Bed-wetting : therapeutics
Here are the most commonly indicated homeopathic remedies for primary & secondary enuresis / bed-wetting
About Dr Amit Karkare
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पायाखाली खडे व काटे असावेत की पेटते निखारे जास्त सोयीचे?
तुम्ही म्हणाल हा काय प्रश्न? पण प्रत्येक गोष्ट मिळवण्यासाठी काही ना काही कष्ट हे घ्यावेच लागतात. ‘तळहाताच्या रेषांनी सहज सुखा का भोगी कुणी…’ हेच खरे!
तुम्ही बड्या बापाच्या घरी जन्माला या किंवा छोट्याश्या झोपडीत… अापले ध्येय गाठण्यासाठी कष्टाला पर्याय नाहीच. अाणि कष्ट म्हटले की शरीराला तोशीस अाली. वजन घटवायचं तर सकाळची झोप टाळून व्यायाम करणं अालं, मार्क हवे असले तर क्रिकेटची किंवा फुटबॉलची मॅच सोडून अभ्यास करणं अालं… अाणि हे सगळं करुन यश पदरात पडलं की ते टिकवण्यासाठी पुन्हा कष्ट व अापला ‘कम्फर्ट झोन’ झुगारणं अोघानेच अालं.
त्याचबरोबर तोंड देता अालं पाहीजे ते ‘नकाराला’. अाजपासून वीस वर्षांपूर्वी हॅरी पॉटर सिरीजचे पहिले पुस्तक प्रकाशीत झाले. अाजवर अब्जावधी पुस्तके खपलेल्या या पुस्तकाला प्रकाशीत होण्याअाधी पन्नासहून अधिक प्रकाशकांच्या नकाराला सामोरे जावे लागले होते. जे के रॉलींग ने जर त्या नकारांसमोर हार मानली असती तर?
अाज नकार अाला म्हणजे उद्या येईलच असे नाही, अाज अपयश अाले म्हणजे कायम अपयशच पदरात पडेल असा कुठेही नियम नाही… अाणि त्याच चालीवर, अाज अापण विजय मिळवला म्हणजे यापुढे रोजच व अापोअाप तो अापल्यापाशीच राहील असेही नाही.
अापल्या ध्येयाकडे जाणारा मार्ग अापल्याला हवा तस्सा व अापण म्हणू तितका सोप्पा कसा असेल. त्यात खाचखळगे, काटे व पेटते निखारे असणारच! पण त्यांना अोलांडण्यासाठी काहीनाकाही साधने ही ठेवलेली असतात, त्यांना शोधावे लागते. ही साधने कोणत्याही स्वरुपात असतात – एखादा मित्र, बोधकथा अथवा अापल्याच डोक्याचा नेहमीपेक्षा वेगळा केलेला वापर.
ये जिसको जम्या उसकी नैया पार हो गएलीच समझो!!
For the Legs That Do Not Sleep Well at Night
Shobha came to visit my clinic with a complaint that for her was quite funny to narrate. She felt that though she gets good sleep at night, the legs do not. She had an unpleasant tingling sensation in the legs, especially in the calf muscles, which made her to move around or apply bandage tightly. She felt better by stretching the leg out, but still the uncomfortable pain did persist for some time. The intensity of the pain also prevented her to fall asleep or getting continuous refreshing sleep.
Shobha was suffering with nothing but ‘restless legs syndrome (RLS)’. In this condition, one or both legs can get affected. Though the name suggests it being a disease of the lower limbs, some patients also complain of similar symptoms in the arms as well. Apart from the sleep, the symptoms can get precipitated while being in a prolonged position like sitting at a desk, driving a car, watching a movie. The symptoms appear abruptly and can have a pulse-wave pattern of recurrence, making it more troublesome.
The prevalence of this disease increases with the age and it is believed that almost 10-15 per cent of the population is affected by RLS. It has been reported to be one of the leading causes of sleep-loss or insomnia in elderly population. It is seen more often in women than men. Though rare, children too can get affected with it, but the diagnosis is made difficult and can lead to various hyperactivity disorders or growing pains.
