A Case of Diabetic Gangrene(LT) Foot

Author: Dr. Amar Nikam

This week let us see an astonishing case of Diabetic Gangrene of Left Foot treated with Homoeopathy.

Case History:
Chief Complaints:

1. 1. Diabetic gangrene of (Lt) foot since 1 year.
      • H/o amputation of great toe of (Lt) foot done in 1998 because of diabetic gangrene.
      • After a year, gangrene had reappeared on the same toe base.
      • Oozing of profuse watery, sticky discharge from the toe base.
   2. Wound was about 1.5 inch deep & was growing in character; base of wound was reddish & painless because of advanced diabetic neuropathy.
   3. Unsatisfactory stool since 10-15 years. Chronic H/o Constipation.

Physical Generals

• Habit : Smoking. Now left since few days
• Diet : Vegetarian
• Desire : Sweets, Milk, Banana, Rice, Sour, Cold Drinks
• Aversion : Spicy, Oily
• Tongue : Moist, Pallor
• Teeth : Teeth extracted because of early caries, necrosis & swelling of gums
• Thirst : Moderate
• Stomach : < Fasting
• Abdomen : Heaviness of abdomen sometimes
• Bowel : Unsatisfactory stool
• Perspiration : Moderate
• Sleep : Sound, 11 pm to 7 am. Alert sleep
• Ear : Impaired hearing of (Lt) ear specially
• Thermally : HOT patient. Desires fanning. > Open air

Past History

• H/o Typhoid in childhood
• H/o Appendicectomy in 1962
• H/o Jaundice in 1963
• Amputation of great toe of (Lt) foot in 1998
• Cataract operated in 2002 both eyes (Lt) to (Rt)

Investigations
Random BSL – 200-mg/100 ml.

06.06.2005 :
BSL (F) : 84 mg%
BSL (PP) : 240 mg%
Wt. : 71.4 kg.
BP : 166/86 mmHg.

Mind

1. Nature:
   With a broad smile he said, I am irritable at times but cool down easily. My wife always says that my anger rises up & falls down in seconds. I like to be busy all the time and get angry if anyone points my mistakes.
2. Childhood:
   I was born & brought up in a small village in ‘Konkan’ with a poor financial background. I was a happy go lucky child. I had many friends and enjoyed their company. Due to poor financial condition, I was unable to complete my graduation in Arts.
   (But the next moment he laughed and said,)
   I was quite short tempered & angry when anybody did not listen to me.
3. Things that make you sad:
   I feel sad because I have been married for 40 years, but we have no issue. I felt sad & lonely after my father expired in 1995. (I noticed that while speaking he became sad for a moment & the very next moment he laughed loudly).
4. Work:
   I am retired from the Trade License Department in 1995. Now, I am doing a small job and the rest of the time I help my wife in her household work. I also have a farm in Konkan with plenty of Coconut & Betel nut trees, which I manage on frequent visits.
5. Sad/Unforgettable moments:
   It was a court case, which lasted from 1972 to 1983 that troubled me a lot. My cousins had filed that case against my father regarding a property dispute. They purposely tortured & harassed my father who was really a very gentle and calm fellow & that hurt me a lot. I was very close to my father. Afterwards the case was closed in 1983 in our favor. But that period was quite troublesome for me.
   I lost my father in 1995, which was also a very sad moment.
6. Very good relation with all.

Observation:
During consultation, I observed that, he was very jolly &jesting. E.g. when the assistant doctor was asking him, which eye was affected first due to cataract? With a smile, he replied the (Lt) Eye was operated & the (Rt) is always right (unaffected).

Then he again laughed loudly and also all the assistants had a hearty laugh. In spite of uncontrolled DM with threatened gangrene, the patient’s (laughing) expressions and jesting nature astonished me. He was smiling & laughing throughout the consultation.

I observed the rapid alteration of mental condition e.g. when he was narrating his mentals, he was sad at one moment & at the next moment he laughed loudly.

• Loquacity with jesting
• Cheerful / Jolly
• Mild & yielding
• Laughing loudly
• Sitting reclining backwards

Case Solution:

The following rubrics were taken.

Rubrics for repertorization:

Totality:
– Jolly / Cheerful.
– Loquacity.
– Laughing loudly.
– Mild & yielding.
– Changeable disposition.
– Anger from Reproaches.
– Sadness.
– Sensitive to reprimands.
– Anger with quick repentance.
– Diabetic gangrene of (Lt) foot (i.e. ulcerous affections.)
– Sterility.
– Watery, sticky discharge
– Complaints mostly (Lt) sided.
– Chronic H/o Constipation.
– Desire : Sweets, Milk, Banana.
– Aversion: Spicy, Oily.
– Tongue : Pale.
– Teeth: Caries.
– < Fasting. – > Open air.
– Alert Patient. (Even sleep also alert.)
– Desires fanning.

Thermals : hot

Miasm: syphilis

Different Remedies:
ARSENIC ALB, LACHESIS, CROCUS SATIVUS

Remedy Selected:
CROCUS SATIVUS 30.

Follow Up:

After giving a single dose of the medicine, the patient was asked regular check-ups of his BSL.
He was also told to do daily sterile dressing of the gangrenous part.

Date: Day 4

Symptoms:
• BSL is
• Gangrenous wound also started healing gradually. The discharge from the wound decreased with formation of regular margins around the gangrenous part. The patient started feeling sensations over that area with proper healing of the wound. Thus the diabetic neuropathy was decreasing.
• Gradually the wound healed up to 90% & his cheerful eyes and loud laughter is remembered even today.

Last follow-up: There was no trace of any wound or discharge. I advised him dry dressing for the protection of the tender area from any injury.

Learning:
ARSENIC: Is a restless, cautious and anxious patient. Although it has gangrenous tendency with D.M., ARS is a Chilly remedy with hot head. ARS is censorious, restless and fastidious patient.

Lachesis: A left to right, hot, loquacious remedy with decomposition tendency. But LACH is shrewd and cunning. LACH is not so sensitive to reprimands as CROCUS. LACH loquacity includes lustful topics and manipulative nature. Mildness and changeable disposition are not seen in LACH.
This case demonstrates how even a difficult case like Diabetic gangrene of left foot can be cured with Homoeopathy.