A female, SD age 51 years, came to clinic with the complaints of pain in heels. It was diagnosed as Calcaneal Spur by the orthopedic doctor and her X-ray reports confirmed the same.
The patient had extreme pain in the heels and she couldn’t walk barefoot in the house. As soon as she wakes up, she feels the pain. She needs support while walking. She starts weeping with the pain.
Right heel > than left heel.
< - Rising on, standing while and morning.
> - Hot fomentation, oil application and hard pressure.
Acidity & gas. She says “whatever I eat gets converted into gas” stools are unsatisfactory and hard.
Patient’s nature (Mind):
Patient says “I get tensed on trifles, very sensitive to any stress at home. If I hear something about any person then I start getting negative thoughts. If somebody from family is admitted in hospital and that person is suffering, then I feel like helping them doing something for them. I get very easily influenced by people, trust them immediately. I help old and unhealthy people in family. I get worried for children in very small issues.”
She lives in a joint family (Indian set-up where Parents, Siblings, grand-children live together) and she feels it’s her duty to take care of each of the family member.
“I have to be there to help them. I should do it for them. If I can’t manage then I feel bad, I feel like sacrificing my personal things like going out etc. If I have to go out, then I feel that I have become selfish. I will not repeat it... as I am responsible for them. I feel attached to them.”
D- Describe what help means to you?
P- I feel satisfied that I am doing something good. They feel satisfied that I am doing for them.
If my family members are not keeping well I keep on thinking about them. I immediately go to them and take care of them and help them. I get tensed for their health. (Weeps while narrating)
Once my health had deteriorated a lot and doctor said that I had depleted all vitamins and minerals. I got tensed about my health. What will happen to my family members? How will I take care of them if I get such deficiencies…?
I keep doing everything for everyone. I cannot say “No” or be assertive. I stretch myself beyond my capacity. On the other hand, if I have some problem then I will not tell anybody to work for me. I don’t feel good bothering anyone.
I keep on doing for them even if they do not do for me. I just drain myself, people don’t have my value. No value at all. I feel they just use me up and I helped them so much. When they wanted they used me. When I need them they are not doing it for me. It makes me feel very irritable and angry.
I feel they must appreciate me for what I have done. They should at least talk about whatever I am doing for them. Then all those thoughts start overcoming my mind. Then I remember about my religion & about re-incarnation. I feel “karma” will take care of everything.
Peculiar physical generals:
Dreams: About family functions & get together.
She describes one dream as she is stuck in a small room, there is no light. Fear that how will I come out of it.
Another dream “I am on a mountain and I may not able to find the way. Fear what will happen to me. How will I come out of it?
Her experience in the dream was as a child asking for help. “Let me come out. I have forgotten the way. If nobody takes me then I might die. What will happen to me if I die it will be suffocating. When scared I remember my god then I start praying (Navakar Mantra- a Jain prayer)”
The main issue of the patient revolves around her own structure. The issues of lacking (deficiencies, capacity etc.), maintaining, losing/breaking of this structure or organization.
Here in case, patient is talking about she doing things for her family, maintaining the relations, and stretching beyond the capacity to keep the family happy corresponds to maintaining the structure and overusing the structure, indicating towards mineral kingdom.
The patient talks about group & family corresponding to the features of mammals. Mammal features of need to belong to group, doing lot of efforts to be the part of the group and on the other hand , feeling of being used up are observed in patient state but there are no issues of me vs. you or survival ruling out the animal kingdom.
Dreams- She talks about being in a dark room or on top of mountain alone where the experience is of complete helplessness, suffocation and need to find your way out with someone’s help. This correlates to Stage of separation and birth and suffocating/claustrophobic experience of it.
Issue of 'Birth and Separation' is the chief issue of Row 2.
"Am I a separate entity or am I a part of something?"
"Am I attached or detached?"
Carbon is in middle of the 2nd row, during the birth process the head of the baby is descending further and engages itself. The baby is separating from the womb and now there is no going back. But it’s in middle, swaying between letting go off the clinging or being separate.
Her dreams narrate the experience of carbon.
The patient is very anxious about small things. Slightest things would cause anxiety in her. She becomes excited for smallest thing. We can see that in terms of her anxiety, being sentimental, irritated, sadness. The slightest cause is sufficient enough to cause turmoil within her. She is conscientious about the things that she does for her family. She looks timid and lack confidence She is very sympathetic for everyone surrounding her and wants to help everyone. During the narration she was weeping and felt better after the case. She kept on asking about the recovery of pathology that she had with very less hope.
Rubrics illustrating this feature are:
Graphites 200 1 dose. Follow up would be after 3 days.
Follow up after 3 days:
No change in intensity of pain. But there was change in her overall mood. I have become less irritable, less aggressive and angry. Acidity has improved. The gas formation has reduced.
Sleep is sound and no dreams.
Analysis: We will repeat one more dose to see the effect of the medicine as it has helped patient at the mental level.
Rx Graphites 200 1 dose
Follow up after 15 days:
No change in the intensity of pain. However, the mental and physical generals continue to improve.
Analysis: the general changes at mental level are persistent but there is no improvement in Physical particular.
Understanding the case from the miasmatic background.
The main feeling of patient is that she is expected to perform exceedingly well. So the demand is put up on her and she tries to cover her incapacity by putting her extra efforts Patient has taken up her survival by overdoing things for everyone, stretching beyond her own capacity and tries her own structure to be perfect. She tries to maintaining higher limits for her.
Carcinosin 1M 1 powder followed by placebo for 7 days.
· Follow up after 7 days.
Intensity of the pain slightly reduced. General and mental state looks to be more improved.
Rx: Carcinosin 1M 3 doses on consecutive days once a day followed by placebo.
· Follow up after 7 days.
Pain intensity reduced further. Pain on waking was improved. She could at least walk in house without support.
· Follow up after 3 months.
She felt 80% better with the pain. Intensity reduced further. She can walk barefoot and without support. She can walk continuously for more than an hour without pain. General condition improved. Acidity is less.
Rx: Potency of Carcinosin was increased to 10M as the state of miasm was prominent.
After the dose pain improved a lot. Asked to stop medicines after 3 months.
· Follow up After 6 months.
100% better No relapse of pain. No other aggravating complaint. Her general state continues to be better.
Graphites worked as her constitutional medicine and Carcinosin as Intercurrent which could remove the miasmatic block and add to further improvement for the patient.