Grace Over Kenya;
A Case of Post Tuberculosis Cough

T. W. E, 32 yrs old
Case #1

Initial Intake:
Case note: in this case, I list unconfirmed AIDS as one of the chief complaints. This is simply because most of my patients were supposed to have AIDS, but none would admit to it, and virtually none had been actually tested for it.

Tuesday, July 11th, 2000 (Kariobangi Clinic - Nairobi)
CC: Dyspnea, Asthma, Post TB cough, unconfirmed AIDS, & Pectoral Pain
S: I’m here for chest pain & I have difficulty breathing. When its cold, I can’t breathe – or when dusty. When the weather is cloudy I have total breathing. Say more about the breathing problem? When I try to breathe in or out I feel a problem – lots of pain – a burning pain – been almost 14 years now. When it is cold, dust, or heavy work – I have the difficulty. I have asthma – use a ventolin inhaler. However, the medicine I’ve been using is finished. After the problem of Asthma, also dx’d w/ TB. Still coughing though. Coughing? I cough a lot then I feel s/t is not coming out. When I use the inhaler, then s/t comes out. S/t whitish that is so thick – like a rotten smell. Pain is at the RT side (pt points to her upper RT pectoral). When I’m sleeping on the LFT – feel great pain on the RT chest, when sleeping on the RT, I don’t cough so much. When I had TB – I used to cough lots of blood – most pain came from RT side. When I cough & lift my RT arm – feel pain on RT chest. Anything happen around the time of first illness? No. Family hx? Father has asthma. S/t it comes by itself – the white expectoration – other times after using the ventolin. S/t I feel a lot of heat, I feel all over the whole body – can feel it if you touch my skin – I’ve no appetite when I feel the heat. When I’m weak – I can’t work. Say more about the heat? It happens at different times. Menses? Before my menses, I have back pains – slight pains. S/t has cramps. Blood quality? Lumps & dark, & s/t watery – flow is 3 days. Quantity? After birth, heavy flow. Before menses I loose my appetite, but can eat oranges. Sleep? S/t unable to sleep. Used to go to bed @ 11 – if go to sleep before that, can’t sleep. Dreams? I dream I’m in church, we are singing. Not bad dreams. When small, used to dream of being on a tall tree – I’d fall down from the tree – it was a repeating dream. Feeling? Afraid. When I wake up, I feel like I’m floating – only when dreaming – I’m frightened – I don’t hit the ground. Do you have any fears? No. Any feelings about animals? No. Once my finger was swollen, for 3 years – then got shock of electricity – it went away. Floating? Just floating. Heights? When I climb high building – I feel lots of pain in my chest. I have fear I’ll fall down, only when looking down, it is normal, not strong. Since TB, I feel that so many things affect me – always sick. Flavors I dislike spicy & sweet things – especially when chest problem. I don’t take my tea with sugar.
When you think of your five senses: light, sound, taste, touch, or smell, is any one hypersensitive? Smell is the strongest, bad smells, perfumes I don’t like. Perspiration? Especially when very hot – whole body perspires, feel so sick. Thirst? Only after eating, the expectoration seems < mornings, and evenings.
O: Physical Exam deferred due to overload of pt’s in waiting room.
A: It is unfortunate we are so busy, as it would have been very interesting to see if there is some consolidation at the upper right lobe. Nonetheless, the case has some very clear symptoms. Given that the case is considerably focused on this cough of 14 years, it should be the focus of the case. In particular, her expectoration being white, rotten smelling, and thick, as well as her coughing modalities. Of interest are the following to me: that she had a foul smelling expectoration and she mentioned being sensitive to smells, that she has difficulty getting up this expectoration without her ventolin. This idea seems to explain how her body hasn’t been able to throw off this cough for so long. The right sided burning of the chest goes along with her feelings of heat generally. Since I’m trying to affect this patient deeply and constitutionally, I also thought it significant that she remembered a childhood repeating dream of falling. Below are the graph and the rubrics I chose for this case:
P:

Sanguinaria 200c (single dose dry given in office)
Sanguinaria 22x QD (daily dose)

First Follow-up
Thursday, July 20th, 2000 (Kariobangi Clinic - Nairobi)

Case note: The patient was given Sang 200c on Thursday, July 13th, 2000, 7 days before this follow-up.

CC: Dyspnea, Asthma, Post TB cough, unconfirmed AIDS & Pectoral Pain
S: The coughing has stopped. How long were you coughing? 14 years, when the chest is blocked, is when I cough. Two days after the homeopathic medicine, coughing stopped. Completely stopped? It is reduced, now only some coughing during the night. It is better. I feel as if my chest is blocked. Breathing and asthma? During the day I breathe normally, during the night it feels blocked. When coughing @ night, It is less blocked then it used to be. Is this an improvement? The flu has stopped - discharge from the nose. Able to work now, couldn’t work before the medicine. Any sx’s worse? No, now I can walk and work. The pain in the RT shoulder is still there – it is the same. I have regained my appetite, and I feel very active. Pain on RT chest? It has gone. How long did you have the chest pain? 5 years. Sensation of heat? I felt hot for a few minutes after the medicine, not since. Menses? Haven’t had yet. Sleep? I sleep normally now. Dreams? No. Fear falling/floating? The fear is gone. Any sx’s that haven’t responded? The pain on the shoulder, when coughing I feel as if the pain goes towards the shoulder. The bad smell when I cough has gone too. Only the shoulder is unchanged. I’m also not using the ventolin as often.
O: Physical exam deferred.
A: It is interesting to note the sx “pain of the coughing going towards the right shoulder here. Sang has the rubrics: Chest; PAIN; general; extending to; shoulder (13), & Chest; PAIN; general; sides; right; extending to; shoulder (7). Patient is improving clearly even though the Rx was given only one week ago, therefore:
P:

Watch and wait
Continue Sang 22x

Tuesday, August 1st, 2000 (Kariobangi Clinic – Nairobi)
CC: Dyspnea, Asthma, Post TB cough, unconfirmed AIDS, & Pectoral Pain
S: The first medicine (the 200c), helped, but the second medicine (the 22x), isn’t working. Coughing returned when? 3 days after the 22x, the coughing returned. Any sx’s worse? The RT side – have a lot of pain (shoulder). There is blockage in chest, makes it impossible to breathe. The medicine didn’t help much in blocking of chest. The discharge from my nose is gone. How long did you have the discharge from nose? I’d had is since the asthma began, years ago. Did the first medicine (the 200c) help the RT shoulder pain? It helped me, but when I start coughing, the pain resumes. I can still work. Pain of RT chest? When I cough I get the pain. Doctors said I’d lost a lot of blood with the TB – RT side was affected. When I sleep on the RT, I feel the pain. If no coughing – no pain. Bad smell when coughing? No bad smell anymore. Heat? No, it is gone. Periods? No, haven’t had yet. Sleep? I sleep well now, an improvement from 1st medicine (200c).
A: Here we have a clear relapse. It appears that the 200c hasn’t lasted.
P:

Sang 200c dry in office
Sang 30c Q/week
Stop Sang 22x
RTC in one month

Case Note: This patient did very well with all of her sx’s for several months after we left Kenya. The nun who ran the clinic emailed me updates saying that she responded to the medicine well and continued to improve on the 200c. She was followed for more then 6 months with excellent responses to the same Rx.