A Case of Seronegative Spondyloarthropathy

Preliminary Information:

NAME: Mrs. D.K.
Age: 46 yrs.                      
Sex: Female
Marital Status: Married since '76              
Education: J. J. School of Arts
Occupation: Housewife                           
Add: Vashi

Chief Complaint:

Associated Complaint:

Personal History:

Perspiration    :        Neck3, back3, legs2, Colour yellow, fast2, odor+

Desires          :        Sour², Seasoned³, Pickles², Sweets²

Sleep            :        Light, disturbed thoughts.

Dreams          :        Accident, death relatives (Brother), Marriage, Snake³.

Sexual Relation         :          after 3^rd child, Coition during < C/C³

Thermal Response     :        Chilly

General Modalities     :        < Sun

                                      < Bus

                                      < Fasting - Coldness & Numbness of fingers.

                                      < Wet getting - nose block

Menstrual function:  

Menopause since 3 years, late 6-8 months, color - brown-red, scanty, stain - fast2, clots2, 3 days before <³ C/C, weakness, irritability.

Pregnancy:

Jaundice 1^st pregnancy (Abortion) in '78

Varicose veins during pregnancy

2 FTND ('77, 81) ('85 1 FTND died of pneumonia)

(FTND - Full Term Normal Delivery)

Life Space:

A female in early forties coming form a middle class gujarathi family. Her Husband is accountant in a private firm. She has 2 daughters 14 & 10 yrs they are residing at Vashi. Her childhood was in poverty, Father was working with a grain merchant at Masjid Bunder. He is of irritable domineering temperament. He was vexed over financial worries and he vented all his irritability at home. Throwing plates was a regular scene. As a child they were in a state of fear. House was small, all their basic need was unfulfilled. She said they avoided going to any function because they did not have descent clothes.

Now her father is an estate agent in Ghatkopar. He is irritable3, outspoken3 and can insult anyone in the gatherings. But he is sentimental also and will apologize later. She is the 2^nd daughter she is more attached to her parents and will rush to them at the 1^st news of any discomfort. She is irritable like her father and any contradiction will give her anger and throw things. She is anxious from the beginning and will be anticipating any bad happening. All sisters are good at drawing and she has taken a job of drawing teacher.

After marriage she came in joint family. Younger BIL had love marriage at same time. SIL & she could not get along from the beginning as she felt her dominating. Husband would not interfere in their matter. Husband got an opportunity to do trading business of machine spares parts in Nagpur. She joined him in a year's time, business was flourishing and they were the happiest times. But after 2 years they suffered heavy losses and have to return to Bombay. They stayed with father, here they had humiliating experience with Brother & SIL as they treated them as if they have nothing to stay and they are in need. At the same time she had an unplanned pregnancy. Son was born in '89. but he expired on 5^th day due to Pneumonia. She went through prolonged grief depression after this.

BIL sold flat, gave them Rs. 90,000/- than they went to Vashi. Now she is teaching drawing and her husband is going for job and they are more peaceful. But her complain have started after physical sprain. 4 yrs ago when they had booked a bigger house for a few months they had to stay in fathers house. Her 2 sisters taunted them that they are even now dependent on father, Patient and husband were very much hurt but father did not cleared up the matter. They felt neglected due to brothers extravagant ways as he is a millionaire now and this large gap hurts her. She has fear of deadbody3, alone3, dark3, accident, bad news, she is very sensitive to her circumstances3, she is excitable3 and cannot bear contradiction.

Physical Examination:

General: Normal                   

Systemic Examination:

R.S.: NAD                CVS: NAD                P/A:  NAD                CNS: NAD

Examination of Spine and Back

No tenderness of spine

SLR +ve.

