Diabetic foot ulcer symptoms, definition, causes, treatment in homeopathy
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A Standard Care With Integrative Approach To Diabetic Foot Ulcer With Homoeopathic Treatment

AUTHOR:

DR JACINTHA MONTEIRO (PROFESSOR, DEPARTMENT OF ORGANON OF MEDICINE, FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL- DERALAKATTE)

CO-AUTHOR:

DR SKANDHAN S KUMAR (ASSISTANT PROFESSOR, DEPARTMENT OF ORGANON OF MEDICINE, FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL- DERALAKATTE)

DR SR SELMA VARGHESE (PG SCHOLAR -MD – II DEPARTMENT OF ORGANON OF MEDICINE) FATHER

MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL MANGALORE).

ABSTRACT: A known case of diabetic mellitus with diabetic ulcer and multiple abscess on lower extremities treated homeopathically with acute and constitutional medicine (Nux vomica) bases. The parameters used for the analysis of prognosis are sugar levels (FBS) and follow up criteria.

KEYWORDS: multiple abscess, acute medicine, constitutional medicine, diabetic mellitus.

ABREVATIONS: + = present, G = good, < = aggravation, > = amelioration, s = same, D = decreased.

INTRODUCTION: 

As we all know that Nux Vomica Is the greatest of polycrest, because the bulk of its symptoms correspond in similarity with those of the commonest and most frequent of diseases. It is frequently the first remedy, indicated after much dosing, establishing a sort of equilibrium of forces and counteracting chronic effects.

This is a case of multiple painful abscess in the lower limb. A cutaneous abscess is a localized collection of pus in the skin and may occur on any skin surface. Symptoms and signs are pain and a tender and firm or fluctuant swelling. Diagnosis is usually obvious by examination. Cutaneous abscesses are painful, tender, indurated, and usually erythematous. They vary in size, typically 1 to 3 cm in length, but are sometimes much larger. Initially the swelling is firm; later, as the abscess points, the overlying skin becomes thin and feels fluctuant. The abscess may then spontaneously drain. Local cellulitis, lymphangitis, regional lymphadenopathy, fever, and leukocytosis are variable accompanying features. Abscesses can occur more frequently in people with diabetes. They can also occur in higher severity because diabetics are both more prone to infection and heal more slowly. Here we have a case of diabetic ulcer with cutaneous abscess which were managed by homoeopathic medicines. The selection of remedy is based upon the theory of individualization & symptom similarity by using holistic homeopathic approach keeping our cardinal principals in background. This is the only way through which a state of complete health can be regained by removing all the signs and symptoms from which patient is suffering. The constitution and causation are considered supreme while treating any chronic diseases. The aim of Homoeopathy is not only to treat presenting complaints but to address its underlying cause and individual susceptibility

CASE HISTORY

A 59-year-old man presented with the complaint of ulcer over the right medial malleolus of the leg since 3 years and multiple abscess formation in lower two third of the right leg since 1 weak. (fig.1) He is a known case of hypertension and insulin dependent diabetic mellitus. His complaints started on right leg, injured while gardening his leg initially developed small puncture ,later he didn’t take care  that wound on right medial malleolus so it increased in size and he also have recently developed abscess started as local erythema and edema evolved, followed by boil formation, which then resulted in abscess that opened spontaneously drained. The abscess is filled with a thick yellow pus. After the manual draining, sinuses were present under the skin along with this complaint patient have disturbed sleep due to pain and decreased appetite. Patient experiences burning pain in leg that increases during night. He was hospitalized for the above presenting complaints.

PAST HISTORY:

      Cellulitis 2 months before on the right leg.

FAMILY HISTORY:

      Mother – Hypertension.

TREATEMENT HISTORY:

       Allopathic medications for cellulitis, diabetes mellitus, hypertension.

PATIENT AS A PERSON:

      Appetite – Decreased since 1 week.

      Thirst – thirsty 2 litre / day.

       Craving – fish 3+, meat 3+

       Aversion – nil.

      Bowel habit – once per day, hard stool.

     Bladder habit – 3 to 4 times per day, once per night.

     Sleep – disturbed since 3 days due to pain.

     Perspiration – profuse (general)

     Dreams – nothing significant.

     Thermals – hot patient.

     Addiction – alcoholic since 25 years, smoking since 25 years, 3packets/day.

LIFE SPACE INVESTIGATION:

     Patient hails from a middle socio economic family. Had apparently a pleasant childhood. He is a B.com graduate. He has a good friend circle. He is a type of person who does not like contradiction. If he takes a decision he won’t change that.

     MARRIAGE: He got married at the age of 32 years. It was an arranged marriage. He has a good relationship with his wife. He has two sons.

     ACCORDING TO WIFE: He is a man who give more importance to his friends than his family. He shares most of his problems with his friends rather than his wife. He used to get drunk and abuses his wife verbally. One year back he met with a financial loss of rupees 50 lakhs in his business that ended up in deep sorrow.

    AS A PERSON: easily angered, obstinate, contradiction aggravation, gets irritated easily then forgets the cause.

