MIASM CASES

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MIASM CASES
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CASE 1

• KOCHS KNEE JOINT

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KOCHS CASE

• MR M.S.
• c/O Pain And Swelling In (L) UPPER-Tibial
  Region ?15 Days.
• Fever For One Day Only
• ? Recurrence Of Koch's AS IN PAST at same lacation

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H/O KOCHS

• H/O Koch In 2001?Left Knee And Left Ring Finger.
• (Took Rx For 2 Yrs, A 1 Year Pain Persisted
  AND ltTension
• Showed Resolution ? Rx Was Continued For 2 Yrs
• NOTE THIS SPEED WITH AKT IN PAST

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OUR HISTORY

• Patient Is A Software Engineer at job
• B Sc Graduate, Then Did Law, Computer Courses
• Stress Period
• In 12th STD, Did Not Get Enough
  Marks To Pursue Computer Engineering.

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• Was Depressed For Almost 6 Months. He Felt Like A
  
• Failure? But Gradually Came Out Of It,
  Successfully Completed His B.Sc Did Law And
  Software Computer Courses

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Stresses mount

• 1999? Went To U.S thru a Friend But He Did Not
  Get What He Had Expected. He Would Get ¼ Th Of
  Salary.
• His Aim Was To Work Hard And Earn Lots Of Money
  Staying There For A Few Yrs .but..
• FEELING FAILURE

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Usa sour grapes

• When He Comes Back To India, He Can Have A
  Comfortable Life. ? That Did Not Happen, He felt
  like A FAILURE.
• Felt Betrayed and Felt That You Cannot Trust
  Anyone.
• Therefore He Did Not Achieve What He Wanted Came
  Back To India, In 6 Months

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Uk grapes ??

• In 2000 ? Got A Job In London InBritish
  Airways. Things Were Moving Fine,
• But When The Company Was To Shift Its Base To
  India .
• But He Wanted To Stay There For Few More Months,
  So That He Could be secure.
• SO FEELING FAILURE
• THEN ALL THE Symptoms Started

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FOXING SYMPTOMS

• Arthralgias knees joints and elbow joints for
  few days swelling around the knees.
• ?Then
• Fever of 102?F?lasted only for 4 days
• During fever ?felt extremely CHILLY³-generally
  feels ambi towards hot (Needs A.C all the time)
• Thirst ?? (felt thirst less)-generally drinks
• Almost 2 L of water /day.
• Temperament Extremely dull and irritable

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TROUBLES WITH Rx

• Came back to India- and was empirically
• Treated for malaria.
• After 15 days developed severe RASH.
• Diag Steve JOHNSON SYND (1st time developed
  rash a taking the medicine).
• In childhood had taken antibiotics several time
  for recurrent RTI ? but never developed any drug
  reaction that time )

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diagnosis

• After investigation and M.R.I confirmed koch-
  left knee and left ring finger started c AKT
  was fine after taking Rx for 2 yrs

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• NOW In 2006, currently is
• ? work stress ? sometimes, as things
  arent going the way he wants.
• RETURNS ARE SLOWER THAN EXPECTED ? feels FAILURE

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STATE WITH ILLNESS

• Mental temperament during illness
• Feels dull and irritated
• ?
• Says I ALWAYS need to move around
• during illness I cant move around so I feel dull.

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WHERE IS FAILURE?

• I have decided lots of things ?about my work. I
  have this and that- work remains pending, so I
  feel upset about it. I start feeling INSECURE.
  Insecurity comes up because of fear and failure.

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CONCOMITANT STATE

• During illness I become weak, makes me feel weak
  so I feel that I am weak .
• Insecurity means weakness. If I am weak lots of
  risk involved cause I am not able to work, , I
  will not able to earn. If I can not earn? I am
  failure.

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CONTD

• Failure to support my family members. People who
  are dependent on me. Because if I fail, then I
  will be dependent on some one
• If I am dependant I feel very depressed because
  it is my habit to do my work myself. If I cant
  do it I am a failure. Failure means to be
  dependant on someone

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CONTD

• ambitions regarding my career. I want to reach
  the highest position to a level where
  everybody, looks up to you, where you guide every
  thing, you get lot of name and fame means to
  earn lots of respect and money. So that you are
  an authority. Makes you feel a sense of
  achievement

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GOAL ? POWER?

