A Case of Calcified Bursitis

Background of the case

Date of 1st consultation: 27 October 2012

A young married lady of 29 who is a fashion designer by profession but presently a housewife, was brought with diagnosis of “calcified bursitis” for which she was advised operation and that there was no medical treatment. She came for treatment on persuasion of the sister to give a last “try”, as operation was the only resort.

Case taking session: (D: doctor, P: patient)

D: tell me what is the problem at the present moment?

P: I am diagnosed as calcified bursitis. (She showed the reports and x ray)

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Dr- Tell me more?

P- Actually we went to Lonavala (hill station/vacation spot) and I lifted bag, it was heavy bag. That day there was nothing. After I came from Lonavala and I got up from sleep I just couldn’t move my hand. I thought maybe some change in sleeping position. So I took Combiflam (anti inflammatory NACID- used as pain killer) for 2-3 days. Then there was severe pain and I did x ray. It came as calcified bursitis. Then normal physician gave me anti inflammatory and did cold fomentation. Still pain was there. So started with physiotherapy. I did that for 10 days. I took acupressure. I am feeling better with this all. Hand movement is better but still when I get up from sleep this portion pains. If there is any movement then there is severe nerve pain.

Dr- Tell me more about this pain?

P- Actually there is not much activity now. I can’t pick up my daughter also. And I don’t work at home also. But if I do something also then it pains here. But when I get up from sleep it pains more.

Dr- A little more about this.

P- When pain is there it was very much, too intense. I felt like crying and hand couldn’t raise this much also. It becomes very stiff. Still strength of this hand is very less. If I am picking something I feel it will fall. Since a year before this I was telling my husband I feel this hand is weak. Normally what I can do with other hand, I don’t know I feel this hand has become weak. I could do everything but I felt it has become weak. Now also strength is less and when pain was there, that time there was no strength. After wearing sling this has swollen up.

Dr- How is it is affecting you?

P- It is affecting my work. I have to do everything by one hand. If I do anything by this hand I feel it will pain. No strength also. I don’t feel like doing anything and whatever happens this hand could come first for work

Dr- You said it “disturbs your working” ;tell me more?

P- I feel very incomplete. It’s very uncomfortable in sleep. I have habit of sleeping on stomach, with hand this way

It doesn’t feel good. I feel comfort is not there

Dr- Just describe “comfort is not there “.

P- I feel irritated and feel what happened to my hand. I want to sleep but I can’t sleep I feel how come suddenly I didn’t have it and I got it. It’s just because of this small calcification I can’t do anything I want to do

Dr- Tell about “I can’t do anything I want to do”?

P- I can’t work, I can’t hold my baby, and I can’t sleep beside my baby. My interaction with baby also becomes less. I don’t bath her now. I used to stay away from her even she used to get irritated mummy is not picking me up. Mummy is not coming near me. Either my mother in law does it or my mother. She also had weight loss. So I did not like it. Somebody comes and take her away from me. I don’t like it.

(When you ask about her chief complaint she immediately connects it to a feeling of being weak, no strength, not able to – and she feels incapability to do things and especially what she wishes to do. Things are not done according to her choice and that is what is her main problem. )

D – Any other problem?

P- Initially my sleep was very less. Home tension, have to adjust so didn’t get sleep. My mother in law nature is such what she thinks only that should happen. Sometime it doesn’t match my thinking and I feel why this. That all small small things disturbs at night. I am very happy with husband. He is very understanding.

Dr- So what is the problem with the mother in law?

P- Sometimes it irritates me. She feels what she thinks is right. Sometimes our thinking is also right.

Dr- Talk more about the irritation

P- Don’t like it. It feels I want to do something but I can’t do it. We can’t tell her also because she is mother in law. I tell my husband he tells I will tell mummy but then I say no, because they are elder.

Dr- This feeling “we want to do something” I didn’t get this?

P- Means we have something in mind and we want to do it but we can’t. Things don’t go according to us.                             

Dr- How does it feel that time?

P- I feel we have also thought something to do in life and we don’t get to do it. It’s that we have to keep adjusting.

Dr- So how does it feel within?

