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| Hpathy Ezine - September, 2006 | |||||
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Dr. Praful M BarvaliaDHMS, MD (Hom)<-- Interviewed by Dr. Leela D'Souza |
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| Dr. Leela: Welcome back Dr. Barvalia! Quite a few people have read your earlier interview in the Hot seat in April 05, as there is a widespread interest in the Autism Spectrum of Disorders and successful and integrated homeopathic management of these children. I encourage people to read the first interview to get some introductory background as we're going straight into the thick of discussion now! I was delighted to hear, talking with you in June this year, of your wonderful plans and futuristic vision for bringing good quality homeopathic treatment to the masses, especially the poor and under-privileged. I’d like to talk in detail about this exciting project a little later. First, many people I meet online, ask me to recommend reliable online courses where they can also avail of clinical training. I thought I’d find out more about your Global Online Fellowship Course. We mentioned this briefly in the last interview and now it appears you are ready to launch it. Please tell me how you envision this educational initiative.
You asked about the Global Online course. We have worked out a very comprehensive structure for the total education of the clinical homeopath. Our institute has obtained accreditation from AYUSH, the department of Indian Systems of Medicine & Homeopathy, which is part of the Ministry of Health of the Government of India. It conducts clinical research projects in collaboration with various institutes. The objectives of the institute will be part of the online course content as well, and are broadly divided into following categories.
I’d like to further elaborate on the importance of further
training in the applied aspects of homeopathy for every homeopathic
physician which is a central focus in this Fellowship. Dr. Leela: You mean, how a physician
develops his clinical acumen from the homeopathic standpoint? Dr. Barvalia: Yes, something like that. A physician has to develop an integrated approach to any case present before him using the three tools of Organon and Philosophy, Materia Medica and Repertory to reach a similimum remedy indicated for that point of time. To understand this process of integrated thinking, lets take an illustrative case of an unmarried woman of 49 yrs who worked in a Bank and was diagnosed with a CVA (Cerebral Vascular Accident - Stroke). She was admitted to our Mumbadevi hospital in an unconscious state. She was brought there by her maid as she lived alone and she did not have any close friends. Most of the history we gained was from this maid. She was apparently fine in the morning getting ready to go to work when she suddenly developed weakness of her legs, stumbled and fell. She got up and started having her breakfast. She then told the maid that she was unable to hold her cup as her hand was trembling. A little later she developed a severe headache and fell down unconscious (having suffered a CVA). She had a history of hypertension. Also, she had a history of repeated hospital admissions in the past on flimsy symptoms where nothing was found wrong with her. The case has to be understood and analyzed based
on homeopathic philosophical training. It is an Emergency posing
its own challenges for the homeopathic physician. We have to
focus and observe the homeopathic symptoms and evaluate them from
a philosophical standpoint. This also includes deciding what type
of remedy is needed in this situation - an acute, an antimiasmatic
or the chronic remedy. Based on this, one has to evaluate the hierarchy
of symptoms. A good knowledge of the Materia Medica aids
our search for characteristic symptoms that indicate probable remedies.
These symptoms converted into appropriate repertorial rubrics
enable a repertorial analysis. The choice of a similimum remedy is
based on a proper understanding of the Materia Medica of that remedy.
