Non Surgical Homoeopathic Treatment for Avascular Necrosis of Femoral Head

AVN & HOMOEOPATHY

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.
#AVN
#AVN & HOMOEOPATHY 
#AVN FEMORAL HEAD & HOMOEOPATHY
#NONSURGICAL HOMOEOPATHIC TREATMENT OF AVN

Non Surgical Homoeopathic Treatment of Avascular Necrosis of Femoral Head

Mr R.A.M., 40 yrs, staying at Mumbai,
came on 7th Nov 2002,
a diagnosed case of Avascular Necrosis of Femoral Head Left > Right with complaining of

Severe Pain in Lt Hip Joint since 1 yrs
< & >: Continued Slow Motion
Pain in Lt Leg – Calf > Stretching the limb
Pain in Lt Leg – Calf > Uncovering at night
Lt Hip Swelling/ Inflammation/ Stiffness
Lt Leg shorter than Rt
Painful Varicose Veins both Lower Limbs Since 3-4 yrs

Past H/O: Since Childhood Allergic Bronchitis & Leucoderma – A lot of Steroids consumed in the past for the same.

Family H/O: Paralysis PGM, MGF.

Personal H/O:
Craving: Sweets++, Tobacco++
Aversion: Fatty Food+++
Sleep: Disturbs due to pain as well as due to frightful dreams
Dreams: Cousin Brother who died in 1985+++; Frightful+++; Death of Relatives+++.
Thermal: Ambi-thermal

Mental State including Life Space Investigation:

Patient from Poor Socio-economic Family;
Childhood Average; Completed 10th & Went to Mumbai in 1985 for service;
Working as a Machine Operator in a company;
Married in 1986; Spouse – House wife;
Have 2 sons & 2 daughters;
Happy go Lucky life was going on till last year except off and on episodes of Allergic Bronchitis; Vitiligo settled with Allopathic Treatment consisting of long term use of Corticosteroids;
Very hasty in Nature; does everything very hurriedly;
Since last year, started getting recurrent pain in Lt Hip Joint; Consumed Treatment from a GP quiet a long; As recurrence and spread to Rt Hip increased, shown to Orthopedician Dr K J Kamat who advised him MRI of Hip and diagnosed as a case of Avascular Necrosis of Lt Femoral Head. He advised him Total Hip Replacement Surgery which is not at all affordable for the patient.
Since last 6 months, getting difficulty in concentrating at work due to pain; One interesting thing he told that when he doesn’t concentrate on his work, he use to eat something which makes him comfortable; He becomes so restless that he avoids the work & wants to quit the job but he can’t as whole family depends upon him; He is quiet anxious about Surgery and the consequences of it because it was told to him that after the surgery he cannot seat down forever & re-surgery requires every 5-10 yrs. That’s why he came for Homoeopathic Treatment to avoid the surgery.

Physical General Examination:
Wt: 77kg
P: 80/min
BP: 122/78 mm of Hg
Male Pattern Baldness
Tongue: Flabby
Difficulty in Walking & even Riding on Examination Table
Looks: Anxious, Sadness.

Clinical Examination:
Lt Leg shorter than Rt
Stiffness Lt Hip; Can’t bend it; Can’t lift the Lt Leg
Walks with limping


Investigations:
MRI OF HIP JOINTS (31/01/02)

MRI of both Hip Joints reveals:
Feature suggestive of Lt hip AVN with changes causing architectural distortion & subarticular irregularity seen in the left femoral head with mild joint effusion. The left acetabular margin is normal.
The right hip joint & both sacro-iliac joints are normal.

RUBRICS FOR REPERTORISATION:
1. Concentration; Difficult
2. Concentration; Difficult, Eating, amel. from
3. Anxiety
4. Dreams; Dead, people, of, Weeping, with
5. Dreams; Death, of, Relatives
6. Dreams; Frightful
7. Fear; Poverty
8. Hurry, haste; Tendency
9.Generalities; Caries, necrosis, of, Bones
10.Generalities; Exostoses, Syphilitic
11.Generalities; Food & drinks, Fat & rich food, Aversion
12.Generalities; Food & drinks, Sweets, Desires
13.Generalities, Necrosis, Bones
14.Extremities, Pain; Lower limb, Hip, Motion, amel
15.Extremities, Pain; Lower limb, Leg, Calf, Stretching, amel.
16.Extremities, pain; Lower limb, Leg, Calf, Uncovering, amel.
17.Extremities, Swelling, Joints
18.Extremities, Shorter,one than other leg
19.Extremities, Varices,Leg,Painful