It is believed that RLS runs in the family; and is triggered or aggravated by epochs like Pregnancy, or systemic illnesses like kidney failure, and anemia related to iron or vitamin deficiency. The insufficient iron, which is a common manifestation of the above conditions, can be the reason to have the basic lack of dopamine. The brain uses dopamine to control limb movements. The diagnosis is usually made according to the symptomatology and clinical presentation. There is an opinion to check the levels of iron in the blood, although many people who have RLS can have perfectly normal levels of iron but abnormal levels of iron in the cerebro-spinal fluid that bathes their brain.
The treatment primarily includes dopamine-like drugs, sedatives along with behavioral strategies that include stretching, taking a hot bath, or massaging the legs before bedtime. The patients of RLS are often asked to avoid caffeinated beverages to reduce symptoms. If required and documented by the blood level tests, one can be given iron, vitamin B12, or folate supplements. Some patients may even require mild doses of anti-convulsive therapy, while some do feel relieved with analgesics.
Homeopathic medications have found more effective in relieving the symptoms of RLS without causing any unwanted side effects that are seen with any of the above treatments. A constitutional medicine approach along with the acute remedial prescription based on the symptom-similarity is the best approach to deal with this ailment.
Sir, Do You Prescribe Rare Remedies?
An inquisitive student was asking me this question, as a part of an interview she was conducting before joining my clinic as a learner. That’s a very common experience now days. I remember, not more than 10 years back when I had just passed out, me and my colleagues were interested in learning whatever the physician could teach us from his busy clinic hours, but today’s learners are quite selective, and they have to be! They are much more oriented and aware about homeopathic schools, methods and techniques than what we were even after couple of years of practice.
But what exactly are RARE remedies?
Dictionary gives the meaning of the word ‘Rare’ as – ‘Not widely known; especially valued for its uncommonness’ or ‘recurring only at long intervals’. If I try to apply these definitions to homeopathic practice, I find each and every homeopath has got his own repertoire of medicines that he plays with. To give an example, it might be surprising for most of you but, I have yet not prescribed Thuja, Ambra Grisea, Palladium or Medorrhinum in last 10 years of practice as a constitutional remedy. For me these are rare remedies.
The point I want to put forth here is – do we talk about rare remedies for the faculty of homeopaths or for the individual ? I think what counts the most is the later. And I thoroughly would like to prescribe rare remedies, the remedies that have been prescribed rarely by me till now, due to my ignorance and lack of knowledge about them. It takes some hard case that makes me to solve it in the learnt protocols, to find some odd remedy emerging from the process, leading to a rare remedy prescription.
I have met my colleagues who have prescribed more ‘calcarea silcatas’ than ‘pulsatillas’. I have yet to unfold the mystery behind numerous remedial forces, by rising against my blocks. Yet to discover the scope of known remedies in its true sense.
Thus, my dear student (?), YES, I would like to prescribe rare remedies. Will you help me to reach them by questioning my prescriptions ? Would you like to be my teacher ?
I can see a world-map on my tongue
Rohini, a television anchor and a news reader by profession, visited my clinic with a very strange complaint, she had never even heard about before. For the last few months, she was observing patchy white areas of yellowish white coat on her tongue. She first ignored it thinking it just due to the disturbed gastric schedule, but within a couple of months, she started getting burning or soreness in the tongue area on eating any citrus fruits like oranges or lemon. These areas were getting resolved spontaneously, but a new patch used to appear on the other region of the tongue, thus not letting the lesions resolve completely.
She had been to her local physician for the same, who first prescribed her local mouth wash, but instead of relieving the complaints, it aggravated the irritation further. She was then treated with antihistamines and topical steroids, without any significant improvement in the lesions. She was thus asked to continue a dose of multi-vitamin tablet, especially of b-complex vitamins.
