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