A case of undiagnosed abdominal in pain in a young girl treated with Magnesium Mur
Dr. Rishi Vyas MD Hom
In-house Consultant ‘the other song’
Edited By- Dr. Alifiya Dedanwala, Publications team, ‘the other song’
This is a case of a 16 year old girl who consulted Dr. Rishi Vyas at ‘the other song’ Clinic of Advanced Homeopathy on 29th April 2015. She came with abdominal pain and twisting sensation in there. On observation she was lean thin, her eyes were sunken and tired. She looked weak and was accompanied with parents.
*Below is the case interview between the doctor and patient. The abbreviations D=Doctor, P=Patient
D: What is happening?
P: There are cramps in abdomen and loose motions after eating. Weakness and head pain. Anything she eats she has loose motions. Since last 1 yr since she is suffering, she has lost weight almost 8 kgs. She feels hungry but does not feel like eating. As the weather changes, her she has throat pain and difficulty in swallowing. There is a lot of pain in shoulders.
D: Tell about pain?
P: It suddenly starts and then it gets better on its own. Since last 10-15 days it is more. At the center of the abdomen, I feel as if something is getting twisted. [hg] (wringing of hands). The pain is temporarily better by cold application. During that time energy levels are very low.
In the past 8-10 months, the pain has aggravated a lot. I cannot bear it and have consulted a couple of doctors. They have prescribed pain killers and other medicine. With those medicines, I get temporary relief and I am back to the same. No one is able to diagnose the problem.
D: Describe twisting?
P: I want to sit at that time.
D: Tell about twisting?
P: the way you wriggle clothes when you have to dry them.
D: Describe little bit more?
P: I have nausea and vomiting sensation. It comes at any given time.
D: Tell more about the pain?
P: Pressing makes it better, It happens for 2-3 minutes then goes. It stays there, then I lie down.
D: You lie down means?
P: I lie straight,
D: What makes it worse or better?
P: I feel good if someone is near me, I need my mother besides me. I don’t like hot so cold application makes it better. This has gotten worse in last 15 days. If I eat anything I have urge for passing motions. [I was thinking does she suffering from Irritable Bowel Syndrome]
D: What else?
P: I go to washroom atleast 3-4 times. There is slight pressure like feeling in the stomach as soon as I eat so I have to use the washroom. There are no loose motions, stools are normal formed stools.
D: How is your appetite?
Appetite is fine, she feels hungry but cannot eat. Even her favorite things she cannot eat full. Stomach feels full. After few morsels, she feels full and fears that she will have to use the closet. She is scared that she will get eructations and motions (urge for stools). With slightest overeating, she feels difficult to breathe.
D: What else?
M: She also complains of headache.
D: Tell about it?
M:It gets worse from slightest heat or going out in the sun. The pain is more in the vertex and on sides (temples). She is complaining of the headache since couple of years. When she was about 3-4 yrs old, she would come from school and complain of headache. She gets headache when she is anxious. If she doesn’t eat on time she starts getting headache.
AGG: sun, warmth, heated, hunger, if you do something against or make her do something forcible then she gets head pain.
D: Tell about this?
P: I didn’t want to go to a wedding, but MY mother made me to go so I was very angry. So I cried and I was very angry.
D: What did you do?
P: In anger I was very upset, I threw what was in my hand. When someone forces me to do things I get very angry. Why should I do, why someone is saying when I don’t want to do.
D: What do you feel?
P: The feeling is ‘Why are you forcing me?’. I will not do it, I am stubborn. Why are people altering what I want to do or think. Let me do what I want. Sometimes its ok, but sometimes I don’t like to do.
D: What do you feel like doing?
P: I feel like crying. I don’t like it when I am forced to do something, it feels very different. Irritation and anger within. I feel like crying. I don’t feel like talking to anyone then.
D: In anger what you do?
P: When I get angry I feel like going into my room and crying. Sometimes I feel like writing. Anything that happens against my wish or will or I am forced to do it, makes me angry. If someone doesn’t listen to me, I feel like keeping quiet.
Parents: She will not like someone consoling her or speaking to her at that time. She weeps very easily, anything you say she will starts weeps.
Parents wanted her to take science but she didn’t want her to take. Since last 2 months we are pursuing her to take science. I want to do MBA and law. One year ago she wanted to do fashion designing.
She says “I want to do something in psychology or philosophy”
D: Why do you want to take up this field?
P: I like to think about topic and want to do it, like why it happens. Why poverty and suffering are there around you, how it be helped. I cannot see all this in movies or in novels, if the ending is not happy then I get affected.
D: Give an example?
P: I get very sad. I read a book – “the fault in our stars” and was very disturbed by it. It was a story of a girl and boy both suffering from cancer. They both love each other, their friend too has cancer of the eye.
