A running case of De Quervain’s tendinitis

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A running case of De Quervain’s tendinitis

Name. JS
Age: 30 Years
Sex: Female

Presenting Complaint: Bilateral lateral wrist pain.

History of Present Illness: The patient is a 30-year-old female who is 7 months postpartum via C-section. The patient developed bilateral wrist pain after 3 months after the delivery. It was gradual in onset. She tolerated this for some days and then taken some ibuprofen which were of benefits for sometime but after that nothing. After the gap of some days, she started to have breast lump and pain possibly due to obstruction of milk for which she take some nimsulide and serratopeptidase which in addition to her breast pain also relieved her lateral wrist pain of both hands quite significantly in starting then moderately and now she is getting mild relief from her nimsulide and serratopeptidase which she started to take on a prn basis for her pain, not for breast pain. There was pain with the use of hand and thumb. She applied ice on that side 1 but it cause her aggravation in pain. Pain is worse after use of hands and wrist and relieved by rest. She is a nursing and working woman.

Past Medical History: None of .

Past surgical history: C-section 7 months ago.

Medication: Nimsulide and serratopeptidase.

Allergies: No known drug allergies.

Social history: Married. Does not smoke or drink.

Family history: Noncontributory.

Physical examination: The patient is a 30-year-old pleasant female in no acute distress. Height: 4'9". Weight: 45 Kg. Vital signs were normal.

On examination of the wrist, she was tender on lateral side of both wrist at thumb area. Extension of thumb was painful and there is mild swelling. On palpation, it was tender also. Finkelstein maneuver was performed which was positive.

Diagnosis: De Quervain’s tendinitis.

Homoeopathic Evaluation:
The patient is affectionate (asked who loves she and whom she hates, answered many for love and none for hate), mild irritable (asked about anger episodes, she has a few anger episode but with reasonable reason), cheerful (by observation), desires company, no delirium, no delusion, no fear in excess, no forgetfulness. She takes deep sleep, dreams of daily working, family members, mostly unremembered, and sometime amorous. These days she has no particular desire or aversion to any foods.

After analyzing the case thoroughly, we reached to Phos, Puls, Sulph, Nat Mur, and Nux Vomica
Phos 30 C 3 doses at 10 minute interval prescribed to patient on November 26, 2008 and asked to report in 1 week and advised to avoid using wrists and hands as much as possible and try to purchase gloves to help with pain shown on PC on Glove type-1 . glove should suppor both wrist and thumb glove type-2 glove picture-3.
This case is cured for more detail see follow-ups.
Dr. Rakesh Kumar (B.H.M.S., Lko)

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Follow-ups on Acne in 30-year-old female

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On November 23, 2008 patient reported
"I took the sulphur this morning, 3 x 30c every 10mins from 9am till midday. Through out the morning i felt increasingly achey in my muscles, mainly my gluts, my back and across my shoulders. I put this down to my workout this morning but i did nothing i normally do and it was not strenuous. I am thinking it might be the sulphur. I am also shivery/cold but with a hot face, very lethargic and disoriented and nauseous (though not been sick. This is all totally out of character for me and I felt fine until about 10am after the sulphur. Is this possible and should this be happening? It is now 1430 and I still feel unwell as above. "

I reassured the patient and said wait and see

On November 24, 2008 the patient reported

"Right now I feel normal again! I have been to the toilet twice this morning with very loose bowels but now I am fine. I have little appetite. My skin seems worse these last 2 days, but mainly on my left and spreading higher up my face. The spots are painful and swollen. My hands and feet do not feel so cold! Will the excess sulphur cease to work or will the desired outcome still be the same?"

Once again, I reassured her and said "it is good indication, outcome still be same, please do not take any medication now for anything until any major requirement"

On evening of November 24, 2008 she reported
"I will ammend and say I have been to the toilet CONSTANTLY all day! Still no appetite but apart from that I feel OK. Not taking any more medication, homeopathic or otherwise. I will update you in 3 days as requested originally or if anything immediate changes, then sooner."



Comment by Dr. Rakesh: So this is a classical case of homoeopathic aggravation i.e. short and sharp aggravation, but patient says "i feel OK". Second onset of diarrhea suggesting discharge.

Keep in touch to know the outcome after this homoeopathic aggravation

Rakesh Kumar, B.H.M.S.

