Doctor, Should Someone like me get Married?
NATIONAL JOURNAL OF HOMOEOPATHY 2003 Mar / Apr VOL V NO 2.
Dr D J Karat
'lyco

Mr AK, a 30 yr old single male patient working in a Radio Station as Electric Engineer,reported on 14/08/1998 reported to the out patient department with the following complaints -

PAST HISTORY AND Rx HISTORY
At 2 yrs of age-Eczema-Homoeopathic T/t.
At 13 yrs of age-Phimosis-Rx-Circumcision.
At 22 yrs of age-Chicken Pox.

FAMILY HISTORY
Father - Diabetes Mellitus
Mother - Arthritis
Siblings - Has 3 brothers and 3 sisters-All healthy.

PATIENT AS A PERSON
Built-Lean
Appetite-Decreased
Desires-Non-veg ²,Sweets³
Thirst-Takes 8 to 9 glasses of water per day.
Stools-Hard.
Perspiration-Scanty, rarely perspires.
Thermals-Hot.

Sleep-disturbed-if nervous or emotionally disturbed-gets up many times.
Dreams-rare; fear causes dreams. Occasional dreams with spermatorrhoea.

LIFE SITUATION
The patient was a neatly dressed bespectacled young man. He made it apparent that he could discuss his complaints only with a male physician, and after the case was taken, insisted on talking directly to the chief physician in privacy.
Though he appeared outwardly calm, the interview revealed that he was deeply disturbed about his complaints. Right from his puberty he felt something was wrong with his genitals and was always very self conscious, especially when playing and moving about in public. He used to feel that, if watched closely, people could detect his abnormality and hence was very uncomfortable in public. This worsened in the last 2 years when he felt that his scrotal sac had further enlarged. He finally consulted a doctor, and after ultrasonography about 2 weeks back, was confirmed to have Grade I, left sided Varicocoele. Somehow his long continued anxieties were confirmed.
But things got further worse when he found out that one of his acquaintances who had Varicocoele was infertile. He felt sure that he would suffer the same fate. He expressed his feelings that due to his inadequacies, he should not be getting married. But his parents were repeatedly bringing the subject up and he was at a loss as to what to tell them. He did not want to get married and at the same did not want to tell them the reason.
Worries about his complaints and their repercussions plagued him and he often got overwhelmed.
Work area: he said that he was good at his work, but yet his confidence used to fail at times, especially when handling important assignments. He became very nervous and his sleep got disturbed. He constantly felt that something may go wrong. He wanted to do better in life but had always harbored a fear of failing in life.
He usually does not talk much to his colleagues. Never shares his real problems, except with his closest friends. Even here, he does not discuss his very personal problems. He says that he feels better if he discusses his problems with someone, but in spite of that he avoids revealing his difficulties. He likes being in their company as much as possible just for the sake of the companionship though they don’t discuss anything important.
At work place or at home, he says he can’t tolerate if the atmosphere is not right, if there is any fighting or arguments. He tries to avoid such situations. If faced with such unsavory occurrences, he gets extremely disturbed.

INTELLECTUAL STATE
Memory-good Confidence-shaky
EMOTIONAL STATE
Inferiority Complex³ ® Self Conscious³, Feels everyone is watching him.
Fear²-of failure in life.
Anticipatory Anxiety²-even though he feels he is good at his job ® disturbed sleep.
Sensitive - cant tolerate arguments
Brooding
Reserved-but > sharing, talking about his problems. Discusses problems only with close friends.
Wants company always.

PHYSICAL EXAMINATION
B.P.-126/80 mmof Hg.
Examination of External Genitalia: No visible scrotal swelling. No tenderness.
Left spermatic Cord feels enlarged.
Systemic Examination: RS/CVS/ P/A - NAD

INVESTIGATIONS DONE
Pt. had brought old Inv. Reports with him.
Colour Doppler study of Testes. - 28/07/98
Both Testes appear to be normal in size & echotexture. There are multiple echo free tubular structures adjacent to the left Testes.
Impression: Grade I Varicocoele (Lt)

CLINICAL DIAGNOSIS: Lt Sided Varicocele.

CONSTITUTIONAL TOTALITY
Inferiority Complex³®Self Conscious³
Fear²-of failure
-that everyone is looking at him.
Anticipatory Anxiety² ®Sleep disturbed.
Confidence shaky
Sensitive   Brooding
Reserved but wants company.
PHYSICAL GENERALS
Thermally-Hot   Lean Built
Cr-Sweets³, Non veg²
Motion-Hard 
Perspiration-Scanty

CHARACTERISTIC PARTICULARS
Sensⁿ of Scrotal swelling
<² limb movements
concomitant-Self Consciousness³

