A CASE OF URINARY INCONTINENCE
by Jayesh Shah, Devang Shah and Pallavi Mahadeshwar
A 70 year old gentleman came to us on 11 April, 2012. His main concern was urinary incontinence which had begun after an operation to address prostate enlargement. He was also concerned because although he was on allopathic medication for type 2 Diabetes, his sugar levels were widely fluctuating. He wanted help in these matters and in generally ensuring a healthy future.
The patient appeared to be a sensitive, gentle person. He spoke in a mild, gentle manner, yet also with a kind of dignity. He related to us that he felt hurt that the surgeon had not warned him about potential post-operative side effects, including urinary incontinence and hindrance in his sexual life. (This interest in sexuality stood out as somewhat peculiar.)
He is living with his second wife at present. His first marriage ended in divorce, after which he remained single and followed a spiritual path for nine years.
He described himself as cool and calm, but said that he gets angry at injustice and dishonesty. He enjoys running his own business which for him is a creative outlet. He is popular with his friends, and especially likes to be appreciated for his work.
He worries a lot. He says that he often dwells on past memories of his childhood with his father. His father was a very forceful, strict person. He was terrified of his father’s angry reprimands. His father disapproved of spending money, which was a huge source of stress. He once witnessed his father hit his older brother for spending too much money and this frightened him a great deal. He was so afraid of his father’s disapproval that he suppressed his dream to pursue a career in the sport of badminton, although he was a champion at it. Instead he pursued a degree in commerce, following his father’s wishes.
His father’s dictates often caused the patient embarrassment in public. For instance on one occasion his father humiliated him by forcing him to wear short pants in front of his colleagues. He says that his father was like a tyrant.
His mother provided all of his love and care. He describes her as a gentle and loving soul, very affectionate by nature, a strong contrast to his difficult father. During the interview he talked at great length about the differing natures of his two parents.
The patient has a strong fear of hospitals, and is very sensitive to others’ suffering.
As a child he was emotionally sensitive in general. When playing with his cousins he could not bear even a small joke at his expense. He used to weep when he lost a game or when he was teased.
As a child he was also highly claustrophobic. Once there was an incident on an airplane which was about to take off. He became so panicked that the crew was forced to reopen the plane to let him off. At the time he was desperate to be out in the open. He also had anxiety in crowded places.
He remembered two peculiar dreams. Once he dreamt that he was standing on a beach with a wall behind him, when a big wave washed over him. His feeling in the dream was an acute fear of dying, which caused him to wake with a start. In the second dream he was sleeping in a room with his five brothers, and on waking he discovered that all of them were dead and he was the only one alive. When asked about his feeling in the dream he said that it struck him as very strange.
The most striking and stressed aspect of his case was the patient’s great distress in childhood due to his extremely strict father. He was very mild and could not bear his father’s harshness. For example, his father did not like to spend money and would reprimand his children for that. The patient spent a lot of time talking about how his father was a dictator and how his mother was very soft and gentle.
Hearing a 70 year old man talking on and on in this way, we understood that this must be his main issue. The memories of childhood trauma at the hands of his father are still fresh in his mind! He spent much more time talking about that than about his main complaint. This speaks about his sensitivity to this childhood situation. We see especially his sensitivity to all of the harsh reprimands. Trying to connect his fear and claustrophobia with his life situation as a child, it was interesting to see that this fear was probably similar to the fear experienced in the presence of the strict father. Often the client does not clearly connect his deepest feelings in a situation directly. We can then understand them through fears, dreams, and in interests and hobbies. There are multiple situations and windows through which one can understand the level of experience.
As he grew, he became sensitive to injustice in the world. He stands up against injustice when he encounters it.
Along with his sensitive and gentle nature, we have observed a kind of dignity about him. So we are dealing with a person who is very dignified and sensitive to hurts.
He said that he is creative in his business, popular among his friends, and likes to feel appreciated. So we see the polarities of criticism and appreciation. Now we know we need a remedy that has these aspects of criticism and appreciation, and also covers his post-operative ailments.
The following rubrics (shown in the repertorization graph) were derived from the characteristic symptoms of the case.
On consulting Phatak’s Materia Medica, we find, for Staphysagria, the following descriptions:
Nervous affections with trembling is a marked feature of this remedy. It has irregular sexual appetite and a tendency to masturbation. [This shows the sexual mindedness of Staphysagria.]
Acts on URINARY ORGANS; fibrous tissue; Morbidly sensitive; the least word that seems wrong hurts her very much;
Sphincters; lacerated and stretched. LACERATED TISSUE; perineum etc. Stitching pains, remaining after operations. Ill effects of anger and insults; reserved; anger, injury, falls; clean cut wounds; operations; sexual excess;
[Post operative injury to the sphincter was the main complain of this patient.]
