Homoeopathic Treatment of Severe COVID-19 with Uncontrolled Type II Diabetes

Author Affiliations:
Guest Faculty Professor, Department of Practice of Medicine, Bhagawan Buddha Homoeopathic Medical College and Hospital, Malathahalli, Bengaluru, Karnataka, India – 560056, http://www.bbhmc.org

Ethical Declaration:
The case details and investigation reports do not reveal identity of the patient, and is shared with informed consent.

Keywords:
Homoeopathy, COVID-19, pneumonia, homoeopathic medicines, Arsenic album 200C , Stannum metalicum 30C & 200C, Syzygium jambolanum Q, Pulsatilla 200C.

Abstract:
The second wave of COVID-19 pandemic that hit India caused tremendous loss of lives and caused severe strain on essential services and supplies. The difficulty in getting a hospital bed, oxygen support, medicines and the required laboratory tests done when the patient is in strict home quarantine, was all very challenging.

I’m presenting a case-report of a woman of 43-year whose husband and daughter all contracted covid-19. She developed severe dyspnea, with SpO2 dropping to 88% and later to 85%. She was also suffering from Type II uncontrolled and neglected diabetes for years which became worse with covid-19.

In spite of it all, she could be managed at home, under quarantine and without any oxygen support. During the treatment, she underwent severe emotional distress when she lost her husband to complications of covid-19 infection. Homoeopathic remedy selection was based on her acute totality and the remedies – Arsenic album 30C and later Stannum metalicum 30C and 200C were found to be very effective. Syzygium jambolanum Q helped manage her blood sugar levels.

Introduction:

A family of three members, a woman of 43 (the patient here), her 45 year old husband, and their 21 year old daughter, were staying together in Bengaluru, and contracted COVID-19 during the Indian national lockdown in April – May 2021. All became RT-PCR COVID-19-positive.

Her husband become severely dyspneic and was shifted to hospital. The patient also developed severe dyspnea and her condition could not get stable with the medicines prescribed and the SpO2 kept dipping. This is when her daughter approached me for further treatment.

After taking relevant case details on a mobile call, and based on the homoeopathic totality of her symptomatology, I prescribed remedies and advised general management. Follow-up details were taken almost on an hourly basis initially. Later on, as the improvement set in, follow-up was managed a few times in a day. A few investigations were repeated to confirm her improvement.

Some other residents living in the same building had already developed covid-19 infection, so it was sealed by the local municipality. In the fear and anxiety of it all, also with the patient being extremely weak, I could not advise her to go out and get a chest X-ray or HR CT chest. It would have been helpful to quantify the severity of the pulmonary involvement and also would have added value to the record of her case.

We could manage basic blood investigations only, sufficient to understand the course of treatment. For progress of the patient, I was dependent on oximeter readings, patient’s overall comfort-discomfort level, the improvement in the symptoms and observation findings by her daughter all done via mobile and online communication.

Case Report :

Mrs GDK, 43-years married, pure-vegetarian, Hindu, middle-class housewife living with her husband and young daughter at Bengaluru. Her husband had become severely dyspneic on 03/05/2021 (Temperature -100.9, SpO2 – 88%, Pulse -110) and with great difficulty managed to get a bed with oxygen support in a hospital the next day. Soon she too developed dizziness with severe dyspnea. Both the patient and her daughter were put in strict home quarantine. None were vaccinated against covid-19.

Following is the evolution of her clinical state:

On 29/04/2021, patient had sudden onset of continuous bouts of sneezing that lasted a few minutes, followed by mild cough and feverishness. In next few hours, she lost her sense of smell and of taste, got more feverish, coughing bouts increased and she developed weakness.

On 30/04/2021: Body ache, tiredness, fever, eyes reddish and swollen. Her homoeopathic consultant put her on Belladonna 30, Rhus tox 30 and Ferrum phos 6 X.

01/05/2021: The test came positive for Covid –19. The tests were done for all the building residents where patient lived, as some cases were previously reported and the municipality informed the patients on mobile call that all three family members were RT-PCR positive and should be strictly home-quarantined. No report as record was made available to the patient.

02/05/2021: Redness and swelling around eyes is better now.

03/05/2021: Body ache is better. Meanwhile, as stated earlier, her husband’s condition was getting worse.

04/05/2021: Onset of menses. Body temperature is back to normal. (husband manages to get a bed with oxygen support and is getting worse.)

