Jane, 26, was seen in the Emergency Room three times in the past 2 months for what Jane called an "attack:" chest pain behind her sternum (chest bone) and severe nausea. Usually while in the ER she also had a bout or two of severe, explosive diarrhea. Once the diarrhea occurred, the ER doctors knew the chest pain and nausea were related to the digestive system instead of the heart.

Despite the prescriptions to prevent recurrences of the symptoms, they returned. First would be the chest pain, then the nausea (and sometimes vomiting) then the diarrhea. When the diarrhea settled later in the day, so did the other symptoms. The chest pain and subsequent symptoms occurred maybe twice a week; she never went longer than 10 days without an "attack". When she could no longer tolerate the disruptions, she sought care outside the medical system.

As Jane’s symptoms had begun a relatively short time ago, the change in her health status would be considered "acute." In homeopathy, to find a remedy, the practitioner looks at what has changed from the norm using the acronym CLAMS:

Concomitants: what other symptoms exist with or occur because of the main concern; what accompanies the main symptom? The onset could be from anything physical, dietary, emotional or mental; or a combination of these.

Locations: where is it exactly? Does it move to other locations or has it spread?

Aetiology ("etiology," old spelling but still used for the acronym): what caused it; when did it begin?

Modalities: what makes symptoms better or worse?

Sensations: what does it feel like, taste like, look like, etc.? How do the 5 senses perceive the symptoms?

Concomitants

The chief symptom is the chest pain. The concomitants are what accompanies or follows the chest pain.

The concomitant symptoms nausea, occasional vomiting and diarrhea that follow the chest pain. Flatus (gas) is also present as well as belching.

The pattern was the pain followed by nausea about 1 hour later (occasionally vomiting) then the diarrhea would start an hour after the nausea. All symptoms would continue together until the diarrhea would end, then all other symptoms ended too.

She also had a craving for a salty snack with sweet pieces, "like a trail mix with peanuts and raisins or M & Ms".

Locations

The pain in the chest is behind the sternum (the chest bone in the center of the chest to which the ribs attach and behind which are the heart and esophagus). Nausea was in the stomach and the diarrhea was in the bowels.

Aetiology

The pain began 2 months ago. She was married 2 ½ months ago.

Attacks occurred once or twice weekly; in the past 2 months she never went more than 10 days without an attack. If an attack occurred, it was always between 4 and 5 a.m., waking her. If untreated by the ER, the attacks lasted until early afternoon around 1 or 1:30 p.m.

She had a long history of digestive issues, beginning with projectile vomiting in her youth and continued throughout her lifetime. It happened soon after she would fall asleep (around 10 p.m.); occurred maybe once a month in her youth, then 3 or 4 times per year later in life. She had every medical test available to diagnose the condition but nothing was ever found. It was later decided by the medical profession that it was genetic as her father had a "sensitive stomach." Anti-nausea drugs were given but were ineffective; she never had nausea, just the vomiting. In the end, she stopped the drugs and just dealt with the vomiting if it happened. It always happened shortly after falling asleep so it never disrupted her life.

Modalities

Although Jane was on several different drugs, there had been no change in the pattern or the occurrences. Her prescriptions were 2 different ones for nausea and 1 for GERD. When treated in the ER, the pain and subsequent symptoms ended an hour or two after onset.

She often feels dehydrated after an episode; when treated in the ER for the pain, they also treated the dehydration with IV fluids.

Jane modified her diet to include only bread, chicken and a few vegetables. She believed this helped "a little" with the severity of the pain but it did not decrease the frequency of the attacks. She has been unable to determine if her diet contributes to the pain, nausea or diarrhea.

All symptoms are better if crunched with knees up to chest. Worse if she is active.

No subsequent symptoms affect the pain in the chest.

Sensations

Pain: like "pressure and like a huge splinter sticking me in the heart. Like I was having a heart attack." The sensation lasts throughout the attack; it does not lessen with vomiting or diarrhea.

Nausea and vomiting: the nausea came in waves of greater intensity; on those peaks she would either vomit or not. Emesis, vomitus, was undigested food from the night before, then she would have the dry heaves once the food was gone.

Diarrhea: explosive with gas that smelled like Sulphur; belching also smelled of Sulphur. Diarrhea smelled of Sulphur and was offensive. It is loose, watery. The early diarrhea has round brown balls mixed with pieces of undigested food from meals even several days ago—usually vegetables such as corn, peas or spinach; or "hard-to-digest foods". As the diarrhea episodes continue, they just become brown water. Amount of each stooling is of little amount, much less than a typical bowel movement for her. During each episode she has approximately 5 bowel movements.

It often takes her 2 days to recover from the attack; she feels weak and tired after the episode.

Finding the Right Remedy

When looking for the right homeopathic remedy, the whole person has to be considered. All of the symptoms Jane relayed were of the physical condition, the changes physically. When asked about her mental/emotional status during the attacks, the only thing she mentioned was anxiety because she didn’t want the symptoms to get worse to where she had to go to the ER.

Having an underlying "weakness" in the digestive system, as seen in her long history of vomiting, it was evident that a stressful event would impact this system. Granted getting married is a stressful event, but what is the perception of the stress that is impacting her body?

How is Jane usually? Jane considered herself to be a thinker and a doer. She is always thinking of that next project, or of what needs to be done. She is happiest when she is actively working on a project or planning one. Her mind is always thinking. She used to have difficulty falling asleep because she was thinking so much; she loved to think every waking moment. She liked to wake early to start a project, even if she fell asleep relatively late; she used to wake up at sunrise (around 5 a.m. daily, even in the winter when the sun rose later in the morning). Now she sleeps a couple more hours before starting her day.

Lack of sleep has always been an issue for her, and she wondered if her symptoms are worse due to lack of sleep as she has been sleeping less the last couple of months because her husband and she own a business and this is the busy season, and they are newlyweds.

She loves being outdoors but is hating the winter this year because it is too cold and too much snow to go outside for any length of time. In the spring and summer she always has her windows open for fresh air.

She is very religious and prays often, although she is upset that her prayers regarding her chest have not been answered.

The following rubrics were chosen:

--Thoughts, persistent

--Ritualistic behaviors: praying.

--Anxiety about health.

--Ailments from diarrhea (weakness, tiredness, dehydration, need to recover for 2 days after event).

--Delusion (belief) that she is forsaken (God has not answered her prayers).

--Craving for salt and sweets.

--Craves fresh air.

--Fresh air ameliorates (makes her feel better).

--Sensation of splinters, splinter-like pain in chest.

--Pressing pains in chest.

--Gastric complaints accompanied by flatus, from loss of sleep.

--Onset or worse at night (between 10 p.m. and 6 a.m.)

--Diarrhea and nausea.

The remedy selected: Argentum nitricum (Arg-n).

Interpretation

The common theme between Jane’s physical symptoms and her mental status was that she always felt better when she was moving, thinking, doing something. Her mind was always active and engaged in thought except when asleep. The diarrhea is a physical manifestation of rapid motion, rapid movement.

Before getting married, she used to awaken around 5 a.m. daily to do tasks or projects. Since marriage, she would sleep in. Her "attacks" occur between 4 and 5 a.m. when they do occur.

Result

Because Jane had misunderstood the instructions, she took only 1 dose in the month before her first follow-up. After that 1 dose of the Argentum nitricum Jane’s symptoms improved dramatically; she had only 1 attack in the month but the pain was so mild that she was able to fall asleep and it never progressed to having nausea or diarrhea. She was instructed to repeat the dose if the symptoms occurred again—but they never did.