• This is a goal which I have set for my self and I
  want to reach there
• Authority means I get power. If I get this power
  I would feel the best that would be the best
  thing that could happen to me
• FAILURE NOT GETTING NEAR THIS GOAL

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INNER WISH

• childhood very CREATIVE.
• drawing and Sketching good at landscapes and
  still life.
• Very vast and open serene, greenery I feel
  quite relaxed.
• (Has bought a house opp . Powai lake so that he
  can see natural beauty from his house.

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BUT YOU CANT TAKE CHANCE

• SO I AM organised person. THINGS MUST BE In
  its place and clean.
• in particular order. There should be a sense of
  discipline.
• I have set rules for myself and live my life
  that way. when things dont work the way I want
  , I Get angry and I shout I'll tell the person
  what to do , and Ill wait for some times.

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GENERALS

• Desireschicken³, sweets³
• Thermals generally hot (during fever?chilly³)
• Needs A.C all the times.
• Recurrent tendency to catch cold cough ?
  childhood allergic colds lt in a warm room ,
  exposing to heat starts c but of sneezing
  watery

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ADDITIONS

• Pains splinter like pain at the operated site
  pain lt initial motion³
• gtc conditions motion.
• Dreams ?of finding a solution to his problems.
  Sorting out issues.
• ?Open spaces- nature leisure.

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NOTICEABLY ABSENT

• NO ISSUES ABOUT WIFE
• 
  CHILDREN
• PARENTS
• ONLY ME !!!!

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CONCEPT of kochs joints

• AGENT
• 1.GERM THEORY-
• DISEASE AGENT?MAN?DISEASE
• AGENT Mycobacterium tuberculosis
• 2.EPIDEMIOLOGICAL TRAID-
• 
  

ENVIROMENT Poor quality of hygiene--Droplet
infection Poor housing
/ overcrowding
AGENT M. Tuberculosis

• Host factor
• Susceptibility
• Nutrition
• Mental- sensitivity
• Genetic factor

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CLINICAL FEATURES

• Symptoms
• General features
• Fever- evening rise of temperature
• Fatigue
• Anorexia
• Weight loss
• Local
• Kyphus/ Gibbus- (is due to local abscess
  formation and sometimes may be too small to be
  evident)
• Mild Backache- it may be minimal in comparison to
  a potentially crippling disease
• Joint stiffness or spasm
• Signs
• Synovial thickening
• Muscle wasting
• Abscess- typically cold abscess (not red, and
  slightly warm)
• Range of movement is painfully restricted
• Spine tenderness
• Kyphus

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Investigations

• Haematology Raised total counts and lymphocyte
  counts haemoglobin may be low.
• ESR is raised
• Mantoux test- Positive
• Radiology
• Bone density is slightly reduced
• Soft tissue swelling
• Disc space is reduced
• Bone Destruction (Anteriorly of two adjacent
  vertebral bodies)
• X Ray Chest to rule out Pulmonary Tuberculosis
• Computerised Tomography
• Histology
• Bacteriology

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FACTORS OF BACTERIOLGY

• ? causative agent mycobacterium tuberculosis
• ? Acid-fast bacilli.
• ? Resistant to intracellular killing.
• ?Three types cause Koch's in men i.e.
• 1) Human type M. tuberculosis.
• 2) Bovine type M. bovis.
• 3) Atypical mycobacterium saprophytic
• i) photochromogens e.g. M. Kansasi.
• ii) scotochromogens e.g. M.scrofulaceum.
• iii) non-photochromogens e.g.
  M.intercellulare
• iv) rapid growers e.g. M. fortuitum.

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Natural history of disease

• a) Prepathogenic phase
• Mode of spread
• 1) Blood bornecommonest type
• 2) Lymph bornerare type
• Varieties
• Centraldisease start as diffuse osteomyelitis in
  middle body.
• Metaphysealdisease arises near epiphysis of bone
  and involves body of epiphysis. (Commonest)
• Anterior or posterior varietyfocus lies beneath
  anterior longitudinal ligament. (Rarely in
  adults)
• Appendiceal tuberculosistransverse process
  rarely vertebral arch affected

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Progress of Disease

• Related to reactivation of
  hematogenous foci or to spread
• from adjacent Para vertebral
  lymph nodes.
• Primary source of infection most
  often from the urinary
• tract, skin or lungs.
• Also considered as metastasis
  process resulting from
• hematogenous dissemination of
  tubercular bacilli.
• May begin in vertebra or inter
  vertebral disc involving
• adjacent structures.
• As tubercular process advances one
  or more vertebral
• bodies collapse causing an
  angular kyphsis (gibbus).

