Lycopodium clavatum in a Case of Gilbert’s syndrome

Lycopodium clavatum in a Case of Gilbert’s syndrome

 Gilbert syndrome is a presumably lifelong disorder; it is a common, mild liver disorder, in which the liver doesn't properly process bilirubin.

Gilbert’s syndrome affects 3 to 10 percent of the U.S. population. More males are affected then females.  Because males tend to produce higher levels of bilirubin, a male-to-female ratio is ranging from 2-7: 1, and occurs in all races (2). This Syndrome may become apparent shortly after birth; it may not be recognized for many years. It is rarely diagnosed before puberty because production of bilirubin increases at this point. It is usually diagnosed around puberty, possibly because of the inhibition of bilirubin glucuronidation by endogenous steroid hormones. In older persons, the diagnosis is usually made when unconjugated hyperbilirubinemia (1, 3).

30% of patients are asymptomatic, Fatigue, nausea, abdominal pain and diarrhea may also occur but these are much less definitive in determining the diagnosis. The mild jaundice may be especially evident. Pigmented skin thickenings, similar to moles and soft yellow spots (xanthelasma) on eyelids may occur. An increase in pigmentation on exposure to light and heat are other symptoms of this liver disorder. Enlargement of the liver and spleen are rarely seen.

Gilbert syndrome can be diagnosed by a thorough history and physical examination and confirmed by standard blood tests. Repeated investigations and invasive procedures are not usually justified for establishing a diagnosis (3).

Homeopathic concept: Gilbert syndromes fundamental cause can be psoro syphilitic with few exiting causes like stress, strain, and exposure to heat. In a day to day practice we are missing this syndrome and treating for other hepatic causes. Few months back a case was referred to me with clinical diagnosis as Gilbert syndrome. The following is the case.

CASE SHEET

                                  Code: 207B

Name: Mr. M   Age:     25Y                  Sex: M

Occupation:     soft wear engineer      Religion: Hindu, weight: 50kgs

 Address:         Hyd                  Marital status: not married

PRESENTING COMPLAINTS:

Nausea on and off since 2 years

< Fatty food 2 years,

No work stress, food > warm food,

Desire fat food 8 months

< riding in a car or bus 6 months

Loss of appetite since 8months

HISTORY OF PRESENTING COMPLAINTS:

Complaints developed gradually. Two years back the patient developed nausea, took allopathic medicines with a family physician for 8 months with partial relief, then he consulted gastroenterologist, he after doing investigations he diagnosed the condition as  Gilbert’s syndrome. In spite of his treatment for over a year his symptoms persisted with every three months remission. With this patron of symptoms he developed anxiety about his health; Contradiction < with out work stress, he opted for Homoeopathic treatment. Nausea  on and off since 2 years , no particular time , < fatty food ( Puri , Biriyani etc )  on and off since 2 years , desire fat food 8months , food  > warm food , < riding in a car or bus since 6 months . He developed loss of appetite since 8months.

PAST HISTORY:

Since 2 years every 3-4 months similar complaints in spite of allopathic treatment

FAMILY HISTORY: father and Mother alive with apparently good health. Maternal or paternal side history he was not able to tell because he was away from home.

PERSONAL HISTORY:

Appetite: Diminished

Thirst: Decreased

Diet: vegetarian 

Desires: fats +

Aversions:  --------

Bowel movement: Regular / Satisfactory

Micturation: normal

Perspiration- np

Sleep: refreshing

Dreams: occ dreams which he cannot remember

Habits & Addictions: -

Sexual functions: -N

LIFE SPACE INVESTIGATION:

Patient was brought up in a middle class family. He was brought up with supporting love and care, with frequent transfers to his father he studied in boarding school, he was little shy, his schooling and college life were normal and got his engineering degree. and got job as software engineer. He developed nausea, < fat foods. Of late he developed anxiety about his health; Contradiction - intolerant due to present illness.

 

SOCIO-ECONOMIC AND OCCUPATIONAL HISTORY: Good, no work stress.

INTER PERSONAL RELATIONSHIP: satisfactory, mixes with people when ever it is needed.

