Towards the end of the year 2012, we received a call for a home visit, as the patient, a 20 year old girl, was unable to walk on account of her paralysis, diagnosed as Neuro-degenerative disease. We always tend to explain our patients the process of the first consultation with regards to case taking and required time span. The outcome of this was realized when we reached her residence and met a girl with an inanimate face. She seemed absorbed into herself and soon handed us a written conglomerate of her troubles. On asking to justify her action, her mother explained that she has always been uncomfortable expressing about herself and thus she preferred to pen it down.
We could deduce the following from the matter received from her and from our personal interaction where she said, “Since the age of 12 years, I have always had the complaint of recurrent apthous ulcers and in the last 2 years this has increased. Because of this, it is difficult for me to eat or even drink anything. Also, since past 2 years my menses have been irregular”. Furthermore, with water welled up in her eyes, she said that watering from the eyes has been a constant complaint since long.
On asking her to elaborate about each ailment in detail, we discovered that she had been operated thrice for fibro-adenoma of the breast. It all started with sudden amenorrhea at the age of 18 years, which was diagnosed as bilateral fibro-adenoma of breast. On enquiring more, we were astonished to know that every time she went under the knife, her menstrual irregularities would settle, only to be again followed by the fibro-adenoma, which was later diagnosed as benign phyllodes tumor.
The major concern for the patient was, she not being able to walk or even get up from bed. Elucidating it she said that it started with her leg pain about which she said that, I used to lose my balance and felt like falling on the left side. I had difficulty in standing as well. The pain was more in my left leg.
I used to end up using my right leg more to compensate for the pain and then it also started to hurt. My legs used to ache a lot, especially my heels. There was swelling in both my legs. I could not sit with my legs folded. Also I could not lie on my back. I had to lie on either sides and whenever I used to lie down and stretch my legs, it was painful. The leg pain made it difficult for me to get up from the bed. I had to sit for at least 5-10 minutes and then get up, that too only with some support. Now that I recall, all this gradually started after being operated for fibro-adenoma for the third time, which was in the month of December-2011.
Explaining the previous complaints, she said that I am having difficulty in eating because of mouth ulcers. Ever since childhood, I have been very fussy about food, be it vegetables, non vegetarian or fruits. I only have those things which I like. There were times when I only had Tea along with Bread and Biscuits. I do not like to have food from someone else’s plate. Also I cannot tolerate anyone touching my belongings.
She further continued saying, as a kid I was not very fond of playing, I only liked watching television. Now I do not feel like doing anything. I feel my body has become very weak. I do not even feel like getting up. I feel very sleepy and this seems to have increased in the past two years.
Her mother added to this by saying that, she used to always complain of leg pain and her gait was also affected. This was noticed only after she was operated for the fibro-adenoma. Moreover, since September 2012 her left leg used to get twisted following which she could not walk at all. She also said that her daughter is unable to control her urge for urination, so much so that when she sleeps on her abdomen she passes urine involuntary.
On a detailed interrogation of the evolution of her troubles, we could trace that at the time of birth she had aspirated meconium which had lead to pneumonia and she was also an over-weight baby with birth weight of more than 3 kgs. Then she contracted chickenpox at the age of 12 years, back in 2004. Within the time span from birth to the age of 12 years, she did not suffer from any major illness, other than constipation.
Since 2006, she noticed graying of hair. In the year 2009, their family had shifted and was now staying in a joint family.
Later on in 2010, she had irregular menses and was then diagnosed with fibro-adenoma of B/L breast, which was operated in September 2010. After this the patient got her regular menses in October 2010, but was again diagnosed with fibro-adenoma and this was again resected. This process continued for 3 consequent times until 2012.Further we could actually pin-point that in January 2012 after being operated for the last time, the weakness, pain in the legs and disturbances in her gait were noticed. In the month of August 2012, she had to bear the news of the sad demise of one of her cousins. And by the month of September 2012, she again started to complain of amenorrhea and also now even inability to walk.
On asking her to describe about her persona, she mentioned that – Since the very beginning I do not like anyone touching me, be it my father when I was a kid or my mates in college. I also don’t like people touching my possessions. I even ask my mother to wash her hands before touching any of my stuff. I warn them that whatever you want, you ask me, I will give it to you. You do not touch my things.
She doesn’t like it when her mom washes her hair. She tends to get angry if hot water is used for bathing as she further states that it makes the leg pain worse. She has always had a liking for dancing and watching TV serials and becomes angry if her mom says a no for watching them.
The mother contributed to the conversation by saying that, my daughter doesn’t like it much here after we have shifted. She has also started getting angry, especially when she is alone. When I am around, she feels better. While we were still discussing this, the patient distracted us by saying that, I have always been afraid of my mother. She used to hit me when I was a child. She also used to lock me up in the room. She never allows me to act according to my will. Continuing further the mother added that, before shifting, while in their old residence, her daughter used to roam around and would be with everyone. But here in the new house, because of the fights, she used to say we should not stay here and you don’t get into fights.
