A case of canine "hypothyroidism": the importance of keeping an open mind

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A case of canine "hypothyroidism": the importance of keeping an open mind

There is a tendency in veterinary prescribing to emphasize physical symptoms, even relatively common ones, to the exclusion of mental and emotional disturbances. This is understandable, given the difficulty of accurately assessing mental symptoms in dogs and of selecting reliable rubrics in the repertory.

In the case I am presenting here, there are quite a few physical symptoms, but without an understanding of the mental and emotional symptoms, it would be very difficult to come up with the simillimum. This is not to say that physical symptoms are unimportant. Indeed, they are much easier to assess objectively, and in most cases will guide the prescriber to the correct remedy. When I take a case, I typically review first all of the physical symptoms, past and present, then the generalities, and finally, I discuss the behavior and personality to "confirm" the remedy choice. In this case, however, the center of gravity of the case is clearly in the mental and emotional realm, and the physical symptoms will not lead to the simillimum.

Presentation

Brin was a two-and-one-half-year-old intact male black Giant Schnauzer living in Maine. I took his case in September 1992. He had been diagnosed as hypothyroid based on an elevated auto-antibody level to T3, as well as low levels of free T3 and T4 on a blood test in March 1992. He was put on thyroxin. One peculiar symptom was excessive yawning, especially in the car and on rainy days.

Medical History

His medical history is as follows: He had many vaccinations as a puppy (five doses of a 6-in-1 combo by 14 weeks of age, as well as a rabies at 12 weeks), and standard yearly revaccination thereafter. He developed sarcoptic mange (scabies), and was treated with multiple chemical dips. He had a progression of many intestinal parasites (roundworms tapeworms, whipworms, coccidia), all of which were treated with "standard" anthelmintic drugs. In March 1991 he developed conjunctivitis in the right eye, treated with antibiotic/steroid ophthalmic ointment. It was about this time that Brin's behavior seemed to get worse. He was defiant, refusing to submit to his person, and yet seemed fearful. More on this later.

His worm problems, and drug treatment for them, continued, with loose bloody stools, weight loss, and the onset of the excessive yawning. He was treated with prednisolone (a corticosteroid), with some improvement in his symptoms. It was at this point that he was diagnosed with hypothyroidism and put on thyroxin. A month later he developed a histiocytoma on the right front foot, which was treated topically. In subsequent months, the elevated T3 auto antibody increased.

Generalities

Brin was not especially chilly or warm, and tolerated both hot and cold weather well. He liked open air, and loved to go for walks. He would generally drink water only at night, tanking up on large quantifies infrequently. He had a good appetite, with no particular cravings or aversions other than liking raw carrots, and paper, such as napkins. He would have loose stools when he had worms, which was most of the time. He would mark territory with his urine excessively.

Behavior and Personality

Since he was a puppy, Brin would snarl and snap at his people if, for example, he did not get his way or had something taken away from him. He was more defiant with the woman of the house than the man. This had gotten progressively worse over time, as noted above. Yet he was also very loving, indeed overly affectionate.

The really peculiar thing is that he would have sudden changes of mood, alternating between being overly affectionate and aggressive growling and snapping. In general, he was aggressive to people and to other dogs, his person describing him as "wild" and "screaming," although he did not actually attack. It seemed to her that he "enjoyed" scaring people.

She described him as being jealous of attention to others. He was mischievous if he did not get enough attention, stealing rugs and pillows. Again, however, when not angry he was sweet, loving and demonstrative, would lick her face, and was "overcome with joy and love." He had a strong emotional attachment to her despite his defiance. He was like a spoiled child, happy as long as he got his way.

For the record, he had no strange behavior about water, no fear of thunder, did not roam, had no sensitivity to pressure around the neck, and had no fear of snakes.

Discussion

There are many rubrics that are applicable on the physical plane, and even more in the mental symptoms. One could repertorize the physical symptoms from here to Kalamazoo and get nowhere. Would one use the rubric External throat: GOITRE? (Note: this is the rubric to use for hypo- as well as hyperthyroidism.) Is this dog truly hypothyroid? Should one use the rubric based on laboratory analysis of the blood without corroborating physical symptoms? I will give you a clue. The remedy is there.

In my analysis, I focused entirely on the mental symptoms, and subsequently found the remedy as a grade one in many of the physical symptom rubrics. If you want to try analyzing the case yourself, now is a good point to stop reading and to get out your repertory (that is, assuming you do not already know the remedy).

