The Reluctant Patient
NATIONAL JOURNAL OF HOMOEOPATHY 2004 May / Jun VOL VI NO 3.
Dr Vishpala Parthasarathy
'Nat-m / Bry / Puls

Mr UJ, 21 yr Marwari, came to me on 4^th March 2004, for continuous headache in orbital and temporal region since 2001. Frequency 4/week lasting 2-3 hrs. Since July 2003, he also got Rt sided sinus headache. Feels dull and heavy head. A/F cold weather, <10 am ³, < sun³, < fasting, < aerated drinks < on waking in morning (pt wakes up with the headache) > after breakfast, > changing position in bed, >Eructations after, > walking, > luke warm water or drinks. It is associated with anger, irritability, thirstlessness, acidity³. He was diagnosed to have acute sinusitis with polyp and was advised to go for surgery.

He also has Coryza with dark yellow discharge on day 1  throat pain, nose block³, with lachrymation  fever. < damp weather, < cold drinks, > warm. Right ear pain with sensation of heaviness and constant air sensation, < during headache, < morning³, < pressure on the neck, > closing the ear.
The other C/o since 2002, neck pain, spondylosis, AF bad posture.
Acidity, gases, eructations, A/F fasting³, < morning ², > eructations³.
Stools 2 / Day - Normal.

Patient As A Person
Ht: 6’¹/²’’. Lean and tall. Fair complexion with acne mark on the face.
Dandruff³.
Teeth: Caries +++ teeth, 2 Root Canals done.
Perspiration: < palms, soles and forehead, non-staining, non-offensive.
Appetite: Normal
Thirst: Scanty³.
Cravings: Chocolate³, Salt³.
Aversions: Sweets³.
Urine: Normal.
Daily Routine: Very erratic.
Sleep: 8 hours deep sleep still unrefreshing.
Dreams: Unremembered.
Thermals: Hot C2H3 (Likes winter. Wants fan in all seasons. Covers in winter. No covering in summer. Bath with warm water in all seasons.)

Life Situation and Mental State
21/3/1982 Born in Rajasthan
1983 Moved to Delhi. Studied in Delhi since 1992
1992 Calcutta
1998 SSC 80%
2000 HSC 85.5%
2003 B Com. 55%
Jan 2003 Father joined Reliance company in Mumbai. The residence is at 17^th floor, which our patient hates, since there is no ground contact.
May 2003, gave MBA entrance.
June 2003, Ghaziabad for IMT-2 yrs course.
Mind: He is irritable, very short tempered. Brooding³. Cries only when alone. Fear dog, fear of dark. Very rude to talk with.
Anxiety³ anticipation < when expecting results  perspiration palms. During exams, appetite becomes low, urine frequency increases.
Obstinate.

Fastidious, wants everything perfect, if it is not, then screams.
Loves to be in company, makes friends easily, has 3 close friends.
An understanding of Patient Care:

(We titled this patient as a reluctant patient as during the course of treatment, he suddently came on 01/05/04 demanding to know name of the Homoeopathic remedy, as he would leave for Hostel in June. Explanation that June was a month away, held no water. He left that day without taking the medicine! Later he returned on 22/05/04 with his mother, as he realized he had been much better with treatment, After the scan, he became totally vociferous about efficacy of VP Brand Homoeopathy. This details allow us to learn how to sometimes let patients go, when they don’t comply with the rules of our clinics.)

Investigations
21/10/03 : CT Scan Paranasal sinuses
Limited CT scan of Paranasal sinuses was done in coronal plane.
Polyps are noted in the maxillary sinus.
There is an evidence of soft tissue density in the Rt frontal and anterior ethmoidal air cells.

There is erosion of medial wall of Rt orbit with displacement of medial rectus muscle. There is erosion of roof of Rt maxillary sinus. Extension of soft tissue in Rt nasal cavity. Soft tissue is seen in Rt ethmoidal air cells, Rt sphenoid ethmoidal recess and Rt sphenoid sinus.

The L maxillary and L sphenoidal sinus are normal.
Conclusion : Soft tissue in right maxillary ostie with resultant maxillary polyp. Soft tissue lesion in Rt anterior ethmoidal air cells eroding medial wall of Rt orbit. inferior extension to the right cavity, soft tissue in Rt posterior ethmoidal air cells, sphenoid-ethmoidal, and Rt sphenoid sinus. The changes would be most likely as sino-nasal polyposis.

Repertorial totality

1. Irritability
2. Brooding
3. Company desire for
4. Anxiety exams during
5. Obstinate
6. Fastidious
7. Rude
8. Disobedient
9. Right sided headache
10. Headache < sun
11. Headache < fasting

Remedy
Acute: Bry 200
Constitutional: nat-m 200
Intercurrent: tub-b 1M

Follow - Up

22/5/04-Post Treatment Follow-up Scan
Limited CT scan of Paranasal sinuses was done in coronal plane.
There is a mucosal thickening in Rt maxillary sinus. There is mild deviation of nasal septum to the left.

Previously visualized nasal polyposis in Rt posterior ethmoid, spheno-ethmoidal recess, sphenoid sinus, nasal cavity are totally resolved.
Extensive soft tissue in frontal and maxillary sinus is not visualized now.
There is pneumatisation of Lt middle turbinate.
Frontal, ethmoidal, Lt maxillary sinus are Normal.
The osteometal complexes are Normal.
The spheno-ethmoidal recess is normal.
No bony erosion or destruction is noted.
Conclusion: Mild deviation of nasal septum to left.
Considerable regression from previously visualized extensive nasal polyposis.