online case RH Jan 2002
Posted: Thu Jan 10, 2002 2:00 am
Hi, Joy. Here's, finally, the case I promised. I'm sorry it's so long --
very complex. It's about 8 pages in all when printed in 12 point type.
I'll really look forward to people's thoughts on where I might turn for the
key to the heart of this perplexing case which now hinges on a patient's
need to be sick, regardless of the objective disappearance of physical
symptoms.
58 y/o male, c/o pains in extremities, recurrent colds with bronchitis/
pneumonia/ sinusitis, insomnia, "bad stomach".
He asked for help with the above symptoms. His first words are:
"Basically, I have the constitution of a horse." Of course, I think,
"sulphur," and there are quite a few sulphur aspects to this case, but there
are also too many other things.
He's overweight, fairly meticulous in dress, has a quick, busy manner, talks
a lot in a fussy, affected accent -- theorizing, expounding on very esoteric
concepts and details. He's a college English professor, teaching writing to
undergraduates. His sense of duty is overwhelming, and he works 80 to 100
hours a week, feeling obligated to do this to "do his job right." His
apartment, on the upper west side of Manhattan, is in a doorman building.
It's a relatively prestigious address, and the staff all call him "Dr.
Lutrin," although he does not have a doctorate. His apartment is crammed
floor to ceiling with old classical albums -- 33s, although he does not have
a working record player -- lots of art work, antique furniture and rugs, and
piles and piles and piles of papers -- unfinished work. There is merely a
path through the piles to get to the different rooms. His tiny galley
kitchen is crammed with spices and condiments. He's difficult to reach by
phone, as after his grueling workday that has stretched from 5am to 7 or 8
pm, he typically goes out to dinner, goes to the theatre, the opera, a
concert, some cultural event. He has wealthy woman friends who pay his way
to exclusive benefits and performances to which he wears his tux and where
he enhances their image by being the elegant escort.
In the interview, when I ask him about the causation of his ills, he zeroes
in on the death 15 years previously, from a sudden heart attack, of his life
partner, a cardiologist (ironically). He is still mourning this partner.
He keeps looking for a new partner, but he really wants the former one.
Therefore, everyone he dates is unavailable for one reason or another, or he
rejects them all as uninteresting. He dates each potential person only once,
then moves on. He admits to being sexually compulsive, and has had dozens
and dozens of one-night partners in this way, sometimes several times a
week. He says sometimes he thinks about sex 24 hours a day.
He was an oldest child of 4 siblings. His father was a perfectionist, very
demanding. The father ran a grocery store, and the patient worked in the
store from an early age, assuming adult responsibilities. His father had
cancer twice, and his mother had severe heart disease (several MIs), and had
cancer three times, eventually dying from metastatic cancer. He felt close
to his mother, is fairly distant from his siblings, and disliked his father
intensely.
He suffers excruciatingly from numerous complaints although he has never had
a life-threatening illness or any diagnosis of a serious disease.
MAJOR SYMPTOMS
I'm just going to include the narrative he gave, because its flavor can't be
captured just by summarizing the symptoms.
NARRATIVE:
Basically, I have the constitution of a horse, although I notice my
endurance isn't as good as before -- effects of aging. I'm afraid the
things that have been happening to me might end up being devastating.
For instance, the bunion on my left foot has been painful and puffy,
especially after wearing hard shoes (he walks many miles every day in
Manhattan, using public transportation exclusively). I've had twitching
flashes in the muscles of my arch, flashing to the first two toes. It's
happened occasionally to my right foot, too -- but much less. More
recently, my fingers have started aching too. It feels better if I arch the
fingers in a grasping motion. My other siblings have had arthritis for
several years.
When I get undressed, I notice that my left foot is swollen, and the color
of a cooked lobster. I HATE things on my feet -- heavy, tight, hard.
I get red welts from cat claws and teeth, and itchy eyes if I rub my eyes
after playing with Sidney (he LOVES cats, and always has one or two as
companions.).
I'm still dealing with the remnants of my last bout of sinusitis -- this is
the 9th day of antibiotics. In addition to cats, I'm also allergic to dust
and mold -- cleaning up all the papers lying around raises lots of dust and
mold. And I'm allergic to trees and grasses. I get colds all the time with
terrible sneezing.
My esophagitis isn't too good -- even the Prilosec doesn't work too well. I
have heartburn to die from. My throat is raw from the postnasal drip. It's
worse in the evening and at night, in the bedroom, and when I go to bed.
I'm taking melatonin so I can get some sleep. I have anxious dreams and
wake up early and thirsty. I drink water during the night. It's worse when
I don't have everything done -- which is common. I usually get 4 hours of
sleep and then wake up unrefreshed. I want to go back to bed and sleep at 8
or 9 am. I also get sleepy after I eat anything, even the smallest meal. I
feel exhausted.
Everything has been worse since Robert died. (His dear partner died almost
20 years ago, and he's still in a state of deep mourning!).
I HATE taking ANY medications!!!
