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I Just Can't Hold It
We present this case not only to illustrate the success possible in treating gastrointestinal complaints with constitutional homeopathy, but also as a useful teaching case in differential diagnosis for homeopathic prescribers.
Phyllis, 59 years old, is a graphic designer. She had been treated by us successfully 11 years previously for Epstein-Barr-related fatigue and menopausal symptoms. Phyllis came to see us 18 months ago due to a microscopic colitis, for which she had been told there was no cure. Her finances, already quite limited, made it impossible to continue spending $500 per month in medications, especially when they weren't helping her significantly.
I'm tired all the time. I just don't feel good. I have accidents with loose stools no matter what I eat. I don't have muscle control of the rectum. The stool just oozes out like pushing on a tube of frosting. It happens nearly every time I need to urinate. There's a lot of gas in there. If you could look at it through a clear tube, you would see air bubbles everywhere.
I've been married for 20 years. My body has changed since I turned 50 due to menopause. I'm gaining weight in places I've never had it before. A belly. A whisker here and there. I compare my body a lot to those of other women. I wish my sexual energy were higher. The gas doesn't help.
My hands get icy cold. Some fingers turn pure white; others deep purple. They feel numb and really cold. It's like I've been outside in really cold weather playing in the snow. I try to rub them to get the circulation back.
I only sleep in 15-minute increments, even though I take melatonin at bedtime. My legs become very restless. That funny feeling where you just can't be in the same position and have to keep moving them.
What bothers me the most, though, is my bloated tummy. I just stand up and the stool comes out. It is so embarrassing! Bloated like a balloon. My tummy just gets bigger and bigger. As if you blow into a balloon and it gets bigger and puffier. The more air you put in, the bigger it gets. Not completely full, but almost all the way. Then, when it comes out, there's no stopping it. It's humiliating. I'm an adult and it's something I'm supposed to have control of, rather than be dependent like a child. It makes me feel helpless, mortified, undignified.
I find myself not wanting to have conversations with people in general, because I can't think of which words I want to use. It's embarrassing to have a conversation. I find myself shying away from talking to people socially. It's not new for me. I was chubby as a child, and I didn't feel smart. I loved school until the seventh grade. Then it became torture. You know how mean kids are. They make fun of you so that you never feel good about yourself. I always avoided being the center of attention because I was afraid that people would laugh at me.
My mom died at 59, the same age I am now. I had a partial hysterectomy in the early '90s because of a uterine prolapse. Your body just starts giving up on you as you get older. Even if you are able to keep your brain function and don't get Alzheimer's or dementia, your body still starts to revert.
Wrong Kingdom, Wrong Plant within the Right Kingdom, Wrong Plant within the Right Family
We first prescribed Baryta carbonica (barium carbonate), a well-known homeopathic medicine for people who feel inadequate regarding their intelligence and social skills. It is well covered in the homeopathic materia medica, and can be indicated in patients with a variety of abdominal and rectal complaints. But, above all, patients needing Baryta carbonica typically use the same phrases as Phyllis did about feeling stupid and embarrassed and being laughed at.
But at her six-week follow-up visit, she had experienced no improvement whatsoever from this prescription. Looking back, we see where we went wrong in our case analysis. Barium carbonate is a mineral, and homeopathic medicines from the mineral kingdom are required by individuals whose main issues include security, structure, performance, roles, relationships, identity, and fear of loss. Specifically, there is a fear of depending on others and of being helpless. This material is based on the Schema of Dr. Rajan Sankaran, of Mumbai, India, with whom we have studied closely since 1993.
We have taught the differentiation between the mineral, animal, and plant kingdoms for years, yet we went astray with the case analysis. Phyllis indicated entirely too much sensitivity for a mineral. Her embarrassment, for example, was an expression of her acute sensitivity, as were the detailed sensations regarding her bowels. In fact, there are a number of different well-expressed sensations, such as the balloon feeling, that suggest various possible plant families. So, despite the fact that there were many appropriate indicators for Baryta carbonica, Phyllis's sensitivity pointed to a plant. The randomness and changeability of the bowel symptoms arising "whenever they want" also suggests the spontaneity and unpredictability (in the word of the patient) of a plant medicine.
