Another one of my complex cases!!
Posted: Mon Oct 25, 2004 1:06 am
Dear All,
This patient is constantly phoning me and I thought maybe you would give me some
ideas about where to go on this one!! She is aware that I am posting to a list.
Rochelle
--------------
Background This 28 year old woman presented as a thin woman, with short hair and glasses and looking older than her years. She spoke and acted in a nervous manner. She is married and teaches She had her adenoids removed in 1984 and had possible glandular fever in 1996. At the same time she sustained a whiplash injury from a fall onto concrete. She is taking Propanolol (Bedranol) which is a beta blocker and Amitripytiline 10mg. She sees a rheumatologist and an osteopath. Before I had finished the consultation I could see that she was
getting edgy. It was because her mother was waiting for her with the car and would be furious because she has been so long. She left sooner than I hoped as she seemed to be frightened of her mother's tongue. Her head is in constant movement which she says is something to do with how she holds her spine.
Presenting complaints- ME/Fibromyalgia pain/nerve pain and mood swings/excessive tearfulness/panic attacks and possible polycystic ovaries.
She had been to see a rheumatologist this morning and she told me that he moves her back and causes a tremor in the neck when she sits in certain positions after she has been to him.
"I have pain in my ribs on the left side. It starts in the back and comes round to the front. It is a stabbing dull pain underneath the left breast near to the heart. If I lie on my left side I vomit. It feels like my chest is caving in. It feels like breast pain. I took Efamast and then went onto Starflower oil. It suppressed something as it has got so much worse since I stopped taking it. From the age of 15 I did lots of physical activity like rowing cycling and tennis. Maybe I did too much."
"I take the beta blocker because I have constant tachycardia without it. It starts in the morning, as soon as I bend over and stops at 2pm. I feel the tachycardia sometimes in my head."
"I wake with stiffness in the base of my spine. This gets better as the day goes on. The more immobile I am the worse I am. All my problems stem from the spine. It's like it throws out signals. I can't lift my arms. After the starflower I was great."
"Even on the Starflower oil I had a stomach and bowel problem."
"I get dizzy when I stand up. My BP is fine."
"I also get a feeling that something is trapped and I get constant reflux and
can't eat."
"I have been on the Amitripytiline for 4 or 5 months and without it I am racked with chronic pain and get very angry. It's like something builds up and I have to urinate or do strong exercise which I can't do anymore. I feel ill on junk food and am on a very plain diet. I have a massive sugar craving.
"I have just been told I have cysts on my ovaries since I came off the
starflower. My periods are now 8 weeks apart. I have diarrhoea that comes with the period and last time the diarrhoea carried on for a couple of weeks."
"I have had so many antibiotics in my lifetime. I had lots of cystitis as a child. I had antibiotics for acne and for kidney infections and stones."
"At age 20 I had possible glandular fever the same year as the whiplash. Afterwards I had a year of night sweats which I was told was a classic symptom of spinal shock. I also had the worst case of chicken pox that my doctor had seen during this year. It was the second time I had it. I had a year out of university as I got so depressed doing the dissertation. I then went back in my usual workaholic state and came out with a 1st class degree."
"Everything started at age 20. There was lots of pressure. I found it difficult to do my dissertation. It was difficult to take decisions and I became panicky and anxious.
"I got depression after the fall. I was being carried and was dropped by my boyfriend. We had had too much to drink. I don't think I hit my head."
"I have difficulty concentrating which I call brain fog. I get dizziness and I struggle to walk up and down the stairs. If I look at a straight line, like Venetian blinds the lines jump and move."
"> at work but I can't think fast enough."
Speech- "I stammer every now and again"
Ears - "Repetitive noise irritates all my nerves and it can be painful."
Nose - hypersensitive to smells like smoke, alcohol, gas, glasses in a
restaurant often smell damp and musty and even soapy.
Mouth - taste -"like poison like metal (coppery). My tongue is often coated white." It was nice and pink when I looked at it. "Drinks often taste off".
Teeth - nerve pain
Respiration- can get s.o.b. because of the ribcage pain.
Joints - "the pain is a dull ache and my joints crack."
Digestion - "I get heartburn after eating. Chocolate, peppermint, coffee and alcohol *** agg.
