See french version on interhomeopathy.fr
2007 February
Lac Equinum for Anxiety and depression
CASE
First appointment: June 27, 2003
Chief Complaint: Anxiety and Depression.
Sixty nine year old female presents with chronic panic attacks. She was a childhood survivor of a concentration camp. She has a strong European accent, and some of her use of english is a bit confusing. She speaks very seriously, very gravely about her problems. She rarely smiles and gets right to the point. She begins spontaneously:
Susanna: "If home, on the weekends, I sit in the house. No matter what I do, I get panic attacks, and I want to die; I don’t want to live. I don’t want to go keep going through this. During the week, I’m fine, doing things.
My momma said I’d scream at night “Momma, Momma!” and would come to her bed. I remember a dream. I was standing with my sister. The person came in, with an orangey-pink cloak over him, and he was going to kill us. That is all I remember. Every night that is all I could remember, I was living that dream, maybe there was blood there too. That may have been the start of the panic, that dream.
Then I got taken away to a concentration camp. I was eleven when they took me away from my momma. My momma and sister went to another camp. Every year I was sick, didn’t know how I could still walk. Don’t know why I’m still here. Family members would take clothes and trade them in for some beans, and some food. Family members would sneak in children. This was in the camps. We had nothing. Then they substituted me for another child and got me out. At the end of May, I went to the camp where my sister was; I couldn’t find my momma. After a time we all came together again. I didn’t have any panic attacks all that time until in the 1960s.
In ’59 I came to America. I would work daytime; but at night I’d wake up and have this feeling of being scared to death. Then I’d doze off in the living room, and the same feeling would repeat. Five years like that. Then in ’65 I had a panic attack in Europe, in the night. The next day I was scared and shaking. Took sleeping pills, and was so dizzy and panicky from those pills. My mother-in-law had some valerian drops, from the doctor. She gave me twenty-five drops and I was fine.
At 7 p.m., I calm down, but I can wake up at night, panicky and scared. A year ago I bought everything to commit suicide."
Everything?
"They put me on Paxil, and I got worse every night. I was going to do it, kill myself. Then my sister called. The doctor told me to go to the ER. I did and they gave me another drug which gave me dry mouth and made me hungry for sweets.
At 6 p.m. I would go walking. They thought I was doing it for my health, but I was going because everything chokes me. I’m scared to death, and I don’t know what I’m scared of.
When I got panic attacks, at a friend’s house, I would mow the lawn to keep busy. I was panicking waiting for my neighbor to come to my house. Then she didn’t come anymore. Or I’d walk around and around in the house, to keep moving and moving, until 7 p.m. Then I’d calm down and be okay. Then two years ago my son got married. They sold the house and built one for themselves. I had to move to an apartment and was by myself. Then is when it got real bad. Then the neighbors moved in and I was not as close with them as I am now. Now with their kids, I’m their best grandma.
The weekends are bad if I have to be alone in the afternoon. If some child comes for an hour or two, I’m better. I don’t feel perfect, but I control it better.
If this—this (patient points to chest and throat)—doesn’t open here, if that starts then I know. If it tightens up, I want to open it. When that starts I get depressed and don’t want to live. What for? I’m old enough, my kids are gone. With my husband I had a lot of problems. He had alcohol problems like lying. (Patient starts weeping.) Why did he die and not me? I was the one who was sick—breast cancer, back surgery, stomach ulcers. I can’t shake that awful feeling. Why am I scared? Why am I scared of sitting by myself?
If I go on vacation I can’t sleep in another house, I panic. Even thinking about going to Europe, all I think about is the panic. I can’t get on a plane because it is too crowded. In a church, I can sit in the aisle only. I’ve tried six drugs and herbs. With Xanax my tongue didn’t work and my head would buzz. I know people who take drugs for years and years and it works for them, but I have other friends like this too, not just me."
Can you tell me about the first panic attack?
"The first time I had it that I remember, I woke up at night my whole body feeling funny like something was going to happen. I didn’t know what it was. I would watch TV, then doze off and it would come again. That feeling, a scary feeling, it’s weird. It is a different scared . . . it is like you are on top of a hill and you are the only one in the whole world and you’d be up there, that is how it feels. If I do something it is okay, but when I relax that is when it happens. Or if something comes up."
Can you say something more about the first time?
"It woke me from sleeping. If it’s bad the panic wakes me up. It's because I don’t like the dark, the shaking would wake me up. I shake and panic. Sometimes it wakes me in the middle of the night, sometimes in the morning. Sometimes during the day, in the afternoon."
Afternoon?
"With no one there and nowhere to go, if I sit two hours in my house by myself I get the attacks. If someone calls and I can talk for a while I’m better. I have to think about what I’ll do the next day upon going to sleep. So I have to have something to look forward to. So I don’t have time to sit and do nothing."
Has it ever happened when you were with someone?
"Oh yeah, in the movie theater, in church—I have to talk—or in a freeway when there were cars around me.
I don’t like tunnels, don’t like elevators, I go in them, but I don’t care for them. When something comes up and gets me upset then it is bad."
Upset?
"Like my neighbors going to move, or if my son would be sick, something triggers it."
Do you have any physical sensations during panic?
