The journey of Homoeopathy in haemophilia

hemophiliaHomoeopathy In Haemophilia is a self governing research organization working for the Haemophiliacs through interdisciplinary approach purely on charitable basis.

Project Title:
Homoeopathic Medicines As Supportive Therapy For Managing Severe  Haemophilia Patients In A Resource Constrained Set Up Of A Developing Country.

Introduction:
Haemophilia is a genetic bleeding disorder resulting from deficiency of clotting factor VIII (Haemophilia A) or Factor IX (Haemophilia B). The disease affects males where as females are the carrier. A person with Haemophilia (PWH) suffers various bleeding episodes ranging from superficial cuts and bleeds to life threatening intra cranial hemorrhage whereas haemarthrosis remain the common presentation of the disease. Latest Haemophilia census says that there are all together 60-70,000 haemophilia patients are there in the country of which 90% suffers from Haemophilia-A, remaining 10% of Haemophilia B. Only 16,000 are registered in National Haemophilia Register. Remaining patients are undetected due to poor awareness and paucity of latest updated Investigations as available in IHTC only.

Common problems of PWH
Haemarthrosis is the commonest presentation, and can occur 2-3 times/weak. The repeated bleeding in the joints leads to joint deformity thereby increasing the morbidity. Conventional management of the disease includes infusion of deficient factor concentrate/FFP  during bleeding phase and physiotherapy is recommended to increase the joint mobility. Repeated infusion with factor concentrate or FFP carry the risk of transmission of transfusion related disorders like Hepatitis C,HIV etc .and may develop Factor inhibitor. A PWH with inhibitor requires to be infused with FEIBA (Factor Eight Inhibitor Bypass Activity). In developing country like India where 80% of population resides in rural areas and more than 80% of PWH belong to lower socio- economic strata having per capita income between 15,000-40,000/year, the exorbitant cost of the standard hemophilia management makes it out of reach of many haemophiliacs. The treatment cost increases in patients with inhibitor positive/ Hepatitis C infection or if there is any associated disease.

Inception of the project:
In view of above a charitable research project has begun in 2007 by Dr. Tapas K Kundu, at Nashik with all necessary Advises, Navigation and Support from Dr. Kanjaksha Ghosh. All Laboratory investigations were carried by in NIIH and IHTC.  Hemophilia Federation of India played very important role by providing patients in all centres from the respective chapters and by extending logistic support (in Mumbai and Surat). Homoeopathic medicines are being given as a supportive management during bleeding and non-bleeding phase with the following objectives.

  1. To minimize the bleeding episodes of PWH without compromising with the quality of life.
  2. To increase the adaptability of PWH.
  3. To reduce morbidity.

Treatment plan:
During acute bleeding episodes homoeopathic medicines based on the law of similia (TOS) are prescribed along with the use of Hammamelis Q as a local application (cold fomentation). In case of haematuria, where factor infusions are generally avoided, the same is given orally dissolved in water. Patients are asked to maintain a diary noting the number of bleeds, amount of factor utilized , daily activities , any psychological upsets  or  altered behavior. A detailed case report format is filled and a constitutional similimum is prescribed based on  symptoms pertaining to emotions/psychology  in response to the disease(Cognitive symptoms- obtained from interaction with the  patients and gist from the diary), behavioral changes adopted  to cope with the disease( Conation) along with characteristic physical and particular symptoms. The repetition of the doses is done according to the susceptibility. The disease is managed as per the severity under three levels.

Level I: Advocated For Patients As Self Management

  • Soak a gauz piece with hammamelis q       10-15 drops
  • Apply over the affected part   q +1 cup water  for 15-20 min

Level II:  frequently used medicines with indication (Acute Prescription)

  • Calcarea Carb 1M- Muscle haematoma with ecchymosis.
  • Bryonia Alba 30- Painful swelling of the joints ameliorated by rest.
  • Apis Mellifica 30/6- Swelling of joints with effusion and redness of overlying skin.
  • Ledum Pal 30- Pain/swelling of the joints ameliorated by cold fomentation.
  • Arsenic Album 6/30- Restlessness with pains and amelioration by warmth.
  • Lachesis 6/30- Increased activity of children inspite of injury or pains. Bleeding dark in color.
  • Phosphorus 30-Bright red bleeding with anxiety.
  • Rhustox 30-A/f over exertion of the muscles. Amelioration by continuous motion.
  • Silicea 30/200/1M-Sense of responsibility despite the sufferings. H/o-repeated factor/cryo ppt/plasma infusion.
  • Merc Sol 200/1M- Individuals reacting violently with pains associated with intense thirst and flabby tongue.

