case of Ankylosing Spondilytis

[Rochelle]

OK here is the case. I have the patient's full permission to post it.
Rochelle
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Background
This 34 yr. old woman She walked in holding herself stiffly. She is tallish,
thin, freckly with moles wearing very subtle makeup. She was dressed in
black smart jeans. She has greenish eyes and dark hair dyed blondish with
the roots obvious. Her lower lids were baggy and droopy. She works out and
about in sales for a household name.

10th October 2002
Presenting Complaint - Ankylosing Spondilytis

"I can only turn my head a little and it hurts. I have a tense pain around
my shoulder and joints crack in my neck." We did EFT about the shoulders
and the pain went away.

"It started at 18. There was nothing going on. I had a job and did a lot of
horse riding. I had a boyfriend , who was my first sexual partner and he is
now my husband. I started going out with him when I was 16. My parents split
up when I was 12/13. The onset was a virus. They thought I had rheumatic
fever. It's one of those immune system things. After a month in hospital I
was OK. As the years go on it has progressed. At age 19/20 I had painful
hips and then that went away. Then the lower backache and I couldn't lie
down but I don't get that now. Then I got painful hands but not now. Now I
have the neck pains. Most recently has been knee joint swelling just above
the knee, which I keep having drained. Also my ankles swelling. They are
very hot and I want ice on them."

"I'd like to have another baby" Her child was IVF which worked first time.
Her husband has poor sperm count. There were no problems except sickness
when pregnant and her condition disappeared to return with a vengeance 10
days after the baby was born.

She has been tearful recently and is not thirsty.

She thinks she is a hot person.

"I would worry about my husband if he was late home with what would happen
to the family. She would also worry about her child. My mother in law is
coming up and she doesn't see my child very often and she is not used to
kids. But if she wants to take him out to the park I am worried if she will
look after him properly. It's my child and I'll do what I want. I don't want
my father to take him sailing.

Food - She likes lamb and the fat on it but not on bacon. She loves butter,
lashings of it. She couldn't think of any dislikes. She drinks cold drinks.

Fears - she used to be awful about being on her own in the house and used
to search all the rooms when she got in but now has an alarm and feels fine.

Psoriasis - a bit on elbows and has itching ears.

When she gets a cold the discharge is often green.

Stool - has haemorrhoids- like passing glass sometimes. She has mucus in her
stool sometimes.

Menses - regular

Sleep - wakes unrefreshed. Sleeps on her back. Wakes at 4am

Cracking in cervical vertebrae.

Feet get cold.

She has the bedroom window open at night and likes fresh air.

Dreams - from things on her mind.

She says that she in not indecisive and can make a decision quickly

Her pains are changeable.

"I feel alone with this illness. I say to my husband that he doesn't show me
any sympathy."

"I am affectionate with my son but not generally affectionate."

"I think I am independent."

Anger - "none really. The last time was probably about my son not picking up
his toys when I know he is capable. I shout."

She is very tidy. Fastidious. She is busy all the time. "I can't relax until
I've done everything."

Jealousy- "possibly"

Childhood - "Mum and dad weren't happy and they split when I was 12/13. I
turned into a rebel for a couple of years. I had a horse and spent time with
people at the farm and didn't tell my Mum when I would be back. I saw dad
once a week. I was an only child. There was an expectation from Dad to do
well but I left school at 16. I didn't like school and would rather do other
things. I did a secretarial course.

Family Medical History
Mother- psoriasis

Presciption - Puls 30 od 5 days

Follow up
Since I saw her last she phoned a few days later and told me that after the
Rx she had a sore throat which she reckoned that she had never had before.
She also had a "funny cold". Her sleep was better and therefore she had more
energy and ankles better. She had also had a bad headache. Weepiness
better. She phoned on 18th October to say that all was as bad as ever so I
sent her a Puls 200. She had a sore throat again after this.

7th November 2002
I noticed when she walked up the drive that she didn't appear to be as stiff
looking.

"On Tuesday I had my knees drained and a steroid injection and I feel better
now"!!

She had not been good in herself and the swollen knees had also caused a
pain in her left hip when she walked. "There was so much inflammation in my
body and I was beside myself. Usually I have to wait ages for this (knees
drained + Steroid injection) to be done and I was offered it immediately."

Full description of the knee. "It fills up crisp and dry (In the Alps in winter) < humid and damp.

She still can't come up with any fears!

I started looking up Rhus Tox and asked her about superstition. "Yes I am
superstitious in that I won't walk under ladders and things like that."

Shoulder and neck - massaging helps.

She is NOT restless.

"I think I am quite a confident person. There is no problem in my head or
anything psychological - only the illness."

Her anti inflammatories have been changed to Volterol.

Analysis
I can still really see only Puls. here. Has the steroid injection in August
prevented the Puls from doing much? There is obviously a reaction as she had
this short lasting sore throat with the 200 as well as with the 30. However
the sore throat is a new symptom she thinks.
www.rochellemarsden.co.uk
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[Arun]

Hi rochelle,

looks so much like puls, perhaps should try 1m before changing (30 has
helped hasn't it ?)
Also, does kali sulph fit in (very much like puls & complementary)
Apis is another possibility, like joy suggested. Very few remedies want
"ice on them" (joints)
regards,
Arun

[Rochelle]

Hi Arun ,
I have to say that because of the stiff manner in which she walked in the
first time I was also thinking of a Kali salt. I will add this one to my
studies.
Thanks
Rochelle
www.rochellemarsden.co.uk