A patient B.B. aged 65 yrs admitted with a physician in Gokak, was diagnosed to be suffering from Dengue fever. The patients white cell and platelet count started dropping dangerously low. The physician thought it best to refer the case to a referral hospital 80kms away in Belgaum. The patient approached Dr.Kowshik and was treated by him for less than 24 hrs before his counts touched normal again. In gratitude the patient and his relatives approached the press to publish the story of the dramatic cure so that other patients too would benefit.
Read my blog (revert to Home page) for more cases of dengue and other near-fatal cases treated miraculously with Homeopathy. Also read my blog `STEP BY STEP METHOD OF TREATING CLINICAL EMERGENCIES' - A well analyzed study of several hundred acute emergencies treated with Homeopathy. The article will serve as a confidence building exercise and a fairly precise guide on how to diagnose, monitor and treat acute critical cases.
28-07-2013: As of today I have had the opportunity to treat 8 cases of proven Dengue, all with thrombocytopenia ranging from 15,000/ul and above. No patient was referred elsewhere and none developed hemorrhagic symptoms. Platelet counts started rising within 24 hrs and crossed the 100,000/ul mark within 4 days.
DENGUE FEAR IN THE CAPITAL
New Delhi the capital of India is in the grip of a Dengue epidemic. It is amazing to note that the Government is busy running around like a headless chicken with no clue on how to handle this situation. Yes, prevention is better than cure. However, increasing the number of beds in public hospitals where the treatment offered is non-specific and not curative is preposterous. Does Mr.Kejriwal the Chief Minister not know anything about Homeopathy? Where are all the Homeopaths of N.Delhi? There are some very big names and persona who never miss a chance to strut around on stage at seminars proclaiming to have cured the incurable. Where are they? Have they opened a repertory to check the rubric `Dengue'? Have they lost their tongues or their self confidence? Or is it easier to fake cures at our most unscientific seminars, where single, poorly documented cases of Vitiligo and Diabetes are discussed ad-nauseum over 3-6 hours? Wake up my fellow Homeopaths! Now is the time to prove a point!!
DENGUE WITH PNEUMONIA
23-10-2015. Mr.S.P. aged 32yrs was brought to me with fever of 12 days duration. Chills followed by fever was intermittently controlled with allopathic medicines and the symptoms would recur after a couple of days. He was admitted with a surgeon who diagnosed him as a case of R.Lobar pneumonia. But his fever persisted despite treatment. He had a hard dry cough < daytime, talking. >at night. Cough with pain in abdomen and vomiting on eating. Intermittent fever < night with severe shaking chills. Thirst +++ but unable to retain what he drank or ate. P.R. 90/min. BP 110/80mm Hg. RS-Dullness and poor air entry with adventitious sounds R.chest. Temp- 101.5*F
His investigations advised by me were as follows:
Hb: 13.5gm%; WBC 24,310; P78%, L27%, M 4%, E 1%.Platelets: 16,000/ul, HCT 38.5%
Dengue test: IgG +ve, IgM: Nonreactive, NS1 antigen: Nonreactive. X-ray: R.middle lobe pneumonia.
Prescription - simillimum given in 1M potency every 2 hours
24-10-2015. Patient subjectively better, Temp- 99*F
Hb 12.9gm%, WBC 16040/cu.mm, P68%, L26%, M0, E 6% Platelets: 16000/ul. HCT 34%
Prescription: same as before
25-10-2015. Patient reported he was OK. No fever since last night. Mild cough.
Hb 12.0, WBC 11520/cu.mm, P69%, L25%, M3%, E3%. Platelets: 49000/ul. HCT 33%
Prescription: same as before, dose reduced to every 4 hours.
27-10-2015. Patient is asymptomatic. RS adventitious sounds much less. Cough occasional.
Hb 12.2gm%, WBC 7150/cu.mm, P63%, L29%, M 3%, E 5%.
Reduced dose to thrice daily.
ANALYSIS & CONCLUSION:
The patient had contracted secondary Dengue during his admission to hospital. The pneumonia was detected late and the patient was in dire straits when he came to me. His vital signs though were fairly well maintained, hence I took up his case for treatment with remarkable recovery. His pneumonia will need to be treated for a few more days.
