Case Quizes

Irritable Bowel Syndrome

Can you solve this brain teaser case quiz on Irritable Bowel Syndrome from Dr. Amarsinha Nikam?

This is an interesting case of a male patient aged 25 years suffering from Irritable Bowel Syndrome since 2 yrs and C/o   Headache since 1 yr.

This complaint may sound quite uncomplicated, compared to the previous cases I’ve presented, but the selection of a remedy is a real brain teaser, so try hard!

Regarding the patient’s day to day activities, he is a hard worker, who wanted to be a doctor but couldn’t, due to a poor financial situation. He now works in a pediatric hospital where he can handle almost all the work. He can manage IV drip, understand investigations and at times manage patients. He works there from 8am morning to 2pm and at night till 11pm – a very hard worker. He couldn’t be a doctor, but he did perceive his passion.  Here is his case history:

 

He started with the complaint of loose motions 2 yrs ago. Initially it was termed as amoebiasis and he was treated accordingly, but without relief.  His complaints span 2 years and increased to the level that he had lost 2 to 3 kgs of weight. He was also experiencing headaches for the last year. Meanwhile he had accompanied his brother to my hospital for the treatment of his nephew for seizures. During the case there was a short discussion about his complaints. I then told him to provide the case history after which he was consulted and admitted.

Homeopathically one can consider this case to move from the Psoric to the Sycotubercular miasm. It has a lot of comorbidities as depression etc., which have the capacity to affect the entire personality. So, one just can’t afford to ignore and neglect the condition. Proper medication is a must.

Medical Perspective on IBS

Irritable bowel syndrome (IBS, or spastic colon) is a symptom-based diagnosis characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. As a functional bowel disorder, IBS has no known organic cause. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C or IBS-A, respectively). Historically it’s a diagnosis of exclusion. A diagnosis of IBS can now be made on the basis of symptoms alone, in the absence of  features such as age of onset greater than 50 years, weight loss, gross hematochezia, systemic signs of infection or colitis, or family history of inflammatory bowel disease. Onset of IBS is more likely to occur after an infection (post-infectious, IBS-PI), a stressful life event, or onset of maturity.

Although there is no cure for IBS, there are treatments that attempt to relieve symptoms, including dietary adjustments, medication and psychological interventions. Patient education and a good doctor-patient relationship are also important.

Several conditions may present as IBS including coeliac disease, fructose malabsorption, mild infections, parasitic infections like giardiasis, several inflammatory bowel diseases, bile acid malabsorption, functional chronic constipation, small intestinal bacterial overgrowth, and chronic functional abdominal pain. In IBS, routine clinical tests yield no abnormalities, although the bowels may be more sensitive to certain stimuli, such as balloon insufflation testing. The exact cause of IBS is unknown. The most common theory is that IBS is a disorder of the interaction between the brain and the gastrointestinal tract, although there may also be abnormalities in the gut flora or the immune system.

 

Comorbidities

Researchers have identified several medical conditions, or , which appear with greater frequency in patients diagnosed with IBS.

Headache, Fibromyalgia, Chronic fatigue syndrome and Depression: Inflammatory bowel disease (IBD): Abdominal surgery: A recent (2008) study found that IBS patients are at increased risk of having unnecessary cholecystectomy (gall bladder removal surgery) not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications. Endometriosis: significant link between migraine headaches, IBS, and endometriosis.

Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia.

 

  • Investigations : not done

 

His complaints were as follows:

  • · C/C :
  1. 1.    Gastric disturbances since 1-2 yrs.

–            Onset gradual.

–            Progressing.

–            Urgency for stool; has to go for stool as soon as he eats anything, even after taking liquids.

–            Stool: Watery, yellowish. Very offensive like rotten eggs. 15-16/ Day & 3-4/Night.

–            Abdomen: bloated sensation.

–            Stomach: Acidity with burning in chest.

–            Eructation: Normal, no taste but continues 6-7/day.

< Milk+++.                     > During sleep.

< Oily food++.                        > Night.

< Spicy++.                     > Roti.

< Eggs++.                                >12:00 – 4:00 pm.

