Congress 2010 Case Report Squamous-cell bronchial carcinoma From terminal care to healing With

Congress 2010 www.facultyofhomeopathy.orgwww.raymondsevarhomeopathy.com

Case Report

Squamous-cell bronchial carcinoma

From terminal care to healing

With seven years survival

Dr Raymond Sevar MRCGP FFHomDean of the Faculty of Homeopathy UK


Abstract/Summary

• A 58 year old lady with squamous cell carcinoma of bronchus confirmed by bronchoscopy/biopsy is referred by GP at the request of her terminal care nurse who has an interest in holistic care. The primary cancer is large, fills most of her right chest, appears adherent to her pericardium & is deemed inoperable with metastases in thoracic vertebrae. She is in pain despite morphine & dexamethasone.

Abstract/Summary

• Holistic integrative care using homeopathic medicines, nutritional supplements, diet and a regime of daily prayer and exercise elicit a remarkable response:

• the primary cancer shrinks to a quarter of its original size & becomes full of hard scar tissue

• the secondary cancers in her thoracic spine disappear



Abstract/Summary

• she stops her conventional medication

• seven years later she is alive & well with occasional hot flushes & mild osteoarthritis

Keywords

• Squamous cell bronchial carcinoma, homeopathy, diet, nutritional supplements, exercise, prayer


Introduction

• “J” has had palliative radiotherapy to metastases in her thoracic spine

• is taking Morphine MST 40mg twice a day and Dexamethasone which is now reduced to 2 mg daily, but still has considerable pain.

• She recently had a deep venous thrombosis in her left thigh and is on Warfarin


Consultation December 2000

• Observations: • She is very obese • an obesity of the trunk with thin

legs and a red Cushing’s face • is scruffy• has thinning of hair on vertex• anxious with trembling hands


• Six years ago I fell off a high stack of hay & fractured 6 ribs but didn't come out in a bruise. Five years ago I fell off the hay again & had a crush fracture of my first lumbar vertebra - I have had back pain since. In August last year I got a terrible pain like a band right around my lower chest & went for tests & they found the cancer …




• I get a lot of hot flushes with sweats on my head, neck & chest & am tired all the time ....

• My face is getting fat & my legs have got thin & I have a horrible chemical taste in my mouth since I started all these pills …


• I grew up on a farm then went to art college. I got married & had 2 children ....

• My mother was kind & gentle & would do anything for anyone .... In build & in nature I suppose I am very like my mother .... She died very suddenly 16 years ago of a burst aortic aneurysm. It was such a shock

• Observation: she is weeping.




• I am still upset about it …

• I have been very warm for the past 2 years which is odd because I was always chilly ....

• I get hot flushes & sweats from my head downwards ...

• I can't sit too long in the sun, I get headaches ...

• my sweat smells more since the pills ...


• I stick my feet out of bed because they are too hot ... the soles are too hot. ..... I absolutely hate eggs ... I just love chips and ice-cream ....

• I am very tidy. Everything has to be in its proper place - I can't rest till it’s tidy …




• I am terrified of snakes. I even dream of snakes. The snakes curl up on my bed & are under my bed. I wake up scared & I know that if I put my foot out of bed they will get me, wind round me & bite me..... as a child I saw a film where a huge snake crushed a man to death & I have been scared since ....

• I can't breathe if I am shut in a small place.


• .... I want to live till my daughter's wedding in August but they tell me I have only a few months.

• Observation: she begins to cry & cries for a while – I sit & give her time



ANALYSIS 1

• She is terminally ill with cancer

• She is in severe pain despite morphine

• She is intoxicated with dexamethasone (which is distorting her fat distribution & causing weakness of proximal muscles)

• She has little or no hope that she will live till her daughter’s wedding

ANALYSIS 1

• The dreams/fear/delusions of snakes are typical of Sulphur as are: her red face, untidy dress but fastidious need for order, burning heat of feet which she must uncover & desire for ice-cream & chips & aversion to eggs.


