A Case of Crohn’s Disease and its Etiology
Volume 18 of American Homeopath, published 2012
By Samantha Spencley, BA Hons, DSHomMed, RHN
Initial Appointment, June 26 2010:
The patient was a 38-year-old male, lean, of average height, with strawberry blond hair and blue eyes. He was a referral from another patient, and had come in from a small town west of Toronto to meet with me, because his situation was getting desperate. His chief complaint was that he had been having symptoms of Crohn’s Disease since 2005, having had an appendectomy that year and a bowel resection in 2006 in order to have some relief. As the interview went on, his etiology became more and more apparent as the culprit of his pain and discomfort. At the time of taking this case I was freshly graduated from the Canadian College of Homeopathic Medicine, with my ceremony only days away. This was a fantastic case to be challenged with so early on in my career. I should mention that this was the second time we had attempted to have an appointment, the first time being cancelled by his wife because he was taken to the hospital due to his attacks, needing emergency care.
The patient said that his abdominal pain started after a car accident in 2005, and afterward he was having one attack a week until he was diagnosed with an erupting appendix. It was removed in 2005, but unfortunately this did not give him any relief from the abdominal pain, and he continued to have cramping and vomiting after the surgery.
After testing that same year, it was decided that three feet of his intestines needed to be removed due to adipose tissue discovered within. He says he felt great for the first two years after the removal, believing that he had been cured. But the pain and discomfort started up again in 2008, and he had not been able to find relief since. Because of the immense pain, he was told by his doctors that the next step would be an immune suppressant drug and that he and his wife would have a hard time conceiving once he was on the drug. As this was a lot of information full of life-changing decisions, he decided to seek alternative methods, thus coming to me. At the time of our meeting he had a new baby boy and he and his wife were trying for their second due to the looming possibility that he may have to go on the drug. He also told me that in 2007 he and his wife lost their first child at 27 weeks gestation and that he hasn’t been able to get over it. He thinks of the baby daily; even TV commercials can still make him misty and sentimental when normally they wouldn’t. I noticed that, although he said that he is sentimental about her memory he never wavered in his emotions while speaking about her.
What he desired seemed impossible - to be without pain after five years and not have to go on the drugs. He understood that the immune suppressant drug would diminish his resistance to illness and it would lessen their chances of conceiving.
When I asked him if he knew when the abdominal symptoms started, he got very animated, sat up straight and looked me directly in the eyes. While I was in school we were always told to pay close attention when the patient gets excited or intense while talking, but it’s always interesting when it happens to you as the practitioner for the first time. He said it all started when he was living in the Caribbean with his wife and he decided to go out for a night with friends to a local bar. He was too intoxicated to drive home so he called her for a ride. On the way home they got into an accident when a truck going 100km/hour hit them head on. He and his wife had to be cut out of the car. She was unharmed, but he had a broken pelvis, broken ankles and bruised internal organs. It was at this point in the story that he said he felt guilt for putting his wife in the situation because he chose to drink. He also said that he still felt a lot of anger towards the truck driver, which was clearly seen on his face while telling the story. While he spoke, I could see that the situation was still as fresh in his mind as the night it happened. Even my notes were untidy as observing him was so intense that I wasn’t able to take moments to look down as I wrote. It was clear to me that I needed to give the most importance to this anger and guilt from this time period in his life. Lastly he said, “I keep telling the doctors it’s since the accident but they don’t believe me,” proving that this moment in his life was the trauma that started his physical symptoms and that homeopathy is the best solution as his etiology is so clear.
His medical history included hay fever; symptoms that he had as a child until adulthood, when he and his wife moved to the Caribbean, and which seemed to stop once he moved to the new climate. Since he returned to Canada, his symptoms had never returned. He had chicken pox at five years old, and repeated throat infections leading to his tonsils being removed when he was eight years old.
He said he felt stress mainly in his shoulders, neck and his stomach, that he hated his job as a fork lift driver in a freezer and he was in school getting his real estate agent licence. He said he generally keeps to himself at work. He loves pop and cold drinks, dislikes hot drinks; he loves spicy foods, salt, pasta, pizza, steak and seafood. He will eat soup but not by choice. He loves the sun, and oscillating air, thunderstorms and cool rooms, disliking rainy days. He perspires on his back and forehead. He sleeps on his back to his side and wakes on his stomach; he kicks and moves a lot during his sleep. He can tend to startle himself awake, never remembers his dreams and he’s been told by his dentist that he grinds his teeth although he is symptom free. His urine is cloudy in the morning.
