Cured Case of Myasthenia Gravis by Louis Klein, Homeopath.

Initial Visit: Muscle Weakness and Themes of Abuse
She was diagnosed with myasthenia gravis. "Twelfth person this year in British Columbia to have this illness."
She had the flu for a few days, then had out of town visitors, and then began seeing double while she was driving.
Her right upper eyelid had been drooping (3) even before the flu, for about two months.
She has double vision (3).
Her right arm was tingling last night (1). Her hands tingle.
Has numbness in her left leg.
Experiences fatigue and weakness (2).
She took medication (pyridostigmine bromide) for three or four days and felt uncomfortable. All her muscles were contracting. She then discontinued the medicine.
Previous to this she was diagnosed with a hiatus hernia, with discomfort in her stomach. She took cimetidine, then stopped eating dairy foods and taking the drug, and got much better.
She had a nervous breakdown 20 years ago and recovered. (Her first husband was diagnosed with heart problems.) She was hyperventilating. Her husband died from myocardial infarction after one year of marriage.
Family History:
o Family is stress-prone, with weak nerve disposition.
o Mother: Migraines and vomiting after stress.
o Sister: Stress problems.
(She speaks quickly and forcefully, and is extremely loquacious.)
She ran a farm on her own with her daughter for 18 years. Sold the farm four years ago and then remarried. It is an adjustment to be remarried.
Her husband is jealous of her daughter (crying); the patient suffers because of this.
Since the patient's sickness, her husband is trying to be more understanding and less critical.
They moved to a small town because of a job opportunity for him. "I believed in him." He managed a shopping mall in the small town. He did very well. Both worked hard, and the shopping mall succeeded.
He is dominating (3). In the past, when she would speak, he would say "shut up" in front of other people. Always feeling that he wants to keep her down.
He screams at her.
Her daughter is very uncomfortable around him and rarely visits.
He is always critical of her.
Her husband is very jealous of all her old friends; he said she had to drop all her friends (profusely crying). When they are alone he waits on her, but he can't share her.
He struts around with her in front of others. At first, it felt good.
She enrolled in a college course. She got A's and B's. Went to Vancouver on her own (January 1987 to 1988) for art courses.
It is difficult to establish friends in a small town. Her husband always causes friction with people she gets involved with. He says, "I don't need friends." He has only superficial friends. She finds it difficult to share her friends with him. Sooner or later they are offended by him.
She gets offended; closes in and holds grudges (2). He hurts her to the core (3), and she keeps it in. She has problems forgiving (3). (She becomes more and more upset, speaking extremely quickly and aggressively.)
She can regain strength only in solitude (3); needs time by herself.
When she screams, he doesn't take it seriously (3).
He goes through her drawers and rips things out of her books.
She got panicky and tightened up living in the small town. In the summer she worked in a small art shop; the owner constantly threatened her.
In August she left her husband. She went to Vancouver and stayed with her mother and sister. Shortly before leaving, her husband became insanely jealous: "You slept with everyone."
Then her husband came to Vancouver. She traveled with him and her brother. During this time she got the flu and the double vision.
After three weeks of traveling with her husband and brother, she decided to move back with her husband. He's changed since she became sick. Now she feels he will change even more because her illness is so life threatening.
More on her husband:
o Sometimes he makes violent threats.
o She feels like an insect being dissected to the core.
o All her values are being trampled (3), things she loves (3). Friendship and decency don't mean anything to him (3).
o She feels very low (3), like a worm (3), as if anyone can do anything to her.
o "He wants to prove I'm worthless."
o Everything she knows is pulled into the gutter.
o He prides himself on bringing the worst out of people.
o Normal sex: High sexual desire; "Well, not that high."
o He lacks respect for her.
o She has no privacy (1).
She is better if she has a good rest.
Her symptoms (vision; weakness) are worse in the morning (3); better in the evening (2). Then, vision can even be okay.
She is sensitive to heat and cold (2); sensitive to temperature change (2).
Warm-blooded (2).
Likes fresh air (2).
Controls her diet. Limits sweets; usually no dessert.
Craves bread, chicken, and fish (1).
Avoids dairy products.
No thirst (2). Drinks four glasses a day. Forces herself to drink.
Sleeps on her right side, with pillows elevated.
Finished her menses two years ago; a few hot flushes, but menopause was okay.
She had headaches during her menses (migraines).
No vaccinations recently.
She flushes easily (3), like a young woman, especially with excitement or (3) anticipation.
No tuberculosis, cancer, or other major diseases in her family.
