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A Case of Severe Constipation with Colic and Congenital Deformities

Sujata Owens, LCEH (Bom),k RS Hom (NA)

Published in the International Foundation for Homeopathy (IFH) PROCEEDINGS OF THE
1995 PROFESSIONAL CASE CONFERENCE– Small Remedies & Interesting Cases VII

 

Initial Visit
Male
Age 7

Chief Complaints:  History of congenital megacolon, or Hirschsprung’s disease; kidney problems, adhesions; and constipation with colic.

Hirschsprung’s disease is characterized by a congenital absence of autonomic plexuses in the large bowel wall and absence or abnormality of peristalsis in the involved segment, resulting in continuous smooth-muscle spasm and partial o complete obstruction.  Symptoms are obstipation, distention, and vomiting.  The obstipation can lead to toxic enterocolitis, which can be fatal if the condition is not diagnosed and surgically treated.

(His mother talked throughout the interview.  The boy just sat and sucked his thumb the whole time.)

 

Observation: His eyes have a sad look.  He does not smile.  He does not have any desire to talk.  It seems as if he is not interested in anything.  He is a lean and thin boy with an almost malnourished look.

He gets severe, sharp, twisting, and cramping pains in the umbilical regions of his abdomen (3).  His while body becomes rigid with pain.  He may stretch out or hold his knees.  The pain is better from doubling up (digging in the abdomen helped once), and hot baths.  It is aggravated from gentle massage.

He has a sensation as if the anus is closed when it is time to have a bowel movement.

He gets bloated; worse after eating (3).

For the last three years, the pain has recurred every six months.  In the last six months, the frequency has increased to every month, and, in the last month, it has come back every 15 days.  The severity of pain is also increasing.  The pain is so severe that he has to be admitted to the emergency room each time it occurs.

(Even though it sounds as if the pain has a periodicity to it, when questions, it was found not to be so.)

He has bowel movements once a week or less.  Never has a satisfied feeling.  Has to strain.  It is difficult to pass the stool color is white to brown.  Texture is hard and crumbly.  The pain is better after a bowel movement.  He had no bowel movements the first four months of his life.

He vomits three or four hours after each episode of pain.  He vomits undigested food that was eaten as much as six hours before.  Then, the vomit becomes juicy.  The color changes from green to brown.  Dry heaves follow when there is nothing left in the abdomen.

When he was five months old, he underwent the following procedures to correct congenital deformities: exploratory laparotomy, colonic biopsies, and sigmoid colostomy.

When he was ten months old, he underwent a Duhamel pullthrough (surgical repair for the megacolon) and incidental appendectomy.

He has several urinary complaints: sensation of fullness every five minutes (2), frequent urination (2), trouble starting the stream while urinating (1), burning urination (1), wets the bed every night.  An ultrasound shows that he has only one kidney, the right kidney.  It is large to compensate for its being the only one, and it functions normally.

He is exhausted (3).  Feels worse from any activity or work.  Wakes up unrefreshed.

He is below average in school.  It is difficult for him to learn.

He has a nervous habit of sucking his thumb.

His mother says he is satisfied with just sitting around.

It takes a long time for him to open up in front of people, especially strangers.  He loves to have friends to play with.  He looks lively when he is with his friends.  He does not like to be alone.  When his mother has to run some errands, he asks her to leave his sister with him.

He does not like changes in schedules.  He gets anxious about trips, tests, and changes.

He has always been underweight.

He is a quiet, shy boy with very low energy.

Nervous.
Sad; almost depressed.

(I asked about anger.)  His mother says he is not an angry child at all.  He is fairly even-tempered.  Not much excitement either way.

His appetite is poor.  Picky eater.

His tongue has a thin, white coating.

Drinks water or pop, about two ounces each time.  Likes warm drinks (1).

Desires sweets (3), cereals, and salty foods (2).

He is chilly.  His feet get cold easily.

His perspiration is normal.  He sometimes gets severe soaking sweats in the night.

The family history shows nothing significant, except that his father suffers from psoriasis.