Level III: Selection Of Constitutional Similimum Based On

1.Persistant behaviour of the patient obtained from

  • The Daily Dairy
  • Physician’s Observation
  • School teachers’ report or peer report.
  1. History obtained from the case performa
  • Emotional/psychological symptoms
  • Physical Generals
  • Particulars

3.Physician’s Observation

  1. Miasmatic Diagnosis

*** In all three levels the medicine is selected as per the law of Similia and also the unified decision of the treating physicians (at least two) and where Fleiss kappa is substantial.

Evaluation of the patients:  Besides noting the number of bleeds, patients are evaluated as per the following scales by the physicians.

  1. Pain Rating Scales:     a.Wong Baker Pain rating scale(0-10) for children below 10 years
  1. Numerical pain rating scale(0-10) for individuals 10 0r above

2.Vineland’s Adaptive Mal adaptive behavioral scale (0-24) (Modified-2007)

  1. Activity (0-8)
  2. Co-operation (0-8)
  3. Communication Skill (0-8)
  4. SF-32 joint mobility scale.
  5. Pain Type
  6. Swelling (Measured In Cm)
  7. Range Of Motion
  8. Disability

4.Frequency of bleeds:

  1. Number of bleed
  2. Duration of bleed
  3. Healing time
  4. Factor required/not/amount of factor required.

Service To PWH:
To start with 14 PWH were enrolled during first camp at Nashik, which slowly went on increasing and till date we have treating total no of 806 patients in our three nodal centres and three sub centres (Table 1). The PWH from various parts of Maharashtra and India are being treated under Nashik Centre. Extending the service to other parts of Maharashtra and Gujrat, haemophilia centres such as Mumbai, Surat , Miraj and Amrawati has started with 313,81,46, 42 patients respectively.

Updated till 30-04-2015 Nasik Mumbai Surat Miraj Amrawati
Parel Dombivali
Total number of Camps Conducted 89 87 49 30 16 2
Emergency & telephonic prescribed 3,047 429 337 255 54 6
Total number of interactions with patients 11,141 1798 486 281 234 73
No. of patients 324 232 81 81 46 42
Total Patients 806

During monthly camps along with homoeopathic medicines, physiotherapy and psychological counseling are also provided.

All emergencies are attended by the corresponding centres as they belong to.

The achievements:

  1. As an outcome of the study the research paper saw the light of publication under the

ELSEVIER-Homoeopathy entitled ,” Homoeopathic medicines substantially reduce the need of clotting factor concentrate in haemophilia patients: results of blinded placebo controlled cross over trial. Homeopathy (2012) 101, 38-43, 2011.

2.The homoeopathic medicines are found to reduce the episodes of bleeding as well as effective in the management of acute bleeding episodes whether concealed ( Haemarthrosis, intra muscular bleeds especially psoas bleed) or open ( epistaxis, bleeding from injury, fall of teeth, conjunctival or haematuria). The analysis of this study is under the process of publication.

Social Impact Of The Project;

  • The prevalence of PWH of factor inhibitor ranges from 8.2-13%.This percentage is observed to reduce to a great extent as only 1% of haemophiliacs under homoeopathic treatment were found to be positive for Inhibitor.
  • With homoeopathic medicines as a supportive therapy the cost of the disease management greatly reduced. Savings on Individual patient’s average usage at a rate of Rs 10/IU  on (12347-864 )  e. 11383 Iu X 10 = Rs. 1,13,830  /patient/ year.

Cost of homeopathic medicine including doctors fee will not be more than  Rs. 4000/ year. Hence final overall financial gain with better health status as they bleed less often is  Rs 1,09,830/ pt/ year.

