A good anamnesis saves time

Ulrike Ritz, Naturopath, Warendorf, Germany

Good day to you, ladies and gentleman!

First of all I would like to introduce myself to you. My name is Ulrike Ritz and I have been working as a naturopath for 13 years in my own practice in Warendorf, Münster. Diagnosis and therapy using BICOM® technology formed the focus of my practice from the very beginning and I can confirm that after switching to BICOM 2000 in 2005 I have enjoyed much more therapeutic success.

I am certain that through the seminars, workshops and further training held by Regumed most of you are able to make good, if not very good, diagnoses which go beyond normal medical diagnostics. Nevertheless, regardless of whether we are beginners or renowned experts, we should never forget that every diagnosis starts with a good case history. This is a fact recognised even by long-established conventional medicine whereby a study carried out in Spring 2006 confirmed that, statistically speaking, a doctor who listens to his patient for just 5 minutes longer will make a diagnosis which is around 20% more accurate, although spending longer with a patient certainly isn’t the same as taking a full case history.

Taking an example of a case history for a fictitious patient I would like to explain to you the things which I feel are important to look out for when questioning patients.

1. Name, date of birth, address

At this point I’m already asking my patients with hayfever or allergy-related respiratory problems whether they live in the town or countryside and whether they live in a new or an old house. Old houses and agricultural land with stables and barns often contain stresses caused by moulds. Sometimes there are stresses in old houses caused by lead pipes or in very new houses there may be an additional stress from copper pipes which have not yet been oxidised and are still giving off copper ions and could affect hyperactive children, for example. Furthermore I like to know whether pets are kept in their living area or if they have contact with animals.

2. Occupation/hobbies

I also find details about occupation or hobbies relevant in order to find out whether patients have come into contact with toxic substances (e.g. pesticides when working in the garden, vapours when welding or soldering) or whether they have been exposed to particular physical or emotional strains.

3. Report on one’s own health

After taking down these personal details I let my patients tell me in their own words about their symptoms and ask for more specific details, such as:

• When did the symptoms start?
• Are they persistent or do they come in waves (pains, for example)?
• Are there differences depending on the time of year? Hayfever in spring, late summer or throughout the whole year? Do the symptoms get worse in good weather (pollen or ozone) or when it’s rainy (moulds)? Are there problems with breathing, especially in winter or early morning when in bed (house dustmite allergy)?
• In cases of animal hair allergy: Do the problems arise through direct contact with the animal or do the symptoms appear when cleaning out the cage or stable (test straw)?

• Where there are gastro-intestinal problems: Does the patient feel pain or feel unwell during or after eating? Does the patient feel worse after eating fatty foods (liver/gall bladder) or sweet foods or food containing alcohol (pancreas)?
• Are the symptoms frequent or do they occur regularly at certain times? (organ times taken from 5 element theory)
• Do the symptoms vary when under stress or at weekends/during holidays? (points to problems in dealing with stress or problems with the autonomic nervous system).
• Before the symptoms appeared was there a significant event such as a shock, trauma, major illness, change in lifestyle or living arrangements?
• Are the symptoms worse particularly in the mornings after waking up and do they improve throughout the day? This information can sometimes point to geopathic stresses.

4. Medication

Another important question is that of medication. I like to know what medication the patient takes regularly or as required. Are food supplements also taken? Often I get patients to bring their medication or supplements with them to identify or rule out hidden intolerances. I sometimes find that intolerances have less to do with the active ingredients and more to do with the actual adjuvant or dye from capsule shells or tablet coatings.

In cases where children are suffering from ADD or ADHD I always ask whether the mother was given drugs such as Partusisten or similar during her pregnancy to prevent premature labour since these children often develop a stress later on. (Sometimes it is helpful to have a good link to local gynaecologists to get hold of a test ampoule.)

5. Childhood illnesses, inoculations

Another area in the case history is details of childhood illnesses experienced, such as measles, rubella, mumps etc. and the jabs received. When listing inoculations, it is important to include vaccines given prophylactically for long-haul travel, for example, such as hepatitis, yellow fever etc. If my patient is a child I always ask the age at which they received their first inoculations, whether they received separate jabs (and unfortunately this is very rare) or multiple jabs and whether the child was able to tolerate the inoculations. Inoculations given before the age of 3 are to be viewed critically because the nervous system of the child is extremely sensitive at this age.

6. Operations

In order to gain evidence of possible scar interference fields I find out whether the patient has had an operation. I explicitly ask about dental surgery or whether lacerations were stitched because sometimes it isn’t the large, visible scars that are causing the interference. Small scars made by endoscopic operations, e.g. in the navel following a laparoscopy or through varicose vein stripping, prove significant. 

