A Case of Uterine Fibroids

Name: R S B

Age: 51 Years     

Sex: Female

Occupation: Homemaker

Marital Status: Married

Ethinicity: Asian

Address: Asia

Referred By: self

CHIEF COMPLAINTS OR PRESENTING COMPLAINTS-

Client had been diagnosed with uterine fibroids and advised surgery. She wanted Homoeopathic treatment to get rid of uterine fibroids as she did not intend to undergo surgery for the same.

She presented with the following complaints-

AILMENTS FROM/ CAUSATION- ??? Hormonal therapy for infertility was taken at the age of 35 for three years with no conception.

LOCATION	SENSATION	MODALITIES	CONCOMITANTS
1) Extreme dry skin since childhood.         2) Face since 5 years.       3)Female genital system- 4 years	Hereditary, all her paternal side family members have this problem No burning or itching   Hyper pigmented patches on both cheeks.   Irregular menses, Pain in uterus- crushing type of pain, has cramps.	—           <sun         <during menses	—           —         over sensitiveness

 

PERSONAL HISTORY:

APPETITE- good

DESIRE- bread ³⁺, apples ²⁺

AVERSION- cold drinks⁺²

AGGRAVATION/ AMELIORATION OR ANY ALLERGIES- no allergies

THIRST- 5-6 glasses per day.

HABITS- has tea 4-5 cups a day

ELIMINATIONS-

PERSPIRATION- on face and forehead when out in hot weather

URINE- 6-7 times in day/ 1-2 times in the night

STOOLS/BOWELS- once daily

THERMALS- CHILLY⁺³

SEASON- better in summer

CHANGES IN TEMPERATURE-                                                             comfortable           WARMTH- prefers

DRAFT OF AIR/WIND-         aversion to

COVERING- preferred

FAN- only in summer

STORM- SUN- AIR CONDITIONER-not comfortable

DAMPNESS- dislikes

SEASHORE/HIGH MOUNTAIN- nothing significant

MENSTRUAL HISTORY-

MENARCHE-      13 years of age                        LMP-13 September 2014

DURATION- 3-4 days flow                                 CYCLE- irregular

QUANTITY- uses 2-3 pads in first 2 days, uses one pad a day in the last 2 days – COLOUR/STAIN- dark red with occasional clots

COMPLAINTS-

Before- none

During- has cramps⁺³

After- none

OBSTETRIC HISTORY-

G₀ P₀ A₀ L₀

The client had taken hormone therapy for infertility for three years with no results. After that, she adopted a baby girl who is 13 years now.

LEUCORRHOEA- occasionally white discharge, sometimes light yellowish

MENOPAUSE

PAST HISTORY-

MAJOR ILLNESS OR OPERATIONS- none

CHILD DEVELOPMENT AND GROWTH-VACCINATION- done

MILESTONES- attained at proper age

CHILDHOOD ILLNESSES- recurrent cold, measles at the age of 8

FAMILY HISTORY-

Mother- Hypothyroidism

Sister- Depression

Father- high Cholesterol, Diabetes Mellitus, extreme dry skin (she says all her family members; on her paternal side have extreme dry skin, no eruptions.)

Maternal grandmother- died, 67 years, was paralyzed (Hemiplegic?), bed ridden for 6 years and she also suffered from Asthma.

Maternal grandfather- died, at the age of 75 due to Alcoholic Liver Cirrhosis

Paternal grandfather – died, at the age of 72, due to heart attack

Paternal grandmother- died, at the age of 66, due to complications of chemotherapy given for Abdomen CA.

MENTALS (Anxiety, Worry, Anger, Jealousy, Joy, Sorrow, Fear, Fright, Irritability, Rage, Delusions, Hallucinations, Feelings, Sensations; Ailments From Grief, Sadness Etc….)

She says she does not worry about anything. She has everything she wants. She came for consultation as it is an auspicious day in the calendar and she will be cured of her illness. She says she looks for auspicious time and day, before she does anything or commencing any new work or even travelling. If not, her work would not be successful. She says she does not go outside on a new moon day as it is not auspicious.

