CASE STUDY
Individualised homoeopathic treatment in surgical cases! An evidence-based case report of appendicitis.
Dr Tamara Afroza*[A], Dr Biswajit Bera[B], Dr Umesh Kumar [C]
ABSTRACT:
A 23years old girl having diagnosed with appendicitis in USG came for homeopathic treatment with the hope to avoid surgical intervention. After full case taking, case analysis and proper individualisation single homoeopathic medicine was prescribed. After four months of treatment, the patient not only got relief of her presenting symptoms but also a positive USG report gave result of no inflammation of appendix. This article gives a clinically useful review of a case with evidence about how an individualised homeopathic medicine treated appendicitis successfully. This case makes the confidence level high for a homoeopath which gives an idea about why and how one should apply and can do homoeopathic treatment instead of doing surgery. This article is intended to make readers aware of current thinking in this field.
KEYWORDS:
appendicitis, individualisation, homoeopathy, case report
ABBREVIATIONS:
Right(rt), history of (H/O), ultrasonography (USG), once daily (OD), right lower quadrant (RLQ), magnetic resonance imaging (MRI), computed tomography (CT), C-reactive protein (CRP), white blood cells count (WBC)
INTRODUCTION:[1-3]
Appendicitis is the inflammation of the vermiform appendix which typically presents acutely, within 24 hours of onset, but can also present as a more chronic condition. Classically, appendicitis initially presents with generalised or periumbilical abdominal pain that later localises to the right lower quadrant. [1] The appendix develops embryonically in the fifth week. During this time, there is a rotation of the midgut to the external umbilical cord with the eventual return to the abdomen and rotation of the cecum. This results in the usual retrocecal location of the appendix.[2]The exact function of the appendix has been a debated topic. Today, it is accepted that this organ may have an immuno-protective function and acts as a lymphoid organ, especially in the younger person. Other theories contend that the appendix acts as a storage vessel for “good” colonic bacteria. Still, others argue that it is a mere developmental remnant and has no real function. [3] In this particular case, the girl presented her clinical symptoms of pain on rt iliac region with severe tenderness at McBurney’s point, weakness and nausea was there with H/O occasional occurrence of pyrexia.
PATIENT’S INFORMATION:
• A 23 years old girl, fair complexion, moderately built.
Case history: –
- Patient was presented with pain abdomen around rt iliac region for 15 days.
- She suffered from repeated pyrexia with nausea and McBurney’s point tenderness.
- Malaise and weakness of her complaints comes mainly at night and after sleep.
• She was passing hard stool 2-3 days interval.
• Hot flashes from occipital region at night in sleep.
- From narration of her parents the girl is very talkative, sentimental with jealous mentality.
CLINICAL FINDINGS:
• The girl was restless and irritable while examining, was not allowing the physician to touch the abdomen.
• She was very loquacious while taking the case.
• She was giving reply to physician’s query when asked in the way of blaming the luck with disappointment for the complaints.
- The girl was taking name of God constantly and likes to worship in regular basis.
TIMELINE:
Medication, advise and follow up of the case done for 5 months till all presenting complaints disappeared.
DIAGNOSTIC ASSESSMENT: –
HOW APPENDICITIS IS DIAGNOSED?[1,3]
The emergency department physician must refrain from giving the patient any pain medication until the surgeon has seen the patient. The analgesics can mask the peritoneal signs and lead to a delay in diagnosis or even a ruptured appendix.
(1) This disorder is usually diagnosed by history of recurrent episodes of right-lower-quadrant or epigastric pain, suggesting McBurney’s sign and Aaron’s sign positive. [1]
(2) Appendicitis is traditionally a clinical diagnosis. The three primary methods used to diagnose appendicitis Laboratory testing, imaging techniques like dominal CT scan, ultrasonography, and even MRI. Today, ultrasonography is the method most often used to detect appendicitis. Occasionally, appendicitis is diagnosed with plain x-rays. [3]
3)Laboratory measurements, including total leucocyte count, neutrophil percentage, and C-reactive protein (CRP) concentration, are usually done with diagnostic steps in patients with suspected acute appendicitis. Elevated white blood cells count (WBC) with or without a left shift or bandemia is classically present, but up to one-third of patients with acute appendicitis will present with a normal WBC count. There are usually ketones found in the urine, and the C-reactive protein may be elevated. A combination of normal WBC and CRP results has a specificity of 98% for the exclusion of acute appendicitis.[3]
PATHOLOGICAL TEST:-
USG of whole
abdomen- appendicitis
(Fig.1)
Analysis and evaluation of symptoms
| Mental generals | Physical generals | Particulars |
| 1. Preferred company. 2. Talking in sleep. 3. Fear of dark or shadows. 4.Loquacious. 5.Suspicious. 6.Religious. 7.Jealousy | 1. Hot patient. 2. Craving for meat. 3.Aggravation at night and after sleep. | 1. Stools – hard. 2. Hot flashes from vertex of head. |
Totality of symptoms:
