Monthly Archives: December 2013

TREATING AMY

TREATING AMY (AMZ)
This article was published in the Australian Homeopathy Journal Similia in 2007 under the title Treating Maryam

I first saw AMZ when she was a month old .She was born in 2003.
AMZ is the youngest child in a family o 3 children. Her other siblings had no history of eczema or asthma . Her parents are also healthy and have no history of any chronic skin problems or asthma.
When her mother was pregnant with AMZ , she was treated for a viral fever which subsided after a week.
AMZ first had an exfoliating rash when she was a month old. I treated her with homeopathic remedies based on the law of similars. The remedy that I had given her when she was a baby was Bell which ameliorated what looked like a bad infantile eczema. Bell worked well several times, whenever she had a recurrence.
The reason I chose Bell in the first place was because the rash always had an erysepelous base and in my experience Bell works well. It proved to work quite well at first.

From Lippes Materia Medica on Bell:
Under face:“Erysipelatous swelling of the face. “
Under skin:”Vesicular eruptions, with scabs, white edges and œdematous swellings. “
Whenever she had a fever, she also had a very mild erythematous rash and Bell also suited the fever which was very hot and dry.

I usually give Bell in 200c potency as a liquid dose. I ask the dose to be stopped when the condition starts to improve. If 5 doses failed to act, they were to stop the dosing and get back to me.
Her condition recurred several times throughout the years, leading up to her flare up in December of 2006 which makes one think of a miasmatic base. I should have suspected it already, seeing that her initial complaint was at one month old!

She was not always treated with homeopathic remedies, since she was also seeing other doctors who were panel doctors for the company her father worked in so I note several occasions when she was given paracetamol, anthistamine and steroid creams for her skin.
What I write below is the focus of this paper so I will put a time line for the events that took place as well as try to give a rationale of my prescriptions.

27/11/2006
She had a bad flare up on for which I gave Bell. Her symptoms at this time were the same rash on an erythematous base on her head. Her rash was exfoliating, which gave me more reason to prescribe Bell.
I gave Bell 30c to be taken daily until improvement. This time I gave dry doses.
She did not get better and then, in fact she became steadily worse.
In December 2006( 1/12/2006) she had a very bad flare up which spread to her whole body .
Her symptoms were again, an exfoliating rash now not confined to her head but had spread from her head to her limbs as well as her torso in the front and in the back.

I was away at this time and my locum doctor panicked and she was referred to the General Hospital and admitted to the ward for one week. She was pumped full of steroids and antibiotics. They thought she had childhood psoriasis. The doctors warded her for a week and, 3 days after they discharged her and she had was ill again, only this time it was worse than before she was admitted.

15/12/2006
She came to see me again. She was febrile, her joints were stiff and painful, her knees swollen and red with the skin exfoliating.!She also had a wet cough . I gave her hepar sulph 200c , 5 doses in water , 6 hourly based on her extreme sensitiveness and she seemed a wee bit better when I saw her after 3 days But , she was still quite bad I changed to pulsatilla 200c , 5 doses 6 hourly in water. My rationale for the pulsatilla was her extreme clinginess as well as the polyarthritis and the weepiness and the cough which was worse lying down. I was also thinking that the rash resembled an exanthema .

Lippe on Pulsatilla.
“Peevishness, which increases to tears, with chilliness thirstlessness “
“Red-hot swelling of the feet extending up to the calf, with stinging pain. “
“Cough, with expectoration in the morning or during the day only, without expectoration at night. “

“Exanthemata itching-stinging, chapped. “
26/12/2006
No improvement , if anything she seemed worse, with severe chilliness, needed to be wrapped up with extreme sensiviteness, joint pain,swelling and stiffness, the whole body was peeling.She was febrile and her legs looked like erysipelas , with redness swelling and heat as well as pain. I feared for her life since she was losing a lot of heat and moisture from her skin but parents refused to send her to hospital and there are no homeopathic hospitals here. .Her whole body was peeling away , the skin was red and inflammed., she had an exhausting cough and she was also having rigours . It was too painful for her to move so she was lying down semi curled up , at the same time she was uncomfortable and had to move slightly to change position.