All this is done in an integrated fashion in an intuitive process,
and not in any predefined stages. Dr. Leela: I understand what you mean
– normally our first response is to rush to the ER and try
resuscitation measures without thinking about the symptoms and how
they developed in the homeopathic sense. Instead we see a CVA
case who is unconscious and we're desperately trying to
ascertain the point of lesion by clinical examination anxiously
awaiting the CT scan report. Thus we waste valuable
time from the homeopathic perspective. Dr. Barvalia: Clinical diagnosis is equally important in homeopathic prescribing. In fact it can be crucial especially in life threatening situations. But we have our own homeopathic applications of it. That is what I mean when I say it is an “applied aspect”. What is important in these situations is sound observation, the right quest to identify 'PQRS' (Peculiar, Queer, Rare, Striking/Characteristic) symptoms and an ability to make proper correlations. In this case we observe the progression of symptoms from the homeopathic philosophical basis; legs >> to hands >> to head. This is interpreted in homeopathic terms as “Ascending Paralysis” which is found in the Materia Medica of Conium. The Hypertension was attributed to Atherosclerosis. Since the patient was a spinster, the possibility of sexual suppression existed. Her repeated hospital admissions of the past point to a probable ‘hysterical’ element. Now bereft of a good history in an unconscious patient, we are able to formulate a picture for a prescription based on one central reliable symptom, the ascending paralysis, and further supported by other observations. We were able to be fairly confident
that Conium was the remedy she needed and started her on
this before any investigations were completed. She did very well
on it, regained consciousness and recovered. No other treatment
was required. Dr. Leela: I looked up Complete
Repertory for Ascending Paralysis and here are the rubrics
and remedies: Generalities; PARALYSIS; General; extending; upward (22) : aconin., agar., alum., Ars., bar-acet., bar-c., Con., gels., hydr-ac., Kali-c., karw-h., lath., led., lyss., mang., Ox-ac., phos., pic-ac., plb., sec., sulfon., vip. Conium
is in both rubrics! Dr. Barvalia: :) Modern medicine has its own severe limitations in such situations. If we put on our Homoeopathic caps instead, we can begin the curative treatment long before all investigations are done. As a hospital in-patient we could monitor
the case around the clock. My MD friend from modern medicine
was at our beck and call, in case any grave situation
arose.
Dr. Leela: You have repeatedly stressed about developing one's Homoeopathic perspective. Can you elaborate on it a little more?
Dr Barvalia: It is our ability to perceive individuality in any phenomenon that makes us resourceful homoeopathic clinicians. Equipped with this ability, trained through rigorous disciplined practice, we can acquire a perspective to perceive the ‘Homoeopathicity’ in the phenomenon under observation.
We are fortunate to have various masters whose teachings have helped us to find a pathway to similimum within a real maze. One such master is Dr. C.M. Boger, whose unique contribution is his Synoptic Key which is an instrument par excellence in sharpening a physician’s analysis and synthesis. Boger’s approach to totality was not centered on pathology but on pathogenesis. We need to grasp this difference accurately. His focus was on the ‘pathogenetic’ potential of a remedy which was manifested at various planes: Physical, Mental, Pathological.
He stated: “Correct prescribing is the art of carefully fitting pathogeneticity to clinical symptoms, and thus in a present situation requires a special aptness in grasping the essential points of symptom images; through great drudgery in mastering a working knowledge of our large Materia Medica or through the most skillful use of many books of reference”. The focus here is on the physician: his skills and faculties that need to be cultivated.
Dr. Leela: Words of Wisdom, that we will need to have spelled out for us ;)
Dr. Barvalia: I'll oblige. Here is a small example from my practice which will demonstrate the way I perceive Boger’s thinking: A junior physician in the Out Patient Dept. handles a case of acute Upper Respiratory Infection. The patient presents with a severe pain in throat, fever, backache and bodyache. The thermal state is chilly, thirst unchanged. He was prescribed Rhus tox 200 and later 1M without any relief.
The junior asks for a senior’s help. The consultant finds the patient in a state of physical distress. The throat congestion is quite severe. Elongated tortuous violet blood vessels are visible on throat examination. On further questioning we find out that excruciating BACKACHE with fever was present since day one. On these indications, AESCULUS 200 was prescribed, which brought about prompt and total relief with 2 doses.
Now, AESCULUS is well known for its applications in Haemorrhoids. Tortuous, purplish elongated veins in rectum, would easily make us think of AESCULUS. But in Homoeopathy, similarity is not in pathology, but in pathogenesis. AESCULUS has a tendency to produce tortuous, purplish, elongated veins; not only in the rectum but also in the throat, abdomen etc. It has pain in lumbo-sacral region as an important concomitant.
Dr. Boger rightly focuses on venosity; purple puffy parts: as an essence of Aesculus. A homoeopath who grasps this concept will not limit AESCULUS as a local remedy for piles, but will fully exploit its potential to deal with any number of diseases where the above mentioned Aesculus state exists.
Do read Boger’s essay “The Language of Disease” as it brings out, in his unique, concise and precise style the essence of philosophy.