The patient’s daughter approached me on 07/05/2021 with this recent history and that the patient was having dizziness since morning with oxygen saturation fluctuating between 88 -90%. Later it dipped to as low as 85%. To manage the dyspnea, apart from intake of the above homoeopathic medicines, she was lying in prone position which would give temporary relief. She had complaint of menorrhagia too, it being the 3^rd – 4^th day of the flow.

Very severe mental distress due to seriousness of her husband’s condition and daughter’s suffering. Hospital bed was not available. She needed to be handled at her home only. Oxygen support could not be arranged. Patient is a K/C/O Type II diabetes, since last 10 years and is on and off on homoeopathic medicines.

There is no regular record of blood glucose checked at laboratory. Seems that Diabetes may not be managed well here. She had tried allopathic medicines in the past to control blood glucose levels but says that it increased her weight by 4 – 5 kg in a month. So, she stopped it and did not want to try any other allopathic medicine again. Recently, she had become erratic in the intake of her homoeopathic medicines for diabetes.

Complaints of:

LOCATION	SENSATION	MODALITIES	CONCOMITANTS
1. RESPIRATORY SYSTEM : Nose : since 5 days Throat & chest since 7 days	Smell lost. No blockage or any discharge. Sneezing + Mucus causes irritation and coughing. Dry, continuous cough with little whitish, foul-tasting mucus hawked out or coughed out. No pain. Dyspnea getting worse. Oxygen saturation fluctuating between 88 – 90%.	< drinking water, >mucus hawked out. < coughing	Sensation of numbness in palms and soles since a day Left > Right Feverishness.
2. GASTROINTESTINAL SYSTEM: Mouth: since 5 days Rectum since 7 days	Loss of taste. Everything tastes like sand, or rotten, putrid taste in mouth when expectoration comes out. Dryness. Feels like cotton in mouth Loose stools between 2-4 times a day First part of stools is normal Then its yellow frothy and loose Towards end, mucus is passed with little loose stools. No tenesmus, or abdominal pain or tenderness felt	No modalities could be elicited.	Mental distress+++ as her husband is getting worse in the hospital. Food intake is erratic and reduced as not able to cook. No one to help her in house work.
3. Female Genital System, since 4 days.	Menorrhagia LMP : 4/5/2021 Usually has scanty flow for 10 days and irregular cycles.		Weakness+++
4. General : since 1 day	Fainting sensation. Weakness +++.	>Sitting, waking up > after drinking juice <Even while sleeping feels like fainting.

Personal history:

APPETITE: Reduced. Taking food twice a day. Irregular timings now as doesn’t feel like cooking. Anxious, tired and no one to help in kitchen. Patient feels hungry but is unable to eat due to loss of taste, feels full very soon.
THIRST: Now, it has increased, amount varies, must keep drinking water very frequently due to dryness of mouth.
AVERSION: dry food makes mouth feel drier. DESIRES: juices now.
URINE: almost every 1-2 hours and 2-3 times at night, a recently developed feature.
BOWELS: loose stools now. Had no complaints in the past.
PERSPIRATION: sometimes increased
SLEEP: Erratic timings, but manages 8-9 hours. When gets sleep, it is deep and undisturbed. DREAMS: has lot of strange anxious type dreams but does not remember on waking.
THERMAL STATE: Hot patient ++

General Physical Examination:
(data given by her daughter who is a final year undergraduate homoeopathic medical student) Obese build. No pallor, edema or cyanosis. No clubbing nails, icterus or lymphadenopathy.

Vital signs:
Oxygen saturation 88 – 90%. Pulse rate 99 / min Afebrile.
Blood pressure: Measured with home gadget: 132/81 mm of Hg. Last week it was elevated to 150-160/90 mm of Hg

Systemic examination:
Tongue: dry, no coating or ulcers. Throat clear.
RS: Except mild tenderness on anterior left upper chest around 3^rd intercostal space, rest is good. Other systems nothing important detected and reported by her daughter.

Diagnosis:
Covid-19 infection who was RT-PCR positive for COVID-19.

Repertorial Totality:

Mind, Anxiety
Sleep, dreams, anxious
Stomach, Desires: refreshing things
Stomach, Thirst, extreme,
Stomach, Thirst, small quantities, often
Mouth, Taste, putrid
Mouth, dryness
Generals: Weakness
Genitalia, female, Menses, copious
Bladder, Urination, involuntary, cough, during
Bowels: loose stools
Expectoration, taste, putrid

Repertorial Chart based on Synthesis App ( Zeus Soft):
The evaluation order is as per the chapter in the Repertory.

