NAME – Mrs. A AGE- 33 yrs
SEX- Female OPD No.- 5650
DATE – 17-1-07

PRESENTING COMPLAINT-
1.Inability to move left leg and fixed flexion deformity of left knee joint since 1 yr. -
Patient cannot move her left leg. She cannot straighten her left leg, there is contracture of left knee joint.
HISTORY OF PRESENTING COMPLAINT- Patient was apparently well 1 yr back when she developed pain in left leg. The pain gradually increased with stiffness of left knee and leg. She took allopathic treatment from safdarjung hospital, she was given calcium supplements and pain killers. This gave temporary relief but eventually the pain subsided and contracture developed. Now the left foot hardly touches the ground and she cannot take weight on left leg. She cannot walk without support, can’t even stand without support. She had X –rays and MRI scan of left leg done and she is diagnosed as SUB-ACUTE OSTEOMYELITIS WITH NECROSIS OF LOWER END OF LEFT FEMUR. She was advised to under go TOTAL KNEE REPLACEMENT.

PAST HISTORY-
History of similar complaint – pain and contracture of both legs at 11yr of age. She was treated with plaster of both limbs for 2 months and she recovered with no residual deformity.

FAMILY HISTORY-
1.Cancer- mother.
2.No significant family history of diabetes mellitus, hypertension, heart diseases or other diseases.

PERSONAL HISTORY-
Education- B.A.
Occupation- House wife.
Marital status- Married for last 9 yrs.
Diet- Balanced diet
Life space situation- Patient is a house wife, she has two children. Husband is working in some company. Economic standard is average. She has congenial environment at home and her husband is very caring.

GYNAECOLOGICAL AND OBSTETRICS HISTORY-
Menarche- 13 yrs of age
Cycle- 28/4days, flow is regular, bright red, with occasional clots. No associated complaints.
LMP- 1/1/07
G2P2A0L2. Both full term normal vaginal deliveries.
No complaints during pregnangy, delivery or puerperium.
LCB- December 2003
Both children alive and healthy.

PHYSICAL GENERALS-
APPETITE- 3 meals/day.
THIRST- 4-5 glasses /day. Normal tap water.
DESIRES- Spicy food (3+)
AVERSION- Apples(3+)
STOOL- D2NO. Normal consistency, brown coloured, no specific odor. No complaints before during or after.
URINE- D5-6N0-1, pale yellow,no complaints before during or after.
SLEEP- Normal refreshing sleep, 6-7 hrs/night.
DREAMS- Nothing specific.
PERSPIRATION- Cold sweat on soles of feet occasionally.
THERMAL REACTION- Towards chilly(2+)

MENTALS-
Fear of cancer(3+).
Desires company(1+)
Desires consolation (3+).
Despair of recovery(3+)

GENERAL PHYSICAL EXAMINATION-
ANEMIA- absent
JAUNDICE- absent
CLUBBING- absent
CYANOSIS-absent
PIGMENTATION-absent
OEDEMA-absent
BP-118/80 mmHg/left arm/sitting/at 11:30 am.
PULSE- 90/min,regular, good volume,normal condition of vessel wall.
TEMPERATURE-99.8F
THERMAL REACTION- towards chilly(1+),desires covering even in warm weather.

SYSTEMIC EXAMINATION-
Examination of left knee joint-
- Fixed flexion deformity.
- Temperature normal
- No redness
- No effusion
- Limitation of movement(both flexion and extension

LAB INVESTIGATIONS-
1.HEMOGRAM-
Hemoglobin- 11gm%
WBC- 16000/cmm
ESR- 112 in I hr.
2.X-Ray(left knee joint )-
Shows changes of subacute osteomyelitis
3.MRI(test of choice)-
Shows increased signal in the bone marrow consistent with bone marrow oedema & may also reveal associated soft tissue infection.

REPERTORIZATION- (RADAR)

Tina Sharma -Osteomyelitis

Sum of degrees - Sum of degrees - Intensity is considered
1 1234 1 MIND - CONSOLATION - amel. 30
2 1234 1 MIND - FEAR - cancer; of 63
3 1234 1 GENERALS - INFLAMMATION - Bones; of - Bone marrow; of 24
4 1234 1 GENERALS - FOOD and DRINKS - spices - desire 1 34
5 1234 1 EXTREMITIES - CARIES of bone - Thighs - Femur 5
6 1234 1 GENERALS - FOOD and DRINKS - apples - aversion 5

phos. puls. sil. carc. fl-ac. hell. agar. ars. calc. sulph.
7 7 6 5 5 5 4 4 4 4
1 2 4 1 1 - 2 1 - - -
2 1 - - 1 1 - 3 3 1 1
3 1 1 2 1 1 - - - 1 -
4 3 2 - 2 2 - - 1 - 3
5 - - 3 - 1 - - - 2 -
6 - - - - - 3 - - - -

PRESCRIPTIONS-
1.First Prescription- Flouric acid 30/tds/15days(17/1/07)
ADVISE- Physiotherapy

FOLLOW UP- Patient experiences over all improvement.
No improvement in limb function.
Prescription- Flouric acid 30/tds/15days(24/1/07)

FOLLOW UP- Limb movement started.Patient experiences 20% improvement in limb function. She can now extend the left leg to some extent.
Prescription- s/l/tds/7days(9/2/07)

FOLLOW UP- Patient is standstill.
Prescription- Calcarea flour 30/tds/1month(16/2/07)
Calcarea flour 6x/tds/1month

FOLLOW UP- Patient is markedly improved. Now she is hopeful of recovery. Fear of cancer is much reduced but still she desires consolation. Limb function is restored upto 60%. The left foot now touches the ground ,the patient can walk without support for about 100 metres. The patient has stopped physiotherapy.
Prescription- Carcinosin 1M/1 dose-(as intercurrent)
Calcarea flour 30/tds/1month(17/3/07)
Calcarea flour 6x/tds/1month

FOLLOW UP- Patient is much better ,feeling very well. The limb function is still improving. No fear of cancer now.
Prescription- s/l/tds/15days(20/4/07)

FOLLOW UP- Improvement is standstill. Wants consolation.(3+)
Prescription- Silicea 30/tds/15 days(2/5/07)
Indication - Silicea is the only remedy in the rubric EXTREMITIES, Ankylosis, knee.

FOLLOW UP- Patient improved remarkably. Limb function is almost 80% restored. She can walk for some distance without support, can easily climb stairs.( 25/5/07).She has developed craving for raw onion.
Prescription- Thuja 30/tds/ 15 days (25/5/07)
Indication- Thuja has craving for raw onion, and it is a complementary of silicea .

FOLLOW-UP – Patient shows more improvement. No craving for raw onion, she is feeling very well and refreshed.