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Miasm Research - Cases
Skin Eruption & Sleep Problems
Case by Tania Parker
Tania is a fourth year student at VCCH and this case demonstrates the use of HFA in choosing a remedy for a child. This case is presented with a full transcript to highlight the type of case that can present in the clinic where the information is relatively limited and the number of remedies that can fit the case can be quite high. Facial analysis reduces this number and the final decision is easier to make.
D.O. B 5.9.97 (Age 9.5)
Occupation: Student - Grade 4
Presenting Condition: Red Spots - on inner thighs, groin area, ankles and a little under the arms.
Transcript of Case:
Homœopathic student : I am a student and I have to present a written transcript to my class lecturer, but it is all private and confidential, we only take your first name and your age, no other details. Is that okay with you?
Patient & Mother: Yes.
(Please note; Mother has a very strong accent and speaks very quietly)
HOM STUDENT: Because I am a student, I need to present a case to my supervisor . I won't be able to provide any treatment without their supervision - so they will need to make sure the remedy I choose is okay by them and then it is up to you as to whether you would like to take it.
So I will go through an introduction of what Homoeopathy is. It is where we look for patterns that are similar in your life. We all have patterns in our lives, different stresses, and they will represent themselves as repeated patterns in your life, so we are looking for those repeating patterns, and we also then look at the illness and how nature represents itself in a similar way. So we use what is similar in nature to help fix the illness. We will also be looking at how you respond to stress and that sort of thing.
We'll be doing a physical analysis, looking at history past, present, as a baby, up to now and situations or events that have been stressful for you, at school, at home, wherever. Then at the end we also look at facial features, genetic inheritance different qualities and attributes from parents, grand parents. To do this I need to take photos of your face and it is called facial analysis and I take 5 photos of your face of different sides, just so we can see where your genetic inheritances lie.
So it takes about 1.5 hours, are there any questions so far?
HOM STUDENT: All right. Well we will get started. I just need your first name and date of birth.
Patient: 5 September, 1997.
HOM STUDENT: So you are at school. And, what grade are you in at school this year?
Patient: Grade 4.
HOM STUDENT: What brings you here today?
Mother: because of spots.
HOM STUDENT: What sort of spots? Whereabouts are they?
Patient: On my leg.
HOM STUDENT: On leg, on knee, go right up leg. Below the knee?
Patient: Started here (points to ankle)
HOM STUDENT: Started at your ankle and knee right up to groin. Do they go around the bottom?
Patient: No. Points where.
HOM STUDENT: So Around underneath at the back of the thigh?
P.S: Then it starts again at the ankle. Does it go down to the feet?
HOM STUDENT Anywhere else?
Patient: Don't think so.
Mother: yes tummy
HOM STUDENT: Tummy? Some.
Mother: Right around groin and underarms.
HOM STUDENT: Looks at Underarms. Faint there.
Can I have another look at your ankles, just want to see the colour of them. So they become red like this?
Patient: Red and pussy.
HOM STUDENT: Do they get itchy?
Patient: Itchy sometimes, yes.
HOM STUDENT: have you noticed when they get itchy?
Patient: At night.
HOM STUDENT: So they are < at night. In the morning?
Patient: No, not really.
HOM STUDENT: At night. Do you notice what time it is at night - bed time, dinner time, when you get home from school?
Patient: I think when go in bed.
HOM STUDENT: So at night in bed.
HOM STUDENT: So when did they come on?
Patient: At the end of grade 2.
Mother: Had them for 3 years.
HOM STUDENT: So that might be in end of grade 1?
Mother: Took to GP and said a virus and nothing could be done about it, it would pass in 12 months. At times they require antibiotics.
HOM STUDENT: Antibiotics? Is that because they become infected? From scratching?
HOM STUDENT So what was happening in grade 1, was there anything going on at school in grade 1? Because we look at what stresses were going on around the time of illness.
Patient and her Mother discuss a few things. Problems with teacher.
HOM STUDENT So what happened? Were there things that you didn't like?
Patient: When my teacher would get angry at me, I would start to cry.
Mother: Said teacher called her a sook.
HOM STUDENT Did she say that?
HOM STUDENT So if she got angry at you, you would start to cry, and then what would happen.
Patient: I just don't remember.
HOM STUDENT So it was quite upsetting for you.
Mother: Patient decided she wanted to invite her teacher to her house.
HOM STUDENT Okay, and why did you want to invite her to your house?
Patient: wanted to show her where she lived, what things she liked. She gave her a present.
HOM STUDENT. Lovely, did that help you get along better?
HOM STUDENT Did she get angry at you again and make you cry?