ANALYSIS 1

• The history of recurrent falls and fractures with idiosyncratic lack of bruising except on the face may indicate a need for treatment with Arnica montana later



ANALYSIS 1 RUBRICS & GRAPH


TREATMENT

• factors which influence survival in cancer discussed: determination to survive, changes in diet, nutritional supplements, prayer & exercise

• advised to pray the Rosary daily (she is Roman Catholic)

• advised to go out & walk daily for half hour no matter how ill or how bad the weather

TREATMENT

• Sulphur 30CH one pill daily (see Graph 1)

• Advise supplements - B multivitamins 25 mg daily, Vitamin C 1Gram daily till able to eat normally, then to expand diet variety especially fruit, vegetables & tree nuts


Purpose of Treatments

• To enable your body to fight back• Sulphur to fight off the effects of the drugs

& wake up your immune defence systems

• Supplements to help build up your immune system while you are not eating well

• Exercise to build up your strength & will

• Rosary for grace


• Treatment goal = survival to daughter’s wedding

• Outcome measures at review: energy, mood, sleep, weight, resilience, pain, dying of cancer or living with cancer ...



Consultation January 2001

• My legs are strong again with more muscle - I can walk up & down stairs easily now and walk the dog every day. ......I stopped Dexamethasone 4 weeks ago. I am still on Morphine which makes me nauseous and Warfarin and the vitamins …

• I am much better with more energy. I still get tired and I go to bed at 9, but there is no slump in energy from 2-5 p.m. ....

Treatment

• This change is real & significant

• It means your body has begun to fight back & has more energy to fight back



• I have been falling - I fell in the bath and banged the right side of my chest

• I asked to examine her & she said

• “I don't want you to touch it or prod it” - & she pulled away & guarded the area saying “It is all right”




• I just fall flat on my face for no reason - I have done my whole life. I fell on my left shoulder 1 year ago & needed a steroid injection & I fell off the hay twice - my face bruises but nowhere else …


ANALYSIS 2 & TREATMENT

• The Arnica layer emerges with a recent fall & typical behaviour of guarding the sore place & denial

• Treatment Arnica montana 30CH one pill 3 doses today then continue with Sulphur 30CH daily


Consultation March 2001

• I have stopped Morphine - it was very bad - I was shaking & sick & had diarrhoea for 3 weeks …

• I feel 1000 times better …

• I have even more energy ...


• I am in a fair amount of pain .... in my back(shows lower thoracic spine) & around my sides to the front ... better hot bath & a hot water bottle ...

• I take Paracetamol 2 twice a day & an occasional Ibuprofen - with the tablets I have no pain but the pain comes back when they wear off …



• I am not so warm now. I feel cold more often than warm recently, but I still put my feet put of the bed …



ANALYSIS 3

• The Sulphur state persists with hot feet but she is becoming chilly again

• There is more general improvement off Morphine but the pain from her bony metastases is troublesome with only minor analgesics

• “specific” medicines for bone metastases are required

TREATMENT 3

• Symphytum officinalis 6CH

• & Hekla lava 6CH

• one pill of each twice a day

• continue Sulphur 30CH 30ml 2 drops daily, 10 succussions before each dose (see Graph 2)





Consultation April 2001

• I feel great with the new medicines

• I have been walking more & I have bought an exercise bike & I have been gardening

• I can do all the housework now: cooking, washing, ironing ...


• my back aches a bit when I have been resting for a long time and when I first move but then it is OK ... I have never had the bad back pain or girdle pain...

• my energy is still gradually increasing …




• I still get the hot feet and still stick them out the bed....

• my weight is going up – that’s why I got the exercise bike...

• I have developed a craving for sunflower seeds in the last few weeks …


• I am busy organizing my daughter's wedding .... I am still taking Paracetamol & Ibuprofen & Warfarin

• Treatment: continue Sulphur & Hekla lava & Symphytum



Consultation June 2001

• The cancer has shrunk - I had a Chest X ray & they can see it is much smaller …

• Observation: a big smile with glistening eyes


• Some days I feel absolutely great ...

• I still have aches and pains in my old joints - lower back, feet and right knee.

• my weight is still going up ...

• my nails are growing fast & they are the strongest that they have ever been my whole life




• The hot flushes are getting terrible. They are getting worse & much more frequent

• I throw the covers off then I get cold quickly so I need the covers back on.....


ANALYSIS 4

• The shrinkage of the cancer is remarkable, her general improvement continues, the surge in hot flushes indicates the partial emergence of a new layer but the image is not yet clear – I decide to give a sarcode as an organ remedy in low potency.