At night, when I'm coughing in the dark or sneezing -- especially
sneezing -- I see stars. I worry it will lead to paralysis. I've been
coughing and sneezing violently. Everything else is worse too with
sneezing. Pains shoot from my shoulders down the inside of my arm to my
thumb and first finger, then the arm goes limp. Also when I sneeze, I get a
GRINDING, SCREAMING PAIN behind my ears, on both sides. It's on the scalp,
not deep inside. It's aching, comparable to what happens when I eat ice
cream, when I get the same pain in my palate. When my sinuses are bad, I
get the same pain in my cheekbones and teeth. I take antihistamines and
Vioxx to try to control it. After a while, then, the scalp on the left side
of my vertex feels exquisitely tender. And my neck is tingling, with a lack
of skin sensitivity, with the same thing in my left hand, 3rd and 4th
fingers. During sleep, I've rolled over on my right arm, and the same two
fingers on that hand have gone to sleep.
The muscles in my right shoulder ache, and I can't use my right arm to help
me turn over in bed. The muscles ache inside the elbow, and the inside of
the upper arm, going down to the forearm.
When I had a pneumonia shot, it made the same thing happen on my left outer
arm (the left tricep was the site of that shot.).
I can't reach behind me to wipe my ass with my right hand.
With all this going on, my lungs were fine -- I could blow the shofer just
fine.
My "stomach" is a problem too. I've had irritable bowel syndrome since
1975. It's worse when I drink milk (3), or eat bananas, dates, or wheat, or
when I smoke (2). It's a "rapid passage syndrome." A lifetime of heavy
drinking seems to have been one factor in this irritation. Bowel movements
are frequent in the morning, but not the day or the evening, unless I've
just eaten something or I'm having a bad stomach. The stool is watery, and
smelly.
Twice last year, I experienced involuntary bowel movements -- no control. I
knew it was coming, and could feel it moving through the rectum. The
movement comes in waves, progressively stronger.
I used to eat a lot of hot peppers. It didn't do anything to my mouth, but
it made my stools black, so I don't eat them so often. But when I do, I
still get an internal pain in the lower bowel while I'm having a bowel
movement. I take fiber to try to slow things down.
I really crave fatty meat, but it makes my stomach worse. I get dyspeptic
to the point of madness with the reflux. I hate anything smoked, and tomato
sauces, especially ketchup. I LOVE pickles, but they don't agree with me --
my throat tastes metallic. White wine makes my stomach worse, too.
My throats hurts when I drink anything hot, and I have difficulty
swallowing. This happens with alcohol, too. I really CRAVE coffee in the
morning, and drink a whole liter, hot or cold (3). But it makes my stomach
and throat worse.
The reflux gets much worse with stress, especially worry. I get acid burps,
with a sour food taste, coughing, burning pain. It's worse when I drink
water or if I get in a draft.
I worry mainly about work. There's such a lack of democratic process it
ties me up in knots, and wakes me up in the middle of the night. I get very
tense and fretful.
I used to exercise a lot more at the gym than I do now, and I miss it --
emotionally, spiritually, even physically. I've put on weight. I'll get
back to yoga and swimming.
I have to get surgery for an inguinal hernia -- the fourth one I've had.
They run in my family. They've happened on both sides.
I get this odd skin irritation, worse in the summer, on my chest. It's as
if I had been bitten by insects -- there seems to be a black filament
visible. If I pull it, it leaves a scab,. They bleed occasionally, but
aren't particularly itchy or painful. I also have bumps along the hairline
on the back of my neck.
My family history includes diabetes, hypertension, hypercholesteremia. I'm
OK on all those things, although I had high triglycerides once. I revised
my will when I had that test -- I was sure I was going to die right then.
Both my parents got cancer twice, and my mother had heart disease, with
several MI's.
MY LIFE CHANGED DRAMATICALLY WHEN ROBERT DIED. I've been afraid of
finances, scared of old age and loneliness, uncertain I'd ever be able to
take care of myself. I'd always taken care of others, not myself.
I stopped drinking so much, because I was afraid I'd become an alcoholic. I
think Robert was one, and I drank to keep him company. When he died, I was
terrified everything would fall apart. I suffered fiercely, but then became
cold about death (but he still attends every single "minyan" in four
different synagogues, which means he's praying several days a week for dead
people he didn't even know!).
I got sloppier after Robert died. Papers of all kinds piled up everywhere
(he lives in a 5 room apartment with little aisles between mountains of
paper.).
My depression changed profoundly after he died. When he was around, I kept
my tendency to depression under control. I didn't want to rumble the
relationship by imposing my illnesses or needs on him, and wouldn't let
myself give in to depression.
For me, being depressed means sleeping more. I function with what is
expected of me, then I withdraw and avoid being social or doing things for
fun. Ordinarily I'm a great wanderer, explorer, adventurer, socializer.
SPONTANEOUS STUFF IS FINE. BUT WHEN SOMETHING GETS PLANNED, THEN I DON'T
WANT TO LEAVE THE APARTMENT. I can't stay on top of bills and papers.
Sometimes I spend 3 hours searching frantically for one overdue bill.
