Clinical Cases

A Case of Joint Pain – A Small Remedy

Dr. Amit Singh Pal presents a case of joint pain which he solved using his deeper understanding of the small remedy required.

Mr. KNR, aged 50yrs was referred to me for multiple complaints. The first thing that surprised me was that he travelled a long way from Bangalore to Belgaum and secondly that he came with his son (and throughout the interview, he was dependent on his son for emotional support. It was as if he was looking for approval from his son, after answering every question put by me. Why he was looking for support became clear to me when I enquired about his work). Basically he has always been unemployed. He never worked in his life, so he passes his time mostly at home and with certain local politicians. He’s involved in a few social works going on in his locality; (to what extent is hard to determine. He tried to brush off the subject as ‘matter of fact’).

Presenting complaints:

  • Pain in left heel since 3yrs.

On X-ray, found to be Calcaneal spur.

Pain more after rising from seat for 10 steps or so, after that normal.

Now, since 6months, on rt.side also.

  • Pain in knees since 3yrs.

Wt: 86kg. All complaints since he had chicken guinea 3yrs back.

  • Also pain in back< bending forward.
  • Tingling in Low limbs<going to bed++ at night.

>pressing++.

  • Cramps in toes < working in water.
  • Cramps of diaphragm < bending forward++.
  • Pain under right chest, liver region < sitting for long++.
  • Can squat on front toes only, cannot put heel down on floor.
  • Random pains in fingers and elbow >standing, sitting on chair.
  • Unable to sit normally, can sit with back support only or with legs straight and support on sides of chair.
  • Pain in low back < rising from seat. Unable to raise the leg straight while exercising. Needs support on rising from seat. < over-lifting, after.
  • Occasional Abdominal pains since 7yrs. Nausea < after eating.  Feels fullness of abdomen. Difficulty in running, breathlessness. Pitting type of Oedema< both legs.
  • Sleepiness: More that 15hrs/day, easily goes to sleep anywhere, anytime. <reading+++, travelling, listening music, watching TV etc. Yawning is very frequent.
  • Memory-forgets frequently. Hard to recall things.
  • Black discoloration of face on right side and on axillae, groins.
  • Perspiration: odor, offensive; sticky in groin region.
  • Occasionally chattering of teeth during sleep, not a regular symptom.
  • Biting of tongue during sleep, then wakes up.
  • Offensive odor from mouth occasionally.
  • Pain Sciatica < bending forward.
  • Pain lumbar, sometimes > only after painkillers.
  • During fever, easily relieved but body becomes very heavy++.
  • Much laziness since chicken guinea.
  • Constipation.
  • Urine – urgency if he drinks more water than usual.

Here I would like to give you some live details as to the happenings in the clinic with him. I asked him what was troubling him and he started with Lower limbs and I started writing. He was quite animated in showing his complaints and was eagerly showing me, pointing out the affected area etc. and throughout the complaints, standing, sitting, bending etc. Now, every time he stopped with a complaint, I would ask him, IS THERE ANYTHING ELSE; and to my surprise he would spontaneously come up with next complaint, again explaining in details about his pain. It went on this way for a hour and a half until which he had travelled from lower limbs to upper limbs, abdomen, head, mouth, sleep, sweat and so on. When I realized that his complaints are not going to stop and the remedy was already clear to me now, I decided at last to stop him and jump to the next section. I am sure that had I let him continue, he would have just come up with more complaints. It was as if his whole body was affected, each and every organ was affected. Here, I could see his anxiety about health+++.

 

Past history:

  • H/o recurrent fevers with vomiting+. This symptom is not present since 15yrs.
  • Many sneezes at a time, during coryza, which amel.

 

Family history: (Sycosis is the dominant miasm here – in my view).

  • Mother: Joint pains, greying of hairs since childhood.
  • Father: Jaundice – expired.
  • M. Aunt: Joint pains.
  • Siblings: 1-self. 2-Bro: joint pains, obesity. 3-Bro: bone cancer, expired. 4-Sis: acidity, epileptic fits.

