Wednesday, June 8, 2016

Irritable Bowel syndrome & Homoeopathy

Irritable Bowel syndrome - a challenge in medical practice
Prof G R Mohan
(NHJ, Vol 8, no 2, March/April-2006
full length article in Wonders of Homoeopathy an evidence based study
Irritable bowel syndrome a motility disorder involving the entire GI tract, it is a challenge to treat Irritable Bowel Syndrome in clinical practice with high prevalence of one in four. The cause of irritable bowel syndrome is unknown. No anatomic cause is seen. Emotional factors, diet, drugs, or hormones may precipitate or aggravate GI motility. Some patients of IBS have anxiety disorders, particularly panic disorder; major depressive disorder; and somatization disorder. However, stress and emotional conflict do not always coincide with symptom onset and recurrence. This clinical condition, which has long been misunderstood and misdiagnosed, may represent a complex interaction of altered neurochemical mediators in the enteric nervous system with psychosocial and environmental influences. (2).
The pathogenesis of IBS is poorly understood although roles for abnormal gut motor and sensory activity, central neural dysfunction, psychological disturbances, stress and other factors have been proposed.
            Abnormal psychiatric features are recorded in upto 80% of IBS patients, however no single psychiatric diagnosis predominates. An association between prior sexual or physical abuse and development of IBS has been reported.  Forms of sexual abuse associated with IBS include verbal aggression, exhibitionism, sexual harassment, sexual touching and rape. The pathophysiologic relationship between IBS and sexual and physical abuse is unknown. However physical and sexual abuse may result in hyper vigilance to body sensations at CNS level and visceral hypersensitivity at the gut level.
Gender, race, and age all play a role in the prevalence of IBS. Recent studies suggest that in the United States the incidence of IBS is 10% and its prevalence 20%. These numbers are dependent on the diagnostic criteria used as well as on the population studied. Approximately 70% of patients who meet the diagnostic criteria for IBS do not seek medical care; the remaining patients account for 12% of primary care visits. Community-based estimates suggest that up to 30% of patients with a gastrointestinal complaint will have IBS but only a minority of patients diagnosed by a gastroenterologist.
There are two major clinical types of IBS, constipation predominate IBS, and Diarrhea predominate IBS.
In constipation-predominant IBS, constipation is common, but bowel habits vary. Most patients have pain over at least one area of the colon, associated with periodic constipation alternating with a more normal stool frequency. Stool often contains clear or white mucus. The pain is either colicky, coming in bouts, or a continuous dull ache; it may be relieved by a bowel movement. Eating commonly triggers symptoms. Bloating, flatulence, nausea, dyspepsia, and pyrosis can also occur.
Diarrhea-predominant IBS is characterized by precipitous diarrhea that occurs immediately on rising or during or immediately after eating. Nocturnal diarrhea is unusual. Pain, bloating, and rectal urgency are common, and incontinence may occur. Painless diarrhea is not typical and should lead to consider other diagnostic possibilities e.g., malabsorption, osmotic diarrhea, and etc.

The key to diagnosis of IBS is effective history taking, which requires attention to directed, but not controlled, elaboration of the presenting symptoms, history of present illness, past medical history, family history, familial interrelationships, and drug and dietary histories. Equally important are the patient's interpretation of personal problems and overall emotional state. The quality of patient-physician interaction is key to diagnostic and therapeutic efficacy. Patients with IBS generally appear to be healthy. Palpation of the abdomen may reveal tenderness, particularly in the left lower quadrant, (4)
Rome II Criteria for diagnosis of Irritable Bowel Syndrome
Abdominal discomfort or pain with two of the following three features for at least 12 weeks, not necessarily consecutive, during the previous 12 months:

 • Relief with defecation

 • Onset associated with change in stool frequency.

 • Onset associated with change in stool formation.

Supportive Symptoms-
1. Fewer than three bowel movements per week.

2. More than three bowel movements per day.

3. Hard or lumpy stools.

4. Loose or watery stools.

5. Straining during bowel movements.

6. Fecal urgency.

7. Feelings of incomplete evacuation.

8. Passage of mucus during bowel movement.

9. Sensation of abdominal fullness or bloating

Diarrhea-predominant irritable bowel syndrome = one or more of 2, 4, and 6 and none of 1, 3, and 5
Constipation-predominant irritable bowel syndrome = one or more of 1, 3, and 5 and none of 2, 4, and 6 (4)
Symptoms can be triggered by stress or the ingestion of food is 50% higher than for patients who do not fit the diagnostic criteria. These patients undergo more surgical procedures (such as hysterectomy, appendectomy, and cholecystectomy) and have a higher rate of work absenteeism and an increased number of physician visits per year. Moreover, these patients have significantly impaired quality of life even when compared with chronic disease such as diabetes. Upto 40% of referrals to gastroenterologists are IBS. (2,3).
Lactase intolerance is another common condition that can mimic diarrhea-predominant IBS, antecedent event such as a viral gastroenteritis or food-borne illness is important because there is evidence that up to 30% of patients will develop IBS-like symptoms after experiencing Salmonella enteritis,

Laboratory examination:
  • Physical exam.
  • Blood tests.
  • X ray of the bowel: This x-ray test is called a barium enema or lower GI (gastrointestinal) series. Barium is a thick liquid that makes the bowel show up better on the x-ray. Before taking the x ray, the doctor will put barium into your bowel through the anus.
  • Endoscopy: The doctor inserts a thin tube into your bowel. The tube has a camera in it, so the doctor can look at the inside of the bowel to check for problems.

