The importance of pre-accidental symptoms in life-threatening situations

In the course of 19 years of practice, there have been three occasions where I was asked to provide homeopathic help in life-threatening situations. By their nature, these were highly emotional experiences which, due to the bizarre nature of the biographies involved, have had a profound impact on my homeopathic thinking.

Case I
The first case goes back to 1988 when a chief of police on his way to church on an early Sunday morning was run over by a car while crossing a street where, especially at that time, there was hardly any traffic at all. He was hospitalized with severe brain damage and given up by the doctors in charge. Despite the comatose condition he was in, there were indications of pain and agitation and he had difficulties breathing. The relatives asked me to do what I could to relieve his condition. I was able to achieve some marginal palliative results with the obvious remedies (Antimonium, Arsenicum album), but the reaction did not last long and was not very significant. The man passed away without having regained consciousness.
Nevertheless, I was acutely aware of the importance of this experience for my future life as a homeopath. In essence, it was a situation in which there was nothing to loose and little to gain. There were no risks involved in treatment because although there obviously was hope among the relatives of the victim, his condition was basically hopeless.


Case II
The second time I was asked to assist in a case of similar severity was in 1999, when a colleague asked me to help with the treatment of a girl I had first seen in consultation three years earlier. At the time my colleague had started treating her in 1996, the girl, Melanie, was nine years old. She didn’t react well to the remedies prescribed, so the colleague asked me to take a look. During consultation the following information was given.
Melanie has two sisters, senior in age by seven and nine years. Her parents had not planned for her and the pregnancy came at a time when her mother was just about to make a second start in professional life (antimonium). Still, it took her only two weeks to get used to the idea and there were no complications during the rest of the pregnancy. She desired: apples, aversion: coffee, butter and the smell of melted butter, nor during the (induced) process of labor and giving birth. Melanie grew up in a protected environment and she was a happy, easy child.

She’s a girl with blond hair and a thin mouth which she has a tendency of leaving open, her large tongue flopping out. During consultation she blows little bubbles of spittle. Her left eye is slightly turned outward, with the other eye following suit on occasion. She sucks her thumb and walks with stamping feet. She is quiet and timid most of the time, even shy, but she can also be clownish and sneaky, delighting in snatching things away.
She has problems with new situations, and she is conscientious about trifles. She only goes outside to play when the weather is good and she hates riding her bicycle because it makes her feel tired. She enjoys games of imagination, she sings and likes to help her mother in the kitchen. She is a lively, talkative child in the classroom, but shy when asked to talk in front of the class. She's not comfortable participating in school theatricals. Her behavior is generally changeable. She can be very helpful, but at times she is grumpy and dismissive. She avoids contact, even with her mother, sometimes for days on end. During the last twelve months, this has become a recurring pattern.
She can have a strong urge to scream at a high pitch. She often searches for reasons to say no and seems to delight in disapproval. She is obsessed with the contents of the evening meal, but often refuses to eat. She doesn't eat very much, especially in the morning and can only defecate when no one is around. She has little patience and when she can't get something done, she throws and kicks things around. When her mother is angry, Melanie gets upset. Melanie hates it when people talk about her. She has a special bond with her grandfather, and she's very caring toward him, especially since the death of the grandmother. She can suddenly make jokes about basically serious matters.

Complaints
**She has trouble falling asleep and she doesn't remember her dreams. She rises early on weekends, but has trouble getting up on school days. She is moody in the morning, although this usually only lasts for half an hour. She sleeps on her side or on her belly and wears socks to bed.

**She has hearing problems, right < left. < winter from October until April (2), ever since she suffered from Pfeiffer when she was four years old and just entering kindergarten. Sometimes her ears suddenly start to hurt, a pain which gradually fades away most of the time. Yawning relieves the pressure and sometimes there is a discharge of foul smelling pus.
**During the winter months she is tired and listless, but she seems to immediately spring to life again when the weather improves.
**Abdominal pains > lying on her stomach.

Family anamnesis; CNSLD, diabetes, Hodgkin's disease.
Fear: the haunted house at the fair, spiders, snakes, thunderstorms.
Desire: cold, raw vegetables, tomato, cucumber, soup (3), fruit, tuna, tea.
Aversion: rice, sprouts, butter, egg yolk .
Thirst: normal.
Temperature; chilly.
Perspiration; none.
Childhood diseases; mononucleosis, chicken pox.
Vaccinations; no particular reactions.


