By: *Dr. Lalith Singh, **Dr. Kunal Paul, ***Dr.Divya Agrawal
Abstract: A case of extensive venous ulcer, even infested with maggots, in a diabetic patient was treated very effectively with homeopathic medicines with proper management of the ulcer.
Mrs. M.M., a 75 yrs old lady, attended N.I.H. outdoor on 03/08/2010 with extensive ulceration and swelling of her left leg which has increased to its present stage after a suffering of 20 to 25 yrs. Swelling was dark bluish in colour and the extensor surface of foot up to the knee joint was ulcerated. There were deep irregular ulcers. The ulcerated area above the dorsum of foot was full of maggots. Offensiveness was marked. Left foot up to knee was warmer than the rest of the body. She was admitted in N.I.H. IPD and a detailed case was taken.
Patient when admitted was running 101°F temperature (axillary). She was drowsy and unable to answer properly. After repeated questioning it was found that she was having severe burning pain in affected leg which was more at night and was better from warmth and loose covering. Dark non-coagulable blood was oozing out from ulcers.
History of her present sickness: It started as gradual swelling of her left leg some 20-25 yrs ago. Slowly from a small ulcer her condition worsened. Case was throughout treated by different homoeopathic physicians with no improvement in her case. Her blood sugar was fasting 128mg/dl and PP 207mg/dl. X ray findings of the affected limb showed periosteal thickening seen around lower tibia and fibula. She was non hypertensive.
Patient as a person: Patient appeared quiet apathetic and no information could be gathered as regards to her generalities. Her appetite was very less last few months and she had desire only for liquids. Patient was lying on her back. Her daughter described that these days she has become very irritable due to her sickness and has lost all hope of her recovery. She also told us about her mother’s fastidious nature when she was in better health.
Life situation: Her husband has died some 50 yrs ago, since then she has worked very hard to feed her family which comprises of her two daughters.
Past history: Diphtheria during her childhood
Family history: Nothing revealed
Diagnosis: Venous ulcers with secondary infection
Selection of the remedy: Selection of the medicine was difficult due to paucity of symptoms. While going through the previous prescriptions, all homoeopathic ones, it was found that she has received Arsenic in various potencies and scales in last 20 yrs with a few other remedies like Lachesis 200. Arsenic was still our apparent choice as:
- Pain, burning in nature
- Offensiveness marked
- Relief from warmth
- Fastidiousness, etc.
But after long thought and discussion it was decided to start with Anthracinum 0/1 B.D., as the drug covers the malignant ulcers, septic inflammations, sloughing, terrible burning, and all inflammations in connective tissue in which there exists a purulent focus with modalities like Arsenic and where Arsenic, when indicated, fails.
Considering the severity of condition and her old age, it was important to bring down blood sugar level as well else it would have stood as a maintaining cause in this case. Syzygium jambolanum θ was also given in ten drops B.D as this drug also covers diabetes with old skin ulcers.
Local cleaning and dressing was done under the guidance of our surgeon Dr. M.C.Jhunjhunwala. Leg was kept elevated to 30° to promote drainage.
No fever since last night. Patient opened her eyes but did not reply to any question. Offensive discharge persisted. Severe burning pain at night. On first dressing approximately 80-100 maggots were removed. Dressing was directed to be changed every 5th day to allow for granulation tissue formation.
Patient asked for solid food, could eat as well. Greeted doctor with a smile and asked when her dressing will be done. Pain and offensive discharge (although less in amount) persists. No maggots were found while dressing. As on 11/8/2010, FBS 102mg/dl and PPBS 132mg/dl. Anthracinum 0/2 B.D started and Syzygium was omitted.
General condition remarkably better. Sitting, asking for her choice of food, talking smiling. Pain much less. No burning. Offensiveness and discharge much less. It was surprising to find all large ulcers almost healed up with healthy granulation tissue. Local heat also subsided.
Anthracinum 0/2 continued. Much improved. Walking to toilet herself. No offensiveness with hardly any discharge. No discharge. Soakage almost dry. Appetite, sleep all improved.
Suddenly pain increased with burning. Wound was opened to find in improving condition only.
Pain persisting with increasing severity. Considering Homoeopathic aggravation, Anthracinum was stopped. Evening dose was also not given.
Pain subsided. No burning.
[Patient discharged 10 days later]
- 24/11/2010 (at 3 month follow-up)
Patient is still on placebo, without any complaints.
This case throws light on the subtle power of homoeopathic medicines with correct management that can cause wonders. Within a span of 26 days miraculous results were seen in a case that suffered last 25 years and gave new life to a bed ridden patient.
* R.M.O, N.I.H. **, *** 12th Batch PGT, Practice of Medicine.