Dr. Barvalia: In order to manage critical cases, this perspective and ability to synthesize helps immensely. I would explain this with another illustration:
The following evolution of her disease was available:
She was diagnosed with this illness 12 years back. She would have frequent acute episodes of pain – once every 2 months. During this time, her Hemoglobin would fall to 6 or 7 gms%. Each episode lasted for 15 days. Twice she was given a blood transfusion. She remained weak and frail. Each episode tended to precipitate suddenly. This time it began with intense pain in right shoulder followed by severe pain in left hip. After a few hours it was left shoulder followed by right hip. The pains were excruciating making her bedridden within a day of onset. Allopathic medication would give her comfort only for 6 days.
The pains were worse on slightest touch with pain in shin of her right tibia being very intense. She was thirstless, chilly and had a bitter taste in the mouth. Her pains were so intense, she was in hardly any mood to speak. The PQRS that stood out were:
Diagonal affection: Direction of pains and symptoms Shin (bone) of Tibia….. intense pain < TOUCH Thirstless and chilly
When we correlate these characteristics, along with sensitive bone pains and anemia caused by ischemia and haemolysis, MANGANUM comes up. This remedy covers the tubercular – syphilitic pathogenesis of the bones as well. MANGANUM 200 4 hourly promptly relieved her pains and she started walking within 2 days! Later on, her constitutional state of NATRUM MUR became apparent and was administered. She needed a few doses of TUBERCULINUM during remission. Her Hemoglobin became stable and stayed at around 10 gms% and gradually the Serum Ferrittin level reduced to normal.
After 2 years the acute phase changed, she developed chills, fever with an episode of Urinary Tract infection. A SEPIA picture was evident and it cured the Urinary infection. Her other biochemical parameters showed a tremendous improvement despite her Sickle Cell Hemoglobinopathy. She required Nat.Mur periodically while the Manganum phase of Sickle Cell crisis returned only twice over those 6 years of follow up.
This case demonstrates how an effective clinico-pathalogic-miasmatic correlation when philosophically made, can be applied in practice.
Dr. leela: In simple words, in serious cases, one must perceive the presenting picture of PQRS symptoms for a prescription, and then understand why a remedy is indicated at a particular point of time as similimum. This is not only based on its PQRS indications, but also on the understanding of its pathological and/or anti-miasmatic scope in a particular disease.
Dr. Barvalia: Yes, perceiving the Manganum totality, the use of Tuberculinum and posology used; all this was dependent on the understanding of the nature of illness and miasmatic state in the pathology of Haemolytic Anemia. An integration of the miasmatic totality is crucial in the Anamnesis of cases with genetic disorders.
Revisiting this area of disease from the Homoeopathic
perspective will be immensely helpful to the entire homeopathic
medical fraternity, enabling us to handle many serious genetic
disorders where very little can be done by Modern Medicine. NOSODES
are the most potent, deeper forces of our remedy armamentarium
that can play decisive role in the cure of these diseases. This
will demand a whole hearted acceptance of Hahnemann's miasmatic
doctrine in the Theory of Chronic Diseases, while keeping
our analytical faculty open, agile and active. Any
ambivalence to our own philosophy will be disastrous and self-destructive.
