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SAMPLE
CASE Initial
visit—February 3, 1999 The patient is a 42-year-old male with fair skin, dark
eyes and hair, with an awkward, self-conscious presentation. He is a large,
muscular man. He complains of joint pain and depression. The patient reports: “I have
trouble with my knees, hips, elbows, shoulders. They ache and feel sore and
stiff. I take anti-inflammatory medication (Ibuprofen)—which helps, but I
don't like taking it. It seems like I am taking poison or something.
I have had this since I was in my teens. It comes and goes, but I have
not seen any pattern as to why. The ones on the right side hurt more often, but
they all hurt. Sometimes I have some swelling around my right knee and my left
elbow. “My life feels flat—I feel like I am dead inside.
Sometimes I think I am just an empty corpse walking around, with no living soul
in me at all. There is nothing I care about, nothing that inspires me or excites
me. I just go through each day, getting through it. I just don’t care. I go to
work, I go to home, it is all the same, nothing matters. Even sex doesn’t
interest me much, I have almost no sex drive. My brother has a wonderful wife
and family, a job he loves, and I feel jealous of him often. I am envious of the
joy he has in his life. I wonder why his life seems so different from mine,
because we were not that different as kids. I avoid him if I can. “So many
things irritate me. Traffic, dumb things the government does, politics at the
office, my neighbor who plays loud music, waiting in line . . .
I am probably the least patient person on the planet, and the longer I
have to stand in line, the more annoyed I get. I don’t like being touched, and
it is irritating to walk in a crowd where people bump against me. It seems like
I am mad about something most of the time. It is a lousy way to spend my life. “Despite
the pain in my joints, I stay active. My energy level is good. I work out
regularly and I ride my mountain bike on the weekends. Maybe that is part of why
my joints hurt. I am pretty clumsy, I guess, always have been. Have never been
very well coordinated, and I fall off my bike with annoying regularity, or run
into things. But my joints hurt even when I haven’t been injured lately. “I get
styes in my right eye about twice a year. They really hurt, swell, and burn. I am always thirsty—it feels like I drink gallons every
day but it is never enough.” Initial
Assessment: This man has come for homeopathic care in hope of finding
relief from the chronic pain he has in his joints—but, as a practitioner, I
feel that his mental/emotional state is more of a concern. He describes himself as apathetic, death-like, irritable,
impatient, jealous. Along with the joint pain and occasional swelling, he
mentions that he has styes in his eyes which burn and swell. He notes that he
has unquenchable thirst. Repertorization,
using Kent’s Repertory: Mind, Delusion, dead, that he himself was dead Mind, Irritability Mind, Indifference, apathy Mind, Impatience Mind, Jealousy Eye, Styes Stomach, Thirst, unquenchable Extremities, Pain, joints The remedies I seriously considered, based on this
repertorization were: Apis, Bryonia, Phosphoric Acid. Apis mellifica was the only remedy, in the final set that
I considered, which was listed in the rubric for “Delusion of being dead.”
Apis covers the joint pains, styes, mental symptoms and thirst. It was
interesting to find Apis in italic type in the rubric for unquenchable thirst,
because thirstlessness is a keynote for this remedy. In addition to the rubrics
chosen, Apis demonstrates a fear of being poisoned—which the patient mentioned
in reference to the medication he takes for the joint pain. He also refers to
himself as clumsy; Apis is listed in bold type for the rubric: “Extremities,
awkwardness.” The swelling he mentioned for the styes and occasional elbow and
knee joints is characteristic of this remedy as well. These additional
confirmations make Apis the strongest choice. Bryonia was one of the remedies I thought of while
listening to the case,—hearing him tell about his joint pain, irritability,
and great thirst—and it did come through in repertorization. However, his
indifference, jealousy and sense of being dead are not covered by this remedy.
