Homeopathy Tips for 6/16/09 More Difficult Cases

     It seems many of you are benefiting from last weeks newsletter about difficult cases. Here is another example of a difficult case and how are abilities as a homeopath are not always the reason for our seeming failure.

    I had a client that I had seen at another clinic 3 years ago contact me asking for help again. At that time I had given him a remedy for general weakness and loss of motor control. He is a man 62 years old. After recommending Zincum Metallicum 6c at our first meeting I never saw him again for a follow-up.

    Now after two years he has returned and still complaining of the same symptoms. At the time I was working at a clinic that he had not felt so comfortable with and decided to stop all treatment with them. He liked the homeopathic approach and our initial visit but waited to return to me. In the mean time he had received a medical diagnosis of Parkinsons disease but the specialists were not 100% sure of the diagnosis. They put him on the drug Stelevo and sent him home. After two years and no improvement he wanted to try the homeopathic approach again.

     When I retook his case the remedy Zincum still appeared to be the remedy and since I had not seen any follow-ups and he could not report how he responded to the first remedy I started Zincum 6C again. After learning of his symptoms more I did not think it was Parkinsons. He did not have the classic symptoms of tremor. The doctors he was working with were also confused as to his diagnosis but elected to treat him as if it was Parkinsons.

      After investigating some of his more recent symptoms they were similar to the “side effects” of the drug. I never remove someone from a drug I have not prescribed. I recommended that he go back to the doctors who prescribed them and ask for assistance in getting off the drugs.

     After two months we had our second follow-up. His condition had become worse. In addition to the weakness in his extremities, grasping an object or writing, now he was feeling slow of thought and difficult comprehension as well as a profound despondency. He was having trouble keeping up with his work and dictation. Talking was also weakening. He was still taking his drugs at this time. I changed the remedy to Alumina because of the mental and physical slowness and the paralytic nerve symptoms.

     After another two months we had our second follow-up. He still had not improved. His condition was no worse but there seemed to be no response to the remedy. He was in the final week of weaning himself off of the drug. His story,  prior to the onset of his symptoms, was that he had been working many hours each day and had alot of pressure in his job. Due to a restructuring of the company he was going to loose his job which he was overworked but had great freedom in. Now the job that he was being asked to do was under a superior and he had much less freedom. He was fearfulo of not havinga job at all. This was effecting him greatly and he chose to continue the new job because of security even though he disliked it. When I asked him about the hours he worked he said between 14 and 16 hours per day. He was exhausted all of the time. So I prescribed Picric Acid 6C.

   After another 2 months he returned again. This time he was doing a little better, sometimes experiencing a little more energy, but all other symptoms were as bad as before.  He was now off of all medications for the last 6 weeks. He reported that after having a good spell he would pay a price for doing too much. He was still having trouble focusing and thinking. It would be very exhausting. His dark thoughts and depression were significantly better. For the first time I felt he was maybe responding to the remedy. I recommended he continue Picric Acid 30C  two times per day.

     Again after 9 weeks he returned and this was the visit that more was being revealed about his case. He was now feeling much better with more energy and some new symptoms and older symptoms he had not reported before. Even on questioning him each visit, “what more is there?” he failed to mention the pain in his side that had been with him this whole time. He was seeing an acupuncturist who was treating his liver meridian and another practitioner with some device that diagnosed his liver as well. When I asked him to point to the pain in his side he pointed directly to his liver. He reported that he felt much improvement after doing a liver cleanse.  Now I may have discovered the missing link to his case. His new symptoms were swelling in his fingers. He was feeling better and had more energy. Now I was really faced with the question of whether the remedy was helping or was his improvement due to being off the drugs and having some support for his liver. He experienced no other liver symptoms other than discomfort and fullness. He had seen a doctor for this a year ago and was told there was nothing wrong.

     His problems of weakness in the extremities especially when writing, weakness in his legs and some loss of coordination and talking exhausting him were all still present. Most  improvement was in his attitude. He liked to make comments about women and repeated these comments again this visit, even in the presence of his wife. I had noticed this before and had considered Fluoric Acid instead of Picric Acid but Picric Acid fit the case much better.