Personal history:

  • Appetite: Good++.  Heavy breakfast and then directly dinner. Warm food is preferred.
  • Thirst: ½ ltrs on waking. Good. 1 – ½ ltrs/day.
  • Desires: Chicken+++. Mutton (sheep)+++. Fish++. Egg. Salt (N). Sour++. Fruits++. Earlier, he used to use much lemon+++ in food.
  • Aversion: Vegetables. Bakery items. Sweets++.
  • Micturition: Mild odor in urine, if urination is delayed.
  • Bowels: feels, he may be constipated.
  • Sleep: Deep, excess. Sleeps on right side, mostly on sides. Covers up to chest. Most fresh in mornings.
  • Dreams: not specific.
  • Perspiration: Profuse during summers. Other times only on forehead and arms. Offensive in axilla. White staining.
  • Habits: smoking, drinking. Occasional headache in morning (?after sleep).

 

Thermals:

  • Bathing: Not too warm.
  • Feels more heat generally.
  • Fan: Needs even in winters.
  • A/c: Feels good.
  • Season: < getting feet wet++.
  • Hill-station, sea-shore: Normal.
  • Travelling: Normal. Occasional vertigo, falling sensation.
  • Prefers open air, prefers a steady stream of open air.
  • Generally cannot tolerate heat++.

 

Physical:

Dark complexioned, Clean tongue, Clubbing of finger-nails, with white lines on them, a few deformed nails. Obese++. BP: 150/106mm Hg.

Life-space:

  • Anger: sudden, lasts for short while only.
  • Always talks with a smiling face (My impression was that he is manipulative with a sweetness ).
  • Not at all religious.
  • Difficulty to say ‘No’ to anyone; readily goes with what the other person is saying.
  • Hesitation while talking face to face; bashful+.
  • Broods for 2-3 days, if makes a mistake.
  • Self-respect, anxious about it.
  • Fear of snakes++.
  • Went into work after 10thstd, where he failed (in 10th std.) due to fever.

Additional notes:

After this case, I decided to take a little break, hence left the clinic along with the patient himself. On the way out, he started chatting and I was surprised by his questions! He asked me how much do I earn daily? How quickly can my son buy a house if he was in this profession? His questions were all based on money and materialistic things. He even asked me what kind of house I lived in and how much rent I pay for it!I could clearly see his predilection or fixation over money. Other than all this, he seemed overall a sweet person.

 

Analysis:

After listening to his many complaints, the remedy was clear to me. However, in the end when he started talking about money matters, it was doubly confirmed and I was now completely sure as to his cure.

Let me share with you an incident before I jump to reveal the remedy. In 2006, when I was learning under Dr. Sunil Parse, every Sunday he would go to a separate clinic where from morning till night, he would only prescribe acutely, without taking a complete case. I learned that such a practice definitely sharpens a physician’s mind. So one Sunday, I got the opportunity to accompany him, and there a lady came up, aged around 60yrs and she started complaining in the same fashion. Starting from lower limbs, it went on and on and then her abdomen, her neck, her headache and so on and on..within 15-20 mins she had narrated about 40 complaints with  their modalities. She was still continuing when he stopped her from talking and somehow just convinced her to take the medicine that he was giving. She was somehow not convinced and continued with her chatter of complaints that she was having. Standing by his side, I was wondering which organ is left now to complain about! She had almost covered everything.

Now, imagine my surprise when she came for follow-up after a month and she just offered 6 complaints and then kept quiet. I was literally shocked as to what happened to her  many complaints. All complaints had just disappeared and only a handful remained.
He again prescribed a dose of 10M with placebo for a month.

This was a unique experience for me and I had much to learn from this. I enquired as to why he prescribed this remedy and he explained in short that there was already a line of waiting patients. From what I could make out, he explained that patients of this remedy have a kind of deep insecurity, they are extremely miserly and they want value for their money. So with the typical human thinking, they respond in a manner that anyhow they are going to pay the doctor, so why not get treated for this and this and that and so on.

In this case also, we can see a similar behavior and this is what led me to decide my remedy. Now, I will tell you what he did when he reached back to Bangalore after my interview. I had asked him to check his blood pressure daily in the evening at the same time for a week and inform me. He instead went for all investigations regarding his heart and was diagnosed with hypertension. See the irony here is that I had already prescribed my medicine and he had consumed that single dose. The investigations were done after consuming the single dose. However, after a week, his blood pressure had totally normalized and he phoned me to say that with a relief.

