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Creating Waves of Awareness

I was in my beginning of my course of Homeopathy medicine(2nd year and I did not have enough idea about repertorisation), during which I came across a patient with a huge ganglion on the dorsum of his right hand. I was asked to prescribe a medicine by my father(He is an allopath).

Presenting Symptom:
The patient showed me a swelling on the dorsum of his right hand and complained of tenderness in it. He said that he has pain in the swelling while the swelling comes under pressure, especially while sleeping he feels pain as his dorsum hits on any hard surface without his knowledge.
When he consulted a Doctor of a modern medicine, he was asked to get it removed surgically (Which the patient does'nt want to).
The patient did not have any major complaints as such.

History of presenting complaints:
The complaints started before 3 years the swelling has enlarged slowly.

Past History:
The patient has Allergic Rhinitis. There is itching and irritation his nose. He also has a problem of blocking of nose quite often. He is allergic to dust.

Family History:
Mother is a cardiac patient and father is a chronic diabetic and recently he is suffering from Facial neuralgia.

Symptoms Observed:
The patient was constantly sneezing and also a blowing his nose. He had an inhaler and he was inhaling it constantly. He was quite talkative and he was a proud man and was boasting himself. He was cunning too.

Desire: Sweets
Aversion: None
Thirst: Normal
Stool: Normal
Appetite: Normal
Agg: Cold weather, dust exposure
Amel: Warm drinks, rest.

Provisional Diagnosis: Ganglion of the right dorsum of the hand..

Totality of symptoms:
. Swelling in the dorsum of the right hand.
.Tenderness in the swelling.
.Sneezing agg on exposure to dust and cold atmosphere.
.Nose blocked
.Tendency to blow the nose frequently

Remedy selected: Ammonium carbonicum
First prescription: Ammonium Carb 30
Once daily for 1 week.

Second Prescription:(after 15 days)
Pain slightly subsided.
SL 0nce daily for one week

Later I left to my college after the vacation. I could not keep in touch with that person. After 3 months, my father told me that the patient called him and he said that the swelling is completely gone and there is not even a sign of such a swelling in that area.
He said that after 15 days the pain completely subsided, later the swelling gradually decreased in size. The patient was very happy that surgery was not required. And he became a strong believer of homeopathy.

Reasons for my Prescription:
Generals-Tumor-Ganglion
Extremities-Ganglion-wrist on(I took this symptom as general symptom for the hand)(Eliminating Symptom)
Generals-Cold weather-Agg
Generals-Pressure-Agg

The remedies that scored highest were
Am-c
carb-v
phos.
Rhust.
Sil.
Sulph.

Among them I confidently prescribed Am-c only because of the fact that he was constantly inhaling an inhaler(Smelling bottles). This was a concrete symptom for me to depend upon.
Good that no miasm interfered..

Tags: Poorni, ammonium, carb, community, ganglion, homeopathy, swelling, world, writst

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Dear Poomi, congrats, keep it up, Ruta would have been the first choice, its a specific. Was his allergy also cured?
Dear Dr,
Thanks for the appreciation. The patient was quite astonished to find even his respiratory symptoms getting cured. But later I actually lost track of the patient after 4 months. As I was studying in the hostel I could not keep in track..
Thanks and Regards,
Dr. Poorni Sudhakar
Dear Porni and Dr Batra. I had the same question in mind. Were the respiratory problems affected due to the taking of ammonium carb?

WHAT IS NORMAL?
I would like to understand when you enter "normal" what this means? Neither thirsty nor not thirsty? How does one determine this? How many drinks per day and of what nature, whether it is hot, cold, room temperature, with or without ice, etc?

Interesting, as well, that you say, "The patient did not have any major complaints as such." And, as I read further, there were considerable chronic respiratory ailments. This is often the case when a patient first comes in and says there is nothing really wrong and they have no problems. But, given a few minutes they spill the beans and the list keeps growing. Then, it is up to the homeopath to connect the dots.

