A Case of Nephrotic Syndrome

Passive Case Witnessing Process (CWP):

(Area- presenting complaints)

P: Yesterday, the doctor told me that this disease is not curable. Chances of cure are not there it seems. They have prescribed me Tabacum Wysolone 6omg OD and Telma 40 mg BD. After doing the biopsy they said; 20-25% glomeruli are damaged and we cannot cure this.

D: Okay, now tell me about you.

(Area -Evolution of disease and past history)

P: So, history from where to start…. in 2004, in urine blood was being passed, so he did blood tests and he said there are kidney stones in you. In 2011, I had fever, malaria fever. In 2011 I had tonsillectomy. In October 2012 again I had fever. So, to tell you, once in a week, I used to take alcohol. I have habit of tobacco chewing, smoking I won’t do. So, after that, I had fever in October 2012. I consulted MD, he asked for blood investigations. He checked Creatinine and that was 2.5, in 2012 October. And, Albumin-protein was 4+ was being passed through urine. In 2012 sonography was done. Then there was slight swelling in left side kidney. Then he advised me to consult the Nephrologists (Homeopathy for Nephrotic Syndrome). There, they put me on Wysolone tablets for 2 ½ months. For 1 ½ years nothing happened to me. Neither fever nor any other complaint. The other day, there was itching of face and fever. To consult for that, I had come one month back. After consulting (nephrologist), they said a biopsy has to be done. After biopsy, now everything is revealed. For 1 ½ years, even now there is no problem to me, neither exhaustion, nor reduced ability to work, nothing like that happens.

D: What’s going on in your mind?

P: Same, whether it will be cured or not.

D: What else?

P: Nothing… only this much. (Pause)

(As from here the patient was not moving further I asked him another open ended question)

D: What affect has this had on your life, since all this has started in 2004?

P: Nothing…. No problem. (Pause)

D: In your routine life?

P: Nothing, no problem to me. (Pause)

D: Effect of your disease on your routine life?

P: I never thought of disease. Since 1 ½ years I have this problem, that was not there in my mind. I had taken it away from my mind and heart. The other day, it relapsed. Since, 1 ½ years I never thought of it. Earlier, Creatinine level was 2.5, now it is 1.8, comparatively less than earlier. I had removed that thought. But this again…. after biopsy, those thoughts are coming back to mind. Why it has happened? Since 1 ½ years I have that matter inside me….. Inspite of that I was freely eating everything, roaming freely. I had not stopped anything for 1 ½ years. Only fever for 2 days for that reason I had come for consultation. I had started eating beef. I’ve the habit of eating more non-veg, especially the Beef. At least, twice or thrice a week I want it. After Beef, its fish. Veg I don’t eat much. Since 1 ½ years I was eating, drinking everything, a tablet for BP was started.

D: Tell me something about yourself…. In homoeopathy, patient behaviour, nature, psychology what’s going on in the mind, what tensions, what dreams you have are important. Fear of anything. How were you in childhood? How are you now? Fears in childhood, fears in adulthood, dreams of childhood, dreams of adulthood. Any other habits, hobbies, interests. Everything you say as a person, knowing about all these areas is very important.

(Area- Habits)

P: Habits….. While in 10^th standard, under influence of friends, I started smoking. After 2 years I stopped smoking. During 10^th standard I used to eat Gutka, now I won’t eat. Only once in a while like once in 6 months. Alcohol I take, once in a week or twice that too when there is too much pressure of work or when there are night shifts or when there is too much tiredness, only then I have or else no. Smoking is rarely. No other habits to me. I had some problem in nose, means there is no breathing on one side, and it is twisted on one side. I was beaten in childhood, I had consulted; they said it has to be operated. It can be straightened. Now I’m advised against painkiller so I refused operation. When I’ve cold then on one side breathing is not there. (Pointing left nostril)

D: Left side?

P: Yes, left side.

P: One more thing, how much ever I try to eat and maintain my physique, it’s not happening. I’m not putting on weight. Personality is remaining the same. Even I tried ‘Gym’ for 2 years, but it didn’t help and nothing else. (Pause) Tension, I don’t have any regarding home. Only, about job. I’m on contract basis. Only regarding job there is tension. Nothing else apart from that.

