Wednesday, February 27, 2013

Mind Approch

MINDING THE MIND IN THE CLINIC A SERIES OF MONTHLY ARTICLE By Dr Ashok Mohanty Editor 'Aude Sapere' Mob.: 9810026564 MINDING THE MIND IN THE CLINIC: APPROACHING CHILDREN I interact with many doctors who have querries, “How to take the mental state of an infant or child who hardly or never speak? In my daily practice I see around 10-15 infants/children by understanding their mental state during sickness. Let us find the possibilities of deciphering their mental state by common and uncommon behavior of these children during sickness in the clinic. In case of infants/children we get symptoms from the following sources. 1. From the infant/child himself, if they can speak and willing to do so. 2. By observing their acts and behavior inside the clinic. 3. From the parents, if the child is sleeping or he/she is not willing to talk. 4. In case of not acute condition like Enuresis, Forgetfulness, Loss of Appetite sometimes the child doesn’t complain but you have to take the symptoms of the child in healthy condition. 5. Mind you, never take parental concern into account while prescribing in case of child, sometimes parents show more concern than the child. You have to evaluate the symptoms after seeing the child and take symptoms accordingly into merit. 6. Some children are slow to react so don’t be impatient. Repeat your question till the child understands. Never get irritated with the child. 7. Try to be friendly with the child. 8. Never look into the eyes of a child when he enters into the clinic if you find the child is nervous or having fear over his face. 9. Give some time to the child to be familiar with you and other clinic staff. 10. Take into account everything the child does inside the clinic like touching items kept on table, stamping the feet, his gestures and other acts. Let’s discuss some cases of children where you can find medicines just by observing the child when he enters the clinic. Case I A small boy of four years age was brought by his parents for treatment of recurrent bronchial infection. As soon as their turn came his father came inside. His mother was behind him but the child was not entering inside the chamber. He was holding the two sides of the door with both hands and resisting his mother not to come inside. His father who was already inside told, “Sir, whenever he goes to somebody’s place first time, he does like this.” He was still struggling with his mother not to enter. His father further told, “We are giving allopathic treatment since two weeks, but when we stop the antibiotics the problem recurs. Initially when we visited the previous doctor our child behaved same way as here but after two or three visits he became normal and even takes injection without crying and any hesitation. Regarding his behaviour, her mother added he becomes very stubborn during the episode of cough. If he wants something he will make all the efforts to get that and you have to provide the same. Nobody can make him understand that time.” The child was still standing on the door struggling with the mother not to come inside. Her mother told him, “Let’s show to the doctor then we can eat panipuri (water balls) while going back in the market. You are such a nice son, nobody on this earth can match you.” She was telling all good things and praising him. After sometime he agreed to come inside. There was nothing, which I could have asked further as he was reluctant to give any information. From the above conversation and observation I took the following rubrics: 1. FEAR - room, on entering 2. FEAR - strangers, of 3. PERTINACITY 4. FLATTERED - desire to be - gives everything, when flattered A dose of Lycopodium 30 was given which brought down the cough and breathlessness in 12hrs time. The case was followed up till six months with no recurrence. His stubbornness reduced to some extent, so as his mingling with new people for which he used to have some fear earlier. Here in this case the child didn’t want to enter the room because of the fear of stranger and new people inside the room. He didn’t have the confidence to face them. Hence, he became stubborn not to enter the room. His mother’s pampering to great extent made him to come inside. What is Pertinacity? Holding firmly to some purpose, belief, or action, often stubbornly or obstinately. Hard to get rid of; unyielding; persistent What is Obstinacy? Unreasonably determined to have one’s own way, stubborn, resisting remedy or treatment. How do we differentiate between the two? In pertinacity, there is strong reason behind his action (better known to the individual) In obstinacy, he just wants to do it without any sufficient cause behind that. Let me give one example each to make these two rubrics more clear. The child is crying at night to have hot popcorns, which can’t be available at that time. You tell him that it can not be obtained at that time; he doesn’t listen and presses more for the same. He then stops talking with the parents and eating his normal food. This is obstinacy. The child wanted to buy a toy aeroplane in the market. You told