Case Quizes Clinical Cases

Revisiting: Constant Spitting With Sore Throat

Last modified on August 16th, 2017

Elaine Lewis
Written by Elaine Lewis

Did you guess the right remedy?

Mom, it’s Quiz Time again!

The way I see it, Shana: First we make a big splash in the Hoacuoidep Quiz, then it’s “Hollywood, here we come!”

You know what else is exciting?

What?

The next part of my favorite anime is out on DVD in English!

Oh geez…..

Now, I know the ezine readers don’t know what anime is…

You got that right!

but, to put it simply, it’s animation from Japan.

No one cares, Shana!

I know you’re not fond of anime, but, I really love it!

And you picked now to announce it to the world?

Here’s the title of the anime.

It picks up where the first anime from 2001 left off.

Shana, I think I hear The Scorpions playing….. 

The whole second anime is 26 episodes and the DVD is in two parts, for some reason.

Maybe you should look into that right away!

Both Parts 1 and 2 are on DVD now.

Is this going to cost me money?

Here’s a trailer for the DVD:

Also I know you will be interested in this next thing.

Dear God, I hope so!

The sixth season of “Family Ties” is finally coming out on DVD!

Is this something else I’m going to have to pay for?

It’s out in April, after a long wait from season five!

Also one other thing before you present your quiz case. I read an article that the Rolling Stones are planning 18 North American tour dates this year. I know you will probably try to get out of going, but I’m all excited! Nothing else in detail has been mentioned but if they hit Philly, I want to go to the show.

So you have a “news report” about something that hasn’t actually happened!

I guess so.  Is there a “Death Report” this month?

Hello!!!!  Shana, you took up so much space with your “News Bulletins” on Family Ties, a badly-produced Japanese cartoon, and speculation about a non-existent tour, there is nothing left for me!

Oh and consider this, me dropping hints for my 21st birthday on April 22nd.

Shana, isn’t it obvious that you want the 6th season of “Family Ties” and that other thing I won’t mention?

I guess it is. Who died this month?

Well, Shana, if you must know….I hardly know where to start!  There were so many but we only have time to mention that the founding member of The Raelettes and The Cookies died, Darlene McCrae.

I don’t think I know her. I only know Margie.

Margie!  Margie died in the ’70’s.

Meanwhile Mom, don’t you think you should tell everybody who The Raelettes are?

Yes, good idea!  

raelettes

Because what’s the likelihood that anybody knows who they are?

Slim to nothing!  The Raelettes were the famous back-up singers for the man who everyone considers to be the father of Soul Music, Ray Charles! Shana, get me a picture of Brother Ray!

Check!

Shana, find me “My Baby”, with Margie’s great solo!  This is a live performance–very rare, I can’t even believe it exists; so, you’ll forgive the few glitches and bad edits, like the fact that it cuts off the beginning of the song!  I doubt that anyone’s ever heard this song but me anyway!  I actually have the record!  On the video, Darlene is on the right, I think.

Here are Ray Charles and the Raelettes with “My Baby” from the Newport Jazz Festival, 1960:

Mom, don’t get all verklempt because you still have to do Cleotha (“Cleo”) Staples from the Staple Singers!

OMG! I forgot all about Cleo Staples!  Listen, there are too many, all I can do is mention them by name:  Lost to us this month, besides Darlene McCrae, are:

Cleo Staples of the Staples Singers

Julius Greene of The Mad Lads

Bobby Rogers of The Miracles

Richard Street and Damon Harris of The Temptations

Thanks for the music, guys!!!  And now you can start the Quiz!  Who’s the patient today?

Oh no, I need a fictitious name!  Wait, I got it!  “Maurie Amsterdam”!

Mom! Isn’t Maurie Amsterdam a writer for the Alan Brady Show?

No, Shana, you’re thinking of Maury Amsterdam, this is Maurie Amsterdam!

Of course! So, what is “Maurie Amsterdam’s” problem?

He’s a 4 year old with a sore throat.

Really?  I never would have guessed!

