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Please help for a NOT typical diabetic condition

Hello,any help will be greatly appreciated.
Female patient,85 years old. 1,5 m height, about 42 kg weight. Since about two years ago began having eye trouble,loss of long sight vision and blurring forms of things; near sight keeps, she can read at about 30 cm; her vision is about 1 to 1.5 m, without details; of various consulted, no ophtalmologist gave a certain diagnosis, and the problem went on worsening; about a year and a half ago her blood tests showed some degree
of hypoglycemia (60-65 after a nights fast). Since about a year ago began presenting changes in her conduct, i.e. lacking energy, self absorption, bad nightly sleep (would catch sleep near midnight, then awake at about 4 to 5 in the morning and then go back to sleep at about 6 till 9 or ten in the morning, then napping along the day), as wel as increasing forgetfulness and losing of practical sense; even if she denied it,apparently the eye trouble was worrying and depressing her quite a lot. Along this past year and a half also there has been the demise of some of her contemporaries and other known people, some of them near to her affections, which, again,even if she sternly denies it, apparently have been depressing her quite more. She also has had intermittently but continually golden and silver zig-zags in her vision, since long time ago, many years, and these increased since two years ago. She has had also for many years varicose veins in the legs, no pain, no burning,no complications. Also capillary fragility since long time ago, which provoked often small bruises in the legs, mainly the right one; hammamelis never helped this, but in the past year Arnica and then Lycopidio practically eliminated the bruising. She had two bad falls hitting her head two years and a year ago approximately, for which she didn't receive any treatment. She had been treated along the past years homeopathically with Hammamelis,Ignatia, Apis, Lycopodium and other concurrent remedies, without apparent curative or even clear palliative results for any chronic signs, except the bruising,as said, recently. In the past six months she began to present signs of quickly failing memory, short term memory, and some mental slowing, emaciation and muscular mass loss and weakness. This increased since the end of past June. and got complicated with increased body temperature,which would keep constantly between 37.5 up to 37.8 at nights, no sweating, no heat, no chill. And she then complained of a pain in the upper rigt side of the head, where she says she hit herself in the fall she had about two years ago. In July she was treated with Staphysagria, Ignatia and Lycopodium in this order, with not clear results; the pain in the right side of the head subsided but her general condition worsened and presented great drowsiness (not any congestive symptoms) and was then treated with Nux Moscchata,without clear results either, that is, the drowsiness remitted some but the general state kept in bad shape. She was by then passing most of time in bed, till now; presently
she does not complain of permanent aches, but has fleeting ones, mainly in the left temple and inner ear of the same side, and in the last days also in the left knee, more a dull kind of pain, also transitory; from about ten days ago her feet began to swell and two days ago the the swelling of them increased, apparently there's not more swelling yet in other parts, exception of under the eyes, but this has been for many years.
-She hasnt complied of any pain in the digestive tract.
-She has not had thirst, not even the normal (this is a long standing characteristic of hers, for many years),
-nor appetite (she is eating now a 1200 calories,not even reaching that), she has lately expresed some attraction for having some hot capsicum in her meals, as well as a little desire for sweets and starches; she likes warm meals and soups.
-She is urinating often, about every two hours,night included, but small amounts of urine each time, about a half to two thirds of a cup at a time.
-Feces, except one time after stress, when taken to the city for the tests, when there was a diahrreic, painless and otherwise nondescript episode, are solid, until recently moving the bowels daily (after the diahrrea day it has been about every other day, apparently normal,except that it is being too thick; it gives the impresion the rectum is being lazy.
-As said upwards, since about ten days ago it began swelling of the feet, particularly the left one; and these last days it has increased. There is also some swelling under the eyes, but this has been present for long time now. Not other swelling is yet percepotible.
-Since her worsening in July, she has had a little almost constant annoyance in the throat; coinciding when her temperature was higher there was also some swelling and induration of tonsils, the right one more, which afterwards changed to the left, and nowadays, there's again some annoyance, as if there was an irritated point, in the right side of the throat. Scarce cough at any time till now. Same about nasal discharge or phlegm,the past two days there has been a very isolated pale yellowish-greenish phlegm, just a couple of times.
.Short term memory quite impaired, will forget things that happened or were said just some minutes ago. Long term memory quite good relatively. She dislikes much to be interrogated and will get very annoyed by it if insisted upon; mood swings; does not like or want to admit the seriousness of her condition; reserved about it; would say her state is about how everybody else's is; stoic point of view. Likes to talk alone to herself. Likes to be read aloud to her. When her mind is slower, she would repeat the question or phrase told to her instead of answering, then reflects on it; also tends to not answer directly and definitely to questions. Simplistic reasoning, forgetting or not taking in account concurrent elements.