Then, based on her appearance which reminded me of scarlet fever and taking note of all her symptoms , I repertorised for the case and I gave rhus tox 200c in water, with instructions not to exceed 5 doses and to stop as soon as there was some change. I also gave her a referral in case the remedy did not work since she was in grave danger of dying from dehydration..You can see the repertorising I did was only for her symptoms .The remedies that were in all the rubrics were Aconite, Arsenicum, Rhus Tox, Sulphur Phosphorus and Mercury. I chose Rhus Tox because of her modality of finding it painful to stay in one position while it was also painful to move. The desquamation was also a deciding factor and I was certainly not going to prescribe sulphur in such an acute state. Arsenicum would seem an obvious choice given the severe anxiety everybody was going through but the extent of the skin made me think Rhus Tox .Mercury might have made some sense as would Phosphorus but Rhus Tox scored higher using weightage.

ARYANA1

repetorizing
repetorizing

I saw her 5 days later, a real huge change,the skin on her face and body was no longer peeling, joints were no longer stiff nor were they swollen, the skin on her legs were still red and the skin from her feet were still peeling but she was cheerful and afebrile. Her cough had become very minimal . Her appetite was good! No remedies at this point.

When I saw her five days after the Rhus tox, She was very well and very cheerful, all that was left was some rough skin and a wee bit of scurf on her head .

Follow up11 /1/2007
AMZ still had a mild rash but was otherwise well.
I retook her case and gave her Phosphorus a remedy that fitted her very well constitutionally. It is a miasmatic remedy in Hahneman’s book Chronic Disease and seemed to be a good constitional remedy as well. (When she is well, she is a very cheerful and friendly girl) Looking through her notes again I discovered she had seen a regular doctor a month prior to her severe attack complaining of cough and was found to be having asthma. Another reason for the phosphorus since I found that in my practice, more than 60 % of the asthma cases seemed to need phosphorus. I have her 3 dry doses of 200c to be taken 12 hourly.

Follow up: 11/2/2007

Not even any scurf, very well indeed.

24/4/2007
She came in with a cough cold and fever , for the first time she had a fever without any accompanying rash. Prior to this , she would always develop a slight erythematous rash when she had a fever from a cold or a flu. The dandruff was also quite persistant. There was none on this visit .What comes to mind is that such chronic symptoms in one so young should have given me warning of the miasmatic basis of her dandruff rash and erythema.
There was some slight exfoliation on the feet , it was very mild and I would wait and see if she needs another remedy. This exfoliation is a feature of both psoriasis and eczema but at this point , I am thinking perhaps another miasmatic picture is showing itself. Ardavan says to let the miasm speak to you and I think now she is expressing a different miasm. Her mum showed me eczema of her nails which recently manifested as pitting of the nails., another feature that could be either eczema or psoriais except it is rare in childhood psoriasis.. According to Ardavan’s materia virosa , this could be a herpes miasm. If we waited for a bit, a better picture of this would turn up and be easier to treat.

Here are some photos I took as she was getting better, I did not take any pictures when she was gravely ill, never thought to take them at that point!

ARDYANA5
1st Jan

5 days after Rhus Tox 200c no more exfoliating on her face which was still slightly red and she had dandruff on her head .

1st Jan
She was very much better but her feet and legs were still red and peeling.

ADRYANA4

9th Jan
When she came again a week later, there were only scabs in her scalp .

ARYANA5

24 April.
She had a cold and a slight fever, which explains her solemn look. No rash , only mild exfoliating on her feet which is good because being confined to her feet would be consistent with the direction of cure.

Discussion:
Thus far it seems that I have noted that the rash was erythematous and also that right from the start there was an element of exfoliation and desquamation. The clinical picture would be consistent with infantile eczema or childhood psoriasis .

Going by the above description, it would not have been off the mark for the doctors to suspect that AMZ had a severe form of childhood psoriasis as well as their wanting to opt for cytotoxic drugs.
It is claimed that the cause for childhood psoriasis is unknown but also that it can be triggered by a viral such as chicken pox or bacterial infection such at a strep throat .2 This is interesting in the treatment of AMZ because I noted that the symptoms looked like a very bad case of Scarlet Fever .