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Pathogenesis

• Tubercular bacilli after settling cause
  tubeculous endarteritis.
• In devitalized tissues tuberculous follicle is
  formed which grows slowly to form
  
  
  
  
  visible
  yellowish gray nodule.
• This nodule grows bony lamellae around it that
  gradually rarify and disappear.
• This leads to vertebral causing kyphosis,
  gibbus or hump back.
• Complication 1) abscess formation
• 2) Potts paraplegia

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Agent factor

• Low permeability of cell wall makes agent
  resistant to antibiotics.
• Liparabinomannan, a molecule in mycobacterial
  cell wall involved in pathogen-host interaction,
  facilitates survival of pathogen in macrophages.
• Virulence of bacilli is determined by its lipid
  rich cell wall and glycolipid capsule both of
  which confers resistance to compliment and free
  radicals of phagocytes.
• Few genetic factors and strains also determine
  virulence of bacteria.

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Host factors

• Age early childhood, majority between 3-5 years
  of age.
• Malnutrition and sever underweight.
• Individuals innate susceptibility to disease
  and level of function of cell mediated immunity.
• Few genetic factors determining hosts
  susceptibility to TB.
• Bactericidal activity of macrophages.
• Balance between hosts responses
• 1) Tissue damaging response
• 2) Macrophage activating response
• Interplay of various cytokines and their cross
  regulation determines hosis response.

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Environmental factors

• Prevalent in developing countries.
• Poverty
• Homelessness
• Overcrowding in poorly ventilated rooms.

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Psychological Factor

• Known to occur in individual with hyper
  sensitivity
• Kwon to occur during major psychological stress
• Historically it use to occur to painters,
  sculptures dramatist with artistic sensitivity.
• Premorbid Morbid personality

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Risk factors

• Immigration from countries with high prevalence
  of tuberculosis.
• HIV infection.
• Drug abuse.
• Dismantling of health services.

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3.MULTIFECTORIAL CAUSATION ?AGE FACTOR BELOW 5
YEAR ?SOCIAL FACTOR Poor quality of life /
Large family/ Lack of education
Lack of awareness of cause of
illness etc ?ECONOMIC FACTOR
MODEL Poor
housing factor 1
malnutrition factor 2 reaction
at cellular level

factor3 ?CULTURAL FACTOR
DISEASE
Overcrowding Population
explosion ?GENETIC FACTOR Not hereditary
disease but inherited susceptibility. ?
PSYCHOLOGICAL FACTORS Hypersensitive
individuals
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WEB
OF CAUSATION THIS THEORY SUITED FOR STUDY OF
CHRONIC DISEASE WHERTHE DISEASE AGENT IS OFTEN
NOT KNOWN BUT IS THE OUT COME OF INTERACTIONOF
MULTIPAL FECTOR CHENGE IN LIFE
STYLE ? STRESS /
AGE
SMOKE Poor
nutrition hard working
long time sitting
standing Lean,thin,debilited more stress on
vertebral body vital breathing
capacity of lung person
( T 10 L 2 ) Immunity
IV DISK softening or compressed
thickness of wall surface
area Decried affect
central tissue
destruction
primary infection in lung Part of vertebra
hyper sensitive to infection
childhood

secondary infection peripheral
pott's spine
Part of vertebra advanced age
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Homeopathic Perspective

• Holistic concept
• Integrated concept of Health Disease
• Covers mind to miasam

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MAINTAINING CAUSE

• Basically over here, Channalizes his whole energy
  in reaching to the top.
• He wants success and his stress as regarding how
  he can reach at the top-fastest.

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Trying to resolve

• Take home messages given to him
• ? in stress lot of energy spent in it , makes
  you feel drained out, it kind of fires your
  immunity. If this energy is saved, you can
  utilized it in your work c_ would give you much
  more positive output.

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Dont get stuck

• E.g. you are on the 10th floor
• and want to go on the 15th floor instead of
  living in stress as to when youll reach the 15th
  floor.
• Where you are declined to reach
• -enjoy the journey
• from 10th to 15th floor

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contd

• ? Illness come in our lives for reason - when we
  are moving too fast, exhausting all our
  resources, it puts a break so that we charge our
  selves up and move ahead

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CONTD

• e.g. when we overload our hard disk, programming
  get, affected and the whole system crashes down
  so we have to again organize the whole thing
  again before we can function normally again.

