Injury Cases Quantified

Drs. Navin Pawaskar, Ashish Ranade and Subodh Naik present 7 cases to illustrate how injury cases can be managed by considering causation, nature of injury, tissue affinity and the goals.

Reprinted with permission from the Indian Journal of Applied Homoeopathy where it first appeared. https://www.jimshomeocollege.com/ijah-publications/

CASE 1:

Mrs TD, 50 yrs., fell from a chair 6 days ago and injured the upper 1/3 of her Right tibia. She immediately developed pain and a swelling 33cm in diameter. The swelling continued to gradually increase in size. 3 days later she also got fever for a short period.

The Orthopaedic opinion: Haematoma over RT tibia, possibility of secondary infection.

Advised:  leg elevation & compression bandage.

Action: Arnica 30 QDS

Remedy Selection:

A/F: Injuries trauma in all forms of recent or remote. Pathology of Haematoma formation – Arnica acts on the blood vessels causes’ relaxation leading to hematoma & ecchymosis.  It handles complications of recent as well as old injuries.

Individualisation: In this patient susceptibility is low; there are no local modalities or characteristic present. The sensitivity at the level of mind and nerves is also low.

Objective of Treatment: is to want to achieve the resolution of haematoma & prevent secondary infection and facilitate the fibrosis.

Prescription: Considering 6 day old injury in an old lady with low susceptibility and low sensitivity, Arnica 30 QDS was prescribed.

Remedy Response Analysis:

Within 3 days of starting Arnica 30 QDS swelling subsided by 30 % and became soft. There were no signs of secondary infections. By 5th day of treatment pain was completely ameliorated and swelling had become fluctuant but with no signs of inflammation, indicating resolution of hematoma. By 8th day there was no further progress and case came to a standstill. Hence, considering short amelioration to 30th potency, Arnica was prescribed in 200 c QDS. On 10th day hematoma further reduced in size and by 20th day of starting the treatment a Hematoma of 33 cm resolved completely without being secondarily infected, with healing by secondary intentions. Patient was prescribed constitutional remedy to prevent any after effects of trauma and to sustain healing.

ORTHOPAEDIC OPINON: – Complete fibrosis has taken place and the case file can be closed as cured.

 

CASE 2

Mr. RJ 32 years, was passing by the hospital, and as luck would have it, had a vehicular accident in front of hospital, with attention at hand immediately. X-ray showed fracture at junction of medical 1/3 and lateral 2/3 of Right clavicle. Patient was in severe pain due to trauma.

Orthopaedic Opinion: # of right clavicle

Advice: Figure of 8 bandage and Homoeopathic medicine for containing pain & haemorrhage.

Prescription: Arnica 1M QDS.

Remedy Selection:

Cause: There is recent (few minutes) history of trauma;  Injury # to clavicle

The pathology is of active bleeding. Arnica has the capacity to handle complications of active bleeding from injury. Its sphere of action is on vessels and capillaries, with tendency for easy haemorrhage.

Individualisation: Severe pain indicates high sensitivity. The pathology of active bleeding and local acute inflammation points to high potency with frequent repetition.

Objective I of Treatment: Stop active bleeding, limit hematoma formation and control pain.

Action: Arnica 1000 C QDS was given for 4 days, and a figure of ‘8’ bandage applied.

Remedy Response Analysis:

After four days of Arnica 1000 C, swelling pain and tenderness reduced by 60%, indicating first objective of the treatment was achieved.

Objective II of treatment: bone union through promotion callus formation is the focus of attention.

Advised: Symphytum 1000c QDS for 1 week.

Remedy Selection:

A/F: Blow & Fall   –  Pathology of the fracture of bones – Symphytum acts on the periosteum, promotes callus formation.  It controls bone pain after injuries.

Remedy response analysis:

Day 12: X – ray showed good callus formation.

Orthopaedic opinion: Average time required for good callus formation is 3-4 weeks.

Constitutional medicine was used at the later date to prevent after effect of the injury.