< Morning+ 5-6 times. > Lying on Rt. side.

< Tea.

< Drinking water – Slight pain in abdomen.

< Waking on. Urge for stool.

 

 

  1. 2.    Headache since 1 yr.      

–            Gradual onset, gradual decline.

–            Duration : half to an hour

–            Progressing.

–            Location : Frontal, vertex, temporal region.

–            Sensation : Throbbing, wants to hit head to wall sometimes due to severe pain.

< Concentration during.                 > Relax.

< Noise, irritation.                          > Closing eyes.

< Morning.                                      > Lying on back.

< Sleep after.                                   > Fanning.

< Waking on 7 – 8:30 am occ. up to afternoon.

·     Physical Generals :

§   Diet                  : Mixed.

§   Appetite           : Decreased. Can tolerate hunger.

  • Desire              : Rice+++, Milk+++, Milk Products++, Sweet++, Non-Veg+, Ice Cream+.
  • Aversion          : Spicy, Salty.
  • Food<              : Spicy, Milk, Oily < complaints.
  • Head                : Headache.
  • Eyes                 : Using specs since 2 months for both eyes. Perspiration around eye white.
  • Thirst               : Thirsty. S.Q.L.I. 1-2 lit/day.
  • Mouth              : Dryness.
  • Tongue            : Dry, white coated.
  • Chest                : Burning d/t acidity.
  • Stomach &

Abdomen        : Acidity. Heartburn 1:00 pm to 3:00 pm.

  • Bowel              : Loose motions.
  • Bladder            : 2-3 times / day.
  • Perspiration     : Profuse, slight offensive; whitish stains, more on above & below eyelids.
    • Sleep                : 7 hrs. Disturbed. Awakes at 3-3:30 am then again sleeps at 4-4:30 am to 7-8 am.

Lying on Lt. side.

Refreshing but after sometimes headache starts.

Requires 1 Pillow.

§   Thermally        : Hot.

 

·     MIND

  1. Tell me about your childhood?

I have stayed in a village. Financial condition was average. I was good in studies. I have studied 12th Science. I wanted to be a doctor but I couldn’t due to weak financial condition.

By nature I was mild. I never liked to be much amongst people. I always had few selected friends.

I was short tempered. I never liked anyone contradicting me, criticizing or doing wrong to me.

 

  1. What are your present situations?

I got married 3 yrs back. I had 2 sons, one of which passed away just 3 days after birth.

We stay as nuclear family. At present I am working in a pediatric hospital. I have got good experience here. I can manage most of the work in hospital. I am well versed with many medical procedures. Financially things are working good.  I do have a plan to set a business.

 

  1. Tell me about your nature?

I am mild. I do feel bad if someone teases, criticizes, contradicts or does wrong to me, which is the case many a times in hospital, but I never react to them. If such incidents occur in the office I directly inform the seniors and they take appropriate action.

I still don’t much prefer to be around people. I don’t like people sympathizing me. I hardly have any friends but I am fine with it. I share a good relation with my family members.

I like cleanliness and to follow time.

 

  1. What are your Worries?

I feel worried about son’s future. I do feel sad about not able to study more after 12th because of poor financial condition. I started doing job very early.

I want to start a new business. Meanwhile my brain is occupied with these thoughts. I want to work hard and develop a good business.

 

Please send the name of the remedy you selected, along with your reasons for choosing that remedy to:

[email protected]   (Subject Nikam Quiz)

Good Luck!

About the author

Amarsinha Nikam

Amarsinha Nikam

Dr. Amarsinha Nikam is a renowned homeopath who runs Aditya Homoeopathic Hospital and Healing Centre in Pune. He started his career as R.M.O. at Lokmanya Hospital Pune, Homoeopathy Division and subsequently practiced as the consultant Homoeopath for 14 years at various places such as Beed, Khopoli, Chakan, Kate – Pimple, Pimple – Gurav and Pimpri Gaon, Pune. Dr. Nikam teaches students to understand the depth of homeopathic treatment and differentiate it from other pathies. He instructs them in his method of practice, but also inspires them to innovate and explore.

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