A case of autoimmune arthritis treated with Magnesium Silicata
Dr. Rajan Sankaran MD Hom
Dr. Meghna Shah BHMS, FCAH
Edited by- Dr. Alifiya Dedanwala, Publications Team.
(This case has been published in Dr. Sankaran’s Book Structure)
A 20 year old girl studying medicine consulted Dr. Sankaran on 21 December 2006 with the sudden appearance of rashes accompanied with joint pains (poly arthritis) for the past 20 days. But there was no improvement with anti-allergens.
The physician advised her to have an ANA test and ESR. He suspected an auto immune disorder. The ESR was 89 and ANA was negative.
She had a history of asthma from 2002 to 2003 and recently she has started coughing again. The main modality for all of her problems is: worse before exams.
(The abbreviations D= Doctor, P=Patient)
Her case further interview as follows:
P: I cannot study because of the rashes. Feel very tensed. Exams are nearing. If I don’t complete my portion I will fail. And then I will be away from my friends. Will be totally isolated. Very scared of being away from my friends. Then I won’t be able to relate to them.
Always think ‘What will people think of me? What impression they will have of me?’ I am very judgmental. So even people are going to be judgmental of me.
Need friends to share secrets. Tell them everything. Somebody to listen to me, somebody to support me. I know that she will be there for me whenever I need her. Understands me and relates to me. Don’t feel alone. Even if I fail they will consider me a part of them. Part of their life. You become a part of them and they are part of you. There is somebody who can also be like me.
Lost, isolated. All of them together and you are alone. I’ll be completely lost.
Dreams: She dreams of ghosts and describes a dream of her mother on her death bed:
P: Most scariest. Feel very helpless (Hand gesture). What will I do without her? She is the pillar of my life. She knows me so well, knows me in and out. She is responsible for what I am right now. (She weeps.)
Need her for everything, for emotional support. She is very possessive about me. Cannot imagine my life without her.
Cold palms and soles
Cold finger tips
Cough < before exams ++
Remedy: 1M single dose.
Within a month her ESR dropped down to 35 and subsequently the rashes and joint pains were completely better. Her anxiety before examinations and her level of confidence is quite better than before.
(* Since the case had a dramatic improvement, it became significant from the learning point of view)
D: Basically we are recording to learn from whatever is happened.
You recall when you came to me first time and all you complaints at that time.
P: The first time I came here was more than 1 year back might be around 1 ½ years. That time I had these joint pains and rashes which had appeared just when my final exams had started, they were constant throughout the day and I had gone to allopathic doctor before that who told me. I had allergic arthralgia and after that he himself told me to come to homoeopath, so I came to you and I showed you all my report and I started your medication and within 2-3 months my joint pains had all gone. I mean rashes also appearing and both of them disappeared together. (HG) since then I have not had any episode of that. I guess you told me probably it must be stress and right now nothing at all.
D: You said you ESR had also raised.
P: Ya ESR had raised it was 96 and now it is 26.
D: So, tell me what was your stress at that time?
P: Mainly exam stress.
D: Can you tell little bit more about this stress.
P: I thought I was not well prepared, throughout the year. I had studied but not as much as I should have in the end it all precipitated (HG). Finally I thought I would fail. I didn’t get the confidence to appear for my exam and when I went to stay at Thane because my exams were in …… First 2 or 3 days I was fine but suddenly all of a sudden joint pains have started then I had a stomach ache and backache, itching all over my body and the rashes appears, after that I took antihistaminic. I had been to hospital locally, after that nothing once medication was started nothing happened.
D: Tell me?
P: About the stress.
D: Tell me you said there was fear to not do well in exam.
D: What was the significance for you, for not doing well in exams? What would it mean for you?
P: Mainly if I wouldn’t have done well my parents would have been annoyed, secondly I would have not been with my friends, next thing would be in odd batch means 6 months behind and a new group and people with whom I am not comfortable with, so that mainly.
D: So, tell about that little bit more, new group, not comfortable, tell about that.
