Perthes disease and behavioural issues: a case of RNA

Perthes' disease is a condition where the top of the thigh bone in the hip joint (the femoral head) softens and breaks down. It occurs in some children and causes a limp and other symptoms. The bone gradually heals and reforms as the child grows.

Symptoms tend to develop gradually and can include:

• A limp, which may gradually become worse over a few weeks.
• Pain in the hip and groin area. Sometimes, pain is only felt in the knee or the thigh instead of in the hip - this is called referred pain.
• Stiffness and a reduced range of movement of the affected hip.
• In time, the affected leg may become slightly thinner (wasted) because the thigh muscles become thinner as they are not used as much as those in the other leg.
• The affected leg may look shorter than the good leg.
• Both hips may be affected but this is uncommon.

B. came to see me in January 2012, aged eleven years. She came for behavioural issues; the whole family were at a loss how to deal with her.

She is on the plump side, blond, blue eyes, and freckles. Bites and picks at her nails. Sits in a chair beside mum, frowning; no eye contact with mum.

Presenting symptoms

She has Perthes disease in both hips. Sometimes, it is so painful she cannot sit down. She does not like taking painkillers. She wants to move but cannot because of the pain. It hurts ‘real bad’ worse on the left side. It hurts to move in bed and stings like a breaking arm. It is worse when she is upset.

She had been to stay with (estranged) Dad – “I’m not going there any more.” – and got upset, mum says. She said she cried, felt sad and started yelling at people; swore at them, hit them and bit them. She was sent home.

Onset of hip disease and behaviour problems when parent separated seven years ago. She was happy prior to this. She has not been sleeping well because of the pain. She does not like any restrictions, boundaries, or rules. She reacts violently to ‘no’ and mother gives in.

Screaming matches. She is her own person and does whatever she wants.

B: “I scream, yell, swear at my mother, aunty, uncles but not at school.”

Meltdown when told ‘no’. (Meltdown is mum’s word for extreme emotional reactions)

She likes to go and play with friends, run away and play outside in the dark, especially with torches but must have light on to go to sleep in her bedroom.

She is being bullied at school.

She has never liked water. As a baby, she screamed when put in water; she does not like showers. It is getting worse, argues and shouts but now, she likes swimming in the pool.

Mum went out of the room for the rest of the interview. B. was given pen and paper.

Lynn Smith (LS): What is the anger like. Can you draw it?

B: “The Angry is grey, Its got cracks in it and stuff. Like grass, zig zag, not straight, diagonally. Like an egg. That makes the cracks connect to each other. When the cracks get bigger, I get more angry to my brain.

“Between the cracks is full of happy stuff. The cracks get bigger when I do something naughty and I’m sent to my room. When I’m upset the cracks get bigger, BIGGER. When I calm down they go smaller.”

LS: What is scary?

B: “Dark”.

LS: What else?   Silence. Plays with fingers, notice bitten nails.

B: “White tail spiders”.

LS: Why is the dark scary?

B: “Black, can’t see in it. Ghosts, monsters, spiders.”

She draws a monster, very carefully, concentrating hard. Getting in touch with subconscious. Then, we go back to the anger pictures.

B: “Monsters are scary because they are big and ugly, I don’t like them. They are yuk. I feel scared, I don’t like to see them. I feel as if I will be taken away….from my mum. I will miss my mum. I feel happy with mum (this is not evident in body language with mother).

LS: (looking at the previous pictures) Tell me about the cracks?

B: “They nearly burst. If they burst, they make everything pop. Then, they grow back.”

LS: They pop?

B: “Everything that’s angry comes out. Then, I’m not angry any more.”

LS: Tell me about the angry?

B: “It’s nearly bursting. The knives are going through the cracks to make it burst. They are long and sharp. When the cracks burst, the angry stuff goes into the happy stuff and they start fighting. If the cracks burst, they stay in the circle thing. The cracks go into the happy bits and they start fighting.”

LS: (looking at the Colour chart) The happy bits are C1 (yellow). The angry bits are B16 (blue). Two of the three primary colours.

B: “The fight is like…everything is cracking. If the fighting keeps going, the circle cracks. Then, the fight goes everywhere in the circle. It is fighting full, hard, I can’t control it.”

LS: What is the circle?

B: “The thing that controls it, but its not working. The smiley mouths are the good ones, the zig zags are the bad ones. They try to fight the good ones because the thing that controls it is not working.

Mother is called back into the room.

LS: Tell me about her birth?

Mother (M): “Normal pregnancy, dramatic birth, forehead first, very painful. Baby placid, demanding for food. I had no milk, so Bella was bottle fed, and as she was lactose intolerant with all milk, she went onto soy formula, all types of formula to find one which suited her.”

Family history

Paternal grandmother has diabetes. Maternal grandfather has cancer.

So, the circle, the thing that controls it, is not working. I have come to the understanding that the nucleus of the cell is not working. The nucleus of the cell is controlled by Ribonucleinic acid (RNA).

I have not used RNA before, but it is time to learn from my patient.

Vermeulen: (edited for brevity)

Mind: edgy feeling,

Cannot bear anything, cries at anything,

Quarrelsome and aggressive,

Shrieking at trifles

Wants to go away, to escape

Personality disorders (ugly character, troublemaker, heedless) in children who are slow at schoolwork

General: canine hunger

Unstable weight

Prescription: RNA 1M

Follow ups

February 2012

B. comes in and sits close to mum, they emit closeness, eyes twinkling at each other.

She is being good for mum, no screaming, or yelling. Anger went right down. No problems at school, good friends. Sister less annoying. Showers no problem, because its part of daily routine. Helping at home.

Mum says: “Amazing, no screaming matches, no verbal abuse. A completely different kid. I’m getting my baby back! Great improvement.”

She is sleeping better. Hips alright in sitting position but still cannot run.

Doctors plan a bone graft to hips to prevent dislocation.

No prescription.

March 2012

She is playing sports at school; her legs are sore less often. She can sit at school all day without being sore. She went to visit Dad with no behavioural problems. Occasional outbursts are starting to recur.

Prescription: Ribonucleinic acid (RNA) 1M

June 2012

Some food issues, not eating, she is getting low in energy then grumpy. An adored member of the family is very ill. Ignatia as an acute resolved the issue.

She has a hip operation in August 2012.

Two more doses of RNA were given:  June, 1M and July, 10M

Last seen in August 2013: she is playing netball twice a week, high energy levels. Wonderful help to mum. No behavioural issues. No further prescription.

Photo: Shutterstock
Angry young girl; Pathdock