A case of heloderma suspectum A case of heloderma suspectum (M. Mangialavori)


- A case of heloderma suspectum (M. Mangialavori)
 Heloderma, or Gila monster, is a strange animal. It stubbornly persists in living in its own way, a throwback to the Oligocene period.
 Heloderma,
 It was first officially reported in 1615, when F. Hernandez, in his Historia animalium et mineralium Hispaniae, gave the first account of a large lizard three feet long, thickset and with strong jaws, protected by a shield of bony warts and vividly colored in red-orange and black, that came from Mexico. The natives called it "Ascatelpon" and the Creoles "Escorpion" (actually names by which they referred to all poisonous animals). The Aztecs believed its bite caused madness, and the animal is often represented on statuary heads of idiots in a form of ex-voto. Its smell was considered deadly.
 In 1882 Wiegman named it Heloderma horridum, a member of the family of Helodermidae, separate from the other sauropods. These animals are so strange that the classifiers thought it necessary to create a special family for them, unique among the poisonous sauropods.
 Another species living in the desert of Sonora, in New Mexico and in Arizona, is called Heloderma suspectum, or commonly "Hila." However the two species are so similar that they are to all intents and purposes the same. H. horridum only seems to grow to a somewhat bigger size, reaching as much as a meter and half in length.
 This sauropod lives in desert areas, on the edges of woods. It is not often seen in the dry season, but is much easier to find during the rainy season. Heloderma hardly ever leaves its territory. During the day it hides in burrows underneath the rocks, and in the evening it emerges to slowly roam around in search of food. It is not an aggressive animal and may be picked up with bare hands without biting. If aggravated, however, it flies into a rage and resists capture. It lives off the eggs of iguanas and birds, which it seeks out among the rocks.
 In captivity it behaves like a nocturnal animal and lies stretched out on the bottom of its cage. It is very difficult to get it to take any food, except for a few eggs. Its behavior is sluggish and unresponsive.
 Heloderma is the only poisonous lizard. It has two large glands situated on its head, which are basically salivary glands, analogous to the mandibular glands in snakes. The mechanism for injecting its venom is however very different from that in snakes. It consists of a set of teeth, each with two grooves in them, in both jaws. When the animal bites, venom flows from the gland and, running through the grooves of the teeth, mixes with the saliva. This is then injected into the victim through each fang. Thanks to the strength and tenacity of its jaws, when Hila bites it holds its grip like a bulldog. The inoculation therefore happens very slowly and does not penetrate very deeply. It always poisons in self-defense; this mechanism plays no role in the search for food or the manner of obtaining it.
 The chemical composition of Heloderma's venom is not very well known, but like that of many snakes, it has a paralyzing hemotoxic and neurotoxic effect. Its initial effect is on the respiratory system, on the heart and the blood, in such a way that death is by circulatory and/or respiratory paralysis, or by thrombosis. The venom causes a sharp pain at the moment of the bite, followed by slight necrosis, a hypersecretion of the glands, marked hypothermia, and significant edema in the affected area. The venom is a fearsome weapon, but more in theory than practice, as fatalities in victims are exceptional. The poison seems to have a curarelike effect in frogs and rats, causing immediate hypotension and a reduction in the flow of blood through the carotid artery. In small animals it causes death within a short space of time, while in human beings it acts differently from person to person. Fatal cases, it seems, can all be put down to a pre-existing state of extreme alcoholism. The venom does not have a hemolytic effect on human erythrocytes, though it does have a slightly proteolytic effect.
 Heloderma can live for twenty years in captivity without ever being very lively. It can stay still for hours or days on end, evincing no sign of interest even in other animals put in its cage. Food-wise it will only accept very fresh hens' eggs, and it can only be induced to swallow them by being grabbed by the neck and having its snout pushed in an egg yolk. Only then, and by no means always, will it decide to stick out its tongue and lap up the egg like a dog, but little by little, with exasperating slowness, as though the act of eating were a serious, difficult, painful task.
 Heloderma's tail is used for the storage of fat, which is accumulated during climatically favorable seasons and consumed in adverse ones. In well-nourished specimens the tail is always swollen and thick, while after a long period without food it becomes quite thin. Heloderma is a very hardy animal, and seems capable of going for long periods without food and drink, although afterwards its body will look quite skeletal.
