SCURVY - CONNECTIVE TISSUE NUTRITIONAL DEFICIENCY DISORDER

                                                                                                               

Scurvy (Vitamin C deficiency) is a nutritional disorder characterized by initially as symptoms of malaise and lethargy, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. Spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, jaundice, fever, neuropathy and death.

Vitamin C (ascorbic acid) is essential for the formation of the tissue that holds the body's structures together (connective tissue). It also helps the body absorb the essential mineral iron, and it helps the body recover from burns and wounds. Vitamin C is also a member of the class of chemicals called antioxidants. Antioxidants help protect the body's cells from damage.

Vitamin C does not only invigorate the immune system, it is an essential vitamin that aids the repair of collagen cells. Scurvy was once a common disease among sailors in the 15th, 16th, 17th, and 18th centuries because they were stuck at sea without food for a long period of time without fresh fruits rich in vitamin C. Scurvy affects the dense connective tissue by breaking down the tendons. Dense connective tissue is a type of connective tissue that is characterized by its densely woven fibers of collagen that fit together to form rows called fibroblasts. Dense connective tissue is affected by connective tissue diseases that stem from severe vitamin C deficiency. This disease is commonly known as scurvy.

Causes of Scurvy:

Scurvy is caused by a prolonged dietary deficiency of vitamin C. Humans obtain 90% of their intake of vitamin C from fruits and vegetables, and cooking these sources decreases vitamin C content 20-40%. The body's pool of vitamin C can be depleted in 1-3 months. Ascorbic acid is prone to oxidation in vivo, and body stores are affected by environmental and lifestyle factors (eg, smoking), biological conditions (eg, inflammation, iron excess), and pathologic conditions (eg, malabsorption) that may alter its oxidation.

Risk factors for vitamin C deficiency include

·        Babies who are fed only cow's milk during the first year of life.

·        Alcoholic individuals and those who conform to food fads

·        Economically disadvantaged persons, who tend to not purchase foods high in vitamin C (eg, green vegetables, citrus fruits)

·        Cigarette smokers: These individuals require an increased intake of vitamin C because of lower vitamin C absorption and increased catabolism

·        Pregnant and lactating women and those with thyrotoxicosis: These individuals require an increased intake of vitamin C because of increased utilization

·        People with anorexia nervosa or anorexia from other diseases such as acquired immunodeficiency syndrome (AIDS) or cancer

·        People with type 1 diabetes have increased vitamin C requirements, as do those on hemodialysis and peritoneal dialysis.

·        People with disease of the small intestine such as Crohn, Whipple, and celiac disease, because vitamin C is absorbed in the small intestine

·        Individuals with iron overload disorders - These may lead to renal vitamin C wasting

Pathology of vitamin C Deficiency:

Vitamin C (Ascorbic Acid) deficiency may lead to Defective formation of collagen in connective tissue,Defective intercellular cement,Defective dentine in teeth ,Defective osteoid tissue in bone., Capillary haemorrhages, delayed healing of wounds and defective formation of teeth bones occur during growth, In adults the teeth may become loose, Anaemia may be a prominent feature of scurvy.

Symptoms and signs:

Symptoms of scurvy may begin with Loss of appetite, Poor gain in weight, Fever , Irritability , Shortness of breath (Increased respiratory rate), Disconmfort and tenderness in legs, Pain and swelling over weight bearing bone, Feelings of paralysis.

As the disease advances a scurvy patient may come with Bleeding gums, Loosening of teeth, Bruising and petetial haemorrhage of mucous membrane and skin, Hoemorragic eyes, Poor wound healing , Bulging of eye balls (Proctosis) , Follicular keratosis sometimes associated with vitamin A deficiency ,Costochondral beading (Cartilage between joints) leads to enlargement of costochondral junction, Curly hairs (Corkscrew hair), Sicca syndrome (Autoimmune disease of connective tissue), By the time the disease is fully developed the patient is often anaemic.

Examination of an adult patient with scurvy usually reveals no abnormal physical signs of disease except gingivitis and subcutaneous haemorrhages and so gravity of his condition may not be appreciated, Patient may die suddenly from cardiac failure without warning, In the late stages of disease, general anasarca (generalised oedema), jaundice, oligurea, neuropathy, fever and convulsions and if continue leads to death.
In infants the main clincal features of scurvy are Lassitude (Weakness with lack of energy), Anaemia, Painful limbs, Enlargement of the costochondral junctions. Before the teeth eruption, scorbutic infants do not develop gingivitis & when it occurs the gums have typical 'scurvy buds', a feature of considerable diagnostic importance.

Diagnosis of Scurvy :

The health care providers will perform a thorough physical examination for signs and symptoms of scurvy mentioned above. Exact vitamin C levels can be measured by laboratory tests that analise ascorbic acid levels in the serum (or WBC ascorbic acid concentration). Radiological measures can be performed to diagnose and to see the damage done by the disease.

Skeletal x-rays can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. Early changes resemble atrophy. Loss of trabeculae results in a ground-glass appearance. The cortex thins. A line of calcified, irregular cartilage (white line of Fraenkel) may be visible at the metaphysis. A zone of rarefaction or a linear fracture proximal and parallel to the white line may be visible as only a triangular defect at the bone's lateral margin but is specific. The epiphysis may be compressed. Healing subperiosteal hemorrhages may elevate and calcify the periosteum.

Prevention of Scurvy

Regular consumption of fruits and vegetables helps to prevent scurvy. Ascorbic acid is present in insignificant amounts in foods of animal origin.
Rich sources of vitamin C are: Oranges, Blackcurrants (small black berries), Tomatoes, Lemon, Brussels sprouts, Guava, Papaya, Carrots, Broccoli,  Potatoes, Spinach , Cabbage, Bell peppers, Watercress Extracts of rose hips, Pine needles, All citrus fruits, Fresh vegetables.

Recommended Intake for Vitamin C can vary on health factors. Pregnant and lactating women need higher doses of Vitamin C. Children (1 to 8 years) need 15 to 25 mg/day, Children and teenaged kid need 65mg to 90mg/day, Adults need 75mg to 90 mg/day

Research :

Research done by New England Journal of Medicine in 1970 to explain association between the Sjogren's syndrome and Scurvy. “Five men were given no ascorbic acid for 84 to 97 days, but had all other vitamin and mineral supplements necessary, after which vitamin C [ascorbic acid] repletion was begun. One man had 2.5 mg dietary L-ascorbic acid daily from day 85 to 213, the others from day 98 to 213. From day 214 to 244 they had 100 mg dietary ascorbic acid supplemented with 250 or 500 mg daily. Plasma ascorbic acid and serum vitamin A were estimated weekly and ophthalmological examinations were made 8 times during the study.

Sjogren's syndrome was apparent in 2 of the subjects while they were scorbutic, a third had keratoconjunctivitis sicca, and all 5 had one or more of the features described as components of the syndrome. As plasma values for ascorbic acid increased and the pool size rose during repletion the features of Sjogren's syndrome and the signs of scurvy regressed simultaneously. suggesting an association between the Sjogren's syndrome and Scurvy.

Management

Some of the Common Home Remedies for the Treatment of Scurvy:

Lime and Lemon: The use of lime and lemon is highly beneficial in the prevention and treatment of scurvy. Being rich sources of vitamin C, lime and lemon are regarded as foods of exceptional therapeutic value.

Potato: Potato is regarded as an excellent food remedy for scurvy.

Vinegar: Vinegar is very effective for the treatment of scurvy.

Aspirin: If there is pain in your body due to the deficiency of ascorbic acid, take 1 tab after meal.

Tomato: The presence of vitamin C in tomatoes helps it to fight diseases like scurvy. By drinking tomato juice everyday you can see the difference.

Homoeopathic Management:

Homoeopathy and Nutrition work together as synergistic healing modalities to bring about Holistic Health and A Healthy Balance. We need both to heal and for well-being. Classical Homoeopathy makes Nutrition therapy better. Good Nutrition helps Classical Homoeopathy.

Medicines like Arsenic al, Sulphur, Mercurius, Kreosote, Carbo veg etc are often found indicated in cases of Scurvy.

Arsenic Alb

Pronounced debility; child is emaciated; severe gastro-intestinal disturbances; exceedingly fetid smell from the mouth. 

