Dr. Prafull Vijayakar

Work shop 2002 at Mahabaleshwar

From Verbatim, reprint edition Jan 2005

Male, aged 38 years came in with a chief complaint of severe occipital headaches, which start from the left occiput and then spread in front and then the entire head starts paining. He had vomiting and sweating with severe headache. His headache was aggravated; on reading, in the sun, with tension, loud noise and light. He also had acidity.

Ailments from: About eight years back, he went to the Middle East through an agent who promised him a prestigious job in the Saudi Royal Army. His relatives gave him a big farewell before going there on the prestigious appointment. To his surprise and disappointment, he found that he was deceived. He had been given a job of a motor mechanic in the Saudi paramilitary forces. He returned back and did not show his face or meet any of his relatives. “I was literally hiding and running away from my relatives for 6 to 8 months. This was a very stressful period for me during which time I started getting these headaches”.

Investigations:

MRI dated 07.10.1999:

A cystic cum solid mass measuring 2 cm x 1.7 cm is seen in the sella. The left side of this mass is solid. It enhances after contrast and is- hypointense on the T2-weighted images. Mild suprasellar extension is noted minimally indenting the optic chiasma likely a pituitary adenoma (that is benign, pure sycosis and not oncogenesis or syphilitic). No other abnormality is noted.

Prolactin level = 686 ng/ml (normal=15 ng/ml.)

Field of vision – normal.

He was advised tablet bromocryptine 2.5 mg and tablet sibelium 5 mg daily.

Dr. Vijayakar: Is a pituitary adenoma malignant or non-malignant? Benign means it is pure sycosis at work and no oncogene has been found. Oncogene means actual onset of cancer. When cancer starts, the genetic code is changed because there is substitution. It is like few pages of part I book are removed and instead few pages of part II book are introduced. So, it does not make any sense.

Then the whole image of the constitution since birth does not become important for us and hence, we have to change our approach of treating cancer cases.

Personal history:

Appetite : Normal.

Craving : Nothing particular.

Thirst : Decreased.

Stools : Normal.

Sleep : Normal.

Sweat : Profuse.

Thermals : Hot.

Family history:

Mother: Diabetes mellitus, hypertension.

Nature:

♦ Stays with wife and 3 children. 1st child -10 yrs., 2nd child – 6 yrs. 3rd child – 4 yrs old and younger brother.

♦ Irritable, but always suppresses it.

♦ Reserved. Makes friends with simple people. Will not make friends with quarrelsome and extra smart people. Gets impressed by people’s good nature and not by their money.

♦ Very attached to children. Worries about them a lot. If they are ill, he will remain awake for them.

♦ Family oriented. Doesn’t like fights, quarrels in family. Will think about everybody, brother, sister, parents not only for his wife and children.

♦ Now does job in Saudi consulate at Mumbai

♦ Punctual in his work not otherwise.

♦ Speed is fast.

♦ Loves brain teasers. Likes playing games on internet for hours. Likes reading novels. Not fond of watching TV, traveling.

♦ Fastidious, systematic.

♦ Contended. No demands. Likes simple living. I do not want lot of money, but such a state should not come in my life where I have to ask from others.

♦ Very cautious. Never prefers taking undue risks. Thinks before taking decision. Plans out things. Thinks before talking.

♦ Religious. Never criticizes others’ religion. Says a person should be good.

♦ Anxiety of his disease.

♦ Sympathetic with women and children not with men as men are for struggling and bearing problems.

♦ Never had a fight with wife.

♦ Never back answers to elders even when they shout, though it is not his mistake.

♦ Fond of good clothes. Buys good quality items.

This is the case. So, what rubrics do we take? Take the whole picture, as per aphorism 5 and the disposition. We are proceeding in the way Hahnemann has said, the ailment from, miasm, physical constitution, the will, intellect, and the morals, the environmental factors and the reaction and defense.

Here, the patient felt deceived? So, what do we take. Ailments from deception/ ambition deceived, embarrassment? What is to be taken? It is the reaction. He is hiding, not allowing himself to be seen, did not show his face to anyone for six months. So, we take ailments from embarrassment. The whole family had given him a huge treat on farewell. So many gifts had been given to him and here he finds himself as a mechanic. This was the constitution that was such who did not get angry! If it had been anger, remedies like ACONITE, MERCURY, COLOCYNTH, NUX-VOM, CHAM, would come up.