Congratulations on a case well done.
Dear Debby,
Thanks for the appreciation. The patient was quite astonished to find even his respiratory symptoms getting cured. But later I actually lost track of the patient after 4 months.
Thirst Normal means that the patient did not find any abnormality. I felt if he did not find any abnormality, if I question him regarding that I may have to ask some questions which may lead to yes or no answers, which will not be of any use in finding the simillimum.
The patients major complaint was the tumour, so during the case taking he did not mention much about the respiratory complaints, hence I have written the presenting complaints according to what he said. Later I enquired about his respiratory complaints and recorded it.
The main problem while treating a patient without much knowledge about homeopathy is that the patient thinks that I am asking these question unnecessarily and hesitate to give a proper answer. That too to a budding dr.. Hope you will agree with me..
Thanks keep in touch..

Thanks for the comment and I will make a note of it.
Dear Poorni,
Very good start. Wish you all success in life.
Thank you Dr..
Wonderful answer. Thank you for explaining the case-taking process. Yes. It would have taken the patient off-track of chief complain and lead down the wrong path to have questioned further about thirst.

What is a ganglion? In the hand, a ganglion is a particular type of lump which shows up next to a joint or a tendon. Inside, it is like a balloon filled with a thick liquid. It may be soft or hard, may or may not be painful, and may get bigger or smaller on its own. It may also be referred to as a mucous cyst, a mucinous cyst or a synovial cyst.

What causes a ganglion? Normally, joints and tendons are lubricated by a special liquid which is sealed in a small compartment. Sometimes, because of arthritis, an injury, or just for no good reason, a leak occurs from the compartment. The liquid is thick, like honey, and if the hole is small, it can be like having a pinhole in a tube of toothpaste - when you squeeze the tube, even though the hole is small and the toothpaste is thick, it will leak out - and once it is out, there is no way it can go back in on its own. 

What happens in a ganglion? It works almost like a one way valve, and fills up a little balloon next to the area of the leak. When we use our hands for normal activities, our joints squeeze and create a tremendous pressure in the lubricating compartment - this can pump up a balloon leak with so much pressure that it feels as hard as a bone. The lubricating liquid has special proteins dissolved in it which make it thick and also make it hard for the body to absorb it when it has leaked out. The body tries to absorb the liquid, but may only be able to draw out the water, making it even more thick.

Where will I find a ganglion? Usually, by the time the lump is big enough to see, the liquid has gotten to be as thick as jelly. Common sites for ganglions are: The wrist - on the back ("dorsal wrist ganglion"), on the front ("volar wrist ganglion"), or sometimes on the thumb side. These come from one of the wrist joints, sometimes aggravated by a wrist sprain. The palm at the base of the finger ("flexor tendon sheath cyst"). These come from the tube which holds the finger tendons in place, and are often due to tendon irritation - tendinitis. The back of the end joint of the finger ("mucous cyst"), next to the base of the fingernail. These can cause a groove in the fingernail, or rarely can become infected and lead to a joint infection. These are usually due to some arthritis or bone spurs in the joint.

What can you do about a ganglion? Wait and watch."Over the counter" non-steroidal anti inflammatory medication (NSAID), such as aspirin, ibuprofen, naprosyn, or ketoprofen are used in Western Medicine. With drugs there may be possible side effects and drug interactions. 

What is the legend about ganglions? Some people will smash the lump with a heavy book, and rupture the cyst.  The lump can come back even if it has been successfully treated this way. The urban legend regarding this traditionally involves using a Bible as the book, leading ganglions to be called "Giddeon's disease" in some circles. Some people attempt to drain the cyst by sticking it with a needle - particularly when the cyst is on the end joint of the finger. This can lead to a serious infection in the joint.

What can a therapist do for a ganglion? Provide a variety of hand splints to support the area. Confirm that this actually is the problem. Prescribe a custom prescription splint. 

The common course of treatment is to drain the cyst with a needle and possibly inject the area with cortisone to inhibit the immune system and suppress the vital force. Although this works better for cysts coming from the tendon than those coming from joints, it is a drastic measure. 

Alternatively, a surgeon can remove the cyst and clean out the area where the cyst comes from depending upon the situation. Tendon sheath cysts are more likely to be removed with a cortisone shot than cysts coming from joints. 

