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11/Aug/2021


 

Question: Sir, I am practicing homoeopathy in a very small village near Balaghat district (MP). I have under my care 6 patients of end stage renal disease who require dialysis frequently. Although I do administer symptomatic homoeopathic medicines, yet dialysis needs to be continued for all of them. For this the patients need to travel to the city. It’s a costly affair and very impractical for the patients. Is there a method where I may learn and do their dialysis at the village itself? Dr. Bharne (Lanji)

Answer: Yes! Nowadays dialysis can be done at the patient’s home itself. The method is called Continuous Ambulatory Peritoneal Dialysis (CAPD). It is a simple and domiciliary treatment. The patient need not go to the hospital and can continue with his/ her daily routine. There is no requirement of expensive equipment and trained medical manpower and is better tolerated by the patient especially diabetics, hypertensives and those suffering from Ischemic heart disease. There is better control of Blood pressure since there is greater removal of sodium. Also there is no blood loss, so the Hemoglobin concentration is maintained. There is a better preservation of residual renal function which plays a very important role in deciding the prescription of haemo or peritoneal dialysis. The dietary restriction of sodium and potassium is less as compared to haemodialysis. The only dreaded complication of CAPD is peritonitis. Well, you may learn the procedure from any Nephrologist and can conduct the same at your village.


 

Question: In Allens Keynotes in the chapter of Acid Phos it is written, “Interstitial inflammation of bones, scrofulous, sycotic, syphilitic, mercurial; periosteum inflamed”. Please throw light.Dr. Arif Husain (Karachi, Pakistan)

Ans: Sensation of pain in the bones as if they are scraped with a knife.


 

Question: If Vital force is a force, can’t it be measured like other forces in the cosmos? Likewise Miasm is also a force (although corrupt) hence can’t it too be objectively measured?Dr. Nirupama(Houston, Texas)

Ans: Dear Dr. Nirupama, this question is of importance to the physicists or those scientists with a materialistic bent of mind. How does it matter to a homoeopath, whether or not Vital force or Miasm can or cannot be measured by any means? We should be interested in the expressions (functional or structural) of the vital force (deranged) upon the economy and the methods of rectifying the derangement by the selection of proper similimum and subsequent follow-up.


 

Question: I have a female patient aged 2 years 6 months who has been diagnosed with Congenital Heart Disease – Pulmonary Stenosis. Sir when should I advice her for surgical intervention? John Lee (Singapore)

Ans: Although pulmonary stenosis is a Congenital Heart disorder yet all patients do not warrant immediate surgical correction. However, surgery is recommended at any age if

  • The patient is symptomatic,
  • An asymptomatic patient is detected with critical stenosis and heart failure on 2D echo/ Cardiac Catheterization,
  • If the patient has cyanosis,
  • On investigations if the right ventricular systolic pressure is greater than the systemic pressure,
  • If the pulmonary artery gradient is more than 75/mm if Hg

If any one or more of these parameters are present in your case then you may recommend surgery in your patient.


 

Question: What is the difference in Blood Pressures of the arm and leg? Dr. Nishant Pandya (Rajkot)

Ans: Well! since you have not mentioned the sides we consider the arm and leg of same side. There are no significant differences in systolic, diastolic or mean pressures when intra-arterial, brachial and femoral pulses are compared in normal persons. But by auscultation, the systolic pressure in the femoral artery is about 10mm higher than the brachial pressure measurements. Diastolic pressures are practically same in upper and lower extremities of the same side.


11/Aug/2021

By

Prof. Dr. KASIM CHIMTHANHAWALA

To write an ode for one’s Teacher is both a matter of privilege, pleasure and pride. Being a disciple of Late Dr. J.N.Kanjilal, the author had an opportunity to know the Master Homoeopath intimately. In every fiber of his soul, he was a Homoeopath. His genius, in countless instances, was manifested not only by the tactful approach towards his patient’s complaints but also the untiring work in the academics of this therapeutic art.

It shall be a fitting tribute to Him, if by following his life and works, we may in some way improvise our knowledge of our system and renew our commitments towards the goal of our lives, just as He did.

Birth -30th August 1908 – A Red-letter day in the history of Indian Homoeopathy. On this day, in a small hamlet of East Bengal, present Bangladesh, was born our Guru Dr. Jnananedra Nath Kanjilal. After completing his medical education at the Carmichael Medical College (MB 1936) he started his practice at a small village called Daulatpur near Khulna in 1938.

Transformation – Being a staunch Freedom fighter, he was jailed at Khulna. It was there, in the dark prison rooms that he had a tryst with homeopathy. Being an avid reader, he immediately took this newer approach to treat the sick and drowned himself in the basics of homeopathy. The severe epidemic of 1940 of Cerebral Malaria in his village changed his life forever. He found remarkable success with Homoeopathic medications in controlling the epidemic. This inculcated in Him a deep sense of commitment and respect for Homoeopathy. He proceeded to complete his D.M.S. Diploma and M.B.S. Degree from the State faculty, Homoeopathic Medicine, West Bengal.