      Now I was still looking for a better remedy and with this new information, it all started to fall into place. These are the rubric I choose from the Complete 2005 Repertory;

  • Extremities; PARALYSIS;General;Upper limbs, hands
  • Extremities;SWELLING; General, upper limbs; fingers
  • Extremities;WEAKNESS; Upper limbs;hands
  • Vega’s Boxes; LIVER
  • Mind; LASCIVIOUSNESS, lustfulness
  • Generalities; WEAKNESS; Talking, from

    I now am looking for a remedy that affects the liver and causes weakness in the extremites. It would ideally address the lasciviousness as well. These are the three areas that are the main focal expression of his dis-ease.

  Only one remedy covered all rubrics, but there were others that may be applicable to the case. These included Nux Vomica, Fluoric Acid, Nitric Acid, Lycopodium and Phosphorus. But the remedy that stood out and covered the case in it’s entirety was Actea Spicata. The remedy from the plant with the common name Baneberry. It’s primary focus is on the Liver and joints/extemities. Here is a remedy that I had not considered before because I was focused on nerve weakness. With the new information of Liver involvement I now feel I am on the right path. Fluoric Acid is impelled to walk and and move and effects the bones primarily. This was one reason I did not choose it before. But Actea Spicata is a much better choice.

    When I investigated more about him in relation to the remedy he confirmed all of the following which are a part of Actea Spicata;

  • Desire for company;< worse while alone
  • Ailments from fear or fatigue
  • Anxiety while lying or at rest
  • < worse right side
  • Lassitude after talking
  • Pulsations over the whole body or especially the liver 
  • Swelling in the joints especially the wrist and fingers
  • Weakness in the hands
  • Delusion he will loose his reason
  • Fear of death at night
  • Libertinism or lasciviousness

     Now we must wait and see. I prescribed Actea Spicata 6C one time per day. What I have learned most from this case is that I should have insisted that I get his medical records. I had requested them but he was just lax about gathering them all and I did not follow-up like I should have. Even when asked about any other symptoms the liver symptom was not ever mentioned. His focus was always on the weakness. Now we must wait and see. 

     Be sure to ask for medical records if they have seen a medical doctor. He had seen the medical doctor about the discomfort over his liver but because he had failed to mention it, the focus was always neurological. I have learned very much from this difficult case. Hopefully this will help all of you in your difficult cases as well.

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26 comments so far

  1. Peter Bezemek on

    Thanks again, Robert. It is truly difficult, if not impossible, to come up with a correct prescription when the client does not provide much useful information, even on diligent questioning.

    Btw. I was surprised by the Picric Acid 30C prescription based solely on the idea that he overworked himself few years back in time. I think this is a bit far-fetched Never-well-since prescription, unless he exhibited Picric Acid symptoms at the time of consultation. I believe there should be some other clues pointing to the remedy except that one which could well be irrelevant.

    Anyway, I really appreciate the honesty of sharing such cases. It’s easy to present bullseye cases, but I believe we learn the most from the cases that are not exactly straightforward.

    Thanks,
    Peter Bezemek

    • Peter Bezemek on

      I have looked at this case some more and I would also look at Carbo Vegetabilis, in case Actaea Spicata does not work too well. Carb-v. does cover the case pretty well, in many respects even better than Act (at least according to our books) since it is a better known remedy.

      If you dig deep enough into MM, you’ll find it featured even in rubrics where Carb-v. does not appear in the Complete Repertory.

    • Robert Field on

      Hi Peter,

      Yes he was presenting Picric Acid symptoms at the time of our visit. Great weakness, nearly to the point of paralysis and inability to think clearly. Like all acids he was in the burned out state. If the symptom were far fetched or irrelevant I would not have included it in my analysis.

      Thanks,Robert

  2. Dr.K.M.Sreenivasan on

    Thanks a lot for presenting the experience you had with the patient.This case again emphesis the importance of case taking and spending more time with patient initially asking
    about all the incidennces difficulties the patient experience so as to come to a correct diagnosis.