AMZ did have her skin peeling in the hands and the fingers and toes as well as on the limbs , in fact all over her body! She also had swollen legs which looked like erysipelas , only it did not respond to antibiotics which I presume was chosen according to what the lab findings showed was
Differential Diagnosis for the pitted nails and the skin peeling: Both psoriasis and eczema have pitted nails but pitted nails is rare in childhood

Postcript May 2009
It is almost 3 years since AMZ was cured from this condition.
In this time, the past remedy was repeated 2 times when there was a very mild rash during epsisodes of fever.
For the past one year, AMZ has had a few episodes of viral fevers with NO rash.
Her nails are normal .
There is not the slightest skin problem .

1http://www.bbc.co.uk/health/conditions/psoriasis2.shtml
2Childhood bouts of psoriasis can be triggered by a cold, chicken pox, tonsillitis, or a respiratory infection, like strep throat
3http://dermnetnz.org/bacterial/scarlet-fever.html
4http://www.gpnotebook.co.uk/cache/772145171.htm
5http://www.pubm

THYROIDINUM

Introduction

I first became interested in Thyroidinum when an online friend sent me a scanned copy of an out of print book by Ghosh[i] (has been reprinted since then by BJain) that described the sarcodes and nosodes and his experience with it. I noted some characteristic symptoms and found success in cases which would have otherwise been a lot more difficult to treat. I am sharing the key characteristics of Thyroidinum in this article. Studying the thyroid hormone thyroxin as part of physiology and thyroid deficiency in pathology adds a depth of understanding of the wide yet specific range of action of Thyroidinum. Thyroidinum is usually used as an intercurrent and will move a case towards cure or make the case clearer when it is indicated. In many cases, it is what is needed to complete the cure. I also had a opportunity to treat family members that seemed to have some pathology in the thyroid function and saw first-hand all the symptoms related to this medicine. I will relate about them in the case histories section.

Preparation:

A Sarcode, trituration of the fresh thyroid gland of sheep or calf, attenuation of a liquid extract of the gland. [ii]

Historical Background

Most sarcodes are not as well known as Thyroidinum and this is because a preparation of sheep thyroid was administered subcutaneously to patients by doctors starting in 1882 when it was introduced as a treatment for myxoedema[iii]. Overdoses resulted in side effects which are well documented by Clarke and first reported in the journal Homeopathic World.

Seat of action

The effects on the body would correspond with the actions of the thyroid hormone hence it is not surprising that the areas affected are the thyroid gland, eyes, hair, skin, and muscles. The mind symptoms are also seen in patients with hyperthyroid states such as restlessness and mania as well as the low states of stupor and apathy.

image001

Figure 1 SEAT OF ACTION -THYROIDINUM

Characteristics

Thyroidinum has some characteristics which are hard to miss if one is aware of them. In times when there is a demand for energy and the body fails in its function, thyroidinum is often indicated. Headaches and spasmodic conditions which occur during times of high demand call for thyroidinum. These conditions include adolescence, menstruation, coitus, pregnancy, lactation and menopause.

In all of the conditions requiring thyroidinum, the edema will be noticed. In allergies, the patient is puffed up, and the mucous membrane edematous. In skin conditions, itching is predominant and scratching brings about edema. Urticaria triggered by cold will also look puffed up. As in cases of myxoedema, there is a non-pitting edema which could also have a rash as well, a condition known as brawny edema.

Figure 2 NON PITTING BRAWNY EDEMA
image003
Headaches and spasms occurring during periods of high energy demand point to thyroidinum. This will be made clearer in the case examples. Spasms and rigidity come hand in hand.

As in thyroid dysfunction, a deficiency at birth produces symptoms and signs of cretinism and in the adult signs and symptoms of myxeodema with weight gain, low energy and cold intolerence. Hence cachexia and obesity may call for thyroidinum when the symptoms match.

Affections of the heart are due to the muscles of the heart weakening. The thenar and hypothenar eminences of the palms are a good place to look, to see if thyroidinum is indicated. While the thyroid hormone may be normal, the atrophy indicates thyroidinum . The patient will complain of a weak grip of the hands.

Menstrual dysfunction, dysmenorrheas, fibroid tumours and ovarian cysts may all point to a prescription of thyroidinum.

