I am inflammable… and invulnerable…

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(Read author’s “Objective analysis of the case: 20 points recipe: a blueprint to use homeopathic philosophy and organon into clinical practice”. The following case is an illustration of his analytical method of data processing)

Mrs ED/38 years.

A known case of Rheumatoid arthritis since the last three years.

CHIEF COMPLAINTS

Pain in joints, with swelling and stiffness since the last four years.

It started simultaneously in both wrists, then elbows, shoulders, fingers, knees, ankles etc. Pain, swelling, stiffness < late in afternoon, night, evening 3 ,< 5 to 11p.m.3

Pains: appear gradually, sometimes dull or sharp; > by warm application. < initial motion3, > continued motion3, < descending the stairs3. < standing2.

Wandering pains, go on shifting to different joints. Constant pain in toes when walking.  More pain in wrists and fingers.

Stiffness of joints, < morning, first motion.

Varicose veins since the last 10 years, more on the left side. Visible varicosis. Itching and burning; there is a big network of varicose veins above knees. Heaviness and pain < standing

PATIENT AS A PERSON

Perspiration: Palms and soles < anxiety.

Thermal: I don`t tolerate winter.  I never did like winter. C3H2.

Sleep: Normal. Dreams: Rare. No frequent dreams.

Food: < chocolate and eggs = eruptions, itching, more in folds of arms.

PAST HISTORY

Tonsillitis with pus; no tonsillectomy. During tonsillitis, high fever, pain; once admitted in a hospital as left tonsil was extremely swollen and septic.

Steroids, non-steroidal anti-inflammatory drugs and Methotrexate many times.

FAMILY HISTORY

Mo: Rheumatoid arthritis, goitre, heart problem

Fa: Lumbar spondylosis

MG2F: Ca colon

INVESTIGATIONS: RA test: positive. ESR: 64 mm at the end of one hour. Hb:  8.8 gm%

ASO Titre: 178 units. C-reactive proteins: Positive. ANA test: Positive.

EXAMINATION

Rheumatic nodule on left palm, right dorsum of leg; synovitis.

Left small toe deformity.

LIFE SPACE

I hail from a middle-class family. I live with my husband, M-I-L, a daughter and a dog.

I had difficult childhood.

Father: I felt hatred towards my father. He was dictatorial and used to insist that I must come back early. When I was 20 years old, parents separated. My father became alcoholic and still drinks. Throughout childhood, I saw quarrels only. They continue even today; I usually side with my mother. Father used to torture her, not physically but mentally, he was abusive. I do not want to follow my father. He had extra-marital relations.  He didn’t marry after leaving my mother and is still living alone.

Mother: She is cheerful; likes singing songs.  She has more problems with her health; she has been suppressed and depressed for long.

Sister: She lives nearby. My father loved my sister more than me.  He told me directly, ‘I love your sister more’.  This sentence always hovers in my mind. My sister at the age of 4 sustained serious burn injuries. Since then parents paid more attention to her. I was just 11 years old then. I don`t have jealousy against my sister.

Current family: M-I-L is manipulative. She cries a lot. If someone cries, I feel pity; but she can`t manipulate me; we have been living together since 10 years. I do things directly. I am independent in action.

Husband: Temperamentally different from me.

Daughter: 13 years old, suffers from tonsillitis.

Hobbies: Dancing; folk dances. Fast dances.3.

Job: Since the last 2 years, I am managing a coffee shop. I am doing everything at the job cook, clean, serve and also manage accounts. It’s a satisfactory job. 2 years ago, I was working as a managing director in another shop. Due to some conflicts with the boss, I left the job.

I don`t like to be dependent and helpless. I don`t like to postpone something or I don’t need help from others. I do the things fast and I hate slowness.

I am angry, excitable and anxious by nature. I become restless, impatient and panic. Sometimes I am too direct in communication. I can hurt others and be rough. I like to be a leader and to take charge of the situation

When rheumatic pains are worse, I cry. I feel helpless and angry; < consolation; I never accept any consolation in such moments.

Bursting, I get easily angered but it cools down easily quickly.

