Cases

A 40 yr old male with no comorbidities came with plantar keratoderma (subset palmoplantar keratoderma- PPK). He had lesions on the left foot, almost a 3- inch superficial ulcer with a punched-out appearance on the heel, slowly increasing in size for the last 2 yrs. In the other areas, the skin was thickened and he experienced severe itching. There was a dearth of any other symptoms in the case. 3 doses of Nat carb were given to be taken at 10 days intervals, with
instructions to stop the medicine if improvement starts. After a month the patient reported that the ulcer started healing and there was a reduction in the depth of the lesion. 2 more doses were given with similar instruction: to repeat only if improvement stops, otherwise continue saclac. This time patient returned 2 months later with lesions almost reduced to 1/3rd
the original size. He was kept on saclac without any further dosages and the lesion was completely healed a month later, ending his 2 yr ordeal.

Explanation
This case was a one-sided case with no other symptoms than just the ulcer and itching. The modalities were not clear so were the exciting cause and concomitants. Looking at the ulcer I thought of silicea, kali bi etc. The ulcer was dry and there was no tendency to suppurate. It had the punched-out quality of kali bi but no other characteristic, discharge, or pointer. Pulford keynotes to materia medica describe Nat Carb (given in lycopodium- lyco has ulcer on
instep) as having ulcer on heels. It was on this basis that Nat carb was chosen in a moderate potency. In retrospect maybe a single dose of higher potency would have done the trick, instead of repeating frequent doses of a lower one.

Dr Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com

Download a copy of the case here.

This is a case of 7 yr old boy who came with a complaint of bedwetting at night. The frequency of urination was 4-5 times at night. There was no wetting-free interval since birth (i.e. though the child was potty trained in time, he continued bedwetting). The parents tried everything from reducing fluid intake in the evening to wake him up at night for urination but to no avail. On inquiry, it was found that the urine was very offensive. There was also a crack at the corner of the mouth (persisting despite vitamin supplementation). A dose of nitric acid 200 was given along with a placebo. After 2 months the frequency of wetting was reduced to just once, and the offensiveness of urine was much better. Another month on placebo and parents reported a complete resolution of the complaint.

Explanation

Nocturnal eneuresis is a very common problem in children and causes a dent in the confidence of a growing child. This problem is very easily treated by homoeopathy. Though every case is new and requires individualistic medicine, personal experience shows that medicines like nitric acid, cal phos, tuberculinum etc are more commonly indicated than others. This child had very offensive urine (concomitant) so much so that parents had to use the air freshener in the bathroom every time the child used the toilet (other medicines for offensive urine- benz acid, sep). There was a crack in the corner of the mouth (another concomitant) which led to the prescription of nitric acid. (Offensive urine is a very reliable indication for nitric acid and with that, affection of mucocutaneous junction makes a formidable duo. I once treated a case of vitiligo of perineum in a child based on these concomitants with complete repigmentation of the affected area)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download a pdf version of the case here.

A female patient of 65 years of age had multiple comorbidities. She was diabetic, hypertensive, and had hypothyroidism. She developed bullous eruptions all over her body which were filled with fluid with severe itching. She was put on wysolone, and was on medication for some time, which neither gave any relief of symptoms nor caused regression of disease. There was no trigger that could be found. However, she had amelioration of symptoms during wet weather. In a detailed case taking she was found to have a liking for cold things and slept in knee-chest position. A dose of medorrhinum 200 was given. In the follow up a month later she said she was much relieved, but was feeling slightly itchy again. Her wysolone was tapered and another dose of medorrhinum 200 was repeated. Her eruptions resolved completely at the end of 2nd month. A follow-up (no medication) after a year showed no recurrence.

Explanation

When the patient is already on so many crude medications, it becomes very difficult to treat (as it masks all the indications of medicines and causes iatrogenic disease). This patient despite having taken so many medicines showed some marked modalities and peculiarities as a person, which helped in the selection of suitable remedy on homeopathic principles.

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

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A 23 yr old male sought consultation for hypertension. He was on antihypertensives for last 3 yrs and there was a progressive increase in dosage of the medication needed, gradual, nevertheless increasing. On presentation he was anxious, had palpitations and raised BP despite having taken regular allopathic medication in the morning. There was some stress in the family. Aconite 200/3 doses/ od was given. Given his age, he was also advised some tests, which included 24 hr urine VMA, serum aldosterone levels and renal artery doppler and some other basic investigations. A follow up after 5 days showed his anxiety levels reducing and his BP stabilizing. He was again given aconite 200 but this time only SOS, whenever he felt anxious. During conversation an observation was made which was missed in the first consultation. The patient’s hands were thick and seemed big for his arms. I asked him if there had been any change in shoe size recently which he denied. I asked him to show an old photograph of himself, before hypertension had set in. What was seen raised an alarm. Immediately I sent him for an endocrinology consult with aconite 200 SOS. What was feared was proven right, when he returned a week later. The patient had a pituitary microadenoma as seen in his MRI(advised by endocrinologist). It was this culprit that raised his BP and that thickened his jaw (discerned from comparison of him with his old photograph), his growth hormone (GH) was going off the roof (also advised by endocrinologist) and he was heading towards acromegaly and diabetes. It is here that he mentioned that also experienced profuse sweating. His diagnosis was made within 12 days, and he felt much relieved of his anxiety. His BP readings were more settled now. But this was only a calm before the storm and his pathology had to be tackled. I gave him aconite again, this time alternate day for another 10 days as patient was also sent for a neurology consult. This was the last time I saw this patient, a country wide lockdown had been imposed due to COVID 19 pandemic.

