Minutus

Hi all (this is long, but I'd *love* thoughts from you more clinically
experienced ones!!!!),

My friend who's had trouble since nibbling raw taro leaf has asked me for
suggestions on the latest developments, and I would be grateful for any
thoughts, as I'm way out of my depth.

Recap: About three months ago she nibbled a tiny bit of raw Hawaiian taro
leaf. Within seconds felt sharp pain in throat and mouth, and then tongue
and throat began to swell. Friend called ambulance and she was treated at
ER. There's been several "chapters" between then and now, which I will
will get details of if anyone wants.

The type of taro she ate is known by to toxic when raw, but her reaction has
been way beyond the "usual", and her primary trouble, severe asthma,
shortness of breath and chest pain -- all entirely new since this episode --
is apparently not part of the usual picture of that poisoning. (The
expected course would have been severe but fairly short-lasting irritation
to the mucus membranes that were contacted; hers has gone on and on, and now
mainly involves irritation(?) or inflammation(?) to tissues not directly
touched by the leaf. Evidently she had an allergic response, but why does
it go on and on?

Early on, causticum and arnica both seemed unhelpful. Since then she has
simply followed various doctors' instructions, and the results at this point
are distressing (bad side-effects from both cortisone and codeine!!!) Also,
the chest pain/trouble breathing does not seem to be getting any better, and
no one knows why, or what causes the continuing trouble. (Perhaps
aggravated by the meds, and she is slowly tapering them.)

The trouble now centers in her chest, with very severe asthma, shortness of
breath, and severe pain in the chest (details shortly).

Pulmonary function tests are normal, so her doctors don't know how to
explain the continuing trouble breathing (not constant, but apparently comes
back when the pain does, see below).

She has been taking cortisone for presumed inflammation. It helps briefly,
but insuffiently. But when she stops the cortisone, the pain becomes
unbearable (with attendant severe trouble breathing).
She has been taking cortisone 30c to try to mitigate the bad effects of
it. She says that it seems to help, but can't say how, or how much,
because her symptom picture is so unstable anyway.
She has been tapering off the cortisone (down from 60 mg daily to 11),
but is doing it very slowly because she feels so very bad after each
reduction.
Her doctor has her tapering on a schedule, 1 mg reduction per week, and
with the frequently changing dosages and I don't know what else, she says
there is "no stability [of the symptom picture] in sight, has been none for
months, which is part of why she can't tell me just what the effect of the
cortisone in potency is, and will not be able to do so. (Comments?
Wouldn't it be reasonable to let her stabilize in between reductions???)

She has also been taking codeine for the pain, which is severe in spite of
cortisone, and this is another reason it's hard to get good information.
E.g., I asked what her emotional state has been, and her M/E response to the
whole situation. She answered, "I don't know!... There's cortisone
withdrawal... What do I mean. I am so intoxicated... I was in the middle
of a suppport group, someone was talking, we had just been asked a question
and I have no idea what it was. I have no idea what happened in those 20
minutes. Right now I haven't had any [codeine] since middle of night [some
8 hours previously?], and I'm in a hallucinatory state. I can't explain.
I'm really drugged. While I'm talking to you there's images and words and
stuff floating thru my head. I've been on codeine for months now, taking it
every four hours. But if I don't take it I get this burning and aching pain
in my chest. Right when i take it I tend to get really intoxicated. Three
hours later I'm a little more coherent but my chest starts hurting again."
She says her head has not really been clear in months (tho even a few weeks
back her did not sound so confused on the phone...)

MY THOUGHTS, seeking input:
- Looking again thru old notes, I see Suriya's use of cortico to reverse
effects of suppression by steroids. This is probably something we should
do?
I see she has found it to reverse not only effects of the steroids, but
sometimes also the condition for which they were taken in the first place,
and explains that from the fact that adrenals are suppressed by steroids,
and cortico is an extract of the pituitary gland which stimulates the
adrenals. She has been very, very severely "adrenally compromised" for a
long time, so perhaps this plays into why she has developed this severe and
long-lasting reaction to the taro toxin???
- Another thought is to give her codeine in potency, along with the
potentized cortisone (or perhaps cortico instead)? Or should I initially
leave that alone, or handle it first, argh!!!