7. Allergies

Since in recent years a significant increase in allergies has been observed, the question of allergies or intolerances has become one of the key parts of the case history for me. Are patients already aware of their allergies or has an allergy test, such as a prick test, serology or similar been carried out? What were the results? I don’t just rely on test results, however, because where food allergies are concerned results can often be false positive or false negative. When testing I pay particular attention to cross-allergies. The most commonly known cross-allergies are pollen, nuts, malaceous fruits, carrots and grain. Recently I noticed, however, that very often cross-allergies were between grain (especially wheat) and glucose syrup. Sometimes I have only been able to successfully treat a wheat allergy which was resistant to therapy by first treating the glucose syrup allergy.

8. Family medical history

I find that investigating family stresses is part of obtaining a good case history. Questions relating to history of cancer, allergies, metabolic problems such as gout or diabetes, rheumatic disorders or cardiovascular disease are just as important as knowing about nervous disorders such as Alzheimer’s, Parkinson’s disease, MS, depression or psychosis

9. Dental history

In order to obtain information about pathological currents or stresses in the mouth it is important for me to learn whether the patient has various foreign materials such as metals (gold, amalgam, palladium etc), artificial materials or ceramic in their mouth. If this is the case a brief reading of the currents or stress in the mouth makes everything clearer. The condition of the teeth and knowing whether there are dead or inflamed teeth is important for me in establishing whether a focal toxicosis may be present.

10. Nutrition and digestion

During the initial case history I look into the eating habits of my patients. In order to ascertain what food allergies exist I like to know how the patient eats. Regardless of whether they eat healthy, nutritious food or whether they live on fast food, there are cases where an allergy sufferer either develops a feeling of revulsion or shows addictive behaviour towards “their” allergen. I also ask what and how much patients drink and find out about nicotine and alcohol consumption too. This is always in the hope that the patient feels they can be honest with both me and themselves. Since digestion is directly related to nutrition and metabolism the following information is also important for me to know: Does the patient have regular bowel movements? (Whilst remembering that once every one or two weeks may be considered regular but needs to be assessed in a completely different way). Is the stool properly formed or is it thin and mushy or containing bits of undigested food or mucous and blood? Does the patient suffer from nausea, heartburn, stomach ache, a full feeling or bloating? (If bloating occurs regularly, possibly accompanied by hunger pangs for sweet food, I always think in terms of intestinal yeast infections.)

11. Emotional strains

Finally I enquire about emotional strains, grief, worries and problems. Anxiety caused by unemployment, relationship problems or concerns about children can place people under a lot of pressure and wear them down to the extent where psychosomatic symptoms may also occur. As therapists we cannot solve our patients’ emotional problems but we may be able to find out why all our therapeutic efforts are not as successful as we might expect.

CASE STUDIES

To finish with I would like to present to you, dear colleagues, three cases from my practice which once again highlight the importance of a good case history:

Case 1: 60-year-old man
Suffering from generalised, highly inflamed dermatitis with extremely flaky skin. He had already seen a number of doctors and tests had been carried out for psoriasis, neurodermatitis and ichthyosis but all results were negative.
After a thorough case history was taken the patient happened to mention in passing that his symptoms appeared after a stay in Borneo and after he took a malaria prophlyaxis.
The test for stresses through the malaria drug Lariam proved negative, however. When testing for parasites I found plasmodia (malaria pathogens) on the lymphs and connective tissue. His doctor carried out another blood test but did not find any plasmodia and dismissed my diagnosis as nonsense.Nevertheless, I treated the patient with plasmodia and his skin improved considerably and was normal again within 2 months.

Case 2: 10-year-old child
Asthma and neurodermatitis. Diagnosis pointed among other things to an acute wheat allergy. The child abstained from eating wheat while treatment was administered and this proved successful to begin with as the appearance of the skin improved. But there were always setbacks at weekends. When I asked the mother she told me that only at weekends they ate bread rolls for breakfast but at first glance this did not appear in itself to be the reason for the exacerbation in the condition because during the week the child also ate wheat products such as cakes and pasta. Nevertheless, I tested the bread roll, both the top half and the bottom half separately, because the child only ever ate the bottom halves. This showed an allergic reaction to the bottom half of the roll. Later, after some detective work, it turned out that the reason for the allergy was the grease used by the baker on the baking tray.
Another allergy treatment using this grease finally brought about the longed-for success.

Case 3: 8-year-old girl
Known horse hair allergy. I treated the horse hair allergy with the recognised programs. After three sessions the test showed that a stress was no longer evident in this area. I asked that the child be brought into contact with a horse to test the results of the treatment. Soon after visiting the horse the girl again suffered respiratory problems. Following some intensive questioning about the circumstances surrounding the visit my suspicions grew that moulds could possibly be the reason for the problems since the weather was very damp and the horse was kept in an old stable. A test confirmed this suspicion. in this case too treatment of the moulds brought about the success we had been looking for.

And so you can see, my esteemed colleagues, that there is a good detective hiding within every good therapist and citing a quote from the doyen of German literature, Goethe, I would like to encourage you not to give up so easily on difficult cases:

Wer niemals ruht, wer mit Herz und Blut auf Unmögliches sinnt, der gewinnt!

[He who never rests, he who puts his heart and soul into thinking the impossible, will achieve success!]

Thank you for your attention!