PHYSICAL EXAMINATION:

General appearance: anxious look.

Built & nourishment: Thin built,

Skin: normal,

Cyanosis: Absent

Scalp: N                                                                       hair: occ dandruff,

Eyes: n

Sclera: NAD                                                                 conjunctiva: Pale

Oral cavity: NA D       

Tongue: N

Teeth: hygienic,

Gums: hygienic,

Lips: normal,

Lymph nodes: not enlarged

Nails; N  

Skeletal deformity: absent

Edema:  absent         

VITAL SIGNS;

Pulse rate: 70 PM

Temperature: N

Resp rate: 15

Blood pressure: 110/80mmHg

SYSTEMIC EXAMINATION:

Respiratory system: NAD       

Cardiovascular system: NAD 

Gastro-intestinal system: Abdomen soft, moveable. Liver palpable, 

CNS & PNS: NAD       

PROVISIONAL DIAGNOSIS: Gilbert’s syndrome

INVESTIGATIONS:

Liver and Spleen scan (colloid): Hepatomegaly with multiple photopenic areas.

Red cell fragility test: 0.42% (0.48 % Nacl)                                       

Complete urine examination: no abnormality

Total Bilirubin: 2.4 mg/dl, Alkaline Phosphatase: 170 U/L

Glucose-6-phosphate dehydrogenase (G6PD): N      185U/10 RBCs

Reticulocytes:  1%.

CLINICAL DIAGNOSIS:  Gilbert’s syndrome

ANALYSIS OF SYMPTOMS:

EVALUATION OF SYMPTOMS:

REPOTORIAL TOTALITY:

1) Anxiety - health; about - own health; his

2) Contradiction - intolerant of contradiction

3) Warm food – desire,

4) Fatty food - agg.

5) Nausea

6) Nausea, riding in a carriage or on the cars, while

7) Thirst less

RESULTS OF REPERTORIZATION:

ANALYSIS OF REPERTORIAL RESULTS:

Repertrisation was done on Radar software.

Lycopodium clavatum 47/22, Sepia officinalis 47/19, Arsenicum 44/19, Cocculus indicus 39/18, Pulsatilla 39/16 (as shown in Repertrisation chart)

DISEASE DIAGNOSIS: Dynamic chronic fully developed miasmatic disease

MIASMATIC DIAGNOSIS: Psoro – sycotic

SUSCEPTIBILITY: Moderate

REMEDY SELECTED: Pulsatilla (5, 6)

First prescription Pulsatilla 30C,  in my mind I wanted to give Lycopodium but as it is a first prescription I thought of giving Pulsatilla 30C on following  reasons  a) fats >( 3) ,b) thirst less (3) patients expressions were little shy.(5,6)

POTENCY SELECTED: 30C

PLAN OF TREATMENT, MANAGEMENT & FOLLOW-UP:

              Dietic:  advised to take a nutritious diet more of fruits, and avoiding fasting and skipping meals (Patients has been warned about the causation like misses meals, become dehydrated, viral infection or stress (2)

22/07/06    Pulsatilla 30c, 3doses, placebo 15days were given,

06/08/06    no change,

                  Pulsatilla 30c, 3doses, placebo 15days were given,

20/08/06    no appetite, nausea is less by 10%,

                  Lycopodium 30, doses, placebo for 15days were given,

03/09/06 Anxiety about health came down; appetite increased, nausea is less by 50%,                 placebo for15days were given,

17/09/06 Anxiety is less, appetite increased, nausea is less by 80%, and weight went up to 50.5 kgs,

                  Lycopodium 30, doses, placebo for15days were given,

30/09/06    Anxiety is less, appetite: normal, nausea is less by 80%, able eat fat prepared items and digest.

                    Placebo for15days were given.

04/10/06   GC good, weight 51kgs, no nausea, able to digest every food,

                 Sulphur 30 as a closing remedy, 3doses was given and placebo for15days were given.

Case was reviewed on 05/04/07 (6months) patient was able to tolerate all food, earlier every 3months remission was there, which was not seen.