(After the interview I talked with her and her husband in the waiting area. He seems rather mild mannered and concerned. He tells me that the specialist took him aside and told him that within six months his wife would be in a wheelchair. At that appointment the specialist helped her husband order the wheelchair and gave him the name of a myasthenia gravis support group they could contact. Also, my receptionist tells me that this woman was abusive while she was making her follow-up appointment. She made a big stir over a minor problem and became quite loud and aggressive.)
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Klein: What are your thoughts on this case?
Audience: Focusing only on the physical symptoms, Botulinum came to mind, but it is such a small remedy that I have no idea of its mental and emotional symptoms.
Jeff Baker: Since the focus of the pathology seems to be in the nervous system and around the eyes, I looked at a couple of rubrics, namely, EYE, Hard to keep open, and VISION, Diplopia. Going strictly by the repertory, I come up with Gelsemium. But Gelsemium is not acceptable for this case because they are mild people, and she's not mild at all! Hyoscyamus is in both those rubrics, and the loquacity would support the remedy.
Naja is there for the difficulty in opening the eyes, but not for the diplopia. I like the idea of Naja. Naja people brood over imaginary troubles. They can be excitable, angry, and loquacious. She is hurt to the core, and she keeps it in. Naja has the marked surging of the blood upwards when getting upset. When she says, "I feel low like a worm," I thought of a snake. She has a high sex drive, is worse in the morning, and doesn't like to sleep on the left side, which suggest one of the snake remedies.
Klein: In my experience, Naja tends to be a milder type of person than Lachesis.
Durr Elmore: You'd think of Lachesis, of course. But I looked at two rubrics, MIND, Loquacity, and EYE, Paralysis of lids. Guarea is in both those rubrics, but I am not familiar with this remedy. I would study Guarea.
Klein: With Guarea, it's more of an inflammation of the eyes rather than a paralysis.
Steve Subotnick: I thought of Agaricus, because the Agaricus people I've treated tend to exaggerate everything. She speaks very emphatically and may be overstating things. There are many three-underline symptoms in the case. Then her husband came in, and he didn't look at all like the person she had described. Agaricus, of course, fits the general group of the neuromuscular diseases - the awkwardness, ataxia, paralysis, and diplopia. It also has a stage where, like Lachesis, there are considerable loquacity and rage.
Paul Herscu: When you were reading the case, it seemed like a clear Anacardium case - the husband, that is! [Laughter] But what is really going on? Is this make-believe? Does he actually not suppress her at all? Is it just a delusion?
Klein: In fact, it is not necessarily a delusion. There is some suppression from the husband and some jealousy. Obviously, this woman is sensitive and has a very low self-esteem.
Eric Sommerman: When I first heard the case I had a fleeting idea of Plumbum because of the paralysis, and it does come through a few of the rubrics. But the remedy for this case needs to be more unusual than Plumbum.
So, I came up with Curare. If you look under EYE, Paralysis of lid, upper, right, Curare and Apis are there in italics, in a small rubric. The mental picture of this patient is quite striking. She says her husband is always oppressing and abusing her; then she turns around and seems to be abusive with your receptionist. And the only way she can get over this state of inner turmoil is with solitude. In the repertory, under MIND, Company, aversion to, avoids the sight of people, shuts herself up, Curare is the only remedy. She is so loquacious and forceful, and she gets so worked up with her husband so that the only thing she can do is to go sit in a quiet room and calm herself down. Also, one of the main keynotes of Curare is paralysis of the respiratory muscles, so that fits the ultimate expression of her pathology. That is where she is headed.
Klein: Now, Eric, would you say that this person is healthy? From our homeopathic point of view, what is the level of the vital force? Putting the allopathic prognosis aside, would you say there is a good homeopathic prognosis?
Eric Sommerman: The vital force is quite low even though she is so expressive and puts out her energy so strongly. The diagnosis is very serious, of course. One must balance these two factors in evaluating the homeopathic prognosis. I feel she would respond well to the right remedy. Without the right remedy she would deteriorate very severely. I'd say she has a good chance of a cure if the correct treatment is given.
Klein: My reasoning was quite similar to yours, Eric.
Plan: Curare 30c (Boericke and Tafel), one dose.
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Case Analysis
- My reasons for choosing Curare were as follows:
o The ptosis of the right eyelid. Curare is a remedy in the rubric "paralysis of lid."
o The underlying theme of abuse. This woman feels abused by others and is abusive in turn. George Vithoulkas briefly mentions this symptom as part of the essence of this remedy.
o The nature of the disease itself. Could this disease really be an allopathic description for a remedy "disease," that being Curare? I do not have enough experience treating myasthenia gravis to be able to answer this question. It would be interesting to observe more of these patients.
o Lack of confirmation of polycrests.