Now she doesn’t like going out at all. Even if all members from the house are going out, she says you lock me in the house and go. She says I can’t even walk now. And if anyone asks her about this, tears well-up in her eyes and she is unable to utter a word. Only when someone initiates a talk, she will talk. She doesn’t even talk to her cousins. She wants all her things to be in the proper place. Her mother narrated an instance where the patient asked one of her younger cousins to pick up a thing from the bed and keep it on its proper place. To this he abruptly replied that my father has bought this bed. Ever since she has stopped asking him to do any work.
Throughout the narration, it was observed that the patient was very reluctant even while explaining about her chief complaints. After much digging, she appeared to somewhat open up and admitted that ever since childhood she has been a reserved person. She does not like talking much. She initially liked to roam around, but after shifting that too has stopped. She said I am not very keen on making friends. The mother further hopped into the conversation saying, she does not share her feelings with anyone except few bits and pieces with me. She avoids meeting new people and when amidst them, she hardly speaks. Also she added that her daughter is very stubborn. She does not like her brother much and never allows him to touch or use any of her stuff. If he scolds, she also does the same and asks him to go away. To this the patient snappishly said that, I get angry whenever he does such things. Further the patient added that I do not like to stay in our new house because here my aunt does not treat me properly and she discriminates between me and her own children, that disturbs me. When asked more about it, she seemed to avoid the topic with tears in her eyes. On asking the reason for her tears, she sidelined it by saying that it was merely because of the dust.
Menstrual history:
Amenorrhea since 2010, which was better intermittently after fibroid removal. But since 2012, again amenorrhea.
➝ Cycle- irregular / 4 days, Red, no clots. Offensive
➝ No complaints before, during or after menses.
➝ Leucorrhoea occasional
Generals:
➝Appetite: good, can tolerate hunger.
➝Likes: spicy
➝Dislikes: sweets
➝Thirst: thirstless
➝Perspiration: scanty
➝Urine: no complaints
➝Stools: constipation
➝Sleep: 8 – 9 hours. Refreshing. Salivation during sleep occasional.
➝Dreams: Cannot remember
➝Fears: fear of falling
➝Thermals: can’t tolerate summer, is comfortable in cold. HOT patient.
Examinations:
SUMMARY OF THE CASE
It is a well-acclaimed declaration by medical fraternity – “Neurodegenerative diseases are incurable”, which was even our conjecture until a young girl approached us who was initially unable to walk and later landed up in a paralytic state. A hallmark of neurodegenerative diseases is the formation of misfolded protein aggregates that cause cellular toxicity and contribute to cellular proteostatic collapse, whereby leading to degeneration and death of the nerve cells. Proposed causes for degenerative nerve diseases include genetic and environmental factors suchas being triggered by a viral infection like herpes simplex, Epstein barr, varicella zoster,etc which can induce alterations and degeneration of neurons both directly and indirectly. Similarly in our case the precursor was chickenpox .i.e. varicella zoster, which the patient suffered from at the age of 12 years where by posing a future threat for overgrowths as well as nerve degeneration. Thus we can classify this as a miasmatic disease of non-venereal origin .i.e. Psora.
One of the hindrance while case-taking is an encounter with reticent patients which we also experienced in our patient who was non expressive, sad and with an inanimated face. Even as a child she was reserved and taciturn and always reluctant on making friends and meeting new people. She was disinterested in going out with her family, yet a fear of being alone prevailed where she always wanted her mother around. As a person she aversed any of her family members touching her or her belongings, so much so that she even asked her mother to wash her hands before touching any of her possessions. Experiencing inequity between herself and her brother by her aunt made her upset. Moreover she gets vexed when she is refrained from watching her favouritetv serial. Over the time she appeared to enter into a state of indifference which was a gradual process and could be perceived only after understanding the case in all of its aspects.
Very few rubrics led us to a remedy which worked wonders in this case.
Rubrics considered were –
➝ Talk, indisposed to.
➝ Indifference everything to
➝ Compulsive disorder
➝ Timidity
➝ Contradiction intolerant of
The remedy prescribed was Conium Maculatum
Conium Maculatum proved to be the most suitable remedy as the course of the disease was slow and gradual which constitutes an important aspect of the remedy, as it cannot be thought off in manifestations which are sudden and violent.
One of the eminent features seen in the remedy is of “weakness due to over exertion”, which shows itself on both physical and mental plane.
Talking about the mental faculty, the conium state arises after an emotional set back like incessant grief or anxiety (which is a form of mental exertion). This eventually leads to mental weakness resulting in slow and gradual breakdown of the intellectual faculty whereby comprehending and thinking skills become sluggish. In this state, the mind gives out and even the slightest mental exertion affects the patient adversely and gradually he progresses towards a state of imbecility.
On the physical plane, there is progressive weakness due to over straining which gradually leads to paralysis. Thus the slow and gradual progress of the disease eventually results into imbecility and paralysis on the mental and physical plane respectively.
The long standing mental trauma ensues a depressive state where they develop an aversion to people, society, relations, etc, yet an interesting irony is that they fear solitude.
