icr symposium on homoeopathic prescribing december...

ICR SYMPOSIUM ON HOMOEOPATHIC PRESCRIBING DECEMBER 2018, MUMBAI

EXPLORING DR. C. M. BOGER’S PHILOSOPHY & ITS APPLICATION IN CLINICAL

PRACTICE

Dr.Sunil.D.Bhalinge/Dr.Saima Modak

OBJECTIVES-

1. Understanding impact of neurological pathology on behavior of patient( wife/mother)

and its effect on caretaker ( husband)/son and family relationships

2. Understanding the importance of causation, organ-tissue affection and characteristic

effects on mind and body in constructing totality.

3. Demonstrating the value of symptom analysis and evaluation in selecting a suitable

approach to case.

4. Exploring role and scope of homoeopathic similimum in treating after effects of

neurological pathologies.

DIRECTIVES-

1. Study the Case History, Clinical notes and SCR.

2. Give your understanding of impact of illness on patient and its effects on family

dynamics

3. Considering above -Process the case -Patient as a person and characteristic mental

state .

4. Present the CI & Construct EET.

5. Suggest totality and a suitable approach with reasons.

6. Discuss your differential MM with levels of similarity and dissimilarity.

7. Present your TPD-TPR and follow up Criteria.

8. Fill up the RREF

1. Case History –Written by Husband & clinical notes –Scanned copy

2. SCR-

PRELIMINARY INFORMATION

CASE REGISTRATION NO: V/112/ 18, DATE OF CASE TAKING: 24/4/2018

NAME: Mrs. G.S DOB:12/10/1963 AGE: 54 yrs SEX: female

EDUCATION:B.A.(Sociology) MARITAL STATUS: Married (1990)

RELIGION: Hindu- Tamilian DIET: Veg

OCCUPATION: -Zee Telefilms- Sony

SPOUSE: 63/Retired/Taj Hotels-Finance Dept;Now doing Insurance agency from Home.

SON-27/IT-Zee TV

FATHER:65/Expired/Indian airlines MOTHER:88/HW



PRACTICE

BROTHERS:-- SISTERS-(4) 67/65/64/63

ADDRESS:-----------

CHIEF COMPLAINTS

LOCATION SENSATION&

PATHOLOGY.

MODALITIES

A.F.,<,>,

ACCOMPANIMENTS.

(Strict time relation.)

2001

Head-Brain

For 1 month

Lungs D=6

months

April 2002-

Insidious onset

over a week

Since then

continuous

Right UE/LE

Could not recognize

any one

No LOC

Started with High fever

with Increased BP

Developed Miliary

Koch’s

Severe

headache,Neck

pain,diplopia,

Tendency to fall on

right side,

Loss of coordination

Gait Unsteady Ataxia

Right Cerebral

Tuberculoma

(45x32x26 mm)

Operated –Excision

Done on 17/4/2002

3 months in ICU

Speech slow & slurred

Tremors 2 /

Weakness Grade 4

Coordination loss of

Need help in daily

activities

Pain3,

A/F-Fall from bed

Rx AKT

Rx,physio



PRACTICE

ASSOCIATED COMPLAINTS:

LOCATION SENSATION& MODALITIES ACCOMPANIMENTS.

Head-Occiput 3

Circulation

Since then 3-

4/week

D= few hours

Now since 10

days aggravated

Large vomiting

3 hrs after dinner

involuntary.

nausea absent.

hunger after vomiting

BP 160/170-95 with

headache or else

120/80

(9/2017)CT-

Angiogram Brain –

NAD

All neurological

symptoms of 2001-2

aggravated since

current form

Rx-Migranil

<3midnight after

<fasting3

<2sun

<getting wet

Rx Starpress XL

100mg 0d

2Mind

Since Surgery

Mood swings.

obstinacy.

childlike behavior.

Wants care, attention

or gets irritated easily.

concentration less2

Confidence loss of 2

>2 company of

husband



PRACTICE

PATHOLOGY. A.F.,<,>, (Strict time relation.)

Lungs-Blood

2001

Miliary TB Rx Anti Kochs

May 2010-Right

Kidney

Colic

Right hand-

radius and Ulna

1992

Fracture

Cannot Lift weight

A/F fall

Plating done

Right

malleolus 2011

Fracture A/F fall

Left Knee 2010 OA

Xray\Tibial spiking

Metabolism

Since

Menopause 3 yrs

DM 2 -

Asymptomatic

Detected -FBS-160

PP-180

Normal or Max

range same as

above

Rx Janumet 50/500

1 od

Circulation

Since

menopause

BP 150/100

Headaches

/palpitations

Rx Starpress XL 1-

od

Mouth –Oral

mucosa since 1

year

F-1/month

d-2-3 days

Recurring painless

Ulcers

No aggr- heat or

cold

GIT –

retrosternal

since 5 years.

F-1/month

d-2-3 days

Bloating 2

Belching

Sour, bitter

eructations

Reflux

Sensation of Dry

mouth with

Increased salivation

Occ vomiting

< 2 loss of sleep

< 2 irregular meals

Sleeplessness

Increased app

Nose – Throat

Since 8 yrs

F-1/month

D-1 week

Block 2

Watery discharge

Pain

cough Dry or wet.

< COW 2

< cold food 2

Warm2

.

Sensation of Dry

mouth

With Increased thirst

and salivation.



PRACTICE

Sputum

green,white,thick.

expectoratio

n.