Body language when angry: Screaming; big eyes; movements of hands; throws things away but will not hit the daughter; bangs the door loudly. Husband and daughter know this well. Anger sometimes uncontrollable; abusive, then I feel guilty, but I don’t like to say sorry. Anger can be expressed on any person. Observations: Powerplay of pointing a finger and making a fist several times during interview.

  1. ANALYSIS OF THE COMPLAINTS ACCORDING TO TWENTY POINTS RECIPE

(The bold points refer to the case)

  1. NATURE OF DISEASE
  • Acute/per acute/ acute on chronic (exacerbation). Sub-acute. Chronic/ remission. Mixed / Messed: Natural + Iatrogenic. Psycho-somatic mixed. Somato-psychic mixed. Psychiatric. Auto-immune. Clinical diagnosis: Rheumatoid arthritis.
  1. PHASE OF THE DISEASE
  • Pre/sub-clinical. Clinical. Functional. Structural. Fully developed. Inadequately developed.
  1. AFFINITY
  • Cells/ tissues / organs/ systems/sides (extension, syndrome shifting etc.).

A systemic illness affecting musculo-skeletal system. Veins.

  1. TYPE OF PATHOLOGY
  • Allergic. Atrophic / emaciation / shrivelled / apoptosis.   Benign.   Degenerative.   Destructive.  Dysplasia / proliferation. Hyperplasia / metaplasia / hypertrophy. Induration / hardening. Inflammation (serous, fibrinous, catarrhal, eosinophilic, granulomatous, pyo-granulomatous, fibronecrotic, lymphocytic, suppurative). Malignant. Embolic. Thrombotic. Caries/necrosis/Sclerosis.  Nodular. Ulceration.   Hemorrhagic.   Ischemic. Venous. Calcareous. Fibrotic. Rheumatic. Excess/deficiency.

5.STATE OF PATHOLOGY

  • Borderline. Reversible.
  1. PATTERN OF RESPONSE
  • Sudden.   Alternating.  Changing. Continuous.  Erratic.  Regular.  Irregular.  Paroxysmal.   Periodic.   Lingering.    Shifting.   Progressive.  Recurrent. Static.
  1. PACE OF DISEASE
  • Rapid.  Slow.  First rapid then slow.   First slow then rapid.  Moderately Rapid.

moderately slow.

  1. EXPRESSIONS: (+ = Scanty, ++ = Moderate, +++ = Ample)
  • The field of modalities: General+ Particular ++
  • The field of sensations: General+ Particular ++
  • The field of symptoms:  Pathognomonic ++ Non-pathognomonic +
  • Common ++ Characteristics +
  1. MIASMATIC DIAGNOSIS
  • 1. Dominant / Active:  Sycotic
  • Fundamental: Syphilis
  • Combined/Complex: Syco-Syphilitic

      10. SENSITIVITY: High. Moderate. Decreased.

mind – Increased. Nerves (body) – Increased.

  1. SUSCEPTIBILITY: High. Moderate.  Decreased.
  2. SUPPRESSION: Mind: + Physical: +
  3. GENERAL VITALITY: Good. Moderate. Low.
  4. MONOGRAM
RHEUMATIC. ALLERGIC. VENOUS. SCLEROTIC.
  1. DISPOSITIONS: Temperamental /personality traits

Independent. Decisive. Angry. Excitable. Impatient. Ego Response-Hypertrophic.

  1. BODY LANGUAGE
  • The signals that the patient sent more often: Aggressive. Dominant. Open. Power. The patient was in ‘up’ position throughout.
  1. DEFENSE MECHANISMS: Idealization-devaluation. Undoing. Acting out.
  2. THEMES
  • With the auto-immune process, defining ‘auto’ is important.
  • Inflammation denotes fight and we have to define the ‘fight’ in the patient.
  • Varicose veins indicate stasis, of deoxygenated blood; letting the unwanted stay in the veins and not being able to eliminate; gravitational pull.
  • The system is active. The patient doesn’t like sluggishness of others. She does the things in a fast way. Rheumatoid arthritis prohibits the activity and makes the system slow and still. Stasis also denotes the theme of slowness.

