Homoepathic Didi

Some aspects of “ Rheumatoid Arthritis ” with homoepathic mode of treatment

2009-11-09T21:17:00.000-08:00

Rheumatoid arthritis (RA) is a chronic symmetrical polyarthritis affecting mainly the peripheral small joints associated with some constitutional symptoms.

Age- Though it is seen in some children, it has increasing prevalence with increasing age up to the seventh decade and most often it starts between the ages of 30 & 40 years.

Sex-It is two or three times more common in women than men. In young adults with RA, females have a worse prognosis than males.

Cause-The cause of the disease remains unknown. An infectious agent, perhaps viral, is suspected to be the initiating factor. The process by which an infectious agent might cause chronic inflammatory arthritis with a characteristic distribution also remains unknown. Many immunological disturbances are noted in RA & it is considered to be an autoimmune disease.
Risk factors-
(1) There is an increased incidence in those with a family history of the disease.
(2) A genetic predisposition may also be a factor. An association with HLA-DR4 has been noted in many populations, but not all. In some populations, HLA-DR1 is found in the majority of HLA-DR4 negative patients particularly in Indians & Israelis.
(3) Environmental factors are also supposed to play a role in the etiology of the disease.

(4) Smoking may also act as a risk factor for RA in persons expressing the susceptibility allele.

Pathology- Rheumatoid Arthritis is a disease of the synovium which passes through an inflammatory process followed by proliferation. The chronic inflammatory reaction causes infiltration of the synovium with lymphocytes, plasma cells & macrophages. The synovium then undergoes proliferation with growth over the surface of the cartilage.

Onset- Usually gradual, sometimes acute, especially in the elderly when it is sometimes called ‘explosive RA’.

Clinical features-

(1) Joint pain-The pain is worst on waking in the morning which may improve with activity. Pain at night may cause a disturbed sleep.
(2) Morning stiffness-It often lasts for several hours & with progress of the disease becomes very prominent.
(3) Swelling – Gradually swelling of the small joints of fingers & toes, commonly the former is seen due to soft tissue swelling caused by effusion or synovial proliferation. The swelling starts with one joint, then another joint is involved and ultimately systemic swelling of joints is seen. Bigger joints like wrist, elbow & ankle are usually seen to be involved but shoulder, hip & spinal joints are rarely involved.
(4) Warmth-The joints are hot to feel.
(5) Tenderness- The joints are tender on pressure or movement.
(6) Formation of nodules- Presence of subcutaneous nodules is found almost invariably in individuals with circulating rheumatoid factor. They vary in size and consistency and are rarely symptomatic. Though they can develop anywhere, they are mostly found on periarticular structures, extensor surfaces & over areas subjected to mechanical pressure. Common sites of development are olecranon bursa, proximal ulna, Achilles tendon, and the occiput.
(7) Limitation of movement- Movement is restricted with muscle wasting around the affected joints.
(8) Deformities- Deformities may occur in the advanced stage of the disease.

Investigations- No tests are specific for diagnosing RA.

(1) Rheumatoid factors- Rheumatoid factors which are autoantibodies may be found in more than two-thirds of adults with the disease. But as rheumatoid factor is also found in a small percentage of normal population, its presence is not specific for RA.
(2) Routine Blood Tests- Anaemia is a routine finding in almost all cases of rheumatoid arthritis & is usually normochromic, normocytic in nature. It is proportional to the activity of the inflammatory process. There is thrombocytosis which correlates with the disease activity. The white blood cell count is usually normal, but a mild leukocytosis may be present. The erythrocyte sedimentation rate (ESR) and C-reactive protein level are elevated and usually both the elevations correlate with disease activity and the likelihood of progressive joint damage. Serum alkaline phosphatase may also be raised in some cases of active rheumatoid arthritis.

(3) X-ray- Early in the disease, radiographic evaluations of the affected joints are usually not helpful in establishing a diagnosis. Juxtaarticular osteopenia is the first radiographic finding to be seen. Loss of joint space indicating thinning of the cartilage may be there after the disease process has reached a certain level. The characteristic lesion is that of an erosion that appears as a mouse-bite on the surface of the affected bone. The primary value of radiography is to determine the extent of cartilage destruction and bone erosion produced by the disease as well as the response of the disease to the treatment.

Differential diagnosis-Rheumatoid arthritis is to be differentiated from osteoarthritis, psoriatic arthritis, ankylosing spondylitis, septic arthritis, sarcoidosis, systemic lupus erythematosus (SLE) etc

Complications-
(1) Vascular System-Rheumatoid vasculitis may be seen in patients with severe RA and high titers of circulating rheumatoid factor, usually in limited forms & especially in the whites. Widespread vasculitis is usually very rare.
(2) Respiratory System- RA especially in men may sometimes cause pleural disease, interstitial fibrosis, pleuropulmonary nodules, pneumonitis etc.
(3) Nervous System- RA usually has no direct action on the central nervous system but vasculitis in turn can cause peripheral neuropathy & mononeuritis multiplex. Moreover, nerve entrapment secondary to proliferative synovitis or joint deformities may produce neuropathies of median, ulnar, radial or anterior tibial nerves.
(4) Eye- Episcleritis & scleritis may be seen in some patients with long standing RA with nodules.

Treatment- Management is directed towards relief of pain, control of synovitis and prevention & / or treatment of associated involvement of other ओर्गंस.

[A] Physical therapy- Physical therapy such as heat & ultrasound is used to decrease joint stiffness & relieve pain. An exercise programme should be fixed for preserving the functional abilities of the patient giving special stress to put all joints through their full arc of motion to maintain this range. Special importance should be given on aerobic exercise.
Relaxation techniques should be practised.

[B] Occupational therapy- Occupational therapy, after proper evaluation of the patient, aims in engaging the patient in modified techniques for performing activities of daily living.

[C] Homeopathic therapy- As no medicine is ideal, it is important to assess the patient’s response so that the most effective regimen is adopted. After proper evaluation, the suitable one is selected from the following homeopathic medicines-
(1) Arnica- This remedy may be used in patients of RA with chronic arthritis associated with a feeling of bruising & soreness, the pain being increased on movement.
(2) Bryonia- This remedy may be used in patients of RA for stiffness & inflammation with tearing or throbbing pain, the pain being increased on movement.
(3) Ledum palustre- This remedy may be used in patients of RA with initial involvement of lower joints which then gradually extends to upper ones
(4) Pulsatilla- This remedy may be used in patients of RA with flare-ups from one place to another.
(5) Calcarea carbonica (Calc.carb)- This remedy may be used in patients of RA with involvement mainly of the knees & hands, especially where nodes have already developed around the joints.
(6) Causticum- This remedy may be used in patients of RA with involvement mainly of the hands & fingers, especially with muscle weakness & contractures.
(7) Calcarea fluorica- This remedy may be used in patients of RA with swollen & hard joints, especially where nodes or deformities have already developed.
(8) Rhus toxicodendron (Rhus.tox)- Rhus.tox may be advised for patients of RA with pain & stiffness which is worse in the morning & improves with continued movement.
(9) Ruta graveolens (Ruta)- Ruta may be advised for patients of RA with deep affection or damage of tendons & capsules of the joints.
The medicine of choice & the potency & frequency of dosage as well as duration of treatment varies with the demand of the symptoms along with severity of the condition & the type of the individual। Lower potency is to be used at the beginning। A single dose is to be used first। If there is response, no second dose should be taken until there is cessation of further improvement। But if there is no response after the first dose a second dose should be taken after a gap of 2 or 3 days. If desired effect is still not noticed, it is better to switch over to a new medicine. Sometimes multiple dosages of the medicine of choice are to be used a day, the frequency is then gradually reduced according to the improvement of the condition, but have to be continued a few days even after the desired effect.

Besides the above mentioned medicines, Ferrum Metallicum may be used to combat the anemia that occurs in रा

.
Prevention-
(1) Intake of a low-protein, high carbohydrate diet with minimization of foods of animal origin.
(2) Elimination of milk & milk products from diet.
(3) Avoidance of polyunsaturated vegetable oils.
(4) Increased intake of omega-3 fatty acids.
(5) Reduction in intake of coffee & tobacco.

Prognosis- Despite full treatment & all the precautions to be taken, a few percentages of patients become severely disabled. The more the number of joints is involved, the poorer the prognosis is. Women & whites have a relatively poorer prognosis. Smoking has a detrimental effect on the course of the disease. Life expectancy may be decreased in some individuals due to associated heart disease, infection etc.

In short, Rheumatoid Arthritis is manifested by pain, stiffness & swelling of the small joints of fingers & toes & is to be treated by Arnica, Bryonia, Calcarea carbonica, Calcarea Fluorica, Causticum, Rhus।tox, Ruta, Ledum, Pulsatilla etc

But in every case, a doctor should be consulted.

Some aspects of “ Pseudogout ” with homoepathic mode of treatment

2009-06-22T21:06:00.000-07:00

Also known as Calcium pyrophosphate deposition (CPPD) disease, pseudogout is an arthrpathy due to deposition of calcium pyrophosphate dihydrate (CPPD) crystals in articular cartilage & periarticular tissue & has many similarities with gout. Pseudogout has been reported to occasionally coexist with gout. This means that the two types of crystals can sometimes be found in the same joint fluid.

Sex- It occurs slightly more commonly in men.

Age- It usually occurs after the age of 60 years. But those with familial chondrocalcinosis may be affected at younger ages.

Aetiology- Aetiology of pseudogout is unknown but there is an association with primary hyperparathyroidism, haemochromatosis, ochronosis, amyloidosis, & hypothyroidism

Risk factors-
(1) Older age- Chance of developing the disease increases with age.
(2) Joint trauma- Trauma to a joint such as a serious injury or a joint replacement surgery, increases the risk of deposition CPPD crystals in the joints.
(3) Family history -Chance of developing pseudogout increases in case of a family history of the disease.

Site of lesion - Larger joints are more affected. In a majority of patients the knee joints are involved. Other areas commonly involved are elbows, wrists, ankles, shoulder & hip.

Associated medical conditions- Hyperparathyroidism, haemochromatosis, amyloidosis, hypothyroidism, hypophosphatasia & true gout.

Clinical Features- The clinical presentation is similar to that of normal gout, however, the onset is much slower, & its course is much milder. The attack begins suddenly with pain & swelling. The affected joint is warm & swollen with a large effusion. The pain may last for days to weeks & can resolve spontaneously. Pseudogout tends to be polyarticular but symmetrical involvement of joints is usually unlikely. Occasionally pyrophosphate deposition may be totally asymptomatic.

Investigations-
(1) Blood test- Serum calcium is normal. ESR may be raised during an attack.
(2) Analysis of Joint fluid- Joint fluid from an affected joint examined under a polarizing microscope if reveals the presence of calcium pyrophosphate crystals, diagnosis is confirmed.
(3) X-ray & MRI - X-ray & MRI, though cannot provide diagnostic confirmation of the disease, may be advocated to rule out other causes of pain & presence of associated medical conditions. They are also helpful to evaluate the extent of the disease & to detect possible damage to bone & surrounding structures. X –ray may also show calcifications in cartilage of joints referred to as chondrocalcinosis.

Differential Diagnosis- Pseudogout is to be differentiated from rheumatoid arthritis, osteoarthritis, gout, psoriatic arthritis, septic arthritis etc।

Treatment-

[A] General measures to be taken are-

(1) Cold compresses on painful joints.
(2) Complete rest.
(3) Exercise after the pain subsides.

[B] Homeopathic medicines to be used – Of the different homeopathic medicines commonly used, Aconite, Benzoicum acidum, Bryonia, Calcarea phos, Colchicum, Formica rufa, Rhus toxicodendron (Rhus.tox),ledum pal, etc. need to be mentioned. The use of the medicines is more or less the same as that in gout. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual along with type of gout whether it is acute or chronic. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine.

Prevention-It is not known how to prevent pseudogout. If the condition has developed because of some other medical conditions, such as haemochromatosis, treatment of that condition may prevent progression of other features of that potentially dangerous illness & may in some cases, slow the development of pseudogout.

Prognosis- Often the inflamed joints heal without any residual damage but in many people permanent damage may occur with severe destruction of some joints. Pseudogout often complicates osteoarthritis, particularly in the knees & hips.

In short, pseugout is manifested by intense joint pain & swelling involving a single or multiple joints, & is to be treated by Aconite, Benzoicum acidum, Bryonia, Calcarea phos, Colchicum, Formica rufa, Rhus.tox etc.

But in every case, a doctor should be consulted.

Some aspects of “ Gout ” with homoepathic mode of treatment

2009-06-18T23:35:00.000-07:00

Gout which may manifest as acute or chronic is an abnormality of uric acid metabolism which results in the precipitation of crystals of uric acid in the form of sodium urate on the articular cartilage of joints, on tendons & in the surrounding tissues.

Sex- Gout is predominantly a disease of men.

Age- It usually begins in middle life.

