A case of poly cystic ovarian syndrome treated with Homoeopathy

The journey to fertility -  A case of  poly cystic ovarian syndrome 

Prof  G R Mohan

M D(Hom)., P G Dip(Env Stud)

Principal, Devs Homoeopathic Medical College,

Deva nagar, Ankireddypalli, Kesara mandal, R R Disrtict, A P

drmohangr@yahoo.co.in

www.drgrmohan.com

Poly cystic ovarian syndrome first described by American gynecologists Stein and Leventhal in 1935, PCOS is a hormonal disorder affecting 10-15% of women, worldwide, irrespective of race or color. The World Health Organization estimates that it affects 116 million women worldwide as of 2010 (3.4% of the women). According  Dr Rajeev Punjabi India witnesses alarming rise in the incidence of  PCOS , India has witnessed about 30 per cent rise in polycystic ovary syndrome (PCOS) cases in the last couple of years. Lack of awareness and lifestyle changes are considered to be the major factor leading to this phenomenon.,1 2

At least 12 follicles  develop in the ovaries (polycystic means 'many cysts'). Cysts are fluid-filled sacs. Increased  testosterone  level,  raised levels  of insulin in the bloodstream is thought to be the main underlying reason to develop PCOS. A high level of  Luteinising hormone  is found in about 4 in 10 women with PCOS this test is suggestive but not diagnostic.^1,3

Symptoms : 80% Menstrual Disorders (absent), Anovulatory Bleeding (<6 nbsp="" span="">Menses per year) Infertility (74%) and Recurrent Miscarriage, Acne Vulgaris oily skin, Hirsutism (69%) Dark or thick skin markings and creases around the armpits, groin, neck, and breasts , androgenic alopecia, Clitoris swelling, 49% Central Obesity (apple shaped ) BMI over 27 (65% of PCOS patients) , Mood disturbance (e.g. Major Depression, Anxiety).

Ultrasound, Glucose to Insulin Ratio < 4.5, A systematically selected homeopathic remedy has the capacity to correct hormonal imbalance due to poly cystic ovarian syndrome  by stimulating the glands to secrete various hormones in the required manner, basic pathology, miasmatic nature, individual study, a suitable homeopathic similimum  will bring  an excellent change in blood and sonographic reading. Homeopathic remedies would help in the regression of ovarian cysts. Losing 5 percent to 10 percent of weight according to B M I, can help to restart ovulation, Exercise can help you lose weight. Diet : Low glycemic index foods, diet include whole grains, beans, fruit, vegetables and lean protein , Eating a few small meals rather than three big ones may help even out blood sugar levels

A case  of P CO D : Patient by name MS S, aged 20 years, unmarried ,

 a B Tec student , who was dreaming to get married and conceive , came to me on 10-02-2013 who was medium built, with 64.9 Kg weight, hot patient, very irritable, known case of hypothyroidism since 4 years presented the following symptoms

PRESENTING COMPLAINTS:

Menses delayed by 5 months, irregularity since 3 years

Irritability 2 years

Anxiety about health 1year

Haughty since 8 months

Hair over upper lip, neck. 2 years

                                                                                               

PAST HISTORY:

Since 2007 period is late, was diagnosed as hypothyroidism and kept on allopathic medication, taking medication for P C O S

FAMILY HISTORY:  F/H hypothyroidism

*         PERSONAL HISTORY

Appetite- Good

 Diet- mixed.

Thirst- less.

Desire- Cold food , desire spicy food.

            Aversions/ intolerance- NS.

Bowels- Regular.

Urine- 5/6 times/day. No special. Characteristics.

Sweat- NP

Sleep- refreshing

Habits and addiction : no

*         LIFE SPACE INVESTIGATION.

*                     She  belongs to an upper middle class family of Hyderabad. Her  father is a business person   . She is a  first child of her parents. Had normal childhood, 3 years back her mother died due to health problem.