BLOOD AND EGO

REPERTORIsATION

RUBRICS

  1. Extremities, pain, motion, beginning of motion, agg.
  2. Extremities, pain, motion, continued motion, amel.
  3. Extremities, pain, < evening
  4. Varicose veins
  5. Generals, food and drinks, chocolate agg.
  6. Generals, food and drinks, < eggs, agg.
  7. Mind, anger, easily
  8. Impatience

FILTER

  1. POSOLOGY
  • Mentioned below.
  1. ANALYSIS OF THE LIFE SPACE

The role of the mind in auto-immune diseases can’t but be emphasized. The latest discoveries in brain-immune interactions and the brain stress response in autoimmune diseases including rheumatoid arthritis underscore the role of mind.

In normal circumstances, cortisol keeps the immune system in check, preventing inflammation from going out of control. In many patients with autoimmune diseases, this cortisol response and the cascade of brain hormones that stimulates its release are impaired, so there is no shutoff valve to end inflammatory response when it is no longer needed. In some patients, the cortisol response may be intact but immune cells are resistant to the anti-inflammatory effects of cortisol due to abnormalities in the cortisol receptor. In both circumstances, inflammation goes on unchecked without the dampening effect of the body’s own cortisol.

There is a strong miasmatic load in this case and mother’s rheumatoid arthritis is a major direct transmission to develop the rheumatic dyscrasia. We have to investigate the life space of the patient on the background of transmitted material.

The painful childhood experience is a major issue to build upon a decisive personality. She goes ahead in her way as per her own will. There is a definite lack of affection from the father but the patient doesn’t harbour any abandoned feeling out of the sensitive phases of childhood and adolescence. She is independent and wants to be a leader. She can cut off the relations and the theme of life is not to invest emotions in other persons. If the things don’t agree with her, she will find her own way. She can’t tolerate domination.

She is angered easily and will speak out when angry. She can be abusive and rough which she may regret but won’t apologize. Her disposition doesn’t allow her to be helpless but ironically she suffers from RA which is known to make one helpless.

III. SELECTION OF REMEDIES

CHRONIC CONSTITUTIONAL REMEDY: DISCUSSION

Repertorization yields many remedies of acute and chronic dimensions. Puls. and Calc. rank high but fall short in essence. Both Puls. and Calc. are yielding, dependent and need support and protection. Ruta is also ranking high as it covers modalities; mentally Ruta patient is very dissatisfied, suspicious and has the weeping disposition. Sep. is chilly and has varicose veins. Sep. is independent too. But she is not Sep. because neither does she have stifled emotions nor has she become indifferent towards anybody. Her work speed is fast and moreover, she wants to work as a leader than to take a back seat of withdrawal through apathetic response as of Sep. Dulc. matches many aspects viz. domineering, strong-minded and possessiveness. These three aspects of Dulc. are chiefly available in family and not outside. In the work area, Dulc. is more confused. Dulc. can be abusive and quarrelsome but without being angry. Soft, gentle and vulnerable Ign. can’t be thought of as a constitutional remedy for this case though it appears in repertorization chart. Nat-m. is known to possess hatred and antipathy towards father (in a chronic way). But Nat-m. becomes melancholic and isolated and there is aggrandizement of sufferings. Our patient lacks the emotional investment that Nat-m. literally pours in others. Sulph. comes more as a quantity than quality in repertorization, though bursting out and detachment are typical for Sulph. Plb. is a good possibility in this case in view of early sclerosis in bones and rheumatic diathesis. But Plb. is much more selfish, egoistic and evolves as slow and apathetic. I often term Plb. as syphilitic Calc.

Ferr. and Lyc. are the best choices in this case and they need discrimination. Ferr. has domineering disposition (like Lyc.) but has no power of love. Lyc. is more manipulative and boaster. Ferr. never feels let down. Both are performance oriented. “Strike the iron when it is hot” is seen more inLyc. Ferr. is more excitable, impatient, easily angered and sensitive than Lyc. Ferr. is allergic too; rather the entry point for Ferr., in this case, is < from eggs. Ferr. is in motion always (like blood in circulation). Varicose veins as the pathological concomitant of rheumatic diathesis is a point in favour of Ferr.

