TMJ, Cystic Acne and Hives in a Woman of 35

Mary, a 35 year-old woman came to me for help with her TMJ, cystic acne and hives.

Initial Consultation – December 8, 2018

Mary took the birth control pill for cystic acne. She stopped in 2017 to have a child, and her cystic acne reappeared on the right side of her face. Painful when not touching it, > cold weather and < night.

Her TMJ symptoms started in 2014 when she was a consultant, talking on the phone for hours. About twice a day, when Mary started to talk her jaw would start to spasm, and she would not be able to talk for 2 hours.

It’s “a dull pulling pain – it feels like someone is pulling on all the ligaments. When it pulls a lot, I feel tired…feels like your muscles are trying to compensate for the straining.”  > massage/stretches.

She enjoys walking; however, extended periods in the cold will cause her jaw to start hurting.  In 2016 while eating, she felt it on the lower jaw. It felt like her molar was moving, because the pain was so sharp.   “It’s very weather dependent, more so than stress dependent”, and goes away within 24 hours of being in a warm climate.

Massages help her shoulder pain, which occurs when it is cold.  She injured it sitting at a computer typing out her PhD exam over 7 days.  Although fine while typing, she awoke the next day with pain in scapula region, left side. 

She had an anaphylactic allergy to wheat when she was financially stressed doing her PhD. She felt the stress even after she won a scholarship and completed her PhD. She avoided wheat until 2015. Her throat no longer swells; just hives remain.

She and her brother have chronic hives.  When she walks outside, slightly red raised fine lines appear on the back of her legs.  They stay for 15 minutes. She had it on and off in 2015 for 2-3 weeks after she started a new job. It started again 6 weeks ago.

Mary is more energetic in the mornings, which she loves because it’s her own time.  She is early to bed and has woken even as a child, to pass water around 1:45 am or 2 am, then falls immediately back to sleep.

She wakes without an alarm at 4:45 am.  She does not think she is grinding her teeth while she sleeps.  At work, she feels sometimes her teeth clench.  It goes away within 24 hours of being in a warm climate. She has bowel movements at least once, and occasionally twice a day.

Mary cannot function without eating something. She has to eat warm rice or bread. She likes really hot drinks and will heat milk before adding it to tea. She prefers hot sandwiches; warm is okay, but not cold. When there is not a warm food option, and she eats salads, she becomes very bloated.  She loves watermelon, but it’s cold and it starts her “coughing to an insane degree”.

She tends to be cold and has 3 layers on today.  She loves the heat, is energetic in heat waves when she feels “alive, optimal”.

With a recent job change, she is waiting 6 months before trying to become pregnant.  She is worried about having a child as her mother lost weight due to excessive morning sickness throughout her pregnancy and suffered from depression following it.

Mary had spotting between her periods from the start of menses as a teenager, and it started again once she stopped taking the pill. She is happy with this and does not want to work on it because it helps her with timing ovulation.

Assessment:  My general observation is that the patient is very organized, neat in appearance and a high achiever in her hobbies, academia and work. She is worried about pregnancy issues due to her mother’s experience. Her aetiologies have mainly been due to anxiety/stress – financial during her PhD and each time she has a job change. (Chart:

MacRep v.8.5.3.6 TBR2)

Differential – Materia Medica

Rhus tox is better from warm food and Arsenicum album is aggravated by cold food or drinks, “Aggravation…from cold; cold drinks or food” (H.C. Allen).  Mary only matched some of the physical symptoms of Causticum, and the patient is aggravated by cold food, whereas Causticum is ameliorated by it. Silica, Bryonia alba, Kali carb and Veratrum album are also better from cold food, and due to the patient’s heightened reaction to cold food, ruled them out.

Mercurius suffers from hot or cold extremes of temperature, whereas extreme hot weather invigorates this patient.  Sulphur, generally suits warm-blooded individuals.  For these reasons, despite the high placements on the chart, I excluded them.

Arsenicum awakes refreshed, whereas Rhus tox has ‘Languor on waking; increasing after rising’ (M.E. Douglass).  Arsenicum has the aggravation time after midnight to 2:00 am.

Interestingly, Arsenicum has, “Mouth: Grinding of the teeth, in sleep. The teeth become loose and painful”.   (T.F. Allen)  She does not think she grinds her teeth, but the effect of the TMJ was feeling as if a tooth moved due to the pain.

Arsenicum also covers her skin symptoms and modality, “Pimples and vesicles, itching, burning, worse at night”  (R. Murphy).