    Thanks,we all will be carefull keeping this in mind.

  3. maimoona bangash on

    dr. robert

    thank you very much to solving same problem which is going on to me now a days i am also victim of this ailness with age 55 female , lost my job , liverfulness , lost power of smelling 80% hearing power 90% and sense of feeling alos lost neither feel fhappy not unhappy but some match of your clien with alos me no feeling of tast

    you have guided me and an angelic work has been done by you

    thank you very much
    maimoona

  4. Surya Narayan Sarangi on

    dear Robert,
    There are many gold medalists but they are not good doctors,teachers…You should remember that intellectual selection of a remedy does not help much.It is the spirit healing another spirit.If this is felt and allowed to operate,then the right remedy comes into you.you are a medium and so also the remedies.
    Acid Picric only boosts the mental faculties and relieves the stress & allied physical complains thereby.It is not indicated in the case you mentioned because the base of the problem is something else.
    If the case is still with you,try Aurum met and Iodium in 1M potency.The case will dramatically change.
    I honour you because you have the right spirit.The result of your treatment is due to your spirit,not due to right selection by going through the rubics.Unnecessary emphasis on rubics kills the success of homeopathy.
    Thanks & regards,
    Surya

    • Peter Bezemek on

      Dear Surya,

      if he is the remedy (spirit healing spirit) then he can cure with any remedy, right? (why bother with selection then)

      Is there any explanation to be put into words, that can justify your selection of Aurum AND Iodium in this particular?

      Also, you might have missed the fact that Robert Field is a classical homeopath, so your suggestions of taking two remedies at once can only be taken as a jest, at best.

      Regards,
      Peter Bezemek

      • Surya Narayan Sarangi on

        Dear Peter,
        Yes,It is possible to cure without a remedy on the basis of spirit healing spirit.For this,one must have spiritual experiences of vital force interactions which is practically developed on going into the feeling and life process of the patient.Since,it is very difficult to attain this state during practices without a heart for it,a remedy is needed.Even one attains this state, a remedy is needed to quicken the process only.What I emphasized is not to denigrate the use of remedies but to lower the emphasis on intellectual analysis(rubics) and higher emphasis on the process of life for better result and human service.This is the inner god-gifted quality of Hahneman,Kent..etc. that resulted in the birth of Homoeopathy and the hidden path of cure.Instead of taking the spirit of homoeopathy,we are more concerned about words in the books.Love is not a word but we claim to love by words only.
        An idea about the action of remedies is essential and when you are linked to the feelings of the patient,then the right remedy comes spontaneously without any intellectual analysis.That is why allopathy has not been able to develop a single remedy despite great advances in science.
        Whether classical or non-classical,healing a patient is the task.Two or more medicines may be needed in view of the present day complex life situations and its drastic effects on the emotional & mental plane and ultimately on the vital force.
        I have felt the nerve of the patient mentioned here and hence the prescription.You can very safely try and see the result.
        And regarding the explanations you want about all those things,there is not enough space here.You cannot catch God by words.
        Thanks & regards Peter,
        Surya.

      • Peter Bezemek on

        Dear Surya,

        all that is very well and I agree that there is more to healing than meets the eye. You may even be (hypothetically) right with the prescription of two remedies in this particular case, but there are several issues here which you have missed and which make me doubt very much the overall value of your approach.

        In your first post, your message comes out as mere criticism without giving much explanation which would benefit the person concerned. Then you suggest taking two remedies (again without any explanation) and you seem very assured they will act profoundly. Now, if you think about it, would you suggest Robert to actually heed your advice and act according to your suggestion?

        In my opinion, he would be a great fool to do that, without understanding the reasoning of such a prescription. Everyone can have its own method of cure, but they should stick to it and do not mix, only thus can they keep a clean conscience.

        As I see it, you have demonstrated quite clearly that you are still unable to be “linked to the feelings of the patient”, as you say, because you have failed to feel where Robert stands and serve your advice in a context which he may benefit from. Two conclusions are at hand – either he accepts your advice without a reservation and he is a fool, or he rejects it and then all your words are in vain.