 

CASE 3:

Mrs H P, 56 yr, post-menopausal came with injury to right wrist after a fall the previous day. We checked our records and also with orthopedician that this patient had haematoma. He confirmed that collies fracture also develops haematomas, although not frequently.

Orthopaedic Opinion:

X-ray ® Colles fracture of right wrist Radio – Ulnar variance normal.

AP view X- ray shows normal radial tilt.  Lateral view: Showed articular angle to long axis of Radius 10 degrees in dorsiflexion (which is normally 0 to 6 degrees) volar-wards fracture of lower end of radius; extra articular with dorsal communication- (means totally crushed to powder) # Rt wrist.

Advice: Due to condition of the bone, close reduction had to be done and a special cast applied. The cast was of a material which would not loosen when haematoma and swelling reduced.

Action: Arnica 1000C QDS

Remedy Selection:

A/F: Recent injury to Right wrist

Fracture of Bone  – Hematoma formation – Arnica is known to have action on blood vessels and, capillaries. It has absorbent action on bleeding parts. It controls after pains following haemorrhages.

Individualization:

Pathology of active bleeding following injury leading to haematoma formation, with swelling, tenderness and acute pain. So, considering cause, pathology and its state, sphere and mode of action of remedy, Arnica was given. Acute inflammation following trauma and the severe pain points out high susceptibility and high sensitivity which demands higher potency in frequent repetitions.

Action: Arnica 1M QDS was given for 8 days.

Objective I of Treatment: Resolving hematoma, swelling and pain management.

Remedy Reaction:

Local swelling on dorsal part of the hand and fingers was better by 50 %

Objective II of Treatment: To promote bone union by callus formation. It’s important to note that the bone had been crushed completely.

Remedy Selection:

Considering bone fracture following trauma and Symphytum’s action of promoting bone union, Symphytum was selected.

Individualization:

State of acute inflammation of bone soft tissue and haematoma around bone, demanded moderate potency in frequent repetitions

Action:

Symphytum 200 C QDS from 2nd week for 5 weeks.

Remedy Reaction:

Gradually pain reduced. X-rays taken showed completely healed fracture within 6 weeks. Then patient was put on her constitutional remedy which was Silicea 200 single dose with expectation to harden the callus. The last X-ray after 12 weeks showed completely united bone as normal (dorsal tilt corrected and with accepted reduction), pretty good going for a post-menopausal woman of 56 years!

 

CASE 4

Mr SK, a 70 yr old Muslim male was operated on for loose bodies in knee. There is operative trauma to soft tissue leading to active bleeding. Experience suggests 80 to 100ml drainage on first day in the drainage bag.

Objective I of treatment:  to control active post-operative bleeding.

Remedy Selection:

Ailments from surgical trauma. Soft tissue injury – Controls active bleeding

Individualization: Recent trauma causing active blood loss from soft tissue with post-operative inflammation suggest need for high potency.

Action: Arnica 1000C 2 hourly was started.

Remedy response analysis: The first day bleeding was approx. 20 ml.

Within 72 hours drainage was totally removed as it was dry for more than 24 hours.

Objective II of the Treatment:

To control the post-operative inflammation and healing of the ligaments and tendons, promote fibrosis and calcification thus hardening the tissues. Prevent tendency for formation of loose bodies, osteophytes etc.

Remedy Selection:

It causes deposition of Ca++ on elastic fibrous tissue like ligament and strengthens them.

Promotes fibrosis yet prevents stiffness

Aids slow healing process.

Individualization:

Since all the indications were based on pathophysiological indications without much characteristic symptoms, a low potency was used. As, the action of the remedy was required at physiological level, low potency was selected.

Action:

Calc-fluor 30 was given TDS in multiple doses with some nutritive supplements. The idea was to promote post-op healing by secondary intention.

Remedy Response Analysis:

3 weeks after Calc fluor, patient came with smiling face as range of movement had increased and he was able to offer “Namaz” as before.

