A case of Hypertension

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Chief Complaints

Mr. A, aged 32 years came with an acute presentation of anal fissures on September 15, 2009. He complained of pain in anus after defecation for 15 days. Pain remained after stools for 6 –7 hours during which he was unable to concentrate on work. Burning sensation 3+. Pain 3 +, H/o one episode of bleeding.

 

Past History

  • 2 –3 similar episodes of pain and bleeding in past 8 – 9 years which had always been aggravated by taking a non vegetarian diet
  • Hypertension since February 2009. Patient is taking allopathic medicines. Blood pressure was detected as140/100 mmHg and the patient immediately started allopathic medicines as prescribed by his general physician.

 

On Examination

  • General Condition – Good
  • Vitals – Normal
  • Per Rectal Examination – Anal spasm, proctoscopy not possible, chronic anal fissures, sentinel tag present

 

Prescription

Patient was given Aesculus 200, TDS for 2 days

Follow Up

Patient better, no bleeding but some pain remained, the acuteness lessened, pain now lasting only for 1-2 hours, but it was decided to take the complete case as patient was hypertensive too.

 

Patients as a Person

Most of the information has been furnished here as verbatim in patient’s language.

Work stress is tremendous. ‘I have a job of deadlines and I have to meet them. I feel if I am not able to meet the deadlines, people would point me out’. Patient was in Marketing Dept. in Sony Electronics which is one of the leading T. V and Electronics brand and had shifted to Honda. When he resigned from the past job two months back, he took extra efforts and wanted to complete the work so that the new team and the existing team do not have to bother.

 

Patient: I should go on a good note. After notice period, they should feel that I was working as part of the team. I work very hard and I am very systematic and organized. I cannot hear anything if anybody points me out. I feel very bad. I say things gently and politely. I make the other person feel where he/she is wrong but I tell this politely. I do not talk rudely to anybody as I want to keep good relations. I want to keep everything cordial, as I may also need that person anytime and the other person might answer back, abuse, create a scene, and the relation will go bad. I am brand conscious. I take things as they come but being with a brand is important for me. For example, Sony is the best brand as far as TV is concerned and now Honda which is a premium brand in cars.

 

Physician: Does the same apply to your choice for clothing etc?

 

Patient: Yes it does. I do prefer wearing branded clothes especially at work and outside. At home, I am still ok with things but yes I do prefer buying branded gadgets and appliances for my home too.

I want respect because of my nature/ behaviour; nobody should wish me because of the fear, because I do not want to force anybody to respect me. My first priority is to keep my family happy and spend quality time with them. All the things that they have should be of the best quality, be it clothes, interior of the house, eatables, so I want to earn more to achieve everything. I would be able to do this only if I am able to give the best in my job, so I have kept my target 5 – 10 years down the line.

People say I am very quiet, but I do not feel like that. It is just that I do not talk irrelevant. I like to sing. In college, I have been a popular guy. I am a likeable personality.  I try to share my knowledge. I do not want to keep it to myself. I cannot say ‘No’ to anybody. Many times I cannot say ‘no’ but just to keep the relation I say ‘yes’. Everybody should think I am a polite and respectable person. When I go somewhere, people should notice and be happy to see me; people should remember me as a helpful person.

 

Childhood History

Brother: He was very protective, he would absorb everything for me, I seek his advice everytime and we used to share everything.

With parents: No fight among us (refers to sibling), never made me feel that we have less, I got everything I asked for, I studied in a good school.

Relation with Father: Very quiet, not expressive, he keeps up to himself, caring, now I share with father as I have to decide for finances etc.

Relation with Mother: Not strict, shared more with her in childhood as father would not talk much

School: For the initial 5-6 years, I was one of the top students. MBA was a trend in those days, no particular reason why I went for it. I had no interest in science so automatically this was the choice. Inspite of the fact that I had done my graduation in science, I went for this field. Everybody disagreed to my decision in the initial phase but the good part is that later I liked this field and I developed my personality so a liking for work also increased. Then I decided to fulfill my desires to achieve comfort for my family by doing the best in my job. I have an aim now which was not defined earlier, and if I have to give them everything, I have to be the best. I wanted a job where every day is a new day which I got here.

 

Physical Generals

  • Diet: Non – vegetarian
  • Appetite: Good
  • Breakfast: Cornflakes with milk with banana or toast
  • Lunch: 1 chapatti, rice, dal, vegetables
  • Evening: Tea 2 cups, snacks in the office
  • Dinner: 2 chapatti, vegetable , dal
  • Craving: Non veg, butter chicken 3+, chciken3+, fish 3+, egg 3+, omlette 3+, junk food, pastries, patties, sweet 3+, gulabjamun
  • Aversion: Bittergourd, pulses
  • Stool: Once a day, morning, feels like going as soon as gets up, well formed, no straining on a usual course, pain increases when has too much of non veg.
  • Urine: D : N :: 5 – 6 : 0
  • Perspiration: 3+ if sits without A.C, Forehead, pillow gets wet if no fan or A.C. No smell, no stains
  • Habits: Tea, twice a day
  • Sleep: Sound, for 7 hours, on side, usually left
  • Dreams: Pleasant, of routine work at office, of daughter
  • Thermal reaction: Chilly