Causes-
(1) Primary or idiopathic- This type of gout has no cause. Most cases of gout belong to this type.
(2) Secondary- This type of gout has an underlying cause. In this type another disease like lymphoma, leukemia etc is the underlying cause of raised uric acid level in the body & the consequent result is the development of gout.

Risk factors-
(1) Diet- Diet comprising too much meat or fish increases the risk of gout as they are rich in purines.
(2) Life style factors-Excessive alcohol consumption increases the risk of gout.
(3) Certain medical conditions- Certain medical conditions like hypertension, diabetes, hyperlipidemia etc increase the risk of gout.
(4) Certain medications- Certain medications like thiazide diuretics used to treat hypertension increases the risk of gout by increasing the uric acid levels.
(5) Family history -Chance of developing gout increases if there is any family history of gout.
(6) Surgery, trauma, etc- Acute attacks of gout are provoked by surgery, trauma, etc.

Site of lesion - It is usually monoarticular & first metatarsophalangeal joint is the most common site of involvement. Ankle, Knee, wrist, fingers & elbow are other joints affected. Distal & lower extremity joints are involved more often.

Associated medical conditions- Gout may be associated with hypertension, obesity & atherosclerosis.

Pathophysiology- The biochemical abnormality in gout is hyperuricaemia resulting from overproduction of uric acid in the body or its under excretion via kidney. Uric acid is the end product of purine metabolism. It is the last step in the breakdown pathway of nucleoprotein & purines. Uric acid is completely filtered by the glomerulus of the kidney & then subsequent complete reabsorption by proximal tubules followed by secretion of its major portion by the distal tubules occurs, thus maintaining the normal uric acid level in the blood. In primary gout the major cause of the hyperuricaemia is increased urate production, but there is also impaired renal excretion. But it is to be mentioned that hyperuricaemia does not always cause manifestation of gout. When crystals of uric acid in the form of sodium urate precipitate on the articular cartilage of joints, on tendons & in the surrounding tissues, then only there is manifestation of gout.

Clinical Features- The signs & symptoms of gout are always acute & occur suddenly usually at night without any warning & consist of intense joint pain & swelling involving a single joint, most often in the feet, especially the big toe. The typical gouty joint is red, warm, swollen & exquisitely tender. Sometimes the inflammation is so gross that it may resemble cellulites. In later stages of the disease, there is presence of tophi in the ear lobules or around joints which provides a clue to the correct diagnosis.

Investigations-
(1) Routine blood test- Routine blood test may show leucocytosis & raised ESR.
(2) Analysis of joint fluid- Joint fluid from an affected joint examined under a polarizing microscope if reveals the presence of urate crystals, diagnosis is confirmed.
(3) Blood test for uric acid level estimation- Blood test reveals high uric acid levels. But it may be misleading as people with high uric acid levels may never experience gout whereas people with normal or slightly raised uric acid levels may have clinical features of gout.
(4) X-ray - X-ray is usually normal but it may show deposits of tophi & bone damage due to repeated inflammations. X-ray can also help in monitoring the effects of chronic gout on affected joints.

Differential Diagnosis- Gout may be confused with cellulites, rheumatoid arthritis, osteoarthritis, pseudogout, psoriatic arthritis, septic arthritis etc from which it has to be differentiated.

Complications- Of the various complications, the following are important:
(1) Tophi formation- If untreated, it may cause deposition of urate crystals under the skin forming nodules called tophi.
(2) Kidney stones- Urate crystals may collect in the urinary tract giving rise to kidney stones.

Treatment-

[A] General measures to be taken are-

(1) Cold compresses on painful joints.
(2) Complete rest.

[B] Homeopathic medicines to be used – There are a lot of homeopathic medicines which are used in the treatment of gout. Some of the commonly used medicines are Aconite, Ammonium Phosphoricum, Benzoicum acidum, Bryonia, Calcarea Fluorica, Colchicum, Cinchona Officinalis, Formica Rufa, Rhus toxicodendron (Rhus.tox) etc. Aconite is helpful especially when the joint is red, swollen & the inflammation is worse at night. Ammonium Phosphoricum is very useful for chronic gouty patients with nodes in joints. Benzoicum acidum is very useful for gouty deposits. Bryonia is particularly helpful when there is pain on pressure on any spot of the affected joint. Calcarea Fluorica is usually used in gouty enlargements of the joints of the fingers. Cinchona Officinalis is useful for cases of chronic gout. Colchicum works better in gout in heel & feet, especially when the great toe is affected & the inflamed joint is tender to touch or move. Formica Rufa is useful for cases of chronic gout & stiffness of joints. Rhus.tox is helpful for those who have hot, stiff & painful swelling of joints. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual along with type of gout whether it is acute or chronic. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine. If the acute stage is over & the disease passes to a chronic stage, the medicine should be changed according to the demand of the prevailing condition of the disease.

Prevention-
(1) Intake of diets with fewer purines. Curtail in intake of excessive proteins.
(2) Reduction in alcohol consumption.
(3) Intake of more low-fat dairy products.
(4) Intake of more complex carbohydrates।
Prognosis - Mild attacks resolve spontaneously within 2 days, more severe attacks may last for 7-10 days. Most patients with gout will experience repeated attacks of arthritis over the years.

In short, gout is manifested by intense joint pain & swelling involving a single joint, most often in the feet& is to be treated by Aconite, Ammonium Phosphoricum, Benzoicum acidum, Bryonia, Calcarea Fluorica, Colchicum, Cinchona Officinalis, Formica Rufa, Rhus.tox etc.

But in every case, a doctor should be consulted.

Some aspects of “Carpal Tunnel syndrome” with homoepathic mode of treatment

2009-06-11T07:19:00.000-07:00

Carpal Tunnel syndrome is an entrapment neuropathy of wrist. It is a disorder caused by compression at wrist of median nerve supplying hand, which causes tingling, numbness.
Sex- Women are more affected than men.

Age- Usually between 30 to 60 years.

Aetiology- Most cases are idiopathic. Trauma to wrist causing fracture or sprain, pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly or hypothyroidism all may play a role in the development of carpal Tunnel syndrome.

Risk factors-
(1) History of affection of any family member.
(2) Certain occupations.
(3) Stress.
(4) Obesity.
(5) Smoking.
(6) Oral contraceptives.
(7) Age over 40 years.

Associated medical conditions- Carpal Tunnel syndrome is sometimes associated with pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly or hypothyroidism.

Pathophysiology- Pressure on the median nerve due to a swelling or anything that makes the Carpal Tunnel smaller compresses the median nerve at wrist which in turn causes tingling, numbness, weakness or pain.

Clinical Features-
(1) The first symptoms to appear are usually at night during sleep & cause nocturnal tingling & pain in the hand & sometimes forearm.
(2) It may be followed by weakness of the thenar muscles.
(3) There may be wasting of abductor pollicis brevis with sensory loss of the palm & radial three & a half fingers which are supplied by the median nerve.
(4) Tinel Test - Taping on the median nerve or on the carpal tunnel if reproduces a shock or tingling in fingers is suggestive of Carpal Tunnel syndrome & Tinel Test is said to be positive.
(5) Phalen test – Flexion of wrist causes compression of median nerve in the tunnel with the result of paresthesia in the median nerve distribution, thus reproducing the patient’s symptoms.

Investigations- The diagnosis of carpal Tunnel syndrome is based primarily on symptoms & clinical findings. X-rays may be advised which would help in detecting any fracture in the wrist that may be the cause of carpal Tunnel syndrome. MRI can also be done for visualizing injury to median nerve. However, the most important diagnostic test for confirmation of the disease is median nerve conduction study which of course has some limitations because a small percentage of patients may have negative result in spite of features suggestive of carpal Tunnel syndrome while a small percentage of asymptomatic individuals have positive results. Besides these, ultrasound imaging, electromyography may also be done.

Differential Diagnosis- Carpal Tunnel syndrome may be confused with nerve compression caused by a cervical disk herniation, thoracic outlet structures. Pain due to osteoarthritis of 1st carpal-metacarpal joint may also simulate that due to carpal Tunnel syndrome.

Treatment-
[A] General measures to be taken are-
(1) Splinting or bracing.
(2) Modification of activity.
(3) Occupational therapy.
(4) Physiotherapy.

[B] Homeopathic medicines to be used – There are a lot of homeopathic medicines which can be used in the treatment of Carpal Tunnel syndrome. Causticum, Lycopodium, Apis, Calcerea carb, Ruta Graveolens (Ruta), Rhus toxicodendron (Rhus tox), Arnica etc can be used according to the presenting clinical features. Ruta may be used when there is pain & stiffness in wrists & hands, Causticum for numbness & loss of sensation in hands, Apis for numbness of hands & tips of fingers. Arnica is usually used when there is flare-up of inflammation or new injury caused by repetitive use of fingers & wrists. Rhus tox is useful when there are stiffness & pain which get worse on initial motion but improve as movement continues. Besides these, Lycopodium may be used if tingling & numbness is confined to the radial three & a half fingers with or without wrist swelling. Calcerea carb may also be used for tingling & numbness & swelling in wrist & the radial three & half fingers. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine.

Prevention-
(1) Reduction of obesity.
(2) Immediate treatment of any disease which may cause carpal Tunnel syndrome.
(3) Regular breaks from repeated hand movements to allow hands & wrists to take a rest.

Prognosis- Carpal Tunnel syndrome is usually not grave. With treatment pain subsides & there is usually no lasting damage to hand or wrist. When the condition occurs in pregnancy due to fluid retention it usually requires no treatment as it is self-limiting.

In short, carpal tunnel syndrome is manifested by tingling, numbness, weakness or pain in hand due to compression of the median nerve at wrist & is to be treated by Rhus tox, Ruta, Arnica, Causticum etc.

But in every case, a doctor should be consulted.

Some aspects of “Golfer’s elbow” with homoepathic mode of treatment

2009-06-09T05:02:00.000-07:00

Also referred to as medial tennis elbow, Golfer’s elbow is a tendinopathy of the insertion of the flexors of the fingers of the hand & the pronators.
Epitrochleitis or Golfer’s elbow is very similar to lateral epicondylitis or tennis elbow but occurs on the medial side of the elbow, where the pronator teres & the flexors of the wrist & fingers originate. Tensing of these muscles by resisted wrist & finger flexion in pronation will provoke the pain.

Sex- Golfer elbow is most common in men.

Age- 20 – 50 years of age but the condition can affect anyone who repetitively stresses the wrist or the fingers.

Risk factors-
(1) Repeated or forceful movements of the fingers, wrist & forearm which causes repetitive strain on forearm flexors.
(2) Acute trauma may also play a role.

Pathophysiology- The flexor muscles of hand, wrist & forearm on excessive strain or over-use, may become irritated, inflamed & swollen. This causes pain & tenderness at the medial epicondyle of humerus. If not arrested at this point & allowed to progress, the tendon develops small tears in it at its attachment to the humerus.

Clinical Features-
(1) The most common symptom is pain & tenderness on inner side of elbow. The pain may occasionally extend along inner side of forearm. Onset of pain is usually gradual & aggravated by using the affected muscles while grasping objects or shaking hands. Tenderness is often less well localized than in tennis elbow.
(2) There may be a feeling of stiffness of elbow.
(3) Weakness of hands & wrists may also be there.
(4) Numbness or tingling sensation radiating into usaully ring & little fingers may be present.
(5) There will be pain on resisted forearm pronation with elbow extended or pain on resisted wrist flexion & these are the tests for clinical diagnosis.

Investigations- Golfer’s elbow is usually diagnosed clinically. X-ray of elbow is often done to rule out arthritis. MRI may be advocated if clinical diagnosis is difficult to be confirmed.

Differential Diagnosis- Golfer’s elbow is usually to be differentiated from Olecranon bursitis, Elbow arthritis, Carpal tunnel syndrome.

Treatment- It is the same as for tennis elbow but the treatment is even less satisfactory.
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Elbow braces.
(4) Stretching exercises for flexor muscles which should be started after the disappearance of the symptoms of Golfer elbow. If there is any pain during or after the exercises, it should be stopped immediately.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Homeopathy may be used effectively in the treatment of Golfer elbow. If it is supposed to be due to overuse, Bryonia should be tried. Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox) are the medicines most commonly used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Besides these, if it is supposed to be due to any previous injury, Arnica can be very effectively used. On the other hand, if it is supposed to be due to overuse, Bryonia may be tried.

Prevention-
(1) Modification of activities or particular techniques that lead to the development of this overuse injury.
(2) Guidance of a coach for sporting activities may often be helpful.

Prognosis- Golfer elbow is usually a self-limited problem which is quite unlikely to cause any long-term health hazard. With athletes a change in technique often resolves the problem. Life style modification is to be considered if Golfer elbow does not resolve or if it recurs.

In short, Golfer’s elbow is manifested by pain & tenderness on the medial side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.