The approach by conventional system in the treatment of IBS is without consideration of person as a whole but in Homoeopathic system the successes rate is more due to holistic approach, in considering the mental and physical aspects of the individual. Giving importance to mind in treatment is the need of the hour in IBS; so homoeopathic treatment has edge over other systems
A high-fiber diet should be advised to reduce digestive system irritation. Alcohol, caffeine, and fatty, gassy, or spicy foods should be avoided. Recommended stress management techniques include yoga, meditation, hypnosis, biofeedback, and reflexology. Reflexology is a technique of foot massage that is thought to relieve diarrhea, constipation, and other IBS symptoms.
The following two interesting cases of IBS treated in OPD
C A S E S:
NAME- Mr.G, 35years. Male-Sex, 

Religion- Hindu. Married.

Occupation – Works in a Private Bank.
Date of first visit-13.03.03 (OPD)

Presenting complaints-

·         Burning in throat since 3 years.
·         Irregular bowel habits since 10 months.

History of presenting complaints-

Patient was well before 3-4 years; to start with he developed symptoms of pain in the right hypochondrium, burning pain in throat, sour eructations, regurgitation of food after eating. he was diagnosed as having cholelithiasis and he was operated for it. He was very well up to 5/6 months of operation, but gradually he developed following symptoms.   
Burning in throat since 3 years < Afternoon 2-3 p.m., taking spicy food, excess quantity of food and after any anxiety or tension.
Regurgitation of food and water
Irregular bowel habit-morning at least gets 3 times urgency before 9 a.m. (before going to office, in holidays also he gets for 3 times.)
First –just after raising from bed.
2nd- mostly after breakfast.
3rd- commonly before starting for office.
Itching in scalp since 4-5years.

Past history-

Chickenpox in childhood.
Treatment history.
1.Allopathic
2.Homoeopathic-a) Ars.alb200.b) Arg.Nit 200.

Personal history-

Appetite-good, now taking food in small quanties.
Thirst- normal.
Desires –cold drinks.
Aversions-Sweets.
Bowels-3/4 times daily. (3times before 9 a.m.).
Sweat- on exertion, offensive odour.
Sleep –sound.
Dreams –not specific.
Thermal reactions- Likes open air. Likes winter.
Life space investigation- He hails from one middle class family. Now works in a private bank. Happy with his work. Married and having a son of two year. Relationship with family members and others is good. Can’t concentrate in one thing for a long time, low in confidence.
Physical examination- Well nourished, moderate built.
No signs of pallor, icterus, cyanosis, clubbing and edema.
B.P-120/80 mm of Hg.
Pulse rate-75/min, regular, full, and no spl. character.
Heart rate –75/min regular, full, no spl. character
Systemic examination-
GIT- No relevant sign found.
Investigations- Within the normal range.
Clinical diagnosis- Irritable bowel syndrome.
Disease classification: Dynamic chronic fully developed miasmatic disease.
Miasmatic Diagnosis: Mixed miasmatic disease (Predominantly Psoric)
Repertorial totality.
Complete Repertory Selected
Mind- Anxiety.
            Ailments from anxiety.
            Confidence want of self.
            Concentration difficult.
Male genital-   Sexual; Desire increased
Generalities-    Food and drinks sweets aversion.
                        Food and drinks, cold drinks water desires.
Perspiration- Odor- offensive.
Stool-  Frequent.
            Morning.
Throat-            Pain – Burning.
Stomach-Eructations-food of, regurgitation.
Result of repertorisation.
1.      Lyco-26/11.                                               6.Ars.alb-20/10.
2.      Phosp-25/10.                                             7.Caust-20/10.
3.      Merc-22/10.                                               8.Puls-20/10.
4.      Sil-22/10.                                                   9.Sulph-20/10.
Remedy selected.
Lyco 200/ 1 dose on 20/03/2003

