Torticollis in a Man of 40

• A 40 years male doctor visited the clinic with a diagnosis of spasmodic torticollis on 16/01/2014.
• Spasmodic Torticollis – a/c Cervical dystonia, is a painful condition in which the neck muscles contract involuntarily, causing the head to twist or turn to one side. It also causes the head to uncontrollably tilt forward or backward.
• This patient is a doctor practicing in a rural area and referred by another doctor friend.
• Patient enters cabin wearing cap, pulls a chair one side towards a wall. Sits taking support of wall to his head.

(Patients expressions are written as it is in conversation format.)

• P: You must have an idea about my condition. I have cervical dystonia. My head is jerking backward. I am on treatment with neurologist right now. I have pain. There are slight tremors. Sleep is disturbed so they prescribed sleeping pills. So now I can sleep well. Is it ok if I sit like this? I need to take support.
• D: Yes, it’s absolutely ok. How did it start?
• P: At beginning while writing prescription, I feel my head pulling backward. There was numbness left little finger and then it started on right too. Then I realized there is some neurological issue. Seen neurologist and started treatment. Before 4 years I had vertigo and imbalance in 2009. So, I linked these symptoms and seen neurologists. But complaints aggravated. I practice allopathy. While giving injection to patients, my head pulls backward. Done MRI but nothing detected. I am on regular treatment since then but condition is worsening. They say its genetic condition (Genetic progressive disorder) so it’s not curable in allopathy. Only can be maintained.
• D: When did t start?
• P: It started before 1 year.
• D: And what happened before 4 years?
• P: at evening I felt vertigo and vomited 3-4 times. I slept well that day. But since morning there were continuous vomiting and severe vertigo. I took injections by myself. Vomiting stopped but vertigo persist. I lost complete balance. Have to walk by holding to something like drunkard. Done MRI at that time too. Neurologist prescribed medicines and it decreased gradually within a month. Then no complaint for 3-4 yrs.
• Then it started since 1 yr. I tried ayurvedic, homoeopathic along with allopathy treatment without relief. So, I stopped everything since last 4 months. There were 8 allopathy drugs, I stopped which are not necessary by my own. Taking 3 tabs now- muscle relaxant, anti-tremor, paciten (used in Parkinson’s).
• D: Any other complaints?
• P: No other complaints. My voice is changed (trembling). My symptoms are changing. My head forced backward if I bend forward to give injection or write prescription.

Now it aggravates during walking. Worse when I change clothes. Previously if I support face with single finger then it used to stop, but not now. Sometimes it is better, sometimes worse – cannot predict that. It is absent during sleep.

< stress, exertion, driving

All relatives know I have this problem. Previously I used to go to functions. But I thought everyone is looking to me. I feel to run away from there. At that time too it increases. I have no social life now. Not go to anywhere like in CMEs. I used to have role in such things, good relations with colleagues. Now I don’t go. I lie to them. I cannot sleep that day. Feels irritability. I had good relations with MRs. Now they call for function and I switch off phone. It feels bad, I cannot even express.

Sometimes friends come or if have accident patient and I start treating him; then after finishing everything I am amazed why it not felt at that time. Means it happen but I could do my work. Allopaths say it increases by anxiety, but I studied about it. It has no specific cause and no cure as such. There are theories like basal ganglion is not working properly or anxiety is cause or relaxation and contraction occurs at same time due to problem in neurons or levo-dopamine secretion is altered, so no proper signals.

I am more irritable now, gets angry easily. If someone say something then remains in mind. If something happens with someone, I knew if I stretch this it will affect me only. So, I step back or be quite but it remains in my mind. Previously if anyone say something then its like final battle. Now I step back.

• D: Meaning?
• P: For example, if something happens between us or if patient say something then I used to reply at that same moment. But now I don’t. if I reply then it remains continuously in my mind till sleep. Feel like brain is frozen, shut down. It is not relaxed for long. It may be because of vertigo.

There was one panic situation in my clinic. There was high grade fever patient. I started treatment and monitoring patient. He was accompanied with his small son. I was telling him that in such high-grade fever one may have convulsions. Suddenly, he shrieked loudly and had convulsions.

I knew what to do about his convulsion as it was expected. But his condition was different. Shrieking loudly, vomited on bed. Vomiting in convulsion is dangerous, patient may aspirate and die there. Child was crying. Those were summer days so nobody was around.

I was so frightened at that time, first time for patient I was frightened. He was perspiring a lot, I have not seen that much sweating, it was like fountain. Then convulsion settled. I started IV. After 3 hours again he had convulsions, more severe than first one. I was panic at that time.

