A Case of Renal Colic

Dr. Tasleem Kalawadia presents a brief case of renal colic, where desire to pass stool with pain, right sided pain, limbs drawn up in a chilly patient were repertorized to find the remedy.

renal calculi

Patients who have had renal colic report that it is the worst pain they have ever experienced. It is treated usually as an acute emergency. Acute supravesical obstruction,as from a stone lodged in a ureter, is associated with excruciating pain, known as renal colic.

CASE RECORD

It was a Sunday morning, 6am and I was awakened by a loud cry of a family member (male 24). He was preparing his breakfast in the kitchen and came crying near the bed. He hadhis hands over the right lower quadrant of his abdomen. He was writhing in pain,his legs were flexed and was unable to lie down. He was yelling its painful, do something!

There were just the two of us in the house and we had moved recently abroad with just a first aid box of homeopathic remedies, but no software or repertories.He was in such pain I couldn’t ask him any questions. I was fortunate to hear those magical words from him, “​I think if I pass stool I will be better’.​And then he continued shrieking for immediate relief. I hurried to check the remedies in my box.

The remedies I could think of were Nuxvom, Bryonia,Colocynth and Lycopodium. Desire to pass stool, with pain. Right sided. Limbs drawn up.

His hands were resting over his abdomen so I thought maybe pressure was making it better, but I was not sure.  It was between Bryonia and Nux.  He was a chilly patient so I selected Nux.

I placed 2-3 drops of Nuxvom 200 on his tongue and was amazed that within 10 minutes he was calm.  He got up and sat on the bed.This was my first encounter with renal colic and I was astonished to witness how fast Nux vomica acted. He drank a good amount of water then and went to sleep. I was still sitting next to him with Nux-vom in my hand, thinking maybe he will need it again.Dr. Kent mentions in his materiamedica :

“​pains in the regions of kidneys and liver. The pain feels as if drawing, a spasm of the muscles. Rending pains in the bowels and every pain causes desire for stool. Such is the characteristic of all the abdominal pains.”

Clinically there is a chance of misdiagnosis as right-sided renal colic sometimes mimicsacute appendicitis. The pacing and writhing suggested renal colic, as a patient of acute appendicitis lies still with pain and it often causes more nausea apart from pain in the McBurney. Also, CRP and leukocytes are elevated in appendicitis.

I examined for costovertebral angle tenderness but it was not significant. The same day we went for ​sonography (KUB) :22nd July 2018. It confirmed a stone of diameter 6/6mm in upper calyces of right kidney and a stone of diameter 5 mm in bladder​.

It is said renal colic is a misnomer, because pain typically does not subside completely,but rather varies in intensity. But after that Nuxvom there was not any single episode of such pain(17th Sept 2018).

Further Prescription​-Nuxvom 200 repeatedly for the expulsion of calculi.A pain episode again would indicate the action of the remedy as the stone would pass down.

Auxiliary mode​: I opted for Barely water. Persian melon (similar to cantaloupe or other muskmelon varieties).

Preventive regimen

Identify the type of stone, which informs prognosis and selection of optimal preventive regimen.  Preventive measures are decided according to the risk factors(dietary,non-dietary or urinary.)

Fluid Intake (rather than specify amount to drink), is more helpful to educate patients about how much ​​they need to drink in light of their 24-h urine volume. For example, if the daily urine volume is 1.5 L, then the patient should be advised to drink at least 0.5L more per day in order to increase the urine volume to the goal of 2L/day.

The role of dietary calcium deserves special attention. Although in the past dietary calcium had been suspected of increasing the risk of stone disease, trials have demonstrated that higher dietary calcium intake is related to a ​lower​risk of stone formation. The reduction in risk associated with higher calcium intake may be due to a reduction in intestinal absorption of dietary oxalate that results in lower urine oxalate. Low calcium intake is contraindicated as it increases the risk of stone formation and may contribute to lower bone density. Despite similar bioavailability, supplemental calcium may increase risk of stone formation.

What I learned from the case

The reason IcontinuedNuxvom after the acute colic was that a year ago, while we were in our hometown, he presented with extreme weakness especially of the extremities.The cause of this weakness was unknown, in spite of getting all the basic diagnostic tests done and a second opinion from other physicians.For this characteristic symptom of extreme degree of weakness without a cause and other symptoms of the case, we prescribedArsenic Alb 1M.

Repertorial totality formed at that time:

MIND-laughing-serious matters,over.

MIND-sensitive-noise,to-slightest noise,to the.

MIND-yielding disposition.

GEN-lie down-desire to.

GEN-closing-eyes-amel.

GEN-history-personal-tonsillitis -of-recurrent.

GEN-Food and drinks-rice-desire.

GEN-Food and drinks-sweet-desire.

Extreme -weakness.

Stomach-eructations-eating-after.

Rectum-flatus-offensive.

Mouth-discoloration-tongue-white -yellowish white.

Personal chapter-Chilly.

Eliminating symptoms-

Lie down-desire to

Mind-sensitive-noise to,slightest noise

Today when I view that repertory sheet, I saw this:

Arsenic alb was selected that time after detailed study of case and reference from materiamedica, although the repertorial totality was closer to Nux vomica. He did well with Arsenic album but the improvement was not up to the mark and this episode of colic where I had no repertory to look for characteristics indicated Nux vomica and opened up the case more clearly.

About the author

Tasleem Kalawadia

Tasleem Kalawadia

Dr Tasleem KalawadiaI completed her BHMS from CMPH, Mumbai and was a distinction holder in Physiology in her 1st BHMS. Prior to that she studied two years of Bsc [chemistry]. Dr Tasleem Kalawadia learned various approaches to homeopathy from different stalwarts by attending workshops and seminars. She pursued the basic course at “the other song”, where she was awarded the scholarship for the advanced program and studied with Dr. Gaurang Gaikwad.

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