Sulphur

Is indicated when in addition to the bleeding gums and fetid breath the patient has old, shrivelled, withered look and unhealthy state of skin. Discharge of blood and fetid pus from about the roots of the teeth. 

Mercurius

When gums recede from teeth and are blue and unhealthy in colour. Legs swollen and very painful. Unhealthy bluish ulcerations of the skin are the characteristic symptoms of the remedy. 

Kreosote

Mouth putrid and cadaverous; gums ulcerated; epistaxis and discharge from the genitalia. 

Carbo Veg

Persistent hemorrhage from gums and nose. It may also occur from kidneys and bowels. 

 

 

CONSTIPATION

CONSTIPATION AND THE PURSUIT OF GENERAL HEALTH IN GERIATRIC PEOPLES Constipation is a symptom, not a disease. Nearly everyone becomes constipated at one time or another. Usually, this condition is not serious. Older people are five times more likely to complain about the symptom than younger people, possibly because of an undue concern about their bowel movement. To avoid most of the problems related to constipation, it helps to know what causes it, how to prevent it, and how to treat it. Experts agree that older people often worry too much about having a bowel movement every day. Normal frequency of bowel movement or volume of stool varies widely from person to person. A decrease in the frequency of bowel movements, accompanied by prolonged or difficult passage of stools, or a sense of incomplete evacuation are all expressed constipation. Constipation is a common symptom among older people.

 CAUSES OF CONSTIPATION IN OLDER ADULTS: Older adults are more likely to have constipation for the following reasons: Poor diet: Eating foods rich in animal fats (dairy products, meats, and eggs) or refined sugar but low in fiber (whole grains, fruits, and vegetables). Inadequate fluid intake: Not drinking enough water can lead to hard dry stools. Fluid is absorbed in the intestine, and people who don't drink enough water may not pass enough water into the colon to keep their stools soft. Caffeine and alcohol: These induce increased urination of water. This leads to (relative) dehydration that increases water absorption from the intestine. This can in turn lead to constipation when not enough fluid is retained in the stool. Poor bowel habits: Ignoring the desire to have bowel movements may initiate a cycle of constipation. After a period of time, the person may stop feeling the desire to move the bowels.This leads to progressive constipation. For example, some people may avoid using public toilets or ignore going to the toilet because they are busy Medications: Many medications can cause constipation. Antacids that contain aluminum hydroxide(Alternagel, Alu-Cap, Alu-Tab, Amphojel, Dialume) and calcium carbonate (Rolaids, Mylanta, Maalox, Tums, etc.), Antispasmodic drugs, Antidepressants, Iron tablets, Anticonvulsant drugs, Diuretics (because they can work like caffeine and alcohol as mentioned previously), Painkillers, narcotic-containing drugs, for example, may suppress bowel function. Lack of exercise Prolonged bed rest, for example after an accident or during an illness Habitual use of enemas and laxatives - The person may eventually require increasing amounts of laxatives to move the bowels.In some instances, the bowel will become insensitive to laxatives and the person will not be able to move the bowels even with laxatives. Travel: Changes in lifestyle, low fluid intake, and eating fast food may cause constipation. Irritable bowel syndrome (IBS): Because of changes in bowel function, if a person has this disorder, he or she may have crampy abdominal pain, excessive gas, bloating, and constipation, sometimes alternating with diarrhea. Intestinal obstruction: Mechanical compression and interference with the normal functions of the bowel may occur due to diverticulitis or Crohn's disease (an inflammatory bowel disease), Inflammatory adhesions and joining of tissues, Intestinal cancers, Abdominal hernia, Gallstones, Twisting of the intestine upon itself (volvulus), Foreign bodies (swallowed or introduced into the intestine from the anus), Intussusception, Postoperative adhesions Connective tissue diseases: Conditions such as scleroderma and lupus SYMPTOMS OF CONSTIPATION Symptoms of constipation depending on his or her normal bowel habits, diet, and age. Symptoms includes • Difficulty in starting or completing a bowel movement, • Infrequent and difficult passage of stool, Passing hard stool after prolonged straining, • If the person has irritable bowel syndrome(IBS) then crampy abdominal pain, excessive gas, a sense of bloating, and a change in bowel habits, • If the person has an intestinal obstruction, nausea, vomiting, no defecation, and inability to pass gas, Distended abdomen, headaches, and loss of appetite, • Coated (furred) tongue, bad breath(halitosis), and bad taste in the mouth The tests may help diagnose the cause of constipation are Anorectal manometry (pressure measurements of the anus and rectum), Barium enema, Complete blood count (CBC), Blood clotting tests ( PT or PTT), Colonoscopy, Proctosigmoidoscopy (an examination of the lower bowel), Stool studies, Upper GI series, X-rays of the abdomen Tips for Preventing and Managing Constipation Many factors can lead to constipation, including a poor diet, lack of exercise, and overuse of laxatives. We can help prevent or relieve constipation by: Eating healthfully. Getting plenty of high-fiber food in our diet, including whole grains, vegetables, and fruits, can help stave off constipation. It’s a good idea to avoid high-fat meals, excessive dairy products and eggs, and rich, sugary foods, since these can lead to constipation. The foods that all good sources of dietary fibre are Beans, lentils and peas, Fresh and dried fruits - particularly if the skins are eaten, Vegetables - particularly if the skins are eaten, Nuts and seeds, Wholemeal and granary breads, Jacket potatoes, Wholegrain breakfast cereals, Wholemeal pasta and brown rice Drinking plenty of fluids. Not drinking enough fluids can lead to constipation, so upping our intake of water and other liquids can help keep your bowels moving. Being careful when using laxatives. If use laxatives or enemas too often, our body can begin to rely on them and stop working the way it should. So talk with doctor about laxative use. Exercising regularly. Keeping active on a regular basis can help stay regular. Going when feel the urge. Waiting too long to have a bowel movement can lead to constipation, so go as soon as sense the need. Treating medical conditions. Certain medical conditions, including stroke, diabetes, or intestinal blockage, can lead to constipation. Working with our doctor to manage these conditions is important. Talking with doctor about medications. Some drugs, including certain antidepressants, antacids, supplements, antihistamines, pain relievers, high blood pressure medications, and Parkinson's disease medications, are known to lead to constipation, so talk with doctor to see if adjusting medications would help.