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Running Case: Acne in 30-year-old female

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This 30-year-old female has acne mild to moderate in severity for many years controlled with oral contraceptive, which has been stopped in order to conceive.
Her acnes are papular and pustular with purplish tint. Sometimes they suppurate. They did not itch and the main location of acne is chin and lower jaw line. These are worse during warm condition.
Generalities: The patient is a cheerful lady with increased need of sleep for refreshment. It is hard to her to awake from sleep in the morning. Her dreams are vivid. Her menses are regular, scanty, short duration, brown fluid with clotted blood. Her acne complaints are much more worse during and just after menses. She wants a definite tasty food. At present, her thirst and appetite are increased. The patient has very dry skin in hands.
She is an active and exercising lady with fit body structure. Her bowel movements are regular.
After considering all of these, Lyco, Sulphur, Lach, and Graphites were considered.
Graphites have many of acne symptoms and menses symptoms of this lady, but is discarded at this due to her fit body and regular bowel movements.

Sulphur and Lyco both have dry skin in hands so it was decided to start treatment with Sulphur 30C, but it seems that she is a Lyco female and would be given after some dosages of Sulphur 30C.
I hope good improvement in her acne condition. She is presently using aloe topically which is quite beneficial for her and is advised to wash face with luke warm water and take Sulphur 30C in the morning that would certainly help.
Keep in touch and know her progress

Rakesh Kumar, B.H.M.S.

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Homoeopathic College in News

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There was a news in Amar Ujala 16 November Lucknow Edition that NHMC Lucknow students are on strike against Dr. RC Yadav Anatomy Department blaming ilegal act and behaviour.

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Dengue Fever and its Homoeopathic Treatment

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Dengue fever is a benign acute febrile syndrome.

Dengue fever is caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae.

Infection with one of these serotypes provides immunity to only that serotype for life, so persons living in a dengue-endemic area can have more than one dengue infection during their lifetime

In a small proportion of cases, the virus causes increased vascular permeability that leads to a bleeding diathesis or disseminated intravascular coagulation (DIC) known as dengue hemorrhagic fever (DHF). Secondary infection by a different dengue virus serotype has been confirmed as an important risk factor for the development of DHF.

Infections produce a spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal hemorrhagic disease

In 20-30% of DHF cases, the patient develops shock, known as the dengue shock syndrome (DSS). Worldwide, children younger than 15 years comprise 90% of DHF subjects.

Symptoms appear 3—14 days after the infective bite.

Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash.

Dengue hemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children.

History of Present Illness

Fever with abrupt onset, rising to 39.5-41.4°C. Accompanied by frontal or retro-orbital headache (pain behind eyes). Fever usually lasts 1-7 days, then return to normal body temperature for 1-2 days then recurring with second rash but not as high.

Rash

Initial rash transient, generalized, macular, and blanching; occurs in first 1-2 days of fever. Second rash occurring within 1-2 days of normal body temperature, lasting 1-5 days. Second rash morbilliform, maculopapular, sparing palms and soles. Occasionally desquamates

Bone pain

Absent in dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS)
After onset of fever
Increases in severity
Not associated with fractures
May last several weeks
Most common in legs, joints, and lumbar spine

Miscellaneous symptoms

Nausea and vomiting
Cutaneous hyperesthesia
Taste aberrations
Anorexia
Abdominal pain (severe in DHF/DSS)

Physical

Fever, Signs of intravascular volume depletion, hypotension with narrowed pulse pressure, delayed capillary refill, hemorrhagic manifestations

Positive tourniquet test
Petechiae, purpura, epistaxis, gum bleeding, GI bleeding, menorrhagia
Rash
Hepatomegaly (inconsistent)
Generalized lymphadenopathy

Homoeopathic Treatment Of Dengue Fever

As other diseases homoeopathy works great if treated according to symptoms of patient not by the name of disease. As written earlier, Dengue fever clinical manifestation ranges from mild viral illness to severe DHF. The symptomatology produced by Eupatorium Perfoliatum is similar to dengue so it is very useful medicine for treating dengue fever and preventing dengue fever while epidemics.

Eup Per 200 C can be used for prevention for dengue. Take 2-3 pills once a day for 4 days if you live in epidemic areas and if you are suffering with fever with classical symptoms of dengue i.e. fever with lots of muscle pain, eye pain, headache, weakness, and live in epidemic area then you can use this medicine 3-4 hourly for 4 to 5 days.

If you do not get prompted relief then you can take additional Rhus Tox 200 C 2-3 pills alternating with Eup Per 200 C.

If you have vomiting and nausea symptoms then you should take Ipecac 200C instead of Rhus Tox 200 C.
For persistence weakness after fever and recovery phase, use China 30 C and Carbo Veg 30 C. to make recovery faster and get back strength soon.

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