Don’t Let ’em Fool You: Clear Etiology is Essential for Treating the Elderly
Joseph Kellerstein, DC, ND
During my first years of practice, I used to dread two kinds of patient: the very old and the very young. Elderly patients always seemed very tricky regarding their reporting and response to treatment. Either I could not get a clear case, or there were so many aggravating factors that characterizing the illness was difficult. I would give them a remedy, and when assessing the follow-up, there either was no clear response or it seemed I had made them much worse or created a side effect.
In working with the elderly, precise case taking is very important. That seems like a silly statement – After all, isn’t it always important? More to the point, be insistent on a clear etiology.
- “When did the problem first come to be noticed?” Establish a time-based frame; a particular day, week or season – something definite.
- “What had happened in life just before?” Repeat the patient’s description of the event and wait a moment while watching their face and body, observing for a change toward discomfort or emotion.
- “OK, that’s what happened on the outside; what was the inside response?” If the patient lists several emotions, write them all while underlining the one that is accompanied by a body language emphasis.
- “That was an important one?” (Wait for acknowledgement.) “Say more about that feeling.” The elderly often are reserved or dismissive of their emotions, and much patience and observation is required. Sometimes, tense facial cues indicating a holding back of expression are important, so watch the face for changes (expression, skin color, moisture, pupil size) and question the patient regarding his or her feelings when it happens.
- “That last comment seemed to have an impact – what was that?”
Precise locations of discomfort should be verified by pointing using one finger, and later again verified by physical exam. Ask the patient to demonstrate exactly which movement hurts. Create a hierarchy of modalities through indication from 1 to 10 of how intensely each factor aggravates. An astute caretaker is a very valuable observer for both the elderly and infant.
Lastly, using the following rubric in the repertory is helpful: Generals; old people; complaints in.
Case Study 1
Brian was in his mid-80s. His wife of four decades had died after a prolonged bout of cancer. Brian was totally devoted to her, and this trauma had been devastating. The response to Ignatia and the Nat mur was very good. There was a nagging decline in vigor that really was not characteristic of any remedy. (One of the most important “thinking tools” I teach in my post-graduate course is “know when you don’t know”; i.e., if you see no characterizing elements in a complaint, don’t scratch too hard for them – there is a danger that the temptation to deduce will be too strong. If there is nothing peculiar, accept this and look elsewhere in the case or wait.)
Soon, a new complaint did develop. The patient became forgetful and on question noted that the lapses of memory were accompanied by an upsetting sensation in the head, “as if air were in the head.” Further inquiry revealed it was not a sensation of wind, draft or other movement of air. It had no temperature associated with it … He just couldn’t explain it other than to say, ‘it’s as though there was air in the head.’ Now, the rubric in the repertory is “as if air passing on and through the head.” This is not so satisfying. A computer search of the precise symptom led directly to the reading of Benzoic acid. “Sensation as if there were air in the head,” “Tired feeling in the head as if from night watching” (staying up while caring for the sick) and the mind symptoms “confused head. Omits words while writing” (Hering). Benzoic acid was in that original rubric, but only a literature search and reading of the actual symptoms could lend any feel of assurance that the remedy fit well. This is usually the case. Notice that there was no direct mention of memory loss, but that the two named symptoms certainly frame the situation well. Benzoic acid 30C was given, one dose per day. In just a few days, the state and the symptoms lifted nicely.
Case Study 2
I recall a case of a senior, a charming lady whose daughters and grandchildren I had treated. Amazingly, both daughters responded well to Phosphorus. This lady had very similar general symptoms, and I thought this one was a “slam-dunk” … but no. Her complaint was a rapidly advancing vision loss and increasing dementia with anger. There is a rubric “loss of vision with delirium” that could approximate this situation, but the remedy is Phosphorus, which did not work. In this case, a careful re-visitation to the onset revealed that the patient did not feel well after a flu shot, and it seems the trouble started up within a couple of weeks of that. One dose of Influenzinum 10M yielded a truly remarkable improvement in her mood and memory, with a slow improvement in vision. Here, the etiology was the needed clue to a nosode based on “never well since.”
Joe Kellerstein, DC, ND graduated as a chiropractor in 1980 and as a naturopathic physician in 1984. He graduated with a specialty in homeopathy from the Canadian Academy for Homeopathy, and subsequently lectured there for two years. He also lectured in homeopathy for several years at CCNM; for eight years at the Toronto School of Homeopathic Medicine; and for two years at the British Institute for Homeopathy. Kellerstein’s mission is the exploration of natural medicine in a holistic context, especially homeopathy and facilitating the experience of healing in clients.