FERRUM-MET IS SELECTED AS A CHRONIC CONSTITUTIONAL REMEDY.

POSOLOGY

We have to see that patient’s age is 38 years and within a span of 3 years, there has been a small toe deformity. X-ray has revealed sclerosis and hence, I have categorized the pace of the disease as moderately rapid and pattern of response as progressive. The chronic inflammatory response is of destructive type. Even though the sensitivity of mind is high and there is a qualified mental state, taking into consideration the stepped-in pathology, the remedy’s action should reach the tissue level. Hence, it was decided to begin with LM scale.

REPETITION SCHEDULE: SOME COMMENTS

Ferr-met LM1 to be given daily one dose at bedtime for 10 days. Then a gap of 10 days. Then again Ferr-met once per day for 10 days. This schedule to be continued for 3 months.

I have found this type of schedule extremely useful in many cases.

This method has many advantages.

  1. You can gradually increase the potencies as per assessment of follow up.
  2. There is no fear of aggravation.
  3. You give a remedy consecutively for 10 days so that the action gets explored fully over the system.
  4. Within 10 days of no medicine phase, the system tries to adapt to the already administered doses.
  5. You have, on one hand, potential remedy’s action being harped on the system for reaching at tissue level through adequate repetition and on the other hand, you allow the system to evoke its response.
  6. At the end of follow up, say, after 2 or 3 months, you are in a better position to assess clearly; there is no confusion whether the remedy has acted or not.
  7. With this method, I suggest going to a higher scale after the improvement has come to a halt. My clinical experience is that if you don’t give the remedy in ascending scale, it stops its action.
  8. Of course, this method can’t be and shouldn’t be followed in all cases. If you follow in all cases, you are not following the principle of individualization. In advanced pathological cases, it has more scope. Further, in cases where vitality is low, pathology is advanced, susceptibility is poor and there is a fear of killer aggravation, this method has a great scope.

PROGRESS NOTES

26/9/2006

Ferrum-met, LM1 one dose daily at bedtime for 10 days and then a gap of 10 days.

Follow-up

3/1/2007

I am definitely feeling better. The pains have reduced and so has the morning stiffness. I felt more energetic during the 10 days of medication. However, my pains became stronger and my mood was bad when I was off medication.

Ferrum met LM2 with the same schedule of 10 days medication and 10 days gap for 3 months.

10/3/2007

Soon after your remedy, I started feeling better. The pain in joints has reduced and I don’t feel heavy as before. Swelling is less. I think I have fewer bouts of anger.

Continue with Ferrum met LM2 with the same schedule.

15/6/2007

I was better but in the last couple of days, I experienced severe pain in knees, elbows and toes. My back is also aching badly and it is difficult to find the right position for sleep.

A dose of Carcinocin 1M was interpolated due to family history of cancer. Then a gap of 10 days. Continue with Ferrum met LM2 with the same schedule.

22/9/2007

I think mentally I am better. I take the things lightly and don’t react overtly. I wanted the leave for some days but my boss refused. Neither did I react, nor did I take it to my heart.

As far as pains are concerned, there is no change and no deterioration also. Morning stiffness is for 10-15 minutes and my knees hurt while ascending the stairs.

Ferrum met LM3 with the same schedule of 10 days medication and 10 days break.

22nd Dec. 2007

I am feeling better, no swelling, no strong pains, at the beginning there was <. Now I am able to open the fingers.

I can say the following – 50% > with LM1 for your first set of treatment. With LM2 – just > temporarily but no further improvement. With LM3, I felt good improvement.

General > of the complaints. Swelling of the joints, stiffness, and pain – all three are relieved.

I have changed a lot – I have become calm. Before the remedy, I was exploding like a bomb, then I was weeping for many days. My irritability has decreased. I had anger spells twice, but I calmed down quickly.

One week ago, for 10 days, I had strong pain in right side of forehead, extending to occiput. First time headache in life. But now it is okay. I don’t know the cause, might be stress related. Pain was for the whole day, spotty.

There is no < from eggs and chocolate and I can consume eggs and chocolate.

Varicose veins: Same. But they are not painful.

