Case Of Benign Breast Abscess With Mastitis

Case Of Benign Breast Abscess With Mastitis
by

Dr. Meghna Shah (BHMS, FCAH)

This is a case of 31-year-old female with who first consulted Dr. Meghna Shah on 7th December 2016 for a discharging breast abscess. She had suffered pain and swelling in the breast before menses and soon after she was diagnosed with a right breast abscess,which was confirmed on X-ray mammography and sonomammography investigation.

Following that, she did FNAC on 5th August 2016, which was negative for malignancy and it benign mastopathy with mastitis was suggested. Tuberculosis was ruled out in FNAC and culture.

On 24th August 2016 she did I & D and histopathology, which revealed periductular and perilobular mastitis of idiopathic origin. She has also consumed several courses of antibiotics. The abscess recurred since October 2016. After undergoing the procedure she got infected again and had to continue dressing the area.

She is also a case of hypothyroidism since June 2012, on 37.5mcg ofEltroxindaily and was suffering from irregular menstrual cycle. Although she is on medicine her levels fluctuate. She also has fluctuating prolactin levels.

Report on 30th July 2016:

x-rayx-ray-2

The onset of her complaintstarted with mastitis (inflammation of breast issue) in July 2016 and following that she had galactorrhoea on both sides with severe pain in the right breast. She had circular breast pain before menses that was worse on changing sides in bed, raising up and caressing her daughter. She had come to the consultation with a discharging open wound that was not healing. Her pain got worse during ovulation. She loved her daughter a lot, and every time she would caress her, there would be discharge oozing.

There was a stitching pain below the nipples especially before and during ovulation, however, it was better on the day of ovulation. There was a squeezing sensation in the left breast near the ribs as though a muscle was stuck. It was worse on leaning forwards while being seated. She felt her lateral muscles were contracted while driving. On the 3rdday of menses, she often suffered an episode of vertigo that got worse on sudden rising from sitting position and lying down from sitting position. It felt like her surroundings were moving in semi-circular fashion.

She also got bouts of acidity after consuming poor quality food, if there was achange in food timings, or if she was having excessive spicy or junk food continuously over a period of 2-3 days. She experienced pain in her right brow with restlessness and nausea, which got better after vomiting. Her vomit was acidic along with a tingling sensation in her teeth. She pointed out to a single spot on her right brow where the pain arose.

During winters, she had coryzathat was worse in the morning with sneezing. She also had phlegm accumulation in her throat. She was very sensitive to the heat of the sun and could not tolerate exposure for a long time. There would be pain in her eyebrows with a drowsy feeling that was better after relaxing.

As a child, she had an incident of being exposed in the sun for a long time after which she developed red spots on her skin along with itching and a sensation of heat radiating from her body. She also had a history of stone in her right kidney with right sided lumbar pain.

She is unable to work for longer durations on account of her breast complaint. There was pain in the right shoulder and hand that got worse on exertion. She experienced weakness below her knees and in her thighs after exerting for long and also before and during menses.

She felt her state of mind was responsible for her physical complaints. She was working for 3 years post delivery but was compelled to resign as there was nobody to look after her daughter. She wished to join her family business after her daughter started school. She also desired to have a home to herself and fulfill a couple of dreams in order to have a brighter future andalso sort the existing family problems.

She often felt lonely as her in-laws were not very concerned about her. During pregnancy her mother-in-law was very doubtful about her ability to care for the child, but she also received lot of positivity and support from her husband and her maternal side. Her husband was very understanding and caring; he would console her dall the time. She was disappointed about her father-in-law not calling her while she was hospitalized. Her in-laws would not look after her or her child. Her daughter was very attached to the in-laws but she felt they did not consider her a part of their own. She also felt they were biased towards her brother-in-law’s son andher daughter was not given her due importance. She narrated an incident where her in-laws preferred looking after the other child during the Diwali festival and did not accompany her daughter who was left playing alone outside the house. She often felt she was not a part of their family and was treated like an outsider. For example, family problemswere discussed only with the sons and not shared with daughter-in-laws. There was a huge communication gap between them and her,which bothered her a lot.

She felt unfortunate as she was financially less settled than her brother-in law. She always felt the thein-laws gave more importance to the brother-in-law and his family since they were financially well off.

She felt all of the important events in their life were delayed. For example, they were late to conceive a child in the family. She was fond of cooking and would often prepare chocolates and bake cakes but was never acknowledged or appreciated for. This would upset her a lot. She felt it was a waste leaving your home and coming to a different home where you are not even acknowledged as a family member. She thought they were probably afraid to appreciate her, as she may become too confident and later bully their son.

