Case of diabetic ulcer

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• Case of diabetic ulcer

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Case-3 Preliminary data Name Mr. Moidu,
Occupation Auto driver Age 50 yrs. Sex M,
from Kerala. Chief Complaints Patient is known
diabetic since 12 yrs. Reported with a
non-healing ulcer on lower left foot. A/F
prick by A fish bone? lightning Pain lt walking
not gt by Allopathic medicines for 2 months. He
was on anti-diabetic Rx. He was given a course
of antibiotics. Wound was not healing. In
addition to that there was a blackish
discoloration, bleeding and offensive discharge
from the part affected.
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He got admitted to the hospital on 12/11/03 and
Debridement of wound was done. He was
discharged on 17/12/03 without complete
healing. After going home, ulcer started
increasing again then he reported to hospital
again. He was given- 1. Insulin 10 units
----- BD 2. Atenol 50 mg ------ 0-0-1 3. Am
lovas 5mg. ------ BD Patient reported to our
O.P.D. on 23/12/03 and patient was admitted to
our. I.P.D.
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Personal History Thirst ?sed for large
quantity of cold water3 Cravings Fish3, cold
food and drinks3, spicy and veg Bladder
8-9times /day, 3times / night with weakness
after urination. Sleep disturbed. Addiction
Smoking3 Alcohol3 Stopped since 2
months Thermal state Chilly to hot Mental
state Company desire 3 can not stay alone.
Does not like to share his problem with
others.Worry 3 about his health and family.
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Physical Examination Pulse 80/m BP
170/100mm Hg. Systemic C.V.S. Apical
impulse lat... to mid clavicular line in
6th Intercostal space, S2 splitting C.N.S.
Diabetic retinopathy ?
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• Local examination
• Ulcer
• Location left (dorsum) foot lat. side below
  lateral malleolus Extending to sole.
• Measurement 8 x 5 x 4 cm.
• Floor pale granulation tissue. Edge sloping,
• Margin full of slough with creamy discharge.
• Base Plantar muscles.
• Investigation done
• Blood RBS 298 mg/dl, FBS 239
  P.P.B.S. 296 ,,
• Urine - sugar Orange color

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• Chest x-ray -
• PA view Cardiomegaly
• E.C.G. Left ventricular hypertrophy
• Ophthalmologist opinion
• Non-proliferative Diabetic Retinopathy with
  Maculopathy
• Provisional Diagnosis
• Diabetic-ulcer with Cardiomyopathy and
  Retinopathy

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• 1st prescription based on
• Particulars ulcer -- lighting pain lt Walking
• Pale granulation tissue
• Creamy discharge
• Tenderness
• RBS 298 mg/dl, FBS 239 mg/dl,
• P.P.B.S. 296 mg/dl
• 1st prescription 23.12.03
• Rx 1. Calendula 6
• 4 4 4
• 2. Cephalandra Indica Q
• 0 0 20

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• 29.12.04
• B.P. 180/100mmHg
• R.B.S 196mg/dl Rx
• (1) Calendula 6
• P.P.B.S. 216/ dl 4
  4 4
• FBS 139mg/dl (2) Cephalandra Ind Q
• New compl. headache 0 0 - 25 Amlovas
  O.D, (3) Rauwolfia Q
• Atenol alternate day. 0 0 30
  drops
• Insulin 10 units daily morning
• 10 units evening alternate day

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29 - 12 - 03
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• 30.12.03
• Headache gt, B.P. 150/90mmHg Atenol 2 days
  interval..Urine sugar - green. No sign of ulcer
  healing
• Analysis of the case
• As the case has got prominent generals and
  particulars, so Kents philosophy was applied and
  repertorised by Murphys Repertory and phosphorus
  was chosen as the similimum.
• Rx Repeat same
• Phos 30 (1P) HS

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• 31.12.03
• R.B.S 196mg/dl Rx
• B.P. 130/90mmHg Repeat same
• 02.01.04
• FBS 125mg/dl Rx
• B.P. 140/90 mm Hg Repeat same
• Ulcer started healing.
• Amlovas alternate day

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• 7.01.04
• pain only on Walking Rx.
• Ulcer healing, 1 Phos 30 (1P)
• BP 140/90mmHg 2. Repeat same
• RBS 163mg/dl
• FBS 140mg/ dl
• PPBS 224 mg/dl
• Amlovas alternate day,
• Insulin 10 units O.D
• 
  

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7 - 1 - 04
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• 13.01.04
• RBS 125 mg /dl Rx.(1) Cephalandra Q
• FBS 113mg/dl 0 0 - 35
• B.P. 140/90mmHg (2) Rauwolfia Q
• Insulin 10 units alternate day 0 0 - 20
• Amlovas stopped. (3) Calendula 12
• 4 4 4
• 22.01.04
• B.P. 140/90 mmHg. Rx. (1) Cephalandra Q
• 0 0 - 35
• (2) Calendula 12,
• 4 4 4

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22 - 1 - 04
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• 27.01.04 Rx
• Slight pain 1) Phos 30 (1P) H.S
• B.P. 170/100mmHg. 2) Cephalandra In Q
• R.B.S. 166 mg/dl 40 40 - 0
• Insulin stopped 3) Rauwolfia Q
• 0 0 30

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29 - 1 - 04
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04.02.07 Rx FBS 190mgdl 1)
Cephalandra Ind Q Ulcer is almost healed 40 0
40 2) Calendula 30 4
4 4
20
4 - 2 - 04
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• 10.02.04
• Ulcer is healed Rx 1). Cephalandra Ind Q
• 40 0 0
• FBS 130mg/dl 2). Rauwolfia Q
• R.B.S. 139 mg/dl 0 0 30
• P.P. 185 mg/dl 3). Placebo
• B.P. 170/100mm/Hg 4 0 4 x 15 days
• Patient was discharged.

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10- 2 - 04
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• 3.03.04
• Patient report to O.P.D. Rx.
• FBS 93 mg/dl Same
• RBS 149 mg/dl
• P.PBS 119mg/dl
• B.P. 180/100mmHg.

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• Cephalandra Indica
• (Ref. Boericke)
• Diabetes mellitus with skin affection
• Great thirst for large quantity of water
• Profuse urination with weakness and
  exhaustion.

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Conclusion This case came with complication
of DM and he was already having treatment with
more than 2 medicine (allopathic). With
Homoeopathic system initially he was treated with
pathological prescription to take care of the
symptoms occurring due to tapering of allopathic
medicines. Subsequently treated with indicated
constitutional medicines to achieve the desired
result.
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thank you