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  • help with breast abscess case!!!!!

    Any advise on this case would be great!!!
    38year old F, 6 weeks post partum.
    Presented with severe breast abscess. Had mastitis twice, treated with 2 courses of antibiotics in the last 3 weeks. Also had the initial abscess drained. Came to see me on Monday when allopathic doctor informed her they recommended surgically removing the abscess. Lower right breat inflamed first, followed by upper area after the antibiotics. When I saw her she was running a fever of 39.7. She was very unwell and the breast was very painful, swollen, red, hot to the touch and 'lumpy'. She had fever with chills and was unable to raise her arm as the armpit was swollen also. She felt fragile emotionally, weepy and felt a failure in motherhood (1st baby). She is a farmer and was frustrated to have no accomplishment throughout the day for the last few weeks. She felt everything she did was not right. She felt dreadful for taking the allopathic route initially - but said she was so vulnerable and open to suggestion. On one hand she was besotted with the bathe - but on the other she wanted to "disengage the baby from her". She is very thirsty for water and herbal teas. She complains of chapped lips. Normally she is very productive and physically active and not used to lounging around. She prefers outdoors and feels frustrated being incapacitated.

    Pregnancy was normal, apart from she was rhesus neg and baby rhesus positive - so she had a course if injections during the pregnancy. Birth was normal vaginal delivery. She had an episiotomy and her placenta was removed surgically.


    On tuesday night I gave her Belladonna 200c. She took 4 doses at intervals until I saw her again on wednesday morning.

    Rubricslooked at:

    Breast, abscess
    Disease, abscesses, absorption of pus
    Breast, pain in breast, right
    Mind, fear of failing in motherhood
    Mind, crying
    Food, thirsty during chill

    To confirm I had a glance at the following rubrics:

    Breast, nodules, right
    Disease, abscesses, absorption of pus
    Breast, abscess, lobe, ulcerates, discharges into one common ulcer with pain
    Breast, ulcers, hard edged fistulous, remain
    Breast, lumps in hard

    I saw her on wednesday morning and she looked much better. She noted that the baby was more settled. She was not as flushed as the night befor and her temp had settled. I prescribed Silica 30c. She took another dose 4 hours later.

    Wednesday night i phoned her: She had had fever back and forth all day. The pressure in her armpit had subside. She had a strange sharp pain in her elbow. Her breast was throbbing and felt bruised (she had been massaging it all day). She felt tired - but good about deciding to take a remedy. Emotionally she felt OK, confident and not weepy. She was not worried about getting things done on the farm and had handed the responsibility over to her husband. She had decided to give herself time to heal. She said she is usually uptight and finds 'letting things go hard".

    Thursday 9.30 am - She felt incredible and noticed a big difference. Fevers were back and forth. The elbow was 'funny' and ok, not as sharp pain any more. The tightness in her armpit was loosened. Her breast was not as hot. She agian noticed that the baby was more settled and she was able to put her down for a while. Her breast looked different, and she felt some shift. She did not feel as chilly.


    Thursday 2.00pm - She phoned to say she had the strange sensation of pin pricks in her breast ( I noted the language of pins - suggestive of Silica!!!) She had the feeling that her breast was different. She stated that it looked different and the skin seemed more fluid. Under the skin seemed more fluid in some parts - possible with a purple /ish colour. At one part the testure looked like a blister - however it was not raised as such. (The breast is still hugely swollenand congested).

    Thursday 6pm - She rang to say that she had just woke from a nap, feeling dreadful and weepy. She was in pain and felt chilly - and the baby was very unsettled and demanding. I advised her to take another dose of silica 30. I will phone her in a few hours.



    Basically that is in an outline of the case so far. Sorry it is long-winded!!! I need advise as to whether an abscess this size can actually be re-absorbed with silica! I feel that the remedy is well chosen - but I would like to hear from other homeopaths to get their opinion. Obviously, it seems that this infection has been rife for some time. Am I being too optimistic???? Please advise!!!

  • #2
    I would keep with the Silica a while longer as there have been changes whilst on it. How about trying it in water? I get better results that way.

