A 29-year-old male patient diagnosed with Ankylosing spondylosis first approached Dr. Rajan Sankaran at the other song – International Academy of Advanced Homeopathy on 17^th November, 2011. His complaints had started in 2001 when there was pain and stiffness in the whole of back. Slowly but surely all the pains and stiffness went on increasing. Currently he was having severe pain in cervical region and lumbar region of the back.
The case-taking interview was as follows. The case has been summarized for brevity and the index to short-forms is P: Patient, D: Doctor.
D: So tell me what is the problem?
P: Sir it is the pain which I have since 2001. My pains started from back, and the doctors after investigations diagnosed me of having ankylosing spondylosis. There is stiffness in neck and lumbar region. As per the doctors, they say the gap in between the bones is filled up so there stiffness, more so in C2-C3 bones of neck are I also feel back pain (indicates lumbar region). I have a lot of back pain while continuous writing or sitting in one posture or when driving a bike or something like that. Bending down is a big problem for me, stooping, there is a problem in stooping. I have some reports and x-rays with me from the past consultation with doctors
D: So where is the pain at the moment?
P: It is in the back – middle (lumbar region) and the neck. I find trouble moving the neck and back. There is lot of stiffness. This is the main trouble right now, but there are few diseases that I went through.
D: What are they?
P:  I had jaundice and chicken pox last year. I feel I have a bad stomach and digestion problem. Maybe it is because of the medicines I’m taking pain killers and antibiotic, I have regular problem with my stomach.
D: What makes this pain better or worse?
P: In early morning, I am worse. There is stiffness all over with lot of pain. Then I am better as I exercise slowly, or move my neck and hands. I cannot work continuously, have to take breaks or the pain increases in back and neck. So, I cannot also be in a single posture for a long time. I have to move a about here and there in the middle.  Besides I also have to avoid cold drinks and ice-creams as they aggravate my pains. And I have to take painkillers everyday to relieve the pain.
D: In morning, when you get up, how you feel?
P: If I don’t take medicine in night when then I have stiffness in morning.
D: Tell me in food and drinks, what are the things you crave?
P: I am a veggie, so I like eating paneer and all, I like sweets, I am a bit fond of ice creams and cold drinks, but I try to avoid them as they aggravate my complaints.
D: What ice cream do you like?
P: Butter scotch is my favourite. Like fruit ice-cream, as I like fruits.
D: How is your sleep?
P: Because of my current job routine has been disturbed, I sleep late bit and get up late. I go to sleep around 2 a.m. at night.
D: What dreams do you get?
P: Generally the dreams are related to the work I’m doing – office place or something like that or friends but not any specific dreams.
D: Generally if you take a hot bath or hot application does it relieve?
P: If I take a hot bath or shower I feel free and pain gets relieved.
D: How much do you sweat?
P: I sweat much
D: Where?
P: On hands, forehead, right now I’m feeling. Sweat is more in palms, even now the sweat is there.
D: Tell me as a child, how was your nature?
P: I was bit talkative kind of person and used to play a lot and talk to people.
D: Generally what are you anxious or tensed or worried about?
P: Work and future.
D: Tell me about work and future.
P: I work as a software engineer, so there is always task completion or such activities going around, that is a bit pressure, because we work in a daily atmosphere, we have to do daily task or activities, so always there is pressure. Early morning you have to take up the task and by evening you have to complete it so entire day goes in thinking that only. And as a nature, I cannot stay alone, if I’m alone at my place, I move out of that place. I can’t stay alone, I want people around me so that I can talk to them and have chat with them.
D: What do you feel when you are alone?
P: I don’t know in words how to express it. I just go out or to nearby places with my friends. Till date I didn’t have many situations where I was alone. But even in my past, if I am alone I try to prefer going to somebody’s place nearby so I have people around me. I don’t know what to do if I am alone.
D: What do you feel exactly?
P: In words I don’t know how to express it, I feel anxious and restless. I don’t know what to do, feel as if everything has stopped.
D: As a child did you have fear of anything?
P: No. I don’t remember any fears.
D: What things you are sensitive to that affect you or disturb you?
