AGENT ORANGE-INDUCED LYMPHOMA

AGENT ORANGE-INDUCED LYMPHOMA

Case Presentation: Extreme Mental and Physical Symptoms

A.R.

Male

Age 42

Initial Visit: September 25, 1990

Diagnosis: Non-Hodgkin's lymphoma -- follicular, mixed type, stage III. Diagnosis was confirmed by biopsy on January 24, 1990.

Medical History: While in Vietnam the patient cleaned out Agent Orange vats. He was one of the first persons whom the Veteran's Administration (VA) diagnosed with an Agent Orange-induced illness, and has been on disability for several years. He has had five combination chemotherapy treatments (Cytoxan, Adriamycin, vincristine, and prednisone) from April to July 1990. During this time his white blood cell count went from 156 to 22.5 (normal range is 4 to 12), and the lymphocyte count went from 74 to 65 (normal range is 20 to 40).

The chemotherapy has been interrupted for three months because the VA did not want to pay for treatments. The man was so paranoid about going to the city that he wanted to continue his treatments at his home in the woods. He refused to go to the VA facility. The VA then refused to pay for treatments outside of its facility. His wife decided to bring him to see me so that he could try homeopathy in the meantime.

His spleen is enlarged (3) about ten times its normal size; it extends down into his abdomen near the umbilical region. It produces a lot of gas and abdominal pain. It decreased in size with the chemotherapy, but has grown back since. Physicians are pushing for a splenectomy.

The cervical and inguinal lymph nodes are swollen (3). The first symptom of disease was a swollen right cervical lymph node.

He is hot (3) all the time. He is sweating in the office.

He complains of nerve trouble and doesn't like to go to the city.

He was drafted to Vietnam. His parents thought he should go. He went straight to Vietnam from technical school, having skipped boot camp, and felt isolated socially.

He started getting stomach trouble. After he had been there a while, he had a nervous breakdown. Apart from being exposed to a lot of chemicals, he had a constant fear of being shot. The rocket attacks at night would send him into bomb shelters that were inhabited by snakes and rats.

The stresses affected him mentally. He couldn't work, was strongly averse to people, and would run away and hide. He would get fearful and short of breath. He heard voices and started seeing things that weren't there, similar to delirium tremens. He was diagnosed with a bipolar affective disorder and sent to a mental ward. It was "like a bad acid trip." He thought he could read minds. It seemed as if time stood still. He wonders if the other soldiers slipped him psychedelics.

The staff of the mental ward put him on 2,000 mg of Thorazine three times a day. This dosage was experimental and was later shown to be just sublethal. He was taken off when he was sent home to Palo Alto, and he improved from there.

Afterward, he felt really washed out. He was drawn to marijuana after the service.

He still suffers with mental problems. He avoids crowded places (2), wants to be by the door and needs to find the exit. Can't go out to dinner. He doesn't want to go out, just sits in his chair and thinks awful thoughts. Yet he doesn't want to be alone, and wants to be close to his wife and family. Is very startled by noises and has to identify the noise. He gets palpitations from nervousness.

He gets vivid, awful nightmares (3), of planes crashing.

He can't plan events in advance because of the anxiety (2). He gets cold sweats at night with insomnia. He hyperventilates, gets rigid, and thrashes in bed with anxiety about tomorrow. He feels the anxiety in his abdomen.

He has strong fears of being alone in the house (3), of the dark (3), and of heights (3), and gets vertigo from high places. He had a fear of crossing bridges as a child. Sometimes he gets a strong fear of death.

Can be very jealous of his wife (2), imagining things that didn't happen. She is loyal. He has had a low sex drive since he has been ill.

Sporadic yellow diarrhea (2) for three years.

Has strong food cravings: sweets (3), pork (3), potatoes (3), meat (2), spicy (2), eggs (2).

Thirsty (3).

Hates seafood (2).

Salt "puts his intestines into knots."

His energy drops after eating.

His nails have been weak (2) over the last five months.

Sleeps on his left side (2).

Strong body odor (2).

His skin heals very slowly (2).

Has an ulcer from stress, which is worse from drinking alcohol.

Observation: He is a warm, friendly, stocky man, who is open, easy to get to know, family oriented, and not very ambitious. He is paranoid about regular doctors.

Bob Ullman: I had the idea of Ceanothus, which is listed in Boericke as having an enormously enlarged spleen. I don't have any information about the mental picture of Ceanothus. The mental picture in this case looks like Argentum nitricum. So, I might give Ceanothus first, see if the mental picture remained after initial treatment, and then give Argentum nitricum at a later time, if it continued to be indicated.