Professional career – Being a Master’s academician, he was associated with D.N.Dey Homoeopathic Medical College and Hospital, Kolkatta. He taught various subjects like Pathology, Clinical Medicine, Materia Medica, Philosophy and Gynaecology. A firm believer in the original Hahnemannian thoughts, he often remarked “Scientific training differentiates a therapist from a quack.”. Having a roaring practice at Kolkatta his approach to the patient and prescriptions blended perfectly with the principles of the Organon.

Academic Associations – He was a Life member and a General Council member of the All India Homoeopathic Medical Association. He was also the only member of the Central Council of All India Institute of Homoeopathy simultaneously. An indefatigable crusader for unity, he was the founder of the West Bengal Homoeopathic Federation and went on to unify the two All India Associations to form The Homoeopathic Medical Association of India. The homeopathic fraternity as a token of gratitude and acknowledgment of the services he rendered, bestowed the coveted chair of the President of Honor for life.

There was no National committee appointed by the Government of India, without Him being its vital force. Some of these being the Research Committee, Homoeopathic Pharmacopoeia Committee, Planning Commission Task Force, etc. He was the Assistant International Vice President for India of the International Homoeopathic Medical League and also president of the All India Homoeopathic Editors Guild.

Till before his retirement about a year ago, he was a regular participant in the International Congresses. I can recount an instance worth mentioning which depicted his deep sense of commitment to the Hahnemannian philosophy and an unwavering zeal that set him apart from the rest. It was at the time when a discussion was taking place at the Homoeopathic Pharmacopoeia committee of the Drug Technical Advisory Board of India on the inclusion of patents in homeopathic pharmacopeia.

Without giving any second thought, when his objections were getting over-ruled he immediately placed his resignation letter. Along with him Late Dr. P Sankaran and myself were the members. It was only after a negotiated settlement that the parent drugs like Alfalfa, Cineraria Maritima, Euphrasia, etc were retained in pure forms and no mixtures were allowed.

With his characteristic fervor and single-minded efforts, he fought for the recognition of the qualified homeopaths of India for being recognized as full-fledged members of the International Homoeopathic league instead of being classified as second–rate associate members.  He was perhaps the only one to return his M.B.S. degree following criticism regarding the modalities of the awards.

Publications – His contribution to the academic and scientific field is outstanding. He has published several extremely useful papers. His hard-hitting editorials in the popular journal Hahnemannian Gleanings on a variety of subjects were an eye-opener and food for thought. He was one of the torchbearers and advisor of the Homoeopathic Heritage as well as the editor of the Journal of the Homoeopathic Medical Association of India. He even offered valuable suggestions and his own precious rare books for reprint. He was ready to sacrifice anything for a cause or a principle.

Even in his ripe old age, in fact, just for a year previous to his death, he remained very mobile and used to attend all conferences and meetings in India and abroad where his august presence was required. He was a colossus in the Homoeopathic field – a multifaceted personality, the like of which shall be very difficult to duplicate again.

I pay my humble tributes to this doyen of Homoeopathy.


11/Aug/2021

By

DR. ADIL KASIM CHIMTHANAWALA

Over the past several decades, cardiologists the world over, have tended to view coronary artery disease in terms of a “culprit lesion” hypothesis. This view allowed the materialistic school to focus on a specific lesion to develop site-specific diagnostic and therapeutic approaches.

First there was the quantification of a specific lesion using angiography, then Percutaneous transdermal coronary angioplasty (PTCA), intracoronary thrombolysis, atherectomy, stents and so on. They even transmitted this idea to their patients when reviewing their findings by using language like, “you had a blockage that we took care of.”

The impact and the persuasion is such that many patients come back and ask, “how is that lesion or blockage?” or “how do you know that it’s not come back?” and “should we take another angiogram to look at it?” They even indirectly imparted the idea that they took care of their entire problem when they treated that specific lesion.

Alternatively, when they could not find a specific lesion severe enough to account for clinical findings the tendency was to tell their patients that they only had a mild disease.

But it has become apparent even to the so-called modern school of therapeutics that if they are to make vital and lasting impacts on the outcome of this disease, then they must move beyond this type of narrow thinking. The culprit lesion notion was wishful thinking on their part that the key to this illness could be localized to a specific site in a portion of a large coronary artery. While this was important for the acute thrombotic occlusion found in the early hours of myocardial infarction, but the pathologists have become preoccupied with this finding.