Mother: No. (Starts to discuss more with Patient about a friend called Amenia - bullying) Mother wants her to talk about it as she believes it will help.
HOM STUDENT: If you can talk about this, it would be good to understand how your body responds to these stresses.
Patient: Cries more. (She does not want to go there.)
HOM STUDENT: Well let's go onto some more physical things and we can come back later.
HOM STUDENT: How was the pregnancy and as a baby?
Mother: All was good. The twins were alright. (Patient is one of another girl twin). I was stressed out during the pregnancy. During the pregnancy had full anaesthetic during 4 month for sutra.
HOM STUDENT: Yes, why is that?
Mother: Well because I had lost a child prior and told not to due to cervix damage. Cervix began to open and repeated scans. Obstetrician said she had placenta previa. Had to have operation to sew up the cervix and high risk of complication due to twins. Doctors said success rate was not high. She never knew if might become infected or what. I was to stay in hospital for the four months.
HOM STUDENT: You had to stay in hospital for 4 months?
HOM STUDENT: So once they had done the stitch you had to stay?
HOM STUDENT: Well that is big.
Mother: Then there was my own stress - you know. Then, they were born caesarean with epidural. And, feeding: Patient did not feed well - too tired, wanted to sleep. Nina did.
HOM STUDENT: Ok. And, is she still like that, does she still need her sleep?
Mother: She needs to sleep, but she is hyperactive.
HOM STUDENT: Ok. In what way? Why do you say that?
Mother: She tells us she is not tired. She can go a long time without sleep. She goes and goes, and emotions go up and up.
HOM STUDENT: So how long is a long time?
Patient: When came back from QLD I was so tired, I just laid down and sleep.
Mother: In QLD for 3 days just 6 hours each night.
HOM STUDENT: So what is her normal bed time at night? Is there a regular thing or is 6hrs normal?
Patient: I play on computer at 9pm I am told to go to sleep and she reads books in bed.
Mother: She has trouble getting to sleep. Last night she didn't sleep until 11:30pm. I feel I can never get enough sleep.
HOM STUDENT: So what happens? Why do you feel you can't go to sleep?
Patient: Because I get bored and I have lots of stuff in my head that I want to do.
HOM STUDENT: Lots of stuff you want to do? Do you want to get up and do things?
Patient: When I wake in the morning I will get up and play the computer.
HOM STUDENT: Is that what you needed to do the night before?
HOM STUDENT: So if she goes to bed at 11:30pm what time does she get up?
HOM STUDENT: So if she goes to bed at 9:30pm what time does she get up?
Mother: Usually 8am, but it depends. If it is school I have to wake her at 7:30am, but on the weekends they get up early.
HOM STUDENT: So you wake up early on weekends? You want to do things?
HOM STUDENT: So when you say you never get enough sleep, do you feel like you never get enough sleep or are you always feeling tired. Why do you say that?
Patient: MMM - School days I feel tired and I want to go to bed. Sometimes I feel tired on weekends.
Mother: points out she gets tiny dots under her eyes if she hasn't had enough sleep.
HOM STUDENT: White dots?
Mother: Purple dots.
HOM STUDENT: Where is it under the eyes?
Mother: Points under eye wear bags would be.
HOM STUDENT: Going back to birth and when she was born. She needed to sleep a lot.
Mother: She was a very good sleeper by 6 months. I just remembered she was much quicker than other sister.
HOM STUDENT: Quicker. How much quicker? Months or weeks?
Mother: Months. 2 months quicker.
HOM STUDENT: When did she crawl and walk. What where her milestones?
Mother: She walked at 12 months.
Teething at 3 months.
Her skin is very sensitive.
HOM STUDENT: In what way?
Mother: She has some eczema.
HOM STUDENT: Whereabouts?
Mother: Behind ears, still some; but was very crusty, little bits on knees and elbows and she was prone to nappy rash.
HOM STUDENT. So she had it behind her ears and then went to knees and elbows?
Mother: I can't remember, but she had some there.
HOM STUDENT. So what did you do?
Mother: I used some cream from the GP.
HOM STUDENT: Cortisone?
HOM STUDENT: Did that help?
HOM STUDENT: How old was she when she started getting the eczema?
Mother: She was just a toddler
HOM STUDENT: When did you notice it clearing. Did it fully clear. Or how old was she when you gave her the cream?
Mother: 3. It helped, but still there.
HOM STUDENT So as a child, any other things in her child hood? Anything you can think of?
Mother: Very Robust. Colds would pass by her, she has a high resistance. Although at 2 she developed broncilitis and became a slight asthmatic.
