Saturday, November 22, 2014

Stop Journeying towards fatigability

Stop Journeying towards fatigability

Prof G R Mohan
MD (H0m) P G Dip (Env Stud)

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.

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
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.    
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
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

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,
7) N Arlappa, N Balakrishna, A Laxmaiah, GNV Brahmam, prevalence of anaemia among rural pre-school children of Maharashtra, India,
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 - TIMIDITY - public; about appearing in
GENERALS - ANEMIA - nutritional disturbance, from
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.
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

Friday, October 3, 2014

Role of Homoeopathy in Irritable Bowel Syndrome

Irritable Bowel Syndrome & Homoeopathy paper was  presented at Omics Traditional and Alternative Medicine at Hyderabad on 9-11 Dec 2013

 Irritable bowel syndrome is a functional gastrointestinal disorder characterized by abdominal pain, discomfort and alteration of bowel habits in the absence of any organic disorder. Irritable Bowel Syndrome is a very common gastrointestinal dysfunction with the world wide prevalence   among general population ranges from 5.7% to 34%, the overall prevalence of IBS in western countries as reported by various studies ranges from 17-22%. However, in Asian countries a highly variable range of prevalence has been observed i.e. 2.3-34%. Many studies have reported that IBS is associated with elevated levels of emotional and psychological stress is a major contributing factor. In spite of strong evidence of a high prevalence of depression and anxiety in IBS there is very limited research on this in India. As there is no clear causes of irritable bowel syndrome, treatment focuses on the relief of symptoms.
Many sufferers seeking homeopathic, complementary and alternative medicine as a part of treatment. Homeopathic treatment is based on Individualization, Constitutional approach with lifestyle modification. In Homoeopathy, Importance is given to psyche symptoms  along with  bowel symptoms in the plan of treatment, There is quite a good number of remedies in Homoeopathy like Argentum nitricum. Sulphur, Podophyllum,Cynodin and carcinocin etc Results are quite encouraging.

Magnitude of the Problem ;
20%   Adults  in western world . More   or less same in India.
Significant impact on quality of life. 2nd common cause (after cold) of absenteeism .
Contribute to 25 - 40 % of practice of gastroenterologists
Rome II Criteria for diagnosis 2
Pain or discomfort for 12 weeks of the previous 12 months, associated with
two Of the following three:
  Relief on having a bowel movement,
Looser or more frequent stools,
Harder or less frequent stools
Symptoms 2,3
Abdominal pain associated with defecation.
Irregular pattern of defecation for at least two days a week.
Three or more of the following:
altered stool frequency; altered stool form (hard/loose);
altered stool passage (straining/urgency/ sense of incomplete evacuation);
mucus per rectum,
bloating or feeling of abdominal distension.

                  Homoeopathic Approach

·                        Case recording
·          Physical examination
·          Provisional diagnosis
·          Differential diagnosis
·          Investigations
·          Final diagnosis
·          Analysis of the symptoms
·          Evaluation of the symptoms
·          Results of repertorisation
·          Analysis of repertorial result
·          Classification of disease ( according to hahnemann)
·          Miasmatic diagnosis
·          Choice of remedy
·          Potency selected
·          Diet
My  study of 23 cases( was from june 2011 –may 2012 ) average age  was 25 years ,female gender were more, home makers  were more with large size of family, 3% were employees . DIBS was more seen then CIBS, past treatment history  majority took  conventional treatment with out any result.
every case was thoroughly investigated and came to conclusion that there   was no pathology.
          15-25 years age group males were (1) females (6)
          26-35 years age group males were (2) females (10)
          36-40 years age group males were (1) females (3)
        In  occupation out of 17 females 8 were home makers, in out of  6 males 3 were I T   professionals 2 were   teachers.
         Remedies used:
         Arsenic Alb , Gelsemium , Argenticum Nitrricum,  Mer Sol , Nux Vom , Cynodyon, Carcinocine   were the remedies              ,potency used 200 ,I M.

         Improvement was as follows
No reoccurring of symptoms three months after stopping medicines ( 6 T + 3 ST) no reoccurrence of symptoms : took it as good  improvement
reoccurring of symptoms three months after stopping medicines ( 6 T + 3 ST) no reoccurrence of symptoms, intensity of symptoms  were less , took it as  moderate   improvement
reoccurring of symptoms  very frequent with  treatment   took it as  poor   improvement

             Improvement in 23 cases  was as follows
  •            N : 23
  •            drop outs                                        :  2  ( 8.7%)
  •           cases  good  improvement             : 15 ( 65.2%)
  •           cases moderate   improvement      :  4 (17.4%)
·                             no  improvement                             : 2 (8.7%)  
        Treated case