He was cold. I shifted him to another hospital. I could not sleep till next day till I see whether he is ok or not. After that I started looking negative in everything. I fear of accident even if I has to drive next day. So much fear that I fear to give simple injection, something will happen from these, routine injections which I use daily.

If slightly critical patient come, I refer them, which previously I used to treat. 3-4 months after this I had vertigo. Sleep was disturbed. Various dreams which were not related to me.  Then I started meditation which relaxed me.

Then there was no problem. Then in February, again incidence happened. I visit one village at evening. There was a case of poisoning. A relative of Sarpanch took poison. I advised to take him to RH. 50-100 people gathered there.

They ask me, you have car so you drive her to Nagpur. I told them that no need to go to Nagpur, let’s go nearer hospital. But due to pressure I had to drive her to Nagpur. She died; I think in car itself. Then I returned to village. I heard that she was killed.

Her neck was pressed and forcefully poisoned her. Then again it started. 2-3 days were so difficult. Her face come in front of eyes. Police will interrogate me and all. These neck movements increased within those 4-5 days to great extent.

If its genetic disorder then my mother has problem of neck movement but she is aged. She is under some psychiatric treatment also. Younger brother is MR since childhood.

• D: Tell me the exact experience in situation that happened before 4 yrs.
• P: It’s like panic. Means like a situation where we cannot do anything. Even we cannot take help of someone. No one was there to help. That child was crying so loudly. Situation was like ‘Don’t know what to do’, though I knew the treatment. Febrile convulsion is not a big thing, happens many times. Injections relieved it effectively, but I was not having daring. If it was elderly relative then I could counsel him. But it was that child and me. Something like holding (HG- fist of both hands). Means don’t know what to do. I was so terrified.

If I want to explain in words, it was panic situation. I cannot explain it. It’s like what will happen next. I was not aware how those 1-2 hrs passed. When I referred him to another hospital and talked to those doctors, still I want to revisit him.

If something happens to him then blame will be upon me. Such thoughts continuously were in my mind for whole night. Then this fear started even for simple fever cases which I can handle. Fear while giving injection. Negative thoughts at home, at outside, while driving, everywhere.

I used to watch lot of political debates and news on TV daily, a lot. Then I realized I am so much involved in that, I saw those at night. Means it was continuously at back of my mind. It was affecting me. So, I don’t watch such sensitive things. I try to avoid it. Started meditation, avoids debates; by all these it relieved. Then I had nothing for 2-3 yrs. Everything was fine, in February this again started.

• D: How did that debate affect you?
• P: It was continuously at back of my mind, he talked like this, he talked like that. So much involved that I am also in that debate. I saw that in my dream or thoughts too. Like I have taken tension of whole country. When I realized I am so much involved then I stopped it. Now I avoid such debates when I feel I am going too deep into that.
• D: How did it affect you?
• P: It do not affect while reading or watching. There are continuous thoughts about it in my mind he is like that. I am completely get involved in that. Like religious issues, at one side we are and on opposite side they are. Like I am completely involved. and These things seen in dreams or thoughts rushed at night.

If debate grow to extreme then more interest develops. If it is quietly then there is no joy. If there is lot of fight, one is shouting from here another from there, then it is more interesting and I involved more. Then my own opinions, these opinions seen at night in my dreams. There was complete involvement. If children disturbed at that time, then I shouted on them – be quiet, go there.

When vertigo started then I realized that this is affecting me. I changed my whole routine. If I am with friends, my stand was like staunch religious. Then my talks were like that. As I used to saw more news my knowledge regarding topic was more.

So, in that debate I get aggressive. No fights though. If someone cross me then I had every explanation for them. So, such things used to happen in clinic or with friends. When vertigo started then I realized it as a doctor. I controlled my previous talking, easy anger. Then everything was alright, at home too. We used to go for picnics a lot.

Then after 2-3 years I feel pulling at neck, strain at eyes. At early stages I didn’t pay attention. Then in that homicide case suddenly everything aggravated. Neurologist diagnosed it in second visit. As I am doctor so I searched on internet, read all books. All said it is genetic and non curable. 2-3 months after diagnosis were so difficult. Lot of thoughts – what will happen in future, to practice, if there will be any disability.

Kids are so young – 10 yrs, 5 yrs. How will I face, like to take son’s admission, I have to go. What will happen there, how will I handle, how will I stand. Those 2-3 months were so difficult. I used to sleep in that and wake in those thoughts.

Before few months friends force to come to Darjeeling tour. There I get lot of time to introspect and also counselling of friends caused some relaxation. I have to accept what I have and I have to live. Whatever may happen. Before that I was frustrated, feels down. If it were any patient so he may have felt same probably less because he doesn’t know about Disease, its progress.

