I like to paint the town red

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I like to paint the town red

• Mrs RB, 34/F housewife, was referred by our
  in-house Gynaecologist for Insomnia and Bodyache
  on 1/1/03.

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Chief Complaint
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Chief Complaint
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Patient As A Person

• Height 54.
• Weight 57.2.
• Weight Gain 1 kg/ 2 months.
• Skin White patches on skin. Tendency to bruise
  easily. Warts 6 on L, 5 on R.
• Hair Early graying. Dandruff .
• Teeth 8 carries Teeth.

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Patient As A Person

• Perspiration Normal
• Appetite Normal.
• Thirst 8-10 glasses/ Day.
• Thermal C3H2

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Patient As A Person

• Craving Milk3
• Craving Salty3
• Craving Sweets2
• Craving Hot food
• Aversion Rich food
• Aversion Sour

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MENSTRUAL HISTORY

• FMP 15 years of age.
• Cycle 5-6/28 till 1994.
• Now 4-5/22, moderate brownish flow, non-staining
  and non-offensive.

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Obstetric History

• G2P2A0L2.
• FTND.
• During Pregnancy Worry and fear of losing her
  figure.
• After pregnancy she thought her life has come to
  an end!

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Sexual Function

• Pain in the vagina with tenderness during
  coition.
• Aggravation during ovulation.

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Life Situation And Mental State

• 1968 born in Kolkata. Only Daughter.
• Father Professor and Head Of the Department,
  Biology. Mother a Housewife.
• 1985 SSC 1st class
• 1987 HSC Science. Distinction. MSc in Botany.
• 1993 Married. Husband was Manager in TISSCO till
  2000.
• 2000 Husband changed the job, so they shifted to
  Mumbai.

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Life Situation And Mental State

• Husband Introvert3.
• His father was strict, dictatorship, no emotions.
  
• Patient loves outing, dinner and dancing!
• Husband does not interact even with the children.
  
• No going out, no shopping, no dressing.

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Life Situation And Mental State

• Once in 2001 Husband on his own suggested going
  out, so they went out and had a fight.
• But Husband now works out of town, so patient is
  on her own with children in Mumbai.
• Goes out has many freinds3.
• Husband has no objection to her going out, as
  long as he is not dragged.

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Life Situation And Mental State

• Once she went to Lonawala and telephoned husband
  that she would come late by 11 pm.
• But they managed to reach by 10 pm. He said, Oh
  you are early!
• She blew a fuse- you want me to sit on the
  doorstep till appointed time!
• There was no welcome on his face, no smile!
• That was the main bone of contention.

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How will you handle this case?? What counseling?

• Husband is happy being in himself.
• He does not want to go out.
• But he is not stopping you of being out.
• The motto of our life is to be happy.

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How will you handle this case?? What counseling?

• You like going out.
• That makes you happy.
• You go why you should think about things which
  are not going to occur and get worried.

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Rubrics

• Affectionate
• Fun loving
• Likes dancing
• Anticipation
• Anxious about health
• Egoistic

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Rubrics

• Obstinate
• Confident
• Bold
• Good features
• gt Company
• Talks excessive
• Pain vagina lt Sex During.

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I like to paint the town RED
Mrs RB, 34Mod Bengali.Mo of 2
Came on 1.1.03ProblemsInsomnia Ovulatorypain
?94crawls!
Born Kolkata.MSc BotanyFa Prof BiologyClose
knit flyBright, fun loving intelligent.
PROBLEM?
HusbandIntrovertNon communicativeNo
emotionsNo interaction with KidsFa - Hitler
Severemaritaldistress
Whenmarried?
1993
Ovulation pain D11- flame inside gt heat.With
diarrhoea, oliguria, acne, bloating Mammae -
tender
Takephysical history
Hates to go out.Happy 2B aloneWants her go out
alone!
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Bold, Bungeejumping.Dancing. Plans3
?
REMEDY
Fear of losingfigure duringpregnancy
COUNSELLING
?
Other dataHot, Warts,bruises easilyCr
Milk3,Salt3, Sw2, Hot food.
Unity in Diversity!!Where shall the two meet???
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Treatment and follow up
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Treatment and follow up
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Treatment and follow up
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Mirror, mirror on the wall

• Case 2

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Chief Complaint
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Chief Complaint
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Chief Complaint
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Chief Complaint
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Patient As A Person

• Height 5.2 Inches
• Weight 27.8 Kgs
• Skin Sensitive
• Teeth Discoloration, yellow

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Patient As A Person

• Appetite Normal
• Craving Spicy3, pickle3, garlic3, sweets2,
  salty3, eggs3
• Thirst Decreased
• Stool Normal, occasionally passes once in two
  days.

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Mothers Obstetric History

• Had skin infection during pregnancy. Was given
  steroids.
• Caesarian baby.
• Caesarian done since there was no pain.

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Developmental Landmarks

• Mild Neonatal Jaundice at birth.
• Birth Weight 3.3 Kgs
• Dentition Normal
• Speech Started speaking at the age of 7th month.
• Sucking reflex was decreased.

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Sleep

• Sleep 10.30 pm to 6.45 pm
• Concomitants Sleep during Teeth grinding OD. P/H
  now occasional
• Dreams Occasional unremembered

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Thermals

• Cannot tolerate sun, summer
• Likes winter.
• Fan.
• Open air.
• Likes to bathe.

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Family History

• Family History
• MGF 66 yrs DM
• MGF HT
• PGM Hypothyroidism, Hypertension
• Past History
• All vaccination done

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Mind

• Attitude defiant
• Appearance definitely a proud attitude
• Egoistic looks
• Conscious of looks, keeps looking in the mirror
• Anger3

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Mind

• Screams
• Weepy3
• Possesive3
• Domineering with immediate friends
• Fear3 falling, drowning
• Obstinate3, mixes very well with the family
  members but takes lot of time when with strangers

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Mind

• Loves dancing
• Loves company3
• Loves pets
• Learning Bharat Natyam since 2005
• Domination at home3, friends3
• Dissuading
• Wants to be taken care of
• Blames others

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Predisposition
Family

MGF DM, HT PGM HYPOTHYROID, HT MOTHER -
ARTHRITIS
PARENTS - CONFLICT
SYPH

Society

LESS FRIENDS
ANGER

DOMINATES HOME FRIENDS
EGO
IRRITABLE OBSTINATE DEFIANT DOMINATING SELFISH CRI
TICAL FEARFUL
Work
SCREAMS, WEEPS

EMBARRASMENT
TUB
SYCOSIS
PSORA
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ENURESIS 1/WK INVOLUNTARY lt LAUGHING, PLAYING, EXC
ITED
SKIN- FACE WHITE SPOTS SINCE 2006 LTgtRT
HOT CR3 -SPICY PICKLE GARLIC SALTY EGGS CR2
SWEETS
COLIC SINCE 2005 lt3 MORNING
R/S COUGH THROAT IRRITATION ltMORNING ltICECREAM ltCO
LD JUICE gt3 SLEEP
MOLLUSCUM CONTAGISUM FUNCTIONAL ABD. PAIN
TONSILLITIS
NOCTURNAL ENURESIS
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Treatment and follow up
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Treatment and follow up
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Treatment and follow up
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Treatment and follow up