Mrs. JAB, a known case of Rheumatic Heart Disease (RHD), came to us on December 30, 2002 with the diagnosis of Primary infertility. She had oligomenorrhoea since 2 years. Her menses were late, coming every 40-45 days and would last 3-4 days. This was also associated with a dysmenorrhoea.
She also had complains of distension of abdomen for almost 15 years. This is aggravated after eating, from rice, potatoes and better by lemon juice.
She has a good appetite and can tolerate hunger well. She likes rice, potatoes, tea and sweets. She has an aversion to meat and fish. The thirst is increased and she drinks large quantities of water frequently. She also drinks 6-7 glasses of lemon juice every day. Her bowel and bladder movements are normal. She does not sweat much, and if at all, mainly on the head. Her sleep is refreshing and she usually sleeps on her side. She is a hot patient.
The patient has 4 siblings. She has studied only till the seventh grade because of her cardiac problems (RHD). She does not mix easily with others- quite asocial. She has dreams of making a lot of money-“If I have money, my future will be bright. I will not need to ask others for help.
“I like to talk- make fun….”
“I do not like to sit idle. I like to work a lot. I do not like to sit at home. If I am idle, I get unnecessary thoughts. I think the doctor will tell me that I should not conceive (because of the heart disease).”
“I don’t hide things from anyone. I feel that in future I will have problems, so if I have done something wrong, I tell it to my husband or my parents.”
“I get stressed easily. To avoid this stress and anxiety, I tell all my problems to others. I keep thinking, why did I get this (heart) disease?”
The happiest moment in her life has not yet come. When quizzed about the saddest moment in her life, she said “I was in love with a boy about 4 years ago and we were going steady for quite some time. But, when he came to know of my heart complaints he started avoiding me. I understood and let him go. This was the saddest moment. I feel he has deserted me. I feel if the person whom I loved and chose did not support me, how could I expect an unknown person to care for me? Why did he do that?”
She is now married to someone her parents chose for her. He is a sweeper by occupation.
She has no other significant history of illness. Her mother has a uterine prolapse.
Investigations:
Echocardiography (19-8-2002) shows mild to moderate mitral valve regurgitation.
Examination:
- PA: NAD;
- Ut: anteverted, normal size,
- Fx: clear
- [Husband’s semen analysis: Sperm count 32 million/ml, 25% Grade IV motility. He was referred by me to a surgeon who ruled out hydrocoele, varicocoele, hernia or any testicular abnormalities.]
Treatment:
2 doses of Natrum mur 1M and SL for 2 weeks.
Follow up:
- LMP- Dec. 8, 2002. Distension of abdomen better. SL given for 2 more weeks.
- January 16, 2003: Feels better in general.
- LMP- 16-1-2003: 2 doses of Natrum mur 1M were repeated with SL for 2 weeks.
- February 1, 2003: Better.
- February 15, 2003: No distension of the abdomen. Dizziness, since the past 3-4 days. SL was continued for 2 more weeks.
- March 7, 2003: No menses as yet.
- (LMP: 16-1-2003) No distension of the abdomen but nausea and retrosternal burning since 10 days.
- Dizziness for almost a month.
- A Urine Pregnancy Test (UPT) was performed which showed a positive result.
- 1 dose of Natrum mur 1M was repeated along with SL for 2 weeks.
- March 23, 2003: Dizziness better, Retrosternal burning and nausea better, appetite, stools, urine- normal.
- On examination: PA: mild tenderness; PV: Cx tubular, os closed. SL was repeated for 2 more weeks.
This patient was followed up during her pregnancy and the minor discomforts of pregnancy were treated with infrequently repeated doses of Natrum mur 1M.
Discussion:
The history of grief and disappointment in love tilted the scales in favour of Natrum muriaticum.