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-PROF. (DR.) PANKAJ AGGARWAL M. D. (HOM.) EX VICE-PRINCIPAL, HOD, ORGANON OF MEDICINE, BAKSON HOMOEOPATHIC MEDICAL COLLEGE, GREATER NOIDA, U.P. RESIDENCE-CUM-CLINIC: 37, SOUTH ANARKALI EXTN., DELHI-51, INDIA PH.: 22512552, 22421972, MOB: 09313212552 E-MAIL: DRPANKAJ89@GMAIL.COM
SALUTATION
THE PATIENT
Name Age/ Sex Date of Consultation Mr. G P 62 years/Male 15.04.2011
Occupation
Qualification Marital Status
Business
B Tech Married
Presenting Complaints
The patient, a DIAGNOSED case of Gangrene as a consequence of diabetes mellitus, presented with the following complaints at the time of consultation: Gangrene of left foot since 6 months Stitching pain in the affected foot < Squatting position < Walking > Resting while and when kept open Discharge Profuse (wets the cotton swab), Watery off and on Blood also oozes out Walking difficult due to pain & discharge
First photograph
The photograph was taken on 14.04.2011 by the patient and submitted at the time of his visit to the clinic on 15.04.2011.
Presenting Complaints
Burning sensation in epigastric region since 5 months Complaint occurred after he started taking antibiotics for gangrene Along with heaviness of Lower abdomen < Eating after > Passing flatus
Treatment history
Taking regular allopathic medicines for Diabetes Mellitus Hypertension Took Ayurvedic treatment for the gangrene on and off for past 2 years
Past history
Typhoid - In childhood Brain hemorrhage (left sided) - 4 years back taken Allopathic treatment; since than weakness of the right arm started (excessive alcohol intake)
Family history
RELATIVE Paternal Grandparents DISEASE No major illness; natural death
Maternal grandparents
Mother
Hypertension
Diabetes Mellitus Hypertension
Father
Brother Sister
from the past history and family history we can percieve the destructive tendencies/ state he has been carrying with him
Personal History
Habits/Addiction: Addiction of drinking alcohol regularly from 1975 to November 2010 No habit of smoking cigarette Diet: Non Vegetarian
PHYSICAL GENERALS
Appetite: Regular, cannot tolerate hunger causes Headache Warm food 3 +; Gravied Food 3+, Sweets 2+, Mutton Nothing specific found
Desire:
Aversion:
Intolerance:
Thirst:
PHYSICAL GENERALS
Stool: Regular; unsatisfactory
Urine:
Sleep:
Thermal reaction: Can tolerate both hot and cold weather equally
Perspiration:
MENTAL GENERALS
History of prolonged working hours
MENTAL GENERALS
Contradiction << Cannot tolerate
PHYSICIANS OBSERVATION
Deep Furrows over forehead Slurring Speech Tongue Furrows in centre, dry laterally Body temperature Normal to touch
INVESTIGATIONS ADVISED
Blood Sugar Fasting and PP
PROVISIONAL DIAGNOSIS
DIABETIC FOOT GANGRENE SUPERIMPOSED WITH INFECTION
SYMPTOMS OF CASE
SYMPTOMS Gangrene on left side of left foot with Stiching pain < Walking > Resting while, in open air Discharge-profuse, Watery, offensive Difficulty in walking Burning sensation in epigastric region with Heaviness of head & lower abdomen < Eating after > Passing flatus H/o - Brain Hemorrhage CAUSA OCCASIONALIS No
Yes
Yes
SYMPTOMS OF CASE
SYMPTOMS Addiction of drinking alcohol Cannot tolerate hunger Thirst - drinks in sips, frequent Stool - Regular, unsatisfactory Urine - Increased Frequency in night Desire - warm food Desire - Sweets CAUSA OCCASIONALIS No No No Yes Yes No No
SYMPTOMS OF CASE
CAUSA OCCASIONALIS No No No No No No No No No
SYMPTOMS
Sleep- disturbed , thinks about his disease Anxiety for small things Anxiety - disease Workaholic Contradiction<< Cannot tolerate Desire open air Perfectionist Deep Furrows over forehead Slurring Speech
EVALUATION OF CASE
KENTS METHOD
MENTAL GENERALS Perfectionist Workaholic Contradiction << Cannot tolerate Anxiety for small things, disease Desire open air PHYSICAL GENERALS Cannot tolerate hunger Thirst - Drinks in sips, frequent Desire - Warm food, Desire - Sweets Sleep- disturbed , thinks about his disease