My appetite has increased somewhat. I'm getting overweight, though I'm not
a big eater. I can still only eat big in a Chinese restaurant after a
couple of glasses of wine. Otherwise, I'm not comfortable any more with big
meals. I crave desserts, bread, and Chinese food, with a LOT to drink --
especially gin. But then I wake up and have to drink water all night. I
also crave nuts (3).
For the past three years, whenever I eat tuna fish or anything savory,
within 30-60 minutes, I HAVE to have something sweet, especially a chocolate
candy bar. I crave clementines, but not other fruits, except I do like ones
that taste acidic like pineapples, grapes, and mangos.
About my job, I like the act of teaching (he's an English professor at one
of the community college campuses of CUNY). But I don't like the people I
work with or their mood. It's a whole new bloody-minded, career-minded
generation -- hierarchical, unpleasant, ambitious, cutthroat, fawning --
things I CAN'T STAND!!
Also the synagogue has changed its culture in the same direction, once we
got an official rabbi. I've been extremely angry about it since 1991, when
she came. It's been a lesson in reality for me. She took over a
democratic, volunteer organization and made it hierarchical and ambitious.
She overstepped the bounds originally set. The whole place changed. I
still have copies of her early contracts, with strict stipulations to limit
her. These disappeared over later contracts. Going there isn't a "high"
for me any more, but I HAVE dealt with some of the anger, especially against
Irving Cooperberg who was the agent of these changes (my note: Cooperberg
has been dead for several years, but this patient still proffers lengthy,
detailed unprovoked tirades against him every couple of weeks, implying a
personal affront/ injury by Cooperberg!). I withdrew, felt terrible, got
very depressed.
At about the same time, I turned 50, which I had to sort out.
I'm afraid if I leave teaching, I'll also end up withdrawing.
Oh yes -- we haven't mentioned my back (my note: which immobilizes him every
couple of weeks). I have muscle spasms. Flexeril sort of works.
I fear dependency on medications.
I have no significant hair loss.
DISCUSSION
Major themes:
1. Anger at authority and inability to deal with authority
2. Depression manifested by physical and social withdrawal
3. Occupation ameliorates -- he keeps running till he drops, up to 20 hours
a day
4. Perfectionistic demands on himself and others
5. Huge anxieties: time, performance, finances, health, acceptance,
dependency, aging, death, any decision.
6. Suppression with accompanying explosive release: anger, depression,
diarrhea, catarrh, acid reflux, skin eruptions, even suppression of
expressing needs in his relationship.
7. Spasms of all kinds with symptoms from compression of nerves:
extremities, diarrhea, back, neck, sneezing, cough
8. Ferocious retention of past insults and disasters: partner's death,
synagogue, father, work environment
9. Overly responsible Feels as though things wouldn't work without him
around to do them -- goes back historically to his father's store.
Remedy consideration:
Obviously there are strong overtones here of both Sulph and Nat-Mur, as well
as some reference to Ars, Staph, Calc, and even Nux-V. It was such a
toss-up between Nat-M and Sulph in the initial repertorization that I
finally just sort of tossed a coin and started with Sulph, LM 1 daily.
After a month, when I did the first follow-up, I cracked up laughing after
he had left, because everything was better, but he had an alternative
explanation for each improvement. The interview could have made a humorous
article in a homeopathic magazine. First he said nothing had changed, then
when I went down the list of symptoms he had described, his answer to
everything was "Well, that's better, but it's because..." And then he gave a
different off the cuff explanation for each improvement, other than the
homeopathic treatment. I had him continue taking Sulph for a second month,
but all the improvements stopped. Nothing regressed, just no more progress.
So after the two month follow-up, I figured I'd better change remedies in
an attempt to achieve more progress. At this point, especially since one of
his most salient symptoms was diarrhea every morning after he had arisen,
which is a keynote symptom for Nat-S, I thought that I might resolve the
conflict between Nat-M and Sulph by giving Nat-S. (12c, once daily,
aqueous). The results of this were interesting and very positive -- his
desire for alcohol and his sexual compulsiveness (which he had failed to
mention in the first interview) diminished dramatically. His sleep had
become "fine," his gastric reflux symptoms had abated and he was doing fine
with food that previously had caused problems. His diarrhea was much
better, as were the pains in his extremities. His seasonal allergies just
hadn't happened, right through allergy season. He'd been cold-free.
Emotionally, his sense of anger had gone away, and he said he felt much less
anxious. He also said he was more focused, and was able to get done the
things he wanted to get done, without obsessing over everyone else's
problems.
Like, wow -- to me the treatment seemed like a riproaring success. But he
didn't feel any better, really. He expressed dire worry about some ongoing
throat pain, and said he had a doctor's appointment because he was sure it
was going to be fatal, and wanted an endoscope of his esophagus. And while
his feet were no longer swollen or painful, the skin was flaking, so he had
gotten an appointment with the dermatologist, because he was really worried
about what might be happening to his skin. And he felt it was his
responsibility to work twice as hard as before because he was feeling maybe
a little better. In other words, his initial pattern of not recognizing the
improvement of his symptoms continued, and the smaller the symptoms got the
bigger they became individually in his consciousness so that the end result
in terms of how he was living and feeling about his life were the same. The
symptoms of which he had initially complained were mostly gone. Yet he was
still desperately worried about his health, and still occupying every spare
moment to the point of exhaustion and collapse.
