Case study: Jaborandi
Anton Kramer
Mrs. de G, born 1939, first consultation 1992.
Diagnosis: olivo-ponto-cerebellar atrophy. Report neurologist: severe disorder of the saccadic eye movement and smooth pursuit. Coarse slough nystagmus* with rotary component at cans up, to the right and to the left. No divergent* eye position since eye surgery due to double vision. Do not draw an ataxia or pyramid path. MRI shows striking atrophy of cerebellum, slightly dilated prepontine cisterns, dilation of fourth ventricle. Two brothers and a sister of father had balance problems and walked unstable.
Patiente has a range of symptoms:
- Dizziness*, glidiness* with cold hands and feet. In addition, there is a pulsating* headache in the temples*.
- Headache comes from the neck, pulls to the left* forehead, above the eye >press it. Headache starts in the morning* and if it continues before twelve o'clock* it can shake it; headache that starts after that never gets bad. > Evening (2), > eating fresh food (2), e.g. >> eating sour apple (2).
- Eye and visual complaints. She experiences moving images:
< go up the stairs; her focus* must always be adjusted
< Looking back and forth* (with head or eyes only turning) it makes her dizzy*. When visiting, she therefore sits in the corner.
- Nystagmus when looking sideways. Even at night it bothers her and makes her dizzy and nauseous when she turns too fast*. Wakes up. >Lying on the left* (2), lying on the right (2) and lying on your back.
- Attacks that start with hot flashes, then she gets very bad, pulls white away and gets ice-cold arms and legs. She sinks away*, can answer questions or have a drink, but can't get out of the chair.
< warmth, < busy environment (visitors, city)
- Hot flashes* once an hour since removal of uterus and ovary in 1976 due to polyps (symptoms then: fairly constant abdominal pain with frequent urination due to feeling of pressure; menses sometimes clots). The hot flashes are intense*: they come from the abdomen, she has a red head and neck and is soaking wet*. OAC helps quite well. Her mother often had hot flushes until she was 65 years old and to a lesser extent when she was 80 years old.
Patient is a teacher at LBO and Mavo, and gives textile forms of work, manual work and general techniques (handling machines, drilling machines). She likes to do it, is very down-to-earth* with regard to all new regulations in education and also with regard to difficult pupils. When there is a conflict she talks it out (after a while). When a patient tells us about this, it is striking that she tells us very soberly and in few words* about it. I get the impression that nothing touches her and that she will not elaborate on it*; she reacts somewhat suspiciously to my questions about her character and background.
Patient once had a conflict with the headmistress. "That was not well received, but I had lost it". "I'm quite calm now, but I used to be pretty frantic* about silly things". She could also be very fierce with her parents if she didn't get her way; she could fly them to the throat.
She hates lying or a big mouth. She felt grief during the war: "I have been dragged back and forth a lot by the fact that we were evacuated several times". She has no fears.
Temperature: clay (2), cold hands and feet, but << warmth and >> fresh air and outside. I'd rather have goose bumps in the house than be too hot. Headaches improve with the windows open. Patient can't drink against (cold) water.
Food: like mustard (2), spicy (2), salt (2), vinegar (2), sweet (3) (candy, pastry, sandwich filling, licorice (not salt)). Also Italian, Thai, Chinese, meat, fish, eggs, fat. But intolerance to fat, cabbage, cucumber, onion. Drinks 9 cups of coffee (!), little tea or water, also called Cola (!).
Sleep: maximal 6 hours per night, wakes up at 6.00 a.m., then 15 minutes of puffs. Patient is tired at 23.00, sleeps well in; nycturia 1-2 times. Dreams fairly frequently*, often anxious, over a staircase or a journey you never get out of.
Medium....
Second consultation clear improvement during three weeks: swell better and therefore less anxious, energy much better. Then gradually worse, almost back to the old level.
Medium repeated. Third consult not good. Complaints are no longer improved. New drug...
Fourth consultation as good as after first consultation. Striking because it was very busy at school (month before Christmas). Headache was better, fatigue much better, eye complaints much better. Patient was clearly more energetic.
In the course of six months the whole pattern of symptoms stabilises; she is not free of symptoms, but says she is 80% better.
A year and a half after starting with this drug, the patient visits again. It had been very good, regularly the disease seems to be gone (..). Only the hot flushes and the stomach problems with cabbage, fat and cucumber still play a big role.
Six years after the last consultation, I'm calling her about the
course. She is doing very well, she has a bad day every now and then and then and then she takes it easy. In general she doesn't suffer much from dizziness, vision disorders, fainting etc. She hasn't had any other therapy.
The asterix (*) means that the symptom is known to Jaborandi.
VISION; DIM; looking; sideways amel.*