 The differences between the sexes are so minimal, whether in terms of shape, color or size, that the only certain way of determining the sex is by anatomical dissection. The biological function of the vivid coloring is not very clear, being neither a form of protection nor a means of sexual recognition.
 Although in their natural state they hardly ever come into contact with large expanses of water, they are very good swimmers, and often spend hours immersed in water. If deprived of this activity in captivity they die more quickly and easily. In contrast to other reptiles, saurians are not able to bear very high temperatures, and expire when their body temperature exceeds 45ยบ. Heloderma adapts to increases in temperature in different ways, such as by increasing the surface area of its body or by changing their color to a lighter shade.
 Tommaso speaks up and this time I noticed that he is definitely using many more verbs, and talking in a much more self-confident manner.
 Rx: Heloderma 200c.

 Follow-up
 A few days later Tommaso's mother calls me to say that he has a sore throat. I ask her to bring him in and, looking in his mouth, I see that he has an inflammation and that both tonsils are so swollen they almost touch each other. The submandibular lymph nodes are also swollen, but painlessly. The tongue is dirty and filmed with white; Tommaso's breath is fetid and has a sulphurous smell. He has a temperature of 39.8°.
 I consider this to be a normal reaction to the remedy, and advise her to wait without giving any other treatment. After two days the sore throat is better.
 I see Tommaso again after three months. As on the first occasion, I talk first with his mother. Although she admits that her son has made good progress, she doesn't seem very enthusiastic.
 "We are very pleased because we've seen some progress. Tommaso has begun to talk to us again and every now and then he shows signs of using a verb. His teachers are amazed because he doesn't repeat himself stubbornly any more if he can't explain himself clearly. He just looks for another way of saying it, although still he doesn't use verbs. They say that his speech is more expressive and above all that he is much more willing to make himself understood."
 In view of the mother's coolness towards me, I decide to ask Tommaso in at once, and he asks me, "Us two without mummy?"
 I ask Tommaso if he wants us to talk alone, but I don't understand his reply, so he shakes his head to indicate "no." "Even your mummy isn't with you when you doctor?"
 I ask Tommaso if he means that my mother isn't present either while I'm working. "Right!" he replies, smiling with satisfaction.
 I respond by saying that I didn't know he worked at school. "If you in bed don't eat...if me in bed no eggs or tagliatelle."
 His mother interrupts: "Don't say that now-you shouldn't take that so seriously."
 I ask her to explain. "Today he said he no longer wants to go to school, and we told him that it was his work and that if he doesn't work he doesn't eat."
 Tommaso interrupts in a sarcastic tone: "Grandpa goes for a walk." His mother replies, "Grandpa worked hard when he was a boy." "Tommaso too," he answers back.
 I am very struck by Tommaso's irritated reply. I ask him if his grandpa used to like his work. "Grandpa old carpenter, you can see what he did. Lots of furniture, doors, windows. You don't see Dad's work-coffee goes in the stomach."
 I ask Tommaso to tell me more about his work. "It's difficult... not very, but quite. The table, homework, drawings, room, toys. Always everything tidy." Having said this, Tommaso looks away, as he did before.
 I ask his mother if he had any other episodes of tonsillitis in the past. "I forgot to tell you, but you know, I've got three children, He always used to get sore throats and we often had to give him antibiotics. At one point the pediatrician put him on a course of penicillin for almost a year and after that he didn't get sick any more."
 I ask her if she remembers when it first started. "When he was three years old. But I don't think it has anything to do with the birth of his sister. I had tonsillitis too when I was a girl, and I wasn't jealous." She says this in a very irritated way, though I hadn't mentioned the birth of his sister.
 Feeling that the prescription was correct and the remedy was working, I decide to go up in potency to give Tommaso a bit more help.
 Rx: Heloderma 10M.
 Four months later I see Tommaso again. This time he comes with his father, who doesn't seem particularly well-disposed towards me either. He apologizes for his wife's absence. "I came with my son this time because my wife says she can't get on with you. She says that she feels judged by you. This is a problem my wife has always had, even when we went to the psychologist. But she asked me to tell you that we are very happy because Tommaso is getting much better. His teachers say that he is making big leaps forward. He has even lost weight and started to go swimming. His food cravings have also changed a lot: he eats far fewer sweet things and doesn't ask for eggs as much as before. He sleeps well in his room and doesn't need the light on in order to go to sleep.
