from Dr Joseph Kellerstein. Canada.
Monday, December 8th, 2008
Marie is a 55 year old lady who walks down the hall using a cane. Her measured steps punctuated by physical effort and lots of obvious pain. She has a charming smile and soft manner that has been strengthened by determination over the years to counter the reflex grimace that suffering demands.
Chief Complaint. Patient presenting November 3/04 – Arthritis. Knees.
Beginning in 1990 she woke up one morning and the left knee ‘went out’. Since then it kept getting worse. She has had 4 surgeries on the knee. 2 arthroscopic,1 osteotomy,and finally a knee replacement. The patient relates that recoveries from the procedures have always been long. In general although the replacement has helped there is a feeling that the pain has been much worse since the first arthroscopic procedure.
For years there has been this incredible pulling down in my knee. Like a weight pulling me to the ground so severe it stops my legs from moving.
The right knee has a sharp pain that will make me cry out.
Stiffness is worse in the morning.
Knees are worse before rain or snow(latter is more obvious)
Worse spring and fall
Worse hot humid
Worse warm applications.
I ache terribly in muscles. It all acts up at the same time (joints and muscles).
I am always hot. Profuse perspiration. It is worse any exertion. Since a recent D and C flashes are worse.
Working as an assistant to an executive I felt like a servant, as if I was being targeted. I was ordered around and got all of the worst jobs. I have always had a problem taking things personally. I am a pleaser.
Chronic Case and Medical History.
I am tired at 10pm and go to sleep. Wake after 1.5 hours due to knee pain and become restless. Best sleep is 6 to 8am. Dream of snakes occasionally.
In 1979 patient gave birth. Very shortly after all 4 parents died. This was followed by Hypertension. Soon after there were a series of 3 gout attacks.
What struck me initially was the idea of great heaviness in the affected part,worse before the snow, slow healing and grief in a menopausal lady. Sepia sure looked good. Sep 30c
November 17/04 – 25% less fatigue. Thinking is sharper. More dreams. No other changes Assessment; for this early on looks promising. Plan; continue.
Dec 8/04 – As of one week the knee pain has gotten worse and continued bad steadily. Fatigue has returned. Patient has been weepy. Very reliant on cool applications which offer lots of relief. Assessment and Plan; Sepia had some degree of similitude but not enough to move the pathologies. No new symptoms but latest most intense symptoms indicate Puls.
Puls 30 b.i.d.
Jan 5/05 – Some improvement in stiffness, energy and muscle pain but it relapsed within 2 weeks. Now feel much worse. That incredible sense of weight pulling me down; worse before storm, worse weather change warm to cool. Assessment and Plan; A closer simile but no bull’s-eye. We relapsed to a more intense version of the initial case. The body is trying to tell us these are the leading indicators. I just can’t find the remedy.
I will spare myself the humiliation of the next 8 followups and a similar tale.The symptoms simply talking back to me saying nice try but no cigar.That is no movement in that small cluster of symptoms more than a week and if I went up in potency – no result.
Finally after these wrong prescriptions I sat myself down again and took stock of what was clear.The intense heaviness. The worse before a snow. The various other atmospheric modalities.I was unclear so I called the patient and went through it again carefully. As it turned out she was aggravated with any change of weather especially warm to cold. A computer search led me to a lovely little Boenninghausen rubric in the CompleteRepertory-Heaviness internal, as from a load. I lead with this rubric and followed with worse snow air and worse change of temperature; warm to cold. Suddenly Mercurius became obvious. It still is not a cure. Its too soon but there has been a steady improvement in all symptoms for the last 6 weeks.
And so it goes. Successive approximations until even I can see it.