Dr. Barvalia: Yes, we organize 2 workshops per year where international online students will be expected to participate in order to gain the essential clinical application they require. Students taking the course will be divided into 2 categories: Basic Foundation Course of 1 year for those with very minimal exposure to clinical homeopathy, but have a basic acceptable homeopathic qualification. This course will take them through the fundamental principles of homeopathy, the art of perceiving the case and its analysis to reach a remedy. Further, through appropriate case management in order to evaluate not only remedy response, but also to consider what other ancillary measures are needed in each individual case to assist with healing. Advanced Fellowship Course of 1 year with detailed modules specifically in the fields of HIV and Child Care. Each of these subjects encompasses a wide variety of cases which have specialized structures of management that include the study of the pathology of disease and other ancillary support needed. We integrate this study with tools available in Modern Medicine today, that are a necessary part of evaluating management and healing. All this needs to be taught to homeopaths. Of course, the basic principles here are applicable in various other clinical cases. But our work so far has built up a wide range of reliable documented evidence on Child Care and HIV and hence it seems appropriate to start with fellowships in these two areas first. Those who have a homeopathic qualification
and are of paramedical or medical background will be able to complete
the first course in 6 month period, before embarking on the fellowship
course. In India of course, the basic qualification is a DHMS or
BHMS degree. Dr. Leela: What I find exciting about the
course you have planned is that it also includes the clinical
workshops necessary for developing the confidence and clinical acumen
needed to handle a variety of patients. This really widens the scope
of homeopathy for these practitioners. Dr. Barvalia: Yes, since we have experienced homeopaths with well developed practices on the faculty, students are able to experience first-hand clinical management. Besides this, there are the ongoing research projects and patient groups with the Spandan initiatives in Tb, HIV, Autism and other hyperactive disorders, thyroid disorders, developmental disabilities in children, patients with various other Neurological Disorders, etc. These cases are all well documented along with qualified medical opinions on their progress, from neurologists, psychiatrists, etc who are part of our team. We also include cases cured from various types of clinical pathology like renal failure, pancreatitis, nephrotic syndrome, cardiac diseases, including various cases of viral and bacterial infections as well. Our homeopathic faculty comprises of very
senior and competent homeopathic consultants who have a rich
out-patient/in-patient and research experience. Dr C.B Jain,
Dr Amit Daftary, Dr Shankar Chawala to name a few, part
of this team. All of us have been working together for last 20-25
years! Dr. Leela: That speaks of true commitment! Dr. Barvalia:
The workshops in Mumbai twice a year are especially for international
students. But we also conduct smaller workshops held in various
parts of the country throughout the year in order to enable Indian
homeopaths in the fellowship programme to participate. I travel
3-4 times a year to these areas, as do the other members of the
faculty. We’re busy! But what remains a central focus right now
is progressing with the plans for the Dr. Leela: I’m excited to hear more, as this has always been my core interest in homeopathic management. I have had the opportunity to work in allopathic hospitals for about 6 years, both as a homeopath and as a medical officer. One year I worked as Homeopathic Medical Officer at Holy Family Hospital, Okhla, New Delhi and that experience was tremendously inspiring – in terms of the potential scope of integrated medical work with other medical and paramedical professionals competent in their field of work. This, in addition to the tremendous scope homeopathy has to offer in the emergency hospital situation. Tell us more about this ‘ambitious’
project as you call it. Dr. Barvalia: Let me explain to you my vision for this hospital. As you know in-patient work is not new to us. I attended for 16 years, the Mumbadevi hospital where you worked, as well as the Dhawle foundations’ various projects/hospitals. People with so called ‘serious diseases’ in all these places have been cured with homeopathic management. Beyond that I have also been called on innumerable occasions, to handle serious medical and surgical cases for relatives of my patients who were under the care of MD’s in various allopathic hospitals. Homeopathy was considered their last hope. We have been successful and saved people’s lives. This has been a strong motivation to establish a fully equipped hospital on a larger scale where homeopathy becomes the central therapeutic modality. The need of the hour today is for homeopaths to understand the scope of multidisciplinary care and its operational implications in healing. In India we are fortunate that we have a large number of well qualified MD’s, MS's and Super-Specialist's in modern medicine who have a keen interest in homeopathy and support our treatment protocols. They add to this their much-needed and experienced opinion on the pathological status of the case. Like our master homeopaths, Kent, Hering, Boenninghausen, Boger, etc, these MD’s have all personally or through their patients, experienced the curative capacity of homeopathic remedies and are ever willing to support such major projects especially in their professional capacity. We have already been fortunate to have respected senior MD’s working on our team in Spandan over the last 8 years. This team experience has resulted in a phenomenal quality of clinical work. I believe that this documented evidence will serve as a ‘Research Tool’ for the future, in all such hospital ventures by the homeopathic community worldwide. This team work I term “Interdisciplinary Management” and “Multidisciplinary Management”. I am keen that our colleagues in America and Europe experience this first-hand with us, and are able to replicate the same in their own countries, once legislation is in place to support these types of projects there. We have already had a team here from
Europe which was extremely impressed with our strategy and functioning.