At the next visit, Phyllis elaborated more on the bowel symptoms. "I never know when I will have the loose stools. It's not predictable. It happens whenever it wants to happen. The bowel movement starts with a pressure, pushing feeling. Then it gets more urgent. Pushing from the inside. Squeezing of the bowels. Pushing it out. You feel it pushing down through you. It just comes out. A tightness. Like if you were blowing up a balloon. Bigger and bigger. Tighter and tighter."
It turned out that Phyllis had recently begun to suffer from back pain. Again, she expressed many different sensations: "tight, stiff, like a rubber band, stretched too far, pressure, knotted, clenched."
Again, many sensations indicating a homeopathic medicine made from a plant. As you will see, the patient may appear to need plants from a variety of families, but the homeopath needs to pursue the interview until one primary sensation emerges. We could have easily chosen a medicine from the Cactaceae family, due to the emphasis on the balloon feeling. However, we first prescribed Podophyllum, a plant from the Berberidaceae family, whose predominant sensation is changeability and adaptability. This medicine, whose common name is mayapple, is the most common homeopathic treatment for diarrhea with an explosive stool, cramping, and exhaustion. There was no improvement, but at least we had chosen the right kingdom. That still left, however, at least a couple of thousand remedies among which to distinguish.
Closer and Closer to the Right Medicine
We have had very good success in treating colitis, so we knew there must be just the right medicine to help Phyllis. We listened more carefully. "I can't hold it. I should be able to control it. We are adults and we should be able to control our bowel movements. … I've never had a ton of self-confidence. When I was really young, really overweight, the other children teased me a lot. Called me names. I still remember some of them. Even my mother told me all the time to lose weight." We asked Phyllis once more to tell us the main sensation of the stool. "My main feeling is that stool will come out. I can only hold it for so long. Then it oozes out."
Restudying Phyllis's case led us, finally, to the Liliflorae (lily) family, whose predominant sensation is forced out, squeezed out, extruded. This same sensation causes a feeling of being excluded, left out, and neglected. This theme carried through, over and over, Phyllis's physical complaints as well as her emotional state since childhood. Which member of the lily family did we choose? Unfortunately, not the right one the first time. It is easy to confuse the sensation of being excluded and left out with what Sankaran calls the "leprosy miasm" (also the feeling of exclusion and being an outcast). We prescribed Aloe, a Liliaceae very well known to address bowel complaints. This medicine did act, but not as well as we had hoped.
"A lot of the urgency was gone. I no longer feel like I have to have a BM with no warning. It still varies on a daily basis. The oozing is not happening. The gas is still terrible and embarrassing. I haven't noticed the icy cold feeling in my fingers." Looking back over her case, Phyllis had had not mentioned the other typical miasmatic words: "disgust," "dirty," even though the idea of avoiding social contact did fit the case.
We believed that the prescription was now close, so we delved more deeply into the sensation of the digestive symptoms. "You can feel gurgling, hear the rumbling. Feel the bubbles moving down, the pressure. That bursting, pushing. Like you're pushing air out of an upside-down ketchup bottle."
Correct Kingdom, Family, and Plant
Phyllis, partly because we had treated her successfully in the past and also because she had nowhere else to turn, held great confidence in our ability to find the right medicine for her. That is always helpful to encourage the homeopath. It still seemed clear that the lily family was correct, but we needed to find another member of the family that fit Phyllis perfectly. We consulted the following rubrics for repertorization: abdomen, rumbling noise, as if diarrhea would appear; abdomen, gurgling sound; stool within one word of ooze in the homeopathic program Reference Works; rectum, urging, desire in diarrhea; stool, forcible sudden gushing (we considered this to be similar to oozing); and ailments from mortification.