    The other remedy to consider is phytolacca.

    Comment


    • #3
      Fri 9.30, spoke to my patient. I am concerned. She has been feverish on and off all night again. she is very tired - but not as weepy. She feels cranky and sore. There is no further change with the bresat. although she reports that it is painful to nurse, the pain radiating around her back. She had never reported thsi symptom before. The baby is having a growth spurt - therefore feeding more often. Her breast feel' tight'.
      I have advised her to another dose of silica in water. She lives in a remote area which is difficult to get to today due to snow. She has no other remedies. I looked at phytolacta before. but now - with the pain radiating from the breast to the back - perhaps it is time to change.
      pain, breast, radiating from - phyt

      One concern I have is that i have 1 envelope with phyt - however (to my horror) it has been stored beside a small bottle of aromotherapy oils - and the envelope smells of lavender. It is a mixture of oil - there is no camphor or mint. Would this effect the efficiency of the remedy???? There is no other phyt available to me. If I ordered some it would not arrive until monday. If it did not work, It would be difficult to assess if it was because of 'contamination', or the wrong remedy!!!!!

      Allopathic doctors are trying to persuade thsi lady to go for surgery soon.

      Comment


      • #4
        Stay away from surgery

        all that does is suppress the symptom (abcess) and induce later chronic illness.

        As you have been using Silica it is well followed by Hepar Sul - which promotes the endocrinal system to absorb and dispose of unwanted material via the lymph system.

        I would then suggest a single dose of Bellis per 1m and wait.

        Comment


        • #5
          I managed to get phyt30c to her today - unfortunately I am snowed in and will not be able to get any other remedies to her until probably Sun.

          Originally I had looked at sil, hep and phyt. However, I was under the impression (please correct me if I am wrong) that hep would promote suppuration and bring an abscess to it's head. As i have intervened with homeopathy at a late stage I felt hep would be unsuitable. However - had I known it would stimulate the endocrine system, perhaps I would have sent a different remedy today!!!

          I sincerely hope that I have not messed this case up! Considering the position I am in now, in your experience do you think the phyt will not act and do you think it is a poor choice. I am confused now?????

          Comment


          • #6
            I don’t know why you left Belladonna so early. Try to prescribe on her constitution. You may think of tuberculin also Belli-per is not a bad selection, but I recommend in low potencies such as 30. I live in London you may call me at 07951277892 so that I can talk to you for better advice.

            Thanks and regards

            Dhiman

            Comment


            • #7
              6pm friday - I have just spoken to her. She has taken 2 doses of phyt 30 since 2pm. She does not feel feverish anymore (however the fevers have been intermittent over the past few days and seem worse at night). She feels that the pressure in the r breast has been relieved a bit. The area around the nipple is no longer red - but pale and white. The area around the abscess is purplish and the upper part of the breast is mainly reddish and hot to the touch.

              The sensation when nursing (3 hours after phyt) was little pin pricks in the centre of the spine. This was relieved by adjusting her sitting position. She felt 'cranky' this morning - but now feels very relaxed and 'spaced out'. She feels so tired - but can not fully sleep. she tried to read but found it tiring.

              She is still very thirsty for water. Overall she feels that the breast has 'loosened up'. Her mood came across as relaxed and content over the phone. She was not per-occupied with the farm work she should be doing.

              Dhiman Roy, thank you for your reply. I left belladonna early as when I repertorized what I felt were the guiding symptoms it did not come up much. When I gave her the bell, she was in a feverish state with glassy eyes,etc.. However, next morning when I checked her - I di not see the bell picture. I would be interested in giving you a call - as I feel I have much to learn from this case.

              Comment


              • #8
                Dear members, dear saoirse

                To evaluate the remedy selections in this case is beyond my capacity, yet on a general note,
                -- i would expect quicker recovery going by my own clinical experience.
                -- If I had in mind to repeat a C-potency, I would disolve it in a bottle, so that i can change the potency with every successive dose, avoiding antidoting (partially, or fully) previous positive effects.