GERENAL PHYSICAL EXAMINATION:

       Moderately built and well nourished.

       EDEMA:  pitting edema ¾ of the right leg.

       TONGUE: yellow stained.

      No other positive findings.

VITAL SIGNS:

     BP: 140/100mmHg – right arm – supine position.

     PULSE: 72 beats/mins.

     TEMPERATURE: afebrile.

     WEIGHT: 90 kg.

LOCAL EXAMINATION – right leg.

   INSPECTION: ulcer: one ulcer over the right medial malleolus, slopping edge, granulation tissue present

                            Size: 1.5 x1.5 cm

                            Dryness and scaling 2+ with blackish discoloration.

                            Swelling present over the lower 2/3 of the leg.

                            3 abscess just above the lateral malleolus.

                            3 abscess over the anterior lower 2/3 of the leg.

                            1 abscess posterior aspect of the lower 2/3 of the leg.

   PALPATION: tenderness 3+.

                           Local rise of temperature present.

                           Peripheral pulses felt.

SYSTEMIC EXAMINATION:

          RESPIRATORY SYSTEM: NVBS heard, no adventitious sounds.

          CARDIOVASCULAR SYSTEM: S1 S2 heard, no murmurs.

CLINICAL DIAGNOSIS: Diabetic ulcer with Cutaneous Abscess of right leg

MANAGEMENT:

ACUTE TOTALITY:

Sleep disturbed

Appetite decreased

Burning pain 3+ on right 2/3 of the leg

Yellowish discharge from the abscess

PRx: Nitric acid.

CONSTITUTIONAL TOTALITY:

MENTAL GENERALS PHYSICAL GENERALS CHRACTERISTIC PARTICULAR
Obstinate Easily angered Sorrow – business failure Desires company < contradiction. Cr: meat 3+,fish3+ Perspiration- profuse Hot patient     Right lower extremities Multiple abscess Burning pain3+ <night

Prescription: (10/2/20)

1. Nit Acid 30 (1-1-1)

2. 5 Grn Tab (1-0-1)

3. No ii Pills (3-3-3) (before food)

Follow Up Criteria

  1. Sleep
  2. Appetite
  3. Burning pain
  4. Discharge from abscess
  5. Abscess
  6. Swelling over right lower 2/3rd of the leg
  7. Healing of ulcer

       Daily dry dressing was done with Echinacea Q

Follow up No.1: 15/2/20

1 2 3 4 5 6 7
G S S S S S S

Prescription:

 Follow up No.1: 20/2/20

1 2 3 4 5 6 7
G G S S S

Follow up No.1: 25/2/20

1 2 3 4 5 6 7
G G S S

Follow up No.1: 28/2/20

1 2 3 4 5 6 7
G G

Itching present on right lower 2/3rd of the leg.

Follow up No.1: 5/3/20

1 2 3 4 5 6 7
G G

Itching reduced.         

Follow up No.1: 10/3/20

1 2 3 4 5 6 7
G G

Three abscess healed completely.

Prescription:       1) Nux Vomica 200 1P HS

                                2) 5 grain tab 1-1-1 (After Food)

                                3) No.2 Pills 3-3-3 (Before Food)

                                Daily dry dressing advised with Echinacea Q.

CONCLUSION:

Patient named Mr. BT, came with the complaint of localized swelling and erythema over the lower 2/3rd of right leg, and one ulcer on the right medial malleolus. The case was diagnosed as sub-cutaneous abscess and diabetic ulcer. Nitric Acid 30 was prescribed as an acute remedy and followed it up with Nux Vomica 200 constitutionally. Patient completely recovered from the abscesses and he was discharged

10/02/2020
15/02/2020
20/2/2020
25/2/2020
28/2/2020
5/3/2020
11/3/2020 – On discharge

Homoeopathy is not just based on casetaking its all about the art of physicians way of perciveing the case and its nothing but the perception what a Homoeopath does about the case he attends, what you perceive may be a reality for you in a case and what I perceive may be a reality for me above all the reality may be something different but it’s the phsysicians mission to know the reality and and perceive the case in its true way so that we can arrive at the exact similimimun by constructing the right totality of the case. Same has happened in the above case in this case we were able to percive the totality as per the case reqired on particular phase of the disease and were able to give a a standard care with integrative approach to diabetic foot ulcer with homoeopathic treatment.

REFERENCE

  1. Sainani. G. S., API Textbook of Medicine. 6th Edition. Association of Physician of India. Mumbai.
  2. Harrisson Tinsley R. Harrisson’s Principle of Internal Medicine, Vol I, 18th ed. USA: McGraw Hill; 2012.
  3. Boger CM. Boenninghausen’s characteristics Materia medica & Repertory. New Delhi: B Jain Publishers (p) ltd. 2003.
  4. Boericke W. New Manual of Homoeopathic Materia Medica & Repertory. New Delhi: B Jain Publishers(P) ltd. 2002.
  5. Boericke W. Organon Of Medicine by Samuel Hahnemann; Sixth Reprint Edition. New Delhi: IBPP; 2001.

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