Some aspects of “Tennis Elbow” with homoepathic mode of treatment

2009-05-14T22:14:00.000-07:00

Also referred to as ‘Lateral epicondylitis’, Tennis elbow is an eponym given to many painful conditions about the elbow & is the pain & tenderness on the lateral side of the elbow, some well defined & some vague that results from repetitive stress. Because people who play tennis or other racquet sports sometimes develop this condition due to faulty playing technique, it is known as “tennis elbow”. Tennis elbow usually affects the dominant arm but it can also occur in the nondominant arm or both.

Seen in-
(1)All levels of tennis players in whom ‘Backhand Stroke’ appears to be the prime cause in most of the players but ‘SERVE’ also plays a role.
(2) Seen in other sports also.
(3) May be occupational etc.

Causes in tennis players-A majority of tennis players all over the world are affected with this problem over 35 years of age.
(1)Novice.
(2)Excessive playing of games per week.
(3) Age over 35 years.
(4) Equal sex incidence.
(5)Backhand stroke appears to be the cause in most of the players followed by ‘SERVE’.
But ‘Forehand stroke’, ‘Backhand volley’, ‘Overhead smash’, or ‘Forehand volley’ may play a role.

Contributing factors in tennis players-
(1) Little playing experience.
(2) Consistent missing of ‘sweet spot’ while hitting.
(3) Poor stroke techniques: use of arm instead of body.
(4)Poor power or flexibility.
(5)Heavy stiff racket, large handle size, too tight racket stringing.
(6)Heavy duty wet balls.
(7)Playing surface-balls bounce quicker off the cement court (quicker bouncing like Playing surface).

Sex-It affects men more than women.

Age-It affects people between ages of 30 & 50, although people of any age can get it.

Site of lesion-Lateral tennis elbow involves the common tendon to the extensor muscles of the wrist & hand. The tendon of the extensor carpi radialis brevis has been identified as the most common site of the lesion.

Clinical Features-
Symptoms-At the very beginning due to acute inflammation, the patient complains of pain during activity. The pain is very soon felt both during activity & at rest due to chronic inflammation. Ultimately the patient complains pain at rest, & pain during daily activities & even night pains.

Signs-
(1) Local tenderness over the lateral humeral epicondyle at the common extensor origin with aching pain in the back of the forearm.
(2) Extension of the wrist against resistance with elbow in full extension elicits pain at the outside of the elbow.
(3) Passive wrist flexion & pronation with elbow in extension produces pain.

Investigations- Tennis elbow cannot be diagnosed from blood tests. Radiographs only rarely reveal soft tissue calcification near the lateral humeral epicondyle, & MRI is of questionable aid in making the diagnosis. It is rather usually diagnosed by description of pain & certain findings from physical exam. However, MRI has been shown to be helpful in diagnosing cases of early Tennis elbow.

Differential Diagnosis- Other causes for lateral elbow pain should be considered, including radiocapitellar arthritis & posterior interosseous nerve compression,elbow arthritis, radial tunnel syndrome etc.

Treatment-
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Avoidance of lifting of heavy items especially with palm facing downwards.
(4) Wrapping of a band around forearm near the elbow.
(5) Wearing of a wrist splint.
(6) Exercises to stretch & strength the wrist extensor muscles. But exercise should be started when healing has occurred to the level that the exercises do not increase pain.
(7) Physiotherapy.
(8)In tennis players exercises, light racket, smaller grip, elbow strap etc are helpful.

[B] Homeopathic medicines to be used – Homeopathy plays a vital role in treatment of Tennis elbow. Constitutional treatment is essential specific remedies include Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox). If it is due to any previous injury, Arnica can be very effectively used. If it is supposed to be due to overuse, Bryonia should be tried.

Prevention-
(1) Correct technique of play to be adopted, backhand stroke to be played with whole body & not just with the wrist.
(2) Use of a forearm brace wrist or elbow is weak.
(3) Wet, heavy balls should always be avoided.
(4) Use of a light racket in case of an occasional player.
(5) Strings should not be too tight.
(6) Activities requiring repetitive wrist & forearm motion should be avoided.
(7) Change in size or type of tennis racquet or tool may be helpful.
(8) Change of occupation to prevent further injury may also help in some cases.

In short, Tennis elbow is manifested pain & tenderness on the lateral side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.

Some aspects of “Dequervain’s disease” with homoepathic mode of treatment

2009-05-13T20:58:00.000-07:00

It is a stenosing tenovaginitis of the tendons in thumb.

Sex- Women are more prone to this disease compared to men.

Age- Mostly found between ages of 30 & 50 years but anyone at any age can get it.

Aetiology-Exact cause is not known. It may be due to repeated overuse of the wrist. A direct blow to the thumb, & certain inflammatory conditions can trigger the disease.

Associated medical conditions- Pregnancy, diabetes mellitus, osteoarthritis, or rheumatoid arthritis.

Pathophysiology-There is apparently spontaneous thickening of the common sheath of abductor pollicis longus, extensor pollicis brevis tendons at the wrist & the consequent result is the entrapment of the tendon. The swollen tendons & their coverings rub against the narrow tunnel through which they pass. The result is pain at base of the thumb.

Clinical features- Presentation may be gradual or sudden. Pain along back of the thumb is the most common symptom. Thumb motion may be difficult & painful, particularly when grasping objects. There may be tenderness & swelling over the thumb side of wrist. Pain may be raised with movements of the thumb & wrist. Tenderness can be elicited by sudden ulnar deviation of the flexed hand. It is the surest sign for diagnosis of Dequervain’s disease & is known as Finkelstein’s test.

Investigations- No X-rays or laboratory investigations are usually needed for its diagnosis. But blood sugar examination to rule out diabetes mellitus & other investigations to see the presence of associated medical conditions like rheumatoid arthritis etc or any other pathology causing the symptoms are to be done.

Differential Diagnosis- Dequervain’s disease is to be differentiated from osteoarthritis of 1st carpo-metacarpal joint, Carpal Tunnel Syndrome, Intersection Syndrome etc.

Treatment-

[A] General measures to be taken are- Besides treatment of the associated medical conditions, if any the following should be done-
(1) Rest.
(2) Limitation of activities that aggravate the condition.
(3) Occasionally a splint on the affected hand to restrict the joint movement.
(4) Exercise.
(5)Physiotherapy.

[B] Homeopathic medicines to be used – Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox), can be very effectively used as its remedy. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual.

Prevention- Prevention consists of avoidance of excessive movements such as hand & wrist twisting, pinching & forceful gripping.

Prognosis- Majority respond well with treatment if started early.

In short, Dequervain’s disease is a stenosing tenovaginitis which is manifested as pain, tenderness & swelling over the thumb side of wrist & is treated by Ruta & Rhus tox.

But in every case, a doctor should be consulted.

Some aspects of “Trigger finger” with homoepathic mode of treatment

2009-04-23T05:09:00.000-07:00

Also known as ‘Flexor Tenosynovitis’, it is a stenosing tenovaginitis, in which the sheath of a flexor tendon thickens, apparently spontaneously, so as to entrap the tendon. It is more common in dominant hand & most often affects the thumb or middle or ring finger.

Sex- More common in women than men.

Age- Occur most frequently between the ages of 40 to 60 years.

Aetiology-Exact cause is not known. It is usually found in those with repetitive gripping actions. Diabetics are also more prone to this disease. Diabetics can have several fingers involved.

Aggravating factors- Prolonged, strenuous grasping may aggravate the condition.

Associated medical condition- Rheumatoid arthritis, gout, hypothyroidism, amyloidosis, diabetes mellitus.

Pathophysiology-The protective sheath surrounding the tendon in the affected finger if becomes inflammed due to any cause, the space within the tendon sheath may become narrow & constricting। As a result, the tendon cannot glide through the sheath easily & at times there is catching of the finger in a bent position। With each catch, the tendon itself becomes irritated & inflammed, worsening the condition। With passage of time inflammation becomes prolonged & there is scarring & thickening & occasional formation of nodules. As a result the gliding of the tendon becomes more difficult & the tendon may momentarily be stuck at the mouth of the sheath as the finger is extended. A pop may be felt as the tendon slips past the tight area. This causes pain & catching as the finger is moved.

Presentation- Pain & limitation of the movements of the involved tendons are the presenting features.

Clinical features- Patients frequently note catching or triggering of the affected finger or thumb after forceful flexion। In some instances, the opposite hand must be used to passively bring the finger or thumb into extension. In more severe cases, the finger may become locked in a flexed position. Triggering is often more pronounced in the morning than later in the day. Stiffness & catching tend to be worse after inactivity. A nodule or tenderness is noticed at the base of the affected finger. The nodule generally moves with finger flexion & extension.

Investigations- No X-rays or laboratory investigations are usually needed for its diagnosis। But blood sugar examination to rule out diabetes mellitus & other investigations to see the presence of associated medical conditions like rheumatoid arthritis, gout are to be done. Blood sugar estimation is particularly essential if multiple fingers are involved.

Differential Diagnosis- Trigger finger may be confused with Dupuytrens contracture, Carpal tunnel syndrome, Rheumatoid arthritis etc.

Treatment-

[A] General measures to be taken are- Besides treatment of the associated medical conditions, if any the following should be done-
(1) Rest.
(2) Limitation of activities that aggravate the condition.
(3) Occasionally a splint on the affected hand to restrict the joint movement.
(4) Exercise.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Ruta Graveolens (Ruta) is the specific remedy which is very effective as its remedy. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(1) Avoidance of repetitive grasping & releasing of objects.
(2) Modification of activity if it can not be avoided.
(3) Proper selection of tools for the job.
(4) Minimization of repetition. Periodical rest of the hands briefly during repetitive or stressful activity.
(5) Frequent stretching during repetitive activity.

Prognosis- Trigger finger can be effectively managed with homeopathy if treatment is started at the beginning। But patients with diabetes mellitus have a lower response rate.

In short, Trigger finger is a stenosing tenovaginitis which is manifested as a painful condition where a finger or thumb locks when it is bent or straightened & is treated by Ruta.

But in every case, a doctor should be consulted.

Some aspects of “Achilles tendonitis” with homoepathic mode of treatment

2009-04-18T22:38:00.000-07:00

Achilles tendonitis is the inflammation (tendonitis) of the Achilles tendon which is the thickest & strongest tendon in the body connecting the heel to the calf muscles & thus enables a person to stand on the toes, to walk, to run or to jump. Achilles tendonitis is a frequent complaint in athletes, especially runners training under less than ideal conditions.

Causes- Lack of flexibility & overpronation are the two basic causes. Associated causes may be the following-

[A] Extrinsic-
(1) Repetitive stresses to the tendon.
(2) Overuse.
(3) Overtraining.
(4) Poor conditioning.
(5) Improper training surfaces.
(6) Improper stretching exercises.

[B] Intrinsic-
(1) Age.
(2) Tight Achilles tendon.
(3) Different congenital foot & knee deformities.
(4) Medical diseases affecting tendon tissue like diabetes mellitus.
(5) Use of long continued steroids.

Clinical features-
(1) Pain over & above the back of the heel which increases on participation in activities especially after a period of inactivity. Hence patients complain of pain after first walking in the morning & also on running or jumping.
(2) Tenderness over the Achilles tendon.
(3) Stiffness of the tendon in the morning which gradually lessens as the tendon warms up.
(4) Inability to stretch Achilles tendon without pain.
(5) Mild swelling on the tendon.
(6) Occasionally a cracking sensation when the tendon is under pressure.

Investigatins-
(1) Blood Tests- Routine Blood Tests for sugar estimation to exclude diabetes mellitus.
(2) X-rays- X-ray is not useful but should be done as a routine to find out other possible conditions.
(3) MRI- MRI is helpful in evaluating a patient for tears within the tendon. It also can provide useful information in refractory cases & helps in preoperative evaluation & planning in patients being considered for surgery.

Differential Diagnosis- Achilles tendonitis may sometimes be confused with Achilles tendon rupture, Ankle Sprain, Ankle fracture, Retrocalcaneal bursitis, Athletic foot injuries, Achilles bursitis, Deep venous thrombosis, etc

Treatment-

[A] General measures to be taken are-
(1) Rest.
(2) Wearing of a heel pad that slightly raises the heel.
(3) Exercises to strengthen the tendon.

[B] Homeopathic medicines to be used- Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the clinical features & the causative factors. Ruta Graveolens (Ruta), Thuya, Benzoicum Acidum (Benz.ac) etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(1) Warming up & stretching before any sort of sport.
(2) Strict restriction of overdoing of any sport.
(3) Wearing of correct footwear.
(4) Designing of shoes according to the sport with adequate heel support.

Prognosis- Achilles tendon having a poor blood supply is slow to heal. But with proper treatment the affected tendon usually recovers completely, provided treatment is started in time. In case the starting of treatment is delayed, it may develop into a chronic one. With passage of time the inflammation may lead to degenerative changes within the tendon & may even lead to small tears within it which make it susceptible to rupture. Incomplete rehabilitation or a hasty return to activity should be strictly prohibited as it would hamper the healing process & may also lead to re-injury.

In short, Achilles tendonitis is the inflammation of the Achilles tendon which is manifested as pain, tenderness & stiffness of the tendon that increases on participation in activities especially after a period of inactivity & is treated Ruta, Thuya, Benz.ac etc.

