A Case of Rheumatism in a Woman of 68

CHIEF COMPLAINT

Mrs. V P, 68 years old, consulted me on 2^nd December 2016 for rheumatoid arthritis.

LOCATION	SENSATION	MODALITIES	CONCOMITANT
Finger Joints since 10 years	Pain Stiffness	< Night
Knee joint Since 8-9 years	Stitching pain Weakness Stiffness	< Standing < Ascending stairs < Standing < Night
Feet – sole Corn since 2-3 years	Pain

PAST HISTORY:

Hysterectomy in 1997 – uterine fibroid; ovaries are preserved.

GENERALS:

Food: irritable when hungry²⁺

Desire: meat ²⁺, sweet

Aversion: milk³⁺

Perspiration: axilla, non-offensive, non-staining.

Sleep: sleeps on sides; salivation during sleep¹⁺

MIND

The patient is a retired school teacher who was born and brought up in Nashik.

Education: M.A., B.Ed. She is the 3^rd child of the four siblings. Father was strict regarding studies. Shifted to Mumbai in 1980 after marriage. Started teaching in government school 1985.

“Since the time I was diagnosed with R.A., I have become a little depressed. Don’t feel like talking to anyone. Don’t go out much, because people will come to know about my disease” (i.e. deformed finger joints?). “Whenever I do anything, I think how my actions will affect others. If it bothers them, then I don’t do it.”

Anxiety: at every small matter, ameliorates in open air²⁺

Anxiety: about health – “If something happens to me, what will happen to my children, who will take care of them?”

Fear: of accident, of going on an escalator.

History from husband: She is very restless, doesn’t sit in one place. She will keep herself busy by doing some activity. She cannot sit idle. She loves shopping. Also loves making rangoli, knitting and cooking.

Memory: Weak. She constantly feels that she is missing or forgetting something, so she keeps checking 2-3 times. When she goes shopping, she constantly checks her bag or purse. This is not only the case with money but also with her cupboard or kitchen, etc., she will always wonder whether she kept her things properly.

REPERTORY SHEET

PRESCRIPTION

Iodium 30C

4 drops 6 hourly

For 15 days

FOLLOW-UPS

DATE	FOLLOW UP	PRESCRIPTION	COMMENT
15^th December 2016	Severe aggravation in pain for initial 5-6 days followed by no improvement.	Iodium 30C 4 drops 4 hourly For 15 days
4^th January 2017	No change in the pain and the overall condition is same.	Iodium 30C 4 drops 4 hourly For 30 days
6^th February 2017	Slight amelioration (10%) in pain.	Iodium 200C 4 drops 12 hourly For 30 days	{Kent’s second observation: Long aggravation, but final and slow improvement. If, at the end of a few weeks, he is a little better and his symptoms are a little better than when he took the dose, there is some hope that finally the symptoms may have an outward manifestation whereby he will attain final recovery, but for many years you may go along with prolonged aggravations. You will find in such a patient there was the beginning of some very marked tissue change in some organ.}
15^th March 2017	Pain is much better (40%)	Iodium 200C 4 drops 6 hourly For 30 days
17^th April 2017	No change in pain.	Iodium 200C 4 drops 4 hourly For 30 days
13^th May 2017	Severe aggravation in pain.	Iodium 1M 4 drops 12 hourly For 30 days	After effecting the patient for a few months, probably the potency is exhausted. Hence potency raised to 1M
20^th May 2017	Finger joint pain –SQ- Knee pain –SQ- Finger joint pain < Night²⁺ No ameliorating modalities Knee pain < Night³⁺, standing Slightly > by warm application Weakness in knees < Standing, ascending stairs	Tuberculinum residuum CM 1 Dose Iodium 1M 4 drops 12 hourly For 30 days	*When the apparently indicated remedy fails:* In a case where the apparently indicated remedy fails to act or there is a lack of response to a previously effective remedy, an intercurrent dose of the appropriate nosode can be prescribed
30^th June 2017	Much better in pain- about 60%-70%	Tuberculinum residuum CM 1 Dose Iodium 1M 4 drops 12 hourly For 30 days
4^th August 2017	Pain much better	Tuberculinum residuum CM 1 Dose Iodium 1M 4 drops 12 hourly For 30 days
11^th September 2017	Pain in finger joint-0- Pain in knee joint-0-	Tuberculinum residuum CM 1 Dose Iodium 1M 4 drops 12 hourly For 30 days
3^rd November 2017	No complaints	Iodium 1M 4 drops 12 hourly For 30 days
1^st December 2017	Since 12-14 days, complaint of pain³⁺ in left great toe. Swelling with redness in left great toe. Pain < touch²⁺, cold³⁺ Pain > warm²⁺ Investigations: 2 December 2017 Uric acid: 10.3 ESR: 69 *RUBRICS* · EXTREMITIES – SWELLING – Toes – first – gout-like · EXTREMITIES – ARTHRITIC NODOSITIES – Toes · EXTREMITIES – PAIN – rheumatic – weather – cold – agg. · EXTREMITIES – PAIN – Joints – gouty · GENERALS – COLD – agg. · GENERALS – COLD – air – agg. · GENERALS – SEASONS – winter – agg. · GENERALS – WEATHER – cold weather – dry – agg. · GENERALS – WIND – cold – agg. · GENERALS – WIND – cold – dry – agg.	Rhododendron 200C 4 drops 6 hourly For 7 Days	Auxiliary treatment advised for high uric acid.
9^th December 2017	Slight amelioration in pain 10%	Rhododendron 1M 4 drops 6 hourly For 7 Days
15^th December 2017	40%-50% amelioration in pain.	Rhododendron 1M 4 drops 6 hourly For 7 Days
23^rd December 2017	Not much difference in pain. It has not increased; its bearable.	Rhododendron 1M 4 drops 4 hourly For 7 Days
3^rd January 2018	90% amelioration in pain Investigations: 2 January 2018 Uric Acid: 7.8 ESR: 49	Iodium 1M 4 drops 12 hourly For 30 days

Patient is still on Iodium 1M. Overall the patient is much better. Energy level is good. Mentally stable, anxiety is much better. Patient was encouraged to continue the uric acid diet to avoid further attacks.