"With my pain I get very irritable and > urination for a short time."
Bowels - IBS- "I can get diarrhoea which has no relation to anything. They say it is to do with what is coming from the spine."
Bladder - "Irritable - it feels as if there is heaviness. I get an urging."
Genitals - "I get lots of discharge which is green, sometimes yellow and has no smell. Yes it does stain."
Tidy
Menses - heavy used to be deep red with clots but lately it has been a lot lighter. It lasts 7-8 days.
Sex - not interested and nor is husband as he has very bad chronic eczema (sees a homeopath near where he works).
Sweat - "I've always sweated a lot. It has a nasty smell, like onions. I am worse for stopping the sweat. I have tried all sorts of deodorants and none are any good." sweating, > period maybe >discharges.
"I am serious, anxious emotional, negative, GSH, can empathise with others, am slightly obsessive in things that I do. It is an obsessive anxiety and it runs in the family. We check things."
"My dad died when I was age 9 from meningitis. As a family they don't show emotions so wasn't able to grieve. I check things like the gas hob, front and back door and it goes with the anxiety".
"I am not confident except with my ability at work and can be a workaholic. I have a very sharp mind and memory. My students would say I am chatty, humorous, and strict and all their homework is marked on time. I have a conscience about this."
"I like to be with people- I am not good by myself. I enjoy being with the kids at school. I've not much patience and if people irritate me they really do. I don't go out a lot because of the loud noises and because I don't drink."
"I grew up with my husband since age 3. Our parents were teachers."
"I've had a lot of x-rays and have had a barium meal twice and that's why I don't want another they want to give me in the next few weeks. I have had dye in my kidneys and neck put in."
Food - desires chocolate, sweet things, likes, rice chicken, tuna, mackerel bread, toast, white wine and sherry, biscuits. Aversion, very spicy, red meat. Doesn't fancy the idea of stuff like octopus etc.
"I feel fed up, confused and very up and down. Some days I cry all day and others I am angry."
Anger - "I am very critical and slightly abusive. I can shout with rage and now have a shorter temper than normal. I know this is not me. I behave irrationally- it's like there is no control over it. I have always been weepy with PMT, always wound up."
Crying - sometimes in company other times I want to be on my own.
Husband - "I see him as a good friend and I get upset when he gets ill. We got married 2 years ago. We didn't live together because Mum is strict catholic and that wouldn't have been allowed. I have had a couple of other boyfriends.
"The main person I was attached to was my Dad. Mum is very critical and not at all emotional. My mother is oppressive but I don't like being by myself. Although I have friends at work after work we don't mix. My Mum rules my life. I have a fear of confronting her as my brother did and now she doesn't speak to him."
Confrontation- "There were 2 incidents at work last year. One was a bad parent's evening where a parent complained about me and I still had to teach this lad. The lad was threatening me. (His attitude) There were 2 lads I was worried about but one I felt I could deal with. It was a fear of intimidation. I don't like being criticised as I have a desire to please. I don't like aggression. In the classroom I am strict - I won't speak over their chatter- but I don't yell. People think I am calm. A panic sets in when I am intimidated."
"When I was young there was a lot of hassle about me being overweight. I went on a diet and lost 4 stone. I was picked on at school as I wore glasses.
Fears - thunderstorms***
- dying
- not keeping up which is work related
- heights*
Religion - "It means guilt faith and hope. I do go to church regularly. It is a way of being close to Dad.
Family Medical History
Father - ulcerative colitis, meningitis, d 53
Grandparents - diabetes d 64, heart attack, 53, cancer 70
Diabetes and DVT common family illnesses
Chronic back pain
Analysis
I think this is a tricky case. It is difficult to find out exactly where this all started but possibly with the fall and the whiplash.
There seems to be a suppression of all her symptoms from the starflower oil as everything returned and more after she stopped taking it. I am not too happy with the allopathic medication but for the time being she will have to stay on it as the tachycardia is unacceptable although it is strange that it ceases at 2pm. The Amitripytiline appears to control the chronic pain but I wonder what else it is doing.
There are some quite marked SRPs in this case.
Tachycardia 2pm
amel urination
Lots of antibiotic abuse
Massive sugar craving
Noise is painful
Confrontation/intimidation is a bit thing in her life.
