Iron Deficiency Anemia and Headaches
The patient is 8 years old girl. She has finished 1st grade of school. She looks pretty toll and thin, her face is pale. She is shy and timid, being addressed, looks at her mum. Complaints are iron deficiency anemia and headaches.
Her case as given by her mother, August 15, 2008
“Hemoglobin is lowered, 9.5 g/dl. Doctor prescribed iron therapy, but she get pain in the stomach after taking it and we have stopped. Also she often complains about headaches. This has begun in the beginning of summer. It looks like there were no stresses during that time”.
(I ask the girl in what particular place the headache occur. She looks at the floor, and then looks at her mum. Then quietly speaks: "here", shows on a forehead, and above the left eye. The girl cannot describe the character of pain. The pain is easier in a quiet, dark room, worse from a bright sunlight and noise.)
“She is very much stick to me. In general she is very emotional and, sensitive. She cries often enough. When I comfort her, she calms down gradually, but if her daddy comforts her – she is not calming down. The consolation from the daddy is not accepted as well as from the other relatives.
It takes time for her to feel comfortable with strangers or in a new company, she needs time. In general she is very much shy and timid with the unfamiliar.
She is pretty smart girl, studies very well, it is not necessary to push her to do her homework. Additionally she goes to music, to painting and to swimming. She likes all of it.
She drinks a lot, more than 1. 5 liters per day. From food most of all she likes fish, especially salty fish. She salts all meals, even without testing it before. Can start salting sausages”.
(Me: How pregnancy and delivery proceeded?)
“I had threatened miscarriage in 5 months and have taken Ginipral and Kurantil. All this lasted for 2-3 months. The delivery was normal; her weight at birth was 3,350 g.
She was on artificial feeding since 3 months; I had not enough breast milk.
She developed normally, without any complication.
Sat – in 6 months
Started walk – in 11 months
First teeth – in 6 months
Toilet trained by 2 year, there was no enuresis.
She had a dysbacteriosis in 2 years of age, has taken many drugs, and then it is gone. She is rarely ill with cold and recovers quickly. Caries is not present.
The family anamnesis:
The great-grandfather has died from pulmonary embolism in 50 years. The grandmother on a father's line is ill with rheumatoid arthritis”.
Initial Assessment:
On appointment a mother with a girl of 8 years of age, with complaints on frequent headaches and iron deficiency anemia. Headaches are localized above the left eye, it aggravates from a bright sunlight, noise, and it is better in a quiet, dark room. The girl is diligent, smart; she studies well, and in the same time she is timid, weepy and accepts consolation only from mum, not from other relatives or from her daddy.
Food desires: fish, salty food. She has remarkable thirst.
The remedies seriously considered based on this Repertorization were Natrium Muriaticum, Pulsatilla and Phosphorus.
Pulsatilla has very similar mental characteristics: tearfulness, shyness, emotionality, sensitivity and the girl is very connected to mum, that is also important symptom for Pulsatilla.
Pulsatilla covers headache characteristics (localization of the pain and aggravation from a bright sunlight), except aggravation from noise. But this girl has strongly pronounced food preferences, which are not characteristic for Pulsatilla: desire for salt and fish. Besides, the girl has strong thirst and though in a rubric «Stomach; Thirst; extreme» there is a Puls in 1st degree, thirstlessness is more typical for this remedy.
Another characteristic of the case is that the girl accepts a consolation only from mum, but not from her daddy or other relatives. It is not typical for Puls which loves to be comforted and consoled. Pulsatilla does not cover all symptoms of the case.
Phosphorus covers all rubrics of the case. The girl is toll, thin, pale, anemic, sensitive, and emotional, with headaches – all of these are very similar to Phosp. Strong thirst, desire of salt and fish also are typical for Phosp. Patients of Phosp, however, usually are more open and sociable. Vermullen wrote: «the Extrovert, loving and sympathetic». This girl, on the contrary, communicates with people not easily, she is very timid. And patients of Phosp are also more anxious, they are full of fears (fears of loneliness, darkness, a thunder-storm, and ghosts) that absolutely are not presented in this case. Probably, this remedy might be required in the future, but for now it is not the most similar remedy (not a similimum).
Natrium Muriaticum is not only covers all the rubrics, but corresponds to the case essence. And mental characteristics of the girl correspond to this remedy, such as: tearfulness, emotionality, shyness; she does not accept a consolation from anybody, except mum; smart. Physical general symptoms match well with Nat Mur: desire for fish, salt, strong thirst and anemia. Headache’s modalities and localization are also corresponding to this remedy. Considering all set of symptoms, Natrium Muriaticum in 30C potency has been given.