                For further details see: www.Boger-Boenninghausen.com/Q-potencies

                best of luck and a quick recovery for your patient!!
                Hans Weitbrecht
                HOMEOPATH / IRELAND

                Comment


                • #9
                  Thankyou Hans. The reason I am writing for advise is that this is the first time a remedy I have given has not worked straight away. Optimistically I was expecting the abscess to reduce and the infection to clear within 24 hours. When giving the remedy in water how many times would you recommend she succusses it? I have not much experience, and normally work with the dry dose.

                  My initial fear of giving hep after silica was that I read it is the antidote - even though it supposedly follows well.

                  I am finding this case so difficult, as the information given by the patient seems sparce and she seems reluctant to go into detail of her emotional feelings. I seem to be getting conflicting symptoms given - for example, initially she said the pain inher breast was ameliorated by feeding - however, today she stated that it had always been worse for feeding. Perhaps the symptoms I used to guide me were slightly unreliable. Either that, or i have not taken the case very well.

                  Normally, I work by trying to find the centre of the case - however, for some reason i can not see the centre of this clearly. Perhaps the most strangest emotion noted was that she wanted "to disengage" the baby from her as she was not able to be productive. However this may not be so strange as there is so much discomfort associated with nursing the baby. Since disclosing this feeling she has tried to overcompensate by expressing positive emotions towards her child.

                  On the emotional/ healing sense - the biggest change I have noticed is that since receiving homeopathy she has decided to give herself the time and space to heal. She has allocated help with the farm. For the last few months she has benn soldiering on in attending her responsibilities. She feels calmer as she is not as worried about being incapacitated now. This has confused the case even more for me - i can see such a shift one level - yet a stagnation on the physical level. i suppose it is not what I had expected.

                  I have been searching my repertory for the sensation of pin pricks - to no avail. Can any-one recommend a rubric??? (I am using Murphy rep).

                  Thankyou

                  Comment


                  • #10
                    Dear members, dear saoirse

                    Coming back to the question of succession of C30 in bottle (like LM)
                    I found ten good successions to rise the potency sufficient.

                    The disease-picture may take a mix of any kind of symptoms – but not all symptoms present are relevant for the remedy selection.
                    It is the main symptom + its direct accessory symptoms + the change in mood since the start, are solely taken into consideration.

                    This translates in this case to leaving out the symptom:
                    Mind, fear of failing in motherhood,

                    It is debatable if not anyone would be very frustrated being in this situation, and somehow at the end of the nerves, close to tears, if two courses of ATB’s failed to stop the inflammation, and frightened at the thought of someone sticking a knife into the already highly inflamed breast.

                    So lets see what is primarily there:
                    Inflammation of Breast ( which includes swelling, redness, tenderness = normal)
                    Lumpy ?? are those single small lumps like knots, or is it a hard swelling.
                    This is accompanied by fever with chills
                    She is thirsty – but did that come along with the inflammation?
                    Chapped lips—since then?

                    If we take away what’s unsure we are left with:
                    Inflammation of the breast accompanied by fever with chill.

                    This would be not enough to make a grounded prescription –
                    We would need to clear the things with questionmarks, and maybe the skin has a peculiar discoloration, or there is a time modality to the pain, or there are circumstances where it’s better or worse -- .

                    Well Bell was selected –one of many which would be suitable, but what exactly should Bell remove?

                    One see’s if the initial caseinformation is incomplete, we are in even greater difficulties after a few days—not knowing exactly what to expect from a remedy.
                    The modern repertories do not give the answer – it’s the MMP, so we are left in the lure.

                    Anyway:
                    >> I saw her on wednesday morning and she looked much better. She noted that the baby was more settled. She was not as flushed as the night befor and her temp had settled. I prescribed Silica 30c. She took another dose 4 hours later.

                    There is Org.: par 246 which reads:
                    --Every perceptibly progressive and striking increasing amelioration during treatment is an condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine whatsoever, because all the good the medicine taken continues to effect is now hasting towards its completion. –

                    And furthermore: Where are the indications for a change of remedy, where are the striking new and persistent symptoms calling forth Silica?? Why repeat the same potency 4 hours later without indication?