Judyth Reichenberg-Ullman: I thought of China because of the chills and the night sweats. It also occurred to me that the patient has a lot of Arsenicum elements. I therefore looked at Chininum arsenicosum. It doesn't really fit his delusions, but there are a number of specific characteristics that do fit. The remedy has splenomegaly, sweats, chilliness, imaginings, spiteful images, and insomnia. Chininum arsenicosum can't digest fish, and this patient doesn't like fish. The remedy has fear at night that evil will come. And Arsenicum album has an aggravation from salt. So I suggest Chininum arsenicosum.

Jennifer Jacobs: I usually prescribe polycrests, and my idea for a polycrest remedy in this case is Argentum nitricum. It seems that it's a textbook "essence" case of Argentum nitricum, with the fear of heights and bridges and the desire for sweets. He's also warm-blooded, open, and friendly. So that's what I would prescribe.

Tori Hudson: We were looking at Hippozænium. I know nothing about this remedy, but it does come up in the physical aspects of the case: the enlarged spleen and lymph nodes, and the lymphatic swellings. It also basically covers cancer of various kinds. I would be interested if someone else might be able to shed a little more light on this remedy, especially the mental and emotional aspects.

Sommermann: Those are great suggestions. Would anyone else like to make a suggestion? If not, let me explain how I approached the case.

Case Analysis: Taking an Organopathic Approach

My first thought about this case was, "what a tragedy." Here is a man who is very close to his four children, has a loving wife, has a healthy family history -- with no evident major miasmatic taint or abuse history -- but he has a terminal illness at age 42. It seems that war took its toll on him years later. The doctors already started chemotherapy, and soon they would remove his spleen. He didn't have much hope. Maybe I could palliate some of his trouble with remedies. I felt sorry for his children who would miss him a lot.

This is a very complex case. I decided to use only current symptoms, because there were plenty to pick from. Thus, I didn't consider the mania symptoms or earlier problems. Initially, I repertorized the case using the following symptoms:

- MIND, Fright, complaints from.

- MIND, Fear, alone, of being.

- MIND, Fear, dark.

- MIND, Fear, high places, of.

- MIND, Fear, crowds, of.

- MIND, Fear, public places, of.

- MIND, Anticipation, complaints from.

- MIND, Jealous.

- MIND, Starting, noise, from.

- VERTIGO, High places.

- GENERALITIES, Heat, sensation of.

- ABDOMEN, Enlarged spleen.

- GENERALITIES, Leukemia.

- STOMACH, Anxiety.

Argentum nitricum comes up the strongest by far. It best covers the mental state of the patient, and I felt deep down that this was an Argentum nitricum constitution, before I repertorized the case. He is a friendly, straightforward, emotional person who is content with a simple life. The phobias and anxieties are well covered by this remedy. Imagine an Argentum nitricum personality in Vietnam! He is very warm, and has strong food cravings, gastrointestinal problems, and vertigo from heights to confirm the remedy. But Argentum nitricum isn't listed under enlarged spleen. The proving mentions stitches in the spleen, but this is a well-proven remedy and I wanted more than that out of a remedy for this fellow.

I have seen the "correct" constitutional remedy produce a nice aggravation in cancer patients. But in spite of the aggravation the disease runs its course and the patient dies a few months later.

Argentum metallicum doesn't cover the spleen either. So I looked down the list.

Phosphorus and Pulsatilla both come up behind Argentum nitricum, but neither remedy has as much to offer in symptom strength, although Phosphorus covers the enlarged spleen.

The snake remedies pop up sporadically in the repertory, and if you combined them you could make a strong case. However, I like using a single remedy, so I tentatively abandoned them.

Kali phosphoricum covers leukemia and the fear of being alone and in crowds. These patients also startle easily, but they are typically chilly and don't have the spleen enlargement.

After I got to this point, I threw out the totality and looked at the case from the "pathology first" perspective. I do this when the pathology is very strong and I can't see a remedy that covers the whole case. After all, this man's spleen is huge -- it hangs down to his navel. So I went to the enlarged spleen rubric and investigated each remedy in the materia medica. On the basis of constitution, I ruled out polycrests such as Arsenicum, Aurum, Calcarea, Conium, and Natrum muriaticum. This left only minor remedies. I read what Boericke had to say about each remedy left in the rubric.

I immediately went to Ceanothus, a remedy I had studied several months earlier. It is the only small remedy in bold type. Boericke says, "This remedy seems to possess a specific relation to the spleen. Enormous enlargement of the spleen. Splenitis. Leucæmia." As far as the pathology goes, this remedy fits the bill perfectly.

I also read about Arsenicum iodatum, China, Chininum sulphuricum, Hydrastis, Ranunculus scleratus, and others, but none of the other remedies had such an affinity with the pathology in this case. Another possibility would be to try potentizing Agent Orange. But I didn't have the time to experiment because more chemotherapy was looming on the horizon. To make a long story short, I cautiously decided on Ceanothus as a first choice. Because this is really an organ remedy approach, I chose a 12c daily.