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TOTALITY

• SELF CENTERED EGOCENTRIC
• INDUSTRIOUS AMBITIOUS
• SENSITIZED FAILURE OF GOALS
• A/F ANXIETY DEEP SEATED
• ? KOCHS JOINT SYCO-SYPH
• SPLINTER LIE PAINS
• gt CONTINUED MOTION
• HOT PATIENT.

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Kali Iod

• FEELING OF BEING DECEIVED
• ATTACHMENT TO SELF OVEROCCUPIED ABOUT SELF?
  KALI
• SPLINTER like pain (at joint)
• TUBERCULOSIS OF JOINTS
• COLDS from exposure to heat
• Coldltwarm room
• HOT salt of kali
• H/O In Childhood
• Not putting on weight in spite of eating
  well

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Rx

• Remedy given
• kali iod 200 one dose
• Response he has improved quite well in all
  respects.PAINS ZERO NEXT DAY
• Kochs lesion improvement faster ,as per
  orthopaedic surgeon.

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FINAL RESULT

• ALTOGETHER 3 DOSES IN 4 ½ MONTHS DECLARED CURED
• He has restarted painting
• Has refused a job abroad for family
• Much better with family
• NOTE SPEED OF RESPONSE
• depth of result

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CASE-2

• Miss S F/10 27/7/02
• H/O Fall In Last Sept
• Injury To Lt Elbow
• Operated March02.
• Complaining Of Restricted Movements Of Lt Elbow
  Joint ltLifting Any Object, ltFlexion At Elbow

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CHIEF COMP

• Joint Normal Prior To Injury,
• Plaster On Lt Elbow Jt For 45 Days But Couldnt
  Regain Her Movements. Operated In March02 At
  Benaras
• But Still Complaining Of Restricted Movts Pain
  On Lifting Any Objects.

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C/C contd

• O/E - Tenderness Site Of Operation. Movt
  Elbow Joint Above 90, Linear Scar With Outline
  Mark Lips.
• Palpn - Local warmTenderness.
• Large mass around elbow
• So conclusion Fracture Humerus ?gtMal-united
  with soft tissue mass around ie Myositis
  Osscificans

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investign

• Investigation Report Done On 11/9/02 -
• Serum Alkaline Phosphate-321 U/L
• Xray - Left Elbow Joint AP Lateral--gt Evidence
  Of Old Fracture. Olecronon Process Of ulna
  Fracture Fragements Unfused. Doubtful Old
  Lower End Of Humerus. Surrounding Soft Tissue
• swelling

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generals

• Lean Thin. Crave - Spicy, Sweets, Biscuits,
• THERMALS - Chilly
  Thirst - 2-3 Glass/Day.
• BACKGROUND - Patient Is Staying In Village With
  Mother, 2 Sister, 1 Brother. FATHER IN JOB HERE
• MOTHER NOT HERE

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Mind contd

• Come To Mumbai for 3 Months For Her Treatment Of
  C/C.
• Doesnt Like Here. Likes Over There To Play With
  Friends, Going To School. Likes To Go In Fairs,
  Ballons, Playing Games. With Friends

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Mind

• Shy Initially Then Mixes. And Mild with
  Strangers, so Late Mixing,
• Close To Friends. Likes Physical Active Games.
• Observation - Constantly Face Down. Constantly
  Fidgety With Fingers.

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SEE HER
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Rx ?Had received many medicines

• Last Rx was Failure on calc flour 6x qdsgiven at
  previous clinic for 3 months
• we began by calc phos 30 single dose.
• her pain subsided.
• movements remained same for 2weeks.
• Mass same size for 2 weeks.

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Later multiple doses

• calc phos 30 hs daily ? bd
• Then in 2 weeks stiffness gt 25
  Scar tenderness-0-.
• Tds ? qds done in next 4 weeks whenever
  improvement halted

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TO GIVE OR NOT TO GIVE

• with calc phos 30 qds.
• in next 4 weeks rom 0-100
• gt50
• Next SL ? SQ FOR 2 WEEKS
• AGAIN gtgt calc phos 30 qds
• ANOTHER 4 WEEKS rom gt 75

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Post -Rx

• Xray On 2/1/03 - Juxta Articular Demineralization
  Seen. High Suspicion Of Old Healed
  Supracondylar Region Humerus.
• Soft Tissue Swelling regressed completely
• 2/1/03 - Alkaline Phosphate 154 U/L