"Shaking, and suffocating. (Patient makes repeated pounding motions with her hands violently toward her sternum and the left side of her neck.)
I have tightness in the center of my chest and in my throat. I wish I could open them up. Even after the attacks, the tightness remains. If I get depressed, that is when it happens. It is like something closing there. It only happens on the left side of the neck or the center of the sternum. Like something is not relaxing; it is tight. Then? I take a breath, but mostly I don’t think of breathing because my mind is here (patient points to sternum and throat). It is like a spasm; I want it to relax, to open. It comes suddenly, like when I have it in the house. I’ll be sitting there on Sunday, then the next day I am usually depressed, then I have tightness in my chest. Then I don’t want to go into the house, because it reminds me. If I have an attack in one place and then go to that place again, I panic.
I tell myself I’m stupid and childish, but it doesn’t do any good. If I do exercise or am jumping around it gets better. That is how I live with it. It is horrible; you never know when it comes."
When you’re feeling panicky, are you thinking of anything?
"No, I’m just scared to death; I just want to get out of it. It is not like a snake or something. If there is a snake, I know it is a snake, but with this the only way to run away would be to go outside. Then I have a hard time coming in again because it would hit me again. That is why I run around in the house, to try to make myself get used to it."
When is it particularly bad?
"I wake up day and night, can’t eat and just want to die. I’m always thinking about how to commit suicide without my son finding me."
Suicide?
"I don’t want to live like this anymore. I don’t want to be scared anymore. Yet I can’t do it, to have my son find me dead. I can’t do it, but I don’t want to live. I don’t want to go through this panic. The only way out is to take my life."
Can you tell me more about your thoughts on suicide?
"I would take sleeping pills, and rum, or vodka. If it wasn’t for my son finding me, that’s the only thing that has kept me here so far. I have no other way out, or take those pills and be drowsy all day."
My General Questions:
Do you have any fears, anxieties, or phobias?
Crowds, darkness, a small room with no windows. In a doctor’s office with no windows, I panic. I changed dentists because of that. I have to have control.
Can you tell me something about your relationship to animals?
Horses. I’ve always had bad dreams about horses; they always chase me. They were always so big, and they’d chase me. I have a lot of dreams where it is dark and I get lost and the people don’t speak my language. It gets dark and I panic then I wake up. Once I had this dream that they came with guns. We were hiding. They came very close. But the dream about the horses, I have this often. They come and I can’t get away and I can’t get out. They force me up against the stall. The horses never get me but sometimes it is very close, but I finally get away. It is always a struggle to get away, it is so big. I’m afraid of horses.
Can you say something about other animals?
I was always afraid of dogs; I once got bitten by a dog. If a dog is not on a leash I don’t like it. I walk around them, afraid, but not panicked.
Are there foods that make you sick, or that you don’t like?
Well, milk I gave up a long time ago and ice cream. I used to have headaches, used to have a lot of headaches. I don’t eat greasy stuff.
Do you react to dairy?
I used to get a headache and would feel sick, like vomiting from dairy. I drink soy milk instead. I have hot flashes. I had two cancerous tumors in my breasts.
(Thinking that Laq-eq might be the appropriate remedy)
Are you fastidious?
I’m a neat freak. Everything has its place; everything has to be dusted. They call me the one who always cleans. I always clean up someone’s house. Not that it bothers me, but it helps her, my neighbor. It makes me feel good to make her feel good.
Can you tell me something about your sleep?
Yeah, I wake every hour, hour and a half. I blame the hot flashes.
Do you have any menstrual or female issues?
I’ve always been anemic; my period is never on time.
Anything more?
I didn’t have enough red blood cells.
Can you tell me about your appetite?
It’s fine, I eat every two hours. I eat a lot of food. I have breakfast at 8 a.m., at ten I have some nuts and fruit, at noon I have my big dinner, at two I have fruit, and at five I eat my supper and some fruit again. I don’t eat sandwiches. I don’t eat ham, processed meat is not good anyway. I don’t eat out a lot.
Tell me something more about your sleep.
I go to sleep and half an hour later I awake. If panicky, I wake up panicky. My husband died at 11 p.m. and ever since I wake at 11 p.m. When I go to bed it takes me awhile to go to sleep. I can’t stop looking at the clock. By 4 a.m. I am usually awake if I don’t take something.
While sleeping are you restless or still?
I move and the hot flashes wake me up. Sometimes, before the hot flashes come, you are so cold and then you are so hot.
When awake are you restless?
I can leave things, like not washing my glass, but then I think about it. Or I make my bed every day. My mother was like that, everything had its place.
Tracking:
ß If I could sit in my house through the afternoon without panic or having to get out or call someone.
ß If I could think about going to Europe without having panic or tightness in my chest and throat.
ß Sleep better—I’m not calm, I can’t relax, I have to look at the clock.
ß Waking so easily.
ß Fear of closed-in places and small rooms.
ß Tightness in chest and throat when panicky.
ß I get burning in the back of my legs from sitting a lot or when walking in the mall.
ß I get pain in my back and my legs from sitting.
ß Pain in my bilateral thoracic area.
ß Pain in my right shoulder.
ß Pain in my right forearm.