TREATMENT 4

• Add Folliculinum 6D one pill twice daily continue

• Sulphur

• & Hekla lava

• & Symphytum



Consultation August 2001

• Observation: freckly, tanned & happy

• I was very busy before my daughter's wedding. I made her wedding dress & the bridesmaid's dresses & the wedding cake & I was fine. It was such a lovely day, thank you …



• The hot flushes are nearly gone - much less frequent & each flush is milder & shorter...

• I keep forgetting to take the paracetamol & Ibuprofen. .... my knees don't hurt so much & my back isn't sore till after 6 pm or after gardening

• Treatment: Continue Sulphur, Symphytum, Hecla lava & Folliculinum


Consultation October 2001

• I still feel great. • I am not dying of cancer. • I am living with cancer …


• The bone pain in my knee got worse & I had a bone scan which showed a hot spot. I did a lot of raking of leaves off the lawn & my left shoulder has been very sore - the pain shots all the way down my arm to the fingers & my fingers are a bit tickly.



• I am sure that it is just arthritis after too much gardening but they’re arranging an MRI scan ...

• I take an occasional paracetamol or ibuprofen



ANALYSIS 5

• Even after her daughter’s wedding (her initial survival target) she feels certain that she is still recovering & is not anxious about a new bony secondary, she feels sure that the pain is rheumatic from overuse

• Rheumatic pain shooting down the limb indicates Kalmia latifolia

TREATMENT 5

• Kalmia latifolia 12CH one pill 3 times a day for shoulder

• continue Sulphur, Symphytum, Hecla lava & Folliculinum




• I am fine - the scans show the cancer is now half the size it was & the cancers in my spine have gone & the shoulder & knee scans are just arthritis

• Observation: shining with joy


• My hands have been getting very sore & the joints are all lumpy. My shoulder is fine - It was OK 2 weeks after starting the Kalmia

• On examination: marked Heberden's nodes & osteoarthritis of distal inter-phalangeal joints both middle & index fingers


ANALYSIS 6

• The disappearance of cancer metastases in vertebrae has coincided with the appearance of Heberden’s nodes in finger joints & a surge in osteoarthritis



TREATMENT 6

• stop Hekla lava & Symphytum & Kalmia

• continue Sulphur 30CH & Folliculinum 6X

• take Cod Liver Oil/fish oil

• increase oily fish in diet


OUTCOME DEC 01-AUG 02• I continue to see her every 3 months. By

March 2002 her osteoarthritis & hot flushes are her only complaints, her energy is good, her weight continues to gradually increase on Sulphur 30CH 2 drops once a week

• Oncologist continues to be surprised & sees her infrequently

• The hot flushes continue to increase in frequency & severity



• I am going on holiday to Jordan in 2 weeks – my 1st holiday in 3 years

• The hot flushes are ridiculous – absolutely terrible – I have a fan in every room & 3 air conditioners, & my husband says the house is like an igloo …


• the heat starts low down in my body & whooshes up to my head & face & I go bright red & pour out sweat

• The flushes get worse through the day & keep on waking me at night – I throw the covers off till I get cool then I get chilled & pull the covers back up



ANALYSIS 7 & TREATMENT

• The picture of Sepia is now clear• Sepia & Sulphur are

complementary• Treatment: Sepia LM1 30 ml, 10

succussions & 2 drops in water daily, continue Sulphur 30CH 2 drops once a week

OUTCOME TO JUNE 2003

• Two months later her flushes are beginning to ease off (30% better)

• Her flushes gradually continue to settle with Sepia LM1 then LM3 plus Sulphur 30CH 2 drops once a month






• I have been great. The oncologist is very pleased & surprised

• The scan shows the cancer has shrunk to a quarter of its original size & seems to be full of hard scar tissue …

• Observation: shining with joy



• The hot flushes are much better – only about a quarter of what they were – far less frequent & far less bad …

• My joints seem to be gradually getting better as well – I have been doing a lot of gardening …

• I am going to be a grandmother …

TREATMENT

• continue Sepia LM3

• if flushes increase again start Sepia LM5 30ml, 2 drops daily



OUTCOME

• In December 2005 (5 years after initial presentation) I discharge her from formal follow up.