Mag carb/ Nat mur/sulph maybe interesting to look at as they have the fear of aggression/confrontation that she seems to have with her mother as they are afraid that they won't get the love and attention if they do something wrong. She is fearful that her mother, who I think she relies on for companionship will leave her in the lurch as she did her brother when he had an argument with her.
Reading Vithoulkas Carc there is a lot in that as well.
Rhus Tox comes up high in the rep but is there the restlessness?
Sac Alb - is another Rx that it might be worth looking into. This leads to Lac H as well.
All in all I decided to give a dose of Arnica to see if it would do anything since it is possible that everything stemmed from the whiplash injury and I have seen Arnica do remarkable things.
Also she needs to cut out sugar.
Prescription
Arnica 200 - 1 dose
Update - 26th August
More photophobia - she is finding white light painful as it hurts behind her eyes. This is an OS
Sinusitis - back of throat greeny yellow with little ulcers - OS
Urging bladder with the build up feeling that she gets.
She is wondering whether she is fit enough to return to work next week.
28th September 2004
"I have been up and down. I don't think the Candida diet has made any
difference. I am off the Amyitripytiline and now on Gabapentine 900mg a day. The side effects are that my nose blocks up and I sweat the smell of it."
"The Arnica stopped the vaginal discharge for 5 days. I have felt worse from the cold."
"I have still got the photophobia but the sinusitis has gone away. I still have the urging bladder and build up feeling."
"I have not had the X ray and barium meal yet and not sure if I want to have them now."
"The pain in my ribs can be clicked from side to side to up and down. There is
possibly a change. There was a lot of pain in the head and sinuses (CF above!!)
"I don't think there has been any difference in the tachycardia."
Stiffness - better
Menses - on time. The diarrhoea was still there with it.
Noise - still irritates her nerves.
She still has the hypersensitivity to smells and the taste of copper in her
mouth.
SOB has been better.
Heartburn - better
Sweat odour - no difference
Anger - no difference or the fed up feeling.
"I am still up and down but far more stable."
Sugar craving - gone
"I am constantly fidgeting. Noise makes her restless.
Itching skin - OS
Analysis
The Arnica obviously had a reaction but didn't do anything major. Maybe it should be repeated. It's difficult to know what coming off the Amitripytiline and going on the new drug has done. However she came all yenned up about Rhus Tox and when we discussed it and I gave her info from the MM she was well impressed.I decided therefore to give 30C split and then start on the WP as she has so many drugs. The menses on time was good considering the PCO she is meant to have.
Unfortunately I don't seem to have saved the next follow up on the computer so I will type some of it from my printed notes:-
8th Oct.- She days her white coated tongue has totally cleared.
10th Oct - urine infection- constant urging, pain during and after urination, no burning, she is crying all the time. I sent her Puls 30
13th Oct - Very depressed because the hospital said they can do nothing for her. The Puls got rid of the cystitis very quickly. Pain in the ribs is the same, Feeling down , very hypersensitive to noise
15th October
She came in really for EFT - she insists it is a nerve pain that extends from the vertebrae at the back around to the front. "If I put my arms up I get a pain across my chest. If I grip I get a pain that goes across my spine. Sometimes it is there a while as a burning pain and other times it goes away quickly, I have a desire to vomit when I bend over using my arms to pick something up. A tingling goes down my arms. I am >heat> pressure. There is a pain behind both eyes that interferes with my vision. It makes it blurry and flashy. My osteopath
says it comes from the neck. It feels like a pin going through from the front to the back. (Spig)
Emotions - "I dread feeling like this indefinitely. My husband can't cope much longer. I can't go to work. I may lose my marriage. It may be the end of life as I know it." She has had negative feelings at school again from intimidation from a pupil.
Update 18th Oct.
She is thinking of taking antidepressants and asked me if I had something that acted like that!! It was a I can't bear the pain cry. I thought I would try Coffea.
Update 24th
She has just phoned to say that the vaginal discharge has returned- she says it went away with the Rhus Tox. The coffea did nothing to help. Her mental state is a panic that comes on with the pains in the chest She feels it's all hopeless and keeps crying. She is on 1/2 term now and she did say she was dreading being at home because she is better being occupied.
www.rochellemarsden.co.uk
[Non-text portions of this message have been removed]
This patient is constantly phoning me and I thought maybe you would give me some
ideas about where to go on this one!! She is aware that I am posting to a list.
