robert c dumont, md and youngran chung, md cedh ... · robert c dumont, md and youngran chung, md...

Chronic Diseases in ChildrenRobert C Dumont, MD and Youngran Chung, MD

CEDH International Conference Chicago, 2016

5th International CEDH Conference - June 24-26, 2016

Approaching the Young ChildFirst meeting: sizing up the child


Interactions

The Child is the most important person in the Room

Size up the child and interact with him/her first

Begin forming a sense of his “energy”, constitutional/behavioral style

80-90% important elements of an exam can be from simple

observation.

Recognize their developmental level (and where they are at the

time emotionally) and interact at that level

Remember parents will often tell you only the things they believe are

important you or they believe is related to that particular complaint

To Treat the Child, First Treat the Mother (parents)


Respiratory

Gastrointestinal

Dermatology

Other

Pediatrics

Behavior


Common Pediatric issues

Respiratory

URIs

Otitis media

Allergic Rhinitis

Sinusitis

Bronchitis/pneumonia

Bronchiolitis

Asthma

Gastrointestinal/nutritional

GERD/Upper GI dyspepsia

Recurrent abdominal pain/IBS

Constipation

Diarrhea

Failure to gain weight/feeding problems

Dermatology

Eczema

Acne

Other Rashes

Neurologic/Behavior

• ADHD

• Autism

• Tantrums and ODD

• Insomina/parasomnias

Other

Endocrine

Dysmenorrha

Genitourinary

Urinary tract infections

Enuresis


Clinical Homeopathic Approach

Histopathological or pathophysiological approach

Pathogenetic approach

Approach by the Chronic Reactional Mode (CMR)

Sensitive type (ST) approach

Etiological approach


Stressful event

Strong Moderate Weak

Pathophysiologic reaction/symptoms

Disease is predominant Common disease expression with Individual expression

individual variation of symptoms is predominant

The range of disease and symptom expression

Etiology/Triggering event

Chronic Reactional Mode

(Sensitive Type)

Toxicology (detoxification)


Pathogenic

Approach

Chosen

Medicine(s)

Pharmacology &

Toxicology

Clinical

Indications

(Experience)

“Herrings Cross”

Lesional stage,

tissues, location

Sensation

modalities

concomitant

symptoms


Terrain Medicines:Chronic Reactional Mode

and Sensitive Type

It is more important to know what sort of person has a disease than to know what sort of disease a person has. -Hippocrates


PSORIC

Arsenicum album

Hepar sulphuris

Lachesis

Lycopodium

Nux vomica

Psorinum

Sulphur

Graphites

Kali bichromicum

SYCOTIC

Causticum

Dulcamara

Natrum sulph.

Medorrhinum

Nitricum acidum

Thuja occ.

Rhus tox.

Phytolacca

Hydrastis can.

TUBERCULINIC

Arsenicum iod.

Calcarea phos.

Iodum

Natrum mur.

Phosphorous

Pulsatilla

Sulphur iod.

Tuberculinum

Argentum nit.

Ignatia

Drosera

Chronic reactional Modes Medicines

PSORO-SYCOTIC

Silicea

Calcarea carb.

Sepia

(Graphites)


CRM in Children:

Tuberculinic

Recurrent ENT infections

Especially in thin

children with tendency

to lymph adenopathy

Arsenicum iodatum

Calcarea phosphorica

Iodum

Natrum muriaticum

Phosphorous

Pulsatilla

Sulphur iodatum

Tuberculinum

Argentum nitricum

Ignatia

Drosera


CRM in Children:

Psoric

reactive mode or

reactional pattern

Skin, Mucous

membrane (and serous

membrane)

Inflammatory or

spasmodic (and

metabolic)

Family History

May have begun as

rash/eczema

Arsenicum album

Hepar sulphur

Lachesis

Lycopodium

Nux vomica

Psorinum

Sulphur

Graphites

Kali bichromicum


CRM in Children:

Sycotic

The problem never

stops:

Chronic secretions (of

mucous membranes) -

rhinitis, chronic serous

otitis media…

There may be a

precipitating event

Causticum

Dulcamara

Natrum sulphuricum

Medorrhinum

Nitricum acidum

Thuja occidentalis

Rhus tox.