HOMOEOPATHIC MANAGEMENT: Homoeopathic remedies indicated for constipation often work at a deeper level than nutritional supplements and most herbs because they target the mind and the emotions in addition to the physical body. Essentially homeopathic remedies assist in unlocking the stress that may be underlying the constipation symptoms, ideally leading to a permanent resolution of the problem, since constipation symptoms are often difficult to differentiate on a physical level. Remedies used for relieving constipation: The most common and effective medicines to cure constipation are: Aesculus, Aletris, Aloes, Baptisia, Bryonia, Calc carb, Carbo veg, Chelidonium, Collinsonia, Dioscorea, Graphites, Hydrastis, Iris vers, Lycopodium, Natrum mur, Nux vom, Opium , Plumbum, Podophyllum , Pulsatilla, Sepia, Silicea, Sulphur, Veratrum album. In old people: Old people suffering from constipation could be relieved from the complaints by the following medicines: Aloes, Alumina, Antimonium crudum, Baryta carb, Bryonia, Lachesis, Opium, Phosphorous, Phytolacca, Rhus tox, Ruta. Person who have habitual constipation: For habitual constipated persons Abies nigra, Alumen, Alumina, Bryonia, Calc carb, Causticum, Collinsonia, Conium, Graphites, Lachesis, Lycopodium, Sepia, Sulphur. Persons who lead sedentary life: Aloes, Bryonia, Iris, Hydrastis, Lycopodium, Nux vomica, Opium, Platina, Podophyllum, Sulphur. Alumina: dry and slow, Confused and depressed, especially in the morning. Mind slows down, forgetful and absentminded. Easily disoriented: gets very distressed if hurried. Skin is dry and itches without an eruption. Severe constipation even with a soft stool. Weakness with trembling. Dry, hacking cough. Bladder weak: urination slow,has to wait for it to start. Aversion to/Aggravation from potatoes. Worse from warmth in general. Ambra grisea: erratic and embarrassed, Many bereavements and losses. Forgetful and confused. Easily embarrassed: shy and anxious in company (especially with strangers). “Prattles” and asks questions without waiting for answers. Prefers to be alone. Constipation: with anxiety and ineffectual urging and straining. Can’t pass stool or urine if others are within hearing distance. Dry, nervous cough which is worse from talking and is followed by burping. Insomnia: finds it difficult to fall asleep beforemidnight. Vertigo: with feeling of weakness in the stomach. Numbness, twitching and/or trembling anywhere. Generally worse from company (from conversation) and from music. Symptoms are erratic and worse when lying down. Arsenicum album: anxious, fussy, and restless Very scared of disease, of cancer, of death. Fears are worse when alone; to the point of despair. Extremely tidy, cannot rest until everything is in its place. Indigestion with burning pains and nausea. Loss of appetite and weight. Diarrhea, which is worse in the morning. Involuntary urination: day and night. Insomnia with restlessness and anxiety. Skin eruptions: itching without eruption. Palpitations with anxiety. Chilly. Burning pains which are better for heat. Symptoms are generally worse from midnight to 3 a.m. Thirsty for warm drinks; sips them frequently. Baryta carbonica: childish and petty, Absent-minded, confused and forgetful. Revisits childhood in old age. Has great difficulty making decisions. Extremely anxious about little (unimportant) things. Gets upset thinking others are talking about them. Vertigo: when getting up or bending down. Headache when bending. Indigestion and weakness after eating. Constipation with straining and an unfinished feeling. Weak bladder with involuntary urination: frequent urination at night with great urgency. Rattling cough with difficulty coughing anything up. Insomnia: restless sleep, wakes frequently from getting overheated. Much worse from the cold and damp. Carbovegetabilis: sluggish and gassy, Great indifference and apathy. Sudden, recurring loss of memory and difficulty concentrating. Rude and irritable, especially with relatives. Indigestion, flatulence, and diarrhea. Severe, painful bloating with gas, better for burping. Rattling cough with breathlessness, better for burping. Sluggish mentally and physically. Worse eating rich foods and fats; worse overeating. Much worse for getting overheated. Wants to be fanned; wants fresh air and breezes. Coniummaculatum: withdrawn, slow, and dizzy, Absent-minded, forgetful, and confused. Difficulty understanding when reading. Tired of life: becomes withdrawn; doesn’t want company. Superstitious. Everything is slow: thinking, answering, moving. Digestion, respiration, pulse, healing are all slow. Vertigo: worse lying down, when rolling over in bed or turning the head, better for closing the eyes; everything swirls. Dry tickling cough which is worse at night. Weak bladder: frequent, dribbling urination. Ignatia amara: loss and grief, Very upset after a loss or a big disappointment. Wants to be alone and doesn’t want any comforting. Finds it difficult to cry but eventually sobs hysterically. Sighs a tremendous amount. Feels as if there’s a lump in the throat. Headache, indigestion, diarrhea, palpitations, insomnia and/or weakness from grief. Twitches and spasms and unexplained numbness anywhere. Contradictory symptoms accompany physical complaints (e.g., cough worse coughing). Can’t stand tobacco smoke. Lycopodium: irritable, anxious, and gassy, Depressed and anxious: worries about absolutely everything. Any changes or responsibilities are very stressful. Lacks self confidence. Becomes absent-minded and forgetful. Snappy: irritable and critical. Sentimental: cries when thanked. Thin and gassy. Appetite poor: feels full after only a few bites. Everything turns to gas, terrible indigestion with bloating. Frequent urination especially with prostate problems (in men). Rattling cough with lots of expectoration (mucus). Craves sweet things and chocolate. All symptoms are worse between 3 and 4 p.m. and between 4 and 8 p.m. Nux Vomica : Anxiety ridden, worries about work and money, stays awake at night thinking of all the work that must be done the next day; extremely irritable when people or situations (traffic, lines, slow clerks, etc) get in the way of them staying on the schedule they had in mind, interfering with their productivity, impacting their ability to make money; also extremely irritable at colleagues and co-workers who don't pay attention to detail, waste time or make mistakes that causes loss of money. Work hard, play hard archetype - always has plans for what to do when not working, the sophisticated and accomplished city dweller. Physical symptoms: chronic constipation, irritable bowel syndrome; muscle cramps and spasms; lower back pain; tends to run very cold; hypersensitive to noise; craves spicy food; likes alcohol. Opium : Disconnected and blissed out, often the individual becomes disassociated from their feelings and their physical body following a fright and/or head injury, it's as if they're floating above their body, not really dealing with reality. They may suffer from narcolepsy, and/or painlessness from complaints that are normally painful. Alternatively, the individual may also be a workaholic that is hurried and impatient and has great mental clarity. Phosphoric acid: weakness and apathy, Overwhelmed by loss especially bereavements. Ailments from grief and disappointment. Forgetful; mind is too weak to even think. Severe weakness. Painless diarrhea, palpitation, headache, and extreme weakness after grief. Headache. Wants refreshing things (like fruit and fruit juices) to eat and drink. Feels better after a nap. Rhustoxicodendron: restless, stiff, and achy, Anxious and forgetful. Terrible restlessness; can’t rest in any position (because of the aching). Joint and back pains (rheumatism and arthritis) which are worse on first motion and better for continued motion and stretching. Shingles. Symptoms are worse at night; worse for cold and for damp in any form; better for warmth.

