Homeopathy Online's interactive case analysis is moderated this issue by Ian Townsend, Clinical Director of the Sheffield School of Homeopathy in the United Kingdom. Ian acts as a tutor at both the Sheffield School and the Scottish College of Homeopathy, and has also taught at the London and Manchester Colleges of Classical Homeopathy.
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Case: Male, in his sixties.
I've chosen this case to fit in with the theme of this issue. It's necessary to think about this, and apply that sort of reasoning to the case — so — it's not a straight-forward, what I call "Hierarchy" case. It needs creative, lateral thinking, a knowledge of the materia medica, a willingness to read around remedies as well as a good search of that ole Repertory!
Cases like this I solve represent an extremely small proportion of my case-load. Perhaps one patient a year.
The patient comes into the consulting room in a bright, confident way, making direct eye contact with me. I notice his movements are precise, and he is very neatly dressed. Shirt, tie, blazer (? Sports coat for our transatlantic friends). Pressed trousers, well-shone shoes. I note that skin of his face is quite red, almost mahogany-red in fact.
A product of his environment (look at the age), or pathological clues? Only
you can decide . . . What are you going to treat? Which symptoms are
important? How are you going to approach this case?
When I left school I went straight into mining business — been in this family concern all my life. What with the change of environment, diet and irregular meal times, it wasn't long before started with chronic indigestion. The way I cured that was to go to a local herbalist/osteopath — who put me on a diet. I had no fried food at all: about the time that I saw him, as well as having indigestion the whole system went — upsets in the system — I had blind boils and styes — he put me on a herbal product as well as a diet — and that all cleared up.
After that, about 18 months later, I still wasn't back onto ordinary meals. I started with chronic catarrh and it was chronic — wondered if that was tied up with the work I was doing, the dust etc — I don't know — it was a little bit different from what you get with nose blocked, although I did have a few colds, always been a bit allergic to dust.
The herbalist sent me to another practice, where I was put on strict diet for three months, virtually rabbit food and carrot juice and no tea, no coffee, no sugars, no cakes, etc.
At the time, the catarrh was so chronic I had it in me ears as well, squelching sai (= sensation as if) water in them. After a while it cleared the head, and I was then in similar position to what I am getting at the present time — headaches as such — it's a very odd sensation — my — balance.
Had a pretty good time after that — I enjoyed my health right up to — and I term this the present — ten years ago (touches heart area) — I was in a — rather hard job — I wasn't just manager walking round in collar and tie; I had to pitch in and do all manner of things. Apart from — it was obvious in the course of those years I had to go to the osteopath from time to time — back — occupation hazard I suppose if you lift something — esp. the mining tubs — I had to pitch in.
Ten years ago for no reason at all, I'd never had any heart problems — I used to play football and cricket — and I suddenly started getting palpitations — thump, thump, at any time — could be down mine, in office, relaxing at home watching TV and they'd be thump, thump, thump. I had a check-up, a full medical check and reported back to GP (general practitioner / family doctor) — blood pressure OK, ECG — showed an atrial flutter.
For the next eight years, every two years I had these check-ups. The only thing they told me to do was to get a bit of weight off — lost it through keeping dairy produce to a minimum non-skimmed milk, no sugars.
Then — 3 years ago — I went up on the moors digging post holes on a cold January day for two hours. I was thinking that you could do what you used to be able to do. Well, something odd happened: both my GP and consultant (when I told them about it) thought I had had a slight stroke — it was a cold day, I was there two hours, and I had been digging, jabbing away with a crowbar only it was a cold day — found I had not much use (taps right sole) of my foot or leg, and also with gripping with me right hand; could have been just muscular.
For years and years I had these severe headaches at first — not thumpers — not chemically induced with toxic fumes from the explosive these were headaches — for quite a few years I had them every day — Nitroglycerine-based — used to get quite a few headaches. [I asked the patient about his role in the mine he worked in and he told me that he was the deputy shot firer, responsible for drilling, siting, packing, snd setting off the chemical explosions.]
Sometimes made feel so sick didn't want to eat. Fresh air >> >> >>'d the headache by time supper time had arrived. Used to get headaches which were so severe would thump nape neck and occiput from walking every time put foot down.
And also — immediately after the next day when I went to the GP — tended to drag the right foot as he walked.
Well, this thing with the — it might have been a stroke — it passed off — but I always been conscious ever since that the right is a bit of a dead leg cf. with left, also just possibly, just a little bit of saliva, bit droop R side mouth for a day or two — that passed off.