She likes spending money to buy new clothes, new jewellery and other new things for home. She says her husband and daughter feel she is careless, as she keeps money carelessly at home, it is everywhere. They say she does not care for them, to which she says they are grown up and mature, and can manage themselves well.

She says she is confused at times, regarding what she is doing or what she has to do. Even with day to day housework, she is aimless. She cannot do one thing properly and she is totally confused as to what she has to do. She remembers what she has to do, but cannot figure out what to do first. She says there are no specific fears unless she is doing everything at the proper time (auspicious) and the results will also be good. She says she is oversensitive to all impressions, for example, she can’t bear even a slight strong odor – feels dizzy or even if her husband holds her hand- she feels her hand is aching. She likes to be on her own, dislikes company, but wants someone around as she fears to be alone. She says she just wants someone around the house.

Her husband and daughter confirm that she is very careless. She shops a lot and buys things which were not needed. They also confirmed her hysteria spells, when she reacts rather unnecessarily to odors, touch or anything; all these are exaggerated when she has her periods.

SLEEP– sleeps on sides, good refreshing sleep.

DREAMS– nothing significant

OBSERVATIONS-

She seems to be hysterical- instructs me to hold her hand very softly when checking pulse.

She says, “Be careful while checking my BP, my hand hurts”

She often says, “Oh, I have so much do to do, it is so cold here- I’m freezing (it was a bright sunny day); Oh, I have to get rid of this fibroid and that’s it.”

GENERAL PHYSICAL EXAMINATION-

BUILT-       heavy                                       HEIGHT- 5.3 feet

WEIGHT- 75 kg                      SKIN- dry skin⁺²

FACE- has small soft, pedunculated warts; even on the neck. Hyper pigmented patches on both cheeks.

EYES-no abnormality detected

NOSE- no abnormality detected

EARS- no abnormality detected

MOUTH-TONGUE- yellow coated

TEETH- slightly yellowish

THROAT- clear, normal

TONSILS- normal

PALLOR- present

OEDEMA- absent

CLUBBING-absent

ICTERUS- absent

LYMPHADENOPATHY- absent

CYANOSIS- absent

SYSTEMIC EXAMINATION-

GASTROINTESTINAL SYSTEM-

Inspection- Fat abdomen, soft with some stretch marks on the right and lumbar region.

Palpation- soft, no tenderness, no palpable mass.

Percussion- tympanic note due to some gas.

Auscultation- peristaltic sounds heard.

CARDIOVASCULAR SYSTEM- No abnormality detected. S1 and S2 heard.

RESPIRATORY SYSTEM-  No abnormality detected. Respiratory rate is 14/min

NERVOUS SYSTEM- No abnormality detected.

VITALS-

TEMPERATURE- 36.1 ⁰C

PULSE- 86/min, regular

BLOOD PRESSURE- 132/90mmHg

RESPIRATORY RATE- 14/min

INVESTIGATIONS-

20 September 2014-

USG Pelvis- Impression- FIBRIOD UTERUS.

-Bulky uterus with few intramural fibroids.

-In anterior myometrium- sub serous fibroid- 6.3 X 4.8cm.

-In posterior myometrium- few fibroids, largest measuring- 2cm.

-Endometrial thickness – 9mm.

DIAGNOSIS- UTERINE FIBRIOD

MIASMATIC BACKGROUND-

DOMINANT MIASM (on present complaints) – PSORA- SYCOSIS

FUNDAMENTAL MIASM (on past and family history) – SYCO-SYPHILITIC

DISEASE CLASSIFICATION ACCORDING TO DR.HAHNEMANN-

Dynamic Diseases/ Disease Proper- Chronic Diseases- Fully Developed Symptoms – Miasmatic Chronic Disease- Compound Disease- PSORA+ SYCOSIS

DIAGNOSIS OF PHASE- CHRONIC

TOTALITY OF SYMPTOMS– (Evaluation of symptoms- according to Kent, prescribing totality constructed on rare, peculiar and strange symptoms

