Breathlessness and Dry Cough in a Man of 49

Chief complaints- breathlessness on walking for more than 1 km and climbing upstairs for more than 40 stairs. He was on allopathic treatment but relief was negligible. For 3 months, dry cough-single paroxysms. Respiration is difficult while lying down on his sides but feels better while lying on his back.  The chief complaints that the patient suffered from with regards to breathing difficulty, dry cough paroxysms, disturbed sleep and bad mood are all indicative of interstitial lung disease (ILD).

15/3/22 A scan report reveals reticular interstitial septal thickening in both lungs without any zonal predominance and with relative sparing of the subpleural areas in lower lobes. Multiple ground glass opacities are also noted in both lung fields. These f/s/o interstitial lung disease probably NISP pattern. Other possibility is of hypersensitivity pneumonitis

Most times the cough was so severe that he has to sit up straight to give it a break. Due to this routine his sleep was disturbed and badly affected his work and mood. He has claw like patch on his chest but doesn’t have any complaint associated with it. Inhaling cold air also caused aggravation of the cough. He was taking tablets for hypertension that is under control.

History- appendix operated 5 years ago

Father- leukemia, but now fine

Physical generals:

Appetite- normal

Thirst- 4-5 L/ day, more

Desire- sweet++ , dry sweet, fruits++

Aversion – no

Sleep- 7-8 hrs /day, refreshing. His wife said that he shouts in sleep like he is afraid of something

Dreams- doesn’t remember

Fear- no

Natural eliminations: Urine- 5-6 times/day,

Stool- 1 time/day

Perspiration- profuse, no odor

Sexual activity – often

Thermals- hot

Food- normal, cannot tolerate hot food

Fanning- wants

Covering- wants

Bathing- cold water

Open air- desire

Season- winter

Childhood- He was a favourite in his family. He was pampered and got everything easily, whatever he demanded. He had many friends and mixed easily. He went for outings on every weekend with his family.

He said he is a perfectionist. He got angry when his father didn’t listen to him. He was obstinate. He wants everything in its place and shouts if things are messy.

School- He was a topper in school, good at captaincy. He was good in singing and drama. He still makes videos of himself. He had not done homework once and got beaten up.  That was very embarrassing for him. However, that was for the first time and the last time.

College- He was too ambitious since childhood. He wanted to do civil engineering and became excellent at it. He met his wife in college and wanted to marry her; he made this very clear to his father.

While studying he was doing part time job as he wanted to earn so that he can marry his girlfriend. After marriage he went to Mumbai for 23 years for work but his son suffered from cerebral palsy so he returned to support his wife and to care for him.

He gets irritable easily and is short tempered, especially when he can’t handle his child. He is religious and prays daily. He is a workaholic. Of late there was a big financial crisis in his company and that made him leave his family for work.

He is a revengeful person and waits for the right time to strike back at anybody who has wronged him. He drinks daily. He doesn’t like to apologize which gets him into trouble. He said girls get attracted to him but he does not have time for them.

Every time there is a problem in his family with his child or in his business, he gets extremely angry. His wife said that there is no reason to get so worked up but he gets angry and very upset. His father is old now but he still wants to find out what is going on in his son’s business.

The patient does not like anyone giving him advice or asking about his work. This conflict makes him very angry. Then he shouts at his father for interfering. This has been their rapport since childhood. The patient strongly objects to his father’s bossiness.

The patient’s wife said that both father and son are alike in this trait of wanting things to happen only their way. That is why there is so much tension in the house. However, at the end of the day the patient feels very sad for being so rough with his father.

He feels that his father is now very old yet wants to control things in his old rigid ways that are impractical in today’s times. This sadness then makes his heart beat very fast and he needs to take a walk outside to calm down. The daily struggles with his father make the patient very angry and sad. He can’t get over it. Thus, symptoms of breathlessness become worse.

He has to take care of 3 daughters of his brother-in-law because he is not doing well. The patient confesses that he doesn’t like it but for the sake of his wife, he has to continue with this.

Remedy – Kali iodatum 200, 1 dose. Follow ups – patient came back after one month. He was much better, dyspnea better, cough almost 70% better. SL.

2nd month improvement good. He started to get itching on his body. SL.

3rd month much better; itching and eruptions on body increasing. Sleep improved. SL.

5th month itching better and overall patient much better. Repeated the scan which showed 80% resolution of the fibrosis as compared to the previous scan. The mental anguish had gone down markedly. his relations with his father specifically were better and he spoke to him instead of shouting.

10/1/23 scan report:

As compared to previous CT scan dated 15 March 2022 there is near

complete resolution of the ground glass opacities, with 80% reduction

in the degree of the interstitial thickening s/o good response to therapy.