Follow up-


27/03/2003
No change in symptoms.
Placebo- 1 dose
8/05/2004
No change in symptoms.
Along with previous mental symptoms patient now have a marked aversion to do the official work.
As before he has a strong desire for cold drinks,
Basing upon these symptoms and as before also Phos. was in the 2nd position in repertorization , Phos 200 planned to be prescribed. 
Phosphorus 200C / 1 dose.
22/05/2004
Feels better.
Bowel habit reduced to 2 times in morning.
Placebo/1 dose.
29/05/2004
Feels better.
Bowel habit once in the morning.
Burning pain and regurgitation reduced.
Placebo /1 dose
Case Summary: In this case due importance was given to the mental symptoms of the patient and the case was marked improved after Phos 200 may be due to its highest similarity to the case and as it covering more prominent mental symptoms. 
CASE NO.2
Mr. K, 51yrs/M, Hindu, Married, illiterate, Agricultural laborer, admitted in our IPD, Bed no.31 with the complaints of sensation of fullness of abdomen < after eating, stool >flatus; aching pain in the abdomen on and off with urging to stool < during urging to stool >flatus; constipation, frequent, ineffectual, urging and burning sensation in both soles

Past History

No significant past history.  Took allopathic treatment for the presenting complaints for the last 6 months with only temporary relief

Personal History:
Appetite: reduced                                          Thirst: 5-6 glasses/day.
Desires: Sweets                                               Aversions: sour things
Urine: (D/N): 6-7/0-1                                     Perspiration: only on exertion 
Bowels: Constipated, frequent, ineffectual, urging.
Sleep: refreshed
Thermal state: Ambithermal


Mental generals: Ailments from silent grief, cannot bear contradiction.
Investigations: On 24/06/2004, CBP: Hb%- 13.5gm%, T.RBC-4.8 milli/cu mm, T.WBC-8,000cells, ESR-5mm/1st hr, 9/2nd hr; DC-L.60%, L.33%, E.5%, M.2%: Stool analysis-No cyst, No ova, No occult blood, No parasite. FBS, LPT – with in normal limits
Diagnosis: Irritable Bowel Syndrome.
Disease classification: Dynamic chronic fully developed miasmatic disease
Miasmatic Diagnosis: Predominant Psora - Syphilis
Repertorial Totality:
[KT] [Stomach] Desire: Sweets:
[KT] [Stomach] Desire: Sour:
[KT][Abdomen] Fullness, sensation of: Eating: after:
[KT][Abdomen] Fullness, sensation of: Flatus, passing: amel:
[KT][Abdomen] Pain: Aching: Flatus, passing: amel:
 [KT][Abdomen] Pain: Aching: Stool: Urging, during.
[KT][Abdomen] Pain: Aching: Stool: Before:
[KT][Rectum] Constipation: Ineffectual urging and straining
[KT][Extremities Pain] Pain: Burning: Hand: Palm: Night:
[KT][Extremities Pain] Pain: Burning: Foot: Sole: Night:
Repertorial Result: Sulph 20/9, Lyc 17/7, Carb.veg 16/8, Sep 15/8, Calc.carb 12/6
Previous Homoeopathic Treatment: Initially Nux vom 200C and Lyco 1M prescribed based upon the prominent physical generals and gastric symptoms but there has been no relief for 15 days, but after careful interrogoration about his life space investigation, he revealed the death of his son 6 months back, after that he was constantly brooding over that matter without expressing outwards and from then onwards started his complaints gradually and cannot bear contradiction 
Follow Ups:
Date

Observation and progress

Treatment

26/06/2004
First prescription (Based on acute emotional causative modality)
Ign 200C/1D
01/07/2004
Complaints slightly reduced.  General’s normal.
S.L / 2 weeks
07/07/2004
Complaints completely reduced. Generals’ normal.  Patient was discharged and advised to attend OP every Thursday.
S.L/ 1 month
15/07/2004
Recurrence of complaints since 3 days. App-reduced, thirst- more, H/o of grief
Nat.m 1M/1D
S.L / 2 weeks
19/08/2004
No recurrence of complaints.  Burning pain in the soles reduced completely.
S.L/2 weeks
23/09/2004
No recurrence of complaints.
S.L / 2 weeks
28/10/2004
No recurrence of complaints.  Patient feels better
S.L / 2 weeks
20/01/2005
No recurrence of complaints. 
S.L/2 weeks

Case Summary: Mr. K, aged 51 years, developed fullness and aching pain in the abdomen after stool and burning sensation in the soles following his son’s death. He was treated initially with Ign 200C/1D and later Natr.mur 1M/1D as per the case required.  This led to marked improvement as there was no recurrence of complaints and the patient is still under observation and further results awaited.
Bibilography
1) Lynn, Richard B., and Lawrence S. Friedman. Irritable bowel Syndrome In Harrison's  Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998
2) By Rebecca C. Dunphy, MD, and G. Nicholas Verne, MD, Malcom Randall Veterans Affairs Medical Center and the University of Florida College of Medicine in Gainesville.
3)  Manning AP, et al: Towards a positive diagnosis of the irritable bowel syndrome. BMJ 2:653, 1978.

4) Thompson WG, et al.Functional bowel disorders and Functional abdominal pain. Gut 45(suppl II):1143, 1999.

5) Phlip M Bailey, Homoeopathic psychology,B.Jain publications

6) Weatherall D.J, Ledingham G.G and Wavell D.A : Oxford textbook of medicine.  Oxford medical publishers, Oxford, 3rd edition – 1996.
  Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of which they know nothing”           - VOLTAIRE, 1694-1778

Prof. G. R. Mohan,     H.O.D, P.G. Dept. of Organon and Phil.                                                                               Dr. Ch.v.Kishore kumar, P.G. Final year.                                                                                                   Dr Amulya Ratna Sahoo, P.G. Final year.



