Covid -19 in a Woman of 62

Patient: Smt AP, female, 62 years, married, Hindu, Mixed diet, basically from Kerala. But settled in Bengaluru since her marriage around 44-45 years back.

CASE HISTORY:

Patient has a k/c/o type II diabetes, hypertension and hypothyroidism, controlled on allopathic medications for the same for last 5-6 years. Her son approached me on 9/5/21, to treat her covid-19 pneumonia.

The husband and her son were both covid-19 positive as per their RT PCR tests. She had come negative in both rapid antigen test as well as in RT PCR but her HR CT chest showed her to have viral pneumonia, with CO-RADS V, and CT severity 15/40.

Her oxygen saturation was dipping and they could not get a bed in any hospital. They were desperately trying for bed with oxygen support, or any bed and trying for oxygen cylinder with no success. In desperation they contacted me for help after getting to know of me from some staff in a local government hospital.

Chief Complaints : on 9/5/2021

LOCATION, ODP	SENSATION	MODALITIES	CONCOMITANTS	INVESTIGATIONS
Respiratory System Since       6 days, more A/F : H/O exposure to covid-19 positive son      and husband	Dyspnoea +++ SpO2 80 to 83, in prone would occ be 89 Coughing +++ , continuous, one after other, mostly dry, with occ. scanty white sticky, difficult to expel, expectoration. Occasionally dirty white color.	Whole    day, esp night <     >Complete rest	H/O high fever 25/4/21 she was given Allopathic medicines. And it became fine.       Mouth completely dry with thirst increased. Appetite reduced.	Son and husband both had tested RT PCR positive for covid19 while she had tested negative in both RAT   done     on 26/4/21 and RT PCR done on 3/5/21.   Her HR CT chest showed CO RADS 5,       covid pneumonia with severity score mild

 

Chest, retrosternal and lower ribs on sides	Pain	<    coughing while	Changed taste to bitterness. Smell sense okay. Headache, forehead, if tries to get up, faintness. Pain in eyes region when headache gets severe. Lower back pains +++ Weakness +++ Drowsiness as due to dyspnoea has    had    no proper sleep last 2-3 days. Stools,          urine, sweat NAD Temp : 98 Pulse : 111/ min	15/40 done on 8/5/21.   Had taken 7 days course of : –      Ivermectin 12 mg OD, –      Doxycycline 100 mg BD, –      Montek   lc OD,  –      Dolo    650 mg  from 26 April with no relief, except fever was reduced, but her state was only, worse and her SpO2 was dipping. Was advised further allopathic tt and oxygen support ASAP but bed not available.
General Since  5-6 years	Diabetic Hypothyroid hypertensive	On allopathic medication. Glycomet 500 od, Thyronorm 50 mg Tab Repace 25 od		No invest done for last 3 yrs. PATIENT ADVISED     TO CONTINUE WITH HER ALLOPATHIC MEDICINES. Fresh invest of thyroid profile and random blood glucose given , both came wnl.

She had been to govt hospital K C General Hospital on 8/5/2021 and was advised oxygen inhalation, inj dexona 6 mg IV stat, and Inj Deriphylline  1 amp IV stat. that time her  SpO2 recorded was  93%, and BP was 114/79. (Reports attached)

Was also advised Vit C and some investigations like CBC, CRP, D- Dimer and serum ferritin. But due to unavailability of bed and after trying at other hospitals too, they took her home so the above injections were not brought or given to the patient.

The whole case was taken online, on WhatsApp chat and calls.

DIAGNOSIS: Covid pneumonia

HOMOEOPATHIC PRESCRIPTION:

Based on the acute totality of the case, Bryonia 30, one dose was prescribed every 30 min.

GENERAL MANAGEMENT:

• Start zincovit BD
• Eucee or Vit C OD or two lemons juice and two fresh fruits
• Had advised sea cod capsules OD alternate days but could not get from chemist. They routinely eat fish though so was skipped.
• Steam inhalation twice, deep breathing exercises as and when could,
• Lot of lukewarm drinks,
• Betadine gargle
• Diet: Protein rich home cooked soft food, low in salt and low in refined, sugars and starch. Explained in detail.
• Monitor TPR and oxygen saturation levels every hr for next 24 hrs.
• Blood tests given for CBC, ESR, CRP, Bl glucose if fasting or random whatever is possible, Thyroid profile. Since patient was too disturbed to go to patho lab, home collection was advised and due to lockdown and difficulty in manpower present, was left to the patho lab technician to come whenever they could at the earliest.
• Patient’s allopathic medicines for controlling BP, blood sugar and thyroid hormones were allowed as it is, no interference in them.
• Daily monitoring of sugar levels with home glucometer. Readings were all wnl.
• Managed to get an oxygen concentrator. Used it few hrs at late evenings for two nights and SpO2 rose to 96.

INVESTIGATIONS:

Her HR CT showed CO RADS 5, covid pneumonia with severity score mild 15/40 done on 8/5/21, but patient suffering a lot from the time CT was taken.