P: There are very few people in the odd batch there are 7. In the normal class there are 100 people, in my batch there are 25 people and I talk to all of them so. I always think if I would fail I would have to go to new group and new friends. I know I would somehow be friend’s over period of time but it will be different and I would keep missing my old friends.
D: What would be the feeling to be without your old friends?
P: Missing out all the fun that they are having, not sharing my problems, my secrets and generally not being with them all the time. I know that they are not going to consider me out of the group even if I fail, but the time span I would spend with them would obviously decrease and I would not have that kind of bonding with them.
D: Tell about that kind of bonding?
P: Normally I am the one who is always talking, obviously I listen too, and generally I am very friendly. I mingle well with everyone. If anyone of us has problem they come to me, if I have problem I go to them. We are very good friends and cannot be happy without each other.
D: What would be the feeling to be without friend?
P: It would be horrible. I cannot go to college and be alone. I would not go if I’m alone. There are times when I go alone, but I generally I am accompanied with a group. I don’t want to be alone, I don’t want to feel lonely. I wouldn’t be comfortable like that.
D: Describe the feeling of lonely and alone, how does it feel?
P: It feels as if, I don’t know exactly but, I just feel when I am with my friends. I am very happy. I know that I can be (HG) self sufficient and happy, to my myself too, but when I am put to situation when I could have with my friends but I am not because of certain problems, I have failed or something, then I am uncomfortable. I don’t know how to explain it to you and I know that I am going to be alone, then I set my mind that way that OK I am suppose to be alone. But where I am not suppose to be alone but then I am alone then, then I feel like that.
D: What is the feeling then?
P: I feel incomplete (HG) and very out of space and not good. I don’t know how to describe it.
D: You are doing very well, what is incomplete?
P: Generally I keep imagining (HG) if these people would have not been with me what I would have done. If I would have fail and I would be in such situation then what I would have gone. I don’t know I don’t feel good that way.
D: What is the importance of having friends, what does it give to you, what is friend in other words?
P: Friend is one with whom you share your world with, you share your secret. Your thoughts your life with and you expect the same back, you are dependent, not completely dependent but to an extent dependent on a person and expect the same back.
D: Dependent what way?
P: Emotionally dependent, you know that if that person was not there then, these things which I want to tell that person would have been with me, inside me, I wouldn’t have told it to anybody.
D: You can trust?
P: Ya, the person.
D: Who else is there besides a friend with whom you can have this kind of connection?
P: My mom, I can tell her everything, but she tends to be a little possessive about me but I tell her about everything that is happening in college.
D: What means possessive.
P: She feels, she really doesn’t trust me, trust guys; she feels I am very naïve, very foolish, very stupid, and get into problems very soon and people can put into a trap. She always tells me not to mingle much with guys, friendship is fine. When I tell her something about the things happening in college, she starts assuming that those things are happening with me. For example, if somebody is having relationship with somebody in college, then she would think, probably this is happening with me too. This is a stupid thing to say, once I had been to a palmist long time ago when I was 12 years old. He had told me twice, there will be guy who will ruin your future, he will come into your life, but you have to be careful. Ever since then, my mom has this in her mind that someone is going to ruin my life. So, she wants me to stay away from all and prevent me from getting into that kind of situation.
D: In that situation, with your mother when she is not trusting you, she is possessive about you, what do you feel?
P: I feel I am not getting the kind of freedom, I should get.
D: Describe that freedom.
P: I feel she should be trusting me.
D: What is freedom?
P: Freedom is being with whom I want to be; being with friends. I am not the kind of girl who would want to be in a relationship with anybody. I always have this phobia about relationships. I’d never want to be with anyone, but I want my mom to tell me that its fine if you are going to get into a relationship and not keep these restrictions and prevent me from going.
D: Describe the restriction.
P: Restriction (HG) not going out with somebody alone.
D: What is this you are showing with hand?
P: (HG) I don’t know.
