Ms Iron v/s Local Train: A case of Rheumatic Valvular Heart!
NATIONAL JOURNAL OF HOMOEOPATHY 2002 Jan / Feb VOL 4 NO 1.
Dr Mirza Anwar Baig
'Ferr-met / Ferr-iod
She was 20 years old then; now 22, well built, fair, tall and blond with a heavy bust, a known case of Chronic Rheumatic Heart Disease. She came to us on 29.10.2000, brought by her elder sister, who contacted me two weeks prior to discuss her case. At that time she was bed ridden and unable to even go to Sir JJ Group of Hospitals, Mumbai to get her monthly Penidura injection on the scheduled date (These Penicillin injections were given regularly to this patients since 7 years). Her Reg No at JJ was 16113, dated 1993. As per record she had last injection from the hospital on 16.10.2000 (Follow up Reg. No. 994/2000).
Soon after that, she developed low-grade fever, CCF and signs of shock and was bed ridden because of the relapse. At this stage her sister came for help. I prescribed some medicines just on history; that palliated her sufferings so she was able to again go to JJ hospital for her due course, last one was taken on 16.10.2000. There after she did not go to hospital, having decided to take only Homoeopathy.
Her clinical & complementary remedies prescribed on basis
of symptomatology but without seeing the patient were Veratrum-alb and Naja,
along with Cactus and Crataegus as supporting remedy in Q form.
She had this since seven years, her first admission at JJ Hospital was as on
26.7.93 for Acute Rheumatic Fever with Carditis. Since then she is a patient of
Rheumatic Valvular Dysfunction. Surgery was advised which she could not afford.
During seven years she had several relapses inspite of proper follow-ups.
O/E At first visit, on 29.10.2000 - Pallor with face
flushed full volume accelerated pulse, purple gums. Her complaints were
palpitation on walking. Pain in knee Lt more than Rt << on ascending
stairs. Breathing difficulty ++, << ascending upon. History revealed that,
in the year 1993 she developed swelling and soreness of legs along with pain in
the joints and fever. History further revealed before when she got injury on her
leg while crossing the railway track, her one leg was trapped inside the track
so she pulled it out, resulting into a bruise and later swelling.
Patient As A Person:
Menses were regular, 28 day cycle. Particular modalities
were << rice, spicy food. general << heat. Storms also upset her. Mentals:
appeared confident and bold, but shy and wanted to become a teacher. Why? Likes
teaching was her answer! She could not complete her studies because of her
complicated disease, but was not sad.
Past History:
Jaundice. Mother: Asthmatic. Family history of TB (both
Mother & Sister).
Follow-Up:
I prescribed Arnica 200, as a single dose, and asked
her to continue Cactus & Crataegus in mother tinctures as
specific support. I considered physical trauma as the actual cause of her
problems. Till 10.12.2000 she showed improvement, Carcinosin was the
intercurrent and miasmatic remedy. She was ambitious and wanted to serve the
Nation.
On 24.12.2000, she started showing the signs of relapse in form of palpitation on walking, chest pain lying on left. ‘Naja’ 30/2 doses were repeated, (first it was given to her without seeing her). But this time it did not help her much. She showed some palliation then again relapse. She also developed other constitutional symptoms, sometimes tonsils affection, sometime got fever along with palpitation, and cardiac dyspnea. I analyzed the case again: Palpitation on exertion, sweats easily <tea, <rice and some other. ‘Thuja’ as intercurrent, ‘Carcinosin’ as constitution, ‘Adonis’, ‘Crataegus’ & ‘Phytolacca’ as per laurels helped little & palliated her sufferings. Calcarea added little more benefit. At that time I also came to know that she had already stopped going to JJ, as she never felt benefited like now with those injections which she took, regularly, and religiously since seven years.
Now she is able to go out and enjoy life. Also she came on her own to collect her medicines, whenever she needed. Then I lost the track. However, she kept on coming to the Academy OPD and was attended by other homoeopaths. During this period she had a fall while riding on a back seat of motorbike and hurt her elbow. Some trauma medicines were prescribed (Dated 9.8.01 to 16.8.01) after which she recouped gradually but rheumatism relapsed and made her bed ridden again. Few more days passed like this without improvement.
Her sister requested that I come personally to their house
and see her. When I saw her, she was lying quietly on her bed under the fan. I
found her in a state of shock with bloated face and signs of congestive cardiac
failure with history of fever with delirium. Her head and face were hot but
extremities cold with pitting edema, more on Lt leg, with purpuric eruptions,
with fever. Her sister reported that during night, fever used to be high with
delirium. She used to repeat TV serial’s incidences, as if had happened to
her. Her sister used to laugh, but she would become irritable and sad.
There was also a large purple erythematous patch on the
wound, one of her ankle looked as if it was erysipelitic. Her pulse was slow,
weak and irregular but heart sounds were loud with haemic murmur. She was also
having a dull, burning ache in the region of heart. While examining her, she
fainted while trying to sit. Her face became pale. I also observed, with slight
motion her heart beat increased, with visible pulsation on the neck.
She was lying quietly turning towards right and holding up left leg towards abdomen. Lying on left shoulder was painful, because of rheumatism. Drawing up legs used to relieve pain in abdomen
This was real difficult condition for her and for me as well. What to do? Send her hospital? Sending her to public hospital meant, they would ridicule on me and Homoeopathy. Since patient and the family members were not very anxious, I did not send her to hospital.
