Her head peaks around the corner of the door asking if I’m ready for her. I wave her in and a tiny figure wearing a bright pink and purple top walks through. Mary* is 43 years old but I wouldn’t have given her a year more than 35 and would have believed it if she told me she was 30.
Sitting down she tells me why she has come to see me. Although happily married for 8 years with who she calls her best friend, her heart’s wish has not been fulfilled yet: a little baby. They have tried for as long as they have been married and she has fallen pregnant only twice. Both pregnancies ended in miscarriages within the first trimester.
She speaks openly and easily about both her physical and mental symptoms and comes across very balanced and she says she forgives as easily as she gets angry and cries when upset. However she seems so balanced that my inner not-very-objective-homeopath starts to wonder how much suppression there is, especially when she tells me in a matter of fact tone that she works six days a week as a caregiver and that she and her husband live with the elderly lady. Carcinosin? I am however quickly put to shame for thinking that all disease these days comes from suppression when I ask her more about the pregnancies and she starts to cry. Mary is surprised by her own crying having thought she had processed her grief but she gratefully thanks me for letting her cry as she feels better for it.
For the rest of the consultation I silence my inner judge and try to be this unprejudiced observer Hahnemann speaks of (§6, Brewster O’Reilly, 1996).
Medical tests have not found any abnormalities for Mary except a few fibroids in the uterus which according to the gynecologist are normal for her age and not a problem for pregnancy. Infertility does not run in the family at all. During the miscarriages she experienced a bearing down sensation, a painful pushing on the vagina, and extreme nausea on smelling or eating food, with vomiting practically every 15 minutes. The last miscarriage also lead to cystitis which she had never had before. This last miscarriage was 5 years ago.
Mary’s periods started at 12 years old, stopped for a year and then resumed again. She did not remember if anything specific was going on for her at the time. In her twenties her periods would sometimes not come at all for 3-8 months but since she got married at 35 she has been having a regular cycle (28 days) with short periods of 2-3 days and two days of spotting. Mary and her husband have sex at least twice a week although I cannot get a clear answer on what her libido is like. There is also some mystery on why her husband has not let his sperm be checked out and why he will not come along to the appointments with his wife. However, despite my reminder that it takes two to tango and that the problem may lie with him and not her, she is happy to have just treatment for herself. When I promise her that with treatment we can at the very least prepare her body for pregnancy and get her to be the happiest healthiest possible version of herself, she responds with “that sounds great to me, we have already accepted that God may never let me be a mother, but I want to do everything I can that is within my own power”.
Why no baby?
Although the gynecologist claims that Mary is in good enough health to conceive and says that the fibroids are not an issue for a pregnancy the latter could be questioned, as fibroids increase the risk of pregnancy complications (Deveer et al. 2012; Conti et al. 2013) and there are no other clear indications of why Mary has had the miscarriages. Perhaps she has even been pregnant more often than she thinks, but did the embryos never get a chance to implant due to the fibroids.
Mary’s short flow may be a clue as to why there is difficulty in conception as it may be due to a hormonal imbalance. Or perhaps it is a lingering candida and/or genito-urinary infection preventing conception (Rhoton-Vlasak 2000). Or, is there possibly heavy metal contamination like mercury? (Cutler 1999; Northrup 2006)
Perhaps it is more what I like to call “emotional infertility”. Does Mary’s body recognize that already taking care of another human being 6 days a week does not leave much room for a baby? Is it her subconscious that is not allowing her body to conceive? (Shapiro 1996; Northrup 2006)
As already mentioned there is also the possibility that the main problem lies with the husband. However, the fact that Mary has suffered miscarriages makes it likely that her body is not in perfect condition for a pregnancy at this point either way.
Of course we cannot leave out Mary’s age either. Nevertheless, if a patient is having regular cycles and if ovulation can be re-established, I do not see why there should be a problem with conceiving.
It is very rare that in the Western world we encounter patients with no drug layers at all but Mary never visited a hospital till the first miscarriage nor did she receive any medication at the hospital, nor did she take any antibiotics for the cystitis and she very rarely takes any pain killers. She makes very clear that she is adverse to taking anything and cares a lot about simple healthy food, drinking enough water and regular exercise. I was so very excited to once and for all test this minimal dose concept and decided that whatever repertorisation and analysis would bring up, if any case asked for a genuine minimal prescription it would be this one.
Upon repertorisation of general, emotional and physical symptoms, Sepia comes up highest, followed by Calcarea-Carbonica and Natrium-Muriaticum. Calcarea-Carbonica may very well be her core remedy considering her desire for basic types of food, her particular fear of graveyards, and her on-and-off periods in teens and 20s. Natrium-Muriaticum tempts me to consider whether there really isn’t more to the story especially since I cannot get a clear answer on her libido or why her husband does not let himself be tested or why he does not come to the consultations with her. However, Sepia is the only one of the three that covers both the miscarriages in the third month and the fibroids, which are the only clear symptoms possibly associated with Mary’s infertility. Other symptoms in the case also suiting Sepia:
- Bearing down pain with miscarriages in combination with nausea at the smell of food
- Premenstrual irritability with her husband
- General amelioration after exercising (“I feel toxic if I don’t”)
- Fear something bad will happen to the family
- Dreams about babies (although this makes sense if you want to fall pregnant)
- Desire to be alone when crying; consolation aggravates
- Scanty, dark, clotted periods
(Murphy 2005; Murphy 2006; Allen 2008; Vermeulen 2004)
A shift in the hormonal balance is to be expected next consultation, most likely evidenced by a heavier and/or longer menstrual flow.
New patients I always start on a 30c or lower even if the vitality of this case and lack of drug layers allows a higher potency (Watson 2004). Three doses in 24 hours.
The following month
The following consultation Mary says she feels much lighter and less toxic, ever since taking the Sepia. She has perspired more and loves that feeling. Also her emotions were more stable before her period and in general she feels happy with the remedy. I guess this minimal dose and minimal repetition still seems to work in our Western world today, even in the city!
She did have a bit of a headache again pre-menstrually and although her period was not longer, it was more profuse the second and the third day, as well as being bright red while before it was dark and clotted. It felt more like the type of menses she had in her teens. Music to a homeopath’s ears!
Mary tells me that she forgot to say last time that normally after her period she has a week of vaginal discharge which has a fishy odor but now after the remedy the odor was practically gone. Ha! Isn’t Sepia also known for foul smelling leuchorrhea? (Kent 2004; Murphy 2006) What a good example especially to starting out homeopaths that indeed you do not need to know each and every symptom of a patient to find a helpful simillimum.
Over a period of four months I prescribe Sepia to Mary several more times going up to 1M. The vaginal discharge and odor stay away and the periods stay bright and regular but do remain short. Mary says she feels good, happy and healthy. She learns more about her body and charts her cycle to discover if she is ovulating. However, a month later she says she wants to stop treatment. She doesn’t expect to fall pregnant anymore but says she does not mind as she is so much happier and healthier for the treatment she has had.