Stramonium, a case of PTSD

Case

The following is an edited transcript from a patient who presented with post traumatic stress disorder. Post traumatic syndrome disorder (PTSD) is explicit in this case, however it can also present in a more insidious fashion. The main themes I’ve observed to help me consider PTSD as the primary diagnosis are:
1. Escape:
    a. Unconsciousness, Numbness, Floating, Disassociation, Painlessness, Restlessness/Occupation
2. Hyper vigilance:
    a. Someone is in the house, behind me, or lurking
    b. Hypersensitivity – noises, touch, smells, etc.
    c. Mistrust and suspiciousness (especially if harm was perpetrated by people rather than natural disasters, accidents, etc.)
    d. Insomnia
3. Hyper-defensiveness:
    a. Rage & outbursts, pushing others away, promiscuity, OCD (controlling environment as defense)
4. Stuck in the past:
    a. Flashbacks, repeating nightmares or dreams, brooding on past, Déjà vu.


The patient was 35 at the initial intake. He was referred by his adopted mother, a therapist, who came to a local talk I’d done on PTSD. He is African American, thin and well built. The patient had been frequently moved around from foster home to foster home as a young boy. At one of those homes in particular, he was frequently abused in a variety of ways. Finally he was adopted by a wonderful family.
He was mild mannered and soft spoken. He paused frequently, sometimes for long moments. He would often look like he was struggling to form thoughts at times, often putting his hand to his forehead as if working hard to come up with thoughts. In addition, throughout treatment, especially in the beginning, he often would struggle with basic concepts. His presentation is somewhat scattered. I found it necessary at times to focus him with a variety of prompts.


