Case of the month by Dr. Dhiraj Nanda

 (Diabetes with Chronic Renal Failure)

Presenting complaints

•10/08/05

•NIDDM – 8 years - under control. On medication

•HTN – 8 years -under control. On medication

•Pain Left side of abdomen, in back ( renal region) – 7/8 months.

•Diagnosed as CRF ? Due to Diabetic nephropathy. Serum Creatinine is 3.1.

Observations

•Patient had noted down all the points on a piece of paper and brought to me.

•He has maintained his medical file with all reports and prescriptions in chronological order.

•Also he brought his reading of blood sugar, blood pressure and renal function on a sheet separately in chronological order.

•There two vertical wrinkles on forehead. 

Past History

•Right eye operated for cataract. 

Physical generals

•Ap. – N;                     Th. – Increased at nights;

•St. – N;                      Ur. – Frequent at nights;

•Sw. – N;        Sl. – N;

•Dr. – Past events +/- 

Thermals

•Patient cannot tolerate cold as good as he can tolerate heat – Chilly. 

•Desires – Sweets++

•Aversions – Nothing particular. Does not like cauliflower. 

Treatment H/o –

•has taken lost of homoeopathic medicines in last 8 months. 

ESD

•Initial years were full of struggle. He was away from family (parents).

•Continued his education and passed his exams while working. 

Mind

•Meticulous - Fastidious

•Q. – Tell me about you nature?

•A. – I want to finish the work given to me as required. That is how I am.  

•Q. – What are your hobbies?

•A. – Nothing specific. 

•Q. – How do you express your anger?

•A. – Generally I do not express my anger. Sometimes I do express it out.

Mind

•Q. - Has there been any change in your nature in last few years?

•A. – Patient’s daughter in law who was accompanying him said, “A lot, doctor. Earlier he was very methodical but of late he is not so. My mother in law is her mother in law’s sister’s daughter (daughter of patient’s mother’s sister). My mother in law and my father’s mother in law both were very dominating and poor my father in law was always dominated.  

Rubrics selected

•Patient has been subjected to lot of domination (A/F domination by others, long H/o);

•Fastidious;

•Desire, sweets;

•Thirst; night;

•Wrinkle, vertical, between eyes (was very marked). 

Repertorial Analysis

Prescription

•Remedy that covers the rubrics selected is Sepia.

•The miasm of patient is syco-syphilis with dominance of sycosis and syphilis setting in.

•Prescription – Sepia 200 / 1 dose followed by Sac. Lac. 200 three times a day.

•Kent has written in MM in chapter on Sepia “In a case confused by remedies think of Calc. Ars. Sulph. Sepia and Ipecac.” 

Follow-ups

12/09/05

•No pain in abdomen. Continue SL 200 three times a day. 

24/09/05

•>> >>. Continue SL 200 three times a day. 

03/12/05

•Patient is better in all aspects. Serum creatinine has come down to 2.6. Continue S.L. 200 three times a day.

Follow-ups

24/12/05

•Over all better.

•Serum Creatinine has come down to 2.1

•Continue SL 200 three times a day.

04/02/06

•Over all better.

•Serum Creatinine has come down to 1.8

•Continue SL 200 two times a day.

Rubric of the month

Financial, loss of wealth or property, ailments from

Meaning - This rubric is applicable when the patient suffers from health problems that start after he has suffered loss of finance, wealth or property.

Miasmatic background – Psora / Sycosis / Syphilis

Remarks – Though mainly rubric is syphilitic, it is the reaction of the patient that will determine the dominant miasm in the patient.
 

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