Analysis: Some Rubrics to Consider:
Mind; ANXIETY; suffocation, with*
Mind; ANXIETY; time is set, when a*
Mind; BUSY*
Mind; DELUSIONS, imaginations; contracted, constricted, everything is*
Mind; DELUSIONS, imaginations; pursued, he is*
Mind; DELUSIONS, imaginations; trapped, he is**
Mind; DREAMS; animals, of; horses**
Mind; DREAMS; danger; escaping from a*
Mind; DREAMS; escape, of**
Mind; DREAMS; pursued, of being**
Mind; FASTIDIOUS*
Mind; RESPONSIBILITY; strong**
Mind; REST; cannot, when things are not in proper place*
Mind; SUICIDAL disposition*
Respiration; IMPEDED, obstructed; constriction, contraction; throat, of*
Sleep; WAKING; frequent*
Sleep; WAKING; fright, as from*
Comments: This patient is in a type of chronic urgent state. So it is important to consider the ways the remedies can present when the situation is not so urgent. In my mind, this may be a case of PTSD (post traumatic syndrome disorder) from the concentration camp. Something she was able to manage for a time by being occupied and around others. But eventually over the years her strategy wasn’t working any more and the panic attacks began to break through. She also lost her husband and she was away from her family. These events happened just before the panic attacks began in earnest.
My Rational for Lac Equinum:
• She had repeating dreams of horses.
• Clearly aggravated by milk.
• Restlessness and fastidiousness are well known for the Rx.
• Chronic headaches (very common pathology for patients needing milk remedies).
• Lung problems are also a weakness specific to the horse in comparision to other mammal milks.
• She had issues with time and pace (watching the clock, or eating every 2 hours), which is another peculiarity of Lac equinum.
• Very fastidious, this is much more central to the horse than the other mammal milks
• Industrious and business – very important for Lac Equinum.
• Burden and responsibility for others (she would regularly clean her neighbors house and refused money for it).
Plan: Lac-equinum (Hahnnemann Pharmacies) , 200c, Q12 hrs x 2 (dry), extra envelope to hold.
Follow up
2nd appointment: Friday, August 01, 2003 (5 weeks).
Susanna: "I’m doing much better. I stopped taking the medication from the doctor the next day. I’ve been busy too. I only had anxiety three times and it was not bad. I sleep good. I was in the house, my neighbors were gone for nine days and I didn’t have to leave the house. Yeah, I’m feeling better. I must feel much better because my neighbor asked me what I thought about last night. Last night there was a fight and apparently I slept through it. They said the walls were shaking. Usually I’d hear everything and I’d never go into that deep a sleep. That was a surprise to me; I couldn’t believe it. I still can’t believe it."
Tracking:
ß If I could sit in my house through the afternoon without panic or having to get out or call someone.
Now I can sit there. Not 100 percent of the time, but I don’t have to get on the phone or leave. I don’t get so anxious, just a little uncomfortable. Nothing like it used to be; it was horrible. 70 per cent improvement.
ß If I could think about going to Europe without having panic or tightness in my chest and throat.
deferred.
ß Sleep better—I’m not calm, I can’t relax, I have to look at the clock.
I woke up only twice with anxiety, once in the morning and once in the afternoon.
ß Waking so easily
Still waking, but now able to fall back to sleep. I would wake up with hot flashes. Now I sleep two hours. Before I would turn and toss with anxiety and wake up. I still wake up every hour and a half or two hours, but then I go back to sleep. Before I was panicky, looking at the clock, wanting the night to be over and watching the clock, unable to fall back to sleep.
ß Fear of closed-in places and small rooms.
I did sit in a car for a ride and was fine instead of being panicky. It used to be I felt this way even in my own house. Before the panic would wake me up, by the time I’d open my eyes I was scared. I had this panic only once. I used to have it a lot, every day.
ß Tightness in chest and throat when panicky.
I had it maybe two times, when I got upset or panicky. I didn’t have it that much. I had it maybe the two or three times of anxiety, but not bad. How often did it happen before? It was whenever I was depressed or panicky. It is a lot better.
ß I get burning in the back of my legs from sitting a lot, or when walking in the mall.
That is better.
ß I get pain in my back and my legs from sitting.
That is also better.
ß Pain in my bilateral thoracic.
Deferred.
ß Pain in my right shoulder.
Deferred.
ß Pain in my right forearm.
Deferred.
My stomach is better too. Before even when drinking only water, twenty minutes later I’d get stomach pains. If I ate something, it would go away. My stomach is better. I do get headaches sometimes. I had one the other day, but it didn’t last long. They used to when I was younger. I felt something after I took that medicine. For two weeks or so, I felt . . . felt like something is working in my head. Not sleepy, but something relaxing. I can’t explain it. Like something was working in my head. Like something was calming me or relaxing me.
I also have arthritis in my back, my spine, up to my neck, and my shoulder (mostly right). I feel pain in the muscles of the back. Spasms of the thoracic (bilateral). Also right side of trapezius and rhomboids. Also get pain in my right shoulder and pain in the right forearm. The muscles are stiff.
Assessment: Excellent response.
Plan: Watch & Wait.