Her description from yesterday morning of the chest pains:
***Chest pain since I've had since I ate that taro leaf, which no one seems
to be able to explain. The pulmonologist quit [stopped working with her]
bcause she dcouldn't find anything on her lung function test... [Lung
function tests come out normal, yet her trouble breathing continues,
sometimes quite severely. Helped somewhat by cortisone, but not well
controlled and now the cortisons is causing problems...]

The chest pain: Feels deep in my chest, more on left side.
There are two kinds of pain: One which tends to be in center of chest,
sharp, spasmy, like my whole bronchial tube freezing up.
Then there's pain that's more broad, across my chest, more on left, and in
middle of back as well as in front, this deep, aching, burning pain. It's
horrible. It's really hard to breathe thru it. I start feeling really
tight in my whole chest. I keep trying to take breaths in. They tell me
there's nothing wrong with my breathing, but I keep fighting to breathe. I
get short of breath when the pain is intense. [I tried to determine whether
the SOB is nervous reaction to the pain or a concomitant/co-effect, and it
seems to be the latter.] From center of chest, out.

Heat, hot water, seems to help. ... In a hot shower the steam makes it
worse, but not water on back makes it better. Heat, hot water, seems to
help. Haven't been able to take hot baths since can't bathe unsupervised
(due to possible seizures). In a hot shower the steam makes it worse (see
below re "light touch"?), but hot water on back makes it better.

The skin gets really sensitive.
Can't stand light touch!!! (In the region of the back pain only)
Excruciatingly painful, burning, horrible. Had massage, had to keep telling
her to press *hard*. Because the nerves in my skin on my back are
hypersensitive (to light touch). Sometimes lying down makes it better,
sometimes worse. Any pressure on chest is terrible, makes it hard to
breath. Can't slouch, have to sit to make the most room in chest or it
hurts more.
That sensitivity to light touch seems the best clue I see so far, so I am
looking at these:

GENERALITIES; TOUCH; agg.; slight: Acon., Apisin., ars., Bell., Chin.,
coff., colch., ham., Hep., ign., Kali-c., Lach., lyss., mag-m., Merc.,
merc-c., mez., murx., nit-ac., Nux-v., ox-ac., ph-ac., phos., sep., sil.,
spig., stann., sul-ac.
(I had looked for such a rubric in Skin, but don't find one there.)

GENERALITIES; PRESSURE; amel.; hard; slight agg.: agar., aloe, bell.,
calc-f., cast., caust., chin., culx., ign., kali-c., lac-c., lach., mag-p.,
nux-v., plb., psor., sulph.
(I'm not sure this second fits; she does not specifically say that pressure

I know there are lots more rubrics I should be able to get out of this and
tomorrow I'll get back to work on it, but I feel I am sooooooo floundering
with various aspects of this. All thoughts welcome, from any brave souls
who have made it this far (weak smile)!

Thanks so much,
Shannon

Shannon -- take a look at Lobelia, which has the majority of the important
symptoms -- even more than Ars, which I thought of first, with the etiology
of poisoning. Another major thought is Aconite, especially since there are
no physical findings on examination -- I bet she was terrified of dying when
she developed the sudden reaction to the taro (especially when she couldn't
breathe), and she's still under that influence. You could ask her. I'd be
inclined to try a dose of that first (it also fits the symptoms). If these
don't work, I'd look at the Arums or Caladium, botanically related to taro,
since in a way this is at least partially a proving. Just a few
thoughts.... Rosemary

Hi Shannon,
Chest pain in the same remedy as breath shortness in the same remedy as touch in the
same sentence as agg/worse/sensitive in the same sentence as touch in the same remedy
as abuse/poisoning in the same sentence as medicaments/medicines in the same remedy as
anaphylaxis:

3Apis, acon., arn., carb-ac., hyos., lob., lyc., nux-v., op., podo., rhus-t., ruta,
viol-o.

stream of consciousness:
-Seems to be a nervous-system case. Wonder if sensitivity of vagus nerve, although
might expect more heart sx. For vagus involvement, lobelia a possibility, but no vomiting, and
only spasmodic asthma as a real commonality.
-Apis (initial reaction was swelling,. and
apis is Generalties; worse after vacc and abuse of poisoning with medicaments (58)).
-This seems to be anaphylaxis become chronic (carbolic acid is anaphylactic and
sensitive to touch);
-person is very sensitive to chemicals (brings up the thought of
arsenicum).
-Dont see the fear of acon. but latter should be studied.
For what it is worth:
Bernoville comment: For anti - anaphylactic function, it is very difficult to find
sure remedies. To be studied in the Materia Medica. All sorts of remedies may be
indicated. Specially Arsenicum album and Thuja.