P: when somebody is not giving attention to what I’m talking, I feel bad. You are working with people, you have friends and all, you feel like sharing your feelings and thoughts with them and when they are not reciprocating the feeling, you feel bad about that.
D: Give me an example?
P: I am very friendly with people and I am ready to help everybody anytime. However,  in the past it has happened that you expect something and you have helped them a lot in the past and now it’s time to reciprocate and you call that person and he deliberately says no. Or he indirectly says he has this problem and says sorry I cannot help you. I feel bad that this is the time I needed him and he was not there for me. I am bit worried about the future, I deliberately go around asking my seniors regarding my work and all, getting feedbacks from them so as to feel bit secure there.
D: Tell me again?
P: I am bit worried about the future. So I have a habit, I go to my seniors or colleagues or my manager, reporting manager and ask about feedbacks and all, very frequently means in a month’s time, weeks two or three weeks time, asking how my work is, what do you feel – which areas should I improve in. That is because I’m not bit comfortable or I feel insecure about that. That’s why I go to them.
D: Insecure means what you feel?
P: Insecure means I think whatever I’m giving is not as per the mark or something like that, even though I never get that feedback that you are not doing good or something. Whenever I do something, I feel I am not doing it correctly.  I’m not giving my 100% or the required thing, bit worried about all those things.
D: In which situation you feel more nervous or anxious?
P: You can say during interview, discussions and all, where I have made a mistake and somebody’s been pointing it to me in my work or my life, or in friends circle if someone is teasing me with something related to my past or something I have done or pulling my legs like in group discussion, so that time I feel bad.
D: If you have to stand in front a crowd and speak and all?
P: I am OK. I have no problem.
D: Can you please explain what happens you said your thing is not reciprocated? Give me an example of this.
P: It’s like that time I will show my anger to people near me, not talking to them, sometimes having bad discussion, most of the time I prefer a verbal exchange with them. I will go to my place and sit quietly sometime and not to discuss with them, indirectly showing them that I’m not happy that you have done to me
D: Give me an example of such a thing that has happened?
P: Usually I stay at my friends place, we have been friends for over 7 years since the time we were at college together. We have worked together and all so we share everything about each other. They know about me, so they talk about past things and a few of them come and something from my past and pull my leg. Saying you are like this…
D: So what are they doing to you?
P:  They are pulling my leg; they are making fun, bringing those things in light. Feel bad especially if there is someone new in the group when they are teasing me.
D: What will happen if they bring these things to light?
P: I feel bad
D: What do you feel?
P: I feel sometime I don’t like to share everything with everyone, there are few parts of my life or few incidents in past that I think they should not know if the person is new to the group or is junior to the group
D: If the new person comes to know that that about you, what will happen?
P: It’s like image will be spoilt in front of a new person.  It will hurt my image
D: what your image. Tell about your image?
P: Image for example you are a senior doctor who has an eminent personality, you have a good image with your colleagues and juniors.
D: So what will happen if the image is spoilt? What can happen?
P: I feel that it plays an important role. For example, if people start talking about someone that he has lost all his assets, he does not have anything and then if that person goes to borrow some money, he will not get any as his image is spoilt. People know that he has lost everything and there is no use giving him anything. So he will not get any money despite being honest and hardworking as his image is spoilt. But if people have not heard anything about him, his image is good, he will not have any trouble borrowing money. if you start saying or people start saying he has lost everything, he doesn’t have anything, he doesn’t have
D: So then what will happen if they don’t give you?
P: Then sometimes it will block your work, you will not have something where you need it immediately, you are not getting it
D: Then what will you feel if you don’t get it?
P: I will feel bad because of the wrong publicity and those words I’m facing problem right now.
D: what kind of problem?
P: I was giving example for that only. In my case the things they are discussing are very generic. I don’t know them so I don’t feel like sharing with them so that is the case. But I never think in that depth that what will happen and that. My friends know this, still they tease me front of others.
D: But friends are important to you?
P: Yeah very important.
D: Why are they important?
P: I said then I can’t stay alone, people I talk with them. There are few friends which are very close to.
D: what is a friend mean for you?
