Seeks quarrels in the family: a case of Kali carbonicum

By Rajan Sankaran, Sneha Thakkar, Rishi Vyas

The 18-year-old patient presented to us with a diagnosis of idiopathic thrombocytopenia (ITP); her blood counts were poor.

The young woman's complaints first appeared in June 2007. In that month she had an unusually heavy period, bleeding for over 15 days; she was very exhausted and weak. Conventional treatment provided only temporary relief. The next period was significantly worse than the first, this time the bleeding lasted four weeks. The accompanying exhaustion was more severe than before. On the twentieth day of the period she developed fever and chills and the patient collapsed.

Investigations showed a markedly reduced haemoglobin of 3.3 g/dL and platelets of 14,000 per microlitre (a healthy value is 150,000–440,000 per microlitre). The patient was immediately admitted to hospital and received a blood transfusion. She was then treated hormonally to regulate her menstrual cycle. During the acute phase a secondary myelodysplasia was suspected, but this was not confirmed. The final diagnosis was idiopathic thrombocytopenia with sepsis. The patient was prescribed corticosteroids and has since complained of menorrhagia and ecchymotic spots all over her body. For four years the patient has been treated each year for periods of 4–5 months with high-dose corticosteroids. Her platelet counts have fluctuated widely.

From August 2011 until 9 September 2011 the count fell from 20,000 to 8,000 per microlitre and her doctors immediately prescribed Omnacortil 60 mg daily. The patient came to us on 23 September 2011; her platelets had recovered (to 604,000 per microlitre) and the medication was reduced to Omnacortil 20 mg/day.

In addition to her main complaints the young woman suffered from severe headaches (since 2007), located mainly at the vertex and usually triggered by sunlight. The patient therefore avoids the sun. She also suffers from menstrual pain with lower abdominal cramps that are improved by bending forward or stooping and are worse when lying stretched out. She is constipated and must strain a great deal to have a bowel movement each day. The patient continues to feel very weak.

When we ask the patient to describe herself, she tells us that by nature she is rather calm, a true family person. But she can also become angry very quickly when she feels she is not being properly listened to. She reports that these fits of anger come on suddenly and disappear just as quickly. In her anger she harbours a distinct aversion to the person concerned and feels unable to speak to him/her. Most often her anger is directed at her brother, sister or mother.

She reacts sensitively to noise; it irritates her; sudden sounds make her start. She reports: “I cannot bear it when someone shouts at me — it feels as if my eardrum will burst.”

She continues: “Sometimes I am afraid that someone might grab me by the wrist, or hold me so I cannot move; I am then unable to speak; it scares me. It is as if all the organs in my body are being held tight and I cannot move at all. It feels constricting, as if someone has gripped me tightly.”

Her mother reports that her daughter talks in her sleep and calls for help.

The young woman fears burglars and ghosts. She cannot be alone. She says: “I get bored. I would always like someone with me.” Being alone unsettles her. If she watches a scary film, or something terrible happens, she cannot sleep afterwards and someone from the family must stay with her.

Sometimes the patient has nightmares. She dreams that a family member is drowning: “I would like to scream out; I want someone to come and save them. It frightens me.”

She tells us of an incident in which she had to witness a friend almost drowning. She was the only witness and was able to call for help in time. The friend survived. Since then the patient fears drowning.

The young woman likes to cover herself up and usually sweats on the head.

Case analysis

Many of you may wonder why we already speak of case analysis at this point — does that mean the case-taking is complete, or are we simply analysing what has happened so far? Is there sufficient information to allow a conclusive case working?

I would say: yes! Definitely yes. The case is sufficiently complete to understand it and to work out the appropriate remedy.

The key to this case lies in careful listening. What may sound like a mere listing of symptoms and a description of this young woman's personality is in fact the key to understanding the case. The simple, uncomplicated manner of the person sitting before us and telling us about herself and her symptoms provides the chief symptoms by which we must prescribe. We only have to listen closely and carefully. The patient had told me everything about herself, even when the actual information was still sparse.

The young woman describes herself as rather calm but quick‑tempered and irritable, especially with noise. It is also interesting that she describes herself as a family person, even though she can be very angry and impatient with her family.