D: Tell me something more about yourself.

P: Education in childhood has been here (Sankeshwar). I’m in Goa since 8 years. Since 8 years, job one after another, contract basis. I went in 2007. Now it’s 2014 it’s almost 7 years. I stay there. Few people advised me to leave Goa, climate will not suit; salty water, humidity might have affected you. I said, for 7 years nothing has happened now what will happen? Why should I leave central Govt job? I work in a central Govt. Company, under defence ministry. Only for such normal problem, coming here (to his native) working.

D: More…

P: Nothing else.

D: Anything else about your nature?

P: I get angry easily. Even for trifle things, I get irritated easily for anything, be it on children or at home. If anyone speaks loudly I can’t bear or if somebody gives back answers to me… suddenly my ‘BP rises’. Even for minor issues in life like tension, I won’t get sleep at night. Do whatever, I’ve to solve the problem. Until the problem is solved, that the thing remains in my mind. The problem has to be solved. Until it is solved I can’t remain cool. Sometimes, I won’t get sleep, for any tension.

D: Anything else?

P: Nothing… (Pause)

D: Don’t think anything, just say whatever naturally comes to your mind.

P: Nothing, only this is there in my mind… why has it happened? Once I go to work, nothing I will remember. I won’t think once I get back to work. I can’t control eating Non-Veg, during work, I feel I want it. Water intake has been limited, not more than 2 litres. If it’s more (intake of water) there seems to be swelling in kidney. And my work is heavy. Normally, during work i.e., before 15 days during day time I used to drink 6 litres of water, minimum 4-6 litres of water I used to drink. Here (In home town) there is less work, 2 litres its OK. During work I want water frequently, without which I cannot do, because of too much of heat.

There, when I’m in work, I won’t remember anything. I forget everything during work. I’m confident in that matter. If at work, I will feel I’m living a normal life, like before.

For me, whatever they tell at home; ‘do this way, maintain this’, repeating one thing again and again I get angered easily. My father has that habit of repeating 10 times one issue; ‘eat only this much, drink only this much, live this way’. For me telling once is OK, repeating the same thing again and again …… it should be finished off at once. What they say over here (at home place) thinking about that makes me angered. If I go outside, I will be free minded (H/G). When I feel like eating, I eat and according to my wish, I maintain myself, neither I overdo nor against anything I do. As far as I feel, once I go there, I’m confident that I won’t remember anything. Whatever goes on inside, I would leave it. I’m trying to go as early as possible. I was about to leave today, but to meet you, I stayed back. If I sit to eat anything at home, I get angered easily.

D: Anything else about yourself?

P: Nothing else, I’ve told everything.

D: A bit more…

P: To tell about nature, this all had happened, all bad thoughts come to my mind. My father-in-law is not good. Every six months something he creates some problem. Yesterday, after knowing this, I felt whether he will create problem. That thought came to my mind. He may say that ‘I have this problem from early days’, but we didn’t reveal it to them. Something of this sort misunderstanding might come up in their mind. That thought came to my mind. If not he (Father in Law), at least my wife may think. She is 4 months pregnant now. What she may think? that thought came to my mind. Later, I felt whatever she may think, let her think. It has happened now, what can be done? It’s of no use. Can’t do anything now. She thinks, I think, but nothing can be done.

D: Anything else?

P: Nothing else. (Pause)

D: Anything else about your nature?

P: Nature…. nothing else. I’m always within me. Never interfere in anyone’s matter. I won’t fall into anybody’s problem only at home; from house to work and back to home never go anywhere outside. Anywhere if I meet any friend, then only for half an hour to 45 minutes, otherwise only from home to work. Here If I come (home town) I won’t go out. There (Goa) also only home to work and nothing else. Regarding my nature, I’m moody. I’m very much attracted to girls. I can’t control it-to talk to anybody. Wife is at home; to make friendship with them, roam with them. This is my nature and nothing else. Moody nature. Want to be happy in life. Only taking tensions; domestic tensions outside, and outside tension at home. I keep domestic things at home and outside things outside. Only free minded with friends outside. At home, nothing, very sincere.