Ferrum met LM3 with the schedule of 10 days remedy and 10 days break.

Investigations: Hb 10.5 gms%. RA Test: Positive. ESR: 36 mm/hr.

19/4/2009

Last 2 years the patient has not seen me. She told me that you are just increasing the potency of Ferrum -met. I decided not to meet you and I took Ferrum-met 4, 5 and 6 in your way of 10 days of medicine cycle and 10 days of break.

Overall, I am better than what I was before 2007.

But now there is some crisis. New small nodules have appeared within the last 3 months on my right hand. Morning stiffness for 30 to 60 minutes. Veins of legs are more painful; of course,I have to  stand at work for the entire day. I dismissed two workers in my cafe as they were cheating and chatting more. Now I do all work single-handedly.

Anger is less. I am calmer than before.

Menstrual cycle is normal.

I became chillier this winter.

Has put on more weight.

Last crisis was > with Ferr-met LM6. But now it is not helping.

Pains: Sharp and strong at different places.

I interpreted this data in two ways-not meeting me and taking further ascending doses by her own discretion indicates her independent disposition and secondly, Ferrum met LM6 has stopped its action.

I explained to her how the follow-up from a doctor is essential and she should not act as a doctor!

DILEMMA FOR A PHYSICIAN

  • What should I do?
  • Ascending scale of Ferrum-met in LM?
  • Ferrum-met in centesimal scale?
  • Change of remedy?
  • Use of an intercurrent? Which intercurrent? A nosode or any other?

I decided to follow a different method.

  1. Ferrum–met LM7 two times daily for 3 months without break and
  2. Plumbum-met 200 monthly one dose for 3 months.

The reasons to give Plb-met: To stimulate the vitality both at the systemic and local level, to check the auto-immune process (sclerosis) and to give a deeper-acting remedy in complementary relationship. Nosodes are not the only intercurrents. Note that Plb-met is also listed under ‘lack of reaction’ for 3 marks. I think that the remedies covering ‘lack of reaction’ should be thought of for intercurrent prescribing.

9/11/2009

No crisis within 6 months.

Nodules have disappeared. Swelling is less. Pain in feet. Itching spot over ankles. I have pains but they are bearable. Overall, I am better. There is no deterioration.  I work hard and my energy status is good. Morning stiffness is definitely less. I travelled a lot in many places in Europe and didn’t notice any crisis. I enjoyed the vacation.

I suggested continuing the same schedule for 3 months.

2/4/2010

I am fine; my arthritis comes and goes. But I must say that I am much better. There are no crises as before and my daily activities are not hampered.

I did tests: RA is weakly positive. Hb 11.3 gms%. ESR: 32 mm/hr.

I could not meet you because when you came to our country, I was travelling with my family. But I continued your recommended recipe. I am taking Plb-met 200 once every month and only last month, I started taking Ferrum met LM8 daily two doses as per recommendation on skype.

Varicose veins are on both legs, more on 1eft, but they are not painful; occasional itching. Over the years, with your treatment, there is > in varicose veins and no new varicose veins.

Morning stiffness has lessened and I have shoulder pains in morning.

No eruptions from eggs and chocolate.

I am much much better and my arthritis is well under control.

**********

About Author

Dr AJIT KULKARNI M.D. (Hom.)

  • Director, Homeopathic Research Institute, Pune
  • A veteran homoeopath, an academician and a famed international teacher
  • A classical Homeopathic physician practicing since the last 35 years
  • Co-Author: Absolute Homoeopathic Matera Medica & Five Regional Repertories: AIDS, DM, Thyroid, HTN and Trauma
  • Author:   Body Language and Homeopathy, Homeopathy through Harmony and Totality (Three volumes), Law of Similars in Medical Science, Homeopathic Posology, Family and Its Relations, Homeopathic Covidoscope (published by Amazon), More than 100 publications on various aspects of homeopathy & Many papers and books translated in several languages
  • Award of ‘Excellence in Homoeopathy’
  • Award of ‘Homoeo-Ratna’
  • ‘Life achievement Award’
  • ‘Dr B. Sahni Memorial Award’
  • Member, Editorial Board, National Journal of Homeopathy, Mumbai

 

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