If we translate these symptoms into the language of the repertory, we get the following (1):

- Irritability from noises

- Quarrelsome with her family

- Desire for company; worse when alone

Another very characteristic symptom leading us to the remedy is the patient's tendency to pick fights with the people she depends on and to whom she is most closely attached. The following rubric expresses this symptom very well:

- Desire for company; treats those who approach her badly

Next we have the striking sensitivity to noise, which makes our patient start at the slightest sound:

- Startled, by noises

- Startled, easily, by slight causes

The patient's dreams show marked fears; she screams and cries for help. We have the following corresponding rubrics:

- Screaming; for help

- Screaming; for help; in sleep

Also notable is the pronounced fear of drowning, which was triggered by the incident with her friend. When I cannot find a rubric that exactly matches the situation, I combine suitable rubrics (fear, dream, delusion) that all belong to the level of delusions. In this case the fitting rubric is:

- Dreams; of drowning

Furthermore, many fears are evident on several levels in this case:

- Fear of robbers and ghosts

- Fear of being alone

- Fear for her family members, who drown in the patient's dreams

The repertorisation with MacRepertory gives us the following result:

As a result we have the remedy Kali carbonicum.

At this point I would like to draw your attention to the description of the remedy in Phatak's Homoeopathic Materia Medica:

General

- The weakness produced by all potassium salts is particularly marked in this typical salt of the Kali group.

- WEAKNESS; of the muscles; of the heart; of the back; of the limbs; mental weakness.

- Tendency to be startled with a loud cry; on touch, even slight, especially of the soles of the feet, which sends a shock wave through the whole body.

- Weakness after miscarriage or childbirth.

Mental and emotional

- Irritability.

- Startled; jumps on touch, especially of the feet; also when falling asleep.

- Anxious fears, fear of being alone.

- Very irritable.

- Oversensitive to pain, noise, touch.

- Fears: of the future; of ghosts; of death.

- Apprehensive and anxious about their illness.

- Resents their lot; quarrels with their family.

Female genitalia

- Severe cramping pain before the period, which irritates the genital region and has a sharp odour.

- Bleeding that does not stop after curettage or other therapeutic attempts.

- Severe uterine cramps when the period should occur but does not, with heat and restlessness.

The description of the remedy in my book 'The Soul of Remedies' also fits the patient's symptoms very well:

Rubric: Desire for company; treats those who approach her badly.

In this symptom the three main aspects of Kali carbonicum are united. The first aspect is the desire for company: she longs for company and depends on it; she is worse when alone, needs support and likes to be with people who give her that support. The second aspect is found in the patient's dissatisfaction. She is unhappy with her own dependency and therefore treats her family badly. Thirdly, there is quarrelsomeness: she is discontented and cannot keep it to herself but seeks quarrels.

In Phatak's 'Homoeopathic Materia Medica' we find the following:

Resents their lot; quarrels with their family.

It is characteristic of Kali carbonicum that they vent their dissatisfaction and quarrelsomeness on spouse and family rather than on outsiders (the exception here, unfortunately, is the doctor).

When several characteristic symptoms form a coherent whole and a particular remedy crystallises out in this totality, I would always consider that remedy and consult the Materia Medica. If the remedy picture then exactly matches the patient's symptoms, I would choose that remedy.

Dosage

In this case I prescribed an LM potency. LM potencies are indicated when the pathology is progressive, persistent and continuous, i.e. not intermittent. The course of illness in our patient is certainly progressive — she required corticosteroids increasingly often and after each course her platelet count fell markedly. The appropriate potency is LM8, because the patient's disease is one of immune weakness and the symptoms were expressed at the level of delusions and dreams. She therefore needed Kali carbonicum LM8.

Follow-up on 20 June 2012

The patient has considerably more energy and sleeps well. Apart from a slight heaviness in the head when in the sun she has had no further headaches. She still feels weak, but nowhere near as extreme as before.

Her emotional state and mood are very good. She is hardly irritable or angry any more.

She still complains of constipation, having a bowel movement only every two days and needing to strain.

The patient's last period was on 18 May 2012; the bleeding lasted 3 days and was rather light. On the second day of the period she had mild lower abdominal pain, but less severe than before. The menstrual problems and the extremely heavy bleeding have therefore improved.

