MY EXPERIENCE IN DIABETIC FOOT WITH HOMOEOPATHY

-PROF. (DR.) PANKAJ AGGARWAL M. D. (HOM.) EX VICE-PRINCIPAL, HOD, ORGANON OF MEDICINE, BAKSON HOMOEOPATHIC MEDICAL COLLEGE, GREATER NOIDA, U.P. RESIDENCE-CUM-CLINIC: 37, SOUTH ANARKALI EXTN., DELHI-51, INDIA PH.: 22512552, 22421972, MOB: 09313212552 E-MAIL: DRPANKAJ89@GMAIL.COM

SALUTATION

Hipocrates, Father of Medicine
LIFE IS SHORT ART IS LONG

Dr. M.L. Agarwal
MY FATHER

Master Hannemann, A Great Teacher
MEDICAL ART IS MY SUBJECT

Prof. L.M. Khan
MY TEACHER

THE PATIENT
Name Age/ Sex Date of Consultation Mr. G P 62 years/Male 15.04.2011

Occupation
Qualification Marital Status

Business
B –Tech Married

Presenting Complaints
The patient, a DIAGNOSED case of Gangrene as a consequence of diabetes mellitus, presented with the following complaints at the time of consultation: • Gangrene of left foot since 6 months Stitching pain in the affected foot < Squatting position < Walking > Resting while and when kept open Discharge – Profuse (wets the cotton swab), Watery off and on Blood also oozes out Walking difficult due to pain & discharge

First photograph

The photograph was taken on 14.04.2011 by the patient and submitted at the time of his visit to the clinic on 15.04.2011.

Presenting Complaints
• Burning sensation in epigastric region since 5 months Complaint occurred after he started taking antibiotics for gangrene Along with heaviness of Lower abdomen < Eating after > Passing flatus

Also associated with Heaviness of head

History Of Presenting Complaint
3 years back, the patient suffered from a similar gangrene on the big toe of the left foot for which he was operated and was relieved. From the past 6 months, he has been suffering from gangrene of left foot which did not healed even after taking antibiotics regularly. His blood sugar level at the time of consultation was 319 g/dl (random) and his blood pressure was 136/84 mm Hg (after taking allopathic medicine in morning).

Treatment history
• Taking regular allopathic medicines for • Diabetes Mellitus • Hypertension •Took Ayurvedic treatment for the gangrene on and off for past 2 years

•Taking Antibiotics for the same (since 6 months)

Past history
• Typhoid - In childhood • Brain hemorrhage (left sided) - 4 years back – taken Allopathic treatment; since than weakness of the right arm started (excessive alcohol intake)

Family history
RELATIVE Paternal Grandparents DISEASE No major illness; natural death

Maternal grandparents
Mother

Hypertension
Diabetes Mellitus Hypertension

Father
Brother Sister

Died due to Cardiac arrest
Chronic Renal Failure Blood Cancer

• from the past history and family history we can percieve the destructive tendencies/ state he has been carrying with him

Personal History
Habits/Addiction: Addiction of drinking alcohol regularly from 1975 to November 2010 No habit of smoking cigarette Diet: Non Vegetarian

PHYSICAL GENERALS
Appetite: Regular, cannot tolerate hunger – causes Headache Warm food 3 +; Gravied Food 3+, Sweets 2+, Mutton Nothing specific found

Desire:

Aversion:

Intolerance:
Thirst:

Nothing specific found
Drinks in sips; frequent, for water at normal temperature

PHYSICAL GENERALS
Stool: Regular; unsatisfactory

Urine:
Sleep:

Clear, Increased Frequency at night
Disturbed

Thermal reaction: Can tolerate both hot and cold weather equally

Perspiration:

Profuse on slightest exertion

MENTAL GENERALS
• History of prolonged working hours

• Anxiety – for small things
• Anxiety-disease • Workaholic • Perfectionist •Anger- expressed by shouting

MENTAL GENERALS
• Contradiction << Cannot tolerate

• Economical – thinks before spending money
• Fastidious – but like if somebody else cleans • Desire open air • Punctual • Sympathetic

PHYSICIAN’S OBSERVATION
• Deep Furrows over forehead • Slurring Speech • Tongue – Furrows in centre, dry laterally • Body temperature – Normal to touch