P: person you can share all your thoughts about you, even sometimes you don’t share everything with your family, because there is a restriction, but with friends you can do that.
D: Why there is a restriction?
P: it’s like restriction because you are not staying with them. Past 7 years I’m away from them studying and I am at work half a day now. But friends are always together, they can understand.
D: How are you with taking decision?
P: Not that good,
D: In what way?
P: In people’s opinion, family, friends, that I am bit lazy. I take time to take decisions and that hampers my work and life. So laziness is there. I usually consult people around me, I’m thinking this, I’m thinking that, so what’s the opinion? of course I will not go on what they say, I once think I have to do this so let me do that but I will ask for the opinions to see what they are saying. That is my habit and I usually ask, don’t hide much about myself from people especially things I’m doing or whatever thing you are doing.
D: Generally you feel comfortable in warm weather or in cold weather
P: Warm weather
D: You feel chilly, you feel more cold?
P: I feel cold more. My pains are also worse in cold weather.
D: How were you studies in school and all?
P: Good, never facing problems as such.
D: And with exams you were easy or you were very tensed?
P: Sort of easy
D: How come?
P: Generally I cleared my exams everytime, irrespective of how much and when I studied. So was never tensed about exams as I studied mainly to pass.
D: Ok we will start your treatment
Analysis
The patient has ankylosing spondylosis, which is worse in morning, better with slow movement, exertion, nothing which is really characteristic as they are common to the diagnosis. The more important characteristics come up when the patient starts describing himself as a person. The first most important thing is that he cannot stay alone. The meaning for alone according to him is that when there is no one to talk to, share, no family, friends, no talking, no communication. Sharing, family, communication are all features of Row 3 of the Mineral Kingdom. Also, the patient needs communication and is not comfortable when he does not have someone to talk and share with. This helps us determine which side of the Row 3 the patient may belong to – which is namely the left side as the patient needs, or is lacking or desires communication.
Now on the left side of Row 3 we have Natrum, Magnesium, Alumina and Silica basically. Also you see some issues of irresolution that he cannot decide, choice, he can’t make a choice and he needs to depend on somebody else. So to depend on somebody for choice, sharing, communication etc so you have either you need Natrum or Magnesium, one of the two.
On other side, we see that the patient is very concerned about his image; if somebody new comes and that fellow points out to something they don’t know right in that sense my image will be spoilt and that image being spoilt and very particular about image also goes along with sweaty of his palms, nervous, palms sweat, image that takes us towards silica because he also says in my work they expect some things out of me. For this, he is very bothered if he is fulfilling their expectations. That is his main anxiety that is why he goes around asking feedback from people, whether he is up to the mark.
So am I upto the mark, what is my image, what do people think about me; this is his anxiety. There are two issues here; one is the need for company, sharing, this that which is more towards Natrum and Magnesium and the nervousness which is definitely Silica. These are the two issues only two issues in his life. He is definitely chilly as he cannot stand cold that also goes towards Silica or Silicate
So he either needs Natrum Silicata or Magnesium silicata. He was given Magnesium Silicata. He was given Magnesium as his dependence is not so absolute like in Natrum. I just cannot be without somebody else, this is not so intense. He stills has his choice a little bit, he still has his own thing but it’s not enough so it’s not zero but insufficient and also it is not towards one person but towards a group of people. So natrum would normally get attached to one person that I have this one person without whom I cannot be, without him I cannot exist, I cannot live and I want love. That is little bit romantic in a way, isn’t it? But he is not like this. He is more I miss my family, I miss my home, the friends are my family, friends are my home therefore I need them.
So he got Magnesium Silicata and the potency given was 30 because all his affections are at a very local level. So his level of experience at the moment is only the joints, the back, Ankylosing spondylitis. His need for company is there but it is well compensated for, he is not feeling it acutely, I am now alone, I’m forsaken, nobody wants me such a feeling is not available at the moment. Therefore he got 30 bd progressive pathology we can get LM also but we don’t have LM so we gave him 30 twice a day for a month and I expect to see really dramatic changes in the next 3 months, he should be much better. So his local sensation and modality were common to the illness like stiffness better by movement, better by heat. These are very very common. We can’t give it to much importance. There is no specific sensation in him, like twisting, burning, needle, pricking, tearing, such symptoms were not available. Ankylosing spondylitis means stiffness which is better by heat and better by movement so you cannot give Rhus tox to everybody, but at deeper level we have these characteristics, the cannot be alone, I need people and secondly I need my image or my good opinion in society. I should live up to expectations.