EVALUATION OF CASE
KENTS METHOD
PARTICULARS Gangrene of left foot with Stitching Pain < Walking > Resting while , in open air Profuse, Watery, offensive discharge
TOTALITY OF SYMPTOMS
Perfectionist Workaholic Contradiction << Cannot tolerate Anxiety for small things, disease Desire open air Cannot tolerate hunger Thirst - Drinks in sips, frequent
TOTALITY OF SYMPTOMS
Desire - Warm food, Desire - Sweets Sleep- disturbed , thinks about his disease Gangrene of the big toe with Stitching Pain < Walking > Resting while , in open air Profuse, Watery, offensive discharge
MIASMATIC ANALYSIS
SYMPTOM Anxiety for small things Anxiety for disease Workaholic Contradiction - Cannot tolerate Desire open air PSORA SYPHILIS SYCOSIS ++ + + + + +++ ++ + + + + +
Perfectionist
Cannot tolerate hunger Thirst - Drinks in sips, frequent Desire - Warm food Desire sweets
+
+ + + +
++
MIASMATIC ANALYSIS
SYMPTOM PSORA SYPHILIS SYCOSIS
+
+ + + + + +++ + + + +
SELECTION OF MEDICINE
Lycopodium Clavatum and Arsenicum album were the two most indicated remedy for this case but taking into consideration the pathology of the disease, its acute totality and the affinity of Arsenicum album for the diseased stage, we prescribed Arsenicum album in 50 millicimal potency
FIRST PRESCRIPTION
Arsenicum Album 0/1, 10 Strokes, BD, first cup
(Date of prescription 15.04.2011)
FOLLOW UP
DATE 22/04/11 CHANGES IN SYMPTOMS General condition > Pain in the wound - slightly > Discharge not as profuse as it was at the time of consultation Sleep - no change Blood sugar 130 g/dl (F) 180 g/dl (PP) PRESCRIPTION Arsenicum Album 0/2, 0/3 -10 strokes, B.D Placebo 3X, 16 tab
7/05/11
General Condition >> Pain >>; the patient is able to walk better Discharge Absent Sleep - Slightly Improved Constipation>> but unsatisfactory
FOLLOW UP
DATE 21/5/11 CHANGES IN SYMPTOMS General condition >> Discharge Slightly Increased since 5 days (patient had an history of prolonged exertion at home) Pain is Absent Stools satisfactory though slightly hard in consistency Blood sugar 140 g/dl(random)
As a whole patient better Discharge is decreased Pain in the wound- better Constipation - off and on but stools are satisfactory Sleep better Anxiety level better
PRESCRIPTION Arsenicum album 0/6, 0/7 - 10 strokes, B.D, 2nd cup Sac Lac 3X,16 Tab
4/6/11
Arsenicum album 0/8, 0/9 -10 strokes; BD 2nd cup Sac Lac 3X ,16 tab
FOLLOW UP
DATE 24/6/11 CHANGE IN SYMPTOMS General Condition >> Discharge- decreased markedly Sleep is Better, refreshing Constipation is better, satisfactory stools Anxiety better Contradiction still not tolerable Blood sugar 108 g/dl (F) 136 g/dl (PP) As a whole patient better NO PAIN AT ALL not even on touching Discharge was absent Sleep has improved much Blood sugar 130 g/dl (random) PRESCRIPTION Arsenicum album 0/10, 0/11 - 10 strokes, B.D 2nd cup Sac Lac 3X /16 tab
10/7/11
Arsenicum album 0/12, 0/13 - 10 strokes, B.D 2nd cup Sac Lac 3X /16 tab
SECOND PHOTOGRAPH
Complaints
Dates
Arsenicum Album was prescribed with increasing order in 50 millisemal till 10/9/11. Last prescribed was Arsenicum album 0/16 ;10 strokes; B.D 3rd cup
22/ 4
Wound Pain Discharge Stool
7/5
21/ 5
++ +++ -+
4/6
++ + ++ ++ +
24/ 6
+++ +++ +++ +++
10/ 7
+++ +++ +++ +/-
30/7
+++ +++ ++ +++
same
+ +
Same
++ +++ +
same
Sleep
Anxiety Heaviness
Same
Same Same
+
+ +
+
+ +
++
++ +++
+++
+++ +++
+
++ +++
Same Same
Complaints 12/8 Wound Pain Discharge Stool Sleep Anxiety Heaviness +++ +++ ++ ++ +++ ++ ++ 28/8 +++ ++ ++ ++ ++ ++ ++
+++
+
++
With Great Thirst he drinks often, but always little at a time (S.NO 383)
Acrid, burning, corroding discharges, often extremely offensive. Retards decomposition (in those fatally poisoned). Gangrena senilis sicca, with coldness, desire for more covering ; > from warmth. Gangrene : > from heat ; (< from heat, Secale). Gangrenous ulcers half an inch broad, causing insufferable pains, surrounded and partially covered with a gangrenous crust.
