Prostatitis

The Patient

Lon was a 35 year-old mortgage broker from Portland, Oregon, who came to our office in late 2000 with chief complaints of vertigo and benign prostatic hypertrophy and prostatitis. Attired in a black leather jacket and pants with motorcycle helmet in hand, he appeared to be an intense and interesting character from the moment we met him. Lon munched on his children's Halloween candy as he spoke.

[ILLUSTRATION OMITTED]

"I'm too young to have that condition, I've had an enlarged prostate since I was eighteen. The vertigo began two months ago. It makes riding my motorcycle a challenge. They say it's a virus. It's troublesome because I'm an adrenaline junkie. I like to be on my motorcycle or dirt bike. I was in the military for ten years. Desert Storm and other operations. I don't mean to be morbid, but anything that reminds me of my mortality is fun for me. I did sky diving for six years. I really enjoyed it. My wife forcibly retired me four years ago after our second child was born. It was the same time that I left the military.

"The prostate condition began when my wife and I became sexually active. I experienced pain at base of the penis and during ejaculation. The not-so-competent military doctors told me to slow down my sex life. There are times when it's better and times when it's worse. I'm also used to dealing with pain on a daily basis because of my surgically-reconstructed knees." We inquired about Lon's specific symptoms. "Urination is painful. I feel it at the base of my penis. Getting started urinating is slow. Like an old man. I have a normal stream, frequency, and urgency. The pain is hastened by caffeine, alcohol and spicy foods. It feels like a knife being jabbed in the bottom underside of my penis. At times the sensation can be quite severe. I have no history of STDs (sexually-transmitted diseases). My wife has been my only partner."

Lon was an excellent informant. He reported his symptoms so accurately and spontaneously, with little need for prompting. "The prostate swelling began a month or two after being sexually active with my wife. I am a caffeine addict. I used to down a pot of coffee before 10 a.m., sodas in the afternoon, and more coffee up to five minutes before going to sleep. It was a psychological dependence ... an addiction. I was married, in the military, going to school, making house payments. I was actually doing two other part-time jobs at the same time. I was on the go quite a bit, as was my wife. I had too many other things going on at the time when I was away from her, like ducking bullets, to notice if I had the prostate problem then. I would guess that sex would make it better. Kind of exercising the prostate. I am very active sexually."

We explored a bit more about Lon's life. "I'm the son of an alcoholic and a drug user. My parents were products of the sixties. My dad's discipline style was to hit, hard and often. I'm an athletic person--a three-letter sport guy in high school.

"My military background was more counterintelligence. Many of those things I still haven't told or can't tell anyone. I might have been exposed to some chemicals in Kuwait. If they were there, I was exposed to them. I was around the oil fires. Four of my colleagues came down with rashes and joint pain.

"I've had a number of knee surgeries. I inherited weak, gravelly knees from my father. I tore my ACL (anterior collateral ligament) in the service. Then I blew it out again playing basketball. There's a graft in there now. I also tore the MCL (medial collateral ligament) in same leg. I tore my other patellar tendon when I was ten and it was surgically repaired. Then I slid on a piece of glass while sliding into second base, and lacerated the tendon. You could call me accident-prone. I broke my nose four times and broke my knuckles countless times while boxing. Then there were two injuries to the third and fourth metatarsals on my right foot twice--while playing basketball and volleyball. I suffered a compound toe fracture at eight when my foot got wrapped up in the spokes of a bicycle.

"I was a very wild kid. At the age of four, my brother and I burned down our apartment. We were just curious what it would be like to look at a candle in the dark under the couch. Nobody got hurt, but the family lost nearly all of our possessions. Then there was the time we killed all of the goldfish in our pond because we tried to give them a bath with Tide. He and I once split a month's worth of our mom's birth control pills. The pediatrician told us we'll never get pregnant. We drank Drano when I was three and he was five. My brother had to spend some time in the hospital for that. I was always going a hundred miles an hour and giving 180% at whatever I did. I excelled in whatever sport I played. And on my bike.

"The first time I ever got shot was when I was seven. My grandfather was drunk on moonshine and fired two bullets over my head and one between my feet. I was in my underwear and leapt out of a second story window to get away. It was a very unusual upbringing."

We inquired more about the specifics of the vertigo. It was not positional but was aggravated from motion. Lon was unable to keep his balance. Along with the dizziness he suffered headaches and earaches. He received a prescription for Amoxicillin then Antevert, which made the vertigo even worse. A workup with an EENT revealed normal inner ear function. "My goal for the vertigo," Lon explained, "is for it to be gone right away. The prostate I can live with. Conventional medicine tells me I'll get over it within eight to twelve weeks. That answer doesn't satisfy me in the slightest.