How could the established and growing list of risk factor conditions for this disorder, which is all systemic such as increased LDL, hypertension, diabetes, inflammation, etc., resting on the fundamental bedrock of an active Tubercular (Psoro-sycotic or Psoro-syphilitic or Psoro-Syco-syphilitic) miasmatic state be expected to cause only a culprit lesion? or a singular pathology. Intracoronary ultrasound and even some angiography studies have identified more than one site of complex plaque or thrombus.

Multiple sites of rupture-vulnerable plaque are clearly present in those with what was previously termed only mild or minimal disease. And in those with more severe stenoses, it seems that the severe stenosis is a marker for many more rupture-vulnerable plaques at other sites.

Also, studies using radionuclide perfusion or directly measured coronary blood flow by Doppler wire have confirmed functional abnormalities at the small artery and arteriole level even when the more proximal lesions are not flow limiting.

These microvessels had generally been thought to be spared of atherosclerotic disease because of the absence of a large plaque. It is now clear that these dysfunctional microvessels fail to dilate appropriately to myocardial demands and contribute to malperfusion.

Thus, it seems reasonable to extend our thinking of this disease to one with generalized arterial involvement. Perhaps “panarterial” or even “arteriopathy” would be more useful terms to help better convey what we now know about the disease.

Furthermore, it is wise to know that the basic disorder is the “tendency to atherogenesis”, due to an activated tubercular miasmatic state, whereas arteriopathy is the pathological result of the disease. This notion conveys the message that the disease extends well beyond a localized site in a coronary artery. Indeed, early manifestations of panarterial atherogenesis are detected as endothelial dysfunction of the peripheral arteries of young individuals with risk factor conditions.

 

It is also likely that rupture-vulnerable plaque is present in other arteries but only becomes clinically apparent when rupture occurs in the coronary or cerebral arteries or the aorta. It has long been recognized that there is a heightened frequency of stroke associated with acute coronary syndromes.

 

The latter was believed due to cerebral embolization of ventricular mural thrombus. But it is likely that some of these strokes relate to embolization from complex lesions in the aorta, carotid, and vertebral systems. Further, the homeopathic remedies that help to decrease the adverse outcomes of this disease (including lifestyle modification) have their actions on at the luminal surface of all arteries (endothelium) through the vital force. Herein lies the most positive potential benefit from a shift in thinking toward a more systemic disease. If we were to make a concentrated attempt to think of this disease as a panarteriopathy rather than a culprit lesion, perhaps we could better influence patients and practitioners to heed advice relating to the need for constitutional treatments i.e to cure the tendency of atherogenesis.

 

As Late Dr. J.N.Kanjilal pens “theory, practice and experience are closely interlinked and mutually complementary. A theory, if it has to be substantial, must originate from practice, by the process of induction. A substantial theory usually evolves from the generalization of a particular fact observed in all cases of a particular branch of practice when it assumes the prestige of a Law of Nature. Thus a real theory originates from and is sustained by true practice.” In this way alone we may be better able to impact the outcome of this disease in the new millennium.


11/Aug/2021

By

DR. ADIL KASIM CHIMTHANAWALA

Sumbulus moschatus or Ferula Sumbul (Musk-root) is a well-known but until recently, a partially proved remedy, used since antiquity in cardiological disorders, especially for remodeling atherosclerotic arteries. The root has long been used in India medicinally and as incense in religious ceremonies.

The results of the proving of Sumbul can be found in Allen’s Encyclopedia of Pure Materia Medica and Hering’s Guiding Symptoms. Apart from these works, there is little in our literature about this drug. Like every homeopathic remedy, Sumbul is useful when indicated. It shall fail to act if it does not cover the totality of the symptoms. It is not called for in every heart lesion. But when it is the indicated remedy nothing can excel it inefficiency.  It is very close to Medhorinum, Moschus, and Asafoetida in its provings.

In the proving of this drug at our clinics, we too (as the previous provers) observed the following symptoms as regards the cardiovascular system. Cardiophobia; Nervous palpitation in hysterical subjects; Early features of Rheumatic carditis as tightness or oppression in the chest which was one of the chief symptoms. The sensation of heaviness under the sternum. A stretched feeling across the left anterior precordium < on inspiration < on stooping < thinking about it. Sick feeling near the left breast and all over. Hot flushes from back left arm numb, heavy with shooting pain in fingers (Ulnar side); On examination – Pulse: soft, irregular, missed beats, compressible; want of elasticity in vessels. Apex impulse strong, forceful after exertion or postmeal. Apex beat- at times irregular, rapid, then slow. Soft systolic murmur at the apex (Grade I/VI).Investigations -Ventricular Premature Contractions on ECG especially in Leads V1-V4.

