Clinical Cases

A Case of Subacute Osteomyelitis

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Editor’s Remarks: Most of the cases published in our journals and presented in our seminars are ‘single remedy, single dose, wonder cures’. Most modern gurus would like us to believe that every case has its own ‘single’ remedy, without which a cure is not possible. No doubt, that is the ‘ideal’. But the reality is that most of the cases treated by most homeopaths go like the case below. Remedies are changed as the symptom picture changes, inter-currents are given and it’s not always a straight line to cure. This case reflects the generosity of homeopathy. If you know how to manage a case, even a set of close partial simillimums can take a case to cure.


Abstract

Osteomyelitis is a bone infection secondary to direct spread from a soft tissue infection (80% of cases). Most frequently the long bones of the extremities are involved. Staphylococcus and streptococcus account for most cases of osteomyelitis. Patient presents with fever, localized bone pain and warmth, tenderness, erythema, swelling and limited motion of the adjacent joint. Conventional treatment is the surgical debridement of necrotic, infected bone. The aforesaid patient had developed permanent contracture with fixed flexion deformity and surgical debridement of the necrotic bone was advised. She received homoeopathic treatment for about one year and the limb function was restored almost completely.

NAME – Mrs. A
AGE- 33 yrs
SEX- Female

DATE – 17-1-07

PRESENTING COMPLAINTS

1. Inability to move left leg and fixed flexion deformity of left knee joint since 1 yr. – Patient cannot move her left leg. She cannot straighten her left leg, there is contracture of left knee joint.

HISTORY OF PRESENTING COMPLAINTS

Patient was apparently well until one year back when she developed pain in left leg. The pain gradually increased with stiffness of left knee and leg. She took allopathic treatment from AIIMS hospital, where she was given calcium supplements and pain killers. This gave temporary relief but eventually the pain subsided and contracture developed. Now the left foot hardly touches the ground and she cannot put weight on left leg. She cannot walk without support, can’t even stand without support. She had Xrays and MRI scan of left leg done and she was diagnosed as SUB-ACUTE OSTEOMYELITIS WITH NECROSIS OF LOWER END OF LEFT FEMUR. She was advised to undergo surgical debridement of the necrotic bone with total knee replacement.

PAST HISTORY

History of similar complaint – pain and contracture of both legs at 11yr of age. She was treated with plaster of both limbs for 2 months and she recovered with no residual deformity.

FAMILY HISTORY

1. Cancer- mother.

2. No significant family history of Diabetes mellitus,  hypertension, heart diseases or other diseases.

PERSONAL HISTORY

Education- B.A.

Occupation- House wife.

Marital status- Married for last 9 yrs.

Diet- Balanced diet

Life space situation- Patient is a house wife, she has two children. Husband is working in some company. Economic standard is average. She has congenial environment at home and her husband is very caring.

GYNAECOLOGICAL AND OBSTETRICS HISTORY

Menarche- 13 yrs of age

Cycle- 28/4days, flow is regular, bright red, with occasional clots. No associated complaints.

LMP- 1/1/07

G2P2A0L2. Both full term normal vaginal deliveries.

No complaints during pregnancy, delivery or puerperium.

LCB- December 2003

Both children alive and healthy.

PHYSICAL GENERALS

APPETITE- 3 meals/day.

THIRST- 4-5 glasses /day. Normal tap water.

DESIRES- Spicy food (2+),

AVERSION- Apples(1+)

STOOL- D2NO. Normal consistency, brown coloured, no specific odor. No complaints before during or after.

URINE- D5-6N0-1, pale yellow, no complaints before during or after.

SLEEP- Normal refreshing sleep, 6-7 hrs/night.

DREAMS- Nothing specific.

PERSPIRATION- Cold sweat on soles of feet occasionally.

THERMAL REACTION- towards hot  (1+),desires  cold bathing even in winters and is ameliorated by it.

MENTALS

Fear of cancer(3+).

Desires company(1+)

Desires consolation (2+).

Despair of recovery(1+), great anxiety.

GENERAL PHYSICAL EXAMINATION

ANEMIA- absent

JAUNDICE- absent

CLUBBING- absent

CYANOSIS-absent

PIGMENTATION-absent

OEDEMA-absent

BP-118/80 mmHg/left arm/sitting/at 11:30 am.

PULSE- 90/min, regular, good volume, normal condition of vessel wall.

TEMPERATURE-99.8F

SYSTEMIC EXAMINATION-

Examination of left knee joint-

–         Fixed flexion deformity.

–         Temperature normal

–         No redness

–         No effusion

–         Limitation of movement(both flexion and extension

LAB INVESTIGATIONS

1. HEMOGRAM-

Hemoglobin- 11gm%

WBC- 16000/cmm

ESR- 112 in I hr.