"I'm the kind of person who likes things regimented, strict, and well-defined. I'm a visual person. If I can see it, I can understand it. I paid for all of my college without going into hock. I'm not confrontational but not anti-confrontational either. I consider those who work with me like they are family. I love my kids to death. I'm very protective of my family. Messing with them is like messing with me. I don't take kindly to it. Just like my dad. Family was all we had. I know what it's like to not have anything. I watched my mom go without food and wear the same clothes day after day so we kids could get our needs met.

"I naturally take charge of most things I attempt to do. I can't just sit around and wait for things to happen. Physical or mental clutter makes me anxious. I can quickly act to make sense out of chaos. I'm Type-A to the hilt. It's a compulsion. You can die at any time. I can't predict when it's going to be, so what's the point of being afraid? I'm very driven, very ambitious. I work very hard to further my career. I can focus very well. Even when I eat a meal, I concentrate on each course in a very focused, systematic way.

"I'm a people person, not a hermit. I don't see myself as ever living as a bachelor. I need people. I like to feed off of other people's energy, just like my son. It has tendered me up having very sensitive children."

Lon had recurrent dreams of violence, chasing and being chased, fighting, shooting, and killing, but they were not disturbing to him. His dreams were frequently a reenactment of life events. Sometimes he would play out military strategies in his head while dreaming. Skydiving was one of Lon's favorite dreams. "It's very real to me. I'm in the moment--not afraid." In his real life, Lon enjoyed skydiving a great deal and he had jumped over 50 times.

The interview concluded with Lon mentioning once again that, "I'm always doing 30 things at the same time. I'm a much happier person when I have those adrenaline outlets."

Now study this case and turn to page 126 for the analysis. It's a complicated case and we gave several different remedies. Just have fun with it. It's a great case for differential diagnosis.

Initial Prescription

There are elements of many remedies, and even more than one kingdom in this case. The features that impressed us the most were 1) Lon's intensity, persistence, and determination; 2) His tremendous courage (sometimes this can mask an underlying fear, but this did not seem true of Lon); 3) His larger-than-life experiences; 4) How much he had been through by age 35: injuries, surgeries, war, children, dangerous scenarios; 5) That his symptoms (BPH, arthritis, surgically-reconstructed knees) are typical of someone much older than Lon. He struck us, overall, as a remarkable fellow.

First, without addressing the physical symptoms, there are a few remedies we think of for individuals with this high-adventure, adrenaline-rush type spirit. One is Agaricus muscaria--rubrics include "runs around in dangerous places." They have the moving-in-harm's-way yearning along with Lon's benevolent spirit. Oreodaphne ("audacity," "courageous," and "exhilaration"), and some of the other drug remedies can present similarly in this way. The medicine we chose was Medorrhinum (nosode), which has the prominent features of thrilling, daredevil behavior, a quest to experience life to the fullest, busy mind, and urogenital complaints. It is a medicine that has been useful in Reiter's syndrome (a syndrome including urethritis, arthritis, and conjunctivitis). We have seen a number of cases that responded well to this medicine in which there was a strong affinity for fast and furious bike riding, complete with jumps and flips. Patients needing Medorrhinum can also have a family history of premature heart disease. The medicine also covered "vertigo from motion," penis pain, and prostatic enlargement.

Improvement in the Vertigo

Lon called three weeks after taking one dose of Medorrhinum 1M to say he felt great after the medicine but that his symptoms were returning. We sent another dose. At his five-week follow-up visit he reported an 80% overall improvement. He rarely had to make adjustments due to the dizziness while riding his motorcycle. "I won't stop riding. I must do it. I ride, therefore I am."

Though the vertigo was markedly improved, the prostate symptoms remained unchanged. "I've dealt with the prostate pain for 15 years now." Lon was resigned to living with the urinary symptoms. As strong and determined as he was, he knew he could tolerate or push through whatever cards he was dealt. We asked a bit more about Lon's nature. "If I'm protecting loved ones or my soldiers, and I picture it not going well at all, I take it to a logical, dark conclusion. They all die. I can get myself into a fight mode. Like an athlete would psyche himself up. The adrenaline rush is very useful when you need to mobilize your body and motivate yourself to be able to perform at a level to take a life or to take an act that's wrought with risk. To put your life on the line. Sometimes a movie can actually put me back in a mindset. Or a dream.

"If I want to, I can psyche myself into it. This ability is also useful during sports. I have a violently competitive attitude. It's a way to legally pump drugs into your system--drugs released from the brain. I don't like to lose. I would rather give 175%, which is why I'm prone to injury. When you pump or psyche the body up, you can get injuries; the brain is releasing those things into the system. I was always the smallest on my team, so it gave me an edge. Being small meant that I had to play that much harder. I love competition and sports. I lettered in four sports. Typically you only pick three. To letter in four, you have to drop one and letter in another because there are only three seasons."