 Tommaso speaks up and this time I noticed that he is definitely using many more verbs, and talking in a much more self-confident manner: "I'm not scared any more. Why should I be frightened? I know that there's nobody in the dark, and anyway I sleep with Lucia (his little sister). Now we get along and we sleep holding hands. We love each other very much and I'm teaching her to talk. I've had so many speech lessons that now I know everything. I can teach her better."
 His father continues: "We really are grateful to you-it seems that his treatment is working very well."
 I ask Tommaso to draw me a picture and he draws three parrots. They are all different sizes, and the one in the middle has its beak open. I ask him what the parrots are doing. "The one in the middle has woken up and is yawning; the other two are waiting so that they can sing together."
 I ask him to tell me about the parrots' mother and father. "They are looking for something to eat while the parrots play."
 I ask what will happen when they get back to the nest. "They'll sleep because they're tired."
 I ask what the little parrots will do. "They have to sleep too. But the one who's yawning has just woken up and isn't so sleepy. Even the others don't want to sleep very much but they make them poo in their pants. (He means that the other two parrots are scared of their parents and so they go to sleep even though they don't want to.)
 I am convinced that Tommaso is much better and still making good progress. His father, however, would like to see more and insists on "a stronger dose."
 Rx: Sac lac.
 After that, I don't see Tommaso for several months. His father calls me once when he has chickenpox, but on this occasion too I prescribe Sac lac and the illness takes its normal course without any complications.
 I do however hear about the boy from his aunt, whom I see regularly. It seems that the mother really bore a grudge against me and, to be honest, I too found it difficult to get on with her on the two occasions when we met.
 I am however very pleased with Tommaso's progress. His aunt confirms that the speech problems have almost disappeared and the tonsillitis has not returned.
 One year after Tommaso began to get significantly better, his mother fell seriously ill-a nervous breakdown, according to the aunt. She is currently under psychiatric treatment, and has been hospitalized on several occasions.
 I see Tommaso again after an interval of two years, one time when his aunt brought her daughter in to see me and took him along too. I only have the opportunity to exchange a few words with Tommaso, but I notice the richness of his vocabulary and a clearness of exposition appropriate to a boy of his age. We spend a few minutes talking in the waiting room, and Tommaso doesn't miss a single verb. His speech is much more fluent.
 His aunt has repeated the remedy twice for slight sore throats, once last winter and then a few weeks ago. In both cases Tommaso recovered well without getting tonsillitis as he used to in previous years.
 She told me that her brother hadn't thought it necessary to bring the boy back to see me as he considered him cured. She also told me that he was sick and tired of consulting doctors and that he considered me the last in a long line of doctors who had made his wife fall ill.
 Tommaso's aunt hasn't managed to follow her nephew's and nieces' progress so easily because of the difficulty of her relations with her sister-in-law. When she began to be hospitalized, the aunt came round every day to look after the children. She clearly has an excellent relationship with them.
 I have published this case of Heloderma because it seems the most interesting of the ones I have seen so far. I don't think one can say that Tommaso has resolved all of his problems in depth, given the nature of the family pathology, but his reaction to the remedy is very interesting. In particular, his acutes also responded to Heloderma, which I consider an essential confirmation of the correctness of a prescription.
 I ask the aunt to keep a close eye on Tommaso's development, especially during adolescence. I think I can count on her help in the future.
 Repertory additions for Heloderma suspectum, taken from the 3rd volume of Massimo Mangialavori's Additions to the Repertory:
 MIND; CHILDISH behaviour**
 MIND; FEAR; animals, of; cats, of*
 MIND; FEAR; animals, of; lizards, of**
 MIND; FORSAKEN feeling**
 MIND; HOUSEHOLD DUTIES; aversion to***
 MIND; INDOLENCE; aversion to work***
 MIND; OBSTINATE, headstrong**
 MIND; SLOWNESS***
 SKIN; CRACKS, fissures; cold weather agg*
 GENERALITIES; EMACIATION**
 GENERALITIES; FOOD and drinks; eggs; desires**
 GENERALITIES; MENSES; agg.; before*
 Massimo Mangialavori trained as a pediatric thoracic surgeon. He was introduced to homeopathy while studying medical anthropology with a South American shaman. He lives and practices in Italy. Massimo can be reached by e-mail at mamuiol. it

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