Case Quizes Clinical Cases

Solution to Dr. Amarsinha Nikam’s CROHN’S Case (Feb 2013)

Dr. Amarsinha Nikam’s solution to February’s Crohn’s Case Quiz

  • Totality :

–         A/F Post-Operative/mortification/chagrin.

–         > Open air.

–         > Lying on back.

–         > Flatus.

–         < Sour.

–         Emaciation severe.

–         Hardness of abdomen.

–         Glandular affections chronic.

–         Forsaken feeling.

–         Contradiction intolerance of.

–         Anger sudden violent.

–         Talk indisposition to.

–         Ambithermal.

  • Remedy Selected : MERC SOL 30.
  • Response :

After seeing her critical condition, I concluded that she needed to be hospitalized.

On regular follow-up and observation, I found that her pain in abdomen, legs and painful backache gradually vanished.

Within a week, she got a sigh of relief from backache and abdominal pain. Hard stomach gradually turned smoother.

Also her bloatedness and rumbling of abdomen gradually disappeared. Previously she was unable to have rice in her meal as it was worsening her abdominal complaints. Now, she can have a complete diet.

Her pain during menses also decreased.

Her appetite increased and within a month she rapidly put on weight as per previously. Dusky color turned to shiny skin tone. Her Hb% moved from 7 to 11 gm%

Along with physical status, her mental status has improved a lot, seen from her behavior, i.e. now she loves to communicate and mingle with people.

  • D/D :

Arsenic :

It is very close to Merc Sol in this case as it covers the forsaken feeling, the mortification. But a few points differentiate :

1.     It does not cover A/F operatives.

2.     Aggressive nature of patient.

3.     Positivity of patient which is extreme.

4.     Also Arsenic does not have > Flatus.

5.     Arsenic is Chilly. Patient is Ambithermal.

6.     Glandular complaints are well covered by Mercurius

Lachesis :

It does not cover :

1.     A/F operative.

2.     Doesn’t have > flatus.

3.     Lachesis has more of sexual aspects.

4.     Patient is ambithermal and Lachesis is hot.

5.     Glandular C/o are covered well by Mercurius

 

Below is the original case presented in Feb 2013

This is a case of a young lady all the way from Jalna, aged 20. When she came for treatment her condition was bad. She had a distended abdomen with a thin stream-lined body. It seemed to be a severe problem.  During consultation, I learned that she was suffering with this problem for the last year. She mentioned that initially, she was suffering with abdominal pain only during menses, but later severity increased.

She underwent U.S.G., but reports did not reveal much. Her haematological tests reports were not satisfactory, especially Hb% which was very low, i.e. 7 gm%. Accordingly she underwent 3 blood-transfusions. Meanwhile, she was treated with high doses of painkillers; which didn’t give her any relief.

She continued complaining about darkness of skin and severe backache with distended abdomen. She had lost approximately 5-6 kg of her weight, which was clearly noticeable from her emaciated extremities.

She felt breathlessness because of distended abdomen. Bloated feeling with rumbling due to flatulence and pain was present day and night.

She underwent C.T. Scan and endoscopy as advised by gastroenterologist which revealed a mass, but it didn’t confirm any diagnosis. She then underwent diagnostic biopsy. It revealed the diagnosis of “Crohn’s Disease”.

Crohn’s disease was found at a developed stage for which modern science was left with no remedy.

She consulted on 16th Dec. 2007.

Crohn’s Disease : It is one of the major forms of Inflammatory Bowel Disease with a prevalence of 50-60 / 100,000 with a peak incidence between 20 & 40 yrs. Aetiology is unknown, but the racial difference & geographical clustering suggest both genetic & environmental causes. There are no HLA markers but HLA – B27 is increased in patients with Inflammatory Bowel Disease. Crohn’s Disease is a Chronic Inflammatory condition that may affect any part of the GIT from the mouth to the anus, but has a particular tendency to affect the terminal ileum. The disease can involve one small area of the gut or skip lesions. It may also be extensive, involving the whole of the colon / small bowel. The involved bowel loop is thickened and narrowed. Inflammation extends through all layers of the bowel.

Modern Science suggests immuno-supressive agents, steroids for this disease with dietary  supplementation. Approximately 80% of patients will require an operation at some time during the course of their disease, yet a recurrence of about 15% per year is almost inevitable and most deaths are associated with surgery.

  • Investigations :

28.09.2007 : Barium Meal Study :

Multiple long stricture involving ileum and distal portion of jejunum with segmental dilatation and loss of normal mucosa fold; highly favor of Crohn’s disease, rather than Koch’s Abdomen.