The patient is chilly, and I looked therefore at Nux vomica.  However, Arsenicum is “anxious about health” (Boedler’s Psychic Causes), whereas Nux vomica  has “certain amount of anxiety about health.  None of the acute fear of Arsen.” (Blackie).  This was an excellent confirming symptom for Arsenicum, as the patient tries to mitigate her health concerns by seeing multiple practitioners as well as doing yoga, Pilates, swims, or walks each day.  Arsenicum also covers, “Spasms; and of jaws” (T.F. Allen).

Mary matched Arsenicum album very well in terms of symptoms and also her mental/emotional outlook and appearance. I did not see any obstacles to cure because of her good lifestyle in terms of food, adequate sleep and daily exercise.  I chose 30c because it matched the intensity of the chronic disease picture.  Beginning with 30c gives room to increase the strength as the treatment progresses, and avoids potentially overwhelming a patient’s vital force, which starting with too high a potency can do.

Prescription: Arsenicum album 30c – test dose 2 drops from the bottle, no succussions.  The test dose enables me to determine repetition and strength. I asked her to let me know after the aggravation and amelioration (I explained primary and secondary action to the patient), when she had 2 days of worsening symptoms.

January 19 and Jan. 27, 2019 phone follow-ups (Mary took the remedy after her vacation on Jan. 15)

There was an aggravation initially of symptoms and sleep; then she felt better for a bit and feels like she is back to how she is normally.  I determined from the test dose that diluting the remedy in one cup of water would be sufficient to minimize any aggravation.  After the 2^nd dose (2 succussions, 2 drops from RSB into 1 cup distilled water; 2 drops from the cup), she experienced minor shoulder aggravation and saw only one hive each day, which was a big improvement from before.  The aggravation/amelioration cycle was gentle and lasted two days; I asked her to repeat the remedy every other day.

February 18, 2019 – Follow-up appointment

Mary’s TMJ has not really acted up at all – just on one day. For the last 3 years she had get it massaged 3 times in January due to spasms. She said the TMJ improvement has really impressed her. We will need to wait until the next appointment to see if the remedy is helping with her shoulder because she twisted it doing yoga.  She feels good mentally/emotionally. Sometimes she does not need to wake up and go to the bathroom during the night, “which is new.”  Hives are the same size, but go away in 10 minutes and are not as itchy. She said remedy seems to last for three days.

Assessment

With improvements in sleep, her TMJ and hives, the remedy is working well.

Prescription:  Repeat dose every three days, with all else being the same.

March 30, 2019 – Follow-up appointment

Mary’s TMJ was really painful 2 weeks ago.  No hives until yesterday.  Her acne has been great.  She had no spotting between periods.  She got sick from a bug bite on March 19. They started small, expanded over the week, and became rash-like.

I was surprised, not at an acute occurring, rather how the TMJ had gone back to pre-treatment level after such an excellent first follow-up, especially when acutes often suppress the chronic symptoms, which this did for the rest of her symptoms.

I asked Mary how she reacts when upset, because I wanted to make sure of the original remedy choice.  She said from childhood, she was taught to suppress any overt display of emotion.  She said she tends to be passive aggressive when mildly pissed off, but when really pissed off she will let you say your piece and then she would be bluntly truthful about how she feels.

She said, “I get intensely upset or angry, and then I generally forget those emotions.” She said she is “not depressed, not an optimist either – feel I’m more pragmatic or even more pessimistic. I feel we calibrate to a new normal when stuff happens”.  She has also recently grieved deaths of loved ones.

Interestingly, normally Mary is highly sensitive to food poisoning, and is like the canary in a mine for others.  After a party everyone except her had severe food poisoning; she felt like the flu might be coming on, but then the feeling went away.  With Arsenicum being one of the top remedies for food poisoning, it appears the remedy that fits her chronic disease acted prophylactically.  This was an unintentional and happy consequence of her chronic remedy matching the acute illness.

Assessment

Although, I heard more about her grief and suppression of emotions during this appointment, Arsenicum did initially work very well. I was able to rule out Nat-mur as she does not bottle things up inside; can express herself when she disagrees and does not allow herself to be a victim. Arsenicum also covers, “herpetic eruption with itching and burning.” (J.H. Allen).

Prescription: No changes.

May 7, 2019 – Follow-up appointment

She is almost over a bad cold; no more coughing; her ears are better; she can hear again.  Clear nose expectoration, < right.  She stopped the remedy while it was bad. The bites were diagnosed as Pityriasis rosea. > ice when it starts, < right arm.  She described it as “so scary”.  < right side, except the legs (< left, < night). Pimples and vesicles, with acrid discharge.  Itching and burning.  It then becomes “rashy and shiny”.  Her TMJ became worse during the illness but was now gone again.