Loss of appetite

Dullness 2

Bodyache 3

PATIENT AS A PERSON

APPEARANCE : Short height, short hair

Wound Healing: n

Perspiration: Forehead 2; Axilla 2 , : Odors: Offensive 2 since menopause : Staining :Nil

Appetite: N (Increased/Decreased in acutes) Cravings : warm food 3

Stool:. Frequency: N Urging : N Satisfaction: N

Urine: Frequency: N Urging : N Control: N

Menstrual function-H/o Regular, Flow –n, Color-black or dark Red; H/o menses During – Back

ache2 /bodyache2- used to take painkillers occ

Menopause since 3 yrs –Persp; BP fluctuating; Mood swings, (DM 2- Now under control)

Leucorrhea- H/o during menarche and offensive during menopause

Sexual Function: H/o N ; Interest /Desire –Less since Illness

Sleep : Disturbed due to thoughts;anxiety -financial

DREAMS-Dirty Toilets; not able to pass stools

< 2 sun= Headaches < 2 Fasting= Headaches No food Aggravations.

Fan- Summer-Full/winter/rainy-Medium AC- in summers + Covering –Light

Bath- Cold in Summer ;Warm in Winter and rainy { C3 H2 }

FAMILY HISTORY : Father-IHD

PHYSICAL EXAMINATION:

Temp: N Pulse: 76/m RR: N BP: 181/122 Weight: 58 Kg Height:

RS: NAD CVS : S1 S2- N, No Oedema P/A: NAD

CNS- Conscious ; Speech- Slow,Dysarthric

Gait- Unsteady; Short Wide steps Imbalance on closing eyes;Walks 1 km with support

Power Left Side UE-LE-Normal Right UE/LE- Grade 4

Reflexes –DTR-K/A/S-Left-Normal Right-Sluggish

Tremors – Right side

C. LIFE – SPACE INVESTIGATION.

Mrs G was residing in Chennai till 3 std with mother, brother, sister and Gr Pa. Father

was Personal Officer in Indian airlines was posted in Delhi (transferable) . He visited them on

weekends. Family did not move with father so that schooling of children is not affected. Patient



PRACTICE

used to get many things when father returned so his absence did not affect her. Father was

calm and most nonviolent person. She described mother as smart, intelligent, mild aggressive,

decisive3, cleanliness maintaining 3, fastidious. Parents shared a good relationship She used to

adore her parents. She is attached to her mother. IPR with grandparents good.

She has 4 elder sisters. Elder one; she described as one who is thinks is smart but

actually is foolish. (there was an expression of dislike for her while talking ) she has done BA

and now house wife (waste of education). She had done love marriage. She described this BIL

as an ideal man.

Second sister is very patient. She has done BSc and now works as regional manager

in pharmacy. Relationship with this sister is good. She said 2nd sister's husband is very short

tempered, it was a shock for her to witness their fights, she feels sad for sister but does not

interfere saying its his nature.

With third sister good IPR.She is a teacher in montessori.

Fourth sister, she is attached3, one with whom she can speak her heart out. She has

done B. Com and is secretary in office. She said her house was like any other house-very nice,

no fights, understanding, lucky to have such family.

When patient was in 6std father expired, it was sudden, as a child she said had no

effect and did not know what can be the consequences. 4th sister helped her a lot, like a mother

she is to her. Patient family experienced financial crunch3, home was given on rent, relatives

stopped coming to their place, she said they are selfish people and is thankful that she

witnessed such phase to identify the people and is grateful to her elder sisters and BIL for help.

Mother played double role and gave full attention to family.

School /college was fun3, enjoyed3, selective friends, good in academic and sports,

essays. ECA3. Daring, no fears, liked to read fiction and enjoy nature. She likes work perfect,

punctuality and has self-reproaching attitude. She studied up to B.A. Sociology.

Post marriage, MIL FIL had expired. BIL stayed in Chennai . SIL in Mumbai. She has

cordial relations with them, not attached as their wavelength doesn't match. Described husband

as understanding, caring, motivator, lucky to have one

She stayed in Chennai for few years then Mumbai with son and husband as husband job got

transferred. She works as a content editor in censor department in TV. Tamil, now Zee.

Enjoys3 satisfied 3 with work-desk job3. She is workaholic, no time for family, when worked up

(maximum times) used to displace anger, frustration on family, loose temper easily at work

when done wrong, not listened to.

About illness- she earlier felt ‘why me? I cannot work. She feels she has wasted

golden years of life.Was depressed, she had lost her confidence, was unable to do any work,

needed help for day to day activities., house EMI burden on husband because of her, there was

neglect of son's health and education. Son is very attached to her, he suffering from

somnambulism, depression with suicidal attempts and hallucinations, practises meditation3

which relieves him.



PRACTICE

Since 3 years is attending 'Access Consciousness -' it has made her more calm, she

does not shout now at family as realizes they are close precious ones. She closes door and sits

down quietly for some time. It has even increased her confidence and contributed on a good

way to life. She has changed, gives time and value to family. Family has come closer, husband

more caring, he left his job and did insurance work from home so that he can take full care of

patient, son has become more responsible and caring, now she thinks only about the positive

outcomes of that phase that family came closer.

HUSBAND VERSION OF PATIENT.

Before surgery-she was calm, understanding. Now she is child like,mood swings 3,obstinate 3,

manipulates to get what she wants. I have to handle her like a child. She doesn’t forget. She will

not talk. She wants company of husband . No socialization.

He left his job to take her care but she never appreciates him. Since then he has started

Insurance work, but whenever he has an client visit, she is unhappy as wants him at home all

the time.

INVESTIGATION:

MRI- Brain- Gliosis on Opertaed Site USG Thyroid -NAD

Scanned by CamScanner

icr symposium on homoeopathic prescribing december...

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