Large Ovarian Tumor in a Woman of 32

C/O:

1. Amenorrhea, since 2 months.
2. Vertigo <morning & evening, since 5 years
3. Pain in right side of chest (as like the pain in wry neck), since 5 years
4. Bearing down sensation in lower abdomen < stool during, since 1 year
5. Pain starting from right lumbar region of abdomen, extending to the urethral region since the paracentesis has been done for plural effusion
6. Sore throat, sneezing since 3 months

History of present complaint

• To start with, she was alright approximately up to 2004.
• During 2004 she started feeling pain in her abdomen, which was almost labor- like.
• During 2005 she started getting back pain which compelled her to walk or stand bent, for which she took homeopathic medicine.
• Some days later she was affected with typhoid fever and treated allopathically.
• After the treatment of typhoid, she developed pitting edema on her face, abdomen and lower extremities. A painful mass was felt on left abdomen with unsatisfactory stool & urine.
• Pain in chest was there and pleural effusion was detected. Paracentesis was done for it.
• After that she developed bleeding P/V almost monthly twice, for which she took allopathic medicine. As a result, her period became delayed which was at approximately every 2.5 to 3 month intervals.
• Now sometimes, she is feeling pain in right side of abdomen also.

Diagnosis made at that time- Meig’s syndrome (triad of benign ovarian tumor, ascites and pleural effusion)

Past history– Typhoid before 4-5 years

Physical generals
Desires – egg, ice cream, meat
Perspiration- Increased from palm and sole
Thermal- Hot
Thirst- Thirsty
Speed- Slow

Physical examination
B.P. – 150/98 mm of Hg
On USG of abdomen & pelvis (30/01/11) – A large complex mass showing inhomogenous echo pattern of 100mm X 85mm X 58 mm size having well defined and lobulated margin is seen in cephalad and right to the uterus, suggestive of ovarian mass.

Mental general
Dream- Snakes (before 3 months, continuing for about 2 months almost every night)
On observation– Sighing (4 times)

Life history of the patient (from the patient herself and her husband)

Childhood

• She was regular in her class during her study (Diligent), but performance was not too good.
• She was of shy nature, hesitated to approach strangers. (Timidity)

Adulthood & present life

• Indisposed to talk, yet talks with others because it will create a bad image and others will talk about her. (Sensitive to reprimand, criticism, reproaches)
• She is too much conscious about her self-image. She tries her best to manage everything so that no one could criticize or blame her. If someone reproaches her, she starts weeping. Despite their financial problem, she never compromised in making gifts to others, because she doesn’t like to be criticized. (Sensitive to reprimand, criticism, reproaches)
• Obstinate, refuses to take food or refuses to talk if she gets angry.
• If someone yells at her, she starts weeping. (Sensitive to rudeness)
• On watching a sad movie also, she starts weeping. (Sentimental)
• She is too much adoring to children; not only to her own, but also to the kids of her neighbour. She also gives them baths and feed them as if she were their own mother. She said that she gets pleasure out of it. During her childhood she had a pet dog and a pet She used to feed them herself. (Affectionate)
• She donates food as well as her clothes to the maids working at her home. On being asked about why she does so, she replied, “Don’t they feel hunger? They also have some desires.” (Sympathetic)
• She even had allowed some of her nephews and a few kids of her village to stay at her home, and helped in their upbringing.
• Her main stress was her financial problem. Many times, when she is alone, she starts weeping thinking about it (but not in front of others). (Grief, silent)
• She is very neat and clean; cleans clothes and bed-sheets often. (Fastidious)

SO THE MENTAL RUBRICS ARE:

• Diligent
• Timidity
• Obstinate
• Sensitive, reprimand, criticism, reproaches to
• Sensitive, rudeness to
• Sentimental
• Affectionate
• Sympathetic
• Grief, silent, pent up
• Fastidious

REPERTORIAL ANALYSIS
Repertorizing the above mental rubrics (except ‘diligent’) from complete repertory, we will get the following medicines, Ignatia, Puls, Nux v, Nat mur, Carc, Lyco
All these medicines are diligent except Nat mur (Refer Dr Praful Vijaykar’s diligent and non-diligent remedies and his book ‘Frequent Encounters’)
Patient is basically hot, thirsty and slow.
Nux vom is ruled out as it is a chilly and fast medicine.
Ignatia is also ruled out as it is chilly.  
Puls, being thirstless, is excluded.
Then remained, two medicines, i.e. Carc, Lyco

FINAL PRESCRIPTION
As it was my early practice life, I prescribed the non-diligent Nat mur though the patient was diligent.
25/01/11– Nat mur- 200/1 dose and placebo  (at that time, size of right ovarian mass was- 100mm x 85mm x 58mm)

FOLLOW UPS

18/02/11
Menses started on 05/02/11 and continued for 7 days, profuse
Now, pain lower abdomen <eating after
Dull fever since 3 days <morning up to 12 pm, evening
With Cough and bitter taste in mouth
B.P. – 120/82 mm of Hg
Placebo continued

19/03/11
LMP-10/03/11, normal cycle
Now, pain right abdomen < eating after, but not intense
Placebo continued

