Creating Waves of Awareness
A Case Of Nephrotic Syndrome
Dear Homeopaths, kindly help how I should proceed further in this case.
1. I had a case of 4 year 7 months girl child, diagnosed with Nephrotic Syndrome (NS) with odema when she was 1 year 10 months old. Her mother during pregnancy and her child had been under my supervision as well as conventional medicine since then
2. Her mother during her pregnancy had a placenta previa (for which she was given Sepia 30 followed by Nux Vomica 200 after 3 days during the last week of pregnancy), Intra Uterine Growth Retardation (for which she was on low dose aspirin (75 mg daily during the last 2 months of pregnancy) and gestational hypertension (for which she was given Sulplhur 10M single dose three weeks prior to delivery but the effect of remedy was very short-lived). She was given two cortico-steroid (betamethasone) injections for lung development of child. The child was born prematurely by cesarean at 8 months. The child did not contract jaundice
Past Complaints
3. The child had obstructed lachrymal duct at birth which did not go away by pressing the inner canthi, for which Natrum Mur and Rhus Tox was given at the end of 1 year. The duct got opened.
4. The child had frequent bed falls in first 1.5 years (as many as 30). Every time she was given Arnica 200 immediately and rarely natrum sulph.
5. The child suffered from frequent bacterial conjuntivitis in first 3 years, the first one at 10 days after birth. Often she had yellow or green mucous in her eyes which were sticky when she woke up in the morning. Pulsitilla was quite effective as well as Tobramycin eye drops.
6. The child suffered from frequent viral fever from the onset of NS to 3 years and 9 months. The first fever was at 5 days after birth for which she was given Natrum Mur.
She experiences excessive sleepiness for fevers above 100. Her head is hottest followed by upper part of the body and then the extremities. Homeopathic remedies were quite effective as well as paracetamol
7. The child suffered from frequent diarrhea in first 3.5 years (loose, watery, yellow) which was greatly relieved by Nux Vomica. In the first 5 months, whenever the child was nursed, she passed greenish-yellow stool. She was never constipated.
8. The child suffered from frequent and persistent wet cough (viral) from 1 year 1 month to 4 year 4 months which never goes away easily.
Every cold goes through the nose to the chest quickly. Expectoration is transparent and frothy. She gets fever often whenever she catches cold when heated. Cold to Cough to fever quickly in matters of hours.
Different symptoms at different times were cough>on going to sleep, cough>after exertion, mucous in throat rattling, mucous in chest rattling, ailments from cold when heated, cough>on waking, abdomen>pain>cough during, chest>pain>cough during, cough>vomiting with, night waking from cough, chest>wheezing, unproductive cough, etc.
From 3 year 1 month to 4 years 1 month of age, she vomits most of the time she slept, especially during night. Sometimes as soon as going on sleep. Drosera was effective but the child developed mild breathlessness. Drosera stopped, Lycopodium resorted to, breathlessness stopped as well as vomiting during cough. Her physicals and generals change so frequently that they call for new remedies. For most of the time she did not came out of the acute situations
Finally Arsenicum Album and Kali sulph alternatively reduced cough by 60%. Now the child can tolerate cold and sour food/drink to quite an extent. Further reduction by 30% in cough by eliminating milk from diet.
9. Ear-ache during last winters (6 months back) more prominent in right ear for which her mother gave her ayurvedic ear drops for which she got relieved each time.
Present Complaints
10. Nephrotic Syndrome with odema
NS since 1 year 10 months of age
TB Test =negative, Chest X ray=normal, Ultrasound = normal except when protein loss remains high i.e. 4+ for long time, then moderate fluid retention in abdomen
Blood Test (during 1st episode): Platlet =821 (high), Cholestrol=394 (high), Cretanin=0.21 (low), Hb=12.6. Once protein loss stops, all the above parameters returns to normal values within the range not immediately but only gradually
Urine: Offensive since NS, pungent odour, Protein loss: 4+
Skin eruptions after the onset of NS: dry+granular at elbows and knees, had ringworm at the left hip region itchy and red, circular eruption during the 1st episode of nephrotic syndrome, paedritician used anti-fungal ointment, ringworm disappeared
In the very first episode, the child was having bronchitis allergy + nephrotic syndrome with odema, she was chilly as the prolonged albuminuria resulted in hypothermia and the thirst for sips of water, the child responded very well to arsenic album and antim-tart and the bronchitis attack subdied, odema lessened, urine report was negative for albumin which was 4+ earlier. But after 5 days again the odema came up, ars was repeated but did not have any affect. The odema kept on increasing. There was also ascitis. The parents resorted her to paedritican who put her on steroids. Later on Calc (in 30 potency) was given to the patient as an constitutional remedy but the odema was aggravated ++ and urine was very scanty. The parents again shifted to steroids.Once protein loss exceeds 2+ and is either 3+ or 4+, no homeopathic remedy tried till date (except arsenic album) has been able to reduce albuminuria. Her Paediatric nephrologist resort to synthetic cortico-steriod (prednisone) for 6+6 weeks during 1st episode and for 2+4 weeks for subsequent relapse. The child has more than 7-8 relapses of NS till date. She is a case of frequent relapser.
