This is a case of a 49 yr old man suffering from a life threatening disease Acute Hepatitis - B with immune complex and Glomerulonephritis diagnosed in January 2004.
When he reached my hospital he was so exhausted that he could not walk by himself. I observed that he was very pale with a distinct yellow hue. His limbs were swollen, abdomen was distended, eyes dark yellow like turmeric & an equally deep yellow colored nails. He was drowsy & breathless on minimal efforts while sitting.
Hepatitis B : Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus which attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person.
Hepatitis B virus can cause an acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. HBV can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.
Despite all the care taken during blood transfusion, and Hepatitis vaccines available, the disease incidence is increasing nowadays through unprotected sex. The complications include the fulminant hepatic failure which is life threatening. Encephalopathy due to excess nitrogenous waste, cerebral oedema and haemorrhages are the dreaded features of a complicated Hepatitis.
INVESTIGATIONS :
26/01/2004 :
- Australia Antigen +ve.
- Sr. Creatinine - 4.20 mg/dl
26/01/2004 :
USG Abdomen & pelvis :
- Liver parenchymal disease.
- Bilateral medical renal disease.
- Moderate ascites.
- Minimal pleural effusion on (Rt) side.
- Platelet: 60,000. (Normal >1.5 lacs)
20/02/2004 :
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Sr.Bilirubin total : |
19 mg / dl. |
|
Direct : |
16 mg / dl. |
|
SGOT : |
433.0 U/L |
|
SGPT : |
441 U/L |
|
Alkaline phosphatase : |
148.0 |
|
Blood urea : |
60 mg/dl |
C / C
Pain in abdomen since 1 month.
- Dull aching pain present around umbilical area.
- Pain is ascending type.
|
< Bending forward. |
> Lying on (Rt.) side. |
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< Sitting erect. |
> Leaning backward |
Severe weakness since one month.
Exhausted feeling with giddiness
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< While walking |
> lying on (Rt.) side |
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< Standing |
< Exertion. |
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< Ascending & descending steps. |
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Drowsy feeling since one month.
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< Sun heat. |
> Rest. |
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< Daytime. |
> Lying on (Rt.) side. |
Past History :
- H/o Small pox in childhood.
- H/o Jaundice – 18 yrs back.
- H/o Hepatomegaly and ascites 3 yrs back.
Physical Generals
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Habit : |
Smoking, drinks (occasionally) and gutakha. |
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Appetite : |
Reduced |
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Desire : |
Sweet, Sour, Milk, and Fruits. |
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Food : |
Curd < Acidity. |
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Thirst : |
Previously thirsty now thirstless. |
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Tongue : |
Pale with central furrow. |
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Stomach : |
Nausea with sour eructation |
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Urine : |
Deep yellow colored. |
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Nails : |
Deep yellow colored. |
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Perspiration : |
Profuse on soles only. |
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Sleep : |
Disturbed, sleepless at night. Drowsy during daytime. |
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Position – lies on Rt. side. |
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Head high. Snoring loud. |
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Thermally : |
Hot patient. |
I continued the case as follows :
Tell me something about your childhood.
I was born & brought up in a small village in Haryana. I have 3 brothers & 4 sisters. I enjoyed my childhood with my family members & friends. I completed my B.A. I married in 1974 according to our tradition. I have 2 sons and a daughter.
Since how long are you in Mumbai?
Before coming to Mumbai I had a small business of transportation in 1978. Few years later, 1980 proved to be an unlucky year for me. I met with an accident that year. I was carrying the Forest Department’s plants with some officials & laborers. A truck dashed against my van. It was such a great impact that the van rolled 3 to 4 times. Everybody was injured & one of the laborers died on the spot. The dead person was my relative. I felt very sad. He was the only earning member of that family. I felt guilty & offered a good amount to his family as compensation. But after that incident I couldn’t concentrate on the transport business. So I shifted to Mumbai. Now I am working with a cloth processing company.
How is your nature?
I like to help others. I am mild & don’t like to hurt others. I like being in company & I am very emotional. I am always anxious about my work & my business. According to others I am slow in my work. I think a lot on all aspects, before doing anything. I am very straightforward. I am also a bit homesick. I love my family very much.
