Case 1: Violent Cough in a 5 year old girl
Paula is 5yrs old and 17kg of angelic sweetness. She is blond with a slightly pale, luminous complexion and slender. As her parents describe the acute state she snuggles into her dad and strokes his hand for comfort. Paula whispers into her parents ears despite their audible instruction to speak in a clear open voice. She will respond to a direct smile with a smile but t quickly looks away. I just want to throw a bunch of Pulsatilla at her, but the symptoms do not yet warrant this.
Right now it is Saturday morning at about 11am and they have just left the consult room. We have been through quite a traumatic week for all. Paula had an acute respiratory problem for over a week. A violent dry cough with lethargy and very little sleep for the whole family. When she gets into these states she will just lie on the couch and be thirstless (Gelsemium?).
Her Mom had ed me at the beginning of this episode of the process. I did see Paula once before. Her complaint was a recurrent URI with sore throat and loud dry barking cough and fever. These numerous episodes have been ongoing since beginning kindergarten in September of 2011. The cough started as a severe dry cough only at bed time around 9pm. She was kept awake by it for 1 to 2 hours. It was bad again in the morning from four to six. No other symptoms except that her mood was bad. Once it gets going this “terrible chronic cough” will also produce a single cough every 3-10 minutes especially all night.
None of these descriptions were available to me at the time of the initial consultation. I had at first prescribed Sepia for this young lady. Before ing me, Mom (a nurse) re dosed the Sepia 30.
It was fascinating. The report received by email was that after the Sepia her mood rapidly improved. She went from lying on the couch lethargy to up and playing and singing! But, wait a minute, the cough itself got worse! Not only that, to compound the damage done to my previously damaged ego this sweet young thing is now complaining of a headache and a pain in her heart!
First I gather my fractured self and assess the situation. Sepia must have been a close simile. It did pick her up in general but by no means deserving of an Oscar for the performance. The vitality is giving us more clues because I did not name that tune successfully- the headache and heart pain. Yes! Is that in the repertory?
CHEST; PAIN; General; heart; headache; with (2) : Lach. Naja.
So could it be Lachesis or Naja? Do I have any supporting evidence for either of these remedies? Of course, I smacked myself in the head that I’d missed the obvious. She was worse at the beginning and the end of sleep!!! That is a red flag for Lachesis.
I asked Mom to give Lach 30 bid.
Mom went to pick up a tired little Paula and get her home. On the way, in the car she gave her a single pellet of Lach 30. This was at 2pm. Paula immediately closed her eyes and slept for 2 hours. She awoke at 4pm with a high fever at 39 degrees C and a light upper body sweat. Lips were dry but she was thirstless and refusing drinks. The fever being intense alarmed the nursing education of her mother who had her trigger finger on a bottle of Tylenol. She refrained from the old habit. The fever subsided in less than half an hour. It returned again 7pm but with lesser intensity and duration. Again at 11pm it returned with a 37 degree fever for about 2 hrs. What was also notable here was that Paula was not lethargic with these brief bursts of fever but singing and active! Oh yes-I forgot-since waking in the afternoon at 4pm- no cough whatever could be heard.
Next morning Paula was her usual self. A highly unusual resolution to this recurrent issue. This was 4 days ago and Mom and Dad were in this morning to discuss next steps, thoroughly excited by this natural pr ocess of observation and cure.
Case 2: Type 2 Diabetes and Renal Distress
Salina walked into my office that afternoon with a bright smile. Her dark hair was stylishly done. My attention was drawn to large dark eyes and that magnetic smile. It was a few seconds more until I realized this lovely lady was very heavy for someone of her height and youth. I examined her intake form. It was not surprising that the chief complaint was type 2 diabetes. It was shocking that her lab profiles indicated to her physicians that there was significant renal distress and in fact very low kidney function. She had been counseled that dialysis was a probable and rapidly approaching need.
Coming from a Mediterranean background her parents always emphasized food. Obesity was a problem even as a child. Having such a zest for her food had made dietary control of blood sugar very difficult. The lack of symptomatology allowed a kind of denial to go on. This was all changing. It was disheartening that the usual courses of meds and insulin were not helping the new symptoms or the renal function. Exertion was becoming difficult. Salina knew herself as a vigorous young lady. As of late there was a shortness of breath with mild exertion. When sleeping she needed several pillows to ease her breathing. Many nights there was significant perspiration of the chest, mostly between the breasts. Sleep itself was not satisfying. It had become very light. She would wake from slight noises in the house. Waking at 3am was characteristic.
It was noteworthy that Salina until recently was generally a warm blooded person. That is, she was less comfortable in the heat or in, say, a warmer room. This had changed in an interesting way. Certainly she now enjoyed the warmth more and the sun but now if she was still for too long (sitting) she would become decidedly cold. This was improved by getting up and moving around.
There was a past history of headaches. They could become so severe as to cause faintness. More recently several skin issues have become prominent. Small round ulcers have appeared around the ankles and are slow to heal. The foot is developing more callous. Thick horny kinds of callous formation. There are skin eruptions, eczematous in appearance. They get irritated and aggravated by with perspiration. It was alarming for her that recently her ankles and feet have become numb. Low back pain has been a steady companion that very much limits her. The lumbar pain is worse after standing, even a short time and lifting aggravates as well. In the upper limbs there is cramping (occasional) of the fingers.
Consistently she has a chronic cough which is definitely worse while eating.
Certainly all this is a far cry from being asymptomatic. The timeline of onset of these complaints turned out to be quite coincident with a family dispute. The patient is very close with her family, however recently a quarrel has put her on the outside of things. There is a strong feeling of separation from her previously close family. There is constant dwelling of the events which re-enliven the feelings both of anger, indignation and desire for reunion. For me what was most clear was the constancy of the mind dwelling on these issues and the sense of now being separated from the family.
In case analysis we are told by Hahnemann to select those symptoms from the list which are most characterizing in order to obtain several remedies to consider as a prescription. Further examination of the symptoms and provings will lead to a unique selection. Normally I collect symptoms (computer clipboard) in the order of their being rendered in the case. I then play (in different clipboards) with selecting a small characterizing genius until I am satisfied. Various combinations of symptoms are given a trial until something strikes me as being very resonant with this individual case.
Now in this case there were 26 symptoms collected initially. My final group of genius symptoms were;
- Lower back pain (lumbar) worse on standing.
- Cough, worse during eating.
- Skin eruptions parts perspiring.
- Generalities worse 3 am
- Dwells on past disagreeable experiences.
Four remedies emerged strongly. Rhus tox, Sepia, Sulphur and Thuja. It struck me that the repertorization was not satisfying. How do I account for the feeling cold at rest? I found the rubrics chill; motion ameliorates and chill; sitting aggravates. That’s more like it. One remedy emerges. Interestingly enough it is also in the rubric estranged from her family
I gave Sepia 6c one pellet three times daily. It was about one month later on her return that she was not only asymptomatic but her kidneys were much happier and really no one was talking about dialysis. Thank you Hahnemann.