Phytolacca

Hydrastis canadensis


And not to forget:

The Psoro-Sycotic Medicines

Silicea

Calcarea carb.

Sepia

(Graphites)


A few Sensitive types

Phosphorus – may start out shy but then warms up

quickly

Pulsatilla – shy and often clingy (may see the mottled

legs)

Silicea – shy and lack of confidence

Sulphur- robust

Sulphur iodatum – mild Sulphur often with increased

energy with ENT issues (infections)

Calcarea carbonica – “steady”, may be fearful

Calcarea phosphorica – long and lanky, fatigue

Lycopodium – maybe quiet or open but often

correcting parents, emotionally sensitive – self esteem.


Etiologic Treatment

vaccines

beginning daycare or school

repeated antibiotic treatments

recurrent infections

major and disturbing emotional events (divorce, new

child in family

Grief - Ignatia

Abandonment - Pulsatilla

Jealousy - Lachesis


Gastroesophageal Reflux: A Way of Thinking

The phenomenon of refluxWe all have reflux

The manifestations of refluxHow does reflux present?

The root of reflux?What is causing the reflux


GERD: Presenting Symptoms in Infants

Emesis/Spitting up

Regurgitation

Irritability

Feeding refusal/aversion

FTT/weight loss

Recurrent ear infections

Chronic sinus problems

Respiratory symptoms

Apnea

Reactive airway disease

Pneumonia

Hoarseness

Cough


There May be One or More

Contributing Factors

Constipation (younger child) consider homeopathic treatment

Metabolic problems

Anatomic problems

Dysmotility

Protein intolerance/allergy (all ages)

Dysbiosis

Stress (older child, adolescent) – consider homeopathic treatment


Dysmotility and ppi use are

independent risk factors for

small intestinal bacterial and/or fungal overgrowth

C Jacobs*, E Coss Adame+, A Attaluri*, J

Valestin*, and SSC Rao*,+

*Department of Internal Medicine,

University of Iowa Carver College of

Medicine, Iowa City, IA

+Department of Internal Medicine,

Georgia Regents University, Augusta, GA

Aliment Pharmacol Ther. 2013 June ;

37(11): 1103–1111. doi:10.1111/apt.12304.


Gastroesophageal Reflux

and Dyspepsia

Aethusa cynapium

Sudden, profuse vomiting (projectile vomiting) right

after a meal or later (in clots)

with great efforts during vomiting

May see loose stools watery greenish stools or stools

with mucus

Aethusa plus Calcarea carbonica (agg. From starches

and milk,: atopic dermatitis, seborrheic dermatitis,

diaper rash)


Intolerance to dairy

MAGNESIA CARBONICA Sour smelling baby, with low tone (weak muscles) aggravated by milk, may be cold sensitive.

May have frothy green diarrhea

Terrain: Calcarea carbonica)

Nux vomica

Dyspepsia – may refuse feeding

Irritable, hyperactive and impatient

May be colicky with abdominal distension, +/-vomiting

tendency to constipation


Terrain medicines: Cow’s milk

allergy

Lycopodium

Sulphur

Calcarea carbonica



and Dyspepsia

Pyrosis

Robinia: Complement medicine, epigastric burning, <

eating esp. fatty foods, night time

Sulphuricum acidum: Tendency to develop oral aphthae) and acidic gastroesophageal reflux

(burning epigastric pain. Sour odor in babies.

Iris versicolor: Burning of entire tract, belching and

burping



and Belching

Asa foetida

eructation with GERD, esophageal spasms

Antimonium crudum

nausea and vomiting, excessive eating

tendency to overeat, coated tongue, taste-smell of food

eaten

Argentum nitricum

Loud belching, (inflammation, ulceration – pain)


Tourette’s Syndrome and Tic

Disorders

Lycopodium (facial) Often the CRM medicine given weekly

Agaricus muscarinus (all tic disorders and choreiformmovements)

Mygale lasiodora (shoulder, neck)

Magnesia phosphorica (painful facial tics)

Manganum metallicum (throat clearing tic)

Ignacia (tics from emotional issues, hypersensitive, spasmodic)

Staphysagria (tics from held in emotions)