I remember of a friend of mine whose son had gone abroad. He did not like it there and he just came back. He too had got lot of gifts. When asked, now where are the gifts? He said, “Oh! They are all used up.” Totally shameless!

Very positive remedies like FERRUM would have managed it then and there itself. Now we got one strong factor. This constitution is affected by embarrassment to cause tumors. In frank syphilitic cases, where he would have suppressed anger, he would have suffered from paralysis, motor neuron disease, Parkinson’s, or myocardial infarct (all syphilitic diseases). So, anger, rage, sudden fright are all syphilitic. If someone’s mother dies, the reaction can be—”My God! I am all alone, now who is there”. When my mother died, my reaction was anger.

“Why I could not save her”. I was literally hitting the wall. So, reaction differs with the same situation, whereas my father was very contented and said “do not worry, she has lived her life. If she would have lived long, she would have suffered more”. So, there is grief, anger, and contentment.

In every situation different remedies react differently.

Do not take ailments from deception, bereavement, or financial loss. I have found that there are 3 to 4 final emotions that come out.

1) Ailments from anger, suppressed anger,

2) grief, embarrassment,

3) indignation, and

4) joy.

There was a lady who came to me with severe headaches. I probed all her emotional problems in the family, any death, did your servant leave you, or did anyone leave you, your child was sick, or were you vaccinated, antibiotics or dental treatment? I wanted to see what protein had disturbed her protein balance. “Doctor, nothing happened. On the contrary, last full week was very good for me. My dreams came true. I wanted my own house. We got one and gave a grand opening. I invited all my relatives to see. I was the proud owner. Everyone was appreciating that within a few months of employment, I have been able to take a house of my own. I was on cloud nine. That is it!” So with the ailments from joy, the generals, thirst, thermals, and disposition, I prescribed her COFFEA and she recovered like magic. Neurotransmitters cause imbalance and disease.

Therefore, the ailment from is important.

There is relationship between anger and destructive disease, between grief and sycotic disease, and ordinary anxiety and emotional psoric disease. On the whole what do you find about this patient?

♦ Mild.

♦ Reserved.

♦ Does not make friends with quarrelsome people, does not like fights— timid.

♦ Very attached to children and family, affectionate.

♦ Punctual only for work, not otherwise, he is therefore not conscientious.

♦ Systematic; keeps things where he can always find them.

♦ Intellectual; likes brainteasers.

♦ Contended; No wants. Likes simple living. “I do not want lot of money, but such a state should not come in my life where I have to ask form others.”

♦ Very cautious. Never prefers taking undue risks. Thinks before taking decision. Plans out things. Thinks before talking.

♦ Sympathetic with women and children, with weaker section of the society. He is a giver, he likes to give and not to take; benevolence.

♦ Never had a fight with wife. This indicates he is mild and contented, satisfied with his wife.

♦ Fond of good clothes. Buys good quality items. This only tells me that he needs a sycotic remedy. This is a cover up. Take such symptoms only if the intensity is too high or pathological. Those who do not know the defensive mechanism of the miasm at the physical level do not know that pituitary adenoma is sycotic.

♦ Anxiety for family, anxiety for children.

So, we take ailments from embarrassment + contented + benevolence + cautious + hot + thirstless.

Remedies that came up were CAUSTICUM, CARCINOSIN, SULPHUR, ARS-ALB, NAT-MUR, OPIUM, PULSATILLA, etc.

SULPHUR is coming up the highest. We have added unnecessary rubrics. I am just trying to show you this is what happens when you put garbage in. Anxiety for family and children is a psoric rubric. Today, his gears of defense have changed. He is sycotic now.

If we take only three rubrics ailments from embarrassment + contented + benevolence, then only OPIUM comes up.

Sycotic people are only benevolent; Tata, Birla, Ambani (big business and industrial houses). They give after they have accumulated much. Also, the patient says I should earn so much that I can give. I should not ask from others. A psoric person will never give. He will only work and work, to earn money, name, fame, and then charity.

Even if you take up only two rubrics ailments’ from embarrassment + contented then only STAPHYSAGRIA and OPIUM comes up, but STAPHYSAGRIA is chilly.

