Clinical Cases

Recurrent Tonsillitis in a Girl of 9

Apoorva Deshpande

Dr. Apoorva Deshpande presents a case of Recurrent Tonsillitis in a Girl of 9.

PRELIMINARY DATA:

Name: Miss. SSK

Age: 9 years      Sex: Female

CHIEF COMPLAINTS:

Since age 4 she has been suffering from recurrent tonsillitis. Change of weather and slightest exposure to cold   causes inflammation of tonsils B/L with pain. Usually begins with morning cough and coryza later pain and swelling of tonsils. Advised tonsillectomy.

Present c/o cough since 2 days. Cough < morning on waking and continues in bouts throughout day. Cough with white thick expectoration. Daily morning coryza with thick white discharge from nose.

PAST HISTORY:

H/o similar recurrent c/o in past- taken allopathic and ayurvedic Rx

h/o severe gastrointestinal infections in infancy.

h/o endocrinological consultation? Early pubertal development – on Ayurvedic Rx

FAMILY HISTORY:

Maternal grandmother k/c/o hypothyroid, DM

Maternal  aunt K/c/o Hypothyroid

HISTORY OF MOTHER DURING PREGNANCY :

Mother had to go through lot of family issues right from preconception time. Financial tensions and emotional stress+: FTLSCS- non progress of labour and fetal distress at birth-  baby 3.2 kgs – uneventful neonatal period.

PERSONAL HISTORY:

Diet:  veg+egg. Appetite: has been advised strict restrictions by endocrinologist to control obesity. Thirst:  moderate

Likes: fried foods, sour foods – but lead to throat c/o.

Perspiration:  only on exertion- in axillae+, around hairline, neck

Bowel:  satisfactory mostly, occasional flatulence

Sleep:  very sound.  Dreams:  daily activities – sometimes talking in sleep

Thermal:  chilly

MENTALS:  vivacious child- likes making and telling stories, talkative ++, very obstinate, tantrums only when asked to study

EXAMINATION:

  • Build: obese for age  weight- 39kgs
  • Pulse: 78/min
  • Pallor, Oedema, Icterus, Cyanosis, Eruptions: absent
  • S. – nose- congested- mucus secretions+

Throat- Both tonsils enlarged, no redness, <rt side. AEBE, no abnormal breathing sounds

DIAGNOSIS:  Recurrent  tonsilitis

PRESCRIPTION:

  • First Prescription: 14/8/16:

Silicea 30 *  2OD,  Ferr. Phos 6X * 2bd* 8days

  • Follow up 1: 23/8/16: Child better: All c/o < > mild morning coryza on cold exposure o/e: tonsils enlarged but non inflamed:

Ferr. Phos 6x 2bd*15days

  • Follow up 2: 2/11/16:  f/u after 2months. c/o throat pain, cough, coryza, fever.o/e:  Tonsils b/l inflamed. Fauces red. Afebrile

Phosphorus 30 *2 OD* 8days  ,  Ferr. Phos 6X  2bd*15days

(The Phosphorus was  chosen  as  it  specifically  covers  the a/f,  the  character  of  expectoration  and  the  clinical  diagnosis. Also,  it  is  complementary to the first prescription as a remedy that follows well)

  • Follow up 3: 9/12/16: f/u after 1 month. Child better. No major c/o. occasional coryza now and    o/e: tonsils enlarged but non- inflamed.

Tuberculinum 200 STAT ,  Ferr. Phos 6x* 2bd* 15 days

(The  child  predominantly  presents  with tubercular  miasmatic  trait,  and  hence  in  the  presenting  symptom  free  period,  Tuberculinum  as  the  antimiasmatic intercurrent was  introduced with  the  aim  of  providing  an  impetus  to  the  case.)

  • Follow up 4: 30/1/17: f/u after 1.5 month. c/o cough, coryza, swelling  tonsils: Silicea  30 *2 OD , Phos 6X  2bd*8days

(here  the  totality  presentation  being  similar  to  that  at  time  of  first  prescription  -though  of  lesser  intensity  – prescription of Silicea  was  repeated. Also, Silicea  and  Phosphorus  being  remedies  that  follow  each  other  well, the  prescription was  justified here)

  • Follow up 5: 5/3/17: f/u after 2 months. Recurrence of cough and coryza has reduced. Child tolerates cold better. Child generally better. o/e: tonsils large but size –regressed: Phos 6x  2bd* 15 days

RESPONSE:

Scores for Health Related Quality of life :

Pre- treatment: 350/450

Post treatment = 250/450

Scores  for  Symptom Severity Guide:

Pre treatment = 280/450

Post  treatment = 120/450

RESPONSE  TO  TREATMENT –  GOOD

CONCLUSIONS

  • In the  following   case,  a prescription  was  made  considering  the  child’s  presenting  totality  at  each  episode  of illness.
  • The prescription of  the  anti- miasmatic intercurrent (chosen on basis of  repertorisation  of constitutional characteristics) has  been catalytic  in achieving the much needed impetus in  this case.
  • The use  of  Biochemic remedy, in  this  case  has  been  seen to  be  aiding  the  homoeopathic  simillimum  in  maintaining  the  child’s health.
  • The aggregate effect of the Anti- miasmatic, the indicated Biochemic remedy and simillimum were selected using Robin Murphy’s Clinical Repertory. The repertorization was successful  in achieving  improved health.

About the author

Apoorva Deshpande

Apoorva Deshpande

Dr. Apoorva N. Deshpande completed her B.H.M.S from Dhondumama Sathe Homoeopathic Medical College, Pune. She holds an M.S (Psychotherapy & Counselling) - Clinical counselor. She is presently pursuing M.D. (Hom.) - Homoeopathic Repertory from Bharati Vidyapeeth Deemed University Homoeopathic Medical College, Pune.

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