Ambra gresea


“The organs weep the tears the

eyes refuse to shed”Sir William Osler

EK was a 13 year old with significant motor tics

Digging into family dynamics – conflict with mother

Treatment

Lycopodium 30C weekly

Staphysagria 30C 2 x daily and then tapering

Chronic need for Staphysagria while in mother’s house

10 years later – stable lifestyle engaged, steady job, without tics


The Problem Child of Pediatrics:

Diseases of Immune

Dysregulation


Homeopathy and immune

dysregulation

What we know

about Immune

dysregulation

What we know

about

homeopathy and

how it works

Homeopathic

Intervention in

diseases of Immune

Dysregulation


Immune Dysregulation

Let’s Set the Stage


Clinical Homeopathic Approach

Histopathological or pathophysiological approach

Pathogenetic approach

Approach by the Chronic Reactional Mode (CMR)

Sensitive type (ST) approach

Etiological approach

Clearance of substances, drainage, etc


Immune Dysregulation

Environmental Allergy/Sensitivities

Food Sensitivities

Eczema

Asthma

Autoimmune Diseases

Ulcerative colitis

Crohn’s Disease

Autism

PANDAS

Rheumatoid arthritis

Alopecia


From: Bach JF. The effect of

infections on susceptibility to

autoimmune and allergic

diseases. N Engl J Med. Sep

2002;347(12):911–920.


Allergic Diseases

Presentation by

Cezmi A. Akdis

Swiss Institute of

Allergy and Asthma

Research


It is not Nature vs Nurture

Instead: Nature + Nurture


Systems Biology

“Medical practice is three dimensional chess and yet most practitioners are still playing checkers”


Illnesses do not come upon us from out of the

blue. They are developed from small daily sins

against nature. When enough sins have

accumulated, illness will suddenly appear.

Hippocrates (400 B.C.)

Nurture


“When a patient is sick, the doctor should first regulate the patient’s diet and lifestyle”

Sun Si-Miao


Hahnemann on curable

and non curable disease

Those diseases are inappropriately named chronic, which

persons incur who expose themselves continually to

avoidable noxious influences, who are in the habit of

indulging in injurious liquors or aliments, are addicted to

dissipation of many kinds which undermine the health, who undergo prolonged abstinence from things that are

necessary for the support of life, who reside in unhealthy

localities, especially marshy districts, who are housed in

cellars or other confined dwellings, who are deprived of

exercise or of open air, who ruin their health by overexertion of body or mind, who live in a constant state

of worry, etc. These states of ill-health, which persons bring

upon themselves, disappear spontaneously, provided no

chronic miasm lurks in the body, under an improved mode of living, and they cannot be called chronic diseases.


Environmental factorsDiet and lifestyle

Opportunity for new “targets”


Nature + Nurture

Nurture:

Triggers (sycotic induction) - clearance of effects -

vaccines, viral infections, etc

Toxins, heavy metals, pesticides (detox, body of

substances and hepatic/renal clearance

Hygiene theory/Microbiome - parasites, dysbiosis and

regulation of immune system

Food sensitivities, leaky gut, mucosal integrity -

homeopathics?

Generation of an inflammatory state

Residual damage


Functional Medicine

Lifestyle and Diet

Diet

Stress

Genetic predisposition

Sleep

Physical activity

Healthy Non Healthy

Environmental toxins


Non Homeopathic

Interventions

Determine and eliminate “sensitive” foods (often Dairy

and Gluten)

Organic, nutrient rich anti-inflammatory and

microbiome supportive diet

Avoidance of Pollutants and toxicants

Adequate restful Sleep

Adequate Physical activity

Adequate periods of rest and relaxation

Supportive


Toxins, pollutants and Heavy

Metals

“We’ve got 80,000 chemicals approved for use in

commerce, but we know very little about their

immune effects. Our lifestyles are also different than

they were a few decades ago, and we’re eating

more processed food.” Should prevalence rates for

heart disease and cancer continue their decline, Miller

says, autoimmune diseases could become some of

the costliest and most burdensome illnesses in the

United States.

