A 47 year old male accountant, married with three children, presented to me on 7-4-2011 with the diagnosis of bilateral closed angle glaucoma with progressive dimness of vision, since 2004. He was under medical treatment with Diamox (acetazolamide) which is a diuretic.
Present complaints :
1- Recent deterioration of vision with headaches
2- Recurrent aphthus ulcers
3- Hiatus hernia
4- Hemorrhoids with frequent bleeding.
5- Hay fever
6- Frequent dysurea with burning and bad odor
7- A keloid on the chest wall (old scar following a previous injury)
8- Extreme anxiety and fear of blindness
History of the case:
The patient was brought up in an unhappy family. They faced financial hardship as the father had abandoned them at an early stage. The mother was distressed with bad temper. The patient had worked in a bakery shop at the age of ten and had lived an unsettled life. He was always involved in fights, aggression and gang groups, engaging in many malicious acts. In one of the attacks he was injured, sustaining a deep chest wall cut wound.
He was repeatedly kicked out of school due to aggression and bad behavior but managed with struggle to finish his education. His mother suffered for long with cancer. Her death left him with great anxiety, grief, sadness and anguish. He also developed bronchial asthma. He had jobs at different companies but all the time he was a loner, unpopular, headstrong, sensitive to criticism and sometimes physically aggressive. He got married and had three children. His married life however has always been tormented due to his short temper.
From 2000 he started to suffer from repeated severe attacks of headache which always started suddenly and only got relieved by pain killers. In 2004 his vision started to be affected with dimming of vision, white halos and dark floaters. On examination, bilateral closed angle glaucoma with bilateral retraction of the visual fields was diagnosed. He was treated with laser surgery and Diamox (acetazolamide) tablets which helped to reduce the pressure from 25mmHg down to 10mmHg. From 2004 till 2011 his intraocular pressure was fluctuating.
He also developed second degree piles associated with constipation and persistent tearing anal pain following defecation with frequent anal bleeding due to piles. He also was diagnosed with hiatus hernia following his complaint of dyspepsia and heartburn. This was associated with repeated attacks of painful aphthus ulcers in the mouth and throat.
In 2011 he decided to try homeopathic treatment, following an unexplained rise of intraocular pressure and further deterioration of the visual power. Due to some pathological retinal changes, he was extremely anxious about losing his vision.
Family history: Father: Died of heart failure.
Mother: suffered from asthma, died of cancer.
Sleeps on both sides
Insomnia and wakes up at 3 am unrefreshed
Food and drink: likes salt and spicy food. Likes lamb meat and chicken.
Likes fresh vegetables, ice cream, warm food.
Excess foot sweat with bad odor.
Hobbies: Motor racing.
Nervous, short tempered, irritable , quarrelsome, suspicious, jealous, stubborn, weeps easily, worse in the evening
Fear of snakes and spiders
Typology: Tall, slim, dark hair with alopecia on the vertex, thin nails, anxious looking.
Vital signs are normal.
General physical examination is normal apart from the chest keloid which measured about 4 cms.
Both eyes show slight protrusion and upper lids retraction, congestion of
the sclera. The fields of vision are both retracted on the temporal fields.
Fundus : cupping of the optic disc.
Visual power : 6l12 (left eye) 12l24(right eye)
Intraocular pressure was about 18 mmHg (first consultation). (normal 10-12mmHg)
Second degree piles
Analysis of the case:
The aetiology of the case dates back to early childhood. At an early stage there was disharmony and a sense of father’s disappearance, as well as the mother’s depression with financial difficulties which all reflected on his long lasting anxiety and fear. This led to the aggression, disappointment and vindictive attitude with the family and the outer world.
On the physical aspect it has reflected on his eye problem (glaucoma), headaches, bleeding piles, hay fever, repeated aphthus ulcers, urinary problems and hernia . The eye problem has caused him great concern for fear of losing sight forever.
Taking in consideration
The miasm, typology, essence and keynote.
Miasmatical: polymiasmatic predominantly syphilo+++ – sycotic,+++ tubercular++and psoric++.
Typology : slim, dark hair, anxious looking.
Essence: over-anxiety about eye sight, short temper and aggressive attitude.
Keynote: excessive physical and mental irritability, long lasting anxiety affecting body and mind.
Ailments from grief, disappointment and unhappiness.