PROLOGUE: I treated this case for a week with no improvement in his cough. I did his check X-ray AP and Lateral and Sputum test for Acid Fast Bacilli. Both tests were positive for Pulmonary Kochs. Not wanting to treat this condition, I referred him to a Government hospital for further management.
A case of Dengue fever.
14-07-2015. Mr.S.P. aged 19 yrs was referred to me for treatment of Fever of four days duration. The fever began at 6pm on the first day with chills/ heat/ perspiration. On the second day he developed nausea and vomiting. Despite the nausea he was very thirsty and continuously sipped water from a bottle by his side. He had a sinking sensation and uneasiness in the stomach with burning esophagus < drinking water or eating. Severe bodyache and headache. The face was noticeably red despite his dusky complexion. Temp: 102.4*F. His investigations were as follows: Hb 13.2gm%, WBC TC 2360/cu.mm, Poly 48, Lymp 47, Mono 3, Eosin 2%. Platelets 56,000/ul.
Dengue test: NS1 antigen - Positive.
Eupatorium Perfoliatum 30 was given in frequent repetition.
15-07-2015. WBC TC 5190/cu.mm Poly 63, Lymp 27, Mono 3%, Eosin 7%, Platelets 36,000/ul
Redness of face decreased. Patient though febrile (100.2*F), says he is much better.
Medicine continued frequently.
16-07-2015. Patient is much better - no fever or uneasiness, appetite returned - no nausea/vomiting. Thirst normal. Platelet count- 54,000/ul.
Medicine continued 4 hrly.
31-07-2015. Patient had failed to come for follow-up and was summoned through a relative. Says he is perfectly OK and working in his fields as the rains have begun, hence could not come!
Platelet count 3,10,000/ul
As you can see, Diagnostics and the interpretation of test results vis-a-vis the patient's vital signs play a very important role and give me the confidence in selecting and treating such critical cases.
Here I attach an article I wrote on treatment of Dengue which was accepted and published by a peer reviewed journal 'Homeopathic Heritage' in India.
Dengue – Its Homeopathic Management
Dr Dinesh A. Kowshik, MD (Hom)
Abstract: The need to revisit and study the efficacy of Homeopathic treatment of Dengue fever is vital since our system has penetrated the global primary health care arena. This paper presents ten cases of dengue that were managed homeopathically.
Keywords: dengue, homeopathy, arsenic album, fever
Dengue – the dreaded `break bone fever’ is a vector borne affliction, transmitted by the Aedes egypti mosquito. In the patients who may have had multiple infected mosquito bites, the platelet count begins to drop, and may reach life-threatening low levels, below 20,000/µL. A fall in the BP and/or increased pulse rate may be a sign of severe hemorrhagic episode. This hemorrhage requires immediate platelet transfusions and supportive treatment in a referral hospital. According to the Center for Disease Control and Prevention, as many as 400 million people are infected yearly. The most effective protective measures are those that avoid mosquito bites. A rapid chromatographic test can detect NS1 antigen, IgM or IgG antibodies in the blood. The presence of NS1 antigen indicates active infection. IgM indicates recent infection. IgG antibodies indicate old infection.
Dengue fever has been described in the Homeopathic Materia Medicas (Clarke, Phatak, Tyler, Hering) and appears as a rubric in the repertories-
Complete Repertory – FEVER, HEAT - dengue fever
Murphy’s Repertory – Fevers - DENGUE, fever
Boericke’s Repertory – Fever; Type of Fever, Dengue
Clarke’s Clinical Repertory – Dengue fever
The following are the records of ten cases of Dengue fever, some with platelet counts well below the normal range. A thorough case taking and clinical examination was followed by appropriate investigations. Homeopathic remedy for each was selected on the basis of patient’s symptoms with reference from the materia medicas and repertories. For the dosage, the instructions given in Lesser writings by Kent, Boenninghaussen, Farrington and Hahnemann, The Science of Therapeutics by C. Dunham were followed. The follow-up demonstrated quick response to the homeopathic treatment with an uneventful recovery. Not a single case in the series required anything more than the simillimum – no IV fluids or any other interventional therapy was used at any time. This is a serial study and no cases have been eliminated or selected for publication.