D: Anything else?

P: Nothing else.

D: Anything else about you?

P: Everything I’ve told you.

D: Everything?

P: Ya, once in 8 days on left side at the back, I feel as if I’m carrying something, like some weight. It doesn’t pain. Its only weight. It’s only on left side, not on right side. That too, if I pay attention to it. Here I’m sitting; I’m getting it now, as if something is there. This is happening to me since 8 months. It’s not continuous, but in a week at least twice I feel. It’s as if some swelling or some extra thing is kept inside. There is no pain. Daily evening after work, my calf muscles pain. After catching hold of legs tightly, there is some relief. So only calf muscles. And head….. Spectacles are there. Yesterday only, I got them checked, number has increased. That distance (far), I was not able to see clearly. It’s about ‘0.5’, so since yesterday no problem in vision.

Since One month, my hands are trembling, especially while doing minor work, eating and while striking with hammer. After hitting 6-7 strokes, this is there. Since 1 ½ -2 months, it’s there. Before that, it not there. After 6-7 strokes, it’s as if my wrist is filled up and hands start trembling. Now also they are trembling, it’s not continuous. It’s while working especially while trying to hold suddenly or while writing anything; I feel they are trembling a bit. (Area- Chief Complaint)

D: Anything?

P: No other problem, feels heaviness in head. Sometimes giddiness standing in sun, feels giddy. Because, 2 months backs I had fall. I had got hurt (shows occiput region). To avoid doubts, I had got done CT scan the report was normal. It’s been 2 ½ months. That’s all.

D: Anything else?

P: Nothing.

D: Anything else?

P: Nothing. Regarding problems I’ve told.

D: I want to hear from you other than problems.

P: Regarding me nothing else. I’ve told you everything. Nothing is hidden.

D: What dreams do you get?

P: I won’t get any dreams.

D: Since childhood?

P: Anything normal. Nothing else.

D: What do you get?

P: Anything regarding family, job or anything insignificant like something seen on television like serials they come. Nothing significant dreams come.

D: Tell me any one dream?

P: Normally there is one dream. Before marriage I had a girlfriend. She was a Hindu. Later on, up to 4 years there was affair. This was of last stage to explain. Beyond this nothing to explain.

D: That means, until now you’ve not explained…..

P: No, No. I mean, it’s the important one. So, in dreams, what I feel is, last time 3 months back, she came to me and asked me to get married to her once again. I said it would not work out. Then she asked me not to meet her once again. I said ok. So, whenever a thought comes to me, a dream comes to me, that she is asking me to get married, indeed all the family members are there. Situation is under control. Then, everything (dream) vanishes away. (Area – Dreams)

D: You were saying something about ‘serials’?

P: If I see anything horror, then I feel, something here only it might happen. In dreams and all it won’t come…I feel as if it happened in front of me.

D: Do you feel that in reality?

P: No, in dreams.

D: I didn’t understand anything.

P: Suppose I’ve seen a serial, at night and slept. It’s after 2 days; I feel a scene similar to that seen in serial come in my dreams. Nothing else.

D: So, in your dreams what are you doing?

P: I’m not there in that dream. Others will be there. I’m only visualising everything. It’s as if I’m seeing a movie. I’m not there in that.

D: What feelings do you get during visualising that?

P: No nothing.

D: Any other dreams?

P: No dreams.

D: Of childhood? (Dreams)

P: In childhood, nothing like that happened. I can’t recall it too. I’ve that aim in life, like something I’ve to do in life. Now, I’m 26-years-old, so by 30-35 years of age I’ve to achieve something, so that my family members can be relaxed. Achieve some at least some permanent job. Later on If I take care of my parents; that’s OK. Whatever, do anything achieve something, achieve goal, and earn some money. Only that is my aim.

D: Tell me about your fears.

P: No fears…Only I am worried about weather I will be cured or not.

D: More fears

P: Nothing

D: childhood fears?

P: Nothing, I don’t remember…amm…I use to get feared of my father because he was bit strict in nature. (Area- Fears)

D: More

P: Nothing only this much

D: Tell me about interests

P: I love to work. After 10^th standard I started working and I used to enjoy my work., I feel happiness inside. I forget all my worries and diseases when I go to work.