Consultation of Monday, December 27, 2004
What can you tell me?      [Long pause and then he asks me where to start].
What brings you here?      "My mom went to one of your seminars. She thought you could help with some of the feelings I’m having. [Pause while he reflects]. It just makes me think, no I don't really have any problems or things I can’t solve. All the things I've been through, being adopted, moving to a small town, racism, and my reading disability. To sum it up have great parents .. I don’t' know where to go... Sometimes I have the blues, when stressed I bite my nails more then I should - never been able to stop. Usually when I get really really stressed, lower back hurts, now moved into my neck. Severe headaches in the past mostly. Out of everything, this emptiness inside is pretty much it - difficult to be in this situation."
More?      "I've coped extremely well. Out of all the things I've been through, came through pretty good. Had good parents, good community.
Difficult times?      "What is sitting heavy on my mind is the last relationship I went through. With someone I thought was a sound person. But going through the yelling part. In our family, our dad was a yeller, but typical family life, keep everyone in line. But this x-girlfriend, she was a yeller, agitating a person to do something, and always blaming everyone else. Making me feel bad and I was always getting sucked in. She was a heavy drinker, smoked a lot of weed. I did too, but more to fit in. My friends are a bunch of heavy drinkers. For some dumb reason I’m still trying to process that whole relationship. She had a little boy, I cared about him - still do… Again me trying to process why everything went the way it did, that I cared about her.
Being moved around from home to home, with adoption as a kid. Moved from one foster home to another, which was getting the crap kicked out of me, jabbed at with needles, forced to eat food I didn't want to eat. You know - heavy abuse. But going back to her, being sexually abused in my foster homes, to seeing where I am right now, and why can't I make it. Everything bounces off of the last relationship that I had. She said I wasn't there, which I don’t get, I could have sworn I was.
I really hate to say this. But my piece of mind would be about finding someone else. Most of my stuff is just feelings, and it is the blues. Maybe that is a form of depression. For the last 3 months, been getting worse. If sit down and watch some TV, not thinking about me. There is just a side of me missing.
Then think about before adoption and the abuse and trying to figure out where to go. Trying to keep busy so not thinking as much, tire myself out so not thinking as much. Trying to go with the flow. People ask me to go some place, so I go, can only watch so much TV. Usually that is what I do, come home, plop down in front of TV, instead of socializing. "
What do you do for a living?      "I work for an independent contractor doing installation and maintenance. Recently the Xmas or holiday blues. Found myself really struggling trying to read my work orders. My memory has definitely faded. I'll know I'm in a bind, if feel myself angry for no apparent reason. This morning was a bad one. Got really angry, hopped in the car, popped in some gospel music, which didn't calm me down. "
Are you restless?      "Like I got to do something, got to be moving. Friends are always saying I'm never sitting still, always moving. Stay too long in one place… I don’t' know I just like to move.
Sitting around makes me think. All my thoughts go back to my past history. They are not pleasant thoughts, thoughts of poor me. Why was I treated this way. Why can't I read like everyone else. Why does my reading come in strong on some days, and not on others. Vision comes in and out; some days really straining. Then going back to a foster home, and being jabbed with needles whenever I got a word wrong. I was jabbed with a huge sewing needle. I have to limit myself being around my own kind, they set things off inside - it just burns me. Have to keep my mouth shut, so just sit back or I’ll overreact. I do a lot of talking to myself, god this is just not right. Everything I see, always has to go back to before I was adopted. "
I prompt him to tell me more about his past abuse if he is comfortable?      "I'd like to go back if I could. Don’t know if you've seen Antoine Fisher. That movie is always on, always watch it no matter where it is at, wherever it is playing. I have real brothers and sisters out there. Sometimes I have a desire to find them. Or to go back to people who've wronged me and to set them straight. Would that give me some closure - probably. The dude who used to put me in a box and push me down the stairs, or chase me with knives or beat on me with bats. If I could just go back in time and whoop his ass. Reflecting, if I could shut this reflecting off that would be cool. At one house, boys on one side and girls on the other. Things weren't fun, the fights the beatings. I went back when in Junior High, it was alright. Nice to go back, but don’t' think it would solve anything. This anxiety though, nice to know what that is about. "
Anxiety?      "I'll be sitting down, and then have to get up. Then why do I get up, what am I doing. My concentration is totally shot, I get up to do something, then think, what am I doing, what did I get up to do. I think everything needs to be done all at once. "
Headaches? "Most of them are in the front of my head. On a day like this (sunny day) usually have to wear sunglasses. Again any time start to think of past things, get that look on my face of concentration. Then it would sit right here (points to vertex), and then radiate. Used to be really bad, but chiropractor helped a lot. "
