A Case of Chronic Osteomyelitis, Dr G R Mohan

Osteomyelitis is inflammation and destruction of bone caused by bacteria, Mycobacterium, or fungi (1)
Osteomyelitis is a particularly tragic preventable disease; it was once common, particularly among the poor, disease of the disadvantaged children of the developing world (3).
Haematogenous Osteomyelitis and Traumatic Osteomyelitis are two types. In Haematogenous Osteomyelitis bacteria reach bone through the circulation, Traumatic Osteomyelitis particularly follows road accidents and war injuries, in which bacteria reach bone through a badly treated open fracture or wound. And is also seen in inadequate wound toilet and through unsterile theatres. 80% spread is by open wounds and by hematogenous, Trauma, ischemia, and foreign bodies predispose to osteomyelitis. It is often polymicrobial.

The metaphysis of a long bone is the usual site. Osteomyelitis in the proximal tibia, the distal femur, the proximal femur, the proximal end of the humerus, the distal radius or ulna, the distal tibia, or the calcaneus. But any bone can be involved, and sometimes several of them at the same time. (3)
Osteomyelitis tends to occlude local blood vessels, which causes bone necrosis and local spread of infection. Infection may expand through the bone cortex and spread under the periosteum, with formation of subcutaneous abscesses that may drain spontaneously through the skin (3)
Common symptoms are localized bone pain and tenderness with constitutional symptoms like weight loss, fatigue, fever, and localized warmth, swelling, erythema, and tenderness.(in acute osteomyelitis). In Chronic osteomyelitis bone pain, tenderness, and draining sinuses and without constitutional symptoms, it takes months to many years (1)
Diagnosis
CBP, TWBC, ESR or C-reactive protein (will be elevated)
Culture of bone (Will be positive), abscess,
X-rays, MRI, or radio isotopic bone scanning’s-rays become abnormal after 2 to 4 wk, showing periosteal elevation, bone destruction.
Homoeopathic concept:
It can be One sided local-surgical or non surgical. Needs constitutional treatment to remove the fundamental cause. On the phase of disease it can be psoro –syphilitic as there will be bone necrosis with formation of subcutaneous abscesses.

A case of chronic Osteomyelitis


Mr. .M, 27, M, Religion: C came to our OPD on 030303 with following complaints.
Pain in the left upper am, pricking type, pain is aggravated at night, patient in general oversensitive,
On examination we found multiple sinuses, offensive discharging of pus & blood, discharge of bone pieces at times. Local tenderness was present.

Physical generals:
Appetite- 2 meals/day.
Thirst- Normal, Bowels: regular. Sleep: refreshing, Dreams: Nothing specific.
Perspiration: Nothing specific
Thermal reaction: Sensitive to cold air
On examination we found multiple sinuses, discharging pus &blood, discharge of bone pieces at times,
C/o Physical generals: Sensitive to cold air

PAST HISTORY
History of similar complaint, started first in the tibia, underwent surgery and it healed slowly in 2 years.
FAMILY HISTORY: Nothing particular
PERSONAL HISTORY:
Middle school drop out, Occupation- no,
Marital status- unmarried.

Investigations:

Blood report: dated 030303
Hb: 10.9grm/dl
Total RBC: 3.78 mill/cumm
Total WBC: 18000 mill/cumm
N89, L16, E02, M02.ESR:1st hour125, 2nd hour 140.

X-rays as shown below:


Class of disease: One sided local-non surgical
Surgery not helped him; he was in need of constitutional treatment to remove the fundamental cause. Hence it comes under non surgical. The presentation of disease is only on the local part with few symptoms, hence one sided –local. Remedy selected was Hepar Sulph Reasons for selecting Hepar Sulph were offensive discharge, over sensitiveness, sensitive to cold air, it is a good remedy for supportive stage with already formed pus, to remove the sequestrum and it helps in healing.


First Prescription on 030303: Hepar Sulph 30c, 3doses, Rubrum (40) 4pills 12th hourly, for 15 days, advice to Clean the area with calendula external daily.
Follow up:
On 210303: no much change only offensiveness of discharge was less. Total count of WBC has come down, ESR was little lees. Hepar Sulph 30c, 3doses was repeated along with Rubrum (40) 4pills 12th hourly, for 30 days. (table1)
On 100403 patient reported and said pains is less by 25%, offensiveness of discharge and discharge was less but Total count of WBC has shot up to 11800 and ESR was little lees comparative to previous readings. Rubrum (40) 4pills 12th hourly, for 15 days and Calcaria Sulph 6x biochemical tablets were given 4+4 12th hourly.
280403: no much change, Hepar Sulph 200c, 3doses, Rubrum (40) 4pills 12th hourly, for 30 days.
On 230703 came with blood report Total count of WBC came down to 8900 and ESR was little lees. Pain and discharge was less. Still discharge was present a dose of Syphilinum 1M,1dose was given along with Rubrum (40) 4pills 12th hourly, for 15 days and after 15days Calcaria Sulph 6x biochemical tablets were given 4+4 12th hourly.
Patient reported on 140903 with following presentation pain less, discharge is not seen, slight tenderness at the sight, we advised him to go for X ray and routine blood examination. Hepar Sulph 1M, 1doses, Rubrum (40) 4pills 12th hourly, for 30 days were given.


221003 patients came with blood report as shown in table (1), Total count of WBC again shoot up to 10200 but ESR was very lees. No pain and discharge was very less. Slight tenderness was seen on deep pressure. Rubrum (40) 4pills 12th hourly, for 30 days were given.

On 221203 he came with general wellbeing. Hepar Sulph 1M, 1doses, Rubrum (40) 4pills 12th hourly, for 30 days were given. We advised him to come with X - ray.
As patient was better, he was not maintaing the regularity in taking medicines
240404 patients came with a blood report and X-ray as shown below, total count of WBC has shot up to 10200 and ESR was 32mm only, in X-ray there was good improvement. Hepar Sulph 1M, 1doses, Rubrum (40) 4pills 12th hourly, for 30 days were given.

Summary: There is a misconception that homoeopathy may not work for deep seated pathological conditions. The above illustrated case is an example how homoeopathy does wonders.

HEPAR SULPHURIS:
It is suited to the psoric, scrofulous, diathesis. Debilitated subjects.
Tendency to suppurations. Slow torpid constitutions with lax tissue and light hair, great sensitiveness to slightest contact of ulcers, eruptions and parts affected. Great sensitiveness to all impressions. Cold, dry winds. Injuries. Abuse of Mercury. Suppressed eruptions.Unhealthy skin, every little injury suppurates. Abscesses, suppurating glands are very sensitive. wants to be wrapped up warmly. Sticking or pricking in affected parts. . Great sensitiveness to slightest touch. (2)


Table 1
Blood reports of Mr. M:

Date Hb:
grm/dl Total RBC mill/cumm Total WBC mill/cumm N L E M ESR
1sthour/2nd hour
030303 10.9
3.78 18000 89 16 02 02 125/140
210303 12 4.3 7600 70 24 03 03 125/132
090403 13.6 4.80 11800 73 21 03 03 115/125
230703 12.2 4.1 8900 60 34 05 01 110/120
221003 12.2 4.1 7800 59 33 07 01 52/80
090204 13.2 4.5 10200 62 32 05 01 32

** Date wise comparative table