Sunday, October 25, 2015

RESPIRATORY ALLERGIES and HOMOEOPATHY

HOMOEOPATHY

ANSWER FOR RESPIRATORY ALLERGIES

Dr.G.R.Mohan

(Health ACTION, April 2008)

key words : respiratory allergy Homoeopathy
Allergies are a common and significant cause of morbidity, lost-productivity and increased health care.  It is not uncommon to see children on antibiotics, antihistamine cough syrups, tonic and off-and-on bronchodilators for years together without any referral to a specialist.  This irrational treatment not only results in disease and economic burden on the family but also lost opportunities of growth and development for the child.  A respiratory allergy is a specific immunologic response to a normally harmless allergen.  Some people with allergy develop asthma and some allergic rhinitis.

Homoeopathy offers very effective treatment for all allergic diseases such as various skin diseases like urticaria, eczema, and contact dermatitis, as well as given unbelievably miraculous results in asthmatic bronchitis etc.  Allergic rhinitis is defined as an allergen-induced inflammation of the membranes lining the nose and the sinus, often due to an allergic reaction to pollen, dust or other airborne substances.  The various types of allergic rhinitis include Atopic Rhinitis, Seasonal Allergic Rhinitis (also known as hay fever) and Perennial Rhinitis (year round).

Of these, allergic rhinitis remains the common cause of morbidity and social embarrassment.  Recent surveys revealed a four-fold increase in the number of consultations with general practitioners, although the reasons are unclear.

RAPID increase
A rapid increase in allergic diseases like asthma, allergic rhinitis, atopic dermatitis and food allergies has been observed worldwide.  Globally, it has been noted that allergic rhinitis affects 24% of the population n the United Kingdom, 20.6% in Norway, and 19.6% in Germany and 26% of the population in India.  Today, the incidence of asthma-related cases is 10-12 percent.  In terms of the age-groups affected, about 70 per cent of patients develop allergic rhinitis before they are 30 years of age and, the adolescent children have greater incidence with allergic rhinitis occurring between 8-11 years of age.  Over $600 million is spent annually in the management of this disease by United States which does not include the costs of the 2 million lost workdays, 3 million lost school days and 28 million days of decreased productivity from the symptoms of the disease and/or side-effects of the medications used to treat them.

Heredity plays a role in the development of allergies.  The risk of the developing allergies is 18% if neither parent is a topic, 20% if one parent is atopic and 50%, if both parents are atopic.

Common Causes
Irritants like smoke, perfumes, strong smells, air pollutants and temperature changes, dust mites (see figure), polluted areas having high levels of sulphur dioxide and nitrogen diospets, moulds growing on wallpaper, upholstery, carping and plants within the house are found to cause allergic rhinitis.  Grasses and trees that release minute pollen grains are also known to cause allergies.  Allergies contracted from grass are experienced more in the late afternoon while that from mould spores may peak on dry windy afternoons or on damp or rainy days in the early morning.  Intake of alcoholic drinks like wines and beer, sea foods, chlorine in swimming pool water, drugs like birth control pills and female hormones, some drugs used for blood pressure control, aspirin and chronic use of decongestants in the nose can also produce rhinitis.

Perennial rhinitis:  common causes are dust mite found in many homes, and domestic pets.  Salivary protein of cat, allergens from cockroaches etc. also cause perennial rhinitis.  Occupational rhinitis is caused by an agent inhaled at the work place.

When an allergen such as pollen or dust is inhaled by a person with a sensitized immune system, it triggers antibody production.  These antibodies mostly bind to mast cells, which contain histamine and when the mast cells are stimulated by pollen and dust, histamine and other chemicals are released.  This results in itching, swelling, and mucus production.  Symptoms vary in severity from person to person with very sensitive individuals experiencing hives or other rashes.

Symptoms of allergic rhinitis include frequent or repetitive sneezing (it is an allergic reaction to something in the air); a runny or congested nose; itching in the nose, eyes, throat, or roof of the mouth; plugged-up ear canals; sore throat; occasional nose-bleeds; impaired smell and wheezing.  Sometimes, cross-reactive allergy to some fruits such as the skin of apples or potatoes occurs because of similarities in the proteins of the pollen and the food.  Additional symptoms include fever, fatigue, flushing and irritability.  Many patients develop watering, itching and redness of the eyes, collectively known as allergic rhino conjunctivitis.

Almost 20-50 percent of patients with allergic rhinitis go on to develop asthma as allergic rhinitis is a risk factor for developing asthma.  A large number of children who start with asthma also develop allergic rhinitis.

