Case of woman with Prolapsed intervetebral disc
By Dr Meghna Shah
On 22nd September 2011, a 44 year old woman first came to see me with complaint of back pain due to a nerve compression in her side, which had been troubling her for the past thirteen years. She had had an episode of slipped disc in 2005 which was treated with allopathic medication and traction, but the problem kept recurring, keeping her in bed for 15 – 20 days at a time.
The pain is worse on lifting weight, and from movements which give a jerk to her lumbar region. She carefully avoids such movements, avoids lifting her daughter, and wears a lumbosacral belt.
She also has pain in her left leg which became worse after the birth of her second daughter, a little over a year and a half ago. This pain became a major problem in 2005 when she had to work for long hours in the kitchen, which involved frequent rising and sitting, going to get vegetables, and looking after her daughter, all in a hurry. From all this the pain became so severe that she could not move in the least, and had to be taken to the hospital in an ambulance. In the hospital she was treated with traction of 10-12 kilograms.
Before that episode she had been getting pain on and off. Her doctor told her at that time that her nerve was compressed and that she was in danger of developing spondylosis. For this he advised regular exercise.
When asked about the nature of the pain, she says that at times when she is working fast she suddenly feels a jerk, and that usually marks the beginning of an episode.
When asked to describe the jerk, she stood and made a gesture of bringing her hand to her lumbar region, making a sound like ‘tak’ . She said, “This mostly happens when at work. Maybe my spine is too weak, so I get this jerk.” And to avoid this she wears the lumbosacral belt when working, as it gives her support.
She further says that she gets a pain in the vertebrae with this jerk, as if bursting (she describes it in Gujarati as ‘faate’, which means ‘tear’ or ‘burst’), a sort of tingling pain mainly on the left side, which she cannot tolerate. She had an episode of this January when her daughter vomited at 2:00 AM. When the patient sat down suddenly to pick the child up she experienced this jerk, after which she could not move, either to lie down or to stand up.
Only lying on her back and applying electric heat give her a little relief during this pain. The bursting pain is not worse when she is walking, but definitely increases when she goes to use the toilet.
She says that in addition to this, the pain in her left lower leg makes squatting impossible, as the nerve feels too stretched when she attempts to bend the leg
Because of these pains she cannot give adequate attention to her family. She has a lot of work to do all day long due to her family responsibilities. Because of this busyness she has never been able to spare enough time to exercise.
Her elder daughter is fifteen year of age, and the youngest is only one year and eight months. Her most recent pregnancy was the result of accidental conception due to contraceptive failure. She only discovered after four months of amenorrhoea that she was pregnant. She had been experiencing abdominal pain and vomiting so she went to the hospital and underwent ultrasonography, and thus the pregnancy was discovered. As it was already so advanced they decided to go ahead with it. She felt happy about it but had fear at the same time. Because of her severe lumbar pain she had to opt for a C-section instead of a normal delivery. Her main fear was that there would be no one to look after her family if she needed bed rest due of the pain. For instance, she was very anxious about who would take her daughter to school and pick her up afterwards.
Her elder daughter is very beautiful, and when she used to come home from school by bus the boys would tease and make comments about her. The patient was very anxious about this situation. She had once even complained to the teacher about it. Because the boys would make gestures at the daughter and say that they like her, the patient felt that they had to keep an eye on all the boys in the class. For this reason she felt that she could not leave her daughter alone to ride the school bus. She feared that if her daughter was not well looked after, she would fall into bad company and begin having boyfriends, and then her attention would be diverted from her studies and she would begin to lie to her parents.
When asked about her dreams, she said she dreams of the god she worships (Srinathji, an Indian diety). She is very religious and goes to temple every day. As a child, she was very obstinate. If she asked her father to buy her something and he did not, she would refuse to obey him until her demand was fulfilled. She often asked her father to take her with him to his office.
She was quite interested and sincere in her studies so as soon as she returned from school she would sit to work on them. She has two elder brothers but they did not play with her as they were always busy playing cricket or chess.
At age five she fell down a flight of circular steps and fractured her left hand. That was a big trauma for her.
