This patient presented with the diagnosis of Rheumatoid Arthritis since 2012. It began suddenly with swelling and boring pain of knee joints she could not walk. Amelioration by hard massage and hot application. In the mornings her right hand would swell and evenings the left one. She had pains with shoulders and elbows hurting, Joint problems started after 1st delivery in 2008. Pressing or pulling at the shoulder joint gives her eructations which ameliorates her in general. She feels good in the heat of the sun.
Father- healthy, Mother- Hypertension
She was brought up in a middle-class Hindu family. She is the youngest of three sisters. Since childhood her mother did not treat her well and blamed her for the father leaving them. Her parents had tried to abort her but were unsuccessful. She felt unwanted.
Her mother always hated her but after her marriage her mother has become nice to her. She prays and asks God to forgive her mother but she can never forget. She has a very pessimistic outlook towards life. Before marriage she was a very independent person and took decisions with ease. However now she is fully dependant on her husband and will consult him to ask if she should go to a school picnic.
She confesses that her husband is cooperative and nice, however he can’t satisfy her need for love. She always broods for several days if anybody says something to her. She cannot bear any criticism and opposition.
She is very emotional person and suffered when in 2016 she was bedridden and none of the family members came to her rescue. Only her mother helped her. She likes sympathy from others. She holds grudge but doesn’t want revenge. If they are in trouble she will run to help.
She likes to be indoors and wants to clean all the time. Her son tells her that she should join the municipality due to her cleaning talent. At work she is a perfectionist. Never likes to take help from someone.
She is quarrelsome at home, but in school she is afraid when others are fighting. She hides in the bathroom when neighbors are fighting. She has a habit of talking to herself. She has low self worth.
In 2017 she underwent total knee replacement of both knees, taking the opinion of 12 doctors before going for the operation. After that a hairline fracture was discovered and crackling at the knees. The orthopedic surgeons said that her implant seems to loosen and they may have to re-operate. She is afraid.
She feels that she reacts unnecessarily towards her husband and it’s beyond her control. She likes to share her problems with her sister. Likes to pray to God and sing hymns.
Craves- Sour things +2
Lab work and radiology:
R.A factor- 305
X-Ray – Rheumatoid Arthritis bilateral knee
- Diagnosis of phase of disease: Chronic fully developed miasmatically reversible disease.
- Approach: Constitutional approach followed by an antimiasmatic remedy
- Prognosis: case stands a good chance of recovery since the susceptibility is good and the miasmatic load in the family background seems negligible.
Chronic Totality considered:
- Abandoned feeling (loneliness)
- Unwanted and worthlessness
- Sensitive, easily offended leading to anger
- Responsible (Industrious)
- Talks to herself
- Ailments from reserved displeasure
- Delusion unfit for this world
- Remedy Selection was based on the following symptoms: Pains wander impelling motion, chronicity of complaints, ill effects of grief, anger, disappointed love. Brooding alternating with irritability. Loquacity, rapid questioning without waiting for reply, fear from least noise, hateful and quarrelsome. Future looks dark. Oversensitive, Every opportunity is sought for self-destruction. Destruction of bones.
- Rx 24-11-2019 Aurum-Met 200, 1 single dose consisting of 3 pills.
CHARACTERISTICS OF AURUM:
- Strong willed
- Duty conscious
- Helpful social worker
- Dignified personality
On the other side
Irritable, haughty, going to depression, brooding
Anxiety about future, disease. Worrying silent
Grief, hurt feeling
Reserved, non communicative
Disturbed emotions yet unaffected at work level
- Think of Aurum when you see Despair + pain + depression with spread to the bones in progressive diseases
- Wrapped in deep sad thoughts, suffers from delusion that she has lost the affection of her friends and that her friends have lost confidence in her.
- Expects to be respected, understood and not criticized. Holds anger for a long time (tormented by excessive amounts of mental suffering), they always believe in giving more to people than they expect from them.
1st Follow up on 22-3-20:
She appeared happy, smiling and confident. Swelling of Joints reduced 85%. Anger reduced a lot, but when she gets angry it goes out of control but still less than before.
The brooding over trifles is 99% improved. Now she doesn’t take things to heart. Says to herself “Let them say anything that they want.” Even at the workplace she focuses only on her own work and is not bothered by what others say.
During pain and swelling she used to get eructations all the time and now that has reduced. Earlier she was concerned about what people said about her. Since the remedy she thinks in a positive way. She wakes up as usual at 4.30am to do her cooking.
Feel she can’t lead a normal life like others as she is a R.A patient. Complaints of heaviness and stiffness in right knee joint <ascending. She feels as if something is there that needs to be plucked out. Complained of suffering from heat of summer. Likes to have knees covered and prefers warm application out of habit.
Recently she has developed strong craving for spicy things and chillies. Compared to before, she likes to be around people. Weight 69 kgs and she is worried about the consequences of her weight on her knees.
Although she eats little, she is not losing weight. Considering the present shift in her state. I selected Sulphur 200, 1 single dose. (complementary to Aurum and covers the fundamental miasm which is Psora). Advised to repeat R.A factor test (not done due to COVID situation)
2nd follow up on 30-6-20 – She appeared very confident. No pain and no eructations either. She gets swelling only at the time of menses. Now at school she can climb and descend stairs without need of any support. Anger has subsided a lot and she tries to avoid negativity. Appetite and sleep are good. No complaints. P.L
3rd follow up on 04-10-20 – Patient informed me that occasionally there was unbearable pain radiating from right knee to right hip joint, however it goes away on its own. The pain is like the one she used to get before her knee replacement surgery (old symptom returning).
Sometimes she gets swelling in right knee joint, but overall while always working she has almost forgotten that she has had knees replaced. Eight days before menses she used to get swelling of different joints (wrist, elbows) but for the last two months it has not happened.
Earlier she could not eat several things like palak (vegetable: spinach) since it would give rise to itching, swelling and pain in joints. Hence she would avoid those. For so many years she could not eat mackerel (fish) but she tried it twice within a period of one week without adverse reaction. Also she observed that previously she could not tolerate chana grams, dal, milk, but now she can have all these things with no problems.
Mentally also she is more mindful when negative thoughts crop up in her mind. She feels that she is almost forgetting all the old problems that she has gone through due to her sickness. She no longer takes small things to her heart. She recalled that she had consulted many doctors but no medicines had helped her. With homoeopathy she feels very good, becomes stronger day by day and is becoming free of tension. Every single day she walks for 2kms to maintain her weight. P.L
Conclusion: Although this case had deep pathology, the first prescription of Aurum Met was able to rectify the morbid susceptibility and aided in a quick recovery. Sulphur was prescribed in order to prevent any relapse and because of its centrifugal action. Sulphur also facilitates absorption of serous or inflammatory exudates in joints as mentioned in H.C Allen’s Keynotes, hence we see less swelling in the later follow ups. An overall well being of the patient has been accomplished at all levels (particulars, generals, mentals) and the reappearance of the old healthy state. Homoeopathy always has something to offer the hopeless.
Great case but what does P.L. stand for at the end of the Follow Ups. I haven’t come across that before.
PL = Placebo