The case in my opinion was heading more towards multimiasmatic with predominance of syphilo- sycotic tendency with tubercular and psoric miasms.
There were three medicines in mind to compare:
Carcinosin, Calcarea Phosphorica and Nitric acid.
I excluded carcinosin because there were no signs of duality. Although he is rebellious, he was never a doormat or showed any sympathy towards his family.
I excluded Calcarea Phosphorica as it is predominantly a tubercular medicine and the patient did not represent the characteristic signs of Calc or Phosphorus.
I have decided to prescribe Nitric acid because:
1- The sphere of action of this medicine is: skin and mucus membranes, (ulcers), the sweating which is offensive, haemorrhage i.e. bleeding piles and GIT (hiatus hernia), pain following defecation.
2- The personality profile: complainer, nervous, aggressive, quarrelsome, weepy and temperamental. Extreme anxiety about losing his vision forever.
Fist prescription: (on 7-4-2011)
Nitric acid 1M and 10M
The high potency was given because etiology is primarily from a mental cause.
The two doses were given because there is an aetiology.
I also prescribed a bottle of Anagalis mother tincture applied locally to reduce the size of the keloid on his chest, which sometimes caused embarrassment. It will not interfere with the dynamic action of Nitric acid.
Next consultation 6weeks later (22-5-2011): Generally feeling better, less temperamental, the medicine seemed to start its action, the intraocular pressure tested by an ophthalmologist showed 15mmHg which was slightly better.
The frequency of the headaches were less than before by nearly 20%. There was slight increase in dyspepsia. Prescribed Sac Lac.
Second consultation 6weeks later (2-7-2011): Steady improvement and he looked fresh and smiley for the first time! His self- esteem was better despite a few times where he lost his temper ( but not so severe as before). The eye pressure was kept stable since his last visit; He had an attack of hay fever but did not have to take any medication.
Prescribed Sac Lac
Third consultation 12weeks later (3-10-2011) : Progressive improvement. Recently seen by an ophthalmologist who was pleased with the pressure of 12mm Hg . Stable and there is no more deterioration of the visual power. Insomnia is better most of the days. Sleeps longer and is refreshed on waking . Prescribed Sac Lac +Anagalis mother tincture.
Fourth consultation 24weeks later (10-4-2012): Intraocular pressure is at a stable level over the last five months at 12mm Hg; no more attacks of severe headaches; anal pains were improved by 70%; the keloid size has reduced by 50%. The patient felt better in himself.
Prescribed Sac Lac and Anagalis mother tincture for the keloid.
very nice case and thoroughly explained. Can you say a little more about giving 2 doses “because there is an etiology” and how did you gave them (at what interval)?
All the miasms are covered by NIT_AC. Then why was a separate external application given?. Is it ANGALIS a specific for keloids?. Double potency were not clearly indicated by dates. why?
Very nice selection but it is not easy to find out accurate miasm.Thanks a lot
Very nice case though a little more detail on the type of pain and sexual history would have been good to understand more details on NIT-AC, especially about his marriage or extra-marital affairs.
Your views on posology really surprised me. The following paragraph chiefly…
“The high potency was given because etiology is primarily from a mental cause.
The two doses were given because there is an aetiology.
I also prescribed a bottle of Anagalis mother tincture applied locally to reduce the size of the keloid on his chest, which sometimes caused embarrassment. It will not interfere with the dynamic action of Nitric acid.”
I absolutely do not understand how all this is justified in Homoeopathy? How are we to say if Anagalis does not act on Glaucoma and Nit-ac will not act on Keloid and lastly How can one say that one remedy will not interfere with the action of the other.
I will be happy to have more information on your potency selection process. Thank you.
IT IS NOT EASY TO CURE GLAUCOMA. DR HAS BEEN SUCCESSFUL IN BRINGING DOWN PRESSURE AND MAINTAINING 12MM. VERY GOOD ACHIEVEMENT
It is a case treated with great efficiency
excellent presentation …greatest cures are always simplest.. no unnecessary interpretation or philosophical explanation… its only pure relief and that too on simple indications… keep up with more such cases
As high potency and Anagalis mother tincture have explaination,’how miasm have influence on symptom totality on which prescription is based’ should have been given explaination.
Acetazolamide is not a diuretic.
It’s carbonic anhydrase inhibitor.
Its a nice case then , acetazolamide is not a diuretic