HOM STUDENT Slight asthmatic? Does she use a pump or not?
Mother: She does have a puffer. But doesn't use much.
Patient: I never use it.
HOM STUDENT: So nothing much.
HOM STUDENT. I'll just go through the body. Anything about hair, scalp, head? I'm just going to do a top to toe.
Anything about head, headaches, etc?
Mother & Patient: No.
HOM STUDENT: And eyes? Conjunctivitis, itchiness, swelling, apart from tired spots.
Nose? Hay fevers, allergies.
Teeth? Any fillings?
Patient: yes. One here and one there.
HOM STUDENT: So you have a couple of fillings.
HOM STUDENT: So how old are you now?
Patient: 9 I'll be 10 this year.
HOM STUDENT: Yes.
Mother: She has some skin spots on nose that look like pimples.
HOM STUDENT: Skin. Do they itch or do anything?
HOM STUDENT: Just on her nose?
Mother: Yes. Her body is developing an odour.
HOM STUDENT: Is there any sign of hair or anything?
Mother: Has a look. No.
Patient: Neck get's itchy rash and I need an ice pack on it.
HOM STUDENT: Does an ice pack help?
Patient: Yes. It also goes on my chest.
HOM STUDENT: Do you know why? Have you touched a plant, have you been a bit stressed?
Patient: I don't know why. Happened at school.
HOM STUDENT: So Teacher suggested ice pack or did you?
Patient: Teacher did.
HOM STUDENT: So has it happened again? Or was it just that time?
Patient: Just once.
HOM STUDENT: So throat - respiratory we said was….
HOM STUDENT: Heart, everything ok there?
HOM STUDENT: Stomach.
Mother: Talks to her about food and sweets.
HOM STUDENT: If you could have anything you want, what would you have to eat? What do you love?
HOM STUDENT: What's your favourite thing to eat?
HOM STUDENT. Would it be Sweet. Would it be salt or would it be sour?
HOM STUDENT you like sour?
HOM STUDENT: What sort of sour things? Lemons?
Patient: I like lemons. And lollies.
HOM STUDENT: At dinnertime what things do you really like to have for dinner?
Patient: Spaghetti Bolognese.
HOM STUDENT: Is it the sauce or the pasta?
Patient: The sauce.
HOM STUDENT: Is there anything that you really don't like? Really cannot stand.
HOM STUDENT: Is there anything that upsets your tummy or makes you worse?
HOM STUDENT: Everything is okay. So you are okay with milk?
Patient: No, I don't like milk.
HOM STUDENT: So you don't like to drink milk? What do you like to drink?
Patient: Soft drink.
HOM STUDENT: Bowels. How are your bowels? Do you pass a motion regularly? Go to the toilet?
HOM STUDENT: Doesn't hurt - everything is okay?
HOM STUDENT: What about when you urinate - is it ok? Doesn't hurt, sting or anything?
HOM STUDENT: And your limbs. Every broken a bone? Limbs ok?
HOM STUDENT: And your Back? How's Your spine?
Patient: It's ok. I think it's good, because I am in a choir class and I have to stand up straight. We have to sing for the school.
HOM STUDENT: Do you enjoy the choir?
Patient: Yes, I like that choir.
HOM STUDENT: What is it about it you like?
Patient: The singing.
HOM STUDENT: So you're skin is sensitive. In what way.
Patient: When I put cream on my legs it stings.
Mother: When she had earrings done they caused her problems and got infected.
Patient: I had to have them redone.
HOM STUDENT: So going back to ears, has she had ear infections?
HOM STUDENT: So, her circulation. Is she a hot person a cold person what sort of person?
Mother: You don't like the heat.
Patient: Not that much.
HOM STUDENT: So you're wearing a heavy coat today - do you like to rug up and get warm?
Patient: I like to get warm, but Mum told me to wear it.
HOM STUDENT: It's alright, I was just curious about what you liked. (Patient starts to take off her jacket). You can leave it on, I have the window open - and no heater.
So you feel the cold?
Patient: I don't like it when it is cold and raining. And I don't like the heat, when I can't play in the playground because the poles are too hot.
Mother: She can get exhausted in the heat.
HOM STUDENT: What is your thirst like? Do you drink much?
Patient: I like to drink water at night.
HOM STUDENT: What do you mean? In bed?
Patient: I like to have some water near my bed.
HOM STUDENT: So by your bedside?
HOM STUDENT: Do you drink much at school?
Patient: Yes, during hot days I drink a lot.
HOM STUDENT: And perspiration, do you perspire much, do you get hot and sweaty?
Patient: Not often.
Only when I had to try and do a running jump and other things for sports.