Sleepiness has diminished but still tends to sleep well above normal.

-
There were done laboratory tests about ten days ago and the abnormal results were:
In urine:
-presence of blood in urine (80 hem per micro L)
-presence of protein in urine
(30 mg per dl)
-moderate bilirubin
-urine little turbid
-moderate sediment
-density under normal limit, 1.005
-PH 7
-Urobilinogen, higher, 1.0
-Leucocites 15 per microL
In blood:
-Red corpuscles 3.48
-Hemoglobin 9.7
-Hematocrit 29.9
(-Leucocites in range, 9,100)
-Platelets 615 000
-Glycosylated hemoglobin 7%
(she had in a fast test for glucose 112 after a 15 hours fasting)
-Serum glucose 96 (sample taken after 15 hours fastening)
-Serum uric acid 2.03, lower than normal
(-creatinin fine, .8)
(-total cholesterol 163; HDL 49.86, LDL 100, VLDL 13. Triglycerides 65)
-Serum albumin,lower than normal, 2.99
-Oxaloascetic transaminase (ASAT) high but still on range: 33
(-All other elements, from a 27 elements test,were inside range)

Thank you very much in advance for whatever help could be given.
[message edited by jenan on Tue, 27 Sep 2011 19:51:25 BST]
 
  jenan on 2011-09-27
This is just a forum. Assume posts are not from medical professionals.
Is this a relative, friend or patient of yours?
 
brisbanehomoeopath 8 years ago
Hello,thank you for asking, she is a first degree relative, mother.
 
jenan 8 years ago
Are these her words or your observations?

My experience in clinic is that without the actual words ideas and opinions of the patient themselves, the remedy choice becomes more of a guess.

Is she willing to answer questions I might pose here?

David Kempson
Professional Classical Homoeopath
 
brisbanehomoeopath 8 years ago
Dear Dr. Kempson,
again thank you very much for your interest.
I understand very well what you say, and, unfortunately, about the mental signs, they are, except her own recent words about her 'feeling as is in general most of people feels', are observations or interpretations of mine. The exposition of her pains or the lack of them is directly from her. She has been reticent along all her period of illness, and in general has been always a reticent, reserved person, that, in her own words, does not like to 'dwell on things, but to try to get over them and keep going', so she, deliberately, is not any given to introspective analysis. I asked directly if she would be willing to answer questions that you could ask and she answered 'maybe'. I know very well it is difficult to take a case at distance anyway, and then much more if there's not an open cooperation from the patient, but anyway I would appreciate so much if you could try to give an opinion.
By the way, this morning there was a spontaneous unswelling of her left foot, which is still a bit swollen but about a fourth of what it was the day before.
[message edited by jenan on Wed, 28 Sep 2011 23:30:05 BST]
 
jenan 8 years ago
It looks very much like Bryonia, but the miasm is wrong I think. I would suggest looking at the Sycotic member of that same plant family, which is Luffa operculata (Loofah).

The general themes of the Violes plant famiy are Vexation, Irritability, Chagrin and a strong feeling of not wanting to be disturbed, questioned or in company. There is a desire for rest, and an avoidance of people.

