July/August 2014

Local and deeper acting remedies

by Douglas Wilson

This case demonstrates how effective a locally acting remedy can be, but also illustrates that this effect can be short acting. A deeper acting remedy is required to complete the healing process. The patient is Sam, a six year old entire female Staffordshire Bull Terrier with the diagnosis of Kerato Conjunctivitis Sicca (KCS), or Dry Eye. She was referred because of inadequate response to conventional treatment.

09/11/2010: first consultation

The main complaint is a thick white occular discharge from the right eye, which has previously been diagnosed as dry eye.

The onset was six months before, after surgery to remove a benign skin cyst.

Sam rubs her eyes on furnishings and peoples' legs.

Current treatment is Cyclosporin 1% and Liquid tears.

staffieHistory

Her history includes routine annual vaccinations and heartworm prevention. She has had several occasions of pododermatitis. In 2006, Sam developed a lick granuloma adjacent to her left carpus after a period of kennelling. In 2008, she vomited for several days after vaccination. She was also diagnosed with pseudopregnancy that year. A benign skin cyst was excised from her right hind leg in the middle of 2010.

Physical Findings

Physical examination revealed corneal abrasions on both eyes. These were fluorescein positive. Sam was photophobic. A thick white discharge collected over her right eye.

Schirmer Tear Test: Left eye 13mm, Right eye 3mm.

There was a thickened lick granuloma lesion on her left front leg.

Mental Picture

Sam was described as being independent. She has lots of life and wants to please people. She knows if she has done something wrong. She has never been trained; her owners say she does not need that. Although she is an active dog, she will sometimes sit and do nothing. She snores during her sleep.

Initial treatment

The clinic was very busy and there was only limited time to repertorise the case and consider the remedy options for Sam. It was decided to treat the main symptoms at this stage and re-examine the following week. Kali mur 6X was prescribed with instructions to give 4 times daily by mouth. It was also suggested to reduce the frequency of Cyclosporin.

Discussion: Kalium muriaticum was prescribed because of the particular white, viscid, sticky occular discharge as well as other less specific symptoms including the corneal ulceration. 6X potency was used since the aim was to have a broad local effect.

15/11/2010: second consultation

Sam's eyes had improved considerably. The discharge only occured occasionally and she had stopped rubbing her face and eyes. She was also more active and appeared to be generally more happy.

Treatment:  continue Kali mur 6X QID and stop Cyclosporin.

Discussion: the improvement was better than expected, so the remedy was continued and advice was given to stop the Cyclosporin.

19/11/2000: third consultation

The owner made an appointment only four days later since there had been a marked deterioration. The occular discharge had increased and Sam was rubbing her eyes frequently on the carpet.

Treatment: Euphrasia herbal eye drops were dispensed for topical application and Ignatia LM2 was provided for oral administration twice daily.

Discussion: the sudden deterioration indicated that the locally acting remedy was no longer having much effect, especially after the Cyclosporin administration was stopped. The overall constitution of the patient was now considered. The history indicated that the patient had a very sensitive nature: she previously developed a stress induced lick granuloma (after a period in boarding kennels, which was still affecting her), and the KCS developed after a surgical procedure (which was presumably also stressful to her). These stresses caused her grief that resulted in physical symptoms. Furthermore, she had a very yielding disposition. Ignatia does not appear in the Mind section of rubrics: Please others, desire to, or, Independent. However, these rubrics were considered to be too small to be used to eliminate Ignatia as a possible treatment for this patient. Neither does Ignatia appear in the Generals – Vaccinosis rubric in Synthesis v5. It may occur in later editions.

Euphrasia was dispensed to assist healing and provide relief to the eye discomfort.

08/12/2010: fourth consultation

Three weeks after starting Ignatia, the eye was improving. There was less discharge, less photophobia, and Sam was no longer rubbing her eyes. She could now open her eye in the morning, whereas it previously required bathing.

Treatment: Ignatia LM3 twice daily

Assessment: good response to treatment, so continue same remedy at higher LM potency.

30/12/2010: fifth consultation

Another three weeks later, the corneal abrasions were healed. There was no photophobia. The lick granuloma was dry and in the process of healing.

Treatment: Ignatia LM4 twice daily for 21 days, then once daily until finished.

Assessment: both the eye problem and the lick granuloma are healing. Good responce to treatment. Plan to disconinue treatment after eyes and lick lesion return to normal, then re-assess.

31/01/2011: sixth consultation

Sam's eyes were both normal and the lick granuloma was completely healed.

Assessment: Ignatia appears to have completed the problems so no further treatment is required at this stage.

10/08/2011: follow-up report

Sam's eyes and leg are good. There has been no treatment for several months now.

Assessment: no further treatment required.

Discussion: locally acting remedies can be successfully used to assist treatment. However, this case demonstrates that the effect can be short lasting. The deeper acting remedy not only improved the main complaint (KCS) but also healed the chronic lick granuloma that the owners had accepted as being untreatable.

Photo: Wikimedia Commons
Staffordshire bullterrier; Spcenter; CC BY-SA 3.0

 

Categories: Cases
Keywords: kerato conjunctivitis sicca, pododermatitis, lick granuloma, pregnancy, photophobia
Remedies: Ignatia, Kalium muriaticum

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