Knees - mild crepitus

Left leg varicose veins++

Investigations:

X-ray Lumbar spine Ap/Lat

11/03/91:     

Disc space (N)

Mild sclerosis and osteophytosis along with anterior comes of L4 L5

Suspicious break at pars inter articulars of L5

Degenerative spinal changes

No evidence of Lysis

Case processing:

Diagnosis of disease  :        Seronegative Spondyloarthropathy

Dominant Miasm        :        Sycotic

Susceptibility           :        Moderate

Sensitivity               :        Moderate à High

Analysis and Evaluation of symptoms:

Anger contradiction+++                              Qualified Mental general

Anticipatory anxiety+++                            Qualified Mental general

Fear of dead body+++                               Qualified Mental general

Fear alone+++                                          Qualified Mental general

Fear of dark++                                       Qualified Mental general

Vexation < ++                                         Emotional modalities

Dreams snakes++                                   Characteristic Mental Subconscious

Craving - sour++, seasoned++, pickle++     Characteristics Physical General

              Sweets++

Menses stain fast+++                                Characteristics Physical General

Perspiration neck3, back3, legs3               Characteristics Physical General

Perspiration stain fast2                           Characteristics Physical General     

< Before menses3                                  Characteristics Physical G modalities

Throat pain3, < C.O.W3., < Cold drink3

Sour3, Cold food3

Back ache, < coition during3                             Characteristics Physical Particular  Modalities                                         

> Lying on right side2

> lying on back2

Chilly                                                   Characteristics Physical General

                                                          Modalities

Repertorial Totality:

Rubrics:

Mind; Anger; Irascibility; Tendency; Contradiction, from

Mind; Anger; Irascibility; Tendency; Violent

Mind; Anxiety; Anticipating

Mind; Fear; alone, of being

Mind; Fear; dark

Mind; Dreams; animals, of; snakes

Generalities; Food and Drinks; Sour, acids; desires

Generalities; Food and Drinks; Spices, condiments, piquant, highly seasoned food; desires

Generalities; Food and Drinks; Pickles; desires

Generalities; Food and Drinks; Sweets; desires

Perspiration; Staining the linen; difficult to wash off

External Throat; Perspiration

Back; Perspiration

Extremities; Perspiration; lower limbs

Female; Menses; wash off, difficult to

Generalities; Menses; Agg; before

Throat; pain; general; cold; agg; things from

Throat; pain; general; weather; change of, with

Stomach; thirst; pains; with

Back; pain; general; lying, while; amel; back, on

Back; pain; general; lying, while; amel; side on; right

Diagnosis of remedy: Kali Carbonicum.

Selection of Potency & repetition - 30 every night & gradually increased

Follow up:

Sept'91 - Dec'92: Backache >+, able to sit without belt for ½ hour, SLR - 40⁰, frequent episodes of Upper Respiratory Tract Infection - à > Rhus Tox 200 - 1M repeated doses on & off.

Treatment: Kali Carbonicum 30 1P - 3P - 7P, 200 3P-7P, 1M was given in gradually increasing doses depending on the progress of the complaints of a patient.

Thuja 200 - 1M was given once a month doses.

Jan'93 - Dec'94: Complaints fluctuate with exacerbation and remission. Acute exacerbation where control with Bryonia 1M in repeated doses.

Treatment: Thuja 1M, 3P-7P-BD given in regular doses

Kali Carbonicum 10M 3P-7P, Later Kali Carbonicum 50M 1P-7P HS given at regular interval.

Jan'95 - April'96: Backache erraticity continues, Upper Respiratory Tract Infection complaints continue with acutes settle with Ars Alb 10M in repeated doses

Treatment: Kali Carbonicum 30-7P, 200 BD, 1M 7P was restarted with fresh assessment of susceptibility.

Jan'97 - Sept'97: Mental discord between Husband & Wife, Backache++, Wrist pain, Rib pain, plenty of UPPER Upper Respiratory Tract Infection

Treatment: Sepia 200, 3P-7P TDS with Thuja 1M 7P HS given.

Sept'99 - Jan'04: Upper Respiratory Tract Infection > 2-3 attacks per year, Musculo skeletal symptoms  >+

Treatment: Kali Carbonicum 1M 7P - BD and Thuja 1M daily doses.

Jan'05 - March'05: Eye complaints, Lt eye itching, canthi redness, Left Sacro iliac joint painful, complaints fluctuate ++

Treatment: Kali Carbonicum 1M contd.... With Thuja 1M daily doses.

Discussion:   There is a requirement for frequent repetition of doses with various potencies and need for anti-miasmatic. There are plenty of acute exacerbations requiring acute prescription.

Symptoms are too many, analysis and evaluation, and gradation helps in the right selection of the totality. Vexation< is absent in the repertory. It is given as anger, vexations, thinking about former (Past events) (Dwells on past disagreeable occurrences.