REPERTORIAL SHEET
photograph
14.04.2011
22.06.2011
Present Scenario
On 10 October 2011, the patient complaint of fever <evening Shiveing with Advised Widal Test
Presenting Complaint
Patient consulted us on telephone with the following symptoms on 16.10.2011: General Weakness Restlessness +++ His present wound (ulcer) was healed up but the older ulcer reappeared with profuse, watery and offensive discharge. Neuralgic pains radiating to the whole left foot Sloughing of the medial malleolus of the same foot Stools Constipated, hard stools increased Anger with Depressed feeling Mental Anxiety +++ (as he was asked for amputation)
On Reviewing
His old ulcers had re-appeared after the attack of typhoid fever Profuse, watery offensive discharge Neuralgic pains radiating to the whole left foot. Sloughing of medial malleolus of left foot was seen. Anxiety -
Prescription
FOLLOW UP
DATE CHANGE IN SYMPTOMS PRESCRIPTION
5/11/2011
Fever - absent Weakness ++++ Discharge from ulcer +++ Malleolar lesion same Sloughing present Constipation >> Sleep better advised : Blood sugar ,CBC,HbA1C
Crotalus h. 6 / 2 strokes/
6 drops diluted in 100 ml of distilled water Rubrum met 3x/ 16 tab/ H.S.
19/11/2011
Wound at malleolar region > Bleeding points appeared Weakness > Sleep > Anxiety >> ( after noticing the reappearance of circulation at the affected foot)
Crotalus h. 6 / 2 strokes/
6 drops diluted in 100 ml of distilled water Rubrum met 3x/ 16 tab/ H.S.
FOLLOW UP
DATE CHANGE IN SYMPTOMS PRESCRIPTION
5/12/2011
G.C >> Melleolar lesion ->> Pain > Constipation > Blood sugar 127 mg/dl (random)
G.C >> Walking improved Generalities >> Ulcer better Sleep Improved
Crotalus h. 6/ 5 strokes/ 6
drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning
24/12/2011
Crotalus h. 6/ 5 strokes/ 6
FOLLOW UP
DATE CHANGE IN SYMPTOMS PRESCRIPTION 14/01/12 Ulcer better, much healed Discharge slightly present Anxiety level improved Swelling at ankle region present Blood sugar 150 mg/dl (random) 31/1/12 Ulcer- improving Sleep- better Swelling at the ankle region- same Blood sugar -180mg/dl
Crotalus h. 6/ 5 strokes/ 6
drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning
Crotalus h. 6/ 5 strokes/ 6
16/2/12
Wound- better Sloughing- better Blood sugar- fasting-145mg/dl Blood sugar- PP- 155mg/dl Advisded : color doppler of left lower limb
Crotalus h. 6/ 5 strokes/ 6
drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning
DATE 15/3/12
PRESCRIPTION
Crotalus h. 6/ 5 strokes/
6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q 6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q
31/3/1212/5/12
General condition improved Pain- absent Discharge- bleeding off and on Sleep- sound and refreshing Weakness- absent
Crotalus h. 6/ 5 strokes/
21/10/12
(on telephone) No medicine Wound- dry and healed completely Sleep- sound Constipation- absent Anxiety- absent
Complaints
Dates
5/11
Wound(old) Sloughing
19/11
+
5/12
++ +
24/12
+++ +++
same same
same
+ ++ ++ ++ ++
++ ++ ++ + ++
same
++
Same Same
Discharge
sleep Anxiety Weakness
same
++
Same Same
++
++ ++ ++
++
++ + ++
+
+++ +++ +
+++
+++ +++ +++
THANK YOU