I questioned myself again and prayed to God. The patient came to my rescue. She was holding her knee in such a way as if the slightest motion on bed was causing her distress in form of palpitation and prostration. Her sister also guided me by telling few more symptoms, like twitchings and trembling during sleep, with violent shrieks. Sometimes nausea and vomiting! I was watching her constantly: And after carefully studying and analysing, I was able to understand the actual pathogenesis of her sufferings. Her heart was totally failing. She had developed cardiac infection and also of brain, she showed the signs of meningeal irritation.
I questioned myself, "does it mean she is developing
signs of Basal Meningitis? An even more serious ailment!"
After analysing the case, its pathogenesis and the clinical
status, I decided the remedy. I gave her Medorrhinum 1M, single dose
immediately, followed by Veratrum-viride in repeated doses.
The criteria for the Medorrhinum palpitation with
slightest motion, and a relaxing comfortable posture to abdomen so that the
opression of the chest can be minimized. Repertory language speaks the same in
terms of knee chest position. Here Veratrum-viride was a pathological
prescription as per the totality of the clinical picture, you may call it as
clinical remedy. The proving and symptomatology of Veratrum-viride,
matches with clinical condition of "Carditis" and spino brain
meningitis also termed as "Basilar Meningitis". While Medorrhimum
as intercurrent. The guiding symptom was palpitation on slightest motion:
Repertory "Kent", chapter Chest (Page 896, old American Edition).
Rheumatic toxins affect heart, then brain or lungs, before
causing more fatal complications. Ver-viride can help here in bringing
out of the toxins from deeper organs to the surface. In this case it was given
in 30 potency and in multiple doses, every 4 hourly for few days. This helped in
bringing her toxins out from within. Now she developed more rashes on both her
legs with itch. But she started walking. Fever also went down as was palpitation
and pain.
For this no ‘Repertory’ was referred, I called this a
"Pathophysiological approach" and often advocate this method to my
students-it is sometimes an easier way to get a similimum, but only if one also
knows the physiological and pathological symptoms of the remedies and the
ability to induce that particular pathology.
Veratrum-viride, the American (White) ‘Hellebore’ is
an "Indian Poke", acts well on the cerebellum and cerebral portion of
the spinal cord (Brain stem) and the muscular system. This herb also acts on the
heart.
The striking features of this remedy are: rapid & full
pulse, intense fever with twitching. Delirium due to cerebral congestion, also
intense vomiting. Apoplexy or fullness sensation in the brain with livid face or
eyes flush. Patient shrieks in delirium or sits quietly since motion aggravates
her suffering. These are the striking features of ‘Basilar Meningitis’ as
well.
The tragedy is that homoeopathy has always been underrated.
The fact is that ‘Rheumatic Heart Diseases’ cannot be cured by allopathy,
even surgical palliation requires long term follow up treatment.
Medorrhinum single dose, in 1M was given on 19.9.01,
while Verat-vir continued till 13.10.01. Thereafter placebos, along with
some biochemic salts. The patient reported walking on 11.11.01. Now her cheeks
were red, eyes lively. She looked beautiful and healthy so I took the
opportunity to go for a longer interview. What happened and how it happened? I
inquired about the exact incidence which happened 7-8 years back when she was
crossing the railway line.
She revealed, she was going; to school and wanted to catch
the train in hurry. But while crossing, her left foot got struck somewhere in
the track. Actually she wanted to catch the same train, which was halting on the
platform. She tried to get herself free but couldn’t in spite of pulling her
leg again and again. In the meantime, the train started moving, so she also
applied full force in panic and finally could manage to get herself free. She
found her leg was terribly wounded and her sandal broken. Some how she could
manage to go to school but on the same night she got high fever with swelling
and soreness in the leg. I also looked her ‘Echo Cardiogram’ taken at JJ on
10.11.93 which revealed:
‘Left Ventricle’ was mildly dilated with good systolic
function. ‘Left Atrium’ was dilated. The function of Right Atrium and ‘Right
Ventricle’ was normal. Mitral valve was mildly thickened, with no
calcification, its functioning affected and was showing full opening. Aortic
valve was mildly thickened with normal motion and no systolic doming. Pulmonary
valve was normal. No pericardial effusion or vegetation noted.
Their conclusions were as follows:
1. Rheumatic heart disease
2. Severe (Grade III/IV) eccentric jet MR
3. Preserved LV Systolic function
4. Mild (Grade II/IV) AR
5. No e/o active carditis on 2D Echo-Examination
Now I could guess the meaning of her red cheeks. Although she
looked strong but she had no stamina to pull her foot out from the track. Irons
(Ferrums) are mentally strong but physically weak. I missed her remedy earlier.
She was an Iron Lady but I couldn’t identify her in the beginning. Thus it
took such a long way. Pseudo-plethora can cause sudden bleed into the brain and
or into the arteries of heart. Which is a characteristic pathological symptom of
"Ferrum-metallicum".
Ferrum-met, 30/3 doses, on 11.11.01 as her constitution
helped her so much, that she started walking with a baby in her arms, her sister’s
two year old son. She was very happy so was I. Ferrum-met was repeated
for few more doses on 20.12.01 then on 13.2.02 in high potencies. Today Ms Iron
is very fine, now she can run holding a baby in her arms!