D: Just focus on it little bit more.
P: (HG) this is small world I have.
D: Describe little bit more.
P: (HG) You are suppose to stay inside that way. You are not suppose to go, she never allows me to go outside the house with a guy alone.
D: Describe this little bit more, forget the guy and mom everything, just this much, whatever comes to your mind?
P: Probably my mom wants me to keep (HG) this way, you are here (HG) inside this thing of constriction.
D: What do you experience to be in that?
P: Generally I don’t mind but, I mind it at times, I feel it’s good for me.
D: What do you feel to be within that, how does it feel?
P: Its not a very good a feeling, not very bad also. Somewhere in between I feel it shouldn’t have been that way, but at the same time I feel on probably its good for me also because I am not in situation where I could have ruined my life.
D: If you are not in this way, then what happens, suppose you were to step out then, what will happen?
P: I would not have guidance, I know I can make decisions for myself but probably one wrong decision in life, could take me to a stage where I don’t know, generally a point from where I can’t come back and have to repent to be in that.
D: What will happen in that situation where you can’t come back?
P: It would be horrible. If I have my mom back on me, its fine. But if I’m completely on my own and things get worse, I don’t know what can happen.
D: What would be the consequence ultimately for you?
P: Lots of crying, lots of depression.
D: What would be the feeling in that crying and depression?
P: (HG) not happy and repenting this is happened to me. I shouldn’t have done this I should have listen to mom.
D: So, what would happen to you in impractical her when you say you repent, what situation you find yourself.
P: I know there is never going to be time when my friends would leave me for that thing.
D: Your friends will not leave you.
P: Because I am sure that will support me.
D: Who would support you?
D: But who would not support you then?
P: My mom would also support me, but I myself would support myself.
D: What dreams you get?
P: Nothing specific.
P: Earlier I told you my dream of a one man dissecting other man’s dead body and he has amputated one of his limbs and put the body in one bag and carrying it somewhere.
D: I didn’t follow, amputated somebody’s limb.
P: Ya and he puts the body into a trunk and Christ is standing there and something I really don’t clearly remember. There is a church and inside the church all this is happening so that’s what I am thinking how can somebody do something like this in a church.
P: Just amputate somebody’s limb and just pack the body and take it, not very human.
D: Packs the body mean?
P: He separated the parts of body and puts in one trunk and then he closes it, there are too many piles of body lying that way and he is carrying them.
D: What’s the feeling for you; there are piles of body out in trunk and all that?
P: That way I was not scared but I was disgusted because it was happening in church, why have they to do it in church, taking the bodies outside.
D: What they were doing specifically?
P: There was only one man who was, removing one limb of another guy, there is no bleeding, its just a dead body, he is just cutting it and putting it in trunk.
D: Why was he doing this?
P: I don’t know, before that there was very different situation. I was staying in hotel, in my next room is a girl who is foreigner and both of us come out and we enter the church and then I see all this happening, disgusted, and when I look to my right this girl is not there.
D: Disgusted means what is the feeling there?
P: How can they do this to a man inside the church?
D: What are they doing exactly?
P: Just generally separating the body in a very inhuman manner. Generally, we wouldn’t have done it, but if ever I would have done it myself, there would be emotions attached to that body, but this man was very inhuman towards that.
D: Generally there would be some emotions, what would be the emotions.
P: This man has a family and they saw me doing something like that. He should have done it very properly very easily and slowly, but this man just went….
D: If they would have see him do it then?
P: It feels so bad that you are handling the body so badly, its belonging to someone, so I should make sure that I am not hurting their emotions, when I am doing something like that.
D: Why, if you hurt their emotions and somebody saw you doing it, this way, which was evil do it what would you feel?
P: I always feel bad about hurting somebody’s feeling. I never want somebody to feel hurt because of the things I do, be it anyone’s family, I take care that I don’t hurt them.
D: How would you take care that you don’t hurt?
P: If it’s a dead body then handle it properly. If it’s a patient be nice to the patient, not rude to him.