We inquired more about fear: "I'm not really afraid of anything. If it's my time, it's my time. You have to make sure you have no regrets. Try to live a golden rule and know it applies. Let the epitaph read, 'Try to love everyone.'

"Once I turn on that fight mechanism, I have a hard time turning it off. Fight or confrontation or physical violence is a means to an end. Sometimes you can get a little out of control. I grew up in a tough neighborhood. My father taught me not to start fights, but to definitely finish them. He taught me to box when I was three years old."

At this point, we changed the prescription to Agaricus, which seemed to fit Lon's mental and emotional state well. Again, the vertigo remained well, but no improvement in the BPH or joints.

Five months into treatment, we prescribed Ferrum metallicum. This medicine covered the enlarged prostate, pain in the penis, vertigo worse from motion, and the dreams of battle. Lon's warrior nature, his references in recent interviews to feeling "forced" by others to do things, confirmed the prescription. Patients needing "drug remedies" and metals (and, sometimes, nosodes) can look very similar. We want to emphasize that Lon clearly identified the vertigo as his chief complaint from the start. Resigned to living with the penis pain and joint problems, he was quite satisfied with the results of homeopathy. But we were not. We were determined to find a medicine that also addressed his other complaints.

Again, Lon was happy with his response to the Ferrum. So much so that we gave him a total of five doses over a nine-month period. The vertigo did not return. He managed his urinary symptoms to some degree by limiting his caffeine consumption. The tendonitis in his knees improved. And he felt calmer. The prostatitis was only "marginally better."

Going With the Flow: A Different Method of Finding the Medicine

Rajan Sankaran has taught us, as we have discussed in many of our articles, his method of selecting a homeopathic medicine based on the specific sensation of the chief complaint. He explains this methodology in depth in An Insight Into Plants, Vols. I and II, Homeopathic Medical Publishers, Mumbai, India. We will not elaborate on this technique, as we have so extensively before in this column. The idea is to trace the patient's experience of the chief complaint in depth to arrive at a particular sensation. That sensation should ultimately cover not only the chief complaint but the case as a whole.

We changed course and used this method to search out a better medicine. It has resulted in a considerable improvement in Lon's urinary problems for the past year and nine months. We include excerpts from the December 2002 interview to illustrate this method: "I feel the prostate pain on ejaculation. It's like knives are being thrust into the base of the penis. A very sharp pain lasting ten to fifteen minutes. Ninety-nine percent constriction. Something's trying to force its way through. Like I have a very swollen prostate. All the classic symptoms of an older man. Closing and opening. A continuously closed opening that lingers, is chronic. Like someone with coronary artery disease.

"A dam on a river. There's a choke point. Not all the water's getting through. I thought somewhere I had scarred the urethra. It feels like it's leaking. Where free flow and movement is no longer possible. A bottleneck. If you take a look at a coke bottle, it's where it gets narrow. Let's say there's pressure that builds up. It's constricted. It forces things out with greater pressure--like the end to a hose." We asked him to describe the dam. "The water backs up till it goes over the side. Bursts the banks. Exceeds the banks. It has to find some other place to go. Another course. Another path. The pressure continues to build momentum."

The family of the indicated medicine seemed clear. We just needed to verify the miasm and select the medicine. We explored more with Lon about how the condition affected him and how hopeful he was about finding a resolution to his prostate symptoms. "I keep hoping that it's not gonna turn into prostate cancer. So I continuously have it checked and try to keep it under control. It's frustrating. I believe they should be checking it out because nothing has cured it entirely. I'm accustomed to it. Like my knee pain. I deal with it. It's part of my everyday life. I don't have much of a choice."

The sensation method of prescribing works very well for finding homeopathic plant medicines that can't be discovered by any other method. Dr. Sankaran has barely scratched the surface of the myriad of plants. The Compositae family alone, of which the well-known Arnica is a member, has something on the order of 23,000 members! But it's an ambitious start and has allowed us to already prescribe successfully for many more patients.

The family that best matched the sensation described by Lon is the Cruciferae or cabbage family. [Note that we wrote up another case of Cochlearia earlier this year in one of our Townsend Letter columns--a case of ulcerative colitis]. That sensation is one of obstruction, blockage, or interrupted flow. In our experience, patients often use the image of a dam, as did Lon. Common words in this metaphor are "flow, stuck, stopped, and blocked." Once the family is chosen, the next step is to decide which member of the family to prescribe. The procedure is the same for those needing mineral and animal remedies, though the sensations may be fewer. The key to finding the medicine in this schema is to first identify the miasm. In this case, it is sycotic, based on Lon's feeling that he will just have to live with the prostate problem. That there is nothing that can be done about it. You might say that prostatitis, in general, tends to be sycotic, which is true. But, it is how the illness affects the person, the level of desperation, and how the individual copes with the illness. Dr. Sankaran has developed a grid system of which remedies in each family correspond to which miasm. The classification, however, is preliminary, so it is best to research the materia medica and consider any and all members of the entire family.