A month later, he again came down to my clinic for the follow-up. Here is the first follow-up of this case. A single dose of Calcarea fluorica 10M, with placebo for a month was prescribed initially:

  • BP: 110/70mm Hg. Wt: 79Kg (7kg weight reduction within a month!).
  • Pain in heel and general health better by 10% only.
  • Pain in knees reduced by 10%.
  • Pain in back reduced by 10%, but now able to bend further down.
  • Tingling in lower limbs, completely cured.
  • Cramps in fingers, completely absent now along with cramps of diaphragm.
  • Still squatting on front toes.
  • Abdominal pain and fullness is completely cured.
  • Absolutely no edema on either foot.
  • Sleep SQ.
  • No offensive odor from mouth.
  • Constipation and sleep are SQ.
  • He is having acute inflammation of throat after the rains in his area.

Since this remedy also covers <wet weather; and since there were some areas where the remedy had not completely shown its action, I decided to repeat the dose of Calcarea fluorica 10M and so I did.

After that I only received a phone call a month later that all his complaints were better and he does not feel like coming down all the way. Hence he requested that I send the medicines by courier. I continued with the treatment but I never needed to repeat Calcarea fluorica or any other medicine in this case.

Here I would like to point out that I did not repertorize the case as the essence of this remedy was clear to me from what I had practically seen in the clinic. However, the complete picture of this drug was not known to me until a few years later when I was gifted with Materia medica Viva by a friend. George Vithoulkas has put up a beautiful picture of Calcarea fluorica here. Over the years, I have treated some cases with Calcarea fluorica. I would like to point out that this is not a well presented remedy in the repertory, though it is present in about 730 rubrics in Synthesis 9.0. Hence, with this remedy it is often hard to find it on repertorisation. It is the very essence of the ‘non-stop complaints’ of the patient that makes the physician think of this remedy.
One of the chief indications that I have found from past cases is ‘Ailments from financial loss’ or ‘Ailments from fear of financial loss’. E.g. the complaints of the old lady described above had the origin in the fact that she was compelled by relatives to find a match for her daughter. She was so worried about the expenses that in the end she decided that she will not get her daughter married, as she did not want to suffer a financial loss and she was discussing all this openly. In our male patient, no such history is evident but the fact that he never worked in his life itself could be a maintaining cause of his financial insecurity.

These patients not being the argumentative type, often suppress their anger and fears and this is the origin in my view of their problems, which progress very slowly over the years to a full-fledged disease. Due to the sluggish nature of the progress, there is rarely a visit to a physician in all these years. This is in contrast to Arsenicum which visits many physicians even for a small complaint and has the same tendency to exaggerate his complaints, along with the insecurity and miserliness found in Calcarea fluorica. Both remedies are amel. from warm food and drinks and agg. from cold weather. The difference lies in the fact that Calcarea fluorica is more passive in its behavior with the physician and is in general a hot remedy, whereas Arsenicum is a chilly remedy on a general level the patient is forceful with the physician.

There are many other remedies which can be differentiated here, but once the essence of Calcarea fluorica is understood by the physician (even more so, if the physician has been lucky to have seen such a case in practice), there remains no confusion, as Calcarea fluorica is a remedy with unique mental and physical traits.

If readers have any queries, they are most welcome to ask!

About the author

Amit Singh Pal

Amit Singh Pal

Dr. Amit Singh Pal, M.D. (HOM) was born in Uttar pradesh, educated at various universities, and traveled all over India practicing in various places from Delhi to Tamil nadu. Presently he is settled in Belgaum, where he is providing his services at RMO, Bharatesh Homoeopathic Hospital and Research Centre, Belgaum. A teacher of Homoeopathy, he has lectured at various colleges in the country. Dr. Singh Pal has wide experience in the practice of Classical homoeopathy, lately practicing solely on the guidelines of Vithoulkas, after having trained under Dr. Sunil Parse from Nagpur. His varied experiences have helped him treat some incurable cases and now he has gathered his experiences in the form of his upcoming book : ‘Art of Case-Interview’.

47 Comments

    • Yes, 10M is available, but I am struggling to get 50M. If you are around Delhi, Calcutta or Gujarat, then it is more readily available.. at other places, pharmacies don’t keep higher potencies.

