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Case 1:

Mr R.A.M., 40 yrs, staying at Mumbai,
came on 7th Nov 2002,
a diagnosed case of Avascular Necrosis of Femoral Head Left > Right with complaining of

Severe Pain in Lt Hip Joint since 1 yrs
<> Continued Slow Motion
Pain in Lt Leg – Calf > Stretching the limb
Pain in Lt Leg – Calf > Uncovering at night
Lt Hip Swelling/ Inflammation/ Stiffness
Lt Leg shorter than Rt
Painful Varicose Veins both Lower Limbs Since 3-4 yrs

Past H/O: Since Childhood Allergic Bronchitis & Leucoderma – A lot of Steroids consumed in the past for the same.

Family H/O:
Paralysis PGM, MGF.

Personal H/O:
Craving: Sweets++, Tobacco++
Aversion: Fatty Food+++
Sleep: Disturbs due to pain as well as due to frightful dreams
Dreams: Cousin Brother who died in 1985+++; Frightful+++; Death of Relatives+++.
Thermal: Ambi-thermal

Mental State including Life Space Investigation:

Patient from Poor Socio-economic Family;
Childhood Average; Completed 10th & Went to Mumbai in 1985 for service;
Working as a Machine Operator in a company;
Married in 1986; Spouse – House wife;
Have 2 sons & 2 daughters;
Happy go Lucky life was going on till last year except off and on episodes of Allergic Bronchitis; Vitiligo settled with Allopathic Treatment consisting of long term use of Corticosteroids;
Very hasty in Nature; does everything very hurriedly;
Since last year, started getting recurrent pain in Lt Hip Joint; Consumed Treatment from a GP quiet a long; As recurrence and spread to Rt Hip increased, shown to Orthopedician Dr K J Kamat who advised him MRI of Hip and diagnosed as a case of Avascular Necrosis of Lt Femoral Head. He advised him Total Hip Replacement Surgery which is not at all affordable for the patient.
Since last 6 months, getting difficulty in concentrating at work due to pain; One interesting thing he told that when he doesn’t concentrate on his work, he use to eat something which makes him comfortable; He becomes so restless that he avoids the work & wants to quit the job but he can’t as whole family depends upon him; He is quiet anxious about Surgery and the consequences of it because it was told to him that after the surgery he cannot seat down forever & re-surgery requires every 5-10 yrs. That’s why he came for Homoeopathic Treatment to avoid the surgery.

Physical General Examination:

Wt: 77kg
P: 80/min
BP: 122/78 mm of Hg
Male Pattern Baldness
Tongue: Flabby
Difficulty in Walking & even Riding on Examination Table
Looks: Anxious, Sadness.

Clinical Examination:

Lt Leg shorter than Rt
Stiffness Lt Hip; Can’t bend it; Can’t lift the Lt Leg
Walks with limping


Investigations:
MRI OF HIP JOINTS (31/01/02)

MRI of both Hip Joints reveals:
Feature suggestive of Lt hip AVN with changes causing architectural distortion & subarticular irregularity seen in the left femoral head with mild joint effusion. The left acetabular margin is normal.
The right hip joint & both sacro-iliac joints are normal.

RUBRICS FOR REPERTORISATION:

1. Concentration; Difficult
2. Concentration; Difficult, Eating, amel. from
3. Anxiety
4. Dreams; Dead, people, of, Weeping, with
5. Dreams; Death, of, Relatives
6. Dreams; Frightful
7. Fear; Poverty
8. Hurry, haste; Tendency
9.Generalities; Caries, necrosis, of, Bones
10.Generalities; Exostoses, Syphilitic
11.Generalities; Food & drinks, Fat & rich food, Aversion
12.Generalities; Food & drinks, Sweets, Desires
13.Generalities, Necrosis, Bones
14.Extremities, Pain; Lower limb, Hip, Motion, amel
15.Extremities, Pain; Lower limb, Leg, Calf, Stretching, amel.
16.Extremities, pain; Lower limb, Leg, Calf, Uncovering, amel.
17.Extremities, Swelling, Joints
18.Extremities, Shorter,one than other leg
19.Extremities, Varices,Leg,Painful
20.Extremities, Inflammations, Joints, Synovitis, Chronic

RESULT OF REPERTORISATION:

Calc fluor 33/20
Puls 27/13
Sulph 24/12
Lyco 24/11
Calc 22/12
Merc 22/11
Ars 22/10


Homoeopathic Management:

7 Nov 2002: Avoid Tobacco
Weight Reduction
Calc Fluor 6x tds… 3wks

30 Nov 2002: Lt Hip Pains Persistent <> Continued Motion
But feeling better at general level;
Wt: 76Kg
Can walk for 15-20 min freely

Calc Fluor 6x bid… 1mth

30 Dec 2002: Lt Hip Pains Much Better;
Work freely;
Looks Confident;
Thought of leaving the job totally gone;
Can walk freely without limping for 45min;
Wt: 74.5Kg

Syph 1M 1 Dose
Calc Fluor 6x…OD 6mth

14 June 2003: No Pain in Hip;
Working with full strength;
Walking freely for 1hr;
Normally climbing staircase;
O/E: Easily lift the Lt leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 6mth

7 March 2004: No Pain in Hip;
Working with full strength;
Walking freely for 1hr;
Normally climbing staircase;
O/E: Easily lift the Lt leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 6mth

24 Dec 2004:
MRI OF HIP JOINTS (21/12/04)

MRI of Pelvic & both Hip joint for a follow up case left hip AVN reveals
Changes in the superior weight bearing portion of the left femoral head noted with mild flattening of the head.
In comparison with previous MRI there is mild increase in the flattening. However, the marrow changes appear to be localized to the weight bearing portion with reduction of the marrow edema in the neck that was seen in previous study.
The hip effusion which was seen in previous MRI has also resolved. The left acetabulum margin is intact. No para articular soft tissue abnormality.
The right hip & both S.I. joints are normal.

No Pain in Hip;
Working with full strength;
Walking freely;
O/E: Easily lift the Lt Leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 12mth

3 Nov 2005: No Pain in Hip;
Working with full strength;
Walking freely;
O/E: Easily lift the Lt Leg & bend it;
No Tenderness
Wt: 74Kg

Calc Fluor 6x…OD 12mth

4 Sep 2006:
MRI OF HIP JOINTS (1/6/2006)

MRI of Pelvic & both Hip joint for a follow up case left hip AVN reveals
Sequelae of Avascular necrosis seen with architectural distortion with flattening of left femoral head. The left acetabular margin is intact. As compared to previous MRI dt. Dec 2004, no significant interval change noted. No further progression of the disease seen.
The right hip & both S.I. joints are normal.


No Pain in Hip;
Working with full strength;
Walking freely;
O/E: Easily lift the Lt Leg & bend it;
No Tenderness
Wt: 74Kg

Treatment stopped.
Follow Up after 2 years.

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