1. Preferred company.
2. Fear of dark.
3. Talking in sleep.
4. Religious.
5. Hot patient.
6. Loquacious.
7. Jealousy.
8. Suspicious
9. Craving for meat.
10. Stools – hard.
Miasmatic analysis: [4]
The mental and physical characteristic symptoms are showing psoric dominancy so the case points towards psoric miasm. [4]
Repertorisation( Hompath Zomeo) : [5]
As the case was presented with prominent mental and physical general symptoms, Kent’s repertory was selected for repertorisation with the help of Hompath Zomeo.[5]
• Individualised homoeopathic medicine with proper dose and potency by following homoeopathic law and principles.[6,7,8]
(Fig.2)
THERAPEUTIC INTERVENTION:-[6-8]
Prescription:-
First prescription(15/08/2021)
1)Lachesis mutus 200/ one dose
2)Saccharum lactis 30
OD for next one month.
Patient was advised to avoid spicy, fatty foods and visit the physician once in every month for follow up.
Second prescription(11/09/2021)
1)Lachesis mutus 30
Two doses x OD for 2days
2) Saccharum lactis 30
OD for next one month.
Patient was advised to avoid spicy, fatty foods and visit the physician once in every month for follow up.
Selection of remedy[4,5,6]
The selection of the simillimum involves its administration singly and without admixture of any other medicinal substance so single remedy was given.[4,6]After full analysis of the case, physician’s observation, symptoms similarity, especially considering mental general symptoms as well as consultation with repertory LACHESIS MUTUS was the most indicating remedy,[5]
Selection of dose,potency and repetition of doses[6–9]
There are five considerations that influence in the choice of the dose:
a. the susceptibility of the patient;
b. the seat of the disease;
c. the nature and intensity of the disease;
d. the stage and duration of the disease; e. the previous treatment of the disease.[6,7]
So, by considering these points and mental general symptoms for the particular case, a single dose of two hundred potency was selected.[8] Repetition of the remedy was done on the basis of guidelines of our master Hahnemann and clinical experience of the prescriber by considering return of the same complaints and it’s intensity.[4,9]
Follow up and outcomes:
| Date | Symptoms | Prescription |
| 15/8/2021 | Chief complaints | Lachesis mutus 200 One dose (prescription done as if the most simillimum antipsoric remedy by considering the patient’s physical general, mental general symptoms as well as consulting the repertory)[5] (Fig.2) |
| 11/09/2021 | Improved | Saccharum lactis 30for next 1 month |
| 11/09/2021 | Complaint returned with same intensity of pain but no nausea or pyrexia was presented this time. No new complaints reported. | Lachesis mutus 200 Two doses (prescription done as if the most simillimum antipsoric remedy by considering the patients physical general, mental general symptoms as well as consulting the repertory) .[5](Fig.2) |
| 30/11/2021 | Appendicitis disappeared | Saccharum lactis 30for next 1 month |
| 28/12/2021 | Patient’s health improved without having any symptoms of appendicitis. | Saccharum lactis 30for next 1 month |
| 30/01/2022 | No previous complaints with further improvement of the patient. | No medicine gave but advise gave to visit hospital immediately in case complaint returns. |
TREATMENT OUTCOME:-
USG(whole abdomen) report:-Normal
study with no appendicitis was found now.(Fig3)
After three months of homoeopathic treatment, USG of whole abdomen was done with following follow up result.
Patient’s physical state:-
1)No abdominal complaints till now since the treatment started.
2)No attack of pyrexia or nausea till now.
3)The girl was passing stool almost regularly.
4)Appetite, thirst, sleep and all other generalities now had no imbalance.