REMEDY SELECTION
The remedies coming up after analyzes: the Silicea, Calcarea Sulph and Lycopodium.
The extreme self consciousness, awkwardness, the fear of failure and anticipatory anxiety and chronic constipation suggest Silicea. But the self consciousness in this patient is rooted in his feeling that something is abnormal in him and fears of being found to be inadequate by others and not a self consciousness which stems out from the natural shy and timid nature as in Silicea. Also we find that Silicea does not cover the thermal state and the other physical generals of the patient.
Calcarea-sulph came into consideration, because of the strong feeling the patient had that people were observing him, the sensitive nature, desires for sweets, chronic constipation and the thermal state of the patient. Yet, again, Calcarea-sulphfails to be the similimum as it does  cover the other important attributes of this patient-ie, the fear of failure and anticipatory anxiety, his need for company.
The patient showed intense and seemingly unreasonable fear that he may be infertile, on which he based his decision not to get married. This he did without even really undergoing any investigation to confirm that he was infertile. He also was in an extreme state of self- consciousness where he was so afraid that his physical defect, though very minor may become known to someone else. These features reflect the poor self esteem the patient had and his extreme fear that someone else would find out the real state of affairs. His poor self esteem and confidence is also reflected by his fear of failure and the anxieties he suffered when on a deadline. It also reflects the type of escapism from responsibilities a married man would have to take up. All these features point to Lycopodium as the similimum, as do his need for companionship though reserved, his avoidance of arguments and messy situations, thermal state, cravings and the chronic constipation.

POTENCY SELECTION AND REPETITION
Considering his heightened state of mental sensitivity and the fact that though structural changes were evident, they were only in the very early stages, it was decided to start treatment with a relatively high potency of the constitutional remedy with a relatively frequent repetition.

MANAGEMENT
The patient was reassured that every person with Varicocoele need not necessarily be infertile. Especially in his case, where the Varicocoele was unilateral and just in the initial stages, the chances that it would affect his fertility was minute.

FIRST PRESCRIPTION
14/08/98 Rx 1) Lyco 1M(1P)
2) Rii pills B.D.

FOLLOW UP CRITERIA
1) Appetite 2) Motion 3) Sleep
4) Sensation of scrotal swelling
5) Spermatic Cord / Testicular pain

FOLLOW UP:
Positive changes were apparent and in the first follow up itself when he reported after 2 weeks, he reported an improvement in all aspects. He reported an improvement in his appetite, sleep, constipation. Testicular pain was completely absent and the sensation of scrotal swelling decreased a little.
Improvement continued steadily and Lyco 1M was continued in fortnightly repetitions. After about one and half months of such a schedule, he reported that he was feeling much more confident. He seemed to have given rest to his anxieties regarding his fertility, as he said he had allowed his family members to finally persuade him to get married. They were now looking for an alliance.
However, about 2 months into the treatment, on 14/10/98, he suddenly developed a recurrence of the Left Testicular pain with dull aching, tingling and a pulling sensation. O/E-tenderness². It responded only when the repetition of Lyco 1M was increased to once in 3 days. Thereafter, he responded well and reported good improvement mentals, generals and the sector complaints. He discontinued treatment after 04/01/99.
He again reported to the OPD on 16/03/99. He had just been married a few weeks back. During this visit, he brought along his wife, who requested treatment for chronic backache. But now his anxieties that he may be infertile had returned in full force. He requested the physician to order a semen analysis. The physician reassured him again that it was unlikely to be the case but filled out the required form. One dose of Lyco 1M was repeated, and he was asked to report after 2 weeks with the investigation report.
Imagine the physician’s surprise when the report showed not just Oligospermia, but a the most severe degree of Oligospermia with very poor degree of motility. (Oligospermia is classified into -
Mild-10-20 million sperm/ml.
Moderate-5-0 million sperm/ml.
Severe-Sperm Counts below 5 million/ml).

Semen Appraisal Report - 1/4/99
Sperm Count - 1.4 million/ml
-Actively Motile - 2-4/H.P.F.
-Sluggishly motile - occ

At first glance, obvious cause of oligospermia seemed to be Varicocoele.
So considering the probable structural cause, the frequency of Lyco 1M was further increased to daily repetitions and then when subjective improvement came to a standstill, upgraded to twice a day repetitions. The patient was asked to repeat the semen analysis after 3 months of treatment.
When the patient, with enormous gratitude, did report with the repeat semen analysis report 3 months later, the physician was in for another surprise, this time a very pleasant one. The sperm count was within normal limits and there was significant improvement in the sperm motility.
Semen Appraisal Report-13/7/99.
Sperm Count - 38 million/ml.
- Actively motile-30%
- Sluggishly motile-30%
- Non motile-40%
Thereafter things took a very positive turn. He had only one episode of Testicular pain which responded well to a further raise in the potency of Lyco 1M to 10M. Thereafter he remained asymptomatic. He discontinued treatment after November 1999.
He occasionally visited the OPD either alone or with his wife, for continuing treatment for her backache.
On 02/03/2000, he reported the happy news that she had conceived and the pregnancy was confirmed just 1 week back. Except for a slight aggravation of her backache, the pregnancy progressed uneventfully. When he reported with a mild episode of Bronchitis on 19/12/2000, he informed the physician that he was now a proud father of a baby girl. His wife had delivered on 31/10/2000 a full term healthy female infant with birth weight 2.9 Kg. Finally, a happy ending.
The patient still reports occasionally to the OPD (three times in 2001-2002) for episodes of URTI and Bronchitis.