When do you become sad?
I help all those who are in need, especially my relatives but when I was in need, none of these people helped me which made me sad. Hence I detached myself from such relatives.
Any recent tension in your life?
I am very attached to my family but nowadays my brother is indulging in alcohol. He does not work & keeps demanding money. I am worried about his future. He does not even respect my mother who has become ill because of his behavior. Even when I am working I cannot put aside these thoughts completely.
Tell me about your hobbies?
I like socializing, going to hotels & partying with my friends.
Do you have any fears?
I am afraid of ghosts & darkness since my childhood.
Thermal : HOT.
Shows periodicity in its complaints like < 4 - 8 pm.
Remedy for Acute Hepatitis - B negative
Totality :
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Anxiety about business.
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Anxiety conscience
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Enjoyment desire(parties etc)
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Socialize
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Sympathetic.
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Fear of darkness & ghosts.
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Hatred towards persons offending.
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Forsaken feeling by beloved ones.
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(Rt) to (Lt) complaints.
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> Lying on Rt side
.
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< Standing.
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Weakness-from slight exertion.
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Sluggishness of the body.
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Desire: Sweets, Alcohol, Smoking & Tobacco.
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Profuse perspiration over soles.
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Sleepless at night with drowsiness during daytime.
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Desires Fanning.
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Thermal : HOT.
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Miasm : SYPHILIS.
Remedy Selected : SULPHUR 30
Response :
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Observing his poor health I advised him immediate hospitalization. On the next day in the morning he gave me a warm welcome with a smiling face. I observed rapid improvement on general, physical & mental level. Within 2-3 days his appetite started improving which had decreased for last one month. Even his nauseated feeling had subsided.
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He started looking more fresh day by day & taking walks on his own. Also the swelling over his body deduced rapidly. Along with this yellowishness of the sclera, tongue & nails also decreased.
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The serial investigations carried out also showed decrease in bilirubin count with improvement in Hb%.
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Also the anxiety & fear about his life threatening disease, also disappeared.
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He was very happy with a dramatic improvement in his health. He was kept under observation for about 15 days.
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Afterwards when he was investigated for bilirubin count, he curiously carried out Australia antigen test which was negative for Hepatitis B.
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On getting discharged, there was happiness on his face but there was a lack of confidence about the negative report. He was quite anxious about his future. But he was doubtful about that. Even the pathologists were also shocked after seeing the negative test.
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He finally reconfirmed it at 3 more reputed Laboratories & was very happy to get a new lease on life.
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Now he is free from Hepatitis B & has started working hard (for about 12 hrs a day). His weakness has gone without any I .V fluids or any other supplements, with a single dose of Sulphur –30.
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After 15 days he came back for a follow up with a big smile on his face. He had reconfirmed all the reports once again from a well-known lab in Mumbai. (A big thick file).
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Every report showed Australian antigen to be negative.
Investigations : After Medication
|
Investigation |
18/03/2004 |
03/05/2004 |
|
Sr.Bilirubin total |
4.7 |
1.5 mg/dl |
|
Sr. Bilirubin Direct |
3.3 |
1.0 mg/dl |
|
SGPT |
128 |
23 U/L |
|
SGOT |
106 |
31 U/L |
|
Sr.Alkaline Phosphatase |
203 |
98 U/L |
|
Blood Urea |
24 |
|
|
Sr. Creatinine |
1 |
|
|
Investigation |
25/02/2004 |
01/04/2004 |
|
Hepatitis B / Australia Antigen |
+Ve |
-Ve |
D/D : The most answers got were. We can differentiate it :
LYCOPODIUM : It is the Right sided remedy. Symptoms moving from (Rt) to (Lt). It is mostly indicated in liver disorders & jaundice. It is an ambithermal remedy with fanning desire. But symptoms pointing towards SULPH are < Standing & ascending direction of pain whereas descending pains are seen in LYCO. Mentally SULPH shows A/F business worries, desire enjoyment and on the other hand LYCO is more mild and submissive remedy. SULPHUR shows anxiety conscience which is not the case with LYCO. Also the patient shows a give and take kind of nature in terms of relation which again goes for sulphur.