Homoeopathic Prescription:
Homoeopathic medicines — Arsenic album 30, one dose every 10 – 15 min to half hourly till 8-9 pm was prescribed. It covers the respiratory picture here. Lower potency was used very frequently due to severity of the symptomatology. Previous homoeopathic medicines were all stopped.

GeneralManagement:

To take Cap Becosules with Zinc BID
Eucee /Vitamin C – OD / two lemons’ juice / two fresh fruits daily.
Cannot take sea cod capsules as she is pure vegetarian. Advised to buy and take omega-3 oils from vegetarian source, once on alternate days.
Steam inhalation twice, deep breathing exercises as and when can.
Lot of lukewarm drinks,
Betadine gargle
Prone position to manage breathlessness.
Diet: Protein rich home cooked soft food, low in refined, sugars and starch. Explained in detail.
Monitor TPR and oxygen saturation levels every hour for next 24 hrs. With improvement, to make it 3 – 4 hourly charting.
Blood tests given for CBC, ESR, CRP by arranging home collection of sample. Since patient had no help and was much exhausted and breathless, could not advise her to go out to get HR CT or even plain X-ray of Chest.
Daily monitoring of sugar levels. Which was again, not possible as their home glucometer was not working and their building was sealed due to more cases of covid-19 among the occupants.

Follow up:

SR. NO.	DATE	SYMPTOMS & SIGNS OBSERVED	<, > or SQ	MEDICINES/ DOSE/ REPITITION	REMARKS
1	07/05/2021 At 6:30 pm At 20:08pm	Giddiness, weakness. Temperature : 99.6 Sp02 : 97 to 94 Pulse : 104 Temperature : 98.3 Sp02: 95 to 89 Pulse : 95 Taken plain steam.	>	Arsenicum album 30, one drop doses to be taken every half hour, till sleep time	Blood tests advised. Not able to follow all the general management advice given. Diet and supplement intake not possible to follow as not available and she cannot go out.
2	8/05/2021 10:58 am 08:00 pm	Tiredness. Too weak to get up. Mouth dry. Anxiety. Restlessness, like she is not comfortable in any position sitting, standing or lying down. Dyspnea. Menstrual bleeding has reduced a bit Temperature: 99.4 F SpO2 saturation 85 -91%, Pulse: 99 / min, Respiratory rate 20 cycles / min Hoarseness Does not feel as much dyspnea if complete resting. Cough still there although less, a deep hard coughing and trying to bring out the sputum. But the sputum has changed type. Feels chest full of mucus, but on coughing, able to bring out scanty, very thick, greenish, sweetish putrid tasting expectoration with breathing difficulty. Profound weak feeling in chest. Breathing, whispering, talking all is very stressful and excites cough.	>	Arsenic album 200 C drop doses half to one hourly. Advised to stop Arsenic album 200 C and start Stannum met 30 C* on 2 hourly basis. Rest instructions same way.	Anxiety. Restlessness Weakness Involuntary urination while coughing Mouth tastes very bad, she said it tastes rotten and foul. • New totality taken into consideration and with help of homoeopathic therapeutics and referring to books on Homoeopathic Materia Medica, Stannum met 30 C was selected. There are moments when she is not comfortable doing anything and feels a bit restless. But better overall than yesterday. Sputum is thicker and causing problem
		Weakness is there, but she is trying to do some work, like she took a bath. Although she was very tired afterwards. Sleep is good. Had woken up at 4:30am, very thirsty and was drinking water since then. Says drinking water continuously makes her nauseous. No other new symptoms. Breathlessness+ < on exertion, talking, eating, bathing, brushing, using toilet
3	9/05/2021	An extremely sad news. Her husband who was suffering from Covid–19 pneumonia and was admitted in a hospital, expired in the evening of 8/05/2021. Hospital formalities and the shock of it all got her disturbed and she could not send me any readings. Daughter informed me that her SpO2 was fluctuating between 90 – 99%.	>	Breathlessness >>> after starting Stannum met 30 C.Advised to continue as before. Not much data could be taken.
4	10/ 5 /2021	Her SpO2 was fluctuating between 90- 93%. Mostly stayed on 92 Blood test reports of sample taken on 7/5/2021 came : COMPLETE BLOOD COUNT : Haemoglobin : 12.8 g/dl Total Count : 5300 cells/ cumm Differential Leucocyte Count — Neutrophils : 54.7 % Lymphocyte : 38.7 % Eosinophis: 0.8 % Monocytes : 5 % Basophils: 0.8 % RBC Count : 4.7 millions/cum Packed Cell Volume (Haematocrit) : 39.4 % MCV : 84.0 fL MCH : 27.4 pg MCHC : 32.6 g/dL RBC distribution width : 12.0 % Platelet Count : 1.5Lakhs/cumm ESR : 40 mm/ 1st hr D-DIMER : 259 CRP-SERUM : 43.20 mg/L LDH :357.0 U/L Urea : 16.1 mg/ dl	>	1. Stannum met 30 C, 6-8 times today 2. Syzygium jambolanum Q, 6-8 drops tds. Monitor sugar levels and adjust dose accordingly. Also, get advice for insulin control. Diabetic diet and general management as advised.	Prone position and complete rest advised to deal with such low oximeter reading. No hospital bed, or home oxygen cylinder could be managed. Blood sugar was very high. Found that she is not on any anti-diabetic medicine since last few weeks to months. Advised her to get an endocrinologists’ help to control her high sugar. Told her that she will need insulin to control the high levels. Whatever she was using to keep sugar levels in check was either ineffective or not taken properly. Patient seems very reluctant to consult an endocrinologist in spite of strict advice given to get it done asap.
	08:00am 09:24pm	Sr CREATININE : 0.6 mg/ dl Random Blood Sugar:526.2mg/dl Temperature: 98.4 F SpO2 saturation : 80 -81%, Pulse: 84/ min, Temperature: 98. 9 F SpO2 saturation : 96%, Pulse: 90 / min
5	11/05/2021 10:55am	Temperature: 97.2 SpO2 saturation : 97%, Breathlessness reduced. Cough reduced. Mostly dry cough occasionally, sometimes a little bit whitish-yellowish expectoration, but not frequently as before Can taste the tea she had. In general, much better. Appetite better. Sleep better	>	1. Stannum met 200 C, 6 times today 2. Syzygium jambolanum Q, 6-8 drops tds.	She consulted one doctor on phone, in their building complex for her high blood sugar levels. He advised her to stop homoeopathy and take cocktail of steroids and other allopathic medicines for covid19. Patient refused as she is much better on homoeopathy. Said she will consult a diabetologist face-to-face once she is out of quarantine period and the building is unsealed by the municipality. So basically, we have to manage her sugar levels with strict diet control and Homoeopathic medicine knowing well that full control will still be not possible. But she seems to have limited choices in this regard now.
6	12/05/2021 10:00 pm	Temperature: 97.4 F SpO2 saturation : 95-97 range whole day%, Pulse: 84/ min, Feeling much better. Can smell and taste food. Rest cough, dyspnoea all are almost gone.	>>>	1. Advised to reduce dose frequency of Stannum met 200 C, to tds 2. Syzygium jambolanum Q, 68 drops tds. Rest of the advice remains the same	Had requested to get blood sugar checked on a daily basis. But the pathology laboratory near her place said they will not come to a sealed building just for a sugar test. Have to wait till her quarantine time ends for any further tests.
7	13/05/2021	No readings sent as was busy with planning the rituals etc to be performed for her dead husband. But daughter said she was doing fine. No complaints.	>>>	Follow as above advised.
8	15/05/2021	Doing fine. Gave samples today for blood tests as advised.	>>>	1. Pulsatilla 200 . BID 2. Syzygium jambolanum Q, 68 drops tds.	Taken her detailed case as wanted to give constitutional remedy to complete the treatment. After repertorising, arrived at Pulsatilla
8	16/05/2021	Reports : Glucose Fasting (FBS) : 367 mg/ dL LDH (Lactate Dehydrogenase): 602 IU/L C-Reactive Protein(CRP): 17.7 mg/ L Glycosylated Haemoglobin (HbA1c): 17.1% Estimates Average Glucose : 444.07 mg/dL	>	1. Syzygium jambolanum Q, 6-8 drops tds.	Blood sugar has reduced from 526 mg/dL to 367 mg/dL. But still not in normal range. Since she’s a diabetic for more than a decade, and was not well managed, have again advised her to seek a diabetologist. CRP is still not good. Advised her to repeat after a week.
9	21/05/2021 To 24/05/2021	Started on insulin after consulting a diabetologist from 19/05/2021. Advised 25 –35 units as per her levels. Blood glucose levels on 21/05/2021: Morning : 167 Afternoon : 265 Night : 286 Blood glucose levels on 22/05/2021: Morning : 125 Afternoon : 243 Night : 310 Blood glucose levels on 23/05/2021: Morning : 106 Afternoon : 121 Night: 245		1. Syzygium jambolanum Q, 6-8 drops tds. 2. Pulsatilla 200 once in two weeks	RTPCR tests were conducted free in their building by the municipality. Test came negative for both patient and her daughter on 24/05/2021 (attached in investigations).

