June 2014

Anger at trifles: a case of Platina

by Rajan Dubey

pegA fifty year old man was brought into the clinic on July 20, 2010. He was barely able to walk and was almost carried into the clinic by two of his relatives. He looked extremely emaciated and lethargic; he had a gastric tube inserted in his abdomen through which he was fed.

The patient has been suffering from left-sided hemiplegia since February 2010. There was also paralysis of the deglutition muscles, rendering the patient unable to swallow, hence the gastric tube. The patient’s wife carried a plastic bag into which he would spit his saliva.

On asking the patient to describe his symptoms he said: “I have been having difficulty in swallowing since four months.  I cannot take in food; if I force myself to eat, food comes out of my nose. I have a left-sided paralysis of my body. Only my right side is functioning, so I am unable to carry on with my daily activities. The right side of my face has a weird tingling sensation. At times, it also becomes numb and I don’t feel anything there. It becomes very irritating. When I turn my head suddenly to either side, I experience intense giddiness. I feel I might fall down and pass out. My vision has started to become affected; it is blurred and at times, I see multiple images of the same object.”

On asking about the events leading to the paralysis, he said it started suddenly. He was having a conversation with his relatives when he suddenly experienced a black out and collapsed. He does not remember the details after the fall; he woke up at the hospital unable to move his left arm and leg.

The MRI dated February 13 2010 showed a non-hemorrhagic infarct of the right lateral medulla (later diagnosed as Wallenberg’s syndrome). Multiple lacunars with ischemic foci in both hemispheres.   

On inquiring about his nature, he said: “I get angry at the pettiest issues. I can’t control my anger. I abuse the person regardless of who he is. When I’m angry nobody can control me. I don’t like it if my family members don’t do things the way I tell them to, when they don’t obey my decisions. I get upset even if someone takes the television remote control away. I have never been concerned about the people around me, right from childhood. I don’t like people questioning me. If my wife asks about my job then, I get angry and shout at her. If I want to go somewhere, I go – nobody should tell me what to do. I don’t like it when people advise me over anything. I do what I feel is right. If someone hurts me, I get angry, and I start abusing the person. If I have a fight with someone, I stop talking to that person, I cut off all my ties with him. I can’t forgive anybody. I need respect. I don’t chit chat or gossip with people, I don’t like all that. I believe in just working and moving on. I don’t like to go and visit people (neighbors or relatives) for no reason, not even my sister.

Physical general
Thermals: hot
Thirst: thirstless
Appetite: normal
Sleep: disturbed
Desires: lemon juice; ice cold water

Swallowing impossible
Side, left
Abusive, insulting
Food and drinks: cold drinks, desires icy cold water

Prescription:  Veratrum album 200C, 1 dose

After the initial prescription, the patient’s vision improved. He started to walk without support and started to gain strength. The strength of his right hand, which was emaciated, started to improve but the left hand failed to show any improvement. He developed swelling on both feet. About his anger, he explained that “in the past, I was not so angry but now, I get so upset that I throw things at people. I am even more abusive when things don’t go the way I want, and I am becoming angrier.” Although his vision and vertigo were improving, and he was gaining strength, putting on weight, and was able to walk unsupported, his mind symptoms were not improving. In fact, his anger seemed to increase. We waited for two months, after which we repeated Veratrum 200 [29/9/10] and Veratrum 1M [13/10/10]. We were not satisfied with the prognosis of the case because we had expected a complete cure in our patient, which seemed to be eluding us.

We formed a new totality of symptoms based on a review of the case.

Anger violent
Contradiction intolerant
Crosswise sideways left lower right upper
Abusive, insulting
Anger easily
Striking general, anger from
Anger at trifles
Casting off of people against her will
Admonition, ailments from
Ailments from admonition kindly

pegPrescription: Platina 200C, 1 dose on 10/11/10

8/12/2010: the patient started eating since 6/12/10. He was able to swallow saliva, food, and water. His vision improved and the vertigo disappeared. Numbness of the face improved, as well as the movements of his hand and leg. He gained 8 kilograms in weight. Further follow-ups showed a continued improvement at all levels. He said that his anger had reduced considerably and that he was feeling much calmer. He has continued to do well since then, with no further repetition of the remedy.

Learning from the case

Our understanding of the case was that in homoeopathic treatment, complete cure is not achieved unless there is improvement seen on both mental and physical level. Although the patient had shown good improvement on the physical level after Veratum album, on the mental level, he was not improving, even after waiting and repeating the remedy in a higher potency. One of the hallmark symptoms of Wallenberg’s syndrome is sensory deficits affecting the trunk and extremities on the opposite side of the infarction, as well as sensory deficits affecting the face and cranial nerves on the same side as the infarct. Specifically, there is a loss of pain and temperature sensation on the contra lateral (opposite) side of the body and ipsilateral (same) side of the face; this crossing of symptom location is the diagnostic for the syndrome. Clinical symptoms include swallowing difficulty, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner syndrome, diplopia, and possibly palatal myoclonus. The crosswise side affinity proved to be an important symptom, which was not covered by Veratrum album. This highlighted an important fact that common symptoms can become characteristic by virtue of their intensity and side specificity.

Now, we had to find a remedy which covered anger which is out of control, a sensitivity to being hurt on being questioned or given advice and a stubbornness to do whatever he wants to do. The person cannot control his anger and starts to become abusive and throw things. He is not a sociable person, cutting off relations if he feels offended. Only one remedy fits this bill; Platina showed an amazing result.  

Categories: Cases
Keywords: hemiplegia, cross-sided complaints, Wallenberg's syndrome, uncontrollable anger, unforgiving
Remedies: Platina

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