M. K. E, 27 yr. old
Case #2

Initial Intake:
Case Note: This pt was too sick to visit the clinic, so I packed my laptop, the clinic’s med bag, some urine dipsticks and followed my guide through the slum called Kariobangi. It was hard to keep up with my guide (one of our homeopathy students and translators) as she half ran to our destination. At one point, we bumped into a crowd of about 30 small children who began to jump up and down pointing and yelling with glee “mizunga, mizunga, mizunga” (white person).

The apt building consisted of all one room apts., and very small at that. When we got to the 2nd floor where the patient lived, I was ushered into a small dark room with one window. The patient was seated on her bed across from two chairs and a nightstand. That was all the space in the room. MK was a dialysis patient who was very sick and hadn't had dialysis for some months. Like most of the people here, she couldn't afford medical care. One dialysis treatment cost about 6,000 Kenyan shillings, roughly $77 US.

The patient was extremely emaciated and apparently delirious with bulging eyes muttering things in a singsong babbling way when we arrived. There was a strong offensive smell in the air, somewhat cloying. The pt was a dialysis pt who hadn’t been able to afford dialysis. She’d not had any dialysis for approximately 3 months as of this visit. This patient speaks English, though she speaks very weakly with her voice trailing off, like she is somewhere else.

Wednesday, July 3rd, 2000 (Kariobangi Slum House Call – Nairobi)
CC: Renal failure & hypertension.
S: Pt asks for cold water to drink as I walk in, I say it is okay to have a little. It is hard to talk. O: Lachrymation. S: Back pain that extends from the back. Hunger? no, Thirsty? Yes. For what? cold water. Feel better after cold water. Sleep? didn’t sleep, Whole body was painful, Laying with head on a seat cushion with stomach off of the bed, stomach is painful to touch the bed. Sleeps on cushion for about 5 minutes then wakes up, whole body is painful.

O: Lachrymation.
S: Back Pain? Like a stitching pain. Worst? on left side extending over to the right about level of top of sacrum (hip). It is better from rubbing. Crying from the pain. Temp? When feels a warm breeze, feels bad, but when feeling cold, puts on covers or sweaters Touch is painful, whole body is painful. Fear? When someone opens the door, I’m afraid. Afraid they are coming to beat me. I’m afraid b/c so long being sick. O: Pt begins to talk to herself in apparent delirium ( go away don’t come near me, take that , hey you stop). S: Dream? dream about thieves breaking the door and getting into the house. Don’t know the thieves. Since the B/P started to go up, that is when she feels dreams of the thieves. O: pt is moaning from pain, pt starts to whine and cry. The patient then vomits some yellow liquid, with an odor like fish. S: Bathroom? diarrhea, even three times a day, stool is black. Smell to urine? no. Chest pain? starts around the level of the sternum and radiates over to the dialysis shunt (pt has a dialysis shunt at the just superior to the right axilla on the anterior chest wall) on the right side stitching pain. Changes the pain? If I shake my torso around, that helps the pain. My stomach is heavy. Yesterday when feeling cold, whole body was feeling cold. Sensations? Doesn’t want anyone to touch by the catheters. What is your imagination like? Wants to get on with her normal life. When on dialysis before they noticed she wasn’t urinating, she was vomiting seriously. O: I started trying to do a kidney punch she began to cry from pain, very sensitive to mild kidney punch far above the kidneys. Did you urinate today? no. I ask her to urinate and she urinates a small amount of foul smelling (fishy smelling) urine.
O:

Urine dipstick, Plus ++ blood and protein, urobilinogen 1, everything else wnl.
B/P: 180/125 (approx. with a cuff too large and not able to hear very well) P 110,
Auscultation: Heart beat rapid with loud pounding, with tachnypea, shallow, and labored breathing.
Edema: +++ Bilateral-pitting edema.

A: Pt may be experiencing renal failure, and is clearly delirious. She is spilling blood and protein in her urine. Her pain is too acute to even do a kidney punch, she is in an acute state and can’t take a lengthy interview. Therefore, I must prescribe s/t that will help her get out of this state. Also STRONGLY recommended to her friend that she find a way to get her to dialysis. I had no experience with this type of pathology. I was hoping the Rx would have an effect and help her out of her acute distress, but it was a cursory visit due to the severity of her illness, so I was not particularly confident in the prescription.
P:

Phos 200c single dose
RTC in one week

Wednesday, July 12th , 2000 – 9 days after Rx (Kariobangi Clinic – Nairobi)

Case note: I was told by her friend that on the day after she started the phosphorous, she stopped vomiting, was able to eat, stopped the diarrhea, and was able to sleep for the first time in weeks (she'd been extremely restless with delirium for some weeks previous).