He described himself as curious, compassionate and opinionated. He said he had been weeping more since the loss of his baby, unsure if the grief counselling he did after her death even helped. He said he gets irritated with dumb people and those who don’t have common courtesy for others; he can tend to have minor road rage. As he spoke of his symptoms, he would lecture about each situation and give detailed examples in his life, of people at work and on the roads. His irritation about the situations was clear as he spoke with more intensity and emphasis, making direct eye contact and sitting up straight. He said that he had a lot of resentment about the car accident, and that if he could have, he would have beaten the driver of the truck that hit their car. He said he had no closure from the situation and he was still angry about it. He also told me that he was angry about the loss of the baby; it didn’t seem fair for her to be taken from them. Because of the loss, he is now fearful of losing his baby son and feels he needs to be protecting him. He said that he takes offense at everything; he’s sensitive to criticism, intended or unintended and has always been like that. He will shut down and flee a situation if he feels under attack. He is on some prescription medication and is unsure if there are any adverse effects.
Never well since anger/vexation/guilt
Death of a child
Pain, right hypochondriac, sensation of twisting
Pain is 9-10 intensity with each attack
Vomiting, only during attacks
Stool, can be constipated with the sensation of a plug in the rectum; can have diarrhoea
Explosive stool, 4-5 times daily
Rectal fissures and bleeding, itchy
< from salad, corn, peanuts, celery, beer, steak, sausage
< exercising, abdominal muscle exercises
Stomach, vomiting, eating, after, agg.
Stomach, pain, cramping
Stool, forcible, sudden, gushing
I chose to not find smaller rubrics for the physical symptoms for two reasons: firstly because the smaller rubrics were too specific and none of them were equal to what he was experiencing. Secondly, the main symptom was the etiology and I didn’t want to loose sight of the fact that the mental/emotional symptoms were the most important in this case, even though the physical symptoms were the chief complaints.
Mind, ailments from, grief
Mind, ailments from, anger
Mind, reproaching oneself
Mind, restless, bed, tossing about in
Mind, offended, easily
I chose these rubrics as they capture the essence of this case: his anger and guilt about the car accident and the anger about the later loss of his child. The restlessness in bed also seemed very intense, since he couldn’t remember his dreams and yet he said that he could kick his wife while asleep. He was also experiencing bruxism, which meant that something was bothering him while he slept and it was intense enough that at times his wife would have to wake him for him to stop. I added the “easily offended” rubric because of the intensity with which he lectured about people in general: driving, at work, how they are rude, his resentment towards the truck driver and the fact that he said he’s always been like that, sensitive to criticism and takes offense easily. I didn’t add the obvious rubric of “Mind, ailments, death of a child,” because I knew what remedies were in it and figured I’d just cross reference those remedies with what came up from other symptoms.
History of hay fever
Cramping, worse from eating
Vomiting and diarrhea
Prefers cold drinks
Restless at night
Ailments from anger
History of hay fever
Restless at night
Prefers cold drinks
Vomiting and diarrhea
Never well since anger
Ailments from death of a child
Anger at others for their problems
Ailments from grief
Dwells on past events
History of hay fever
Dislikes hot drinks, prefers cold
Vomiting and diarrhoea after certain foods, e.g. farinaceous
Desires salty foods
As Ignatia is the acute of Nat-m and it is also more expressive of its anger and grief, I didn’t feel that this was a good fit for him. He was more closed and less expressive, more like a Nat-m would be as opposed to anIgnatia. An Ignatia would have been crying in my office that day, and although he had many reasons to be, he was not.
Although Arsenicum and Nux-v seemed to be matches, rather than Nat-m, since it is keynoted to be more constipated than loose, it was the intensity of the etiology that I needed to prescribe on, as that was my guiding symptom; the dwelling, anger, old offenses and the loss of his child were of most value in this case. I feared that if I got too caught up in the physicals then I would have missed the opportunity to really see some change for him.
I gave him Nat-mur 200, one pellet dry, one dose. It was the third on my repertorisation chart, but I felt I had to look at this case as a true “never well since” situation, as the patient was adamant that he had never been well since his car accident.