HYPOTHYROIDISM - A GENERAL APPROACH TO UNDERACTIVE THYROID

HYPOTHYROIDISM - A GENERAL APPROACH TO UNDERACTIVE THYROID . Hypothyroidism (also known as underactive thyroid) is a state in which the thyroid gland does not make enough thyroid hormone. Since the main purpose of thyroid hormone is to “run the body’s metabolism”, it is understandable that people with this condition will have symptoms associated with a slow metabolism. Underactive thyroid is a very common medical condition and statistics suggest that 1 in 50 women and 1 in 1000 men will develop symptoms of hypothyroidism. It is more common in older women and can also occur more frequently during pregnancy. Thyroid is a small butterfly-shaped gland, in the front of the neck. The function of the thyroid gland is to convert iodine found in many foods into thyroid hormones triiodothyronine (T3) and thyroxine (T4). Only the thyroid gland has cells that can absorb iodine. The thyroid takes the iodine from foods, supplements and iodized salt and combines it with the amino acid tyrosine to produce T3 and T4. T3 and T4 travel throughout the body through the bloodstream and help cells convert oxygen and calories into energy. The pituitary gland produces the Thyroid Stimulating Hormone (TSH). TSH stimulates the thyroid gland to produce more T3 and T4 hormones. If the levels of T3 and T4 thyroid hormones in the blood increase, the pituitary gland responds by reducing the production of TSH. The hypothalamus gland is located in the brain, it produces the TSH Releasing Hormone (TRH) which communicates with the pituitary gland which in turn stimulates the thyroid gland by producing and releasing TSH. Classification Hypothyroidism is often classified by association with the indicated organ dysfunction Primary - The most common forms include Hashimoto's thyroiditis (an autoimmune disease) and radioiodine therapy for hyperthyroidism. It’s due to dysfunction of thyroid gland. Secondary - Occurs if the pituitary gland does not create enough thyroid-stimulating hormone (TSH) to induce the thyroid gland to produce enough thyroxine and triiodothyronine. Although not every case of secondary hypothyroidism has a clear-cut cause, it is usually caused by damage to the pituitary gland, as by a tumor, radiation, or surgery. Secondary hypothyroidism accounts for less than 5%or 10% of hypothyroidism cases. Tertiary - Results when the hypothalamus fails to produce sufficient thyrotropin-releasing hormone (TRH). TRH prompts the pituitary gland to produce thyroid-stimulating hormone (TSH). Hence may also be termed hypothalamic-pituitary-axis hypothyroidism. It accounts for less than 5% of hypothyroidism cases. Causes There are several potential diseases and conditions that can cause Hypothyroidism. Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine-replete individuals hypothyroidism is frequently caused by Hashimoto's thyroiditis, or otherwise as a result of either an absent thyroid gland or a deficiency in stimulating hormones from the hypothalamus or pituitary. Factors such as iodine deficiency or exposure to iodine-131 from nuclear fallout, which is absorbed by the thyroid gland like regular iodide and destroys its cells, can increase the risk. Hypothyroidism can result from postpartum thyroiditis, a condition that affects about 5% of all women within a year of giving birth, the first phase is typically hyperthyroidism; the thyroid then either returns to normal, or a woman develops hypothyroidism. Of those women who experience hypothyroidism associated with postpartum thyroiditis, one in five will develop permanent hypothyroidism requiring lifelong treatment. Radiation therapy – Radiation used to treat cancers of the head and neck can affect thyroid gland and may lead to hypothyroidism. Medications – A number of medications (such as lithium which is often used for psychiatric disorders) can contribute to hypothyroidism As a Consequence of treatment for hyperthyroidism – People who suffer from hyperthyroidism are often treated with radioactive iodine or anti-thyroid medications to reduce their thyroid function. When the function is reduced too much, hypothyroidism can result. Stress is known to be a significant contributor to thyroid dysfunction; this can be environmental stress as well as lesser-considered homeostatic stress such as fluctuating blood sugar levels and immune problems. Adrenal insufficiency can also result in hypothyroid symptoms without affecting the thyroid itself. Clinical Manifestations Early symptoms are Hard stools or constipation, Increased sensitivity to cold, Fatigue or feeling slowed down, Heavier menstrual periods, Joint or muscle pain, Paleness or dry skin, Sadness or depression, Thin, brittle hair or fingernails, Weakness and Weight gain. Unexpected weight gain and difficulty losing weight may be one of the first noticeable signals that struggling with hypothyroidism (a sluggish thyroid) or subclinical hypothyroidism. Late symptoms, if left untreated: Decreased taste and smell, Hoarseness, Puffy face, hands, and feet, Slow speech, Thickening of the skin, Thinning of eyebrows A physical examination may reveal a smaller-than-normal thyroid gland, although sometimes the gland is normal size or even enlarged (goiter). The examination may also reveal: Brittle nails, Coarse features of the face, Pale or dry skin, which may be cool to the touch, Swelling of the arms and legs, Thin and brittle hair Uncommon clinical manifestations are Impaired memory. Impaired cognitive function (brain fog) and inattentiveness, A slow heart rate with ECG changes including low voltage signals. Diminished cardiac output and decreased contractility, Reactive (or post-prandial) hypoglycemia, Sluggish reflexes, Hair loss, Anemia caused by impaired haemoglobin synthesis (decreased EPO levels), impaired intestinal iron and folate absorption or B12 deficiency from pernicious anemia, Difficulty swallowing, Shortness of breath with a shallow and slow respiratory pattern, Increased need for sleep, Irritability and mood instability, Yellowing of the skin due to impaired conversion of beta-carotene to vitamin A (carotoderma), Impaired renal function with decreased glomerular filtration rate, Acute psychosis (myxedema madness) (a rare presentation of hypothyroidism), Decreased libido in men[18] due to impairment of testicular testosterone synthesis, Decreased sense of taste and smell (anosmia), Puffy face, hands and feet (late, less common symptoms), Gynecomastia, Deafness, Enlarged tongue. Diagnosis - The only validated test to diagnose primary hypothyroidism, is to measure thyroid-stimulating hormone (TSH) and free thyroxine (T4).[40] However, these levels can be affected by non-thyroidal illnesses. High levels of TSH indicate that the thyroid is not producing sufficient levels of thyroid hormone (mainly as thyroxine (T4) and smaller amounts of triiodothyronine (T3)). However, measuring just TSH fails to diagnose secondary and tertiary hypothyroidism, thus leading to the following suggested blood testing if the TSH is normal and hypothyroidism is still suspected:  Free triiodothyronine (fT3)  Free thyroxine (fT4)  Total T3  Total T4 Additionally, the following measurements may be needed:  Free T3 from 24-hour urine catch[41]  Antithyroid antibodies — for evidence of autoimmune diseases that may be damaging the thyroid gland  Serum cholesterol — which may be elevated in hypothyroidism  Prolactin — as a widely available test of pituitary function  Testing for anemia, including ferritin  Basal body temperature GENERAL MANAGEMENT Diet - The thyroid gland needs an array of nutrients to function optimally. Add essential fatty acids to your diet. Cold water fish such as salmon and cod as well as flaxseed, walnuts and almonds are great sources. Another option is to take a daily supplement such as fish oil. Seaweed, chlorella and algae should also be consumed frequently. They are rich in iodine and essential nutrients that maintain thyroid function balance. Another important thing to keep in mind when it comes to a natural diet for hypothyroidism is that there are also foods that actually slow down thyroid function. These include broccoli, Brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. Also, take care to avoid overly processed food and limit dairy, sugar, artificial sweeteners, caffeine, and alcohol intake. Natural remedies and herbs can also be used to support optimal thyroid function. Bladder wrack (Fucus vesiculosus) is a natural source of iodine, essential for healthy thyroid function. Shilajeet-Asphaltum puniabiunum is one of India’s most prized herbs and is considered a ‘wonder drug’ by many due to its high mineral content. Makandi (Coleus forskohlii) has been studied extensively for its use in supporting thyroid function. Clinical trials have shown that forskolin (a chemical found in coleus) may help to support thyroid hormone secretion. Supplements of Vitamin C, E, Riboflavin, Zinc, Niacin, pyridoxine might also helps boost thyroid hormone production. Exercise – Aerobic exercise for 15 – 20 mins a day is excellent for maintaining good thyroid function. It may boost the metabolism thus promoting good health. HOMOEOPATHIC MANAGEMENT: Homoeopathy considers a disease to be the result from emotional distress and frustration, which blocks the life force energy into various different organs or glands. Homeopathy considers thyroid problem as one such autoimmune glandular dysfunction. Homeopathy offers better chances of a cure since the treatment is based on the person's individual constitution. Conventional treatment of thyroid dysfunction relies mainly on drugs and surgery, whereas homeopathic treatment improves the function of the thyroid gland through natural means. Homeopathic remedies work by stimulating the body's own healing power. Homeopathic remedies stimulate the body to reactivate the hormone secretions, replenish and restore the thyroid tissue through the pituitary and other glands as a whole allowing the body to heal itself. Another striking thing about homeopathy is that it has no side effects. People on multiple medications can safely take homeopathic medicines. Homoeopathic drugs are non-habit forming and have no addictive characteristics. Homeopathic remedies stimulate the body's own immune system and offer a long lasting cure rather than giving temporary relief Homoeopathy offers good prognosis to cases of hypothyroidism. Medicines like Calcare phos, Calcarea carb, Lapis alb, Iodium, Thyroidinum, Spongia, Lycopus, Calcarea iod etc are often found indicated in cases of hypothyroidism. Iodum is indicated in cases especially where there are symptoms of hyper or hypo thyroidism, according to Dr. William Boericke in the "Materia Medica and Repertory." The person needing Iodum may feel very hot, agitated, and shaky with trembling hands and heart palpitations. There may be an increased appetite, with a desire to eat all day long, resulting in obesity; however, the individual may also have an increased metabolism and not be able to gain weight. Given in controlled doses and the correct potency, Iodum may help regulate the thyroid and the pituitary gland, the source of thyroid stimulating hormones. Fucus vesicelosus, or sea kelp, may help thyroid conditions where there is an under-active thyroid with slow metabolism, according to the "Materia Medica of Homeopathic Medicines." The remedy has the power to stimulate the thyroid and pituitary gland, helping to adjust the amount of thyroid stimulating hormones, and boost metabolic processes. When used correctly, this powerful remedy can offer relief from many thyroid conditions and successfully reduce a myriad of symptoms, such a helping with weight loss, reducing sluggishness and fatigue. It may alleviate headaches; muscle pain and joint discomfort, as well as overcome many other unwanted symptoms of thyroid dysfunction. Additionally, this remedy also has the ability to suppress an overactive thyroid when given in higher potencies and larger doses. Fucus vesicelosus should never be self-administered. It should only be used under the supervision of an experienced homeopath that can monitor your case closely. Never adjust your dose or change the potency of the remedy without first consulting your practitioner. Dietary kelp is contraindicated while taking homeopathic Fucus vesicelosus. Kali carbonicum is indicated for individuals who suffer from a slow metabolism, often seen in hypothyroidism. The remedy may relieve symptoms of coldness and chilliness, pain in the back, chronic constipation, indigestion, flatulence, belching and a sour taste in the mouth, writes homeopath Roger Morrison in the "Desktop Guide." The person needing this remedy may be aggravated in general by drinking icy-cold drinks, which may produce nausea and vomiting. The person may experience chronic bronchitis or sinus infections, which are the leading indicators for using this remedy in cases of hypothyroidism. In addition, there may be obesity and fatigue, which may be relieved by taking Kali carbonicum. References 1. Harrison's Principles of Internal Medicine 2. http://en.wikipedia.org/wiki/Hypothyroidism 3. Davidson’s Principles and Practice of Medicine, 4. Lilienthal S., Homoeopathic Therapeutics 5. http://www.womentowomen.com/hypothyroidism/symptomsrelief.aspx 6. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001393/ 7. http://www.homeopathyworldcommunity.com/profiles/blogs/hypothyroidism-and-its 8. http://www.livestrong.com/article/361095-homeopathy-for-thyroid-imbalance/ 9. Homeopathic Materia Medica by Boericke 10. http://www.nativeremedies.com/ailment/hypothyroidism-symptoms-and-natural-treatments.html 11. http://www.amcofh.org/blog/homeopathic-treatment-thyroid 12. https://www.pramilahomeopathy.com/thy.html 13. Dewey W. A., Practical Homeopathic Therapeutics Prof. Dr. S. SABARIRAJAN., M.D. (Hom) (Prac. of Med), PGDHHM Dept. of Practice of Medicine Vinayaka Mission’s Homoeopathic Medical College & Hospital, Salem, Tamilnadu.