When I am first consulted in 1996, Melanie had already experienced two life-threatening situations where she came close to suffocating. The most recent incident having occurred in 1993, when she choked on a piece of sausage and was taken to the hospital. When the ambulance arrived there, the lump of sausage just happened to spring free. The incident seems to be related to, not necessarily the origin of, a long history of fear, particularly the fear of suffocation.

Based on her history (Pfeiffer), the lack of reaction on previous medication, the actual complaints (sleeplessness, behavioral disorders), the aversion to butter in both mother and child and in spite of the sensitivity to cold, I decide to prescribe Carcinosinum. The reaction is no more than moderate.

This is the last I hear of Melanie until 1999, when a tragic accident causes the homeopath treating her, a friend of Melanie's mother, to call in my assistance. That morning Melanie has been hit by a small van while crossing the street on her way to school. Her parents, both qualified nurses working in the IC department of a hospital specialized in neurosurgery and neurotraumatology, immediately understand the seriousness of the situation. The girl has stretching cramps (caused by uncontrolled stimuli from the brain), a skull base fracture on the left side, combined with brain and heart contusion. She also suffers from severe neurotrauma causing a heightened need for oxygen to the brain At the same time, the stress reaction leads to accumulation of moisture in the lungs and the alveoli, which collapse as a result of dissolving the protective layer. There is little hope of survival and the parents ask for additional homeopathic treatment, a request to which the neurosurgeons do not object.
When I see Melanie she is in a coma. The situation hangs in the balance, so much so, that my colleague and I are reluctant to use any of the common acute remedies. We are afraid that remedies such as Arnica may cause an initial aggravation which, in her condition, the girl would not survive.
The only significant observation is the cloudy aspect of Melanie's skin, particularly on the legs, which have taken on a marbled blue color.

As it happens (as happen it will), my colleague had seen Melanie in consultation only three days before the accident. She had not decided on a prescription yet, but during the consultation a number of remarkable symptoms had been identified:
The urge to scream.
Fear of getting involved in a traffic accident (3).
A desire for tea.
Frequent staring.

This led us to Hydrocyanicum acidum, a remedy that although having been considered on the basis of pre-accidental symptoms, seemed appropriate just the same.

The pathogenesis of Hydr-ac. is mainly composed of symptoms observed in poisoning cases and clinically verified, but it has also been proved by Jórg and his pupils in 1825, on 5 persons.
Hydrocyanic acidum, present in bitter almonds, stones of peaches, plums and other fruit and laurel leaves. It is a rapidly acting deadly poison, producing convulsions, paralysis, collapse, and cramps everywhere. Effects are sudden. Convulsions and paralysis express the action of this remedy. Spasmodic constriction of the larynx, feeling of suffocation, pain and tightness in chest, palpitation, pulse weak and irregular.

MIND; Fear of imaginary troubles. Fear of death, house falling, horses, cars, of crossing the street (even when the vehicle is at a considerable distance). Loud involuntary screams, just before the convulsions. Unconsciousness. Wild delirium.
SKIN; Bluish discoloration during convulsions. -
Sources - Phatah, Murphy, Vermeulen
DD; ” Snake remedies”, Rosaceae (Laurocerasus), Antimonium, Solanaceae, Hell , Nux vomica, Opium, Cicuta, Tabacum, Arsenicum, Cuprum, Belladonna.

According to Jan Scholten Hydrocyanicum acidum can be seen as the acute of the Rosaceae which all contain hydr-ac especially in the seeds.

It took us some time to get hold of the remedy, but when we administered it, the monitoring equipment showed a clear positive reaction. Against all medical expectations there was a complete and under the circumstances, quick recovery, much to the astonishment of the doctors in charge.

Revalidation: Melanie had to learn how to speak and walk all over again which took a year. Since then she has fully recovered and has become a perfectly normal child, although still cross and obstinate on occasion. Shortly before writing this article, I contacted my colleague to ask how Melanie was doing. I learned that she had just suffered an anaphylactic shock after having been stung by a wasp. Once again, there were severe respiratory problems. My personal opinion is that Melanie needed more Hydrocyanicum-acidum, but unfortunately, due to other circumstances, homeopathic treatment has been cancelled before it could have been fully completed.