Apart from the soreness, the major concern for Rohini was the dirty appearance of the tongue, which was prominently hampering her screen-image. She was once asked by the cameraman not to laugh with mouth wide open, since it made the appearance of the tongue much obvious. One of her friends then suggested her to take a homeopathic treatment and thus she came to me. Rohini suffered with what is called ‘Benign migratory glossitis’ or ‘Geographic tongue’.
Clinical features:
As the name suggests, the condition is benign [possessing very less morbidity and no mortality] affecting almost 4% of the human population across the world. It is mostly asymptomatic but patients can experience burning, irritation or soreness that gets aggravated by certain food items and astringent flavored items. Many patients also get swelling of the tongue along with the appearance of deep fissures on the tongue surface.
It is believed that it is more common in patients suffering from psoriasis, but it is insignificant to link the two ailments since geographic tongue is seen commonly in non-psoriatic patients as well. It is also linked with hormonal changes withing the body, diabetes, smoking and spicy diet. It can be seen running in the family, but it is attributed more to the diet pattern than the genetic predominance. Females are seen getting affected more than males.
Treatment:
Ideally, there is no particular treatment for this ailment. Mostly the lesions can resolve without any treatment, giving undue credit to the multi-vitamin or local steroidal preparations prescribed empirically.
Homeopathic approach towards this ailment is that of a constitutional disorder. Rohini was interviewed in detail for the constitutional assessment and was prescribed Natrum mur, which not only resolved her tongue patches but also relieved her recurrent migraine attacks.
Other significant remedies that can be useful are – Nitric acid, Rhus tox, Taraxicum, Arsenic, Kali bich and Mercurius.
White patches on cheeks – worms or calcium deficiency or… ?
“Doctor, please do something for these white patches that appear on his cheeks I have started giving him oral calcium supplements but it didn’t help. Do you think it is because of worms?” a mother was asking me anxiously. She was worried about the light-colored circular patches that had appeared on the cheeks of her son. This is a very common complaint encountered in pediatric patients. Mostly parents connect it with either a deficiency of calcium or due to worm infestation; while some go to the extent of considering it a pre-vitiligo stage. The worried mothers empirically start treating the child with some OTC drugs, without knowing what is it actually?
What Is It:
Pityriasis alba, is a common skin disease, predominantly affecting children of 3-16 years of age [boys affected more than girls] and affects almost 8-10% of children at least once in their lifetime. The word ‘pityriasis’ denotes the finely scaled appearance while the word ‘alba’ is Latin for white, the color of the patches. The patches are definitely not permanent and the condition is known to be self-limiting, resolving on its own after a certain period. There is no evidence that it progresses to vitiligo in future, since pathophysiologically, both are completely different entities.
The Cause:
Pityriasis alba falls under idiopathic dermatosis, which means the cause is yet unknown.
Clinical Presentation:
It is considered as superficial dermatitis, that is usually seen in atopic [prone to allergy] children and presents with dry-scaled, light colored patches on the face – especially around the mouth. Due to its color, it seems accentuated during the summer. It might itch during the early stage of appearance.
It is most likely to be mistaken with vitiligo or leucoderma, where there is a complete absence of the dark pigmentation. The pityriasis alba lesions do not usually have a well-defined border [like in vitiligo] and they do not coalesce [as in tinea versicolor].
Treatment:
Ideally, treatment is not necessary for pityriasis alba, but one should consult a physician to rule out the other causes of hypopigmentation, which might need treatment. Antifungal ointments have shown improvement in some patients.
Homeopathy can help these patients with its constitutional treatment approach as per the assessment of individual psycho-somatic disposition.
“On the Children” by Khalil Gibran
Your children are not your children
They are the sons and daughters of life’s longing for itself
They come through you but not from you
And though they are with you yet they belong not to you
You may give them your love but not your thoughts
For they have their own thoughts
You may house their bodies but not their souls
For their souls dwell in the house of tomorrow
Which you cannot visit not even in your dreams
You may strive to be like them but seek not to make them like you
For life goes not backward nor tarries with yesterday
. . .