Fever or wet cough or prolonged dry cough triggers albuminuria immediately.
She has been almost on steroids since the time NS has been diagnosed. The side effects of prednisone includes hypertension, acidity, calcium depletion, cataract and suppresses the immune system.
before NS she remained active during fever but after NS she has excessive sleepiness as the heat rises
Suppressed Fever has some role to play in NS
11. Nosebleed: Between 3 years 3 months and 3 years 8 months, the child had two falls resulting in injury inside nose and bleeding. Now she frequently bleeds whenever she blows her nose hard, picks or when violent cough.
12. Inter-Dental Carries at the side of teeths since the child was 2 years 8 months
13. Freckles: child has started having freckles (had 5) in the last one year
The child was hit hardest from 1 year 10 months to 3 years when she had Nephrotic Syndrome all the time and frequent Conjunctivitis, fever, diarrhea and cough.
General picture of patient
GENERALS: Thin, little Brownish hair (which were black at birth but gets converted to brownish by 6 months of age), easy perspiration on neck and occiput region of head, throat red with tonsils, right one more swollen and once had pin point pus in the right tonsil with yellowish green pus, Colicky abdomen due to obstructed flatus since last 1 year, redness of urethra off and on since birth
MENTALS: Enjoys company of others, Fearful, Fear of dark, desires consolation and appreciation , likes rain, loves dancing (dances gracefully), drawing and colouring
SENSITIVITY: when subjected to frequent loud scoldings while taught by the mother gets frightened, though she is a bright child
SOCIABILITY: more social with females than males, whenever goes to the park hovers around the children and wait for them to call her for play, generally does not take initiative (the first initiation), shy at the first instance whenever meets strangers, later on mixes up well, follows the people she likes but leads who obey her
THERMALS: Can not bear cover during sleep unless it’s very cold, the child kicks off covers at night, on the contrary can not bath with cold water, asks for lukewarm water for bathing, catches cold easily through nose and if left untreated it goes to the chest within a day or two. takes cold easily when walks barefoot. tonsilitis from taking cold or sour food or drinks
DESIRES: Sweet, Salt, Cold drinks, Ice Cream
THIRST: increased during summers that too demands cold water or ice/ice-cream
WHAT HAS NOT CHANGED SINCE BIRTH: love for dance, stools offensive since birth, fear of dark, the child had a mongolian spot at birth at the sacrum of bluish colour which has faded in colour with age
MISCC: the child (as well as the mother) can not bear tight clothes around the body
Family History
Mother: Iron-deficient anaemia (chronic), desires open air, not social (aversion to company), reserved, short-tempered, hot patient
MOTHERS' STATE DURING PREGNANCY severe anemia, attention seeker, pitied herself for not being attended though she was attended, felt unwanted when not attended, the mother was worried,anxious and fearful once the IUGR was detected during the 6th month of pregnancy, had anxiety during nursing
Father: Atopic dermatitis since last 15 years, perspiration offensive, 6 fingers at birth, colicky renal stones, tonsillitis during childhood
Grand father (paternal): Hypertension, asthma, piles
Grand mother (paternal): gallbladder stone
Grand father (maternal): Hypertension, constipation
Grand mother (maternal): Hypertension, uterine fibroids
Any further questions or clarifications regarding the case is welcome
Regards
NancyTags: homeopathy
Views: 14
Replies to This Discussion
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Permalink Reply by Louise Barton on -
Hi Nancy
Debby Bruck suggested I join this group and have a look at your case. I would be more than happy to help you if I can. I am involved with the Victorian College of Classical Homoeopathy research project into miasms and facial analysis (Homeopathic Facial Analysis - HFA). We have been getting consistent results with many pathologies using the traditional method of repertorising on the generals of the case and then fine tuning the final remedies through matching the facial analysis (miasm) of the patient to the miasm of the repping remedies. We have success rates of 80% within 4 remedies using this method.
