Advantage of Homeopathic IPD
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Sep / Oct VOL VI NO 5.
Dr Dinesh Rao
'Calc-c / Phos / Kali-c

Totality of the Constitutional Remedy

1. Grief
2. Fearful
3. Timid
4. Mirth
5. Sentimental
6. Dreams: dead relatives
7. Anxiety: financial future.
8. < Before menses
9. Fasting <
10. Morning Sickness (< Pregnancy)
11. Perspiration profuse - scalp
12. Cr Sweets
13. Hard Stools

This totality points towards Calc-carb as the constitutional remedy.
Action: Calc-carb 200 1P given on 26-9-04 at 10.30 am temp was 99.2 F. The plan was to give a single dose and assess response after 12 hrs and then plan the repetition schedule. This is one of the advantages that we have in a IPD set up The FU after 12 hrs showed no significant improvement- Fever range remained 99 F and so it was made TDS.

FU on 27 evening: Generals much better . Fever touched Normal 2 times in 24 hrs FBS: 210.7 US: + PPBS: 254.8 UR: N due to insulin doses and antibiotics.

After this there was a gradual improvement in general + specific symptoms in patient. Fever range was between 99-100 but more on 99. On 29th it remained normal for more than 6-8 hrs, for the 1st time in 8 days!!

Patient was discharged on 30th. She followed up after 4 days. She had only one spike of 99 at home, that too she did not feel it. Patient has been reporting regularly and is much better. Her diabetes is being taken care of by insulin injection, diet and exercises.

Learning

1. Scope of homoeopathy in fever case where diagnosis is not very clear.
2. Advice of treating complex fever cases in a homoeopathic IPD set up
3. Role of homoeopathic management in co ordination with allopathic consultants in fevers

Case 2
Mr NP, 30 years, Occupation: Service MIDC Contract, Married since 7 yrs, Br: 2 younger, No sister, Children: (3): 6 yrs, 4yrs, 6mo.

Date of screening 6/10/04 at 10 am with C/O.

1. Fever high grade since 21 days. Usually associated with chilliness and 3-4 episodes of rigors. Fever < 4-6 pm²
2. Vomiting since 21 days F: 2-3 times / day. Vomiting <2 immediately after eating and drinking warm water, can retain cold water for sometime.
3. Pain + in Right Iliac Fossa, continuous mild pain
4. Along with fever: App , Thirst large quantity frequently 1 glass ½ hrly Cr. For cold water², (His last symptom but during acute), Weakness³
5. Stool N. Urine N.

Patient has pain in RIF since 1 yr. This pain is always associated with vomiting and fever. F: Once / Month, D: 3 days & >3 allopathic treatment

O/E: GC OK, T: 104 P 116/min, Wt: 46 kg, BP 112/60, RS: Clear, CVS: S1S2-N, P/A: Liver 1 FP non tender Spleen0, Tongue. Thick coated white²

Previous Investigation
21/2/04: Hb: 16.6, PCV: 47.4, RBC: 5.84, WBC: 6,800, N58, L31 E4, M7
S. Creat: 0.7 U. R: E/C 5-6 P/C: 2-3
3/4/04: Barium Meal follow through: Appendix not filled. liver echopattern

Recent Investigation:
6-10-04: USG Abd: Parenchymal inflammation of liver with subacute on chronic appendicular mass. ? Inflammatory iliocecal mass with minimal fluid collection.
X-ray Chest: prominent Bronchovascular markings.
Widal: Typhi 0 1:120
Paratyphi A: 1:120

Thus we see in this case, the patient has contracted an acute infection (typhoid) & at the same time has a sub-acute on chronic infection. Initially this presentation possesses a problem of clinical diagnosis. But careful history taking along with investigations makes our task easier.

Totality
Acute: Fever < 2 4-6 pm
Desire Cold drink² with fever
Thirst large qty. and frequent with fever.
Vomiting < 2 immediately after eating and drinking
Can retain cold water for some time
Susceptibility/ Sensitivity- Moderate - 200

Case was defined in detail on 6-10-04 evening
Totality after going through lifespace.

Chronic Totality

1. Fear of dark+
2. Atatchment² with parents
3. Anxiety² anticipatory about daughter
4. Sleeplessness anxiety from
5. Dreams of dead bodies
6. Dreams of snakes
7. Dreams of water
8. <+ Riding - Vomiting
9. <2 Fasting - Weakness, Backache
10. <+ Sun - weakness, occ headaches
11. Cr. Spicy³
12. Perspiration profuse³
13. Chilly

Correspondence- Kali-carb
Susceptibility / Sensitivity - Moderate

Treatment / Follow Up Summary

1. Patient admitted on 6-10-04
2. All investigations were done & in spite of totality available we waited for investigation reports and to study the temperature range. It is always better to wait for 12-24 hrs to observe the temperature charts and confirm what patient says. It is also important to observe pt and ask them about their subjective symptoms. Eg. one patient with rigors in a malarial fever (P. vivax) assumed a knee chest position during chill and rigors and on being asked said she always does it and feels better (she never gave this history)
3. Temperature range around to 100 to 102.4 F Phos 200 QDS was started on 27-9 at 11 am. Patient gradually improved in all his symptoms. 1st there was no subjective feeling of fever/Chills. His appetite, nausea, weakness gradually improved. Patient had dry cough which was better within 2 days.
4. By day two his concomitants of increased thirst was better. His temperature range (Highest fever) fell by 1 F every day & on day 2, i.e 9-10-04 it was 100 F. Phos was continued as it was giving relief to the patient. Patient also reported that the pain in rt iliac fossa was much better.
5. Then on 9/10 there was one spike of 101 and the general distress again increased. This indicated that the Phos 200 QDS was not holding. At this point of time there were 2 options. To go to phos 1M or go to the constitutional. As the form of Phos had disappeared Kali-carb 200 1P was given on 9/10 at 10 pm. After introduction of the constitutional, patient made a very rapid progress and temperature touched normal with in 24 hrs and remained so for the next 24 hrs. On 11am there was one spike of 100 after which Kali-c 200 3 powders was given. Patient was kept under observation for 24 hrs after the fever touched normal. Patient was discharge on 12 & all his reports came normal.

Learning

1. Phos 200 QDS was fairly slow in its action. Probably going to 1M on day 2 or day 3would have cut short the duration of acute disease.
2. Phos 200 was continued even after the susceptibility stopped throwing indications for Phos - (Totality of signs & symptoms). The demand of the susceptibility was fulfilled by Kali-carb. If this force would have been given on 7th or 8th, it would have sped up the recovery process.

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