I asked his mother the following questions:

  • What does she do during the pain? He is aware and overwhelmed by the pain.  He looks very uncomfortable, and he wants the pain to go away.  He never faints.  He screams and yells, wanting us to do something to stop the pain.  His face becomes pale.  He wants me around the whole time.  He assumes different postures to see if one will make him comfortable.  It is scary to watch him like that, and we bring him to the emergency room.
  • Do you feel he is doing it for the attention? No, that thought never crossed my mind.  The pains are so genuine.
  • How do you see him? Would you tell me more about his personality traits? He is a shy, quiet, and introverted child.  I am afraid of people taking advantage of him.  He does not stand up for himself and his rights.

 

Review of Medical Records

I reviewed his medical records starting in October 1983 (when the surgical pullthrough was done).  I did not find anything significant until July 6, 1988.  On that date he was admitted for the first time to the emergency room for abdominal pain.  He was diagnosed with partial small bowel obstruction secondary to adhesions, given IV hydration and nasogastric suction, and discharged on July 9.

Another episode of pain and subsequent admission to the emergency room occurred on January 16, 1990.  He was diagnosed with a viral illness and given fluids (antispasmodics and Peptobismol).  The hospital records indicated the following symptoms:  abdominal pain, vomiting, and low-grade fever.  A rectal examination revealed no significant stool in the rectum, no pelvic tenderness, and no apparent mass.

The medical records from a March 12, 1990, episode reveal a differential diagnosis of partial bowel obstruction from adhesions, an upper proximal jejuna obstruction, and pancreatic and gallbladder disease.

They took an ultrasound of his kidneys, ureters, gallbladder, and pancreas.  The ultrasound of his kidneys revealed that the right kidney had compensatory hypertrophy for the absence of the left kidney.  All other tests were normal.  At this point, the hospital decided to do an empirical trial of Flagyl.  They also suggested that a renogram be done to exclude the possibility of ectopically located renal tissue.

 

Maryann Ivons: I think that Aethusa fits this case.  We usually think of it as a diarrhea and colic remedy, but Boericke also says it has “obstinate constipation, feels as if all the bowel action is lost.”  Aethusa is in italics for constipation and in plan type for inactivity of the rectum and abdomen.  Aethusa children can be depressed, quiet, and lonely, and they can have problems with concentration, reading, studying, and confusion before exams.

 

Bob Ullman: I ran a search in Reference Works for megacolon.  The search came up with a single remedy: Thioproperazine, from Julian’s Materia Medica of New Homeopathic Remedies.  His is an antipsychotic drug that seems to have the mental state of the boy, including the sadness, the melancholy, the indifference, the dullness of mind, and the feeling of isolation from the world.  It also has his gastrointestinal symptoms, with hard, pebble-like stools.

 

Barbara Dively: I thought of Alumina because of the nonfunctional aspect of the bowel, and then I thought of Silica because his mother says that he never stands up for himself.  When I look up the symptom, being aggravated along, ameliorated in company (under aversion to company), I saw Alumina silicate, Bismuth, Hepar sulphuris, Phosphoric acid, and Ranunculus bulbosus.  Alumina silicate is also listed under timidity.  It is not listed under twisting pain in the abdomen.  But both Alumina and Silica are listed individually, which gives the possibility of the combination prescription.

 

Kacenka Hruby: One remedy to consider is Ptelea.  It has atonic states of the stomach and pain at the umbilicus that feels better from pressure.  It also has languor and a disinclination to mental work.  I was also beginning to look at Plumbum, because of the muscular atrophy.  Plumbum can certainly have depression.  There is probably more about his mental state that would fit.  And Plumbum matches the colic and umbilical pain.

 

Case Analysis

In studying the case, I systematically considered three areas of symptomatology: the mentals, the physical generals, and the physical particulars of the pathology.

Mentals

  • MIND, Exertion, mental, aggravates.
  • MIND, Sadness, mental depression, waking, on.
  • MIND, Timidity, public, about appearing in.
  • MIND, Anticipation, complaints from.
  • MIND, Company, desire for.

Physical Generals

  • GENERALITIES, Heat, vital, lack of.
  • STOMACH, Desires, sweets, salt, and.
  • STOMACH, Appetite, diminished.
  • GENERALITIES, Exertion, physical, aggravates.
  • GENERALITIES, Sluggishness of the boy.
  • GENERALITIES, Emaciation.