P- I don’t feel good. I feel like crying. Even I have my own life. I need to do something. Not able to do anything because of her and I can’t tell her also anything.

It is very irritating. I do according to her thoughts only but I feel in mind that what is this, even I want to do it. But I never do. At moment it hurt. Sometime when I want to do it I feel what she will think. She will feel bad. I will do what make her happy. My husband is very supportive and I don’t have any complains about it.

(On asking about the associated complaint, she spontaneously connects it to her most stressful area in life. Here when we explore her feelings it again comes to the problem of having a choice but not able to express it. This is the same as what we saw with her chief complaint. In fact, chief complaint is a kind of reflection of this deeper level of dynamic disturbance. Having found something common in two areas, to get deeper insights now we go to the most uncompensated areas like childhood, dreams, fears, etc)

Dr- Tell me about your nature as child?

P- I was very shy in school. I started crawling after I started walking. I never crawled. My teething was also late. My eating habit was very good. Only milk I never used to like. Meal I used to have it. I was naughty but mom said I didn’t harass anyone. I use to go to everyone. Someone use to come from building and take me. Keep me for one hour. I used to eat whatever they gave me. When I was small I used to eat lot of raw tomato. I was very calm. Not the hyper one. I like to keep everything at place since childhood. Even before taking another toy I used to keep the first on in its place.

Dr- Tell me more

P- My elder sister was very naughty. She used to be with mummy every time. Even while going to the washroom mummy had to take her. I was not like that. I was ok with everybody. If I know that person then it’s ok if they take me. My sister cried a lot in school. I never cried. I was settled on day one of the school. But in school I was very reserved. Before asking something I used to think, can I ask or not?

Dr- What upset you?

P- My sister was 6 year elder than me. Her school was almost over. We use to fight for things. She use to watch TV and I was not able to study. I use to tell mom that you are not telling her anything.

Dr- How did you use to feel?

P- I used to feel that they are paying more attention to her and not me.

Dr- What was the feeling?

P- I use to feel left out

Dr- Tell me more about this?

P- I use to feel nobody care for me. Nobody think about me. Her schooling is over so she can do whatever she wants. But when she was in school then everybody use to say me don’t make noise. Don’t bring your friends at home she is studying. Go out and play and now when she is grown up nobody is thinking about me.

Dr- So how did you feel being in that situation?

P- I used to feel she is the only daughter they have.

Dr- Say more about this, that she is the only daughter?

P- I was not feeling good. I was feeling everyone think about her. They don’t think about me.

Dr- How did it feel due to that?

P- I then had little interest in study. I was like nobody care about me. If I do well or not it doesn’t matter.

Dr- More about this nobody care?

P- Its like they never used to tell her. You close your room and study. She has finished her school now what she will do

Dr- How did you feel?

P- I use to feel bad. They are not understanding me. They should support me. They should make me learn. They should teach me. They know everything. Instead of saying that they doing this.

Dr- How did that feel? Bad means what?

P- Feeling that they didn’t understood me. When I need their help. Instead they are telling me to close the room and study. Nobody thinking about you, nobody care about you. You do whatever you feel like.

Dr- what is that one word that could describe this?

P- Left out

( As a child she felt neglected by her family from whom she wants care, help, understanding and support. Also that she was shy and very adjusting and non opinionated.)

Tell me about your nature?

P- Actually my nature is that I cannot hurt anybody. Even if it is their mistake I cover up.

Dr- Why?

P- Because I don’t like somebody is hurt because of me. They will feel bad then they will not talk. But I have to be with her only. I don’t like to be in that situation whole day. I feel very depressed. I can’t see her talking to me roughly. So I don’t bring situation near to me

Dr- What is the worst that could happen ?

P- They all will misunderstand me- my husband will understand. I know he is with me. But what if the fight increases and she will be away from me. I feel we all should stay together as we may need anyone and in such situations it is very helpful. If people around us are hurt because I feel that the love and affection amongst family members should be there. It is very necessary, only then we can be happy. So I rather prefer to not talk and hurt and keep quiet.

Dr- Any fears in childhood?