him, “I will give it tomorrow as I am not having enough money today.” Tomorrow he will ask for the same. You somehow manage to postpone the buy for next day. Next day he again asks the same. You told, “No, now I can’t buy that.”The child will not leave you till you buy the same. He will never forget the same. This is Pertinacity. In obstinacy there is more emotional reaction to a stimulus, the child closes down himself and does not participate in any activity and stays indifferent, but in Pertinacity there is more action involved where the child will by any means makes tremendous effort to complete the task in hand for which he had made up his mind. Case II One of our colleague’s daughter suffered from very high fever which couldn’t be brought down in spite of changing different remedies in different potencies. We tried individually but there was no relief. The fever was continuing since two weeks. We thought to take the case together. Her temperature used to rise very high up to 1040F. She used to lie down or read that time. On asking during that period she tells, “I am OK.” On further questioning she tells, “I don’t feel any pain now. I sometimes feel the need to relax. But I am totally OK and comfortable. Don’t worry about me.” When her father asks, “You have so high temperature, is there pain or any anxiety or something else?” She replied, “Papa, don’t worry nothing is going to happen with me. I am more perturbed by your and other doctor’s queries than the disease. I don’t feel good when all of you ask and meet me to select medicine, repeatedly ask the same questions.” She further added, “Papa I am totally comfortable and I am sure nothing is going to happen to me, please let me relax.” Further she told her mother to tell her father that she doesn’t want to take medicine.” The following rubrics were taken: 1. WELL - says he is well - sick; when very 2. IRRITABILITY - questioned, when 3. REFUSING - medicine; to take the 8. REST - desire for A dose of Arnica 30 brought down the fever and she was followed up with no recurrence. Arnica child doesn’t wan anybody to come near him as any touch be it mental or physical hurts him during the process of recovery so he tells other that he is well. In the above case the rubric which was guiding to the state of the girl was ‘WELL - says he is well - sick; when very’. There are different reasons for which, in spite of the sickness the patient tells that he/she is well. Let us discuss another case of this rubric to find out why they tell OK during sickness. Case III A boy of six years was brought to me for skin eruptions with severe itching resembling scabies. Doctor: “How are you?” Patient: “fBd gSA (I am alright).” Doctor: “Once you are alright then why you came for medicine?” Patient: “Papa brought me here.” Doctor: “You don’t have any problem.” Patient: “No, I am OK.” His father told, “He tells the same way always and plays with his cricket bat and ball. When the itching is more he leaves the game and keeps on itching. If the itching doesn’t subside then he applies coconut oil on them.” Doctor: “Why you apply coconut oil?” Patient: “It gives me soothing effect. I feel better after applying oil.” I took following rubrics: 1. WELL - says he is well - sick; when very 2. PLAYFUL 3. LIGHT - desire for A dose of Belladona 30 cured the skin eruption and itching. Belladonna child says well as he wants to play and does not want others to disturb him by taking him to doctor or wasting his play time by giving medicine etc. Case IV A boy of 10years age was brought to me by his parents for complete loss of appetite. Some time he complains of pain in the hepatic area. His mother told, “Since last seven years he is having the same problem and taking treatment continuously either from Ayurvedic or Allopathic doctor. I asked him, “How do you manage the pain?” He replied, “I just sit down or lie down during the pain. When the pain reduces I start playing.” His mother told, “He always plays. Even sometimes during pain also he plays on the bed by throwing the ball to the wall or to the sides of the bed. He never bothers others about his pain. Let it be any severity, he just lie down and never disturb others. He is very sober and nobody from neighbors or from school complained about him. He sometimes fights with his sister momentarily if she disturbs him in his activity or changes the channel of the TV which he used to see regularly.” I took the following rubrics: 1. PLAYFUL 2. CARES, full of - others, about 3. ANGER - interruption; from 4. MILDNESS A dose of Cocculus 30 settled the case. Cocculus Ind. Child plays a very contented play, never disturbing anybody in any condition. UNDERSTANDING THE RUBRIC : MOROSE, CHILL DURING I had a case of a lady, age 40 years, suffering from trigeminal neuralgia. The pain and numbness used to be very intense, so severe that she almost goes mad during the episodes. I gave her number of medicines with temporary relief. She was continuing treatment for almost a year. This time again she got severe episode of pain. She called me and told, “I can’t bear it further. Please do something so