Explanation

A young patient with hypertension should be evaluated to find out the underlying cause of hypertension. This patient had a progressive increase of hypertension, becoming refractory to medicine. This is what raised a reg flag and kicked my medical training into action. Hypertension in young adult should first be evaluated for surgically correctable causes (as per medical literature). The most common include:

• Renal artery stenosis (diagnostic modality used- renal artery doppler)
• Hyperaldosteronism (diagnostic modality used- serum aldosterone levels)
• And pheochromocytoma (diagnostic modality used- 24 hour urinary VMA)

It was a relief to see all the tests negative. However, the cause was still unknown. It was a casual observation that led to his diagnosis. Had his big hands, gone unnoticed or the observation shoved under the carpet and had not his old photograph been compared with his present self, it would be no one knows how long before his diagnosis would be made. He had no other symptoms, no headaches, no vision disturbance. Aconite was a purely symptomatic prescription. He was anxious and had high BP. It would not have helped in the long run. After his diagnosis was made, I had to give him a deeper acting medicine that would target his pathology as well. Before I had a chance to further his case the circumstances (pandemic) ended the treatment prematurely and patient was lost to follow up. This case emphasizes the need for diagnostic skills in homeopathic physicians. It epitomizes Aphorism 3 of Organon of Medicine: the physician must know, what is to be cured in a disease (knowledge of disease, indications). It was not his hypertension that needed treatment but a deeper lurking pathology.

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download a copy of the case here.

Presented here are two cases of unerupted permanent incisors in two different children aged 6 and 7 years, one male child and one female child respectively.

The medicine given was Tuberculinum 200 one dose to both of them when they presented with the above-mentioned complaint. The first child had not erupted the tooth for six months had started signs of eruption within 10 days, which rapidly developed and completed eruption by the next visit after a month. The second child had not erupted the upper incisor for 4 months, started showing signs of eruption after 15 days of the medicine.

Explanation

Generally, calp hos 6x comes to mind for such kids and many parents come seeking the same. However, the primary failure of eruption is a deeper miasmatic condition (most of the time) than just a deficiency of calcium metabolism. Tuberculinum covers this condition and strikes it at the root or clears up the case, paving way for the next remedy if nothing else.

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download a copy of the case below.

This is a case of a female in her early 50’s who had been diagnosed as having severe osteoarthritis. Both knees were affected and there was no history of injury or any other precipitating cause (physical or emotional). She had Heberden’s nodes in her distal phalanges’ hands due to OA. On questioning it was found that her pains aggravated during summer months and were ameliorated in winters. She was given Syphilinum 200/ 4 doses to be taken weekly once (if needed), and stop the medication if she responds to any of the doses.

A follow-up 2 months later showed a marked improvement in her pains and lessening of swelling. She was later given a dose of 1M of the same medicine.

Explanation

It is unusual to give such deep-acting medicine in such cases. There was a dearth of information in this case except that her modalities were marked and clear. It was for this reason a deep-acting medicine in moderate potency was decided to be given. (I would withhold any discussion on miasm at this point of time, and save it for later discussion)

(Behind each successful case treated there are many that failed and showed no improvement. We as homeopaths must make a collective effort so that the experience of previous generations is successfully transferred to the next, wherein we stand on the shoulders of those before us rather than starting from scratch).

                                                                                                                                                Dr Shivangi Jain

                                                                                                                    BHMS, MD, PGDMLE, PGDHHM

                                                                                                                        drshivangijain79@gmail.com

A child around 7-8 years came with a viral wart on the inner angle of the left eye. The parents had taken treatment elsewhere by another homeopath. The names of the medicines with which the child was treated were unavailable. A dose of Staphysagria 200 was given to the child. The follow-up a month later did not show any change. I repeated the medicine, another dose of Staph 200. Next month’s follow-up was a happy meeting. The mother reported that the wart fell off during sleep, sometime in the preceding month, when she found, one fine morning that it was gone.

