Case Synopsis

YD is a 25 year old Tibetan woman who escaped from the Chinese’ religious persecution and occupation of her native land. Traveling for two weeks, over high snow mountains, YD eluded the Chinese troops, and arrived safely in India.

She came to the clinic complaining of pain from large abdominal tumors. Her mother had died of this same disease at age 30. YD had surgery the year before to remove multiple cysts attached to her kidney. Now there were new tumors in the abdomen. After homeopathic treatment the tumors shrunk and have not returned during the last two years. No further surgery has been necessary.

Case Details

Name: YD
Age: 25
Female
Date: 5/27/11

Chief Complaint: Burning pain in abdomen, poor digestion

Diagnosis: congenital multiple abdominal cystic tumors. Exact diagnosis is not known.

Patient Report: Two years ago she had surgery to remove large abdominal cysts on the exterior of the right kidney. She reported that her mother died of abdominal swelling at age 30. In addition she had a cholecystectomy due to multiple stones. Patient now has a large palpable swelling mass in right hypochondrium. She has burning pain which extends around the right side to the back. She also has a pain in her lower abdomen (pelvic area), accompanied with a white discharge.

She is generally very aggravated by the sun. She loves potatoes, and pork aggravates her digestive system a great deal. Her face is slightly puffy and swollen, especially her lower lip. It is also cracked in the center. She is very sad, closed, very childish, and not in touch with her feelings. There is a pervasive dullness about her. She looks like someone who has not had enough sleep for a long time, although this is not the case. She has had much trauma, and is not able to talk easily. Most questions are answered with a blank stare, a blush, or an I don’t know. She is not hiding anything, she is just timid, dull, and not able to express herself easily.

She lost her parents at an early age and became orphaned. She escaped from Tibet to India about five years ago, with only Tsampa (barley flour) and one set of clothing. It was a dangerous 10 day journey over very cold, high snow mountains. She narrowly escaped capture by the Chinese. She says that she does not feel really comfortable in India but could not stay in Tibet any longer either.

She is very afraid of being alone and of the dark. She dreams of falling. She often feels all alone, and cries. She feels that no one is there for her. She feels helpless. She has a strong fear of ghosts. She is afraid that people, whom she used to know, will come back from the dead. She is very afraid of things she doesn’t know, such as new places, new languages, new people, etc.

Note:
When I first took this case, I was using the sensation method quite often and I was relying heavily on the mental section from the repertory. The analysis here represents a transition in my way of working in rural India.

My first impressions of the case were of natrum and carbon. Working in a foreign country (India), with different languages (Hindi, Tibetan, Nepali…), I must rely heavily on my observations of the patients emotional states and their bodily expressions. I rely less on my translator’s mediocre skill, less on exact vocabulary, and more on my emotional intelligence to solve cases.

Carbon seems present in the case because of the speechlessness, feeling caught in middle, and the falling sensation. Also the stupor, the dull look, and the sleepy feeling suggests a carbon remedy. There is a lack of reactivity. The fear of ghosts is also present in many carbon remedies.

The Natrum element is suggested by the closed, quiet, introverted persona. The fear of being alone, the sadness, the helplessness, and the feeling to weep, are all common expressions of the natrum family. Her dependent nature, coupled with her inability to speak and react to her own feelings and to new situations suggested Natrum Carbonincum.

After repertorizing the case, natrum carb came up very strongly and it was given. I specifically selected mainly general rubrics and observational rubrics. In this case I purposefully did not take many mental symptoms, as I as looking to see what came up from the generals and observational signs.

The following rubrics were chosen in the case.
Generalities; FOOD AND DRINKS; POTATOES; Desires
Generalities; FOOD AND DRINKS; SPICES, condiments, piquant, highly seasoned food; Desires Generalities; FOOD AND DRINKS; PORK; Agg.
Generalities; SUN; AGG.
Face; SWELLING; LIPS; Lower
Mind; CHILDISH BEHAVIOR
Generalities; AFTERNOON, ONE PM. – SIX PM.; AGG.
Abdomen; LIVER AND REGION OF; CHRONIC
Face; CRACKS, FISSURES; LIPS; Lower
Mind; FEAR; ALONE, being
Generalities; TUMORS, BENIGN; CYSTIC, steatocystoma, steatoma

REMEDY: Nat Carb 200c one dose, see after one week.

1st Visit: 5/27/11
200c nat carb 5cm 2x a day. 5cm is shorthand for the 5 cup method as used by Dr. Farokh Master. It is based on the 6th edition of the Organon and uses frequent repetitions of highly diluted c potencies.

Follow Up: 6/20/11
BP 105/65, mild hypotension. She is doing better, swelling in abdomen feels less. Complains of less pain, less frequency, better digestion. The abdominal mass is smaller after palpation. She is smiling now, more cheerful, less fearful. still quiet, but happier. Prescription: Continue Nat carb 200c, 5 cup dilution method , one teaspoon, 3x a day. Also advised to take remedy whenever burning pain comes.

Follow up: 12/6/11
Patient took the remedy in 5 cup dilution off and on for 6 months. She was not a regular visitor and we had to coax her and confront her to come to the clinic to get her medicine. I do not do this with all of my patients, but she has such a potentially serious pathology, and is unaware of the severity of it, so I made an extra effort to get her to take the medicine.

She is very much better. The abdominal mass is no longer evident from palpation. However there is some slight pain when pressed deeply. Otherwise there is very little pain, only on occasion. Patient is much happier, smiling, still quiet and reserved, but her appearance has completely changed.

Follow up: 5/8/12
Looks dramatically better, not sad, had some unrelated vaginal infection and took antibiotics!!! She has just finished them. Patient has not been to clinic to continue her medicine. She is much better, with no evidence of abdominal tumors, no pain, and a cheerful demeanor. Abdominal palpation feels normal. I advised the patient in very clear terms that her disease is not curable by allopathic medicine, and that homeopathy is her best hope to remain healthy and not follow the same fate as her mother. I waited one year to give this advice, but now felt there was no other option but to tell the truth. The next week her husband came to pick up a refill of the medicine for her.

Follow Up: 9/10/12
today gave nat carb again. 200c 5x 2x a day, patient returned with complaints of burning pain. BP: normal now – 120/80

She continues to do well. She is much more confident, less childish, and more extroverted. She is always smiling. She is now a “good patient” and comes to refill her prescription and have regular check ups. She seems to take homeopathy more seriously now. Occasionally she will have a minor pain in her abdomen, when she takes the remedy it always goes away.

Prognosis: It is difficult to know exactly what her future will bring. Even the allopathic specialists were unsure of the exact nature of her condition. We do know however that her mother died an early death, probably from the same condition.

12/20/13
During the last year, she left her very abusive older husband, lost some excess weight and moved to Europe. Everyone in the village was talking about how much she had changed, from a depressed timid girl, to a happy attractive young woman. I recently asked about her, and her relatives assure me that she is still doing well in Europe.