The case is well laid out and should be able to provide a solid repertorisation. If the patient's parents are willing please have them take facial analysis photos (as per uploaded instructions) and send them to the college - admin@vcch.org. We will provide an analysis and remedy suggestions based on the analysis.
We are so pleased with the clinical success of the HFA methodology and the consistency of results and want to promote and share this throughout the profession. Please see more information at the college site www.vcch.org
Best wishes
Louise Barton
- Attachments:
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HFA photo instructions.pdf, 248 KB
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Permalink Reply by Dr. Nancy Malik on -
Thank you Louise for looking at my case. And thank you debby too. Let me ask the parents of the child and get their consent for the photographs for Facial analysis for identification of miasms.
Regards
Nancy
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Permalink Reply by Louise Barton on
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Dear Nancy
Knowing the underlying miasm of the case - which we can observe through the facial structure - means we can choose a remedy that matches both totality of symptoms AND the miasm - just the way Hahnemann instructed. It is important the photos are taken correctly. The child must be sitting up straight and the camera operator at the same level. Where we cannot get the correct information (if the child can't sit still or the parents don't fully understand the instructions) the practitioner can get the same information in person or via Skype. If you need help please let me know.
We have come to realise that Homeopathy is more a scientific system than an artistic one and when the protocols of Hahnemann are observed the rate of success is very high. These eight principles are vital to include when seeking the correct remedy
- Law of similars
- Potentised remedy
- Remedies known through provings
- Remedy selected by totality of symptoms
- Totality remedy cross matched to miasm (The Chronic Diseases)
- Stronger suppressing the weaker
- Single remedy
- Repeated doses (Organon 6th ed)
Numbers 5 & 6 are as important to the case process as all other principles yet are not widely included nor even understood. The research project we have conducted through the college (VCCH) concentrated on these aspects and we have found when all eight are included the results are remarkable.
Regards
Louise Barton
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Permalink Reply by Dr. Nancy Malik on
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Dear Lousie
Thank you for your kind efforts.
The parents of the child are not convinced about the facial analysis. They say, "how a child can be cured just by seeing the photograph of his face?" They are terming it as unscientific. Let's see if I am able to convince them.
Regards
Nancy
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Permalink Reply by Binay krushna sahu on -
Madam let me remind u about Antim Tart and Aethusa on behalf of the child according to Ur reporting.
I shall also advise her parents not addict her with allopatic drugs as it would diminish her resistance.
If u find allopathic medications the don't forget to give sulphur and neutralize her sufficiently
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Permalink Reply by Dr. Nancy Malik on
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Thank you for your reply.
Yeah, ant-tart has helped her in the initial phase of NS also.
But on what basis are you prescribing aethusa?
Regards
Nancy
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Permalink Reply by Claudia Knecht on -
Hi
I was looking into Salicylicum acidum (aspirin) as I was wondering if the taking of aspirin over period of 2 month has affected the child.
The MM states albuminurie and other symptoms you have mentioned. Maybe worse looking at next to the miasmatic therapie.
kind regards Claudia
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Permalink Reply by Dr K Saji on -
Dear Dr Nancy
Let me try my way
List of symptoms with Evaluation and Analysis.