D: More

P: Nothing, ya my urine is foamy and has a rotten smell. (Pause)

D: Ok wait for some time; will call you back.

ACTIVE CWP

FOCUS: Work and job

D: Tell me about your experiences and feelings while you were at work

P: Hmmm… (Smiles), I work in a shipping company in Goa, I am in a technical department. I love my work very much, I don’t want to leave that job and come back here, because I feel relaxed there. When I am at work I forget all my worries and disease. I become completely normal and healthy. If I come here, my father starts eating my head, because of which I get irritated; I don’t like somebody telling me the same thing again and again. If anyone speaks loudly I can’t bear or if somebody gives back answers to me.

D: Hmmm… More

P: My ex-girl friend is also there, occasionally if I feel lonely if I miss her, I go and meet her casually. And if I come across any girl, I can go freely to approach her, because nobody knows me there. I can’t control my feelings, I feel to talk and make friendship with more and more girls.

D: More about work

P: I want to become genius in my work; I want to achieve something in life.

ACTIVE-ACTIVE

D: Just stay with this happiness and experience of doing work, and tell me more about it.

P: I love my work very much, I forget everything when I am at work, and I lead my life normally without any problem. I want to achieve something… I want to reach the top, and I want to become perfect and genius.

D: To become a genius what do you do?

P: I take advice from my seniors; I try to know how to do this work so that I become perfect in future.

D: What kind of advice do they give?

P: They give good advice; what I ask they tell me.

D: If they give you some bad comment then?

P: That is also good for me only, but it hurts, I want appreciation instead. If they pass bad comments then no problem, because I want to learn and I become aware of my weakness, and these type comments help me to become more perfect and genius in my work. (Pause)

D: Ok anything more?

P: Nothing… (Pause)

D: Ok thank you

 

CLINICAL EXAMINATION

B.P – 170/90 mm of Hg

INVESTIGATIONS

11/3/14: KIDNEY BIOPSY- 4/7 glomeruli are partly or completely scleroses. Mild tubular atrophy involving 20-25% of the cortex.      Chronic FSGS is a possibility.

14/3/14: CREAT– 1.89 mg/dl

POTASSIUM– 4.33 mEq/L

    CALCIUM- 9.2 mg/dl

    URINE– Protein (++) and RBCs (Plenty)

 

Kingdom: The centre of the case is that the patient is more interested in his job and performance. His centre of energy is in his job. He feels better, completely better when he is at work. He even forgets his disease and leads a completely healthy life without any worries about his disease, like a normal healthy person. He talks about job, work, performance, health, money, place etc. All these issues point towards the mineral kingdom.

Row: He is talking about performance in work, appreciation, comments, skill, inquisitiveness, talent, solve, solution, problem and perfection. These issues of performance, inquisitiveness point towards the fifth row of the periodic table.

Column: He is talking about refining, perfection, achievement, genius and feedbacks etc. These issues point towards the 7^th column of the periodic table.

We have Technetium Met at the junction of Row five and column seven.

About Technetium Met:

Referring to Dr. Ian Scholten

Concepts

Stage 7

Adding to

Practising

Doubt

Teaching Learning

Fine tuning Feedback

Compliments

Creation Inspiration

Aesthetics: Beautiful Ugly

Show Performance

Queen Ambition

Humiliation

Sexuality

Middle age

Group analysis:

Practising your forms of art.

Wants to receive lessons in creativity.

Admiration is shown through compliments.

Practising to be a minister.

Cooperation in science.

Practising sex.

Picture of Technetium Metallicum

Essence: practising your forms of art.

Practising art: They like to practice their various forms of art because there is a lot to learn before they can call themselves an expert. There are a lot of experiments still left to be done before their research can be rounded off. Wants to receive lessons in creativity. They need a lot of feedback, because although they feel they can create something in principle, they can benefit from the comments of more experienced colleagues. They like to polish up their talents, to mould their inspirations into more refined forms of expression. They want to back up their theories with more detailed experiments. They often feel the need to have a guru, so they look for an artist or a scientist who excels in his field under whose guidance they can continue to learn.