But in every case, a doctor should be consulted.

Some aspects of “Baker’s Cyst” with homoepathic mode of treatment

2009-04-11T21:38:00.000-07:00

Also known as a ‘Popliteal Cyst’, Baker cyst is a distended bursa caused by knee joint fluid protruding to the back of the knee. It is thus a benign swelling & is named after Dr William Morrant Baker who first described this health condition. The term is a misnomer as it is not a true cyst but is due to synovial fluid distending the bursa.
Aetiology-
(1) Idiopathic- Baker cysts may sometimes develop without any apparent cause particularly in children.
(2) Infection- Local infection may cause a retention of fluid with the subsequent formation of a Baker cyst.
(3) Trauma or injury to the knee- It may cause an effusion, thus triggering the formation of a Baker cyst.
(4) Arthritis-Arthritis is the most common & osteoarthritis probably the most frequent among arthritides.
(5) Internal derangement of knee- Internal derangement of knee like meniscal tears etc. may cause an effusion resulting in the formation of a Baker cyst.

Location- It is located posterior to the medial femoral condyle, between the tendons of the medial head of the gastrocnemius & the semimembranosus muscles.

Age- Baker cysts appear much less frequently in children than in adults.

Pathology- Being an extension of the knee joint, a Baker cyst is a synovial cyst lined with a true synovium. In most cases herniation of synovial membrane through posterior part of capsule takes place. . Escape of fluid through the normal communication of bursa with knee is the other mode. The knee joint effusion caused by intrinsic intra-articular disorders or any other cause is displaced into the popliteal bursa, thus reducing potentially destructive pressure in the joint space. So a Baker cyst may have a protective role to play for the knee. In such cases, the popliteal bursa becomes filled up with fluid & consequently expands resulting in the formation of a swelling. The cyst usually communicates with the joint by way of a slit-like opening or may pinch off.

Associated health conditions-Medical conditions associated with Baker cysts are as follows-
(1) Arthritis is the most common among which osteoarthritis is the most important. Rheumatoid arthritis, Juvenile rheumatoid arthritis etc are also common.
(2) Internal derangement of knee like meniscal tears etc.
(3) Infection like septic arthritis.
(4) Miscellaneous- Hypothyroidism, Gout, Psoriasis, Systemic lupus erythematosus, Sarcoidosis, Haemophilia, etc.

Clinical features- May be asymptomatic or may have the following features in addition to the features of the underlying primary cause-
(1) A slight swelling behind the knee which is particularly noticeable on standing & when compared to the opposite uninvolved knee.
(2) The swelling is usually soft & fluctuant & is with or without pain. Typically these cysts are not painful unless swelling is extensive.
(3) A sensation of tightness behind the knee, especially when the knee is extended or fully flexed.
(4) Restricted mobility of the knee joint.
(5) Transillumination- Transillumination by a shining light through the cyst may show a mass filled with fluid.
(6) In case there is rupture of the cyst, calf tenderness & bruising at the ankle may be present.

Investigations-
(1) X-ray- An X-ray of the knee joint will not show any cyst, but it may show the presence of other abnormalities which may cause development of a Baker cyst.
(2) MRI- An MRI helps to show a cyst with its size & location.
(3) Ultrasound- An ultrasound can also determine the location & contents of a cyst.
(4) Arthrogram- Arthrograpgy may also be utilized for its detection & it is more sensitive than ultrasonography in its detection.

Complications- A Baker cyst may sometimes compress vascular structures & may cause a deep vein thrombosis. It may also rupture & cause extravasation of fluid in the calf. There may also be haemorrhage into the cyst in some cases, particularly if there is any associated bleeding disorder. Infection in case of a Baker cyst is very rare.

Differential Diagnosis- A Baker cyst may sometimes be confused with thrombophlebitis or deep vein thrombosis from which it is to be differentiated by urgent blood tests & other investigations. It may also sometimes be confused with septic arthritis or a ganglion cyst.

Treatment-
[A] General measures to be taken are-
(1) Treatment of underlying cause like arthritis or torn knee cartilage.
(2) Temporarily avoiding activities that may increase the load on the knee joint. (3) Physiotherapy.
(4) Exercises to maintain mobility & strength of the knee joint.
[B] Homeopathic medicines to be used – Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the size of the cyst along with its cause & the symptoms produced. Ruta Graveolens (Ruta), Rhus toxicodendron (Rhus tox), Bryonia etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention- Prevention of knee injury is essential for reducing the risk of development of a Baker cyst for the first time or its recurrence after treatment. Hence supportive footwear appropriate to the activity of an individual is to be worn as well as stoppage of the activity & seeking of medical advice after an injury is needed.
Prognosis- Prognosis of Baker cysts depends on the presence of any underlying knee pathology & the degree of its response to treatment। Most Baker cysts without any underlying knee pathology disappear spontaneously after several years, particularly in children & young adults in whom usually there is no underlying knee pathology। But in some cases a Baker cyst continues to grow with worsening of the symptom & ultimately may rupture & produce acute pain behind the knee & in the calf & swelling of the calf muscles।

In short, a Baker cyst manifests itself as a soft swelling behind the knee with or without pain & can be treated by Ruta, Rhus tox or Bryonia.

But in every case, a doctor should be consulted.

Some aspects of “Housemaid’s knee” with homoepathic mode of treatment-

2009-03-15T05:13:00.000-07:00

Also known as roofer’s knee, it is a benign swelling over the knee on account of an enlargement of the bursa named prepatellar bursa in front of the patella, which in turn is due to an inflammation of the said bursa. Housemaid’s knee is so named because of the fact that this health problem was once found to be a major occupational hazard of Housemaid’s knee & was believed to be caused by leaning too much on the knee by them.

Pathology- Prepatellar bursa is a superficial bursa with a thin synovial lining in front of the patella in between the skin & the patella. It is seen in the lower half of patella & upper half of ligamentum patella. The bursa develops after birth within a few years of life as a result of mechanical pressure & friction. It helps in reducing friction on the underlying structures & thus allows maximal range of motion in the knee. The inflammation of the bursa usually due to repeated trauma to the knee with excess fluid causes restricted movement of the joint with pain, swelling & heat.

Age- Any age group can be affected.

Sex- It is more common in males.

Predisposing factors-
(1) Repeated rubbing or pressure on the knees from kneeling on hard surfaces in an occupation.
(2) A direct blow or a fall on the knee causing rupture of blood vessels & subsequent swelling of the prepatellar bursa.
(3) Spread of an infection from a surface injury, such as a skin wound over the kneecap. Infection is usually the main cause of Housemaid’s knee in children. Infection is also the main cause in people in whom the immunity is deranged such as those on steroid therapy or chemotherapy for cancer.

Clinical features-
(1) Swelling over the kneecap.
(2) Warmth over the kneecap.
(3) Limited motion of the knee.
(4) Painful movement of the knee.
Kneeling usually aggravates the symptoms, while sitting still relieves them.

Treatment-
[A] General measures to be taken are-
(1) Avoidance of the aggravating activity.
(2) Wearing of knee pads while kneeling.
(3) Exercise to strength the quadriceps muscle.
(4) Physiotherapy.

[B] Homeopathic medicines to be used are- Specific remedies include Arnica, Bryonia or Ruta graveolens (Ruta)। The potency & frequency of dosage varies with the severity of the condition & the individual। Usually a lower potency is to be used first for thrice daily & to be continued till the persistence of the symptoms। If improvement is seen, the same medicine is to be continued. But if there is no significant improvement or improvement has come to a standstill, the frequency of dosage should be increased. And in cases where there is no response within a reasonable amount of time, the medicine should be stopped & a different medicine is to be started. It is to be kept in mind that Housemaid’s knee caused by infection needs to be recognized quickly & treated promptly.

Prevention- Use of knee pads by those whose work necessitates kneeling for extended periods of time. This is especially true for those who had already an episode of Housemaid’s knee to prevent recurrence.

Prognosis- Housemaid’s knee may interfere with physical activity, but otherwise it is relatively harmless. But if left untreated, there may be associated loss of quadriceps muscle strength which in turn may cause the leg to give out.

In short, Housemaid’s knee manifests itself as a swelling over the kneecap & can be treated by Arnica, Bryonia or Ruta.

But in every case, a doctor should be consulted.

Some aspects of Student’s elbow with homoepathic mode of treatment

2009-03-09T22:27:00.000-07:00

Also referred to as Olecranon bursitis, it is a chronic inflammation of the olecranon bursa. It is so called as it is found in students who tend to keep their elbows repeatedly over the table, bench etc over long periods during writing, reading etc & the resulting chronic friction leads to its development.

Aetiology -
(1) Repetitive minor injuries or irritation.
(2) Microcrystalline deposition.

Clinical features-
(1) Usually a swelling on the bony bit at the back of the elbow.
(2) Associated pain if there is inflammation.
(3) Gradually pain at rest & during movement of elbow.
(4) Restriction of elbow movement.
(5) On bleeding into the bursa, the swelling as well as the pain increases.

Investigations-Aspiration & culture of the bursal fluid to exclude the possibility of an infectious aetiology.

Treatment-
(1) Rest & protecting the area from any kind of trauma.
(2) Application of ice.
(3) Immobilization of the arm.
(4) Homeopathic medicines to be used are usually Benzoicum acidum (Benz.ac), Bryonia or Belladonna (Bell) etc. The potency & frequency of dosage varies with the severity of the condition & the individual. Usually a lower potency like 30 C is to be used first for thrice daily & to be continued till the persistence of the symptoms.

Prevention-
(1) Wearing of elbow guards during playing a game in which there is a chance of getting hit on the elbows.
(2) Change of writing or reading habits so that leaning on the elbows for long periods of time can be avoided.

Prognosis- Microcrystalline-induced bursitis has a good prognosis & the symptoms usually resolve after a few days, whether treated or not. But bursitis due to repeated minor irritation is more difficult to treat.

In short, Student’s elbow is a chronic inflammation of the olecranon bursa which manifests as a painful swelling over the tip of the olecranon & is to be treated by Benzoicum acidum (Benz.ac), Bryonia or Belladonna (Bell).

But in every case, a doctor should be consulted.

Some aspects of “Bursitis” with homoepathic mode of treatment

2009-02-22T09:55:00.000-08:00

Bursitis is inflammation of a bursa. A bursae is a cushion like sac lined with membrane similar to synovium which is located between a tendon & a bone thus reducing friction between them & allowing the tendon to glide easily over the bone. When subjected to repeated pressure due to over & abnormal use it gives rise to bursitis.

Site of lesion-
Bursitis most often occurs in –
(1) Shoulder .
(2) Elbow.
(3) Knee.
(4) Hip.

Causative factors-
(1) Overexertion of a joint. The repeated motion of a joint causes friction in the bursa. Subsequently, with continuation of activity, the bursa becomes inflammed & filled with fluid. The bursa thickens & does not function well. Both the bursa & the tendon become irritated.
(2) Occasionally a bursa will become infected by haematogenous spread or due to open trauma to the overlying skin or blow to an area containing a bursa.

Clinical features-
Presentation -The patient presents with complain of pain, stiffness of a joint along with malaise & possibly fever.
Signs-
(1)Pain, tenderness & redness of the area of the affected bursa .
(2) Swelling & warmth around the area of the bursa.
(3)Restricted movement of the nearby joint with the subsequent result of restricted function of the affected limb.

Differential Diagnosis- Bursitis has to be differentiated from acute exacerbations of rheumatism & flare-ups of gout both of which clinically manifest with significant erythema & swelling.

Treatment-
[A] General measures to be taken are-
(1)Rest to the affected area & protecting the area from any kind of trauma.
(2)Exercise & application of heat.
(3) Stopping of the activity causing pain if the bursitis is a chronic one.
[B] Homeopathic medicines to be used are-
Benzoicum acidum (Benz.ac)- It acts well when the pain is tearing with stitches & the adjacent joint cracks on movement.
Bryonia- It may be used when the adjacent joint is stiff & painful & the pain is of stitching or tearing type & becomes worse from even the slightest motion.
Belladonna (Bell)-It acts well when there is shooting pain along limbs.
Rhus tox -This remedy is particularly helpful where there is pain on initial movement which gradually improves with movement. The pain may also be worse during sleep & in the morning on waking.
Silicea (Sil)- It acts well when the pain seems to be tightly bound & the sensation seems to be suppurating. Ruta graveolens(Ruta) – This remedy is particularly useful for bursitis after any injury. It is also helpful in acute bursitis with great stiffness & aching pain.

Some points to be kept in mind-
(1) The potency & frequency of dosage varies with the severity of the condition & the individual. Usually a lower potency like 30C is to be used first for thrice daily & to be continued till the persistence of the symptoms. If improvement is seen, the same medicine is to be continued. But if there is no significant improvement or improvement has come to a standstill, the frequency of dosage should be increased. And in cases where there is no response within a reasonable amount of time, the medicine should be stopped & a different medicine is to be started.
(2) If bursitis is caused by an infection, the infection should be combated first in addition to treatment of bursitis.
(3) If bursitis is related to any inflammatory condition such as arthritis, or gout, the disease is to be treated also for control bursitis.