Shana, take my word for it, this is a very exciting case!  The father filled out the questionnaire.  Here it is now:

 

Questionnaire

1. Describe the complaint or complaints in your own words in as much detail as you can. Don’t forget to include the onset (did the complaint come on suddenly or gradually?)

Last night “Maurie Amsterdam” woke up from sleep and complained that his throat is hurting. He also said he wanted to drink water. There was also yellowish green nasal discharge.

After waking up twice for drinking water and complaining of throat pain, I gave him Aconite around 4:00 AM. This did not help much. Actually before going to sleep also he did not feel very hungry. And upon waking up also he was not hungry either. Upon waking up he was still complaining of throat pain. There was some yellowish green nasal discharge. And he was spitting a lot.

2. Etiology–this means the CAUSE, if you know it. What caused you to get sick?

I don’t know. But he did get to swim yesterday evening. Maybe he picked it up from there. But nobody knows for sure.

3. Sensation–describe the pain or other feeling you have.

He says that his throat hurts when he swallows. He is also saying his stomach is hurting. He is not able to describe the pain.

4. Appearance– anything remarkable?

His nasal discharge now appears both clear watery and there is also nasal congestion at the same time.

There are two small red spots on both his cheeks.

5. Location–where on the body is your complaint located?

Throat, Nose. There is also some stomach pain.

BTW he is not asking for drinking water. He is indifferent for thirst.

6. Modalities–What makes your complaint better or worse?

No idea. And I have no way to find out.

7. Concomitants (other symptoms that are “along for ride”)

There is some dry cough sometimes.

8. Discharges–color, odor, consistency and sensation.

Saliva is watery — not slimy.

Nasal discharge seems clear. But it was greenish yellow in the morning. But the nose also looks congested now.

9. Generals–these are all the symptoms that begin with the word “I”:

He says I am feeling sick. But not able to articulate beyond that. He is spitting 4-5 times per minute — yes he is spitting continuously.

10. The mentals: Is the complaint changing you mentally and emotionally?

He is not hyper. He is normal. Not aggressive, somewhat dull — not too much.

11. What have you been saying?

I am sick.

12. What are you doing?

Playing by himself.

13. Describe your thirst and appetite

He is not hungry at all. He is not eating at all.

14. Fever?

No fever.

15. Sweating?

No sweating.

16. Odors?

No odors.

17. What is most striking, peculiar or identifying about your condition?

Spitting 3-4 times per minute

18. Is there a diagnosis?

Pharyngitis, according to his aunt, who is a doctor.

19. Describe your energy

Calm

__________________________________________

Follow-up questions:

What time did he wake up to complain of sore throat?

2:00 AM was when he woke for the first time. The second time he woke up around 4:00 AM or so.

What temperature water did he want?

He did not specify. I gave him room temperature water and he drank it.

When you say “spitting”, do you mean drooling?

Not drooling, spitting. And spitting 3-4 times per minute.

Does the swimming pool often bother him?

No. Never.

Which side of his throat? Look at his throat and tell me what it looks like. Also what his tongue looks like.

Can’t see and he can’t tell which side. Throat looks normal to me (maybe a little red). Tongue also looks normal.

What size are the two red spots on his cheeks?

The size of dimes, roughly.

Anything more to say about the stomach pain?

He is mostly constantly complaining of throat pain. Stomach pain he is not complaining about it too much. He just said please help me, my throat hurts.

Is he worse talking?

Maybe. But not sure.

Eating?

He just doesn’t want to eat.

Swallowing food or empty swallowing?

When I ask him to swallow, he spits right away and says it hurts.

Does it burn?

I don’t think so. But area around nose is red.

What does he spit into, a cup?

No matter what we say, he only wants to spit on the floor! Only if we hold the cup for him he spits into it. Otherwise he spits on the floor.

Is he spitting because of excessive salivation or because it hurts to swallow? Does the pain shoot to his ear? Which one?

No, pain shoots to stomach, I think. Because he says when he spits his stomach hurts. He is not able to tell clearly.

Bad breath?

no

So, there’s no prostration, no desire to lie down?

No

Is he chilly? Hot?

Indifferent

____________________________

Observe him and see if he is swallowing at all.