Europe may be ready to launch into the holistic hospital multidisciplinary
concept of homeopathic management. The US will not be far behind,
I assure you. They only need adequate legislation put into place. Dr. Leela: Yes I do think this will
be the beginning of a worldwide phenomenon. Please tell us what
is your vision of the Interdisciplinary Management and Multidisciplinary
Management in a Dr. Barvalia: Yes I have identified 3 different groups of patients that require hospital level management:
This classification is based on the
clinical presentation and the pathology of a given case. Making
these classifications help us decide for hospital admission,
and, at the time of admission, the management required for the
case. This assessment has to be based on how we perceive the case
with our homeopathic principles, and not what is the present
perception of the same in Modern Medicine. Dr. Leela: You know Dr.Barvalia, I
think this is an education that is required by the homeopathic community
as a whole. I believe it is those practitioners who develop
a deep faith in the reliability of core homeopathic principles,
who then have tremendous clinical success in handling
serious pathological problems. Dr. Barvalia:
Yes I think this education starts first with the homeopathic practitioners
themselves. They have to understand that perceiving a case has to
be based on the way we perceive disease in The Organon
and Theory of Chronic Diseases. This tri-fold classification
has to be perceived when a patient arrives in the ER, in the
private clinic or at the hospital for treatment. On admission,
the homeopath has to be able to understand how to co-ordinate the
involvement of various experts and their opinions for the best care
of the patient in the homeopathic hospital infrastructure. Dr. Leela: Please explain to us, Sir,
how you visualize this classification in practical terms from the
homeopathic standpoint. Dr. Barvalia: Yes I would like to do so. Lets talk about Emergency Care first. When a patient arrives in the ER, one needs to have an immediate qualified and experienced medical opinion about the status of the case. Then investigations required for monitoring the development of the case have to be decided. Ancillary measures and supplementary measures have to be considered in case the patient requires life saving management. We have to be aware that a patient may deteriorate to a situation of suspended animation that requires their vital force to be strengthened in other ways in addition to the similimum remedy. When this support is available, the homeopath instead concentrates on a good homeopathic prescription by observing the homeopathic characteristics in the case, the rest being taken care of by other experts. These are cases of Trauma, Cardiac Emergencies, CVA’s, Poisonings, Obstetric Emergencies, etc, to name a few. The basis for this care is explained in The Organon Aphorism 67 and its footnote. The next area of homeopathically classified
hospital cases are the Inveterate Diseases. Hahnemann makes
a reference to these in The Organon Aphorisms 51,
206 and in the Introduction. This
group of cases includes all diseases that are termed “incurable”
by Modern Medicine. Often these patients come to us after being
on symptomatic prescription drugs for years. Cases like SLE
(systemic lupus), Rheumatoid Arthritis, long standing Bronchial
Asthma, are in this category because they come for homeopathic
treatment after having taken painkillers and steroids, for
extended periods of time. They become heavily immuno-suppressed.
They present with structurally
advanced pathology while the disease is still in an 'active' state.
At this point they are in a dangerous state of susceptibility as
any small attempt at withdrawal of the allopathic drugs results
in a severe exacerbation of the chronic complaint. These patients
cannot be treated on an Out-Patient basis. They need continuous
close monitoring over a period of months dealing with these acute
exacerbations and changing symptom pictures, before they are stable
enough to be seen as Out-patients. During this period of hospitalization,
they are tapered off the prescription drugs and reach a point of
stability on the homeopathic similimum prescription, before they
are sent home. Dr. Leela: I remember a lot of these
‘Inveterate’ cases handled as in-patients in our hospital. I think,
most important at this time, is to have a philosophically
sound interpretation and management plan for them. Do give us some
examples of your cases so we can understand better how you handle
them. Dr. Barvalia: Here are a couple of examples: The first is a case of a person diagnosed with Bronchial Asthma, suffering for 17 years. She was on allopathic medication and had now reached a point where she was developing serious side effects to Steroids and they were not even helping any more. She developed severe osteoporosis besides the chronic immuno-suppression. She, on her own began to taper off the Steroids and went into a severe withdrawal exacerbation of asthma that would not respond to any bronchodilators. This was her condition when we first saw her. We had to concentrate on the acute totality to give her immediate relief. Along with this she continued with the nebulizer and bronchodilator as an ancillary measure that was reduced and stopped as she responded to the remedy. The acute remedy indicated worked for
about 7 days, then on the 8th day the acute picture changed.