In consultation with hospital Dr. we came to the conclusion about the headaches and the being giddy, dizzy that it was symptoms of the blood not getting to the head and the heart wasn't thumping, beating, quickly enough. He thought headaches and giddiness could be — vertebra-basiliar insufficiency — due to the neck which I hasten to add, being in mining from time to time — banged head quite a bit.
It may have been something to do with that I don't know — but the decision was taken to have a pacemaker fitted. I've had it just over 6 months now — I thought that could have been the magic wand.
Gradually these headaches may have disappeared for a while, not altogether, and this giddiness, but it is coming back.
Increasingly back in severity — I'm OK sitting, driving, lying down, it's when I come to walk. The headaches: am when I get up, first half-hour, hour OK, it gradually creeps up on me. Simultaneous if I have a headache I am giddy from then on or it can ease off, tends to fall to R and Backwards.
Headaches not slight stroke. Just as if somebody putting hand on front of head — pressure and I feel I would go with little sway.
With pacemaker, I can get round quite a bit better without huffing and puffing.
Think that is it at the present time.
? Anything else medically worrying you?
Arthritis in hip, little bit in lumbar region back where I used to go to chiropractor. In the lumbar region, also with the neck — don't know if it will crack today — it was cracking yesterday. And you could hear it sitting there. Went to Dr. who wouldn't give him a manipulation because it might give him another stroke.
Arthritis = Pain, ache. < over-exertion. And again < from jarring in the hip. Started really six years ago; I had lifted a tub down below ground — you lift with the thighs and the buttocks — and chap giving me a hand let go, and I took the strain and twisted — and that, plus the wear and tear over the years, started the aching in L hip and the small of the back. Became apparent with the muscles in the small of the back and the buttock just there as well; oddly enough didn't get sciatica as such, now I get it just (touches lower L leg) will feel it stiffen up in the evening, as well as just in the groin.
It just eases it, for a day or two, then drop them off, wish I could drop all the other drugs off but can't do that.
GOUT: Every spring I get it last 3 years had it through being in the garden and being in mining — toes are back with kneeling down — either weeding or putting bedding plants in, can just feel it catch toes, that's all. Joint L toe — swollen, and ball — this is the 2nd time this spring has had it; and has had it in R toe as well.
? Else about you: what — do you mean about how I feel in the condition — I feel a ruddy old man, I put a brave face on it, try to hide a lot from family, wife is concerned esp. with the heart and she is aware that I could have had a slight stroke, she very concerned but I don't tell her. Yes, these illnesses make me feel like an old man. When you are 68 and can't do what you can when you half that age.
? Personality: Self-praise is no recommendation — really I am — yes I am talkative . . . when I get to know people, didn't know you, chatting away within a couple minutes.
[He has taken gone along for Arnica ointment for the gout. And Comfrey. And various anthroposophical substances for the arthritis — all without effect].
Personality: I get along with most people, obviously if people cross you and with the type of industry I was employed in — you have to wield a stick — and show your temper — I very, very rarely lose my temper — if in control of yourself you've got the whip hand sometimes certain things get under skin and have to blow your top. I think it's a good thing to get things out of your system cf. bottle it up.
As an employer I — honest day's work for honest day's pay. I pulled me weight and employees had to and they knew it — had a pretty good relationship and think that most of people employed would say that I was firm, but fair.
Academically I'm one of the old School — my life was mining.
Parents — I switch back, these things come into mind — father was tough; mother was — my wife said, I'm just like me mother, sister said just like mother — more placid and easy-going — I'm pretty easy-going.
Father had a heart attack, a stroke, enough that he couldn't grip after he had his stroke, could dress himself but not grip same as he used to do — father had gout; was quite a heavy smoker.
Mother — arthritis — osteo-, spondylosis, she used to play the piano, latterly she couldn't because was gnarled with arthritis. That's about it for those.
+ duckling and pork (but don't eat them any more);
+ fish;
- seafood — never ever liked it (cockles, muscles);
- cauliflower and Brussels because they tend to repeat somewhat;
< none.
Sleep: OK.
Dreams: don't dream much.
Edouard B Edouard.Broussalian@wanadoo.fr
Gl = glycerine, O = oxygen, N = nitrogen, called Glonoinum by Constantin Hering.
Here’s the reasoning which makes me think Glon. indicated in this man exposed to such as an explosive !
What are the most striking signs ? Aside from the intense pain, the extreme sensitivity to jarring and the clear modality > in open air.