        If the latter is true, you have failed to help Robert and thus failed to “heal the patient” (which is all-important, as we all agree), which, in my opinion, reflects the value of your advice quite well.

        Regards,
        Peter Bezemek

    • Robert Field on

      Hi Surya,

      I agree that it is all spiritual. I also do not negate the need or usefulness of good repertization and materia medica to help guide us. Unless a homeopath is completely claivoyant and has a very clear channel to G-d, which I believe we are all in this flow anyway, then using the tools to help us should not be ignored. In regards to Picric Acid if we limit our understanding of the remedy to “only boosts the mental faculties and relieves the stress and allied physical complaints” then we have made a great judgement about how a person could ever respond to a “homeopathic” healing energy. The remedy is much bigger than this. Primarily because it is never about the remedy (only it’s indications) and always about the persons resonse to it. I agree that proper intention on the part of the homeopath is essential to the process but rarely is it enough to bypass the need for the remedy energy to inspire healing. Even when a remedy prescription comes through inspiration, most often it can be repertized as well and supported through some understanding of materia medica. If not then why should we ever call ourselves homeopaths?
      Thank you so much for your comments,
      Robert Field

  5. dr naseer on

    dear doctor robert

    I have a patient female diseases multiple sclerosis

    age 28 chronic case of nervous fatigue loss of

    momnent in lower extremities can not walk weakness

    can not stand long time eyesight weak great depression

    grief chronic case of m s diagnosis my Medical

    and nervous specialist by Ultra sound of MS

    ONE YEAR TREATMENT OF THE FOLLOWING MEDICINE.

    Arg nit 200 and plumbum met 200 and alumina 200

    50% cured this chronic case.

  6. dr.ghulam mustaga on

    Hay Mr. Robert

    Whether classical or non-classical,healing a patient is the task.Two or more medicines may be needed in view of the present day complex life situations and its drastic effects on the emotional & mental plane and ultimately on the vital force.
    DR.GHULAM MUSTAFA PAKISTAN

    • Robert Field on

      Hello Dr Ghulam Mustafa,

      I rarely give two remedies at the same time. The reason is, if I am going to prescribe a remedy I want to know the clear response to this remedy. In our provings we have learned about what one remedy picture could look like. The remedies were never proven as combined with each other. I am not negating the fact that the vital force would respond to a combination remedy, but how would we ever know from which part of the combination it responded to? Then how could we ever manage the case without knowing the remedy responsible for the response? There is only ONE vital force. I have found that if it can be inspired by a single remedy energy, then it is much clearer and easier to understand. It is only on rare occasions I will ever give two remedies simultaneously.
      Thank you for your remarks,
      Robert Field

  7. Dr.Poonam Batra on

    Dear Robert,
    Remarkable case, keep informing about the improvement of the patient. I would like to know regarding the source of mental symptoms of actea spicata, since it is a very small remedy and much is not there in the materia medica.

  8. Dr bajwa on

    please send tips on duchanne muscular dystrophy.

  9. Philip Joseph on

    Dear Dr Robert: Thanks for sharing this very difficult case. I am still trying to confirm for my own satisfaction if Actaea S was a 100% fit (obviously it worked based on the patient reponse). I looked up Ranunculaceae family (Pg 1391 Sankaran’s Plants Vol III) but I found only a few of the many plant family sensations found in this patient (Distresed, Harassed, Numbness). The other main sensations of Ranunc family (sharp, stitching, stabbing, stinging bursting pains)were not mentioned here By the way Ranunculacae includes Acon, Hell, R.Bulb, Actaea S, Puls, Cimic, Staph, Hydas, Clem etc. I was thinking that even a basic proving would have affected the liver enough(a vital organ) for it to be at least mentioned in the common medicas. I may have a long way to go to understand this case, But I respect your choice of remedy and a brave decision to try it. Certainly you see something more in the case that I don’t see with my limited experience. I always felt that a Medica should confirm what the repertory guides us to. But for this remedy, the traditional medicas give very sparse info and not much in way of strong confirmatory symptoms. Thanks again for your deep insight that we others need to develop over time.

