General Wellbeing Of CKD Patients With The Help Of Homoeopathy

ABSTRACT
Patients coming with a history of CKD (chronic kidney disease) were under a dialysis regimen for several years or months. Most of them suffer from DM, HTN, and Glomerulonephritis etc. Their diagnosis mostly happens at an advanced/final stage and hence directly gets to the dialysis right away. Mostly the regimen prescribed is 2-3 dialysis per week. Further, these patients while undergoing dialysis suffer from various physical and mental stresses as well.
We illustrate the case of a 59-year-old Indian man with CKD, systemic hypertension (since 18 years), He has been put under a dialysis regimen of two dialysis per week for the past one year. We present general wellbeing of dialysis patient can be improved further with the help of homoeopathic medication followed by a gradual withdrawal of Allopathic medicine and eventually continuing with the dialysis regimen, solely on homoeopathic medicine only.

KEYWORDS: Renal failure, Dialysis patient, Individualized Homoeopathy, stoppage of Allopathic medicine
Key-Messages: General wellbeing of dialysis patients can be done with the help of Homoeopathy.

INTRODUCTION:
Renal failure has become a very common health issue nowadays, and thus on a dialysis regimen for several years or months. That means the diagnosis was already made. Delay in diagnosis is due to inappropriate consultation, inappropriate investigation and patient didn’t notice the symptoms due to vague presentation. Thus, it is important to accurately identify the reasons which lead to the advanced/final stage renal disease so that appropriate homoeopathic consultation can be provided in a timely manner. Under modern medicine, the dialysis procedure continues into an end-stage renal disease. The patient feels dialysis state as the end of their life in this part of the world
Dialysis patients suffer various health issues include physical and psychological problems. During the dialysis procedure, the patient never gets further health improvement other than the purification of their blood and in the process becomes deficient in vital minerals or salts which is much needed for the body. If we can address these health issues properly, then they can continue to lead a better quality of life as normal people. They can do their daily routines, jobs, studies etc. if they feel healthy even undergoing regular dialysis procedure. In the process under homoeopathy we can correct the physical and psychological symptoms of dialysis side effects along with their other particular diseases or conditions like breathing difficulties, weakness, urinary disturbances, change in blood pressure, appetites, thirst, sleep, bowel habits disorders. Thus they can lead a better, comfortable quality of life. Each case presentation is different in ways. In the majority of the patients, the renal disease never shows any symptoms until the last stage. Final stage presentation is vague, with symptoms like vomiting, weakness, oedema etc. The patient recognizes end-stage renal disease with the help of lab investigations like serum creatinine, blood urea etc. Serum creatinine level becomes high in end-stage renal disease. At that stage, dialysis becomes the only solution to continue.
Uncontrolled blood pressure, DM, renal diseases, urinary tract malfunction, hereditary, unwanted allopathic medication, painkillers, steroids etc are the factors patient may not be aware of and further the risk factors arising from a systemic disease like high blood pressure and diabetes mellitus. CKD is an end-stage disease so presentation is delayed until disease becomes incurable.
Modern medicine comes with a conclusion that dialysis is the end of kidney function. Only further procedure is kidney transplantation. Sometimes they fail to control the renal damage causes like DM, HTN etc.even with high doses of allopathic medicines. They can’t even correct the dialysis’s side effects also.
Here our Homoeopathy can help these patients effectively.

We present a case wherein general well-being of dialysis patients can be improved further with the help of homoeopathic medication followed by a gradual withdrawal of Allopathic medicine and eventually continuing with the dialysis regimen, solely on homoeopathic medicine only.

CASE HISTORY
5/7/2018
Case of a 59-year-old Indian man with CKD, systemic hypertension (since 18 years), varicose ulcer in the left leg, medial aspect above the medial malleolus. He started dialysis for 1 year. First diagnosed in hospital with oedema on both ankles, decreased urinary output, vomiting, weakness etc. On following ultrasonography study and blood counts revealed End-stage renal disease. Now he was put on the following Allopathic medications;
T.Lasix 40mg(1-0-1)
Amiodarone 100mg(1-0-1)
Pantocid 40mg(1-0-1)
M-M-Z (1-0-0)
Frucemide 40mg(1-0-1)
Inj.Eposis 2000IU post HD
Inj.Iron sucrose 200mg IV once a month
Cilacar 10mg(0-0-1)