Admiration expressed in compliments. They love to receive compliments because then they know they are on the right track. Compliments stimulate their ambitions, stimulate them to keep following their chosen path. But, they are not averse to criticism either, as long as it is constructive. At least it will show them what adjustments to make to get even better results. They like to cooperate with others, it encourages them and they know they can learn a lot from others.

Generals:

Locality: left.

Complaints

Weakness, bruised pains, itching.

Headache in forehead, temples, vertex.

Eye complaints: inflammations, disturbance in vision.

Remedy prescribed: Technetium Met 200, 3 doses and s.l for 1 month (on 16/3/14)

Follow up:

After 1 month (on 20/4/14)

D: Ya tell me

P: I am feeling comparatively better

D: In what way?

P: No pain and heaviness, no trembling, feeling relaxed

D: Good, what about your nature

P: Nowaday’s my anger and irritability are reduced very much. I am having itchy eruptions on my chest, and my face is also a bit swollen. This much only.

D: What about sexual dreams, attraction towards girls and all?

P: I didn’t got such dreams, and this attraction is also reduced somewhat.

D: What about your headache, urine problem and trembling?

P: No trembling and headache; foamy urine is same only smell is reduced a bit. Creatinine and protein levels are same.

D: Anything more you want to add about yourself?

P: Nothing

O/E: B.P – 140/80

Advice: Reduce HTN tab to one in the morning and Wysolone to only one tab in the morning

Remedy: Technetium met 200 every fifth day one dose for 1 month

 

After 2 months: (on 18/5/14)

D: Ya tell me

P: I am feeling completely better, no problems except urine is still foamy and fishy.

D: Same as before?

P: No 20 to 30% reduced.

D: Ok any other complaint?

P: Ya my face is still bloated, why it is so?

D: Due to steroids, don’t worry it will also reduce.

O/E: B.P – B.P 140/80

Remedy– Technetium met 200 every fifth day for one month

Advice: Reduce tab. Wysolone to 20mg

 

After three month: (on 22/6/14)

D: Yes, how are you now?

P: I am very happy, my Creatinine level is completely normal now.

D: Great, any complaints?

P: No complaint, except blotted face and urine is still smelling and foamy, but not as before.

B.P: 150/90

INVESTIGATION:

30/05/14: Creatinine – 1.0 mg%

Haemoglobin – 11.2 gm

Remedy: S.L for one month

Advice: Reduce tab Wysolone to 10 mg

 

After 4 months: (20/7/14)

P: Still I have blotted face, but comparatively less, and swelling of my feet is completely reduced. Still urine smells.

D: What about your foamy urine?

P: Occasionally I get.

D: Ok what else?

P: Some 10 days back, I did investigations. Haemoglobin is reduced a bit about 0.4, and protein is still 1+ in the urine. Only this much.

O/E: B.P – 140/80 mm Hg

Remedy: Technetium Met 200, 3 doses and S.L for 1 month

 

After 5 months: (on 24/7/14)

D: Yes please

P: Now I have very minimal swelling of face and minimal smell in the urine. Creatinine and urine reports are normal.

D: Good, anything else is bothering you?

P: nothing, I had loose stools for one day, but didn’t took anything.

O/E: B.P- 130/80mmHg

Treatment: Technetium met 201 one dose, S.L for one month

Advice: Tabacum Telma 40mg ½ OD and stop Tabacum Wysolone

 

After 6 months: (on 21/9/14)

P: My hands are trembling occasionally. Why it is so? Because it was not there since I have started treatment.

D: Due to abuse of steroids, don’t worry. Anything else?

P: Nothing.

O/E: B.P – 130/80 mmHg

Treatment: Technetium met 201, one dose and SL for one month

Advice: Stop BP tablet and keep it for SOS.

 

After 7 months: (on 19/10/14)

D: yes?

P: I am having cold since two days.

D: Anything else, about your previous problems?

P: Nothing, I am feeling completely better.

D: good

O/E: B.P- 130/90mmHg

Treatment: SL for one month

Technetium has conquered his initial fears, he is quieter, has the courage to show his work, and is keen to show it to receive feedback.