INVESTIGATIONS ADVISED
• Blood Sugar – Fasting and PP

PROVISIONAL DIAGNOSIS
DIABETIC FOOT GANGRENE SUPERIMPOSED WITH INFECTION

SYMPTOMS OF CASE
SYMPTOMS Gangrene on left side of left foot with Stiching pain < Walking > Resting while, in open air Discharge-profuse, Watery, offensive Difficulty in walking Burning sensation in epigastric region with Heaviness of head & lower abdomen < Eating after > Passing flatus H/o - Brain Hemorrhage CAUSA OCCASIONALIS No

Yes

Yes

SYMPTOMS OF CASE
SYMPTOMS Addiction of drinking alcohol Cannot tolerate hunger Thirst - drinks in sips, frequent Stool - Regular, unsatisfactory Urine - Increased Frequency in night Desire - warm food Desire - Sweets CAUSA OCCASIONALIS No No No Yes Yes No No

SYMPTOMS OF CASE
CAUSA OCCASIONALIS No No No No No No No No No

SYMPTOMS

Sleep- disturbed , thinks about his disease Anxiety – for small things Anxiety - disease Workaholic Contradiction<< Cannot tolerate Desire open air Perfectionist Deep Furrows over forehead Slurring Speech

EVALUATION OF CASE
KENT’S METHOD
MENTAL GENERALS • Perfectionist • Workaholic • Contradiction << Cannot tolerate • Anxiety – for small things, disease • Desire open air PHYSICAL GENERALS •Cannot tolerate hunger •Thirst - Drinks in sips, frequent •Desire - Warm food, •Desire - Sweets • Sleep- disturbed , thinks about his disease

EVALUATION OF CASE
KENT’S METHOD
PARTICULARS • Gangrene of left foot with Stitching Pain < Walking > Resting while , in open air Profuse, Watery, offensive discharge

TOTALITY OF SYMPTOMS
• Perfectionist • Workaholic • Contradiction << Cannot tolerate •Anxiety – for small things, disease •Desire open air • Cannot tolerate hunger • Thirst - Drinks in sips, frequent

TOTALITY OF SYMPTOMS
•Desire - Warm food, •Desire - Sweets • Sleep- disturbed , thinks about his disease • Gangrene of the big toe with Stitching Pain < Walking > Resting while , in open air Profuse, Watery, offensive discharge

MIASMATIC ANALYSIS
SYMPTOM Anxiety – for small things Anxiety – for disease Workaholic Contradiction - Cannot tolerate Desire open air PSORA SYPHILIS SYCOSIS ++ + + + + +++ ++ + + + + +

Perfectionist
Cannot tolerate hunger Thirst - Drinks in sips, frequent Desire - Warm food Desire sweets

+
+ + + +

++

MIASMATIC ANALYSIS
SYMPTOM PSORA SYPHILIS SYCOSIS

Sleep- disturbed , thinks about his disease
Gangrene of the left foot Stitching Pain < Walking > Resting while > in open air Profuse, Watery, offensive discharge

+
+ + + + + +++ + + + +

PREDOMINANT PSORA SYPHILITIC MIASM

SELECTION OF MEDICINE
Lycopodium Clavatum and Arsenicum album were the two most indicated remedy for this case but taking into consideration the pathology of the disease, its acute totality and the affinity of Arsenicum album for the diseased stage, we prescribed Arsenicum album in 50 millicimal potency

FIRST PRESCRIPTION
Arsenicum Album 0/1, 10 Strokes, BD, first cup
(Date of prescription – 15.04.2011)

FOLLOW UP
DATE 22/04/11 CHANGES IN SYMPTOMS General condition > Pain in the wound - slightly > Discharge– not as profuse as it was at the time of consultation Sleep - no change Blood sugar – 130 g/dl (F) 180 g/dl (PP) PRESCRIPTION Arsenicum Album 0/2, 0/3 -10 strokes, B.D Placebo 3X, 16 tab

7/05/11

General Condition >> Pain >>; the patient is able to walk better Discharge – Absent Sleep - Slightly Improved Constipation>> but unsatisfactory

Arsenicum Album 0/4,0/5,10 strokes, B.D Placebo 3X, 16 Tab

FOLLOW UP
DATE 21/5/11 CHANGES IN SYMPTOMS General condition >> Discharge – Slightly Increased since 5 days (patient had an history of prolonged exertion at home) Pain is Absent Stools satisfactory though slightly hard in consistency Blood sugar – 140 g/dl(random)
As a whole patient better Discharge is decreased Pain in the wound- better Constipation - off and on but stools are satisfactory Sleep – better Anxiety level better