This remedy is a good match for the physical symptoms (joint pain, thirst, styes)
but there is not a close enough match on the mental/emotional plane to select
this remedy for this patient. I
suspect that if Bryonia were given it would be only palliative. Phosphoric Acid was characteristic of the apathetic,
irritable mental state, even noted in the rubric for jealousy. Although it was
not included in Kent’s rubric, “delusion of being dead,” Roger
Morrison’s Desktop Guide describes the mentals of Phosphoric acid as
“Depressed, apathetic patients —almost dead inside.” It also covers the
joint pain, styes and thirst. However, Phosphoric Acid, like many acids, is more
typically associated with states of collapse and depletion—but this fellow is
energetic, working out and riding a mountain bike. That is not to say that an
energetic Phosphoric Acid case could not be found, but that the typically low
energy that could confirm this remedy is missing. The additional verifications
found for Apis (poisoning, awkwardness, inflammatory swelling) are not found for
Phosphoric Acid, making it a less likely candidate. However, there is still much
similarity to the case, and it is my second choice of remedy. Based on the above evaluation, Apis was selected. It was
given in a 200C potency. The fellow was generally in good health, his symptom
picture was clear, and he had no limiting conditions which would have led me to
choose a low potency. This is the potency I generally start a case with unless
there is a reason to go higher or lower. He took a single dose February 10,
1999. Follow
up—April 4, 1999 The patient reports: “About two weeks after I took the remedy, I got a stye
in my right eye which was very painful and lasted for over a week. The joint
pain came and went as normal until three weeks ago, and then it stopped. This is
the longest I have gone without any trouble with my joints for at least 10
years. I am still thirsty often, but don’t drink as much as I used to.
I don’t have that feeling of always being thirsty no matter how much I
drank. “I have taken up a new hobby which quite interests
me—I’ve begun to do some wood-carving and have signed up for some classes.
Nice to have something to do that I look forward to after work.” In response to questioning, he indicated that he still
felt dead inside and was impatient as ever, though he noted that he was less
irritable, improved by perhaps 50%. My assessment, based on this information, was that the
Apis was acting. The appearance of the stye may have been part of an
aggravation, and was followed by relief of the joint pain. The patient notes
that the sense of being dead inside was still the same, but his irritability was
less, and he had an interest in something new, which was a marked change from
his prior apathy—I saw this as confirmation of improvement. It is not
surprising to see the physical symptoms improving first as the mental symptoms
were quite deep. George Vithoulkas notes in The
Science of Homeopathy, that apathy is among the deepest of emotional
illnesses. Because of the physical improvement in joint pain, and the
partial relief of irritability and apathy, I felt that the action of the remedy
was in progress and it should be left to do its work. No action was taken and a
follow-up was scheduled. Follow-up—May
12, 1999 The patient reports: “I am surprised to be saying this, but I am even
enjoying my life somewhat. I brought a wood carving for you to see. When I first
started carving, I was in a hurry to finish whatever I was working on, but I
think it has taught me some patience, doing this. When I am carving, it is as if
time stops and I focus on the wood completely. “I don’t feel thirsty as often. I even declined when
someone offered me something to drink the other day! My knees bothered me a
little last week, but it wasn’t much, and it went away after a day or two. It
was the first time they had ached since I was here to see you last. “About two weeks ago, I had an outbreak of hives all
across my back—it itched like hell. Seems like I had that before when I was in
college, but I had forgotten. It happened one night when I couldn’t sleep.
Lasted for hours. But the next morning it was gone. Couldn’t remember eating
anything or getting something on my skin—don’t know why it happened." When I asked him more about the feeling of being dead
inside, he said he wasn’t sure about it. His jealousy of his brother was
unchanged. He continued to be less irritable, and waiting in traffic or standing
in line were not as annoying to him as they used to be. He thought wood carving
was teaching him patience. My assessment was that he was continuing to improve. The
mental symptoms are improving, with a lessening of the impatience and
irritability, and he is no longer certain about the sense of being dead inside.