3. Case Note: Monday, August 04, 2003
Patient called and saying relapse happened starting this past Saturday (three days ago). She has been having anxiety, difficulty sleeping, waking from anxiety similar to prior to Rx, but not quite as acute. She denies any worsening factors.
Plan: 200c, quarter teaspoon once per week, starting August 04, 2003
4. Next appointment: Friday, September 19, 2003 (Approx 3 months).
Susanna: I’m doing pretty good. My arthritis is bothering me; I think it is the weather. I’m much better. I can handle it now better when I’m at home. I don’t know how it will be when the days are short. This last weekend I was home and I did okay. I didn’t get that panicky feeling. In the afternoon when I’m alone, I don’t get this “have to do something” feeling. In the morning I don’t have to get out of bed.
Tracking:
ß If I could sit in my house through the afternoon without panic or having to get out or call someone.
Better.
ß If I could think about going to Europe without having panic or tightness in my chest and throat.
The tightness I’ve not had, just that time I called you in August. None in the last two weeks.
ß Sleep better—I’m not calm, I can’t relax, I have to look at the clock.
I sleep okay, except for hot flashes—they wake me up.
ß Waking so easily.
Doing fine.
ß Fear of closed-in places and small rooms.
I used to have that, I felt a little uneasy when with my granddaughter; I was a little anxious, but not panicked. I felt stupid. I remember praying a lot last week because I felt so good—let it always be this way.
ß Tightness in chest and throat when panicky.
Don’t have it.
ß I get burning in the back of my legs from sitting a lot, or when walking in the mall.
It is better.
ß I get pain in my back and my legs from sitting.
That is better.
ß Pain in my bilateral thoracic.
That is worse.
ß Pain in my right shoulder.
Better, but hard to tell.
ß Pain in my right forearm.
This is good; it is okay now. I’m surprised—I worked with a hoe and it didn’t bother me.
I need more warmth on the back and cooler on the front. I can’t sleep in a warm room because I can’t cool off from the hot flashes.
How’s your stomach?
It’s doing okay. One day, (patient sighs) I had this pain like a knife in the right side. I felt so nauseated. If I bent over, I felt so sick, like something was stuck. I had this several years ago. I thought it would get worse and I would have to go to the hospital and then it went away.
I’ve had sinus infections all my life. And flu problems. And chronic nasal inflammation. I just had it this past winter.
I always had to be thinking about what I was going to do the next morning before going to sleep because I wanted to get out of the house to not be alone. A friend asked me recently, “What are you doing tomorrow?” And it was Saturday! That was my worse day and I hadn’t even thought about it. It is so good to feel good!
Assessment: Patient is still doing very well. She has plenty of Rx to use.
Plan: 1M in dropper bottle for possible use, to hold onto.
5. Interim Phone Consult: February 14th, 2003
Patient and I had conversation today about surgery. She went to see her Primary care doctor because of some abdominal pain. He did an exam and thought the pain was due to gall stones and suggested removal. Somehow either from a suggestion from her GP or from her own mind, she got the idea that she needed to get the surgery to prevent possible cancer. In our discussion I encouraged her that she should not get the surgery on that basis. I also encouraged her to make a follow-up appointment. She was in an agitated state and concerned about the cancer possibility. She has been reluctant to come in as she has been feeling well and it is inconvenient for her to get a ride into town and the cost given that her chief complaint is resolved. Given her fear and anxiety about the cancer, I suggested an occasional dose of the 1M, perhaps one dose per week.
P:1. Lac Equinum 1M QWk PRN (once a week as needed)
6. Case note: Tuesday, May 25, 2003
Patient left phone message:
Hi Dr. Shannon, I’m doing fine, I didn’t have the gall bladder surgery and none of your medicine since the second week of March. I’m taking nothing except vitamins. I’m very busy seven days a week. I’m doing just fine. If there is a change, I’ll just let you know. You will hear from me when I get to need you again, probably by the fall or whenever.
Final Analysis:
That is the last contact I’ve had with the patient. This is the type of case that I consider a “gift” in my practice. Only in the sense that she clearly had the “signature” of the substance she needed. I could confidently prescribe the remdy right at the intial interview. This is possible in only about 30% of my cases. So given that many cases present and require more research, it is always nice to see a patient in need of a clear animal remedy.
Some ideas of animal “signatures” in clinical practice:
The utility of signatures with patients that need animal remedies is often useful, but it can also be misleading if used superficially. For instance, sometimes a patient will talk so much about birds, you can’t help but think about bird medicines. However, the remedy will not work unless the other themes of the birds are present in the patient. Also, animals often express archetypes that generalize. For instance, many patients are leery around snakes, but many remedies can have that fear without needing an actual snake remedy. The archetype of a snake is universal. The same is true for many animals.
In my mind, the signature is useful when we carefully confirm the rest of the symptoms that belong to the family and the totality of the case. In addition, I try to see if the substance the remedy is made from actually makes sense for the type of pathology the patient presents with.
Signatures are also much more prominent with patients that need medicines from the animal realm. I have many successful prescriptions of animal medicines where the patient has many signatures of the animal that helped – it is very common in my experience. However, this is not nearly as common with patients needing medicines from the mineral or plant realm.
Tim Shannon, ND
Portland, Or.
drt@drtshannon.com
First appointment: June 27, 2003
Chief Complaint: Anxiety and Depression.