    • Robert Field on

      Hi Philip,

      The key to the case- “I now am looking for a remedy that affects the liver and causes weakness in the extremites. It would ideally address the lasciviousness as well. These are the three areas that are the main focal expression of his dis-ease.” Actea Spicata covered the case and with such clear indications for a small remedy ( a remedy without alot of materia medica written about it) I could see no better choice, especially when knowing essences of the other remedies, but they did not fit. The one leap of understanding that I took was the common name is Baneberry. Bane means a source of woe or harm. When the information of liver involvement became revealed, and it is a remedy in Vega’s Liver Box Repertory, I felt I had a real clue to the possiblity of this remedy being so very perfect. This is my thinking. We will find out. Understanding the case is prior to the selection of any remedy. What has made this case difficult is that the information to understand it has not come as quickly as I would prefer. I never argue with “what is” All will be revealed through the perfect order of the universe. In time we will know. Until then we wait and see.

      Blessings, Robert

  10. Philip Joseph on

    Dear Doctor: Perhaps my choice of “numbness” in my earlier comment was wrong. I meant physical slowness but they are really not the same…my apologies….Hopefully by more responses from your students, the case and remedy will get clearer to me…Philip

  11. Robert Field on

    Hello everyone,

    I have been very busy and have just had time to visit the forum here and see that many of you are sharing your thoughts. I am very pleased to see this. There are as many ways to do homeopathy as there are homeopaths. My desire is that all of you develop YOUR own way. In the end it will be your way that you see the case, understand what is asking to be healed and understand the remedy and why you would want to give it. This is the job of the homeopath.
    After the remedy has been given it is in the hands of
    G-d. Our job of the homeopath does not stop, but the response to the remedy we have no control over. I do not know what this clients response to the Actea Spicata will be. I only know that as I see the case and understand his response to previously well selected remedies and now armed with more information, it is the best remedy I can percieve. If I am right or wrong about the remedy selection, it does not matter. It is out of my hands now. But I care deeply that there is a healing response to the remedy and always desire for the client to improve. I do not judge myself harshly if I am wrong. All of your wonderful comments and recommendations I appreciate very much. I will consider them, but at this point in time there is nothing more to do than hold the client in a light of love and healing and wait to see or hear of a response. Everything else is conjucture.
    The point of the article was not really the remedy selection as much as why it was difficult and what I was learning. The difficulty was in seeing well selected remedies not working and finding out more about a condition he has had that he failed to ever share. This I do not think was connected to any part of me being a good or bad homeopath. I have repeatedly asked him for more information at each visit. It is obvious that the universe was not ready to yield this information until most recently. Even if I had insisted that he share medical records with me, there is no assurance of compliance. I had requested them several times before. And even had I done a physical exam there is no assurance he would have shared the information since the area is not sensitive on palpation.
    I trust that all is meant to be and that what created the sense of this being a difficult case was as much for my learning as it is for his continued suffering, even though I would not have chosen it this way. In the end we can choose only so far, then it is out of our hands. If any of you think that YOU are the healer, you are wrong. Healing comes from a source energy that is far bigger than any one of us. So I will learn from this case and all of your comments. I hope you will benefit as well.

    Sincerely and warmly,
    Robert Field

    • Carol on

      I have a question which is an observation as well. I have been in similar situations where a patient does not reveal a piece of information that (when finally revealed) is a key part of a diagnosis. I have seen others experience the same situation. After giving the initial remedy and then finding the new information, and changing the remedy, it is often said that had there been full disclosure in the beginning the “correct” remedy would have been selected. So, was the correct remedy given in the first place for the patient to be able to give the full disclosure. In my observation the reason the patient does not always reveal these details is d/t the fact that those (later revealed) details are so hidden or abstract that the patient does not even put their mind towards them, and until enough of the more immediate ailments are relieved in even a minute, unmeasurable way, does the thought of the entire picture even surface. I am wondering how this fits into the classical homeopathic perspective?
      Thank you
      Carol

  12. Dr Ejaz Mahmood (Pakistan) on

    Thanks a lot for presenting the experience you had with the patient.This case again emphesis the importance of case taking and spending more time with patient initially asking
    about all the incidennces difficulties the patient experience so as to come to a correct diagnosis.