Until recently, atherosclerosis was thought of as a degenerative, slowly progressive disease, predominantly affecting the elderly and causing symptoms through its mechanical effects on blood flow, particularly in the small caliber arteries supplying the myocardium and brain. Thus, the approach to treatment has traditionally been surgical. However, recent research into the cellular and molecular events underlying the development and progression of atherosclerosis, prompted by careful descriptive studies of the underlying pathology, has shown that atherosclerosis is a dynamic, inflammatory process that is eminently modifiable by medicines.

Time and again, homeopaths are questioned about the modes of action of our remedies on the cellular plane. The department of Homoeopathic Cardiology of The National Academy of Homoeopathy, India, after proving the above-mentioned drug, has proposed the hypothesis of action of Sumbul in atherosclerotic plaque remodeling at the cellular level.

The modulation of various biological mechanisms involved in atherosclerosis and the action of Sumbul thereof, has been summarized as follows –

      1. 1. Endothelial function – Endothelium is the cuboidal cell lining,forming the inner coat of blood vessels. Within the coat itself, there exist specialized cells. They release vital hormones in the bloodstream which not only modulate the vascular tone but also are involved in inflammatory reactions and the entire process of atherosclerosis. It’s well established that Endothelial Dysfunction is the first step of the chain of atherosclerosis and vascular disease. Central to the dysfunction is the deregulation of endothelial-derived Nitric Oxide. This chemical plays a major role in vessel dilatation, reaction of the sub-endothelium with blood monocytes and proliferation of smooth muscle cells in the subendothelial layer. Sumbul increases the bioavailability of nitric oxide, thereby preventing the pile-up of cholesterol and other debris at the site of endothelial tears. The reversal of this endothelial dysfunction in persons of Tubercular miasmatic state who are prone to tendency of atherogenesis can be one vital biological mechanism for the action of  the drug at the molecular level.
      2. 2. Inflammation – The role of inflammation and immunity in the pathogenesis of atherosclerosis has increasingly been recognized. The secretion of inflammatory cytokines by macrophages and T lymphocytes modify the endothelial function, cause smooth muscle proliferation, collagen degradation and promote thrombosis. Inflammatory processes are early signs of atherosclerosis and stability of the atherosclerotic plaque. A number of clinical studies have shown a clear correlation between reduction in inflammation as measured by inflammatory markers as CRP and a positive clinical outcome. Sumbul is believed to inhibit this process of local inflammation.

        3. Plaque stability – The atheroma is a disease ultimate or the end result of a disease process i.e atherogenesis. It begins as a subendothelial accumulation of lipid-laden, monocyte-derived foam cells and associated Tcells which form a non-stenotic fatty streak. With progression, the lesions take the form of an acellular core of cholesterol esters bounded by an endothelialised fibrous cap containing vascular smooth muscle cells and inflammatory cells, predominantly macrophages which tend to accumulate at the shoulder regions of the plaque. Also present in advanced lesions are new blood vessels and deposits of calcium hydroxyapatite. Thus atherosclerotic plaques are complex and it is the dynamic interaction between the different components of the plaque that dictates the outcome of the disease. Rupture of an atherosclerotic plaque leads to the acute coronary syndrome. Sumbul helps in stabilizing this plaque. It probably acts by modifying the lipid contents of the plaque thereby preventing plaque rupture and further episodes of ischemia.

        4. Smooth Muscle Cell Proliferation – This is important in the development of plaques in post-angioplasty restenosis and venous graft occlusion. Our studies at the Academy suggest that by controlling smooth muscle proliferation, Sumbul may modulate the cellularity of the arterial wall in the proliferative psoro-sycotic atherosclerotic lesions.

        5. Vasculogenesis – Sumbul also promotes neovascularization or vasculogenesis and thus contributes in reducing the recurrency of coronary vascular events.

       

      CONCLUSION : From recent evidence we can effectively conclude that Sumbul has a pleiotropic effect that may largely account for the clinical benefits observed. It has been shown to stabilize unstable plaques, improve vascular relaxation and promote neovascularization at the cellular level. The clinical relevance of these effects is now a reality.

      REFERENCES

      Allen T.F: A Primer of Materia Medica for Practitioners of Homoeopathy.

      Boericke W: Pocket Manual of Homoeopathic Materia Medica, 9th Edition.

      Chimthanawala K: Is Doctrine of Miasma myth?

      Clark J H: A Dictionary of Practical Materia Medica

      Deedwania P.C: Endothelium: a new target for cardiovascular therapeutics:                                                         J.Am Coll Cardiol, 2000; 35:67-70.

      Gibbons GH, Dzau VJ: The emerging concept of vascular remodeling.                                                                 N.Eng J Med, 1994; 330 (20): 1431-1438

      Hering’s Guiding Symptoms

      Kanjilal JN: Writings on Homoeopathy; Vol 2. 238-254.

