The patient, a woman of 67 years, first reported a non-healing wound below the left heel and near the calcaneum in June 2018. She was a known case of diabetes mellitus, hypertension, hypothyroidism and had suffered a mild stroke a year ago. A carotid doppler at that time had revealed intimal thickening and cerebral thrombosis.
The wound initially presented with pain and swelling, an opening discharging pus and with reduced sensation. Subsequently she would get a recurrent boil with throbbing pain which would then burst with bleeding and pus. This would generally begin after exertion or walking for long periods of time. Once the pus had found a vent, the pain would subside and the whole cycle would be repeated again after some time. This continued for almost six months before she came to Homoeopathy in January 2019.
An X-ray of the left calcaneum in 1999 revealed a compressed, sclerotic bone with spurs and soft tissue swelling which suggested an old case of osteomyelitis. A recent X-ray showed partial resorption of the posterior part of calcaneum with irregularity and soft tissue swelling. The findings were suggestive of chronic osteomyelitis. The surgeon had suggested debridement and accordingly she had come to us after the procedure, wherein despite 40 days of dressing and topical applications and medicines the wound looked as seen below.
Offensive pus was still continuously oozing and the healing, as expected was very slow. It was at this time that she was put on homoeopathic medicines. She was given the indicated simillimum and for local application, our wonder medicine, Calendula mother tincture diluted in water. All other medications and topical applications were stopped. Daily dressing was continued to assess the improvement as well as to allow Calendula to work efficiently.
Her blood sugar levels were under control and so was her thyroid and lipid level, as she was on anti-diabetics, statins, blood thinners and hypothyroid medicines. Those were not stopped and our medicines were given in addition to them. The primary objective now was to stimulate the healing powers of the body without disturbing the chronic processes of dysfunctional metabolism. The predominant disturbance needed to be addressed first as that was the most immediate dynamic disequilibrium.
This patient was handled on the phone as she lived far away and information was available through her son and daughter in law. The patient had grown up in an insecure environment as her father was an alcoholic and her parents divorced when she was just seven years old. She was brought up by her grandmother and there were many financial constraints and the situation difficult. She took some basic education and was employed in a manufacturing unit. Eventually she fell in love with and married the owner who was of a different caste. They have two children and post marriage things have been very fine and stable.
She is very strict by nature and since the beginning her children fear her and obey her and generally do not contradict her. Her husband has always been very supportive of her and overall she has maintained good relations in the family. Very prominent about her nature is her short temper; she gets angry very easily and will then shout and ensure that she is obeyed. Her daughter-in-law says that she doesn’t like if her parents visit them and will always express her displeasure through her words and body language; she will not even talk to them at times. Her words can be very hurtful and sharp and she will generally not relent easily.
Nowadays she has frequent altercations with her teenage grand-daughter who seems to be the first in the family to revolt against her dictatorial methods. She also has a lot of anxiety. She worries about each and every thing, about future, about everybody’s health, about every small thing.
On the physical level nothing remarkable was observed except a tendency to constipation and flatulence and disturbed sleep for many years. She had episodes of lumbar spondylolysis and rotator cuff tendinitis in the past.
The Biothesiometry report suggested a value of 26.2 for the left foot which is an indicator of raised threshold for perception of vibratory sensation which suggests a high risk for development of diabetic foot and ulceration.
Summarizing the case
We are dealing with an elderly patient with a primary complaint of chronic osteomyelitis for almost 20 years. Her system has been under the additional burden of chronic diseases like diabetes mellitus, hypertension, hypothyroidism and recently, stroke which was clearly thrombotic in origin. The bone of the left foot is involved and the pathology is destructive with fistulae, suppuration, haemorrhage and reduced sensation which suggests that the medicine we choose has to be an anti-syphilitic. Her problem has been a slowly progressing chronic deep-seated pathology and slow tissue repair after debridement, which suggests that we need to frequently repeat the medicine in low potency to arouse the susceptibility of the patient. Also to note is the likelihood of neuropathy complicating the state of probable reduced blood supply due to narrowed blood vessels which could be co-existent and thus prolonging cure.
Now if one observes the wound closely, one notices irregular edges and exuberant granulation tissue with offensive persistent suppuration. Add to this the caustic temperament, the angry, insulting nature, the aggravation from contradiction, the obstinacy, the quarrelsome and scolding propensity and we have a very clear medicine which can rid her of her ills.
Nitric Acid 30 TDS was prescribed.
After a week, this was the photograph sent by the patient,
One can see that the wound looks healthier and the margins of the ulcer have narrowed and its depth reduced considerably, which indicates that the Simillimum has stimulated healing rapidly and gently. In a diabetic patient with non-healing ulcer, this finding is of tremendous importance as it shows that the vital force, when adequately and dynamically roused, will find its own ways in overcoming atherosclerosis, thrombosis, deficient blood supply, ulceration, suppuration and a failure to heal and thrive. Despite all the accompanying health challenges the vital force will bring about the state of health that is most possible and feasible. Day in and day out we see the dramatic workings of the vital force, in health, in disease and in cure!
After two weeks,
The patient reported considerable improvement in all parameters and sent the following photograph.
Two months later
As one can see Homoeopathy has once again achieved rapid, gentle cure in this case. The ulcer has healed easily, smoothly with minimum deformity and scarring. The combination of the Simillimum and external application of calendula mother tincture in water is an ideal method to treat such cases.