OTHER PROJECTS:

  • Carrier Mother Project:

Genetic counseling is the main tool for the prevention and control of the disease, targeted at families with affected birth or with a family history of  disorder. A project for carrier mother is started with the view to limit the transmission of faulty gene to the offspring. The success of this project might reduce the incidence of haemophilia. The females planning to conceive are given Homoeopathic similimum and is repeated in infrequent interval during pregnancy.

  • Patients with Hepatitis C     Haemophiliacs developing Hepatitis .C infection as a consequence of repeated factor infusion are also being treated.
  • Patients with Inhibitor:    Patients diagnosed as FVIII Inhibitor positive are also being managed with homoeopathic medicine.
  • Counseling:    Most of the females experience marital conflict on account of being carrier of the disease. These conflicts are taken care by psychological counseling with the parents and family members. Carrier young girls prefer to stay unmarried to avoid problems in future. These females are motivated to take up positive decisions in life.

Funding For The Project:
The project is being run for past seven years on charitable basis. The medicine and other logistic support are managed by the project co-coordinator and Investigators.

Pople Behind The Project

Principal Investigator:
Prof (Dr.) Tapas Kumar Kundu
BHMS (Cal), PGDPC, MS(Ibms)
E-mail:- [email protected]

Co-Investigators: Dr. Afroz Farooque Shaikh, Dr. Priyanka D. Singh,Dr. Aafiya Sheikh, Dr. Hiral Shah Bothra,   Dr. Omkar R. Kumat

Visit:- www.homoeopathyinhaemophilia.com

Courtesy : The paper orginally presented in world homoeopathy submit at Mumbai by Global Homoeopathy Foundation (GHF)

2 Comments

  1. ‘Mind Symptoms’ and ‘uncommon
    symptoms’ (for selecting the remedy) are not what you have learnt but they are,
    in reality, something different which you ought to know and learn.

    –Explanation of Section 213 and 153 of the Organon—

    Dr. V. KRISHNAAMURTHY

    C-4/4. Silver
    Park Apts (Opp. Hindi
    Prachar Sabha), T. Nagar, Chennai – 600 017

    Phone: 044-24360013, 09884612450.
    E-mail: [email protected]

    Again,
    most of the valuable ‘mind’ or ‘uncommon’ symptoms cannot be classified under
    any head in the repertories and the conscious homoeopath has to learn them by
    rote. (‘rote’ means mechanical or habitual
    repetition—Oxford). Therefore, in many cases (if not all cases),
    homoeopathic software is of no use, however costly it may be and however
    praised by the so-called leading homoeopaths.

    The following
    actual cases cured by the author would give the reader a clear and accurate
    meaning of ‘mind symptoms’ and ‘uncommon symptoms’ in a matter-of-fact way. Dr.
    Hahnemann advises that without prescribing on mind symptoms a cure is not
    possible (Section 213 of the Organon.) ‘Anger’, ‘restlessness’ etc. are
    ‘common’ symptoms of mind. ‘When Section
    213 is read with Section 153, we infer that we have to prescribe on ‘uncommon
    mind symptoms.’

    Case 1: A
    renal failure patient under dialysis and waiting for kidney transplant, was
    under our treatment. We could not find his remedy.

    There
    is no guarantee for kidney transplant, because after a few years, many patients
    die because sooner or later the donor kidney stops functioning. After
    transplant he was heard saying, “Now I feel as if I am released from prison . .
    . as if I have taken a rebirth.” This he said because he is now freed from
    torturing and exhausting bi-weekly dialysis, taking rest, body becoming weak
    etc.

    This
    mental picture of the patient should at once bring to our mind the following
    words:

    …desire
    to be released from what seems to be a perpetual burden of sorrow… (See
    p. 111 of the Final Mat. Medica of Mind Symptoms by the author)

    We
    are going to give Ignatia to him and we are confident that his other
    kidney would start functioning and even if the donor kidney fails he would live
    long.

    CASE
    2:
    A patient with weeping eczema etc., came to me and said, “Doctor, I am not
    taking the treatment to live long. But I have an aged daughter to be married
    and a son who is looking out for a job. Who would come forward to marry my
    daughter, if I have a weeping eczema? Only because of that, I want to get
    cured. Before I die, I want to settle things in my family; my daughter getting
    married and son getting a job. Then I can die peacefully.”