He has been put under a dialysis regimen of two dialysis per week for the past year. He came to our clinic and presented himself with the following symptoms; (5/7/2018)
Numbness and heaviness of head.
Aggravation on lying down
General weak feeling, want to lie down
Dryness and itching of skin. Especially on both forearms with peeling of the skin.
Varicose ulcer on the medial aspect of left leg, not showing any sign of healing, with sore feeling.
Burning sensation while urination especially during the day.
Appetite: Increased.not satisfying.
Bowel: Regular.
Sleep: Disturbed, due to breathing difficulty.
Thirst: Increased.
Forsaken feeling, Disappointment.
Family situation is not satisfactory which disturb him a lot.
Breathing difficult aggravation motion, lying down and night.
He underwent surgical resection of varicose ulcer one year back and is still having the varicose ulcer which is under regular C & D at the hospital daily. His blood investigation and USG, CT, regular dialysis data from concerned hospital reveals the state of CKD. A final diagnosis of CKD was made based on this.
On physical examination, he appeared comfortable and his body mass index was 24. The temperature was 36.3 deg.cel, heart rate: 94 bpm, the blood pressure 164/100 mm Hg and the respiratory rate is 17 breath/m. There was no inguinal lymphadenopathy. The remainder of the examination was unremarkable

DIAGNOSIS
Their diagnosis mostly happens at an advanced/final stage and hence directly gets to the dialysis right away. He underwent surgical resection of varicose ulcer one year back and is still having the varicose ulcer which is under regular C & D at the hospital daily. His blood investigation and USG, CT, regular dialysis data from concerned hospital reveals the state of CKD. A final diagnosis of CKD was made based on this.

INVESTIGATION
Complete blood count and kidney function test were ordered. These tests showed elevated levels of kidney function test parameters such as serum urea-160 mg/dL ( 7-20 mg/dL), S.Creatinine- 11.8mg/dL (0.6-1.2 milligram/dL), S.Pottassium- 3.8mEq/L (3.5-5 mEq/L), S.Sodium- 130 mEq/L (135-145 mEq/L) and low hemoglobin level 6.3g/dL (12-15.5g/dL), RBS-247mg/dL.
Ultrasonography of abdomen and pelvis showed changes suggestive of chronic kidney disease or end-stage renal disease.

TREATMENT
Homoeopathic treatment is based on a holistic approach. Treatment strategy based on individual symptoms includes physical illness, systemic diseases, cause of disease, and psychological factor of patient. The patient was referred to our clinic with no urine output, altered bowel habits, oedema, breathing difficulty, abdominal distension etc. We administered proper homoeopathic medicines accordingly. Along with homoeopathic medication, a proper diet was recommended and periodic counselling was done as well. Further, the following homoeopathic medicines have been given to the patient;

REMEDY
After case taking and analysis, we select 5 symptoms for repertorization which felt as most striking in this case. During the first case taking patient explained mainly about his physical symptoms which are the most disturbing symptoms of the patient.
Breathing difficult even after dialysis, Venous ulcer on his leg,non-healing ulcer even with regular allopathic medication, Appetite increased so he can’t maintain regular weight gain during each dialysis, every time he gains weight more than 4 Kg in each dialysis. It leads to further dialysis side effects like weakness, prostration etc. Chilly patient, he is intolerant to cold.
The above symptoms are taken for reportorial totality along with the help of Vithoulkas expert system. His strong mental symptom as a forsaken feeling also considered.
After materia medica analysis
The present condition was stabilized by homoeopathic medicine; Magnesium carbonicum 200. Which is most similar with last materia medica analysis.

REPERTORIAL ANALYSIS

HOMOEOPATHIC MEDICINE
5/7/2018 (On first visit)
⦁ Mag carb 200/1 dose BD in half glass aqua
⦁ Phytum tablet 1 grain/1-0-1
⦁ Sac lac /20 dose(0-0-1)

CASE ANALYSIS

Table 1.Blood Test Report
Date	S.Urea	S.Creatinine	S.Sodium	S.Potassium	Hemoglobin	RBS	Serum albumin (gm/dL)	SGPT (IU/L)
	(mg/dl)	(millieq/L)	(milliL)	(gm)	(mg/dl)
03/7/2018	160	11.8			6.3	247
18/8/2018	115	7	130	3.8	10.1
22/9/2018	101	6.4				135
23/11/2018		6			7.2		4	10
29/11/2018				5.6	8.6
02/01/2019		7.1			7.7		4.1	25
02/02/2019		5.1			7.6		4.3	23
	Table 2. Urine Output
	Date	Quantity
	05/07/2018	<100ml/day
	10/08/2018	100-150ml/day
	15/09/2018	200ml/day
	20/10/2018	300-350 ml/day
	17/11/2018	400-450 ml/day
	22/12/2018	400-450 ml/day
	24/01/2019	400-450 ml/day
	10/02/2019	390-450 ml/day
	02/03/2019	420-430 ml/day
	06/04/2019	400-430 ml/day
	07/05/2019	410-430 ml/day
	09/06/2019	420-450 ml/day
	10/07/2019	410-460 ml/day
	04/08/2019	430-470 ml/day

