Dr. Pankaj Aggarwal Ppt on Diabetic Foot

MY EXPERIENCE IN DIABETIC

FOOT WITH HOMOEOPATHY

-PROF. (DR.) PANKAJ AGGARWAL M. D. (HOM.)

EX VICE-PRINCIPAL, HOD, ORGANON OF MEDICINE, BAKSON

HOMOEOPATHIC MEDICAL COLLEGE, GREATER NOIDA, U.P.

RESIDENCE-CUM-CLINIC: 37, SOUTH ANARKALI EXTN., DELHI-51, INDIA

PH.: 22512552, 22421972, MOB: 09313212552

E-MAIL: [email protected]

SALUTATION

Hipocrates, Father of

Medicine

LIFE IS SHORT ART IS LONG

Dr. M.L. Agarwal

MY FATHER

Prof. L.M. Khan

MY TEACHER

Master Hannemann, A

Great Teacher

MEDICAL ART IS MY SUBJECT

THE PATIENT

Name Mr. G P

Age/ Sex 62 years/Male

Date of Consultation 15.04.2011

Occupation Business

Qualification B –Tech

Marital Status Married

Presenting Complaints

The patient, a DIAGNOSED case of Gangrene as a

consequence of diabetes mellitus, presented with the following

complaints at the time of consultation:

• Gangrene of left foot since 6 months

Stitching pain in the affected foot

< Squatting position

< Walking

> Resting while and when kept open

Discharge – Profuse (wets the cotton swab),

Watery

off and on Blood also oozes out

Walking difficult due to pain & discharge

First photograph

The photograph was

taken on 14.04.2011 by

the patient and submitted

at the time of his visit to

the clinic on 15.04.2011.

Presenting Complaints

• Burning sensation in epigastric region since 5 months

Complaint occurred after he started taking antibiotics for

gangrene

Along with heaviness of Lower abdomen

< Eating after

> Passing flatus

Also associated with Heaviness of head

History Of Presenting Complaint

3 years back, the patient suffered from a similar gangrene on

the big toe of the left foot for which he was operated and was

relieved. From the past 6 months, he has been suffering from

gangrene of left foot which did not healed even after taking

antibiotics regularly. His blood sugar level at the time of

consultation was 319 g/dl (random) and his blood pressure

was 136/84 mm Hg (after taking allopathic medicine in

morning).

Treatment history

• Taking regular allopathic medicines for

• Diabetes Mellitus

• Hypertension

•Took Ayurvedic treatment for the gangrene on and off for past

2 years

•Taking Antibiotics for the same (since 6 months)

Past history

• Typhoid - In childhood

• Brain hemorrhage (left sided) - 4 years back – taken

Allopathic treatment; since than weakness of the right arm

started (excessive alcohol intake)