                    Anyway:
                    The following two days there were no more definite improvements, the fever remains, and even a well-known proving symptom came out; ( in this context, it is always decisive to find out, if such a symptom persists, or if it is only transient)

                    Why repeat Silica in this situation, if it has not brought any marked improvement sofar?
                    The Organon advises to retake the case as it stands and to find a more suitable remedy. ( Org.: 183, 184)

                    Then Friday morning:
                    Isn’t that clear language of the liveforce: Silica is the wrong remedy???
                    No independent improvementsigns, and no improvent of the disease –

                    Why repeat Silica again ??????????????????????

                    And again Silica –
                    The pain radiating to the back is simply a sign, that your inflammation has gone deeper, and that the whole nerve segment is affected by now. –
                    Many homeopathic remedies have pain extending from chest external towards back--.

                    Anyway, then Paskey comes in with Hep-s, but there are so many more remedies which can follow Sil well, and besides this point, its again the signs and symptoms now present which determine, not a follow well list.

                    Dhiman Roy comes in with the right question and the wrong answer – it’s not Bell per – it still remains the remedy which is now indicated by the signs and symptoms.
                    AWAY with all these theories Hep-s promotes suppuration, or affects the endocrine system – so many others do that as well.

                    And amidst of all the patient suffers on and on, while the homeopaths consider theories –

                    Anyway – phytolacca is given – after that the sleep is disturbed as well, and the fever is not any better, And this thirst for cold drinks, SO explicitly !! No mentioning of Phytolacca in the rubric (Kent 484 –( took Kent because Phyt is well included) ) !!
                    How should Phytolacca do anymore than a bit of palliation at the most??

                    So here we are – Centre of the case what—that does not answer your question: Where do I go from here.
                    What is the emotional/ healing sense – isn’t it just the universal rectification that every development is good??

                    The patient is interested to get over that mastitis as quick as possible, healing or not, so the following questions may be a bit more realistic:

                    How is the mastitis
                    How is the inflammation?
                    How is the temperature?
                    Did the abscess open, harden, go away, or is it still the same? Etc.
                    When<, When>
                    By which<, >
                    What comes along with it? (This thirst )

                    Basically – what I am saying here is: retake the case completely prescribe properly (confirmation of a few rubrics in Murphey’s is not good enough as seen above)

                    You have already wasted enough time by faulty case management.
                    Hans Weitbrecht
                    HOMEOPATH / IRELAND

                    Comment


                    • #11
                      i appreciate your honesty - and you are right, my patient is suffering. i shall digest this information and get back to you all tomorrow night. ( I will unfortunately be offline for 24 hours)!!!

                      Comment


                      • #12
                        dear mebers, dear saoirse

                        Why wait for 24 hours ??

                        I see, that you are living in the same country -- if you are not up to it, why not refer the patient to me??
                        The responsibility to relief suffering and pain as quick as possible is paramount.
                        Hans Weitbrecht
                        HOMEOPATH / IRELAND

                        Comment


                        • #13
                          Dear Saoirse, dear Members

                          How are things? Any movement?
                          Hans Weitbrecht
                          HOMEOPATH / IRELAND

                          Comment


                          • #14
                            yes - turned out amazingly - I will write it all now and post it.

                            Comment


                            • #15
                              Friday 25 november 10am - I rang and had a long chat with my patient. She felt very out of touch with her body and dreamy. She was light headed and had fever all evening. She was tired and feeling guilty. "Not so good at being sick". She related how she was feeling resentful as her mother had arrived the day after the baby was born from America. She had to cook/ clean and entertain her mom as she felt she needed to give her a good holiday. Her mother fawned over her husband and baby - she felt RESENTFUL for being neglected. "I feel stifled in the house and fixed on the way things used to be." Her mother stayed 3 weeks and she had cracked nipples by the 2nd, mastitis by the 3rd. Feels very cranky. (I immediately thought of staphysagria) Dose of phytolacca 30c just before I phoned.