She would tell her daughter to excel and create a name internationally. During her pregnancy, she would speak to her child, and talk about becoming an extraordinary person and of having a bright future ahead. She had high expectations from her daughter and wanted to see her being successful. She was disappointed that they were yet struggling to have a home to themselves.

She also felt that there was fault in our existing education system. A lot of money was incurred for donations before taking admissions for children. She felt the system was taking advantage of the situation and was against it. Demanding donations was like being blackmailed. Formerly she was a teacher and worked very sincerely. She was also studious and would complete her studies in time.

Recently, she heard about a child being abused at a day care, where the baby was thrown on the floor and had suffered multiple injuries. After hearing about this she decided to quit her job and stay home with her daughter. She wanted to be with her daughter and give her all the attention in the world. She felt mothers should not give importance solely to their career and put the child’s life at risk. She promised her daughter while she was in her womb to welcome her and fulfill all the responsibilities of a mother. She was very attached to her. Even when away, she would keep a check on her.

In her childhood, she would dream of anacondas, huge in size (the patient described this with a magnified hand gesture). She also dreamt of a figure, half human and half snake who told her he was her ancestor. She spoke about KaalSarp (in astrology this meansa wrong doing in previous or present lifetime). She apologized in case she had done anything wrong. She also dreamt of not being able to complete a task in the given time limit; likewise she wasnot able to make it for a wedding, and she was yet applying make-up. Another dream was about her brother’s death. Besides this, she dreamt of wild cats, where they come and suddenly pounce on her. She was extremely afraid of cats in general; she would run away at their sight.The fear was of being injured their paws. She was scared to look into their eyes especially at night, as they shine. Whenever she saw one, she would scream and start running away. She believed that purring of the cat was a bad omen and compared it to the same feeling when one heard the sound of an ambulance passing; as though something bad was going to happen.

She was sensitive to harassment of people, especially the stronger one troubling the weaker. She said, ‘During fights, it’s the weaker ones that are bullied and taken advantage of.’ She disliked having animals at proximity even if they were petted. The fear was of being bitten. Besides, they shed their hair, which was not safe for children. She was afraid of cows and buffaloes too. Cows and buffaloes are applied tikka (Indian custom of applying red color on head of cows). She was scared of applying tikka or feeding them. She was scared her hand could get stuck between their teeth. She narrated an incident from her childhood, ‘on a rainy day, when roads were flooded and jammed with traffic. Her brother had left early from school and left her behind. As she was walking back alone, a rickshaw was honking at her continuously and in no time a cow suddenly pushed her from behind. She fell right on her abdomen in the muck. Fortunately it didn’t walk over her.’ After that incident, she started disliking them was afraid ofbeing attacked.

She experienced pain in her thighs and back before menses. After developing mastitis, she had tenderness in her breast before menses. Earlier she had occasional tenderness but not pain.

During pregnancy she had nausea from strong fragrances such as perfumes and incense sticks. She was aggravated by strong odors. She was averse to apple. As a child she was afraid of cotton; fear was of being poked or pricked.

She made a doodle on case record form. She described it as a round face with multiple holes on it that was dirty and disgusting. It was unbearable for her to see it long as it was very dirty.

Patient’s Doodle:

Patient’s

CASE ANALYSIS

In this case, the patient expresses a vivid picture in the mind symptoms along with multiple physical complaints. Her main pathology is affection of the breast tissue that is aggravated before menses. Along with that she has occasional bouts of acidity, vertigo and coryza.

We have an interesting mental picture to explore. As she rightly pointed out, her physical complaints were an outcome of her mental stress. She spoke about her constant conflict with her in-laws; where she felt she was not supported by them; not accepted as one of their own and left out. She also felt she was not acknowledged and appreciated for her work.

She was very sensitive towards abuse of children, harassment of the weaker by the stronger; being bullied or taken advantage of. We also see a strong maternal instinct, where she is extremely attached to her daughter. She had given up on her job in order to give all her attention to her. The conflict with her and in-laws, sensitivity towards abuse and harassment, anger against the system, struggle within herself gives us a hint of the Animal kingdom. The theme of victim- aggressor, stronger- weaker, one versus the other is that of Animal Kingdom.