       Patient Ms V, aged about 39 years with weight  56 KGs, consulted me on 5th June 2011 for pain abdomen > stool after, pain drawing in lumbar area, passing stools 4-5 times stool. C T Scan abdomen  was done it was WNL.  Case was diagnosed as a case of I B S by local Gastroenterologist

         Irritability, anxiety about health of his own health, pain abdomen > stool after, diarrhea anxiety after, cold water cold drinks <, cold food <., 
Ars alb 33/15 , NUX Vom 25/11, Silicia 23/15 were choice remedies 

Treatment follow up

5/06/2011          Nux Vomica 30 c  3 doses  were given
15/07/2011       case was repertorised   as shown  in next slid    Ars Alb 200, 5 doses  was given
14/08/2011       pain in abdomen  reduced ,  general condition improved,
29/09/2011      Nat sulf 200 was given  and followed by  Ars Alb
27/10/2011      general condition improved, Ars Alb 1m one dose was given
02/12/2011      was a symptomatic , with good general health , Tuberculinum  1M one dose was given as           closing remedy and treatment was stopped and advised her to see me after 4 months .

       1) Govind  K Makharia, Anil K Verma, Ritvik  Amarchand  Anil Goswami  J Neurogastroenterol Motil. 2011 January; 17(1): 82–87.Published online 2011 January 26
         2)">Irritable bowel syndrome
         3) Irritable_ bowel _syndrome paged4htm
         4) Dr GRMohan Irritable bowel syndrome challenge in medical practice, NHJ, Vol 8, no 2, March-April-2006


Saturday, August 9, 2014

Back pain Agony

Back pain Agony
Prof G R Mohan
M D (Hom), PGDip (Env Stud)
Principal, Devs homoeopathic medical college, Hyderabad
Visiting Professor (P G), VM Homoeopathic Medical College, Salem, TN,India.

Pain according to the International Association for the Study of Pain defined as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
There are two major types of pain, nociceptive and neuropathic. Nociceptive pain results from tissue damage. Nociceptive pain can be subdivided into somatic and visceral pain. Nociceptive pain can be experienced as sharp, dull, or aching. There may be radiation of the pain, but it will not be in a direct nerve distribution. Nociceptive pain tends to worsen when stress or pressure is applied to an affected area.
Neuropathic pain descriptions often have an electrical quality: burning, lancinating, buzzing, tingling, zapping, and lightning like. Neuropathic pain tends to radiate in a distribution that follows nerves. Classic examples include trigeminal neuralgia and herpes zoster pain. Neuropathic  pain may occur when there is either damage to or dysfunction of nerves in the peripheral or central nervous system. Neuropathic pain frequently coexists with nociceptive  pain. Neuropathic pain may have "reverb"-like phenomenon, with paroxysms of pain due to light touch, temperature change, or even air movement.

Back pain is one of humanity's most frequent complaints in the US. About eight in ten Americans are suffering from back ache at some point in their lives. Is the fifth most common reason for physician visits after colds, it's the No. 1 cause of missed work. Yet a cure for the common backache is as elusive as ever. Back pain can originate from many sources, and treatments are just as varied, Lower back pain can be very agonizing. The pain can make a person feel helpless, can irritate a person and lead to psychological distress .1,2
Back pain is divided into following grades  a) acute (less than 4 weeks), b) sub acute (4 – 12 weeks), c)chronic (more than 12 weeks).
Low back pain may be classified on the involvement are organs:  
a)   Skin: (herpies zoster ) b) muscles : sprain ,strain, myositis , fibositis  and muscular spasm c) bones :spinal disc herniation and degenerative disc disease or isthmic spondylolithesis and spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease d) spinal cord : (sub arachnoid, syringiomyelia  e) viscera : ( carcinoma of oesophagus, Acid peptic disorder, pancreatitis ,diseases of gall bladder, f)febrile conditions like Dengue, g)Psychogenic : (The researchers determined that patients suffering psychological distress were three times more likely to develop back pain than those with better coping skills) 1. In a survey conducted amongst sufferers of chronic low back pain of more than three months, it was observed psychological distress with abnormal illness behavior was about 43% and the contribution by the actual physical problem was only 67%. In 1996 published their studies on the role of psyche in 131 subjects with chronic low back pain in which they concluded that the demonstrable bone or soft tissue structural problems accounted for only 38% of the pain and the rest of it was all due to the psychological stress 2
Lumbar disc prolapse has become one of the most common problems in the Indian population.Conventional systems of medicine have its limitation in tackling these disorders, and their approach in the treatment of disc prolapse is to provide temporary relief than a permanent cure through drugs and Microdisectomy, which a common Indian cannot afford. Homoeopathic system of medicine, however, provides hope for a more permanent cure and relief if the treatment is planned methodically. With the Homoeopathic treatment with minimum rest pain reduction was seen.
Although homoeopathic medicines have been proven to be effective in treating Disc prolapse, not much evidence based ground work has been conducted in this field.
Ultimate answer from homoeopathic medicines gave good results are shown in the. Pain reduction 90%, Work returns 90% and increased physical function 60%(3,4)
A live case :