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Now listen to conclusion
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PLEASE NOTE

• PATHOLOGY 1 YEAR OLD .GROSS
• IMPROVED ACTUALLY IN
• 3 MONTHS
• NOTE MIND AND GENERALS
• NOTE SPEED OF RESPONSE

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DOES IT MEAN

• ALL PATHOLOGICAL CASES NEED
• MULTIPLE DOSES ALWAYS??
• NO
• we already saw in case1

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CASE 3

• ADVANCED PATHOLOGY CASE

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Young age disability

• 10 A case of bilateral avascular necrosis of
  the hip joints
• Name Ms. ab
• Age 28 years
• status Single/unmarried
• Religion and Caste Hindu, from mp,
• Backward class

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1st look

• B.Com working as acctant
• Appearance Tall, thin,
• with acne on face, predominantly on the left
  side

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generals

• Desires Spicy2, rice products2
• Thirst Thirstless, mostly
• Stool Irregular bowel movements
• perspiration Forehead3, upper lip3, back,
  sternum2.
• Sleep Disturbed. Wakes 2-4 times at night
• Position On . Sides, on2.

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• OTHER GENERALS
• Menstrual Cycle 10-12 days LATE
• Colour reddish black
• Complaints before Mild pain abdomen one day
  before the menses

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GENERALS

• General Reactions
• Hot thermal state, i.e. uncovering3 AND, wants
  fan full throughout the year, bathing cold in
  summer and lukewarm in winter.
• Getting wet causes stiffness in all the
  joints
• Noise gets frightened.
• Sun causes headaches3

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• Family History
• Father had myocardial infarction twice
• Mother weakness of bones (?osteoporosis), T.B.
  spine
• Past History Jaundice two years ago. Chest pain
  as of pin pricking3. Better with doctors
  medicine for circulation. Now the pain occurs
  off and on.
• Surgical history Core decompression of necrosed
  hip 6 years ago

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• Life situation and mental characteristics
• My main problems are at home because of my
  father. He is very egotistical, short-tempered
  and strict. He doesnt like to be contradicted.
  Not just me, but everyone fears him. My eldest
  brother left the house because of him.

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FATHER AMBI-VALENCE

• Father is a very hardworking person. He didnt
  have a job, but by hard work, he has done a lot
  of things. Actually I love him, but tensions are
  created because of him.

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OH WE ALL SULK

• He should consider the feelings of the family
  members. often uses very bitter words even while
  saying something simple. He gives more importance
  to society than to his family. He has this
  misperception that we his children will not take
  care of him in his old age.
• Just compares and curses

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HE IS GOOD BUT

• But he is also very good. He has never refused us
  anything, provided that he also likes the same
  thing. He may have gone without new clothes, but
  he never kept us without clothes. He has taken a
  lot of trouble for us.
• However, we were of zero value to him. Thats
  why we girls never made any friends and even if
  we did, we gave them up.

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LIPS -CLOSED -FAMILY

• We all loved him, but now we hate him. But none
  of us shows it openly in our words. Out of the
  house, with others I talk, but at home my lips
  are locked, especially when Fathers at home. I
  just dont feel like saying anything. I feel as
  if theres nothing interesting in life. At home I
  am very obstinate, and outside just the opposite.

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HOW DEPRESSED

• Initially I was very outgoing, used to speak a
  lot, make many friends. I used to talk about my
  feelings, but when father realised that, he
  opposed me. After that, I stopped talking. I
  cannot express myself now. I have lost all my
  friends because of father., I feel I have lost my
  sense of humour.

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SUICIDAL

• Because of this, I feel I am not capable of
  mixing with others. I have only a few friends,
  and even to meet them, I have to sneak out of the
  house. At times I feel like leaving my home, and
  at times I even think of committing suicide.

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Jail and rules

• I tried to leave the house two or three times,
  but a friend kept counseling me not to. I myself
  only know what I am going through what I am
  suffering. Some things just cross the limit.
• Recently A boy from another caste proposed to me.
  I told my father about this. He opposed it very
  severely. I want to get married to him. I told my
  parents that if I dont marry this boy, I will
  not get married at all.

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jolt

• Two years ago I wanted to get married to a boy
  (love marriage). I TOLD ABOUT HIM in the morning
  and in the that night itself Father got him
  arrested. Later I came to know that the boy had
  got married elsewhere. At that time I felt
  relieved that I had got free from the hassle.