P- I use to be very brave. Even if it was dark I use to go and play. I used to be scared of dogs. My father was going to temple. And dog just came he bitted and went away. He did that very badly. He had to take injection. Since that time I was very scared.

Dr- What were you scared in this?

P- It’s just that you cannot just trust dogs. Without any reason he came and bite. I thought they had nature when they are angry they bite. They don’t think anything else like that person has not done anything so we should also not do any harm to him.

( Here “ fear of dogs” leads to more deeper feeling that “aggression can be harmful”.)

Dr- Anything in TV news that you are sensitive to?

P- I like family movie. I don’t like action movie. I use to like horror before. I don’t know I just avoid it. I don’t like to see blood.

Dr- You said you like family movie, tell me about that?

P- I like family staying together and going for picnic. I like peaceful movie. I like “Hum sath sath hai”. Any movie without violence I like.

( the same idea of violence and aggression is seen again)

Dr- So what about them you like most?

P- The way they stay together happily.

Dr- What is staying together happily?

P- You understand each other very well. You take care of each other and live happily

Dr- What dreams do you get?

P- Some are related to family, I went to this place her and there. I don’t get much. Not many dream to remember.

Dr- Ok what do you like to eat most? And what you like less.

P= I like Chinese and any spicy food. I don’t like khicdhi (Indian dish usually bland in taste)

P- I like seasonal fruits, strawberry and mango. I don’t like apple banana. But I have it. I like all the sour juicy fruits . I like spicy. I don’t like much sweet. I like pastry and ice creams. I don’t like much oily. Oily food makes me burp a lot. I drink very less water. And I hardly go to urination. Water is such if I go to kitchen I drink it.

And yes, milk!!! …I don’t like it at all. I drink it forcefully one time in morning. I don’t have habit of tea. I eat all vegetable. Till today I eat all vegetables

Dr- You like it?

P- ya I like it. I like all vegetables. I don’t like methi (fenugreek), green leafy vegetables at all.

Dr- you don’t like leafy vegetable?

P- I like coriander but not methi and palak. Except karela I eat all vegetable. I like them.

Dr- What do you tolerate more? Heat or cold?

P- Cold I can’t tolerate it.

Dr- Any problems during periods?

P- Yes, I have too much pain and my periods were irregular before marriage, sometimes in two months or three months. Now it is regular

Dr- Was it painful?

P- Yes. Now it is not there and I used to get angry and irritated before periods. 2-3 days before. And leg pain a lot before periods.

Dr- Any problem in your childhood?

P- I learned late to talk. I was walking after 11 months

Dr- What major illnesses or complaints you have had in the past?

P- I have very much teeth problem. I get wisdom tooth from all sides. One I removed by surgery and one is paining a lot. I did root canal. I don’t brush properly and have habit of eating chocolates. So every tooth is with cavity. Right now also my root canal is going on.

Dr- you have wisdom tooth problem?

P- Yes, one wisdom tooth I removed. And one during pregnancy.

Dr- oh, that much trouble it was, was it more in pregnancy?

P- Yes I suffer a lot in 5th and 6th months. We had to remove it after gynecologist opinion. It got so much aggravated during pregnancy.

 

Understanding of the case :

The most peculiar thing in the chief complaint is that it makes her feel weak, incomplete, not capable and no strength. This is the same when she talks about the stressful situation. These are the words that come repetitively and out of context.

The whole pattern of these non human specific (NHS) words of

“WEAK/NO STRENGTH/ INCOMPLETE/ NO COMFORT/CAN’T DO ANYTHING/ CAN’T WORK/ NOT ABLE TO HOLD BABY / NOT ABLE TO DO ANYTHING” hints towards the mineral kingdom. (1)

Sankaran in his “Structure” states that Mineral kingdom remedies perceive something lacking in themselves i.e. a defect in their structure (1). This is expressed during case taking in the form of words like weak, incomplete, incapable, etc as we see in this case.

This experience is found as the basis of every area of their life, like dreams, interests and hobbies, occupation, areas of sensitivity and even the complaints that they suffer; in addition to this, each row in the periodic table of remedies has well defined specific areas where they perceive this weakness and incapability; as in

Row 1 has to do with conception;

Row 2 feel like a baby in the womb and about to be born.

