A Case of Chronic Myeloid Leukemia
— Dr. Amarsinha D. Nikam
This is a case of a middle-aged man from Gulbarga. He looked very anxious and restless with a very pale, puffy earthy looking face and was extremely weak.
He had brought his Lab Investigation reports. Initially he wasn’t informed by the specialists that he was suffering from “CHRONIC MYELOID LEUKEMIA – BLOOD CANCER.”
The specialists had advised chemotherapy and blood transfusion if needed. The patient was not told about the diagnosis. But he came to know that something was seriously wrong by the reaction of his close relative who accompanied him.
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Chronic Mueloid Leukemia is a haematological malignancy marked by a sustained increase in the number of granulocytes, spleen enlargement and a specific cytogenetic anomaly — the Philadelphia chromosome in the bone marrow of more than 90% of patients. The disease affects one or two people per 100,000 and median survival is about 4 years.
CML results from a trans location of genetic material between chromosome 9 and 22. The translocation results in the production of an abnormal tyrosine kinase that makes affected cells immortal.
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Investigation :
Low HB (10.4 gm%).
Total WBC count — 20,000/mm3 (high).
Presence of Myeloblast (7), Myelocyte and Metamyelocyte (30), Band cells (30) and Mature Neutrophil (20).
There was Neutropenia (39) and Lymphocytosis (L-58).
He had mild hepatosplenomegaly.
He complained of :
Severe loss of appetite since 6 months.
Weakness : extreme with drowsiness and indolence.
Recurrent epistaxis from (Rt) nostril < heat.
Dull pain in extremities <Exertion
<Standing.
Oedema over face.
Dyspnoea on exertion <Ascending stairs.
Personal History :
Appetite : Decreased. (Previously good)
Desire : Meat++, Green Veg., Fish++, Eggs, Sweets++, 0ily++, Cold things.
Aversion : Milk.
Thirst : Thirsty patient.
Tongue : Large moist, pale.
Throat : 0cc. pain <Cold drinks
<Cold air draft.
Head : Headache, Pressing nature — temples <Tension
<Loss of sleep
Eye : Dimness of vision of (Lt) eye.
H/o Foreign body trauma.
Nose : 0cc coryza < Cold bath.
Redness of nose during coryza.
Back : Lumber pain < Stooping.
Perspiration : Profuse.
Sleep : Excessive sleep, Pillow required.
Drowsiness++ now sleeps from 8 p.m. to 10 a.m.
Yet wants to sleep more, i.e.
Unrefreshing sleep.
Thermal : HOT, Cannot bear heat in any form.
< Cold air draft.
I continued the consultation as follows:
How is your nature?
I am a hard worker but now I feel very weak. I like to be in the company of others. I am a jolly, fun loving person and like cracking jokes. I like to travel long distances since childhood. I have good social contacts.
How was your childhood?
I am the eldest amongst 4 brothers and a single sister. I wanted to do business since a very young age and so left education after the 7th standard. Then I worked very hard in a garage. After earning sufficient money, I started my own small business. I don't like cheating anybody. I believe that a good name in society is more important than earning lots of money.
In childhood, if anyone scolded me, I used to run away from home and then my family used to search for me and bring me back.
Any specific fear?
I am afraid of accidents. Also, I cannot see burnt faces or distorted ugly bodies.
Any Tension?
My father died of a heart attack 3 years ago. I thought it was a turning point in my life. I took the responsibility of my mother and family for their well being.
My younger brother was in bad company. He used to waste time and earn nothing. I somehow sent him to Riyadh for work. But he didn't work hard enough and came back without earning anything. He did not even bear the responsibility of his own family. I provide everything for his family even now. Still, he is very ungrateful.
I feel very sad. He has created a bad impression of our family.
When do you feel sad?
After my brother came back from Riyadh, he was a total failure. At that time I helped him and allowed him to join me in my business. My view was also to expand the business and to get a good reputation. The business was doing pretty well. But unfortunately I got this illness and for the past seven months I have no physical strength to attend to my business. He took advantage of this situation and started saying publicly, "See! It is me who does all the work… my brother just sits idle!
I feel extreme sadness at these rude comments! (He couldn't hold back his tears while narrating these words!)