    Thanks.

  13. Bhav on

    I am highly impressed with your valuable Tips. I would appreciate if I could be given Remedy for In-growing Toe-nail problem. Toes swollen, oozing pus & blood of 11-yr girl

  14. P.Venkatappaiah on

    Dear Sir,
    I am really grateful to the valuable tips. The spirit and putting your heart wholly into the case is what Dr.Haneman desired in a homoeopath. As a matter of fact the homoeopthy touches the spirit. You are right and serving the spirit in right earnest. May the Almighty the Guiding principle help you and every homoeopath who put their heart into it.

    The discussions/exchange of correspondence between Dr.Suryanarayana Sarangi and Dr.Robert Field and others is quite elevating and enlightening bringing forth the real play behind the apparent materiality. After all we are not just matter only. Thanks a lot for this forum.
    Once again I remain very grateful for the tips and experiences you are sharing with while giving valuable tips.

    I remain looking forward for further such tips/advices.
    Yours sincerely,
    P.Venkatappaiah.

  15. Robert Field on

    This email submitted by Philip Joseph – student at Resonance School of Homeopathy

    Dear Dr Robert: I went back & read and re-read this case to try to understand the remedy better.

    The 3 (or rather 4 legs of the stool to stand on, chosen so well by you were) swelling, finger joints;
    ; pulsations, liver; paralysis of extremities; and lasciviousness.
    Most Materia Medicas mention Act Sp only for gout or rheumatic swelling of finger joints < usage (or fatigue),
    fear of failure, pulsations and sour stomach. A fewer mention the Liver derangement such as Clarke, Hempel,
    Boericke.
    Still fewer of them mention the sexual behaviour of Act Sp (Hering for example) as 'inclined to debauchery'.

    The old books gave such scanty information. But I struck Gold when I read Vithoulkas's Materia Medica Vol-I
    that writes nearly 7 pages of information on Act Sp.
    And Page 76 says "Actea Spicata men tend to be flirtatious,…
    may qualify as womanizers and may degenerate into debauchery".
    Eureka!! So, I think your selection was absolutely correct, but one has to search across several Medicas
    to gather the remedy picture seen through different eyes.

    I went thru nearly 7 medicas before I came across the 'lasciviousness' aspect of Actea Sp.
    It is very easy for me to play Monday morning quarterback to your remedy selection but thanks to your rubrics,
    I am able to imprint the picture of Act Sp in my mind's eye.
    Thank you for selecting rubrics so wisely. Although I am just a beginner with Sankaran's method,Sankaran has
    placed only 1 member of the entire Ranunculacae family (namely Act Sp under the Ringworm miasm).
    This miasm has a forward, setback, forward, setback kind of life pattern which seems to be a pattern
    in this patient. So both approaches point to the same simillimum.

    Finally, "A comprehensive Materia medica of the Mind by Dr H.l Chitkara" under Actea Sp has one rubric
    "libertinism" which I think means the same as Lasciviousness.
    Thanks doctor for your deep insight.

    Respectfully submitted by Philip Joseph Student at Resonance School of Homeopathy

  16. ginni on

    Dear All,
    I have a client who is 40 yrs old, unmarried that has been diagnosed as bi-polar.She has tremendous highs and tremendous lows[almost comotose].she was a cesarean baby, shipped off to boarding school[great lonliness and bullying].she is full of fears and cannot function as a normal person.I initially gave aconite which seemed to work well for a while. I considered opium but phos fit the picture better.phos 30 for a week. ok then collapse.Strong indication for carc so I gave carc 1m. lots of past stories came up. collapse again.after re- wiring the case i now have positr as a remedy. a[ I am unaware of this remedy, have no drug picture information and am feeling a little lost by it all. when she tried to withdraw from medication she collapsed again.’who will look after me?’ she says ‘I can’t do anything for myself!’any advise?

  17. William Sole on

    Blogging keeps me insane. Keep up all the positive work. I too love to blog. I found this one to be very informative


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