1. Nephrotic Syndrome – Clinical – Reference rubric (Rr)
2. Edema – Common symptom (Cm)
3. Obstructed lachrymal duct at birth – Past History (PH)
4. Frequent bed falls in first 1.5 years – PH – Chance for Assumption Error (CAE)
5. Frequent bacterial conjuntivitis in first 3 years,.- Striking Reference rubric (SRr)
6. Frequent viral fever - Characteristic+++ (Ch)
7. Frequent diarrhea in first 3.5 years (loose, watery, yellow) In the first 5 months, whenever the child was nursed, she passed greenish-yellow stool. - Ch++
8. Frequent and persistent cough from 1 year 1 month to 4 year 4 months - Ch+++
9. Ear-ache during last winters (6 months back) more prominent in right ear – (Rr)
10. Urine: Offensive since NS, pungent odour, Protein loss - Ch +++
11. Skin eruptions after the onset of NS: dry+granular at elbows and knees – Needs more details and confirmation. (NC)
12. Had ringworm at the left hip region itchy and red, circular eruption during the 1st episode of nephrotic syndrome, paedritician used anti-fungal ointment, ringworm disappeared - CAE
13. Excessive sleepiness as the heat rises – Ch+
14. Nosebleed: Between 3 years 3 months and 3 years 8 months, the child had two falls resulting in injury inside nose and bleeding. Now she frequently bleeds whenever she blows her nose hard, picks or when violent cough. - CAE15. Inter-Dental Carries at the side of teeths since the child was 2 years 8 months - Cm
16. Freckles: child has started having freckles (had 5) in the last one year – Ch++
17. Thin, little – Ch+
18. Brownish hair - Rr
19. Easy perspiration on neck and occipital region of head – Ch+
20. Throat red with tonsils, right one more swollen and once had pin point pus in the right tonsil with yellowish green pus, - Cm
21. Colicky abdomen due to obstructed flatus since last 1 year - NC
22. Redness of urethra off and on since birth – Ch+
23. Enjoys company of others - Cm
24. Fearful, Fear of dark – Ch+
25. Desires consolation and appreciation - Cm
26. Likes rain, Rr
27. Loves dancing – Ch+ (dances gracefully), drawing and colouring
28. SENSITIVITY: when subjected to frequent loud scolding while taught by the mother gets frightened, though she is a bright child - CAE
29. SOCIABILITY: more social with females than males, whenever goes to the park hovers around the children and wait for them to call her for play, generally does not take initiative (the first initiation), shy at the first instance whenever meets strangers, later on mixes up well, follows the people she likes but leads who obey her CAE
30. Can not bear cover during sleep unless it’s very cold, the child kicks off covers at night, - Chance for over generalization error (COGE)
31. Cannot bath with cold water, asks for lukewarm water for bathing, - Ch+
32. Catches cold easily through nose and if left untreated it goes to the chest within a day or two – Ch+
33. Tonsillitis from taking cold or sour food or drinks – Ch+
34. DESIRES: Sweet, Salt, Cold drinks, Ice Cream – Ch+
35. THIRST: increased during summers that too demands cold water - Cm
36. Stools offensive since birth - Cm
37. Cannot bear tight clothes around the body – Ch+
Rubrics for Repertorisation Proper :
- Fever, Relapsing
- Coughing, Chronic
- Rectum, diarrhea, Chronic
- Urine, albuminous
Repertorial Result :
Ars 1123 – 7/4
Sulph 3112 – 7/4
Remaining Symptoms :
- Eye, inflammation recurrent (6) - Ars, Sulph
- Sleep, Sleepiness, fever, during - Ars, Sulph
- Skin, freckles - Ars, Sulph
- Generals, Lean, thin. - Ars, Sulph
- Scalp, perspiration, occiput. (16) - Ars, Sulph
- Urethra, Redness of meatus. (12) - Sulph
- Mind, Fear of dark - Ars, Sulph
- Mind, Dancing -
- Generals, bathing, aversion to cold (6) - Sulph
- Throat, pain, cold drinks from (13) - Ars, Sulph
- Desires, sweets - Ars, Sulph
- Desires, salt - Sulph
- Desires, ice – Ars, Sulph
- Desires, cold drinks - Ars, Sulph
- Generals, clothing, loosening amel - Ars, Sulph.
Ars has given you some positive response as it covers many symptoms of the case.
I think a dose of Sulphur may give further improvement.
May be I am wrong, but I was trying to explain my view point.
Saji
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Permalink Reply by Debby Bruck on -
Dear Dr Saji ~ So nice to see you today. Thank you for Abbreviation Key
Clinical – Reference rubric (Rr)
Common symptom (Cm)
Past History (PH)
Chance for Assumption Error (CAE)
Striking Reference rubric (SRr)
Characteristic (Ch)
The Plus + indicates weight of each rubric/symptom
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Permalink Reply by Dr K Saji on
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Dear Debby,
I was using those Keys just to avoid repetition of terms.
'Rr' was used for 'Reference rubric' ie. 'A rubric with only a few medicines under it. (Below five - technically )
Common symptom - A symptom which is found under many medicines and many diseases. ( Many have a confusion regarding 'common symptom' and 'disease symptom'.)
We should think seriously for some universally acceptable abbreviations keys for the commonly used homoeopathical clinical terminologies.
Saji
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Permalink Reply by Debby Bruck on
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Good idea. I have such a hard time remembering the meaning of abbreviations. It's much easier for me to read out the entire word or phrase.
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Permalink Reply by Dr. Nancy Malik on
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Dr. Saji
Thank You very much for your detailed investigation into the case as well as sorry for replying late.
I appreciate your effort in coming out with Sulphur. Many of the symptoms are of sulphur as you have shown. And I can see many of them are also indicated in phos. So the choice largely rests among ars, sulphur and phos.
Thank you once again for your help.
Regards
nancy
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