The more suitable rubric is certainly « Sensitiveness, Brain, Stepping », which should be cross referenced with « Sensitiveness, Brain, Jar ». One could take the general rubric Pain, walking
Ian
Mary Wulff-Tilford animals@bitterroot.net
Well, I am just a beginner, but from what I have studied, and on intuition, I would choose Glonoinum. He kept mentioning "stroke" and threatened apoplexy is mentioned in the materia. The "surging of blood to head and heart", also. Thanks for letting me "guess" Mary
Practitioner's Response:Keep on guessing - and you might like to look around other remedies to see *why* differential diagnosis is so important - see how many remedies look *like* Glon by following the references to them in e.g. Boericke or Clarke.
Look forward to hearing from you again
Ian
Jennifer Craig jcraig@awinc.com
Sorry I didn't respond sooner but I have been unable to reach HO due to a wrongly placed digit in Trumpet setup. I hope the fact that there have been so few responses doesn't deter you from continuing this valuable learning exercise.
I read the journal and Sam's case so the first thing I did with this one was create a timeline. The last thing to have happened was insertion of pacemaker and since then his previous headaches have returned with increased intensity. As we are looking at cause and as we treat the latest symptoms first, I went for the cause being nitroglycerine. Therefore glonoin. So I have reached the same conclusion as the others but by a different route.
I then looked at the head pains under Glon and found a black type of increase and decrease with the sun. He says he is OK for the first hour and then the pain gradually creeps up on him. Glon also has pressing head pain in the forehead, worse for stepping and better for open air.
I would start with a shot of Arnica for the pacemaker insertion coz all that bruisin ain't amusin. Then give Glon.
Working backwards, the next thing is the gout, then the sciatica, then the palpitations
Many thanks Ian, for your time in doing this.
Practitioner's Response:thanks for your input.
Ian
Ian Townsend sheffhom@msn.com
Ian's Analysis: This was a case where I spent much longer than usual coming to find a remedy which would help the patient. I was very concerned because of his recent, major, heart surgery, so I decided that either I wanted a remedy so well represented and so clearly allied to his condition that I was in no doubt that it would help him, or one so small that it might just touch the vital force, and help me see a clearer picture.
My analysis of the case focused on the following aspects of his presentation:
Loquacious Anxiety About Health Gout - pain jabbing and throbbing as well Headaches
and I explored all manner of rubrics to represent the mental, emotional, and physical symptoms. So many that I'll not repeat them here. I wasn't at all satisfied with the remedies coming through these analyses, and in the end decided to approach the case from the point of view of exciting and maintaining causes. I was struck by his history in the mining industry, and the nature of his description of the headaches. Looking at two definite but generalisable rubrics
Head, pain, air amel Stomach, nausea, headache with
I noticed the presence of Glon, and started to read up its Materia Medica. It looked a very good analogue; but I also knew that there were other 'explosive' remedies I could look at - TNT and Gunpowder are also in our Materia Medica - though very under-represented. I read them all in turn. And despite the fact that both Glon and TNT read better, in terms of affinities and specific symptomatology, I kept returning to Gunpowder. There's very little written on it - only 67 references in Zizia (which contains 120+ homœopathic books) - most of which relate to its use in battlefield conditions as an anti-septic in the treatment of boils and other skin conditions. I phoned the patient up to question him further about the nature of the explosive he used. "Very long time ago," he said, "in the early days of my mining . . . we used to use that black powder . . . you could smell it, taste it in the air after the explosions, we used it for a long time before the newer explosives took over."
Despite all my homœopathic training, my previous training (I originally qualified as a teacher of Chemistry) took over. I wondered if the specific substance which started off his ill-health, potentised, would help him now. Nothing to loose, perhaps something to gain - I ordered Gunpowder LM 1 from Helios Pharmacy, and asked him to take it on a daily basis.
Follow-Up Visit One Month Later
Improved slightly for a start after Rx - then tended to step back - if you like to say two steps forward and one back - I get good days and bad days now - yesterday wasn't a very good day - OK driving and sitting down, swimmy when getting out of the car; got back, had a nap, and was all right again.
Vertigo on rising from seat; with headache. Still there, not as noticeable. Not a drunk feeling, just slightly swimmy.
I'm surprised, Ian, those headaches have cleared up, except for a few muzzy ones like a tension type headache - I'm not getting any of the thumping type I usually suffer from.
When I have a little sway its sort of a muzzy headache.