RELATIVE DISEASE

Paternal

Grandparents

No major illness; natural death

Maternal

grandparents

Hypertension

Mother Diabetes Mellitus

Hypertension

Father Died due to Cardiac arrest

Brother Chronic Renal Failure

Sister Blood Cancer

Family history

• from the past history and family history

we can percieve the destructive

tendencies/ state he has been carrying

with him

Habits/Addiction: Addiction of drinking alcohol regularly from 1975 to

November 2010

No habit of smoking cigarette

Diet: Non Vegetarian

Personal History

PHYSICAL GENERALS

Appetite: Regular, cannot tolerate hunger – causes

Headache

Desire: Warm food 3 +; Gravied Food 3+, Sweets 2+,

Mutton

Aversion: Nothing specific found

Intolerance: Nothing specific found

Thirst: Drinks in sips; frequent, for water at normal

temperature

Stool: Regular; unsatisfactory

Urine: Clear, Increased Frequency at night

Sleep: Disturbed

Thermal reaction: Can tolerate both hot and cold weather equally

Perspiration: Profuse on slightest exertion

PHYSICAL GENERALS

• History of prolonged working hours

• Anxiety – for small things

• Anxiety-disease

• Workaholic

• Perfectionist

•Anger- expressed by shouting

MENTAL GENERALS

• Contradiction << Cannot tolerate

• Economical – thinks before spending money

• Fastidious – but like if somebody else cleans

• Desire open air

• Punctual

• Sympathetic

MENTAL GENERALS

PHYSICIAN’S OBSERVATION

• Deep Furrows over forehead

• Slurring Speech

• Tongue – Furrows in centre, dry laterally

• Body temperature – Normal to touch

INVESTIGATIONS ADVISED

• Blood Sugar – Fasting and PP

PROVISIONAL DIAGNOSIS

DIABETIC FOOT GANGRENE

SUPERIMPOSED WITH INFECTION

SYMPTOMS CAUSA

OCCASIONALIS

Gangrene on left side of left foot with

Stiching pain

< Walking

> Resting while, in open air

Discharge-profuse, Watery, offensive

Difficulty in walking

No

Burning sensation in epigastric region with

Heaviness of head & lower abdomen

< Eating after

> Passing flatus

Yes

H/o - Brain Hemorrhage Yes

SYMPTOMS OF CASE

SYMPTOMS CAUSA

OCCASIONALIS

Addiction of drinking alcohol No

Cannot tolerate hunger No

Thirst - drinks in sips, frequent No

Stool - Regular, unsatisfactory Yes

Urine - Increased Frequency in night Yes

Desire - warm food No

Desire - Sweets No

SYMPTOMS OF CASE

SYMPTOMS CAUSA

OCCASIONALIS

Sleep- disturbed , thinks about his

disease

No

Anxiety – for small things No

Anxiety - disease No

Workaholic No

Contradiction<< Cannot tolerate No

Desire open air No

Perfectionist No

Deep Furrows over forehead No

Slurring Speech No

SYMPTOMS OF CASE

EVALUATION OF CASE

KENT’S METHOD

MENTAL GENERALS

• Perfectionist

• Workaholic


• Anxiety – for small things, disease

• Desire open air

PHYSICAL GENERALS

•Cannot tolerate hunger

•Thirst - Drinks in sips, frequent

•Desire - Warm food,

•Desire - Sweets

• Sleep- disturbed , thinks about his disease

EVALUATION OF CASE

KENT’S METHOD

PARTICULARS

• Gangrene of left foot with Stitching Pain

< Walking

> Resting while , in open air

Profuse, Watery, offensive discharge

TOTALITY OF SYMPTOMS

• Perfectionist

• Workaholic


•Anxiety – for small things, disease

•Desire open air

• Cannot tolerate hunger

• Thirst - Drinks in sips, frequent

TOTALITY OF SYMPTOMS

•Desire - Warm food,

•Desire - Sweets

• Sleep- disturbed , thinks about his disease

• Gangrene of the big toe with Stitching Pain

< Walking

> Resting while , in open air

Profuse, Watery, offensive discharge

MIASMATIC ANALYSIS

SYMPTOM PSORA SYPHILIS SYCOSIS

Anxiety – for small things ++ + +

Anxiety – for disease + +

Workaholic + + +

Contradiction - Cannot tolerate +

Desire open air + +++ ++

Perfectionist + ++

Cannot tolerate hunger +

Thirst - Drinks in sips, frequent +

Desire - Warm food +

Desire sweets +

SYMPTOM PSORA SYPHILIS SYCOSIS

Sleep- disturbed , thinks about

his disease

+

Gangrene of the left foot + +++

Stitching Pain +

< Walking + +

> Resting while + +

> in open air +

Profuse, Watery, +

offensive discharge +

MIASMATIC ANALYSIS

PREDOMINANT

PSORA SYPHILITIC MIASM

Lycopodium Clavatum and Arsenicum album were

the two most indicated remedy for this case but taking

into consideration the pathology of the disease, its

acute totality and the affinity of Arsenicum album for the

diseased stage, we prescribed Arsenicum album in 50

millicimal potency

SELECTION OF MEDICINE

FIRST PRESCRIPTION

Arsenicum Album 0/1, 10 Strokes, BD, first cup

(Date of prescription – 15.04.2011)

DATE CHANGES IN SYMPTOMS PRESCRIPTION

22/04/11 General condition >

Pain in the wound - slightly >

Discharge– not as profuse as it

was at the time of consultation

Sleep - no change

Blood sugar – 130 g/dl (F)

180 g/dl (PP)

Arsenicum Album 0/2,

0/3 -10 strokes, B.D

Placebo 3X, 16 tab

7/05/11 General Condition >>

Pain >>; the patient is able to

walk better

Discharge – Absent

Sleep - Slightly Improved

Constipation>> but unsatisfactory

Arsenicum Album

0/4,0/5,10 strokes, B.D

Placebo 3X, 16 Tab

FOLLOW UP

DATE CHANGES IN SYMPTOMS PRESCRIPTION

21/5/11 General condition >>

Discharge – Slightly Increased

since 5 days (patient had an history

of prolonged exertion at home)

