14/8/18- First consultation
A 73 year old man(Civil Engineer) brought on wheelchair by wife, son and daughter-in-law, entered in chamber with crutches.He is known case of systemic hypertension with sick sinus syndrome with PPMI (permanent pacemaker implantation).
With H/o giddiness since 2010, sensation of being imbalanced that comes all of a sudden, uneasiness lasting for 2 minutes occasionally.Attacks once or twice in a month, since 2010.(Findings on ECG – Sinus Bradycardia).
Finally in 2013 diagnosis was- syncope with vertigo with ACS (acute coronary syndrome)
Pacemaker was implanted in 14/11/2013.
Again, since1 year,May 2017 attacks of giddiness are frequent, daily, many times in a day. ENT specialist opinion was taken. (NAD- no abnormality was detected)
Chief complaint on first consultation:
Yesterday night I felt giddy a little bit, so went to sleep. I slept well. I was fresh in the morning. I went near table, had tea, and I just felt like falling backward. All of a sudden and I don’t know why? It is unpredictable. So could not sit there. It is beyond my imagination. Why is it happening? After few minutes everything subsides. Objects stop moving (up & down). So I went to sleep .
I am fond of Reading ++++++ Willing to read something. Now unable to concentrate.I am unable to concentrate on PC as well. I feel giddiness.I feel helpless.Also have hardness of hearing.Can better hear at right side. Hardness of hearing is mainly on left side.Tinnitus constant
No H/o any major or minor illness for 60 years of my age, but in in 2009 I met with an accident at Muscat, Oman.
Past Medical History:
1) In 2009 met with major road accident at Muscat,Dubai, had fracture of shaft of right femur bone and after that it got infected(osteomyelitis),operated 4 times. Ball is been cut, direct rode is been implanted. Difference in length of both lower limbs is apparent after operation.
X-ray of right femur (AP & LAT) (report attached – date-29/12/2009)
2) In 2010 – C/o – uneasiness , giddiness
Findings on ECG – SINUS BRADYCARDIA
3) In 2013 – while watching TV, suddenly got blank; family doctor was called and he said heart beats are going down, Sudden stoppage of blood flow, heart beats are low,so had to implant pacemaker
ECG findings – HR- 67 bpm,absolute arrhythmia, atrial fibrillation/flutter, with 1 ventricular extrasystole, with 6 aberrant complexes.
Clinical Dx- Systemic hypertension with sick sinus syndrome with PPMI (permanent pacemaker implantation) (done in 2013).
4) on 2/5/2017 – Admitted to SpandanHeart Institute &Research Centre (I)Pvt.Ltd. with H/o giddiness & Syncope, 4 episodes since last 2 weeks.
ECG showed sinus bradycardia with first degree AV block with T wave inversion in V3-V6.
2D ECHO showed ischaemic heart disease with good LV systolic function with LVEF 60%.(report – attached – 2/5/2017)
CIMT(Carotid intima media thickness )report showed CIMT is increased on left side.(report attached – date -3/5/2017)
Past history of -DX. With syncope with vertigo with ACS(acute coronary syndrome), angiography was done that showed non critical coronary artery diseasewith normal LVEF 65%
5) on 8.5.2017-consulted an ENT specialist(home visit). On examination less rotational, more imbalance is found.His opinion – unlikely to be labyrinthine dysfunction.
He prescribed Tab.Vertin, without any relief.
Q:Tell me about yourself
I am happy go lucky man – never been to hospital for 60 years age of my life, now my only wish is I want allmy familymembers to stay together. Actually,son shifted at Baroda from Nagpur. We sold our Nagpur house few months back. Booked here(at Bbaroda) Without son it was difficult for us(me and my wife).He is with us so I feel ok.
I was computer addict after accident. Movies downloading was done continuously. …. but now unable to concentrate, it causes giddiness. Since last 2-3 days it is happening frequently, I am unable to sit and concentrate.
After shifting over here Irealized thatI don’t have much freedom, can’t purchase plot,so we booked a flat.
After accident(in 2009) he has to sit at one place only. So he learnt computer on his own.
I was making industrial,residential, factory and dams models. Carpentry was my hobby, at my house I have tools available with me costlier than my wife’s gold jewellery.After pacemaker implantation I donated all my tools to Nagpur IIT college, cause now I can’t do anything,, Had all kinds of tools ….since 50 years I had preserved all those tools, two big trunks I have brought here also.I’m fond of carpentry.
Q-How do you feel while doing it?