STOP STRESSING, START LIVING – APPROACH TO STRESS DISORDERS

Stress, an unpleasant state of emotional and physiological arousal that people experience in situations that they perceive as dangerous or threatening to their well-being. The word “Stress” means different things to different people. Some people define stress as events or situations that cause them to feel tension, pressure, or negative emotions such as anxiety and anger. Others see the stress as the response to these situations. Stress is a common experience. We may feel stress when we are very busy, have important deadlines to meet, or have too little time to finish all of our tasks. Often people experience stress because of problems at work or in social relationships, such as a poor evaluation by a supervisor or an argument with a friend. Some people may be particularly vulnerable to stress in situations involving the threat of failure or personal humiliation. Others have extreme fears of objects or things associated with physical threats-such as snakes, illness, storms, or flying in an airplane and become stressed when they encounter or think about these perceived threats. Stress produces numerous symptoms which vary according to persons, situations, and severity. These can include physical health decline as well as depression. Physical Signs and Symptoms: Increased heart rate, Pounding heart, Elevated blood pressure, Sweaty palms, Tightness of the chest, neck, jaw, and back muscles, Headache, Diarrhea, Constipation, Urinary hesitancy, Trembling, Twitching, Stuttering and other speech difficulties, Nausea, Vomiting, Sleep disturbances, Fatigue, Shallow breathing, Dryness of the mouth or throat, Susceptibility to minor illness, Cold hands, Itching, Being easily startled, Chronic pain and Dysponesis Emotional signs and symptoms of stress: Irritability, Angry outbursts, Hostility, Depression, Jealously, Restlessness, Withdrawal, Anxiousness, Diminished initiative, Feelings of unreality or over-alertness, Reduction of personal involvement with others, Lack of interest, Tendency to cry, Being critical of others, Self-deprecation, Nightmares, Impatience, Weakened positive emotional response reflexes, Changes in eating habits and, Insomnia, Reduced self-esteem, Obsessive rumination, Narrowed focus, Experience opportunities, Decreased perception of positive . Cognitive/Perceptual Signs and Symptoms of Stress: Forgetfulness, Preoccupation, Blocking, Blurred vision, Errors in judging distance, Diminished or exaggerated fantasy life, Reduced creativity, Lack of concentration, Diminished productivity, Lack of attention to detail, Orientation to the past, Decreased psychomotor reactivity and coordination, Attention deficit, Disorganization of thought, Negative self-esteem, Diminished sense of meaning in life, Lack of control/need for too much control, Negative self-statements and negative evaluation of experiences Behavioral Signs and Symptoms of Stress: Increased smoking, Aggressive behaviors (such as driving - road rage, etc.), Increased alcohol or drug use, Carelessness, Under-eating, Over-eating, Withdrawal, Listlessness, Hostility, Accident-proneness, Nervous laughter, Compulsive behavior and Impatience. Signs of Stress in the Workplace Stress Arousal Stage - Persistent irritability and anxiety, Bruxism and/or Insomnia, Occasional forgetfulness and/or inability to concentrate Stress Resistance Stage - Absenteeism or tardiness for work, Tired and fatigued for no reason, Procrastination and indecision, Social withdrawal with cynicism, Resentful, indifferent, defiant, Increased use of coffee, alcohol, tobacco, etc. Severe Exhaustion Stage - Chronic sadness or depression, Chronic mental and physical fatigue, Chronic stress related illnesses (headache, stomach ache, bowel problems, etc.), Isolation, withdrawal, self-destructive thoughts Long Term Implications of Stress Exposure to stress on a long-term basis can be debilitating both physically and mentally. Under stress, the body produces an increase in the hormones adrenaline, noradrenaline and corticosteroids. In the short-term these hormones produce tense muscles, queasiness and an increase in breathing and heart rates. Long-term complaints that are stress related include: Allergies, Anxiety and depression, Digestive disorders , Fatigue, Headaches and migraine, Heart disease, High blood pressure, Impotence and premature ejaculation in men, Insomnia, Irritable bladder, Irritable bowel syndrome, Menstrual problems in women, Mouth and peptic ulcers, Muscular aches and pains, Palpitations, Panic attacks, Eczema, Ulcerative colitis POSSIBLE STRESS DISORDERS Possible Physical Disorders Caused By Or Exacerbated By Stress are Hypertension, Cardiovascular disorders, Migraine and tension headaches, Cancer, Arthritis, Respiratory disease, Ulcers, Colitis, Muscle tension problems Possible Emotional Disorders Caused By Or Exacerbated By Stress are Anxiety, Panic attack, Depression, Adjustment disorders. Possible Behavioral Disorders Caused By Or Exacerbated By Stress are Eating disorders, Conduct disorders, Alcoholism, Hyperchondricism. Stress and Aging Recent research results suggest that long-term exposure to adrenal stress hormones may boost brain aging in later life. Writing in the journal “Nature Neuroscience”, scientists at the University of Kentucky in Lexington looked at the results of memory tests taken by elderly patients with high levels of the stress hormone cortisol, released by adrenal glands when the body is stressed. That high-level group scored lower than others with reduced levels of the hormone, researchers say. The level of hormone released apparently affects the total volume of the brain's hippocampus -- a major source of recall and memory function -- in later life. Those with high levels had a hippocampus volume 14 percent less than those with lower levels, researchers found. The study results suggest "chronic stress may accelerate hippocampal deterioration," said the researchers. GENERAL MANAGEMENT If we think about the causes of stress, the nature of the stress response, and the negative effects of some types of stress (prolonged, unexpected, or unmanageable stress), several healthy management strategies become clear. Diet - A well balanced diet is crucial in preserving health and helping to reduce stress. Certain foods and drinks act as powerful stimulants to the body and hence are a direct cause of stress. This stimulation, although quite pleasurable in the short term, may be quite harmful in the long run. We will look at a few of them: Foods to Eat - Whole grains promote the production of the brain neurotransmitter serotonin, which increases your sense of well-being. Green, yellow, and orange vegetables are all rich in minerals, vitamins, and phytochemicals, which boost immune response and protect against disease. Foods to Avoid - Coffee and other caffeinated beverages: If you are currently addicted to coffee, drink black tea; it has less than a third of the caffeine of coffee, and none of the harmful oils. Fried foods and foods rich in fat are very immune-depressing, especially when stress is doing that, as well. Reduce animal foods. High-protein foods elevate brain levels of dopamine and norepinephrine, both of which are associated with higher levels of anxiety and stress. Caffeine - This is found in coffee, tea, chocolate, Coke, etc. It causes the release of adrenaline, thus increasing the level of stress. When taken in moderation, coffee can increase your alertness, increased activity in the muscles, nervous system and heart. Consuming too much caffeine has the same effect as long term stress. Smoking - Many people use cigarettes as a coping mechanism. In the short term, smoking seems to relieve stress. But in the long term smoking is very harmful. Its disadvantages far outweigh its short-term benefits. Alcohol - Like caffeine, taken in moderation, alcohol is a very useful drug. It has been shown to benefit cardiovascular system. Exercise - Research has shown that physical exercise is the best tension reliever. It is a very important remedy for stress. Nothing eases stress more than exercise. Exercise, when property done, gives our body time to operate in the efficiency mode. Nature is one of the best soothers of stress. Taking a quiet walk in a park or watching a beautiful sunset can do wonders. Physically, exercise improves our cardiovascular functions by strengthening and enlarging the heart, causing greater elasticity of the blood vessels, increasing oxygen throughout our body, and lowering our blood levels of fats such as cholesterol and triglycerides. All of this, of course, means less chance of developing heart conditions, strokes, or high blood pressure. Mentally, exercise provides an outlet for negative emotions such as frustration, anger, and irritability, thereby promoting a more positive mood and outlook. Exercise improves mood by producing positive biochemical changes in the body and brain. Regular exercise reduces the amount of adrenal hormones your body releases in response to stress. Recommended Exercises are Aerobic exercise daily like Walking in the woods, at the beach, or in a park, Participate in a sporting event, such as tennis, basketball, volleyball, racquetball, softball, and many others, Ride a bicycle and yoga. Chewing gum helps release stress & improves one's mood. Water - In addition to exercise, it is important that your body gets enough water. Drink plenty of water , it will help you to flush out toxinsWater is necessary for our body to operate efficiently. Water is vital to the body in temperature regulation, nerve impulse conduction, circulation, metabolism, immune system, eliminative processes, sensory awareness and perceptive thinking. Meditation and Relaxation Response can help combat stress and revitalize the mind. Smile more! Being depressed affects ur immune system & raises blood pressure. Deep breathing infuses the blood with extra oxygen and also stimulates the body to release tranquilizing endorphins. It is one of the simplest yet most effective stress management techniques. You can do it anywhere, anytime, and it becomes even more effective with practice. Aromatherapy : Plant and flower extracts are infused with base oils to create a palette of aromas that when inhaled, or experienced as part of a massage can bring relief to muscular tension and stress in the body. Essential oils such as lavender and bergamot are popular, and one can even enjoy a cup of chamomile tea to ease tension before bed. Craniosacral Therapy - This treatment is similar to massage, except that it uses more gentle techniques and has the head, spine and pelvis as its primary area of focus. As this area is the source of the nervous system, gentle manipulation of this zone results in an alleviation of muscular and nervous tension. Emotional Freedom Technique - Emotional Freedom Technique uses aspects of Traditional Chinese Medicine, specifically acupressure to relieve a wide range of issues including stress, tension and anxiety. Hypnotherapy - This treatment uses hypnosis to unlock the power of the unconscious mind and effect positive changes in the life of the individual. People who are hypnotised generally feel very relaxed, which is why it is often successful in relieving stress and anxiety. Yoga - Yoga is a discipline that combines the mental and physical, with controlled breathing and precise poses used to unify the mind, body and spirit. It is useful in easing stress as the meditative aspect of it aid in lowering blood pressure and heart rate. Massage - Massage is perhaps one of the more widespread natural treatments available, with a range of techniques and styles to choose from. Gentle or more vigorous deep tissue massage stimulates circulation and often leads to a reduction in muscular tension HOMOEOPATHIC MANAGEMENT: Homoeopathy is a rational therapeutical system with its holistic, integrated, multi-disciplinary and totalistic approaches the subject of stress in a convincing rational way. Homoeopathy has long been used to relieve mental and emotional disorders, including stress and anxiety. The system has a huge range of remedies for practically every ailment and condition, including stress and anxiety. The best way to investigate the benefits of homeopathy is to consult an accredited practitioner who is bound by a professional code of conduct and standards of practice. The speed of action, safety and lack of interaction with drugs have made Homoeopathic medicines a popular means of dealing with many health issues. Mental and emotional stress and anxiety are very common conditions, and scientific stud¬ies have confirmed that homoeopathy is an effective means of treating these disorders''. - Rober T Medhurst Following is a list of frequently used homoeopathic remedies for these conditions, and the factors that may help to narrow down the choice of the remedy. Aconite - Panic disorders, restlessness and anxiety following a fright or shock. Worse for heat and worse after exposure to cold dry winds. A great remedy for 'never well since' a shock. Aethusa - Anxiety accompanied by vomiting, diarrhoea and extreme prostration. Especially useful in children. Worse in the open air and early mornings, better out in the open air, around other people and animals. Anacardium - Anxiety when walking, and anxiety tends to be accompanied by violent language. Absent minded with a poor memory and suffers from nervous exhaustion from overstudy. Symptoms are improved by eating and aggravated by the application of hot water Argentum nitricum - Arg nit in an excellent medicine for anticipation anxiety. Exams, driving tests, auditions, weddings, and impending competitions can all be made much easier to deal with by the action of this remedy. Those who hold unreasonable concerns for their health have also benefited from Arg nit. Symptoms are aggravated by warmth, from being alone, and eating sweet foods, and improved by company, cold and fresh air. Arnica - Normally thought of as a remedy for shock and physical injury, Arnica is also a very useful remedy for the long term effects of acute stress, shock or trauma. Worse for jarring, cold or damp and better for lying down with head low. Arsenicum album - Anxiety, unreasonable fear, fear of disease or death and restlessness in those of a fastidious nature characterise this remedy. Panic attacks in the very early hours of the morning may also call for Arsenicum. Worse when alone or exposed to wet or cold weather, cold food or drink and better for com¬pany, heat and warm drinks. Aurum Metallicum - Anxiety leads to severe depression, often to the point of suicide and often with outbursts of anger. Symptoms are often relieved by music, and aggravated by cold weather. It is not uncommon to see those suffering from seasonally affective disorder (SAD) or seasonal bipolar disorder, a depressive condition predominant in autumn and winter, being pre¬scribed Aurum. Chamomilla - Stress, sensitivity, restlessness and great irritability often lead to the prescription of chamomile. An excellent remedy for stressed or anxious children, chamomile is worse mid-morn¬ing or at night, worse for heat and better for being carried or held. Coffea cruda - Anxiety accompanied by a great restless of the mind, Coffea is often the answer to stress induced insomnia. Drinking coffee or consuming stimulants often aggravate the symptoms for this remedy, as does any strong emotion such as joy or surprise. Symptoms are generally improved by warmth and lying down. Gelsemium - Gelsemium is often very useful for stress associated with anticipation of an event (examinations etc) and ailments that occur after a fright or shock. Stress is often associated with shaking and fatigue. Complaints are often aggravated mid morning, damp weather and are better after urination. Ignatia amara - Ignatia is an excellent remedy for ailments that follow grief, and are often chronic or long standing. Anxiety is often associated with alternating moods, sighing and great sensitiv¬ity. These symptoms may be aggravated by coffee and expo¬sure to open air, and ameliorated by eating. Kali ars - Stress and anxiety related to fear of disease, particularly heart disease, or fear of death are good indicators for this remedy. Worse for cold air, cold food or cold drink. Lycopodium clavatum - The symptoms that call for this remedy often revolve around anxiety about health. and career as well as anticipation anxiety. Symptoms are often worse in the mid afternoon to early evening, worse from heat and better for motion and warms drink or food. Natrum muriaticum - Anxiety leading to severe depression in those of a fastidious nature are often brought back to a happier disposition by the action of Nat mur. Efforts to console the Nat mur often make their symptoms worse, as does heat, and symptoms are ameliorated by open air and cold bathing. Nitricum acidum - Extreme irritability and fears of death by things such as cancer associated with stress are often indicative of the need for Nit ac. Symptoms are aggravated by hot weather and improved by travelling in a car. Nux vomica - Nux vomica is associated with anxiety with extreme anger, frustration and irritability in those of a fastidious or compulsive nature. Those who respond best to this remedy are often intolerant to noise, odours and lights and their symptoms are worse in the morning, worse for mental exertion and better while at rest. Phosphoric acid - Anxiety and depression with mental weakness, apathy and indifference, often as a result of grief or disappointed love, are good pointers to Phos ac. The condition improves with warmth and is aggravated by exertion or anything that's likely to restrict the circulation of blood. Phosphorous - Phosphorous is often of benefit with anxiety worse when alone, in the dark or during thunderstorms and fear that something bad is about to happen. Worse for touch, physical or mental exertion, better for sleep, eating, cold food and cold, open air. Pulsatilla nigricans - Anxiety with weeping, sadness and changeable moods often resolve under the influence of Pulsatilla. They are generally worse in a warm room, worse for rest and rich foods, and better in cold, open air and after a good cry. Silicea - Stressed and anxious about noise, imminent event and trivial things may indicate the need for Silica. Silica is sensitive to all impressions and may appear to lack self-confidence. Worse for cold air and drafts, better for warmth. Staphysagria - Staphysagria frequently suits those suffering from anxiety from grief, suppressed anger or suppressed emotions. They may be prone to weeping, depression and appear to have a low self esteem, but may become violent when angry. Worse for cold drinks and touch better for warmth, rest and breakfast. Stramonium - Anxiety characterised by fear of death, water, and darkness, and often extreme violence brings Stramonium to mind. Symptoms are worse after sleep and better for warmth and company. Tarentula hispanica - Those who are most likely to respond to this remedy suffer from anxiety with impatience, restlessness. often to the point of chorea — they have to keep moving although motion such as walking often aggravates. Music and dancing soothe this savage beast. Worse for touch, cold and damp conditions. References 1. Harrison's Principles of Internal Medicine 2. Journal of the Australian Traditional-Medicine Society March 2004 Volume 10 Issue I 3. Homoeopathy For Stress And Anx Iety By Rober T Medhurst 4. http://en.wikipedia.org/wiki/Stress management 5. Homeopathic Materia Medica by Boericke 6. http://www.holistic-online.com/stress/stress_home.htm 7. http://www.similima.com/stress-and-homoeopathy 8. http://www.naturaltherapypages.co.nz/article/Natural_Treatments_Stress_and_Anxiety 9. http://www.medicinenet.com/stress/page10.htm#How_can_we_manage_stress 10. Lilienthal S., Homoeopathic Therapeutics 11. McCuteheon LE. Treatment of Anxiety with a Homoeopathic Rem¬edy. Journal of Applied Nutrition 1996 12. http://www.drhomeo.com/about/ 13. http://www.askdrshah.com/remedies.htm 14. http://hpathy.com/cause-symptoms-treatment/vitiligo-leucoderma/ 15. Dewey W. A., Practical Homeopathic Therapeutics Prof. Dr. S. SABARIRAJAN., M.D. (Hom) (Pract. of Med), Dept. of Practice of Medicine Vinayaka Mission’s Homoeopathic Medical College & Hospital, Salem, Tamilnadu.