Pain is Absent

Stools satisfactory though slightly

hard in consistency

Blood sugar – 140 g/dl(random)

Arsenicum album 0/6,

0/7 - 10 strokes, B.D,

2nd cup

Sac Lac 3X,16 Tab

4/6/11 As a whole patient better

Discharge is decreased

Pain in the wound- better

Constipation - off and on but stools

are satisfactory

Sleep – better

Anxiety level better


0/9 -10 strokes; BD

2nd cup

Sac Lac 3X ,16 tab

FOLLOW UP

FOLLOW UP

DATE CHANGE IN SYMPTOMS PRESCRIPTION

24/6/11 General Condition >>

Discharge- decreased markedly

Sleep is Better, refreshing

Constipation is better, satisfactory

stools

Anxiety better

Contradiction still not tolerable

Blood sugar – 108 g/dl (F)

136 g/dl (PP)


0/11 - 10 strokes, B.D

2nd cup

Sac Lac 3X /16 tab

10/7/11 As a whole patient better

NO PAIN AT ALL – not even on

touching

Discharge was absent

Sleep has improved much

Blood sugar – 130 g/dl (random)


0/13 - 10 strokes, B.D

2nd cup

Sac Lac 3X /16 tab

SECOND PHOTOGRAPH

This photograph was taken

by patient on 22.06.2011

after 2 months of treatment

Complaints Dates

22/

4

7/5 21/

5

4/6 24/

6

10/

7

30/7

Wound same Same ++ ++

+

+++ +++ +++

Pain + ++ +++ ++ +++ +++

+++

Discharge + +++ -- ++ +++ +++ ++

Stool same + + + +++ +/- +++

Sleep Same - + + ++ +++ +

Anxiety Same

Same

+ + ++ +++ ++

Heaviness

Same Same

+ + +++ +++ +++

Arsenicum Album was prescribed with increasing order in 50 millisemal till 10/9/11.

Last prescribed was Arsenicum album 0/16 ;10 strokes; B.D 3rd cup

Complaints Dates

12/8 28/8 10/9 26/9 10/10

Wound +++ +++ ++ - --

Pain +++ ++ ++ - -

Discharge ++ ++ - - --

Stool ++ ++ - - -

Sleep +++ ++ +++ - +

Anxiety ++ ++ + - --

Heaviness

++ ++ ++ ++

+

WHY ARSENICUM ALBUM?

Arsenicum album is the most similimum for the symptoms of the

PHASE OF THE DISEASE covering maximum number of

symptoms as well as the pathological stage of the disease. The

selection is also justified with the proof from the source books of

our Homeopathic Materia Medica.

From the pages of Materia Medica Pura, Vol 1 By

Samuel Hahnemann

• An Ulcer that is particularly painful in the morning, which

contains a dark brown, bloody matter under a thin scab, with

single stitches whilst sitting, which are relieved by standing but

most effectually by walking (S.No 779)

• Tearing pains in ulcers (S.No 782)

• On the affected part, in the ulcer, a burning as from a live coal

(S.No 783)

• The old ulcers, hitherto painless, became a painfully sensitive

(S.No 786)


• The ulcer discharges much black coagulated blood (S.No 787)

• Itching in the ulcer passing into burning (S.No 788)

• Cancerous ulcers which rendered it necessary to ampute the limbs

(S.No 791)

• The ulcer becomes inflamed all around bleeds on being bandaged,

and gets a superficial dry scab (S.No 792)

• Burning pain in the ulcers (S.No 794)

• Needle pricks on the skin (S.No 804)

• He wishes to rise up, but when he rises he can hardly maintain

himself (S.No 862)


• Sleepless with restlessness and moaning (S.No 869)

•He drinks much and often (S.No 922 )

• He is thirsty, yet drinks but little at a time (S.No 928)

• Anxiety (S.No 1012)

• The most intolerable anxiety (S.No 1014)

• Long continued Anxiety (S.No 1018)

• Sensitive peevish disposition; the least thing can annoy him and

almost cause him to be angry (S.No 1063)


From the pages of The Chronic Disease, their

peculiar nature Vol 1 By Samuel Hahnemann

• Introduction – Ulcers in the soles of the feet; ulcers with corrosive

blisters on the soles of the feet and toes; pains as from soreness on

the balls of the toes , as if rubbed open from walking.

