THE ABCS OF PEPTIC ULCER MANAGEMENT


THE ABCS OF PEPTIC ULCER MANAGEMENT. In this paper, I propose to give you a short concise practical treatment and cure. It shall include the minor cases to the advanced ones with hemorrhage complications, perforation, and partial to almost complete obstruction, together with their feeding difficulties.


In this paper, I propose to give you a short concise practical treatment and cure. It shall include the minor cases to the advanced ones with hemorrhage complications, perforation, and partial to almost complete obstruction, together with their feeding difficulties.

(1) AMBULATORY. The average run-of-the-mill office cases. Most of my cases run to Nux., Anac., Phos., Ars,. Bell., Lyc,. Chel,. Calc.c,. depending on their individual history, of course. The indications for each remedy are familiar to any homoeopath. I have a set of diets that I start them on immediately called A,B, C,D, and E.A is nothing but a glass of milk, alternated with 1/2 milk and 1/2 cream, every 2 hours, for 8 feelings a day, with special instructions with regard to habits of living as listed in separate sheet.

If a glass full is too much. I cut it down to suit their capacity and lay stress on raw milk and cream from a reliable, clean and disease free source. A good rule to remember that anything that begins with the letter “is” will irritate the stomach as salt, sugar, sweets, sour, spices, spirits, smokes, sauces. The rest of the diets B, C, D, and E are modified Sippy diets.

(2) PERFORATIONS. Of course, here is the place where one should be on his guard and be ready in diagnosis to recognize such a surgical emergency. The sudden, violent pain, with shock and board-like hardness of the abdomen, calls for immediate surgical intervention. The first few hours are golden. After 6 hours from the onset, the morality rate rises unbelievably fast. No time should be wasted by giving a homoeopathic remedy. The abdomen should be opened and the hole neatly closed; then it is time for the remedy. For perforations, or suspected ulcers n in the act of perforating, Kali bi, should have a place somewhere along the line.

(3) HEMORRHAGE, Phos. and Crot. h. occupy a place; and, as a specific, keep in mind the injectable solution of the sodium salt of ascorbic acid, a 10c.c. ampule containing 2 grams or 2000 milligrams of Vitamin c.

(4) OBSTRUCTION. Partial to almost complete obstruction cases where the ulcer is at the pyloric valve. Here is offered a rare feeling problem. The cases are easily filled up; often there is intolerance for the least food with vomiting. When there is persistent and intractable vomiting, I take them off all food and drink for 12 hours; then start them with holding cracked ice in their mouths for a few hours; then state them with holding cracked ice in their mouths for a few hours, which you will find will be tolerated by even the most touchy stomach.

Then comes the Thompsons Malted Milk regime: 3i of malted milk to f3ii of water, a teaspoonful every 15 minutes for the first hour; then if that is well-tolerated gradually step it up to a tablespoonful every 15 minutes. Of course, loss of fluids from vomiting in the meantime is restored by intravenous and Murphy drip. I need not tell you these are all stormy cases. To put a levine tube into the stomach by way of the nostril and give constant feeding, 60 drops a minute, is most annoying to the patient, I like the other way the best. As the patient comes along you can then gradually get him into the Diet A schedule previously mentioned. Atrop sul. 3x is a remedy to be kept in mind; also Carb v., Kali bi. and Scirrhinum.

(5) CANCER SUSPECTS. For those who have a cancer heredity, there is nothing I like better than Carcinosin high as an intercurrent. If Ars. is indicated, and they dont do too well, I think of Cadm. ars. Likewise with Phos. and Cadm. phos., Lyc. is splendid. so is Nux low. Ornithogalum may do good. It has indications along the line of Lyc. Dont forget Carbo animalis and Carbo.veg., Sulph. and Cadm. sulph., Hydr., Bism, Kreos.,Acet. acid. An excellent anti-acid powder is:

Calc., carb. IX powder 8 oz.

Carb.veg.2x powder 8 oz.