Explanation

When we think of viral warts a lot of medicines come to our mind, viz caust, thuja, nit ac, nat mur and even staph. What was interesting about this case was the way I reached the medicine. Now here was a very shy child who did not make much eye contact (he had been scolded by his mother and was quite angry, and this was his usual way of reacting to being scolded) (quis/who), who was thirstless (quibis auxiliis/concomitant or a generality if you want it from Kent’s perspective) and who had a wart just near the inner angle of the left eye (ubi/ location). Having recently read Guernsey’s Key-notes to the materia medica, I remembered, in Staphysagria it read- ‘Affections of the angles of the eye, particularly the inner.  I chose to give staph and when initially it did not seem to work, repeated the same medicine. I was skeptical initially as the case had already been medicated earlier, with remedies I had no knowledge of. So, when I found the location was also covered by staph it gave me confidence (well, you cannot overlook a pointer given by Guernsey!!!) and when it did not work, I repeated rather than changing potency or medicine. And it worked!

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From a personal perspective this is one of the most unusual cases I have treated. Unusual not in its presentation but in the outcome that it had, after giving the medicine, something which took me completely by surprise, and believe me it was a delight.

A patient’s grandson came asking for a medicine for his grandmother, for an injury to head after a fall. This lady an octogenarian had a history of stroke and was on various medications. she sustained a fall in the house after which she lost consciousness. An immediate medical attention was sought and she was advised to be operated upon as the subdural hematoma that she developed after the fall could be fatal. Given her age and comorbidities, there was an inherent risk in the surgery, a chance that the daughter was unwilling to take.

 This is where I came in picture. Notwithstanding my advice tilting in favor of blood evacuating burr hole surgery, the family showed more in faith me than I had in myself. I gave the 3 doses of Arnica 1m to be taken on alternate days and report after a week, with advice to admit on least signs of further deterioration.

Comes in the surprise after one week. Not only did the patient improve in terms of her head pains post falls, she had a remarkable improvement in her speech. It was noted that she was cared for, in her daughter’s house by a nurse, towards whom she was abusive, with an extremely limited vocabulary. She was not able to recognize her daughter and other family members after the stroke. Arnica not only took care of her SDH, her memory improved (she started recognizing her family )and she started talking in long sentences which she had not done for the longest time. She stopped being abusive towards her caretaker and a follow up MRI after a month showed an almost resolved hemorrhage.

Explanation

Why Arnica? A detailed study on head injuries and their management can be read in the ‘internal medicine’ section of the blog.

Arnica not only took care of her acute condition but also acted on other parts of the brain which might have been afflicted in a similar manner (covered by arnica in its chronic form), something I had a very incomplete history about.

This case was a demonstration of far-reaching actions of medicines, which are intended or otherwise. It becomes a double-edged sword, one that can harm but can be a tool of great power in hands of those who understand it.

It is with this intention that we should strive to do better. To understand our tools better.

I am extremely indebted to Prof L M Khan who revealed to me the real power of arnica in practice. And I wish the same for all colleagues and fellow homeopaths.

Aude Sapre

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Here is a downloadable version of the case

Presented here is a very short case of urticaria, in a male patient, of recent onset,
with no other comorbidity.

The patient got wet in the rain and developed urticaria consequently. Rhus tox
10M one dose was given initially. The patient was much better in the follow-up
after a month where both frequency and intensity of urticaria was reduced, but
with stagnation beyond a point. Therefore, another dose was repeated. The
patient required one more dose after this (total 3 doses) and the urticaria was
completely gone as was found in a follow-up a few months later.

Explanation
This is a simple case of clear-cut cause (exciting cause, aph 3/ getting wet in the rain
in this case) and effect (development of urticaria). However, the patient would have required a deeper/ anti-miasmatic remedy later on.

It was these acute cases that brought Hahnemann his fame in the initial days of
his practice. (Had the patient not gotten well after this, a deeper cause would
have been addressed to). Only after did he notice the recurrence of symptoms
not responding to earlier effective medicines, did he search for obstacles and
developed the idea of miasm.

Aude Sapre

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

You can download the case below.

A child one and a half years of age came with a diagnosis of laryngomalacia.

He was advised to get operated on or wait till he gets 3-4 yrs old when the condition would resolve on its own.

The breathing was audible from a distance (called a stridor).  It was more pronounced during sleep. The child was running around in the clinic and wanted to touch everything. On further questioning, it was found that the child had aversion to bathing and had to be forced to take a bath. 

A dose of sulph 200 was given. A follow-up 15 days later showed a marked improvement in the condition with the breath barely audible otherwise (except when hand was put on chest, then it could still be appreciated).  Another dose of sulph was given to parents with proper instructions of repetition if needed at all.

Explanation

A child who has a desire to touch everything, hates water (quis/ the person who is suffering, Boenninghausen) and who has a weak larynx (where, ubi, location, Boenninghausen/ Phatak repertory), who had < during sleep (a common symptom of laryngomalacia, though not considered in the selection of medicine nevertheless was covered by selected medicine), would need sulph.

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Download the case in pdf format below.