Bad?      "Didn't want to open my eyes. Also these ear muffs, if could block sound, it wasn't as severe. Got these red ear muffs on, like used for heavy machinery, and sunglasses and hat. Would get pounding headaches, sometimes went right into the nervous system.
Always get a pain on my arm, it was like a bruise. Just to have a shirt to touch it, would hurt, it would move around, sometimes on this arm, or the other arm. It would move around, really weird. "
During headaches?      "Yes. I'd try to grin and bear it, then sit yourself down in front of the TV, wearing sunglasses while watching. It was the top part of the head. "
Anything else around the headache?      "No, headaches and sore muscles. "
I wonder if you have any fears or phobias?      "The dark, fears of the dark. Always being locked in closets. Imagine yourself being shoved into a box, and then closed on you, and down 12 flights of stairs. Oh! if I could see him now! Or tight places, can't go on rides with pressure on my chest, or anything tight on my chest - I'll flip out. Being pinned down.
Which was another one of those things. Being adopted, some foster homes are good, but a lot are just.... just not right. It is funny, the social workers would always ask, how are you doing. You know you have the foster parent right around the corner, always wanted to say something but then knew if I did, would be in more trouble. Didn’t want to be moved from home to home.
I Can't go in any rides, or small areas. If do, really have to concentrate really hard. Which really sucks, because a lot of neat rides I'd like to go on, but seeing a 35 year old man flipping out. I just avoid them, and say just not feeling well, instead of telling the truth - scared shitless. "
Other fears?      "Heights was another one. Yeah, it is so funny. Everything leads up to this one house, this dude used to pick me up and dangle me above these stairs. Every now and then he'd drop me. So heights, small areas, the dark. The small areas was being shoved into a dryer, and having it turned on. You can see why I don’t' want to think.
Now after talking about it today, have to watch it, because will overreact. Any little thing I see, that someone is doing to a small person. Heights, small places, dark, being pushed down, someone restricting me. Having to eat something I really don't want to. Oh yeah! It used to be water. Used to be fear of water til I learned how to swim. Used to be extremely nervous around water, but thanks to a good teacher, not a phobia of mine anymore. "
Most of the fears related to abuse?      "yes, again this one family. Supposed to be given a bath, she couldn't do it, and foster brother would do it. Haven't even told my counselor about all of this, it is in the back of my head. Fear or phobia that aren't related to the abuse? all of mine go back to being in the foster homes.
Other than that, like to think of myself as a pretty good well rounded person. "
Animals?      "Spiders, centipedes, not to keen on worms or snakes. That’s not connected to abuses; cockroaches, the little white ones that look like rice. Should say bees, too. Always been fascinated with bees, but for some reason get stung when fascinated with them. Something that small can make a person run for his life. "
Any hypersensitivities?      "Being forced to eat peas, or spinach, or meatloaf, still can't stand meatloaf. Any time I come through an apt building a certain smell hits me, that anxiety hits me.
Peas and beans and spinach for some reason. I'm thinking something, and it flies out of my mouth. I’ll say oh, “I’m not eating that!”, then think to myself, oops I said that out loud. Then try to cover it up. To be polite honestly, peas I have a tough time with, but spinach and cabbage, will stomach them. But peas just can't. The other one blurting out of my mouth. "
Any Nervous habits?       “nail biting. Having to just get up and moving around. The nail biting has gotten really bad, tried hot sauce on my hands, smashing peas on them. "
Hot/Cold Body part?      “I used to have problems with circulation. Fingers from forearms on down, would go ice cold. It would happen specifically when playing in a basketball game. I couldn't get them warm. As soon as I stopped, as soon as stopped playing, then they'd go to sweating as the rest of me was cooling down. "
Numbness or tingling sensations?      “Every now and then, your hands or feet would go to sleep. It was either one or the other. "
Pain threshold?      “Normal range, except if you come to me with a needle. still a huge fear of needles and whoever has it, whoever is holding one. More jumpy around needles than knives. "
Physical health complaints?      “With the last girlfriend, I had sexual problems for 6 months in the middle. Scared the shit out of me actually. "
Problem?      “Erectile problem. "
Urinary?       “bladder infections, had maybe 4 of those. "
recall?      “I've had only 2 girlfriends since High School, had 2 with Tammy, just typical bladder infections, extremely painful. Blood and all that.
This last relationship was really stressful, going through the abuse, and arguing. Being thrown in jail, being hit by her, getting herpes from her, to getting into a fight with her Dad. Then I said, enough, I've got to leave. I've done pretty well.
Who are you aside from all that? That is a really good question. I had a friend who asked me, who I was. And I don’t know. I've always seen myself with someone. Friends, along with mom and dad, say you need to find yourself. What does that mean. I love the forest, wanted to be a park ranger, getting out of the city. I know what I like to do. I like to hike, going to the falls. Hiking and camping, love to do all that stuff. Every year I go rafting, that water has a lot of force, scares the crap out of me. It is one that I've really been able to overcome, really proud of it. "