OUTCOME

• May 2007 her daughter reports “J” is alive & well - a happy healthy grandmother with a few hot flushes & some osteoarthritis controlled by Sepia LM5 drops & cod liver oil & fish chondroitin & glucosamine



DISCUSSION - SURVIVAL

• This lady’s survival response is impressive but not unique

• Surprising survival durations following homeopathic treatment in cancer care have been previously reported

• Rajendran ES, Surprising Cancer Survival with Homeopathic Treatment, Homeopathy, 2004 Apr; 93(2): 99-102


DISCUSSION - SURVIVAL

• The positive effect of holistic integrative care coupled with CAM interventions in cancer survival is being increasingly reported

• Monti DA, Sufron M, Peterson C., Potential role of mind-body therapies in cancer survivorship. Cancer, 2008 Jun 1: 112(11Suppl): 2607-16

• Monti DA Yang J, Complementary medicine in chronic cancer care, Semin Oncol. 2005 Apr; 32(2) 225-31

• Pujol LA Monti DA Managing cancer pain with non-pharmacologic and complementary therapies, J Am Osteopath Assoc, 2007 Dec; 107 (12Suppl7): ES 15-21


DISCUSSION - CAM

• Evidence-Based Clinical Practice Guidelines begin to acknowledge the important role of holistic integrative care & CAM in the control of symptoms associated with cancer & cancer treatment

• ACCP Evidence-Based Clinical practice Guidelines (2nd Edition). 132(3) (Supplement):340S-354S, September 2007 (Multiple authors)


DISCUSSION - SPIRITUAL

• Spiritual issues are not often discussed between doctors & patients yet there is evidence to suggest that patients wish to discuss spiritual issues with their doctors in at least some circumstances - the most acceptable being life-threatening illnesses, serious medical conditions & loss of loved ones

• McCord G, Gilchrist VJ, Grossman SD et al. Discussing spirituality with patients: a rational and ethical approach. Ann Fam Med. 2004;2(4):356-61


DISCUSSION - SPIRITUAL

• this wish reflects a desire for physician-patient understanding & the belief that such discussion would inform the physicians' ability to encourage realistic hope, give relevant medical advice, & change medical treatment

• Reed P. Spirituality & wellbeing in terminally ill & hospitalised patients. Res Nurs Health 1987;9:35-41

• As she was a practicing Roman Catholic the advice to pray the Rosary daily was relevant & appropriate


DISCUSSION - DIET

• There is a lack of good quality evidence to support the role of oral nutritional supplements in cancer treatment

• Vitamin supplements were only continued until she had stopped synthetic drugs, regained her appetite & expanded her diet to include a wide variety of fresh fruits, vegetables & tree nuts

• Subsequent nutritional supplements of fish oils were advised for osteoarthritis

• The patient elected also to take fish chondroitin and glucosamine


DISCUSSION - EXERCISE

• There is some quality research on the role of exercise for patients with active cancer showing that exercise-based interventions are associated with reduced fatigue, greater quality of life, reduced emotional distress, improved immunological parameters, improved aerobic capacity & muscle strength

• Galvao DA, Newton RU. Review of exercise intervention studies in cancer patients. J Clin Oncol. 2005;23(4):899-909


DISCUSSION - EXERCISE

• The first large-scale quality trial looking at cancer survival & exercise found that women who exercised to the equivalent of 9-15 MET-hours per week (roughly equivalent to 3-5 hours walking per week) had half the death rate from breast cancer over 4-18 year follow-up compared to those who did little or no exercise

• Holmes MD, Chen WY, Feskanich D, et al. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293(20):2479-86


DISCUSSION

• It is not possible to differentiate with certainty the relative impact of each of the interventions used in this lady’s management

• The oncologist suggested a final explanation of spontaneous remission

• The patient replied “How dare you”

DISCUSSION GRACE & WILL

• I suggest her response flowed from:

• grace & will

• therapeutic effect of holistic consultations

• to each indicated homeopathic medicine appeared to be brisk in onset & sustained effect



DISCUSSION – GRACE & WILL

• her determination to survive till her daughter’s wedding – an act of will

• her continued determination to live & the birth of her granddaughter

• praying the Rosary daily

• diet expansion & daily exercise

Documents

Congress 2010 Case Report Squamous-cell bronchial carcinoma From terminal care to healing With