What I do is very simple. I just take what is present, predominant and persistent. In the case, what is the strongest thing we can see. I don’t go too much into things that are hidden or where I have to probe to pull things out, no. What is obvious? If the anticipation is obvious, cravings are obvious, everything that is the first thing I take. What is really obvious and clear, simple, direct and persistent in this patient that represents him. This worked the best for me. If the patient not able to go beyond, so what you feel if your image is spoilt. He can’t say, he is not able to say. I don’t push him, push him into something he doesn’t want to go or he doesn’t know to go. There where he stops, I stop. Image is image, alone is alone. I want to share, I want to communication, I want to talk, I want my family, I want my friends. This is good enough. Then I just ask him one simple question how is it to make decisions. This is a corroboration or confirmation that he is in row 3. Row 3 means he cannot decide. If it’s not that, then it’s not row 3 or at least not Magnesium. So this is a corroboration or confirmation. And if comes out spontaneously, clearly, loudly without doubt then I take it otherwise leading questions are misleading so you have to be careful there but if it’s clear and sure then you can take it.
Follow up dated: 17-08-2012
D: Tell me please how are you?
P: Fine sir compared to past disease, stiffness is less and compared to past the movement is also bit increases from neck and back bending is not possible completely.
D: So about 9 months have passed since we started, how do you feel today as compared to when you came the 1^st time?
P: It’s much better like not only for stiffness but also the other things like I used to have upset stomach and gas troubles but that has been reduced drastically and doesn’t feel those problems and my daily routine is also been change a bit in I used to be lazy and compared to what I used to go very late to bed and early morning hours were not that easy because stiffness. And all was there. But compared to past it is much better today.
D: Yo what extent would you say your stiffness and your main complain has been better now?
P: This 2-3 months it’s like been bit aggravated early morning, otherwise it was 40-50% better what it used to be previously.
D: Are you taking any other kind of medication like pain killers?
P: No
D: In your state of mind and moods, how are you compared to 9 months ago?
P: Bit more stable, it’s like previously I used to have very continuously changing thought process. I used to think twice thrice or sometimes very negatively thinking and if I do this, this will happen and if I do that. In office also it used to happen. Sometimes I used to get very aggressive to someone else’s thought in my work place. Nowadays I feel that I dissolve the certain things and not go to certain extent; listen to what others are saying not only put my thoughts only. Nowadays, I put my thought but I also respect others thought as well.
D: Also you had something to do with self confidence? There were situations you would feel anxious, nervous like this.
P: To some extent, but it’s like I am not observing such things.
D: What about meeting people or in new situation or stage presence or something like that. What are the situations that would make you anxious?
P: Meeting people was not that complaining for me, it’s like going in front of new people and talking to them was not and stage fear was also not in my case I don’t remember if I have a fear that somebody asked me to say and go up to say something I won’t hesitate in doing that.
D: Like you said in interviews and discussions and all you used to be little thinking that I could make a mistake and things like that, do you remember.
P: It’s like interview and all and talking to new person and all it’s a different thing, in that situation you always know that you always know have to lose something. In that situation sometimes like it happens.
D: How is that now, have you noticed anything about it?
P: No it’s like in these days I have not faced any of those situations currently.
Doctor 2: Have you done any investigations? Xray cervical as we had seen.
D: X-ray cervical what was seen? ESR must have been done. Get the x-ray repeated. Ask them to compare with last one. Get the ESR done and how much was the last ESR any idea?07.42
D: 20, repeat the ESR. Good things are progressing and you will go to complete cure.
 
Author: Dr Rajan Sankaran, Head, the other song
Co- authors: Dr  Sneha Vyas and Dr  Alifiya Merchant, Editors, the other song
Source: National Journal of Homoeopathy –June 2016