A Case of Leg Ulcer

Mr GS

Profession: landscaper/environmental arborist by trade.

DOB 1959  (44yrs)

First seen 9.12.03

 

Main complaint:  Daintree Ulcer on posterior aspect of L calf muscle in leg

 

Daintree ulcer, also known as Bairnsdale ulcer or Buruli ulcer is caused by Mycobacterium ulcerans. Mycobacterium are the same family as TB – usually soil borne.  This particular one is an environmental mycobacterium that produces a toxin that kills fat cells, blocks capillaries and inhibits local immune responses. It is usually an ulcerative condition of the skin and subcutaneous fat but can result in very extensive skin loss.

 

http:/members.ozemail.com.au/~groverjohnson/Mulcerans.htm  is the site where I obtained a fairly good description of the condition.

 

Mr GS has had this ulcer for 3 ½ yrs.  Has had varied history in that time with the ulceration ­¯ in that time. At presentation it was at the worst it had been.

Ulcer covers an area approx 7-10 cm in diameter.  Has multiple openings and appears to be more fistulous and burrowing than large areas of skin destruction. There was marked loss of muscle tissue within the calf making the ulcerated area quite indented into muscle bulk.  I took this as a personal characteristic particular as all the clinical descriptions gave a picture of a more open large area of skin loss.

 

Has a red / blue areola around each hole.  GS said the openings can heal and then break out again or in a different place.  Openings leak some blood, also discharge from milky orange through to creamy or yellowish – discharge can leak out and drip down leg at times. Amount of discharge is variable.

 

Pain:  Was painless!! For a year or so (Syphilitic?)

When painful it was a deep burning throb of a dull nature.

Now can be painful < touch, < pressure (of bandage, at time only)

 

Last 1-2 months – pain radiates up into L outer hip area and is

< driving especially if driving long distance

Some throbbing & pulsating (but not pulsating in time with pulse)

 

Circulation to the area is poor.

Smell: Ulcer has a foul smell, putrid < recently

SAI ulcer has a mind of its own

 

I asked GS what had happened in his life around the time of the ulcer starting

 

4 years ago –  Person at his place of work undermining him – anger, resentment, feelings of aggression – got ill and quit job.  Had a breakdown (has history of depression see past history).  Also had resentment and frustration re his relationship which was not evolving as he wished it to – agitation and would say hurtful things.  This would all ‘eat away at him’

 

OTHER COMPLAINTS

 

Head aches / neck

Last 3-4 mths – neck would crack, catch for a moment then come loose and jar

< stooping the head

Headache would then come on and would stay for whole of next day or even longer.  lateral & vertex,  Constant dull with some sharp pains

> aspirin, > reiki, > rubbing with finger tips

 

GENERAL INFO

Bowels – rarely constipated usually loose

Thermal Ambi – upper body hotter > cooler weather,

Sleep usually disturbed esp after 4 am restless, tosses & turns

Some nocturnal pains – bone pains in shins

Gets indigestion and heartburn

Some flatulence

Lethargy

Sweats – maybe more than normal – head & upper body – if sweat gets in eyes can make the eyes a bit gunky

< for wheat / dairy

craves – spicy, warm/hot foods, acidy foods, bread & butter

Averse- sweets, chilli/curry, cucumber (makes him burp), rockmelon, watermelon

Drugs taken – nil except alternative medicines – at present is using colloidal silver & gold,

 

MENTALS

As child shy, strong willed, dyslexic (more writing than reading), Anticipatory anxiety but can do task once started

Slight stutter at times

Very self critical and hard on self

Likes to achieve

Has had several breakdowns and major depression

 

Family history

Mother – Motor neurone + yearly TB screening

2 out of 3 members of the family get motor neurone (SYPHILITIC)

 

Past history

 

Mother was taking tetracycline during pregnancy – affected patients teeth – discoloured

Sickly as child

Boils

Multiple ear abscesses

Tonsils and adenoids removed

Positive reaction to TB mantou test

Grommet placed in L ear – R ear TM already breached & discharging

Acne – mild

HEP A (never well since) ? post viral syndrome

UTI’s

1995 Major depression

97/98 Infection – face around nose and into sinuses Staphylococcus and other unnamed bacterium found – pt was overseas in South America at the time so some info not known – infection recurred a 2^nd time this time went into mastoid/ maxillary area then formed sinuses ( fistulae) to surface and discharged for quite some time – given antibiotics

 

