Role of Homoeopathy in TRIGGER FINGER

A CASE OF TRIGGER FINGER

(The Homoeopathic HERITAGE, Vol 30,no 12,Dec 2006 )

Prof G.R. MOHAN

Professor Vinayaka Mission’s                     

Homoeopathic medical college & hospital, Salem, TN

INTERDUCTION: Trigger Finger or snapping finger or Digital Tenovaginities Stenosans are SYNONYMS. In this condition when patient attempts to open the closed fist the affected finger remains in flexed position (locked) and it has to be passively stretched with other hand. It goes into extension with click. More commonly seen in females with a frequency 2-6 times that observed in men.  (1). The most commonly affected digit is the thumb, followed by the ring, long, little, and index fingers Increased incidence in the dominant hand is observed. Involvement of several fingers is not unusual. It is a result of nodule formation on flexor tendon. It occurs as complications of either simple Tendon Synovities or Rheumatic Arthritis. Nodule is usually small. The Nodule commonly is trapped under the Meta carpo Phalyngeal ligament as the tendon flexes. The finger is them locked in flexon and active extension is impossible. To unlock the finger passively pressure is used.  Sudden snapping (Trigger) of the digit occurs, finger is extended. Locking or catching during active flexion-extension activity may need passive manipulation to extend the digit in later stages .Stiff digit, especially in long-standing or neglected cases ,Pain over the distal palm ,Pain radiating along the digit are symptoms. Systemic causes of Trigger Finger are collagen-vascular diseases, including Rheumatic Arthritis, Diabetes, psoriatic arthritis, amyloidosis, hypothyroidism, sarcoidosis, and pigmented villonodular synovitis.

Treatment is not satisfactory in other systems of medicine. Only cartico steroid injection or operation in which incising the mouth of the fibrous flexor sheath longitudinally (1).

CASE:

Patient by name Ms. J. aged 45 years, married with two children without any history of Diabetes or Hypertension. She was diagnosed as Trigger finger by local orthopedic surgeon. She came to me with following symptoms to avoid Surgery. Pain in Rt. Little finger since one year – pain drawing type, aggravated by initial movement, aggravated early morning,  inability to extended the finger, only passively she has to extend the finger with other hand and in general aggravated in damp weather. Sleep: N, appetite: N, Bowels: Regular, Urine: free, perspiration: Normal and menses: attained Menopause.

F/H Arthritis

O/E Slight swelling the finger with tenderness.

There are no much symptoms, only probable cause is over use of her fingers in daily dowe mixing. On 22/6/05 Rhus Tox 200 C, 3 doses. 4^th hourly one dose was prescribed followed placebo for 5 days. Very slight improvement was noticed. 30/06/05 Rhus Tox 1M, 1 dose followed by placebo 7 days was prescribed. After this course pain reduced slightly only, inability to extend finger is as usual. Nodular condition, involvement of flexor tendons (3) Ruta Graveolen 200 C, 3 doses, 6^th hourly one dose followed by placebo for 7 days prescribed. After Ruta.G patient was able to extend the finger little bit and pain reduced. Ruta G 1M, 1 dose was given along with placebo for 15 days. Patient reported back and she was able to extend her finger without any help, pain totally reduced. A complimentary drug Cal Phos 200 C, 3 doses was given lastly. The symptoms did not return even after one year.

DISCUSSION:

This is a case of few symptoms. Rhus Tox only helped her to some extent.  Ruta G is having tendency to the formation of deposits in the periosteum, tendons, and about joints, especially wrist it acts upon the periosteum, cartilages and Flexor tendons, was tried up to 1m potency with good response even after one year there were no recurrence of symptoms. Case was diagnosed on clinically only. Most of the Pathological and radiological investigations will be normal.

REFERENCE:

1.            John Crawford Adams and David L. Hamblen (1991) Outline of Orthopedics, 272 Churchill Livingstone.

2.            C. Vyaghreswarudu, Principles and Practice of Orthopedics, Andhra University Press – Waltair.

3.            J.T. Kent (2EDI) Lecturer on Homeopathic Materia Medica, 834)

4.            Robin Murphy ND, Lotus Materia Medica.

Stop Journeying towards fatigability

Stop Journeying towards fatigability

Prof G R Mohan

MD (H0m) P G Dip (Env Stud)

www.drgrmohan.com

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.

  Epidemiology:

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}

Causes:

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.    

Symptoms

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

Investigations:

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 drmohan@blog.com

References:

1) http://en.wikipedia.org/wiki/Anemia

2) http://medind.nic.in/ice/t12/i1/icet12i1p16.pdf

3) http://medind.nic.in/ice/t12/i1/icet12i1p16.pdf

4) Worldwide prevalence of anaemia 1993–2005 WHO Global Database on Anaemia. W H O

 5) http)://www.mayoclinic.org/diseases-conditions/anemia/basics/complications/con-20026209

6) Rubeena Bano, Nadeem Ahmad, B. C. Sharma, Ashok Agarwal, Nutritional Anemia in the Medical Students, http://medind.nic.in/ice/t12/i1/icet12i1p16.pdf

7) N Arlappa, N Balakrishna, A Laxmaiah, GNV Brahmam, prevalence of anaemia among rural pre-school children of Maharashtra, India, www.iapsmupuk.org

8) A P I Text book Of Medicine,8^th 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 – SADNESS

MIND - TIMIDITY - public; about appearing in

RECTUM - CONSTIPATION - chronic

FEMALE GENITALIA/SEX - MENSES - painful

GENERALS - ANEMIA - nutritional disturbance, from

GENERALS – WEAKNESS

HB % was 8,

ON repertorisation   Plumbam Met 32/13, Lyco 29/13, Nux Vom 29/13 and Silicia 29/13.

ON 12^TH March Plumbam Met 30C 5does was given Rubrum for 15 days were given, there was not much improvement,

ON 28^TH March Plumbam Met 200 C 5does was given Lacethine 3x four grains twice a day was given, Rubrum for 15 days were given,

12^th April patient came weakness’ and constipation were to some extent relived Rubrum 5 doses and LACETHINE 3X FOUR GRAINS TWICE a was given,

20^th 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.

21^TH 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.

22^nd 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.

27^th 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.

Conclusion:

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

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

STUDY

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 5^th 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 .

Bibliography

•       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) http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106">Irritable bowel syndrome

•         3)  http://www.onhealth.com Irritable_ bowel _syndrome paged4htm

•         4) Dr GRMohan Irritable bowel syndrome challenge in medical practice, NHJ, Vol 8, no 2, March-April-2006

•         5) http://en.wikipedia.org/wiki/holmes_and_rahe_stress_scale