 

Criteria

  • Bath: Warm in winter and rainy season, lukewarm in summers
  • Sweater: 2 sweater and a coat in December and January when cold is extreme
  • Covering: December and January – Two quilts, November and February – Blanket
  • In comparison to others: Sensitivity to cold is more
  • Season: I like winters as I sweat a lot, so summers are very uncomfortable

 

Rubrics Selected

 

 

Theme and Understanding of the Patient

The basic theme of the patient that I have concluded from the history is the image consciousness, that is, he is a good son, a good husband, a good, polite and gentle human being. For being good, he has taken efforts to excel in the kind of job which is otherwise not very suited to his personality. A marketing job is usually taken up by people who are outgoing, creative and outspoken and sometimes needs aggression. In India, Marketing is either a common department or a close-knit department so people responsible for marketing are also answerable for sales up to a certain extent. The patient had chosen the job as this was the trend at that time but then says ‘I changed my personality to suit the job requirement’, as he wanted to prove that he has made the right decisions, but lately he enjoyed his job and his targets. He has to maintain his cool to make sure people like him as a polite person which is he wants from all sectors of his environment. I think his image consciousness which is the core of the case.

I have also seen that Silicea people are usually brand conscious and would always wear branded clothes. Not to get biased by, as this is something seen in all youngsters of today but in Silicea, you will find this as a special personality trait.  They are very well dressed, with ironed clothes and are neat and clean, which will be visible when they come for consultations. This patient also presented with such behaviour; very courteous, polite (as he wanted to be) and well dressed.

 

Prescription

Silicea 200C 3 doses, with sac lac B.D for 2 weeks

1st Follow Up: October 8, 2009

  • Pain 90% >>, burning >> but + sometimes, twice in a week, had burning after stools, had been more in last 2 days but pain did not last that long.
  • Blood Pressure: 120/80, taking allopathic medication for blood pressure
  • Same dose was repeated for 2 weeks

Patient did not come after that, his family used to come, so physician knew he did not have any attack of fissure, for B.P he was taking allopathic medicines.

 

2nd Follow Up: January 16, 2011

The patient had been taking ‘Cardace H’ 5 mg O.D morning for blood pressure since 2009; but the blood pressure had shot up to 160/100 and he lately gained some weight. He was lethargic and had a swelling over the face. He had gone back to his general physician and found that the blood pressure was out of control and his thyroid levels had also risen. His TSH count was 9.6, cholesterol was 217, uric acid level was raised and he wanted to take homeopathy for the same. He had not started any allopathic medicine expect ‘Cardace’ which he had been taking regularly. He had also been sleepy and lethargic and especially in the afternoons he was very lethargic and used to get severe headaches in between.

 

Prescription

Silicea 200 H.S for 2 weeks, with Sac Lac B.D for 2 weeks. I had given more repetitions this time as I felt that the disease pathology was deeper and the susceptibility of the patient was low, therefore I started with the same potency to which he had responded last time, but with more repetition.

Patient was also advised to take a low salt diet and to start physical activity for a minimum of 5 hours in a week. He had also been advised to stop eating oily and rich food.

3rd Follow Up: February 1, 2011

Blood Pressure: 136/70, swelling on the face much reduced, sleep: refreshed, afternoon – he was still a little sleepy

Some improvement was seen, so he was given sac lac for 2 weeks

4th Follow Up: 19 February 2011

Headache: No attacks

Sleep: Sound and refreshed, laziness >>

Face swelling: Much better

Stool: Normal

B.P: 136/84

 

Prescription

Sac lac was given with Silicea 200 as a reserve. The patient was asked to discuss on the phone if there was any problem.

5th Follow Up: March 15, 2011

Patient’s wife called me because his B.P was very high; he was out on an official tour for an annual budget meeting within the city. Blood pressure was 140/100. No swelling on the face and no other problems. He was fresh and active otherwise, but had headache for which he checked his blood pressure and it was high.

 

Prescription

Silicea 1M, 3 doses were given, asked to check the blood pressure three hours after taking one dose and not to take rest of the medicine if blood pressure came down.  If blood pressure came down substantially, he was advised to take one dose every day and kept me updated after every 12/ 24 hours.

Patient informed me on the phone after 4 days that the B.P had come down to 118/88 within 3 hours of the dose but he still took 3 doses for 3 consecutive days.

6th Follow Up: April 3, 2011

All the complaints were better.

  • P: 120/80
  • Cholesterol: 204 (217 earlier)
  • Uric acid: Normal
  • TSH: 6.2 (9.6 earlier)

The blood pressure had been normal for many days. Patient was given Sac lac with a dose of Silicea 1M as a reserve.

 

Conclusion

I have seen in my experience with hypertensive patients that their blood pressure raises when under stress, whatever factors affect them emotionally. If given the dose of the constitutional homeopathic remedy, the blood pressure comes down to normal within few hours. I have tried this in other cases and this has worked instead of giving Rauwolfia Q or any such tincture. I have found the constitutional remedy to be of much help because the blood pressure that rises due to stress is an acute exacerbation of a chronic disease and not an acute disease. So the constitutional remedy responds better in such cases. Dose selection and repetition can be further planned as per response.

 

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