Another feature of the remedy is being very particular about trifles which ranges till the degree of obsession. On the emotional plane they are very sad and discontented with everything which slowly and gradually advances to a state of indifference which makes it difficult to extract history from the patient.
In my years of clinical practice I have seen this remedy to hold a great utility in non-miasmatic cases where a physical injury has lead to a gradual process of degeneration. The other remedy which came close was sepia. However, in sepia the indifference is directed towards loved ones arising from a long-standing history of being abused, domineered or contradicted, whereas in our case the indifference was reflected in a generalized way, thus, sepia was ruled out.
Although “Fear of being alone, yet company desire” persists in both conium and sepia, the only difference was the exciter as also understanding the component of indifference in its full length.
An important lesson that this case fetched me was that- remedies appear to be closely-knit in some of their facets, which makes them look alike. However, the key to disinter the similimum lies in perceiving each and every aspect of the patient as also the remedy in its complete finerity.
REMEDY PRESCRIBED:
Conium Maculatum 200
22/12/2012:
➝ Able to stand but only in a bending posture and with support.
➝ Not able to straighten her legs.
➝ Able to walk with support since last 15 days.
➝ Swelling over the right leg still present.
➝ Also complaining of back pain recently.
➝ Pain the lower abdomen: Both iliac fossa since the beginning the December. Pain extends to both the legs.
➝ Sensation of urine and stools restored, but control has not been established yet.
➝ Appetite has improved now eats well.
➝ Weight has increased.
➝ Menstrual history:
LMP: 15/12/2012
Flow for 2 days.
No significant complaints during menses.
30/01/2013
➝ LMP: 11/01/2013
➝ Tingling sensation in both lower limbs.
➝ Unable to sit.
➝ While sleeping, folds her legs towards her abdomen.
➝ Cannot move her feet.
➝ Urine frequency has increased.
➝ Constipation.
1/03/2013
➝ LMP: 7/02/13
➝ Pain in lower abdomen extending to the legs, still persisted with the same intensity.
17/04/2013:
➝ LMP: 20/03/13
➝ Leg pain and swelling – cries with pain.
➝ Urine frequency has reduced.
➝ Constipation still same. Ineffectual urge. Doesn’t pass stools for 4 days. I have to strain. Has to do manual evacuation of stools.
➝ On examination: pitting-type of pedal edema, b/l.
10/12/2013
➝ The patient seemed to improve gradually but did not get menses in the month of July.
➝ August 2013- menses on 11th August
➝ No menses in the months of September, October and November.
➝ LMP: 01/12/2013
The patient was gradually improving and was on sac lac throughout the year of 2014.
There was improvement in her gait and she could now walk and stand, although not independently but with minimal support. The control over bladder and rectum was completely established. She was started with physiotherapy and dietary advice as an auxiliary mode of treatment. Her menstrual cycles showed slight irregularities intermittently which did not require any interference.
In the year of 2015, improvement continued until in August, when she complained of reoccurrence of the lump in her breast.
18/08/2015:
➝ LMP: 23/7/2015
➝ Menses are regular now.
➝ Pain in the left heel.
➝ Blackish discoloration over the left foot. No itching. Occasional watery discharge.
➝ She complained of pain in her leg, extending from the right iliac fossa, but now only during physiotherapy.
➝ Heaviness in the abdomen. Passes flatus.
➝ Constipation. Passes stools in 4-5 days. Also pain in the anal region. Because of this complaint, she refuses to walk.
➝ Reoccurrence of lump in the right breast in the upper, inner quadrant. It was non-painful, mobile lump.
She was advised not to take treatment in any form for the lump.
21/11/2015
➝ LMP: 17/11/2015
➝ The eruption over the left foot has increased since 2-3 days. Watery discharge.
➝ Pain in left iliac fossa, only in squatting position and during exercise.
➝ Mouth ulcers occasionally, especially before menses.
➝ Constipation is better, passes stools every alternate day.
➝ Since the start of winters, there is pain in my legs and also burning sensation in my right leg.
➝ While walking, I cannot touch my heels to the ground.
➝ The lump in the breast is still the same. There is no pain.
Gradually she could now climb up the stairs, but descending the stairs was still not possible. Intermittently, she experienced imbalance in her gait. Her menses were regular now, with a rare skip in the cycle.
In the year 2016, she visited us in the month of October-
14/10/2016:
➝ She was much better now.
➝ The size of the lump in the right breast is still the same.
➝ LMP: 9/10/2016
➝ Swelling over feet has disappeared.
➝ There is a corn over the left heel which is painful on pressure.
➝ This time there was much improvement in her gait and could walk without support. On asking, she said she could also jump and also did so. She could bend forward and now sit on the floor and also get up.
The patient is better since then. She can walk better now without any support, with a slight imbalance.
The menses are regular. The lump in the right breast is still the same.
The recent follow up is as follows:
18/05/2018
➝ LMP: 22/04/2018
➝ Now walking on her own. One incidence where she had a fall, no injury. But after this she is again complaining of burning in the right leg.
➝ No apthous ulcers.
➝ Lump in the right breast- no change.
The patient is still on continous treatment with us.