25/07/2012. Mr BB, 64 yrs/M. An old case of Ca rectum presented with Chills, continuous fever since 7 days. He had consulted a physician who had got his CBC and Dengue test done. He tested positive for Dengue IgM and IgG. His platelet count was 1.46 Lakhs/µl. Hematocrit was 36%. He was advised hospitalisation for two days. The patient opted for homeopathic treatment instead.
Extremely chilly, followed by sensation of heat and burning with intense thirst. Woke up past midnight with these symptoms along with fear due to thoughts of death. He wanted to see the doctor immediately. He had intense weakness, unable to sit in the waiting room. Since two days, there was continuous dry heat with painful cervical glands. Face was red and there was bitter vomiting. He had a desire to eat but experienced nausea on attempting the same. He could drink only water but vomited soon after. Temp 102°F; Pulse Rate 94/min; BP 110/80 mm Hg.
Prescription: The mind symptoms (Death, thoughts of; Impatience; Fear, death) coupled with the typical intense thirst and post midnight aggravation of symptoms; the intense weakness and restlessness indicated Arsenic album.
Arsenic album 1M 4 globules every half hour for 3 hours. 2 hourly from next day.
Follow up: 27/7/2012. Hb 10.5gm/dl; Platelet count: 1.71 Lakhs/µL. Medicine continued two hourly.
31/7/2012. Platelet count 1.87 Lakhs/µL. Patient asymptomatic. Treatment stopped. Advised appropriate diet to correct anemia.
2/12/2012/. G.R. 18yrs/M presented with high grade fever. Irregular paroxysms since six days, controlled with Paracetamol. Symptoms were scanty due to suppression with Paracetamol and other antipyretics. The only thing that stood out was his nightly aggravation of fever with intense thirst and nausea with disproportionate weakness. Fever with headache. PR 106/min BP 120/70mm Hg. Hb 13.5gm/dl, WBC 2780/cu.mm; Platelet count: 59000/µL; HCT 38%. Dengue test: NS1 positive; IgM and IgG nonreactive.
Prescription: Arsenic album 1M, 4 globules hourly on first day, later 4 globules 2 hourly till fever subsides.
Follow Up: 3/12/2012. Vomiting soon after eating/drinking. Dry hoarse cough, throat pain; < night, lying on back, warm drinks.
Phosphorus 30, four doses given at 2 hourly intervals. Low potency was selected with frequent repetition since it was an acute complaint (? accessory symptom). Phatak’s MM.
8/12/2012: Patient came after 5 days, unmindful of the strict instructions regarding the regular follow up and medication. He said he had been asymptomatic since 4 days. Refused treatment but got his blood tested. Hb 13.0gm/dl; WBC 4900/cu.mm; P60/L35/M4/E1. Platelets 1.63 Lakhs/µL. HCT 40%.
18/4/2013. Miss DK, 11yrs/F. Chills on first day, then continuous dry heat with headache since 4days. Fever < midnight and after. Tongue red edges and tip. Intense thirst for small quantities but unable to eat anything- no desire for food. Pain in limbs especially legs and hip region. PR 89/min. BP 120/70mm Hg. Investigations done on 17/4/2013 showed Hb 13.7gm% WBC 4100/cu.mm P47/L53/M0/E0. Platelets 42,000/µL.
Clinical diagnosis: Dengue. Patient advised to come with blood reports next day.
Prescription: Arsenic album 1M every half hour 6 times, Second day: 2 hourly.
Follow up: 19/4/2013. Fever subsided partially. Repeat investigations showed: Hb 13.2gm% WBC 4760/cu.mm; P42/L57/M1/E0. Platelet 61000/µL. HCT 40%. Dengue test: NS1- Nonreactive, IgM – Reactive, IgG- Nonreactive.
20/4/2013: Patient asymptomatic. Treatment stopped.
21/4/2013. Patient was very emaciated weighing 22Kg. Hb 13.3gm%, WBC 5390/cu.mm; P 40/L54/M2/E4. Platelet count: 1.8 Lakhs/µL. HCT 41%.