First Follow Up, July 23, 2010:
The patient came for his first follow up one month later, bright and smiling. He said he had no symptoms for the first time in years: no cramping, no twisting, no vomiting, and no signs of being sick. His pain went from 9-10 intensity to 0. His stool was no longer explosive; it could be loose but wasn’t diarrheal, and could now have a “finished” feeling. He’s having stool 2-3 times daily, where it had been 4-5 times daily before the remedy.
He’s been able to drink beer without complication, but the biggest shift was that he took himself off his medications (his choice, not by my suggestion) and cancelled his appointment with his gastrologist! I asked him how he knew that it was the remedy and not just his body or the drugs he had been on for years. He said he knew it was the remedy because he re-dosed himself on July 2, when his symptoms started to act up again. I had not advised him to do so, but he said he knew the remedy had an effect so he didn’t want to waste time or be in pain, so he just took another dose. He said his symptoms were triggered by stress from his real estate exam and his wife miscarried again the same week. He started to cramp so he re-dosed, and felt better right away. He said that he was able to handle the news of the miscarriage better after the remedy. His sleep has been calmer; his wife hasn’t mentioned him kicking her at night.
Curiously though, he had a new symptom of headaches: no etiology, tender to the touch, occipital, worse on the left side, better from sleep, feels like a knife stabbing. Since Nat-m has occipital headaches, this was something I wanted to watch, in case he was over stimulating himself and the headaches were a proving symptom for him. I advised him to call me at the first sign of any symptoms, as the stress from the miscarriage and test may have been the catalyst for his re-dosing and this may not continue to be an issue this month. The holding power from the first dose to the second seems to be related to his stress levels. He was seven days without symptoms after the first dose and then re-dosed himself. This has now held for twenty days and is still holding, as he wasn’t showing any signs of relapsing at this time. Watch and wait seemed to be the best option at this time.
Second Follow Up, August 21, 2010:
The patient re-dosed himself again on August 19, saying that he was having another attack and it was the first one since the last time he re-dosed himself. He said this attack was extremely intense and in the past, would have sent him to the hospital. He said everything was perfect up until that day, and he wasn’t sure what triggered the attack. It is clear too that there is a correlation between his stomach and his emotions, so it’s possible that he’s not equating emotional stresses in his life as triggers for his pains. I asked about his headaches and he said he hasn’t had any since. His had not been kicking in his sleep, he’s still able to enjoy a beer every now and then and he is still having cloudy urine in the morning upon rising. One thing he mentioned is that he had a massage and the oils may have been pungent, and possibly antidoted him. For this reason I wanted to watch and wait again.
Third Follow Up, September 18, 2010:
The patient again re-dosed himself the week before, and clearly we should have been shortening our follow up time frame, but I’m pleased that he was listening to his body. He said the cramping was less intense this time, 4 out of 10, unlike the last months, which were a 9. The symptoms were gone by that night. He was able to eat corn on the cob, something he hasn’t been able to enjoy for years. He said he was still more restful at night, no longer startling himself awake and he had no headaches to speak of. He wasn’t sure about his urine this time, which could be a sign that it is shifting. At this point, because he was managing his own symptoms with the Nat-m 200, I felt it best for him to call me when he needed me or when new symptoms appeared.
Patient Phone Call, September 23, 2010:
I got a frantic phone call from the patient, who was driving to the cottage for a weekend getaway. He was suddenly having hay fever symptoms, which he had not had since he moved to the Caribbean in 2003. What an awesome turn of events! Of course I was excited that old symptoms were returning, but he was not amused. I asked if he had his remedy with him and he said he didn’t, which tells me how confident he was in his body. I told him to do what he had to in order to be comfortable while away and told him to call me when he returned when we would work it out.
Fourth Follow Up, September 27, 2010:
The patient had purchased a vial of Nat-m 200 when he returned from his getaway and when I asked if he had to re-dose the week before, which seemed to be his pattern, he said he didn’t. He hadn’t had any cramping or diarrhoea since the last dose in mid-August, indicating to me that the remedy is having a better holding power. But of course it was the return of the hay fever that I was most interested in. He had to use Reactin to get through his vacation and it turned into a cold, which he was in the tail end of at the time of our appointment. The cold symptoms were: thick and yellowish discharge, gooey and stringy, worse at night; a cough that was productive with yellow discharge in balls and semi solid. I suggested some Kali-bi as I had seen this acute already this season and it was not responding to Pulsatilla at all.