Thirst?      “Will go through the day without drinking. Sometimes go 2 months drinking a lot of water, then the next 2 months I'll struggle with it. "
Lower back?       “when in High School, had a severe accident. The car that struck us, I was sleeping near the door, wonder why I'm still alive. So anytime I get stressed out, it would go to my back. Now it is my neck. If holding my head up and stressed it would go into my neck, and then rolling into the shoulders. "
Describe?      “Like a nerve is between a bone, and getting rubbed over. A dull but sharp pain. "
Sleep?      “I lay down, tired fall asleep. Go to bed 11 or 12ish. Sleep 2 hours, then wake up, or sleep for 4 hours. Longest I’ve gone is 5 and a half. Then up and wide awake. In the last 5 months, really started dreaming heavily. But can't make out what they are about. Used to have déjà vu feelings all the time. Déjà vu, - like I've been here. Friends say, no you haven’t. I'd be describing things as if I’d been there before, it was scary. "
Recall any Dreams?      “I'm walking in these woods, coming out from behind two trees . There is this voice that is calling, want to turn around, but for some reason don't. Then like about to slip into another dream and another one, but trying to wake myself up, but feel myself slipping more and more. There is pitch black on one half, and on the other half, trees and the house where I grew up. On the other side, our child hood home, where the garden was, it’s totally black. Can' t make out the voice. I'm heading towards the dark, but felt like someway loosing myself. Then thought should head back. Then woke up, panic and sweating, heart racing out of my chest. I used to get that dream all the time, or a face that was always chasing me. It happened after being adopted. It was the same dream. I thought I'd tried to fight it, and as soon as I matched the face, that stopped the dream. It was the face of someone that was always abusing me. Now they are not as deep and as serious, used to have them up until High School, seeing a counselor then.
Anger expression?      There is a side that wants to react, and the other side that doesn't. Always been picked at, poked at. Not so much is physical. Even with the stuff with last relationship, physical on her end. it was starting to get physical on my end. It is a big huge rage that is building up. I'm not kidding, I said I'm not taking any more abuse from you, your brother, or your father. There is definitely a rage in me.
I have anger and frustration, why am I in this situation. I don't want this feeling. "
Does something trigger anger at times?      “Change is one of those things that can bring it out. The anger slips out. Change makes me mad, when there is change, and I don’t feel there needs to be. Change sets me off. "
More?      “maybe change is the wrong word. "
Confrontation?      “There is a side of me that wants to, and the other that wants to let it go. "
Opposites?      “there is a right way and a wrong way. Whenever I'm doing it the right way, why am I always getting hurt. I'm getting stepped on, now is my time to react.
Now the one that just burns me, you have to be the bigger man and let it go. "
Do you feel contained?      “Yes. "
Your anger?      “it doesn't show up. I get there. Where it shows up is me going off by myself and just crying. For it to come out, it’s like I’d end up loosing myself. When I was in jail, everyone thought I'd lost it. My x-girlfriend had told people that I'd done all this violence to her. Those were things I'm not capable of - I did a week of crying. "
Violent?      “I lost it dead in the jaw by her father. Wouldn't let him get the best of me. He'd said I had to leave. It took me back to before I was adopted.
I decided to go back and say good bye. Then within a few minutes he was coming up behind me. I turn around, then every swear word came out of my mouth. I turned back around, then he hit in me in the jaw, and again. For a split second, as soon as I'd reacted, trying not to react. Then realized that now you'd done it. So grabbed him in a bear hug, and we hit the ground.
Then her relatives came out, and a free for all on my back. I don’t' remember feeling any blows. I just knew I wasn't going to go out like this. Rolled around on the ground with him, knew I was going to get a beating. Then when they realized I wasn't doing anything, they let me be, then released. Then I'm starting to cry, looking up to her grandmother, she'd been so nice to me. Then out of the blue, hit twice more by her dad. That is the only time I'd reacted. It is there, just as of this point, there is self control. "
Do you have an overactive imagination?       “Yes, happens when not concentrating on my driving. yes, I tend to go over my life, over and over and over. It drives me up the wall. No matter what I'm doing, constantly replaying everything in my life. It just pisses me off. Gets to a point where unable to function. I have dyslexia. Sometimes driving and find myself on the wrong road. It is almost like a black out. That happens occasionally. "
Other examples?       “One of the other incidents at work, I was supposed to be doing an installation out of town, and would find myself half way to the wrong city. Or forgetting to pick things up. The driving ones are the main ones, where supposed to be somewhere but end up somewhere else. My concentration is just not there. "


