not want to interfere with the good response to Calc Carb she had thus far experienced. Repertorised the diarrhea symptoms: (MacRep for Windows)

Rubrics Chosen:

RECTUM: DIARRHEA: eating after agg (101)
STOOL ODOR: offensive (179)
STOOL FORCIBLE, sudden, gushing (93)
STOOL: THIN, liquid (197)

Repertorisation brought up a number of remedies, however Calc Carb did cover all the symptoms. Decided to go with Calc Carb 6C before trying Phosphorus Podophylum was also considered and would be used as a last resort.
Also noted that she had complained of sporadic diarrhea prior to the diagnosis, so decided to use a low potency of the Calc Carb before choosing to change remedy.

Calc Carb 6C daily

27th December 2007: Phone contact. 1 bout of diarrhea since commencing Calc Carb 6C. Feeling very good. Said she was under a lot of stress with her father’s situation but “I am cruising.”

Continue Calc Carb 6C daily.

24th January 2008: Been extremely good. No use of gum or eye drops. No Raynaud’s symptoms. Coping with stress extremely well. At this point we decided to stop the Calc Carb 6c and monitor situation.

6th March 2008: Phone contact. Return of symptoms. Energy levels down. Requiring rest on weekends. Started to use chewing gum again. Sandra could not come in to see me for a couple of weeks. She still had some Calc Carb 6C, so made an appointment and re commenced Calc Carb 6C daily.

19th March 2008: Had an immediate improvement with the Calc Carb 6C. No use of chewing gum and no need for weekend rest. At this point I decided that the Calc Carb 6C was good. Continue with it rather than go back to the 30C or 200C which I had planned to do if the symptoms still indicated the remedy.

16th April 2008: Much improvement.

Continue Calc Carb 6C daily.

14th May 2008: Improvement continues.
Continue Calc Carb 6C daily.

26th June 2008: Rheumatologist appointment. No progression in her condition. Work has been extremely stressful and amazed at how well she was coping.
Continue Calc Carb 6C daily.

23rd September 2008: Doing well. Had a recent visit to the dentist who commented that her mouth and teeth were in the best condition he could recall seeing them – very surprised and impressed. Mouth seems a bit drier and eyes feeling a bit gritty.
Decided to move to Calc Carb 30C daily.

29th October 2008: Doing extremely well. Have gone to 2 monthly appointments.
Continue Calc Carb 30C daily.

COMMENTS:

This case has been a bit messy potency wise and certainly if given an ideal situation, would not have prescribed as I did (in particular the use of 200C). However it did show me a few things –
1. The remedy is the most important and the potency is secondary.
2. This is a long term degenerative condition and I will probably keep the patient on this remedy for sometime yet, unless I get a reason to change. It certainly appears that the remedy was stopped far too early the first time. The long term use of the remedy does not seem to have had any ill effects and if anything has continued the improvements.

What does not come through in these notes and comments is the complete change in demeanor I have seen in this patient. I could only have described her manner in the first consultation as very brusque and sharp – almost brittle. Now she is a lot softer, gentler and more relaxed. Our consultations are a lot of fun.

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Robyn Williams
Dip Hom. Aroh, Dip PE HDTS (PE)