- Why one 30c dose? In some neurological-wasting diseases I have had the unfortunate experience of aggravating the condition, with little improvement. I thought I would test the waters with one 30c dose only.
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Follow-Up
First Follow-Up: One Month After the Initial Visit
Progress started after two weeks, with no aggravation.
The ptosis of her eyelid is gone (much better)!
Her vision is normal (much better)!
She still is not 100 percent better; has numbness in her arms and muscle tension in her head.
Her fatigue and weakness are much better.
She is gradually getting stronger after excess physical work.
She bought her own apartment and feels really good about this. Her husband opposed it.
She has a part-time job restoring furniture.
She's working on creating more space for herself.
Still flushes easily.
Assessment: She improves dramatically. Our only course of action is to wait, while keeping in mind that it is a 30c dose and the effects may not last very long.
Plan: Wait.
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Second Follow-Up: Six Weeks After the Last Visit
She feels weakness after a busy day.
Her eyelid is excellent; no sign of ptosis.
Her double vision is better.
She is having trouble with her specialist. She feels that he abuses her. He now refuses to say it is myasthenia gravis.
No other myasthenia gravis symptoms.
Her skin problems are worse (2):
o Angry red patches (2) on her back and face (2).
o Worse when damp.
o Uses cortisone.
o Allergic to many cosmetics (2).
Is much calmer emotionally.
Wants to create a retreat by having her apartment.
Feels pressure when she is with her husband for a whole day.
Will start counseling after the new year.
He gets angry easily. She is less involved in her husband's anger even though anger usually affects her.
She had returned to the specialist. She told him that she was better, that she was under homeopathic care, and that she was not taking the medication he prescribed. He said it was impossible for her to get so much better because myasthenia gravis is incurable and is progressively degenerative. He also said that remissions of the disease are not as profound as she had experienced and therefore she never had the disease in the first place! He, the specialist on myasthenia gravis in British Columbia, said that he had misdiagnosed her problem and that he had suspected all along that she may have had an ocular tumor that was now in remission. (Unfortunately for homeopathy, this situation is not that unusual.) In keeping with her nature, she got very angry and abusive with him, which didn't help matters much.
Assessment: She is showing signs of a possible relapse, but the more profoundly limiting symptoms continue to be gone. She is even much calmer emotionally. The return of skin eruptions is also a positive sign, according to Hering's law.
Plan: 1. Wait.
- 2. Discontinue cortisone.
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Third Follow-Up: Four Months After the Last Visit
She is doing well.
She still has skin eruptions (1). Is working three days a week, so uses cortisone on her skin, which has a temporary effect. Dry, ripply patches (2) that turn red when in contact with water. Pimply on her chin. Her skin is bright red (2).
Six or seven years ago her skin was worse. Used nothing. Had a severe eruption at that time.
Flares up after discontinuing the cortisone cream.
No other symptoms.
She is still angry about the specialist who's not admitting that she's better or that she even had myasthenia gravis.
She feels stressed. Overextends herself; "on the run." She is in school, and she works at a fabric store. Lots of running around.
Her husband "doesn't have a hold on me anymore."
Plan: 1. Wait.
- 2. Discontinue the cortisone.
- 3. Use calendula cream as needed.
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Fourth Follow-Up: One Month After the Last Visit
She has severe pains in her stomach again. Was previously diagnosed as hiatus hernia. Had bouts of pain last year; they are returning lately, even though she is not eating dairy products. Only slightly better.
Episodes of internal pain, with shivers (1). Can't have pressure on her stomach. A burning sensation. Takes cimetidine at night. Sore pain in stomach (1), as if something is weakened. Has pain "inside" her stomach (2), with discomfort (2). Better when she is eating (3). Usually happens at night. Is worse with pressure (3), even a slight touch (3).
Her doctor says she's too emotional.
Wakes up at night with severe pain and can't get back to sleep. Feels like it is burning, a raw feeling. Has a strange taste in her mouth, with a sore throat.
Has been using cimetidine every day for one week.
Her stomach was much worse one week ago.
She is busy with school (textile design) and is almost finished.
Her husband is away, and she's on her own. He is returning in a month.
Her husband is short-tempered and angry inside. She suffers from his angry outbursts.
She moved one week ago, and her stomach got worse.
She wants to maintain her spiritual health.
Does not feel any anger.
She doesn't want abuse from her husband but is also sympathetic to him.