Name:Mr (322H), Hindu male, aged: 31 years, married, engineer by occupation Consulted me on   Date 14/04/07 with following PRESENTING COMPLAINTS:
Patient experienced sudden pain while getting up from seat, 10 days back, for which he took pain killers without any relief , Pain in lumbar area, aching  type of pain, < lying on the back, inability to walk straight, pain the left calf muscle, numbness in the left foot since 10days, < cloudy weather,> warmth in general,
Temperament of the patient was hurry, irritable and offended easily, from the beginning,
PAST HISTORY: H/o. injury to knee joint. FAMILY HISTORY: Father & G Father: obesity, HTN. Mother: HTN & PILES,
PERSONAL HISTORY: Appetite: moderate, Thirst:  moderate Desires: NP Aversions: NP B/M: regular, Urine: N Sleep: Sound
GENERAL PHYSICAL EXAMINATION: Pt is well built and well nourished.
No pallor, Icterus, no cyanosis, no clubbing, no lymphadenopathy
CVS:   NAD .RESP: NAD .CNS: reflexes normal, motor power slightly decreased in left lower limb, Sensations normal GIT: No organomegaly, abdomen soft.
Investigations of significance:

M R I of lumbar spine  (09-04-07): central and bilateral Para central Disc herniation noted at L5---S1 level, with caudal migration causing thecal and root compression.
Spinal canal and neural foraminal stenosis noted at l5—s1 disc level. 
Nerve conduction study (19-04-07): prolonged F response suggestive early L5—S1 radicular involvement.
X-Ray L S Spine AP/LAT ( 08-04-07) : Sbluxation of L5 over S1, disc space normal.


CLINICAL CLASSIFICATION: Dynamic chronic fully developed miasmatic disease

MIASMATIC DIAGNOSIS: Psora (41.99 %) –sycotic (34.02 %)-Syphilis (23.38 %). (CARA miasmatic chart)

Mind – hurry haste
Mind –offended easily 
Mind – abusive insulting
Generals- > warmth,
Generals – cloudy weather <
Generals – obesity,
Back – pain aching lumbar area
< lying on the back,
Extremities: Numbness in left foot
Mercurius: 14/9, Nat mur-16/9, Pulsatilla 20/9, Sepia 15/9.
Nat Mur covered more marks and score more for general symptoms also.
First prescription:

16/4/07: as expressed by patient, for pain due to slip disc without seeing the case on phone Hypericum 1M, one dose in water was given, Rubrum for 2 days as he was away, was not in position to come to the clinic.
19/4/07: Still he was walking with pain, case was taken and repertorised, the remedy selected was Nat Mur 200C, and 3doses was given,
* Reason for selecting  Nat mur covered 9 symptoms with 16 marks as shown in reportorial chart given below. Even though Pulsatilla covered 20/9, numbness in left foot has been covered by Nat Mur only,                      
16/5/07:  pain in the sacral area reduced by 30% was able to walk, numbness was still persisting, and Rubrum was given.
2/6/07:  pain in the sacral area reduced 30%, numbness was still persisting Nat Mur 200C, 3doses was given,
19/6/07: pain in the sacral area reduced 50% numbness was still persisting, Nat Mur 1M, 1dose was given,
30/6/07: Numbness in the foot was better by 25% only, rubrum was given for 10days

11/07/07: Numbness in the left foot was present; he developed upper respiratory symptoms like sneezing, nose dripping. Because of change of season (wet weather <)   
Thuja 30C, 3doses were given, as Numbness in the left foot, was persisting (only two remedies are there Nat Mur and Thuja) It has 14/9 score in follow up Repertrisation it is a follower to Nat Mur.

27/07/07: Numbness in the left foot was better by 25%, upper respiratory symptoms have reduced. Thuja 30C, 3doses was repeated.

12/08/07: Numbness in the left foot was better by 35-40% only, with general well being. Rubrum for 15days was given.

23/06/08 Patient has come for his son’s problem, meanwhile he stopped treatment numbness in the left foot was better by 40-50 % only.

2) Yoga for back pain-(psychological stress)

 Tuesday, November 25, 2008, 11:7 [its)
3) Prof Gundimeda Ram Mohan, Herniated Lumbar Disc - A Clinical Study, Homoeopathic Links, Volume 21,winter 2008.
4) Prof G.R. Mohan, lifestyle and lumbar spondylosis, The Homoeopathic Heritage, vol.33, no 1, Jan 2008

 *** published in ., ( vol:3, issue :4)