Comparative Readings :

No. DATE LDH RBS/ FBS CRP

07/05/2021 357 IU/L 526 mg/ dL 2 mg/ L
16/05/2021 602 IU/L 367 mg/ dL 7 mg/ L

LDH in high levels have been seen in many cases of covid-19 especially those with diabetes and have been known to indicate poor prognosis. Some studies done in covid-19 cases even indicate that it may predict acute respiratory distress syndrome in patients with fever.

However, this test basically is done to determine the presence and the amount of tissue damage especially in conditions where there is inflammation of the lungs, liver, heart, muscles, kidneys etc. Normal values for an adult may range from 105 to 333 IU/L and they may vary slightly from different laboratories.

In the above case, the patient improved clinically, temperature and the oximeter readings became normal, the blood sugar levels and also CRP reduced and later patient became RT PCR negative for covid-19. Taking the whole picture, I can assume that due to a long time with neglected diabetes, and covid –19 infection, there was tissue damage but overall, we managed well with homoeopathy. If the blood glucose levels would have been managed by insulin early on, LDH would not have been so much raised. That was one aspect we could not (and were aware) handle completely.

CRP is another non-specific test to indicate tissue damage. The initial level of 43.2 mg/ L indicates how severe the covid-19 infection was. Patient was advised to repeat the tests again after a week but could not manage to get it done. And once she was better symptomatically and her oximeter readings improved, she did not want to spend further on the test. She was already in a financially difficult situation due to death of her husband, the only earning member in the family.

Discussion points:

There were many challenges faced in the treatment of this severe case with dropping SpO2 and high blood glucose levels.

Unavailability of hospital bed, oxygen support,
Even monitoring vitals on regular basis was difficult as patient was too tired,
No possibility of an attendant to care or even get cooked food, even getting basic investigations needed to monitor progress in covid-19 was difficult,
Conventional medicine practitioners not ready to accept an integrated approach even when patient is doing well and not ready to manage what falls out of the scope of homoeopathy,
The financial burden it caused as some could not afford the tests and repeat tests from private laboratories.
Although, diabetes was not well managed since long, it worsened during covid-19 infection, yet we could turn round the case for the better with Arsenic album 200C initially and later with Stannum met 30C & 200C and Syzygium jambolanum Q.
Patient was advised to continue good nutritious food with Supplements, Plain steam inhalation once or twice to soothe throat and help with any congestion and Deep breathing exercises.
Advised constitutional medicine Pusatilla 200 C once in two weeks so as to avoid any post covid-19 health issues and also would help with better management of her stress and diabetes.

Conclusion:

The above case of COVID-19 with uncontrolled diabetes, severe mental distress and a dropped SpO2 to 85% was successfully treated with homoeopathic medicines. It showed how individualized homoeopathic intervention, dietary and supplemental support, breathing exercises, all was effective in managing the case and could be used in other similarly affected cases too.

Investigations :

2. CBC, ESR, D-DIMER, CRP, LDH, Urea, Creatinine and Random Blood Glucose values 07/05/2021:

3. FBS, LDH, CRP, HbA1C report 15/05/2021:

4. RT PCR Test dated 24/ 05 / 2021

4.Testimony by the daughter of the patient:

References :
Homoeopathic Materia Medica by James Tyler Kent
Homoeopathic Materia Medica by William Boericke
Homoeopathic Materia Medica by John Henry Clarke
Repertory of Homoeopathic Materia Medica by James Tyler Kent
Synthesis Repertory and Synthesis App
Lot of online literature on COVID-19
Guidelines for Homoeopathic practitioners for COVID-19 https://atm.amegroups.com/article/view/49792/html
https://pmj.bmj.com/content/early/2021/10/19/postgradmedj-2020-139542

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