Case III
The third instance where I was asked to assist in a life-threatening situation, occurred in March of 2002.

Jim had undergone surgery for an inguinal hernia he had developed while building a Hindu sculpture garden in his backyard. It was a routine case of laparoscopic surgery. A few hours later he found himself in acute and terrible pain and had to be operated on again. The probable cause was an intestinal perforation, leading to peritonitis which in turn led to rapid heart and kidney failure. Here was another life-threatening situation and again, the prospects were grim.
When I first see him in the IC department where he is being kept in a coma, the tall, slender person I have come to know is now in such a severe state of oedema, that I have a hard time recognizing him. His ears are almost swallowed up by his extremely inflated head, his skin is about to burst and riddled with moisture bubbles. His condition is, in a word, extreme. He is in a fever and there is a red sediment in his urine. I begin to repertorize, consciously keeping in mind what I have learned from my previous experiences in life-threatening situations.

History
Jim, born 1941, first consulted me in August of 2001. He came from a family of six children. During a bombing raid in World War II, he watches his mother die in a shelter while giving birth to her sixth child. Because of the air-raid, there is no doctor present. Jim is two years old at the time. Three years later his father re-marries. In Jim's perception, his stepmother has always been a dominant and achievement-oriented woman. He grows up to become an architect and manager of a construction company. In 1975 he starts suffering from hyperventilation and burn-out. He feels trapped in his job responsibilities and makes a dramatic career switch to become a yoga teacher and hypnotherapist. He finds fresh energy in this new form of social interaction after the feeling of exhaustion from his former, essentially controlling and rational life. It is by no means an easy transition and during this period his marriage breaks up. In 1998 a cyst was removed from his left popliteal space and he was extensively treated for parodontitis. Teaching yoga he meets his second wife and by 2001 the couple have two young children.
In June of 2001, he gets sick. He feels faint, coughs, has backpains and feels generally tired. In July he is diagnosed as having pneumonia. Treatment consists of a course of antibiotics, followed by a second one later that month. This is when the headaches start, caused by sinusitis, accompanied by diarrhea and chest pains. By the end of July, he is hospitalized with IV antibiotics and after having been discharged in August he has to stop working. The attacks of hyperventilation return, he suffers from vertigo and diarrhea, has pain attacks in arms, legs and chest causing him to faint. When he throws up he has to lie down, because otherwise he will faint. The fever comes back (39.7), he feels completely exhausted. The inflammation on his lower left pulmonary lobe remains and there is still a lot of expectoration in the form of green mucus. He has a persistent cough and in spite of all the antibiotics, there are still piles of green mucus coming out of his nose. Sick, he becomes absent-minded, pensive and scary thoughts start creeping into his mind. He has burning red cheeks in an otherwise color-drained face. He suffers from migraine attacks that cause a sharp pain right above the eyes which is only alleviated by crying. When he sleeps, he wakes up with a headache. He regularly has nose bleeds.


Fear; Flying.
Temperature; Warm.
Perspiration; Seldom.
Desire; Sweet drinks, spicy food, Thai, Indian.
Aversion; Milk, dairy products, fish (3) and the smell of fish(3), meat, chocolate, potatoes.
Agg.; Throwing up (not just recently)<< milk. The smell of fish.
Thirst; None to speak of
Urination; Frequent at night

Personality
Jim is a man of principles and conscience. He has an overactive mind and sees work everywhere. His house and office are immaculate, he has built and designed them himself and the interior decoration demonstrates wonderful taste. There is little room for patience in his hurried, irritable nature. He hates waiting and when he drives his car he likes to step on the gas. Underneath a phlegmatic outer appearance, he is nervous and tense. He never complains and hardly ever talks about himself. Activity is his second nature and he finds it hard to relax. He is strict with his children and demands obedience. He has a distinct dislike of dancing.