At this stage the sub-kingdom is not very clear. In order to find out, we need to go deeper and explore other areas of the case. After that she described her childhood, her dreams and fears. She was very scared of snakes and would dream of huge sized anacondas. She also dreamt about a half human and half snake figure who told her about Kaalsarp. She had lot of fear of wild cats and cats in general. The fear was of being attacked or injured by them. She could not tolerate to look into their eyes as well. She would scream and start running away as soon as she saw one.She has a marked fear of animals. The above also gives us a hint that patient belongs to the victim group of animals and not the aggressor. To add to this she spoke about her sensitivity towards cows and thatshe was never able to apply tikka to their head or offer food to them; though cow being a Holy animal and worshipped by her community. She narrated the incident where she was attacked by the cow and thereafter she had become very fearful of it. From the above, we can consider the following rubrics:

  • mind; DREAMS; animals, of
  • mind; DREAMS; snakes
  • mind; Delusion of being beaten
  • mind; FORSAKEN feeling
  • mind; DREAMS; cats, felines (75)
  • female; OVULATION; agg. (59)
  • female; MENSES; before (188)

The above reportorial chart shows Lac defloratum coming up in the case. Interestingly, we see a strong connection to the source as well.

The following are a few distinctive features of mammals:

  • Strong need to belong to a group/community/family. Within the group they feel safe and secured. We see the same feeling in the patient; where she feels strong need to be accepted in her new family; she wants to be considered as one of them. That would make her feel safe and secured.
  • And the feeling of being forsaken/neglected and abused/tormented/harassed by the group.
  • Strong maternal instinct: We see a strong maternal instinct in the mother. She gave up on her job in order to give time and attention to her daughter. She felt she should provide her with best means possible and give her a bright future. She would talk to her in her womb promising her to fulfill all her responsibilities.
  • Feelings of dirty, disgust.
  • Sensitivity towards abuse.
  • Affections of female organs: it is often observed they suffer from menstrual and lactation complaints. Especially aggravation of symptoms before menses. In this case, we see galactorrhoea and discharging breast abscess as the chief problem in the patient, which was recurring in nature.

The doodle with rounded face and multiple holes confirmed the feeling of disgust and dirty as seen in mammals. She required a remedy from the Lac family based on the above understanding. She received Lac defloratum 200 followed by LM6 daily for 1 month.

Materia Medica Reference:

  1. Soul of Remedies by Dr. Rajan SankaranSoul of Re

She receivedLac defloratum 200 followed by LM6 for 1 month. The reason being the wound was painful and discharging. However the plan was to gradually step up the potency to 1M and correspondingly the LM potency to LM8.

SUMMARY OF FOLLOW UPS IN 6 MONTHS

Gradually the patient was stepped up to Lac defloratum1M followed by LM8 (that was later on stepped to LM10).

By June 2017, she was much better. There was no more abscess formation and no galactorrhoea. The pain around ovulation improved. She has not taken any further course of antibiotics. Her menstrual cycle became regular. Her symptoms before menses improved. Amongst her other complains, her back pain improved. She continued to complain of sinus trouble, which is less in intensity and does not need to take any other medicines.

She had started practicing yoga and it was helping her a lot. Her hemorrhoids and digestion had improved. Her TSH levels don’t fluctuate further and continue to remain WNL. She still continues Eltroxin, and the plan is to gradually taper the dose. Despite repeated requests, she is not too keen on repeating the mammography. She does not feel the need for it and also due to the pain involved in the procedure.

She also improved in general, in her state of mind. Where she felt less negative against her in-laws and more accepting of them. She was feeling more positive about her situation and hopeful that things will work out.

The patient continues to follow up and remains on the same remedy.

ABOUT:

Dr. Meghna Shah (BHMS, FCAH), Dean, the other song: International Academy of Advanced Homoeopathy

A young, dynamic, dedicated, intelligent and sincere person, she is gifted with an extremely intuitive mind inclined towards research. She also possesses excellent managerial qualities with tremendous insight into human psychology. She is an ardent follower of Homoeopathy, and having trained under Dr.RajanSankaran for 10 years. Dr.Meghna has worked in the Mumbai homoeopathic hospital after receiving her degree in 2000. Since 2001 she has been a physician in Dr.Sankaran’s clinic. She has organized video and live seminars of Dr.RajanSankaran and has been instrumental in starting the web-group ‘Insight-Alliance Homoeopathic’. She has been an active member in organizing ‘Wednesdays with Rajan’, one of the most successful programs in Homoeopathy. She has assisted Dr.Sankaran on the books: Sankaran’s Schema, Structure – Experiences with the Mineral Kingdom,The Other Song, and Survival Reptilia, all of which have been highly appreciated and translated into many languages. She has spent two years researching the reptiles for this book, including a stay at the Reptile Park in Chennai, where she observed them firsthand and consulted the park’s herpetologists. She is currently working on Survival – the Arachnida, apart from being at the deanof The Other Song.

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