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Dominated

• I am very much troubled whenever there is a
  discussion on the issue of my marriage. If I say
  anything, I am emotionally blackmailed, but Im
  scared that whatever my parents say, I wont back
  off in doing that.

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Depressed ? failed

• My education was very disturbed. I did not clear
  my T.Y. even at repeated attempts, because of
  illness. My confidence decreased. I could not get
  a good job, though I am capable.
• I have had to face failure at many times.
  Appeared for M.Com Part I exam, but again proved
  to be a failure.

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At work it reflects

• Work situation Now at my work there is a lot of
  work pressure and less pay. I have not much
  financial satisfaction, but I like the nature of
  the work. There is frustration, insults. If
  someone scolds me, I would make more mistakes. If
  the same thing is said nicely, I would do it
  better. I cant say no to work.

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• I do everything conscientiously, no matter how
  difficult the task is. But, on the other hand, if
  I show too much honesty, I get frustrated,
  because all the responsibilities come on me. If I
  am alone, Ill do all my work properly and with
  full interest, but if theres someone else, Ill
  do it lazily.

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reactions

• If I am asked to talk to anyone superior, then I
  start getting palpitations. Also, if an elder
  commits a mistake, I get very scared to tell him
  about it. I also fear to face a crowd.
• I dont feel like pursuing any of the hobbies I
  am interested in. I like to travel, but cannot do
  so because of my situation

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Sensitive

• Sensitivity I behave according to the situation.
  I feel bad when somebody says something bad about
  someone, without any reason or without
  understanding the situation properly. I dont
  like gossiping. If I hear people gossiping, I
  leave the place.
• I have no sense of humour. Anyone will just come
  and make fun of me. At that time I feel very
  small. I feel bad that I do not have a sense of
  humour.
• My acne is my only social difficulty. People
  question me about it wherever I go. Therefore, I
  dont mix up with anyone.

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now

• Now I like to be alone3 .
• desire for quietness3. Sometimes I visit Mahim
  Church, after that I feel calm.
• I feel like crying when I am alone. Wake up at 2
  or 3 in the morning and weep, thinking that
  whatever I have thought to do in my life doesnt
  happen. Even if I dont weep, I feel uneasy.
• Consolation I do not react, because they do not
  know what I am going through. I dont actually
  share my feelings with others. I just say I feel
  better for their sake.

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now

• Anger when someone says bad things about others
  without any reason.
• Fear have the illusion as if suddenly suffocated
  or strangled. Even occurs during the daytime. At
  night I dream about this, or have a feeling that
  I am suddenly being strangled or suffocated
  throw the bedsheet aside have to go out of the
  room, stand outside, then feel better

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dreams

• Dreams Daily, especially in the early morning3,
  around 4-5 p.m.
• Ghosts3, Monsters3 coming to kill me, pulling my
  leg, throttling me, pressing my mouth. Then I
  feel suffocated and begin to perspire.
• Accidents3, of self and others
• Death of self and close friends. See myself
  lying dead.
• Dead neighbour whom I was very close to, and who
  had expired one year ago, seen coming behind me
  to speak to me.
• Murdered, being3. These dreams are recently
  appearing more frequently since my elder brother
  went missing some time ago.
• All are laughing laughing so bad that my
  head will burst.

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additions

• FATHER IS A POLITICIAN
• Sensation of pin prick at the region of hip and
  at the site of operation. Repeated poking
  sensation at one point particularly, for the past
  2-3 years. Agg sitting
• L R hips terminal flexion, abduction, adduction
  painful and restricted
• Pimples for the past 7 years. Discharging yellow
  fluid and blood. Starts with left side of the
  face, followed by the right

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TIME CORRELATIONS

• 1st AVN WITH SMALL INJURY IN SHORT TIME
• RECURRENCE IN 3 MONTHS AFTER LOVE MARRIAGE PLAN
  SHATTERED
• NOW WORSE WITH DENIED
• FOR OTHER CASTE BOY

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AVN GRADES

• 21/06/2003Fresh X-RayGrade II-B avascular
  necrosis bilateral, with minimal head extrusion.
• Clinical diagnosis Bilateral avascular necrosis
  of hip joints, with reactive depression and acne.

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Rx

• Treatment started from 30th of June 2003
• Remedy given Staphysagria 200 ONE DOSE, SHE
  IMPROVED IN DEPRESSION. BUT PAIN MOVTS ltlt
• then H.S DAILY. for a month, then B.D. for some
  time, then T.D.S., then Q.D.S. Pain subsided
  completely by February 2004.

