AVN & HOMOEOPATHY: AVASCULAR NECROSIS OF FEMORAL HEAD

Non Surgical Homoeopathic Treatment for Avascular Necrosis of Femoral Head

My colleague, Homoeopathic Doctor, 42Yrs, Male, called me on 5^th August 12, having severe pain in Right Hip Joint since 2 months. Actually, he took some Anti-inflammatory medicines without any effect. Being a Doctor & worked with the Orthopedician, and observing a recent case of Osteo-Sarcoma in his OPD, he was worried about the Cancer. He himself has done at first X-Rays of both hips AP & LATERAL views which looked absolutely normal. He took Ars Alb, Thuja, Rhus Tox as suggested by some senior homoeopaths without any result. As pain was increasing affecting his daily work, not able to squat or sit down & limping due to severe pain, he has done MRI of both HIPS which was showing:

·        Altered marrow signal in the right femoral head & the neck is most likely suggestive of transient bone marrow oedema or early changes of Avascular necrosis of femoral head.

·        Moderate right hip joint effusion.

His chief complaint was

·        Right Hip Joint Pain: Heaviness as well as throbbing

< by cold draft

< by squatting

< at the start of motion

> continued motion

·        Right Hand, Dorsally a flat wart since 6 months.

Past history:

·        H/O Bilateral Renal Calculi

·        Left heel Corn operated in childhood

Family History:

·        Diabetes: Father & mother

·        BEP: Father

·        Paralysis: Father

·        Hypertension: Mother

·        Herpes Zoster: mother

State of Disposition & Mind:

Being a Homoeopath, he has explained his mental state very nicely in a descriptive style. He started explaining his past disappointment in love before marriage around in 1993-94 which made a lot of impact on him. He got married with a Doctor in 1996. He has 2 daughters. He has explained regarding his past life to his wife. As a result of depression of the disappointment in love, he joined a Religious commune & got much attached with it thereafter till today. Because of his attachment with the religious commune, he was spending much time in the temple. This has created some disputes between him & his wife. She was expecting his responsibility regarding the daughters as well as his attention at home which she was missing. There used to be some fights or quarrels between them. Whenever there used to be a dispute, he used to escape from home to temple. He told that he is much lazy & not proper in following the timings. Because of the disappointment & dispute, he became indifferent towards everything. He used to be much conscientious regarding every little matters as well as relations with parents as well as with patients. During the interview, he asked me number of questions. He used to frown a lot while talking.

Before the MRI was done, he had a fear of Cancer in his mind & when the diagnosis Avascular Necrosis was found, he started worrying about the future. Due to pain, he was saying – ‘when these pains will stop, I am fade-up from these pains.’ While talking, he told number of his thoughts, theories regarding his life.

He was seen by the Orthopedician who advised him to take Anti-inflammatory along with complete rest till the pain settles, avoid sitting down, squatting etc.

Physical Examination: 

Weight: 66.5 Kg

P: 78/Min

B.P.: 127/79 MM Hg

Face: Greasy, has a big religious mark on his forehead, brown spots on his face.

Clinical Examination:

·        Not able to lift the Right Leg easily as it was much painful

·        Not able to bend his right leg & thigh on abdomen.

·        Not able to squat in lying down position

·        Tenderness +++ in Right Hip Anteriorly

Miasmatic Background:   SYCO-SYPHILITIC

Result of the Repertorisation:

Remedy Name Sep Sulph Lyc Ars Puls Verat Nux-v Lach Totality 34 32 27 30 29 25 28 26 Symptoms Covered 14 13 12 11 11 11 10 10 Kingdom [Complete ] [Mind]Love:Disappointment, unhappy, ailments from, agg.: 1 3 3 3 2 3 [Complete ] [Mind]Indifference, apathy:Everything, to: 4 1 3 3 4 1 3 1 [Complete ] [Mind]Escape, desire to: 3 1 3 4 2 3 3 1 [Complete ] [Mind]Religious affections: 4 4 3 4 4 4 1 4 [Complete ] [Mind]Conscientious about trifles: 4 4 4 4 4 4 4 3 [Complete ] [Mind]Inquisitive: 1 1 1 1 1 1 [Complete ] [Mind]Fear:Cancer, of: 1 4 1 [Complete ] [Mind]Anxiety:Future, about: 3 4 1 3 3 1 3 3 [Complete ] [Mind]Mood:Repulsive: 1 1 1 1 3 3 3 [Complete ] [Face]Greasy: 1 1 1 1 1 [Complete ] [Face]Brown:Spots: 3 3 3 1 1 [Complete ] [Mind]Frown, disposed to: 1 1 3 1 4 [Complete ] [Mind]Theorizing: 3 4 1 1 1 3 3 [Complete ] [Mind]Indolence, aversion to work: 4 4 3 4 3 3 4 4

Homoeopathic Management:

12/08/2012: 

·        No restriction of the movements

·        Asked him to do all the activites

·        Sepia 1M                                      3                      Doses

·        Bio-combinaton No.26                 BD                   15 Days

This is my personal 20 years experience that Bio-chemic Salts when used on the basis of their pathogenetic actions, works very fast & hasten the cure process. Bio-combination No.26 by name is for Easy Parturition but it contains following tissue salts which cover the patient’s pathology perfectly.

Bio-combination no.26

·        Calc Flour     6X       Degenerative Pathology & Vascular affection

·        Mag Phos     6X       Spasm & Pain

·        Calc Phos     6X       For Regeneration & remodeling

·        Kali Phos      6X       Homoeopathic Tranquilizer

This combination is very useful in all types of Degenerative Bony & Muscular Pathologies such as Osteo Arthritis, Cervical & Lumbar Spondylosis etc.

The question always arises that why not Sepia only?

 This is definitely a debatable issue. My answer to the question is that Sepia alone can also be sufficient but it will take its own time to work even though you used it in any potency. The group of the patient generally I use to see is not that much capable of understanding the difference between the Palliation & the Cure. They want the difference in the pain & an early result. This was not the issue for this case but as a routine I prescribed it to him also. And why not we should be result oriented? Since 20 years I am working on these Bio-chemic Salts & those being the semi dynamic, found to produce very fast results at the cellular level. If the marrow oedema settles immediately, patient becomes very comfortable to continue the treatment for long duration. Calc Fluor is the medicine which has the capacity to dissolve the osteophytes. I have experienced it number of times regarding this action. In cases of Osteo-arthritis, Spondylosis, Spinal Canal Steniosis one must think of this remedy.

Follow-Ups

28/08/2012:

·        Pain in right hip: 80% better;  occasionally < start of motion > continued motion

·        Limping while walking still persist

·        Able to squat 70% on lying down

·        Able to bend the hip

·        Tenderness on Right Hip: Absent

·        Wart on right hand decreased in size

·       

         Homoeopathic Management:

·        Asked him to try squatting in sitting posture

·        Bio-combination No.26                BD                   continued

24/09/2012:

·        Pain in Right Hip: Absent

·        Able to squat in sitting as well as lying down posture

·        Limp absent

·        He danced in religious commune without any trouble

·        Able to bend his Hip

·        One hour played a Tabala in squatting position

·        Very much happy as he was able to perform all his duties & enjoy the hobbies

·        Homoeopathic Management:

·        Asked to continue all the activities

·        Bio-combination No.26                HS                   continued

DISCUSSION

As this case was very Acute & Recent in appearance (Even though the disease is chronic in nature), proper Homoeopathic Management can bring such patients very fast in a gentle way.  

Now a day, I am treating Avascular Necrosis cases often & what I observed is Lachesis, Sepia & Calc Fluor appeared commonly in those cases. So, I studied the cases in retrospective manner to find out that whether I am becoming prejudiced in prescribing? But it was not the case. So, I studied the action of all three remedies & found that all of them have an action on Vascular System, Circulation, Venous System. I think, we must study the actions of our medicines even at cellular & tissue level so that we can make our Materia Medica more rich & more perfect.