Then he took off on two days notice to visit Europe for two weeks, traveling
all over Europe and partying with friends in different countries. When he
came back, many of his symptoms had reasserted themselves. However, he was
still about 90% better than when we had started.
I did point this out to him, after a discussion of "direction of cure" and
how positive his picture was, with the impressive disappearance of almost
all of his initial symptoms, and he replied "Well, I don't DISbelieve you."
So his inner pessimism appears to have remained untouched.
Also, he then focused compulsively on the events in New York, and started
using this as an opportunity to hold forth at great length on all the
injustices in the world, and how corrupt the world is, and how impossible
all situations are ... This leads to my real concern that even if he
experiences a total resolution of his physical symptoms, he will still be
living in a black hole because he seems to have organized his whole
self-perception and emotional life around his sense of suffering. The cure
can't really occur until he can move out of his unrelenting pessimism. And
I don't think we've touched that, essentially, at all. Obviously, in some
way, we've reached the heart of the case.
So now the central question: what role does that pessimism play for him?
Why is it so important to him? I can't ask him directly, because he doesn't
recognize that he IS so pessimistic. The question applies also to his
physical symptoms, which he's also not willing to relinquish, despite the
physical evidence that they've disappeared -- in his mind, he's still just
as sick as he ever thought himself to be. He NEEDS to think he's sick. Why?
What's the focal point of this?
He's basicallly an "agitated depressive," with a hyperactive life the main
thing keeping him from falling into deep despair. Is the hyperactivity more
sycotic or more cancerous? His way of keeping himself functioning
emotionally is to always be moving, acting, doing. He never just relaxes.
The closest he comes to "relaxing" is the whirlwind tour of 6 European
countries in 14 days. He goes out several nights a week, attends concerts,
operas, parties; he is a one-man kaddish resource in several synagogues,
showing up to become part of the minyan for virtually every congregant who
dies. He also, totally gratis, officiates at many services, in many
different ways -- serving as rabbi, cantor, counselor. At work, he signs up
for every extra project, serves on every important committee, teaches one or
two extra classes each semester. In other words, he takes on enough
activity to keep two or three people reasonably busy.
More sycotic or cancerous? The activity itself is probably more sycotic.
But there is an analogy as well, a powerful one, between the proliferation
of activities and obligations and the proliferations of cells in cancer,
overwhelming the individual. Is it cancerous also to become allied with
these proliferative cells (=activities, symptoms), to begin to need them for
emotional survival as he seems to do? My perception of cancer heretofore
has been that patients feel at war with the proliferating cells and the
disease -- they feel attacked; they don't use it as their basic life
justification.
Although his overall history and symptoms also correspond closely to Nat-M,
Nux-V, Staphysagria, and Calc, as well as the Sulph that acted well
initially then stopped, it's fairly easy to eliminate Calc because his food
cravings don't match Calc, nor do his other modalities. Plus, he just isn't
a Calc type. Likewise, he doesn't match Nux-V, especially in his tenacity
in holding on to negative situations from the past. The Nux irritability
comes and goes much more quickly, and doesn't show this patient's pattern of
grudges and complaints held on to forever. Staphysagria is extremely
difficult to eliminate on the basis of his mental symptoms alone, although
the physicals don't match Staph too well. At the start, the case was very
strongly both Nat-M and Sulph, and the combined salt has worked well, but
better for the sulph physical side of the symptoms than for the Nat-M
emotional side. In light of this, rather than change everything at once
(giving a nosode and a new remedy too), I decided at this point to simply
give Nat-M and see how far that took him. So my next prescription was for
Nat-M, 12c, aqueous, daily, following a split dose of 200c.
Now I can't even get hold of him for the next follow-up, because his pace
has become even more frenetic. I know he's had a couple of colds which just
came and went away, which is a good sign. But his life has basically
deteriorated into total chaos, with his mother being mortally ill in Florida
(he lives in Manhattan) and he being determined to teach all his classes and
fulfill all committee and synagogue obligations AND be at his mother's
bedside. So this led to an 8 week pattern of thrice weekly East Coast
commutes via plane, until she died early in December. In the middle of
this, Sept. 11 had happened six blocks away from the college where he
teaches, and that also represented a massive disruption in his physical and
emotional life, which he has also magnified by his response. It strikes me
that it may be time for an intercurrent nosode, which is the reason for my
discussion here of sycotic vs. cancer patterns. Which nosode? Or which
miasm? The classical use of nosodes and Hahnemann's interpretation of
miasms was that they should be considered at points where a cure isn't
holding for some reason.
And what remedy have I missed in the midst of all this chaos and
proliferation? I've clearly found near-simillima. But the heart of the case
hasn't yielded yet. When I do finally catch the patient for a follow-up I'll
post a better description of what's happened with the Nat-M. Obviously,
until his underlying emotional problem is modified, he's going to keep
presenting bigger and bigger obstacles to cure, which will ultimately lead
to failure of treatment.