Rochelle
--------------
Background This 28 year old woman presented as a thin woman, with short hair and glasses and looking older than her years. She spoke and acted in a nervous manner. She is married and teaches She had her adenoids removed in 1984 and had possible glandular fever in 1996. At the same time she sustained a whiplash injury from a fall onto concrete. She is taking Propanolol (Bedranol) which is a beta blocker and Amitripytiline 10mg. She sees a rheumatologist and an osteopath. Before I had finished the consultation I could see that she was
getting edgy. It was because her mother was waiting for her with the car and would be furious because she has been so long. She left sooner than I hoped as she seemed to be frightened of her mother's tongue. Her head is in constant movement which she says is something to do with how she holds her spine.
Presenting complaints- ME/Fibromyalgia pain/nerve pain and mood swings/excessive tearfulness/panic attacks and possible polycystic ovaries.
She had been to see a rheumatologist this morning and she told me that he moves her back and causes a tremor in the neck when she sits in certain positions after she has been to him.
"I have pain in my ribs on the left side. It starts in the back and comes round to the front. It is a stabbing dull pain underneath the left breast near to the heart. If I lie on my left side I vomit. It feels like my chest is caving in. It feels like breast pain. I took Efamast and then went onto Starflower oil. It suppressed something as it has got so much worse since I stopped taking it. From the age of 15 I did lots of physical activity like rowing cycling and tennis. Maybe I did too much."
"I take the beta blocker because I have constant tachycardia without it. It starts in the morning, as soon as I bend over and stops at 2pm. I feel the tachycardia sometimes in my head."
"I wake with stiffness in the base of my spine. This gets better as the day goes on. The more immobile I am the worse I am. All my problems stem from the spine. It's like it throws out signals. I can't lift my arms. After the starflower I was great."
"Even on the Starflower oil I had a stomach and bowel problem."
"I get dizzy when I stand up. My BP is fine."
"I also get a feeling that something is trapped and I get constant reflux and
can't eat."
"I have been on the Amitripytiline for 4 or 5 months and without it I am racked with chronic pain and get very angry. It's like something builds up and I have to urinate or do strong exercise which I can't do anymore. I feel ill on junk food and am on a very plain diet. I have a massive sugar craving.
"I have just been told I have cysts on my ovaries since I came off the
starflower. My periods are now 8 weeks apart. I have diarrhoea that comes with the period and last time the diarrhoea carried on for a couple of weeks."
"I have had so many antibiotics in my lifetime. I had lots of cystitis as a child. I had antibiotics for acne and for kidney infections and stones."
"At age 20 I had possible glandular fever the same year as the whiplash. Afterwards I had a year of night sweats which I was told was a classic symptom of spinal shock. I also had the worst case of chicken pox that my doctor had seen during this year. It was the second time I had it. I had a year out of university as I got so depressed doing the dissertation. I then went back in my usual workaholic state and came out with a 1st class degree."
"Everything started at age 20. There was lots of pressure. I found it difficult to do my dissertation. It was difficult to take decisions and I became panicky and anxious.
"I got depression after the fall. I was being carried and was dropped by my boyfriend. We had had too much to drink. I don't think I hit my head."
"I have difficulty concentrating which I call brain fog. I get dizziness and I struggle to walk up and down the stairs. If I look at a straight line, like Venetian blinds the lines jump and move."
"> at work but I can't think fast enough."
Speech- "I stammer every now and again"
Ears - "Repetitive noise irritates all my nerves and it can be painful."
Nose - hypersensitive to smells like smoke, alcohol, gas, glasses in a
restaurant often smell damp and musty and even soapy.
Mouth - taste -"like poison like metal (coppery). My tongue is often coated white." It was nice and pink when I looked at it. "Drinks often taste off".
Teeth - nerve pain
Respiration- can get s.o.b. because of the ribcage pain.
Joints - "the pain is a dull ache and my joints crack."
Digestion - "I get heartburn after eating. Chocolate, peppermint, coffee and alcohol *** agg.
"With my pain I get very irritable and > urination for a short time."