PRESCRIPTION Arsenicum album 0/6, 0/7 - 10 strokes, B.D, 2nd cup Sac Lac 3X,16 Tab

4/6/11

Arsenicum album 0/8, 0/9 -10 strokes; BD 2nd cup Sac Lac 3X ,16 tab

FOLLOW UP
DATE 24/6/11 CHANGE IN SYMPTOMS General Condition >> Discharge- decreased markedly Sleep is Better, refreshing Constipation is better, satisfactory stools Anxiety better Contradiction still not tolerable Blood sugar – 108 g/dl (F) 136 g/dl (PP) As a whole patient better NO PAIN AT ALL – not even on touching Discharge was absent Sleep has improved much Blood sugar – 130 g/dl (random) PRESCRIPTION Arsenicum album 0/10, 0/11 - 10 strokes, B.D 2nd cup Sac Lac 3X /16 tab

10/7/11

Arsenicum album 0/12, 0/13 - 10 strokes, B.D 2nd cup Sac Lac 3X /16 tab

SECOND PHOTOGRAPH

This photograph was taken by patient on 22.06.2011 after 2 months of treatment

Complaints

Dates

Arsenicum Album was prescribed with increasing order in 50 millisemal till 10/9/11. Last prescribed was Arsenicum album 0/16 ;10 strokes; B.D 3rd cup

22/ 4
Wound Pain Discharge Stool

7/5

21/ 5
++ +++ -+

4/6
++ + ++ ++ +

24/ 6
+++ +++ +++ +++

10/ 7
+++ +++ +++ +/-

30/7
+++ +++ ++ +++

same
+ +

Same
++ +++ +

same

Sleep
Anxiety Heaviness

Same
Same Same

-

+
+ +

+
+ +

++
++ +++

+++
+++ +++

+
++ +++

Same Same

Complaints 12/8 Wound Pain Discharge Stool Sleep Anxiety Heaviness +++ +++ ++ ++ +++ ++ ++ 28/8 +++ ++ ++ ++ ++ ++ ++

Dates 10/9 ++ ++ 26/9 ++ 10/10 --+ -+

+++

+
++

WHY ARSENICUM ALBUM?
Arsenicum album is the most similimum for the symptoms of the PHASE OF THE DISEASE covering maximum number of symptoms as well as the pathological stage of the disease. The selection is also justified with the proof from the source books of our Homeopathic Materia Medica.

WHY ARSENICUM ALBUM?
From the pages of Materia Medica Pura, Vol 1 By Samuel Hahnemann
• An Ulcer that is particularly painful in the morning, which contains a dark brown, bloody matter under a thin scab, with single stitches whilst sitting, which are relieved by standing but most effectually by walking (S.No 779) • Tearing pains in ulcers (S.No 782) • On the affected part, in the ulcer, a burning as from a live coal (S.No 783) • The old ulcers, hitherto painless, became a painfully sensitive (S.No 786)

WHY ARSENICUM ALBUM?
• The ulcer discharges much black coagulated blood (S.No 787) • Itching in the ulcer passing into burning (S.No 788) • Cancerous ulcers which rendered it necessary to ampute the limbs (S.No 791) • The ulcer becomes inflamed all around bleeds on being bandaged, and gets a superficial dry scab (S.No 792) • Burning pain in the ulcers (S.No 794) • Needle pricks on the skin (S.No 804) • He wishes to rise up, but when he rises he can hardly maintain himself (S.No 862)

WHY ARSENICUM ALBUM?
• Sleepless with restlessness and moaning (S.No 869) •He drinks much and often (S.No 922 ) • He is thirsty, yet drinks but little at a time (S.No 928) • Anxiety (S.No 1012)

• The most intolerable anxiety (S.No 1014)
• Long continued Anxiety (S.No 1018) • Sensitive peevish disposition; the least thing can annoy him and almost cause him to be angry (S.No 1063)

WHY ARSENICUM ALBUM?
From the pages of The Chronic Disease, their peculiar nature Vol 1 By Samuel Hahnemann
• Introduction – Ulcers in the soles of the feet; ulcers with corrosive blisters on the soles of the feet and toes; pains as from soreness on the balls of the toes , as if rubbed open from walking. Burning pains in the ulcers; slow in going to sleep…… • Anxiety (S.No 14) • He drinks much and often (S.NO 382)

• With Great Thirst he drinks often, but always little at a time (S.NO 383)

WHY ARSENICUM ALBUM?
• Bloatedness of the region of the stomach (S.No 469 ) • Heaviness in the stomach, as from a stone, after eating (S.No 472) • Constipation (S.No 562) • Constipated abdomen (S.No 563) • Ulcer which is painful, especially in the morning , with dark- brown, thin bloody pus under a thin scurf , and with single stitches while sitting , alleviated by standing and still more by walking. (S.No 1057) • Cancerous ulcer, which compels the amputation of a limb (S.No 1058) • Painful sensitiveness of old ulcers which hitherto were painless.