Specific indications

· New borns with vomiting and jaundice or diarrhea especially born of mothers who were physically ill during pregnancy

· During pregnancy

o Eclampsia in pregnancy with convulsions and edema

· After pregnancy

o Diarrhea turning chronic, more indicated if there is edema and weight loss

· Ailments during dentition

· Malnourished children and failure to thrive as a adjunctive treatment

· Ailments before menses

· Ailments after coition including headaches cramps convulsions

· Allergic conditions during periods of high metabolic demand accompanied by edema and angioedema

· Headaches of various causes: wakes up with a headache

 

image002

Figure 3 CHARACTERISTICS THYROIDINUM

image006

 

Figure 4 CONDITIONS OF HIGH DEMAND

Modalities and Aggravations

Typically, a patient requiring thyroidinum will have aggravations by cold weather or applications as well as aggravation by exertion.

Cases cured or ameliorated by Thyroidinum

A lot more could have been said about thyroidinum and all the side effects of overdose could be mentioned but it has all been documented in Clarkes Dictionary of Materia Medica, under Thyroidinum and Ghosh has also gone into details of its indications so for this article I will instead note down the cases which did well on Thyroidinum in my own practice.

An epileptic child

A chubby child of 12 was brought to see me by her mother, she had been diagnosed with epilepsy and the symptoms were worse when the weather was cold and wet. The fits occurred during sleep.

There was nothing in her symptoms except aggravation by cold that would lead me to prescribe Thyroidinum, I instead found this in her family history.

Her mother had atrophy of both thenar and hypothenar eminences and while she was not hyperthyroid, the condition was cured within 3 months of prescribing Thyroidinum

Her uncle had Thyrotoxicosis with heart involvement

Another aunt had a fibroid uterus.

All of these cases would have had indications for thyroidinum. I eventually treated the aunt who was cured from menorrhagia and dysmenorrhea and she was well enough not to undergo hysterectomy although the fibroid did not shrink fully.

As for the girl, while she improved considerably on the first prescription of Bufo, the cure came after a prescription of Thyroidinum.

Headache after coitus

A 30 year old woman came complaining of headache after coitus, this case was cured with Thyroidinum 30c, 5 doses

Eczema of the whole body

A 5 year old child who had eczema soon after birth was brought to see me. She was a quiet child who spent all her energy scratching. I treated her for more than 6 months and at one point the mother reported she was quite naughty. I thought that it was because the energy to be her real self had come back since she did not spend all her energy scratching. Among the remedies she had were tuberculinum and thyroidinum because of the aggravation by cold. I did not see her for the next 5 years but the mother came to see me about another daughter and reported that this girl was not only the healthiest of her children but also the brightest and tallest.

Vasomotor rhinitis with allergic sinusitis and headache

A 28 year old lady with symptoms of vasomotor rhinitis, with edema of the mucous membrane accompanied by headaches did well on Nux Vomica but the condition kept lingering over a few weeks until it was discovered that she used to get urticaria which looked edematous and the appearance of the mucous membrane was noted. The itching accompanying the rhinitis also pointed to Thyroidinum which was given with clearing up of the rhinitis and headache within 24 hours.

Compare with the following remedies:

1. Iodum which is an important component of the thyroid hormone has many of the symptoms of Thyroidinum but Iodum is aggravated by heat

2. Arsenicum Album has a complementary relationship and has been known to cure myxoedema and psoriasis when characteristics match

3. Bacillinum: Cases needing thyroidinum are frequently easily infected with the TB bacillus and thyroidinum is frequently needed to complete the actions after Bacillinum in PTB

4. Lachesis : wakes up with a headache

Conclusion

This article does not record all of the symptoms and indications for thyroidinum since it has been better stated in several books including the two that I have referred to earlier that is:

1. Clinical Experience with Some Rare Nosodes, Thyroidinum, page 1 -27: by Ghosh S.K.

2. A dictionary of practical materia medica , Volume 3 page 1437-1443: By John Henry Clarke

Instead, I have written it to make it easier to spot cases in which there is a possibility that a prescriptions of Thyroidinum could help in the healing.

[i] Ghosh S.K. Clinical Experience with Some Rare Nosodes ISBN: 8180561208 ISBN-13: 9788180561207,publisher: B.Jain

[ii] Clarkes Dictionary of Materia Medica

[iii] http://www.jameslindlibrary.org/illustrating/articles/the-discovery-of-thyroid-replacement-therapy