Iodium – Grand Keynote Symptoms

Amelioration by eating
Anger or irritability if they skip a meal
Constipation, with ineffectual urging amel by drinking cold milk
Eats ravenously, yet emaciates
Empty eructation from morning to night, as if every particle of food was turned into air
Great weakness and loss of breath on going upstairs; during the menses
Hot patient
Leucorrhoea: acrid, corrosive, staining and corroding the linen; most abundant at time of menses
Palpitation worse from least exertion
Swelling and induration of lymph nodes, endocrine glands and thyroid with atrophy of mammary glands
They have too many ideas and a tendency to execute them all at the same time.
Very restless

J.J. Clarke – I have seen it given with excellent effect in lower attenuations, when swollen and deformed joints have been left behind after an attack of acute rheumatism (Homeopathy Treatment for Rheumatism).

Rhododendron Chrysanthum Indication

Sensitive to windy or stormy wet weather; even if he is in the house. Rheumatic drawing, tearing pains in all the limbs, worse at rest and in wet, cold, windy weather.
Amelioration: dry heat, motion or exercise.
It is like Rhus tox., but in Rhododendron the pain is felt more in the periosteum and the deeper structures as compared to Rhus tox.
Mostly affects the small joints. Acute inflammatory swelling of joints, wandering from one joint to another; severe at night.
It is particularly important in gouty affection of the great toe-joint. There is usually a fibrous deposit in the affected part.
The pains are drawing and tearing in character and are felt in the periosteum. It also affects ligaments of small joints. Like Causticum, Rhododendron abounds in arthritic nodes.

Tuberculinum Residuum Indication

Aggravation from prolonged rest
Amelioration from fresh air, movement when lying down
Arthritic constitution
Digestive heaviness
Emaciation despite a normal appetite
Pain in the joints and stiffness of ligaments
Rheumatism: Shoulders painful, stiff, movements limited and difficult. Dorsal pains, aggravated by movement. Drawing pains in all the joints, with feeling of stiffness, aggravated on waking and after a prolonged rest. Aponeurotic and ligamentary retraction. Peri-arthritis. Ankylosis of the vertebral column. Tubercular rheumatism.

BIBLIOGRAPHY

Hering: The Guiding Symptoms of our Materia Medica; 7th impression 2010; B. Jain Publisher
George Vithoulkas – The Science of Homoeopathy; 5^th edition 2009; published by the international academy of classical homoeopathy. Chapter 12 (page no: 163), 13(page no: 183), 14(page no: 195), 15(page no: 212), 16(page no: 224) and 17(page no: 237).
Herbert A Robert: The Principles & Art of Cure by Homoeopathy; 3^rd edition; B. Jain Publishers
J T Kent: Repertory of the Homoeopathic Materia Medica; edition; B. Jain Publishers
Kent James Tyler: Lectures on Homeopathic Materia Medica; 3rd ed., Philadelphia: Boericke & Tafel, 1923
L. Dhawale: Principles & Practice of Homoeopathy; Fifth Reprint Edition 2008; Published By Dr. M.L. Dhawale Memorial Trust
M Choudhuri: A Study of Materia Medica; revised and augmented edition march 2001; published by B. Jain Publishers; page no: 509, 868.
A JULIAN: Dictionary of Homoeopathic Materia Medica; reprint edition 2006, B. J Publishers, page no: 325, 326, 327.
Pierre Schmidt: The art of case taking and interrogation including other treasure works; B. Jain Publishers; 1^st edition 2016

If this acute illness only came once in patient’s life, it is quite alright, but if it is a recurrent disease – throat pain or headache or anything like that – the time to give that remedy is always right after the acute crisis. That is the time when the body had tried to throw the toxic stuff away and is the best time to let the remedy act properly. So that is why, when he has an acute case, the art of the physician lies in taking care only of the symptoms of the moment, of the acute symptoms that he has before him, not to take into consideration that the patient has had tuberculosis, or cancer – these are beside the acute things. Please think the situation is bursting out, it is like a flare-up. The symptoms are clear, the desires and aversions are typical. So give at this time, please, consideration only to the acute symptoms, to the symptoms of the patient at the moment. And this is not the time to take into consideration the chronic case – the tendency of the family, the mother, the father, anything else. It is only when you have no results that it shows you it is not a pure typical acute case but is an exacerbation of the chronic disease. And here we make a distinction. Between the chronic and acute, there is a bridge and in the middle of the bridge is what we call the exacerbation of the chronic disease, which sometimes flares up. There you can give your remedy, which first is the acute one, then comes or follows the chronic one. And an interesting thing is that all the remedies have acute and chronic phases and we must try to find what are the indications of the acute phase.

R. Phatak; Homoeopathic Materia Medica
Samuel Hahnemann: Organon of Medicine; translated with preface – William Boericke; 6th edition; Indian Books & Periodicals Publishers
William Boericke; Pocket manual of Homoeopathic Materia Medica with Indian medicine and repertory
Software: RadarOpus 2.0.35

A Case of Rheumatism in a Woman of 68

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Ajay Pandey

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Ajay Pandey

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