HOM STUDENT: What about dreams. Do you dream much?
Patient: Not much.
HOM STUDENT: Just something I forgot. What is your appetite like? Is it small or large?
Mother: Quite big.
Patient: I try lots of foods.
Mother: She is very adventurous. She doesn't like breakfast, but she grazes through the day.
HOM STUDENT: So she wouldn't eat 3 meals and some snacks. It is more constant?
Patient: At breakfast I don't have much, I like dinner, I like meat and salads and sandwiches.
HOM STUDENT: Tomato sauce?
Mother: No. Salad dressings she likes.
HOM STUDENT: Oh so more vinegary things?
Patient: I like salt and vinegar chips Student.
HOM STUDENT: So beetroot?
Mother & Patient not sure what it is.
HOM STUDENT: I think we've pretty much covered all our physicals.
Is there anything you want to add?
We are looking for how your body responds to stress and how you can get over stresses and that sort of thing.
Patient: I get stressed fighting with my sister. I can get stressed by not sleeping.
HOM STUDENT: When you say you can get stressed - what do you do? How do you know you are stressed?
Patient: Because I just get angry at everything.
HOM STUDENT: So you respond with anger. In what way do you express your anger?
HOM STUDENT: What is the first thing you feel like you want to do?
Mother and Patient discuss bits - Patient not sure.
Mother: She can become physical with her sister.
HOM STUDENT: Ok. So confrontation.
HOM STUDENT: So some people when they get angry will shout and scream and hit. Others who get angry will go inwards and they might sleep. Everyone shows it differently, So what I am interested in is how you show it and express it.
Patient: I cry and I bang my doors
Mother: You shout.
Patient: I want to hide under my blanket.
HOM STUDENT: Do you do anything under their or do you sleep?
Patient: I just hide.
HOM STUDENT: OK. Well I think we've covered everything now and I will look at something to try and help fix you. Now, I just need to get some photos of your face. I need to take 5 photos.
We go through taking photos.
HOM STUDENT: Ok. What I will do, I will go through everything we've gone through and type up all this stuff. I will work out a remedy and share it with my supervisor and give you a call and see if you want to go ahead.
Mother: Shows me the spots on her leg and wants to take a photo of spots.
Patient: Shows me the white centre on some of the spots.
HOM STUDENT: What did the Doctor diagnose it as?
Mother: A virus?
HOM STUDENT: Was it a molluscum virus?
Mother: Don't know.
HOM STUDENT: Did he say it was warts or anything?
HOM STUDENT: We just take photos of the spots on her legs.
Mother: We now have a memory of them now heh. If ever you want to look at them when you are a grown up, you can see what they used to look like.
So you will type it all up.
HOM STUDENT: Yes. And within a couple of weeks I will work out a remedy. I am sorry it takes a little longer and the process is slower than normal.
Mother: Thank you very much - Tania.
HOM STUDENT: Thank you for coming today.
PART 2 - Summary:
Anger < for
Bullying - being
School dislikes and makes her tired.
Sleep desires but has trouble getting to sleep 11:30pm
Hyperactivity < lack of sleep
Teething early 3months
Skin spots acne like on nose
Sweat - body odour slight - observed by mother
Food Aversions: Milk, broccoli
Lack of Appetite in morning - breakfast
Food Desires, Sweet, Sour, Meat
Aversion Heat and Cold weather
++ Thirst < Night
Eczema - behind ears, knees, elbows
Nappy rash tendency
Skin: Red dots some with white centre
Skin: Itches < night
Skin spots get infected needing antibiotics x twice.
Eyes < tired/lack of sleep
Purple dots under her eyes like bags
RUBRICS CHOSEN - McRepertory
MIND; WEEPING, tearful mood; tendency (356)
MIND; AILMENTS from; anger, vexation (110)
GENERALITIES; FOOD and drinks; milk; aversion (75)
GENERALITIES; FOOD and drinks; sour, acids; desires (115)
STOMACH; THIRST; night (78)
SKIN; ERUPTIONS; red (92)
SKIN; SENSITIVENESS (144)
Sulphur, Calc, Phos, Bry, Lach, Rhus, Sepia, Ant-c, Ant-t, Ars, Bell, Mag-c, Arn, Am-c repertorise using these rubrics.
Eye teeth? (only one very pointed)
Didn't take ? marks into equation.
Although Red was one in front I couldn't find enough to really warrant it being 2 points in front, and Blue was very close behind it. Therefore, I chose Purple as the miasm.
MIASM CHOSEN = PURPLE (Syco-syphilis)
PART 4 - REMEDIES:
Only 2 Purple remedies were listed - BELLADONNA & LACHESIS.