20.Extremities, Inflammations, Joints, Synovitis, Chronic

RESULT OF REPERTORISATION:
Calc fluor 33/20
Puls 27/13
Sulph 24/12
Lyco 24/11
Calc 22/12
Merc 22/11
Ars 22/10


Homoeopathic Management:

7 Nov 2002: Avoid Tobacco
Weight Reduction
Calc Fluor 6x tds… 3wks

30 Nov 2002: Lt Hip Pains Persistent <> Continued Motion
But feeling better at general level;
Wt: 76Kg
Can walk for 15-20 min freely

Calc Fluor 6x bid… 1mth

30 Dec 2002: Lt Hip Pains Much Better;
Work freely;
Looks Confident;
Thought of leaving the job totally gone;
Can walk freely without limping for 45min;
Wt: 74.5Kg

Syph 1M 1 Dose
Calc Fluor 6x…OD 6mth

14 June 2003: No Pain in Hip;
Working with full strength;
Walking freely for 1hr;
Normally climbing staircase;
O/E: Easily lift the Lt leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 6mth

7 March 2004: No Pain in Hip;
Working with full strength;
Walking freely for 1hr;
Normally climbing staircase;
O/E: Easily lift the Lt leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 6mth

24 Dec 2004:
MRI OF HIP JOINTS (21/12/04)
MRI of Pelvic & both Hip joint for a follow up case left hip AVN reveals
Changes in the superior weight bearing portion of the left femoral head noted with mild flattening of the head.
In comparison with previous MRI there is mild increase in the flattening. However, the marrow changes appear to be localized to the weight bearing portion with reduction of the marrow edema in the neck that was seen in previous study.
The hip effusion which was seen in previous MRI has also resolved. The left acetabulum margin is intact. No para articular soft tissue abnormality.
The right hip & both S.I. joints are normal.

No Pain in Hip;
Working with full strength;
Walking freely;
O/E: Easily lift the Lt Leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 12mth

3 Nov 2005: No Pain in Hip;
Working with full strength;
Walking freely;
O/E: Easily lift the Lt Leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 12mth

4 Sep 2006:
MRI OF HIP JOINTS (1/6/2006)

MRI of Pelvic & both Hip joint for a follow up case left hip AVN reveals
Sequelae of Avascular necrosis seen with architectural distortion with flattening of left femoral head. The left acetabular margin is intact. As compared to previous MRI dt. Dec 2004, no significant interval change noted. No further progression of the disease seen.
The right hip & both S.I. joints are normal.


No Pain in Hip;
Working with full strength;
Walking freely;
O/E: Easily lift the Lt Leg & bend it;
No Tenderness
Wt: 74Kg

Treatment stopped.Follow Up after 2 years.

Non Surgical Homoeopathic Management of Lumbo - Sacral Disc Prolapse

Homoeopathic management of disorders of Lumbar inter-vertebral discs
NATIONAL JOURNAL OF HOMOEOPATHY 2003 Jul / Aug VOL V NO 4.
Dr Prasad Rasal