                              Friday evening (by phone)- Freezing cold and feverish. Feels like the pressure is relieved by the remedy thurs (phytolacta). Feeding on the right breast - pain gone - just a little pin prick sensation in the centre of spine. Less cranky than earlier. Spaced out and tired - hard to read. can't fully sleep. Breast mostly red - a little purple. Right around the nipple is white and purplish near abscess. Upper part red and hot to the touch. The abscess feels like it is coming to a head. "Loosened up". finding it difficult to talk. Spoke for a while about her resentment and anger at husband for not being more helpful. She feels GUILTY about having any negative thoughts about her husband and mother. For the first time, she really opens up and speaks about some core emotional issues - all related to feelings of guilt and suppressed anger. She tries to be sweet all the time.

                              Sat evening 10pm ( I was a a conference 250 miles away all day) She feels very angry at herself for letting the situation with her mother happen. She feels angry for not saying no and taking the time to bond with her baby and recover from the birth. She is trying to forgive herself - but it is difficult not to react. There is a blister on her breast. There have been changes - but not major. She feels very emotional - shapped at husband. Lots of sobbing and anger. She feels so uptight and hard to relax.


                              Sunday morning - I spent a few hours with her. I had asked her to write alist of her feelings over the weekend on a piece of paper. 16 emotional words were written down. The one that stood out the most was shameful. when I asked about thsi feeling , she told me that evne though she is an organic farmer, and leads a holistic lifestyle - she has a terrible secret. She informed me that she smoked cigarettes and (infrequently) joints throughout the pregnancy. She had tried to stop the day before thinking it might interfere with the remedy. All her smoking is in secret. She feels guilty when she feeds her baby.

                              Staphysagria 200c prescribed

                              Monday 10.30am

                              The swellin in her lymph gland under her right arm is gone. The redness is about the same. The fevers (nightly) have gone. her range of mobility is greater (breast). Her general feeling has changed emotionally.

                              Monday 6pm - the abscess has now broken the skin. It has festered a little pus - yellowish.There is a lot of fluid behind it (it is a enormous abscess - always has been -possible 5inches wide - originally scan showed it was at least 3-4 inches deep). It was completely indurated (hardened like a breast implant) when I first saw it. Now it is more fluid. Her mental state was still very dreamy - like sleepwalking.

                              Tuesday 11.30 am

                              Very tired but slept well. No fever during the night. She looked great and bright. The wound (1 inch wide) was releasing yellow/ green pus. She reflected on the last week and had a very strong sense of emotional healing. The time spent recuperating had been valuable. She had managed to communicat her feelings to her husband, and had decided that she needed to create firm boundaries. It was quite and amazing to hear her speak so resolutely and profoundly. she ahd realised so much in such a short time - and had gained insight into the emotions that lead to her body expressign such deep pathological changes. She was glad in a sense to have been 'forced' to take the time to evaluate her life.

                              Tuesday evening - I went to see her. She was very relaxed, pain free and the breast was suppurating slowly. She decide she was going to go to the hospital breast clinic the next day to show them her breast and to see if it could be drained now that it was open (as opened to slicing it open with surgery). I supported her with her decision and realised how strong she appeared in comparison to the week before. Part of the breast had an open suppurating wound, and another abscess was very near the surface- like clingfilm over a blister.

                              Thursday 1pm - She called to tell me all about the events that unfolded weds. The hospital is 2 hours away. During the journey, she had the sensation of pressure in her breast. As she arrived int the clinic - there was a sudden release. She described it as a volcano - the breast suddenly erupted and let go. The nursing staff had to help her over a bath, as there was a huge flow of green pus. It lasted half an hour. She was so glad to have th help of the nursing staff, as she would have been afraid and unsure what to do if she had been alone at home. The abscess totally drained - therefore surgery was not required. However, the crater it left behind was so huge, it required being packed with dressing. She was relieved to have it all out and to have avoided the 'knife'. However, she felt guilty being in a hospital. After having the dressing changed, she felt invaded. On one hand though she has agreed to stay in the ward for a few days so she can recouperate fully. She is relieved to have help with the baby, meals cooked, no duties to distract her from getting better and help to change the dressing. I sent another dose of staphysagria to her tonight.

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