Abdominal and Urinary Tract Symptoms

  • ABDOMEN, Pain, cramping, constipation, during.
  • RECTUM, Constipation, children, in.
  • RECTUM, Constipation, chronic.
  • RECTUM, Constipation, contraction spasmodic of anus, with.
  • RECTUM, Constipation, difficult stool.
  • RECTUM, Constipation, insufficient, incomplete, unsatisfactory stools.
  • ABDOMEN, Distention, eating, after.
  • ABDOMEN, Pain, twisting, pressure, firm, ameliorates.
  • BLADDER, Fullness, sensation of.
  • BLADDER, Urination, frequent.
  • BALDDER, Urination, involuntary.

Having chosen thee rubrics for the case, I used the MacRepertory program to analyze them (Figure 1).

 

Remedy Differential

Several remedies came to mind while I was observing this boy and then studying his case:  Plumbum, Nux vomica, Colocynthis, Platina, Nux moschata, and Opium.

Nux vomica and Colocynthis had been prescribed earlier by another homeopathy.  They did not help, so I decided to rule out these two remedies.

Platina was easy to rule out because the patient does not show any arrogance, pride, or overestimation of self.  The mental symptoms in this case also do not match the Platina picture very well, although the abdominal pains do.

{insert MacRepertory info}

 

Figure 1
Graph Analysis of Boy’s Case

Both Nux moschata and Plumbum people are chilly and better from warmth.  But my patient does not have the irresistible drowsiness observed in Nux moschata patients; rather, he seems sluggish.  While in pain, instead of having the inclination to faint as do Nux moschata patients, he has the stretching and rigid abdomen characteristic of Plumbum.

The most difficult differential was the Opium, even though it does not score as well in the computer analysis.  Opium’s primary action is painlessness, but in the secondary action we find a sensitivity and reactivity to pain that is similar to this case.  Opium has the following symptoms: hyperesthesia during pain, other times anesthesia; stretching and throwing off of extremities during pain; all senses acute during pain, otherwise dullness; wants nothing and says nothing; a dulled state of mind; and a drowsy, stuporous state and staring eyes without much reaction.  And, of course, the boy’s constipation and type of stools strongly suggest Opium.

However, Opium people are usually hot and desire cold.  This patient is chilly, and he loves warm baths.  In Opium we see a tendency to lie and steal and we find it in the rubric.  Want of moral feeling.  He does not seem to have this tendency, nor does have Opium’s euphoric state, history of right or head injury, aversion to company, and tendency to faint with pain.

Finally, when I read in J. T. Kent’s material medica that constipation with no urge indicates Opium but that constipation and colic indicate Plumbum, I made up my mind to give Plumbum.

Plan: Plumbum metallicum 200c, single dose.

 

Follow-Up

July 7, 1990

Excellent results.  Eighty percent improvement.  His mother just can’t believe what a single dose of the remedy has done.  She is thrilled and wants to bring her whole family for treatment.

He is energetic and talkative.

He is mentally alert for the first time in his life.

He has been cleaning his own room and playing with friends.

He has at least one, sometimes two or three bowel movements every day.   They are brown, malodorous, and well-formed to soft.

No pains.  He used to have an episode of pain every 4th of July for the last three years, but not this year.

No episodes of vomiting.

His appetite is good.  He is interested in trying new foods.  He used to be a very picky eater.  Now he has been eating soups and certain vegetables.  His craving for sweets has lessened.

Has stopped wetting the bed.

No burning pains during urination.

Assessment: The remedy is the right one.

Plan: 1.  Wait
2.   Report immediately if pains in the abdomen recur.
3.  Keep close watch; it is too soon to be excited.

 

December 4, 1990

Observation: I am amazed to see him.  What a change of personality!  In front of me is a boy who has grown tall and has put on weight.  He is acting mature and self-confident.  No thumb sucking in the office.  I could see he is not content to sit around.  He is interested in life again.  His mother is totally pleased with the wonderful, positive changes she has seen in him.  He is mentally alert in the interview, answering my questions satisfactory.

Not a single episode of pain.

His bowel movements are regular and satisfactory.  At times, his stools are hard.  His mother then gives him more fiber and he is fine.

Hates taking a bath.