WHY ARSENICUM ALBUM?
• Inflammation of an ulcer in its border; it bleeds on being bandaged and a superficial dry scab forms. (S.No 1068 ) • The ulcer discharges much black coagulated blood (S.No 1069 ) •Great indolence and indisposition to the lightest movement (S.No 1071) • Sleeplessness (S.No 1086)

WHY ARSENICUM ALBUM?
From the pages of The Guiding Symptoms of Materia Medica, By C. Herring
•When alone, he falls to thinking about disease and other things, which he can scarcely keep out of his mind. •Mental derangements with satiety of life in drunkard. •Deep-seated melancholic affection; ceased after tetter-like ulcers appeared on lower limbs. •Anxiety and impatience. •The least thing offends him, and moves him to anger.

• Vexation, with anxiety, restlessness and chilliness.

WHY ARSENICUM ALBUM?
•Obstinacy, avarice, inclined to malice and satire •Dryness of mouth, with violent thirst. •Irresistible longing for water frequently disturbing sleep at night, undiminished next morning. • Bad effects from inordinate use of spirituous liquors. •Sugar in urine. • Voice : trembling ; weak ; unequal, now strong and again weak ; hoarse ; rough ; hollow ; loss of voice. Right limb swollen and full of suppurating pimples, with an unbearable itching •Old ulcers on lower limbs, with burning and lancinating pains.

WHY ARSENICUM ALBUM?
• Old ulcers on legs, with burning and stinging. • Pain in an ulcerated leg so violent that it waked her up at 4 A. M., and prevented her from sleeping. • Ulcer on foot surrounded by a gangrenous crust. • Loss of power of toes; walking is performed with soles. • Stitches which cause her to shudder, from little left toe to great toe. •Sore pain on balls of toes, while walking, as if chafed.

•Great restlessness with fear and anxiety.
•Sleep anxious, unquiet.

WHY ARSENICUM ALBUM?
• Ulceration constantly extending in breadth. •Superficial ulcer, penetrating daily deeper, circumference, edges more and more everted. increasing in

•Acrid, burning, corroding discharges, often extremely offensive. • Retards decomposition (in those fatally poisoned). •Gangrena senilis sicca, with coldness, desire for more covering ; > from warmth. • Gangrene : > from heat ; (< from heat, Secale). •Gangrenous ulcers half an inch broad, causing insufferable pains, surrounded and partially covered with a gangrenous crust.

PHYSIOLOGICAL ACTION OF ARSENICUM ALBUM
It is an agent when applied to skin acts as a caustic and produces a violent inflammation with sloughing of parts. When small doses are taken, it has a tonic effect upon nervous system and circulation, stimulating the flow. The RBC’s are decreased in number, and the blood rendered less coagulable, followed by eczema, urticaria, herpes zoster, bronzing and exfoliating of the skin.

REPERTORIAL SHEET

photograph

14.04.2011

22.06.2011

Present Scenario
On 10 October 2011, the patient complaint of fever <evening Shiveing with Advised Widal Test

.

Presenting Complaint
Patient consulted us on telephone with the following symptoms on 16.10.2011:  General Weakness  Restlessness +++  His present wound (ulcer) was healed up but the older ulcer reappeared – with profuse, watery and offensive discharge.  Neuralgic pains radiating to the whole left foot  Sloughing of the medial malleolus of the same foot  Stools – Constipated, hard stools increased  Anger with Depressed feeling  Mental Anxiety +++ (as he was asked for amputation)

The photograph was taken on 16.10.2011

On Reviewing
His old ulcers had re-appeared after the attack of typhoid fever Profuse, watery offensive discharge Neuralgic pains radiating to the whole left foot. Sloughing of medial malleolus of left foot was seen. Anxiety -

Prescription

5 drops diluted in 100 ml of distilled water; 2 strokes/3 times a day

Crotalus horridus 30;

FOLLOW UP
DATE CHANGE IN SYMPTOMS PRESCRIPTION

5/11/2011

Fever - absent Weakness ++++ Discharge from ulcer +++ Malleolar lesion – same Sloughing present Constipation >> Sleep – better advised : Blood sugar ,CBC,HbA1C

Crotalus h. 6 / 2 strokes/

6 drops diluted in 100 ml of distilled water Rubrum met 3x/ 16 tab/ H.S.

