A short case management quiz…
A woman had been suffering from a bad dose of poison ivy. She had taken steroids, and some of the rash still persisted. She felt something still needed to heal and asked for treatment.
I gave Mercury LM1, which helped the rash immediately, but then within a day or so the patient started coughing. The next day, the cough went to the chest, productive cough with thick yellow mucus. The patient said this is chronic, and was very worried that the cough would get much worse and remain for months, as that is what usually happened.
What questions would you ask the patient at this stage? What’s the next step? Why?
This is a situation which we all deal with, in many if not most cases. We have given a remedy which is doing well on the chief complaint but within several days, an old symptom emerges. The patient may be extremely distressed, insisting that he or she be given a medicine to deal with the chronic, as now it will only get worse as it usually does.
And now we must understand what is going on, what’s the trail of activity and response here, in order to determine the next step.
Is the old symptom an aggravation from the remedy? Or has the patient simply moved into a familiar chronic state as they suspect? and fear?
As people in the facebook discussion correctly responded, we want to look into the nature of the old symptom, and especially to see if the symptom is now presenting in the same way as always, or if there is something different about it. We also want to see whether the old symptom is covered by the remedy we gave.
In this particular case, the old symptom was presenting slightly differently, and it was indeed covered by the remedy given. I told the patient to wait. It wasn’t what she wanted to hear. Yes, we can always prescribe sac lac in these cases, but then the patient learns nothing.
As I and others have noted in the use of LMs, an aggravation of an old symptom often passes within hours, usually passes within one or two days, and occasionally drags on a little longer. In these situations, usually after a day the patient will say the symptom is still there, but less. In C potencies, the aggravation may take longer.
What we must be aware of is that when there is an aggravation triggered by the remedy, it is a substance symptom which is sitting on susceptible areas in the organism – treading on its corns, so to speak – and not a disease symptom. And the symptom is challenging the immune system to address it. It’s an opportunity to allow the immune system to finally recognize a symptom it has not been dealing with properly (resulting in chronic illness), and to deal with it as needed. If we rush in with a remedy or even antidote, we are passing up on a vital opportunity for the organism to become stronger and more effective.
Obviously, if the symptom persists, becoming more and more identical to the old chronic, it must be addressed – the case must be reviewed, symptoms chosen again, and the best remedy prescribed for the situation.
However – a word of warning. Sometimes it is possible, especially when the dose given was too high, for the patient’s situation to slide into an acute flare-up of the chronic, something too intense for the organism to handle, especially when weakened by the heavy-duty symptoms it is experiencing. For this reason, I believe it is essential to keep tabs on what is happening, to ask the patient to check in after 24 hours, to understand exactly what process we are looking at.
In this particular case, the old chronic symptom passed within two days, all in all around five days after one dose of the remedy was given. It was already easing after 24 hours. The patient expressed amazement at the strength and duration of the remedy.
One of the most important elements of this kind of situation is that when we prescribe, we must have a clear path in mind of what we want to see, of why we’re seeing what we’re seeing, and of the options available to us. Most importantly, patients will insist on new prescriptions, different remedies, etc., but if we are to help them we must understand whether their insistence is based on deeper understanding of what’s happening, which can happen but is rare, or simply on their lack of knowledge about how homoeopathy works, mixed in with real fear of getting sicker.