The major rubrics I looked at were: mostly from Boger Boenninghausen Rep

1. Ulcers deep
2. Ulcers fistulous (I used this as an eliminating rubric)
3. Ulcers foul & offensive
4. Ulcers painless
5. Ulcers purulent suppuration
6. Ulcers discharge bloody
7. Syphilitic
8. Discharge yellow
9. Betrayal  (I felt the betrayal at work was the biggest causative factor)

 

I also considered that the remedy had to be tubercular/syphilitic as he was showing a marked tendency to Syphilitic miasm – family history & personal history.  Pains < night, bone pains, ulcerations of a destructive nature, deep depression with thoughts of suicide

 

Also I was loathe to start at Tubercular or should I say Tuberculinum because of the warnings re using Tub when there is active TB – while he does not have TB per se – he reacted positively to the TB mantou test and the bacteria he is fighting at present is from the same family of bacteria as TB.

I therefore  selected Syphilinum (Leueticum) 30C as the miasmatic intercurrent.

 

The remedy that came immediately to mind was Silica.

Fistulae, infection based history, ulceration, anticipatory anxiety, tonsillitis, ear abscesses, acne, boils, strong willed, self critical (high expectations of self) fear of failure, pussy discharges, bloody discharges, Tub/Syphilitic remedy, strange scarring at sites on ulcer – almost keloid ( Homeopathy Treatment for Keloid Scar ) appearance, bone pains. I chose Silica 30C as the preferred potency – his susceptibility and sensitivity were both morbid in my mind therefore I chose a lower potency with frequent repetitions.

 

 

Remedies given

Leueticum 30C  daily taken in morning on rising

Silica 30C TDS

Calendula Tincture to be diluted as a wash to clean ulcer

Sunlight – to bathe the ulcer with sunlight (not in middle of day) for approx 10-15 mins whenever time & weather allowed

Vit C & Zinc supplement

Good Multivitamin and mineral supplement (only in short term to combat depressive thoughts and tendency that was starting to rise again – had not been eating well for a while so thought the supplement worthy for a while until diet picked up again.) Stop colloidal silver & gold.

 

Received a call one week later to say that he was wanting to retake the colloidal gold as he was experiencing agitation and frustration and that his sleep was again getting very restless and couldn’t sleep past 4 am, concentration down, neck worse.   Leg – smells better, discharge had at first increased with hard lumps of yellow green pus coming away – then came back to a more constant level but was cleaner though still orange(ish) in colour.  Pain in leg had increased at times – tightening stabbing

 

I did not want him to retake the colloidal gold – Aurum had also come up very high in my repertorisation and I felt that it had a place in the treatment.  I had at first not been willing to give it until I could observe the results of withdrawing the material dose of Gold.

 

I then gave Aurum 200 HS x1 PRN to be reviewed after 1^st dose.

 

I then did not see the pt until last night  (2.2.04) – as he had just started a new job and did not have time to come  – I took it as no news is good news!!

 

2.2.04

Leg was slow to improve at first then improved rapidly for 2-3 weeks then stabilised and had not gotten much better but definitely no worse – however the stalling of the progress also corresponded to an increase in stress with starting the new job, his father being ill and requiring surgery and not making a deadline for copy for a book he was contributing to (he was very down on himself about missing the deadline) – However he had improved on the whole mentally and emotionally and had managed to hold his own even though the stress was some of the greatest he had had for some time.

 

I looked at the ulcer – leg looked better, circulation in area better in general, some openings had healed over, those that were still open had good granulation and much more healthy looking flesh visible; discharge was down though not stopped but was not offensive, leg – whole area around the ulcer appears to have regained some shape and bulk (the area was quite sunken and greyish when first seen, areola was much less pronounced and colour more into red than red/blue.

 

Headaches/neck pain much decreased.  In all more positive in his outlook. Sleep much better

 

Remedies given

Leueticum 30 once a day mane

Silica 30 TDS – BD (he’s having trouble remembering the midday dose while at work and since he is so down on himself for not doing things right – I said BD was OK as I felt he had worse reaction from emotions than by missing a dose.)

Aurum  HS PRN – I have left it up to GS to time the Aurum – he is in touch with the changes that indicate it – (ie. The disturbed sleep begins again – with the 4am aggravation and a day or two after that the headache / neck problem returns – repeat on night after sleep starts this pattern.)

 

Continue Calendula Tincture and Vit C & Zinc (our soil here in Australia is very deficient in Zinc) unless he gets a metallic taste in mouth then stop zinc. Zinc also came quite high in some of the repertorisations.