She reports that she dreamed of her family, of daily life and of travelling; the dreams left her with a good feeling. She had no more nightmares.

Overall her complaints have improved markedly. Remaining are a slight weakness, attributable to the fact that the patient is now walking more and is not accustomed to it, and constipation.

Prescription: Kali carbonicum LM8

Follow-up on 20 October 2012

The patient is much better. Two days ago her platelets were 378,000 per microlitre. She is happy that her counts are progressively recovering, although she is no longer taking corticosteroids.

She still has headaches when she stays in the sun, but these are less severe and occur less frequently.

She no longer has constipation; she has daily bowel movements and passes stool without difficulty.

Her last period lasted 4 days and the bleeding was moderate. On the second day she had mild lower abdominal pain, which she found tolerable.

The patient reports that she has not had any more spots on the skin for some time.

In general she is well; she has no problems at school. She reports that she is hardly ever irritable or angry now and gets on splendidly with her family. She says she is about 60% better.

Prescription: Kali carbonicum LM8

The patient's mother suffers from the same illness as her daughter and is now also being treated in our clinic ‘The Other Song’.

Summary of the patient's blood counts

Discussion and conclusion

In conventional medicine the therapeutic options for ITP are limited: mainly glucocorticoids and IVIG therapy (intravenous immunoglobulin) are used. Other options include steroids, immunosuppressive drugs and splenectomy — therapies that may be contraindicated because of potential side effects. The adverse effects of corticosteroid therapy are well known: osteoporosis, glaucoma, cataracts, muscle wasting and increased infection risk. Immunosuppressive treatment and splenectomy add immune weakness, increased infection risk and sepsis. (http://emedicine.medscape.com/article/779545-medication)

Our patient had already been taking glucocorticoids for four years. Would it have been ethically acceptable to subject a young woman of her age to treatment that can have partly severe and irreversible side effects and would have further increased the burden on the patient in addition to her serious illness? Are there alternatives? In this case homeopathy proved to be the right therapeutic approach. A simple, gentle healing method with no unwanted side effects that helped the patient recover on a holistic level — physically and emotionally. Remarkable results like this strengthen our patients' confidence in homeopathy and make us homeopaths more self-assured. It reinforces our privilege of repeatedly witnessing the wonderful effects of homeopathy.

At this point the question arises how such results can be achieved consistently. A certain acumen in case-taking is indispensable. As a homeopath one should not only be able to understand what the patient is really trying to say while telling his or her story or the drama of their life, but also to interpret that information correctly.

In the present case the rubrics are expressed very clearly, for example: ‘Desire for company; treats those who approach her badly’. One can only understand this if one learns to read between the lines and to classify what is said correctly. In this patient the symptoms were very striking and became apparent quite quickly.

We must remain flexible in our approaches and act as the case requires. Hahnemann writes in §83 of his Organon of the Healing Art: “This individualising investigation of a case of disease, for which I give only a general direction here and of which the investigator of disease retains only what is applicable to the case before him, demands of the practitioner nothing but freedom from prejudice and sound judgement, attentiveness in observing, and fidelity in recording the picture of the disease.” Hahnemann explicitly states that there can be no rigid, fixed approach to understanding a case. Every case is unique and requires individual consideration. Analysis and evaluation based on the data obtained in the history will vary from case to case.

Here lies the key to success — mastering the different approaches and applying what is right and appropriate for each individual case. After a few years one will find that the different approaches unite into a wonderful whole and, despite their different applications, lead to the same result — to the remedy that fits the patient like a key in a lock.

It is this flexibility that makes us successful and consistently delivers good results. It will give us homeopaths new confidence and motivate us to continue practising our art of healing for the benefit of all humanity.

1. Rubrics from The Complete Repertory, 2012, by Roger van Zandvoort, MacRepertory 8.2.0.1

This case example was originally published on http://theothersong.wordpress.com/ in the newsletter ‘Voice’.

Category: Cases

Keywords: idiopathic thrombocytopenia, irritable from noises, quarrelsome with family, desire for company; dreams of drowning

Remedy: Kali carbonicum