Sixty nine year old female presents with chronic panic attacks. She was a childhood survivor of a concentration camp. She has a strong European accent, and some of her use of english is a bit confusing. She speaks very seriously, very gravely about her problems. She rarely smiles and gets right to the point. She begins spontaneously:
Susanna: "If home, on the weekends, I sit in the house. No matter what I do, I get panic attacks, and I want to die; I don’t want to live. I don’t want to go keep going through this. During the week, I’m fine, doing things.
My momma said I’d scream at night “Momma, Momma!” and would come to her bed. I remember a dream. I was standing with my sister. The person came in, with an orangey-pink cloak over him, and he was going to kill us. That is all I remember. Every night that is all I could remember, I was living that dream, maybe there was blood there too. That may have been the start of the panic, that dream.
Then I got taken away to a concentration camp. I was eleven when they took me away from my momma. My momma and sister went to another camp. Every year I was sick, didn’t know how I could still walk. Don’t know why I’m still here. Family members would take clothes and trade them in for some beans, and some food. Family members would sneak in children. This was in the camps. We had nothing. Then they substituted me for another child and got me out. At the end of May, I went to the camp where my sister was; I couldn’t find my momma. After a time we all came together again. I didn’t have any panic attacks all that time until in the 1960s.
In ’59 I came to America. I would work daytime; but at night I’d wake up and have this feeling of being scared to death. Then I’d doze off in the living room, and the same feeling would repeat. Five years like that. Then in ’65 I had a panic attack in Europe, in the night. The next day I was scared and shaking. Took sleeping pills, and was so dizzy and panicky from those pills. My mother-in-law had some valerian drops, from the doctor. She gave me twenty-five drops and I was fine.
At 7 p.m., I calm down, but I can wake up at night, panicky and scared. A year ago I bought everything to commit suicide."
Everything?
"They put me on Paxil, and I got worse every night. I was going to do it, kill myself. Then my sister called. The doctor told me to go to the ER. I did and they gave me another drug which gave me dry mouth and made me hungry for sweets.
At 6 p.m. I would go walking. They thought I was doing it for my health, but I was going because everything chokes me. I’m scared to death, and I don’t know what I’m scared of.
When I got panic attacks, at a friend’s house, I would mow the lawn to keep busy. I was panicking waiting for my neighbor to come to my house. Then she didn’t come anymore. Or I’d walk around and around in the house, to keep moving and moving, until 7 p.m. Then I’d calm down and be okay. Then two years ago my son got married. They sold the house and built one for themselves. I had to move to an apartment and was by myself. Then is when it got real bad. Then the neighbors moved in and I was not as close with them as I am now. Now with their kids, I’m their best grandma.
The weekends are bad if I have to be alone in the afternoon. If some child comes for an hour or two, I’m better. I don’t feel perfect, but I control it better.
If this—this (patient points to chest and throat)—doesn’t open here, if that starts then I know. If it tightens up, I want to open it. When that starts I get depressed and don’t want to live. What for? I’m old enough, my kids are gone. With my husband I had a lot of problems. He had alcohol problems like lying. (Patient starts weeping.) Why did he die and not me? I was the one who was sick—breast cancer, back surgery, stomach ulcers. I can’t shake that awful feeling. Why am I scared? Why am I scared of sitting by myself?
If I go on vacation I can’t sleep in another house, I panic. Even thinking about going to Europe, all I think about is the panic. I can’t get on a plane because it is too crowded. In a church, I can sit in the aisle only. I’ve tried six drugs and herbs. With Xanax my tongue didn’t work and my head would buzz. I know people who take drugs for years and years and it works for them, but I have other friends like this too, not just me."
Can you tell me about the first panic attack?
"The first time I had it that I remember, I woke up at night my whole body feeling funny like something was going to happen. I didn’t know what it was. I would watch TV, then doze off and it would come again. That feeling, a scary feeling, it’s weird. It is a different scared . . . it is like you are on top of a hill and you are the only one in the whole world and you’d be up there, that is how it feels. If I do something it is okay, but when I relax that is when it happens. Or if something comes up."
Can you say something more about the first time?
"It woke me from sleeping. If it’s bad the panic wakes me up. It's because I don’t like the dark, the shaking would wake me up. I shake and panic. Sometimes it wakes me in the middle of the night, sometimes in the morning. Sometimes during the day, in the afternoon."
Afternoon?
"With no one there and nowhere to go, if I sit two hours in my house by myself I get the attacks. If someone calls and I can talk for a while I’m better. I have to think about what I’ll do the next day upon going to sleep. So I have to have something to look forward to. So I don’t have time to sit and do nothing."
Has it ever happened when you were with someone?
"Oh yeah, in the movie theater, in church—I have to talk—or in a freeway when there were cars around me.
I don’t like tunnels, don’t like elevators, I go in them, but I don’t care for them. When something comes up and gets me upset then it is bad."
Upset?
"Like my neighbors going to move, or if my son would be sick, something triggers it."
Do you have any physical sensations during panic?
"Shaking, and suffocating. (Patient makes repeated pounding motions with her hands violently toward her sternum and the left side of her neck.)