In aphorism No 3 of 6^th edition of organon of medicine, Dr Hahnemann says that: The homoeopathic physician should have following knowledge in order to achieve IDEAL CURE.
(1) Knowledge of disease, indications.
(2) Knowledge of medicinal powers.
(3) Choice of the remedy, the medicine indicated.
(4) Proper dose. and
(5) Obstacles to recovery.
So, here the first point explained is of very much importance while dealing with Lumbar Intervertrebral Disc Disorders i.e."KNOWLEDGE OF DISEASE , INDICATION"
The sentence is divided into two parts:
1) Knowledge of Disease: ie understand the pathogenesis and pathology, so we can handle the patient better.
2) And later on how the same disease expresses in an individual ie (Knowledge of Patient- Individualisation.
So, first let us understand the important disorders of LUMBAR INTERVERTEBRAL DISCS.
Two important disorders of Lumbar inter-vertebral discs are: 1. Lumbar Disc Prolapse
2. Lumbar Spondylosis
HOMOEOPATHIC MANAGEMENT
Generally in homoeopathic practice, clinical examination, clinical diagnosis, laboratory investigations and special investigations are overlooked by a number of homoeopaths. Only symptomatic approach is used by them and that’s why even the best Similimum fails as case is treated without understanding of disease pathogenesis. No proper auxiliary methods are tried. That is why, I always use the word homoeopathic management than Homoeopathic Treatment.
We will discuss the management of above discussed Lumbar Inter-vertebral Disc Disorders.
(A) Acute prolapsed lumbar inter-vertebral disc with lower radiculopathy.
In acute phase:
(1) Immediate Hospitalisation and Continuous Lumbar Traction or Complete bed rest depending upon severity of pains (for 4 days to 10 days )
(2) Acute similimum
(3) When patient comes out of pains, gradual Spinal Extension Exercises to prevent further prolapse of inter-vertebral disc.
(4) Ask the patient not to lift heavy weight by direct forward bending.
(B) Chronic prolapsed lumbar inter-vertebral disc with lower radiculopathy
If disease is chronic with ACUTE exacerbation, same management is needed to take over acute episode followed by (and even in chronic disease itself) finding out :
1. Deep Acting Chronic Constitutional Medicine.
2. If needed, use of deep acting bio-chemic medicine supplementation select on General Biological Action of Medicine,
3. If needed, use of miasmatic NOSODE depending on individualisation.
4. Asking patient to avoid lifting heavy weight with direct forward bending.
5. If patient is of old age use of Lumbo sacral corset or belt during working and travelling.
6. When pains subsides, gradual increase of spinal Extension Exercises.
ILLUSTRATIVE CASE
Mr Y S K 59 yrs/M. Retired primary teacher now a Farmer.
First came on - 18/07/1998
Diagnosed case of Degenerative disc disease with marked narrowing of spinal canal at L 3-4 with disc prolapse at L 4-5 causing severe focal canal stenosis. [Xerox copies of Reports MRI attached]. Patient was posted for Laminectomy and Discoidectomy,.

Chief Compalints and Associated Complaints
Since three months.....
Location	Sensation	Modalities	Conc
Rt lower extremity Posteriorly Sciatica	throbing, neuralgic numbenss Pains Claudication in both legs	A/F : lifting weight (sudden) < lying on Rt. side < bending toward < walking > pressure > complete rest < slightest motion < Walking very small distance	(RF) LE

Past History: Haemorrhoidectomy 1994
Family History: Father - Koch’s
Personal History: 1. Appetite-normal
2. Thirst-Large quantity of water 3-4 hrly
3. Desires-Sweets ++, Tobacco ++, Salt ++
4. Micturition-Normal
5. Bowels-Normal
6. Perspiration-Neck ++, Offensive ++, Staining yellow ++.
7. Sleep-Disturbs due to pains
8. Dreams-Frightful, farm about
9. Thermals-Ambi-thermal, but always desires fans
Mental State: Disturbed due to disease as he has to lie down all the time and cannot work. He is always thinking about disease with fear of surgery. Anxiety about household problems i.e. marriage of son, building house etc. Quiet, yet dominating in house. But fears quarrels. Religious ++, Emotional ++, Loquacity ++, Expressive ++, Dominating ++, Dictatorial ++, Suspicious ++ and doubtful about recovery. Leadership in service previously, Never likes contradiction, irritable with violent ++ anger. Patient has three sons and a daughter. Only daughter married. Always quarrels with cousins regarding farm. Likes to remain in company and tries to maintain friendship.
Physical General Examination:

• Male pattern baldness with gray hair
• Flabby and trembling tongue
• Tall, slender, emaciated
• Weight: 58 kg

Systemic Examination:

• Straight leg raising test (SLR) Right side: +ve
• Femoral roots stretch test (FRST) Right side: +ve

