A Case of Joint Pain – A Small Remedy

Mr. KNR, aged 50yrs was referred to me for multiple complaints. The first thing that surprised me was that he travelled a long way from Bangalore to Belgaum and secondly that he came with his son (and throughout the interview, he was dependent on his son for emotional support. It was as if he was looking for approval from his son, after answering every question put by me. Why he was looking for support became clear to me when I enquired about his work). Basically he has always been unemployed. He never worked in his life, so he passes his time mostly at home and with certain local politicians. He’s involved in a few social works going on in his locality; (to what extent is hard to determine. He tried to brush off the subject as ‘matter of fact’).

Presenting complaints:

• Pain in left heel since 3yrs.

On X-ray, found to be Calcaneal spur.

Pain more after rising from seat for 10 steps or so, after that normal.

Now, since 6months, on rt.side also.

• Pain in knees since 3yrs.

Wt: 86kg. All complaints since he had chicken guinea 3yrs back.

• Also pain in back< bending forward.
• Tingling in Low limbs<going to bed++ at night.

>pressing++.

• Cramps in toes < working in water.
• Cramps of diaphragm < bending forward++.
• Pain under right chest, liver region < sitting for long++.
• Can squat on front toes only, cannot put heel down on floor.
• Random pains in fingers and elbow >standing, sitting on chair.
• Unable to sit normally, can sit with back support only or with legs straight and support on sides of chair.
• Pain in low back < rising from seat. Unable to raise the leg straight while exercising. Needs support on rising from seat. < over-lifting, after.
• Occasional Abdominal pains since 7yrs. Nausea < after eating.  Feels fullness of abdomen. Difficulty in running, breathlessness. Pitting type of Oedema< both legs.
• Sleepiness: More that 15hrs/day, easily goes to sleep anywhere, anytime. <reading+++, travelling, listening music, watching TV etc. Yawning is very frequent.
• Memory-forgets frequently. Hard to recall things.
• Black discoloration of face on right side and on axillae, groins.
• Perspiration: odor, offensive; sticky in groin region.
• Occasionally chattering of teeth during sleep, not a regular symptom.
• Biting of tongue during sleep, then wakes up.
• Offensive odor from mouth occasionally.
• Pain Sciatica < bending forward.
• Pain lumbar, sometimes > only after painkillers.
• During fever, easily relieved but body becomes very heavy++.
• Much laziness since chicken guinea.
• Constipation.
• Urine – urgency if he drinks more water than usual.

Here I would like to give you some live details as to the happenings in the clinic with him. I asked him what was troubling him and he started with Lower limbs and I started writing. He was quite animated in showing his complaints and was eagerly showing me, pointing out the affected area etc. and throughout the complaints, standing, sitting, bending etc. Now, every time he stopped with a complaint, I would ask him, IS THERE ANYTHING ELSE; and to my surprise he would spontaneously come up with next complaint, again explaining in details about his pain. It went on this way for a hour and a half until which he had travelled from lower limbs to upper limbs, abdomen, head, mouth, sleep, sweat and so on. When I realized that his complaints are not going to stop and the remedy was already clear to me now, I decided at last to stop him and jump to the next section. I am sure that had I let him continue, he would have just come up with more complaints. It was as if his whole body was affected, each and every organ was affected. Here, I could see his anxiety about health+++.

Past history:

• H/o recurrent fevers with vomiting+. This symptom is not present since 15yrs.
• Many sneezes at a time, during coryza, which amel.

Family history: (Sycosis is the dominant miasm here – in my view).

• Mother: Joint pains, greying of hairs since childhood.
• Father: Jaundice – expired.
• M. Aunt: Joint pains.
• Siblings: 1-self. 2-Bro: joint pains, obesity. 3-Bro: bone cancer, expired. 4-Sis: acidity, epileptic fits.

Personal history:

• Appetite: Good++.  Heavy breakfast and then directly dinner. Warm food is preferred.
• Thirst: ½ ltrs on waking. Good. 1 – ½ ltrs/day.
• Desires: Chicken+++. Mutton (sheep)+++. Fish++. Egg. Salt (N). Sour++. Fruits++. Earlier, he used to use much lemon+++ in food.
• Aversion: Vegetables. Bakery items. Sweets++.
• Micturition: Mild odor in urine, if urination is delayed.
• Bowels: feels, he may be constipated.
• Sleep: Deep, excess. Sleeps on right side, mostly on sides. Covers up to chest. Most fresh in mornings.
• Dreams: not specific.
• Perspiration: Profuse during summers. Other times only on forehead and arms. Offensive in axilla. White staining.
• Habits: smoking, drinking. Occasional headache in morning (?after sleep).

Thermals:

• Bathing: Not too warm.
• Feels more heat generally.
• Fan: Needs even in winters.
• A/c: Feels good.
• Season: < getting feet wet++.
• Hill-station, sea-shore: Normal.
• Travelling: Normal. Occasional vertigo, falling sensation.
• Prefers open air, prefers a steady stream of open air.
• Generally cannot tolerate heat++.

Physical:

Dark complexioned, Clean tongue, Clubbing of finger-nails, with white lines on them, a few deformed nails. Obese++. BP: 150/106mm Hg.

Life-space:

• Anger: sudden, lasts for short while only.
• Always talks with a smiling face (My impression was that he is manipulative with a sweetness ).
• Not at all religious.
• Difficulty to say ‘No’ to anyone; readily goes with what the other person is saying.
• Hesitation while talking face to face; bashful+.
• Broods for 2-3 days, if makes a mistake.
• Self-respect, anxious about it.
• Fear of snakes++.
• Went into work after 10^thstd, where he failed (in 10^th std.) due to fever.

