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Presented with Neck and back problems. turning head sideways was very painful, back was tense down to lower back , shoulder pain down to both Scapulae. Manipulation gave relief for a few weeks but is a recurrent theme. Gets headache traveling up neck to temples when severe. History: Patient had hysterectomy age 28. (Fibroids and intense pain.) Urinates a lot and takes medication to control the urging. Has been taking hormones since hysterectomy. Pretty even disposition, get irritable only when in pain or if hormones run out.Other symptoms, Patient cannot help but to fall asleep within minutes if traveling in a vehicle. One other thing I noted is that patient does not perspire much even in intense heat.That is the case. It was a difficult one. The first medicine I gave did not work. See which are prescribing symptoms, and which are confirmatory, and which are not symptoms of the case at all. Case Analysis:
Dear colleagues, this was a difficult case. By now we know that the medication is kali-c. I ignore if somebody got the solution; those people who posted in the blog didn´t. I was far away from finding the remedy due to the fact that kali-c is not in the rubric "irritability", at least in the Therapeutic Pocket Book. But - there is a footnote in the P&W Version explaining the meaning of irritability. In German it is "Reizbarkeit". 170 years ago, the meaning was more like "excitability", a quick and strong reaction to every emotional/physical trigger. The reaction might be positive or negative. Maybe we misunderstand "Reizbarkeit", having in mind only the negative "irritability"? If you look up "dissatisfaction" or "ill-humour", you will find kali-c. Not very strong, but there it is. Another issue is: we had no information about the onset of the different ailments. I decided not to use "frequent urination" because this problem is related to hysterectomy. But what if the onset of this symptom occured many years after the hysterectomy, related in time to the back-pain? Just a few thoughts...I would be happy to have the opportunity to discuss all this with you! What do you think about the case? Christine
Hi, I think one stumbling block is choosing the right rubrics to base a prescription on. I am not familiar enough with many of the rubrics to know which are most appropriate. Also using the subtleties of grading in the TPB in terms of completing a symptom like "falls asleep in the car immediately" using Aggr riding in carriage and Sleepiness caused by other complaints and seeing kali-c there in both rubrics graded 3 makes it a strong candidate for the remedy.
Hi, I think it's important to start with what is clearly presenting without any shadow of a doubt, giving priority to clear modalities. In addition - rather than getting caught up in semantics it's important to go back to the provings of any remedy that looks like a strong candidate. The repertory will give us one word or other, and a lot can hinge on translation issues. In the proving because there is a broader context it is easier to verify the intent. Sometimes a remedy looks strong in repertorisation but when you look at the section in the proving relating to the main area of complaint it just doesn't look right. Other times there is a remedy that covers all symptoms in a lower grade which, when you check in the proving, seems to be describing the patient exactly.
IMO too much attention has been given in the discussion to the symptom of falling asleep in the car and it's acted as a bit of a red herring - rather than the confirmatory symptom which it definitely is. I don't know about the real case, but in the presentation of the "paper" case it was presented as secondary. It was not clear if the patient fell asleep while driving (in which case the symptom would have been more important as harming function) but it didn't look like that was the case. The same is actually true of the irritability, whatever definition is found to be best from the German.
In my view we tend to overthink cases dramatically, when what we need to do is use the TPB to guide us to several provings, and read the provings to see if we can find the picture of the patient's complaint. That is the only route to any degree of certainty according to the law of similars, to see what substance can produce the symptom picture in front of us.
Originally, in taking this case, I saw a clear picture of Sepia. Let me explain. Originally, I did NOT spend too much time other than looking up an odd symptom or two to confirm my prejudged knowledge of Sepia. It started to work positively, however within a week all action had ceased and her symptoms all returned as described. What did I learn from that? I learned that knowledge of the remedy is essential, but in writing a prescription for the remedy, it had better match the symptoms of the patient. I hate paper cases. Its a fine balance between presenting the case and in giving the case away. This case took me out of my comfort zone. Sepia did not work for an obviously Sepia menopausal woman! Only, that was my assessment of the case and not the reality. Yes she was 'hormonal' but it was not the symptoms that required Sepia. In analyzing any case, it is a matter of balance. It is a matter of completing symptoms and a matter of synthesizing all the information. Generally, a physician would outline a complete picture of the diseased state, by noting the areas of disorder. In this case we have a woman who has had a hysterectomy in her late 20s. She is receiving and has received hormone treatment since then. The results of the hysterectomy, even WITH hormone treatment is frequent urination, it is controlled by medication. So here we see, REGARDLESS of the cause, she is troubled with this problem. This is a symptom that exists and is always present. P&W Therapeutic Pocket Book Rubric number 477: Urination, frequency, too often. 90 remedies.
If we combine this with the direct action of the hysterectomy, the resultant state is one of suppressed menses.
P&W Therapeutic Pocket Book Rubric number 2529. Menses suppression of. 68 remedies.
So now, we have a direct correlation to the present cause and genesis of one presenting symptom which has narrowed the remedy search down to 68 medicines.
We now note that the patient suffers from pain in the back, neck and shoulder blades.
P&W Therapeutic Pocket Book Rubric number 686: Back 122 remedies Rubric number 685: Shoulder Blades: 112 remedies. Not very helpful as most medicines can produce areas of discomfort in this location.
She has a modality of a pain in the neck when turning the head. So we add that because it’s a constant. P&W Therapeutic Pocket Book Rubric number 2483: aggravation head turning: 60 remedies.
In looking at the chart, we can see Calc and Kali Carb are represented quite evenly in grades, with Kali Carb being even across the board. Grades in themselves mean NOTHING except to represent a value of consistency of appearance/presence in a symptom. It has no affinity to intensity of a symptom. A grade value of 1 can be of a higher intensity of pain but not seen so often as a grade of 3 or 4.
At this point, I looked in the Materia Medica and chose Kali Carb for the patient. I noted these other symptoms expressed by the patient as well.
As we can see, the headache, the sleepiness from riding in a car and the lack of perspiration, all symptoms noted in the patient but NOT chosen as prescribing symptoms were present.
Also, as I read Kali Carb, I noted an affinity for fibroids and uterus disfunction which was the main cause for the hysterectomy.
There are many ways to arrive at a prescription. Im just giving an oultline of my thinking in this case.