      Sarkar B.K : Commentry on Organon


11/Aug/2021

 By Dr. Aadil Chimthanawala 

Time passes, summer comes and goes. But there are few moments that also teach us something, provided we are susceptible to learning. Such an educative experience happened with us in this summer of 2009. It was in the form of 2 neonates born on the same day and practically at the same time of different parentage who had battled for life just after birth. One was victorious but the other sadly lost. In the process of management of these two cases, several lessons were learnt that would go a long way in deciding numerous aspects of homoeopathic management in new born children. It is these lessons that I wish to share with the homoeopathic fraternity.

CASE I]   MAGNESIA CARB for HYPER- AMMONEMIA in a NEWBORN

Ravi – a 7 days old male child, was referred to us with complaints of –

1. Vomiting, recurrent abdominal colic and loose motions – since 4 days

2. Convulsion – 3 days ago.

Ravi is the first male child (after 2 female siblings) of a non-consanguinous marriage. He was delivered vaginally at a local village (Bhandara) nursing home at 39 weeks gestational age (22/4/19). At delivery, he had good APGAR score of 9 at 1 minute with a good cry. He was seen by a pediatrician and discharged the 2nd day. He was feeding well on breast milk since birth for 2 days when on every feed he started having non projectile vomiting of curdled milk, abdominal colic followed by loose motions that were sour, offensive frothy and with fatty masses. He was hospitalized and started on cow’s milk with parental fluids and an antibiotic. Serum Calcium / Glucose levels were within normal limits. 1 day after admission symptoms continued. In addition, he had a single generalized seizure with heavy breathing. Hence he was referred to a tertiary center at Nagpur.

On admission, he was afebrile with weight-2.86Kg, length-42cm & head circumference-31cm. He had spontaneous movements and a good sucking reflex. He had good eye opening but startled on slightest touch. There were no abnormalities noted in the head or neck and he had no respiratory distress. He had regular heart rhythm with dual heart sounds and no murmur. His pulses were easily palpable. He had no pallor, icterus or cyanosis. His abdomen was soft, non distended. Liver was enlarged 3.5 cm but non tender. No other organomegaly was present. On neurological examination there was good movement of all the limbs and sensory examination revealed him to withdraw the soles normally. He underwent a chest x-ray that was normal and an abdominal sonography that was essentially normal with mild hepatomegaly.

His blood counts, RBC indices, haemoglobin, stool & urine examination ruled out septicemia or enterocolitis. Blood gas pH was 7.33 and PCO2 of 41. All his serum electrolytes & creatinine were within normal limits. Blood urea was 9.8mg /dl, Serum Ammonia was 490mg/dl (Normal 50-150mg/dl) and Total Bilirubin was 4.2mg/dl.

F/H – Ravi has 3 maternal aunts. The male children of all the three died within 1-3 weeks of their respective births. Maternal grandmother died – Astrocytoma.

 

Following symptoms were considered

1. Vomiting, curdled milk,

2. Abdominal colic

3. Stools – loose, sour, offensive frothy, fatty masses with

4. Startled < slightest touch

5. Liver enlarged

On repertorisation the set of medicines that came out were – Arsenic alb, Mag carb, Verat alb, Aethusa

27/4/19 Blood sent for R/o Urea Cycle Enz         NBM + Dextrose 5% @ 80mg/kg/d

             deficiency or amino acid dysfunc              Mag carb 30 3 hourly

28/4   Vitals stable. No Vomit /colic                       Mag carb 30 TDS                   

29/4   Started oral feed- glucose water                Mag carb 30 BD. Omit IV Fluids

30/4   Started breast feed. No vomit/LM              SL. No IV Fluids

          S.Ammonia 78 mg/dl

1/5     Patient >>                                                   No meds

2/5     S. Ammonia 61mg /dl          

3/5     On discharge, Ravi was stable on room air throughout his stay. He had remained stable from a cardiovascular standpoint –never evidencing a murmur on exam. He has been breast feeding well every 3 hours with no emesis, loose motions or convulsion. He had no evidence of any infectious disease.  His mother’s blood group is ORh+ and Ravi’s blood group is A+ and thus they are potential set for ABO incompatibility. Bilirubins were monitored for 1 week but they were within normal limits.  Pink, active baby with weight 2.5 Kg, Temp 36.7, HR 144/min, RR 36/min, BP 78/41 mmHg.. Liver-palpable 2.4 cms. Neuro– alert, responsive and patellar reflex present bilaterally. The results of the work-up done to rule out enzyme deficiency were normal.

Final Diagnosis – Transient Hyper-ammonemia of Newborn.