Halfway through August, I start him out on Sulphur 30. There is a slight improvement, particularly with respect to the scary images that used to haunt him. Next, I prescribe Lachesis 200, which cures the nose bleeds, the fainting fits, the sinusitis and the headaches. He now has a regular pulse, his inguinal hernia no longer bothers him and the swelling is gone. Ever since he started taking Lachesis halfway through August, recovery has been very quick, but doubts remain as to the effectiveness of the prescription, particularly in Jim's own mind. There is after all, a chance that he had already begun to recover spontaneously prior to taking the remedy. Within this context and with the information available to me at that time, I am beginning to feel slightly insecure myself. He can put up with the children much better now, but what keeps bothering him is that despite his enormous appetite, he fails to put on any weight. "I look like those pictures of people in concentration camps," he says, choosing an image which may be significant in light of his childhood war experiences. His gums no longer bother him and he sleeps well.

He returns in September complaining of stomach-ache after eating. He still feels an obstruction in his chest, he has not gained any weight and he has a pronounced craving for juicy things. I prescribe Phosphor 200. During October and November the recovery continues. He can do anything he wants to do, but suffers from epicondylitis lateralis (right side) and backpains.

He is back in December still suffering from migraine and still coughing up lightly colored slime. His gums are inflamed again and the elbow still gives him pain. His stomach is okay and the pressure in his chest is gone. He talks about a recurring dream he has had all his life, about some thief stealing his beautiful cars. Jim has always been a car freak and at one time, he almost bought a vintage Cadillac. He also has dreams about having to pee, but either the toilet is out of order, he just can't do it, or people are watching. He yawns extensively. I prescribe Ozone 200 (dd Fl).

This is the last I see of Jim until I find him on the IC department in March 2002. During my visit I observe, but I also ask his wife if she can tell me anything that might help. As it turns out, this hetero-anamnesis produces very relevant information. One of the things she tells me is how much Jim enjoys cuddling up to her when they are in bed together. She also tells me how distrustful he can be, how he refuses to accommodate to anybody and how provocatively he behaves toward his in-laws. One thing he cannot stand is disorder. I am reminded of his unusually fast recovery after he had started taking Lachesis. I am now convinced there has been some partial healing reaction after all. All this in combination with the image now painted by his wife, my own impressions of Jim as a person, his heart and kidney failures, his heart rhythm disorders and his warm-bloodedness, makes me decide to administer Crot-h 200, another hydrocyanic containing remedy.

A few hours after the remedy has been administered, his temperature goes up to 39 degrees. Next morning the fever is gone and he has started to urinate. He is breathing more regularly and after two days, the moisture bubbles on his skin have dried out. He is no longer sweating excessively, his face is beginning to take on its old, normal shape again and he is now urinating normally. His heart rhythm is also returning to normal.
He still needs regular doses of Crot-h, but they are always immediately effective. There is a short setback during recovery when he develops cystitis, but here too, a new dose of Crot-h proves effective. While still in the hospital, Jim has one more attack of hyperventilation when he observes a green wall, which brings back images of the air-raid shelter and the death of his mother. Later, back home, he still feels a lot of pent-up anger when watching images from the war.

Crot-h has proved very effective in the acute situation, but there have been major improvements on a constitutional level as well. In July of 2002, Jim is working full-time again. He himself says everything is perfect, except for a slightly sensitive pubic bone and the old epicondylitis pains. I prescribe Crot-h M.

In retrospect, I believe I was wrong when I started doubting the partial recovery reactions brought on by the Lachesis. These doubts led me away from the 'snake' track, which in the end proved to have been the right one after all.

Conclusion
To me, these three cases, apart from demonstrating the effectiveness of Hydrocyanide acid and Hydrocyanide acid containing remedies in cases of life or death, clearly illustrate the importance of remedies chosen on the basis of pre-accidental symptoms and analysis, even in cases where there is acute injury and accident trauma. In the first case there was simply too little information available to act on and I have only mentioned it because to me, the strong sense of premonition I felt at the time makes it the first incident in what I have come to view as a chain of interrelated events. In the other two cases, adherence to - or, in the third case, resumption of, remedies chosen on the basis of pre-accidental symptoms and information not pertaining to the isolated accident itself, have proved effective in the face of imminent loss of life to the point of actually resulting in full recovery. I feel there is definitely a lesson to be learned from these case histories. Although I realize that additional studies would be needed to justify conclusions on a general level, I do believe these case studies support the proposition that in cases of life-threatening situations pre-accidental symptoms are vitally important and should always be taken into consideration.