APPROCH TO VITILIGO

AUTOIMMUNE DISORDER – APPROCH TO VITILIGO
Dr. S. Sabarirajan., M.D. (Hom)
An autoimmune disorder is any of a number of conditions in which a person's immune system reacts against the body's own organs or tissues, and the person's immune system produces antibodies to them. An autoimmune disorder is NOT an "immune deficiency". Vitiligo is a condition that causes depigmentation of sections of skin. It occurs when melanocytes, the cells responsible for skin pigmentation, die or are unable to function. In the case of vitiligo, we believe that the immune system probably sees the person's own pigment cells as foreign bodies, and attacks them, destroying them or weakening them. There is increasing evidence to support the view that vitiligo is an autoimmune disease and that it shows a familial trait in about 18% of cases. Vitiligo is a benign skin disorder due to loss of pigment. Estimated 1.2% of American and world population, about 8% of Indian and Mexican population suffer with this disorder.
Association Of Vitiligo With Autoimmune Disease:
Vitiligo is more common in people with certain autoimmune diseases (diseases in which a person's immune system reacts against the body's own organs or tissues). Autoimmune diseases that are associated with vitiligo include: hyperthyroidism (overactivity of the thyroid gland), adrenocortical insufficiency (the adrenal gland does not produce enough of the hormone corticosteroid), alopecia areata (patches of baldness), and pernicious anemia (a low level of red blood cells caused by the failure of the body to absorb vitamin B12).
The basis for the association between vitiligo and these autoimmune diseases is not well understood. Moreover, the connection between them seems optional. Most people with vitiligo, fortunately, have no autoimmune disease such as hyperthyroidism, adrenocortical insufficiency, alopecia areata or pernicious anemia.
Vitiligo & Hereditary
The cause of vitiligo is not fully known, but there are several theories. One theory of some substance is that people with vitiligo develop antibodies that, instead of protecting them, turn upon them and destroy their own melanocytes, the special cells that produce the pigment melanin that colors their skin.
Another theory is that the melanocytes somehow attack and destroy themselves. Finally, some people with vitiligo have reported that a single event such as a severe sunburn or an episode of emotional distress seem to have triggered their vitiligo. Events of this nature, however, have not been scientifically proven to cause vitiligo and may simply be coincidences.
Vitiligo may be hereditary and run in families. Children whose parents have the disorder are more likely to develop vitiligo. However, most children will not get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.
Psychological Effect
An important aspect of vitiligo is the psychological effect of the disease. Vitiligo is often immediately visible to others and those with the condition may suffer social and emotional consequences including low self-esteem, social anxiety, depression, stigmatization and, in extreme cases, rejection by those around them. In people with a pale white skin colour, vitiligo may cause little concern.
Aetiology
The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes. various hypothesis are suggestive of its genesis. Among these the important ones are: -
• Immune Hypothesis - Melanocyte destruction and dysfunction or both may result into Hypopigmentation of vitiligo.
• Neural Hypothesis - Neurochemical inhibitors are released at nerve endings that destroy the melanocytes or inhibit their functioning.
• Melanocyte Self-Destruction Hypothesis - Proposes that an intermediate in melanin synthesis causes melanocyte destruction.
• Dietary deficiency of Proteins and Cupro minerals is a major factor for causing vitiligo. Serum skin and cerebro-spinal fluid copper levels are low in theses cases.
• A gastro-intestinal disorder like chronic amoebiasis, chronic Dyspepsia and Intestinal Worms may be additional factors.
• Use of Broad spectrum Antibiotics, especially Chloramphenicol and Streptomycin leads to appearance of vitiligo.
• Trauma or Local irritation caused by wearing the sari or Trousers too tightly do produce vitiligo in individuals predisposed to it.
• Acute Stress may be followed by fast spreading type of vitiligo proving the theory of Troponeurosis. Emotional crisis may be an additional factor.
• An Endocrinal disorder may be operative, Diabetes, Pernicious anaemia, Thyrotoxicosis, Myxoedema, and Addison's disease may be associated with vitiligo.
• Composite Hypothesis - None of the theories alone is entirely satisfactory. Actual mechanism of inhibition or destruction of melanocytes is much more complex than any of these mechanisms suggested.
Precipitating Factors: -
• Emotional Crisis - Death in family, Loss of job, Sudden shock etc.
• Gastro intestinal tract disorders like Worms, Jaundice, amoebiasis etc.
• Prolonged use of Drugs, antibiotics, Oral an ovulating agents etc.
• Local causes like trauma, burns exposure to chemicals etc.
• Pathologically: - A defect in enzyme Tyrosinase is held responsible for vitiligo. According to some Dermatologists, it is a Trophoneurosis and Melatonin, a substance secreted at nerve endings inhibits Tyrisinase, thus interfering in pigment formation.
Clinical Features
People with Vitiligo develop white patches on their skin of irregular shapes and sizes. Vitiligo is more common on the exposed areas for example hands face, neck and arms. It also occurs on covered areas too: – like genitals, breast and legs. In some patients the hair may also turn grey early and in the inside of the mouth, white discoloration may also occur.
The spread of Vitiligo cannot be determined. It may stop completely after the first patch but often these patches do spread. For some patients further development may takes years and for others the large areas can be covered in months. In some patients mental stress has been seen to increase the growth of these white patches.
The three main diseases that can be mistaken for vitiligo are tinea (pityriasis) versicolor, piebaldism and guttate hypomelanosis. Tinea versicolor is a superficial yeast infection that can cause loss of pigment in darker skinned individuals. It presents as pale macules typically on the upper trunk and chest, with a fine dry surface scale. Piebaldism is an autosomal dominant disease in which there is absence of melanocytes from the affected areas of the skin. It usually presents at birth with depigmented areas that are usually near the mid-line on the front, including a forelock of white hair. In idiopathic guttate hypomelanosis, multiple small, white macules are noted, mostly on the trunk or on sun-exposed parts of the limbs. When vitiligo affects only the genital areas, it can be difficult to exclude lichen sclerosus, which sometimes can coexist with vitiligo.
Vitiligo & leucoderma
Vitiligo is also known as leucoderma in India, which is technically not correct. Leucoderma simply means white (leuco) skin (derma), i.e. a disorder where the skin loses its normal color. Leukoderma is a cutaneous condition, an acquired condition with localized loss of pigmentation of the skin that may occur after any number of inflammatory skin conditions, burns, intralesional steroid injections, postdermabrasion, etc In case of leucoderma, there is partial and superficial pigment loss; while in case of vitiligo there is deep and complete pigment loss.