As a child she was very bold, with no fears. She used to travel alone to an adjacent suburb in order to reach her school. However now she feels she cannot go out alone. She says that in those days when travelling alone she had no problems; no one made any comments. But these days if her daughter is merely coming home at 8:30 PM boys make comments at her, so her father has to accompany her.
She likes reading, watching television, and playing throwball.
She tells of an incident ten years ago when she saw a very scary serial on television. The plot involved friends who were studying at college. After a disagreement they became enemies. One student mixed some sleeping pills into another student’s drink, then when he was unconscious, put him in a car and set it afire, making it look like an accident due to drunk driving. The victim never knew what happened. The patient had a strong reaction to this story and felt very afraid. Now she cannot watch anything of this nature.
The patient reports that she cannot tolerate cold. During the winter she wears a sweater even during the daytime. After she got married her in-laws used to laugh at her about this, but she was not embarrassed.
She is very fond of cleanliness and used to do all of the housework work by herself prior to her lumbar ache. She does not like animals as at all because they make home dirty and because they eat non-vegetarian food.
She tells of an incident when one of her daughters was ill. The patient was so anxious that she lay awake the whole night, and by morning her face was swollen and itching with an outbreak of urticaria. That next day her daughter was worse, and at one point fell unconscious. The patient became extremely scared when she saw her daughter fall to the ground; she began hitting her to try to rouse her. She experiences suffocation in a closed room and wants to just get out of the room (HG of pushing her hands apart).
The main complaint of the patient is backache due to nerve compression. She had a slipped disc problem in 2006 and could not move. She describes this as a kind of “jhatko”, a jerk. This complaint is aggravated by the slightest jerk to that part, or when lifting her daughter or any other weight. She feels that her spine is very “weak” and needs the help of belt, a “support” all the time. She again and again described her pain as a sudden jerk. She had a severe episode at night in which she could not tolerate the pain. The pain is better when lying straight on the back. So mainly we see that something is happening to her suddenly. Also we get certain modalities of her chief complaint.
This is as far as the chief complaint goes. It does not have many characteristic symptoms, so it leads only to a group of remedies. But when asked about the effect of the complaint on her we get a much deeper insight. The main effect is fear and anxiety that she will not be able to look after her family. She says it is mainly because of looking after her family that
 A game similar to volleyball.
she has neglected her own health. She does not have any time for herself. And in her story we see a tremendous anxiety for her family and for her daughter. The main worry was ‘who will look after my family?’ – especially that there is no other female member in the family to care for them. So we understand here that she is extremely busy and has great anxiety for her family.
The story about her daughter underlines what is characteristic in the case. Her daughter is very beautiful and the patient is afraid of the boys teasing her and making comments to her. She is very anxious for her daughter’s well being. The belief is that if her daughter is not supervised she may take up with a boyfriend and lie, do things that she is not supposed to, and neglect her studies. So she feels that her daughter should never be left alone. If her daughter is late coming home or does not call, she rushes to her school. She feels that her daughter, because she is young, has no knowledge what is good for her. So here we see that there is great anxiety for daughter, with the feeling that something could happen to her as she is too young to know what is good for her.
She has religious dreams of seeing Srinathji (the deity she worships). As a child her nature was stubborn and she would get very cranky when she was not given what she wanted. She was bold and could go out alone and travel to school alone, which she cannot do these days.
If we are to look at the characteristic rubrics of her case we see:
Now, if we are to look at the case from a system point of view, we see that there are two main themes running through the case. The first is intense fear. She is very anxious and fearful by nature. A lot of the fear and anxiety revolves around her children, as for example when the child is late she will just rush to the school. She fears that something will happen to her children.
In childhood she had no conscious fear and was very bold. But we see the fear very vividly now in her fear of being alone and in her reaction to frightening movies. So there is fear all around her, as if everything is frightening, especially when she is alone.
The second theme that features very prominently in her case is that of the family. The main thing that bothers her with her complaints is that there will be no one to care for her family if something happens to her. She feels that her daughter will not be safe and does not know what is good for her. This conveys that she sees her daughter as dependent on her; she sees herself as the support which her daughter needs. Interestingly, what she says about her chief complaint is that her spine is ‘weak’ and her belt gives her the support that she needs. This conveys the theme of column one of the Periodic Table of the Elements.