? arthritis: all right - still stiff in the joints, gout has cleared up - but was taking Dx (my symbol for allopathic medicine prescribed by GP) for that - only just cleared up - has had a double dose - in both feet.
Rx - the gunpowder is helping - carry on with LM1, and order LM2 in stock: send it to him
Follow-Up Appointment Another Month On
I've been a lot better - I really was at my wits end when first came to you because of the dizziness and headaches - still get a little giddiness on occasions = but 75% better - headaches are virtually gone, still occasions muzzy but will go. Nothing like it was.
The patient had rung me because I had increased the potency and he now seems to be a lot better since.
Headaches used to be much
Fourteen Months Later: I rang patient up to ask for his permission to use his case in Homœopathy Online. He was delighted to give his permission, and reported that, with only occasional doses of Gunpowder (LM3) his headaches had got better and better - to the extent that he had not suffered from any sort of headache for many many months. Nor had he been troubled with his arthritis or gout. Under the circumstances, I was surprised by the effect of the remedy.
Discussion: Here we had a case where consideration of the exciting cause led me to a remedy which has had a definite curative effect, the nature of which surprised me very much. As I become more experienced in my homœopathy and prescribe small remedies, I'm continually surprised at how they can show dramatic improvement with the person concerned.
But let me emphasize that cases such as this form a very small percentage of my practice. I'm not advocating in any way the idea that, having identified an exciting cause, you them jump to an homœopathic remedy analogous to it. There's no substitute for careful analysis of the case, identifying what needs to be cured, drawing up a hierarchy, and exacting repertorisation. Only - in this case, hours of the latter failed to yield a remedy I felt justified in giving. The patient - and the case - and the remedy reaction reminded me once again how wonderful a therapy we have in homeopathy, and how long detailed study is necessary for good results.
Ian - Sheffield School of Homeopathy UK.
Bob Riske Rysk@ismi.net
As a self-taught layman and novice (under 10 years, right?) I welcome suggestions and direction in my choice of rubrics for this case. Thanks to all who share their thoughts and reasoning in these cases. My analysis: His objective symtoms: dark, red face and locquacity along with his chief complaint, headache with vertigo, suggest Lachesis. His history of jarring his head in the mines and his aggravation from jarring in other complaints suggest a general symtom of aggravation from jarring and along with the periodicity of his gout (springtime) reinforce the choice. He is > in open air and his narration of incomplete sentences and thought patterns in the interview suggest Lachesis.
The history of leftsidedness in this case fulfills the requisite that at least ONE of the four grand characteristics of Lachesis be present in the case.
Practitioner's Response:Ian
Ingrid Bekhor ibek@axess.com
Based on the assumption that the exposure to explosives (ie: black gunpowder) is the etiology, would we not want to find a similar substance (homeopathy) as opposed to the same substance (isopathy)? In this case Gunpowder (the same)worked, I however would have given Glonoine because it is homeopathic.
Practitioner's Response:Ian
Ingrid Bekhor ibek@axess.com
Based on the assumption that the exposure to explosives (ie: black gunpowder) is the etiology, would we not want to find a similar substance (homeopathy) as opposed to the same substance (isopathy)? In this case Gunpowder (the same)worked, I however would have given Glonoine because it is homeopathic.
Practitioner's Response:thanks for your thoughts
Ian
Geir Marcussen getm@nord.eunet.no
Feb 1816:24:13,
How can one say that use of gunpowder is not homeopatic, when it fits the picture better than gloin? used as such it is homeopatic. If strengt of isopathie in ians answer is ment to point to isopatic use, i am with you, isopathic remedies are strong, and causes problems, read organon.If it is ment as Ian her did follow isopatic prisples, i am not with you!
ian
Aaron Wedemeyer uncle@isle.net
Feb 2717:34:18,
I'm actually just exploring homeopathy, really considering some thoughts I have heard that an "untrained" interviewer is better because that person will not have knowledge of rubrics and will only pay attention to sysmptoms. I think you kinda cheated, you got to go back to the patient after you were unhappy with Glon. Patient mentioned had been in mines since teens, I might have asked about other explosives up front. Is that the real lesson here, that more questions needed to be asked of the patient?
Actually, this is a very very big question, and the experienced practitioner will be able to access all these skills at varying times in the interview. No good having vague symptoms if one hasn't closely clarified them.
The real lesson to be learnt is that each patient is an individual, as is each homeopath, and in the ideal world, each homeopath-patient interview will be unique.
Good questions - hope you carry on exploring.
Ian
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