 

Diet has improved so can take Multi vitamin & mineral only if he is very stressed or starting to feel a bit down

 

18/5/04

Silica 30 needed at least 3 x day to maintain emotional status quo and had been feeling ‘down in the dumps’ a bit lately.

 

Physical improvement stopped and mentals not holding .

Silica 200 To repeat ORS (on return of symptoms)

 

23/12/04

 

Changing jobs again and doing 2 jobs for a while STRESSED

Leg much better but again mentals not holding and feeling down again.

Had gone back to Silica 200 daily (had been about  1 x in 4-7 days)

Silica 1M ORS

 

30/8/05

 

Taking Silica 1M approx every 4^th day

Leg looking good. Calf muscle filling in and looking a more normal shape again.  Only one fistulous opening and active area of ulcer now covering area of 3cm x 2cm. Keloid like scarring is diminishing and flattening out somewhat.

 

Said he is still taking the odd dose of Aurum 200 approx once every 1-3 weeks depending upon his stress load. Leueticum stopped. He had been only taking it weekly to fortnightly. He is quite intuitive so leave the timing to him – if he’s unsure he rings.

 

14/11/05

 

Feels Silica 1M is not working the same, as emotional stuff is coming up again and remedy not helping that much. Took Aurum 200 x 1 dose and felt > not huge shift just subtly. At present just feels like in limbo. Not bad not good! Still a lot of stress with job. Feels really restless. Wants to pack it all in and travel again but kids are not at age or stage to be good with this. I finally feel that I am ready to try Tuberculinum, not sure still, but feel that the ulcer is not really active anymore and things are stalling!!??

 

Leg no better, no worse.

 

Tub 1M  HS x 1

Silica 30 ORS (left it to him to find his timing and ring me if needed guidance – GS has been using Homoeopathy since he was a child and has a good feel for it.)

 

27/3/06

 

Presented with sore neck and headaches – had put neck out plus stressed at work again – concerned over ethical differences with work colleague – resigned but resignation was refused. Frustrated with work and life in general.  Leg ulcer had stirred again recently.

 

Reported that when he took the Tub 1M back in Nov – for first 2 weeks felt like he wanted to run away, felt vague and ‘away with the pixies’ a bit.

 

Got a cramp like pain in ulcer. At first the ulcer flared – back to 2 openings (but very close together) then settled. After Xmas he wasn’t feeling very well so decided to restart the Zinc and Vit C. After this the ulcer healed very quickly and all openings closed.

 

Leg looked quite good when I viewed it today. Are a couple of what looks like Calcium granules (size of pin head) working their way out of the scar of last opening to close. The scarring still looks a bit keloid but some of the areas the tissue has had to cover are quite large ,so neat scarring is probably not an option. The muscle bulk of the calf has filled out and is near to a normal shape. Said he took Tub weekly for a while (if he left it longer he got cramps back in the area again and they agg after the dose of Tub for a day or so but didn’t do it if he took it weekly. Once ulcer got better, he forgot to take it so only now and then especially if he feels like running away again.

 

Has been quite stressed lately and feels that the ulcer area is stirring a little bit every now and then but nothing happens. Emotionally is struggling again. Says that he has tried Aurum again a couple of times since he had the Tub, but says it just didn’t feel right anymore.

 

Considering Nat mur as a follow up to Aurum now that I feel he has returned from such a Syphilitic state

 

************************************************************

So in looking back I feel that we have made some real progress especially with the ulcer. Considering that they are medically an enigma and usually leave massive deformity from both the ulcer and the surgical methods of ablating the tissue away from the ulcers, I feel that the progress has been quite remarkable. Just wish I had owned a digital camera to have been able to document this with pictures. I made drawings to scale so I had a good idea of the size and number of openings.

 

I still feel that I have not been able to make the inroads to his psyche that I would have liked to. He is somewhat fearful of the Motor neurone disease which is prevalent in his family. He says that most of the males in his family have been dead by 50 and he is 47 now… though not showing any symptoms yet.

 

Addendum: 2013 – He has recently had genetic testing for MNS and is negative.

 

He still struggles with his depression at times and paucity of work available for him has been a big issue in this. Remedies help though never seem to eradicate this tendency.

 

Leg still looks good and has filled out more – though still a little less bulk in gastrocnemius muscle than the other leg in a couple of places and scars are much softer and more level.

 

I was very early in my practice when I did this case and wonder if I would have chosen the repetitions etc. that I used the same way now – however the results were great and I learnt a lot. It was good working with someone who had used Homeopathy for most of their life as GS was good at being able to feed back when things were stalling and when to repeat doses. This was all done with dry doses – I now use a lot more water doses these days.