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A Case of Chronic Osteomyelitis with Trophic Ulcer of FootHomeopathic Journal :: Volume: 1, Issue: 5, Jul-Aug 2008 (General Theme) - from Homeorizon.com
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Author : Dr. Aloke K.Ghosh, BHMS, MD Article Updated: Oct 18, 2009 |
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ABSTRACT- A 6 yrs. female child was suffering from Swelling of both legs (feet) with ulceration and discharging sinuses since 2yrs was treated successfully by Homoeopathic medicine. PRESENTING COMPLAINTS- Swelling of both legs (feet) with ulceration since 2yrs. Incontinence of urine since birth. Numbness of both legs since birth. HISTORY OF PRESENTING COMPLAINTS- 1) Swelling of both feet with ulceration since 2yrs. Onset- Gradual Location- initially ulcer developed first on left great toe and then various small Irregular ulcer developed on dorsum of foot also involving sole of feet. On medication, the ulcer got healed up. Then after due to playing bare foot ulcer developed again on medial side of right sole. On left foot also ulcer again due to rat biting. Character of ulcer- left leg ulcer-irregular shape, Blood oozes out. No discharge with formation of crusts, when ulcer dries up. Right leg ulcer- irregular margins, no discharge. Associated complaints- there is sinus formation below the ulcer on right Sole of foot. Diagnosed as Osteomyelitis Character of discharge- Pus from sinus, white, watery, sticky and offensive discharge. Diagnosis given from A.I.I.M.S - Osteomyelitis of right ankle joint with tropical ulcer and discharging sinus. Lipo-meningomyelocoele with neurological deficit left lower limb. 2) Incontinence of urine since birth Mode of onset- At the time of birth she was diagnosed with spinal cord tumour in the lumbar region at 14yrs of age, which was operated. At 1yr of age her mother noticed incontinence of urination and after operation in 2002 she was diagnosed with neurogenic bladder. Character of urine- Dribbling of urine with normal stream and scanty sometimes. No burning. Frequency- D7-8 N0. since last 1yr, she tells about the urge for urination. Photograph take before the treatment
PAST HISTORY- History of memeigomyelocele at 1yr of age (2002) History of vaccinations- not given History of X-ray- done. PERSONAL HISTORY- Diet- veg Developmental landmarks- On time Addictions- Nil Environment at home- Congenial PHYSICAL GENERALS- Thermal reaction- Chilly Appetite- Normal, 3meals/ day Thirst- Reduced, 1/2- 1L of water/ day. During fever thirst increased. Urine- Incontinence of urine, D7-8 N0, no burning, offensive. Stool- Normal, satisfactory stool. But usually remains constipated. Desire- Fried, spicy. Aversion- Sweets Sleep- Normal Dreams- N.S MENTAL GENERALS- Anger, introvert and reserved. Desire company. Memory- normal. PREVIOUS TREATMENT & INVESTIGATIONS REPORT-Patient was diagnosed as 'Meningomyelocele in the lower lumbar region' from A.I.I.M.Sl, New Delhi on 19-01-2002. For this she was operated on 24-01-2002.Patient developed neurogenic bowel & bladder since the time of operation. Then patient developed 'Osteomyelitis & Trophic ulcer of the foot' according to the report of A.I.I.M.S on 29-10-2004 which was treated by allopathic medicine since then but no improvement found of the Osteomyelitis & Trophic ulcer of the foot. INVESTIGATIONS REPORT- 6/02/06 VSG- normal ventricular system 14/02/06 MRI- spine- lipomeningomyelocele in lower lumbar region with thickening of distal cord to the wall of the sac. 10/7/02 USG KUB- normal study 18/07/02 FUC of lumbosacral meningomyelocele- plain X-ray, Lt CDH, shows failure of fusion of posterior process. No VUR, PVR present. 