Other reports not brought

Her complaints were:

  • C/C :

1.     Pain in abdomen : 1 year on & off, but increased since 2 months.

–         Pain starting from (Rt) side of abdomen and spreading to whole abdomen.

–         Pulling type of pain with sensation of hardness of abdomen.

–         Rumbling in abdomen, on & off with flatulence disturbances.

–         Distension & rumbling of abdomen.

< Rice.                                > Flatulence after.

< Overeating.                      > Warm Application.

> Rubbing over back.

> Lying on back.

2.     Backache ∵ 2 months

Location : It was over spine, starting from lower lumbo-sacral region and going upwards up to cervical spine with stiffness sensation of neck.

A/f  Post Operative.

< Menses before.                             > Rubbing over back.

< Abdomen pain during.                   > 2nd day of menses.

< Sitting prolonged.

3.     Blackish discoloration of skin  : 9 months.

4.     Weight loss from 40 kg to 35 kg within last 2-3 months. (More marked over extremities.)

  • Past History :

1.     H/o Jaundice & Tonsillitis in childhood.

  • Personal History :

1.     Appetite          : Loss of appetite since 2 months.

2.     Desire       : Pungent++, Spicy+++, Milk & Milk products, Ice-cream, Oily.

3.     Aversion       : Sweet, Sour.

4.     Food <        : Cold things, sour < Throat pain /

Tonsillitis.

5.     Head  : Headache on forehead since 1 month.

< Cold air.                    > Pressure.

> Tight Bandaging.

6.     Tongue          : Pale, moist, slightly fissured.

7.     Thirst       : Moderate.

8.     Bowel       : Satisfactory & regular.

9.     Sleep       : Sound.

Position : lies on sides.

10. Female       : Menses regular cycle. 4/35 days. Since 1 yr. pain in abdomen and back.

< Before menses.       > 2nd day of menses.

11. Thermal       : Ambithermal.

In general  > Open air.

12. Mind :

1.     Let me know about your childhood?

I was born and brought up in Jalna. We were 5 people in family with one elder brother. I was the only girl child and hence pampered by family members who had made me aggressive and irritable in nature. I was very passionate about the things which I want. I was average in studies and good in drawing. But, I fear to be alone. I am an Arts Graduate and pursued ‘Diploma in Fashion Designing’ for a year.

2.     Tell me something about your married life?

I am newly married, just couple of months back. Since I was not feeling well from months back, my husband and mother-in-law felt that I have a serious disease and they started avoiding me. Later on, whole family started isolating me. I was not permitted to enter in kitchen and even our beds were separated.

Nowadays, I am staying with my parents, no communication with my in-laws; however I feel that some or the other day, they will accept me when I get cured.

3.     What about your nature?

As I previously mentioned I am very obstinate in nature; I get angry very soon if someone contradicts to my statement. Moreover my attitude is to remain silent and do not will to mingle with people. If someone talks rudely, I get hurt and start crying.

Her parents added that she very often gets violent and bangs her head on the wall; or not eat food. With a smile, her father added that once she was demanding a particular thing, but due to lack of money, we opposed and she went on a fast for 2 days. In addition, father stated that she feels embarrassed when she is insulted. She continues with her anger, remains silent for longer time and takes time to calm down.

4.     What type of tensions did you face previously?

I hardly face tension regarding my studies, rest all things were normal.

Nowadays there are somewhat tensions regarding my in-laws’ behavior.

5.     What makes you afraid?

I am scared of monkeys, of darkness and to be alone.

End

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About the author

Amarsinha Nikam

Amarsinha Nikam

Dr. Amarsinha Nikam is a renowned homeopath who runs Aditya Homoeopathic Hospital and Healing Centre in Pune. He started his career as R.M.O. at Lokmanya Hospital Pune, Homoeopathy Division and subsequently practiced as the consultant Homoeopath for 14 years at various places such as Beed, Khopoli, Chakan, Kate – Pimple, Pimple – Gurav and Pimpri Gaon, Pune. Dr. Nikam teaches students to understand the depth of homeopathic treatment and differentiate it from other pathies. He instructs them in his method of practice, but also inspires them to innovate and explore.

3 Comments

  • want to ask something sir

    here she is very headstrong but you have not choosen it at all.

    Many other modalities are there. What about those like >rubbing back
    >hot application

  • Hello I am curious also about the way you selected the modalities taken in the case, since there are so many!
    Thank you

  • Dear Sir,

    My question is similar to Dr Mukesh. Could you please explain how you choose which symptoms or modalities to select before you prescribe. This is my sincere question. Thanks

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