Words: Dr Joseph KELLERSTEIN
Elderly patients always seemed tricky regarding their reporting and response to treatment. Either I could not get a clear case, or there were so many aggravating factors that characterising the illness was difficult. Give them a remedy and when assessing the follow-up carefully there is either no clear response, or it seems I have made them much worse, or created a side-effect. During the first years of my practice I used to dread two kinds of patients. The ‘very old’ and the ‘very young.’
In dealing with the elderly, precision case-taking is extremely important [this seems like a silly statement; isn’t it always?]. Be insistent on a clear aetiology [cause]. “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 towards discomfort, or emotion. “Okay, 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 are, usually, more than 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 just watch the face for changes [expression, skin colour, moisture, pupil size,] and question the patient regarding their feelings when it happens. “That last comment seemed to have an impact — what was that?”
Precise locations are verified by pointing one finger. This is later verified by physical exam. Ask to be shown which movement exactly hurts by demonstration. Create a hierarchy of modalities through indication from 1-10; and, how intensely each factor aggravates. An astute care-taker is a valuable observer for both the elderly and infants [and, also pets].
Lastly, the rubric, or symptom [in normal parlance], in the homeopathic symptom-remedy index, or repertory. Generals. ‘Old people, complaints’ is useful.
Brian was in his mid-80s. His wife of four decades had passed after a prolonged bout of cancer. Brian was totally devoted and this trauma had been devastating. The response to Ignatia amara and Natrum muriaticum was very good.
There was a nagging decline in vigour that really was not characteristic of any remedy [one of the most important ‘thinking tools’ I teach in my post-graduate homeopathic programme is, “Know when you don’t know,” i.e., if you see no characterising 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. Just can’t explain it other than to saying 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 leads 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.” Now, Benzoic acid was in that original rubric, but only a literature search and a 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 framed the situation well. Benzoic acid 30C was given. One dose, per day. In just a few days, the state and the symptoms lifted nicely.