CRP done on 9/5/21 was 32 mg/L

CRP done on 12/5/21 was 18.9 mg/L

CRP done on  26/5/21 is 3.2 mg/ L

FOLLOW-UP:

DATE & TIME	S/S	>/< / SQ	PRESCRIPTIO N	GENERAL MANAGEM ENT	INVESTIGATION
9/5/21 5:30 pm	Received medicines from nearest homoeopathic pharmacy. Started as advised.		Medicine started. Bryonia   30, half hourly	As given above in detail	Her HR CT showed CO RADS 5,      covid pneumonia with severity score mild 15/40 done on 8/5/21, but patient suffering a lot from the time CT was taken.   COMPLETE BLOOD COUNT done on 9/5/21   1.           Hb            –  9.4 2.           TWC        – 8000 3.           DC : N –  83, L – 08, E – 04, M – 05, B –  00 4.           PLATELETS COUNT :       – 1.98 5.           RBC COUNT –  3.6   PCV                – 29 MCV               – 81 MCH               – 26 MCHC            – 32   CRP : 32 mg/ L

 

9:30 pm	Cough better, oxymeter SpO2 reading 94. Temp normal	>	Continue Bryonia   30, half hourly
10/5/21, 3:18am	SpO2 : 89, pulse 112. Temp 100.3.	<		Prone position. AC       2-3 degress lower than room temp for comfort
3:40 am	SpO2 dipping to 89, breathlessness severe	SQ	Carbo veg 30 every 5-10 min.	Prone position. Rest all same.
3:59 am	SpO2 : 93	>	Carbo veg 30 every 5-10 min	Prone position
10/5/21, 10.10 am	SpO2: 89, 91, temp 97.5. pulse 112/ min, having severe headache also as told by husband		Carbo veg 30 every 15-30 min
10/5/21, 11:   28 am	SpO2 90, Pulse 98, Temp: 99.6 Dry coughing with pain in       chest , bodyache   and feverish feel.	>	Bryonia 30 every 30 min.	All manageme nt follow.	gen to
13:19 pm	SpO2 90, Pulse 98, Temp: 98.4. Had little food, oats in milk, but some was vomited, headache still there.	>	Same continue
14:14p m	SpO2 92, Pulse 98, Temp: 100. Was hungry so had some rice soup. Headache  mainly on forehead and both temporals And near eyes too.	>	Same continue
14:30 pm	SpO2 95, P 97, Temp 96.5	>

 

15:15 pm	SpO2 : 90, Pulse , Temp: 99.1 Coughing         had reduced but again  some coughing restarted,     with difficult       sticky expectoration coming out.	<	Kali bi 30 , doses every 1 hrly	Steam plain water. Deep breathing exercises. Sit in bed. Light activities.
19:10 pm	SpO2 : 92, Pulse : 107, Temp: 100. 2	>
20:     15 pm	SpO2 : 90, Pulse : 99, Temp: 99.1 Headache still there, had loose motions 23 times, after eating getting urge and passing small amt loose stools, pain abdomen, thirst +, mouth dry. Weakness and very tired after going to washroom and back. Wants to lie still.	>	Bryonia 30, 2 hourly
11/5/21, 01:06 am	SpO2 : 83, Pulse : 87 Temp 98.4, weakness +++,bitter taste mouth, gastric digestion feels problem, discomfort abdo, back pain better,	<	Carbo veg 30 frequently	prone position
1: 40am	SpO2: 85, then rose to 90. Remained so during daytime. Had better appetite, took some fruits and food. Weakness still there, passing stools soft type after ever small meals.		Cinchona 30 every two hourly	Advised to use oxygen concentrat or for few hrs     till SpO2  raises to around 95-96
07:     03 am	SpO2 : 90 Pulse : 87	>	Same continue	Used oxygen

 

	Temp 97.9 Headache          better, vomited      once          in night, no further loose motion			O2concentrat or for few hrs     at night. Feeling better.
12:07p m	SpO2 : 94 Pulse : 87 Temp 36.8 C	>	Same continue	No Oxygen concentrat or req.
12/5/21 10:          52 am	SpO2 : 83 Pulse : 97 Temp 37.7 C Just woke up. Will check again after some time. Cough is reduced.	<	No medicine.	Oxygen concentrat or used half an hour. Having no discomfort.	Repeat CRP done on 12/5/21 was 18.9mg/L. And her random sugar was 111. Thyroid profile is wnl.
12:          12 pm	SpO2 : 95 – 96 Pulse : 95 Temp 37.7 C Hungry, asked for fruits and also ate boiled egg	>	China 30, 2-3 hourly		COMPLETE BLOOD COUNT done on 12/5/21   1.           Hb            – 10.2 2.           TWC        – 4600 3. DC : N –  75, L – 20, E – 03, M – 02, B –  00 4.           PLATELETS COUNT :       – 1.67 5.           RBC COUNT –  3.4   PCV                – 32 MCV               – 89 MCH               – 24 MCHC            – 26 ESR 54 Random      sugar 111   CRP 18.9