D: So what affects you?
P: It was a very sad, it affected me. Suffering.
P: If I am doing something which I like, then parents are sad. You are not happy with me, I am not able to keep you happy (weeping + + ). Parents have problem with me (weeping). I want to take commerce but parents don’t want me to take it, they will not be happy but you can be.
D: So … ?
P: I feel they should be happy, If they are not happy, I am not happy they are close to me so I get affected.
Not parents – but anyone who is close to me, they attached to me –like brothers, sisters… etc. They shouldn’t be sad. I don’t feel good and happy.
D: What is the feeling?
P: Why I am not able to make them happy….or keep them happy.
P: Does changes in surrounding bother you?
P: If someone is with me, and then they leave, then I long for them. I remember them. My real brother is studying in college so when I don’t meet him, or my cousins then I feel I need to meet them. I don’t feel good. I remember them.
D: So what you want to do?
P: I am not clear as what I want to do in life. I don’t know what I want to do. I like literature. I don’t like doing science or engineering. Probably looking to do may be designing or go for commerce.
D:What are you Interest and hobbies?
P: Listen to music, drawing, book reading, swimming, and shopping. Like dance also
D:What is the feeling?
P: Like it, feels very good. I am more cheerful.
D: What dreams do you get?
P: Daily routine, not fresh when I wake up in the morning. I also take time to get up.
D: What fears you have?
P: Losing my parents, best friends, brother. I fear a lot.
D: What do you feel?
P: I won’t be able to live without them. If they are with me I can go through anything.
D: What other fears you have?
P: Fear of high places, scared of boating. Earlier I would feel that I will fall. I did not take part in adventure sports.
She also gets worried of exams. She feels she needs to perform well in exams. She tries to get good marks, in order to make her parents happy. There are times when she gets pain in abdomen before sometimes during exams she is scared as what will happen, she has not completed her studies. She will not be happy. She feels says ‘Parents do so much for us, So I feel I need to make them happy’.
D: Describe attached to people?
P: When I get attached to anyone I cannot see them upset. Why they are upset? What should I do for them? If they are unhappy with me or angry I get more upset.
P: Why they have to go through all because of me.
D: How is the feeling with them?
P: I feel joyful I like it. I am happy. I become excited. When I am too happy, I fear it shouldn’t end and continue to last long.
D: What you like then?
P: I like everyone’s caring nature, supporting even if I am wrong; they care and support me. They do not beat me or scold me for doing anything wrong. Everything happens as per you desire.
D: Caring means?
P: Eat properly, taking care of you. Asking you. Always there for you.
She has back pain on the 1st and 2nd day of menses. She also experiences mood swings before menses and gets irritated and upset on trivial matters. She gets obstinate over things and wants to have her way. She is highly irritable before menses. She also has leucorrhoea before menses, sticky in form.
She generally desires spicy, sour, desserts, ice-creams, cold milk and cold food. She is averse to milk, fried and deep friend things. She perspires mainly on upper lips and sleeps on abdomen. She is more sensitive to hot weather and desires cold weather.
Analysis of the case:
In this case we see a young 16 yr old girl brought by her parents complaining with pain in abdomen and loose motion. She appears thin, weak with eyes sunken. She had lost almost 8 kg weighing 43 kg only. The parents were very anxious and concern about her as physicians were unable to diagnose her condition. She was receiving medicines only to relieve her pain but not helping in resolving the issue.
So let’s understand her symptoms comprehensively. She complains of pain, which comes up suddenly any time, and the entire abdomen pains; the pain is as if twisting, like how you wriggle clothes (hg – hand gesture). It stays for 2-3 minutes associated with nausea, vomiting sensation, she has to lie down the pain is better by pressure and cold application.
Associated with that, she also has head pain, which is on vertex and on sides, worse by sun, on being heated, hunger, and when things are made to do forcibly by her; when she it is against her wish and someone is forcing her to do it. Her reaction is anger, doesn’t want to speak and communicate, she goes to her room, does not like to be approached, or made to understand or consoled. In anger, at times she ends up crying.
So when we look these symptoms in repertory, we have some group of remedies coming. These can become a guiding information.
These episodes had increased since last 1 yr. She was in her 12th grade her parent were pursuing her to take science whereas she wants to opt for commerce stream. She felt forced to do something that she didn’t want to. And this became her main conflict.
She further added, if she does pursues she wants or likes then she will disappoint her parents but eventually it will be of her interest which makes her happy. But if she decides to fulfill her parents wish make them happy, then she is not happy. So whats her parents to be happy with her choice and what she does.
This conflict of hers manifests on her health in form of pain and discomfort. This disturbance needs to be addressed.