Rosemary C. Hyde, Ph.D.
very complex. It's about 8 pages in all when printed in 12 point type.
I'll really look forward to people's thoughts on where I might turn for the
key to the heart of this perplexing case which now hinges on a patient's
need to be sick, regardless of the objective disappearance of physical
symptoms.
58 y/o male, c/o pains in extremities, recurrent colds with bronchitis/
pneumonia/ sinusitis, insomnia, "bad stomach".
He asked for help with the above symptoms. His first words are:
"Basically, I have the constitution of a horse." Of course, I think,
"sulphur," and there are quite a few sulphur aspects to this case, but there
are also too many other things.
He's overweight, fairly meticulous in dress, has a quick, busy manner, talks
a lot in a fussy, affected accent -- theorizing, expounding on very esoteric
concepts and details. He's a college English professor, teaching writing to
undergraduates. His sense of duty is overwhelming, and he works 80 to 100
hours a week, feeling obligated to do this to "do his job right." His
apartment, on the upper west side of Manhattan, is in a doorman building.
It's a relatively prestigious address, and the staff all call him "Dr.
Lutrin," although he does not have a doctorate. His apartment is crammed
floor to ceiling with old classical albums -- 33s, although he does not have
a working record player -- lots of art work, antique furniture and rugs, and
piles and piles and piles of papers -- unfinished work. There is merely a
path through the piles to get to the different rooms. His tiny galley
kitchen is crammed with spices and condiments. He's difficult to reach by
phone, as after his grueling workday that has stretched from 5am to 7 or 8
pm, he typically goes out to dinner, goes to the theatre, the opera, a
concert, some cultural event. He has wealthy woman friends who pay his way
to exclusive benefits and performances to which he wears his tux and where
he enhances their image by being the elegant escort.
In the interview, when I ask him about the causation of his ills, he zeroes
in on the death 15 years previously, from a sudden heart attack, of his life
partner, a cardiologist (ironically). He is still mourning this partner.
He keeps looking for a new partner, but he really wants the former one.
Therefore, everyone he dates is unavailable for one reason or another, or he
rejects them all as uninteresting. He dates each potential person only once,
then moves on. He admits to being sexually compulsive, and has had dozens
and dozens of one-night partners in this way, sometimes several times a
week. He says sometimes he thinks about sex 24 hours a day.
He was an oldest child of 4 siblings. His father was a perfectionist, very
demanding. The father ran a grocery store, and the patient worked in the
store from an early age, assuming adult responsibilities. His father had
cancer twice, and his mother had severe heart disease (several MIs), and had
cancer three times, eventually dying from metastatic cancer. He felt close
to his mother, is fairly distant from his siblings, and disliked his father
intensely.
He suffers excruciatingly from numerous complaints although he has never had
a life-threatening illness or any diagnosis of a serious disease.
MAJOR SYMPTOMS
I'm just going to include the narrative he gave, because its flavor can't be
captured just by summarizing the symptoms.
NARRATIVE:
Basically, I have the constitution of a horse, although I notice my
endurance isn't as good as before -- effects of aging. I'm afraid the
things that have been happening to me might end up being devastating.
For instance, the bunion on my left foot has been painful and puffy,
especially after wearing hard shoes (he walks many miles every day in
Manhattan, using public transportation exclusively). I've had twitching
flashes in the muscles of my arch, flashing to the first two toes. It's
happened occasionally to my right foot, too -- but much less. More
recently, my fingers have started aching too. It feels better if I arch the
fingers in a grasping motion. My other siblings have had arthritis for
several years.
When I get undressed, I notice that my left foot is swollen, and the color
of a cooked lobster. I HATE things on my feet -- heavy, tight, hard.
I get red welts from cat claws and teeth, and itchy eyes if I rub my eyes
after playing with Sidney (he LOVES cats, and always has one or two as
companions.).
I'm still dealing with the remnants of my last bout of sinusitis -- this is
the 9th day of antibiotics. In addition to cats, I'm also allergic to dust
and mold -- cleaning up all the papers lying around raises lots of dust and
mold. And I'm allergic to trees and grasses. I get colds all the time with
terrible sneezing.
My esophagitis isn't too good -- even the Prilosec doesn't work too well. I
have heartburn to die from. My throat is raw from the postnasal drip. It's
worse in the evening and at night, in the bedroom, and when I go to bed.
I'm taking melatonin so I can get some sleep. I have anxious dreams and
wake up early and thirsty. I drink water during the night. It's worse when
I don't have everything done -- which is common. I usually get 4 hours of
sleep and then wake up unrefreshed. I want to go back to bed and sleep at 8
or 9 am. I also get sleepy after I eat anything, even the smallest meal. I
feel exhausted.
Everything has been worse since Robert died. (His dear partner died almost
20 years ago, and he's still in a state of deep mourning!).
I HATE taking ANY medications!!!