Case Analysis

The symptoms that stood out to me were (1) the rapid alternation of (2) profuse demonstrations of love with (3) violent anger. [Synthetic Repertory, vol. I: MOOD, alternating, 760; ANGER, violent, 39; what rubric would you choose for (2)?] Also interesting to me was (4) seeming to enjoy scaring people [SR I: MALICIOUS, 720]. The only physical symptom that I thought was important was the yawning. [Sleep, YAWNING, sleepiness, without, Repertorium Generale, 1038].

There are quite a few other rubrics that could be used here, including PASSIONATE, JEALOUSY, ANGER from contradiction, and DEFIANT. But, I wanted to avoid getting into a laundry list of symptoms that would only lead me into a quagmire of possible remedies. Using that approach, the case could look like Lycopodium, or Nux vomica, or Ignatia, or Anacardium.

So, at this point, I stepped back from the specifics, and thought about a dog that was very loving and demonstrative, "overcome with joy and love," and yet passionate, with violent anger, defiant, even malicious. I thought about the excessive marking of territory with urine. In dogs, this is like a statement that "This is mine!" a statement generally made "only" by males. It is a dominant behavior related to masculinity, or in a broader sense, to sexuality. In dogs, dominance/submission and territoriality are secondary sexual behaviors.

WARNING!! This is your last chance to figure out the remedy on your own.

The following is not really how I thought about it, but I am hoping it will be helpful to those of you less familiar with treating dogs.

Try to imagine what Brin would be like if he were a human. Think of the aggressiveness to other dogs, the excessive territorial marking. Can you see him as a real macho kind of guy? Think of the excessive demonstrations of affection, including licking people a lot. Can you imagine someone who loves to touch, to hug and kiss, perhaps a man who loves women, yet must maintain superiority? Picture now the violent temper, the intensity and volatility of emotion. In all of this, plus his defiance, acting like a spoiled child, can you imagine a person that is very haughty?

In confirming the remedy, I asked his person if "haughty" was a good word to describe him. Her answer was an emphatic, "Yes!! Definitely!!"

What remedy has haughtiness, violent anger, immoderate display of affection, and sudden mood swings, all with sexual overtones? You guessed it: Brin's remedy was Platina.

The best rubric I could find for the immoderate displays of affection was KISSES everyone [SR I 687], which has Platina as one of only nine remedies. As mentioned earlier, Platina appears in External throat, GOITRE. It is also seen in Rectum, WORMS, ascarides and WORMS, taeniae [RG 542], in Stool, BLOODY [RG 543], and Stool, SOFT [RG 548]. It is one of only two remedies listed as grade 3 in YAWNING without sleepiness.

However, it does not appear in the rubrics for scabies [RG 1087], conjunctivitis [RG 203-204], thirst at night [RG 450], thirst for large quantities [RG 451], or desire to eat paper [SR II 260] or indigestible things [SR II 250].

If one were to focus primarily on the physical symptoms, I think it would be nearly impossible to find the remedy. Even focusing on the behavioral symptoms, one could easily become lost with too many rubrics. What was needed here was to look past the surface, beyond the individual behaviors to the essential elements of the "pattern" of behavior, that is, the "essence" of the case. This requires a certain amount of reasoning and deduction, but is often the only way to arrive at the simillimum.

Very briefly, Brin received one dose of Platina 1M, and the thyroxin was continued. There was no change at all for 6 weeks. He then became gradually more obedient, less erratic, less aggressive, less overly affectionate, there was less yawning, and he had his first negative fecal exam in quite some time. His owner described him as "pleasant to be with...I never thought I'd say that."

He was then weaned off thyroxin, and needed a repetition four and one half months after the first dose. By two months after the second dose, all his symptoms had cleared up, and Brin was a happy, well adjusted dog with no behavioral problems at all. I could find no symptoms on which to prescribe, so I instructed the client to call me if symptoms developed.

This article is about keeping an open mind, or perhaps more accurately, developing an open mind. It was necessary in this case to hold all of the symptoms together in the mind, to look past the "laundry list" and to perceive the larger pattern, the essence of the case. This is a skill that requires (at least for me) great effort and continued practice.

In any case, it is important that we not limit ourselves by excluding or ignoring any aspect of a case. In order to improve our prescribing, we must use all of the tools at our disposal, and then push ourselves to an ever deeper understanding of our patients. In this way, I believe, we can advance from being homeopathic prescribers to being true healers.

International Foundation for Homeopathy.

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By Jeffrey Levy

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