I could not resist the temptation to translate the core concept of the prose in Marathi…
भावानुवाद…
कितीही गाजवा मालकी, तरीही आपली नसतात मुले
जगण्यालाच येते हुक्की पुन्हा जन्माला यायची,
आपली प्रजनन–शक्ती ही इतकीच पुरेशी लायकी,
बाहेर येताच त्यांना होते सगळे अवकाश खुले,
कितीही गाजवा मालकी, तरीही आपली नसतात मुले
आपल्या प्रेमाखाली रुजते मायेची आसक्ती
संस्कारी–चमच्यात भरवितो थोटी विचारशक्ती
नाकारुनी या सर्वांवरती चढलेली ती पुटे,
कितीही गाजवा मालकी, तरीही आपली नसतात मुले
बांधतो घरट्याच्या नावाखाली आपण चार–भिंती
आकांक्षांना तोलून त्यांच्या आपल्या निकषांवरती
स्वप्नांपुढती त्यांच्या ठरते आपले विश्वच थिटे,
कितीही गाजवा मालकी, तरीही आपली नसतात मुले
‘बदल’ हा एकच शाश्वत सत्य म्हणोनी राही
भूतासारखे भविष्य असणे कधीच होणे नाही
काळानुसार बदले तो फेऱ्यातून सहजी सुटे
कितीही गाजवा मालकी, तरीही आपली नसतात मुले
An apple a day…
You can be a physicist, historian, doctor, sportsman, religious follower, chef, story-loving child or a health-freak, APPLE is the fruit that must be close to your heart.
The contribution of this ‘forbidden fruit’ goes from inspiring Isaac Newton about gravitational force, to providing a sodium- & cholesterol-free source of antioxidants exhibiting anti-cancer properties. Though an old English adage says, ” To eat an apple before going to bed, will make the doctor beg his bread.”, a doctor also bonds with it through ‘Adam’s Apple’ in the early Anatomy classes
ORIGIN
Apple (Malus domestica) is a pomaceous fruit from the family of Rosaceae (rose) and ranks as one of the most widely cultivated tree fruits. Finding its origins in the wild mountains of Central Asia, today there are more than 7500 known varieties of apples that are cultivated across the world. Most of these varieties are eaten fresh, though some are specially used for cooking or making cider.
Apple trees are deciduous, which means their leaves fall off at the end of the growing season.
NUTRITION
Apples are bulky for their caloric content (like most fruits and vegetables) and thus ranks amongst the negative-calorie fruits. A medium-sized apple provides only 80 calories. Water and air constitute almost 80% of Apple’s volume [that is why it floats].
HEALTH BENEFITS
Apples not only are cholesterol free but also help to reduce existing cholesterol by preventing re-absorption, thus helping people with heart disease, obesity and high lipids.
Research suggests that apples may reduce the risk of colonic cancer, prostate cancer and lung cancer, possibly due to the phenolic compounds (quercetin, epicatechin and procyanidin B2) they possess, that have anti-oxidant properties. According to the USDA, apples and apple juice are among the top 20 foods with the highest antioxidant content per serving.
The fiber content, though less than in most other fruits, helps to regulate bowel movements.
Apple juice concentrate has been found to increase the production of the neurotransmitter acetylcholine in mice, providing a potential for protecting the brain from the effects of oxidative stress.
APPLE FACTS
- Apples ripen almost ten times faster at room temperature, thus keep them stored in the refrigerator.
- Store apples away from strong-smelling foods to prevent them from absorbing unpleasant odors.
- Coat sliced and diced apples with a mixture of one part lemon juice to three parts water, to prevent browning.
- Don’t peel your apple. Two-thirds of the fiber and lots of antioxidants are found in the peel.
- Apple day is celebrated on 21st October.