that I get at least some relief.1 Again the pain is like the earlier attack. It is the most horrible condition of my life. It is as if living in a state which nobody ever wants to live in.3 you only can take me out of this situation.2 Please come down and see me. I don’t see anything which can give me some relief which I need badly now. Nobody understands me better than you. You have only handled my case since one year. My family members might be feeling that I am acting. It is fruitless to tell them everything in detail. Hence, you are the only person whom I can tell everything.4 I open up in front of you spontaneously without any hesitation. Though I have ample intention to tell all these to my husband and son but they don’t understand me. So, in front of them, I hardly can express my feelings.5 The pain becomes so severe that I don’t see any way out of this situation.6 You are the only one who can take me out of this gloomy condition, I will not leave you till I am cured 7. Please, doctor saab, come and see me.“ Her request was so intense that I went to see her at her place which is quite far off from my clinic twice or thrice in a span of two weeks. I took the following rubrics and prescribed a dose of Camphor 30 which gave her immediate relief and it continued for long with out any recurrence. DELIRIUM - crying, with - help, for SHRIEKING - help; for DELUSIONS - hell - is in NAKED, wants to be - bares her breast in puerperal mania WEEPING - desire to weep - eyes are dry; but MOROSE - chill, during CLINGING - grasps at others The state of Camphor shows its extreme low feeling in the way of experiencing the conditions of hell in present scenario. When a person feels that he is in hell, his reactions to everything changes. The predominant reaction is Morose, chill during because of the gloomy scenario. Morose is a state of bitter unsociable temper, a gloomy and sullen phase where in the individual behaves in such a manner so that others are forced to take some action. Before explaining you about the state, let me tell you how I earlier used to take this state. I used to combine sadness, irritability and repulsiveness to understand this state. The information of this patient suddenly made me to realize that it is beyond the combination of these three rubrics. The patient expresses his feelings in a bitter way, “Tell me frankly whether it can be cured or not by you. (crkbZ, vki ls Bhd gks ldrk gS ;k ughaA) The tone and manner here is very important in these expressions. “What to tell? (D;k crkmaA) Always I tell you that I am not well, but still you never understand.” (gj ckj eSa vkidks crkrk gwa dh eSa Bhd ugha gwaA fQj fHk vki ogh pht nksgjkrs gksA”) From the inside, he is very sad and feels the future is dark and depressing and hardly there is any way out. He is in a condition wherein he feels extreme helplessness to continue further with the disease. This brings on a state of extreme irritability and fretful attitude in him which also shows his impatience. Even a single word can show his morose feeling. Chill is unpleasant coldness of air, lacking warmth, to dispirit, and depressing influence. When the condition of the patient becomes extremely down where he feels that it is hardly revivable then it is chilly state. Morose chill during is a state where patient becomes gloomy and feels there is hardly any way out and thereby expresses his despondency with severe irritability and sadness. Let me explain you another case of a small boy which will further consolidate your understanding of this rubric. A small boy, aged 4 years, was brought to me for treatment of loss of appetite and ADHD (attention deficit hyperactivity disorder). The boy was hyperactive, moving around the clinic with speed, not sitting at a place for more than few seconds, continuously telling his mother to take him out and play with him. He pulled the purse of his father from his pocket and then threw all the paper on the floor when his father told him to sit down quietly. He became very angry when his mother admonished him in a strong tone, and threw all her articles inside the vanity bag. When she caught hold of her bag he shouted in a high pitch. Mother: “He is like this, troubling us throughout; never allow us to take some rest. Because of him I always remain sick; my back pain always remains in worst condition. He will only do the thing which he likes and if we tell him that it is not right he will become very angry and throw everything, even household items from the balcony. Even if we beat him, he will not accept what we say. Though he weeps while we beat him but he will continue doing the same things which irritate us. We are really fed up. If he is not cured then we all will become sick.” Dr.: “When he becomes angry and cries how he becomes normal?” Mother: “He will continue crying for very long with telling why we admonished and manhandled him. He will repeat the same thing till I take him in my arms and cajole him. After lot of fondling he will become normal and start playing. His hyperactivity becomes bit normal after giving him lot of caressing. But again he