I have tightness in the center of my chest and in my throat. I wish I could open them up. Even after the attacks, the tightness remains. If I get depressed, that is when it happens. It is like something closing there. It only happens on the left side of the neck or the center of the sternum. Like something is not relaxing; it is tight. Then? I take a breath, but mostly I don’t think of breathing because my mind is here (patient points to sternum and throat). It is like a spasm; I want it to relax, to open. It comes suddenly, like when I have it in the house. I’ll be sitting there on Sunday, then the next day I am usually depressed, then I have tightness in my chest. Then I don’t want to go into the house, because it reminds me. If I have an attack in one place and then go to that place again, I panic.
I tell myself I’m stupid and childish, but it doesn’t do any good. If I do exercise or am jumping around it gets better. That is how I live with it. It is horrible; you never know when it comes."
When you’re feeling panicky, are you thinking of anything?
"No, I’m just scared to death; I just want to get out of it. It is not like a snake or something. If there is a snake, I know it is a snake, but with this the only way to run away would be to go outside. Then I have a hard time coming in again because it would hit me again. That is why I run around in the house, to try to make myself get used to it."
When is it particularly bad?
"I wake up day and night, can’t eat and just want to die. I’m always thinking about how to commit suicide without my son finding me."
Suicide?
"I don’t want to live like this anymore. I don’t want to be scared anymore. Yet I can’t do it, to have my son find me dead. I can’t do it, but I don’t want to live. I don’t want to go through this panic. The only way out is to take my life."
Can you tell me more about your thoughts on suicide?
"I would take sleeping pills, and rum, or vodka. If it wasn’t for my son finding me, that’s the only thing that has kept me here so far. I have no other way out, or take those pills and be drowsy all day."
My General Questions:
Do you have any fears, anxieties, or phobias?
Crowds, darkness, a small room with no windows. In a doctor’s office with no windows, I panic. I changed dentists because of that. I have to have control.
Can you tell me something about your relationship to animals?
Horses. I’ve always had bad dreams about horses; they always chase me. They were always so big, and they’d chase me. I have a lot of dreams where it is dark and I get lost and the people don’t speak my language. It gets dark and I panic then I wake up. Once I had this dream that they came with guns. We were hiding. They came very close. But the dream about the horses, I have this often. They come and I can’t get away and I can’t get out. They force me up against the stall. The horses never get me but sometimes it is very close, but I finally get away. It is always a struggle to get away, it is so big. I’m afraid of horses.
Can you say something about other animals?
I was always afraid of dogs; I once got bitten by a dog. If a dog is not on a leash I don’t like it. I walk around them, afraid, but not panicked.
Are there foods that make you sick, or that you don’t like?
Well, milk I gave up a long time ago and ice cream. I used to have headaches, used to have a lot of headaches. I don’t eat greasy stuff.
Do you react to dairy?
I used to get a headache and would feel sick, like vomiting from dairy. I drink soy milk instead. I have hot flashes. I had two cancerous tumors in my breasts.
(Thinking that Laq-eq might be the appropriate remedy)
Are you fastidious?
I’m a neat freak. Everything has its place; everything has to be dusted. They call me the one who always cleans. I always clean up someone’s house. Not that it bothers me, but it helps her, my neighbor. It makes me feel good to make her feel good.
Can you tell me something about your sleep?
Yeah, I wake every hour, hour and a half. I blame the hot flashes.
Do you have any menstrual or female issues?
I’ve always been anemic; my period is never on time.
Anything more?
I didn’t have enough red blood cells.
Can you tell me about your appetite?
It’s fine, I eat every two hours. I eat a lot of food. I have breakfast at 8 a.m., at ten I have some nuts and fruit, at noon I have my big dinner, at two I have fruit, and at five I eat my supper and some fruit again. I don’t eat sandwiches. I don’t eat ham, processed meat is not good anyway. I don’t eat out a lot.
Tell me something more about your sleep.
I go to sleep and half an hour later I awake. If panicky, I wake up panicky. My husband died at 11 p.m. and ever since I wake at 11 p.m. When I go to bed it takes me awhile to go to sleep. I can’t stop looking at the clock. By 4 a.m. I am usually awake if I don’t take something.
While sleeping are you restless or still?
I move and the hot flashes wake me up. Sometimes, before the hot flashes come, you are so cold and then you are so hot.
When awake are you restless?
I can leave things, like not washing my glass, but then I think about it. Or I make my bed every day. My mother was like that, everything had its place.
Tracking:
ß If I could sit in my house through the afternoon without panic or having to get out or call someone.
ß If I could think about going to Europe without having panic or tightness in my chest and throat.
ß Sleep better—I’m not calm, I can’t relax, I have to look at the clock.
ß Waking so easily.
ß Fear of closed-in places and small rooms.
ß Tightness in chest and throat when panicky.
ß I get burning in the back of my legs from sitting a lot or when walking in the mall.
ß I get pain in my back and my legs from sitting.
ß Pain in my bilateral thoracic area.
ß Pain in my right shoulder.
ß Pain in my right forearm.
