ICR SYMPOSIUM ON HOMOEOPATHIC PRESCRIBING DECEMBER 2018, MUMBAI EXPLORING DR. C. M. BOGER S PHILOSOPHY & ITS APPLICATION IN CLINICAL PRACTICE

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1 DR.SUNIT NIKUMH - CSE-3 OGER SYMPOSIUM/DECEMER 2018 Objectives : 1. Importance of study of Structure-Function-Form-Time axis (SFFT) in lcohol withdrawal cases 2. Illustrating the Value of pathological general symptoms in prescribing 3. Learning to apply oger s concept of studying patho-physiology in treatment of various expressions of lcohol withdrawal 4. Overcoming the biases in treatment of chronic relapsing condition like lcoholism and lcohol withdrawal Directives : 1. Study the LSMC of the case and arrive at clinical diagnosis with its prognosis and outcome with the help of SFFT 2. Identify and classify the symptoms from the case 3. Prepare the totality and differentiate the various Materia Medica images 4. State the plan of management with difficulties you anticipate. Name: Mr.R R L HIIMS No.: ge: 62 yrs Gender: M ddress: Saphale. Family members: Fa: Died 20 yrs ago, Reason not known Mo: 80 yrs [ ronchial sthma] ro:3---1-suicide Sisters 3 Child 3 dmission Date:14/5/2018 Discharge Date:16/5/2018 Time:11:30pm Time:5:00pm Patient referred to Psychiatry department i/v/o following complaints: 62 yrs male patient not a k/c/o any major illness, refereed for c/o severe generalized weakness, difficulty in walking [ataxia] since than 1 month. 1. He is experiencing pain in bilateral lower limbs since 1 month. 2. Tremors in bilateral upper extremities; no tremors at rest 3. Sensation of fullness of abdomen 4. Loss of appetite since more than 1 month. Urine, stool normally passed Pt is chronic alcoholic and tobacco chewer. Personal history P/H NS F/H- NS

2 O/E : T: feb P: 80/m RR: 18/m P:180/110 General : ND Systemic: RS: Clear EE CVS:S1 S2 pure CNS: conscious Oriented P/: soft NTND DTR RT LT Power RT LT J + + UL 5/5 5/5 TJ + + LL 5/5 5/5 KJ + + J + + Planters Flex Flex INVESTIGTION SHEET Hb PCV WC N.L.E.M. PLTELETS MCV MCH ESR MCHC 14.2/ /21/03/02 1,96, Na K UN S.Creat TOTL IL Dir/ndirect SGOT SGPT Radiological Findings: Sonography CT scan /MRI Findings Hepatomegaly, Fatty liver rain: Old lacunar infarct in both cerebral hemispheres LCOHOL SCREENING SHEET Duration of alcohol consumption yrs but was occasional that time Frequency of alcohol consumption Daily since 2 years, H/O only once a day while working Type of alcohol consumption Desi Indigenous, Occ-Taadi Quantity of alcohol consumption 90 ml Tolerance No bstinence from March 2018 pril since 15 days again started WITHDRWL SYMPTOMS Physiological Tachycardia Sleeplessness Loss of appetite gitation Tremor of hands Psychological Pre bs bs bs Pre

3 General Information about his behaviour when under influence or in intoxication Family Work Society IPR with wife/ family members: after alcohol consumption IPR - Yes ttention on family members-??? ttendance at work place ---Regular No- Motor bike accident due to alcohol NO- Legal issues due to alcohol NO -Physical fight Mental Status Examination: On admission ppearance ehavior Speech Mood and ffect Sensorium Perception Thoughts /Thinking Insight and Judgment 62 yrs male lying on bed, well groomed, Trembling of bilateral Lower legs Co-operative Obeying Commands Clear comprehensible relevant Euthymic and congruent Oriented to time place and people Clear- no evidence of Illusions No active disturbances found in thoughts Grade 4/Good Evaluation done by Psychiatry Team 62 yrs old male pt evaluated i/v/o tremors since one month but increased since days, ataxia since one month but increased since days, last intake of alcohol 3-4 days back. ppetite sed, fullness of abdomen since 1 month. Pt is alcoholic since yrs but was occasional that time. lcohol brought at home by pt s mother Since 2 yrs daily intake has increased post retirement where in there were IPR issues with wife. Since his retirement, he gives his entire pension to wife but she is not happy with that and always tells him that he does not do any work and earn money. Pt feels very bad about it and thinks what s the use of service of so many years if I had to listen to this? Pt had complete abstinence since 1 month and did not have any complaints during that period but when again abstinence was done from pril to May there was trembling of body. Family history: Mo: Chronic alcoholic In the past patient had been for de addiction treatment but started again Location Sensation and pathology Modality ccompaniments CNS O Since 1 month Gait >ataxia No able to walk on floor /F- lcohol after increased since 15 days D Daily without support Swaying sideways Trembling whenever stands

4 P Gradual on floor Upper extremity- Trembling /F-Since withdrawal GIT Stomach Fullness of entire abdomen appetite /F- FOLLOW UP Sr. no. Criteria Criteria 1 urning in i-lateral soles - I/F Temp 2 Tingling in i-lateral soles I/F Pulse 3 Trembling while standing I/F RR 4 Walking with support P 5 Gait ataxia present Reflexes 6 Sleep 7 ppetite 8 Thirst Gait ataxia absent Romberg s FOLLOW UPS: DTE Your action ctuality TIME 12am on admission information& 4 am Pt sleeping comfortably DTE: TIME:8 am sed + + sed + >well + + feb 80/mi n 24/min 130/ information& Pt is vitally stable; t night slept well; Conscious oriented well t morning walked on own; No muttering; Trembling all over body ppearance Mental Status Examination Well groomed, wear a hospital dress well, taking blanket on legs and slept on bed at one side

5 information & ehaviour Calm, Quiet, obeying the commands properly slight confusing Speech Comprehensible, relevant, tone-n, Pitch-N Mood Euthymic/congruent Thoughts Not specific Memory Remote, intermediate, recent: Intact Insight Grade 4/ Good DTE: TIME:7pm >50% >50% >50% >50% se se + N N d d feb 88/min 24/min 160/ sed DTE: TIME:7am >/ sed >/ sed >/ sed + mild -- Good N N feb 80/min 18/min 140/90 N Neg + DTE: TIME:11:15 am >50% >50% afeb 11:15 pm 80/min S/ Dr. Minal Pt was apparently >50% in morning rounds. ut since few minutes his tremors sed, taxia sed. Wants support to stand and walk