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Her overall change
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Dr mamtoras obsevations
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Brief summary

• Investigation
• Feb 2004 XR both hips. Compared to the earlier
  one, it showed much better quality of bone,
  sphericity of head better, cystic changes almost
  gone.
• 10/03/2004 M.R.I. Scan reveals Grade III
  avascular necrosis both femoral heads. Changes
  due to core decompression on both sides. Changes
  due to secondary osteo-arthritis.
• 14/03/2004
• Assessment by orthopaedic physician Very good
  acetabular cover. No further collapse of head.
  Minimal oedema (bright on T2). Osteo-arthritic
  changes very minimal. Impression Doing well. AVN
  has stabilized.

102
How come ?

• 1st phase one dose ? daily till
  depression clear
• 2nd phase doses contd and TUB BOV 1M ONCE
  A WEEK
• Patient did well ,all accounts,
• Also radiologically

103
later

• 3rd phase after 2 years
• we thought of SL
• AND IN A FEW MONTHS
• PAINS WORSE
• RADIOLOGICALLY WORSE
• SUDDENLY

104

• CLINICALLY BETTER
• WITH STAPH MULTIPLE DOSES
• BUT WE DIDNT START
  INTERCURRENT
• SO CLINICALLY BETTER
• BUT RADIOLOGICALLY SAME

105

• LAST PHASE
• TUB WEEKLY
• RADIOLOGICALLY STABLE NEXT 6 MONTHS

106
Something something by homeopathy

• After the pain subsided, Staph 200 was given a
  dose at a time, or on a S.O.S. basis infrequent
  doses
• Last follow-up 28/07/2004 No pain. Sleep
  normal. Left hip tenderness much reduced.

107
APPLYING LEARNING

• CASE 4

108
Case of bronchial asthma ending into pneumonitis.

• Y P m/8 yrs UP ITE TROM SLUMS
• SON OF A GARAGE MECHANIC
• came to us for c/c of
• Cold, cough ending into BL since 8 months of age
  which was better only by IV medications.
• Had Pneumonia at 8 months of age, hospilalised
  for same
• Also had h/o of eczema Rx with steroids.
• .
• Also rec Severe Tonsillitis.

109

• Our Observation in chronic evolution
• Cold cough immediately leading into BL
• Thin person with prominent jaw
• Never well since Pneumonia 8months
• Poor thriving worse last one year
• Milestone Talking late
• Eczema suppressed with steroids
• Restless Activity shouts at brother at not given
  things, weeps if console, shouts at mother

110

• 8) Continuous ceaseless activity
• 9) Good in maths
• 10) Mischevious
• 11) Loquacity
• 12)Asthma needing steroids
• 13) Tubercular miasm
• Based on above few characterstic we started with
  Tub 1M

111

• Was doing fairly well with Tub
• 18/11/03 to 5/04/04
• Cold, cough 8episode
• Gen all ok
• Teeth grinding SQ
• One episode acute BL with GIT episode vomitting n
  pain gt2 with Ars alb 200

112

• 12/6/04 to 20/12/04
• Cough Occ BL
• Eyes- redness, lachrymation
• Diagonsed as nasolachymal duct with
  dacrocystistis Rx Tub 1M
• 1 episode GIT severe pain
• Hospitalised for 2-3 hrs
• Diagnosed as worms n discharged
• Constipated hard stools.

113

• 21/12/04
• Fever episode,
• Sudden chest pain for 1-2 hrs.
• Fever, dull moaning yest app decrease
• Weeping, snoring loudly even during day time
  small siestas.
• Irritable yest Quiet today just not talking

114

• Nauseated3 Vomitting
• Cough SQ
• RS ltlying down

Absolutely non responding to calls or
pinches. Then Sleeping LIKE A DEAD BODY gets up
on its own for a while. Laments about noise n
then gets again.
115

• O/E
• RR- 60/min
• BIL Air entry low
• Crepts faint.

116

• BRONCHO PNEU
• CNS HYPOXIA
• TEMP-DELERIUM
• STUPOUR-HPOXIA INFECTION
• MELANCHOLIC
• FEIGNING
• HYS
• RS ACIDOSIS
• PUP REACTION
• TUB MEN

117

• ObjectivesPRIORITIES
• Relieving the distress
• Faster resolution.