Additional notes:

After this case, I decided to take a little break, hence left the clinic along with the patient himself. On the way out, he started chatting and I was surprised by his questions! He asked me how much do I earn daily? How quickly can my son buy a house if he was in this profession? His questions were all based on money and materialistic things. He even asked me what kind of house I lived in and how much rent I pay for it!I could clearly see his predilection or fixation over money. Other than all this, he seemed overall a sweet person.

Analysis:

After listening to his many complaints, the remedy was clear to me. However, in the end when he started talking about money matters, it was doubly confirmed and I was now completely sure as to his cure.

Let me share with you an incident before I jump to reveal the remedy. In 2006, when I was learning under Dr. Sunil Parse, every Sunday he would go to a separate clinic where from morning till night, he would only prescribe acutely, without taking a complete case. I learned that such a practice definitely sharpens a physician’s mind. So one Sunday, I got the opportunity to accompany him, and there a lady came up, aged around 60yrs and she started complaining in the same fashion. Starting from lower limbs, it went on and on and then her abdomen, her neck, her headache and so on and on..within 15-20 mins she had narrated about 40 complaints with  their modalities. She was still continuing when he stopped her from talking and somehow just convinced her to take the medicine that he was giving. She was somehow not convinced and continued with her chatter of complaints that she was having. Standing by his side, I was wondering which organ is left now to complain about! She had almost covered everything.

Now, imagine my surprise when she came for follow-up after a month and she just offered 6 complaints and then kept quiet. I was literally shocked as to what happened to her  many complaints. All complaints had just disappeared and only a handful remained.
He again prescribed a dose of 10M with placebo for a month.

This was a unique experience for me and I had much to learn from this. I enquired as to why he prescribed this remedy and he explained in short that there was already a line of waiting patients. From what I could make out, he explained that patients of this remedy have a kind of deep insecurity, they are extremely miserly and they want value for their money. So with the typical human thinking, they respond in a manner that anyhow they are going to pay the doctor, so why not get treated for this and this and that and so on.

In this case also, we can see a similar behavior and this is what led me to decide my remedy. Now, I will tell you what he did when he reached back to Bangalore after my interview. I had asked him to check his blood pressure daily in the evening at the same time for a week and inform me. He instead went for all investigations regarding his heart and was diagnosed with hypertension. See the irony here is that I had already prescribed my medicine and he had consumed that single dose. The investigations were done after consuming the single dose. However, after a week, his blood pressure had totally normalized and he phoned me to say that with a relief.

A month later, he again came down to my clinic for the follow-up. Here is the first follow-up of this case. A single dose of Calcarea fluorica 10M, with placebo for a month was prescribed initially:

• BP: 110/70mm Hg. Wt: 79Kg (7kg weight reduction within a month!).
• Pain in heel and general health better by 10% only.
• Pain in knees reduced by 10%.
• Pain in back reduced by 10%, but now able to bend further down.
• Tingling in lower limbs, completely cured.
• Cramps in fingers, completely absent now along with cramps of diaphragm.
• Still squatting on front toes.
• Abdominal pain and fullness is completely cured.
• Absolutely no edema on either foot.
• Sleep SQ.
• No offensive odor from mouth.
• Constipation and sleep are SQ.
• He is having acute inflammation of throat after the rains in his area.

Since this remedy also covers <wet weather; and since there were some areas where the remedy had not completely shown its action, I decided to repeat the dose of Calcarea fluorica 10M and so I did.

After that I only received a phone call a month later that all his complaints were better and he does not feel like coming down all the way. Hence he requested that I send the medicines by courier. I continued with the treatment but I never needed to repeat Calcarea fluorica or any other medicine in this case.

Here I would like to point out that I did not repertorize the case as the essence of this remedy was clear to me from what I had practically seen in the clinic. However, the complete picture of this drug was not known to me until a few years later when I was gifted with Materia medica Viva by a friend. George Vithoulkas has put up a beautiful picture of Calcarea fluorica here. Over the years, I have treated some cases with Calcarea fluorica. I would like to point out that this is not a well presented remedy in the repertory, though it is present in about 730 rubrics in Synthesis 9.0. Hence, with this remedy it is often hard to find it on repertorisation. It is the very essence of the ‘non-stop complaints’ of the patient that makes the physician think of this remedy.
One of the chief indications that I have found from past cases is ‘Ailments from financial loss’ or ‘Ailments from fear of financial loss’. E.g. the complaints of the old lady described above had the origin in the fact that she was compelled by relatives to find a match for her daughter. She was so worried about the expenses that in the end she decided that she will not get her daughter married, as she did not want to suffer a financial loss and she was discussing all this openly. In our male patient, no such history is evident but the fact that he never worked in his life itself could be a maintaining cause of his financial insecurity.

These patients not being the argumentative type, often suppress their anger and fears and this is the origin in my view of their problems, which progress very slowly over the years to a full-fledged disease. Due to the sluggish nature of the progress, there is rarely a visit to a physician in all these years. This is in contrast to Arsenicum which visits many physicians even for a small complaint and has the same tendency to exaggerate his complaints, along with the insecurity and miserliness found in Calcarea fluorica. Both remedies are amel. from warm food and drinks and agg. from cold weather. The difference lies in the fact that Calcarea fluorica is more passive in its behavior with the physician and is in general a hot remedy, whereas Arsenicum is a chilly remedy on a general level the patient is forceful with the physician.

There are many other remedies which can be differentiated here, but once the essence of Calcarea fluorica is understood by the physician (even more so, if the physician has been lucky to have seen such a case in practice), there remains no confusion, as Calcarea fluorica is a remedy with unique mental and physical traits.

If readers have any queries, they are most welcome to ask!