Feels pressure from her husband (2); feels incompetent.
Can never sit calmly with him.
She is upset by the thought of her husband moving in with her. (She turns red while thinking about it.)
Still has skin problems (2), patches (1).
Her energy is great.
Craves bread (3).
Avoids acid, milk, salt, and oranges.
Has a little bloating.
Update on the specialist: She and her husband received a personal letter from him asking for funding for a new myasthenia gravis research center at the local university. She rants about this for a few minutes.
Assessment: This is the make-or-break point in this case. What to do? Well, I did nothing. Why? Because the severe neurological symptoms are still better, and an old symptom returns. Even though the order from within outward is not exactly as we'd like to see it, it is a return of an old symptom with no recurrence of the more profound problem.
I also prefer at this point to see if the problem will continue and if more homeopathic modalities will present themselves. This way, I can be certain about the remedy prescription and not disrupt the progress this woman is making on more limiting neurological levels.
Plan: Wait.
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Fifth Follow-Up: Six Weeks After the Last Visit
She is "fine."
Her stomach is under control.
Her husband was transferred, and she feels peace and quiet.
She is not afraid of him, and has space for herself.
Avoids sourdough bread and feels better. "Came by this naturally."
The stomach pain and discomfort are better from eating, and worse from slight touch.
She is using Keri lotion, and her face is breaking out.
Her face breaks out occasionally.
She has a hard time dealing with upsets (1).
She is better being on her own (1); needs to recuperate her emotions.
Plan: 1. Continue to wait.
- 2. Use calendula cream instead of Keri lotion.
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Long-Term Follow-Up
I am surprised as she continues to do well with only one 30c dose of Curare and some potentially "antidoting" influences. She is now into her third year of "no other treatment." She still has skin flare-ups and uses calendula cream. She lives on and off with her husband and does not experience stomach upsets.
I wish that I were this successful in treating other patients with progressive neurological disorders. Perhaps we should use Curare more frequently, considering its proving symptoms and allopathic toxicology.
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Potential Uses for Curare
- I do not have in-depth clinical experience with Curare, but I will attempt to share a few important points on this remedy.
- The remedy that was first proved in homeopathic circles is different from the allopathically "purified" tubocurarine chloride. Hering describes the homeopathically prepared Curare as follows:
A powerful poison used by the South American Indians upon their arrows. Authorities differ as to the composition of this poison. Probably several totally different kinds of poison are designated by the same name.
- Hering goes on to say that various authors and travelers describe the poison as being made from different plants (curari plant, Cocculus toxicoferus and a new species of Strychnos, and so on). Even various snake venoms and toad poisons are added to the list. The South American tribes of each region used different sources for this poison. The exact formula of the original proved substance is unknown. Allopathic tubocurarine chloride is extracted from the genus Chondrodedron.
- Whether in crude or extracted form, Curare is a powerful paralyzer. Poisoning causes death through paralysis of the respiratory organs. So, in homeopathy we think of Curare for muscular paralysis, especially of the respiratory organs. Hering continually uses the words "nervous debility" in describing many symptoms.
- Hering also says, "Arms and fingers weak.... Arms become numb, feeling as if heavy weights were hanging to arms." This paralysis in the extremities is especially related to the right deltoid region and, according to Kent, to the extensor muscles. Kent describes Curare as a good remedy for old piano players who experience weakness of the extensors in the upper extremities. He does not have a full section on this remedy but mentions Curare only in relation to Alumina and Plumbum, which are used for weakness in both the extensors and flexors. Curare patients also show a lack of reflex action.
- Curare has traditionally been a treatment for ptosis of the eyelids and face. In this regard, the allopathic description of the features of myasthenia gravis are strong indications. The description of tubocurarine chloride in the allopathic drug catalog carries a warning against the use of this medicine for individuals with myasthenic problems. Of course, this can be an indication for its homeopathic use in our dilute and potentized form.
- The element of paralysis also affects the mental and emotional level. "...indecision, no longer wishes to think and act for herself, nervous debility." This progresses to a peculiar state of abusiveness that pervades the mental and emotional states of individuals needing this remedy. In the case I just presented, you see this tendency. The materia medica and repertory indicate this abusiveness as self-abuse and abuse of others. In Kent's repertory it is in the rubric, MIND, Striking himself, and in other abusive-type rubrics, including want of moral feeling.
- Along this line of thought, Curare has the delusion that everything is dirty and foul. It is also in rubrics that relate to the inability to act, irresolution, stupefaction, and, interestingly enough, kleptomania.