So, we changed the indicated acute remedy. She remained on this
remedy for the next 5 months! In between, Thuja was
the indicated anti-miasmatic remedy which was prescribed when its
miasmatic indications came up. It was only after 5 months that
her recurrent exacerbations settled and could be shifted
onto her chronic constitutional remedy. She remained stable ever
since with occasional inter-current prescriptions that were treated
on an Out-patient basis. Dr. Leela: Five months on an Acute! One
certainly needs
to be philosophically very sound to be happy with that J
Just shows that we ALL have a lot to learn in terms of management
of various types of cases. Dr. Barvalia: (Smile) That’s right. Another example is a patient with Rheumatoid Arthritis who was on Steroids and NSAIDS for many years. She presented with an acute exacerbation of evening rise of fever spiking to 103F -104F. The NSAIDS and Steroids could not bring this fever down and the Rheumatologist had given up trying to treat this case. That’s how we were called in. Now the focus was to treat the acute exacerbation before we dealt with the chronic picture. The only characteristic symptoms in this presentation were the evening rise of fever with high spikes that was not responding to any conventional drug. Along with this was a pronounced weight loss recently. The interpretation was that the disease was in a miasmatic stage of expression that needed a nosode as inter-current to arouse the reactivity. The symptoms pointed to the tubercular miasm and the remedy of choice was Tuberculinum. She was given Tuberculinum 1M and the fever responded immediately. It was repeated as needed if the symptoms increased again. Once her symptoms settled, the
chronic picture came up more clearly of extreme coldness of the
extremities which along with other features, pointed to Calc
Silicata as the constitutional remedy. This was a
case that needed a more frequent interpolation of Tuberculinum
1M during the course of treatment in order to arouse the reactivity even
to the chronic remedy. In addition while she was hospitalized, she
was gradually tapered off Steroids and went home on her chronic
remedy along with NSAIDS, till the latter could be tapered off as
well. Dr. Leela: Thanks for sharing your invaluable experiences, Dr. Barvalia. I think this explains how an anti- miasmatic intercurrent helps a case move forward. From Hahnemann’s Theory of Chronic Disease, I have understood that this is exactly how Hahnemann prescribed Sulphur, Mercurius, Thuja and his other anti miasmatic remedies. (Sepia, Nitric Acid, Hepar Sulph, etc). Importantly though, one has to be
taught the ability to perceive the miasmatic picture of disease
expression. Our readers must understand, that an advanced study
and training in miasms is required to perceive
and make use of this theory clinically in treating
serious cases - so here is a great opportunity to learn with Dr.
Barvalia. Dr. Barvalia: Here is one more case in this category. We had a patient with Rheumatoid Arthritis come to us for treatment who had already been put onto Gold salts for pain control. As you know, this is the tertiary line of treatment in Modern Medicine, when NSAIDS and Steroids don’t work any more. She was however taking both the Gold salts and the NSAIDS. We admitted her in the wards and began to withdraw the gold salts (while the NSAIDS continued). Almost immediately she got worse, her pains exacerbated and she developed a peculiar symptom, that of greatly increased salivation. From the Materia Medica we know that Merc Sol is an antidote to Gold. Our philosophical interpretation was that an antimiasmatic, inter-current prescription was needed at this stage that covered the presenting picture. Reaching the point of needing Gold Salts for pain relief indicated a syphilitic miasmatic expression. Hence Merc Sol was prescribed
and she did very well on repeated dosing right through the withdrawal
of Gold salts. Over a period of time the constitutional features
began to emerge and she was completely off the gold salts. She was
given her Chronic remedy in frequent repetition and sent home still
on NSAIDS. The next step was to wait for her to be stable enough
to start withdrawing the NSAIDS, to which she would have developed
a metabolic dependence that needed to be overcome. Dr.
Leela: Yes, here I have in Relationship of Remedies: These cases are revealing! I think our readers will have a better idea of which cases you term "inveterate". Often homeopaths are unable to handle such cases homeopathically because they do not understand the concept of antimiasmatic remedy, or the need for multiple dosing or else they have a prejudice against prescribing when allopathic medication is going on. I view this as another ability a homeopath has to develop: learning to perceive homeopathic characteristics required for a prescription even while the picture is distorted by allopathic medication. Tell us now your experience with
Multidisciplinary treatment. |
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