However, I have also included a hand selected or written repertory to try and get some more purple remedies included. I have attached this repertory to the back. The next closest remedy was STAPHYSAGRIA and then a lot further down was PLATINA.
It was a difficult decision choosing between Belladonna and Lachesis as both have the red spots quite highly rated, along with ailments from anger, and most other symptoms were very similar.
Belladonna is known as a good children's remedy and she is only 9 this was a high consideration. The thirst at night was also important as she liked to drink water throughout the night and whilst it showed in Belladonna, it was higher in Lachesis. Another area I found to be like a PQRS was her general desire for sour foods - lemons and again while both Belladonna and Lachesis repertorised Lachesis rated higher. Yet with her weeping and general tendency to be angry, lash out and then weep was higher in Belladonna even though it rated in both remedies.
Ultimately the one thing that stood out for me, which I didn't repertorise on but found it a distinguishing symptom, was her tendency to purple discoloration spots under her eyes when she is tired. These her mother said she got regularly and were a good indicator of level of tiredness. As Lachesis has this tendency to dark, bluish, purple discolorations, I decided this was the only real symptom that separated the two remedies and that meant Lachesis rated higher than Belladonna overall.
PART 5 - REMEDIES:
I chose Lachesis and the potency I feel is good to begin with is a 30C - especially with her sensitivity. As the symptoms are basically functional pathology and not very severe, she has a sensitive tendency, and I am not sure as to how sensitive she might be, so this would make me want to give a lower potency. Also, she is a child - so know it is necessary to keep the potency at lower end.
PART 6 - TREATMENT PLAN:
- Conventional diagnosis:
In 2004 diagnosed as viral infection and should clear in 12 months.
- Treatment history:
Putting cream on when spots itched a lot and if the spots got infected then antibiotics were given on 2 occasions.
- Results of physical examination:
Red spots on inner thighs, ankles, groin area and knees.
- Summary of health and lifestyle advice:
As she was leaving, I suggested she use bandaids where needed to help protect the spots she had scratched and exposed, from infection.
- Strategy for patient contact:
I explained that I would have to talk with my lecturer/supervisor before I could commence treatment and only if she then decided to take the remedy - which she did agree to. I also explained that this process could take a couple of weeks before I was able to post the remedy to her.
- Future visits:
Frequency; After receiving the remedy she is to contact me and we would make an appointment for her daughter 2 weeks later.
After this we would see how the remedy was going and if all was going well, I would organise contact again for another month. If things hadn't changed after this then another 2 week follow up would be required.
- Therapeutic expectations:
Pathology: the red spots I would like to see begin reducing, with no further additions and some clearing within two weeks.
Regarding her well-being; I would like to see her sleeping better and getting to sleep easier. Also her energy levels during the school week could be a little better.
- Need for referral:
Should any of the spots begin to show signs of infection again, then it would be advised to get a diagnosis from her GP.
If the spots were not clearing at all, no signs of clearing or were increasing after 4 months of trying, then I would look at referring her to our student clinic or a professional qualified homoeopath.
05.2.07 Posted Lachesis 30 in pillule form, with instructions to take once a day. Then to phone me and organise a follow up visit in 2 weeks time.
Spoke via phone on 1.3.07: Patient has less dots in an infected state and can reduce the number of bandaids she is wearing. They are not as red or as pussy. They were itchy for 1 week after beginning treatment but not anymore. She was a lot calmer during their recent holiday in Tasmania, the first time in a while.
We organised a visit for the next day - a Saturday 2.03.07.
2.03.07 Spots almost gone. Just a couple left on her leg with a weeping yellow colour. Underneath her arms have all gone. Spots on her bottom, groin, knees and thighs have all gone. There is a little bit of scarring with a reddish hue of where the spots once were and I mentioned this will fade over a month or so and she shouldn't have any discoloration left. Itch has also gone.
Eczema behind ears gone.
Nose has small pimples showing.
Sleep - it now takes her only 5-10 minutes to fall asleep. Dreams: she had the first dream she could actually remember.
When they were holidaying in Tasmania her mother mentioned that she decided that she was tired and took herself to bed and slept! This is the first time ever. Usually it is an argument to get her to go to bed.
Patient is no longer afraid to wear shorts and is happy to wear them now.
I recommended she continue taking the remedy until all the spots had completely gone.
Her Mother is to phone me in 4 weeks time to update.
20.04.07 Spots have now completely gone. The purple dots under her eyes have completely gone. A few pimples on her nose. Her sleep routine is varied, sometimes she does not want to go to bed but when she goes she is able to get to sleep ok.