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68 years old male patient Mr. C.M.P. (Patient reference no.
L6406) was brought to the clinic by his 2 children for
complaints of increased frequency of micturition since 5
days. He would have to rush for passing urine every 30- 45
minutes and there was pain in the left side of the abdomen
radiating from the loin to groin region. The pain would come
on intermittently and was quite severe in intensity. He also
had mild nausea since a few days but no vomiting. The
ultrasonography of the abdomen revealed a 7mm calculus at
the left uretero-vesical junction which was causing certain
back-pressure changes in the left kidney. He did not have
any history of fever or passage of blood in urine. He had
been diagnosed as having benign enlargement of the prostate
about 8 months back. Since then he had been having increased
frequency of micturition but it was never as severe as this
time.
He had been suffering from right sided hemiplagia (paralysis
of the right side of the body) since past 5 years. He had
recovered to some extent after this attack but there still
was stiffness of the right side of the body but he could
manage to walk with some support.
He would get episodes of frequent colds since the last 25
years. He had chronic thick whitish discharge from the nose
and constant clearing of the throat. He would occasionally
get severe bouts of sneezing.
His appetite had decreased significantly in the past few
days. He was very fond of sweets, yogurt, cold drinks and
ice-creams. He did not like eating vegetables. His thirst
was lesser than normal and sweat was scanty in general. His
sleep would be quite disturbed due to increased frequency of
micturition at night.
He was a retired person who was previously employed with
Air force and later with the ministry of communication. He
stayed with his 2 daughters. His son reported that the
patients vocabulary had markedly reduced after he had
suffered from the stroke. He would be at a loss of words and
would often have to use gestures to communicate with others.
He would often use one word instead of another and would
have great difficulty in finding the correct word to speak.
His speech was clear and there was no slurring. His
activities were much restricted because he did not like
watching TV or reading newspapers and would not be able to
talk to someone on the phone either. He would get angry very
easily and would shout when he was angry. His anger would be
easily triggered by contradiction. He was a very impatient
person and could not wait for things to happen; he would
want things to be done quickly. Obstinacy was an important
feature in his case; his daughter said that once he says
no for anything, he will never change his opinion. He
would not obey the opposite person even if it was in the
best of his health to do so. He was otherwise a very
soft-hearted, kind and helpful person. He had much anxiety
about the health of his daughters, one of whom suffered from
Bipolar disorder and the other one who suffered from lupus
arthritis. He would like to have company of people and
desired o remain active rather than doing nothing. He would
often weep when he was sad and would feel better when
consoled by someone.
In the past he had one episode of ureteric calculi about 10
years ago and left sided stroke about 5 years ago. His elder
brother had similar complaints of renal calculi and diabetes
mellitus. His mother had arthritis and another brother of
his suffered from hypertension and ischemic heart disease.
Based
on the above history he was prescribed strychninum 30
repeated 4 times daily for his ureteric calculus. A week
later he reported that the pain was much better, more than
75% better than before. The frequency of micturition was
almost the same as of now. He did not have any burning
during or after micturition and the nauseas was completely
gone. His appetite had also improved as compared to before.
Another week of medication relieved him of the pain
completely and the frequency of micturition came down to his
original (every 2 hours). He did not have any nausea or
vomiting or fever. The medication was continued later for
some more time for his frequent colds.
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