This organopathic approach is, of course, not new. Several months after this prescription, I discovered a nice account of Ceanothus in Tyler's Homeopathic Drug Pictures. We find that Paracelsus was the father of organopathy, as with so many other things. Burnett brought Ceanothus into homeopathy and published a booklet entitled Diseases of the Spleen. He correctly points out that organopathy is correctly used only when a simillimum that covers the totality and the pathology cannot be found. I assume he used this approach only when the pathology was extensive.

Plan: Ceanothus 12c daily.

First Prescription: Proving Symptoms and Dramatic Improvement

October 26, 1990

He called me and said that his glands were shrinking in his neck and that his spleen felt smaller. He also said he felt calmer and much better.

Assessment: He is improving.

Plan: Continue Ceanothus 12c daily.

November 14, 1990

His cervical glands seem normal.

His spleen is still shrinking, just like it was right after chemotherapy.

He feels a lot better, except that he felt really bad after some acupuncture.

His skin is healing tremendously faster, and his nails are stronger.

Mentally he feels calmer, and he rationalizes better.

No nightmares.

He is not as hot.

He still hates crowds (2).

Still waiting to start chemotherapy.

Plan: 1. Stop acupuncture.

2. Ceanothus 12c daily.
3. Hope that VA doesn't pay for chemotherapy.
January 9, 1991

Was a little depressed at Christmas.

His face has filled out again.

His energy is better than five years ago.

His mind is a lot clearer.

He has fewer stress reactions; no anger flare-ups.

Sleep is okay; not sweating at night.

Fears heights (3), being alone (3), and crowds (2).

Gets stomach pain after eating (2); gets shaky if he doesn't eat.

Craves sweets (2), pork (1), rice (2).

Thirsty (2).

His lymphocyte count is 47, down from 65 on August 31. His white blood cell count is normal at 6.2.

Plan: Ceanothus 12c daily.

February 20, 1991

He started getting diarrhea (2) and gas (2) the last couple of weeks.

Feels nervous, as if he's going to jump out of his skin.

His spleen is still shrinking; his lymph nodes are barely swollen (more on the right side).

Feels nervous as if responding to a big trauma (2), but nothing is happening; apprehensive (2) and withdrawn (2).

Warm (1).

No food cravings.

No night sweats or insomnia.

Fears heights (3). Averse to crowds (2) -- feels like people look through him.

Assessment: Burnett says that in low potencies Ceanothus frequently relaxes the bowels, even causing diarrhea. He thus appears to be proving the remedy. He has, after all, been taking the remedy once a day for several months.

Plan: Stop remedy.

March 21, 1991

He has been tired (2) for 1 1/2 weeks. Goes to bed at 7:30 p.m.

His spleen is a little larger (2).

Has joint pain (2) with Rhus toxicodendron modalities (stiffness, better warmth, worse first motion).

He becomes warm when excited (2).

Tori Hudson: I would probably put him back on the same remedy and potency, but less often, because he was previously proving the remedy after taking it daily.

Bob Ullman: I would prescribe the 30c potency of Ceanothus. He's not on any other medications, so I would give him only one dose and then wait.

Sommermann: That is just what I did. That's what the old books say about the lower potencies. If you get a proving, then discontinue the remedy and wait; if the same symptoms return, then increase the potency.

Plan: Ceanothus 30c, single dose.

April 9, 1991

His spleen shrunk dramatically the day after the remedy.

The glands in his groin are swollen.

He felt better for one week after the remedy, calmer, then felt worse.

His joints are better.

Plan: Ceanothus 30c, one dose every two weeks.

April 18, 1991

His lymphocytes are normal at 37. His white blood cell count is low normal (5.9) for the second reading in a row. In spite of obvious improvement, his physician recommends splenectomy and chemotherapy. When the patient said he was trying homeopathy the doctor took him outside (where the other clinicians wouldn't hear) and told him to keep doing what he was doing. The doctor said he had learned a lot from the patient.

July 3, 1991

Two weeks ago he felt nervous, had yellow diarrhea, and had abdominal distress. He felt as if he were going to jump out of his skin, exactly like the proving from Ceanothus 12c.

Assessment: Proving symptom.

Plan: Discontinue the remedy and wait.

Second Prescription: The Image Has Changed

October 11, 1991

He wants to see a psychiatrist.

He feels anxious (3). The anxiety is worse around people and when he is outside. He doesn't go out because he gets nervous.

He is also anxious about his health (2).

Fears heights, with vertigo (2).

He covers up how he feels. He feels scared and unsure about what's happening.

Has pressure in his chest near the solar plexus -- like an ulcer, a dull ache (2).

