The case of Lady Ponsonby-Blythe

The case of (the fictitious) Lady Gwendolyn Ponsonby-Blythe

There are certain attributes to this case (details given again at the end of this post), some reflect prescribing symptoms, and some must be noted with care….

• the patient is haughty
• chief complaint – pain on turning the head to the left and to the right
• aggravation from drafts
• coughing and sneezing
• susceptibility to neck pain since childhood
• hot bath amel
• brandy amel
• lachrymation
• agg mortification

The mortification this patient felt in not getting an invitation to the wedding does seem to be part of the trigger for the flare-up and I would include it in repertorization.  So too aggravation from drafts and turning the head, the amelioration from brandy and from a hot bath, and even the weeping.  But although I would not include haughtiness in my repertorization as it is part of her personality, not part of her pathology (although some would say it is the inbred pathology of many aristocrats…), I wouldn’t be surprised if haughtiness was found in the chosen remedy’s proving.  The spring allergies will probably show up in the proving as well.

Possible remedies are easy to see here.  But I didn’t post this small fictitious case as an exercise in choice of remedy.  It’s not particularly complex, and there aren’t even any interesting a-ha moments in it.

The important thing to note is that this case is an acute flare-up of a chronic condition.  This kind of case can be very muddied by dosing as if it is a completely new acute.  Often, less doses are needed, and greater care must be taken that the patient won’t aggravate.

Very often patients come with an acute complaint which turns out to be a flare-up of a chronic condition.  In such cases I have found patients to be more susceptible to remedies and more likely to aggravate on frequent dosing.  This is also a logical expectation.  For example, if someone is chronically susceptible to insults, and usually gets sick after any mortification, any remedy which can cause a feeling of offense in a person will be treading directly on the thin ice of a large frozen lake of existing sensitivity to this.  Sensitivity is increased, and so dosing must be carefully monitored.

In addition, because this is really a chronic, not an acute, there is more likelihood that changes in the symptom picture during treatment, both in resolution of the acute flare-up and subsequently, will make it necessary to switch remedies.

In these cases, the patients can be difficult to work with.  They often find it hard to believe that they aren’t being told to take a remedy three times a day for a week, and some will even be convinced that the instructions for minimal dosing were wrong, and will take more of the remedy “just in case”.  In these situations, a slew of old and new symptoms may appear, and case management becomes far more complex than it should be.

More on case management in a future post.

***************************************************************************

another british aristocrat…

Lady Gwendolyn Ponsonby-Blythe sat condescendingly in my consulting room. I have never seen anyone sit condescendingly before, but Lady Ponsonby-Blythe’s sitting had an expression all of its own. She looked around and sniffed, clearly unimpressed by my simple chairs, desk and unadorned walls.

I asked how I could help.

“It was the royal wedding, you know,” she confided. I must admit, I was impressed.
“You were invited?” I asked.
“One’s television screen in the main hall of one’s castle is set at the most inconvenient angle,” she continued, ignoring my question as an expression of plebeian ignorance. “Since the royal wedding, one’s neck hurts, every time one turns it, so,” and she turned her head to the left and to the right, wincing with the utmost gentility. I thought for a moment that she was about to wave to imaginary courtiers.
“It’s dreadfully cold in the big hall, impossible to heat, you know, and one cannot stand drafts.”

I asked about other complaints.
“Spring allergies, you know, most people have ‘em,” was the response. “One still suffers from the occasional cough and sneeze,” and she withdrew a small square of cambric and patted her nose.

“And does one – er, do you get neck pain often?”
“Oh yes,” she responded. “Since one was a child, always the drafts, one just can’t abide ’em . One asks Tompkins to draw one a hot bath, that and a small brandy, for medicinal purposes, you know.”
“Does that help?” I asked.
“Of course,” the lady snapped, clearly impatient with so many impertinent questions.

And suddenly, the small square of cambric emerged again as the lofty Lady Gwendolyn Ponsonby-Blythe dissolved into tears. I don’t know which one of us, whether it was “one” or myself, was the most surprised.

I handed her a glass of water and waited.

She sipped the water with a grimace, as if it was not sufficiently well-bred. When she spoke next, her voice was uneven but controlled.
“It was that damned wedding,” she explained. “Obviously Cedric and oneself must have been invited, but without the invitation there would have been a fuss, don’t you know, and one does not like fuss. So common, you know.  So one watched the event on the television – and now this!” she ended, turning her head gently but painfully from side to side.
“It’s just all too much!” The tears threatened again, but were subdued into silence by “one’s” iron will.

I asked some more questions, gave a remedy and instructions, and Lady Ponsonby-Blythe sailed, galleon-like, out of my consultation room into the masses of the great unwashed, cambric handkerchief held gently to her nose for protection.

As others greater and wiser than myself have said of this kind of story – it didn’t happen but it could have done… in a parallel universe or somewhere equally exotic…

What remedy would you give – and why?
How would you dose? And why?
What results would you expect?

Viewed through proving: mystery remedy…

Ladies and gentlemen – a mystery. Not really, but I’d like you to look at the symptoms below before scrolling down, and think what remedy proving they belong to.

– Anxiety, thinks he will be ruined (aft. 1 h..).
– Anxiety in the region of the heart, with suicidal impulse, and feeling of inclination to vomit in the scrobiculus cordis.
– Trembling anxiety, as if about to die (aft. 1 h.).
– Anxious solicitude about his health.
– Restless state of the disposition, as if he did not do his duty properly (aft. 18 h.).
– Extreme hesitancy.
– Neglect of his business, hesitancy, sobbing respiration and loss of composure.
– Sometimes he wants to do one thing, sometimes another, and when he is given something to do, he will not do it (aft. 10 h.).
– Dull, cross, very chilly.
– Sullen, lachrymose, anxious. [Stf.]
– He is very silent. [Fr. H-n.]
– He hesitates in his speech; it vexes him to have to answer.
– Everything disgusts him; everything is repugnant to him.
– Her head is so quiet and all about her is so empty as if she were alone in the house and in the world: she does not wish to talk to anyone, just as if all around her were no concern of hers and she belonged to nobody.