5)USG(whole abdomen) report:-normal study with no appendicitis was found now.(Fig3)
CONCLUSION: [4,5]
To conclude, this was a 23-year-old female who presented with RLQ pain and was diagnosed with acute appendicitis. Therapeutic intervention was given instead of surgery. This case raises awareness of a surgical case of appendicitis where the pain was localised to the rt iliac region. In the above described case, it is very clear that individualised simillimum remedy can give quick recovery. We know that smaller the dose of a truly indicated medicine, the better as it produces a gentle remedial effect.[4]After full analysis of the case, physician’s observation, symptoms similarity especially considering mental general symptoms as well as consultation with repertory LACHESIS MUTUS was the most indicating remedy,[5] Then the follow up of the case with the same medicine was given for further improvement of the symptoms, where first prescription gave palliative relief of the complaints followed by second prescription gave outstanding result of recovery from the presenting complaints with no inflammation of appendicitis in USG. Even after five months later of the prescription of LACHESIS MUTUS, the patient gave no afterward complaints till date.
WHY INDIVIDUALISATION IS THE OPTION OF CHOICE?
For selection of the homoeopathic remedy through individualization,It is described in §153 of organon, totality of symptoms should be the most striking, singular, uncommon, peculiar, or characteristic symptoms of the disease that are to be kept chiefly and most solely in view; it is for analogues to these that we must search through the lists of medicinal symptoms. [8]
REMARKS:[6-10]
The homoeopathic dose, therefore, is always a sub-physiological or sub-pathogenetic dose;[6] that is, a dose so small as not to produce pathogenetic symptoms; for we desire, not to produce more symptoms, but only to remove and obliterate symptoms already existing.[7]It must also be given in a dose so small, as not to produce a severe aggravation of the already existing symptoms.[8]The success of homoeopathic treatment depends to a great extent on the correct selection of the potency and the requisite potency should be selected through the susceptibility of the patient. [9,10]
REFERENCES:
- Vaos G, Dimopoulou A, Gkioka E, Zavras N. Immediate surgery or conservative treatment for complicated acute appendicitis. A meta-analysis. J Pediatr Surg. 2019 Jul;54(7).
- Gignoux B, Blanchet MC, Lanz T, Vulliez A, Saffarini M, Bothorel H, Robert M, Frering V. Should ambulatory appendectomy become the standard treatment for acute appendicitis.World J Emerg Surg. 2018.
- Eng KA, Abadeh A, Ligocki C, Lee YK, Moineddin R, Adams-Webber T, Schuh S, Doria AS. Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US. Radiology. 2018 Sep;288(3).
- Hahnemann S. The Chronic diseases, Their Peculiar Nature and Their Homoeopathic Cure. New Delhi: B. Jain Publishers (p) Ltd; 2016.
- Hompath Zomeo – homeopathy software [Internet]. Hompath.com.
- Ganguly SN. Annotated Text of Hahnemann’s Organon of Medicine. 5th ed. Shahdara: Birla Publications PVT. LTD; 2007.
- Close S. The Genius of Homoeopathy. New Delhi: B. Jain publishers (P) Ltd; 2004.
- Dudgeon RE. Lectures on the Theory and Practice of Homeopathy. New Delhi: B. jain publishers (P) Ltd.
- Dey SP. Essentials of principles and practice of homoeopathy. 4th ed. Kolkata: Published by Smt. A Bhattacharya; 2009.
- Kent JT. Lesser Writings. New Delhi: B. jain publishers (P) Ltd; 2004.
ABOUT THE AUTHORS:
[A]MD, Hom. (Part-II pursuing) in Practice of Medicine from The Calcutta Homoeopathic Medical College and Hospital. B.H.M.S (Honours) from D.N.DE Homoeopathic Medical College and Hospital. Kolkata, WB. [B]MD (Hom) in Practice of Medicine from The Calcutta Homoeopathic Medical College and Hospital. B.H.M.S (Honours) from The Calcutta Homoeopathic Medical College and Hospital. Kolkata, WB. [C]HMO,SHD:Tulsipur Shrawasti,Govt of Uttar Pradesh, MD(Hom) Part-II in organon of medicine from National Institute Of Homoeopathy(NIH), B.H.M.S from NIH, Kolkata, WB.
