Day Care centre: A Stress-buster for Mother and Doctor!
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Sep / Oct VOL VI NO 5.
Dr Vishpala Parthasarathy
Dr Bhavini Mehta
'Gel / Puls / Phos / Tub / Phos

A 3½ yrs old baby girl brought on 11/10/04 for recurrent URTI. Monthly colds: starting with sneezing, going on to continuous coryza on day 2, - fever of 102°F on day 3 lasing 2-3 days. By day 6 thick, greenish discharge with cough and hoarseness of voice lasting for 4-5 days. No clear modalities. Maybe infection from school? With fever she became slightly dull and quiet, with reduced thirst.

When came to us on 11-10-04, she well and had no attack. So we took advantage of the free interval: recurrent colds spelt the Tubercular Miasm and we flagged her off with Tub-b 1M - 1 dose to act as the anti-miasmatic and Puls as SOS stock I hand in case of acute attack. She was called next week. But next time she came straight off with high fever.

Acute Episode
Fever had started from 20/10/04 morning 8.30 am: 99. 1 dose of Pul 200, (SOS given on first visit) then as her mother went to work, temp not measured. 8 pm 101 Pul 200 2nd dose at 8.15. 8.30 fever 101.5. Mo gave Crocin. 10 pm fever 100. 21/10/04 2 am 102, 6 am 104. 8 am 102.5 Pul 200 3rd dose. 11 am she brought her to our clinic: T=101.8 0F child crying while passing urine.

O/E ? tiny, ?papular eruption on labia of vagina with white discharge. Pt was quiet, would not open eyes even for examination. Re-evaluating in terms of flesh evidence of ? UTI, we felt Pul was still indicated. So gave Pul 1M - 1 dose. 11.30 fever.103.4. We felt that Pul 1M had aggravated. Child was lying comfortable on our examination couch all through this. Not moving, no water, no crying. In 1 hr fever ct to rise.

The mother now said the drowsiness was much more than normal. We reviewed. And decided that the totality was more in favour of Gels, so Gel 200 1 dose was given at 11.50am. Within 5 mins she started chatting with mother, asked for an apple. This was definitely a good sign, though fever was 103.4. At 12.20 am fever 103.4. Gel 200 repeated. 1 pm Fever 102.8 pt was sent home and asked to take Gel 200 4 hrly and crocin to be given only if fever goes above 104. Was asked to come back in the evening. Did not come due to traffic. We continued talking to her on tel. and fever was coming down. 0n 22/10/04.Mo said in evening at 8 pm it was 101, 10pm 100. Patient slept well.

Morning in the clinic, pt afebrile, and throat redness now visible. Urine examination showed Albumin faint trace, Pus cells 1-2/hpf, RBC 3-5/hpf

Was given Gel 200 for 2 days followed by constitutional and intercurrent. To decide those, we give you the remaining history.

The case details given below for reference for constitutional medicine.
Patient as a person
Lean, Small hypopigmented patches around the mouth.
Perspiration: Moderate, non offensive, non staining
Ears: itching++. Wax ++cleaning required once in 6 months.
Tongue: Coated posterior.
Appetite: reduced since 1 month. Otherwise has full 4 meals/day
Craving: Curds, Chocolates, Salty³.
Aversion: non vegetarian, Sweets. Prefers Dal, roti, sabji, rice. Avoids Junk food.
Thirst: 4-5 glasses/day
Urine: Bedwetting everyday < Mumbai. (Does not bed wet in Grand parents place)
Sleep: 9 hrs. Restless in sleep. Screams in sleep.
Dreams: frightful. Feels insecure, says people will leave her and go.
Thermals: CH4. Likes winter. < Winter. Wants fan always. Likes to be in AC. No covering.

Mother's Condition During Pregnancy
Morning sickness ++ for 5 months, was on T. Pregnidom for 3 months. Mentally very stressed due to her job. Quit at 4 months of pregnancy and went home to parents’ house in Bangalore.. Her sister was about to get married. Sister very dominating and used to fight with parents for small things. Pt would build up stress.

Labour was easy lasting only for 4 hrs.

Development: Birth weight: 3.5 kgs, 1st 3 months severe colic, stubborn, cranky, Dentition difficult, speech at 6 months.

Life Situation and Mental State
1997: Parents love marriage. Father Rajput, Mother Konkani.
Working Mother; worked at different places. Till 1998 was in Times of India. 2000 in Planet Asia as a manager: a very stressful job; no fixed timings, not cultured environment- clients got nasty for small things, Inter colleagues fights; which mother being sensitive could not tolerate. Worried about all this how much my poor child in womb is suffering. So quit the job when 4 months pregnant and went to Bangalore to mother's place.

5/3/01 Pt was born in Bangalore. FTND. Returned to Mumbai after 3 months. Pt is now very affectionate. Hugs and kisses. Imaginative - creates stories. But moody. Aggressive for no known reason. Weepy³. Stubborn, demanding. Reasonable and understanding. Shares things easily. Loves reading. Calm, plays alone but prefers company. Takes time to make friends. When angry shouts, cries and occasionally hits mother. Feels insecurity, thinks people will leave her and go. < Contradiction3.

Totality

1. Affectionate RM(992)
2. Cautious RM (1009)
3. Careful RM (1009)
4. Insecurity RN (1067)
5. < Contradiction RM (1017)
6. Company Desire for RM (1012)
7. Crying, children in RM (1019)
8. Obstinate Children RM (1086)
9. Nightmare children in RM (
10. Coryza fever with RM (1186)
11. Cr chocolates
12. Cr salty
13. Av sweets

Remedies: Lyc, Sil, Phos
Plan Of Treatment:
Acute: Gel, Pul
Constitutional: Phos
Intercurrent: Tub-b

Learning

1. IN a situation where the fever goes to 104, we usually tend to panic, To calm down the parents anxiety and also the physician's, where the medicine is not working or when fever is not coming down but the generals start improving. This case is the example that tells us when to wait and see the effect of remedy and when to change?
2. Why Tub-b first prescription, not work? Probably it was too early. May be the acute fever stage had already started developing in the patient which was unidentified by the mother and also?? Physician. So Tub-b could not abort it, may be it required acute interference.

Case 2: An Acute Phase
A 3 yrs old girl used to come to me since 1 yr for recurrent URTI with fever. Want to describe only an acute attack on 1/7/04 - acute fever.
The fever started from 30/7/04.

WHY? The case needed to be reviewed since though the fever was less it was not touching normal. Also the cough was status quo. X ray chest showed a pneumonic patch. There was a particular symptom that cough was more lying on left side. RM Pg 218 only 3 mark remedy was Phos.

So Phos 200 was given 4 hrly. Next day fever was absent. Cough >. Headache ++. O/E no neck stiffness. So it was agg of Phos 200. Pt was kept on SL and asked to report next day. On 5/7/04 Cough > +, sleep >. expectoration whitish. Headache 0. Phos 1M 1 dose was given.

8/7/04 Cough +. Vomited after food. O/E chest rales > +.wt: 16.8kgs Phos 1M 1 dose. 15/7/04 Cough >75%. Wt 17.4. X ray chest showed improvement. Was kept on observation and only SL. No recurrence was seen.