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Case Study

The Trials and Tribulations of a Teacher
Dr Dilip Bhaskar Dikshit

Mr Narayan Patil came on 1-11-2000, for Deep Vain Thrombosis. He was 46 yrs old
Studied till 13th D Ed. Occupation: Teacher.
His Father died 3 yrs back
Mother is Alive. He has 2 Sisters 48 yr, 38 yr.
4 Children: Son: 20 yr, Daughter: 22, 18, 16 yr.
Lives in More-Kuran

Chief Complaint :





Both Calf muscles:
Since 2 months




Diagnosis: Peripheral vascular disease.

<Walking 100 meters.
<Walking long distance


Associated Complaint :





H/O Once in 2 yrs

Fever with chillness had to be carried.

> Rx.


Patients as a person
Wt loss: 60 kg
à 56 kgs in 2-3 months.
Perspiration: Partial: Feet, Hands. Odours: feet2 .
Aversion: Vegetables. Craving: Non-veg3, Chillies.
Smoking since 20 yrs.
Sleep: Deep & Sound.
Dreams: 1) Dog behind him and Snake behind him
2) Unremembered.

Reactions- Physical Factor:
Fan: S: 5, W: 2. No < from draft.
Covering: S: Nil. W: Double blanket head to foot.
Woolen: Occ when on picnic & driving in morning.
<3 Toddy & <3 Curds - Loose motion.

Past History :
Cigarette, Bidi.
Family History:
 PGMo: Asthma at later age.
Physical Examination:
Nails: H/O White Spots+, Ridges++ vertical.
Weight: 62 kgs.
Tongue: Coating ++ Yellowish Center.
Palms: Coldness+, moist+.

Life Space Investigation
Patient is of medium height, dark complexioned with a stocky built. Very co-operative during interview, willing to give information, even when second interview had to be taken due to loss of history form.

Financial situation was very bad in childhood. Father was in Govt service and they had land cultivation. But father was not able to manage both and his Govt. earning was not sufficient to meet both ends and look after patient’s education. With great difficulty Fa sent money to patient. Once when patient came home during vacation, he decided not to go back and stayed home saying that he had holidays. Father sensed something was amiss and went to collage, which was away from hometown and learnt the truth. Father asked him to join college immediately. Reluctantly patient obeyed, but found a way to support his own expenses. He started givng tuitions to students. He now earned not only his keep but could send something home. He returned father’s money saying that he has got a job. Till today patient has not sat idle and has been constantly working.

After 12th he did D Ed. He applied for a job. Meanwhile he joined his uncle as supervisor in small factory. Within some months, he got a call to join as a teacher. Now he teaches in the day and after school hours, he cultivates his own land at two places and tries to complete all the work on his own.

His father was very caring and affectionate. He expired 3 yrs back. Mother is also very loving but has recently developed sudden bouts of erratic behaviors and uses such bad words such that no one can tolerate her.

Patient is the only son with two sisters. One was widowed at an early age immediately after marriage. Patient wanted her to remarry. But did not pursue it, in case she felt that she is a burden on him. She has no one from her in-laws. As she is alone and gets pension every month(husband was in Govt service) she has a lot of savings. She has no children. Hence patient gets a lot of financial help from her. She loves his children like her own and stays alternately there and at her own house. All the family members are very attached to her.

Patient is irritable by nature but immediately repents and feels guilty. He is very helping and never expects help in return...

Wife is bold and hot tempered, very straightforward. Never fears anyone. Helpful like patient. Gets along well with patient. Looks after the family and has taken responsibility of all roles properly.

WBC- 7300, N-59, L-31, E-10

BUN- 16, Creatinine- 0.8, Sodium- 140, Potassium- 6.2, Chloride- 98,
Alk.PO4- 3.4, Bilirubin- Total- 0.4, Proteins- Total- 5.6, Albumin- 3.4,

WBC- 7700, N-55, L- 34, E-11.
BUN- 14, Creatinine- 0.7, Sodium- 142, Potassium- 4.4, Chloride- 92,
SGOT-34, SGPT- 39, Alk.PO4- 2.3, Bilirubin - Total- 0.5, Proteins- Total- 5.5,
Albumin- 3.0, Blood group- A + Ve, Blood Sugar Fasting- 80, Prothrombin time13sec pro index 84. Kahn’s test-negative. Wasserman test: - negative

Cholesterol- 182 (N: 130-250), LDL- 98(N: 0-130), HDL - 53 (N: 32-54),
VLDL-31 (N: 10-35) Chol: HDL- 3.4 (N: 0-5.1), Triglycerides- 156(N: 10-250)

Prothrombin time: 13sec, pro-index 84.

01/11/2000 Tuberculinum 1M 1P weekly and Silicea 30 6P every night. Patient started improving within 2 weeks.
15/11/2000. Silicea 200 1P /per week. After that patient showed greater amelioration3.
12/06/2002: can walk distance of 1 mile without any problem.
13/02/2002: can walk 2 miles without problem
Patient last reported on12/11/2003. Good relief. Can walk longer distance without any pain.