General Measures
Diet & Regimen: Foods that are excessively sour should be avoided. The ascorbic acid in sour foods tends to reduce melanin pigmentation. So the patients should restrict their intake of citrus foods. Non vegetarian foods are also to be avoided as they act as a foreign body to pigment cells. Flavoured drinks are to be avoided. Artificial colours used in various food preparations should also be avoided. There may not be enough scientific evidence to prove how these foods worsen vitiligo.
Healthnotes Newswire (August 21, 2003)—Supplementation with a standardized extract of ginkgo (Ginkgo biloba) may help slow the progression of skin depigmentation and actually increase pigmentation in adults suffering from vitiligo, according to a study in Clinical and Experimental Dematology . Other nutrients that may be useful in treating vitiligo include picrorhiza (Picrorhiza kurroa), a traditional Indian herb, may also stimulate repigmentation of skin in people with vitiligo.
Supplementation - A small study at the Department of Dermatology of the University of Alabama Birmingham Medical Center found that supplementation with folic acid, vitamin B12, and vitamin C resulted in noticeable repigmentation of the subjects' skin. Taking a vitamin-B complex containing 100 milligrams of each of the major B vitamins and at least 400 micrograms of folic acid daily; 1,000 micrograms of vitamin B12 daily, and 2,000 milligrams of vitamin C twice daily.
Ayurveda, Natural Treatment - Local application of Babchi Oil over the depigmented areas, Use of Copper utensils.
Homoeopathic Management
Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. Homoeopathy is able to give wonderful and miraculous cures in many cases of Vitiligo. This is due to the fact that homoeopathic treatment enhances the natural production of pigments. According to homoeopathic philosophy Vitiligo not a disease in itself but an expression of an inner disturbed state of the body. Thus, the cure should occur at a level where things have gone wrong.
Boericke- skin- leucoderma. - Ars.alb., Ars.sulph.flavum., Bacillinum., Graphites., Merc sol., Nat.mur., Nit.acid., Nux vom., Phos., Sep., Sil., Sulph., Thuja.
• Arsenicum Sulfuratum Flavum - This is one of the specific remedies used for the treatment of vitiligo in homeopathy. It has discoloration of the skin in blotches that are pale or white in color. It is also a good remedy for eczematous lesions which are moist and have intense itching with corrosive discharge. Pyoderma and urticaria also find a solution through this drug.
• Bacillinum - The patient is suffer from chronic cold, cough & occasional history of haemoptysis. He has loss in weight, loss of appetite, flat chested young boys & girls, prominent ribs & prominent clavicles. We get history of asthma, pneumonia, bronchitis & even T.B. in patients. A Maceration of a Typical Tuberculous Lung Mind. Taciturn, sulky, snappish, fretty, irritable, morose, depressed and melancholic even to insanity. Fretful ailing, whines and complaints; mind given to be frightened particularly by dogs.
• Graphites - Obese patient with a history of suppressed itch. Suited to – Excessive cautiousness; timid, hesitates; unable to decide about anything. Fidgety while sitting at work. Sad, despondent; music makes her weep; thinks of nothing but death.
• Merc sol. - There is history of dysentery with mucus & blood. Jaundice with liver enlargement. These patients are worst at night with salivation & have a syphilitic miasm. They perspire in bed & do not tolerate too hot or too cold climate. Nervous affections after suppressed discharges especially in psoric patients. Glandular and scrofulous affections of children.
• Nit. Acid - White spots are found at the muco-cutaneus junction. More at the angle of the mouth, eyes, nose, nipples, glans penis, vulva, etc. Along with it, there may be fissure at the same spot. In some of the patients along with this there is a desire for eating chalk, pencils, etc., particularly in children.
• Sepia - Best acted in females. Beside the usual white discolouration, these patients have irregular menses either early or late, scanty & painful menses in young girls. Leucorrhoea, prurites, dysparunia, & frigidity is noted. Most of the patients complain of morning sickness along with motion sickness, nausea, vomiting or headache travelling in a car or bus. These patients are not social, they prefer to be alone. Adapted to persons of dark hair, rigid fibre, but mild and easy decomposition.
• Sulphur - There is a history of suppression of skin diseases or any other suppression like suppressed diarrhoea, dysentery, jaundice, typhoid & in tropics many other fevers. There is heat in the palms, soles, eyes, anus, vulva, vagina & on the top of the head. Generally hot patient but could be chilly. Irritability & obstinacy is also noted. Adapted to persons of a scrofulous diathesis, subject to venous congestion; especially of portal system. Persons of nervous temperament, quick motioned, quick tempered, plethoric, skin excessively sensitive to atmospheric changes. For lean, stoop-shouldered persons who walk and sit stooping like old men. Standing is the worst position for sulphur patients; they cannot stand; every standing position is uncomfortable. Dirty, filthy people, prone to skin affections. Aversion to being washed; always <. after a bath.
• Thuja - There is history of vaccination. There is dreams of falling, startling in sleep, have warts on face or on the body, with loss of appetite after vaccination. There is history of tuberculosis or respiratory diseases. Adapted to hydrogenoid constitution of Grauvogl. Acts well in lymphatic temperament, in very fleshy persons, dark complexion, black hair unhealthy skin. Ailments from bad effects of vaccination; from suppressed or maltreated gonorrhoea. Fixed ideas: as if a strange person were at his side; as if soul and body were separated; as if a living animal were in abdomen; of being under the influence of a superior power.

In order to archive this, the patient is analyzed on various aspects of mental and physical and familial attributes and also a complete study is done on the psychological-environment that the patient has gone through in his life. The exact remedy is best chosen by a qualified homoeopath.
References
1. Harrison's Principles of Internal Medicine
2. http://en.wikipedia.org/wiki/vitiligo
3. Homeopathic Materia Medica by Boericke
4. http://viticlear.com/vitiligo.asp
5. http://en.wikipedia.org/wiki/Leukoderma
6. Vitiligo: Current Knowledge & Nutritional Therapy by MD, MS and FRCPC Leopoldo F. Montes
7. http://www.njhonline.com/forums/viewtopic.
8. http://hpathy.com/cause-symptoms-treatment/vitiligo-leucoderma-2/
9. Lilienthal S., Homoeopathic Therapeutics
10. http://www.drhomeo.com/about/
11. http://www.homeorizon.com/homeopathic-articles/dermatology/vitiligo-cure
12. Wanakee' s Nutritional Approach to Vitiligo & Other Autoimmune Diseases by Wanakee Hill N.D. and Michael D Hill
13. http://www.askdrshah.com/remedies.htm
14. http://hpathy.com/cause-symptoms-treatment/vitiligo-leucoderma/
15. Dewey W. A., Practical Homeopathic Therapeutics


Dr. S. SABARIRAJAN., M.D. (Hom) (Prac. of Med), Professor, Dept. of Practice of Medicine