    Under the remedy
    Petroleum (Boericke’s Materia Medica) we find the following:

    Feels
    that death is near, and must hurry to settle affairs.

    Now, this
    sentence fits with the remarks made by the above eczema patient. This remedy
    was given in single dose and it cured him completely.

    CASE 3: A peptic ulcer
    patient’s condition worsened day by day and allopathic antacids were giving
    only temporary relief. At the height of his suffering (hunger pain with burning
    sensation in the food pipe, temporarily relieved by eating) he was heard
    saying, “I think that my end is approaching; I must call the lawyer to write
    the will; that this hotel of mine should go to my wife; money deposited in the
    bank is for my son. My widowed sister who has been living with me for several
    years and helping me should take the house which I bought recently.”

    This mind
    picture agrees with the remarks made by the patient in case No. 2 above. One single dose of the remedy Petroleum-10M
    cured this patient as well. We do not
    prescribe on names of disease or pathology but on ‘uncommon’ symptoms having no
    relevance to pathology. Anger, irritability etc. are not ‘uncommon mind
    symptoms’.

    CASE 4: A seventy year
    old carpenter was under my treatment. During
    one of his visits he was accompanied by his 48-year old son. The latter was
    coughing with chest congestion etc. The carpenter told his son; “Why don’t you
    also take treatment from this doctor. See how much I have improved, whereas the
    other seven doctors to whom I consulted earlier could not do anything in my
    case.”

    To
    this, the son said: “The new house where I shifted has no raasi.”
    (‘Raasi’ in Tamil means luck). In other words the person feels that everything
    was going wrong ever since he started living in a particular house. So, that
    house has no raasi. Or, a person feels that ever since he bought and started
    using a car, nothing went right. He attributes his sufferings, failures,
    difficulties etc. to that vehicle. I hope the reader would understand this. The
    son continued, “Even the new work place where I am going daily is not raasi (or
    has no good luck.)”

    The
    other word to describe ‘raasi’ would be ‘sentimental’ ‘luck’. The carpenter’s
    son was not ready to take treatment from me only because he felt that the house
    and the work place is the cause of his respiratory complaints.

    I
    gave him one dose of a remedy telling him to take that and he need not pay me
    any fees. He took it. (Later I learnt that he was completely cured.).

    Can
    the reader tell me what remedy I gave the patient?

    MIND Symptoms:
    Superiority of Lilienthal:

    Read
    the remedy Staphisagria in the chapter Melancholia in Lilienthal
    (p. 701.) There we find the following:

    Inwardly gnawing
    grief and anger, he looks at everything from the darkest
    side . . . disinclination to work and think; dread of the future
    and dread of being constantly pursued . . . a sorrowfulness
    ending in paralysis of the intellect . . .

    Homoeopathy
    is an exact and accurate subject. Precision and versatility is its culture. No
    one can practise it from imagination.

    The
    enthusiastic reader would be eager to know how I selected this remedy for the
    above case.

    (a) Reproaches
    others (blaming the house and work place.)

    (b) Sentimental.

    I write down the remedies common to both
    the above rubrics in Kent’s
    Repertory (Mind) and read them in the chapter Melancholia in Lilienthal.
    Staphisagria suited the symptoms of the case.

    Case 5: A
    lady of forty-two came with a large calculus in her urinary bladder. She said
    that allopathic doctors advised surgery as the only answer but she declined to
    undergo it. She continued that she had already undergone two caesarean sections
    and one appendicectomy; after each one of these surgeries, her general health
    came down. Therefore she cannot afford deterioration of health any further with
    another surgery and that she must safeguard her health for the remaining period
    of her life. Under the remedy Nux vomica (p. 128 in the Final Mat. Medica of
    Mind Symptoms by the author) we find the following:

    Afraid she may not have enough to live
    on.

    Nux-vomica-1M
    one single dose was given in the evening. Not only her general health improved,
    but also the size of the stone started reducing. (Patient still under
    treatment)

    CASE 6: A chronic renal
    failure patient came to me with a few relatives, all of whom were allopathic
    doctors. They showed me a file containing the medical papers of the patient. After this, one by one,
    the relatives went out.