CC: Renal failure & hypertension.
S: I’m fine, I’m eating, no vomiting, no diarrhea, nothing is worse. I do feel very tired. I’m sleeping well. Dreams? Thieves coming (yesterday). I saw them coming, after I awoke, then they went. Feeling of dream? I was frightened and shaking, I breathe a lot when I walk a long distance. The dream felt the same as other dreams of thieves. My urination is normal, three times a day – no odor. I also went for one dialysis treatment last week. Craving cold water? No.
O:

B/P: 172/118
Urine Dipstick: Protein ++, Blood +, urobilinogen .2, pH 6.0
Kidney Punch: RT side negative, LFT side Positive

A: I’m none to pleased at this assessment. The B/P is still dangerously high, she is still spilling both blood and protein in her urine, and she is still seeing fearing and dreaming of the robbers. However, since she did get some initial benefit from the Rx and probably the dialysis, I decided to repeat in a higher potency.
P:

Phos 1M single dose in office.
RTC in one week

Monday, July 17th, 2000 (Kariobangi Slum - House Call – Nairobi)

Case Note: The patients’ friend, our translator, informed me that MK was doing poorly again and could not leave her apt. So off I went to see what I could do…

CC: Renal failure & hypertension.
S: Did the 1M of the medicine help? I didn’t notice any change after the medicine. After taking the medicine I started feeling sick after that medicine, vomiting and diarrhea & difficulty sleeping came back, also chest problems – heaviness in the chest. S/t better, S/t worse. Worse? Unable to breathe. O: Weeping & VERY WEAK. S: Vomiting? Green fluid and yellow TID. Thirst? Cold water or soda – before I got sick I also craved cold water. Sleep? Cannot breathe, I’m leaning over with pillows on the table, this helps me to breathe easier. Breathing is harder when I sleep. < breathing when lying on my back, also < pain @ shunt. Allopathic Meds? Yes, been taking consistently. Urinating? I’m urinating 3 to 4 x qd. O: Pt shows wounds on her legs, look like ulcer on RT shin 3” superior to ankle – no pain – it has been improving.
++pitting edema bilaterally.

Dreams? People dead, people who are sick. If w/ someone – spend the day w/ someone. I’ll dream of that person that night. Dead people? I can see someone in a coffin or lying on the bed dead. More then once I’ve dreamed this, though not before my sickness. Feeling? Shaking and frightened. Of? Can’t sleep again after that. I’m afraid of the dreams of dead people. Dreams of sickness? I feel sorry for those who are sick, no fear of thieves, no fear now. Dreams of visitors I’ve had before, not before the sickness. Diarrhea? Some times a dark bluish color, or black – but not red. Feelings about animals? I like cats and dogs, I dislike snakes, dislike cows and elephants. Dreams of elephants. Dislike snakes most, frightened of pictures of snakes. Menses? Stopped from December. The color was bright red. Problems? H/a, Vomiting, & pain. How about clothing tight or loose? When I’m not sick, I prefer tight, now prefer loose. Tight clothing on abdomen is too much. Jealousy? No. Vomiting and diarrhea that is blue (dark blue), or black. Swelling legs? – uncomfortable, I stretch them out. > sitting, also keep my feet down on the floor. Alone? Afraid of being by myself, if someone around okay. Temp preference? Warm, like it warm, even before the sickness liked warm over cold. Urination? Normal. Think about death? I think about dead people, some I know, others not. I tremble, I’m afraid – also had before I got sick. Feeling walking alone? That I’d be beaten by people, they would come from a bush (motions as if someone is coming from behind her). Imagination? As if they are after me to beat me, also when alone I fear this. Has s/t happened to you like this? No, never happened.
O:

Urine Dip: Protein +++, pH 7.0, Blood – trace
B/P: 180/136 RAS, P 86, R:20
Lung Auscultation: No adventitious sounds
Percussion – WNL except left upper lung field may have some dullness – subtle however.
Egophony – Negative
Kidney punch: Negative bilaterally

A: Pt’s friend told me after the interview that the pt was raped in 1992. Given the hemorrhagic diathesis, the idea that she would be attacked (she motioned that someone would jump her from behind), and her fear of snakes, I considered the case a PTSD case from the rape. I suspected a snake and repertorized the case (using Mangialavori’s additions):

The differential above is difficult, given that crot-c and crot-h come up so close together. I decided to give crot-c because it is listed as having dreams of coffins in synthesis and Mangialavori has a case of the Rx with this symptom.
P:

Crot-c 200c single dose dry (given by friend)
RTC this week if able.

Tuesday, August 1st, 2000 (Kariobangi Clinic – Nairobi)

Case Note: A brief follow-up was done as the pt showed up at the clinic spontaneously when other pt’s had appointments.

The patient looks much better but is still quite weak. The bulk of the pt’s sx’s have been improved. The Blood pressure was down to 130/70, this is significant since the pt had been on B/P Meds for more then 6 months and her B/P would still never fall below 170/120.

Case Note: I received the following email from Didi several weeks after this visit:
Still having swelling of body, legs. Now coughing. Urination is better. Today vomited. Early morning. Otherwise not so often.
BP 147/97 Pulse 82
Last Rx given (Crot-c) gave headache.
She said she was feeling better.
O: She looked puffy to me. face, legs.

Summary:
The above mentioned cases are not being presented as long term cures. I was only there at the clinic for 5 weeks. Additionally, I only got sporadic feedback on the patients and the patients were not well managed after I left. The above cases had significant benefit from the rx’s prescribed, but it is impossible to know how long the rx’s will act, and if the rx’s listed will go to cure the cases ultimately.

I am a student of Massimo Mangialavori, MD. He uses a standard which I share. The standard is that a prescription is not the simillimum unless the cure lasts for at least 2 years with only one remedy. Additionally, the remedy must address all acute complaints as well as chronic ones.

The purpose of sharing these cases is to give our community some idea about doing homeopathic “missionary” work. I found it to be deeply rewarding and incredibly affirming of the power of homeopathy, especially in the light of the gravity of the cases. I look forward to doing more of this work in the future.