Nothing conclusive, hope it is nonetheless furthering.

Andy

Hi Shannon
I have been following this thread since the beginning.
Something you said today and the sensations you described made me think differently about the case
I feel that pain, even if accompanied by other things to be treated, should be addressed high priority.
You friends pain, even though she describes it as excruciating may be able to tolerate it so therefore it may not really be 'intolerable' - inother words, less severe than it could be.
I have had pericarditis, which has exquisite pain on inspiration, so bad that it is tempting to hold the breath to avoid the pain. The pleura also can give off pain on inspiration.
As her pulmonary function tests do not indicate asthma type condition, I would guess from what you have described that it is possibly involving the sympathetic nervous system, due to the burning and aching nature of the pain, and could even have a rheumatic/neuralgic source.
Be that as it may, I had a look at the pain sensations and description on their own, with their associated modalities and came up with an interesting possibility.

Take a look at Ran b.
It has anxiety and irritability with pains
chest pains that are worse on inspiration
anxious oppresed breathing with desire to draw deep breath
Margaret Tyler is a source for skin, sensitivity to touch
Roger Morrison a source for coldness in the lungs

Rheumatic pains in the chest
Sensations include confusion of the head as if intoxicated
Burning in left side of chest
As if a full breath could not be drawn
cold sensation internally
burning and coldness in small spots

I know this is not something that others would probably come up with, but take a look and get a feel for the remedy and the nature of the descriptions your friend has given of her pain.

Something off to skew, but maybe worth a look

it maybe also worth noting that Hepar Sulph particularly 200 is indicated for hypersensitivity to pain when there is a local lesion, but it is not usually of the radiating type.

Robyn

"To be ignorant is not the special prerogative of man; to know that he is ignorant is his special privilege". (An Idealist View of Life - Radhakrishnan).

Hi Shannon,
Not only brave but imprudent enough since you wanted to know only
from clinically 'experienced'.(Do not laugh.I'm into serious things)
I used Boger's & Knerr's rep.

In Knerr's Pg 790& 791. Inner Chest,oppression: with constant burning
pain.
(idiopathic and rheumatic endo and pericarditis)- ver-v

Boger's:
Respiration: impeded by : Chest,burning in: Ran-b
do : oppression
of:aco,arn,can,cic,cina,cocl,dro,ign,mar
merc,nuxv,pul,ranb,rhust,saba,sars,scil,seng,spi,Ver a

She said:I have no idea what happened in those 20 minutes:
Thoughts vanishing ? Ran -b
Touch agg: ranb,
( In synthesis, ranb is shown as warm amel)

(Hering gives a fair acccount of its affinity to left chest,the
oppression, the burning,etc in periodicity he gives- chast pain for
weeks,interesting)

Regards
Venkat

Thanks, Robyn!
Actually, ran-b is the *one* remedy that's come to my mind so far, but I
haven't had time yet to check it out, so am haapy to have you bring it up --
and will check it out more. Or might just have her do it...

What is it that makes things look different to you -- the things that
suggest it may be nerves or connective tissue rather than lung, perhaps?
(That seems reasonable to me...) What she means by "intolerable" is that it
is bad enough that she takes the drugs even tho she hates what they are
doing to her, and is not a pharmaceutical-taking kind of person in
general...

Thanks again, I'll chew over all this!
Shannon
on 12/10/03 3:29 AM, Robyn at folco@tpg.com.au wrote:

Hi Shannon
why not use the Taro in potency.
or
Murphy - Emergency WOUNDS, poisoned poisonous plants, from (1)
1 echi

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