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CASES MATERIA MEDICA GENERAL ARTICLES ABSTRACT MISCELLANEOUS Q & A

Case 67: Osteomyelitis: Myths and reality
Prof Mohan G R and Dr Anandhi
Visiting Professor to Vinayaka Missionís Hom Med College and Hospital, Salem. TN.

Abstract:
Osteomyelitis can be satisfactorily treated if it is detected early. Later on treatment is difficult, expensive and time-consuming. In the OPD we have treated a case of Chronic Osteomyelitis with multiple sinuses by Hepar-sulph, an evidence-based case presented to you worth reading and absorbing.

Introduction
Osteomyelitis is inflammation and destruction of bone caused by bacteria, fungi or mycobacterium (1). Osteomyelitis is particularly a tragic preventable disease. It was once common, particularly among the poor, disease of the disadvantaged children of the developing world (3).

Types:
HAEMATOGENOUS OSTEOMYELITIS and TRAUMATIC OSTEOMYELITIS are two types. In Haematogenous Osteomyelitis bacteria reach the bone through the circulation, Traumatic Osteomyelitis particularly follows road accidents and war injuries, in which bacteria reach bone through a badly treated open fracture or wound. It is also seen in inadequate wound toilet and through unsterile theatres. 80% spread is by open wounds and by hematogenous, Trauma, ischemia, and foreign bodies predispose to osteomyelitis. It is often polymicrobial. The metaphysis of a long bone is the usual site. Osteomyelitis in the proximal tibia, the distal femur, the proximal femur, the proximal end of the humerus, the distal radius or ulna, the distal tibia, or the calcaneus. But any bone can be involved and sometimes several of them at the same time. (3)
Osteomyelitis tends to occlude local blood vessels, which causes bone necrosis and local spread of infection. Infection may expand through the bone cortex and spread under the periosteum with formation of subcutaneous abscesses that may drain spontaneously through the skin (3)
Common symptoms are localized bone pain and tenderness with constitutional symptoms like weight loss, fatigue, fever and localized warmth, swelling, erythema, and tenderness (in acute osteomyelitis). In Chronic osteomyelitis bone pain, tenderness and draining sinuses without constitutional symptoms, it takes months to many years (1)

Diagnosis
CBP, TWBC, ESR or C-reactive protein (will be elevated) Culture of bone (Will be positive), abscess. X-rays, MRI, or radio isotopic bone scanningís-rays become abnormal after 2 to 4 wk showing periosteal elevation, bone destruction.

Homoeopathic Concept
CLASSIFICATION OF DISEASE It can be One sided local-surgical or non surgical and needs constitutional treatment to remove the fundamental cause. On the phase of disease it can be psoro -syphilitic as there will be bone necrosis with formation of subcutaneous abscesses.

A Case Of Chronic Osteomyelitis
Mr M, 27, Catholic, came to our OPD on 03/3/2003 with following CHIEF COMPLAINTS. Pain in the left upper arm, pricking type, aggravated at night. Patient in general oversensitive. ON EXAMINATION we found multiple sinuses, offensive discharging of pus and blood, discharge of bone pieces at times. Local tenderness was present.

Physical Generals
Appetite: 2 meals/day
Thirst: Normal
Bowels: Regular
Sleep: Refreshing
Dreams: Nothing specific.
Perspiration: Nothing specific
Thermal Reaction: Sensitive to cold air

Past History: : History of similar complaint in tibia, underwent surgery which healed slowly in 2 years.

Family History:: Nothing particular

Personal History:: Middle school drop out, No Occupation, Unmarried

Investigations:
Blood report: 3/3/2003. Hb: 10.9 grm/dl, Total RBC: 3.78 mill/cmm. Total WBC: 18000 mill/cmm. N89, L16, E02, M02, ESR: 125 after 1st hour, X-rays showed? Osteomyelitis

Classification of Disease:
One sided local-non surgical. Surgery didnít help him; he was in need of constitutional treatment to remove the fundamental cause. Hence it comes under non surgical. The presentation of disease is only on the local part with few symptoms, hence one sided - local. Remedy selected was Hepar-sulph.

