Cellulitis
This is a case of 57 yrs old man with
pale, wrinkled & emaciated face, having D. M since 25 yrs, diabetic gangrene of left foot since 2 yrs & diabetic nephropathy since 1 month.
His Sr. Creatinine level was 1.5 mg.% & Blood Urea 52 mg% .
He told me that, he had some minute injury to his left foot 3 yrs back. But because of uncontrolled B.S.L. even after taking prolonged allopathic medication (i.e. Antibiotic & daily dressings) wound was not healing & had gradually became gangrenous. So, allopaths advised him amputation of 2nd toe of his left foot .
Then even after amputation of the second toe of left foot (done before 1 year amputated wound was not healing properly.
(It was a non -healing, severely infected ,oozing & foul smelling, gangrenous ,unhealthy wound.) He came to me with such a critical condition.
INVESTIGATIONS:-USG Abdomen
· Mild hepatic enlargement
· Moderate ascites
· Bilateral large pleural effusion
· BSL (F) :- 84 mg %
· ( P.P.) :- 105 mg %
· Sr.creatinine :-1.5 mg %
· BUL :-52 mg %
· Hb :- 10.6 mg %
Chief Complaints :-
· Bilateral oedema over both limbs since 7-8 months
Appearance of oedematous swelling: Reddish with burning
· Breathlessness with cough since 7-8 months
< ascending > rest
· Non-healing ,oozing , foul smelling, gangrenous wound over left foot since 2 yrs.
· Fever on & off since 20 days with rigors , heart & sweating
· H/O Pneumonia 15 yrs back
· H/O D. M. since 25 yrs
·
H/O mild hepatic enlargement with moderate ascites with bilateral pleural effusion
· H/O Typhoid in CH.
· During consulting I observed that , he was sitting with
stooped shoulders with distended belly.
· Breathlessness with cough since 7-8 months.
< Ascending
< Exertion
· Oedema over both limbs Rt - Lt with
marked redness of oedematous parts Intermittent fever with chills & weakness.
· Moderate ascites & bilateral pleural effusion Along with this
· Patient was thirsty with burning and sour eructation
· He had
rumbling in the abdomen <early morning, at about 4 am
· Unsatisfactory mucoid, reddish stools
PHYSICAL GENERALS:-
Desire :-
Eggs, Pungent ,spicy ,vegetables ,fried food, sour
Aversion :- Sweet
Food < :- Toor dal <acidity.
Thirst :- Thirsty
Stomach :- Acidity with heartburn & sore vomitting
Abdomen :- Rumbling in abdomen in early
morning at about 4a.m
Stool :-Unsatisfactory stools. Has to go 3-4 times to pass stool
stool were mucoid & slight reddish coloured
Habit :- P/H/O Habit of cigarette smoking &chewing Ghutakha.
Desire :- Eggs , pungent , spicy , fried food
Aversion :- Sweets
Thermally :- Hot
Mind
-
TELL ME ABOUT YOUR NATURE
I am a mild, adjusting person. I don't want to trouble others. Generally I keep
everything to myself I like enjoying and travelling.
About education : 11th science.
-
TELL ME EXACTLY SINCE HOW LONG YOU ARE DIABETIC ?
I am diabetic since age of 28, just a year after my marriage .
H/O conflicts with wife
·
-
TELL ME ABOUT YOUR HOBBIES / INTERESTS ?
I am very much interested in sports specially cricket & badminton. I enjoy
travelling. I like to be busy all time, specially in my business.
Since last 3 yrs , I am quite worried about my health.
H/O financial loss, thinking over that matter, make me tensed .
-
TELL ME ABOUT YOUR BUSINESS?
I am having hardware manufacturing business which is in partnership with my brother . I am also having my another own business.
Generally , I don't get angry easily . I am mild person . But if anything happens
against my wish, it made me irritable .
-
AS PER TO MY OBSERVATION :
He is mild , yielding person with loud speech .
RESPONCE :-
- After receiving a single dose of Apis -30 gradual improvement started. His cough & breathlessness gradually decreased.
- Oedema also started declining with obvious bony prominences. The non - healing ,oozing wound started healing & meanwhile the
dose of insulin which was previously about 40 units daily was also tapered gradually & now
the patient is on 5 units of insulin daily.
- After about a month at the time of discharge, wound had almost become dry & due to disappearance of ascites & oedema of the limbs,
the
patient's weight was reduced to about 7-8 kg.
- His cough & breathlessness almost vanished with improvement in general condition of the patient .(thirst & appetite improved )
- The patient was fresh & comfortable .