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Case of the month
By
Dr. Dhiraj Nanda

Case of avascular necrosis of bilateral femoral heads

A 41 years old male patient came to consult on 16/1/2009 for following complaints:

1. Difficulty in walking due to pain in legs and knee since 2 years;

2. Diabetes M since 1year.

Investigations 

Treatment history:

He was a known case of avascular necrosis of both heads of femur probably with sero-negative arthritis. 

Patient was on allopathic treatment for above complaints for two years.

Couple of reports of the year 2007 were +ve for CRP and R A factor. After 2007 all of these reports were negative. This may be because of steroid being taken by the patient. 

Family history:

Nothing significant. 

Physical Generals:

Appetite – No complaints,

Thirst – Thirst less,

Urine – No complaints,

Stools - No complaints

Dreams - Nothing specific,

Thermals - Hot

Desires: Spicy; Rich food; Legumes               

Aversion: Milk

Habits: Alcohol® 2 Pegs/ alternative days. 

Mind:

- If hurt will leaves the place and topic. He avoids that person;

- Takes time to mingle;

- Doesn’t like to break relationship because it may affect business (patient is a builder by profession);

- When seriously angry, may beat other person but cools down easily;

- Cannot bear contradiction;

- No fears;

- No clairvoyance;

- Reserved;

- Adjustable;

- Doesn’t allow anyone to dominate on him.

- Wants everything to be best

- Eats rich foods

- Fastidious

- Wants things in order

- Afraid of father till now as he is very strict;

- Likes to maintain relations with cream of the society  

Analysis of the patient:

Mind – Reserved; Avoids* in anger; Violent in anger; Business minded; Does not like to be dominated; Fastidious. (* Avoids the topic and person in anger but does not like to break relations as it might affect business)

Physical Generals – Patient is thermally hot who likes rich food, spicy food; has aversion to milk.

ESD of patient – Father has been very strict but patient never felt any lack of affection. 

Miasmatic analysis of the patient:

Miasm at the level of the disease – Syphilis (necrosis);

Miasm at the level of mind – Syco-syphilis;

Miasm at the level of body – Syphilis (obscured eye-lids, asymmetrical face). 

Repertorization:

Here, only syphilitic aspect has to be considered as the dominating miasm is syphilis. The syphilitic rubrics  at the level of mind are:

1.      Anger, violent;

2.      Anger, talk indisposed to;

3.      Ailments from domination; 

Prescription:

As the patient was on steroids and excessive allopathic medicines, he was prescribed following:

1. Cortisonium 1M / 1 dose as antidotal to the effects of steroids;

2. Sulphur 200 / 1 dose as antidotal to allopathic pain-killers after 15 days;

3. Natrum mur 200 / 1 dose as constitutional remedy after about a month of Cortisonium 1M followed by Vital Force 200 three times a day.

Progress:

Pains were variable, some days no pains while other days pain used to excessive. Initially patient used to take a dose or two of allopathic pain-killers.

Gradually, the requirement of pain killers came down drastically after six months. Patient was advised to go for CT / MRI scan for hip joints to see the progress. CT scan indicated no necrosis.  

However, the case is not yet completely cured as his arthritis also has to get cured.