Diagnosis
The most important diagnostic tool is the history of the illness.  The timing of symptoms also helps in making the diagnosis.  Allergic rhinitis that appears seasonally is almost always due to pollen; and outdoor allergens can be detected by conducting a skin test when the patient is not taking antihistamines. Skin-testing should also be avoided in patients with extensive eczema.  For such patients, ELISA and RAST are two commonly used methods that measure the presence of food-specific IgE I the blood of the patients.  However, they are more costly than skin tests and also take more time and a simple method for detecting common allergens.

Complications of allergic rhinitis lead to ear infections due to blockage of the Eustachian tube, recurring headaches, reduced concentration, reduced hearing, appetite, and growth.

Symptoms of Asthma
Asthma is a chronic disease in which the airways of the lungs become inflamed or narrowed, resulting in disruptions to normal breathing patterns, often called attacks’ or “episodes’.  The level of severity of asthma suffered by each individual, and further, the severity of each attack, varies greatly.  Genetic predisposition toward developing asthma and environmental factors play a role in the actual development of the disease.  Symptoms of asthma include wheezing, shortness of breath, a feeling of tightness in the chest, and coughing, which are due to a narrowing of the bronchial passages in the lungs, and to excess mucus production and inflammation.  Asthma can be disabling and sometimes fatal.

Treatment: A detailed clinical history of the patient’s illness will identify the likely cause of rhinitis.

Medical philosophy is increasingly coming to the conclusion that the mere treatment of symptoms and organs can only help temporarily and that it is the healing power of the body as a whole that has to be enhanced.  Homoeopathy believes in a holistic, totalistic and individualistic approach which provides relief, free of side-effects.

Clinical trials conducted on allergic disorders like atopic dermatitis and childhood asthma in Hyderabad showed encouraging results with homoeopathic remedies.  The same was published in an international journal Homoeo Links.


A few homoeopathic remedies with their indications

Arsenicum album: sneezing (with every change in the weather), watery discharge from the nostrils, excoriation of the upper lip, itching, burning and watering from eyes.

Allium Cepa: Prepared from red onion has this excoriating nasal discharge, there is more lachrynation which is bland.  The discharge ceases when the patiehnt goes into the open air, but returns when entering a warm room again.

Euphrasia: is similar to Allium cepa, but it has profuse lachrymation, while having bland nasal discharge.

Arum triphyllum: all the seretions are acrid, the nostrils and lips are sore.  There is thirst, but drinking causes pain.  The nostrils are sore, and there is contant desire to bore the finger into the nose.

Lemna Minor: A catarrhal remedy.  Nasal polyps, swollen turbinates.  Atrophic rhinitis asthma from nasal obstruction, wrose in wet weather.

Kali lod.  Constitutional remedy, starts with sneezing, pfofuse watry acrid coryza with pain in frontal sinus, cold travels downward to chest, laynhx feel raw, violent cough

Sulphur – found to be helpful in asthma alternating with recurrent skin eruption, fluent burning coryza, worse when outdoors, stops when indoors.  Frequent sneezing.

Teucr ham marum: Catarrhal condition of both anterior and posterior nostrils.  Mucous polyps.  Chronic catarrh, crawling in nostrils with lachrymation and sneezing.  Coryza with stoppage of nostrils.

Solidago: Hay fever.  Spasmodic sneezing with runny nose.  Copious, watery nasal discharge, worse from the odour of flowers, even thinking of flowers increases the discharge.  Oversensitiveness to odours.

Sanguinaria nitrate: Acute clods with sneezing, profuse discharge, burning and rawness in posterior nares, husky voice (must clear throat before speaking).

Pothos: Asthma fromdust exposure (Kalic, Batta, O\, Solanum)

Asthma relieved by stool.


Psorinum: nose dry, coryza, with stoppage of nose, chronic catarrh; dropping from posterior nares, Asthma, with dysponea; worse, while sitting up; better, on lying down.




Saturday, May 16, 2015

Role of Homoeopathy in TRIGGER FINGER

A CASE OF TRIGGER FINGER
(The Homoeopathic HERITAGE, Vol 30,no 12,Dec 2006 )

Prof G.R. MOHAN

Professor Vinayaka Mission’s                     
Homoeopathic medical college & hospital, Salem, TN

INTERDUCTION: Trigger Finger or snapping finger or Digital Tenovaginities Stenosans are SYNONYMS. In this condition when patient attempts to open the closed fist the affected finger remains in flexed position (locked) and it has to be passively stretched with other hand. It goes into extension with click. More commonly seen in females with a frequency 2-6 times that observed in men.  (1). The most commonly affected digit is the thumb, followed by the ring, long, little, and index fingers Increased incidence in the dominant hand is observed. Involvement of several fingers is not unusual. It is a result of nodule formation on flexor tendon. It occurs as complications of either simple Tendon Synovities or Rheumatic Arthritis. Nodule is usually small. The Nodule commonly is trapped under the Meta carpo Phalyngeal ligament as the tendon flexes. The finger is them locked in flexon and active extension is impossible. To unlock the finger passively pressure is used.  Sudden snapping (Trigger) of the digit occurs, finger is extended. Locking or catching during active flexion-extension activity may need passive manipulation to extend the digit in later stages .Stiff digit, especially in long-standing or neglected cases ,Pain over the distal palm ,Pain radiating along the digit are symptoms. Systemic causes of Trigger Finger are collagen-vascular diseases, including Rheumatic Arthritis, Diabetes, psoriatic arthritis, amyloidosis, hypothyroidism, sarcoidosis, and pigmented villonodular synovitis.
Treatment is not satisfactory in other systems of medicine. Only cartico steroid injection or operation in which incising the mouth of the fibrous flexor sheath longitudinally (1).