D: Tell me failure in examination, which was your feeling, one consequence of that would be your friends would have gone and you would be left without friends, any other feeling with failure in exams?
P: My parents they would feel bad, they spend so much on me.
D: How would you feel then?
P: I would feel really let down by myself because they are trying so hard to get me educated.
D: Let down means?
P: Depressed because they are spending so much time on me, so much money, they get me everything that I want. The only job or responsibility that I have is to study and get good result and it is the least I can do for them.
D: So, tell me you are taking treatment for 1 ½ years and you notice change in your complaints, in joints, your ESR, have you noticed any change in your stage of mind the way you think and feel, so in your anxiety levels.
P: I do feel irritable. It’s been there lately since last 5 or 6 months. I don’t know what happens to me. I can’t handle smallest of the things and I go like ohh my God what has happened. I get very irritated if my mom promises somethings, and I don’t get it. If I feel somebody plays a prank on me, kind of cheated on me I feel irritated, it could be a very small thing and unreasonable on which nobody is suppose to get angry and but I get angry.
D: And how would it before.
P: Before that I was totally fine and happy, as if nothing has happened to me. I am very happy person. One small thing that goes wrong, destroys everything, it irritates me.
D: No what I am asking you, is there a change your state of mind 1½ years ago and today, what is the change?
P: Earlier I used to be very patient with everyone, nice and sweet all the time, but now I have realized since 5 or 6 months, smallest of thing gets me irritated. I’ve become more rude and insensitive to situation and I don’t care about people I used to care before. There are 2-3 friends of mine. I used to be very good friends with them earlier but suddenly I am not getting much time with them, because of my studies. I don’t get time out of my college, I feel its not right not that they are investing so much time on me and I am not responding. It is generally both ways, but they feel like that because I don’t give time for them.
D: What was the feeling earlier, that made you give them the time?
P: I think I was not as serious about my studies as I am right now, as it is my final year.
D: And what else, was to you why was it important for you to give time to your friends and be nice to them?
P: I don’t know, whenever I make friends, I always feel my friends are my priorities and studies come later.
D: Why is it important to be nice to your friends earlier. What would be for you the consequence for you and you were not nice, if you didn’t give that time?
P: I am very image conscious, probably that is the reason and secondly I would always feel I would hurt them if I won’t give them time.
D: What is image conscious?
P: What would people talk about me, behind my back, what would they think, what my actions are, I am conservative.
D: And if that image is not preserved that what could happen and if they didn’t think good of you what could happen ?
P: I would feel the whole world talking about me, behind my back.
D: Then what would happen?
P: Generally I don’t know, if the whole world is talking wrong things about me, bad things.
D: And now is the image consciousness, compared to 1½ year ago.
P: Less, much less, I don’t care about what people think about me. I feel what is right is right. If I used to fight with anybody, I used to feel bad that they will feel bad, they will talk wrong about me but now I just feel what is right is right, I am not going to repent my actions because I am right. I use to never respond to anybody’s mean remarks, things said earlier. But now I do because I feel how much you will take it.
D: So your image consciousness going down, your fear to hurt your friends going down so what extent has it gone down compared to year and half ago, how much would you say?
P: 20%, 25%.
D: What difference, has it made to you, in your life, your state of mind, what reduction has this made to you.
P: It makes me feel independent. I feel, I can handle myself, even if I am in bad situations like if somebody is making fun of me. I just reply back, I answer back in such a way I used to never before. If they are making fun of me, I should give back unlike earlier.
D: When you say more independent what you mean by this?
P: I don’t know, just taking care of myself and not letting people hurt me.
D: Good, signs are good, what you think?
P: I think yes.
D: Are you happy within yourself than before or not so much?
P: Happiness remains the same but irritability increasing.