Table 3. Counselling Related Observations
Date	Remarks
05/07/2018	Ready to follow diet and homoeopathic medication for better health
10/08/2018	Following a regular diet. Now amelioration of physical complaints.
20/10/2018	Not following the diet properly. Family atmosphere not so satisfactory. He wanted to prepare his own food. So he depends fully on hotel food. Weakness in general. Sad due to lack of income
22/12/2018	Mistake in diet makes him sick. Advised to follow a regular diet. Mentally condition not satisfactory due to family issues. Improvement in general weakness
10/02/2019	Diet control is not satisfactory. He wants to prepare his own food or fully depend on hotel food. Wife not cooperative, as she never cares about him and would not give food for him. She restricts him from using utensils to cook his food. Mentally weak and depressed due to lack of care and affection from wife and his children. He tries to cope up with his present situation and reveals his problems during counselling which gives him good relief.
	Due to the lack of food control, he gains 3.5-4 kg between each dialysis. Advised for further control.
	Physical weakness after dialysis.
06/04/2019	Physical weakness ameliorated. Mentally weak due to family issues. He tries to control diet.
10/07/2019	Physically not feeling well. Family issues disturb him a lot. Lack of financial support also disturbed him. Family issues persist.
04/08/2019	Physical generals improved. Emotionally stable.

Table 4.Food Chart Related Remark
Date	Remarks
05/07/2018	Advised to follow a regular diet chart. He tried to keep a regular chart but now food fully depends on the hotel so it is difficult for him to follow. But he tried to avoid food that harms kidneys condition.
10/08/2018	Follow a regular diet. Now amelioration of physical complaints.
15/09/2018	Now advised on following a regular diet.
20/10/2018	He tried to keep a regular chart but now food fully depends on the hotel so it is difficult for him to follow. But he tries to avoid food that harms kidneys condition.
17/11/2018	Advised to follow a regular diet.
10/02/2019	Breathing difficulty 1 week back after eating dessert (Pradhaman) which is rich in coconut, Ghee and Milk.
04/08/2019	Try to follow a regular diet.

Table 5.Emotional Remarks
Date	Remarks
05/07/2018	Sad due to lack of income. Family relation not satisfactory. No emotional support from wife and his children. Forsaken feeling is strong due to his family situation along with this disease condition
20/10/2018	Emotionally not better. No support from his family. Treatment and all done with the help of some charity workers. Physically improved.
17/11/2018	Family relation getting worse. Wife and his children need a partition of his property. They are not willing to give support or even food to him. He used hotel food. So don’t follow a regular diet. Wife always criticises him due to lack of income. Sad and depressed due to his family problem.
22/12/2018	Mental torture from his wife. He prepares his own food. No care and affection from wife and children. Wife always quarrels with him in order to make him sick.
10/02/2019	Family problems disturbed him a lot. He cannot use toilet facilities and kitchen in his home. Wife overrules him along with his children. He tries to cope up with such situations. Lack of income for his daily need also disturbs him. Counselling gave for his mental support.
06/04/2019	Physical weakness ameliorated. Family issues disturb him a lot. Fully depend on hotel food.
09/06/2019	Physically feeling normal.
10/07/2019	Occasional breathing difficulty when he compromises diet regulation or during emotional disturbances. Family issues persist. Lack of mental support from wife and his children. Explained his problems during the cancelling section.
04/08/2019	Physically better. Emotional problem due to family issues and lack of income.

OUTCOME AND FOLLOW-UP
We noticed an improvement in physical generals of the patient like appetite, thirst, bowel habits, urination, sleep patterns and reduction in physical illness caused due to side effect of dialysis after homoeopathic medication. With two follow up visit the patient showed amelioration of physical and psychological symptoms and never reported any problem with urination as before. General improvement in the physical and mental status of patient leads them to live a normal life. By further follow-up medication, improvement in hypertension, diabetes mellitus was reported.
In further follow-up visit general improvement in weakness, varicose ulcer showed signs of healing. Appetite became better and sleep disturbance ameliorated. Urine output of the patient increased from 100-150ml/day. Numbness and heaviness of head ameliorated. On further follow up varicose ulcer (which had a history of 9 years) healed completely and urine output improved to 200-300 ml/day. Serum creatinine became 7 mg/dL.
Further routine follow-up presented the improvement in the general wellbeing of the patient. Homoeopathic medication along with the dialysis caused the improvement in the patient (allopathic medication for the patient had been stopped completely before starting of the homoeopathic medication). Now the patient is undergoing normal dialysis with homoeopathic medication alone. The patient now presents himself with controlled blood pressure and general wellbeing.
On further follow up the urine output of the patient increased up to 450ml/day and the serum creatinine reached to 5.1 mg/dL (details given in the case analysis section).
On further follow-up serum creatinine reached to5.3 mg/dL (details given in the case analysis section).
After the second visit (10/8/2018) we stopped all the allopathic medicine. Since the second visit patient is under dialysis with homoeopathic medicine alone.
Through the follow up we can clearly state that even in renal failure case we can make changes with homoeopathic medicines and control the side effect of dialysis also with our medicines.
The patient’s physical and mental general is going well. The patient never complains about the dialysis side effects as physical or mental symptoms because we correct it by homoeopathic medications during follow up. The patient’s blood pressure and Diabetes mellitus are under control now.