Burning pains in the ulcers; slow in going to sleep……

• Anxiety (S.No 14)

• He drinks much and often (S.NO 382)

• With Great Thirst he drinks often, but always little at a time (S.NO

383)


• Bloatedness of the region of the stomach (S.No 469 )

• Heaviness in the stomach, as from a stone, after eating (S.No 472)

• Constipation (S.No 562)

• Constipated abdomen (S.No 563)

• Ulcer which is painful, especially in the morning , with dark- brown,

thin bloody pus under a thin scurf , and with single stitches while

sitting , alleviated by standing and still more by walking. (S.No

1057)

• Cancerous ulcer, which compels the amputation of a limb (S.No

1058)

• Painful sensitiveness of old ulcers which hitherto were painless.

(S.No 1060)


• Inflammation of an ulcer in its border; it bleeds on being bandaged

and a superficial dry scab forms. (S.No 1068 )

• The ulcer discharges much black coagulated blood (S.No 1069 )

•Great indolence and indisposition to the lightest movement (S.No

1071)

• Sleeplessness (S.No 1086)


From the pages of The Guiding Symptoms of Materia

Medica, By C. Herring

•When alone, he falls to thinking about disease and other things,

which he can scarcely keep out of his mind.

•Mental derangements with satiety of life in drunkard.

•Deep-seated melancholic affection; ceased after tetter-like ulcers

appeared on lower limbs.

•Anxiety and impatience.

•The least thing offends him, and moves him to anger.

• Vexation, with anxiety, restlessness and chilliness.


•Obstinacy, avarice, inclined to malice and satire

•Dryness of mouth, with violent thirst.

•Irresistible longing for water frequently disturbing sleep at night,

undiminished next morning.

• Bad effects from inordinate use of spirituous liquors.

•Sugar in urine.

• Voice : trembling ; weak ; unequal, now strong and again weak ;

hoarse ; rough ; hollow ; loss of voice. Right limb swollen and full

of suppurating pimples, with an unbearable itching

•Old ulcers on lower limbs, with burning and lancinating pains.


• Old ulcers on legs, with burning and stinging.

• Pain in an ulcerated leg so violent that it waked her up at 4 A. M., and

prevented her from sleeping.

• Ulcer on foot surrounded by a gangrenous crust.

• Loss of power of toes; walking is performed with soles.

• Stitches which cause her to shudder, from little left toe to great toe.

•Sore pain on balls of toes, while walking, as if chafed.

•Great restlessness with fear and anxiety.

•Sleep anxious, unquiet.


• Ulceration constantly extending in breadth.

•Superficial ulcer, penetrating daily deeper, increasing in

circumference, edges more and more everted.

•Acrid, burning, corroding discharges, often extremely offensive.

• Retards decomposition (in those fatally poisoned).

•Gangrena senilis sicca, with coldness, desire for more covering ; >

from warmth.

• Gangrene : > from heat ; (< from heat, Secale).

•Gangrenous ulcers half an inch broad, causing insufferable pains,

surrounded and partially covered with a gangrenous crust.


PHYSIOLOGICAL ACTION OF

ARSENICUM ALBUM

It is an agent when applied to skin acts as a caustic and produces a

violent inflammation with sloughing of parts. When small doses are

taken, it has a tonic effect upon nervous system and circulation,

stimulating the flow. The RBC’s are decreased in number, and the

blood rendered less coagulable, followed by eczema, urticaria,

herpes zoster, bronzing and exfoliating of the skin.

REPERTORIAL SHEET

photograph

14.04.2011 22.06.2011

Present Scenario

On 10 October 2011, the patient complaint of fever <evening Shiveing with Advised Widal Test .

Presenting Complaint

Patient consulted us on telephone with the following symptoms on 16.10.2011: General Weakness Restlessness +++

His present wound (ulcer) was healed up but the older ulcer reappeared – with profuse, watery and offensive discharge.

Neuralgic pains radiating to the whole left foot

Sloughing of the medial malleolus of the same foot

Stools – Constipated, hard stools increased

Anger with Depressed feeling

Mental Anxiety +++ (as he was asked for amputation)

The photograph was taken on 16.10.2011

On Reviewing

His old ulcers had re-appeared after the attack of typhoid fever Profuse, watery offensive discharge Neuralgic pains radiating to the whole left foot. Sloughing of medial malleolus of left foot was seen. Anxiety -

Prescription

Crotalus horridus 30; 5 drops diluted in 100 ml of distilled water;

2 strokes/3 times a day

FOLLOW UP

DATE CHANGE IN SYMPTOMS PRESCRIPTION

5/11/2011 Fever - absent Weakness ++++ Discharge from ulcer +++ Malleolar lesion – same Sloughing present Constipation >> Sleep – better advised : Blood sugar ,CBC,HbA1C

Crotalus h. 6 / 2 strokes/ 6 drops diluted in 100 ml of distilled water Rubrum met 3x/ 16 tab/ H.S.