Analysis: Some Rubrics to Consider:
Mind; ANXIETY; suffocation, with*
Mind; ANXIETY; time is set, when a*
Mind; BUSY*
Mind; DELUSIONS, imaginations; contracted, constricted, everything is*
Mind; DELUSIONS, imaginations; pursued, he is*
Mind; DELUSIONS, imaginations; trapped, he is**
Mind; DREAMS; animals, of; horses**
Mind; DREAMS; danger; escaping from a*
Mind; DREAMS; escape, of**
Mind; DREAMS; pursued, of being**
Mind; FASTIDIOUS*
Mind; RESPONSIBILITY; strong**
Mind; REST; cannot, when things are not in proper place*
Mind; SUICIDAL disposition*
Respiration; IMPEDED, obstructed; constriction, contraction; throat, of*
Sleep; WAKING; frequent*
Sleep; WAKING; fright, as from*
Comments: This patient is in a type of chronic urgent state. So it is important to consider the ways the remedies can present when the situation is not so urgent. In my mind, this may be a case of PTSD (post traumatic syndrome disorder) from the concentration camp. Something she was able to manage for a time by being occupied and around others. But eventually over the years her strategy wasn’t working any more and the panic attacks began to break through. She also lost her husband and she was away from her family. These events happened just before the panic attacks began in earnest.
My Rational for Lac Equinum:
• She had repeating dreams of horses.
• Clearly aggravated by milk.
• Restlessness and fastidiousness are well known for the Rx.
• Chronic headaches (very common pathology for patients needing milk remedies).
• Lung problems are also a weakness specific to the horse in comparision to other mammal milks.
• She had issues with time and pace (watching the clock, or eating every 2 hours), which is another peculiarity of Lac equinum.
• Very fastidious, this is much more central to the horse than the other mammal milks
• Industrious and business – very important for Lac Equinum.
• Burden and responsibility for others (she would regularly clean her neighbors house and refused money for it).
Plan: Lac-equinum (Hahnnemann Pharmacies) , 200c, Q12 hrs x 2 (dry), extra envelope to hold.
Follow up
2nd appointment: Friday, August 01, 2003 (5 weeks).
Susanna: "I’m doing much better. I stopped taking the medication from the doctor the next day. I’ve been busy too. I only had anxiety three times and it was not bad. I sleep good. I was in the house, my neighbors were gone for nine days and I didn’t have to leave the house. Yeah, I’m feeling better. I must feel much better because my neighbor asked me what I thought about last night. Last night there was a fight and apparently I slept through it. They said the walls were shaking. Usually I’d hear everything and I’d never go into that deep a sleep. That was a surprise to me; I couldn’t believe it. I still can’t believe it."
Tracking:
ß If I could sit in my house through the afternoon without panic or having to get out or call someone.
Now I can sit there. Not 100 percent of the time, but I don’t have to get on the phone or leave. I don’t get so anxious, just a little uncomfortable. Nothing like it used to be; it was horrible. 70 per cent improvement.
ß If I could think about going to Europe without having panic or tightness in my chest and throat.
deferred.
ß Sleep better—I’m not calm, I can’t relax, I have to look at the clock.
I woke up only twice with anxiety, once in the morning and once in the afternoon.
ß Waking so easily
Still waking, but now able to fall back to sleep. I would wake up with hot flashes. Now I sleep two hours. Before I would turn and toss with anxiety and wake up. I still wake up every hour and a half or two hours, but then I go back to sleep. Before I was panicky, looking at the clock, wanting the night to be over and watching the clock, unable to fall back to sleep.
ß Fear of closed-in places and small rooms.
I did sit in a car for a ride and was fine instead of being panicky. It used to be I felt this way even in my own house. Before the panic would wake me up, by the time I’d open my eyes I was scared. I had this panic only once. I used to have it a lot, every day.
ß Tightness in chest and throat when panicky.
I had it maybe two times, when I got upset or panicky. I didn’t have it that much. I had it maybe the two or three times of anxiety, but not bad. How often did it happen before? It was whenever I was depressed or panicky. It is a lot better.
ß I get burning in the back of my legs from sitting a lot, or when walking in the mall.
That is better.
ß I get pain in my back and my legs from sitting.
That is also better.
ß Pain in my bilateral thoracic.
Deferred.
ß Pain in my right shoulder.
Deferred.
ß Pain in my right forearm.
Deferred.
My stomach is better too. Before even when drinking only water, twenty minutes later I’d get stomach pains. If I ate something, it would go away. My stomach is better. I do get headaches sometimes. I had one the other day, but it didn’t last long. They used to when I was younger. I felt something after I took that medicine. For two weeks or so, I felt . . . felt like something is working in my head. Not sleepy, but something relaxing. I can’t explain it. Like something was working in my head. Like something was calming me or relaxing me.
I also have arthritis in my back, my spine, up to my neck, and my shoulder (mostly right). I feel pain in the muscles of the back. Spasms of the thoracic (bilateral). Also right side of trapezius and rhomboids. Also get pain in my right shoulder and pain in the right forearm. The muscles are stiff.
Assessment: Excellent response.
Plan: Watch & Wait.
3. Case Note: Monday, August 04, 2003
Patient called and saying relapse happened starting this past Saturday (three days ago). She has been having anxiety, difficulty sleeping, waking from anxiety similar to prior to Rx, but not quite as acute. She denies any worsening factors.