*         General physical examination

*         The patient was short stature  64.9  Kg weight, B M I: 25,  no pallor, cyanosis, edema, clubbing or lymphadenopathy.

*         Systemic examination

*         Examination of neck : slight swelling of thyroid gland on deglutition.

*         GIT System: abdomen was soft, liver palpable, spleen not enlarged

*         CNS System: Nothing abnormal detected

*         CVS System: Nothing abnormal detected

*         Respiratory System: Nothing abnormal detected

*         Investigations:

*         U S Scan : P C O D ( 2009, 2010 & 2012 )

*         Antverted uterus, Endometrial thickness :

*         F S H 6. 7.9 ; L H :21.78 ; S Prolactine : 8.8

*         T S H : 3.78uiu/ml

*         Clinical diagnosis: P C O D

*         Clinical classification :

*         Dynamic chronic fully developed miasmatic disease.

*         Miasmatic diagnosis

*         Psoro -Sycotic and Syphilitic.

*         Susceptibility: moderate

*         Totality of symptoms :

*          Irritability

*          Anxiety about health

*          Haughty

 Desire for open air

*         Desire for cold  Food , desire spicy food 

*         Menses late

*         Thirstless

*         Repertorisation (attached below) ⁴

*         Phosphorus  and Pulsatilla were the first two remedies emerged on Repertorisation. Reasons for selecting Pulsatilla was due to as it covered  all symptoms with  maximum score. Boericke says that "it is pre-eminently a female remedy , He says that the disposition and mental state are the chief guiding symptoms to the selection of Pulsatilla.

Treatment:

*         10/02/2013   before the total case was taken , on the day one Thuja30C, Five doses were given every 12 the hourly, along with Placebo 5 days .

*          patient came on 26-2-13 no trace of menses Pulasatilla 200c ,5doses were given  with Placebo for 20 days .

*          24-03-13 :  patient came with  no trace of menses Pulasatilla IM, 3 were given with Placebo 30 days . 

*         21-04-13 :  patient came  and said that menses appeared on 17-04-13, bleeding was more. Placebo 30days . 

*         19-05-13 :  patient came  and said  menstrual bleeding continued  for 20 days, extreme weakness  China 200C, 5 doses ,  Placebo 15days  Carcinosin 1M , one dose , Placebo 15days  was given.

*         16-06-13 :  patient came  and said weakness reduced, Menses was again delayed 12 days, it appeared on 29-05-13, LM P  was on 17-04-13,  Pulasatilla I0M, one dose  was  given with Placebo 30 days .  I have advised her to undergo U S Scan of the abdomen.

*         14-07-13 :  patient came  and said menses appeared  on 29-06-13, two days bleeding was present, weakness reduced, Placebo 30days . 

25-08-13 :  patient came  with the U S Scan report which was showing Normal study (attached below). Irritation and other symptoms were normal. Carcinosin 1M , one dose , Placebo 15days  was given.Ahoka Q, was given daily .

Discussion :

In the above case all investigations were done , all investigations were pointing towards  Poly cystic ovarian syndrome . since 2009 she is having problem, took various treatments with any benefit, as age is marriage age any girl wish to get married and concive, but her periods were very irregular, many times she was kept on contraceptive pills to regulate periods and used metformin without any benefit. with that she gained her weight.2009 to 2013 she has put on 11 kg weight.developed sever anxity about her health and future.

In the conventional treatment Medical treatment of PCOS is lowering of insulin levels , restoration of fertility, treatment of hirsutism or acne and restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer. Polycystic ovaries are treated with a laparoscopic procedure called "ovarian drilling" OR Reducing insulin resistance by improving insulin sensitivity through medications such as metformin anti diabetic drug. If fertility is not the primary aim, then menstruation can usually be regulated with a contraceptive pill . ¹

 Pulasatilla has given good result in regulating menstruation , it has changed her mood, helped Her to shed weight and lastly  P C O Ds vanished with homeopathic remedies. In the above case Carcinosin Burnett was given; as  it coved  Sycotic, Tubercular, Syphilitic miasms, it’s a  Chronic, Intercurrent remedy . Thuja Occidentalis  coved   Psoric, Sycotic, Syphilitic miasms

It's surprising to note that Pulsatilla which is selected  on the basis of repatriation , given to the patient gave success, but following observations were noted.