How successful are these treatments?  • Cysts coming from joints are less likely to come back after surgery if the joint itself is cleaned out, but cleaning the joint out increases the chance that the joint will be somewhat stiff after surgery.  
• Cysts on the back of the wrist come back about one out of three times given the joint is not cleaned out, but only about one out of twenty times if the joint is cleaned out.
• Cysts on the front of the wrist (volar wrist ganglions) are more likely to come back after surgery than cysts on the back of the wrist (dorsal wrist ganglions).
• A physician may take x-rays to make sure there are no other potential health problems.  Although uncommon, pain associated with a ganglion may be due to underlying arthritis, bone tumor, ligament injury or fracture.
• Cysts can extend into the underlying bones and cause other types of problems. Cysts on the back of the end joint of the finger (mucus cysts) may gradually thin out and weaken the overlying skin, allowing liquid to drain out but also allowing bacteria to enter the joint, sometimes causing a serious infection.

What if the ganglion is not treated? Most ganglions do not pose a serious health risk, and can be simply left alone. Many ganglions go away on their own. Between one-third and two-thirds of wrist ganglions eventually go alway with no treatment.


What about treating ganglion's homeopathically? Homeopathy treats the disease and the whole person as demonstrated by Poorni's case where the individualized symptoms are addressed. 

Source:
Hi Debby,
Thanks for improving my discussion. After you have given a detailed description about ganglion. I have more responsibility to add a simple physical examination, the differential diagnosis of the different kinds of Ganglion. Which I think will be useful for all the practitioners. Because ganglion is mostly confused with Lipoma and other tumours.

Physical examination:
A ganglion moves along with the finger ie, when you flex your fingers the ganglion also moves along with it, as it is on a tendon.

Differential Diagnosis for dorsal wrist ganglion:
1. Ganglion of tendon sheath, giant cell tumor of tendon sheath, tenosynovitis of inflammatory or infectious origin, or an extensor digitorum brevis manus muscle belly.
2. The proximal pole of the scaphoid may be prominent dorsally in cases of dorsal intercalated segment instability,
3. The proximal pole of the lunate may be prominent in volar intercalated segment instability.
4. A firm mass more radial and slightly more distal may be an osteophyte from scaphotrapezial arthritis.
5. A compressible mass that decreases in size with elevation of the wrist may be a venous aneurysm.

DD for volar ganglion:
1. Aneurysms of the radial or ulnar arteries
2. Intraneural cysts.

DD for volar retinacular ganglion cyst:
1. epidermoid inclusion cyst,
2. giant cell tumor of tendon sheath,
3. foreign body granuloma,
4. lipoma
5. Neurilemoma.

DD for mucous cyst:

1. Heberden’s node
2. Gout
3. Giant cell tumor of tendon sheath.

Diagnosis:

Is mainly clinical. USG and MRI also help in establishing a diagnosis Wrist Arthroscopy has potential advantages in both diagnosing and treating an occult dorsal ganglion that is intra-articular and therefore visible from within the radiocarpal joint, and also provides information about other causes of dorsal wrist pain, such as synovitis, chondromalacia, and scapholunate ligament tears.
In India we would have to think twice before advising MRI for a ganglion :) 5000-6000 INR :)

great case

here is a rubric from Boger Synoptic key.
interesting it is not given in extremities chapter but generalities chapter.....
i just guess it shows the tissue affinity...

Ganglion, bursæ :

Am-c., Benz-ac., Pho., Rut., Sil., Sul.
try to use definite repertories with good generals in the initial part of practice.
neophytes have the habit of running behind synthesis and complete from the very beginning and worse it is encouraged by our seniors and professers alike

which is wrong ..learning of homeopathy deserves a structure.....
Hello Dr,
I agree with you. I treated this case in 2002 (In my 2nd year of B.H.M.S.), during which the only repertory in my hand was synthesis. May be if I would have taken the same case now, I would have used a different repertory.
Thanks for the reference from the Boger Synoptic key.
Thanks for all your comments doctor, it will help me refine myself.

With Regards,
Dr. Poorni Sudhakar

Poorni Sudharkar, How do u understand materia medica description of amm carb? It is described as a remedy for those who constantly use ammonium carb(smelling salt) to relieve fainting.I dont think it can be interpreted as you have interpreted in this case where pt is taking inhaler to relieve breathing trouble.

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