Patient was advised regarding nutritious diet. Gentiana Q given in drop doses twice daily to improve appetite.
27/07/2013. Mr SM 14yrs/M. Sudden onset of high grade fever 102 to 104°F since four days; began at 1:00pm on first day. Chills, heat, perspiration. Tongue coated white, marked thirst for cold water in small quantities. Severe nausea but no vomiting. Water tasted bitter. Sinking, empty sensation in the stomach but could not eat anything. Sore pain in both lower extremities, especially thighs. PR 106/min. BP 110/70mm Hg. Hb 12.8gm% WBC 1830/cu.mm; P67/L32/M1 Platelets 87000/µL; HCT 41%. NS1 – Nonreactive; IgM – Reactive; IgG- Nonreactive
Prescription: Arsenic album 1M 2 hourly
Follow up: 28/07/2013: Throat pain persisted. WBC 2710/cu.mm Platelets: 89000/ul.
29/07/2013. Throat pain persisted. Shallow, spreading mouth ulcers noted on inner cheeks. Bleeding on touch. Fetor oris. TLC 3420/cu.mm, Platelets 1.86Lakhs/µL.
Merc cor 30 3 globules every six hours. Arsenic album to be continued after.
02/08/2013. No complaints except loss of appetite.
Gentiana Q to improve appetite. 10-12 Drops twice daily.
18/09/2013. 10:30am B.S. 45yrs F. Continuous fever since eight days. Dry severe heat < 11 am. Thirst severe for cold water – small sips. Averse to any food. Mild nausea. Malaise and intense weakness, difficulty getting out of bed. Moderate head pain temporal region with nausea. PR 95/min BP 100/60mm Hg. Hb 8.8gm% WBC 1760/cu.mm P62/L30/M2/E5 Platelets 89,000/µL; RBC 3.47 million/ul; HCT 28%. Widal test: Nonreactive. Dengue test: Nonreactive. This case has been included due to the likelihood that the Dengue test was a false negative test due to limitations of specificity. The patient had sudden onset of high grade fever 101 to 103°F < forenoon and night. No chills or perspiration, with pain in the back, thighs, legs and hip region, hence very likely a case of Dengue especially since there were plenty of cases in the village where she lived and the remarkable similarity of both symptoms and test results of the CBC.
Prescription: Arsenic album 1M 2 hourly for 1 day, then 4 times a day for the second day.
Follow up: 20/09/2013. Hb 9.1gm% WBC 4980/cu.mm. P61/L33/M6. RBC 3.89 mill/ul; Platelets 1.76 Lakhs/µL. Patient had no complaints hence no medication was prescribed.
03/09/2013. R.G. 28 yrs/M. History of continuous fever twelve days ago, Severe bodyache, pain in the legs and back remain. Pain behind the eyes. Pains come and go irregularly- no specific modalities. PR 74/min; BP 120/80mmHg. Although the patient had no fever at that time, he was advised investigations as Dengue was suspected due to the clinical symptoms present during the acute phase and the persistent pains in various parts of the body especially retro-orbital. NS1 antigen- Nonreactive. IgM- Nonreactive; IgG-Reactive. Hb 13.8gm% WBC 6300/cu.mm P65/L30/M5. Platelets 2.33 Lakhs/µL
Prescription: Eupatorium perf 30 daily thrice for 3 days followed by placebo.
Follow up: 10/09/2013. Backpain persisted but all other symptoms relieved. The pain was < sitting. > hard pressure or lying on back.
Rhus tox 30 daily 3 doses for 1 week.
13/09/2013, Patient called to say that he was fine and required no further treatment.
20/08/2013. S. 46yr/F. Fever since one day. Severe chills followed by dry heat < night 10pm. Moderate thirst, small, with malaise, slight hoarse voice, pain throat, watery nasal discharge. Mild cough with yellow expectoration. Pain and weakness felt especially in lower limbs and back. Constant pain in the eyes since last night. PR 80/min BP 120/84mm Hg. The patient got his blood tests done the next day. Hb 12.0gm%, WBC 6300/cu.mm, P65/L35. RBC 4.7 mill/ul. Platelets 2.5 Lakhs/µl. Hematocrit 41%
Prescription: Along with the repertorisation and reference from Phatak’s Materia Medica, arsenic album was selected.