19/11/2011

Wound at malleolar region > Bleeding points appeared Weakness > Sleep > Anxiety >> ( after noticing the reappearance of circulation at the affected foot)

Crotalus h. 6 / 2 strokes/

6 drops diluted in 100 ml of distilled water Rubrum met 3x/ 16 tab/ H.S.

Reappearance of Bleeding points

The photograph was taken on 3.12.2011

FOLLOW UP
DATE CHANGE IN SYMPTOMS PRESCRIPTION

5/12/2011

G.C >> Melleolar lesion ->> Pain > Constipation > Blood sugar 127 mg/dl (random)
G.C >> Walking improved Generalities >> Ulcer better Sleep Improved

Crotalus h. 6/ 5 strokes/ 6
drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning

24/12/2011

Crotalus h. 6/ 5 strokes/ 6

FOLLOW UP
DATE CHANGE IN SYMPTOMS PRESCRIPTION 14/01/12 Ulcer better, much healed Discharge slightly present Anxiety level improved Swelling at ankle region present Blood sugar 150 mg/dl (random) 31/1/12 Ulcer- improving Sleep- better Swelling at the ankle region- same Blood sugar -180mg/dl

Crotalus h. 6/ 5 strokes/ 6
drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning

Crotalus h. 6/ 5 strokes/ 6

16/2/12

Wound- better Sloughing- better Blood sugar- fasting-145mg/dl Blood sugar- PP- 155mg/dl Advisded : color doppler of left lower limb

Crotalus h. 6/ 5 strokes/ 6
drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning

DATE 15/3/12

CHANGE IN SYMPTOMS Patient as a whole- improved

PRESCRIPTION

Crotalus h. 6/ 5 strokes/
6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q 6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q

31/3/1212/5/12

General condition – improved Pain- absent Discharge- bleeding off and on Sleep- sound and refreshing Weakness- absent

Crotalus h. 6/ 5 strokes/

21/10/12

(on telephone) No medicine Wound- dry and healed completely Sleep- sound Constipation- absent Anxiety- absent

Complaints

Dates

5/11
Wound(old) Sloughing

19/11
+

5/12
++ +

24/12
+++ +++

same same

same

Pain Discharge sleep Anxiety Weakness

+

+ ++ ++ ++ ++

++ ++ ++ + ++

+++ + +++ +++ +

same
++

Same Same

Complaints 14/01 31/1 Wound(old) +++ Sloughing Pain +++ + ++ +++ +

Dates 16/2 ++ ++ ++ 15/3 +++ ++ +++ 31/312/5 +++ +++ ++

Discharge
sleep Anxiety Weakness

same
++
Same Same

++
++ ++ ++

++
++ + ++

+
+++ +++ +

+++
+++ +++ +++

• On 20/10/12- completely relieved • No sleep disturbance • No wound and no pain • ( On Telephone )

WHY Crotalus Horridus?
From Allens Keynote:  Is indicated in strumous, debilitated hemorrhagic, broken – down constitution; during zymotic diseases; in inebriates; tendency to carbuncles or blood boils.  Diseases caused by a previous low state of the system ;low septic typhoid or malarial fever; chronic alcoholism; exhausted vital force; genuine collapse.

WHY Crotalus Horridus?
From Boger Synoptic Key  Deathly sick, tremulous and weak  Hemorrhage  Putridity, rapid decomposition  Septic

 Petechiae, gangrene, general burning

WHY Crotalus Horridus?
From The Guiding Symptoms of our Materia Medica by C. Herring:
 Suppuration of glands; gangrene; in broken down constitutions, with low fever, tendency to slough, and discharge of dirty or hemorrhagic matter.  Gangrene, skin separated from muscles by a fetid fluid; black spots with red areola and dark blackish redness of adjacent tissues.  Chilblains, gangrene pending ; circulation sluggish.  Ulceration; especially phagedenic, sloughing, varicose, irritable, bubo, "soft sore," mercurio-syphilitic, with offensive discharge, etc., in constitutions broken down by previous disease or bad living ; in inebriates.

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