Reasons For Selecting:
Hepar-sulph were offensive discharge, over sensitiveness, sensitive to cold air, it is a good remedy for suppurative stage with already formed pus, to remove the sequestrum and it helps in healing.

First Prescription on 03/3/2003:
Hepar-sulph 30, 3doses, Rubrum (40) 4pills 12 hourly, for 15 days, advised to clean the area with Calendula external application daily.

Follow Up
21/3/03: No much change only offensiveness of discharge was less. Total count of WBC has came down, ESR was little less. Hepar-sulph 30, 3 doses was repeated along with Rubrum (40) 4pills 12 hourly, for 30 days. (Table1)

10/4/03: Patient reported and said pains are less by 25%, offensiveness of discharge and discharge was less but Total count of WBC shot up to 11800 and ESR was little less comparative to previous readings. Rubrum (40) 4pills 12 hourly, for 15 days and Calcaria-sulph 6x biochemical tablets were given 4+4 12 hourly.

28/4/03: No much change, Hepar-sulph 200, 3doses, Rubrum (40) 4pills 12 hourly, for 30 days.

23/7/03: Came with blood report. Total WBC came down to 8900 and ESR was little less. Pain and discharge was less. Since some discharge was present, a dose of Syphilinum 1M, 1dose was given along with Rubrum (40) 4pills 12 hourly, for 15 days and after 15days Calcaria-sulph 6x biochemical tablets were given 4+4 12 hourly.
Patient reported on 14/9/03 with less pain, no discharge, and slight tenderness at the sight. We advised him to go for X ray and routine blood examination. Hepar-sulph 1M, 1dose, Rubrum (40) 4pills 12 hourly, for 30 days were given.

22/10/03: Patients came with blood report Total count of WBC again shot up to 10200 but ESR was very less. No pain and discharge was very less. Slight tenderness was seen on deep pressure. Rubrum (40) 4pills 12 hourly, for 30 days were given.

22/12/03: He came with general wellbeing. Hepar-sulph 1M, 1dose, Rubrum (40) 4pills 12 hourly, for 30 days were given. We advised him to come with X - ray. As patient was better, he was not maintaining the regularity in taking medicines.

24/4/04: Patient came with a blood report and X-ray as shown below, total count of WBC shot up to 10200 but ESR was 32 mm only, in X-ray there was good improvement. Hepar-sulph 1M, 1doses, Rubrum (40) 4pills 12 hourly, for 30 days were given.

Summary:
There is a misconception that homoeopathy may not work for deep seated pathological conditions. The above illustrated case is an example how homoeopathy does wonders.

Hepar-Sulphuris:
It is suited to the psoric, scrofulous, diathesis. Debilitated subjects. Tendency to suppurations. Slow torpid constitutions with lax tissue and light hair, great sensitiveness to slightest contact of ulcers, eruptions and parts affected. Great sensitiveness to all impressions. Cold, dry winds. Injuries. Abuse of Mercury. Suppressed eruptions. Unhealthy skin, every little injury suppurates. Abscesses, suppurating glands are very sensitive. Wants to be wrapped up warmly. Sticking or pricking in affected parts. Great sensitiveness to slightest touch(2).

Resolution Given By Supervisor: He should not take life in such a negative way. He might have lost the job but life has not ended here. He has so many things in life to do. Every one in life has some bad events but thatís not the end of life. Happy days do come again. It depends on us how we look at it. Patient assured that even though he harboured suicidal thoughts he would not make any such attempt.

Follow Up

Date Hb:
grm/dl
Total RBC
mill/cumm
Total WBC
mill/cumm
N L E M ESR1sthour/
2nd hour
3/3/03 10.9 3.78 18000 89 16 02 02 125/140
21/3/03 12 4.3 7600 70 24 03 03 125/132
9/4/03 13.6 4.80 11800 73 21 03 03 115/125
23/7/03 12.2 4.1 8900 60 34 05 01 110/120
22/10/03 12.2 4.1 7800 59 33 07 01 52/80
09/2/04 13.2 4.5 10200 62 32 05 01 32

Acknowledgement: I thank our patient Mr M, for his co operation and permitting us to publish it in your esteemed journal.

Case 68: "Alopecia" - Chronic or Acute?

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