We prescribed Cochlearia armoraicia (horseradish) 30C. It is the only medicine in Dr. Sankaran's schema under sycotic miasm and Cruciferae. In the repertory, we find that it is well-indicated for pain in the penis. There is too little information on the joint pain and mental picture to be of use. Lon was too busy to come for an appointment until three and a half months later. The prostate pain was much better until he did house painting six weeks earlier. He was quite surprised at the improvement. Lon was even able to drink three to four cups of tea a day, which, before the Cochlearia, would have resulted in pain. At that time we raised the potency to 200C, again in a single dose.

Two months later, during a phone consultation, Lon reported that his prostate symptoms were doing well until he took an acute homeopathic medicine a week before. Lon has received seven doses of Cochlearia (two of 30C and five of 200C, over the past 21 months. His prostate pain has been 80% less, consistently, as long as the medicine was working (he has frequent exposures to antidoting substances).

During each interview we continue to further explore the sensation of the chief complaint to make sure it remains consistent with the medicine we have chosen. We did so in depth one year after Lon first took the Cochlearia. It is important that the same sensation carries through, and ameliorates, not only the chief complaint but other physical symptoms as well. We inquired about his joint pain. Lon described the numbness and shooting, throbbing pain in his hands and fingers. "I keep subluxing the ulnar nerve. If I lay on my left side on the couch, in under two minutes my hand will fall asleep. As soon as the pressure from the weight of my head is off, the pain shoots. When I take the weight of my head off, I start getting a tingle. Then the pain starts shooting." We inquired further about the pressure. "I would describe it as a concentration of something--of weight or water. For example, water pressure as a result of constriction of a hose. It limits the flow. Water moving from a higher concentration to a lower concentration ... moving from point A to point B. If I do that by narrowing the path, by limiting something's ability to move, when I release that, it will be under pressure."

We probed further. "When the flow is limited, there's a buildup. Some form of release is needed to relieve the pressure. Then the water will flow meanderingly. Easily, slowly, deliberately." What, we asked, is the opposite of "meanderingly?" "Volcanic, high-pressure, explosive. A high rate of speed. So high that it would have the ability to knock things down in its way. I read about a violent man with a sword who was subdued with a high-pressure hose."

We have never heard another patient describe his joint pain in this manner. The fact that the hose/flow metaphor applied to the upper extremity pain, in addition to the prostate, was confirmatory of the Cruciferae family, and of the prescription.

Points to Ponder

There is no doubt that Lon improved steadily, especially from the Medorrhinum, then the Cochlearia. His case, however, is complex, and we are still not completely satisfied that we have found the best medicine for him. His miasm, as we see the case in retrospect, appears to lie somewhere between sycosis and cancer. Lon displays the strength of a metal and the organizational ability of a mineral, yet shows far more features of what we call a "drug remedy" than we would expect from a mineral. The way he described the sensation of both the genitourinary and joint symptoms pointed clearly to a Cruciferae. Yet, we still wonder about Oreodaphne, and would like, in future interviews, to further explore some of his military experiences, especially since he dreams often of war and refers to his need to rein in his tendency to fight. A homeopath is always looking for the simillimum--the one medicine that most perfectly matches the patient's symptoms. Even when the patient is satisfied with the results, the homeopath may not be. We hope that Lon continues with homeopathic care over time so we can help him even further.

by Robert Ullman, ND, DHANP and Judyth Reichenberg-Ullman, ND, DHANP

131-3rd Ave. North * Edmonds, Washington 98020 USA

Phone 425-774-5599 * Fax 425-670-0319

www.healthyhomeopathy.com

Judyth Reichenberg-Ullman and Robert Ullman are licensed naturopathic physicians board certified in homeopathic medicine in practice for over 20 years. Authors of seven books, including the bestselling Ritalin-Free Kids, they have also written Prozac-Free, Rage-Free Kids, Whole Woman Homeopathy, Homeopathic Self-Care, The Patient's Guide to Homeopathic Medicine, and Mystics, Masters, Saints, and Sages. Their upcoming book, A Drug-Free Approach to Asperger Syndrome and Autistic Spectrum Disorders: Homeopathic Medicine for Exceptional Kids. The doctors practice at The Northwest Center for Homeopathic Medicine in Edmonds and Langley, Washington as well as treating many patients by phone. They can be reached at 425-774-5599 or through their website at www.healthyhomeopathy.com.

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