Handling a syncope
Syncope accounts for almost 40 percent patients visiting a clinic for the complaints of ‘sudden fall episodes’. It is a transient loss of consciousness associated with the loss of body tone. Most of the patients recover spontaneously. It may occur as a single event without any specific causation or can also be recurrent when it is associated with some organic pathology. The basic pathophysiology includes reduced cerebral blood flow.
An occurrence of syncope needs to be differentiated from a seizure episode since it mimics the later very closely. A recurrent and unexplained episodes of syncope need to be examined for possible structural cardiac pathologies since it can lead to death if not attended in time. Most of the times, syncope occurs suddenly without any warning, but few patients can experience pre-syncope manifestations like light-headedness, dizziness, a feeling of warmth, nausea, and visual blurring.
Causes:
The transient reduction in the cerebral blood flow is mostly due to three basic causes
1. Disturbance in the vascular tone or blood volume
2. Obstructive cardiovascular disorders and rhythm abnormalities
3. Cerebrovascular diseases
The disturbance of vascular tone or blood volume can be due to situations like cough, micturition, defecation or valsalva maneuver as well as due to carotid sinus hypersensitivity. Also due to orthostatic hypotension because of some vasodilator drugs, pure autonomic failure, peripheral neuropathy, and decreased blood volume. Cardiac rhythm abnormalities like sinus bradicardia, sinus arrest, atrioventricular block or atril flutter and fibrillation can also lead to syncope. Vetebrobasilar insufficiency or basilar artery migraine are one of the cerebrovascular diseases causing syncope.
Disorders that can mimic syncope are few metabolic disorders like hypoxia, hypoglycemia, anemia or hyperventilation or some psychogenic events due to anxiety attacks or hysterical fainting.
Neurocardiogenic or vasovagal syncope is usually associated with both sympathetic withdrawal [vasodilatation] and increased parasympathetic activity causing bradicardia. These are precipitated by alcohol consumption, severe pain, extreme fatigue, hunger, prolonged standing, exposure to hot or crowded environment, and during emotional situation.
Diagnosis:
The above mentioned pathologies should be ruled out by conducting diagnostic tests after a thorough clinical history – including serum electrolytes, glucose and blood counts. Electrocardiogram, cardiac enzymes need to be checked in case of cardiac causes. An electroencephalogram will rule out the possibility of a seizure activity.
Homeopathic treatment:
Sporadically occurring syncope attacks do not need any treatment if they are of vasovagal origin. Remedies like gelsemium, belladonna, conium and phosphorus have been most effective in treating recurrent episodes of syncope. The totality should be based on the precipitating factors like exposure to direct sunlight [as in belladonna and gelsemium] as well as the factors that modify the episodes such as getting aggravated on sudden rising, looking up, etc.
Symptoms that follow the syncopal attack too play a significant role in remedy selection. Gelsemium patient will have a drowsy and dull look with reduced thirst. Belladonna will show marked congestion of eyes along with throbbing headache after the episode. Arsenic album will have anxiety with frequent thirst for small quantities of water. Phosphorus patient will have intolerance of light, especially the artificial one. Of course, these symptoms will help to select a remedy for preventing the future attacks.
A well-selected deep-acting constitutional remedy will always have its role to restore the vital force back to normal, so as to treat the basic pattern.
Bach Flower Therapy for Parkinson’s Disease
“ The symptoms that you are talking about are nothing but an indication that you are suffering from Parkinson’s disease”. Almost all patients suffering from Parkinson’s disease have heard this statement at least once from their physician, and have not been able to forget it.
Almost all patients suffer a major setback when they try to accept the harsh reality of getting diagnosed with Parkinson’s disease (PD). That is usually the beginning of a life-long fight with an irreversible ailment that makes one more and more dependent on the environment with every rising day. Each and every patient (and most of their care-takers) experience an episode of depression at least once in their lifetime, and at least 50% of them have to take a treatment for it.
The ever-increasing dependency, not being able to do small and easy day to day jobs, unaffordable cost of treatment, failure of the current medical world not only to cure but even to control the growth of the ailment,… everything leads to a state of anguish and vexation, which itself can hinder the efficacy of the medication given for the disease.