Bowels - IBS- "I can get diarrhoea which has no relation to anything. They say it is to do with what is coming from the spine."
Bladder - "Irritable - it feels as if there is heaviness. I get an urging."
Genitals - "I get lots of discharge which is green, sometimes yellow and has no smell. Yes it does stain."
Tidy
Menses - heavy used to be deep red with clots but lately it has been a lot lighter. It lasts 7-8 days.
Sex - not interested and nor is husband as he has very bad chronic eczema (sees a homeopath near where he works).
Sweat - "I've always sweated a lot. It has a nasty smell, like onions. I am worse for stopping the sweat. I have tried all sorts of deodorants and none are any good." sweating, > period maybe >discharges.
"I am serious, anxious emotional, negative, GSH, can empathise with others, am slightly obsessive in things that I do. It is an obsessive anxiety and it runs in the family. We check things."
"My dad died when I was age 9 from meningitis. As a family they don't show emotions so wasn't able to grieve. I check things like the gas hob, front and back door and it goes with the anxiety".
"I am not confident except with my ability at work and can be a workaholic. I have a very sharp mind and memory. My students would say I am chatty, humorous, and strict and all their homework is marked on time. I have a conscience about this."
"I like to be with people- I am not good by myself. I enjoy being with the kids at school. I've not much patience and if people irritate me they really do. I don't go out a lot because of the loud noises and because I don't drink."
"I grew up with my husband since age 3. Our parents were teachers."
"I've had a lot of x-rays and have had a barium meal twice and that's why I don't want another they want to give me in the next few weeks. I have had dye in my kidneys and neck put in."
Food - desires chocolate, sweet things, likes, rice chicken, tuna, mackerel bread, toast, white wine and sherry, biscuits. Aversion, very spicy, red meat. Doesn't fancy the idea of stuff like octopus etc.
"I feel fed up, confused and very up and down. Some days I cry all day and others I am angry."
Anger - "I am very critical and slightly abusive. I can shout with rage and now have a shorter temper than normal. I know this is not me. I behave irrationally- it's like there is no control over it. I have always been weepy with PMT, always wound up."
Crying - sometimes in company other times I want to be on my own.
Husband - "I see him as a good friend and I get upset when he gets ill. We got married 2 years ago. We didn't live together because Mum is strict catholic and that wouldn't have been allowed. I have had a couple of other boyfriends.
"The main person I was attached to was my Dad. Mum is very critical and not at all emotional. My mother is oppressive but I don't like being by myself. Although I have friends at work after work we don't mix. My Mum rules my life. I have a fear of confronting her as my brother did and now she doesn't speak to him."
Confrontation- "There were 2 incidents at work last year. One was a bad parent's evening where a parent complained about me and I still had to teach this lad. The lad was threatening me. (His attitude) There were 2 lads I was worried about but one I felt I could deal with. It was a fear of intimidation. I don't like being criticised as I have a desire to please. I don't like aggression. In the classroom I am strict - I won't speak over their chatter- but I don't yell. People think I am calm. A panic sets in when I am intimidated."
"When I was young there was a lot of hassle about me being overweight. I went on a diet and lost 4 stone. I was picked on at school as I wore glasses.
Fears - thunderstorms***
- dying
- not keeping up which is work related
- heights*
Religion - "It means guilt faith and hope. I do go to church regularly. It is a way of being close to Dad.
Family Medical History
Father - ulcerative colitis, meningitis, d 53
Grandparents - diabetes d 64, heart attack, 53, cancer 70
Diabetes and DVT common family illnesses
Chronic back pain
Analysis
I think this is a tricky case. It is difficult to find out exactly where this all started but possibly with the fall and the whiplash.
There seems to be a suppression of all her symptoms from the starflower oil as everything returned and more after she stopped taking it. I am not too happy with the allopathic medication but for the time being she will have to stay on it as the tachycardia is unacceptable although it is strange that it ceases at 2pm. The Amitripytiline appears to control the chronic pain but I wonder what else it is doing.
There are some quite marked SRPs in this case.
Tachycardia 2pm
amel urination
Lots of antibiotic abuse
Massive sugar craving
Noise is painful
Confrontation/intimidation is a bit thing in her life.