Follow-up
10/08/2018
BP 140/90mmHg
No breathing difficulty.
Urine output increased.
Weakness decreased.
Varicose ulcer show signs of healing.
Appetite normal and can control appetite.
All the allopathic medicines were stopped. Now the patient is on dialysis along with Proper diet and Homoeopathic medicines only.
Sac lac /2BD

15/09/2018
BP130/90 mmHg
Slight redness around healed varicose ulcer of left leg.
Urine output increased.
Weakness decreased.
Appetite normal.
Sac lac /2BD

20/10/2018
BP 140/90 mmHg
No breathing difficulty.
Varicose ulcer healed.
Urine output increased.
Sac lac /2BD

17/11/2018
BP130/90 mmHg
Cough aggravation eating and lying.
Oedema ankles.
Slight redness around healed varicose ulcer of left leg.
Urine output increased.
Sac lac/2BD

22/12/2018
BP 130/90mmHg
Cough ameliorated.
No oedema on ankles
Urine output increased.
Sac lac /2BD

24/01/2019
BP140/90mmHg
Cough on night disturbing sleep.
No oedema on feet.
Ulcer on left leg healed.
Sleep disturbed.
Urine output increased.
Sac lac /2BD

10/02/2019
BP 160/100mmHg
Breathing difficult aggravation lying, sitting, night
Cough aggravation eating and lying.
Oedema ankles and face.
Weakness after walking.
Sleep disturbed.
Appetite increased.
Mag carb 200/1 dose BD in half glass aqua

02/03/2019 BP140/90mmHg No oedema on feet or face.
Breathing difficulty and cough ameliorated.
Sleep improved.
Appetite normal.
Urine output increased.
Sac lac /2BD

06/04/2019
BP 130/80mmHg
Urine output increased.
Weakness decreased.
Varicose ulcer show signs of healing.
Appetite normal.
Bowel constipated.
Sac lac /2BD

07/05/2019 BP140/90mmHg Weakness decreased.
Urine output increased.
Appetite normal.
Urine output increased.
Sleep improved.
Bowel constipated.
Sac lac /2BD

09/06/2019 BP130/80mmHg No oedema on feet.
Ulcer on left leg healed.
Sleeplessness since 1 week.
Bowel regular.
Sac lac /2BD

10/07/2019
BP 130/80mmHg
Cough on night disturbing sleep.
Breathing difficult aggravation walking.
oedema on feet.
Ulcer on left leg healed.
Sleeplessness since 1 week.
Appetite increased.
Psorinum 200/1 dose BD in half glass aqua

04/08/2019 BP140/90mmHg No oedema on feet.
Ulcer on left leg healed.
Cough ameliorated.
Sleep improved.
Appetite is good.
No weakness after walking.
Sac lac /2BD

CONCLUSION
Renal failure cases have become a very common health issue nowadays and patient reporting is on dialysis for several years or months. So the diagnosis is already made. Delay in diagnosis due to in-appropriate consultation, in-appropriate testing and patient didn’t notice it due to vague presentation. Thus it is important to accurately identify reasons which lead to end-stage renal disease so that appropriate homoeopathic consultation can be made in a timely manner. Modern medicine provides dialysis procedure in end-stage renal disease only.
Among the cases of dialysis patients, general improvement in physical as well as emotional playing can be done in a good manner with homoeopathic medication along with proper diet and regimen.
Through these types of cases, we can understand that even in the End-stage renal disease our Homoeopathic medication with dialysis, excluding all allopathic medication we can correct their health issues and side effects of dialysis. And a gradual reduction of creatinine level. By this way give them a better life.

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ACKNOWLEDGEMENT:
Thanks to Mr Peter Pradeep (Chairman of Help foundation NGO) who reviewed and funded the treatment of the patients.
Peter Pradeep.Chairman, HELP Foundation.
Jacob Chandy Varghese, Consultant, HELP Foundation.