In Murphy’s repertory  under the rubric  female-Tumors, genitals-ovaries, cysts : 44 remedies are there but Pulsatilla is missing

Synthesis 8.1 V repertory  under the rubric  female-Tumors, genitals-ovaries, cysts : 32 remedies are there but Pulsatilla is missing

Boericke O, repertory  under the rubric  female sexual system -ovaries, cysts dropsy  : 25 remedies are there but Pulsatilla is missing

References :

1) Ganie M A, Kalra S. Polycystic ovary syndrome - A metabolic malady, the mother of all lifestyle disorders in women - Can Indian health budget tackle it in the future?. Indian J Endocr Metab [serial online] 2011 [cited 2013 Sep 16]; 15:239-41. Available from: http://www.ijem.in/text.asp?2011/15/4/239/85571

2) http://ayurbhishak.wordpress.com/2010/09/23/%E2%99%A3-india-witnesses-alarming-rise-in-incidence-of-pcos-dr-rajeev-punjabi/

           3) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001408/

           4) Hompath Wildfire

11-02-2013

Teachers Day celebrations at Devs Homoeopathic Medical College , Ankireddypalli, R R District , A P , India , Sept 2013

Dr.S.Radhakrishna’s birth anniversary was celebrated in Devs Homoeopathic medical college on 5-9-2013 Prof.Dr.G.R.Mohan principal of the college priced over the function. On the occasion Dr.Mohan enlightened the salient events of the life history of Dr.S.Radhakrishnan ,futher he said the difficulties of teachers while teaching, the average and below average student also should be benefited with the teaching then  only      He will be considered as a teacher. Students of the college felicitated all the faculty members of the college. Prof.Dr.M.Ramakrishna and Prof.Dr.P.Shankar also spoke on the occasion. The function ended with cultural program me and lunch. 

Is there a need to rewrite the textbook of Practice of medicine according to the need of homeopaths ?

Is there a need to rewrite the textbook of Practice of medicine according to the need of homeopaths ?

Prof G R Mohan,

Principal, Devs Homeopathic Medical College,

Ankireddipalli, Keesara Mandal, -501301

R.R.District, AP

A Teacher is a performer like an actor- the only difference is that the teacher expects learners to perform

Samuel Hahnemann states  in The third aphorism in the Organon :

If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine

Basic objectives of education and training in a Homoeopathic institution is to prepare a competent Homoeopathic Physician who is capable of functioning independently and effectively under Rural and Urban set ups (CCH)

According to C C H syllabus there are three papers for practice of medicine examination which is scheduled in the final year of B H M S course. Two papers are mainly concerned to homeopathic therapeutics. In true sprit a teacher in the Department of medicine has to refer text book of medicine along with material medica  and Organon books to deliver a lecture to satisfy the examination modalities. How far is this practicable? Majority time of 85% is spent on medicine proper; in reaming fifteen percent of time only homeopathic treatment is discussed in the class. Even for students it becomes difficult to collect information with this cumbrous syllabus.

Present day there is a criticism that newly passed out graduates are not able to give correct prescription. How far is it correct ? It is a question to be answered by every teacher in homeopathic medical college. Is it the fault of the teacher ? Can it be the student? Or non  availability of Homoeopathic oriented books ?

Late Prof. John Mitchell & his team have shown that :80% of the accurate final diagnosis & 100% of the management strategies, could be arrived at the end of reading the referral letter and carefully listening to the patient. This clinical accuracy could only be 4% more refined by all the physical examination and only 8% more refined by all the investigations including PET scan.

