In-house Consultant, the other song
With this case, I would like to share my experience being associated with ‘the other song’ academy, working with legendary Dr Rajan Sankaran and trying to incorporate his teachings into my practice. This case is an illustration of his teaching. Dr. Sankaran is often asked which approach to take during the case taking process and his answer would be, just to follow the patient. Begin the case from where the patient’s level is, and complete the symptoms in their totality, i.e. origin, duration, progress, location, sensation, modalities (aggravating and ameliorating factors) and concomitant (associated symptoms).
Often we get the clue of the remedy from this totality and the rest of the case needs to be viewed in the context of what solid information we have established so far. In other words, we need to look into the case for further indications of a remedy (which the totality gives a clue for) before we can affirm it as the similimum for the case.
This case, consulted by Dr. Pratik Desai at the other song clinic has been edited for brevity. The sentences in italics denote the doctor’s understanding.
To elaborate this concept I am presenting this case of a 27-year-old single man living in central India who urgently requested an appointment at ‘the other song’ academy for the treatment of arthritis of hip joints, which he was suffering from since 2011. I first saw him on 5th September, 2013. The patient complained of pain in hip joints either the right or left side. He said that at a time only one joint was affected. The pain started after he had met with an accident in September 2011. The patient had fallen from a bike and had some bruises on his left knee and left upper limb due to the resulting injury, but he had no fracture. His injuries were better in 2 weeks and the pain has ceased. Two months later, to his surprise, he felt pain in his hip joints. Over the past 6 months, the intensity and the frequency of the pain had markedly increased.
The pain was severe and every episode of pain lasted for 8-10 days. It was then difficult for him to manage his routine. He described the pain as very intense and unbearable, and aggravated mostly at night and in cold weather. Whenever the pain started, it became difficult for him to even turn to the side when in bed, or to pick up something from the floor. The patient said that the pain was so horrible that it used to take half an hour to just turn to the side. He described it as, “It is a big task or target for me to change the side”. He had to take support of something and only then he was slowly able to manage to sit or turn to the side.
So here we have information about the origin or the causation of the disease, its location, its intensity and some aggravating factors. Now we need to understand the type of pain or sensation and if there is any concomitant associated with the pain which will then complete the detailed description of the local complaint i.e. pain in hip joint as regards the location, sensation, modality and concomitant.
The patient described the pain as a kind of an electric shock, or jerk, as if someone had bitten him hard. Sometimes, he felt as if his leg was not there as he could not twist or turn and hence had to be in one position for a considerable time. The pain got worse when he stretched his leg, or bent it at the joint. The pain that he then felt was as if the bone had broken, or as if someone was pulling intensely at the bone. As a result, it became difficult for him even to stand from a sitting position, or when he tried to ride a bike or car. When in pain, he could not even talk to anyone and he was very irritated if someone tried to talk to him.
He further described the painful part as very stiff and hard and he had to make cycling motions clockwise and anti-clockwise so as to render the part soft. I asked him to describe the experience of being pulled and twisted and he said that it was as if someone was twisting the leg from the hip joint and it was so intense that he often felt that he should remove the entire leg. It was with great difficulty that he controlled and tried to bear this pain.
The patient then described the experience of being twisted as if somebody was giving too much pressure, as if squeezing the leg. He described the experience of squeezing (hand gesture) as if somebody was draining a wet cloth from by applying too much of pressure from both sides from opposite directions so that all the water was removed. He said that the pain felt so pressurizing that it felt as if it would break the bone or remove it from its attachment.
Now we have a complete description of the pain in hip joints as well as the words that the patient used to describe the pain sensation were pulled, stiff, beaten, broken, twisted and squeezing. Here we get the complete description of the experience of pain in hip joint and sensation words that patient has used were pull, stiff, beaten, broken, twisted and squeezing. So we need to find a remedy which has all these qualities of pain. Now we also need to examine other areas of his life and to see whether they match the remedy that we are looking for.
The patient described his nature as being aggressive, not being able to control his anger. He did not trust people easily. He is helpful to others and gets sentimental over small matters. He was emotionally hurt when his friend to whom he had extended full help and support, broke off his friendship due to some misunderstanding. He described the experience in that situation as of being used and said, “When his motive was over, he had used and thrown me out.” The feeling was that he had treated me as if I had done something wrong.
He described another situation with his elder cousin brother who had promised him that he could stay with him as long he wished, but when he got married, he asked the patient to leave his home. He felt that all responsibility of his family came over him and he was controlling all his aggression within him. He felt very bad that his cousin has told him something but acted otherwise. When time came to follow the commitment, he turned to the side.
The patient has fear of ghosts and of being killed by them. He said that ghosts kill you by tying a rope around the neck and pulling up so that the person is hanged. He has dream of snakes and he is scared of them. In food and drinks, he craves for non vegetarian food and fresh juices especially orange or sweet lime.