- For homeopaths, Curare is an important remedy to be considered in post-viral states (even Guillain-Barré) and neurological disorders progressing to paralysis, especially where the respiratory organs are involved and especially in the type of individual described in this case. Perhaps, if it has not already been done, a proving of tubocurarine chloride (along with observable allopathic "poisoning" symptoms) may help us to gain a clearer understanding of this increasingly important remedy. This is particularly important considering that our future source for this remedy will probably be the alkaloid.
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Klein: Are there any questions?
Nick Nossaman: Would you please review your rationale for the Curare prescription?
Klein: The abusive element in the mental-emotional sphere was strong, and it triggered the idea of Curare. This, combined with the specific symptom of the paralysis of the right eyelid and the "prognostic" symptom of respiratory paralysis, led me to Curare.
What is also important for me when I analyze a case is to take note of what is not there. In other words, I could not readily confirm a major polycrest such as Staphisagria. The case, as Eric Sommerman said, was unusual and did not quite fit into Staphisagria, Lachesis, or other well-known remedies. A lot of remedies came to mind as I was studying the case. Ultimately, I had to rely on this somewhat limited rationale because other major remedies just did not fit the case.
Tony Sweeney: Did the neurologist do a Tenselon test? Was there an objective basis for this diagnosis?
Klein: Yes, they did all the usual testing, which was all positive. Remember, she went to the center for myasthenia gravis in British Columbia. She was thoroughly tested, and the diagnosis was certain. But the specialist subsequently denied it and said he must have been in error. It was the first time he had ever seen such a dramatic "remission" of myasthenia gravis.
Roger Morrison: George Vithoulkas has said several times that one of the key indications he has used for Curare is "inability to swallow solid foods" and "having to drink liquids to force the food down." This case did not have these symptoms, but I thought I would bring it to everyone's attention.
Klein: Yes, I saw that in a case where I used Curare for post-polio paralysis of the throat muscles. The patient had continuous difficulty in swallowing.
Kitty Spivak: Was the remedy you used made from tubocurarine?
Klein: No, this is a remedy that I got from Boericke and Tafel, and I believe it's made from the South American curare poison, of unclear origin and composition.
Durr Elmore: I wonder if it would do any good to send a copy of this chapter of the upcoming case conference book to the specialist?
Klein: Well, it is a difficult situation. It may be somewhat threatening to someone who has invested so much energy and time into another point of view. It may be quite difficult to open up to the possibility of approaching things in a different way.
Durr Elmore: Well, we do get these cases where there is a definite diagnosis and then we produce a "miracle cure." Usually, I suggest that the patients go back to the specialists and tell them about the positive results. It's just a question that I have. What should we do? Do we write a letter to the other doctor, send our notes, and say, "I just want to bring this to your attention"? I feel we need to do something. Many of them are just going to ignore it. But maybe one in twenty will actually take notice of what we are able to accomplish with homeopathy.
For example, I'm currently treating a nine-year-old girl who has RSDS (reflex sympathetic dystrophy syndrome). It's a fairly rare disease, especially in children, and it causes paralysis. The sympathetic nervous system functions abnormally, and there are swelling, pain, and vascular changes. The specialists gave her a dismal prognosis. She was told she would probably never get over it. There is no conventional treatment, except for physical therapy. She could not walk. Then I gave her a remedy, Hypericum, and all her symptoms are essentially gone. It took a week or two for the symptoms to resolve. Of course, the long-term results remain to be seen.
Klein: Well, we do get some very positive feedback from various specialists, but usually after a period of time. For example, there was a rheumatologist who was very anti-homeopathy, and he told all his patients to avoid homeopathic treatment. This man has changed his opinion over a period of ten years because a number of his patients have had such positive results with homeopathy. Their sedimentation rates went down, and their health is better. He has objective results with homeopathy, without the use of conventional medications.
The neurologist in the case I just presented could certainly rationalize the results of only one case as a fluke, some kind of unusual situation. As I say, it usually requires a number of cases for a specialist to recognize that homeopathy has some validity. This is only one case, at this point.
It would be very helpful for those of you who have some myasthenia gravis or Curare cases to send them to me. I recommend this at the end of every talk I give. Today someone told me he had a Scutellaria case that was doing very well and that the prescription was based on what he had learned from my Scutellaria presentation last year. If I could accumulate a number of Scutellaria, Curare, and myasthenia cases, for example, I could acquire a much more comprehensive understanding, which I could then summarize and pass on to the larger homeopathic community. Each individual who presents a remedy or a particular condition could become a "repository" for developing clinical experience with that remedy or pathology.