Fred Miller, director, Environmental Autoimmunity Group at the

National Institute of Environmental Health Sciences in: volume 119

| number 6 | June 2011 • Environmental Health Perspectives

Environmental Factors in Autoimmune Disease

Charles W. Schmidt, MS


Autoimmune Disease and

the Environment

Hereditability of the disease accounts for 50–60 % of its

variance, the HLA-DRB1 shared epitope–containing

allele being the strongest genetic risk factor

active and heavy tobacco smoking which is the most

important environmental risk factor for RA with its

attributable risk sustained for up to 20 years after

discontinuation

Sources of air pollution including traffic and probably

solid fuels are associated with Rheumatoid Arthritis

Is air pollution a risk factor for rheumatoid arthritis?

Mickael Essouma and Jean Jacques N. Noubiap. Journal of

Inflammation (2015) 12:48


There is an association between


environmental Toxicants

Hemdan NY, Emmrich F, Faber S, Lehmann J, Sack U. Alterations of TH1/TH2 reactivity by heavy metals: possible consequences include induction of autoimmune diseases. Ann N Y Acad Sci. 2007 Aug;1109:129-37.

Mishra KP. Lead exposure and its impact on immune system: a review. Toxicol In Vitro. 2009 Sep;23(6):969-72.

Bahadar H, Abdollahi M, Maqbool F, Baeeri M, Niaz K.Mechanistic overview of immune modulatory effects of environmental toxicants. Inflamm Allergy Drug Targets.2015;13(6):382-6.

Suzuki Y, Inoue T, Ra C. Autoimmunity-inducing metals (Hg, Au and Ag) modulate mast cell signaling, function and survival. Curr Pharm Des. 2011 Nov;17(34):3805-14.


What works in the Biomedical

approach to Autism

74% of parents see behavioral improvement

in their children with chelation of heavy

metals


Homeopathic medicines

used in Autistic Disorder

Treatment of Heavy Metals

Alumina

Cadmium sulphuricum

Mercurius solubilis

Plumbum metalicum

Arsenicum album

Petroleum?


Infectious Triggers

Streptococcus

Epstein Barr virus


Homeopathic medicines

used in Autistic Disorder

“Clearance” effect

Medorrhinum

Thuja

Vaccinotoxinum

Streptococcinum

Morbillinum


Diet and Immune Dysregulation

“When diet is wrong, medicine is of no use; When diet

is correct, medicine is of no need.” – Ayurvedic

Proverb

Hippocrates has been quoted as saying “death sits in

the bowels” and “bad digestion is the root of all evil” (400

B.C.)



the Environment

Food Sensitivities

Individuals with autoimmune disease have food

sensitivities - There are many anecdotes of individuals

who show marked improvement or resolution of

symptoms of rheumatoid arthritis in conjunction with

elimination of a particular food. There are also many

individuals with autoimmune disease feel better when

consuming an anti-inflammatory diet, in conjunction

with fish oil supplementation.


Food Sensitivities: Difficult

Eczema Case

17 year old girl with chronic resistant eczema (on body, limbs and face.

No response to conventional medications and no response to experimental medications.

Tried off of dairy, gluten no change

Combination of acupuncture and homeopathy (symptomatic and CRM): 40-50% improvement

Reassessment of treatment protocol (correct)

IgG sensitivity testing: Turkey

Off turkey and completely resolved in 3 weeks


Hygiene Theory: The role of the GI Environment,

Microbiome and Parasites in Immune Dysregulation

Marie-Antoinette

"Qu'ils mangent de la brioche"

(Let them eat cake)

Marie-Antoinette

What she really said:

Qu'ils mangent de la terre

(Let them eat dirt)

Microbiota

“The microbe is nothing, the soil is everything.”

- Louis Pasteur

« La bactérie n’est rien,

c’est le terrain qui fait tout. »

(Bacteria are nothing,

the terrain is everything)

Claude Bernard 1813 – 1878

“If I could live my life again, I would devote it to proving that germs seek their natural habitat – unhealthy tissue –rather than being the cause of unhealthy tissue.”

Rudolf Virchow (1821–1902)


Histopathologic Approach:

Inflammatory Bowel DiseaseInflammation:

Argentum nitricum

Arsenicum album

Mercurius solubilis

Mercurius corrosivus

Nitricum acidum


robert c dumont, md and youngran chung, md cedh ... · robert c dumont, md and youngran chung, md...

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