 

CASE 6

Mr MP, a 21 yr old male came with crushed injury of left thumb. Injury occurred as thumb was crushed between the door of a vehicle. Peculiar thing was, though it was a crush injury involving a digit, the pain component was not very severe as one would expect. Due to injury the nail was totally smashed and avulsed. The orthopaedic surgeon cleaned the wound and corrected the anatomy to the extent possible.

Orthopaedic Opinion: Crushed injury of thumb involving soft tissue, with chance of secondary infection and traumatic gangrene.

Advised: Nail bed repair, splinting, closed wound dressing.

Objective of the treatment:

Prevent secondary infection, control inflammation, pain, and promote granulation tissue.

Remedy Selection:

A/f Injuries  – Crushed & lacerated tissue – Soft tissue – Prevent suppuration, promote granulation.

Action: Calendula

Individualization: Surprisingly the pain component was not severe as was characteristic. Pathology of acute inflammation in a crushed tissue required the use of primary action of calendula which is as follows. Calendula is known to cause vaso-dilatation through action on vaso-motor centre. It causes vaso-dilatation at capillary level by causing paralysis of capillaries.

Primary action of calendula is as follows:

Through the vaso-motor nerves, the capillary vessels become partially paralyzed and consequently receive more blood than usual. This increased blood flow causes irritation, which attracts a large number of colourless corpuscles. Together with the viscosity, or adhesive qualities, of these corpuscles, they provide adhesive inflammation that is most beautifully seen in lacerated wounds, in which, when Calendula is used, to get union by first intention, without suppuration. So to extract this primary action of the remedy, a high dilution was used instead of the crude form of mother tincture.

Action:  Calendula 1000 C QDS per oral.

Remedy Response Analysis:

From the day of starting calendula, within 48 hours pain was reduced by more than 50%. The sixth day dressing a small haematoma was observed; wound had no infection in it. On 9th day wound showed good granulation tissue. On 20th day there were signs of complete healing with skin tissue growth. For the entire 20 days calendula was continued in 1000c potency QDS. Not only did calendula help achieve control of pain and inflammation but it also prevented secondary infection and allowed healing by primary intention without much scarring. Constitutional medicine was prescribed to prevent long term ill effects of remedy.

 

CASE 7:

Mr. B M, a 30 yr came with an H/O snake bite to Lt index finger which occurred 2 months back. Before coming to the hospital, patient used some local medicines for 2 months but the details were not available. The wound did not heal, and showed dark red bleeding which, was painless initially. Then blackish discolouration developed with intolerable pain and swelling with coffee coloured, rotten egg like smelling discharge. Patient presented with flexion deformity of the phalanx.  X-ray showed multiple cysts containing trabeculae in phalanges suggestive of necrotic bone tissue.

Orthopaedic Opinion: Surgical removal of cysts was done with application of mini external fixator to correct flexion deformity. The wound needed to be kept open.

The prescription was based on original unmodified picture of disease prior to operation.

A/F: snake bite;

Chronic action of snake poison.

Pathology: bone tissue necrosis

Coffee coloured offensive discharge.

Individualisation: Destructive necrotic pathology with absence of local characteristics pointed towards 30C potency in multiple doses.

Objective of treatment: Prevent post-operative infection, control sequestrum formation and wound healing.

Action: Hekla Lava 30 C QDS

Remedy reaction:

Within 48 hours of starting Hekla Lava 30, pain was reduced by 50% and there was no active discharge. Hekla lava 30C was further continued for 15 days at the end of which the wound healed completely.

After 15 days of complete healing of wound a pustule appeared on distal end which led to ulceration and brownish dark offensive discharge with surrounding cellulitis. There was the picture of cellulitis. Now, something which will take care of deep seated destructive pathology and cellulitis needed to be given. Wound healing and cellulitis improved in seven days but still had minimal discharge.  Merc Sol 200 qds 7 days which is a complementary to Hekla lava. Wound completely healed, no discharge after 15 days. Constitutional medicine was prescribed to sustain the healing.