    The
    patient was still sitting. He said, “Doctor, my sons say that I am sick and so
    I should not ride bicycle, go out and do our business. They say they will do
    everything and ask me to sit at home taking rest. As my children, they should
    only tell me that I am all right and I would recover soon. But instead of encouraging me for speedy
    recovery they have branded me as a permanent and incurable patient.” [The reader may
    note here that in most cases the ‘uncommon’ symptom (on which we can make a
    prescription) is told by the patient at the end of the consultation, or, in
    some cases, after you have made the prescription! In yet a few cases,
    during the second or subsequent consultations!]

    This
    patient feels that his sons, instead of encouraging, are letting him down. What
    one requires from the relatives is not money nor help but moral support. In
    this case the patient feels that this is completely missing.

    This
    symptom we find in two remedies. (See the Final Mat. Medica of Mind
    Symptoms by the author. p. 114 and 147) They are

    “… a feeling of moral deficiency…” – Kali- brom.

    “… despondency, sadness, moral
    depression and relaxation…” – Tarentula hisp.

    Tarentula hisp.
    10M – single dose was given.

    Case 7: A
    lady of fifty-five, school teacher, was under my treatment for three months for
    sinusitis with little relief. She lives thirteen kilometers away from my clinic
    and she works in a school which is nearer to my clinic. Before going to the
    school she would come to me once a month, take medicine and go to school.
    Seeing no relief in spite of three visits, I told her that a certain
    acupressure doctor would come and give just 3-minute treatment once only and
    for this she need not pay any fees and also I assured total relief. Since the
    acupressure doctor comes to my clinic on Sundays only I asked her to come on a
    Sunday. To this she replied, “I have to come all the way… from … (her
    residence.)”

    During
    the earlier three visits she would come to me in the morning before going to
    her school which is near my clinic. Sunday is holiday for school and she feels
    it an ordeal to come for acupressure treatment all… the… way from her residence
    thirteen kilometers away.

    It
    is hesitation. I told her no need to pay any fees for the one-time acupressure treatment
    and 100% cure was also assured. Therefore, travelling thirteen kilometres won’t
    be a crime. But to do this she has hesitation.

    In
    the above said case, for merely travelling ten kilometres they have lot of
    hesitation as if I am asking them to do some crime or immoral thing. In other
    words, they are over conscious of a trivial thing. The apt term would be
    “Conscientious scruples.” This symptom is in the remedy Arsenicum album. [See
    the Final Mat. Medica of Mind Symptoms by the author. p. 77.]

    Let
    us repeat, that uncommon mind symptom may be in most cases one only, and the
    computer-software or ‘remedy finders’ are of no use. One single dose of
    Arsenicum Album-10M completely cured the above sinusitis patient and even
    acupressure treatment was not given.

    On this symptom,
    let us now see two more cases:

    Case 8:
    This is a cancer patient and after the consultation was over, I asked my fees
    of six thousand rupees. To this he replied, “Money… is…” (The sentence was
    incomplete and hesitation was as if they are asked to do some immoral act.) He
    should say that either he has no money or that he would try to borrow from
    relatives. But he does neither. Ars. Alb-10M, one single, dose cured him.

    The
    above two cases would illustrate the meaning and interpretation of mind
    symptoms of a patient. In some cases the repertory or software is not useful
    and you have to learn by rote these uncommon mind symptoms.

    Let
    no one practise homoeopathy without the help of Lilienthal.

    Precision
    and versatility is required to practise homoeopathy.

    The most useful
    books for mind symptoms are:

    (1) Dr.
    Samuel Lilienthal’s Homoeopathic Therapeutics.

    (2) Dr.
    William Boericke’s Mat. Medica.

    (3) Wilkinson’s
    Final Materia Medica (Compiled by

    Dr. V. Krishnaamurthy).

    (4) Final
    Repertory of Mind Symptoms.

    Lilienthal is
    ten times worth its weight in gold.

    Case 9: A
    patient with chronic headache, after spending much money with various doctors,
    specialists and homoeopaths came to me. After finishing the history of his
    seven years’ pain in head, he ended up saying: “Doctor, if you or anyone can
    cure me of this terrible headache, I won’t mind even giving away half of my
    property (worth three millions) to that doctor.” Doctors of all other systems
    would simply ignore this statement of the patient.