Fifth Follow Up, October 26, 2010:
The client had some cramping due to stress from work on October 2 and had re-dosed himself. He had become angry, feeling that he wasn’t being listened to, and started to react, so he re-dosed and the anger dissipated later that morning. He decided to take a parental leave, feeling that the stress from work was making him sick. He said he has been able to drink eight beers without abdominal symptoms, but his hangover is another situation. It’s interesting when patients start to push the boundaries of their bodies after they begin to feel better. As a new practitioner at the time, I wasn’t sure what to make of it or how to request him not to drink until drunkenness, as he was so excited to even be able to drink at all. He had also been eating spicy foods without problems. His allergies had ended for the season, but we would expect them to return in the spring. He hadn’t had any headaches and his sleep was better: still no kicking. His urine wasn’t cloudy any longer and he had finished his last test for real estate school. He was now home with his son and he and his wife were trying again for another pregnancy. He had also started running again and set a race goal of a 10km run. Again, watch and wait.
Sixth Follow Up, December 28, 2010:
The patient had gastric flu and spent a day in the hospital with dehydration the week before our appointment. Yet he hadn’t re-dosed himself since October 2, and said it was clearly an acute because others around him had the same symptoms. Since October 2 he hasn’t had any attacks, no headaches, and no kicking during sleep. He has since been able to eat peanuts and salad without pain, which was not the case before. His wife is 12 weeks pregnant. They both got their flu shot this season. He is managing his abdominal pain well and seems to be able to eat foods that he couldn’t before the remedy. Follow up again in the spring.
Seventh Follow Up, March 7, 2011:
He recently became a licensed real estate agent and sold his first home yesterday. He re-dosed himself on January 11, due to the stress from writing his real estate exam, and again on February 20. All his cramping was relieved within an hour. He’s still eating foods he never would have attempted before and is looking forward to becoming a father again. At this point, I asked for him to call me when allergy season starts for him.
Eighth Follow Up, May 25, 2011:
I spoke with the patient over the phone, as we were expecting his allergies to flare up over the spring, yet there was nothing to speak of. He has not re-dosed himself since February 20, 2011. He’s had “twinges,” but none of the real cramping he was used to and he is able to handle it on his own. I pointed out to him that we’ve been working on these symptoms for 11 months now and he was amazed at the change in his body and lifestyle and what he’s accomplished over this period. With his new baby on the way, a more comfortable stomach and a newfound method for healthcare, my patient was telling his family and friends about his new respect for homeopathy and encouraging them to try it for themselves, asking if I knew practitioners closer to his hometown for them to be assisted with.
It is now February 2012, and I hear from this patient every few months with symptoms mainly relating to acute issues. His daughter was born last summer and he was suffering from lack of sleep. This past fall he lost his mother to a chronic disease, when he needed treatment for grief. He is still challenged at times by his grief for his lost daughter, but the concerns are never about his stomach anymore and he’s come to forgive himself for the accident that started all of this turmoil. He and I continue to work on his grief. Nat-m has enabled him to make great strides in his ability to deal with his loss. During our last appointment we discussed his next steps in his grieving process, as he actually cried on the phone with me for the first time while telling me that he has begun to make a new marker for his daughter’s grave. He says he never thought he could have done it, as it hurt too much to think of her; now he’s taking pride in nailing the wood together and putting on a second coat of paint with her name on it.
Samantha Spencley, BA Hons, DSHomMed, R.H.N, has been studying and practicing classical homeopathy for five years. A former performer, she became interested in homeopathy when it helped her to conceive her beautiful son. She attended the Canadian College of Homeopathic Medicine and has studied with, and continues to be inspired by, William Ellwood, among others. Samantha is also a holistic nutritionist. She has a private practice in Toronto ON and can be reached at [email protected], www.inthehousehomeopathy.com
When I asked him if he knew when the abdominal symptoms started he got very animated, sat up straight and looked me directly in the eyes.
“I keep telling the doctors it’s since the accident but they don’t believe me.”
He had no symptoms for the first time in years.
…he has begun to make a new marker for his daughter’s grave.