Ars alb 1M in repeated doses.
Follow up: 23/08/2013. Patient had come a day late. No change. Hb 11.9gm% WBC 6140/cu.mm P62/L34/M4. RBC 4.5 mill/µL. Platelets 2.37 Lakhs/µL. Hematocrit 38%. Dengue test- NS1 Reactive. IgM- Nonreactive. IgG- Nonreactive.
Rubrics from Complete repertory –
MIND : Restlessness; nervousness: tendency: heat: with
FEVER: Succession of stages: Chill followed by heat
GENERALITIES: Lassitude: tendency
Rhus tox 200 in repeated doses for 3 days
27/08/2013. Body pain severe, felt more in the back, thighs. Pain head especially eyes. Unable to get out of bed. Platelet count 1.05 Lakhs/ul HCT 38%
Eup. perfoliatum 30 at hourly intervals – ten doses.
28/08/2013. Much better, pain less, head pain minimal, no fever; has managed the kitchen herself. Decided to wait before repeating blood tests as patient was subjectively and objectively very much better.
Eup. perfoliatum 30 at 4 hourly intervals.
29/08/2013. Patient is cheerful, comfortable and afebrile. Hb 12.0 WBC 8900/cu.mm P62%/L30%/M5%/E3%. RBC 4.4 mill/ul Platelets 2.08 Lakhs/µL. HCT 38%. Treatment stopped.
15/08/2013. MJ 3yr/F. Patient had fever following severe watery diarrhea and vomiting since 5 days. Now, patient had chills since yesterday afternoon, intense burning heat, drowsiness and intense weakness. She complained of pain in thighs, legs, hips and back. She cried saying her legs were hurting, wanted the mother to hold them tightly. Marked thirst for cold water. Face red. PR 112/min. BP 90/70mm Hg. Investigations dated 14/08/2013- WBC 10,800/cu.mm. Platelet count: 1.21 Lakhs/µL, Dengue test: NS1 Reactive, IgM Nonreactive; IgG Nonreactive.
Prescription: Arsenic album 1M 4 doses ½ hourly; later 2 hourly for 1 day.
Follow up: 16/08/2013. Patient afebrile. PR 89/min. BP 96/80mm Hg. WBC total count 9000/cu.mm. Platelets 2.06 Lakhs/µL
Arsenic album 1M at 4 hourly intervals.
No fever, no complaints. PR 82/min. BP 110/80mm Hg. Placebo.
01/09/2013. CH 38yr/M. Presented with burning heat since four days. Continuous fever with nightly aggravation. Patient was restless and intensely anxious and delirious. Fear of death- felt he might never pull through this illness. Kept asking only for water. Refused to eat, says sight of food is repulsive. He used to get up and walk about at night despite the fever. Severe pain in legs, thighs and head-temporal region. Taken allopathic treatment in his village including IV fluids and injections for vomiting. PR 112/min. BP 110/70 mm Hg. Hb 13.4gm% WBC total count 3530/cu.mm. P56%/L38%/M4%/E2%. Platelets 0.77 Lakhs/µL. RBC 5.2 mill/µL. HCT 40%. Dengue NS1 Reactive. IgM Reactive. IgG Reactive.
Prescription: Sulphur 200. 1 dose every 2 hours – 4 doses. Followed by Ars. Alb 1M a dose every two hours.
This short course was deemed necessary to tackle what was interpreted as abuse of allopathic medicaments given by the allopathic doctor who treated the patient before he consulted the author. (Complete Repertory-Generalities: Abuse of, poisoning with: medicaments)
Follow up: 03/09/2013. Patient was afebrile and asymptomatic. Says he was much better and wanted only his blood tests done. PR 87/min. BP 114/80 mm Hg. Hb 13.2gm% WBC 6200/cu.mm P67%/L32%/M1%. RBC 5.00 mill/µL Platelets 1.47 Lakhs/µL; HCT 41%.