So the question lies here is what exactly does she want? On this she says she wants to do something in psychology or fashion designing stream, though she is not clear about which of the two.
What we understand is she doesn’t want to do what parents want her to do, she wants to do something else but what she is not yet clear.
Her main thing is she is very close and attached to her friends, parents, brother, and is afraid to lose them. She feels sad when they are away and longs for them. Here we see the ‘Issue of separation, doesn’t want to be alone.’
She cannot see them upset, she feels sad. She fears losing her closed ones. Other fears are of high places, failing and of examinations. Her main concern again in her narration is to make her parents happy with what she does. She is very happy, joyful, feels everyone is so caring, supporting, they take care of food, they are concerned about your desires and choices.
So what we understand is she is a girl who is not yet developed in terms of emphasizing her choice, she has some choice but not yet clear what she wants to do. She is very close to her loved ones, concerned about their happiness, when they go away she misses them, it’s homesickness. She longs for care, understanding and their presence. She cannot live without them. This shows her dependency in terms of love and care.
In terms of materia medica understanding, her issue of ‘Love, Care and Nourishment resonates to the understanding of minerals which is mainly to do with the structure either lacking or losing. Her structure is yet to develop in terms of identity, choice, and ego. She has a choice but she is afraid to put forward, as she will hurt or disappoint her parents. These are issues of Row 3, and in that column II, where there is a choice but afraid to express it, fearing that the she will disappoint them, make them unhappy. She is dependent for love, care, affection and her issues revolve around communication wherein she cannot express, cannot cry, though she feels like.
Column II of row 3- gives us magnesium and question comes which magnesium.
When we consider other symptoms such as tremendous weight loss, anger, irritability before menses, not wanting to speak in anger, shutting herself away, aggravated when consoled gives us Natrum mur and Magnesium mur. Since its column II, our choice of remedy will be Magnesium muriaticum.
What are the other symptoms
Uneasiness and lachrymose humor.
Peevishness and chagrin.
Aversion to conversation, prefers solitude.
Repugnance to exertion.
Nervous excitability, with tendency to weep readily.
Excited, unhappy, fitful, emotional.
Soul of remedies: by Dr Sankaran:
The coped up Magnesium muriaticum patient seems self-dependent (busy with himself), and friendly; he can go out of his way to care for others. He will do a lot for others, but he always has the feeling that no matter what he does for others, he will still have no friends. Although friendly, he is very reserved. He will keep a distance from people and will not reveal his emotions even to those closest to him, not even to his spouse. But as a friend he can be caring, trustworthy and dependable.
The feeling that he is friendless, that there is no one whom he can trust can make him morose, unfriendly, unsocial and repulsive. This stage is seen usually after all his efforts to gain friends have failed. He can become nostalgic about the time when he did have someone to care for him. He becomes taciturn, inexpressive, and answers curtly, in monosyllables. He can be irritable and angry, but will not express his irritability and anger because of his feeling of dependence. Here it resembles Natrum muriaticum in that both feel disappointed, betrayed, and as a result feel irritable and angry, but none of these emotions are expressed in either remedies.
Magnesium mur 1M BD for 2 days
Telephonic Follow up dated: 12-06-2015
Her motions are better
She had itching in her eyes like an allergic reaction triggered by hot weather.
Abdominal pain was much better
Throat pain is better,
Appetite is improving but not able to eat more.
She was less irritable and more happy.
She was more positive towards life. Positive of myself and others also. I have slight pain in back during my menses. Otherwise I can say there are good positive changes in last 1 month
Remedy given: Placebo
Follow up 1 year later:
The frequency and intensity of throat pain and stomach pain has reduced.
There were 2-3 episodes of throat pain, but no abdomen pain.
Her menses were regular, but slight pain on 1st and 2nd days.
She was much happier. She did not opted for science and decided to take up fashion designing and could convince her parents to allow her to move out of the city to pursue her carrier. Parents also willingly agreed.
Her weight had increased by 2-3 kgs.
Energy levels are better.
She is progressively getting better
Remedy given: Placebo.
Dr. Rishi Vyas MD(Hom)
Dr. Rishi Vyas is an in-house consultant and faculty at ‘the other song’ clinic. He has had the privilege to learn under the guidance of various honored doctors such as Dr. Sankaran, Dr. Kamlesh Mehta and many others. His calm personality and meticulous case-taking is much appreciated by all. He is an expertise in ‘pediatric’ cases and is also known for his effective counseling skills. He is a mentor for University courses such as CCAH, FCAH and also other in-house courses. He has played an integral role in the development and functioning of the clinic. He has worked as a content developer for WWR (Wednesday’s with Rajan) online webinar series. His keen interest in IT has led him to actively participate in the development of the ‘the other song’ software.
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