She has taken 1 dose of a Nat Mur 30C on Aug 28, 2008.
Follow up – September 30, 2008
Mother:
“Headaches occur more rarely. She had only two episodes in the last month. She became less sensitive and cries not so often. She also easier communicates with unfamiliar children. We did not have a blood test in this month yet.
She still likes salty food and fish very much; she drinks a lot. There are no changes with it”.
My assessment of the situation was that Natrium Muriaticum has started to act.
Headaches bother her far less, her behavior has improved (less tearfulness, and she became more sociable).
The remedy is not prescribed. Follow up is scheduled.
Follow up – November 12, 2008
Mother:
“Her hemoglobin has raised. She had the blood analysis 5 days ago, and her hemoglobin was 1 2.8 g/dl, such was not since her birth! She had an anemia since her early childhood, and constantly lowered hemoglobin, sometimes it was rising, but never to such figures.
There are no headaches. She behaves not bad, cries sometimes if she is offended, but it is not frequent. It seems to me, she began to eat less salt. Often she simply eats the meal which I prepare, without adding salt”.
My assessment was that her condition continues to improve and prescription of medicine is not required.
Hemoglobin has raised though she did not take any iron therapy, and mother notices that hemoglobin never was such high during all her life. Her nutrition became healthier; she does not eat now so much salt, as before. She cries seldom. Headaches do not disturb her.
Follow up is scheduled.
Follow up – December 17, 2008
Mother:
“Everything is normal. There are no problems with her health currently. Headaches do not come. We did not repeat hemoglobin test after November. Her mood is good, she is usually cheerful now, cries and weeps seldom, only if hits herself or if she has any serious problem. I do not notice such strong desire for salt as it was earlier. She eats the same food as all of us. Still very much likes fish”.
I have decided that her condition is still good.
There are no headaches and tearfulness, desire for salt has disappeared. Mood is good.
Need for prescription of the remedy is not present. Follow up is scheduled.
Follow up – January 26, 2009
Mother:
“Holidays have passed tough for us. We brought her to her grandmother’s house for 2 weeks (she did not want to go without us); she went to some entertainments, to a Christmas-tree celebration, where it was very crowded, and many strangers. She has caught some infection there; there was flu, a cold, and cough. She has recovered in about 10 days. But after that she again began to complain of headaches, and it seems to me, became more whining and irritable. Gets offended by everything, something you say wrong – at once she is in tears, at once offended. Similar to how it was last summer. She does not want to go to grandmother without us, wishes more to stay with us”.
My assessment was that the case relapses.
The girl did not want to go to the grandmother without parents, there were many strangers, it obviously was a stress for her and she was ill with flu. Also her headaches, tearfulness and sensitivity have returned. In such situation I have decided to repeat a remedy in the same potency.
She has taken 1 dose of Natrium Muriaticum 30С on January, 25th 2009.
Follow up – March 5, 2009
Mother:
“This month has passed well. She did not complain about headaches, started to behave more peacefully. Has stopped to take offence at everything and silently cry in a corner if someone told something she did not expect. We have repeated hemoglobin test, the anemia is not present, 12.5 g/dl”.
I have evaluated the situation that the girl again has reacted well on Natrium Muriaticum.
There were no headaches, her behavior has improved, and hemoglobin is normal.
No remedy is required. Follow up is scheduled.
Follow up – April 7, 2009
Mother:
“Everything is all right. There was no headache, she behaves well, strong tearfulness and sensitivity is not present. She communicates with strangers better.
In general I am happy, everything is good. She went for the weekend to her grandmother, a trip was normal and she did not complain.
She does not eat salty food now so much as earlier, eats same as other members of the family, not adding salt”.
My assessment was that her condition continues to improve.
There were no headaches, she can tolerate well a trip to her grandmother, behavior is good, and there is no extreme emotional sensitivity and tearfulness. She eats normal quantity of salt.
Conclusion:
Mother with a girl with complaints of frequent headaches and iron deficiency anemia came for treatment. During treatment physical problems have gone, have completely gone headaches, hemoglobin has raised. Besides, the psychological condition of the girl has improved: tearfulness, sensitivity and strong shyness have decreased. She began to communicate better with strangers. Pathological desire for salt has gone.