Row 3 remedies perceive the world like a child between 3 to 6 yrs with each element having a specific point of development where they are stuck. This is the age when the child needs “care” and “nourishment” from the parents but at the same time they are developing who they are, ie. their “Ego” and self-awareness. Child is getting self aware and develops who he is and what he wants, ie. his “Choice”.

In the case above, we see that what is basic to her is that she feels lacking in the area of what she wants to do and do what she chooses to i.e. in the area of her “choice”.

The idea of choice in this case is she feels she should not assert. This “fear of telling what I feel and want out of the fear of hurting others” is the main thing about the remedy mag carb from the third row .The main feeling of mag carb is that you should not express your choice. They feel “dependent on others” for “love, care, nourishment” and they “fear losing them if they express their choice”. We see the same thing in the case; she fears telling what she wants to do out of the fear of losing the relation since they feel they need those people and are dependent on them. This is the exact pattern match with the idea of the third row and the element “Magnesium”. This is the difference from the element “Natrum” (which comes before it in the periodic table) who has the complete dependence and will not have any choice of their own. Whereas in magnesium it is that they have a definite choice but have a fear to express it. They do not express their choice. This is seen clearly in her childhood when she would go to anyone and eat anything without the fuss. This is typical of the remedy – “Adjusting” to any situation. It is so peculiar for a child to adjust on the very first day at playschool! Strong “forsaken feeling like an orphan” and the need for love, care and understanding from people on whom she is dependent is also see in her childhood and other areas. A strong sensitivity and aversion to “violence and aggression” is also a very important theme of magnesium. They are generally the pacifiers. (2). This is the general thread of the remedy – the genius of the remedy.

There are also definite peculiar symptoms in the case.

  1. Mind symptoms
  2. Forsaken feeling
  3. Aversion to violence
  4. Irritablilty before menses
  5. Dreams of his family
  6. Generals physical
  7. Late learning to talk
  8. Thirstlessness
  9. Craves fruits, sour
  10. Aversion milk
  11. Desire vegetables +aversion only to leafy vegetables
  12. Chilly patient
  13. Associated complaint 1 – toothache and menses complaint
  14. Toothache – wisdom tooth
  15. Toothache during pregnancy
  16. Abdomen pain before menses
  17. Shoulder pain (chief complaint)
  18. < Lifting
  19. Left shoulder affection
  20. <lying on the affected parts

Repertorial totality

  1. mind; DELUSIONS, imaginations; deserted, forsaken (72)
  2. mind; DREAMS; family, own (127)
  3. mind; FEAR; violence, of (64)
  4. mind; TALK, talking, talks; slow, late learning to (29)
  5. stomach; THIRSTLESSNESS (331)
  6. generalities; FOOD and drinks; fruits; desires (170)
  7. generalities; FOOD and drinks; fruits; desires; sour, acid (22)
  8. generalities; FOOD and drinks; milk, milk products; aversion (99)
  9. generalities; FOOD and drinks; spices, condiments, piquant, highly seasoned food; desires (116)
  10. generalities; FOOD and drinks; tomatoes; desires; raw (1)
  11. generalities; FOOD and drinks; vegetables; aversion; green (3)
  12. generalities; FOOD and drinks; vegetables; desires (96)
  13. teeth; MOLARS, bicuspids; last, wisdom teeth (22)
  14. teeth; PAIN, toothache; pregnancy, in (26)
  15. mind; IRRITABILITY; menses; before (71)
  16. abdomen; PAIN; menses; before; agg. (162)
  17. abdomen; PAIN; menses; during (168)
  18. extremities; PAIN; menses; before (37)
  19. extremities; UPPER limbs; lying; while; affected part, on (49)
  20. extremities; SHOULDERS; left (222)
  21. generalities; LIFTING, overlifting, straining of muscles and tendons; agg. (269)
  22. generalities; PAIN; waking; agg. (504)

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It is so amazing to see so much similarity in the case with the remedy at all the levels

level 1 and 2(the local symptoms) : left shoulder affection, lifting weight, after waking;

level 3 : the generals (craving, aversions, menses, etc )

level 4 Delusion( false perception of being “forsaken”)

level 5 sensation level – defect with structure indication mineral kingdom and specific problem of choice, care, nourishment (Row 3) and fear to assert it (column 2)

Remedy prescribed: Magnesium Carbonicum (mag-c)

Potency : There is a predominance of generals and emotions with the absence of many dreams. This corresponds to level 3 of Sankaran’s idea of “levels of experience” and hence potency 200.