CASE:

Patient by name Ms. J. aged 45 years, married with two children without any history of Diabetes or Hypertension. She was diagnosed as Trigger finger by local orthopedic surgeon. She came to me with following symptoms to avoid Surgery. Pain in Rt. Little finger since one year – pain drawing type, aggravated by initial movement, aggravated early morning,  inability to extended the finger, only passively she has to extend the finger with other hand and in general aggravated in damp weather. Sleep: N, appetite: N, Bowels: Regular, Urine: free, perspiration: Normal and menses: attained Menopause.

F/H Arthritis

O/E Slight swelling the finger with tenderness.

There are no much symptoms, only probable cause is over use of her fingers in daily dowe mixing. On 22/6/05 Rhus Tox 200 C, 3 doses. 4th hourly one dose was prescribed followed placebo for 5 days. Very slight improvement was noticed. 30/06/05 Rhus Tox 1M, 1 dose followed by placebo 7 days was prescribed. After this course pain reduced slightly only, inability to extend finger is as usual. Nodular condition, involvement of flexor tendons (3) Ruta Graveolen 200 C, 3 doses, 6th hourly one dose followed by placebo for 7 days prescribed. After Ruta.G patient was able to extend the finger little bit and pain reduced. Ruta G 1M, 1 dose was given along with placebo for 15 days. Patient reported back and she was able to extend her finger without any help, pain totally reduced. A complimentary drug Cal Phos 200 C, 3 doses was given lastly. The symptoms did not return even after one year.
DISCUSSION:
This is a case of few symptoms. Rhus Tox only helped her to some extent.  Ruta G is having tendency to the formation of deposits in the periosteum, tendons, and about joints, especially wrist it acts upon the periosteum, cartilages and Flexor tendons, was tried up to 1m potency with good response even after one year there were no recurrence of symptoms. Case was diagnosed on clinically only. Most of the Pathological and radiological investigations will be normal.
REFERENCE:
1.            John Crawford Adams and David L. Hamblen (1991) Outline of Orthopedics, 272 Churchill Livingstone.
2.            C. Vyaghreswarudu, Principles and Practice of Orthopedics, Andhra University Press – Waltair.
3.            J.T. Kent (2EDI) Lecturer on Homeopathic Materia Medica, 834)
4.            Robin Murphy ND, Lotus Materia Medica.


Saturday, November 22, 2014

Stop Journeying towards fatigability

Stop Journeying towards fatigability

Prof G R Mohan
MD (H0m) P G Dip (Env Stud)
www.drgrmohan.com

Beware of false knowledge; it is more dangerous than ignorance-George Bernard Shaw

Key Words : fatigue, nutritional anaemia, iron deficiency anaemia
Introduction :
Fatigue called exhaustion, tiredness, languidness, languor, lassitude, and listlessness) is a subjective feeling of tiredness which is distinct from weakness, and has a gradual onset. Unlike weakness, fatigue can be reduced by periods of rest. Fatigue has physical or mental causes. Physical fatigue is the transient inability of a muscle to maintain optimal physical performance, and is made more severe by intense physical exercise. Mental fatigue is a transient decrease in maximal cognitive performance resulting from prolonged periods of cognitive activity. It can manifest sleepiness, lethargy, or directed attention fatigue. [4] A tendency to get tired or lose strength. 1
One of the common causes of fatigability is nutritional anaemia; chronic fatigue is a symptom of many diseases and conditions. Like Autoimmune diseases, anaemia and hemochromatosis, drug abuse, mood disorder, malnutrition, diabetes mellitus and hypothyroidism, Fibromyalgia, Sleep deprivation, Lyme disease, Liver failure and in malignant conditions 1
Fatigability is a common problem in students, employees, home makers. Due fatigability day to day work performance is hampered like poor turnout of targeted work, absenting from work, bunking college and schools, poor scoring in examinations, ECT. Fatigability is grossly neglected condition  However, we are educated we compromise with our health problems more so with fatigability by seeing a T V advertisement, buying glucose pack consuming it for months together without any result, on a day when  blood examination is done, seeing haemoglobin levels one open the eyes , even some percentage of people still neglect. Commonly symptoms of anaemia are overlooked.