08/04/11
LMP-07/04/11, normal
USG on 06/04/11– Right ovarian mass- 100mm X 92mm X 58 mm         (Size increased)
Feeling weak and lack of energy
Rx: Carc-200/ 1 dose (medicine changed)

12/06/11
Herpes circinatus on lower abdomen, wrist and thigh.
Period regular
Redness, aching pain in eye ball
Placebo continued

16/07/11
B.P.-110/80 mm of Hg
USG- Right ovarian mass (106mm X 82mm X 65mm) (Size increased)
Menses regular
Placebo continued
(It was my mistake. Medicine should have changed then)

28/07/11
Fever since 4-5 days, typhoid detected
Acute totality: dull/ chilly/ thirsty, desires warm food, fatty food, salty food, gradual onset)
Sighing
Repeated 1 dose of Carc-200
(Follow up- fever subsided within 24 hours)

19/09/11
Sneezing< morning since 14 days
Dull backache since 4-5 days
USG-Right ovarian mass-74mm X 56 mm
Placebo continued

13/01/12
USG- Right ovarian mass (30/12/11)- 64.6 x 70.3 mm
Menses- Regular but scanty
Bloating sensation in abdomen < menses before and during
Itching fingers
Carc- 200/ 1 dose

11/05/12
B.P. – 140/94 mm of Hg
USG- Right ovarian mass (28/04/12)- 75mm X 73mm X 55mm
Placebo continued

22/07/12
Last month period scanty & only for 1 day
This month not started yet (LMP- 24/06/12)
Carc- 200/ 1 dose

15/12/12
Pain in left lateral side of the back (kidney region)
USG (13/12/12)- Right ovarian mass -74mm X 73mm X 52mm (no remarkable improvement)
Calculus right kidney – 1 no (3-4 mm), left kidney)- 2 nos (4-5 mm) and 5-6 mm
Carc- 200/ 1 dose

11/04/13
Toothache (right lower molar) since 2 days, took allopathic pain killers
Carc- 200/ 1 dose

23/06/13
Fever 4 days before and subsided itself, now bitter taste in mouth.
Carc- 200/  1 dose

28/07/13
USG- Right ovarian mass (84mm X 52mm X 32mm); no calculus in kidney
Toothache (right lower molar) increased
Carc- 1M/  1 dose

21/08/13
No appetite, sometimes nausea < eating during
Stool- Constipated
Menses- Regular
On further interrogation it was found that sometimes she punishes her son for any infraction. (Remember, a Carcinocin patient will never hurt others, even she cannot be strict with her children)
Lycopodium-200/  1 dose

01/11/13
Last month fungal infection grew in between fingers and toes and healed itself.
No nausea since Lyc. has been prescribed, appetite good
Placebo continued

01/12/13
Weak feeling since 15 days, nausea, and appetite reduced
This month menses 7 days early
Lyc-200/ 1 dose prescribed

31/12/13
Feeling of mild dyspnoea since 15 days
Menses normal
Lyc-1M/

04/04/14
Till now everything is OK.
USG on 26/03/14- Right ovarian mass (83mm X 73mm X 48mm)
Lyc -1M

03/08/14
Mild vertigo< morning
Fullness of epigastrium< after meal, since 4 days
Aching legs <night, in bed
Placebo continued

08/10/14
USG on 14/09/14- Right ovarian mass (86mm X 83mm X 50mm)
B.P.-120/86 mm/Hg
Lyc -50M

15/01/15
Menses normal
Sneezing and pain both knee joints since 15 days, more of right side < evening
Wry neck since 3 days
Placebo continued

23/05/15
Itching inside and around eyes since 15 days
Constipation
Placebo continued

11/08/15
Bitter taste in mouth since 15 days, toothache only sometimes
Lyc-50M

25/10/15
USG- No SOL seen in ovary
Placebo continued

06/02/17
USG- No SOL seen in ovary

Inference
I will begin discussing this case with a quote of Dr A. P. J. Abdul Kalam,

“Don’t read success stories, you will only get a message. Read failure stories, you will get some ideas to get success. –Dr Kalam”

The actual simillimum in this case is Lycopodium.

Dr Kent has mentioned in his lecture-4 of his homeopathic philosophy that an individual’s constitutional medicine never changes, it always remains the same  throughout his life. His version was like this,

“The man needs the same course of treatment that he has needed from his babyhood.”-Kent

Thus, she will need Lycopodium throughout her whole life for almost all chronic ailments. However, totality of symptoms should always be matched.

Natrum mur, brought on the normal cycle, but it was unable to diminish the size of ovarian mass, which moreover, increased.

Carcinocin somehow at first reduced the size of the mass, but couldn’t sustain the same despite repetition. Also, it produced new symptoms like loss of appetite, toothache, nausea and constipation which didn’t subside.

Natrum mur, being non-diligent should have been ruled out from the beginning.

Now, the point is to compare Carcinocin to Lycopodium. Carcinocin patients are too much yielding and they never hurt others; they cannot even give strict discipline to their children. Carcinosin patients oppose no one; whatever may be the situation they always submit themselves to the wishes of the other. Another thing, Carcinocin patients are artists, i.e., they have aptitude for drawing, painting or sculpting.

But here the patient is strict enough to discipline her children and she has no artistic aptitude. Thus, Lycopodium is the simillimum.