2. X-Ray(left knee joint )-

Shows changes of subacute osteomyelitis

3. MRI(test of choice)-

Shows increased signal in the bone marrow consistent with bone marrow oedema & may also reveal associated soft tissue infection. Reduced bone density & necrosis of Lower end of Left Femur

DIAGNOSIS – SUBACUTE OSTEOMYELITIS

PATHOLOGY –  Gross lesion with permanent contracture and limitation of movement

MIASMATIC BACKGROUND –  mixed miasmatic , but chiefly psoro-sycotic. ( according to Giampetro mismatic analysis )

S.NOPSORASYCOSISSYPHILIS
1Consolation ameliorateCompany desireCaries of bones
2Despair of recovery
3Spices desire
4Coffee desire
5Fear & anxiety

REPERTORIZATION- (RADAR)

Mrs A -Osteomyelitis

Sum of symptoms  – Sum of symptoms –  Intensity is considered

112341MIND – COMPANY – desire for84
212341MIND – CONSOLATION – amel.14
312341MIND – DESPAIR – recovery, of60
412343MIND – FEAR – cancer; of34
512341GENERALS – FOOD and DRINKS – apples – aversion4
612341GENERALS – FOOD and DRINKS – spices – desire45
712341GENERALS – INFLAMMATION – Bones; of – Bone marrow; of19
812341EXTREMITIES – CARIES of bone – Thighs – Femur5
912341GENERALS – COLD – bathing – amel.39
fl-ac.phos.arg-n.calc.sep.ars.calc-p.lac-c.nat-m.puls.
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8877766666
<1
143223132
<2
2114
<3
142311
<4
111113111
<5
<6
231111212
<7
1111
<8
12
<9
221122

USING VITHOULKAS EXPERT SYSTEM OF RADAR-

We are guided towards 3 drugs-

Flouric acid

Psorinum

Mancinella

FOLLOW UP & PRESCRIPTIONS-

1. First PrescriptionFlouric acid 30/tds/15days(17/1/07)

ADVISE- Physiotherapy

FOLLOW UP- Patient experiences overall improvement.

No improvement in limb function.

Prescription- Flouric acid 30/tds/15days(24/1/07)

FOLLOW UP- Limb movement started. Patient experiences 20% improvement in limb function. She can now extend the left leg to some extent.

Prescription- s/l/tds/7days(9/2/07)

FOLLOW UP- Patient is standstill.

Prescription- Calcarea flour 6X/tds/1month(16/2/07)

Indication- It is also listed under Fear of cancer, desire spices, Caries of bones, thigh- femur.

Studying this remedy in RADAR keynotes-

Scar tissue; adhesions after operations. Swellings or indurated enlargements having their seat in the fasciae and capsular ligaments of joints, or in the tendons. Indurations of stony hardness. (Boerike MM)

Recurrent fibroids in the hollow of the knee. Hip joint disease. (Phatak Keynotes)

FOLLOW UP – Patient is markedly improved. Now she is hopeful of recovery. Fear of cancer is much reduced but still she desires consolation. Limb function is restored up to 60%. The left foot now touches the ground, the patient can walk without support for about 100 metres. The patient has stopped physiotherapy.

Prescription- Carcinosin 1M/1 dose-(as intercurrent)

Calcarea flour 6X/tds/1month(17/3/07)

FOLLOW UP- Patient is much better ,feeling very well. The limb function is still improving. No fear of cancer now.

Prescription- s/l/tds/15days(20/4/07)

FOLLOW UP- Improvement is standstill. Wants consolation.(3+)

Prescription- Silicea 30/tds/15 days(2/5/07)

Indication – Silicea is the only remedy in the rubric EXTREMITIES, Ankylosis, knee. It also covers the mentals, although in One mark.

FOLLOW UP- Patient improved remarkably. Limb function is almost 80% restored. She can walk for some distance without support, can easily climb stairs. (25/5/07). She has developed craving for raw onion(3+)

Sum of symptoms- Sum of symptoms –  Intensity is considered

112341GENERALS – FOOD and DRINKS – onions – desire – raw9
212341RELATED REMEDIES – sil. – sil. complementary remedies49
staph.thuj.alum.ars.asaf.asar.aur.bar-c.bufocalc.
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12
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1311111112

Prescription- Thuja 30/tds/ 15 days (25/5/07)

Indication- Thuja has craving for raw onion, and it is a complementary of silicea .

FOLLOW-UP – Patient shows more improvement. No craving for raw onion, she is feeling very well and refreshed.

Rx- Sulphur 200/1 dose ( 16/6/07)

Patient visited on 1/7/07. She said that  “mujhe lagta hai ki akadan kam ho gayi hai. Ghutna modne par ab dard nahi hota” (I feel it has reduced considerably now. There is no pain on bending the knee)

She was kept on placebo for next one month. On 29/7/07, the patient came again, very sad and tearful. She started weeping, on asking the reason she replied that that the physiotherapist suggested a bone biopsy and she fears the terrible pain on account of that. She had previously experienced terrible pain in the bone biopsy. She was greatly comforted by consolation. She has desire for coffee ( 1+)

Mrs A ( 29/7/07)

Sum of symptoms- Sum of symptoms –  Intensity is considered

112341MIND – CONSOLATION – amel.14
212341MIND – FEAR – cancer; of34
312341MIND – FEAR – pain – of the pain16
412341GENERALS – FOOD and DRINKS – coffee – desire52
512341GENERALS – FOOD and DRINKS – onions – desire – raw9
carc.arg-n.calc-p.calc.phos.staph.agar.all-c.ars.aur.
4333332222
1
111211
2
1111133
3
1111
4
1111122
5
112

PRESCRIPTION- CARCINOSIN 1M / 1 Dose

Sac Lac 30 tds/ 15 days

FOLLOW UP- She came on 20/9/07. She was greatly benefited. The fear of cancer and Pain is very much reduced. She was kept on S/l for another 2 months. She improved to great extent, although she has a little stiffness in affected knee occassionally. There is no difficulty in walking. She has overcome most of her fears.

S/l – Sachrrum lactis

About the author

Saloni Sharma

Saloni Sharma

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