Plan: 200c, quarter teaspoon once per week, starting August 04, 2003
4. Next appointment: Friday, September 19, 2003 (Approx 3 months).
Susanna: I’m doing pretty good. My arthritis is bothering me; I think it is the weather. I’m much better. I can handle it now better when I’m at home. I don’t know how it will be when the days are short. This last weekend I was home and I did okay. I didn’t get that panicky feeling. In the afternoon when I’m alone, I don’t get this “have to do something” feeling. In the morning I don’t have to get out of bed.
Tracking:
ß If I could sit in my house through the afternoon without panic or having to get out or call someone.
Better.
ß If I could think about going to Europe without having panic or tightness in my chest and throat.
The tightness I’ve not had, just that time I called you in August. None in the last two weeks.
ß Sleep better—I’m not calm, I can’t relax, I have to look at the clock.
I sleep okay, except for hot flashes—they wake me up.
ß Waking so easily.
Doing fine.
ß Fear of closed-in places and small rooms.
I used to have that, I felt a little uneasy when with my granddaughter; I was a little anxious, but not panicked. I felt stupid. I remember praying a lot last week because I felt so good—let it always be this way.
ß Tightness in chest and throat when panicky.
Don’t have it.
ß I get burning in the back of my legs from sitting a lot, or when walking in the mall.
It is better.
ß I get pain in my back and my legs from sitting.
That is better.
ß Pain in my bilateral thoracic.
That is worse.
ß Pain in my right shoulder.
Better, but hard to tell.
ß Pain in my right forearm.
This is good; it is okay now. I’m surprised—I worked with a hoe and it didn’t bother me.
I need more warmth on the back and cooler on the front. I can’t sleep in a warm room because I can’t cool off from the hot flashes.
How’s your stomach?
It’s doing okay. One day, (patient sighs) I had this pain like a knife in the right side. I felt so nauseated. If I bent over, I felt so sick, like something was stuck. I had this several years ago. I thought it would get worse and I would have to go to the hospital and then it went away.
I’ve had sinus infections all my life. And flu problems. And chronic nasal inflammation. I just had it this past winter.
I always had to be thinking about what I was going to do the next morning before going to sleep because I wanted to get out of the house to not be alone. A friend asked me recently, “What are you doing tomorrow?” And it was Saturday! That was my worse day and I hadn’t even thought about it. It is so good to feel good!
Assessment: Patient is still doing very well. She has plenty of Rx to use.
Plan: 1M in dropper bottle for possible use, to hold onto.
5. Interim Phone Consult: February 14th, 2003
Patient and I had conversation today about surgery. She went to see her Primary care doctor because of some abdominal pain. He did an exam and thought the pain was due to gall stones and suggested removal. Somehow either from a suggestion from her GP or from her own mind, she got the idea that she needed to get the surgery to prevent possible cancer. In our discussion I encouraged her that she should not get the surgery on that basis. I also encouraged her to make a follow-up appointment. She was in an agitated state and concerned about the cancer possibility. She has been reluctant to come in as she has been feeling well and it is inconvenient for her to get a ride into town and the cost given that her chief complaint is resolved. Given her fear and anxiety about the cancer, I suggested an occasional dose of the 1M, perhaps one dose per week.
P:1. Lac Equinum 1M QWk PRN (once a week as needed)
6. Case note: Tuesday, May 25, 2003
Patient left phone message:
Hi Dr. Shannon, I’m doing fine, I didn’t have the gall bladder surgery and none of your medicine since the second week of March. I’m taking nothing except vitamins. I’m very busy seven days a week. I’m doing just fine. If there is a change, I’ll just let you know. You will hear from me when I get to need you again, probably by the fall or whenever.
Final Analysis:
That is the last contact I’ve had with the patient. This is the type of case that I consider a “gift” in my practice. Only in the sense that she clearly had the “signature” of the substance she needed. I could confidently prescribe the remdy right at the intial interview. This is possible in only about 30% of my cases. So given that many cases present and require more research, it is always nice to see a patient in need of a clear animal remedy.
Some ideas of animal “signatures” in clinical practice:
The utility of signatures with patients that need animal remedies is often useful, but it can also be misleading if used superficially. For instance, sometimes a patient will talk so much about birds, you can’t help but think about bird medicines. However, the remedy will not work unless the other themes of the birds are present in the patient. Also, animals often express archetypes that generalize. For instance, many patients are leery around snakes, but many remedies can have that fear without needing an actual snake remedy. The archetype of a snake is universal. The same is true for many animals.
In my mind, the signature is useful when we carefully confirm the rest of the symptoms that belong to the family and the totality of the case. In addition, I try to see if the substance the remedy is made from actually makes sense for the type of pathology the patient presents with.
Signatures are also much more prominent with patients that need medicines from the animal realm. I have many successful prescriptions of animal medicines where the patient has many signatures of the animal that helped – it is very common in my experience. However, this is not nearly as common with patients needing medicines from the mineral or plant realm.
Tim Shannon, ND
Portland, Or.
drt@drtshannon.com
Categories: Remedies
Keywords: anxiety, depression, lac equinum, dreams of horses, restlessness, fastidious
Remedies:
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