There might be a need to differentiate between this plant group and the Ranunculacea family - for which Annoyance and Irritation are strong themes. That group's sycotic member is much more well known - Pulsatilla.
 
brisbanehomoeopath 8 years ago
Dear Doctor Kempson,
she does not like to be interrogated and being directed too much or to have put in doubt or judged her motives and acts, but would want and accept and enjoy, in a subdued way, when not being irritated, company, and enjoys, as I said before, to be talked to and to hear reading aloud (by the way, I think at some time I read that some remedy has the characteristic to like to be read aloud to, but I cannot recall or find it),and if I am not near she would seek where I am, so, it could be said that she wants company, some times direct and anyway to have someone around if not directly with her, so, your idea of Pulsatilla seems to be quite probable indeed. To it also sums the lack of thirst and the occasional desire of sweets. What baffles me is that I can´t find physical symptoms in her that would coincide much with some of Pulsatilla. The urine regime, little a time and often, as well as the somnolence, and then the brilliant zig zags (more, if I am not mistaken, which is very probable anyway, proper of Ignatia), when she gets tense or irritated, all that I cannot adapt to the image of Pulsatilla.
Anyway, dear Doctor, wouldn't you think it could be worth the while to try to interrogate her?
 
jenan 8 years ago
Pulsatilla craves company, wants consolation, wants affection, needs to be caressed and treated softly. The crave attention. Without this I would find it difficult to prescribe Pulsatilla (unless you had a very very strong case in the general state).

She is the only one who can give us the real leads to the right remedy, so I would always insist on questioning the patient directly.
 
brisbanehomoeopath 8 years ago
Dear Doctor Kempson,I agree in all. Please,by all means, if possible for you, let us try the direct interrogation from you, I will try my best to present it to her in a way to not confront her or lead her at all.
 
jenan 8 years ago
Just get her to describe her complaints in her own words. That is the best way to start. You don't need to question her directly about her nature.

Get all the information you can out of each complaint - what it feels like, what makes it better, what makes it worse, and especially not how the complaint affects her life.
 
brisbanehomoeopath 8 years ago
Dear Doctor Kempson,
I am really between a rock and a hard place: what more would I want, but precisely one biggest problem I have had is that she seems to not complain directly about much, except in the times when she was more in pain in her upper and right side of her face and head (I believe I mentioned it), otherwise a constant is that she won't complain, won't comment on her condition, will, if insisted upon, that she 'feels better', she insists in not seeing or accepting the problems, as said, she would say that 'she is not any worse than most people are', more if of her own age, and that she feels fine.
What she would say, in the contrary sense, sometimes, is just that she feels 'a bit tired' after walking some; she won't offer more thatn saying, when she feels it, 'I am having a pain in the eye' or the ear,now is gone, or 'I am having or had a moment ago the visins' (the zig-zags). What could be more noticeable are her attitudes, some body language. I understand very well your own position in the matter, or I think I do, but at the same time I am kinda at the end of my wits, due to that lack of information and communication from her about her illness, and from the lack of valid, in my opinion alternatives of treatment, as
what is found around here is mostly a pluri-remedies outlook (as an example, it was prescribed for her, about ten days ago, Uranium, and at the same time Anacardium, and a mix of Hammamelis and Nux Vomica..., which I didn't give to her). I will, following your advice be very keen in registering and reporting whichever comment of her own she could do, but the illness is advancing (the swelling of the feet, particularly the left one, increased again as this evening came on, also the emaciation keeps going on). I know that even if it is needed that information from her, in her own words, the problem is that practically there is not any of it that comes spontaneously, and when I say there is none I am literal. That is why I thought your original idea of interrogating her directly could be a viable alternative. As a matter of fact, after she answering 'maybe' about it, later, after a nap, she said 'to tell the doctor to please proceed as she had been wrong before'.
[message edited by jenan on Thu, 29 Sep 2011 13:04:57 BST]
[message edited by jenan on Thu, 29 Sep 2011 13:06:31 BST]
 
jenan 8 years ago
Hmmm....that does make it difficult. A patient who doesn't really want to participate in the process is always hard for us.

So she doesn't refuse help, she just doesn't want to complain?

When there is an obstacle like this, you need to find what we call bypasses - these are things the patient is willing to talk about. Hobbies, dreams, family feuds - something that will still reveal the inner suffering even if the patient won't talk about their symptoms directly.