We investigated various members of the family, all bulbs, of course, and chose Colchicum (meadow saffron or autumn crocus). The bulb grows wild in moist meadows of temperate Europe. Its flowering goes against the typical rhythm of lilies by blooming in the fall. Historically, it was used as an aphrodisiac (which is fascinating, since this is a positive effect that it had on Phyllis). Self- or cross-pollination occurs above ground, and the pollen tubes grow down through an extraordinarily long style, to meet the ovary below the ground. The process takes many months, lasting the length of the autumn and winter. The fruit then ripens slowly throughout the summer. It actually takes almost nine months from fertilization to ripeness, a disproportionately long time for a plant, and mimics the human gestation period. [Information gathered from Prisma, by Frans Vermeulen, from Reference Works.]
The name Colchicum comes from Colchis (now Georgia), an ancient kingdom near the Black Sea where the plant grew abundantly, and also the home of the temptress Medea. Common names for the plant include "naked lady" or "ladies," "naked maiden," and "naked boys," referring to the stalkless, unprotected flowers that develop in the autumn before the leaves, followed by the leaves and seeds the next spring.
We knew that it was an excellent medicine for the digestive tract, covering diarrhea with flatus; diarrhea after the slightest indiscretion in eating; flatus during stool; urging for stool when passing gas; and forcible, sudden gushing of stool. Colchicum is best known for its use in gout; its major alkaloid is colchicine, from which is derived the pharmaceutical medication also used commonly to treat gout, as well as cirrhosis and other liver conditions.
It is a medicine indicated for sensitive people who feel unprotected from external impressions. The predominant sensitivity is to rudeness by others, such as the insults that Phyllis received continually from other children concerning her weight. These epithets made a deep impression on her to this day. This characteristic was quite consistent with Phyllis's sensitivity to childhood insults, and also to her longstanding belief that her body was unattractive and not as feminine as she would like.
We prescribed Colchicum LM2 to take daily. Phyllis sent us the following e-mail message five weeks later:
I wanted to let you know that my new remedy is working very well. The urgency is totally gone and the consistency has changed as well. My bowel movements are much firmer and rarely do I have diarrhea or very loose stools. The gas issue has improved as well. The bloating feeling has all but gone away and I don't pass nearly as much gas as I used to. I'm thinking that this new remedy is working very well and I am pleased and satisfied with the results. Thank you so much for all of your help, words can't express how grateful I am.
All's Well That Ends Well
Phyllis was hoping to avoid any other homeopathic appointments, since she felt well and her finances were limited. She was willing, out of gratitude, to come in for one more visit three weeks later, for which we gave her a discount. Her report: "I'm doing really well. I have no urgency at all. The gas is much better. The bloating is gone. I recently started working out again. My sex life is greatly improved." This excellent report reassured, on various levels, that "naked ladies" were exactly what Phyllis needed.
When we called her, 10 months later, to come in for an appointment, Phyllis replied:
I know you want to see me or at least talk to me this spring. I am doing fine, really, fine. I was in remission for a long time and quit taking my remedy. Then I started having problems again, so I started taking my remedy again. Within a week I was seeing dramatic changes and am very happy with the outcome. I am not having any problems, the remedy is doing its job. All is well!! Thank you so much for all you do and I refer everyone who will listen to me to you!!
Judyth Reichenberg-Ullman and Robert Ullman are licensed naturopathic physicians, board certified in homeopathy. Their books include Prozac Free, Homeopathic Self-Care: The Quick and Easy Guide for the Whole Family, Whole Woman Homeopathy, Ritalin-Free Kids, Rage-Free Kids, A Drug-Free Approach to Asperger Syndrome and Autism, The Patient's Guide to Homeopathic Medicine, and Mystics, Masters, Saints and Sages-Stories of Enlightenment. They live on Whidbey Island, Washington, and in Pucón, Chile; teach internationally; and practice at the Northwest Center for Homeopathic Medicine in Edmonds, Washington. They treat patients by phone and videoconference as well as in person, and can be reached at 425-774-5599, firstname.lastname@example.org, email@example.com, or www.healthyhomeopathy.com.