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My eyes are as open as a fish's - a boxfish(1) case

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The patient is a nine-year-old boy whose main symptoms are insomnia, anxiety and bad breath (his mother's main concern). He is a stocky boy with very short brown-blond hair, very pale skin and a round face. In the consultation he sits hunched on his chair; he moves slowly. His voice is monotonous and sometimes mumbled. He enjoys words and wordplay, e.g. he refers to his prominent upper incisor as his "dental chaos".
 
He has a stiff, detached facial expression; although he is very intelligent, he seems somewhat absent-minded or lost in thought. By nature he is a loner who likes to sit alone at home for hours at the computer or read or draw. At breaktimes at school he often does not feel like playing with the other children. Instead he repeatedly walks around a tree and thinks. However, he becomes angry easily. If another child bumps him (accidentally or deliberately), he can become very angry, may attack and give out blows.
 
When he was a baby he developed a rash on the right side and arm that looks like impetigo. It is uneven, red, inflamed and hot. It breaks out when he eats too much sugar. For years the itchy rash has recurred. In most sports he is clumsy and ungainly; although he "runs", he is often the slowest in the group. His mother describes him as a "water baby": from an early age he always liked being in the water and could stay there for hours. He is however not a good swimmer; he is quite content to just paddle about. At home he could lie in the bath for hours.

 

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I took the case in October 2011. I have highlighted the most important parts of the case.
 

Are you anxious?
Patient (P): "I sometimes have stomach trouble, mostly at the beginning of September. I think I had it last year too. My stomach throbs. I wake up in the morning with it – I feel a bit sick and my stomach turns. It happens every few weeks; sometimes I'm sick for a few days." Mother: "He feels ill and vomits. It started when he was in Year 3 – it came out of nowhere."

 
So you don't go to school then?
P: "No".
 

How is it at school?
P: "I'd say it's stressful. I always have to remember to bring my planner home. There's a lot of spelling homework. That takes up a big part of my time. I'd much rather play Minecraft (2)."

 
Do you get upset at school?
P: "A few weeks ago a fuse blew in me at school. It was like I was about to start sobbing quietly. I was angry, hungry and frustrated. Also it was in French class. I don't even know what 'les' means!"
Mother: "When I come to pick him up and ask: 'How was your day?' he answers: 'Lame and boring.'".
 
What do you do at breaktimes?
P: "Mostly I walk around and think about different things, like designing indie games. I walk round the trees until I get dizzy or my feet are tired. The others all play tag."
 

Don't you like that?
P: "Not really. Strategic games aren't my strength. I can't run that fast. I can hardly remember the rules of the sports games from Year Two!"

 

Do you sleep well?
P: "I only fall asleep after two hours in bed. I feel like a fish – you know that fish don't have eyelids. It's as if I lie in bed with my eyes open. That's pretty frustrating. I sleep on my side. I just can't lie still. I tell myself: 'Now go to sleep!', but instead I toss and turn in bed... I go to bed between 9:00 and 9:08 pm. The last time I looked at the clock it was 11:17 pm. I think I fell asleep at 11:42 pm... at about 6:17 in the morning I open my eyes again. Then I bury my face in the pillows for an hour and 18 minutes and toss and turn."

 
Do you sometimes have nightmares?
P: "The range varies and I hardly have time to sleep because my eyes are open like a fish's."
 
Would any particular fish do?
P: "Most likely a boxfish.

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What kind of fish is that?
P: "They cut through the water with ease – that's all the OWL magazine (3) says about them. A company designed a car that has a similar shape."
Analysis
 
The patient's loner nature, his intelligence and his love of water (simply to swim and paddle), combined with his own description of himself as a fish, immediately led me to a fish remedy. Later, when I looked up "boxfish", I found the yellow boxfish: this is the fish Mercedes used as a model for one of its car designs.

However, since the remedy is not commercially available, I had to obtain such a fish and prepare a triturate.
 

Prescription: daily probiotic remedies. Once I have produced it: Ostracion cubicus C 4.

 
 
Follow-ups
 
On 6 December 2011 I phoned the patient's mother: "There has already been a change in his mood: he is much more relaxed and talkative. He is more open and seeks conversation with us, no longer so distant or uninterested. We haven't had a single quarrel since he was with you. Before bedtime he is no longer so irritable. I say: 'It's bedtime', and he goes to bed willingly. There is no anxiety and no insomnia any more! His breathing is also fine now. It cleared up almost immediately after starting the probiotic treatment."
 
The patient remained symptom-free until the first week of January. It was the day before school resumed after the Christmas holidays, and the anxiety symptoms returned in full. His mother, expecting a sleepless night, gave him a dose of Ostracion cubicus C 4. He fell asleep within 10–15 minutes, and the next day he was fine and was able to go to school without problems.
 
27 March 2013: over the past year the patient repeatedly suffered from a perioral rash: very red, itchy and stinging. It is a large rash, so that his mouth almost looks like a clown's. Apart from the rash everything is fine. As a result of a misunderstanding – I thought his mother had given him the C 30 of his remedy that I had provided and nothing had happened – I believed it was time to switch to a new remedy.
 
Prescription: Neon C 200 single dose
 
April 2013: message from the patient's mother: "No change with Neon C 200, but I gave him a dose of his remedy Ostracion cubicus C 4, and the next day it was 50% better!"
 
Since then the mother has given him his remedy several more times, and each time everything improved immediately.
 
Recently he received the C 30, which produced a very rapid reaction: within a few hours the rash began to disappear.
 
**************************************************************************
(1) Ostracion cubicus
(2) Minecraft is an indie open-world game developed by the Swedish programmer Markus Notch Persson.
(3) Outdoors and Wild Life, Canadian children's magazine
 
Photo: shutterstock.com
 

Category: Cases
Keywords: insomnia, temperament, anger, wandering, impetigo, water, vomiting with anxiety, boxfish.
Remedy: Ostracion cubicus

Pascaline Phillips