(patient repeat the incidences again and again in different ways)

 Received Zinc-met, Lachnanthes, Ars-alb, Agaricus, Stram, Phos.

My head move to backward; neck muscles get contracted. I cannot hold my head. If I want to look down, even after putting all force I cannot look down due to muscle contraction. Head falls back. I need support of something to head. I cannot hold my head, it falls back. I feel stiffness at neck at that time. Spasticity, spasm, stiff, hard, no power in muscle. If I want to stretch then I cannot. Rigidness (HG- fist with right hand).

• D: How does that feel to you?
• P: If head is down then no pain. If it goes back then it pains- muscle pain – like contracted – hard. If I am lying or sit with support then no pain. Pain only when those movements start. No numbness. There are tremors at hand if I lift some weight.
• D: Talk about your experience in second situation?
• P: In village some people are at your side and some are not. So had fear if some people involve me, I may be summoned to police station. Actually, I had to go to police station and court. 3-4 days prior to that were difficult, but when time came, I went there, gave my statement and matter closed. When I know I have to face then I become quiet and fear go away. This too happened in college life. Before starting I had fear, once I start it goes well.
• D: Talk about your state in that condition.
• P: I started practice from that village. Then shifted to big town so decrease timings here to evening only. But it become my area. Either patient from that area talk about it or I used to ask about it. What other people say about me as I gave them ride. All that goes on. I used to discuss it with friends who work in court, because of fear whether I will be summoned. I used to think about me if I did wrong by giving them ride in my car? What if my name gets involved? What if someone involve my name in this case? It goes on till my statement in court. Then it stopped.

Physical Generals:

• Hot pt
• Stool / Urine / Perspiration – NAD
• Appetite – normal
• Thirsty
• Hobbies – sports – cricket – playing and watching.
• Sensitive to – debate – religion – injustice with my religion. Injustice on poor. Hatred, anger.

My thoughts:

Reptiles

• Stealth
• Agility
• Suddenness
• Using pretense to intimidate
• Holding on stubbornly
• Hibernation

Suborder Ophidia / Serpents

• Jealousy
• Suspiciousness
• Conspiracy
• Two sides – sweet and violent
• Scheming
• Loquacity
• Clairvoyance
• Sensation of constriction
• Strangulation
• Suffocation

Subfamily – Crotalinae

• Constantly anticipating an unexpected, covert attack
• Need to be vigilant always
• Launching sudden, hidden assault on their opponents
• Clairvoyance
• Social (opposite to Elapids)

Rubics:

• mind; DELUSIONS, imaginations; watched, that she is being (38)
• mind; EGOTISM, self-esteem (64)
• mind; OCCUPATION, diversion; amel .(119)
• mind; THEORIZING(59)
• mind; MEDITATION(98)
• mind; CONFUSION of mind; identity, as to his; duality, sensation of(44)
• External Head; Movements of; backward; drawn(31)
• mind; DREAMS; strange (34)
• generalities; NIGHT, nine pm. – five am.; agg.(1078)

 

• Lachesis 200 single dose on 16/01/2014.
• Fu on 01/02/2014 – Pain decreased. Movements decreased by 50%. Confidence improved. Anxiety decreased. Tremors in voice decreased. SL * 15 days
• Fu on 15/02/2014 – no need to use cap. Can drive well. No anticipation. Sleep improved. No pain. Trembling voice decreased much. SL * 15 days
• Fu on 01/03/2014 – Jerks in neck slightly increased. Mild cramps. No pain. Voice trembling since 3 days. Lach 200 one dose.
• Fu on 15/03/2014 – Relieved. Much better than earlier. Weakness decreasing. Trembling voice decreasing. SL * 15 days
• Fu on 26/04/2014 – complaints slightly increased. May be from exertion (According to pt). Feeling irritable as complaints increased. Lach 200 one dose       SL * 30 days
• Fu on 23/05/2014 – As it is. No change in complaints. Lach 1M one dose      SL * 30 days
• Fu on 19/07/2014 – Relieved much. Irritability decreased. No weakness. SL * 30 days
• Fu on 16/08/2014 – Relieved much. Jerk in neck decreased by 70%. Sleep improved. SL * 30 days
• Fu on 20/12/2014 – Relieved by 90%. SL * 30 days
• Fu on 06/06/2015 – Completely relieved. No any complaints as such. SL * 30 days

Stopped treatment after 17/09/2016. Till he was under observation and receiving doses of SL.

• Allopathy drugs tapered gradually and then stopped till this time.
• Patient is still in my contact in 2022, without any relapse of chief complaint.