  • In fact I am not able to know how long the treatment went for this particular patient.
    Spurr is the degeneration of heel bone and there is growth may be one heel or both.
    In fact the Arthritis some time start with spurr and if the pain is starting from lower to upper side then along with Ledum Pal 200 addition medicines like Calcarea Phos 6, and Heclalawa 6 and Ruta 6 could have been more effective
    Heclalawa because it is a preventive for osteoporosis and stops further degeneration of bones.
    similar cases were cured by giving this combinations including Calcarea Floor 6.
    Regards

    • I am not a fan of polypharmacy as far as homoeopathy is concerned. Other than injury cases, I avoid it in allmost in all cases. Also, may I know the reason for prescribing so low potencies.
      I shall look into the case sheet and inform you, exactly how long the treatment went, but I think you can make a fair idea from the case and analysis.
      I shall give a general opinion here: As far as Centesimal scale potencies are concerned, treatment is never over, the physician just waits for next acute episode or a flare up of chronic disease to appear. In LM potencies, however, the story is different.

    • I suffered from heel pain in October 2002. It was a little after menopause. The remedy that cured me was C.F. I started with 30 potency, graduated to 200 and my problem ended with a single dose of C.F. 1M. It took about 4 months but the improvement began with the very first dose. I do not know whether the spur vanished or not (doctor I consulted told me that it was so and that I can undergo a small procedure which can give me relief and which I politely refused since I had gone to him out of curiosity to get it diagnosed) but the problem or the pain has not recurred.

  • I think everyone deserves a follow-up of this case. Recently a couple of weeks back, he called me to say that he has now lost considerable weight and he is looking more young now! whatever he meant by that. The important point is that he had dark discolouration of face on one side which looked very ugly. I do not remember that I mentioned it or not, but he informed me that over the period of time it has reduced by 70% and face looks more clear now. I felt that anytime soon a 50M may be needed and hence I am struggling to get it..
    Any queries are welcome and thank you for your feedbacks.

  • It is nice case. The finance insecurity is the main cause of so many ailments now a days and Calc Flour is the medicine. As it is deep rooted trouble the medicine should be used in high potency with out repetition or hurry in repetition.

  • Dr. Amith ,I am very thankfull to for sharing your knowledge in excellent mannaer amd with details.
    Thanks and Best regards. God bess you.

  • Dr Amit, excellent case learned a lot from this thanks for sharing.. Can you explain why you gave higher potency only in this case

    • Main criteria was level of confidence in prescription. Also; I want to give you a practical example here. After I posted this case; my colleague came to me and told me that he had a similar case but he prescribed this remedy in 30 potency. There was no effect even after repeated prescriptions.
      A single dose of high potency is ten times better than frequent doses of low potencies. But the physician must be confident of his prescriptions.
      These are my personal views and a limited reply. Posology in itself is a big topic to discuss.
      Thank you for your encouragement and feedback.

  • Dr.Amit Singh Pal sir, your case with details is a very good learning experience for us.THANK U VERY MUCH
    for such a interesting case, and I also request you to let us know how we could collect your upcming book
    “Art of Case-Interview” through hpathy.com, and also request you to send your further experienced cases
    to hpathy.com, thank u once again.

    • Thank you Dr. Niranjan Sahoo for your encouragement. I shall send you a PM with details for obtaining my book. Good day.

    • I think that is against website policy. If admins allow me I shall post the details. However, I checked the profile page on Hpathy.com but it has limited options to fill our details.

  • Hi Amit,

    You said you gave a high potency because of your level of confidence. We were taught to give higher potencies based on the level of experience of the patient. The more intense the level of experience, the higher the potency. So, if they are presenting a clear emotional/mental picture we go with higher potencies. If it’s mostly at the physical level, we stay with the lower ones.

    For remedies, if you can’t find something locally, we’ve had good luck with Helios, in England. You can order online, and they’ll mail it to you: https://www.helios.co.uk/shop/search/remedy/list

    thanks for posting this case,
    monica

    • First of all Thank You Monica for your input.

      Yes, you are right. But as I said earlier, Posology is a big chapter to discuss in these small posts.
      One of the criteria was good level of confidence..there were other criterias too. I prescribe certain remedies high only and certain remedies low only. Some I repeat frequently, some I dont for months…. and so on. Again, I would say, Posology is a big topic to discuss here.

      As for Calc.f, my experience is that it is better to prescribe high and also repeat it as and when necessary.

      Good day.