118

• TOTALITY
• Sudden Onset
• Stertorous breathing
• Comatous state
• Snoring sleep during
• Dull Moaning fever during
• SLEEPING LIKE DEAD BODY
• Sensitive about Noise
• Irritable Quiet
• Reaction poor with RTI with Pneumonia.

119

• Susceptibility Poor Reaction
• Pace of illness rapid.
• Lot of suppression- Asthma Rx with steroids,
  eczema Rx steroids.
• Inflammation at the deep tissue level lung
  parenchyma
• Mental Characterstic vivid at stage of structural
  stage.
• Pace of disease n characterstic fast
• Acute exacerbation of chronic illness

120

• 7)Immune response vulnerable
• 8)General sensitivity high
• 9)Nutritional state low
• 10)No prodrome Directly to structural to vital
  organs
• So poor reaction

121

• REMEDY GIVEN
• OPIUM 200 three Hourhly

122

• We then advised them to meet paediatrician
  colleague for hospitaliazation
• Child awake when reached his clinic
• Dr examined and said ac pneumonia
• And to continue the same treatment at hospital
• Parents not keen so took him home.
• .

123
EYE OPENER

• SUCH A FAST CHANGE???
• SO NO POOR REACTION
• ITS HIGH SUSCEP SITUATION
• AND MIASM? PSORA!!!

124
result

• Patient was better in 2-3 days
• Started with constitutional remedy
• After review.

125
Case 5 malaria
126

• . In the past 5-7 yrs it was observed that
  response to the indicated remedy in fever was not
  as quick and as thorough, as expected. It was
  also observed that the pace of the fevers was
  very fast.

127

• Today your patient is hale and hearty and two
  days later his platelet count drops drown to half
  his weakness and prostration are way two marked,
  his immune response poor and toxicity increasing.
  This is the common scenario in the recent
  epidemics.

128

• But the fact remains that the disease picture in
  the recent epidemics was strongly tubercular and
  clearly indicated the predominant activity of
  tubercular miasm. Thus came the need for
  anti-miasmatic treatment at the onset and
  experimentations have clearly shown that by the
  use of Tub at the onset of Rx the course of
  illness and the residual complaints decreases and
  the recovery is much faster.

129

• Caution -
• Tub and all other remedies have to be
  administered only and only when temperature is
  absolutely normal.

130

• InThe chronic diseases
• Dr. Hahnemann states the most obstinate and
  intractable cases occur chiefly in miasmatic
  patients, and the more deep the dyscrasia the
  more protracted the fever

131

• THE THERAPEUTICCS OF FEVER Dr. H.C Allen has
  given a case eg. Pg.no.40
• A girl with severe fever being helped by
  antipsoric psorinum, then to be helped later by
  sulphur for cure.

132

• Approach
• According to the directions given in Organon of
  Medicine6th edition aph.235
• The characteristics of the heat stage are taken
  for prescribing

133

• Learning
• Initially fever appearing like URTI which
  disappears with one dose of indicated remedy
  again recurs in 2 days suggests the clinical
  diagnosis needs reconsideration.
• Retrospectively studying the case ,was the step
  up of potency required? Why did maculopapular
  rash appear?

134
CASE 6 THE CHALLENGE CASE

• Patient age 12 months Came with semi
  conciousness with Breathless since 3 hours Was
  on inhaler STEROIDS Was Sent to hospital for
  nebulisation by local dr currently not much
  better even with steroid and bronchodilator
  inhalation in last 3 minutes, DULL. NO TALKING.
  NO MOANING. LYING FLACCID AND COLD.
• was given opium 200 every 5
  min in water
• . she improved in about 20
  min slowly.

135
Chronic details taken

• No growth since 6 months Asthma since 2 months
  with poor response to all
  treatments
• Family history- IHD , Hypertension , GREY HAIRS
  , severeOA
• past history gastroenteritis pneumonia and
  recurrent URTI and LRTI
• child timid, chilly, no teeth ,no weight gain
  milestones delayed
• There were no other useful observations to make.
• HALTED GROWTH THE KEY ENTRY
• search materia medica with this theme.and we
  found a drug from embryological tissue the
  medicine which also treated infantile uterus
• remedy given-FOLLICULINUM 7c only available
  potency
• response in 24 hours no resp complaints
  not even cough app improved , new
  tooth erupted,
• in 2 days started standing and talking
  monosyllables
• since then no asthma, no colds
• Gods SMS Set my Salts