At night, when I'm coughing in the dark or sneezing -- especially
sneezing -- I see stars. I worry it will lead to paralysis. I've been
coughing and sneezing violently. Everything else is worse too with
sneezing. Pains shoot from my shoulders down the inside of my arm to my
thumb and first finger, then the arm goes limp. Also when I sneeze, I get a
GRINDING, SCREAMING PAIN behind my ears, on both sides. It's on the scalp,
not deep inside. It's aching, comparable to what happens when I eat ice
cream, when I get the same pain in my palate. When my sinuses are bad, I
get the same pain in my cheekbones and teeth. I take antihistamines and
Vioxx to try to control it. After a while, then, the scalp on the left side
of my vertex feels exquisitely tender. And my neck is tingling, with a lack
of skin sensitivity, with the same thing in my left hand, 3rd and 4th
fingers. During sleep, I've rolled over on my right arm, and the same two
fingers on that hand have gone to sleep.
The muscles in my right shoulder ache, and I can't use my right arm to help
me turn over in bed. The muscles ache inside the elbow, and the inside of
the upper arm, going down to the forearm.
When I had a pneumonia shot, it made the same thing happen on my left outer
arm (the left tricep was the site of that shot.).
I can't reach behind me to wipe my ass with my right hand.
With all this going on, my lungs were fine -- I could blow the shofer just
fine.
My "stomach" is a problem too. I've had irritable bowel syndrome since
1975. It's worse when I drink milk (3), or eat bananas, dates, or wheat, or
when I smoke (2). It's a "rapid passage syndrome." A lifetime of heavy
drinking seems to have been one factor in this irritation. Bowel movements
are frequent in the morning, but not the day or the evening, unless I've
just eaten something or I'm having a bad stomach. The stool is watery, and
smelly.
Twice last year, I experienced involuntary bowel movements -- no control. I
knew it was coming, and could feel it moving through the rectum. The
movement comes in waves, progressively stronger.
I used to eat a lot of hot peppers. It didn't do anything to my mouth, but
it made my stools black, so I don't eat them so often. But when I do, I
still get an internal pain in the lower bowel while I'm having a bowel
movement. I take fiber to try to slow things down.
I really crave fatty meat, but it makes my stomach worse. I get dyspeptic
to the point of madness with the reflux. I hate anything smoked, and tomato
sauces, especially ketchup. I LOVE pickles, but they don't agree with me --
my throat tastes metallic. White wine makes my stomach worse, too.
My throats hurts when I drink anything hot, and I have difficulty
swallowing. This happens with alcohol, too. I really CRAVE coffee in the
morning, and drink a whole liter, hot or cold (3). But it makes my stomach
and throat worse.
The reflux gets much worse with stress, especially worry. I get acid burps,
with a sour food taste, coughing, burning pain. It's worse when I drink
water or if I get in a draft.
I worry mainly about work. There's such a lack of democratic process it
ties me up in knots, and wakes me up in the middle of the night. I get very
tense and fretful.
I used to exercise a lot more at the gym than I do now, and I miss it --
emotionally, spiritually, even physically. I've put on weight. I'll get
back to yoga and swimming.
I have to get surgery for an inguinal hernia -- the fourth one I've had.
They run in my family. They've happened on both sides.
I get this odd skin irritation, worse in the summer, on my chest. It's as
if I had been bitten by insects -- there seems to be a black filament
visible. If I pull it, it leaves a scab,. They bleed occasionally, but
aren't particularly itchy or painful. I also have bumps along the hairline
on the back of my neck.
My family history includes diabetes, hypertension, hypercholesteremia. I'm
OK on all those things, although I had high triglycerides once. I revised
my will when I had that test -- I was sure I was going to die right then.
Both my parents got cancer twice, and my mother had heart disease, with
several MI's.
MY LIFE CHANGED DRAMATICALLY WHEN ROBERT DIED. I've been afraid of
finances, scared of old age and loneliness, uncertain I'd ever be able to
take care of myself. I'd always taken care of others, not myself.
I stopped drinking so much, because I was afraid I'd become an alcoholic. I
think Robert was one, and I drank to keep him company. When he died, I was
terrified everything would fall apart. I suffered fiercely, but then became
cold about death (but he still attends every single "minyan" in four
different synagogues, which means he's praying several days a week for dead
people he didn't even know!).
I got sloppier after Robert died. Papers of all kinds piled up everywhere
(he lives in a 5 room apartment with little aisles between mountains of
paper.).
My depression changed profoundly after he died. When he was around, I kept
my tendency to depression under control. I didn't want to rumble the
relationship by imposing my illnesses or needs on him, and wouldn't let
myself give in to depression.
For me, being depressed means sleeping more. I function with what is
expected of me, then I withdraw and avoid being social or doing things for
fun. Ordinarily I'm a great wanderer, explorer, adventurer, socializer.
SPONTANEOUS STUFF IS FINE. BUT WHEN SOMETHING GETS PLANNED, THEN I DON'T
WANT TO LEAVE THE APARTMENT. I can't stay on top of bills and papers.
Sometimes I spend 3 hours searching frantically for one overdue bill.
