My eyes are open like a fish: a case of Ostracion cubicus

The patient is a nine-year-old boy whose main symptoms are insomnia, anxiety, and bad breath (his mother’s concern). He is a stocky boy, with very short brownish blonde hair, very pale skin, and a round face. In the interview, he sits slouching on a stool, slowly moving around. His voice can be monotonous and sometimes mumbling. He has fun with words and crafting sentences. For example, he refers to his front tooth that sticks out as his “dental disorder”. There is a staring, impassive quality to his face; although he is very intelligent, he appears somewhat vacant or lost in thought. He is quite solitary by nature – happily spending hours alone at home on the computer or reading or drawing. At school, he often chooses not to play with the other children at recess. Instead, he walks around and around a tree, thinking. He has, however, an easily triggered temper: should another child bump into him (accidentally or intentionally), he can fly into a rage and attacks, hitting or punching.

When he was a baby, he got a rash, which looks like impetigo, on his side (right flank) and on his arm. It is bumpy, red, inflamed, and hot. It comes up when he has lots of sugar, off and on for years; it is kind of itchy.

He is ungainly in most sports; although he does “run”, he is often the slowest in the group. His mother described him as a “water baby”: from infancy, he has always loved being in the water, and could spend hours in it. He is not, however, a good swimmer; he is quite content just to paddle around. At home, he could easily spend hours soaking in the bath.

I took the case in October 2011. I have highlighted the more important parts of the case.

Anxious?

Patient (P) “I occasionally get a sick stomach, around the beginning of September. I think I had it the year before too. My stomach throbs. I usually wake up with it – just a bit sick; churning. It happens every few weeks, sometimes for a couple of days.”

Mum: “He has had some discomfort and he throws up. It happened in grade 3 – it came out of nowhere.”

Then, you don’t go to school?

P: “No”.

How’s school?

P: “I’d say it’s a lot more stressful. I constantly have to remember to bring my agenda home. There’s a pile of spelling homework. It takes up a big chunk of my time. I’d rather be playing Minecraft.”

Do you get upset at school?

P: “I blew a fuse at school a few weeks ago. It’s like I quietly start sobbing. I’m upset, hungry, frustrated. Plus, this was in French class. I don’t even know what “les” means!

Mum: “When I come to pick him up and say ‘how was your day’? He answers it’s ‘slow and boring’.”

What about recess?

P: “Mainly wandering around thinking about various things, like indie game designs. It’s mainly wandering around the trees till I get dizzy or my feet get tired. Everyone’s playing manhunt.”

You don’t like it?

P: “Not really. I’m not really good at strategic games. My sprinting isn’t that good. I can barely remember the rules from grade 2 gym class!”

Sleep?

P: “I don’t fall asleep until like two hours have passed. I feel like a fish – you know how fish don’t have eyelids. It’s like I lie in bed with my eyes wide open. It’s a bit frustrating. I’m usually on my side. I just won’t shut down. I say ‘just go to sleep’, but I just start tossing and turning… I’m in bed around 9:00 or 9:08. The last time, I look at the clock is at 11:17. I think I fall asleep at 11:42….. My eyes snap awake at around 6:17. Then, I burrow my face in the pillows for an hour and 18 minutes. I’m tossing and turning.”

Nightmares?

P: “The selection varies and I barely can find the time to have a place in there (sleep) because my eyes are open like a fish.”

Any particular fish?

P: “Probably a ‘block fish’”.

What kind of fish is that?

P: “They cut through the water with ease – that’s all OWL magazine said about these. A company has designed a car similar to them.”

Analysis

The patient’s solitary nature, his intelligence, and his love for water (just being in it, floating, and paddling around), coupled with his own description of himself as a fish, immediately directs me toward a fish remedy. Later, when I looked up “block fish”, I find the yellow boxfish: this is the fish that Mercedes modelled one of their concept cars on.

However, as the remedy is not available, I need to find a fish and triturate it.

Prescription: Probiotic daily. Remedy, as soon as I can produce it: Ostracion cubicus 4C

Follow-ups

6th December 2011, on the phone with patient’s mother: “There’s been a shift in temperament: he’s more relaxed and chattier. More open and wanting to talk with us, as opposed to aloof or disinterested. We haven’t had an argument once since coming to see you. At bedtime, he’s not going into the drama, not getting angry. Now, I say “its bedtime”, and he comes willingly. There’s no anxiety and no insomnia! And, his breath is fine. It cleared up almost immediately since starting the probiotic.

The patient remained symptom-free until the first week in January. It was the day before school resumed, after Christmas holidays, and the anxiety symptoms returned full-on. His mother, anticipating a night of sleeplessness, gave him a dose of Ostracion cubicus 4C. He was asleep within 10-15 minutes, and was fine to go to school the next day.

27th March 2013: for the past year, the patient has been experiencing a recurring perioral rash: very red, itching, stinging. It is a large rash, almost like a clown’s mouth in appearance. Apart from the rash, everything else is fine. Due to a misunderstanding –  I thought his mum had given him a dose of his remedy, I had given her a 30C potency and nothing happened – I believed it was time to move on to a new remedy.

Prescription: Neon 200C, single dose

April 2013, from patient’s mother: “No change with Neon 200 but I gave him a dose of his remedy, Ostracion cubicus 4C, and by the next day it was 50% better!”

Since then, the patient’s mother has given him the remedy several more times, and each time it clears up right away.

He has recently been given the 30C potency, with a very fast response: within hours the rash began to disappear.

Photo: Wikimedia commons
Ostracion cubicus; Norbert Potensky