    If
    a patient is ready to pay 1.5 million… I thought over this. I took this as a
    challenge to homoeopathy. I asked him to first pay me ten thousand rupees and
    also give me two weeks’ time with a promise that if I do not cure him in one
    single dose (or a few doses) I would pay him double the amount paid by him.
    Also, if he is cured he may pay me another ten thousand rupees. He agreed to
    this condition and paid ten thousand rupees.

    I
    took a copy of Boericke’s Materia Medica
    and went to a professor of English and requested him to render me a help. I
    told him that he has to read the lines given only under the chapter ‘Mind’ in
    all the remedies in Boericke’s Mat. Med. and underline if any relevant line is
    found equivalent to the statement of a person who says that he would pay half
    of his wealth if his headache is cured. I paid him five thousand rupees (which
    the professor said is more than sufficient for the work)—It may take a few
    days, daily spending two or three hours to go through the lines given under the
    chapter ‘Mind’ in Boericke’s 688-page materia medica.

    To
    another professor of English I gave a copy of Wilkinson’s Mat. Medica and
    paying him the remaining five thousand rupees requested him to do the job of
    reading the lines given only under the chapter ‘Mind’ in all the remedies (and
    this too would take a few days, daily working for three hours) and tell me if
    he finds anything equivalent to the above said statement of the headache
    patient.

    The
    first professor (using Boericke’s) could not find anything apt. But the second
    professor underlined and pointed out the following lines in the remedy Stillingia
    (under ‘Mind’ in Wilkinson’s).

    “Deplorably downhearted; suffering
    extreme torture from bone pains.”

    Stillingia
    1000, one single dose cured the patient and he paid me another ten thousand
    rupees. After this case I cured two more patients with Stillingia. both
    of whom said the above words (ready to give his entire wealth to the doctor who
    cures him).

    Diligence and knowledge
    of English language, both to the core, are required to practise
    homoeopathy.

    Case 10: Here
    is another case of headache. This 55-year old male patient remarked: “Doctor,
    all these years I have been having these pains; my sufferings are such that no
    amount of compensation would be equal to it. Even if you make me the President
    of all the nations in the world that would not be a sufficient compensation.” I
    told him the same condition which I put to the patient in the earlier case.
    After taking ten thousand rupees I went to the two English professors, one with
    Boericke and the other with Wilkinson’s Mat. Medica. In this case the
    professor going through Boericke’s Mat. Medica could help me. He pointed to the
    following found under the remedy Selenium.

    “Extreme
    sadness. Abject despair,
    uncompromising melancholy.”

    Selenium 10M, one dose
    cured the patient and he paid me ten thousand rupees.

    On
    a later occasion the above said professors asked me what I did by their help
    and I showed them how I practise homoeopathy. Soon both of them started
    learning and practising homoeopathy.

    Homoeopathic system of medicine is exact
    and accurate. Precision and versatility is its culture.

    In some cases
    Calvin B. Knerr’s repertory is excellent to work out cases with
    mind symptoms.

    The other day I
    was sitting by the side of a senior homoeopath in his clinic. A patient entered
    and asked, “Do you have medicine for diabetes?”

    Doctor: Yes,
    tell me your symptoms.

    Patient:
    (Stretching his hand towards the doctor).

    “see
    my pulse; give medicine.”

    [The tone of the
    patient was in a commanding note similar to a king, who, when anything is
    required would order, “Bring the head of the thief in two hours.”]

    The doctor
    turned towards me and said, “See doctor, these patients don’t tell symptoms.
    How can I prescribe?” That doctor always thinks “Sensation, Locality
    Modalities, concomitants. What a wrong teaching?” I took Calvin B. Knerr’s
    Repertory and showed him the following:

    MIND, Answers,
    imperiously: Lycopodium.

    Further I showed
    him the following from Wilkinson’s Mat. Medica under the remedy Lycopodium:

    “Talks
    with an air of command . . . manner stiff and pretentious.”

    Lycopodium 10M,
    one single dose, cured this patient of his diabetes.

    —————

  2. Congratulation : let the work be made aware thru our colleges , it would create confidence in our students,
    .

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