CASE II] ACONITE FEROX for SEVERE PULMONARY HYPERTENSION in a NEW BORN

I was called to visit 9 days old Saurabh at a Neonatal ICU of Nagpur. The baby was on Ventilator and was diagnosed as severe pulmonary hypertension. He was the 1st child of a non-consanguinous marriage and was delivered vaginally at 36 weeks gestational age (22/4/19). At delivery he cried immediately but aspirated the meconium. He went into severe apnea with bradycardia. He was resuscitated with Ambu bag. Although the respiration became spontaneous in 1 minute but the distress continued. He was put on ventilator with an FIO2 requirement of 60%, respiratory rate at 50/minute. X-Ray Chest showed bilateral generalized haziness. 2D ECHO- severe pulmonary hypertension (PASP =55mmHg) + Good Left ventricular Function (EF=60%) + small PDA with non restrictive bi-directional shunt. No Pulmonary Artery / Aortic stenosis or regurgitation. Right Atrium /Ventricle dilated. Inter-atrial septum had a patent foramen ovale with right to left shunt.

Serum Calcium/Glucose levels were normal. Blood gases–acidosis, Liver & kidney functions were within normal limits. USG abdomen was also normal. His blood counts, RBC indices, hemoglobin, stool & urine examination ruled out septicemia. He was on antibiotics, slidenafil citrate and parental feeds. 8 days after admission there was no relief except a little resolution of the pneumonia. Hence the pediatrician asked for homoeopathic help.

When I examined the baby, he was afebrile with a weight of 2.2 Kg, length of 40 cm and a head circumference of 29 cm. He was on ventilator, looked pale and there were no spontaneous movements. The skin was an-icteric and acyanotic. His abdomen was soft, non distended with no organomegaly. FIO2 was 100%, PCO2 55, respiratory rate was set on the ventilator to 72/min.

  • In this artificial setting, following symptoms were considered
  • Asphyxia neonatorum
  • Breathing difficult, pulmonary edema in
  • Breathing difficult, heart problems with
  • Breathing difficult, lung cannot expand
  • Breathing difficult, mucus, in trachea (lungs) from
  • Rattling chest
  • Following medicines came out prominently – Antim tart, Carbo Veg, Laurocerasus, Aconite Ferox

1/5/19                                                         Antim Tart 0/1 inhalation 1 hourly

11 am

 

1/5 9pm  Vitals stable. FIO2 92%, R/R 60 Antim Tart 0/2 TDS inhalation                           

2/5       Vitals as above. X-chest – Haziness          Antim T 0/2 BD. Omit Sildenafil

             less. IVF contd.

3/5       Feeding via  Nasogastric Tube+                Antim T 0/2 BD ct.

              FIO2 80%, R/R 50/min

4/5       Pt. same. Vent parameters same              Antim T 0/3 3h                                

5/5       No change in status. R/R 74/min              Aconite F 0/1 x 1h inh  

6/5       FIO2 46%, R/R 40/min                              Aconite F 0/2 x TDS

7/5       Pt. Set for weaning from Ventilator            Aconite F 0/2 TDS               

8/5       Spontaneous breathing achieved              Aconite F 0/2 BD

            Pt was weaned well.                       

9/5       Sudden cardio- respiratory arrest   CPR given but failed.

LESSONS LEARNT –

1. As physicians our first duty is to save the life of the patient. As homoeopaths, we should dare to accept such challenges of tackling medical emergencies.

 

2. Hyperammonaemia is a metabolic disturbance characterised by an excess of ammonia in the blood. It may lead to encephalopathy and death. It may be primary or secondary. Ammonia is a substance that contains nitrogen. It is a product of protein catabolism. It is converted to the less toxic substance urea prior to excretion in urine by the kidneys. The metabolic pathways that synthesise urea are located first in the mitochondria and then into the cytosol. The process is known as the urea cycle, which comprises several enzymes acting in sequence. Primary hyperammonemia is caused by inborn errors of metabolism that are characterised by reduced activity of any of the enzymes in the urea cycle like ornithine transcarbamylase, glutamate dehydrogenase 1, ornithine translocase  and N-acetylglutamate synthetase.

 

3. Secondary hyperammonemia is caused by inborn errors of intermediary metabolism characterised by reduced activity in enzymes that are not part of the urea cycle (e.g .Propionic acidemia, Methylmalonic acidemia) or dysfunction of cells that make major contributions to metabolism (eg hepatic failure).

 

4. Miasmatically, this transient but violent episode in Ravi, luckily was a psoric disorder hence responded well to a few doses of Mag carb only. The baby was able to feed on its mother’s milk hardly within a week.  It has been found that single Enzyme deficiency states are sycotic and are incurable. The treatment centers on limiting intake of ammonia and increasing its excretion. Dietary protein (a source of ammonium) is restricted and caloric intake is provided by glucose and fat. The laboratory studies indicated in ruling out these sycotic states are – Plasma ammonia, Liver function test (S.transaminases, prothrombin time/activated partial thromboplastin time, alkaline phosphatase levels, S. bilirubin), Plasma amino acid level quantitation, Urinary organic acid profile, Urine amino acid levels, Blood lactate, Blood gas (alkalosis) and BUN. In our case, the cause for hyper ammonemia is unidentifiable.

