Case 11: The subdued one!
NATIONAL JOURNAL OF HOMOEOPATHY 2006
Dr Vishpala Parthasarathy
'Puls / Tub-b

Mr PR, 36 years, creative director by occupation came with:

Chief Compliant Since Nov 2005: Pain in chest from left to right, a dull ache and heaviness in epigastric region. Occasionally the pain in retrosternal region also travels to lumbar back. Pt feels he cannot burp, would feel better only if he could burp. It started after late working hours and irregular timings to eat. < spicy food, < after lunch, < excessive food < 7: 30pm. He had to take antacids everyday.

USG Abdomen: accidental finding of multiple mobile soft calculi within gall bladder. Largest stone measures 0.7 cm in size. No obstruction to the biliary tree. Hida scan of the liver and gall bladder reports normal liver size. Uniform uptake of the dye is seen. GB visualized and contract normal after the meal. Normal GB Function.

Other Reports
S. Creatinin: 1.28
S. Amylase: 37
CBC: Hb:15.2, WBC: 6800, RBC: 5.38, MCV: 73(N=82-92), platelets: 3.14 lakhs.
Blood sugar: fasting: 85, PP: 111.
SGOT: 19, SGPT: 24, T.Bil: 0.89, D.Bil: 0.33, Total protein: 7.10, Alb: 4.30.
Prothrombin time: 14 sec (control 14 sec), INR: 1.0

Other Complaints Occasional throat pain  fever 99. throat > warm, thirst +, feels chilly in the night.

Patient as a Person
Height: 5'10'' Weight: 68 kgs. Wt loss of 10 kgs in 4 months due to diet advised by the gastroenterologist
Skin: P/H allergic to mosquito bite.
Hair loss³  alopecia vertex
Tongue: coated and moist.
Palms are warm to touch
Perspiration: palms³. non-offensive and non-staining
Appetite: normal
Thirst: less - 6-8 glasses/day
Desires: spicy³, sea food³, salt has to be normal.
Habits: beer occasional but stopped absolutely since 4 months. P/H tea 5 cups a day but now reduced to 2 per day.
Sleep: disturbed due to anxiety and worries
Dreams: unremembered
Thermals: likes winter.
Fan: S++. W+. Covering: S-, W+. Bath with warm water through out the year.
C2H3
Sexual Function: once a week. It has reduced from twice a week 4 months back.

Diet and Daily Routine
7:15-7:45: Yoga
8 tea biscuits
9: 45 Breakfast: 2 chapattis and vegetables or omelet and bread.
10:15 Leaves for office
2: 20 Back home
4:30 Tea
6:30 Poha/dosa/sandwich.
9:45: Dinner - 2 chapatis, veg, daughter's rice
11:30 Sleeps

Life Situation 2/12/1970 Born; elder of 2 brothers. Father was working in a Pharma Co; now retired since 5 years. Born and brought up in Mumbai - Dombivli. Average student. Played a lot of cricket.
1991: Studied from JJ Institute of applied arts as BFA. Was a gold medalist. After passing changed many jobs in advertising firm.
2000 Shifted to Dadar from Dombivali. For the house, he had to take a large home loans.
So pt went to Dubai and took the family along. So expenses were more and couldn't pay the loans. Very stressful period.

2002 Came back to India, did a job in Bangalore. Not very happy with the environment.
2004 Came back to Mumbai and took up job over here. Nuclear stays with wife and daughter. Financial responsibility towards wife, daughter and to some extent towards his parents who are alone. Feels most stressed about repayment of housing loans. And about his daughter's health, as she falls sick very often. Broods over it and creates panic in him which disturbs his sleep.

Fears to take risk in taking up a new job. He is the only earning member which bothers him.
Pessimistic: goes into negative mode, though motivates himself. Wants to give best to the family, especially daughter. If daughter is not well he becomes very anxious. Puts him on back seat, affects his work.
Very sensitive. Affected by any incident on the road.
Likes to go for a long drive.

Emotional State
Irritable but does not express. Brooding³ over his loans and future of her daughter.
In childhood fear of dark³, now > +.
Worries³ < trifles.
Anxiety about health of family.
Plans a lot but most of the times fails to execute.

Plan
Acute: Puls
Reasons: Impressionable, leaning, anxious.
Evening agg. Thirst less
Intercurrent: Carc
Reasons: Anxiety, worries³, Responsibility excessive, wants to do best for the family.

Follow Up Criteria

1. Dull ache chest
2. Heavy abdomen
3. Flatulence
4. Hair fall
5. Sex 1/wk
6. Anxiety about daughter health
7. Broods/worries
8. GB stones

Treatment and Follow Up