Of course, there is also the rubric 'Well, says he is, when very sick' - 27 remedies in that. It could be a place to start.
 
brisbanehomoeopath 8 years ago
Dear Dr. Kempson,
please excuse the delay, they are now fixing,or un-fixing, the phone lines around here and the Internet service was down for a while.
Well, it is indeed complicated, she won't talk much on her own; she would not talk about any particular subject, but would comment or ask on daily life minor things, and not much of it anyway, not a particular theme or subject. She more reacts to conversation, she would follow or keep unwinding the yarn, but wouldn't develop one of her own.
Now, one thing that she has asked me repeatedly, as she forgets the answer, is 'well, and what is what you think I have', or 'why are they saying I got diabetes', or 'what was what got me like this'. Another thing is that she would comment about the
nicety of what of the plants outside the windows can be seen, even with her bad eyesight. Another thing is that she would come back often to the subject of painting the house (which makes sense as it really needs it badly). Things like these. And not much more.If not spoken to, she can go for a long while in silence, or talking to herself or to the animals. More when she is sulking.
I wonder if perhaps in a case like this would be necessary to lean more on the physical symptoms?
Here's another thing: from family talk and of her own, from time ago, she was as a child and a youngster a very affectionate, sociable and family oriented girl. Weepy about bad things of life that could know or see. Then in her late teens decided to change and formed a very stoic cover, that became her second nature. This thing alone would make me think again in Pulsatilla, but then I can't see which is the way to arrive to it, as if she was originally Pulsatilla right now she is not so, not in the first layer anyway. And by the way, she was asking today about if it would be possible to have some nice sweets and if there are sweets for diabetics.
[message edited by jenan on Fri, 30 Sep 2011 03:18:14 BST]
 
jenan 8 years ago
A stoic cover doesn't sound typical for Pulsatilla, who complains and begs for attention and affection and consolation. That would lead me right away from the remedy.

The problem we are having already, is we are guessing. Guessing at the remedy is more likely to fail than succeed.

You are right in saying the physicals might need to be leaned on, but they are the least likely to point to the state of the patient, as Hahnemann said in the Organon. Those things which are most peculiar can be relied on, those things that are unexpected in the disease, like thirstlessness in diabetes for example.
 
brisbanehomoeopath 8 years ago
Hello, Doctor Kempson, thank you so much for keep on the case.
I agree with you; what I had in mind, probably wrongly, is that perhaps she was Pulsatilla once, and still would be, 'layers down', meaning that perhaps at some stage would be Pulsatilla again. And precisely the particulars is what I wanted to mean when I loosely said 'physical symptoms'. I think I recall, and again very probably wrong, that Boenninhausen, when it was not too clear the mind symptoms, would fall back in other ones, of course always looking for particulars, and as in this case seems quite difficult to get at the direct mind symptoms, without having or falling in interpreting them by the external observer, even with the 'bypasses', I thought it could be perhaps an alternative to try to find what remedies could present those physical particulars, as you so adequately state, like the lack of thirst, at all times, through diabetes and fever included, and perhaps also the urine regime, little quantities, at more or less short intervals; also perhaps the characteristic smell, a bit naphtaline-like both in feces and mouth, a kind of 'hepatic' smell but slanted to naphtaline; the recurrent fever; the present left side presentation of some symptoms (eye and ear and temple intermitent pains, swelling of foot); sleepiness; ah, and another 'little' one that I had been passing, that at the beginning of eating she gets a 'pull', a contraction, a little painful, in the parotid glands as when one gets something quite acid suddenlylike lemon with a subsequent emission of saliva. Another, this mental, could be the one you already picked up, namely that she is not being aware or not wanting to accept the dimension of her illness and the statement, either bona fide or feigned (probably to 'not give more worries to others' as well as to not yield herself to panic, but again this is just an interpretation from quite isolated words or remarks of her). I think I should mention that she again, today, insisted in that she would be now in disposition to answer questions, in the understanding that it is not easy for her due to the same state of her mind. Thank you very much again and kind regards.
[message edited by jenan on Sun, 02 Oct 2011 01:57:28 BST]
[message edited by jenan on Sun, 02 Oct 2011 02:19:51 BST]
[message edited by jenan on Sun, 02 Oct 2011 02:22:23 BST]
 
jenan 8 years ago

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