21/1/2014. AW 26yr/M. Patient presented with severe chills, heat and perspiration since seven days. Thirst all through the stages of fever. Backpain severe < morning on getting up. Pain in thighs and knees more on right knee. Slight throat pain with mild cough. Not many symptoms due to steroids and anti-inflammatory drugs. PR 88/min BP 110/80 mm Hg. Taken allopathic treatment and had brought his investigation reports as follows: Hb 11.4gm%, WBC TC 9240/cu.mm; P61%/L28%/M3%/E8%. Platelets 1.83 Lakhs/µL Dengue test: NS1 Nonreactive, IgM Reactive, IgG Reactive.
Rubrics from Complete repertory –
FEVER: Succession of stages: Chill followed by heat: persp. followed by: Thirst with:
Prescription: Rhus tox 30 at 2 hourly intervals
Follow up: 30/01/2013. No fever. Patient has diarrhea early morning and cramping pains and gurgling in lower abdomen. Must rush to the toilet. Says he is otherwise OK. Refuses investigations.
Rubrics from Complete repertory –
RECTUM: Diarrhea: <5am
RECTUM: Diarrhea: Bed driving out of
RECTUM: Diarrhea Noises: Gurgling: rectum
Sulphur 200 every 4 hourly 6 doses.
Patient did not return for further follow up.
Total number of cases treated were 10 in number
Age group: Pediatric- 3/ Adult- 6/ Geriatric- 1
NS1 +ve: 3 cases NS1/IgM/IgG +ve: 1 case
IgM +ve: 2 cases IgM/IgG +ve: 1 case
IgG +ve: 2 cases
Clinically indicative, but Dengue test –ve: 1 case
Clinically indicative, but Dengue test –ve: 1 case
Intercurrent remedies used were phosphorus, Merc cor, eupatorium perf, and sulphur.
Thrombocytopenia Defined as platelet counts below 1.5 Lakhs/µl. Counts below 50,000 are capable of causing serious hemorrhagic symptoms. Atlas and Text of Hematology by Tejinder Singh 2nd edition. Chapter 14; Pg 301.
National Institutes of health- http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/
Figure 1 : Number of Cases of normal or decreased platelet counts
Analysis and Discussion
Of the 10 cases described in this paper, except one who did not come for follow-through, all the remaining patients recovered both clinically and pathologically. The recovery time of the patients was remarkable and they suffered no sequelae of the disease. None of the patients in this serial study required hospitalisation or platelet transfusions despite 6 cases having moderate to severe thrombocytopenia and 2 cases with severe Leucopenia.
The weakness out of proportion to the duration of illness, excessive thirst, red face during heat stage of fever, nausea and aversion to food, vomiting even water, sinking sensation in stomach are all pointers to Arsenic album in the above cases. Most of the cases required Arsenic album was prescribed in 8 out of 10 cases. In such critical cases, treated invariably by allopathic medicines, modalities, stages of fever, even entire symptoms may be masked. Hence key notes and thus zig zag cures are inevitable.
Four cases required intercurrent remedies, two of which were due to other symptoms intervening, probably the accessory symptoms. In one case, Sulphur was given at the beginning of treatment due to the patient receiving plenty of allopathic medicines. In repertorisation, the rubric Dengue under ‘fever’ was used only once (Case 7) due to paucity of symptoms in that case and in line with the general rule that diagnosis must not influence the prescription.
POSOLOGY: As recommended by various stalwarts in their Lesser Writings (Boenninghaussen, Kent, Farrington) and Dr.Hahneman himself.
Dose: Dr.C.Dunham – Homoeopathy The Science of Therapeutics. On high potencies; Pg 263.
Since most practicing homeopaths avoid treating medical emergencies, homeopathy may have lost its edge in the management of dengue fever even in its severe form, although transfusion of platelets cannot be avoided once the hemorrhagic symptoms manifest. Skills of clinical judgment and correct interpretation of signs of the disease, monitoring vital signs, as also pathological correlation must be developed and honed to near perfection while handling such critical cases. The expertise when combined, results in correct case selection, which is the key to success.
Though ten cases may not have generated sufficient data, further serial studies of a larger patient sample are merited on the basis of this study. This study shows that with good clinical assessment and laboratory support, critical cases may be handled by experienced Homeopaths who can then train juniors to carry on the good work without feeling intimidated by the severity of the affliction.