Empathy in case-taking

This article was prompted by a discussion with a colleague regarding an old post of mine, entitled “What We Know and What We don’t Know”. Our discussion took us into the subject covered by Dr. Gary Weaver’s original post, on “The Realities of Practice”. In his article, amongst other things Gary set out a prescribing process for a busy clinic where 40-100 patients may be seen a day by splitting up case-taking between one prescriber and two or three nurses or advanced students.  The main symptoms of the case are elicited by the prescriber’s assistants.   The patient is then brought to the prescriber for further questioning, analysis and prescription. This kind of clinic is more common in India, and much less common elsewhere. Many, if not most of us work privately with patients, and I don’t know if any such volume clinics exist in the West.

The point, however, is that clear symptoms may be taken by the assistants within 20 minutes, and that deeper investigation and analysis should not take the prescriber longer than a further half an hour, often much less.

Viewed through Proving: Alumina and Shakespeare

Any Shakespeare lovers out there?  Or are we a dying breed?

Which extremely famous Shakespearean tragic figure do these Alumina proving symptoms remind you of?

Boenninghausen and Treatment of Composite Fevers

Composite fevers are situations where there are all kinds of combinations of heat, cold, shivering, shuddering, perspiration – with each remedy ringing its own characteristic changes on what pattern it will produce.  Each pattern is so individual in each case of sickness, or where epidemic looms, that these composite fever patterns can often unlock cases, point directly to the best prescription and achieve cure.  It is essential in such cases to get very specific information about what comes first and what comes after – is it heat first then chill? Chill, then heat, then perspiration?

Here are some of the composite fever rubrics that appear in the Therapeutic Pocketbook.  Click on the image to see the rubrics more clearly.  The first number appearing after each rubric is the symptom number in the P&W, and the second number is the number of remedies in that rubric.

Viewed through Proving: Calc-Carb – last one for the road…

The patient comes in doubled over in pain from stomach ache.
The mother reports that the child always bends forwards with colic.
The patient reports that he feels so tired he just feels he has to close his eyes the whole time.
The patient reports that his legs ache, he just has to sit down.

I ask in each case – does that make you feel better?  Do you feel better from lying down, sitting down, rubbing the part, bending double?   They answer – not really,  I just feel I have to do it.

סדנא! לקיחת מקרים ובחירת סימפטומים

לקיחת מקרה ובחירת סימפטומים – הברגים והאומים של ההומאופתיה

לקיחת מקרה ובחירת סימפטומים – הדקויות

המרצה:  ורה רזניק

סדנא אינטנסיבית בת 4 שעות בנושא לקיחת מקרה ובחירת סימפטומים, במטרה להגיע לתרופה בדרך נכונה, מדוייקת ויעילה יותר.  מספר המקומות מוגבל

הסדנא כוללת:

• סעיפים רלוונטיים מספר ה”אורגנון”
• לקיחת מקרה ממוקדת
• סיווג סימפטומים וסדר עדיפויות ברפרטוריזציה
• טכניקות של בונינגהאוזן
• עבודה עם פרווינגס
• סימפטומים רגשיים/מנטליים ומקומם ברפרטוריזציה
• עבודה מעשית עם מקרים
• ועוד

מקרים יוצגו באמצעות תוכנת P&W  לספר הכיס הטיפולי של בונינגהאוזן (Therapeutic Pocketbook).  ניתן ליישם את הטכניקות גם בעבודה עם רפרטוריס אחרים.

• תאריך: יום חמישי 28 בפברואר
• שעה:  13:00-17:30
• מקום:  JBC, רחוב הלל 24, קומה 5, ירושלים

הרשמה ותשלום מראש בלבד.

עלות:

• 450 ש”ח – תשלום בפועל לפני 20 פברואר
• 490 ש”ח – תשלום אחרי 20 פברואר

ניתן לשלם במזומן, צ’קים או כרטיס אשראי.

אם ברצונכם להירשם, כתבו ל vera.homeopath@gmail.com   לשריין מקום.  תקבלו מידע נוסף לגבי הרשמה תוך 24 שעות.  אם לא קיבלתם, נא להתקשר ל-ורה בטלפון: 054-4640736.

הנחות מיוחדות למשתתפים:

• – הנחות מיוחדות בקניית תוכנת P&W לספר הכיס הטיפולי של בונינגהאוזן (בתוקף עד 31 למרץ 2013)
• – הנחות מיוחדות על סדנאות בעתיד

סדנא! לקיחת מקרים ובחירת סימפטומים

לקיחת מקרה ובחירת סימפטומים – הברגים והאומים של ההומאופתיה

לקיחת מקרה ובחירת סימפטומים – הדקויות

המרצה:  ורה רזניק

סדנא אינטנסיבית בת 4 שעות בנושא לקיחת מקרה ובחירת סימפטומים, במטרה להגיע לתרופה בדרך נכונה, מדוייקת ויעילה יותר.  מספר המקומות מוגבל

הסדנא כוללת:

• סעיפים רלוונטיים מספר ה”אורגנון”
• לקיחת מקרה ממוקדת
• סיווג סימפטומים וסדר עדיפויות ברפרטוריזציה
• טכניקות של בונינגהאוזן
• עבודה עם פרווינגס
• סימפטומים רגשיים/מנטליים ומקומם ברפרטוריזציה
• עבודה מעשית עם מקרים
• ועוד