 

5. In the second case, although Saurabh was weaned from the ventilator albeit for 32 hours yet the baby died due to cardio-respiratory arrest. Antim Tart was selected and it gave enterprising results for the 1st 4 days. Then the response stagnated even though the potency was increased, rather the respiratory rate and FIO2 increased. It was Aconite Ferox that gave us the chance for weaning the patient off the ventilator. The decision was clinical. Saurabh was a preterm baby with meconium aspiration and the prognosis was already explained to his relatives.

 

6. In our experience, when we compare Aconite Ferox versus Carbo veg & Laurocerasus, we have found that the indications for the 3 remedies are very similar except that Carbo Veg & Laurocerasus predominantly have cyanosis with respiratory paralysis where as it is absent in Aconite F. Hence it was chosen.

 

7. When homoeopaths have to work in such set-ups of modern medicine (ICCU / NICU), the drug selection becomes dicey since time is less, the settings are artificial, there are hardly any natural symptoms to prescribe upon, the patient is already on a good number of allopathic medications, the homoeopathic help is resorted at a stage when the pathology is far advanced and the allopathic medications have failed to act. But for saving the life of the patient, one needs to join hands. Even if the homoeopathic remedy selected is a partial or a pathological similimum (as in our case), the situation demands us of extending a helping hand. God knows! Miracles do happen. 

 

24/Jun/2021

 By Dr. Aadil Chimthanawala 

When the question of Post-graduation in Homoeopathy arises, I am tempted to pen down my thoughts. How the fraternity accepts the same is a question with an open–ended answer. Seeing the present scenario of homeopathic academics, especially in India, it is obvious that post-graduation has taken a front seat and is gearing up to meet coming challenges. I sincerely believe that as time passes by and a greater polishing on this front is achieved, then the future of our pathy is quite bright.


THESIS & SUBJECT SELECTION –  

What is the purpose of writing a Thesis? What is the end product that we wish to see after the latter is completed? Some say that writing a thesis is only a custom that all PGs must accomplish. And how wrong they are! Writing a dissertation instills the confidence that is really required for the precept and practice of the subject but only if it is pursued faithfully. It is a concert of different notes – the aim, methods & materials required to fulfill that aim, review of available literature, observations, discussion of those observations in the light of the literature reviewed, and finally the conclusions as to whether or not the aim is fulfilled. It gives the student a viable opportunity to explore and objectivate those arenas in homeopathy that are yet unfathomed. Future homeopaths could take up the study of such subjects where very little work has been done like scope of homeopathy in Medical Emergencies, Addictions, Surgery, Veterinary Medicine, Botany, posology & newer potencies etc.

The National Academy of Homoeopathy, India has undertaken some projects of Clinical and Literary Research. The Academy firmly believes that the authenticity of any Research in Homoeopathy is established if it passes through the sieve of Organon. Any venture other than this should not be considered as Homoeopathy. Now we shall dwell upon some areas in which Newer approaches are required. They are –

 1. Case Taking – Much of the scenario of cases presenting at the Homoeopathic OPD / IPD has undergone a sea-change compared to those in Hahnemann’s time. A large number of mixed cases (70%) (Combination of natural, altered, suppressed & drug-induced symptoms, secondary symptoms due to ultimates, those due to environmental influences, etc.) present to a homeopathic practitioner. Hence different methods of case taking have to be evolved for different types of cases. It was this reason which prompted the Academy to adopt the approach of case types.

2.  Diagnosis – In today’s era, the knowledge of Medicine is equally important as that of drugs. One has to make both the nosological as well as the person diagnosis. Clinical Examination, pathological cum radiological investigations have become essential for diagnosing cases. Postgraduate research into this area should make Homoeopaths abreast with modern diagnostic technologies & their clinical application in therapeutics.

3. Drug Selection- As mentioned, the varied cases presenting to the homeopath now demand him to use even rare remedies apart from the usual ones. Some form of specialization must be introduced in the curricula so that the homeopath has a defined set of patients to work upon. He will then be able to use “the lesser-used remedies” often and add clinical symptoms to the Materia medica. The Academy has undertaken such works in the field of Cardiology, Gynecology, and Allergic disorders.


CLINICAL TRAINING -Apart from PG subjects that are already introduced in the Universities throughout India, certain others need early induction. These are –

1. Gynecology – When one studies homeopathic therapeutics, one is surprised to find that homeopathy has many solutions to gynecological & obstetric problems. It is that area of medicine that is in demand even in the smallest of villages. Systematic and rigorous training in homeopathic gynecology and skills in managing obstetric patients should be imparted at the postgraduate level. Only then would one see the miracles of Caulophyllum in the induction of labor or the effects of Gelsemium in cervical dilatation.