ANALYSIS OF THE CASE:
This case is significant from the ‘Sensation Point of view’. We see the a young girl with the pathology of Autoimmune arthritis. Her complaints had started suddenly around the time of her examinations and that made an opening through in this case. We see the girl had tremendous fear of examination; of failing or not performing well, not living upto the expectations of her friends and parents. In that her main fear is she will be isolated from her current group of friends, she will be left behind alone. Friends play an important role in her life. She wants to be felt a part of the group and without them her life is incomplete.
Another aspect we see is seeking approval of mother for everything. She does not want to let them down by her actions and wants a good opinion for herself. At the same time, she desires freedom from mother. She wants freedom of Choice wherein she can choose whom she wants to be with. She does not like restrictions when her mother is asking her to stay inside, being possessive. She also wants to be trusted by mother for her actions and to be left to her to decide. So we also see the element of ‘trust’.
She has two characteristic dreams- one of her mother on her death bed- where she is extremely scared how will she move forward as she is completely dependent of her for everything, all her decisions in life.
Another dream is of a man handling dead bodies in the church. Here she is affected by the manner in which he is handling. She feels there are no emotions attached.
From the above we understand that patient has emotionally dependency, is sensitive, has issues with developing or breaking of trust.
These issues of need or want of people, trust, choice, dependence, incomplete, cannot be alone strongly indicate issues of ROW III of the periodic table. We know the Row III is mainly to with Love, care, nourishment, exhibiting choice, appreciation. The left side of Row shows dependence on outside, lacking within or incomplete without support of others. In this case, it is friends, the support of friends means a everything.
So the main issue in this case is ‘if you are like this, the parents (or friends) will accept you and care for you, but if you’re out of this then parents (or friends) will not care’
We see two distinct characteristics in her; one is need for emotional support, dependence on parents and friends as seen in Natrum & Magnesium and the other is getting fixed in an image or identity, being expected to do this or behave like this, have to perform in a certain manner like seen in Silica. Here we understand that if she doesn’t perform in her exams and meet others’ (and her own) expectations (Silica), then she will be forsaken and isolated (Magnesium).
This confirms that we need to give her a remedy that has both; essence of it being ‘I will be cared if I have a fixed way of being, and in order to be cared I have to be like this.’
She received Magnesium Silicata 1M single dose.
Her ESR chart is as follows:
Dr. Rajan Sankaran MD Hom
Dr. Rajan Sankaran, M.D. (Hom) is an internationally renowned thinker, teacher and writer of the Homoeopathic system of medicine.
He is reputed to be a clear and original thinker and is best known for his path breaking concepts in homoeopathic.
His understanding of disease as a delusion and then further delving into unravelling the essential and most fundamental experience of a patient, the vital sensation. This method of unravelling this core experience of the patient, the Sensation Method has resulted in a far greater predictability of results than ever before.
Dr. Rajan Sankaran heads the other song – International Academy of Advanced Homoeopathy – Mumbai, a centre for clinical training, treating and research in advanced homoeopathy.
Dr. Meghna Shah (BHMS, FCAH)
A young, dynamic, dedicated, intelligent and sincere person, she is gifted with an extremely intuitive mind inclined towards research. She also possesses excellent managerial qualities with tremendous insight into human psychology. She is an ardent follower of Homoeopathy, and having trained under Dr.Rajan Sankaran for over 10 years. Dr.Meghna has worked in the Mumbai homoeopathic hospital after receiving her degree in 2000. Since 2001 she has been a physician in Dr. Sankaran’s clinic. She has organized video and live seminars of Dr.Rajan Sankaran and has been instrumental in starting the web-group ‘Insight-Alliance Homoeopathic’. She has been an active member in organizing ‘Wednesdays with Rajan’, one of the most successful programs in Homoeopathy. She has assisted Dr. Sankaran on the books: Sankaran’s Schema, Structure – Experiences with the Mineral Kingdom, The Other Song, and Survival – the Reptilia—which have all been highly appreciated and translated into many languages. She has spent two years researching the reptiles for this book, including a stay at the Reptile Park in Chennai, where she observed them firsthand and consulted the park’s herpetologists.