My appetite has increased somewhat. I'm getting overweight, though I'm not
a big eater. I can still only eat big in a Chinese restaurant after a
couple of glasses of wine. Otherwise, I'm not comfortable any more with big
meals. I crave desserts, bread, and Chinese food, with a LOT to drink --
especially gin. But then I wake up and have to drink water all night. I
also crave nuts (3).
For the past three years, whenever I eat tuna fish or anything savory,
within 30-60 minutes, I HAVE to have something sweet, especially a chocolate
candy bar. I crave clementines, but not other fruits, except I do like ones
that taste acidic like pineapples, grapes, and mangos.
About my job, I like the act of teaching (he's an English professor at one
of the community college campuses of CUNY). But I don't like the people I
work with or their mood. It's a whole new bloody-minded, career-minded
generation -- hierarchical, unpleasant, ambitious, cutthroat, fawning --
things I CAN'T STAND!!
Also the synagogue has changed its culture in the same direction, once we
got an official rabbi. I've been extremely angry about it since 1991, when
she came. It's been a lesson in reality for me. She took over a
democratic, volunteer organization and made it hierarchical and ambitious.
She overstepped the bounds originally set. The whole place changed. I
still have copies of her early contracts, with strict stipulations to limit
her. These disappeared over later contracts. Going there isn't a "high"
for me any more, but I HAVE dealt with some of the anger, especially against
Irving Cooperberg who was the agent of these changes (my note: Cooperberg
has been dead for several years, but this patient still proffers lengthy,
detailed unprovoked tirades against him every couple of weeks, implying a
personal affront/ injury by Cooperberg!). I withdrew, felt terrible, got
very depressed.
At about the same time, I turned 50, which I had to sort out.
I'm afraid if I leave teaching, I'll also end up withdrawing.
Oh yes -- we haven't mentioned my back (my note: which immobilizes him every
couple of weeks). I have muscle spasms. Flexeril sort of works.
I fear dependency on medications.
I have no significant hair loss.
DISCUSSION
Major themes:
1. Anger at authority and inability to deal with authority
2. Depression manifested by physical and social withdrawal
3. Occupation ameliorates -- he keeps running till he drops, up to 20 hours
a day
4. Perfectionistic demands on himself and others
5. Huge anxieties: time, performance, finances, health, acceptance,
dependency, aging, death, any decision.
6. Suppression with accompanying explosive release: anger, depression,
diarrhea, catarrh, acid reflux, skin eruptions, even suppression of
expressing needs in his relationship.
7. Spasms of all kinds with symptoms from compression of nerves:
extremities, diarrhea, back, neck, sneezing, cough
8. Ferocious retention of past insults and disasters: partner's death,
synagogue, father, work environment
9. Overly responsible Feels as though things wouldn't work without him
around to do them -- goes back historically to his father's store.
Remedy consideration:
Obviously there are strong overtones here of both Sulph and Nat-Mur, as well
as some reference to Ars, Staph, Calc, and even Nux-V. It was such a
toss-up between Nat-M and Sulph in the initial repertorization that I
finally just sort of tossed a coin and started with Sulph, LM 1 daily.
After a month, when I did the first follow-up, I cracked up laughing after
he had left, because everything was better, but he had an alternative
explanation for each improvement. The interview could have made a humorous
article in a homeopathic magazine. First he said nothing had changed, then
when I went down the list of symptoms he had described, his answer to
everything was "Well, that's better, but it's because..." And then he gave a
different off the cuff explanation for each improvement, other than the
homeopathic treatment. I had him continue taking Sulph for a second month,
but all the improvements stopped. Nothing regressed, just no more progress.
So after the two month follow-up, I figured I'd better change remedies in
an attempt to achieve more progress. At this point, especially since one of
his most salient symptoms was diarrhea every morning after he had arisen,
which is a keynote symptom for Nat-S, I thought that I might resolve the
conflict between Nat-M and Sulph by giving Nat-S. (12c, once daily,
aqueous). The results of this were interesting and very positive -- his
desire for alcohol and his sexual compulsiveness (which he had failed to
mention in the first interview) diminished dramatically. His sleep had
become "fine," his gastric reflux symptoms had abated and he was doing fine
with food that previously had caused problems. His diarrhea was much
better, as were the pains in his extremities. His seasonal allergies just
hadn't happened, right through allergy season. He'd been cold-free.
Emotionally, his sense of anger had gone away, and he said he felt much less
anxious. He also said he was more focused, and was able to get done the
things he wanted to get done, without obsessing over everyone else's
problems.
Like, wow -- to me the treatment seemed like a riproaring success. But he
didn't feel any better, really. He expressed dire worry about some ongoing
throat pain, and said he had a doctor's appointment because he was sure it
was going to be fatal, and wanted an endoscope of his esophagus. And while
his feet were no longer swollen or painful, the skin was flaking, so he had
gotten an appointment with the dermatologist, because he was really worried
about what might be happening to his skin. And he felt it was his
responsibility to work twice as hard as before because he was feeling maybe
a little better. In other words, his initial pattern of not recognizing the
improvement of his symptoms continued, and the smaller the symptoms got the
bigger they became individually in his consciousness so that the end result
in terms of how he was living and feeling about his life were the same. The
symptoms of which he had initially complained were mostly gone. Yet he was
still desperately worried about his health, and still occupying every spare
moment to the point of exhaustion and collapse.