starts when his demands are not met.” I took the following rubrics: MIND - MOROSE - chill, during MIND - OBSTINATE, headstrong - children MIND - DEFIANT MIND - ANGER - throwing things around MIND - ANGER - trifles; at MIND - CARRIED - desire to be carried - caressed; and A dose of kreosote 30 lessened his hyperactivity and his appetite also improved. CASE - I An old lady came to me for the treatment of knee pain with swelling. She was suffering from this problem since one month. She took allopathic medication for the same which gave her relief but due to the pain killer her stools became constipated and there was pain and bleeding from the rectum. She had earlier taken medicine from me for bleeding piles a year ago but didn’t continue the medication after few days. Pt: The pain in the knee is really troubling me continuously and it is increasing day by day. Earlier I used to walk around the home and help my daughter-in-law for domestic works but now it is so much that I have to sit in place keeping my leg elevated or else the swelling starts increasing. Though there was relief with allopathic medicines but my old piles problem which was cured by you a year back resurfaced because of the side-effect. My daughter-in-law told homoeopathic medicines work slowly. I also know that, but at least my piles problem will not be aggravated. After taking allopathic medicines also, there is no permanent cure. When the action of the pain killer is over, again the pain starts. Why to suffer from two diseases? I feel because of the problem I am putting more efforts in my normal working so that at least I should do my share of work properly but because of the pain I am unable to continue it for longer period. I am not worried whether your medicine take long time or short time but there should be some relief so that because this pain makes me restless and day by day my energy level is going down. In the above case the lady finished her complains in one go. If you look into the case the main concern of the patient is - The disease is continuously troubling her. - She is unable to do her share of work at home. - Because of the side effect of pain killer, she developed piles. - Her energy level is going down. - Need to get some rest so that her energy level is maintained and she can continue working. - Because of the problem though she is putting an effort but there is no comparative gain. When the patient feels that because of the disease there is a loss or damage she is experiencing in health/work or anything else that is DELUSIONS - injury - being injured; is Throughout the case the patient is talking about her work, work and work only i.e. LOQUACITY - business; about. She feels that the amount of energy she is putting in for her work is not being yielding result as per her satisfaction i.e. DELUSIONS - work - hard; is working. She wants to take homoeopathic medicine knowing that it works slowly because there is no side-effect and at least there will be some permanent cure. This is BARGAINING. A dose of Bryonia 30 was given to her after repertorising the above rubrics. She was cured from the pain and piles. Whenever Bryonia feels he can’t pursue business, he will need rest. Because rest will recoup him and he can continue doing business. Rest desire for He needs complete rest, complete means there should not be any disturbance both from inside and outside. Hence he wants to lie down in the dark and doesn’t want to talk to. DARKNESS - lie down in the dark and not be talked to, desire to Hence Bryonia needs rest to continue his business

Blind Eye Cure

Name: Master A. G. Age: 9 yrs Standard: nursery Chief complaints: - Vision: 60-70% can only see straight, not sides, has to turn the head in order to see on sides restricted eyeball movements and field of vision. - He cannot write, unable to hold pen. - Hyperactive child with difficult concentration - Hunger increased very much, can’t tolerate hunger, and has to eat something or other every hourly. - Cracked corners of the lips. Recurrent ulcers in mouth. - Recurrent redness and swelling of the nailbed. ODP: 25th august 2004 he started with fever which was not controlled by medicines. During high fever he had severe headache, occasionally vomiting.he became unconscious and he was being diagnosed as having meningitis.he was operated twice and shunt was implanted on right side.then he started improving and came out of coma,but he lost his eyesight completely.gradually over period of 9 months vision came but only 85% ,he could see only straight not on sides. Investigations: MRI: Multiple small to moderate size infarcts involving rt medial frontal lobe and bilateral basal ganglia region with enhancing cisternal exudates and leptomeningeal enhancement.moderate communicating hydrocephalus is also noted.MRI features suggestive of meningitis.?TB CT HEAD:15\10\2004 Post meningitic sequelae with exudates small right frontal extradural collection.moderate size rt frontal parietal subdural hygroma and small ischemic lesion. CT HEAD :19\11\2004 Moderate size subdural collection is noted in collateral fronto parital region