Clinical Cases

A Case of Non Healing Wound with Diabetes Mellitus

Sept  Satyakaam Trigunait

Dr. Satyakaam Trigunait presents a case of non-healing wound with diabetes mellitus

Preliminary Data:

Name: Mr. MNSMarital status: Married
Age: 62yrsReligion: Hindu
Sex: MaleAddress: DEF
Education: GraduateDate: 8-01-16
Occupation: Retired

 

Chief Complaints: Patient came with complaints of non-healing wound below the left great toe for one year. The patient was on allopathic medicines but there was no improvement in the wound healing. The wound was oval in shape measuring 1cm width and half a cm deep with surrounding dead tissue as if corroded. There was offensive odor and occasional bleeding on walking. He also has left leg pain agg on motion and amel on rest. The wound developed after the removal of a corn at the base of the toe.

LocationSensationModalityConcomitant
Lower Extremity

Left toe

Palmar aspect

Since 1yr

Offensive Odor

Painless wound

Bleeding+

Skin edges hard

A/f Corn removal at base of toesLeft leg pain

Past History:

Diabetes Mellitus since 22 years and on hypoglycemic agents thrice a day

Family History:

Grandfather: Hypertension      Grandmother: Osteoporosis

Father: Diabetes Mellitus                     Mother: Rheumatism

Patient as a person:

Appearance: Tall Thin emaciated         Diet: vegetarian

Appetite: Average                                 Thirst: 5-6 glass/day

Desire: Spicy food++                           Aversion: non specific

Bowel: Regular                                                 Urine: 4-5 times /day

Sleep: Sound                                        Perspiration: Head++

Dreams: Daily routine                          Habits: Tea twice daily

Thermals: chilly

   Summer      Rainy     Winter
Fanning   Slow     Slow    No fan
Covering   1 thin     1 thin    2 thick
Bathing(water)  Warm     Warm    Warm

Life Space Investigation:

He is a retired serviceman staying alone with his wife. He is soft by nature but gets angry when he sees someone suffering because of another’s fault. He fights for the people if they are in need. He said that earlier he used to get angry easily and used to shout at others if they have made any mistake in their work but along with that he used to care about them and help them when they are in need.  He feels very sympathetic for the poor people and also helps them as much as he can. Sensitive to seeing others getting hurt. Very much punctual and conscientious about his work. Even after retirement he works for the society and feels that it is his duty to do so as a member. Even with this condition of his leg, he attends meetings and works for everyone. Anxious about his health and want to get cured. Optimistic attitude towards life

Physical Examination

General Examination:

T – 980 F               P/R – 68/min            RR – 16/min

BP-120/60mmHg    Weight – 62kg

BSL (Fasting) – 160mg/dl        BSL (PP) – 275mg/dl

Urine Sugar – ++, Haemogram- WNL

No signs of pallor, cyanosis, clubbing, lymphadenopathy and icterus

Systemic Examination

Respiratory System: Air entry bilaterally equal and clear

CVS: S1S2+, no murmur         P/A: Soft, non-tender   CNS: Normal

 

Diagnosis of Disease: Non-healing wound

 

Miasm: Syco syphilitic

 

Susceptibility of the case: Moderately susceptible

 

Analysis of symptoms:

 

Mental GeneralsPhysical generalsParticulars
Censorious

Injustice cannot support

Irritability easily

Misfortune of other agg

Sympathetic

Conscientious

Desires spicy food

Emaciation with good appetite

Perspiration on head

 

Wound toes

Extremity pain legs agg walking

Slow healing wound

Repertory used: Complete Repertory

sept-2016-satyakaam-trigunait1

Probable Remedies: Caust, Sulph, Nux, Nat-m

Constitutional remedy: Causticum                   Potency: 30

Reason: Causticum people are very conscientious and duty bound. They are sympathetic by nature and highly sensitive to others’ suffering and to injustice. Syco-syphilitic miasmatic state.  Here you can also see some of the 4th Row issues such as Duty/work, Anxiety about health, Routine work/Performance and Responsibility. Thus the causticum gets highest marks in the repertorization and is prescribed.

Prescription: Caust 30 (4 pills) OD x 15 days + Syzygium jambo 10 drops Bd

Auxiliary measures: Daily Dressing of wound with Calendula tincture. Avoid sugar and sweet things; eat balanced healthy diet with vegetables and fruit juices.

Debridement of the wound was done by me twice during the treatment to remove the dead tissues.

Follow Up:

DATEOBSERVATIONPLAN   TREATMENT
25-01-16Discharges have reduced, no offensive odor from wound, leg pain still present.Wait and watchS.L. BD x 1month + jambo tincture
24-02-16Generally feeling better, wound showing signs of healing with granulation, leg pain reduced 30%. Appetite improved, sleep sound

Fasting- 84mg/dl, PP – 138mg/dl, urine- +

Wait and watchS.L. BD x 1month + jambo tincture

 

28-03-16Wound healthy, no discharge, granulation tissue can be seen, wound almost 50% closed.

Leg pain significantly reduced.

Fasting- 68mg/dl, PP – 122mg/dl, Urine- Nil

Wait and watch

Tapered Anti diabetic drugs twice daily

S.L. BD x 1month + jambo tincture
24-04-16Wound was healthy but not much improvement from earlier follow up. Debridement was done to remove dead tissue

Rest generally doing well

Repeat the doseCaust 30 OD

S.L. BD x 2wks + jambo tincture

10-05-16

 

 

Significant Improvement in wound, almost 80% closed, No more leg pain, generally doing well.Wait and Watch

 

 

 S.L. BD x 1month + jambo tincture

 

 

05-06-16Wound healed completely. He was overwhelmed by the response of homoeopathic treatment. At all levels he felt better.

Sugar levels are also good.

Advised to stop the treatment

 

Only to continue Tincture for few weeks and then stop.

 

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BEFORE TREATMENT

  sept-2016-satyakaam-trigunait4  sept-2016-satyakaam-trigunait3

                                                 AFTER TREATMENT

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About the author

Satyakaam Trigunait

Satyakaam Trigunait

Dr. Satyakaam Trigunait has been practicing in Chinchwad Pune for one year. He completed his MD Degree in Practice of Medicine from Shri Bhagwan Homoeopathic Medical college, Aurangabad. He specializes in treating Gastrointestinal disorders, skin diseases and musculoskeletal disorders. He enjoys reading medical books, playing chess and participating in debates. His approach is deeply influenced by the work of Drs. Kent, Hering and Sankaran.

5 Comments

  • Great. But nowadays patients does’nt like such lenghty investigations. We should check HbA1c to know the diabetic control and then prescribe to control blood sugar to normal limit and also give requisite medicine to heal the wound besides cleaning daily with Calendula or Hypericum. If necessary we can use Nosodes to heal the wound soon. Best of luck. Keep it up.

  • Hello Dr Satyakaam Trigunait I M Dr An Tareen 63y of age prectecing 30y in punjab Pakistan I have Seen Ur Case Foot Thumb Wound U take Lot Of Time heel it u tried very good but i hv cured somany cases daibtic foot gangreen Lach200 once in week Calendula30 &Echnicea30 alternate and locally Calendula Q
    best of luck

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