The most commonly occurring emotional changes are:
- Excessive worrying about the ailment
- Constant unwanted negative thoughts
- Feeling of dependency and being handicapped
- Asocial and aloof feeling
- Loneliness
- Indifference and ennui
- Fear of attaining a vegetative state
- Loss of memory
- Insomnia – loss of sleep
- Suicidal thoughts
- Irrational fear, anxiety, and phobias
Medically it has been proved that the ‘orbito-frontal’ region of the brain does not work optimally in these patients. This is the region that deals with generating the positive and healthy feeling states and is directly under the influence of the dopamine secretion.
Bach Flower Therapy: a simple yet effective therapy for emotional ailments
Bach flower therapy comprise a therapeutic system that uses dilutions of flower essences developed from 38 naturally occurring flowers, to balance physical and emotional disturbances. This therapy was developed and introduced by Dr Edward Bach, a Harley street physician, in 1936, who believed that the right essence can nullify the ‘predominant, persistent negative mental states’ to bring back the patient to a positive mental state. These essences interact with the subtle bodies and so can help people by addressing the emotional responses of patients towards oneself and the disease.
There are 38 original Bach flower remedies, each prescribed for certain mental and emotional problem, together forming a complete therapeutic system of healing. The remedies are prepared by picking fresh flowers, still wet with dew, placing them in a clear glass bowl of spring water and leaving them in sunlight for several hours during the early–morning.
Dr Bach believed that the remedies contained small amounts of the plant’s life-force energy which enabled them to provide vibration patterns needed to either neutralize or serve as an antidote to negative emotional, behavioral, or cognitive states. Each one of the 38 remedies corresponds to a precise psychological imbalance and is suitable for treating an extensive series of symptoms. There is no standard remedy for any disorder as the same problem experienced by different individuals can produce quite varied psychological reactions. Each individual requires a unique treatment. Depending on the symptoms, the remedies can be used singly or in combinations to a maximum of 7. The remedies are taken on the tongue, under the tongue, or at the pulse point of the wrist a minimum of 4 times per day.
Commonly prescribed Bach flower remedies for PD patients:
1. Gorse:
Very useful to treat the hopeless and depressed state where the patient has lost hope and denies any kind of treatment. These patients literally need to be carried to the doctor. These patients will concentrate more on the intractable nature of the ailment, to feel utterly low.
2. Mimulus & Larch:
These remedies can be prescribed for specific fears and the lack of confidence, respectively. These patients always have got a fear of falling while walking, which can be relieved with Mimulus. The addition of Larch to it will boost the self-confidence.
3. Olive:
This remedy is useful treating the state of marked prostration resulting due to the unfailing tremor, loss of appetite, digestive complaints, and recurrent negative thoughts. The patient feels completely drained and exhausted. There is a significant lack of vitality. The remedy Olive can help these patients to regain their strength. Also is useful for the care-taker.
4. White chestnut:
A good remedy for loss of sleep due to recurrent negative thoughts, leading to a state of irritation or agitation.
Advantages of Bach flower therapy:
The flower remedies appear to have no side effects and do not seem to interfere with any form of treatment including homeopathic, herbal or allopathic medication. In fact, due to their ability to improve the receptivity and reaction-pattern of an individual, these remedies can, in fact, improve the efficacy of the concomitant medication. Many psychotherapists take help of these remedies as an adjunct healing force, along with their counseling. It is important to know that the remedies seem to act as catalysts in releasing unwanted negative psychological states.
In patients suffering from Parkinson’s disease, these remedies can help the patient (and the caretaker) to get relief from the negative emotions like fear, anxiety, depression and hopelessness. Once the emotional balance is achieved, one can deal with the physical ailment in a better shape and can face life more positively.
Love, Affection, Sympathy, Care and Homage, we use flowers in all situations of life. Bach flower therapy has proved that flowers not only represent our emotions but can also help to heal them, naturally!