Will, emotion Intellect

• Heedless (Careless)⁺²
• Hysteria ⁺³
• Confusion of Mind ⁺²
• Superstitious ⁺³
• Aversion for company but fears to be alone⁺²

Generalities-

• Desire- Apples ⁺²
• Desire- Bread ⁺³
• Aversion to cold drinks⁺²
• Thermals Chilly ⁺³

Particulars-

• Pain in uterus during menses, cramps ⁺³

DIAGNOSIS OF SUSCEPTIBILITY

NATURE OF DISEASE- Chronic

H/O SUPPRESSION- present

PATHOLOGY- reversible

SENSITIVITY OF THE INDIVIDUAL- High

GENERAL CONDITION- moderate

SUSCEPTIBILITY- Moderateà High

PROBABLE REMEDIES-

After repertorisation, the remedies coming close are Conium and Sepia.

CASE DISCUSSION-  Reasons for choosing the most suitable remedy

The symptoms characteristic to the individual are more similar to symptoms of Conium, including being superstitious. Conium also covers most of the complaints, except for some desires. Therefore, Conium is chosen.

FINAL REMEDY-    Conium Maculatum

REMEDY SELECTED WITH POTENCY AND DOSAGE-

Conium 200C in single dose to start

INSTRUCTIONS TO THE PATIENT- (GENERAL MANAGEMENT- DIET/REGIMEN)

• Exercise and reduce weight.
• Practice Meditation and mild breathing exercises every day.
• Go for regular walk.
• Have a nutritious well balanced diet.
• Reduce on the intake of tea, can take up to 2 cups a day.

FIRST PRESCRIPTION-

24 September 2014-

Conium 200C, single dose

FOLLOW UP-

15 October 2014-

LMP- 9 October 2014

She has been feeling better.

She has been doing things systematically.

No dysmenorrhoea

NO MEDICINE GIVEN

20 November 2014-

Feeling better, except at times a little confused.

Sleep disturbed slightly.

NO MEDICINE GIVEN

14 December 2014-

Acute totality-

Fever since two days, had taken paracetamol with no relief.

Feels very restless, has to keep moving, and keeps changing position in bed.

Pain in joints with stiffness <early morning > movement

Mild red rashes on face and extremities.

Thirst is normal. No chills or perspiration.

On examination – Throat- Mild redness; Tongue- white coated with red tip.

Temperature- 38.3⁰C

         RHUS TOX 1M, 4-5 doses, four hourly and advised to stop soon after fever subsides and joint pain reduces.

5 January 2015-

LMP- 29 December 2014

No fever, no joint pain, feeling much better.

No other complaints.

          SULPHUR 200 one dose given.

10 February 2015-

LMP- 2 February 2015

She had pain during menses, but not as severe as before. She had white discharge which had stopped previously. Feeling a little better.

         CONIUM 200 one dose given.

22 March 2015-

LMP- 6 March 2015

She had mild pain during menses, white discharge is still present. Feels a little confused at times, just want to get rid of fibroids.

CONIUM 200,    three doses given, at four hour interval

15 April 2015-

LMP- 6 April 2015

No pain during menses, no white discharge per vagina.

She feels very light and lively.

She had undergone a scan on 2 April 2015,

USG Scan impression-

-Intra mural fibroid

-Anterior myometrium, few 2-3 fibroids, largest measuring 4.0X3.1 cm

-Posterior myometrium, single fibroid measuring 1cm.

-Endometrial thickness- 7mm.

NO MEDICINE GIVEN

10 May 2015-

LMP- 4 May 2015

She had slight pain in uterus during menses. She has been feeling the same with no further improvement. No any disturbing events or exciting causes.

She is confused at times.

          THUJA 1M, one dose given

8 June 2015-

She has been feeling better. Slight improvement is seen. Not much change

No new complaints.

          CONIUM 1M, one dose given

2 July 2015-

LMP- 18 June 2015

She has been feeling much better now. Feels very clear and does everything very effectively.

USG Pelvis- 30 June 2015- Impression-

– One to two fibroids in anterior myometrium, largest measuring 2mm

-Endometrial thickness 5mm

NO MEDICINE GIVEN