Mother (calls on the phone to contribute): He had a lot of anger as a youth. My husband used to say it was alike a helium balloon, you had to pull the string down. He’d numb out, like he was floating someplace else. Like he'd be in a conversation, he'd get up and be gone, no good bye. He was out of his seat, extremely hyper in school too. In a 20 minute period out of his seat 11 times. Bedwetting from at least 7th grade til Junior High or eighth grade.


Baseline Symptoms:
1 Lack of Concentration - pretty much all day, reading work orders
2 Dwelling on the past - Daily affair
3 Headaches - 4 - 6 headaches in a month
4 Blues - sad, want to go and cry - that is almost daily
5 Phobias - claustrophobia in the back seat
6 Anger - once a week outburst
7 Isolating - avoid friends - daily 8 TV - Daily affair
9 Physical Restlessness
10 Nail biting - daily


Assessment: During the intake I began to suspect a nightshade was indicated. Many themes common in the solanum genus were present. I’d seen several nightshade cases in practice previously (Dat-a published in this journal some years back for example).
In addition, I attended a one week course on nightshades and their look a likes with Massimo Mangialavori in October of 2005. Massimo’s differential of nightshades really help me to more fully understand the entire family as well as other Rx’s that are outside of the nightshade botanical family entirely.
In particular, the two long term cases he showed of Tanacetum vulgare were virtually indistinguishable with nightshades. In addition, I also learned to understand the differential between Belladonna, Strammonium, Hyoscyamus, and Mandragora in clinical practice. He also covered Solanum nigrum, and some nightshade look-alikes such as Lyssin & Gallic acid.

Datura Stramonium – The Nightshade for this case:
I thought this case required Stramonium. My rationale is that he very explicitly talked about being divided, something more common with Stramonium. My experience with Stram shows them to be also a bit more sympathetic than some of the other nightshades. In addition, in adults, they are often more scattered than Belladonna. Belladonna patients in adults are often successful business people or someone who presents as having it together more. They are more forceful or adamant at controlling their dark-side. Hyos usually presents as being more haughty and sure of themselve. In addition, Hyos often presents as almost proud of their dark side. Mandragora is closer to Stram in my experience, so I’m not as sure about how to differentiate the two. However, Mandragora seems less clearly divided or scattered than Stram in my experience. In addition, in both of my Mandragora cases, the craving for cheese was marked. For readers who are helped by repertory, here is my MacRepertory graph:


The patient received two dry doses of Stramonium 1M (Boiron) on 12/29/04


Consultation of Monday, January 24, 2005

How are you doing?       “The sleep was better. Still 4 hours of sleep, but now sleeping harder, waking feel more refreshed. Thinking things, going over old stuff, has disappeared. I'm not dwelling on it anymore. The nail biting, nervousness is all still the same. "


Baseline Symptoms:
1 Lack of Concentration - pretty much all day, reading work orders
      "Unchanged."
2 Dwelling on the past - Daily affair
     " Stopped"
3 Headaches - 4 - 6 headaches in a month
      "No Headaches this month"
4 Blues - sad, want to go and cry - that is almost daily
      "That is not there anymore."
5 Phobias - claustrophobia in the back seat
     " Deferred"
6 Anger - once a week outburst
      "Hard to say"
7 Isolating - avoid friends - daily 8 TV - Daily affair
      "That is the same, no change, though I haven't been watching a lot of TV. Not within the last 5 days"
9 Physical Restlessness
      "It seems like it has subsided, it is still there but not as strong."
10 Nail biting - daily:
      "No change. After I took the Rx, did a week without biting, though that can happen."