The outbreak of hives is interesting, since it is so characteristic of Apis, and
appears to be a recurrence of an old symptom. The case still has forward
momentum and is still progressing. The reappearance of the knee pain could have
been a normal fluctuation, or may indicate that the remedy will need to be
repeated if it becomes a continual problem again. A follow-up was scheduled, and
he was instructed to call in the meantime, if the joint pain returned. Follow-up—June
10, 1999 The patient reports: “All the joint pain is back, and I feel like hell. I
feel like I did when I first came to see you in February. I feel lousy, and very
discouraged because things were just starting to go well. “Over the holiday weekend at the end of May, there was a
family reunion at my brother’s house, and I just hated being there. Everyone
in the family goes on about how well he’s done in his career, such a lovely
home he has, how clever his kids are, what a lovely woman his wife is.
I know it is all true, especially about his wife, but I just don’t want
to hear about it. By the time I had
been there for an hour or two, my right shoulder was hurting and, by the time I
left at the end of the day, I ached everywhere. “Since
then, I just don’t want to do anything. I
have stopped carving wood and just don’t see the point of doing anything.” My assessment at this point was that the case had
relapsed, triggered by the visit with his brother and the strong jealousy he
felt there. All of his prior complaints had returned. Following Kent’s guidelines for the second prescription,
I repeated the same remedy in the same potency. He took Apis 200C again, June 11, 1999. Follow-up
July 29, 1999 The patient reports: “By the
next day after I took the remedy, I was feeling better again. The joint pain had
stopped, and I slept really deeply. My life seemed easier again over the next
week or so, I started enjoying wood carving again. My joints aren’t hurting. “The last month has been hard, though.
I have just wanted to be alone. I
have felt really down. Feeling dead was easier—now I feel this overwhelming
sadness. The truth is that my brother’s wife was my girlfriend when we were in
college. I played on the university basketball team and it took up so much of my
time. Between that and studying, I didn’t have much left over. She finally
said she felt like one more thing on my list of stuff to do and dumped me.
I tried, but she would not go out with me again.
I just stopped thinking about it, focused on my studies. About a year
later, she met my brother and they got married. I think about her all day, every
day. She doesn’t know and I will never tell her. I can’t talk to anyone
about this. I take out other women, but it is just to pass the time. I have
never met anyone else that holds the attraction for me that she does. And she is
my brother’s wife. Nothing can ever come of it. It is so sad for me. (Sighing, barely holding back tears.) “I am having headaches, like I used to get in my last
year of college. I wake up with it, and it is this throbbing pain that stays
with me all day. I think they
usually go away in the evening; I don’t have them at night. “I am getting cold sores around my mouth. They burn, and
the skin in the corner of my mouth cracks. And for some reason, I seem to have
lost my sense of taste—everything tastes really bland. Except salt. I am
putting lots of salt on my food and that tastes good.” My assessment of the case is that a new remedy picture has
appeared. The aspects of the case which pointed to Apis initially (dead feeling,
irritability, impatience, jealousy, joint inflammation, styes, thirst) are no
longer in the picture. He says that the sadness he feels now is harder than the
dead feeling he had previously. The emotion now being described is grief over
the loss of his past girlfriend. His discussion did not mention jealousy of his
brother at all, only sadness about his sister-in-law—which may have been the
source of the jealousy. He has a desire to be alone. He is having throbbing
headaches during the day, which he wakes up with. He has cold sores around his
mouth, a desire for salt, and a loss of his sense of taste. The keynotes of past grief, aversion to company, headaches
during the day, cold sores, craving for salt, and tastelessness of food are
consistent with Natrum Muriaticum—which Boericke notes is complementary to
Apis, calling it “the chronic Apis.” The Apis given previously seems to have taken him back to the
emotional state of his college years, following the loss of his girlfriend. He
notes that he has headaches now, as he did his final year in college. I also considered Phosphoric Acid again, because it is
well-indicated for ailments from grief, but the specific physical complaints of
desire for salt, the herpetic eruptions around the mouth, and the loss of taste
do not match. I considered giving Ignatia as well, because his state of
sadness was profound. He was acutely emotionally distraught about his affection
for his sister-in-law, his sense of loss because she was married to his brother.
As he talked about it, he sighed, and several times almost broke down in tears.
However, because of the complementary relationship between Apis and Natrum Mur,
and because of the physical symptoms that confirmed the state of that remedy, I
decided that Natrum Muriaticum was more clearly indicated. Natrum Muriaticum was given in a 1M potency on July 29,
1999. A higher potency was given because his grief was quite intense. I asked
him to call after one week and leave a message for me, to let me know how he was
doing, and a follow-up was scheduled for September.