Assessment

With the rash still being there and finding out it was not just a temporary bug bite, but instead Pityriasis rosea, it was necessary to reassess the case. I found Arsenicum album covers the cold and Pityriasis rosea symptoms. (Chart: MacRep v.8.5.3.6 Kent)

Prescription: No change to the prescription as the remedy covers the new acute symptoms as well.  I continued with the remedy in 30c rather than 200c or 1m, which would be more appropriate to match her cold symptoms at the start; however, the cold was almost over and I did not want to aggravate a skin disease with too high a dose.

June 13, 2019 – Follow-up appointment

Mary requested we schedule a phone call (we arranged a video call) because there was a storm in Toronto and it was thundering. I asked the patient if she were afraid of lightening.  She told me a family member had been hit by lightening.  She said she is not scared; however she does not like going out because you can be hit by lightening and she does not like to introduce more risk into her life.

This was another confirmation of fear of sickness.  (“Vithoulkas uses the term, “insecurity” to describe the essence of this remedy, by which he means that the patient often has an overwhelming sense of vulnerability and fear for his well-being and material security.”  [Robin Murphy).

In the last few weeks, the Pityriasis Rosea really slowed down. The last one was four days ago.  Her shoulder pain has been on and off, and less than before; she has not had a hive in a really long time, none for 2 weeks at least.

There was one ovulation bleeding last month. There were some spots on her chin, but none were cystic. There is still some TMJ sensitivity.  “I can feel the pain when I brush my teeth in the morning”.

It does not affect her talking.   She said, “It came back after the Pityriasis thing”.   I explained how acute illnesses will often suppress chronic illnesses, and the chronic symptoms return once the acute clears up.

She said for several years she has been taking prescription Reactin throughout spring/summer/fall because her throat was so sore.  Her eyes would itch, and then the sneezing would start. She told me this year she has not taken it, because the prescription ran out and it has not been too bad.

She said she does get a sore throat from time-to-time and a runny nose.  Her throat is usually affected on the left side; it’s always there.  [Arsenicum:  pains in the throat, especially on the left side – Homeopathic Recorder]. She described it as “Not thick mucous – thin mucous comes out, but it’s not helpful.

Coughing to bring it up does not bring up much. It is clear.”   [Arsenicum:  cough, with very little expectoration – Homeopathic World; Arsenicum also has transparent mucous] She said she feels it in her left nostril usually more than the right. Just a sensation pressure in her nose – it’s not dripping.

She has 2 little canker sores in her mouth, which she occasionally gets. [Arsenicum:  Apthae in mouth – NM Choudhuri]

Assessment

The chief complaints have improved, except for spotting in between periods.  Arsenicum covers all of the new symptoms as well.

Prescription:   Continue as before.  Patient noted she was taking it every 3-4 days, and so I asked her to take it every 4 days going forward, and to notice if symptoms worsen around the 3rd or 4th day, because we might need to move it back to every 3 days.

July 15, 2019 – Follow-up appointment

Now that Mary is taking the remedy regularly, her TMJ is a lot better.  Her Allergies have been bad sometimes, but not everyday. Her shoulder pain has been on and off, a little knotty but bearable. She had cystic acne maybe once. It is much better than last summer. She said the spotting is still there.  The remedy was lasting three days.

Assessment

The chief complaints have improved.  Spotting in between periods is the only symptom, which has not improved.  Hopefully, the increase to 3 times per week (taking it consistently on specific days made it easier than counting out every 3), from twice a week will help speed up the improvement of her hay fever symptoms as well.

Prescription:  Continuing with Arsenicum album 30c as above, but increase to three times a week.

September 12, 2019 – Follow-up appointment

Mary said her shoulder pain was really bad when coughing a lot.  It has been, “fine now that I’m not coughing half a lung out.”.  She got the cold on August 20^th and lost her voice. She stopped taking the remedy during the cold, and only began taking it again Sunday (September 8^th).

She said her TMJ has been doing well. “Even though I was stressed out in August, when I was off the remedy my jaw was not hurting.”  She said she has only had 2 spots of acne and it’s the time of her period. Neither spot is cystic.  She feels good mentally/emotionally – a lot more relaxed now that the two big projects are done at her work. She felt a lot of pressure to prove herself, and show that she can do a good job. She is no longer anxious about trying to get pregnant again.

Assessment

No longer a need to continue the remedy as all of her chief complaints have healed, and she was no longer anxious about becoming pregnant. The spotting is something that does not bother her, and was not something she wanted to work on nor would continue treatment for as she is using it to determine ovulation for pregnancy purposes.  I let the patient know that she could contact me if there is any difficulty in getting pregnant, with morning sickness, or other issues.

This was an interesting case.  I grew up with homeopathy and I have never come across a case so beautifully treated by one remedy, which fit all the acute diseases as well as the chronic disease.