  Epidemiology:
Nutritional anaemia is very much prevalent and largely undiagnosed among students in the Professional Institutes. Nutritional anaemia is a disease syndrome caused by malnutrition.. It has been defined by WHOM as “a condition in which the haemoglobin content of the blood is lower than normal as a result of a deficiency of one or more essential nutrients, regardless of the cause of such deficiency”. By far the most frequent cause of nutritional anaemia is iron deficiency, and less frequently foliates or vitamin B12.Various socio-demographic characteristics like age, sex, social class, dietary habits, and infections are the etiological factors for nutritional anaemia 3.
Anaemia is a global public health problem affecting both developing and developed countries. In 2002, iron deficiency anaemia (IDA) was considered to be among the most important contributing factors to the global burden of disease. Anaemia is an indicator of both poor nutrition and poor health 4.

Global prevalence of anaemia in (preschool aged children is 47.4%, in pregnant women is 41.8%, in non-pregnant women is 30.2 %,) 818 million women worldwide (both pregnant and non-pregnant) and young children suffer from anaemia and over half of these, approximately 520 million, live in Asia.5
In one cross sectional study on study conducted in a medical college show the following results, the study was about 100 Medical students, 32.0% students were anaemic, out of which 44.0% were girls and 20.0% boys. 25.0% students had mild anaemia. The majority (81.8%) of anaemic students was undernourished as per their Body Mass Index 6 According to one study conducted by Arlappa, N Balakrishna in Maharashtra, 59.2 % of the rural pre-school children of Maharashtra were anaemic. 2, 6, 7
Causes:
The following are the causes a) Poor dietary intake, b) poor bioavailability of iron  in the diet consumed  c) and increased requirements of iron d)  malabsorption leads to poor iron absorption  e) any Blood loss from Any orifice of the body, (  Gastrointestinal blood loss. Bleeding from gums and oral cavity, Bleeding piles .Bleeding from the genito-urinary tract, in females Menorrhagia, and ante partum and postpartum haemorrhages.
A woman loses about 500 mg of iron with each pregnancy. Menstrual losses are highly variable, ranging from 10 to 250 mL (4-100 mg of iron) per period, an adult male absorbs and loses about 1 mg of iron from a diet containing 10-20 mg daily. Children who drink more than 16 to 24 ounces of cow's milk per day also have a higher risk of Iron deficiency anaemia, because cow's milk can interfere with iron absorption and irritate the lining of the intestines, leading to blood loss. Each gram of haemoglobin contains 3.47 mg of iron; thus, each mL of blood lost from the body (haemoglobin 15 g/dL) results in a loss of 0.5 mg of iron.    
Symptoms
Initially, anaemia goes unnoticed in majority of people. But symptoms increase as anaemia worsens, Fatigue , a feeling of laziness, dizziness, pain in head, tinnitus, diminished vision  a vague feeling that one is not well ; difficult or laboured breathing, Poor  concentration, Palpitations, irregular, forceful beating of the heart, Sensitivity to cold temperatures, Cold intolerance, Pica is not a cause of iron deficiency anaemia; pica is a symptom of iron deficiency anaemia i.e. craving for ice, chalk, dry rice etc , sufferer  looks  pale and life less Leg cramps on climbing stairs, Poor educational  performance, Reduced resistance to infection, Altered behaviour, Dysphasia with solid foods (from oesophageal webbing 8

The following symptoms are less common, Tinnitus ,Dysphagia,Restless leg syndrome, Impaired growth in infants, Spoon-shaped nails (koilonychia) A glossy tongue, with atrophy of the lingual papillae, angular stomatitis Splenomegaly
Investigations:
Complete blood cell picture, Evolution of Iron status is based on Haemoglobin concentration, Serum iron, total iron-binding capacity , serum ferritin. and Reticulocyte counts (Reticulocyt0paenia occurs in Nutritional deficiency Anemias,), Haemoglobin and haematocrit are all decreased in Iron Deficiency Anaemia. MCV, MCH and MCHC are also decreased. The peripheral blood film shows hypo chromic microcytic red cells, Serum iron is decreased, examination of the stools for occult blood and helminthiasis is mandatory in all patients. 8