Oh!I used to work for 10 hours with full concentration. I used to feel very happy. It was creative work.
When I got to know that heart valves are perfectly fine,soI thought let’s stop now.(relatives left the chamber- saying that he is extremely introverted, silent person, rarely talks to anyone, doesn’t have friends except 2 or 3)
Q- Tell me more about yourself.
I have stopped reading almost. I have downloaded some audiobooks. My daughter is also a voracious reader.I am fond of reading novels,fiction and mystery.Now I don’t read anything, only Marathi (local language)newspaper Times of India. Now I don’t read books.
Q:Have you written any books?
NoI’m not capable of that, but while making models I had to put lot of thought into it. Once I had a client. He wanted me to make a working model for an industry. He was specialist at Nagpur. He wanted me to prepare this working model. I took pics, plans of his machine, at that time I was in good health (no accident no heart problem), I went to market to purchased small motors.I attached wings to motors and made them to rotate upto half round to create vibrations in screen at high speed. Material moves in anti-gravity direction,from bottom to top. This small sample. I made it in 7 different ways. All 7 times it was successful.
Q-Tell me more about yourself
My nature is only to do something creative always. For e.g this wall clock, I made these wall clocks also. I had computer cutter machine, with help of this machine I made figures. I made hanging lamp also. My hobby was to do something creative.
Q-What is the difference in doing routine job and doing something on your own??
Routine job is 9am to 5pm. But in your own work you work for 24 hours. Days and nights. I worked constantly for 24 hours in case of emergency of models. At a time people used to work underme. Here you involve yourself. In routine job that element(involvement, devotion) is never seen.
I also did job in construction. At that time alsoI used to take initiative andI was given good promotions also. I was fully devoted. I can never enjoy doing a routine job. I must create something new each day. I can appreciate art in any form whether singing, painting, drawing anything. If someone is doing good art work, I will stop there and will watch his way of working.
Fears – none
Sleep – disturbed,because ideas keep on coming into my mind but I am unable to do anymore. I feel I have lost everything.
Dreams – Idon’t remember
Analysis of case
Creativity is the most important theme in his life.
Most important point is that patient is against routine jobs and prefers his own work andcreativity that keeps him occupied for hours in a day with full concentration. He feels more energetic and happy while working for his models for factories and industries.
After accident(in 2009, at Muscat) he could not work with same energy and capacity, but still he continued his workshop at his home. He started guiding students for making their projects and models.After pacemaker implantation he felt absolutely helpless.Now he’s just watching other peoplewho are creating anything new. Absolutely nostalgia about his achievements and admirations received in the past, his tools, and his models. A
According to Scholten’smineral kingdom classification
5th row – silver series is about
Art Science Mysticism
And 13th column is about
Out of date
Rx – Indium Met 0/3 OD – 1 month
Follow –up3/9/18 – phone call -Better by 80 %, giddiness was gone within 5 days. Sleep improved. Can feel mental peace and calmness. Energy level also improved.
Same Rx was continued.
(Patient walked into the chamber with crutches but no wheel chair.)
I am feeling very well. Had never expected improvement to this extent where I am feeling my original personality as I was many years back.I am very happy. I used to become sleepless when my son used to give me negative answer. But now I can go to sleep without any disturbance.Not taking any tablet for giddiness since one and half months.I feel myself more involved with music and I can make out each and every beat of music, which instrument is being played and my wife is also a very good singer and she does play harmonium. I enjoy it. I do watch videos of artists more often but giddiness is not there. I can concentrate on PC without any problem.
Patient is still in contact and to this day andthere is no giddiness or any other complaint – follow up on phone only.
Encyclopedia of Pure Materia Medica -Dr. T. F. Allen
MIND. Depression of spirits without cause, . Depression of spirits, . Restless, cannot sit still, must walk about, . Feel almost crazed when attempting to study (with dull, heavy nervous headache), . Cannot fix the thoughts on anything, . While reading, mental dullness with full feeling in front of the head, .
HEAD. Dizzy disagreeable sensation in the head on rising from a seat, . After retiring, nausea and dizziness, and pain in region of liver, . When sitting, and stooping slightly, sensation of vertigo and fullness in the front part of the head, . Awoke between 3 and 4 A.M., with vertigo, worse on turning the head on the pillow, much worse on rising, and then attended with faintness and nausea; forced to lie down several times while dressing; at half past eight, being unable to sit up, took a dose of Bryonia 200 and was soon relieved, . [10.] Head felt crammed full, .