23/07/02 urine test- RBC- 5-10/HPF WBC- 15-20/HPF 18/02/02 muscles test- ankle, foot and planter flexor; Muscle power- 0 29/10/04 blood test- Hb- 4.7gm/dl HCT- 17% RBC- 2.46x 10 Platelet count- 476 MCV- 69ft MCH- 19pg MCHC- 28gm/dl 29/10/04 blood biochemistry- urea- 25gm% Cr- 0.4mg% Total protein- 6.7gm% Albumin- 2.9gm% Globulin- 3.8gm% SGOT- 35IU SGPT- 14IU Alkaline phosphate- 112IU 18/02/05 urine test- RBC- 4-6/HPF, 40-50/HPI calcium oxalate crystals- + 28/02/05 USG(KUB)- significant PUR 28/02/05 filling cystometry- cystometric capacity- 89ml static complain- 2ml/cm H2O 5/03/05 MCV- trabeculated outline of bladder with significant PUR. 05-09-2006 Routine haemogram on 05-09-2006 shows there is microcytic hypochromic anaemia. SYSTEMIC EXAMINATION- CENTRAL NERVOUS SYSTEM- Higher functions Consciousness- fully conscious. Intelligence- good. Memory- intact both recent and past. Behaviour- normal. Speech- normal. Orientation- normal. Cranial nerve examination All 12 cranial nerves- normal. Motor cranial nerve Tone- normal in upper limbs. knees, ankle - reduced. Power- U/L- normal L/L- ankle joint reduced, Sensory system Superficial sensation Touch- absent in left lower limb below knee. Pain- upper limb present, below knees absent. Deep sensation-Normal Reflexes Superficial- abdominal reflex increased. Deep tendon reflexes- normal SPINAL EXAMINATION Inspection Scar marks can be seen on spine. Palpation No pain PRESCRIPTION- 5.09.06 11.00pm fever- 103.4o F P.R- 162/min RX Bell 200/4, fractional doses 6.09.06 D/R- all complaints same but fever better. PG's Appetite- Normal Thirst- Small quantities frequently, mouth dry. Stool- Normal, constipated sometimes. Urine- Incontinence. Sleep- Normal. Tongue- White coated thickly. Thermal reaction- Chilly patient Desire- Salty, fried. P.R- 92/min R.R- 18/min. Rx Silicea 0/1, B.D for 2days Dressing with calendula. 8/09/06 GCs- same Fever-102.40 F Rx Silicea 0/1, B.D for 2days 10/09/06 P.R- 116/min R.R- 26/min Rx Silicea 0/1, BD, 1day 11/09/06 fever- 1010 F PR- 74/min RR- 20/min Rx Silicea 0/3, BD, 1day 12/09/06 PR- 92/min RR- 22/min 13/09/06 PR- 76/min RR- 18/min Rx Silicea 0/3, OD, 1day 14/09/06 PR- 80/min RR- 14/min Rx Silicea 0/3, OD, 1day 15/09/06 GCs better PR- 100/min RR- 20/min Rx Silicea 0/3, OD, 1day 16/09/06 PR- 105/min RR- 24/min Rx Silicea 0/3, OD, 1day 18/09/06 PR- 110/min RR- 25/min Rx Silicea 0/3, OD, 1day 19/09/06 PR- 78/min RR- 18/min Rx Silicea 0/3, OD, 1day 20/09/06 PR- 120/min RR- 28/min Rx Silicea 0/3, OD, 1day 21/09/06 PR- 90/min RR- 28/min Rx Silicea 0/3, OD, 1day 22/09/06 PR- 120/min RR- 26/min Rx Silicea 0/3, OD, 1day 23/09/06 fever- 1030 F PR- 102/min RR- 24/min Rx Silicea 0/5, OD, 2days 24/09/06 fever- 98.40 F PR- 80/min RR- 22/min Area around the ulcer was bruised. 25/09/06 fever- 1000 F PR- 100/min RR- 25/min Dirty thick yellowish discharge from scar. Rx Silicea 0/5, OD, 2days 26/09/06 PR- 92/min RR- 20/min Ulcer discharging profuse, thick, light yellow. 27/09/06 fever- 1000 F PR- 120/min RR- 20/min Rx Pyrogen 200/1dose 28/09/06 PR- 92/min RR- 24/min 29/09/06 fever- 100.60 F PR- 118/min RR- 22/min 30/09/06 PR- 120/min RR- 22/min 1/10/06 fever- 1050 F PR- 102/min RR- 22/min Rx Bell 30/1dose (stat) 3/10/06 fever- 1040 F (8.30pm) R- 126/min RR- 30/min Rx Pyrogen 200/1dose 4/10/06 fever- 1000 F PR- 82/min RR- 20/min RX Placebo for 5days 9/10/06 fever- 990 F PR- 80/min RR- 20/min RX Placebo for 5days 14/10/06 Total healing of foot ulcer with no discharge from sinuses. fever- 98.50 F, PR- 75/min RR- 18/min RX Placebo for 5days Photograph take After the treatment
THERE WAS COMPLETE HEALING OF TROPHIC ULCER OF FOOT WITH LEAST SWELLING AND NO DISCHARGING SINUSES COMMENTS- Patient's osteomyelitis of bone and trophic ulcer of foot improved very nicely by homoeopathic medicine but no improvement regarding her neurogenic bowels & bladder was obtained. SILICEA was prescribed on the basis that, patient was chilly & the particular sphere of action on caries of bone. If we see the Kent's Repertory we will see that Silicea is a medicine that covers the rubric 'CARIES OF BONE' as well as all sub rubrics. In caries of bone-foot, Silicea is the only medicine that covers in 2nd grade. PYROGEN was prescribed on the basis of recurrent fever with septic condition from osteomyelitis and tropic ulcer of foot. |
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The article displayed here is the printed version of the original work found online at www.homeorizon.com. When you want to know anything on Homeopathy visit Homeorizon= Homeopathic Horizon, visit www.homeorizon.com.