 

					Report attached. Thyroid profile was dictated on call and was wnl.
13:    42 pm	SpO2 : 95 Pulse : 85 Hungry, wanted rice daal and fish fry. Also had go	>	Same continue
13/5/21 08:00 am	Had a good sleep in night, no vomiting, no loose motion. SpO2 : 92,Pulse 91, no fever. Was hungry. Had oats, tender coconut water, rice daal. No coughing.	>	China 30 3-4 hrly	Didn’t          use oxygen concentrat or
18:12 pm	SpO2 : 95,Pulse 92,	>	China 30 3-4 hrly	Didn’t           use oxygen concentrat or
Night time	No complaints. Slept peacefully. Appetite much better	>		Didn’t use oxygen concentrat or.
14/5/21 20:25p m	Active today, started house work little and cooking. SpO2 94, pulse 87, no fever	>>	China 30 3-4 hrly Returned oxygen concentrator as was not needed last two days/ nights
15/5/21 10:27a m	SpO2 95 Pulse 91 Temp 32.7 Sleep           was comfortable, active now within home, no abdominal discomfort, no loose	>	China 30 4-5 hourly
	motion or vomiting, no headache, no coughing. Only slight weakness there.
16/5/21 11:38a m	SpO2: 95 Pulse 80 No fever. All good	>	China 30 4-5 hourly
17/5/21	SpO2 : 96 Pulse 91 No fever. All good. Slight tired, that’s all.	>	China 30 4-5 hourly
20/5/21	Says shes back to herself. SpO2 keeps at 95-96, pulse at 81-82,  and no other health issues	>	China 30 tds		Gave repeat CBC, ESR   and    CRP whenever possible
26/ 5/21		>	China 30 BD		COMPLETE BLOOD COUNT done on 26/5/21   1.        Hb          –  11.4 2.        TWC        – 5800 3.        DC : N –  51, L – 44, E – 03, M – 02, B –  00 4.        PLATELETS COUNT :       –  3.1 5.        RBC COUNT –  3.99 PCV                – 34 MCV               – 85 MCH               – 28 MCHC            – 33 ESR : 44 CRP : 3.2 mg/ L

 POINTS TO NOTE: 

• After starting homoeopathic treatment, the patient improved and also the oxygen saturation readings improved from lowest 80-81 to 95– 96.
• Oxygen concentrator that was somehow arranged on rent as needed two nights for a few hours only when SpO2 was less than 85. Here would like to say that any patient with SpO2 dipping from 92 towards 90 and below, is a case to be admitted in ICU, ASAP. But due to unavailability of beds, I had the opportunity to handle this level of severe case. And she was manageable even at 85 without oxygen support, if resting in prone position.
• The zincovit and vit C that patient took is a nutritional supplement. I advise all vitamins supplements and a good protein diet. It helps.
• Another very important thing is under homoeopathy, we did not see any fluctuation in her blood sugar, she remained on her usual tablet only..
• Treatment started on 9/5/21 evening, and on 14/5/21, she was completely comfortable, did cooking, made fish curry and dinner. Her cough had reduced drastically on day one of homoeopathic treatment only.

As the testimony from her husband says, apart from zincovit, a nutritional supplement, she was full on homoeopathy and used oxygen concentrator for two nights only. Her other meds for hypertension, diabetes and hypothyroid, the allopathic ones, that she was on for last many years were allowed as such with no change in doses needed.

• Plain steam inhalation twice or thrice to keep secretions fluid and easy to expel. Deep breathing exercise was followed by the patient. I also insisted on light activity on bed and sitting on edge of bed, some stretching exercises.
• Since the whole family was affected and in quarantine, it was not recommended for them to go out for investigations again and again. I advised minimum investigations. The improvement in all readings esp CRP is good indicator of reducing inflammation. Although not specific for Covid 19 cases but it is good, cost efficient investigation that can be repeated frequently to see if condition is controlled with the medicines or not.
• The acute condition improved, I advised the patient to continue good nutritious food with supplements for at least next month. Then can stop the supplements provided food is proper.
• Also, have advised her to consult her family homoeopath to continue her treatment post covid to include the investigation and treatment of the mammary mass found on her HR CT chest, and to also see if her hypothyroidism, hypertension and diabetes can be better managed.

INVESTIGATIONS :  

1. RAT TEST :

2. RT PCR Test:

3.HR CT Chest report:

4. CBC, CRP report 9/5/21:

5. 12/5/21 CBC, Bl Glucose, CRP report :

6. CBC, CRP 26/5/21 REPORT:

Testimony by husband sent to me on whatsapp :

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DR NIVA SHIRKE,

MOB NO 9591797988

EMAIL ID : [email protected]

DATE: 2 JUNE 2021