Feeling anything around the dosing itself?       “After I took it, felt a little perky, could take on the world, felt real good. It lasted for awhile, just started dropping off last week. "
More?       “That anxiety thing is kind of coming back, a restlessness. "
Dreams?       “No. "


Assessment: Overall – good progress. The brooding, headaches, sleep etc. are better. What is interesting is the blankness the patient presented with today. He seemed to really be struggling internally with various questions, or with comprehension. Given that he was still having difficulty with concentration, and that he suffers from long standing PTSD, I thought it best to give him some additional supportive doses. So a 200c in a once ounce bottle once a week was prescribed. I also gave him some instruction to take doses for acutes in the interim as needed, but he seemed to have some difficulty in understanding my instructions in general.


Plan:      Stram 200c (Boiron – a few pellets dissolved in a 1 oz dropper bottle) – 4 drops once a week.


Consultation of Monday, March 21, 2005
Now?       “Concentration is definitely right on point. Definitely more on focus. Just got over a cold, which has been lingering for the past month. For a couple of weeks forgot to take the Rx, but definitely concentration is on point. Anxiety is not bad, it is really not bad, much better than it was. Nervousness it not there anymore, not as much. I'm not replaying anything in my mind anymore. Just everything that is in front of me, dealing with that."
Taking the Rx?       “Daily , took it, daily.
During the cold, I had anxiety so bad, the bedroom I was in, it wasn’t big enough. I got .. started getting claustrophobia, that was about 3 weeks ago. It was so bad, couldn’t be in the room. Was pacing around in the house, then couldn’t be in a bigger room, and then couldn't be in the house. I was sick, and weak, cold, and had to go outside in the cold. Was outside all night pacing the entire night. I'd come back in, sleep a bit, and then back outside, walking around. That might have been the reason why I stopped the dosing. My mother told me to call you and ask about this – but I didn’t. Light, noise everything was bothering me." (Patient had been taking the 200c daily for several weeks by mistake – a misunderstanding. About a month into dosing he had a strong cold that lasted for several weeks. During the cold, he had a sort of crisis of claustrophobia, anxiety, and hypersensitivity. I believe this was due to his overdosing. However this aggressive dosing also appeared to resolve his concentration problems markedly. After the cold, he also spontaneously discontinued the Rx.)


Baseline Symptoms:
1 Lack of Concentration - pretty much all day, reading work orders
      "Clearly better "
2 Dwelling on the past - Daily affair
      "That is done, not anymore"
3 Headaches - 4 - 6 headaches in a month
      "They are gone, other then when the cold came."
4 Blues - sad, want to go and cry - that is almost daily
      "I've slipped back into that. Just noticed that within the last 3 weeks, but still coming off of the cold, it was a pretty strong cold. Went through my muscles, and my nervous system. Yesterday was a tough day b/c of the blues. Just this sad feelings. Anything else about that? No, that is it."
5 Phobias - claustrophobia in the back seat
      "Saturday night, went out with some friends. Was in the back seat of my truck, and didn't notice anything. I was in the middle, s/t I wouldn't do. Now sitting in vehicles, and it seems to not be so there."
6 Anger - once a week outburst
      "Oh, that is better. My boss said Trimet was about to do s/t that makes no sense. And I blew it off. Felt self getting to a point, and then it just released. I could say honestly before I would have been just really mad. It is better, would have been really mad. There was also another demonstration of where I’d normally get very angry, and didn’t, just let go. That does seem better. "
7 Isolating - avoid friends - daily 8 TV - Daily affair
      "It is getting better. It is still there, but I believe it is getting better"
9 Physical Restlessness
      "It feels like it is not there anymore - it is definitely not there. Which has me concerned. Concerned? yes, if do happen to relax too much, may go back to sitting in front of the TV, rather be out moving around. Still can't go to church by myself. Still can't go food shopping by myself. Improvement in shopping? No. It is like not feeling like going to church. And grocery shopping, I just don't want to do it. "
10 Nail biting - daily:
      "A: Continued progress. It appears as if Strammonium is the accurate Rx here. His initial progress was good, yet the concentration was not improving. Now that is clearly improving, and the other initial improvements have been retained. To further his healing progress, I gave him a few doses of 1M and a follow-up date of about 2 months. I expect he will notice further progress again by that point."