Investigations done: 07/14/98
Hb:10 Gm % TLC - 7400/mm DC: N: 58, L: 37, E: 3 M: 2, B: 0
Tuberculin Test : -ve
MRI lumbo sacral spine: Wide spread degenerative diseased disc with marked narrowing of L 3-4 disc. Large diffuse disc bulge at L 4-5 causing marked thecal sac compression and severe focal canal stenosis. Milder degree of disc bulge at L 3-4 and L 5-S1. Bilateral root compression of L 3-4.
DIAGNOSIS: Severe lumbar canal stenosis due to degenerative disc disease and PID at L 3-4, L 4-5, L 5-S1 with right lower radiculopathy.
CASE ANALYSIS:
Patient has wide spread degenerative disc disease with acute exacerbation of PID with right lower radiculopathy due to lifting weight. So even though disease is originally a chronic dynamic one, it also has an acute mechanical problem Giving only medicine will cure his prolapsed inter-vertebral disc and the radiculopathy. Whenever an inter-vertebral disc prolapses, nerve root oedema develops immediately. Removing nerve root oedema is of prime importance. Absolute bed rest achieves 60-70% of nerve root oedema reduction. So case should be managed properly to get absolute result.
HOMOEOPATHIC MANAGEMENT:
Our main aim is to relieve patient’s suffering as early as possible. Otherwise patient will go for operation.
Patient was admitted in our Homoeopathic hospital for eight days.
AUXILIARY TREATMENT:
Continuous lumbar traction for eight days which provides absolute bed rest. Regular soft diet was provided. Tobacco was stopped completely.
HOMOEOPATHIC TREATMENT:
As the case is of chronic degenerative disease, our selection of drug should be deep acting medicine to cope up the situation.
MIASMATIC BACKGROUND: Considering family history of Tuberculosis, past history of Haemorrhoidectomy and patient’s present degenerative disorder and mental state of jealous, suspicious, quarrelsome, dominating, violent, leadership
SYCO-TUBERCULAR-SYPHILITIC MIASM
is dominating. So our search should be towards such medicine, as to cover all these aspects.
Anti-miasmatic Nosode: Tuberculinum Deep acting chronic constitutional: Lachesis selected on following rubrics

1. Dictatorial
2. Jealousy
3. Suspicious
4. Quarrelsome
5. Violent
6. Loquacity
7. Pain, lower limb, sciatica, right

BIO-CHEMIC APPLICATION: To help the homoeopathic medicinal action and to hasten cure, I always uses Biochemic medicines in such chronic degenerative disorders based on its general biochemic action of biochemic medicine.
Chronic degenerative disorders of spine with oesteophyte formation is covered by Calcaria-fluor.
Therefore, Four medicines come out:

1. Chronic constitutional: Lachesis 200. Potency: 200 potency as chronic pathology with degeneration. Single dose is sufficient to arouse the Vitality.
2. Acute totality: Bryonia 10M TDS. Potency: 10M potency as an Acute Similimum to relieve the spasm.
3. Biochemic application: Calcaria-flour. 6X - Biochemic dose in decimal scale.
4. Nosode: Tuberculinum

FOLLOW-UP Lachesis 200 one dose on 1st day.
Next day Bryonia 10M TDS for 10 days.
Calcaria-fluor 6X TDS for 10 Days (Bio-Chemic Application).
HOSPITALISATION PROGRESS: After applying continuous lumbar traction from 18^th July 1998, on 3^rd day i.e. on 21^st, patient’s pain completely relieved. SLR FRST became negative (-ve). Lumbar traction continued for 3 more days. On 24^{t h}, patient was asked to walk for certain distance on plain surface. No pain after walking. Lumbar traction stopped. Only bed rest continued along with medicines. On 25^th, patient walked nearly ½ km without suffering. Continued medicines and bed rest.
On 26^th, patient walked 1 km without suffering. Patient discharged and called after 10 days.
TREATMENT ON DISCHARGE: Advised Bed Rest as far as possible.While walking, use lumbo-sacral corset. Placebo TDS for 10days
Calcarea- fluor 6x tds for 10 days
FOLLOW UP
08/07/98: Able to walk 2 km on pain surface. No pains. Occasional Coryza.
Auxiliary Treatment: Gradual spinal extension exercises.
Calcarea- fluor.6x BD for 1 month.
09/11/98 : No complaints. Doing exercises regularly. Walks 3-4 km a day.
Can work in field. Continue Spinal Extension Exercises. Calcarea- fluor 6x OD for 2 months.
11/12/98: No complaints. Use of Lumbo-sacral corset only during travelling.
Continue spinal extension exercises. Tuberculinum 1M 1 dose stat (Anti Miasmatic)
03/01/99 : No complaints. Continue spinal extension exercises. NO MEDICINE.
08/28/99 : No complaints. Ct Spinal Extension Exercises.