Warm sweat (2), like a nervous sweat.

Has a huge craving for sweets (3) and salt (3).

His eyes are swollen and puffy (2). Red conjunctiva (2) has been developing over the past couple of months. He needs dark glasses. He made an appointment with the doctor to have the eye problem diagnosed but canceled because he was afraid they would recommend chemotherapy.

Sommermann: Now, what are your thoughts?

Stephen King: What's happening with his spleen?

Sommermann: Well, he isn't complaining about it, and he's usually very sensitive to any enlargement. On the man's last visit to the physician, the spleen examination was normal. Also, his blood counts were all still normal.

Durr Elmore: As for the prescription, it looks pretty obvious. The Argentum nitricum picture has really become clear, with the eyes being involved and the mentals becoming even more dramatic. So, I'd give Argentum nitricum, one dose of 200c.

Sommermann: Yes, that's what I did.

Assessment: The image has changed. It is a clear picture for Argentum nitricum.

Plan: Argentum nitricum 200c, single dose.

December 10, 1991

He feels better emotionally. The anxiety greatly improved within two weeks after the remedy. The fears are better, he is less paranoid, and is better around people. He can talk to people, feels calmer.

He is warm (1).

He wants salt (1).

His eyeballs seem swollen (2).

His head is sensitive to being bumped (2) and he scrapes his hands easily (1) ever since the chemotherapy. The skin was damaged by the chemotherapy.

Normal bowel movements.

Sleeps much better.

His glands are close to normal size.

His energy is okay.

"If I go on this way for life, I'll be happy. I'm not going back for chemo. I'm sticking with this."

Plan: Wait.

April 2, 1992

He had his first head cold since the lymphoma symptoms started.

"I feel 95 percent better. People wonder why I'm not dissolving."

His eyes are still swollen (2); photophobic (2).

Some diarrhea.

His spleen is holding its own, and his lymph nodes are okay.

His skin is healing fast, his nails are growing fast, and his nail beds are pink.

He is talking about going back to work.

Assessment: Can't complain.

Plan: Wait.

A Summary of the Symptoms that Ceanothus Improved

This was my first case of Ceanothus, so I'm not ready to say anything definitive about the remedy. Tyler and Burnett both have described the remedy. However, I'd like to summarize the symptoms that improved from the remedy in this case:

- Swollen spleen and lymph nodes with leukemia (presumably worse after chemical exposure).

- Abdominal distress, with sporadic yellow diarrhea.

- Intestines feel knotted up after eating salt.

- Nervous, felt as if he were going to jump out of his skin, as if a big trauma were happening.

- Insomnia with night sweats.

- Vivid, awful nightmares of planes crashing.

- Strong body odor.

- Weak nails.

- Slow healing of wounds.

- Craves pork and potatoes.

Sheryl Kipnis: Did you find confirmation for any of the mental and emotional symptoms under Ceanothus when you were searching the materia medica?

Sommermann: No, I didn't. Burnett brought the remedy into use specifically for spleen problems. There just isn't much on Ceanothus. Even the nightmares are not known to be associated with the remedy.

Connie Wilson: Have you had experience using isopathy in cases like this, or has anyone in the audience had a positive outcome with a case like this, involving a clear poisoning?

Sommermann: It's an approach I think a lot of people use when they're up against the wall, without a better approach. And sometimes it works. I've had some cases, involving the DPT vaccine for example. Others have used potentized penicillin, cortisone, and so on. The idea of using potentized Agent Orange did come up for me. But I'm very glad that I prescribed as I did. It's not absolutely certain that Agent Orange caused the lymphoma. But the VA felt it was the causative agent. The man was massively exposed to it. He was cleaning out the vats every day and it was all over him.

Gregory Pats: When reading Burnett, did you look at the potency that he used as compared to what you ended up using in this case?

Sommermann: Not precisely, but Burnett did use low potencies in a similar way. He may have used 6c, or a similar potency.

Bessie Paes: Could we have covered his mental symptoms by Aconite? There was so much fear in his system.

Sommermann: That's actually a good thought, in terms of the distress. I used the rubric, Complaints from fright. Argentum nitricum is also there. I felt it covered the case better. But I feel that Aconite would have had some impact in the case, because it does cover a lot of the fears and the causation as well. Aconite may have been useful in the acute phase, when he was in Vietnam. It was obviously a complaint from fright, and it was very intense.

Judyth Reichenberg-Ullman: It's interesting that Ceanothus, which is a remedy that was introduced long before Agent Orange was even compounded, worked so beautifully for this case. To me, it means that we don't need to resort to isopathy in most cases. The remedies that we have will work, even for these modern environmental toxicities.

Sommermann: Yes, if you can find the right remedy!

International Foundation For Homeopathy.

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By Eric Sommermann

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