When I ask him to drink water, he actually does swallow it.

Are the red spots mirror images of each other?

Pretty much, I’d say so.

Can he talk without his throat hurting?

He says that his throat is hurting. The thing is he is not able to articulate if it hurts when he swallows or when he talks. But he does say that it is hurting a lot.

And his disposition is average? Normal?

Yes. He is not hyper not very dull. It is normal.

Is he objecting to anything? Like he just objected to swallowing when you asked him to. Is he saying, “Stop, or no, or I don’t want to”, etc. in regard to anything?

He wants a toy. And for the last 30 minutes he is crying that he wants it now. He is outside right now (in the backyard). When we are asking him to come inside he is not — not because he likes it there. but because we are not getting his toy.

Was he spitting in school?

Yes. And they asked us to pick him up early.

Did you try giving him a washcloth to hold?

He doesn’t want to hold. But if we carry a cup and ask him to spit in it he does. But we have to hold the cup.

________________________________________________

So, he can swallow water but can’t do empty swallowing?

Yes

Can he swallow food?
He doesn’t want to eat anything. Not even try it.

He is Whiny. He is crying even when we said we will get him the toy. OK, now his aunt has gotten him the toy and he has stopped crying. His aunt is a doctor. She says he has pharyngitis.

Does crying make his throat pain worse?

Yes.

________________________________________________________________

I can wait till you repertorize. Let me know.

Give him _____________________30C.

(Half an hour later)

Is he still spitting?

Yes. But instead of spitting 3-4 times per minute he is doing it once every 1-2 minutes — ever since his aunt got him the toy he is busy playing with it and then spitting less often.

Does this coincide with starting _______________? Because if he can’t swallow, he can’t swallow; it’s not going to change because he’s playing.

Maybe. But his redness is still there.

That doesn’t matter. Pain goes first.

I asked him if his throat is still hurting and he said, “No, not right now.” But he is still spitting once every minute or so.

OK, so here’s what we’ve got: less spitting and less complaining about pain. I have to think that ______________ is working. It hasn’t been that long since you gave _______________ and I’m guessing that this is the best he’s been all day?

I would say so. OK, shall I repeat _____________________ 30C (water dose) every 30 minutes for the next 2 hours?

BTW his play has also started to become a little aggressive and he is a little loud now.

Then his throat must be hurting less! If he asks for food, he’s getting better!

He just did!!! He asked for food! He wants to eat noodles!

Well, that’s it, we’re done!

___________________________________________________________

OK, everybody, do you know the remedy? Write to me at [email protected] and let me know. The answer will be in next month’s ezine. Bye-bye!

Mom, wait! I have a song to play us out!

A song to play us out? Oh, let me guess! Could it be the Rolling Stones?

Mom, you’re positively psychic! Here are the Rolling Stones with “Dandelion”:

lewis-nov12-image002.jpg

Bye, see you in April!

——————————————————————–
Votes

Rhus tox-3

Mercury-2

Nat-mur.

Hepar sulph.

*****

Not too many answers this time, where did everybody go???? Hello!!!!


Hi Elaine,

Please let me try again if i am wrong. The rubrics-


> 1. Throat, pharyngitis- Sil-3,lac-c-2, phyt-2, merc-1
> 2. Throat pain- on swallowing- empty agg- merc-2, lac-c-2, phyt-1,
> 3. Mouth-spitting constantly- merc-3
> 4. Mouth -spitting must- merc-2
> 5. Aggravation time-2.a.m- merc-2
> 6. Nose- yellowish green discharge- merc-3

Merc sol would be the remedy. It has red spots, it is thirsty.
Two red spots on both the cheeks is the key, i know.

Aha! You did know! Well, then, Monika, you knew all you needed to know!

But i couldn’t find an exact rubric.