Plan:      1.) Stram 1M dry – one dose a day for 2 days
     2.) Return to clinic in 2 months for follow-up


Consultation of Wednesday, May 18, 2005
How are you doing?       "I'm doing well. I've had a friend that moved back from Chicago. Been talking a lot with her, started to go in reverse, started to feel the blues, depression was setting in, but lasted for 3 days. After I realized what was happening in my mind I was okay. I consider that a huge improvement. "
Huge improvement?       "I would have expected to dwell on it and run it through on my mind. When it starts to rain, that is also when the blues set in. Been buzzing right along, friends ask where do you get all this energy from. Anything else from when you first came in. Still biting my nails, that is deep down, don't know about that one. My stress levels have been really low. Had another incident where would have dwelt on something in my volunteer work with kids and didn’t. "


Baseline Symptoms:
3 Headaches - 4 - 6 headaches in a month
      "They have started up again. In the middle of last month, they started up. Prior to that, not having any, or maybe one or two. Now it is more like 4 times per week. Been a long week, a fender bender last week, and this thing that happened with my coaching. Saw a person have a heart attack at a wedding, really freaked me out. Also saw someone have an asthma attack. These are normal things that would really set me off, but they haven't. Another stress would be, taking on more of a coaching role, have stepped up."
4 Blues - sad, want to go and cry - that is almost daily
      "Other than me stepping on head coaches toes, it has only happened once in the last 2 months. "
5 Phobias - claustrophobia in the back seat
      "That is completely gone, been doing a lot of sitting in back seats, really interesting."
6 Anger - once a week outburst
      "I still feel that building up from frustration - really wanting to lash out. It is pretty strong, Frequency? I don't think it is there as much. There is a difference."
7 Isolating - avoid friends - daily
      "That one snuck up on me. I have friends, not necessarily the world's greatest friends. But been going over to friends houses. Isolating not so frequent now? Yes, not at all, but still a pull there."
10 Nail biting - daily
      "No change."


A: Good response all around. Yet his headaches are recurring somewhat and there is still some stagnation in some symptoms. So I suggested a single dose of the 1M he has at home.


Consultation of Monday, July 18, 2005
How are you doing?       "Everything was going real great, until last month. E/t has kind of worn off. Back to getting four hours of sleep. The sleep part is getting bad again. I felt depressed, that was about 3 weeks, now coming out of that. Focus hasn't been too bad, but for awhile there it was kind of. Now everything .. the sleep is not there, it is 4 hours. The nails, I'm still biting the nails. Old memories are coming up. It was bad where if thought about it would have started crying, but kept myself busy. Still hanging out with friends instead of staying by myself. It felt like a little depression, sleep, nail biting. This would be the time where I separated from my girlfriend – 2 years ago. Three weeks ago would be right around when it happened. "
Difficult break for you?       "yes. "
Up until 3 weeks ago, doing okay?       "Yes, doing fine. "
Sleep?       "It is waking up, then unable to go back to sleep, til the time I'm supposed to be getting up. "
Does the anger seem excessive to you?       "I am speaking more to our contractor, so that is a good sign. "
Standing up for yourself?       "Yes, actually do feel that way, not being passive. "
Any other complaints?       "No. "
Your sense of the treatment?       "It has been real good, feels like this tug of war inside of me, not being quite used to.. Sleep was cool when I was getting it. Not being passive but speaking up. I've got nothing but positive things to say about it. "
A: Sounds like anniversary of old Relationship breakup may have relapsed the patient. I recommended he take a stiff daily dose of 1M to see if that would get his sleep and other symptoms back on track.


Plan:      Stramonium; daily from bottle (a few pellets in 1 oz bottle) 4 drops under the tongue once a day for 7 days – than discontinue.


