Primum Non Nocere

A Homeopathic Case Report

Heather is really a vivacious, hard-working 39-year-old mother of 3 boys, ages 7, 10, 21, and a 16-year-old daughter. She has experienced several very stormy, unstable relationships over the past 24 many she is now divorced and living with all 4 children. Heather was identified as having cervical cancer in 1995 and was successfully treated with traditional medicine. She's had several miscarriages and, in '09, she was identified as having endometriosis, which led to a total hysterectomy. She reports experiencing 3 episodes of chicken pox since infancy. There is a strong family history of cancer: Her mother died from the malignant brain tumor, her maternal grandmother succumbed to bone cancer, and her sister was recently diagnosed with thyroid cancer. She quit smoking cigarettes in 2013 and doesn't consume alcohol or caffeinated beverages. She doesn't currently use recreational drugs; however, she was a frequent crystal meth user as a teenager. Overall, her weight loss program is well-balanced and she has no known food sensitivities. She is slightly overweight but exercises daily playing soccer or basketball included in her work.

Symptoms

Heather continues to be battling severe anxiety and fatigue for just two to three years. This came on suddenly with no apparent triggering event. Her sleep is restful and lasts 7 -9 hours every night, but she rates her energy level as 5 -6/10 on the 10/10 scale. Her chief problem is anxiety within the chest with heart palpitations and flushes of heat, specially in the morning upon waking. Anxiety is also experienced with anticipation of certain events or situations, however insignificant they may be. Panic attacks are very infrequent, occurring once or twice annually. Chronic loose, brown stools will also be associated with the anxiety. Heather senses and is very frightened of approaching monsoon thunderstorms, remaining indoors until all is apparent. They must close herself in the bedroom and turn in the TV or radio volume to drown the noise from the storm. Large quantities of ice cold water are consumed during the day, including during every office visit.

Physical exam revealed a small heart murmur that was previously undiagnosed. Additionally, a very light, yellow tint to the sclera of both eyes almost went unnoticed. There is a prominent ebullition or 'bubbling up” of blood towards the face when Heather became excited or emotional in response to questions about her anxiety. She reported significant clammy perspiration of her feet and hands linked to the anxiety, however this is not very unusual. Self-medicating with various B-vitamin formulas and other nutritional supplements continues to be ineffective. She was recently prescribed alprazolam and sertraline by her doctor , that have provided some temporary respite from the anxiety.

Repetorization

There are some remedies to consider in this case. Although present around the repetorization chart , the 3 extremity rubrics are excluded , as they are not necessarily unusual or particularly useful in this example but do provide further confirmation from the selected medicine. I will sometimes use strange, rare or peculiar symptoms by changing them from “normal” for an “eliminative” rubric to help assist with an analysis by narrowing the field . We all have our favorite materia medicas. I primarily exhaust the original provings from Allen, Hering and Hahnemann first, because they are usually the most dependable sources. A great homeopathic dictionary for example Yasgur's is also quite useful for defining terms rarely utilized in the modern medical world.

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Homeopathic Treatment and Follow-up

I prefer to be conservative when unsure of an individual's sensitivity to medicines. Although I felt positive about choosing Phosphorous, I started her on 3 pellets of a 30C potency dissolved in one tablespoon of filtered water. Two days later, Heather stated, “I feel normal again! I do not feel edgy and am peaceful again.” Following a second dose 2 days later, she reported feeling calm and relaxed, and her a pounding heart upon waking had gone away completely. Difficulty breathing was resolved with the anxiety. A third dose of 30C about 7 days after the initial dose produced a minor aggravation reported as slight numbness and tingling in the hands and legs, which quickly resolved after consuming. A severe monsoon during that week didn't trigger any anxiety, which she at this point rated as 40% better overall. She felt sufficiently good to reduce the dose of alprazolam by herself from 1.0 mg to 0.5mg daily. She continued the nightly dose of 25 mg of sertraline. To another 14 days, she reported sleeping more soundly and located she could sleep a little longer without waking before her alarm. Bowel motions were daily and well formed.

About 1 month after her initial visit, she rated her energy level as 8 -9/10, clamminess of the extremities was gone and she or he was going for a 30C dose of 3 pellets only when needed. All this seemed great; however, occasional bouts of anxiety with palpitations were beginning to return. I made a decision not to boost the potency at this time but opted instead for any daily dose of 30C, 1 pellet, dissolved in one tablespoon of filtered water. One week later, Heather discontinued alprazolam completely and halved the dose of sertraline to 12.5 mg nightly.

There wasn't any follow-up phone consult for the next 5 months, and then one day the telephone rang. “I have been using Phosphorous in emergency situations only since i didn't want to exhaust the medication. I have not needed alprazolam unless I don't take enough Phosphorous. But my PCP says I ought to stay on sertraline for some time longer. Whenever I take Phosphorous Personally i think normal like before I ever had any of these symptoms.” She had recently used diphenhydramine to deal with an upper respiratory tract infection with cough, fever and postnasal drip.

I decide it's time to boost the potency and Heather decides you're ready to eliminate sertraline completely. I always prefer to have the prescribing physician involved with regards to titrating down or discontinuing psychiatric medicines, however this is not always possible. Heather's circumstances had stabilized, producing a more peaceful environment. I prescribed Phosphorous 200C, 1 pellet weekly or when needed, only at that point-approximately 6 months following the start of treatment. Heather reports, “things are going good because a large amount of stress is off me.” A follow-up appointment together with her PCP was scheduled to discontinue sertraline completely.

This continues to be a piece in progress, but the future looks optimistic, with some careful case management.

Reflections

One of the profession standard tools I use for assessing depression in grown-ups is the Pfizer Health Questionnaire , since my practice is nearly 100% centered on seeing patients with mental, emotional and behavioral disorders. There is a similar tool available that is adapted for teenagers. Neither is the ultimate tool for any diagnosis; however, they can be beneficial in assessing the severity and duration of depression. In this case, the score was really low as Heather wasn't complaining of depression, only severe anxiety, but often they are interrelated.

At some time, an increase in frequency or more dose of Phosphorous, or even a different remedy, may be needed if the symptoms indicate a big change. For now, the waiting continues, which can be the most challenging part of homeopathic case management.