producing diffuse significant compressive effect over cerebral parenchyma. Gliotic changes in right temporal parietal lobe, right frontal lobe and bilateral ganglion Extensive sub arachnoid hemorrhage observed. Supratentorial and posterior fossa sub cisternal spaces also affected. Past history: Recurrent mouth ulcer in childhood. - Recurrent complaints of cracks at mucocutaneous junction before meningitis - Tendency for diarrhoea and especially G.I.T would get easily affected before meningitis. - He used to have greenish stool in childhood GENERAL MAKE UP: Appetite: Increased very much, hungry eats every one hour. Prefers warm food only Cannot tolerate hunger. As soon as wakes up in morning first thing he asks is t eat something Thirst: Thirsty Thermals: HOT Desires: Sweets+3, Rice, Milk++ Aversion: Sour++ Stool/ Urine: no complaints Sleep: Sound sleep, sleeps on abdomen Perspiration: Profuse summer during. Sensitivity: Sun/ Noise/ Light/ Odor: NAD Tongue: red, moist Tight clothing: Can’t tolerate around abdomen MENTAL MAKEUP: Before meningitis: Very Angry and obstinate child, aversion to bathing, brushing. Used to cry loudly while bathing Memory very sharp. Very talkative, makes friends very easily. Extrovert child could mix easily with new people. He is a pampered child. No fears as a child. After getting angry he used to vomit voluntarily by putting his fingers in mouth. used to bang his head on floor in anger. Though he likes milk very much but couldn’t tolerate changes in milk form if buffalo milk was given then he used to get severe diarrhoea. Never used to take cold milk, he would prefer only warm milk. Weeping on criticism and rudeness Likes hearing music. Since childhood itself hunger is increased After meningitis: His reaction to anger or scolded he becomes aloof and sulks. ANALYSIS: After the case was presented ,Sir asked Father is there any significant change in his behaviour? He said yes his desire to go out of house has increased a lot. Sir asked him to explain. Father said that since earlier he liked very much to go out but after meningitis this nature has increased a lot now he can’t stay at his home at all ,will go to each and every house of his colony and will tell them everything what happened in his house and will ask about their things. Every day he visits everyone’s house without fail. He exchanges all the happening around him in every house. He keeps roaming in the premises around the colony. Sir said that this is syphilitic quality where he just has to go out of his house everyday and this is Wandering desire for Further Sir asked Father to tell about his extroverted nature? He said that we are sitting in your waiting area since 2-3 hours and during this time he had made friendship with all the people sitting outside. Wherever he goes anywhere he will approach to everyone around and will make friends. Sir said that this is Cosmopolitan mind, where he can attract and mix very easily with new people around him. SOA: C.N.S, G.I.T., Mucocutaneous junctions MIASM: Syco-Syphilis INTELLECT: Good WILL POWER: Fair MEMORY: Very Good Mental make up: PSORA: Sensitive to rudeness Non Conscientious Non Diligent SYCOSIS Obstinate, Extrovert, Anger on Self, Hyperactive, SYPHILIS Wandering desire Physical Generals: Hunger aggravates Speed: Fast Thermal: Hot Thirst: Thirsty Repertorisation Thus looking at the Childs Disposition which is Primary extroverted i.e. cosmopolitan, Hyperactive since before illness, very Obstinate and marked desire for milk. Sir said that both Phosphorus and Tuberculinum can attract so many people around them. As child was Hot and Thirsty he was Prescribed Tuberculinum 200 Single dose on 19/01/2010 Follow ups: 9/6/10 ■Now has stopped wandering. (Syphilitic ↓↓) ■Sight improved. ■Does not ask for food immediately as he wakes up, earlier he use to do so. ■Ulcers in mouth better. ■Cannot read, write. ■In excitement repeats things. Remedy given :-SL 24/12/10 ■Concentration improved ■Tries to hold pencil and scribbles. ■Repetition slightly better. ■Vision improved. [can now see even at distance, now sees T.V also] ■No wandering after our medicine started. ■Ulcers in mouth better Remedy given :-SL About Tuberculinum children Sir says that they are very fair, nice looking, good looking. Who are very obstinate headstrong children they don’t listen of anyone do what they want but same time Tubercular diathesis i.e. Long bones and eyelashes, fair complexion, delicate skin and sharp features. They love to travel and wander; they themselves may be slow at times but always want things to be done at fast speed and same time love to travel with speed on bikes and cars. In Drawing also because of their restless and wandering mind they mess up with colours. They are loving and caring but angry, abusive and can be destructive. Main points to be remembered: - Cosmopolitan: likes socializing, extroverted. - Restlessness - Obstinate - Likes wandering To confirm the remedy Sir asks about desire for milk as confirmatory point. Further Sir says that if Patient is Hot and like Phosphorus think of Tuberculinum. Thanks to Dr.P Vijayakar sir