Here it is, in Murphy’s repertory: “Face, acne, symmetrical distribution”. The operant concept here being “symmetrical”, and you’ll see there is only one remedy–ARNICA! Case closed! You know when we take a case, if a peculiar symptom pops up, we’re done! It’s like the tonsilitis quiz we had here when the child was eating butter off the stick? Pulsatilla! Case closed! When we’re taking a case, we hope to find one of these–a strange, rare or peculiar symptom that’s going to make everything else irrelevant, and look at what else you have anyway! All common symptoms, completely worthless! The spitting? He was only spitting because of pain on swallowing! Arnica has symmetrical eruptions, when you see a super-keynote of a remedy in a case, throw everything else out and give the remedy! That’s our lesson for today.  I knew people would pick Mercury but he did not have excessive salivation, he had throat: pain on swallowing.

Is anyone else here today?

Hi Elaine, tough quiz this month.

It must be, nobody’s answering it!

I am between Belladonna and Mercury.

I knew people were going to pick Mercury!

The thirstless rubric worries me, but I can’t come up with another remedy.

The onset is sudden, the red cheeks, it could be Belladonna.

Except, the red cheeks are more like eruptions, the size of dimes, and they’re perfectly symmetrical, mirror images of each other.

It is under 1 grade in rubric “must spit” whereas mercury is a 2.

Yes, Belladonna does spit, but it’s mostly a psychological problem. Here our patient’s throat hurts, so he’s spitting in order to keep from having to swallow. It’s different.

 

So I will vote for mercury. If I am wrong, you already know my second vote 🙂

If it is also wrong, I will come up with a 3rd remedy, and a 4th and a 5th etc.

OK, Maria, here’s the thing, remember last month’s quiz answer when I said there was too much emphasis on symptoms and not enough emphasis on the context they were occurring in? Why is Maurie Amsterdam spitting? Is it because of the “excessive salivation” that Mercury is famous for? Or is it because he has a sore throat and can’t swallow? If he’s spitting because he has a sore throat and can’t swallow, then spitting is not a symptom! Possible rubrics might be:

Throat, pain, swallowing, difficult

Throat, pain, swallowing, on, empty, agg.

Throat, pain, swallowing, liquids, amel. (because he was able to swallow water, remember?)

However, even having said all that, why is it irrelevant? Because there’s a PECULIAR symptom in the case–peculiar to a certain remedy! Remember our “hierarchy of symptoms”? (See my article, “Acute vs. Chronic Remedies, the Hierarchy of Symptoms, and the Kitchen Sink”)

http://hoacuoidep.info/homeopathy-papers/acute-vs-chronic-remedies-the-hierarchy-of-symptoms-and-the-kitchen-sink/

Here is the hierarchy of symptoms:

Etiology (meaning, “Ailments From” or “Never Well Since…”)

State, or diagnosis. In other words, “What’s wrong?”

Onset–sudden or gradual

Delusions or Strange/Rare/Peculiar symptoms

Mentals

Emotionals

Physical Generals

Local Symptoms

So, we’ve got ourselves a Strange/Rare/Peculiar here! That’s going to trump all the local symptoms at the bottom of the hierarchy, we can just throw them all out!

So, Maria, as you might have guessed at this point, the peculiar symptom in this case is…..

the symmetrical red spots on both of his cheeks! The only way to find this symptom is go to:

“Face, acne, symmetrical distribution”. The idea here is symmetry of eruptions. And the winner is…..?

NO WAY!!!!  Arnica????

YES!!!!!

You see I searched a lot for the symmetry but I thought it was discoloration, like flushes of heat, as we get red cheeks when we are shy. I didn’t think of it as eruption. And I did not find anything.

They were just “spots”. That’s all the father said, red spots, the size of a dime. This is a dime, and roughly the exact size, maybe a little bigger, but it gives you an idea:

So a red spot on both cheeks in the same place, that size, would be quite noticeable and quite peculiar!

My selection -ok it has some weakness- is a 2 under “pain, empty swallowing” and a 3 in amelioration from liquids.

So I thought if he can drink water he can swallow saliva, so it must be excessive salivation for spitting that much.

But Arnica??? It is not even in any of these rubrics. How on earth did you find it???