Elizabeth Hubbard said : A through physical examination and routine laboratory investigations has to be done, so that the physician is thoroughly scientific.

Stuart  Close said : Hahnemann devoted  twenty two paragraphs in the ‘Organon’ on examination of the patient ( 83-105)

Really there are no  good homeopathic oriented  text books  for practice of medicine are available but  they are quite good number text books  in allopathic oriented practice of medicine  which naturally impress on the student‘s mind the allopathic approach. Medicine books are written by allopathic oriented authors with mechanical-materialistic approach and outlook. Very little attention paid to the dynamic vitalistic aspect of all these subjects .The disease is described more from nosological diagnostic point of view less from the angle of dynamic vitality and individualistic concept. Prognosis not described according to the homeopathic point of view.    

 Medicine is essentially a practical science and can be more learnt at the bedside than in a classroom. Care should therefore be taken to impart an intensive clinical training to the students during the later part of their study in the college.

Therapeutic method of study consists of studying a remedy in relation to its action in different disease conditions.  For example

Nat.mur-               Eczema, Headache etc.

Pulsatilla-              Mumps, Measles, Haemorroids etc.

Iris Tenax-            Appendicitis.

As teachers  we have to discuss  the predominant site of action drugs which are mentioned  in Materia Medica  with the knowledge of Practice of medicine e.g.:  Cheledonium- Liver, Ceanothus- Spleen, Sabal ser- Prostrate , Ruta-   Periosteum, Hypericum- Nerves. Digitalis – Heart, Euphrasia – Eye and Iodum- Thyroid.  

The modern physiologist reflects the theory that the vast majority of human ills are related in some degree to endocrine imbalance. Every drug in Materia Medica should be studied in relation to the affection of endocrine glands.

Iodum- Hyperthyroidism.

Graphites- Hypothyroidism, Hypogonardism. 

Fucus Vesiculosus- Nontoxic Goiter.

Nat. Mur- Addision’s Disease. Hyperthyroidism

In therapeutics explanation should be more scientifically like :Hardness of hearing> by riding in carriage or train is seen in Otosclerosis (medicine), this symptom is present in Nit. Acid, Graph (materia medica) Enlarged glands.  Hodgkin’s Disease. Seen in  Scrophularia. N.

Even in Materia Medica books contains a vast number of medical terms with many nosological names of disease. So it is difficult to understand Materia Medica without knowing the meaning of the term or signs and symptoms of the disease.

Wen-                     Sebaceous cyst.

Paralysis agitans- Parkinsonism.

Somnambulism-    Sleep Walking.

Hive-                     Urticaria.

Zona-                    Herpes zoster.

The knowledge about the diagnostic symptoms i.e. the pathognomonic symptoms helps in determining the individual characteristic symptoms which form the basis of the prescription in homeopathic practice according to the concept of the totality of the symptoms. It aids prescription by giving information about the location and nature of pathological changes present – pathological generals. It determines whether the pathological changes are far advanced and have affected any of the vital organs. Diagnosis gives indication to use of deep acting constitutional remedies like Silicea, Lycopodium, and Sulphur etc.

Administration of the superficially acting related remedy, Use of high potencies frequent repetition of similar deep acting remedies in acute diseases, the clear diagnosis helps in the differentiation of a natural disease process from other disturbances in the health, E.g.: Asiatic cholera from Arsenic poisoning, cholera from Camphor poisoning .The clinical diagnosis helps the physician in instituting the prophylactic measures (Genus epidemicus) at the time of epidemics. It also makes possible the comparative assessment of the therapeutic results, it also helps to know, to which stage of disease, the drug is more similar. So helps in - Speed prescribing, - Prescription in case of the paucity of symptoms- Comatose patient. 