 

Conclusion:

  • All the above managed cases are Non-Miasmatic Surgical Diseases Aphorism # 186 thru 194.
  • All the cases summarised here have definite Causation of Trauma; either post-operative or accidental trauma.
  • Type of Trauma and Nature of Injury for e.g. contusion, crush injury, sharp instrument, and clean-cut surgical wound were considered while selecting the remedy. E.g. A/F: Type of injury e.g. blunt, cut, crushed, pointed, clean – cut: point towards different remedies.
  • Tissue Affinity of the Drug and Primary Action of Drug also helps in selecting the remedy. E.g: Symphytum acts on periosteum, Hypericum acts on sentiment nerves. Arnica on soft tissues & blood vessels. Calendula causes vasodilation through paralysis of capillary vessels.
  • The type of Tissue Pathology after the trauma is also considered in selecting the remedy and posology. E.g: Active bleeding, passive oozing, post traumatic inflammation, necrosis, suppuration etc.
  • The Duration and Effects of the Injury help in finding the remedy as well as potency. It may be acute, sub-acute, hyper-acute or chronic in nature.
  • General or specific response of the constitution/individual Aphorism # 186 to the injury is also important. E.g. Response of fever at general level and local appearance, modalities, sensations at particular level.
  • In all the above cases, problem resolution Aphorism # 3 i.e. “What is to be treated and achieved in a case” was decided prior to the starting of the treatment. E.g. (1) In case 1, to achieve fibrosis of haematoma was the problem resolution. 2) In case 2, initially, control of active bleeding and acute inflammation was the goal.

 

All these problem resolutions were in alignment with the natural process of recovery. These are the processes of healing which the vital force can support – as per natures law.

  • Ancillary measures Aphorism # 289-291: The mechanical factor is not on the realm of the dynamic vital force to overcome as efficiently as by surgical intervention. One cannot achieve proper bone union in case of fracture by just giving Symphytum without performing close reduction and cast application to ensure required alignment and proximity of fracture ends to heal. Proper co-ordination, team work of orthopaedic surgeon and consulting homoeopath was essential. The roles of orthopaedic surgeon and homoeopath were clearly identified. While homoeopath provided homoeopathic therapeutics, orthopaedic surgeon focused ancillary measures.
  • Periodic follow-ups of patient is essential as clinical picture changes overnight in this dynamic acute state of traumatic illness. Besides, it is important to assess remedy reactions to change homoeopathic remedies and potencies based on indications from time to time. E.g. In case 7, initially considering ‘bone necrosis was the pathology, Hekla lava was given. When picture of cellulitis emerged, something taking care of both, bone necrosis and cellulitis was needed which followed Heckla Lava hence, Merc – sol was given.
  • Individualization of treatment: Though conceptually these cases fall under ‘non – maismatic surgical’ type, every individual responds in its individualistic way to any stress or injury. Hence, individualization of treatment is essential. There cannot be one homoeopathic formula for trauma or injuries. Each patient with injury has to be assessed individually using a standard protocol to observe peculiar differences in the responses of the patient.
  • Role of constitutional medicine for comprehensive healing: The role of constitutional medicine has to be kept open and should be given as in above cases, in order to achieve complete healing and to reduce long term effects of trauma at physical and psychological level. Constitutional remedy thus, needs to be used after handling the injury for healing and rehabilitation, to close the case, and prevent any after effects.
  • Not Well Since: Constitutional medicine will prevent long term impact on the susceptibility. It helps prevent “not well since…..” phenomenon, thus patient does not return at a later date saying: “I am not well since injury”.

About the author

Navin Pawaskar

Navin Pawaskar
M.D.(Hom), MICR(BOM),MHA(USA),CPDM(USA).
JIMS Hospital, Hyderabad.
navinpawaskar@gmail.com
Mobile: +91 750 62 63 508”

About the author

Ashish Ranade

Dr. Ashish Ranade MS (Ortho),
Orthopaedic Surgeon

About the author

Subodh Naik

Dr. Subodh S Naik, MD (Hom) situated at Dadar West, Mumbai

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