Prevention-
(1)Wearing of protective pads if participating in contact sports.
(2)No overdoing of any kind of sports & activities & that too to be done correctly.

Prognosis- In general, bursitis has a favourable result if treated early but if the underlying cause is not removed properly it may develop into a chronic condition.

In short, bursitis manifests itself as a tender, warm, swelling adjacent to a joint & can be treated by Benz।ac, Bryonia, Rhus tox, Ruta or Silicea.

But in every case, a doctor should be consulted.

Some aspects of Ganglion with homoepathic mode of treatment

2009-02-15T07:13:00.000-08:00

A ganglion is a localized, tense, painless, cystic, swelling, containing clear gelatinous fluid. It is the most common soft-tissue tumour of the hand & wrist.

Pathology- The cystic structure of ganglion is formed from the lining of a joint or tendon & is filled with a gelatinous fluid but without any synovial or epithelial lining. A stalk can sometimes be identified communicating between the cyst & an adjacent joint or tendon sheath.

Sex- Ganglion formation is more common in females.

Age-Late teens & young adulthood.

Sites of location- It is commonly seen over the wrist, digital flexor sheath & distal interphalangeal joint, but it can also develop on the shoulder, elbows & knees.

Predisposing factors- Chronic repetitive stress & sometimes injury. Occupational factors may play a vital role in its development. The occupations which require overuse of certain joints such as the wrist, may pose a risk for development of ganglion.

Associated diseases- Some joint diseases like Rheumatoid arthritis are occasionally found to be associated with ganglion.

Clinical features- Ganglion presents itself usually as a painless swelling adjacent to a joint or a tendon mostly on the wrist, especially on the back side & fingers. It is usually asymptomatic & is primarily a cause of cosmetic rather than a functional disturbance to the affected person. The condition, however, may become symptomatic if the ganglion presses on any nearby structure such as an artery, vein, tendon or nerve when the impingement of such a structure may cause pain, triggering of a tendon or vascular compromise. If a nerve is pressed upon, the resulting pain may cause restriction of movements & activity of the affected person. Dorsal wrist ganglion which is most commonly encountered may be small when it is barely palpable but is usually highly symptomatic whereas if it is large it is often soft & only mildly symptomatic. Flexor sheath ganglion may present as a firm mass over the palmar aspect of the flexor sheath & is often confused with a bone exostosis due to its severe degree of firmness.

Differential Diagnosis- Ganglion may have to be differentiated from certain conditions. A few of them are-

(1) Fibroma.
(2) Lipoma.
(3) Neuroma.
(4) Hamartoma.
(5) Tenosynovitis.

Treatment- Homeopathy medicine improves re-absorption of fluid from the ganglion & thus cures the condition. In addition chance of recurrence is minimal. Favourable results are usually noticed within 3-6 months. Treatment should be followed till it subsides wholly; otherwise there is chance of recurrence. Calcarea Fluorica (Calc flour) 200 twice daily or Ruta Graveolens (Ruta) 200 twice daily may be used. Ruta may also be used as a local application over the site of ganglion formation. Other medicines which can also be used include Rhus toxicodendron (Rhus tox), Benzoicum acidum ( Benz.ac), Thuya etc.

Prognosis- Ganglion may increase in size or may disappear spontaneously.

In short, ganglion is a painless, cystic swelling found near a joint or a tendon & is treated by Calcarea fluorica or Ruta.

But in every case, a doctor should be consulted.

Some aspects of Frozen Shoulder with homoepathic mode of treatment

2009-02-08T10:13:00.000-08:00

Frozen shoulder is defined as a clinical syndrome characterized by painful restriction of both active & passive shoulder movements due usually to no intrinsic cause within the shoulder . In India the problem is compounded by the increasingly sedentary life styles & general lack of exercise.

Sex- Females are affected at a slightly higher rate than males.

Laterality- Usually unilateral with the involvement of the non-dominant arm, but a percentage of patients develops the disease bilaterally.

Cause- Frozen shoulder is caused by tightening of the soft tissues, that surround the shoulder joint & gets worse over time

Risk factors-
Factors directly related to shoulder joint- A few of them are -
(1) Injuries to the shoulder like fractures & dislocations around the shoulder.
(2) Tendinitis of rotator cuff.
(3) Bicipital tendonitis.
Factors not directly related to shoulder joint- A few of them are –
(1) Diabetes mellitus, especially insulin-dependent type. Diabetics on insulin therapy for many years are more prone to this disease & have a greater chance of having bilateral involvement.
(2) Thyroid irregularities.
(3) Disc problems in neck.
(4) Illness especially heart and /or lung disease or injury that forces to keep the shoulder immobile for a period of time.

Clinical features- There is a gradual limitation of external rotation & abduction movements of the shoulder with pain more marked at night. The pain is usually dull or aching & is worsened with attempted motion. The pain is usually located over the outer shoulder area & sometimes the upper arm. The patient can not dress himself or comb the hair or scratch the back. Gradually stiffness & pain increase to freeze all the movements of shoulder with wasting of surrounding muscles. The hallmark of the disorder is restricted motion or stiffness in the shoulder. Fortunately, pain progressively decreases from the initial, inflammatory phase. With time, patients are able to use the shoulder with little or no pain, within the restricted range of motion, but attempts to exceed this range are accompanied by pain. The overall course is variable but can last 12-36 months.

Investigations-
(1) Blood sugar estimation both fasting and post-prandial to detect associated diabetes mellitus.
(2) Blood for T.S.H, T3, T4 to exclude any thyroid irregularities.
(3) X-ray – It may show decalcification, loss of joint space.
(4) Arthrography- Radiographic confirmation may be done by it। Compared to the normal capacity of 12ml, there may be marked reduction in the capacity of the joint & often the affected shoulder may not take more than 2-3 ml of dyए.
(5) MRI-MRI may be indicated but is not of much use.

Differential Diagnosis- Frozen shoulder is to be differentiated from the following diseases-
(1) Rheumatoid arthritis which may affect the shoulder but it is more likely to affect the small joints of hands or feet.
(2) Osteo arthritis which may sometimes develop in the shoulder but it is more common at the nearby acromioclavicular joint or in neck.
(3) A tear in rotator cuff muscles of the shoulder with development of shoulder pain & disability but it has a high prevalence in those with athletic activities & has a past history of significant shoulder injury.
(4) Serious diseases like cancer or infection but these are very rare around the shoulder.

Treatment- Treatment should be started before stiffness develops.
A] Exercises & physiotherapy- Active exercise of the shoulder like raising the arm against a wall, circumduction movement in a stooping posture is advised. Physiotherapy consisting of short wave diathermy, ultrasound etc may be continued. It should be kept in mind that active exercise is the mainstay of treatment for frozen shoulder & should be continued at least till the disappearance of the symptoms but is better to continue as long as possible even after the disappearance of the symptoms to prevent any further involvement.
B] Homeopathy- Treatment should be constitutional but specific remedies may include Bryonia (Bry) 30 & Rhus toxicodendron (Rhus tox) 30.
(1) Bryonia (Bry) - Bryonia is suitable effective in those who are suffering from severe pain, especially stitching & tearing in nature, made worse by slightest motion, compelling the patient to keep still & felt better by rest.
(2) Rhus tox 30-Rhus tox is suitable for those who have a feeling of stiffness & are suffering from tearing pain which has a tendency to spread & is worse after rest or inactivity but gradually diminishes on moving the shoulder .
Alternate use of Bryonia 30 & Rhus tox 30 with a gap of 3 hours between each dose, starting with Bryonia 30 so that each medicine is taken three times a day. The medicines should be continued till the disappearance of the symptoms & then continued for a couple of days more with a reduced number of dosage.
Besides these the following may also be tried-
(a) Sanguinaria 30 may be used in right-sided frozen shoulder where pain is worse from movement of the shoulder & better by rest & sleep.
(b) Chelidonium 30 may also be used when the pain affects the arm, shoulder, hand & tips of fingers & is made worse from movement of the shoulder as well as on touching but better from pressure or massage.

Prevention-
(1) Regular performance of ‘range of motion exercises’ to maintain a strong & flexible shoulder.
(2) To have prompt treatment for a shoulder injury.
(3) To engage in activities that use the shoulder joint regularly.
(4) To maintain normal movements of the shoulder through a full range several times a day after any injury to the upper extremity like hand, wrist, elbow etc or even after being confined to bed.

Prognosis- In most patients, the condition improves spontaneously 1–3 years after onset। While pain usually improves, most patients are left with some limitation of shoulder motion.

In short, Frozen Shoulder is manifested by pain & stiffness of the shoulder with limitation of both active & passive movements & is treated in homeoepathy with alternate dosage of Bryonia 30 & Rhus।tox 30.

But in every case, a doctor should be consulted.

Some aspects of Giardiasis with homoeopathic mode of treatment

2008-08-01T11:06:00.000-07:00

This is a small-intestinal disease due to infestation caused by Giardia lamblia, a flagellate that is found worldwide. Cyst causes infection. It is an important cause of traveller’s diarrhea worldwide usually occurring on return from travel. Prevalence is high throughout the tropics. Many individuals excreting giardia cysts are asymptomatic and hence carriers. Symptoms are produced within 1-2 weeks of ingestion of cysts.

Pathogenesis-The organism colonizes & multiplies within the small-intestine and may remain there without causing any detrimental effects to the host. Otherwise it causes alteration in mucosal architecture. The changes in villous architecture may vary from mild partial villous atrophy to rarely subtotal villous atrophy. The mechanism of producing diarrhea & intestinal malabsorption is ill understood.

Age- Children are mostly affected though adults are not immune to it.

Clinical Features- Children often produce symptoms whereas adults may be asymptomatic. Symptoms are produced within 1-2 weeks of ingestion of cysts. These include diarrhea, often watery in the early stage, nausea, anorexia, abdominal discomfort, distension and pain. Stools gradually become paler and frothy, with the characteristic features of steatorrhoea. There is gradual emaciation which is marked even in previously healthy individuals.

Complications-
(1) Malabsorption syndrome in severe cases.
(2) Growth retardation in children due to chronic giardiasis.

Laboratory Investigations-

(1) Stool examination-It may show both cysts and trophozoites. But as the parasite may be excreted at irregular intervals, a negative result does not exclude the diagnosis. Stool examination aids in the diagnosis of giardiasis in 80-85% of patients.

(2) Indirect immunofluorescence (IFA) /ELISA- Detection of circulating antibody to G. lamblia can be done.

(3) Invasive method- An alternative method is upper endoscopy with biopsies of the mucosa of the jejunum and aspirate of the duodenum to detect the presence of the parasite in them if other procedures fail to confirm the diagnosis of giardiasis.

Control and prevention- Eradication is difficult because of the substantial human reservoir of asymptomatic cases and remote hope of vaccine development. Improved standards of personal hygiene and water quality are to be maintained. Standard of water quality may be improved by using different types of water purifiers.

Treatment- Homoepathy can be effectively used for its remedy. If flatulence or abdominal discomfort predominate, China ( Cinchona Officinalis) 6 & Carbo.veg (Carbo Vegetabilis) 6 should be alternatively used each 6 times daily for seven days or until the disease is controlled . Aloes 30 should be used six times daily in diarrhea for at least seven days or till the persistence of diarrhea.

Labels- China ( Cinchona Officinalis), Carbo.veg (Carbo Vegetabilis), Aloe, Biopsy, Prevalence,Villous, Atrophy, Water purifier, Cyst, Duodenum, ELISA, Endoscopy, Invasive, Small-intestine, Diagnosis, Giardia lamblia, Abdominal, Method, Infestation, Flagellate, Mucosa, Pathogenesis, Reservoir ,Growth retardation, Indirect immunofluorescence (IFA), Jejunum, Malabsorption syndrome, Diarrhea, Parasite, Flatulence, Steatorrhoea, Stool, Trophozoite.

IN SHORT-Giardiasis is a small-intestinal disease caused by Giardia lamblia & may be asymptomatic or is manifested diarrhea, often watery in the early stage, nausea, anorexia, abdominal discomfort, distension and pain. Treatment is as mentioned above.

But in every case a doctor should be consulted.

Some aspects of Chickenpox with homoeopathic mode of treatment

2008-07-31T09:01:00.000-07:00

Chicken pox is an acute, highly infectious disease of childhood caused by varicella zoster virus (VZV) which is a DNA virus belonging to the family of herpesvirus. VZV infects only humans and produces two distinct diseases in man- varicella ( chicken pox) and herpes zoster ( shingles) among which chicken pox is the primary infection occurring usually in the childhood. Chicken pox is the primary infection in the non-immune host. It almost never occurs twice in the same individual. The virus then remains latent in the dorsal root and cranial nerve ganglia for the rest of the life. If immunity is impaired which occurs in elderly persons, the virus replicates and migrates along the sensory nerves to the skin or eye causing the lesions of zoster. There are no animal reservoirs of varicella.