Consultation of Tuesday, September 06, 2005
How did that week’s worth of dosing work?       "It helped with the sleeping. "
Doing?       "Pretty good. "
Any concerns?       "No, though still biting the nails. The irritability has gone done, not as intense as before. I haven't really had anxiety. Things that were done to you in the past, how do you feel? If I saw them today, I'd kick the shit out of them, anger. Not going to let you get away with this. That is pretty much it. "
How are things in relationships?       "Still don't have a girlfriend, going on 3 years - not seeing anyone. I was going to dance clubs fairly regularly, and then just stopped. I would go out but not so interested.
Family life, it is tough for me to hang out with my family, everyone is married. My brother had a child, and I couldn't get myself to hold it. Afterwards I come home to my own place, and start to feel sorry for myself, my brother has it together and I don't. So avoid getting together with the family. That has been a problem throughout. But when I do go, do enjoy the time with everyone. But often after leaving whatever function it was, I'm not happy about where I am, I'm emotional, but no tears, no crying. I'm sure they are all trying to figure out why I didn't want to hold the baby. "
You have an idea why?       "No."


Baseline Symptoms:
1 Lack of Concentration - pretty much all day, reading work orders
     " It is fine now, it really is."
2 Dwelling on the past - Daily affair
      "Still happening. "Still everyday? "It is just for a second. Just that thought pops in my head, then it is gone. "Feels different/same? "It is different, now it is like a blip. Maybe dwell on it for maybe 5 minutes, then it is gone, out of my head. "Before? "It was all day, dwelling on the same thing, or a group of things."
3 Headaches - 4 - 6 headaches in a month
      No headaches
4 Blues - sad, want to go and cry - that is almost daily
      "Emotional state after watching the Katrina floods. I couldn’t believe what I was seeing. That was a really emotional thing, really hard to look at, for 35 minutes was in tears talking with my mom and other friends. It really hit home with me, made me really emotional. "Something in particular? "Head officials said they have it under control, and then seeing everything unfold the way it did. Babies being in the street dying with people - people being displaced. Took 5 days for things to get moving, and being unable to go down and help. It really upset me, still does. I cried for 35 minutes, then after that was on to other things. The stuff you've given me helped so I could move on."
5 Phobias - claustrophobia in the back seat
      "We went to the Oregon Caves. They had 16 of us all together. I told them I didn't know if I could handle it, so watch me. You get that cold air that hit me, I was the last one in. It was tight, really really tight. The ranger shut this big gate behind me, it was getting worse, I was pulling on my collar, plus it was dark. Everybody was bumping up against each other. Then I began to back out. After about 15 minutes had calmed down pretty quickly. I would have to have gotten out, I was pretty happy. "Difference? "Yes, I was able to get it together, took some breaths. "Enjoy it? "Yes, really did. Wasn't the other thing heights, I walked up this 150 foot ladder. Coming down was difficult, had to focus on the ladder. But really happy with the heights though, not as bad."
6 Anger - once a week outburst
      I think that is okay now.
7 Isolating - avoid friends - daily 8 TV - Daily affair
      Doing great
10 Nail biting - daily
      Unchanged


A: Patient is doing very well in all major symptoms. The only symptoms that are holding out are the biting nails and perhaps the physical restlessness. I told him we'll be spacing out follow-ups to every three months for a few more follow-ups, then they’ll be as needed.


Final Case Note: The last Consultation was Tuesday, June 27, 2006. At that intake the patient was doing very well. All symptoms were either entirely gone or so markedly improved that he was not concerned. The only symptom that was unchanged was nail biting. I suggested we end formal treatment at this point. We could have worked on the nail biting and perhaps deepening the improvements, but this seemed unnecessary. I also got the idea he was coming to treatment at this point a bit blindly. I wanted to give him the choice to resume treatment from his volition. He agreed this was a good idea. I was also concerned because up til now his mother had been paying and I know he has a low paying job.


Tim Shannon ND
drt@drtshannon.com