Homoeopathic perceptive:
Iron deficiency anaemia is an easily treated disorder with an excellent outcome, but ignorance is becoming hurdle.
However, we educate about the importance of a balanced diet, people they have their own reservation about diet, per capita income is less purching capacity to buy nutritious food items becoming difficult, small group interaction was conducted in a medical institute revelled that 95% are not consummating nutritious iron rich food. hand full people buy the costly anihaemtics which are prescribed by health care persons, but they do not consume due intolerance, oral iron in small percentage of people causes nausea, epigastria discomfort, vomiting, constipation and diarrhoea., The only options left is giving the indicated homeopathic remedy on the basis of the totality of symptoms and suggesting a balanced iron rich food. But still people avoid advised diet due to various reasons. In Homoeopathy Ferum Phos 3x, Lecithin 3x and Vanadium 3x helped majority of people not in people who wants to live with Anaemia.  According to Hahnemann a classification of diseases Anaemia comes under pseudo chronic disease,
 Lecithin is important in the vital processes of plant and animal organisms. It is prepared from the yolk of egg, phosphorus containing complex organic body. Lecithin has a favourable influence upon the nutritive conditions and especially upon the blood, hence its uses in anaemia and convalescence, neurasthenia and insomnia. (Lotus) Tired, weak short of breath; loss of flesh symptoms of general breakdown. (Patak)
Ferrum Phos 3X: In pale, anaemic subjects with violent local congestions. Ferr-p. Increases haemoglobin. Haemorrhages, bright from any orifice. Anaemia. Emaciation. Takes cold easily. Inflammation of the soft parts. Bruised soreness, chest, shoulders
Vanadium is a remedy in degenerative conditions of the liver and arteries. Anorexia and symptoms of gastrointestinal irritation, albumen, casts and blood in urine. Tremors, vertigo, hysteria and melancholia, Neuro-retinitis and blindness. Anaemia, emaciation. Cough dry, irritating and paroxysmal, sometimes with haemorrhages. Irritation of nose, eyes and throat.. (Lotus) Murphy
If you fail to stop your journeying towards fatigability you have to face following:

You suffer with severe anaemia and  Severe fatigue. you may be so tired that you can't complete everyday tasks; you may be too exhausted to work or play. Impaired immune function is reported and prone to infections, doctor visits will be more.  increased risk for psychiatric disorders, The intelligence quotients (IQs) of students will be low . An estimation of haemoglobin should be done to assess the degree of anaemia. For men, anaemia is typically defined as a haemoglobin level of less than 13.5 grams/100 ml and in women as haemoglobin of less than 12.0 grams/100 ml.  If the anaemia is “Severe”, 10 g/dl high doses of iron or blood transfusion may be necessary. If haemoglobin is between 10-12 g/dl, the other interventions are like iron and folic acid rich diet, supplementation and other strategies such as changing dietary habits, control of parasites and nutrition Education.
Evidenced  based Case : is available at homoeocure with drmohan@blog.com

References:
4) Worldwide prevalence of anaemia 1993–2005 WHO Global Database on Anaemia. W H O
6) Rubeena Bano, Nadeem Ahmad, B. C. Sharma, Ashok Agarwal, Nutritional Anemia in the Medical Students, http://medind.nic.in/ice/t12/i1/icet12i1p16.pdf
7) N Arlappa, N Balakrishna, A Laxmaiah, GNV Brahmam, prevalence of anaemia among rural pre-school children of Maharashtra, India, www.iapsmupuk.org
8) A P I Text book Of Medicine,8th Edition,vol 2.

If U have a “Magnetic Personality and still u can’t attract a giral/guy towards U,
It’s not your fault, it just means that the girl /guy has Iron deficiency Anaemia “—by Namam


CASE: Patient named Ms S, aged 19 years, Female, Intermediate student came with following complaints ON 11-03-2014 came with following symptoms:
MIND – SADNESS
MIND - TIMIDITY - public; about appearing in
RECTUM - CONSTIPATION - chronic
FEMALE GENITALIA/SEX - MENSES - painful
GENERALS - ANEMIA - nutritional disturbance, from
GENERALS – WEAKNESS
HB % was 8,
ON repertorisation   Plumbam Met 32/13, Lyco 29/13, Nux Vom 29/13 and Silicia 29/13.
ON 12TH March Plumbam Met 30C 5does was given Rubrum for 15 days were given, there was not much improvement,
ON 28TH March Plumbam Met 200 C 5does was given Lacethine 3x four grains twice a day was given, Rubrum for 15 days were given,
12th April patient came weakness’ and constipation were to some extent relived Rubrum 5 doses and LACETHINE 3X FOUR GRAINS TWICE a was given,
20th June 2014 she came with same complaints, as I enquired why she has not regular to collect medicines, she told me she consulted a general physician, took allopathic medicines without any benefit. Haemoglobin was 9 grams
Nux Vomica 200C, 5doses were given along with Lacethine 3X four grains twice a day was given for 15 days.
21TH July she told me that she is feeling better physically and mentally, but constipation was still persisting, Sulphur 200C, 3doses were given along with Lecithin 3X four grains twice a was given for 15 days.
22nd Aug 2014 she came with complete Blood picture report Haemoglobin was 10.4 grams.
Tuberculinum 1M, 1dose was given along with Lecithin 3X four grains twice a day for 30 days.
27th Sept 2014 she has put on weight, feeling better physically and mentally, Constipation was not totally relived, I advised the patient to take opinion of Surgeon, surgeon opinion was rectal stricture.
Conclusion:
Lecithin is important in the vital processes of plant and animal organisms.
It is prepared from the yolk of egg, a phosphorus containing complex organic
Body. Lecithin has a favourable influence upon the nutritive conditions and
Especially upon the blood, hence its uses in anaemia and convalescence,
Neurasthenia and insomnia. (Lotus) Tired weak short of breath; loss of flesh
Symptoms of general break down. ( Patak)
Article was published in first college day Souvenir  0n 07-11-2014