Her belief about her daughter is a reflection of her own feeling, that she is like a child who will be harmed if left alone, and she needs to run home to the family for security.
We see that the main problem is that her spine feels weak and she is losing support. And her whole story revolves around her family. So the main themes in the case are of structure, relations, health and family. This leads us to conclude that she needs a mineral remedy.
As we see two distinct themes emerging throughout the case we know that she will need a salt. The childlike dependence on the family is seen in the Kali group of remedies, while the theme of danger and the reaction of intense fear is a theme of the nitricums. The salt indicated in this case therefore is Kali nitricum.
The position of Kali, potassium, in the periodic table is group IA where it lies just below sodium, and in the fourth period just to the left of calcium. With remedies from group IA there is a need for relationships and a lot of dependence on those relationships. With Kali there is specifically the need for a relationship with the group or family, and the person is dependent on this relationship. The patient appears very childish in that she is unable to do anything without her husband being around, and is afraid of being alone.
With this we have the theme of intense suffocation in a closed room and wanting to get out. This is an important theme of the nitrates.
 Sankaran, Rajan. The Sensation in Homoeopathy. Mumbai: Homoeopathic Medical Publishers, 2004.
 Sankaran, Rajan. Structure: Experiences with the Mineral Kingdom, vol 2. Mumbai, India: Homoeopathic Medical Publishers, 2008.
In the television serial that she was extremely sensitive to, a person betrayed a former friend, poisoning him and setting his car on fire, then making it appear to be an accident. This is a story of danger at the hands of a trusted person. This is a very specific combination of themes for this salt: danger (nitrogen) from someone on whom one depends (Kali).
Remedy: Kali nitricum 200C
The centesimal scale was selected as the complaints started after a specific event. The emotions of fear and anxiety are prominent in her case and these also affect her physically, causing sleeplessness and even urticaria. Also, her physical state is seen to be having a big effect on her emotions. This kind of psychosomatic correlation is characteristic of Level 3, the level of emotions, which indicates the 200th potency.
Follow-up on 25th September, 2013
It has been a year since the patient began treatment. She has needed only infrequent repetitions of Kali nitricum in that time, and has experienced gradual improvement with each dose. She has used no other kind of medicine.
She is much better. When she first came to me she was unable to lift her left leg to place it on a footstool; now she is able to do that. Some pain in her calf remains but it is much less than before. Her lumbar pain is also much better. Before homoeopathy she had frequent flare-ups of backache for which she had to take a week or two of complete bed rest at least once every three months. Since starting Kali nitricum she has had only a few episodes of pain and these were so reduced in intensity that she never had to resort to bed rest.
Overall her energy levels are good. She tells us that she used to feel lethargic or ‘lazy’, and that is now gone.
Some anxiety about her daughters, that someone could tease them or even kidnap them, is still there. However we see there has been a lot of change. She now trusts her daughters much more, and has gained an understanding that she cannot control what the others do. This shift has lessened her anxiety.
She has not been noticing dreams. Because her anxiety has reduced her sleep is no longer disturbed.
4 For further reference see: Sankaran, Rajan. The Sensation in Homoeopathy. Mumbai: Homoeopathic Medical Publishers, 2004; and The Sensation in Homoeopathy, Ibid.
Remedy: Sac lac
It was an interesting experience to see Kali nitricum come up as a similimum for this kind of pathology – severe pain caused by a nerve compression. Kali-nit is not very well known for this type of complaint, yet the system understanding led me clearly to this remedy. Her great anxiety for her family, as if something would happen to them, made me understand her state and how she was as a person. The rubrics further confirmed that the remedy was indeed the right one.
It was gratifying to see the patient improve to such a great extent. Not only is her physical well-being greatly improved, but even her intense state of anxiety has been diluted, helping her to be in the present moment and allowing substantial improvement in her relation with daughters.
Dr. Meghna Shah
Dean, ‘the other song’ – International Academy for Advanced Homoeopathy