Contentment is sycotic. It is again a cover up, stasis. He has what appears to be ‘apparent contentment‘. If he was contented, then why did he have to go to Saudi to earn more? Contentment can be psoric or sycotic, but never syphilitic. If Warts grow and stay there on the body. They are contented there. Similarly, If there is mental contentment because there is fear of going still further or fear of going down, fear of losing the present reputed position; that gives contentment because of cautiousness.

So, we gave him OPIUM 200 – 1 dose on 18.10.1999. After few days, he came and said he gets headaches between 11 and 4 p.m. and he is better after 4 p.m. After a few days, his headaches were much better. He had slight pain in the last week twice and skin eczema came up. He was generally ameliorated.

CT scan of October 1999 shows the pituitary adenoma.

Follow-up on 27.05.2000:

The pain and pressure in his eye were much better. (The tumor was pressing on the optic chiasma). Giddiness was better. Previously, it was difficult for him to work; now he can work easily. Patient is not very expressive. Answers short, abrupt.

Now we will see the latest reports:

MRI of the brain dated 07.10.1999 was available for comparison.

Comparison with previous MRI shows substantial shrinkage of the pituitary adenoma with alteration in its shape and morphology.

On the T1-weighted images, the solid component appears more hyperintense when compared to the previous scan while the cystic component has regressed completely.

On the contrast-enhanced scan, the tumor is relatively hypovascular compared to the enhancing pituitary gland.

Dr. Vijayakar: Growth was at the cost of the normal body parts, now tumor is getting hypovascular, automatically the multiplication will also decrease.

The residual tumor now measures 13 mm x 9 mm x 8.3 mm. (It was 20 mm.) It is situated in the left lobe and displaces the normal pituitary towards the right. The infundibulum is also displaced towards the right. There is no compression of the optic apparatus. The brain parenchyma appears normal. There is a polyp/ retention cyst in the left maxillary sinus.

Dr. Vijayakar: What does this mean from Hering’s Law of Cure? The displacement is still there, but from more important eye, optic chiasma to lesser important organ now. Supposing on MRI, there is no change in the size of the tumor, then only from this also you know that the medicine is working. It is receding from more important organ.

Conclusion of the MRI Report:

Comparison with the MRI dated 07.10.1999; this now shows substantial shrinkage of the pituitary adenoma and change in its morphology. The residual tumor now measures 13 mm x 9 mm x 8.3 mm. There is no compression of the optic apparatus.

MRI dated 27.01.2001:

Pre- and post-contrast MRI of the brain was performed using T1 – and T2-weighted images at multiple planes. The patient is a known case of pituitary macroadenoma.

Previous MRI dated 06.05.2000 was available for comparison. As compared to the previous MRI, the residual solid component is enhancing less than the normal pituitary gland. The left half of the gland has further shrunken and appears less conspicuous. It now measures approximately 8.7 mm x 4 mm. The stalk is still deviated to the right. There is no compression of the optic apparatus.

The brain parenchyma appears normal. Incidentally noted is a polyp/retention cyst in the left maxillary sinus.

Dr. Vijayakar: What is the significance of this incidental polyp or cyst? The growth in more important organ is shrinking; it has come down.

Conclusion: In comparison with the previous MRI dated 06.05.2000, there is further regression of the solid component in the left half of the pituitary gland.

MRI dated 12.04.2002:

Pre- and post-contrast MRI of the brain was performed.

The patient is a follow-up case of pituitary macroadenoma on bromocryptine. There is normal homogenous enhancement of the pituitary gland, which measures 4-5 mm in its maximum height. Residual T2-weighted signal abnormality is seen in the left half. The stalk is deviated to the right. The supra and parasellar structures appear normal. Brain parenchyma appears normal. Incidentally noted is a polyp/ retention cyst in the left maxillary sinus. Virtual complete regression of the pituitary macroadenoma. Residual gliosis is present.

Dr. Vijayakar: Glia are still in excess, this is sycotic only. The process starts with gliosis and then it becomes a tumor, then solid mass and then cystic mass. There is no polyp, no mention of it also. Here sycosis has now regressed. Pituitary adenoma is due to tumor virus, the one that causes chicken pox in children and tumor in adults. It ended on the skin. It came on to ectoderm straightway. It has to come out or this particular destructive force does not go. This was in 2001. Last month, he bought his daughter with the same complaint—pituitary adenoma

Bromocryptine cannot reverse the whole thing from sycotic to psoric. If at all it does, it will take you to a higher disease. Only one dose was given.