Age- Chicken pox is the disease of childhood. But it can occur at any age and adult chicken pox which is more common in some tropical areas for reasons not understood is much more serious.

Source of infection -The source of infection is a chicken pox or herpes zoster patient. Infectivity is maximum during the initial stages of the disease when the virus is present abundantly in the upper respiratory tract. Infectivity diminishes with the progress of the disease and the scabs are practically non- infectious.

Route of entry-The portal of entry of the virus is the upper respiratory tract.

Incubation Period- 7-23 days, average 2 weeks.

Onset-Acute.

Clinical Features- There are malaise, headache, weakness, fever and prodromal rash. In children the prodromal illness is mild and so the disease is usually noticed only when the skin lesions appear. In adults, however, prodromal fever and malaise with respiratory symptoms lasting 2-3 days are common features. True rash usually appears on the first day of the disease and is vesicular in nature. The rash is centripetal in distribution, affecting mainly the trunk along with face & scalp and sparing the distal parts of the limbs. Moreover, the rash is very superficial and does not involve the deeper layers of the skin. With each fresh crops of rash temperature rises. The vesicles are unilocular and not umbilicated. Fever subsides as soon as new lesions cease to appear. Eventually the pustules crust and heal without scarring. The illness tends to be more severe in older children and can be debilitating in adults. One of the most characteristic features of the rash is pleomorphism and so all stages of the rash that is papules, vesicles and crusts may be seen simultaneously at one time in the same area.

Laboratory Investigations- Laboratory diagnosis is seldom required because of clear-cut clinical signs. Confirmation of the diagnosis is possible by examining the direct scraping of the skin lesion under a microscope, viral cultures or a rising antibody level in convalescing blood samples.

Complications-
Secondary bacterial infection usually due to staphylococci or streptococci may occur.
Varicella pneumonia- It is an important complication that usually 1-6 days after skin eruption. Varicella pneumonia is found mainly in adults where it usually becomes fatal. Besides these, CNS ( Central nervous system) involvement occurs in rare cases. The immunocompromised are susceptible to disseminated infection with multi-organ involvement.

Prevention-Recently a vaccine has been introduced in some countries. The vaccine is effective in preventing chickenpox in a number of cases & is recommended for use between the ages of twelve and eighteen months. In the rest of the cases the severity of a chickenpox infection is lessened by the vaccine.

Prognosis- Chicken pox requires no treatment in healthy children and infection results in life-long immunity. But the disease may be fatal in the immunodeficient or the immunosuppressed. If the primary infection occurs during pregnancy, the virus may cross the placenta with subsequent infection of the foetus. Primary infection of the mother near term may lead to neonatal varicella.

Treatment- Rhus.t ( Rhus toxicodendron) 30 is very effective to cope with skin lesions & should be used six times daily for one week or till the lesions heal & then should be stopped. Dulc (Dulcamara) & Merc.s ( Mercurius –Hydrargyrum ) be also used especially for high temperature.

Labels- Microscope, Infection, Centripetal, Laboratory Investigations, Laboratory diagnosis, Chicken pox, DNA virus, Dulc (Dulcamara), Immunocompromised, Immunodeficient, Immunosuppressed, Lesion, Merc।s ( Mercurius –Hydrargyrum ), Microscope, Pleomorphism, Varicella pneumonia, Foetus, Neonatal varicella, CNS ( Central nervous system), Pleomorphism,Pustule, Rash, Multi-organ, Staphylococci, Streptococci, Incubation Period, Prevention, Complications,Clinical Features.

IN SHORT- Chicken pox is an acute, highly infectious viral disease of childhood which begins with malaise, headache, weakness, fever and a characteristic type of rash appearing mainly the trunk with pleomorphism. Treatment is as mentioned above.

But in every case a doctor should be consulted।

Some aspects of Chalazion with homoeopathic mode of treatment

2008-07-27T21:20:00.000-07:00

A chalazion is a chronic granuloma of one or more than one meibomian glands.

Pathology- A low grade infection, entering through a duct of the meibomian gland, causes infiltration of the wall of the duct with leucocytes along with proliferation of the epithelium of the duct. The duct, thus, becomes obstructed and the meibomian secretion accumulates within the gland. The retained secretion causes irritation resulting in infiltration of the surrounding tissues with inflammatory cells and consequently formation of a granuloma. Much of the glandular tissue is thus ultimately replaced by granulation tissue which undergoes hyaline degeneration forming a jelly-like mass.

Histology- A chalazion consists of sebaceous material in the centre surrounded by giant cells, epitheloid cells and lymphocytes.

Associated Conditions- It may be associated with blepharitis, rosacea or seborrhoeic dermatitis. Chronic chalazion may be associated with hypercholesterolemia.

Age- A chalazion is more common in adults than in children.

Presentation- Presentation is usually at any age with a gradually enlarging painless nodule (swelling).

Symptoms- Depending on the size of the chalazion, there may be a sense of heaviness in the lid and mild irritation. Occasionally an upper lid chalazion may press on the cornea inducing astigmatism and consequently blurred vision.

Signs-
(1) A single or multiple roundish, firm swellings of variable size within the substance of the lid in the tarsal plate, a little distance away from the lid margin.
(2) It is painless or there is initial tenderness followed by little or no tenderness.
(3) The swelling is fixed to the tarsus, with the skin freely moving over it.
(4) On everting the lid, the conjunctiva over it is found to be engorged and velvety in colour.
(5) The regional lymph glands are not palpable.

Course-
(1) A very small chalazion may undergo resolution.
(2) A chalazion may remain as it is.
(3) A chalazion may gradually increase in size over weeks or months and then may remain stationary & may even slowly regress.
(4) A chalazion may burst either on the skin surface or on the conjunctival surface, with granulation tissue protruding.
(5) A chalazion may be secondarily infected leading to the formation of an internal hordeolum.
(6) A chalazion may affect a meibomian duct or may protrude through a meibomian duct when the nodule is found to develop at the lid margin and is called a marginal chalazion.

(7) There may be calcification of a chalazion.

(8) A chalazion may recur.

Treatment-
(1) Lid hygiene should be promoted.
(2) Diabetes mellitus should be excluded by necessary laboratory investigations.
(3) Hypercholesterolemia should be excluded by necessary laboratory investigations
(4) Refractive errors, if any, should be corrected with proper glasses (spectacles) or contact lenses.
(5) Recurrent chalazia, especially in old people should arouse the suspicion of malignancy.
(6) Hot compresses may be applied, especially if there is pain or tenderness.
(7) Of the homeoepathic medicines, Conium 200 twice in the morning at an interval of three hours and Staph (Staphysagria) 200 twice in the evening also at an interval of three hours should be used for at least one month. If not recovered, the same dose schedule should be continued for another month and then stopped. Kali Iod 200 may also be tried.

Labels-Astigmatism, Blepharitis, Chalazion, Conium, Cornea, Homeoepathic medicine, Resolution, Kali Iod, Gland, Granuloma, Hypercholesterolemia, Internal Hordeolum, Lymph gland, Malignancy, Meibomian, Staph (Staphysagria), Treatment, Vision, Hygiene, Refractive errors, Glass, Spectacles, Contact lenses, Diabetes mellitus, Rosacea, Seborrhoeic dermatitis, Hyaline degeneration, Sebaceous, Giant cell, Epitheloid cell, Lymphocyte.

IN SHORT- Chalazion is manifested as a painless single or multiple firm swellings of variable size within the substance of the eyelid, a little distance away from the lid margin. Treatment is followed as mentioned above.

But in every case a doctor should be consulted.

Some aspects of Internal Hordeolum with homoepathic mode of treatment-

2008-07-27T00:06:00.000-07:00

It is the suppurative inflammation of a meibomian gland of exactly same nature as stye but is comparatively rare. It is often called a suppurative chalazion and sometimes may be due to secondary infection of a chalazion.

Causative agent- Staphylococcus.

Symptoms-They are same as for stye but are more severe.

Signs-
(1) A tender, painful swelling within the substance of the lid in the tarsal plate, a little distance away from the lid margin.
(2) The point of maximum tenderness is away from the lid margin.
(3) If the lesion enlarges, the pus points on the tarsal conjunctiva and not on the root of an eyelash. It rarely points on the skin.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) General health of the patient should be improved with good nutrition and vitamins.
(4) Refractive errors, if any, should be corrected with suitable glasses (spectacles) or contact lenses।

(5) Hot compresses may be applied.
(6) Homoeopathy plays a good role in its treatment. Of the different medicines, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be given six times daily for a week if there is intense pain. Silicea 30 may also be used & should be given six times daily for a week if the pain is stitching in nature.

Labels-Blood sugar, Chalazion, Conjunctiva, Contact lens, Diabetes mellitus, Hepar Sulph (Hepar Sulphuris Calcareum), Eyelash, Glass, Health, Homoeopathy, Refractive errors, Spectacle, Hygiene, Internal Hordeolum, Nutrition, Patient., Pus, Silicea, Skin, Vitamin.

IN SHORT- Internal Hordeolum is manifested as a tender, painful swelling within the substance of the lid a little distance away from the lid margin. Treatment is followed as mentioned above.

But in every case, a doctor should be consulted.

Some aspects of External Hordeolum or Stye with homoeopathic mode of treatment -

2008-07-20T10:35:00.000-07:00

External hordeolum or stye is a focal, acute inflammation of the follicle of an eyelash including the glands of Zeis or Moll, usually ending in suppuration.

Causative agent- Staphylococcus.

Associated Conditions- It may be associated with blepharitis, rosacea or seborrhoeic dermatitis.

Associated factors- It may be associated with uncorrected errors of refraction as well as some metabolic factors like diabetes mellitus, debility & excessive intake of carbohydrate.

Age- It may occur at any age, but more common in adults than in children.

Symptoms- Acute pain in the lid margin with a sense of heaviness & heat.

Signs-
(1) A single or multiple swellings at the margin of the affected lid pointing anteriorly through the skin.
(2) Marked tenderness at the point of inflammation on the lid margin.
(3) Swelling, redness & marked oedema of the affected lid as a whole.
(4) Congestion of the neighbouring conjunctiva which may be chemotic.
(5) Enlargement of the corresponding pre-auricular lymph glands.
(6) Finally appearance of a white pus point on the lid margin at the base of a cilium which indicates suppuration.

Course- If not treated, the pus point may burst outside & consequently the pain and swelling subsides.

Complications- Usually none but very rarely the inflammation may spread producing cellulitis of the orbital tissue.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) Refractive errors, if any, should be corrected with proper glasses (spectacles) or contact lens.
(4) General health of the patient should be improved with good nutrition and vitamins.
(5) Hot fomentation should be applied on the lid to hasten suppuration.
(6) If the pus points on the skin of the lid, the pus should be drained by pulling out the affected eyelash.
(7) Homoeopathy plays a good role in its treatment. Of the different medicines, constitutional medicine is Graph (Graphites) 200 for fair, fatty, flabby patients. General medicine is Staphysagria 200 twice daily. If there is severe pain, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be added with it till the pain persists in a dose of four times daily. If there is stitching pain, Silicea 200 should be added with the general medicine till the persistence of the pain. General medicine should be continued till the subsidence of stye and also for another two weeks.

Labels- Homoeopathy, Diabetes mellitus, Nutrition, Vitamins, Refractive errors, Glasses, Spectacles, Blepharitis, Rosacea, Seborrhoeic dermatitis, Swelling, Oedema, Lymph gland, Inflammation, Suppuration, Blood sugar, Health, Eyelash, Pus, Conjunctiva, Treatment, Staphylococcus, External Hordeolum, Stye, Graphites, Silicea, Hepar Sulph, Staphysagria.

IN SHORT- Stye is manifested as a single or multiple swellings at the margin of the eyelid with marked tenderness along with swelling, redness & oedema of the affected lid as a whole. Treatment is followed as mentioned above.

But in every case a doctor should be consulted.

Some aspects of Whooping Cough with homoeopathic mode of treatment-

2008-07-13T10:03:00.000-07:00

Whooping Cough is a type of catarrh of the entire respiratory tract which produces paroxysmal cough and a typical stridor or ‘whoop’ caused by Bordetella pertussis, a gram negative, coccobacillus. Though Bordetella pertussis is the main causative agent, a few cases, milder in nature may be caused by Bordetella parapertussis, the incidence of cases varying in different countries. Very rarely, the disease may be caused by Bordetella bronchiseptica. A whooping cough like clinical picture may also be caused by some other respiratory pathogens like adenoviruses and Mycoplasma pneumoniae. Whooping Cough is one of the most infectious of bacterial diseases and the non-immune contacts seldom escape the disease. One characteristic feature of whooping cough is that the infection is limited to the respiratory tract and the bacilli do not invade the bloodstream.

Host & reservoir of infection-Humans are both the natural hosts and reservoirs of infection.

Age- It is a disease of childhood occurring common between 1-5 years of age. However, no age is exempt.

