Case History
CHIEF COMPLAINT:
Patient aged 72 years Male Christian by religion presented with a complaint of painless bleeding from rectum since 3 months
HISTORY OF CHIEF COMPLAINT:
Patient started with painless bleeding from rectum which was of gradual onset and gradual progression. Initially he noticed the streaks of blood in the stool and then gradually progressed to dark tarry stool.
The blood was dark tarry in nature with offensiveness
The patient also has bloating which is marked in the upper abdomen and the bloating leads to dyspnea which is prominent when stool is not passed. The patient also complaints of hard unsatisfactory stool and passes stool once in 3 days.
He also complaints of weakness all over the body with weight loss which is 11 kg in 2 and half months.
Negative history: Nausea
Vomiting
Diarrhea
PAST HISTORY:
Past medical: H/O Epilepsy during childhood 3 attacks, stroke before 10 years
Past treatment: treatment for stroke and epilepsy
Surgical history: nothing significant
Family history: Father: gastritis, asthma, MI
Sister: stroke with paralysis son: high creatinine
Allergic history: nothing significant
PERSONAL HISTORY:
Diet : mixed
Appetite : reduced, 3 servings /day
Thirst : 1 to 2l/day basically thirst less
Cravings : salty food and spicy food
Aversion : nil
Bowel : unsatisfactory, hard stool mixed with blood, urging present
Bladder : 5 to 6 times /day
Sleep : 9:30pm to 5:30pm refreshed
Dreams : unremembered
Perspiration: more on forehead
Thermals: chilly patient
Addictions: H/O alcohol consumption
LIFE SPACE INVESTIGATION:
Patient hails from middle social economic status childhood was uneventful.
Patient got married at the age of 25 years and is blessed with two boys and has no issue with family.
Life events and impact:
During his son’s birthday celebration, patient had an argument with his brother-in-law over his father’s property which the patient was looking his brother in law and his sister wanted a share out of father’s land but the patient was not willing to divide it as he was the one took responsibility of looking over the whole land. So, he refused to divide and confronted him but his brother-in-law forced him to divide the property if not his brother in law asked him to share the money but as he did not have enough money to give he had to divide his land which he was not interested to sell. This made him very angry but kept he quiet without uttering a single word.
Soon after this incident he moved from his place that is sullya to Kasargod as he could not bear that incident.
In Kasargod, it was very difficult for him to manage his daily needs and also to look after his family and so he started working at someone else’s property and field as a coolie worker which he never liked according to the patient, initially he was working for himself at his own land but now he must work under someone as a coolie worker which is bothering him even now and he said that this insult is unbearable which made him more anxious about his future and then gradually even his health started deteriorating.
As a person he likes to work he says that work comes first then family he gets angered very easily and presently due to his sickness he cannot perform any labour or work which is making him feel bad and is regretting.
GENERAL PHYSICAL EXAMINATION:
Moderately built and poorly nourished
Well oriented with time, pace, person
Weight : 43 kg
Vitals : T : Afebrile
P : 53bpm
RR : 20br/m
No signs of pallor, cyanosis, clubbing, oedema, lymphadenopathy
LOCAL EXAMINATION:
GASTROINTESTINAL SYSTEM:
- Inspection: no swelling
No scar marks
No abnormal peristalsis
- Palpation: tenderness in left hypo gatric region
- Percussion: tympanic note
- Auscultation : 3 bowel sounds/min
SYSTEMIC EXAMINATION:
CVS: S1 S2 hear, no murmurs
RS: NVBS HEARD
CNS: No neurological deficits
P/A: Tenderness over epigastric and hypo gastric region
DIAGNOSIS:
PROVISIONAL DIAGNOSIS
Gastrointestinal stromal tumour
INVESTIGATIONS DONE:
CBC :
- Haemoglobin : 8.5g%
- TLC : 9100dl/Cumm
- ESR : 32%
LFT :
AST : 37
ALP : 51
US Abdomen: IC junction lesion2×1.1cm
Hyper celiac lesion
B/L grade 2 renal mesenchymal change
Biopsy
Colonoscopy
MANAGEMENT:
General:
Diet
Avoid spicy food
Avoid red meat and sea food
Have more of protein rich food
Have raisins and chicken liver (Hb)
SPECIFIC MANAGEMENT:
CHRONIC TOTALITY
MENTAL GENERALS
Irritable
Anxious about health
Anxious about future
Industrious
Grief on property loss
Greedy
PHYSICAL GENERALS
Chilly patient
Appetite reduced
CHARACTERISTIC PARTICULARS:
Hard unsatisfactory stool
Painless dark bleeding from rectum
Bloating < not passing stool
Weakness
Weight loss
REMEDY
PROVISIONAL REMEDY
NUX VOMICA
Industrious
Irritable
Angered easily
Chilly patient
Hard unsatisfactory stool
Bleeding in stool
Bloating of abdomen
2. lycopodium
3. ARSENICUM ALBUM
ACUTE TOTALITY
Dark blackish stool
Painless
Offensiveness
Bloating <not passing stool
Hard stool
REMEDY
PROVISIONAL REMEDY
CROTALUS HORRIDUS
Dark tarry stool with malignancy
Offensiveness
Hard stool
Bloating of abdomen
Exhaustion
PRESCRIPTION:
- Nux vomica 200 4 packets weekly HS
- Crotalus horridus 6C
3-0-3 (B/F)
- Ferrum met 6x
- (A/F)
× For 1 month
FOLLOW UP CRITERIA:
Bloating intensity reduces
Dark painless bleeding reduces
1st Follow up:
After a month, bowel habits regular no blackish stool, intensity of bloating reduced & no bleeding generally feeling better
CONCLUSION:
Patient named Mr. RC of age 75 years presented with the complaint of bleeding per rectum with dark hard stool diagnosed with gastrointestinal stromal tumour prescribed Nux vomica and Crotalus as acute remedy.As we know that our system has a great efficacy in the treatment of Incurable diseases and also provide the better quality of life for the suffering individuals. Here in this case the indicated remedy Crotalus had the major key indications thus was able to give the palliative relief to the patient. if we are able to construct a logical corelation with the case Organon & Materia medica as well as applying this philosophy into practice then definitely the patient will get a most effective palliative relief & will be possible with Homeopathic.
AUTHORS:
Dr Skandhan. S. Kumar, BHMS MD Organon of Medicine (Gold Medalist), Assistant professor department of organon of medicine and philosophy, Father Muller Homoeopathic Medical College. Consultant Homoeopathic Physician at Dr Padiyar’s Homoeopathic Clinic Mangalore.
Dr Jacintha Monteiro, BHMS MD , HOD department of organon of medicine and philosophy
Dr Ashmitha Alicia Coth , BHMS (Intern) Father Muller Homoeopathic Medical College.