19/11/2011 Wound at malleolar region > Bleeding points appeared Weakness > Sleep > Anxiety >> ( after noticing the re-appearance of circulation at the affected foot)

Crotalus h. 6 / 2 strokes/ 6 drops diluted in 100 ml of distilled water Rubrum met 3x/ 16 tab/ H.S.

Reappearance of Bleeding points

The photograph was taken on 3.12.2011

FOLLOW UP

DATE CHANGE IN SYMPTOMS PRESCRIPTION 5/12/2011

G.C >> Melleolar lesion ->> Pain > Constipation > Blood sugar 127 mg/dl (random)

Crotalus h. 6/ 5 strokes/ 6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q for cleaning

24/12/2011 G.C >> Walking improved Generalities >> Ulcer better Sleep Improved


FOLLOW UP

DATE CHANGE IN SYMPTOMS PRESCRIPTION 14/01/12

Ulcer better, much healed Discharge slightly present Anxiety level improved Swelling at ankle region present Blood sugar 150 mg/dl (random)


31/1/12 Ulcer- improving Sleep- better Swelling at the ankle region- same Blood sugar -180mg/dl


16/2/12 Wound- better Sloughing- better Blood sugar- fasting-145mg/dl Blood sugar- PP- 155mg/dl Advisded : color doppler of left lower limb


DATE CHANGE IN SYMPTOMS PRESCRIPTION 15/3/12 Patient as a whole- improved Crotalus h. 6/ 5 strokes/

6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q

31/3/12- 12/5/12

General condition – improved Pain- absent Discharge- bleeding off and on Sleep- sound and refreshing Weakness- absent

Crotalus h. 6/ 5 strokes/ 6 drop diluted in 100 ml of distilled water Rubrum met 3X; 16 tab Echinacea Q

21/10/12 (on telephone) Wound- dry and healed completely Sleep- sound Constipation- absent Anxiety- absent

No medicine

Complaints Dates

5/11 19/11 5/12 24/12

Wound(old) same + ++ +++

Sloughing same

same

+ +++

Pain + + ++ +++

Discharge same ++ ++ +

sleep ++ ++ ++ +++

Anxiety Same ++ + +++

Weakness

Same ++ ++ +

Complaints Dates

14/01 31/1 16/2 15/3 31/3-12/5

Wound(old) +++ ++ ++ +++ +++

Sloughing +++

+++

++ ++ +++

Pain + + ++ +++ ++

Discharge same ++ ++ + +++

sleep ++ ++ ++ +++ +++

Anxiety Same ++ + +++ +++

Weakness

Same ++ ++ + +++

• On 20/10/12- completely relieved

• No sleep disturbance

• No wound and no pain

• ( On Telephone )

WHY Crotalus Horridus?

From Allens Keynote:

Is indicated in strumous, debilitated hemorrhagic, broken – down constitution; during zymotic diseases; in inebriates; tendency to carbuncles or blood boils.

Diseases caused by a previous low state of the system ;low septic typhoid or malarial fever; chronic alcoholism; exhausted vital force; genuine collapse.

From Boger Synoptic Key Deathly sick, tremulous and weak

Hemorrhage Putridity, rapid decomposition Septic

Petechiae, gangrene, general burning


Suppuration of glands; gangrene; in broken down constitutions, with low fever, tendency to slough, and discharge of dirty or hemorrhagic matter.

Gangrene, skin separated from muscles by a fetid fluid; black spots with red areola and dark blackish redness of adjacent tissues.

Chilblains, gangrene pending ; circulation sluggish.

Ulceration; especially phagedenic, sloughing, varicose, irritable, bubo, "soft sore," mercurio-syphilitic, with offensive discharge, etc., in constitutions broken down by previous disease or bad living ; in inebriates.

From The Guiding Symptoms of our Materia Medica by C. Herring:


THANK YOU

Dr. Pankaj Aggarwal Ppt on Diabetic Foot

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