Imagines insults. Great indignation about the things done by others or by himself; grieves about the consequences.
Ailments from reserved displeasure. Very sensitive to what others say about her. Ill effects after scolding or punishment in children.
Remedy: Staphysagria LM3
Comments on potency
The patient has chronic progressive diabetes. We can see that it is progressing because his fluctuating blood sugar is no longer under control of his allopathic medications. There is currently a danger to vital organs such as kidney, eyes, nerves and heart, due to this long-standing diabetes which is now uncontrolled. Considering this chronic progressive aspect of his pathology, an LM potency, allowing for repeated dosing, was selected. He also experienced most of his complaints at level 1, 2 or 3. Even when relating his father’s story he did not really emote during the consultation. There was the sense of remaining in control which is typical for Staphysagria. Furthermore his main complaint was at the local level. Thus LM3 felt like a safe bet to start with, keeping the option of going higher if needed.
The patient responded immediately to the remedy. His incontinence improved within the first month of treatment. After three months the incontinence was around 80% better, and after six months he estimated that it was 95% better. There is no more fluctuation of his blood sugar levels; they have stabilized with the standard dose of allopathic medication that he had been on and can now maintain. His most recent glycosylated hemoglobin was 7.6; it was 8 before starting homoeopathic treatment. His fasting sugar level has reduced from 170 to 120.
Mentally he says he feels a sense of calmness and a kind of acceptance toward the stress of life. He can now overcome small upsets promptly, which was not previously the case.
He told us about a difference of opinion with his daughter related to work, which he had not mentioned in the first interview. He says “Now I have understood it and I am okay with it”. This is very a positive and healing change in him. The ability to accept things as they are has made him much calmer. He says that he is now keen not to impose his perceptions of reality on his daughter. Now he can live with the fact that they have differing views.
So we see that the patient got better at the physical level, in his pathology, and also at the mental and emotional level, as now the stress of life does not bother him and he is able to accept things as they are. This is the beauty of homoeopathy – it does not just cure a physical problem, but also returns the patient to the sense of ease and well-being that comes with cure at deeper levels. This profound holistic effect makes this science one of the best healing methodologies in the field of health care.
After three months on Staphysagria LM3 the potency was shifted to LM4, as there were still fluctuations in the patient’s blood sugar levels. After stepping up the potency that problem disappeared.
The sensation of things narrowing in on him, and thus trouble when in a crowd, is not known to be a very prominent aspect of Staphysagria, and this has been clinically observed to get better with the remedy.
The second aspect which came through in his nature was that he was a worrying person – even small things would cause him a great deal of worry, about himself; disease; money; relations; everything. This is not normally associated with Staphysagria. So I asked myself whether this deeply worrying nature is a less well-known aspect of the remedy. But upon further thought I saw that the underlying factor was not the worry itself, but the type of thing that he was worried about. For instance, when he worried about his father, the worry was that he would be shouted at or scolded. When he worried about money, again, this was fear of his father’s disapproval. And his worry about having to go into the hospital was really due to his deep sensitivity to observing suffering. So what we are really seeing is his deep sensitivity, which is plant kingdom, and the specific sensitivity to harshness, scolding and disapproval which is Ranunculaceae.
Another major aspect of the case was seen in his dreams, in which something huge is coming and he is taken over by that. In one case it was the sea that was coming over him, and in another dream it was a calamity, finding that all his brothers were dead. Neither of these was a recurrent dream; they were elicited after persistent questioning and hence they carry less weight in the analysis. However, from this case we can learn that the feeling of eminent danger or loss of life must be a significant aspect of Staphysagria, because the patient has done so well on this remedy. Fear of disease and dying is an important aspect of the Ranunculaceae family, as we can see in Aconite. Many Staphysagria cases may have fear of death. A fear of being pursued, as if some danger is coming from behind, such as the delusion that someone is behind them, is similar to the idea of ‘fear of his own shadow’. This danger from behind has been clinically confirmed in a couple of cases that I have seen.
Since the patient has done so well on Staphysagria, the clinical suggestions that come up for this remedy from this case are: a brooding type of person, with a lot of anxiety about death and lot of fear of danger coming from behind and taking him over.
Dr. Jayesh Shah
Senior Consultant & Faculty, ‘the other song’ – International Academy of Advanced Homoeopathy
Dr. Devang Shah & Dr. Pallavi Mahadeshwar
Resident Doctors, ‘the other song’ – International Academy of Advanced Homoeopathy
 S.R. Phatak, “Staphysagria”, Materia Medica of Homoeopathic Medicines, as published in ReferenceWorks Pro 18.104.22.168