Kicks off the covers.  Perspires in the bed.  The perspiration has a strong smell.  (Significant change in thermal modality.  He is definitely hot now.)

He has a deep, loud cough with loose, profuse expectoration.  Offensive.  It is worse at night.

He has a strong sensitivity to sulphur.  Feels worse front orange juice, pop, and dried fruit.

Profuse urination.  No bed-wetting.

Plan: 1.  No remedy
2.  Increase dosage of vitamin C.
3.  Call immediately if abdominal pain comes back.

 

Long-Term

I was able to observe him after this, because I was treating other family members.  He would come with them.  He kept on doing well.  His cough resolved within a week, and the pain never came back.  He continues to do well.

 

Materia Medica on Plumbum

I referred to materiae medicae by Tyler, Clarke, Kent, and Sankaran to help me understand Plumbum metallicum in more detail, and I would like to share what I learned with you.

Typically, we see a boat-shaped abdomen that gives the impression that the umbilicus is being drawn back to the spine.   The abdominal area can be hard as a stone and extremely painful.  The patient may roll on the ground, violently pressing the abdomen.

Plumbum patients have intolerable pain from spasms of the rectum.  There is a horrible sense of constriction and contraction in the rectum.  The patient bends backwards as do Dioscorea patients (opposite to Colocynthis).  But Clarke says that the colic of Plumbum is ameliorated by doubling over and by stretching the limbs. Clarke further adds that we observe spasms of the bladder and uterus and also emaciation.

Kent describes the inclination to deceive like Tarentula in addition to the sadness and timidity that is normally observed.  My patient did not have this deceptive quality.

The course of Plumbum symptoms is slow, gradual, or insidious.  Kent also says that we should consider Plumbum for all obstructions of bowels that do not have a mechanical cause.  Constipation with colic and colic with constipation strongly suggest Plumbum.

Sluggishness is everywhere.  The patient is made worse from engaging in any activity – mental or physical.  The patient can strain during a stool, but the rectum is in a state of paresis and cannot expel the feces.

In the acute state we have the fever, colic, sudden constipation, tearing pains in the intestines, and the indigestion with vomiting.  This is the state that we observed in my patient.

The mental, emotional, and head symptoms are aggravated by any exertion, especially exertion in the open air.  Patients are cold, emaciated, and need warm clothing over the body but not around the head.

Rajan Sankaran describes Plumbum patients as being high achievers who need to be in the highest position.  They are afraid of being assassinated, and they have a suicidal disposition in extreme situations.  They feel alone and, therefore, desire company.

 

Daniel Heller: Some teachers of homeopathy stress the importance of selecting only a few symptoms and rubrics for repertorizing so that they can analyze only the most important elements of the case.  You used 22 rubrics.  Would you comment on that, given that your choice of rubrics seemed important in arriving at the remedy for the case?

 

Owens: I was already thinking of Plumbum.  So, I used the fact that it came up so strongly in such a large totality analysis as a confirmation for the prescription.  I felt that I couldn’t go wrong.  Of course, you can select only a few symptoms and be successful.

 

Michael Thompson: I think Daniel has a point.  It seems that the physical symptoms were the most characteristic symptoms, and that’s where the emphasis for the differentiation lay.

Owens: Yes.  But his mental and emotional states also matched Plumbum.

Laura Shelton: What did Plumbum do?  Did it case the body to suddenly grow an automatic ganglion (laughter)?

 

Owens: I believe that the “imprint” of the Hirschsprung’s disease remained in the boy’s vital force after the surgical correction.  The surgery certainly did fix the mechanical problem, but the “memory” of it remained on a more subtle level.  In this sense, I view the surgery as suppressive.

The Plumbum acted on that memory, on that more subtle level.  That’s what was needed.  The workups the boy received never found anything wrong, no obstruction.

Your question brings up the general questions, of course, as to how our remedies do such excellent work.  I believe it is because they act on that subtle level.  This is the place we need to touch with our treatment, with the simillimum.  Once we do, we see curative results like this.

Sujata Owens, RSHom(NA), CCH, HMC
Vital Force Consulting, Inc.
101 5th Street East
Northfield MN 55057
(507) 645-4329
vfc@vitalforceconsulting.com

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