This is why we ask for “concomitants”, Maria. For a concomitant to be valuable, it should have nothing or almost nothing to do with the case, like menstrual cramps with burping, which might tell us that the remedy is Carbo veg. In this case, the two red spots were concomitant to the sore throat. Concomitant means “along with”. “What came along with the complaint?” Answer: “These two red spots.” “Are they mirror images of each other?” “Yes.” We’re done! Good-bye! Nothing else matters! Because it’s a super- keynote of a remedy, and it’s “peculiar”. Homeopathy is not always a matter of listing all the symptoms in a case and repertorizing them, adding them up, so to speak. Sometimes there are “short-cuts”! I wrote an article about that called, “Get A Clue: Who Is Guilty of Disordering This Patient?” http://hoacuoidep.info/organon-philosophy/who-is-guilty-of-disordering-this-patient/

It’s like you’re busy adding up the symptoms of the case, just the way you were taught to do, and then all of a sudden the patient blurts out, “When I walk outside, I’m afraid the buildings on either side of the street are going to fall on me.” Is there any point in going on after that? Is there anything else you need to know? Is the case over now? Can you stop repertorizing? Yes!!!!!! Why? You just heard a super-keynote of Argent-nit that probably no other remedy has, it’s a delusion, and it’s a mental, and it’s Peculiar. The triple-crown! That’s it, you’re done, take the rest of the day off!

You know that “Kitchen Sink” article you mentioned, I have read it hundreds of times! I have printed it out and keep reading it again and again. Well, I wouldn’t have found Arnica even if I kept guessing for months 🙂

When Maurie Amsterdam’s father said there were two red spots on his son’s cheeks, I said to myself, “Please let them be symmetrical, please let them be symmetrical, please, please, please!”

Arnica is a 3 under Skin/eruptions/symmetrical.

Really? Which repertory?

Vithoulkas’ compass. He has a beta software on-line with a repertory in it. Here is the link

You just register with your mail and then you can use it free. It is like his Radar software, except it’s only online and free.

Murphy has this rubric too but I see Vithoulkas has upgraded Arnica to a 3! That’s great! Thanks for the link!

It is here too

If people have learned nothing else here today, it’s that Arnica has symmetrical eruptions!

Is there anyone else here?  I’ll take the next person in line?

Hi, this is my first case quiz that I dare to write you, even though I have been reading them long time ago.

Really????

I would give this patient Rhus-Tox.
The symptoms I choose were:
Nose – Discharge – Yellowish green
Mind – Spitting
Throat – Pain – Swallowing – empty – agg
Face – Discoloration – red – spots

This 4 symptoms give me: Merc, Ars, Calc, Lyc, and Rhus-Tox
*Note: If I use the symtom Face – discoloration – red – spots – cheeks the only remedy that covers all of them is Rhus – Tox,

Hope to read the answer soon
Att. Dr. Javier Chiriboga from Ecuador

Thanks for voting, Dr. Javier from Ecuador! Now, first of all, you can’t use “Mind, spitting” because this is what crazy people do, and the reason “Maurie Amsterdam” is spitting is only because he has a sore throat and it hurts to swallow. What this means is, spitting isn’t even a symptom in this case! The symptoms are as you say–painful empty swallowing, the discharge from the nose and the all-important RED SPOTS! And what do we know about these red spots? They are SYMMETRICAL! So, we’ve got a peculiar symptom here that’s covered by virtually only one remedy and that is (ta-da!) ARNICA! Arnica has symmetrical eruptions. You know about paragraph 153 of The Organon, right? Where Hahnemann says, essentially, that if there’s a strange, rare or peculiar symptom in the case, the remedy has to cover it, forget everything else! So that’s why our remedy here is Arnica and not Rhus tox.

Thanks for coming out of the closet!

Dr. B, nobody won!

Don’t worry, Elaine, someone is bound to get the gold star in May!

I suppose you’re right…. See you back here again next month!

About the author

Elaine Lewis

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at [email protected]
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hoacuoidep ezine, "The Quiz". Visit her website at:
and

About the author

Shana Lewis

Shana Lewis

Shana spices up the Hoacuoidep Quiz with her timely announcements and reviews on the latest in pop culture. Her vast knowledge of music before her time has inspired the nickname: "Shanapedia"!

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