Case: Weakness and Shortness of Breath in a Patient with Terminal Pancreatic Cancer with Metastasis to Liver
The New England Journal of Homeopathy
Fall/Winter 2000, Vol. 9 – No. 2
Amy Rothenberg ND, DHANP
This was the case of a 60 year old white male who presented in September 1996 with pancreatic cancer with metastasis to the liver and with lymphocytic leukemia. I present it here to show how during the dying process, homeopathy can be very effective to address both physical and emotional concerns. I also present it to offer some of my own observations and feelings about treating people who are dying.
I do not know if it is true for all homeopaths but it does seem that earlier in my practice I saw many pregnant women and little babies. I enjoyed seeing families blossom and patients emerge healthy from difficult illnesses and times. And though I still see this population, as my practice itself ages I am increasingly seeing patients who are on their last legs. Occasionally we see miracles and someone who was “suppose to die,” turns around from homeopathy, prayer, allopathic medicine, or plain good luck. But from those who are leaving this world, I have found the limits of my own abilities crash up against the stark reality that all life ends in death. It’s such an obvious thing to say, yet while I am busily going about my work and play it is not something that I keep front row and center in my mind all of the time. These brave patients who walk before me in death guide me in my own thoughts about life and death, and perhaps more importantly, toward my own appreciation for each day I do have to live. And with regard to practice I am pulled back and reminded of the importance of loving and offering help to each patient until and through to the very end.
So, my patient at hand presents with the chief complaint of weakness and shortness of breath. The pancreatic cancer began some 11 months previous with pain in the upper abdomen. The patient reports that it felt like heartburn; eructations ameliorated the discomfort. The pain radiated to the back, directly behind the place of pain. The pain was worse sitting and worse thinking about it. The appointment with the internist was in October and a CT scan was done in December of 1996.
For years, the patient had terrific pains across the anterior abdomen which were worse from eating peanuts or potato chips or other high fat food. He occasionally still gets these pains.
The patient smoked a pack of cigarettes a day for some years but not since 1971. He has never consumed much alcohol.
He has bowel movements 2-3x/day and desires sweets and salt. He is averse to liver and fish. Many years ago he lost much of his ability to smell and taste. He is not very thirsty.
He has lost 36 pounds after surgery and has put back 20 or so during his recuperation.
He does not get headaches and rarely gets sick.
He was a month shy of his retirement when he was diagnosed with cancer. He and his wife had many plans for these years (wife weeps here.) This was such a loving couple, who had many years of hard work and family difficulties behind them. They had been saving it all for their retirement and now this. I was drawn in by the incredible bittersweetness of this scenario; needed to take a deep breath to hold back my own tears.
Since he has had the tumor, he sweats profusely at night, and needs to have a fan blowing on him continuously through the night. Because of this, he becomes hoarse in his speech.
The sweat pours off the back of his head, which is an important symptom because that is the only place he sweats.
In his free time he builds and plays with model airplanes.
I observe much sighing. It is even difficult for him to get a good breath here sitting up in my office. Even so, he is very cheerful and tries to minimize how uncomfortable he is as he holds his wife’s hand, almost consoling her throughout the interview.
He has difficulty climbing stairs-he feels weak especially in his knees, arm, shoulder and hips.
He gets bad cramps in his legs and in his hands which are worse since he has been on Prednisone.
Skin: He has many skin tags and will develop acne if he eats too many sweets.
Nails: He has had a fungus on his finger and toe nails, for many years.
Urination: He has urinary frequency, it is slow to start and he feels that his bladder doe not empty all the way.
Occasionally, he feels that he can’t find the right work as he speaks.
He and his wife had two children. Their first was born with many and severe birth defects. He has lived in a nursing home his whole life. They visit often, he is nonresponsive and doesn’t seem to recognize them. Their daughter had bad eye problems, many surgeries before the age of two, now she is fine.
His sleep is not good, because he needs to get up so many times to urinate. He likes to sleep on his back or his right side. When he sweats, he throws off the blankets. He snores a bit. He has no nightmares, bad or recurring dreams. He reports being in a good mood on rising.
He has a fear of heights which has gotten worse lately, and it is especially worse on coming down. He hates looking down from a high place. He also has a fear of choking, and is claustrophobic.
When asked to describe his temperament he says, “I am a pussycat. It takes a lot to get me going. I don’t need friends too much, although I have a few and enjoy them.”
He doesn’t like change. If things are going well, he prefers not to change them.
He was an only child. Kids picked on him a lot. He says, “I was portly.”
He has an enlarged spleen and has fainted a few times in the last few months. When he was younger, he would pass out at the sight of blood.
He has had terrible gas ever since the surgery, with constant belching and passing gas which gives some relief.
Past medical history: His tonsils were removed when he was age 12. He had a vasectomy in 1970. He had a history of thyroid cancer in 1971 and a right side inguinal hernia repair in 1979. He is hypertensive.
Assessment: The severe nature of his shortness of breath, ameliorated by the constant fanning coupled with his digestive distress point to the remedy Carbo vegetabilis.
Plan: Carbo vegetabilis 200c.
This kind and sensitive gentleman received much help from this remedy. He gained immediate strength and was even able to resume his model airplane hobby. He was better able to breath and his problem with gas was greatly reduced. He still had flatulence but it was limited to the after dinner hour and it was not as intense or long lasting.
We waited with this prescription and told him to call if other problems arose.
I saw him next two months later when he reported that he was in a lot of pain. There didn’t seem to be any position or activity or medication which would help him and he couldn’t bear it any longer. The gas pains as he described them were terrible and he couldn’t get a good breath.
Assessment: Relapse along with a continuation of his grave and progressive pathology.
Plan: Carbo vegetabilis 1M.
12/3/97
The pain was under control now and his breathing was okay. He is still receiving chemotherapy.
He was suffering from relentless anxiety because of the illness. As it has progressed, he has become afraid of dying. The allopathic medicines he tried for the anxiety, made him worse. He paces the room and wanders from room to room in the house. He has loose stools. He is not sleeping at night due to the anxiety. Then he worries that he won’t be able to sleep.
He wants to be warm. He is having difficulty swallowing.
He craves warm drinks and his wife’s company. I speak extensively with his wife by telephone during these days. She too is nearing exhaustion in her efforts to nurse him and keep him company. She says that the anxiety is worse than any of the physical pain he has suffered.
Assessment: Like many others, as he gets nearer to dying he has come into an Arsenicum album state with the anxiety, restlessness and chilliness.
Plan: Arsenicum album 30c.
Arsenicum album in the last few weeks of life in increasing potency helped this patient through to a smoother death. His wife has always been very appreciative of the help and support they found with homeopathy.
This pattern of needing one remedy then perhaps another and then winding up at Arsenicum album, though not universal, is certainly common. I remember for many months after this patient died I was very unmotivated to work. This was partly due to the sadness and partly due to not wanting to wait until retirement to “live my life.” For all of us practicing homeopathy finding that balance between work and play, friends and family, community service and time for reflection remains one of the greatest challenges there is!
Amy Rothenberg ND is the co-editor of this journal. When not busy with the world of homeopathy, she can be found hanging out with her husband, Paul Herscu ND and their three kids, Sophie, Misha and Jonah.