Why don't you just kick him out of the house?
Oh No! I won't do that! People will criticize me for such behavior. "Izzat Nahin To Kya Jeena?" (What's life without dignity?)
OBSERVATION :
– Despite his great sufferings the patient looked very cheerful and talkative. He is a highly conscientious person and managed his business honestly. Due to fear of severe illness he seemed sluggish and dull.
– He is a family oriented person and tried to help his brother in his critical days. He also allowed him to join his business.
– Respectful behaviour.
– Business oriented.
– During admission I observed that he was impatient and business minded, as he didn't want to waste his time in hospitalization despite the grave pathology. He wanted to go back and start working.
– Image conscious.
– Although illiterate, there was softness in his behaviour!
– He was a religious person.
– The Ailmentary factor – the disease started when his brother started interfering and taking undue advantage of his modesty!
TOTALITY:
Decreased appetite.
Epistaxis of (Rt) nostril.
Desire: Meat Sweets Fat
Excessive sleep, Unrefreshing sleep.
Profuse perspiration.
<Cold air draft.
Business interest.
Problems in relations/Forsaken feeling by beloved ones.
Image conscious.
Fear of Accidents — ugly faces.
Industrious.
Conscientious about trifles.
Jesting desire.
Impatient.
Cheerful.
Social.
Family oriented.
Honest.
Indolence.
THERMAL: HOT.
MIASM: SYPHILIS.
Remedy Selected : SULPHUR – 30.
SULPH is a HOT patient but < by air drafts.
RESPONSE :
After giving SULPH – 30, his weakness decreased. And his WBC count reduced considerably (20,000/mm — 5,100)
At the end of the third month, WBC count reduced further. But a drop in HB – 8 gm% indicated that the action of the dose was weaning.
So, SULPH was repeated. After that the Neutrophils increased with a remarkable rise in platelet count. Even the blood investigation showed absence of any micro-macro-megalocytes. Hb% at the end of one and half year rose to 14 with platelet count — 2,20,000 (perfectly within normal limits).
Date
22.10.04
15.01.05
19.09.05
16.11.05
24.02.06
HB
10.4
08.0
11.6
13.2
14.0
TLC
20,000
4,600
9,800
9,900
10,650
P
39
30
53
54
56
L
58
68
44
43
42
Platelets
40,000
78,000
2,20,000
2,20,000
2,20,000
Cell Morphology
Micro-Macrocyte
Micro- Macrocyte Hypochromic.
Normocytic Normochromic
Normocytic Normochromic
No abnormal cells.
Two years have passed and he is now experiencing a joyful and energetic life with the help of homoeopathic medicines only. He is not under any other medication or chemotherapy.
During his last follow-up he said, "Doctor, now I get up at 5 a.m. and work in the shop till 9 p.m. without any break. There is no bleeding from my nose, no bodyache and now I eat so much that it is troubling my wife otherwise !" (His jesting nature).
D/D :
KALI-SUL : Are more disciplined, duty-conscious and family oriented persons. KALI-S does not give much importance to honesty, religiousness and the disgraced feeling is not so prominent! KALI-S is more neat and tidy. SULPH (this patient) is more dull, untidy and indifferent to appearance. Compared to SULPH, KALI S is a more Restless and anxious remedy due to KALI factor.
NAT-SULPH : has tendency towards more dropsical diseases (Hydrogenoid constitution) like hydrocephalous, and also at cellular level ascitis. NAT SULPH has profound sadness and any business failure provokes his suicidal tendency. Also the forsaken feeling, religiousness and honesty are more marked in SULPH. NAT-SULPH has Dry weather and open air.
*Note :
For the last 2 years he is well maintained on SULPH-30 repeated just 2-3 times when his physical generals were down.
Unfortunately, in Sept. 2006, he suffered from Chikun gunya, and was treated by his local physician with painkillers, steroids and antibiotics. The result was that his health deteriorated with a rise in WBC and fall in platelet count (40,000) and HB 4gm%.
I advised him to throw away all those poisons and repeated the SULPH- 30 after Blood Transfusion as a life-saving measure. He followed my instructions faithfully and is now improving rapidly.
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