Sex- The disease is relatively commoner in the female than in the male at any age.

Spread of infection- Infection is transmitted by droplets and fomites contaminated with oropharyngeal secretions.

Source of infection- Source of infection is a patient in the early stage of the disease. In adolescents and adults the disease is often atypical with the presentation of bronchitis who then serves as a source of infection to infants and children. Chronic carriers are not known.

Incubation Period- 7-14 days.

Pathology- It produces a local infection. The organism is not invasive. It multiplies on the surface epithelium of the respiratory tract and causes inflammation and necrosis of the mucosa which in turn may invite secondary bacterial invasion. The whole respiratory tract starting from nasopharynx down to bronchi is thus involved in a necrotizing inflammation along with inflammation of the peribronchial and tracheobronchial lymphoid tissue. As the disease progresses, inflammation of the lung produces a diffuse bronchopneumonia with desquamation of the alveolar epithelium. The stickiness of exudates causes obstruction of bronchioles and atelectasis.

Onset- Insidious.

Clinical Features- The disease usually lasts 6-8 weeks. The course of the disease is protracted and may be divided into three stages- each lasting approximately two weeks-

(1) The catarrhal stage- Clinical diagnosis at this stage is difficult. It has an insidious onset with malaise, anorexia, mucoid rhinorrhoea, conjunctivitis and a dry irritating cough. This is the stage of maximum infectivity.

(2) The paroxysmal stage-It is so called because of the characteristic paroxysms of coughing. It begins about a week later. The cough increases in intensity and comes on in distinctive bouts. The cough is more prominent at night and is increased on crying and during feeding. The characteristic feature of paroxysms of cough is that there is no apparent inspiration in between them which ends in a crowing inspiratory sound, the classic inspiratory whoop. Children under 6 months usually do not produce whoop. During this stage, there is no fever unless complicated by some other infection. These paroxysms usually terminate in vomiting. Conjunctival suffusion and petechiae and ulceration of the frenulum of the tongue may also be seen.

(3) Convalescent stage- During this stage, cough becomes less frequent and sputum is less tenacious.

Complications- The paroxysmal stage is mainly associated with complications. Bronchitis, lobar pneumonia, atelectasis, rectal prolapse etc. Cerebral anoxia may occur, especially in younger children. The respiratory complications are self-limited, the atelectasis resolving spontaneously but the neurological complications may result in permanent sequelae like epilepsy, paralysis, retardation, blindness or deafness. Bronchiectasis may be a late sequel.

Laboratory Investigations- The initial diagnosis of whooping cough is usually based on the symptoms. The following may be done-

(1) Blood examination -Blood examination shows high W.B.C count. Total count is also high with about 90% lymphocytes. No immature lymphocytes are present.

(2) Culture of the organism- The most accurate method of diagnosis of whooping cough is to culture the organisms obtained from swabbing mucus out of the nasopharynx. Unfortunately the organism is delicate. So it is unusual to get a positive culture in whooping cough. In other words, if a swab is negative, the patient can still have whooping cough.

(3) Serological Tests- Serological diagnosis is generally of no use. ELISA may be used for demonstration of specific secretory IgA antibody in nasopharyngeal secretions in culture negative cases. A better and more modern way of detecting the organism is by detecting its unique DNA pattern by means of polymerase chain reaction (PCR).

Control and prevention- Maternal antibodies do not seem to give protection against the disease. Affected individuals should be isolated to prevent contact with others. But this is seldom practicable, as infectivity is highest in the earliest stage of the disease when clinical diagnosis is difficult. Active immunization with triple antigen comprising of pertussis vaccine in combination with diphtheria and tetanus toxoid is recommended for consecutive three months starting at three months of age of the infant.

Treatment- Of the different medicines, Bell (Belladonna) 6, Dros (Drosera) 6 and Aralia (Aralia Racemosa) 6 are some of the medicines used most frequently. Each of them is administered three times daily, giving a gap of at least one hour between two different medicines. The medicines should be continued for at least one week or till cough persists. Then gradually the medicines should be stopped. If there is associated chest congestion, Ant.t (Antimonium Tartaricum ) 6 should be used thrice daily along with the above medicines.

Labels- Epilepsy, Bronchitis, Lobar pneumonia, Atelectasis, Rectal prolapse, Paralysis, Ulcer, Rhinorrhoea, Conjunctivitis, Retardation, Blindness, Deafness Polymerase chain reaction (PCR), Tetanus toxoid, Diphtheria, ELISA.etc.

Some aspects of Mumps with homoeopathic mode of treatment

2008-07-08T10:21:00.000-07:00

Mumps is an acute, highly infectious disease of childhood caused by mumps virus, a RNA virus belonging to the family of paramyxoviruses which has a predilection for glandular and nervous tissues. The virus is antigenically stable and only one serotype exists. Humans are the only natural hosts. No human carriers or animal reservoirs exist. One attack confers lasting immunity and so second attacks are not seen. Introduction of aggressive immunization has dramatically reduced the incidence of the disease in the developed countries.

Age- Although no age is exempt, it is primarily a disease of childhood and young adults it is uncommon before 2 years of age. It often occurs as epidemics in children of 5-15 years as well as in young people living in groups as in army camps.

Spread of infection- This infection spreads by direct contact, airborne droplets or fomites contaminated with saliva and possibly also with urine.

Source of infection- The source of infection is a patient in the late incubation or early clinical stage of illness. The peak infectivity is about a day or two before the clinical manifestation of parotitis and subsides rapidly thereafter.

Incubation Period- Long and is about 12-25 days, average being 18 days.

Clinical Features- The prodromal symptoms are non-specific and include fever, malaise, headache and anorexia usually followed by severe pain over the parotid gland with its swelling. Sometimes parotid gland swelling may be the first clinical manifestation of the illness. Parotid swelling is unilateral to start with but may become bilateral. There is stiffness of jaw, inability to open the mouth. Dryness of the mouth with foul smell is also present. There is local pain and tenderness over the parotid gland region. There is also tenderness over the posterior ramus of the mandible. The swelling of the soft tissue may proceed downwards. The enlarged parotid glands obscure the angle of the mandible and may elevate the ear lobe. The parotitis is non-suppurative and usually resolves within a week. Rarely only the submandibular gland involvement may occur.

Complications- The most commonest complication is orchitis. It is usually unilateral but may also be bilateral when it may cause sterility due to testicular atrophy. Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Besides these, central nervous system involvement is very often seen; it may cause ‘aseptic meningitis’ as well as meningoencephalitis in some cases. But both of these usually resolve without sequelae. A portion of patients with central nervous system involvement involvement may not show any evidence of parotid gland involvement.

Laboratory Investigations- A typical case of mumps does not need any laboratory investigation for confirmation. Laboratory investigations are needed for atypical cases.

(1) Blood Examination- Some non-specific findings may be present in the blood. The WBC may be low with lymphocytes predominating. ESR and CRP may be normal or slightly elevated. Serum amylase levels may be elevated even without pancreatic involvement.

(2) Virus Isolation - Virus can be isolated in cell culture from saliva, throat swab, urine and CSF and virus identification can be performed by neutralization or inhibition of haemadsorption by specific sera.

(3) Serologic test- Positive serologic test for serum mumps IgM antibody or four-fold rise between acute- and convalescent-phase titers in serum mumps IgG antibody level may help in the establishment of the diagnosis of the disease.

(4) Reverse transcription polymerase chain reaction (RT- PCR) Test - Detection of viral RNA by this test is also helpful for confirmation of the diagnosis.

Prophylaxis- Active immunization with a live attenuated mumps virus vaccine given as a single dose can prevent the disease in children over the age of 1 year, below which age the vaccine is not recommended as it may be inhibited by maternally acquired antibodies. The vaccine is not to be given to immunosuppressed individuals or to those with severe febrile illness and also during pregnancy.

Treatment- Homoepathy plays a vital role in the treatment of mumps. Isolation of the patient and proper maintenance of oral hygiene are the first things to be borne in mind. Of the medicines, Bell ( Belladonna) 200 and Rhus.tox (Rhus Toxicodendron) 200 are to be taken alternatively at an interval of three hours between the two medicines three times daily. This should be continued for one week. Then at least for the next two weeks, both the two medicines should be continued two times daily with the gap between them increasing to not less than four hours. If there is associated throat pain, Phytolacca 200 should be added along with four times daily till the pain persists. If temperature is present, Ferrum.Phos 6x should also be given three times daily along with the main medicines.

Labels-Anorexia, Fever, Headache, Immunization, Virus, Ferrum.Phos, Bell ( Belladonna), Reverse transcription polymerase chain reaction (RT- PCR) Test, Attenuated, Isolation, Rhus.tox (Rhus Toxicodendron), Medicine, Swelling, Temperature, Serologic test, IgM, IgG, Acute, Convalescent, Antibody, Arthritis, Oophoritis, Nephritis, Pancreatitis, Thyroiditis, Myocarditis.

IN SHORT-Mumps is an acute, highly infectious viral disease of childhood which begins with non-specific symptoms like fever, malaise, headache & anorexia and is soon followed by severe pain over the parotid gland with its swelling. The parotitis is non-suppurative and usually resolves within a week. The disease may be associated with several complications the most important of which is orchitis. Prevention is done with active immunization with a live attenuated mumps virus vaccine. Treatment is as mentioned above.

But in every case a doctor should be consulted।

Some aspects of Measles with homoeopathic mode of treatment -

2008-06-15T00:32:00.000-07:00

Measles is an acute, highly infectious disease of childhood occurring worldwide and is caused by measles virus, a RNA virus belonging to the family of paramyxoviruses. The virus is antigenically uniform. Humans are the only natural hosts. One attack confers solid immunity and second attacks are uncommon. Introduction of aggressive immunization has dramatically reduced the incidence of the disease in the developed countries but it is still now a very common disease of childhood in the developing countries. Although it is a relatively mild disease in the healthy child, it carries a high mortality in the malnourished as well as in those with other diseases. In the nonimmune, infection almost always causes clinical manifestation.

Age- Peak incidence is in young children between 1-5 years of age. It is rare in first six months of life due to the presence of maternal antibody.

Season- Epidemics occur mostly in late winter and early spring, with a peak in April.

Spread of infection- This infection spreads by droplet during the prodromal stage and in early eruptive stage. Infectivity is maximum at the prodrome and diminishes rapidly with the appearance of rash. It starts from 3 days prior to the onset of symptoms and lasts until the rash desquamates.

Pathogenesis-The virus enters the body through the respiratory tract or the conjunctiva and multiplies locally as well as in the adjoining lymph nodes. The virus spreads to the reticuloendothelial system via blood where it multiplies and then a secondary viraemia carries the virus to the epithelial surfaces including the skin, mouth, respiratory tract and conjunctiva.

Incubation Period- 8-14 days.

Clinical Features- The course of the disease is divided into two distinct phases-

(1) The infectious pre-eruptive and catarrhal stage-
This is the stage of viraemia and viral dissemination and lasts for about 4 days. There are sudden onset of malaise, acute fever, rhinorrhoea, cough, conjunctivitis, photophobia and hoarseness of voice. The cough is hacking and occasionally painful. After 3-4 days of prodromal illness, the rash which is a characteristic of the next stage appears and a day or two before the onset of rash, the pathognomonic Koplik’s spots develop. Koplik’s spots are tiny whitish irregular spots against a reddish background characteristically around the opening of the parotid duct opposite the second molar teeth. Koplik’s spots may occasionally develop on the conjunctiva and the intestinal mucosa. On the 3rd day the temperature usually comes down to a low level and is so known as day of remission.

(2) The non-infectious eruptive or exanthematous stage- This stage is characterized by the appearance of a maculopapular rash which appears usually on the 4th day and initially occurs on the face, mainly on the forehead and behind the ears at the junction of skin and hair. It then spreads rapidly to involve whole of the body, including palms and soles. Initially they are discrete, pink in colour, blanch on pressure but later it become confluent and patchy, particularly on the face and neck. It fades in about a week in the same sequence, leaving behind a brownish discolouration of skin and areas of desquamation. The rash represents an immune reaction between T lymphocytes and cells in which viral replication is going on. During this stage, there is again a high rise of temperature with puffiness of face, headache, cough, photophobia and myalgia. Lymph nodes may also enlarge.

Complications- Although most patients recover uneventfully, a few may develop complications which are due to secondary bacterial infection or to the virus itself and are found in those who are malnourished or have other diseases. Complications include bacterial pneumonia, bronchitis, otitis media and gastroenteritis. Rarely the virus may cause fatal giant cell pneumonia. Less common complications are myocarditis, hepatitis and encephalomyelitis. A rare late complication is subacute sclerosing panencephalitis. Protracted diarrhea may also occur as a complication in children in poor countries. Maternal measles may cause spontaneous abortion and premature delivery.

Laboratory Investigations-

(1) Blood examination -Blood examination shows leucopenia or normal count. Leucocytosis may be seen with secondary bacterial infection.