Non-Surgical Management of the Pyloric Stenosis with Homoeopathy

Mr. B.H.M., 67 yrs, staying at Sangamner, came on 4th Nov 2006,
a diagnosed case of Pyloric Stenosis with complaining of

C/O: Since 36 yrs, But more aggravated since 1 yrs,
Forced out Vomiting as soon as he takes anything;
<> Empty stomach, Vomiting
Pain in Stomach – Constricting, Oppressed, Spasmodic sensation; as if something coming out of it;
<> Warm Food in minimum quantity.
Associated with severe emaciation, weakness, enervation, nervousness;
So weak that not able to sit for Case Taking;
Came with Support of his Son

Past H/O:
Typhoid in childhood
Operated twice for Peptic Ulcer in 1981 & 1999

Family H/O:
Hemorrhoids – Father & Younger Brother
Ca rectum PGF Died
Ca liver Brother Died
Liver Cirrhosis Brother Died

Personal H/O:
Craving: Tobacco+
Aggravation: Onion+++
Stool: Hard; Once in two days
Sleep: Variable
Thermal: Ambi-thermal


Mental State including Life Space Investigation:
Patient was in a state of Anguish due to Pains in Stomach, looking Sad, depressed;
When asked regarding his disease, he told it’s better to die than remaining alive;
He has to get admitted every week for IV fluids due to weakness; Lot of Economical Stress; Done one attempt to suicide by consuming Sedative Pills;
Sighing intermittently when questioned;
Patient was not in a state to give details regarding Life Space Investigation due to pains;
So history is collected from his son.
Patient from Poor Socio-economic Family;
Childhood Average; Studied up to 7th std. Left school because of poverty; Still feels bad about it; started working since that time; Done over work; 12-16 hrs of sedentary work; Started getting Acid Peptic Trouble; Not taken any treatment for it; Later on diagnosed as a case of Peptic Ulcer; Operated first in 1981 for the same; Again in 1999;
Had 3 brothers; 2 died; 1 – due to Liver Cirrhosis & 1 Ca – Liver; Married in 1967; 1 Elder stays separate, never looks towards his illness; Feels left out from his family; Due to illness could not go in to the society; Feels rejected from the society.

Physical General Examination:
Weak, Emaciated, Sunken Face
Wt: 32kg
P: 100/min
BP: 110/70 mm of Hg
Tongue: Dry, denuded patches
Difficulty in Sitting & even Riding on Examination Table due to weakness
Looks: Anxious, Sadness, Depressed; Sighing off an on;

Clinical Examination:GIT: Sunken Abdomen; Scars of previous Surgeries; Tenderness in epigastrium;

Investigations:
Barium meal study 22/301986
No evidence of hiatus hernia or reflux;
Stomach appears grossly dilated;
Persistence residue is seen in the stomach after 3 hours;
Suggestive of Pyloric Stenosis.

Rubrics:
1. Anguish, Pain in, Stomach
2. Sadness, Suicidal disposition, with
3. Sighing, Grief, with
4. Gen: Emaciation
5. Gen: Weakness, Nervous
6. Gen: Onion, Agg.
7. Stomach: Constriction, Pylorus, of
8. Stomach, Oppression
9. Stomach, Pain, Cold, Drinks, after, Agg.
10. Stomamch, Pain, Warm food, Amel.
11. Stomach, Spasms, Pylorus
Result of Repertorisation:
1. Ornithogalum: 13/11
2. Lycopodium: 10/6
3. Nux vomica: 10/6

Homoeopathic Management:
4 Nov 2006
Avoid Tobacco Give Oral Rehydration Sip by Sip
Ornithogalum 200…1 Dose Placebo… tds 10 days

7 Nov 2006
Felt better immediately
Two days consumed some diet
Looking fresh
But today, has consumed onion in diet & again got
3 forceful vomiting
Wt: 33Kg
P: 90/min

Ornithogalum 200…1 Dose repeated

14 Nov 2006
No vomiting thereafter
Looking much happy & fresh
Taking food 2-3 times a day
Wt: 35Kg
P:86/min

Placebo bid… 15 days

03/29/07
Patient never returned for follow-ups
Till yesterday enjoying food & his work
Since morning again got 3-4 forceful vomiting
Again induced due to onion utappa
Wt: 37Kg
P: 78/min
Comparatively looking much healthy

Ornithogalum 200…1 Dose
Placebo… tds 10 days

06/06/07
Patient never returned for follow-ups
Till yesterday enjoying food & his work
Since morning again got 2-3 forceful vomiting
Yesterday consumed Pav Bhaji
Wt: 39Kg
P: 74/min

Ornithogalum 200… 1 Dose
Placebo… tds 10 days

01/03/08
Patient never returned for follow-ups
His son met me & told that he is not having trouble;
That’s why not coming for the treatment.