In reality patients come to teaching hospitals either acute , psedochronic and chronic type, but when a teacher in the practice of medicine has to teach according to the above said classification so that for the plan of the treatment. A teacher who is senior can tackle but for junior teacher it becomes difficult , because no book covers the above problems.

Lastly even after introduction of post graduation in the practice of medicine there is no improvement,  even in  examinations also when the student writes the long or short case , he fails to mention the classification of diseases , fundamental cause exiting cause,  answering blunders in Viva, Performing Very poor clinical examination, writing very few remedies in therapeutic part, no mention of diet nor mentioning general management . Views of a cross section of Homoeopaths  who don’t know about the difficulties in teaching comment like, No Homeopathic orientation,  Poor clinical skill, no filtering in examinations and  on teacher’s attitude

The practice of medicine , Orgonon and materia medica are interrelated , when discussing about  a remedy it should not be theoretical oriented better it should be clinically oriented  material medica to students. Twelve observations of Kent are not shown at the bedside in some of the institutions. Majority of homoeopathic hospitals admission strength is coming down as there is no special care for admitted patients compared to out patiently treated patients. It becomes difficult to demonstrate a good clinical case (successfully homeopathically treated case).

It is for young dynamic teachers of this great system,to come out with a book on the practice of medicine which cover all above said deficiencies.

*** article is published in Medicina Futura homoeopathica,  vol :1 issue :9 Sept 2013

PALLIATION OR CURE: WHAT IS THE NEED OF THE HOUR?

PALLIATION OR CURE: WHAT IS THE

NEED OF THE HOUR?

Prof. Dr. G.R. Mohan

M.D (Hom) P G Dip (Env Stud) .

Principal,

Dev’s Homoeopathic Medical College

Hyderabad.

drmohangr@gmail.com

Editor, Medicina Futura Homoeopathica

“Medicine cures sometimes, palliates often but comforts always”. This is the saying. It is not just a saying but a fact too. Behind this there is also another important factor that always operates and which really influences the whole process of treatment i.e. confidence of the healer in his ability and faith that is imposed by the patient.

As Homoeopaths we always aim to cure. The definition which as homoeopaths we give for cure is also different when compared to the other branches of therapeutics. We consider total restoration of health is only the criterion for health or cure. We have got different types of practitioners even though the principles of homoeopathy do not differ, the law of cure does not change. It is something like diversity in unity. By and large, two homoeopaths do not agree on one point so far as therapeutics is concerned. That is our speciality. I say it is our speciality because at the end of the day both prove to be correct. That is the beauty of Homoeopathy.

Let us analyse our day to day practice. How many patients under our care are really getting cured? How many are getting palliated? How many are just comfortable under your care? (May be due to various reasons). We, as homoeopaths consider hypocrisy as one of the qualifications for practicing homoeopathy,

we do not want the categorization as cure, palliation etc. because we have only “cures”. (There are some exceptions). Many of us feel disturbed when a patient says that he is not better. Our ego does not admit such statements from the patients. But it stimulates your thinking process and you are forced to review the case again. Then as Physicians we feel atleast we should give him some relief so that you need not hear that statement again.

Apart from the above condition there are several patients in whom we can only give

palliation rather than cure for more than one reason. Many homoeopaths especially in bigger towns and cities see around fifty patients a day. The usual ritual that is to be followed for a cure i.e. case taking, analysis, evaluation and repertorizatin etc. will take nothing short of a few hours. Even then there is no guarantee that we can select a simillimum. As such many practitioners adopt a specific approach in the treatment of patients which is almost a routine method and which helps a practitioner to dispose of

patients fast. But the results are not bad. There will be a definite palliation and some sporadic cures as well. (hypocrisy sacrificed). Even then we are doing a lot of good to the patient.