    • I seriously wish everyone takes a complete case for every chronic complaint, however simple it is. Then and only then, can we all have a complete understanding of our remedies, even understanding the parts which did not come out in proving. I hope my book helps to further this objective.
      Thank you for your feedback.

  • Excellent & amazing !Thanks Dr Amit for such a nice presentation.Such high potency can be prescribed by an experienced physician.May we prescribe Hahnemann’s new competencies? I shall request u to post
    such article regularly.

  • HI DR AMIT. HOW YOU DOING? READ YOUR CASE, VERY KNOWLEDGEABLE. BEST PART WAS UNDERSTANDING AND ANALYSIS OF CASE. WAITING FOR YOUR BOOK.

  • DEAR SIR,
    I CONGRATULATE YOU FOR TREATING THE CASE WITH CAL FLOUR 10M IN THE VERY FIRST DOSE, BUT I DO NOT AGREE THAT LOWER POTENCY OF CAL FL DOES NOT WORK. I USE 6X, 30X, 200. THEY ALL WORKED WELL I USED 6X IN TINY LUMP EXPECORATED ONE TIME AFTER STRONG COUGHJNG IN MORNING. I USED 30X IN CATARACT AND HE CAN READ NEWS PAPER FOR THE LAST 20 YEARS WITHOUT SPEC. HE HAS BEEN ADVISED TO USE 3 TIMES SAN.MARTIMA EYE DROPS EVERY DAY WITHOUT STOP TILL LIFE TO MAINTAIN THE SAME VISION. STILL HE IS USING THE SAN,MART DROPS THRICE AND NO SURGERY NEEDED SO FAR. TWO CASES OF HARDNESS IN MAMMAE IN YOUNG GIRLS TREATED WITH 6X 4 DOSES EVERY DAY FOR A WEAK OR SO. BOTH BECAME OK. ONE CASE OF VERICOSE VEINS BECAME OK WITH 200 FOR A MONTH OR SO. MY PROF DR JUGAL KISHORE USED TO TEACH US THAT IT IS MORE IMPORTANT TO USE CORRECT REMEDY THEN POTENCY.
    THANKS
    DR SHEKHAR

    • I wish there was a thumbs up sign (Like button) here as in facebook. 🙂 Thank you Dr. C. S. Gupta for taking time to share your experiences.

    • Thank you Khorshed. In future, I shall try to show some case on LM potency too. I practice on both C-scale and LM, depending on the case. I don’t use other scales so much in practice. Thank you for your feedback.

  • Beautiful presentation of the case. Calc f :” non stop compalints of the patient”, is it mean ” non stop about one or few problems” or ” non stop about many complaints”
    Thank you

    • Non-stop about many complaints. Its not the loquacity of Lach, which is non-stop, sometimes even until the face turns blue. Here, generally the complaints come up when the physician asks, ‘Anything else’ and the patient comes up with a new complaint describing it dramatically as if it is bothering him very much. This process goes on and on… that is what is the peculiarity according to me. I have also explained this in my analysis in case above.
      Thank you for your feedback.

  • Very nice sharing of case study dear Dr.
    I have been suffering from lumber and cervical spondylosis as well as pain below the ankle(the latter symptom lasts for a few seconds after getting up from bed).
    I am very eager to read some cases related to these.

    Regards,

  • If the case were repertorized to pick up CALC F it would have helped an amateur like me to build up the confidence and for the sake of learning the techniques of repertorization.

    • You are right, but it is not that a physician has to repertorise for every case. Once, the essence of the case is understood, and we have a matching essence in Materia medica, direct prescription can be made.
      Repertory is just a tool to reach the simillimum and so are many other ways too. Depending on a single tool will not be a wise idea.
      However, thank you for your feedback. In future, I shall try to post my cases along with the repertory sheet.
      Just as an exercise, Can you find the single remedy rubric in this case for Calc-f.

  • Nice presentation of a clinical case – best way to learn : study of materia medica and its understanding when we meet a patient who needs such a remedy… Always learning!!! Thanks for sharing your clinical experience !

  • It was really a great experience to read the case. I am now surprised to read the comments. Why are there so many comments on the high potency? I know, a lot of cases have been treated by a single dose of 10m or even CM potency when the consultants were truly confident of the remedy. We should read all such successfully treated cases on their merit and not dismiss them because of our bias against the high potency

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