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Monday, 29 July 2013

ACUTE PANCREATITIS 

As it often happens, some cases you treat simply retreat from memory until the patient comes back with some complaint or another patient many years later. Mr.S.G. aged 19 years had come to me on the night of 9th Sept. 2011 with severe upper right abdominal (Hypochondrium) pain. The boy was studying in Dharwad an education-city some 110kms from my town. The boy was diagnosed as a case of Renal colic but the treatment had no effect. Since he had come to me at 9:30pm, no investigations were possible and I gave him Berberis Vulg 30, asking him to see me the next day.

10-09-2011. 11:00 am: The boy was writhing in pain in my waiting room, clutching his abdomen. The pain was burning, intense and accompanied by cold sweat, restlessness and intense thirst. The water tasted bitter and he had vomited 3-4 times since last night. There was extreme tenderness and guarding of the abdomen.  I realized I was up against something far more serious. Pulse rate: 110/min; BP 150/90mm Hg.  His investigations were:
Hb 13.2  WBC count 13500/cu.mm; P84% Ly 16%. Serum Amylase: 3341 IU/Lt; Serum GPT 31 IU/Lt. S.Urea 33mg%; S. Creatinine 1.0mg%. USG: Bulky pancreas with altered echoes- Pancreatitis.

Given the few symptoms I had, it was obvious that the remedy was Arsenic alb. The same was given in very high potency at 2 hourly intervals - 8 times followed by placebo.

11-09-2011. 10:00 am: Patient felt subjectively better, tenderness and guarding less. PR 100/min. BP 124/80mm Hg. The patient was able to retain water. No vomiting since the last 8 hours. Tenderness +++; Guarding +. Placebo continued.

12-09-2011. 11:00 am. Patient quite comfortable. Tenderness +. No guarding.
Hb 13.2gm% TC 9340/cu.mm P50% Ly 43% M2% E 5%. GPT 42 IU/Lt; Amylase 1142 IU/Lt 
Total bilirubin 2.5mg% Direct bilirubin 1.0mg%.
 Clinical progress was continuous and rapid, the patient was monitored every day. Rx: Placebo

15-09-2013. 2:00pm. Patient comfortable and eating well. No Tenderness/guarding of abdomen. No complaints.
Hb 12.5gm% WBC 7560/cu.mm P55% Ly 41% M 4%. Amylase 700 IU/Lt. Total Bil 1.0mg% Direct Bil 0.13mg%.
 Rx  Ars. Alb 2 doses repeated

11-10-2011. Patient completely symptomless. Amylase 120 IU/Lt  Placebo continued for 10 days after which treatment was stopped, the patient had returned to Dharwad for his studies on 17th Sept..

I stress that in Acute cases a thorough and meticulous physical examination with appropriate investigations goes a long way in maintaining my confidence to treat such critical cases. A rigorous, regular and judicious follow-up can work wonders. A slip up at the preliminary stage itself may prove costly to both patient and doctor alike. Philosophical explanations are not entertained in courts of law.
CAUTION: Arsenic alb is not a specific medicine for Pancreatitis or any disease or symptom.
This article is not meant to suggest any such idea. 

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