(2) Immunofluorescence-Detection of measles virus antigen by immunofluorescence in multinucleated giant cells which may be demonstrated in Giemsa stained smears of nasal secretions may be used to confirm the diagnosis. This is very simple and may be used a diagnostic test even before the appearance of rash.

(3) Serological tests- Serological tests like complement fixation test( CFT), haemagglutination inhibition test etc may also be used to confirm the diagnosis. High titre measles antibody if can be demonstrated in CSF is diagnostic of subacute sclerosing panencephalitis, a rare and late complication of measles.

(4) Virus culture- Virus culture may also be used to confirm the diagnosis.

Prophylaxis-Normal human gammaglobulin administered within 5 days of exposure can prevent or modify the disease. This is particularly valuable in previously unimmunized children below the age of 3 years, children with immunodeficiency, during pregnancy and others at special risk. Active unimmunization may be done with single antigen measles vaccine or with combined vaccine, MMR.

Treatment- Bry. ( Bryonia) 30, Kalibich. (Kali bichromicum) 6 or 30, Puls. (Pulsatilla) 30 etc are some of the medicines used most frequently. The dose administered and the frequency maintained depends on the state of condition and the severity of the disease. Bryonia is the prime medicine. It is especially useful in fever with dry cough as well as in fever with internal heat. If there is associated cough, Kalibi is to be added. If there is any abdominal distress or diarrhoea, Pulsatilla should be used in addition to Bryonia.

Labels-Abortion, Antibody , CFT, Epidemics, Gammaglobulin, Giemsa Stain, Haemagglutination, Inhibition Test, Immunodeficiency, Immunofluorescence, Serological Test, Viraemia, Bry. ( Bryonia), Kalibich. (Kali bichromicum) , Puls. (Pulsatilla), Sclerosing panencephalitis, CCF , Otitis media, Gastroenteritis, Peumonia, Bronchitis, Giant Cell, Myocarditis, Hepatitis, Encephalomyelitis.

IN SHORT-Measles, an acute, highly infectious disease of childhood is caused by measles virus, a RNA virus & begins with sudden onset of malaise, acute fever, rhinorrhoea, cough, conjunctivitis, photophobia and hoarseness of voice. The disease is characterized by the appearance of the pathognomonic Koplik’s spots which is soon followed by the appearance of a maculopapular rash. The disease may be associated with some complications which are due to secondary bacterial infection or to the virus itself. Prevention may be done with active unimmunization with single antigen measles vaccine or with combined vaccine, MMR. Treatment is as mentioned above.

But in every case a doctor should be consulted.

Some aspects of Influenza with homoeopathic mode of treatment -

2008-06-12T11:09:00.000-07:00

Influenza is an acute infectious disease of the respiratory tract which occurs in sporadic, epidemic and pandemic forms. It is caused by the Influenza virus which is a RNA virus and belongs to the family of Orthomyxovirus and has the unique ability to undergo antigenic variation. The route of entry is the respiratory tract. Though the disease is generally confined to the respiratory tract, very rarely it may spread to some other organs. The virus is classified into three serotypes, A, B and C, based on the antigenic nature of the ribonucleoprotein antigen. Influenza B is associated with localized outbreaks of milder nature such as in camps, whereas Influenza A is the cause of worldwide pandemics and epidemics. Influenza C rarely produces disease in humans. Influenza also occurs in animals and birds in nature. But isolates from nonhuman hosts belong to type A. Influenza viruses belonging to B and C types are exclusively human viruses and have not been found to be associated with infection in animals and birds. The unique ability of the virus to cause epidemics and pandemics is due to the frequent antigenic variations in it. Major shifts in the antigenic structure of influenza A form the essential conditions for pandemics. On the other hand, minor shifts in the virus results in less severe epidemics. A major reservoir of influenza virus is believed to exist in animals and birds and the source of infection is usually a clinical case or a sub-clinical case.

Spread of infection- Spread is mainly by droplet infection but fomites and direct contact may also be the cause.

Incubation Period-1-3 days.

Onset- Sudden.

Clinical Features- Most of the cases are sub-clinical. The disease varies in severity from a mild coryza to fulminating and rapidly fatal pneumonia. There is high rise of temperature all on a sudden with shivering and generalized aching in the limbs. This is associated with severe headache, soreness of the throat and a persistent dry cough that may last for several weeks. Abdominal pain and vomiting may also occur, especially in type B infection in children. There may be mild conjunctivitis and nasal congestion may or may not be present. During acute stage of the disease there may be flushing of the face and the pulse shows tachycardia. But all these symptoms usually disappear within a few days, an uncomplicated case usually resolving within 2-7 days, except asthenia which persists for several days or weeks.

Complications- Secondary bacterial infection, particularly with Strep.pneumonia and H. influenza is often found. The most important one is pneumonia which is rarer and is caused by Staph.aureus or very rarely by the virus itself. Cardiac complications like congestive cardiac failure (CCF) or myocarditis and postinfectious encephalomyelitis may also rarely occur after infection with this virus.

Prophylaxis- Protection by influenza vaccine is not always successful and is of short duration, lasting for about a year. The major problem is the frequent change in its antigenic make up. Hence new vaccines are to be prepared each time to cover each change in antigenicity of the virus which is a great hindrance to the fight against an outbreak of influenza at the very beginning.

Treatment- Besides bed rest, the following homeoeoathic medicines may be used-
Bry (Bryonia) 30, Bell ( Belladonna) 6, Rhus tox ( Rhus Toxicodendron) 30, Eup.perf (Eupatorium Perfoliatum) 6 or 30 should be used separately one after another at an interval of usually ½ to 1 hour several times in a day depending on severity and nature of the condition. Bryonia is especially useful in fever with pain stitching and or tearing in nature as well as in fever with dry cough. Belladonna is particularly useful in a high feverish state with mild or no signs of toxaemia. It may also be used effectively when there is distension of superficial blood vessels. Rhus tox 30 acts better in chill with dry cough and or restlessness. It is particularly useful when the bowels are loose. Eupatorium Perfoliatum is particularly useful in fever with much frontal ache but without thirst during chill and also in bone pains. For high fever, Ferrum Phos 6x should be used repeatedly in between the above four medicines. If there is any chest congestion, Antim. tart ( Antimonium tartaricum) 6 may be used several times depending on severity of the condition. Lach. ( Lachesis) may be tried in presence of hot flushes and hot perspiration.

Labels-Antim. tart ( Antimonium tartaricum), CCF, Encephalomyelitis, Eup.perf (Eupatorium Perfoliatum), Lach. ( Lachesis), Myocarditis, Pandemic, RNA., Sporadic, Staph.aureus, Ferrum Phos, Chill, Toxaemia, Bry (Bryonia) , Bell ( Belladonna) , Rhus tox ( Rhus Toxicodendron) , Chest, Congestion, Blood vessel, Strep.pneumonia, H. influenza, Orthomyxovirus, Serotype, Epidemic, Ribonucleoprotein, Antigen.

IN SHORT-Influenza is an acute infectious disease of the respiratory tract caused by the Influenza virus which is manifested by a sudden high rise of temperature with shivering and generalized aching in the limbs & is also associated with severe headache, soreness of the throat and a persistent dry cough that may last for several weeks. It may be complicated by secondary ingection. Protection by influenza vaccine is not of much value due to the frequent change in its antigenic make up. Treatment is as mentioned above.

But in every case a doctor should be consulted.

Some aspects of Herpes Zoster infection ( shingles) with homoeopathic mode of treatment-

2008-06-06T10:53:00.000-07:00

This infection usually represents the re-emergence of varicella zoster virus (VZV) from posterior nerve roots in the spinal cord or cranial nerves into the skin, the original infection having been acquired in an attack of chicken pox many years previously usually in the childhood. VZV is a DNA virus that infects only humans and produces two distinct diseases in man- varicella ( chicken pox) and herpes zoster ( shingles) among which chicken pox is the primary infection occurring usually in the childhood. Chicken pox is the primary infection in the non-immune host. It almost never occurs twice in the same individual. The virus then remains latent in the dorsal root and cranial nerve ganglia for the rest of the life. If immunity is impaired which occurs in elderly persons, the virus replicates and migrates along the sensory nerves to the skin or eye causing the lesions of zoster. Shingles is never the direct result of a primary infection. Patients with chicken pox or shingles are infective, the virus being spread from fresh skin lesions by direct contact or airborne transmission and causing chicken pox in susceptible individuals.The disease affects individuals in their middle years or old age. Factors causing re-emergence of the virus are often ill understood and probably may represent changes in the immune state of the host.
In the cranial nerves herpes zoster has a predilection for the fifth and seventh nerve.

Age- Old age, being common after the age of fifty years.

Incubation Period- About two weeks.

Clinical Features- It produces an identical skin lesion to chicken pox, although classically it is unilateral and restricted to a sensory nerve (dermatomal) distribution, thus respecting the midline. But inflammatory oedema may cross the midline, giving the erroneous impression of bilaterality. General symptoms include fever, malaise, swelling of lymph nodes etc, which may precede the development of pain. The first specific symptom is pain in the segmental distribution of the nerves involved and is burning or shooting or cutting in character associated with hyperaesthesia or hyperalgesia over the affected cutaneous segments. Within a few days this is followed by appearance of erythema initially and later on vesicles containing clear fluid and papules or bullous lesions. These eruptions are distributed over the cutaneous segments of the affected nerves. The vesicular eruption is accompanied with much swelling and tenderness. The lesions vary in distribution, density and severity. They may be small, discrete and scattered or large, confluent and deep with haemorrhagic bullae. In course of time the vesicles are dried up leaving behind permanent scars on the skin. Unusual site of involvement such as sacral nerve disease may give rise to visceral changes which may lead to, for example, bladder dysfunction.

Clinical variants-

(1) Zoster of the limbs and trunk-This is the usual type where the posterior root ganglia of the spinal nerves are involved.

(2) Geniculate zoster- This is herpes zoster of the geniculate ganglion causing facial palsy identical to Bell’s palsy with herpetic vesicles on the external auditory meatus, pinna and sometimes on the soft palate. Deafness may also be there.

(3) Ophthalmic zoster- This involves the ophthalmic division of the fifth cranial nerve. There may be keratitis, anterior uveitis, conjunctivitis, scleritis, episcleritis, acute retinal necrosis. There may be cranial nerve palsies of which third nerve palsy is the most common but palsies of fourth, sixth and seventh cranial nerves, though uncommon, may occur.

(4) Generalised zoster- In rare cases there may be scattered eruptions all over the body.

Complications- These are secondary infection, very rarely purpura and necrosis in the affected segment and postherpetic neuralgia.
Postherpetic neuralgia - Postherpetic neuralgia is intractable pain in the zone of the previous eruption after the subsidence of the vesicles. It occurs in some 10% of patients who are often elderly. It is a burning, continuous pain responding poorly to any treatment and depression is almost always associated with.

Treatment- There are lots of medicines for herpes zoster. A few of them are described below-
Dolich ( Dolichos puriens ) may be used in case of intense itching. It is particularly useful in postherpetic neuralgia. Croton tig (Croton tiglium) 6 or 30 potency is useful especially in pustular eruptions on face where there is intense itching but scratching is painful. It is also useful in herpes with eye symptoms. Semperv.t (Sempervivum Tectorum) is also recommended for herpes zoster. But Cantharis 6 may be recommended as the drug of choice if there is burning sensation with or without itching. And in general Rhus.tox ( Rhus Toxicodendron) 30 should be used. Locally cantharis ointment or lotion may be used.

Labels-Croton tig (Croton tiglium), Dolich ( Dolichos puriens ), Keratitis, Postherpetic neuralgia, Purpura, Rhus.tox ( Rhus Toxicodendron), Semperv.t (Sempervivum Tectorum), Cantharis, Ointment, Lotion, Conjunctivitis, Scleritis, Episcleritis, Retinal necrosis, Uveitis, Geniculate ganglion, External auditory meatus, Pinna, Soft palate, Segment, Facial palsy, Purpura, Hyperaesthesia, Hyperalgesia .

IN SHORT- Herpes Zoster is a viral disease usually occurring in old man due to the re-emergence of varicella zoster virus (VZV) from posterior nerve roots in the spinal cord or cranial nerves into the skin. It usually occurs in persons who had chicken pox several years earlier. General symptoms include fever, malaise, swelling of lymph nodes etc followed by pain burning or shooting or cutting in character restricted to a sensory nerve (dermatomal) distribution and associated with hyperaesthesia or hyperalgesia over the affected cutaneous segments. Within a few days this is followed by appearance of skin eruptions which are usually unilateral and confined to the area supplied by a single sensory ganglion. The commonest sites are the areas innervated by spinal cord segments from third thoracic to second lumber and the trigeminal nerve, particularly its ophthalmic branch. The eruptions heal in about two weeks but pain and paresthesia of the affected area may persist for weeks or months. Of the complications, postherpetic neuralgia is very important. Treatment is as mentioned.

But in every case a doctor should be consulted. Signs including swelling of the eyelid, conjunctivitis or blistering at the site of the nose should seek the attention of an ophthalmologist.