First Prescripton : Mag Carb 200 1p stat

Follow up

1month later

Pain started to reduce within a week. The “weak” feeling reduced by about 40 to 50%. She says “Now at least I am able to nurse my child and hold her.” Before due to my illness my baby must have felt like an orphan!!

3 months later

Pain has been not there at all since the last month. Sleep has improved very much. The irritation levels are far more better. Now I don’t pay much attention to what the mother in law says. I really keep attention on my child and my husband. I am very relaxed and happy.

X-ray showed : No calcification at all!!!

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Treatment was stopped 6 months from the starting of the treatment since she was keeping well at all the levels. Remedy needed to be repeated only 4 times in the 6 months of treatment whenever her state got worse. She used to come for her daughters treatment and would tell me that she is well.

2 yrs later

“Never had any problem related to the shoulder at all since then. Not just that I have never been ill for any major complaints in the past two years. I am healthy. My nature has changed to some extent. Now I don’t mind my mother in law’s behavior but started to sometimes register my opinion about some things. I am happy that I am able to do it as this was very difficult for me throughout my life. I am feeling much calmer and relaxed. Thanks to homeopathy that I am so much better. And thanks to you and your system of treating.”

Summary:

This case could have been solved with just symptoms but for me, it was more sure with the idea of mineral kingdom and levels of experience and then correlating it with the symptoms. The main anchor in the case was the “System”- a pattern match with the themes of the third row and then correlating it with the “Symptoms” of the case. This complementary use of traditional and modern ideas of homoeopathy; along with the genius of the remedy makes prescribing more sure and balanced. This is the idea of “Synergy” (4) in practice.

This method I have found to be very useful in my practice.

Bibliography :

  1. “STRUCTURE” – Experiences with the mineral kingdom (volume 1) – Dr. Rajan Sankaran
  2. Minerals of Homoeopathy (magnesiums) – Jan Scolten
  3. The Sensation in Homoeopathy (levels of experience) – Dr. Rajan Sankaran
  4. The Synergy in Homoeopathy – Dr. Rajan Sankaran

About the author

Dr. Tejas Shah

Dr. Tejas Shah

Dr. Tejas Shah is a Classical Homoeopathic Physician practicing in Mumbai, India since 1999. He graduated from the prestigious CMP Homoeopathic medical college in Mumbai and also has a master’s degree from "the other song" academy under the able guidance of Dr Rajan Sankaran. He also holds a degree "CCAH" in advanced homoeopathy. He is currently pursuing his fellowship with MUHS (Maharashtra University of Health Sciences). Dr. Shah is a Visiting Consultant at "The Other Song" and attached as a Consultant Homoeopathic Physician at the "Hindusabha Hospital" in Mumbai. He is on the panel in the Maharashtra University of Health Sciences as a mentor (guide) for the CCAH course (certificate course in advanced homoeopathy). He is the course coordinator and on the panel of mentors for "Essential Homoeopathy" - an the online homeopathic training programme - conducted by Synergy Homoeopathic - USA.

2 Comments

  • Very nicely taken case.
    Very well presented and very crystal clear explaination.
    I am also closely associated with The Other Song and have been practicing the Synergy in practice. Almost all cases that have shown marked results are when the synergy is seen in the cases.
    Without synergy too we can get good results…but with it we can get good confidence on our results even before the followup.
    Keep up the good work Dr.Tejas

  • Mag-c has done wonders in the case treated by Dr.Tejas. Proper selection of the medicine has done the great relief to the young lady.
    Thanks for bringing a nice case.

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