Mag carb/ Nat mur/sulph maybe interesting to look at as they have the fear of aggression/confrontation that she seems to have with her mother as they are afraid that they won't get the love and attention if they do something wrong. She is fearful that her mother, who I think she relies on for companionship will leave her in the lurch as she did her brother when he had an argument with her.
Reading Vithoulkas Carc there is a lot in that as well.
Rhus Tox comes up high in the rep but is there the restlessness?
Sac Alb - is another Rx that it might be worth looking into. This leads to Lac H as well.
All in all I decided to give a dose of Arnica to see if it would do anything since it is possible that everything stemmed from the whiplash injury and I have seen Arnica do remarkable things.
Also she needs to cut out sugar.
Prescription
Arnica 200 - 1 dose
Update - 26th August
More photophobia - she is finding white light painful as it hurts behind her eyes. This is an OS
Sinusitis - back of throat greeny yellow with little ulcers - OS
Urging bladder with the build up feeling that she gets.
She is wondering whether she is fit enough to return to work next week.
28th September 2004
"I have been up and down. I don't think the Candida diet has made any
difference. I am off the Amyitripytiline and now on Gabapentine 900mg a day. The side effects are that my nose blocks up and I sweat the smell of it."
"The Arnica stopped the vaginal discharge for 5 days. I have felt worse from the cold."
"I have still got the photophobia but the sinusitis has gone away. I still have the urging bladder and build up feeling."
"I have not had the X ray and barium meal yet and not sure if I want to have them now."
"The pain in my ribs can be clicked from side to side to up and down. There is
possibly a change. There was a lot of pain in the head and sinuses (CF above!!)
"I don't think there has been any difference in the tachycardia."
Stiffness - better
Menses - on time. The diarrhoea was still there with it.
Noise - still irritates her nerves.
She still has the hypersensitivity to smells and the taste of copper in her
mouth.
SOB has been better.
Heartburn - better
Sweat odour - no difference
Anger - no difference or the fed up feeling.
"I am still up and down but far more stable."
Sugar craving - gone
"I am constantly fidgeting. Noise makes her restless.
Itching skin - OS
Analysis
The Arnica obviously had a reaction but didn't do anything major. Maybe it should be repeated. It's difficult to know what coming off the Amitripytiline and going on the new drug has done. However she came all yenned up about Rhus Tox and when we discussed it and I gave her info from the MM she was well impressed.I decided therefore to give 30C split and then start on the WP as she has so many drugs. The menses on time was good considering the PCO she is meant to have.
Unfortunately I don't seem to have saved the next follow up on the computer so I will type some of it from my printed notes:-
8th Oct.- She days her white coated tongue has totally cleared.
10th Oct - urine infection- constant urging, pain during and after urination, no burning, she is crying all the time. I sent her Puls 30
13th Oct - Very depressed because the hospital said they can do nothing for her. The Puls got rid of the cystitis very quickly. Pain in the ribs is the same, Feeling down , very hypersensitive to noise
15th October
She came in really for EFT - she insists it is a nerve pain that extends from the vertebrae at the back around to the front. "If I put my arms up I get a pain across my chest. If I grip I get a pain that goes across my spine. Sometimes it is there a while as a burning pain and other times it goes away quickly, I have a desire to vomit when I bend over using my arms to pick something up. A tingling goes down my arms. I am >heat> pressure. There is a pain behind both eyes that interferes with my vision. It makes it blurry and flashy. My osteopath
says it comes from the neck. It feels like a pin going through from the front to the back. (Spig)
Emotions - "I dread feeling like this indefinitely. My husband can't cope much longer. I can't go to work. I may lose my marriage. It may be the end of life as I know it." She has had negative feelings at school again from intimidation from a pupil.
Update 18th Oct.
She is thinking of taking antidepressants and asked me if I had something that acted like that!! It was a I can't bear the pain cry. I thought I would try Coffea.
Update 24th
She has just phoned to say that the vaginal discharge has returned- she says it went away with the Rhus Tox. The coffea did nothing to help. Her mental state is a panic that comes on with the pains in the chest She feels it's all hopeless and keeps crying. She is on 1/2 term now and she did say she was dreading being at home because she is better being occupied.
www.rochellemarsden.co.uk
[Non-text portions of this message have been removed]