A patient suffering from Psoriasis had consulted a Dermatologist and took treatment for a couple of years. Still there are symptoms and occasional suffering. The patient asked the Doctor how long I have to continue the treatment? The Doctor said that can a patient suffering with Diabetes or Hypertension or

Thyroid ask this question? No. Because it is a disease where a life long treatment is required. Even this (Psoriasis) is like this. The patient stopped medication and consulted a Homoeopath. The homoeopath also explained the problem and told him that it is a chronic case and there are spontaneous remissions and relapses even in Homoeopathy. Further the homoeopath assured him that certain amount of relief is sure to be there and definitely there will be no side effects. The patient is convinced because during his two

years of allopathic treatment he had no substantial relief of his skin condition besides that he also developed some symptoms like anorexia, joint pains, unexplainable weakness etc. which the patient never had before have been attributed as the side effects of allopathic treatment.

There are several patients or several types of diseases in which palliation itself is a great boon to the patient; not that a cure is not possible, but it cure it may take a long time. We have to hold the patient and it is better to work or review the case again and again and find a final cure. For example take the same

Psoriasis patient, treatment with Sulphur, Sarsaparilla, Sepia, Thyroidinum, Kali sulph, Calc sulph etc. in low potencies and the patient will definitely feel better and does not have any side effects. May be finally a

dose of Tuberculinum 10m gave him a permanent relief. Several examples could be given. In a case of IBS (Irritable Bowel Syndrome) we know how much the patient suffers and many a time a patient goes into depression. (Basically a psychosomatic problem). A few doses of Aloes, Nux vomica, Sulphur, Merc sol, Pulsatilla, Kurchi etc. will give tremendous relief. The other day a patient who is a senior executive

in a MNC was telling that before starting homoeopathic treatment he was always apprehensive about bowel movement because he does not know when he will get an urge for stool and where he would be at

that point of time (being a senior executive he has to attend number of meetings in Indian and abroad also) and ever since he started homoeopathy he has developed more confidence and that fear to go out has gone.

What a wonderful compliment to homoeopathy.

Arthritis is one disease for which usually patients consult a homoeopath very often ofcourse not before trying allopathy. After a period of Allopathic treatment there is always a threat of renal parenchymal disease or in many patients after steroids some very deleterious side effects will develop and come to homoeopathy with a lot of hope. We need not worry about the pathology. The more you are concerned with pathology the more you are apprehensive about the treatment. Go ahead. You are the master. Simple Rhus tox in six centesimal gives instantaneous relief. Many remedies like Bryonia, Colchicum, Actea spicata, Phytolacca, Calc flour, mother tinctures like Guiacum, Gnaphalium etc. will generally help a patient to carry on without much discomfort. May be at a later stage a few doses of Sulphur, Calcarea carb,

Lycopodium etc. may perhaps give a total relief to the patient. A patient suffering from very severe Rheumatoid arthritis was 90% relieved with a few doses of Kali mur 30 and Hydrastis mother tinctures.

We can go on narrating several diseases and we can palliate or cure depending upon the stage of the disease.

What I am trying to emphasize is that as a Physician you have a responsibility to give comfort to the patient. You are not breaking the rule but you are only bending the rule (Dr.Siva Shankar often quotes this phrase) but your patient is happy. He does not apply leave to his office very often; does not have any side effects; life goes on. What else does he want? Not that we do not cure, but first we palliate. I am not against the conventional method. I am not against curing in tune with the Organon of Medicine. But what I am trying to put before you is the need of the hour. Let us treat as many patients as possible. Let us go into the public and cover as many families as possible and ensure that homoeopathy reaches the masses.

I am openly telling what I am doing and what is required to be done. I know many homoeopaths are doing this. But when it comes to open discussion everything will be different. I have participated in State level,

National level and several International level conferences. But I hardly came across homoeopaths who openly confessed about their failures. Sometimes we feel disgusted at the hypocrisy that is manifested.

So let us cure – palliate – but definitely we should give necessary comfort to the patient. 

*** published in Medicina Future , vol 1, issue no 5 May 2013