Follow-up
September 22, 1999 The patient reports: “The week
after I saw you last was hell. I took the week off from work, called in sick. I
thought about my sister-in-law, what an opportunity I missed. Every time I would
think of her, I had this pain in my chest. It may sound corny, but it was like
my heart was broken. I stayed in the house without going out for almost a week,
drank a lot, was as miserable as I can ever remember being. I spent my nights
crying and my days griping. My head ached, but I couldn’t tell if it was
because I had headaches or I was hung over. “Finally I woke up one morning, looked at myself in the
mirror, and told myself I had to get a grip on my life. I had to accept that
things were the way they were and I was just going to have to make the best of
it. Maybe that week of hell was
cathartic, or maybe I just got tired of feeling sorry for myself—but, you
know, I started seeing things differently. I went back to work and really put a
lot of energy into a project there. My boss was so surprised, and I even enjoyed
it. I have been getting along with
the guys at work better—even the ones who used to be so annoying; for some
reason it doesn’t bug me any more. “The cold sores went away after about 2 weeks. Food
tastes like it normally does, and I don’t seem to be putting so much salt on
everything any more. I have not had
a headache for over a month now. “I still think about my sister-in-law sometimes, but it
is not the same. I went to their
house for my brother’s birthday last week, and I noticed for the first time
that she nags at him. Maybe he’s not such a lucky guy after all.
He doesn’t seem to mind, but I sure would. “I am taking another wood-carving class, learning some
new techniques. I have started
working on a piece with a woman in the class.
She is attractive, funny, and I like the time I spend with her. When I
take her out, I don’t just feel like I am passing time.” My assessment of the case at this point was that this man
had gone through a normal grieving for the loss of his college sweetheart. He
endured a week-long period of intense grief, and then began to go on with his
life. The physical symptoms he had experienced were relieved. He observes that
he sees his sister-in-law differently now; perhaps this is sour grapes—but
perhaps it is an awareness of her, unclouded by past emotion. Either way, he is
no longer stuck in his broken relationship with her; he does not think of her
continually now. In fact he has begun to date someone who interests him. I saw
all these as movement toward a stronger state of health for this man,
indications that the Natrum Muriaticum has done its work. No action was taken at this time. Follow-up
November 18, 1999 The patient reports: “I am fine. I haven't been having headaches or pain in
my joints— or anything else, actually. “Work is going well. I got promoted, which was a
surprise. My boss seems to think I had some big change, asked me if I had gone
to a shrink, but I don’t know why he would think that. Work is just easier. “I finished the wood-carving project I was doing with
the woman in my class. Things didn’t work out so well with her. She is going
out with the guy who teaches the classes now.
I am seeing a woman I used to live with a few years ago. We are taking a
vacation to Mexico over Christmas. In response
to my questions, he said that he had seen his brother and his family over the
past month and it was not a problem for him. He no longer felt jealous of his
brother, or grief about the situation with his sister-in-law. He was not feeling
irritable, and did not have his former indifference to life. He was able to take
in stride the ending of one brief romantic relationship and the beginning of
another. My assessment is that he has continued well over the past
few months, with no physical complaints. His mental and emotional state are
stable. He continues to have relationships with other women in his life, no
longer focusing on his sister-in-law. His comment about his boss seeing a big
change (that he doesn’t see) is interesting.
So often, when a remedy has acted deeply, the person doesn’t remember
his former state especially vividly. No
action was taken at the time, and he was asked to call if he had problems in the
future. The symptoms in the follow-ups are in stark contrast to
the apathy, irritability, impatience, jealousy, joint pain, and styes which
marked the case on the initial visit. The
Apis acted well, initially, to relieve many of these symptoms—and then the
deeper state, which had been laid down by his emotional trauma during college,
came to the surface. Natrum
Muriaticum was effective at moving this man forward, emotionally, to the present
time—helping him let go of the grief he had carried for many years. |
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