2. Pathology & Microbiology – These are purely investigatory areas of medicine. A homeopath has as much a right to practice Pathology as our colleagues of the orthodox school. If a degree course is instituted, a battalion of homeopaths would be quite eager to pursue it.

3. Radio-diagnosis – Same holds true for Radio-diagnosis. The orthodox field of medicine has advanced leaps and bounds- courtesy of Radiology. It is one area that has bridged the gap between physics and medicine, between the empirical and the factual. Homoeopaths skilled in radiology would be able to authenticate the results of our dynamic remedies at the structural level and we would not be dependent on the experts of the modern school.  

4. Genetics – It is still in its infancy. The scope of homeopathy is these disorders as of today is limited. But if a greater thrust is given at the post-graduate level one may open up Pandora’s Box in this field.

5. Preventive & Social Medicine – Homoeopathy is not only a clinical medicine. Its expanse encompasses Preventive and Social Medicine too. Rather much better than other prevailing systems of our day. Only if there is a separate specialization in this field, the homeopathic fraternity in particular and the masses in general would realize the vast benefits. Vaccination schedules, recurring viral/bacterial epidemics, etc. have yet not fully seen the permeation of homeopathy.   


 

GROUP DISCUSSION – Group Discussion is a process where the participant’s skills like communication, presentation, vocabulary, and leadership are brought to the forefront. For a post-graduate of any modern discipline, GD becomes a simulated exercise where the participant cannot suddenly put up a show. It’s his /her chance to be more vocal. There are two ways of conducting GD. By forming a group of 10-12 candidates and giving a topic for discussion or by dividing the group into two and the topic would be debated. It develops reasoning ability and is one of the most effective methods for Case Discussion. Alas! it is lacking in most of our PG institutes.

 

DRUG PROVING – It should be made mandatory that each individual who becomes a post-graduate has at least proved one drug with factual data and on the terms put forward by our Master. In this way, many old drugs can be reproved and many new ones discovered. This shall not only increase the repertoire of drugs but also the confidence in the dynamic action of home

EVIDENCE-BASED HOMOEOPATHY– The concept of evidence-based medicine has been evolving over the past 35 years. Evidence-based homeopathy is the integration of best research evidence with clinical expertise and patient values. One may ask, then to what is the best evidence? The answer is that evidence that is

1. Increasingly available in the literature

2. Focuses on outcomes that matter to the patient

3. Helps the patient to make decisions whether or not to take homeopathy

4. Gives real value to statistics making sense to the homeopath and patient.

Furthermore the ability to use our clinical skills & past experience to rapidly identify each patient’s unique health state, individual risks and benefits of potential interventions, & their personal values and expectations is called clinical expertise. Patient values on the other hand are defined as the unique preferences, concerns, and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient. There are many Misconceptions that homeopaths hold about Evidence-Based homeopathy like “what I learned in a medical college is enough”, “an expert opinion is the best evidence”, “I always did it this way”, etc. So then the need for EBH is as follows –

  •  The daily need for valid information
  • Inadequacy of traditional sources of information
  • Disparity between our diagnostic skills and clinical judgment vs. up-to-date    knowledge and clinical performance
  • Up to 40% of clinical decisions are not supported by evidence from research
  • Increasing volume of published evidence
  • Wide variations in clinical practice
  • Concerns about cost and quality
  • Gap between research and practice

JOURNAL READING – The medical faculty in the 21st century is overburdened with information. Simple statistic would open our eyes. It is estimated that about 20,000 biomedical periodicals, 6,000,000 articles, and 17,000 biomedical books are published annually. There are around 30,000 recognized diseases and about 3,000 or more therapeutic agents. To add to this mountain of information, database internet engines like “Medline”, “Cochrane”, and “Best Evidence” survey about 4,000 journals, 11,000,000 citations, about 1.27 million articles related to a single subject as oncology per year. So the bottom line for a Post-graduate in homeopathy is “We need to learn not only how to read the medical literature, but what to read and when”. Postgraduates should select journals that provide structured abstracts with balanced commentary. The articles should be selected from high-quality publications. Such journals can be the best resource to start with when investigating rare clinical conditions or drugs.

POSTGRADUATE GUIDES – The aim of any Postgraduate Teacher is to stimulate the teacher within his student.  A Guide should stimulate the student enough to observe and think. This, I believe is yet not the order of the day. Very few Guides really do guide. But as post-graduation grows so will this concept.

METAMORPHOSIS IN A HOMOEOPATH – The final goal of any post-graduate program especially in homeopathy should be to initiate a metamorphosis in a homeopath. The transformation should be from an ugly duckling to a graceful swan. After three years of a struggling voyage, it should bring about a greater conviction in the art and science of homeopathy in the participants

 
 

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