Then he took off on two days notice to visit Europe for two weeks, traveling
all over Europe and partying with friends in different countries. When he
came back, many of his symptoms had reasserted themselves. However, he was
still about 90% better than when we had started.
I did point this out to him, after a discussion of "direction of cure" and
how positive his picture was, with the impressive disappearance of almost
all of his initial symptoms, and he replied "Well, I don't DISbelieve you."
So his inner pessimism appears to have remained untouched.
Also, he then focused compulsively on the events in New York, and started
using this as an opportunity to hold forth at great length on all the
injustices in the world, and how corrupt the world is, and how impossible
all situations are ... This leads to my real concern that even if he
experiences a total resolution of his physical symptoms, he will still be
living in a black hole because he seems to have organized his whole
self-perception and emotional life around his sense of suffering. The cure
can't really occur until he can move out of his unrelenting pessimism. And
I don't think we've touched that, essentially, at all. Obviously, in some
way, we've reached the heart of the case.
So now the central question: what role does that pessimism play for him?
Why is it so important to him? I can't ask him directly, because he doesn't
recognize that he IS so pessimistic. The question applies also to his
physical symptoms, which he's also not willing to relinquish, despite the
physical evidence that they've disappeared -- in his mind, he's still just
as sick as he ever thought himself to be. He NEEDS to think he's sick. Why?
What's the focal point of this?
He's basicallly an "agitated depressive," with a hyperactive life the main
thing keeping him from falling into deep despair. Is the hyperactivity more
sycotic or more cancerous? His way of keeping himself functioning
emotionally is to always be moving, acting, doing. He never just relaxes.
The closest he comes to "relaxing" is the whirlwind tour of 6 European
countries in 14 days. He goes out several nights a week, attends concerts,
operas, parties; he is a one-man kaddish resource in several synagogues,
showing up to become part of the minyan for virtually every congregant who
dies. He also, totally gratis, officiates at many services, in many
different ways -- serving as rabbi, cantor, counselor. At work, he signs up
for every extra project, serves on every important committee, teaches one or
two extra classes each semester. In other words, he takes on enough
activity to keep two or three people reasonably busy.
More sycotic or cancerous? The activity itself is probably more sycotic.
But there is an analogy as well, a powerful one, between the proliferation
of activities and obligations and the proliferations of cells in cancer,
overwhelming the individual. Is it cancerous also to become allied with
these proliferative cells (=activities, symptoms), to begin to need them for
emotional survival as he seems to do? My perception of cancer heretofore
has been that patients feel at war with the proliferating cells and the
disease -- they feel attacked; they don't use it as their basic life
justification.
Although his overall history and symptoms also correspond closely to Nat-M,
Nux-V, Staphysagria, and Calc, as well as the Sulph that acted well
initially then stopped, it's fairly easy to eliminate Calc because his food
cravings don't match Calc, nor do his other modalities. Plus, he just isn't
a Calc type. Likewise, he doesn't match Nux-V, especially in his tenacity
in holding on to negative situations from the past. The Nux irritability
comes and goes much more quickly, and doesn't show this patient's pattern of
grudges and complaints held on to forever. Staphysagria is extremely
difficult to eliminate on the basis of his mental symptoms alone, although
the physicals don't match Staph too well. At the start, the case was very
strongly both Nat-M and Sulph, and the combined salt has worked well, but
better for the sulph physical side of the symptoms than for the Nat-M
emotional side. In light of this, rather than change everything at once
(giving a nosode and a new remedy too), I decided at this point to simply
give Nat-M and see how far that took him. So my next prescription was for
Nat-M, 12c, aqueous, daily, following a split dose of 200c.
Now I can't even get hold of him for the next follow-up, because his pace
has become even more frenetic. I know he's had a couple of colds which just
came and went away, which is a good sign. But his life has basically
deteriorated into total chaos, with his mother being mortally ill in Florida
(he lives in Manhattan) and he being determined to teach all his classes and
fulfill all committee and synagogue obligations AND be at his mother's
bedside. So this led to an 8 week pattern of thrice weekly East Coast
commutes via plane, until she died early in December. In the middle of
this, Sept. 11 had happened six blocks away from the college where he
teaches, and that also represented a massive disruption in his physical and
emotional life, which he has also magnified by his response. It strikes me
that it may be time for an intercurrent nosode, which is the reason for my
discussion here of sycotic vs. cancer patterns. Which nosode? Or which
miasm? The classical use of nosodes and Hahnemann's interpretation of
miasms was that they should be considered at points where a cure isn't
holding for some reason.
And what remedy have I missed in the midst of all this chaos and
proliferation? I've clearly found near-simillima. But the heart of the case
hasn't yielded yet. When I do finally catch the patient for a follow-up I'll
post a better description of what's happened with the Nat-M. Obviously,
until his underlying emotional problem is modified, he's going to keep
presenting bigger and bigger obstacles to cure, which will ultimately lead
to failure of treatment.
Rosemary C. Hyde, Ph.D.