Taka diastase 1 oz.

Sac.lac. 8 oz.

1/4 teaspoonful in a little water before feedings.

Excellent pain remedies are: 1/4 gr. Belladonna tablets when needed for severe pain, Eucalyptus, 15 drops in 1/2 glass water. All this I offer merely as a suggestion for your armamentarium. Use it. You will come out on top. You cant be too well prepared in trying cases like these, because you are dealing with this highly vital organ.

Finally, in closing, there are mentioned some of Bachs nosodes.

I believe under Proteus there is duodenal ulcer from prolonged nervous strain with a tendency to perforate. Under Dysentery compound there is duodenal ulcer with spasm of the pylorus. These may come in as intercurrents to help you our. I have had no experience with them. I would never operate on a cancer suspect, but advocate surgery only in the following cases” (1) perforation (2) perforating crater on posterior wall of duodenum causing intractable pain referred to the back and very closely resembling fall bladder colic (3) Prolonged medical failures.

I have tried to give you the whole picture. You may sorely need it sometimes as I have. Take it and wrestle with it for what it is worth in a practical way. There are times when you need all you can get at your finger tips to handle these most trying cases.; I know it will help you too !!

GREENSFORK, INDIANA.

DISCUSSION.

DR.DONALD G. GLADISH [Glenview, Ill.]: This is very interesting and well prepared paper. I particularly asked Dr.Bond to write on peptic ulcer because my experience is that we all see them, and certain doctors, like Dr. Bond, have good results with them. It is helpful to the rest to us.

We have a novelty in the Bureau of Surgery in that we have a Bureau of Surgery and yet our endeavor is to avoid surgery in every instance and take care of the patient by other means, since surgery does not cure; it merely sews up the hole (Applause).

I was interested in what Dr. Bond said about giving up tobacco. My experience is that that is one of the most important things to impress on the patient. If they will give up tobacco, it is much simpler to relieve the pain and indigestion, whether it is an ulcer or not, but unless can convince them they have an ulcer and are about to perforate, they usually wont give up tobacco.

DR.G.KENT SMITH [Glendale, Calif}: One remedy, a new remedy, we have found very efficacious in the treatment of ulcer is Penicillin in homoeopathic potencies. Also a palliative medicine that we use in the management of ulcer is defeated hog duodenum, defatted at less than 40 degree.

Dr.A.H.GRIMMER [Chicago,Ill.]: A paper of this value should not go without a little more discussion. Dr.Bond has done a good deed in bringing something like this up. He has endeavored to give us not only the homoeopathic remedies but also the general management, which is a very good thing. It is a very fine paper, Doctor. We appreciate having it.

There is one thing he mentioned, the Cadmiums; but Cadmium metallicum is a remedy that will surprise you in the number of nondescript cases with poor therapeutic symptoms for guidance. If you get a history, especially of the use of aluminum cooking utensils, Cadmium is the best possible antidote to aluminium, and in some localities it is almost a universal first remedy. Many times even the indicated remedies seemingly will not act very well until at least a single dose Cadmium is given, and then you will carry on with the action very quickly and effectively.

A doctor came up to me some years ago when we were in Cleveland and said, “Dr.Grimmer, I want to thank you for calling our attention to Cadmium. I cure all my cases of ulcer, and I have lots of them, with Cadmium metallicum,” because in that location they were all getting poisoned with aluminium, and Cadmium was the antidote.

Another remedy that the doctor didnt mention which is frequently indicated is Merc.cor.

Referring to Dr.Gladishs remark about tobacco,. I should hate to see Dr. Dixon get an ulcer! (Laughter).

Dr. HARVEY FARRINGTON [Chicago,Ill,]: Mr. Chairman, it was a very interesting and instructive paper. I have had a lot off experience with ulcer of the stomach and probably some of the disabilities that the rest of you and that may be all of you have seen, Dr.Bond has given us a simple procedure for controlling.

My principal difficulty was in the diet, I was usually able to get a remedy that helped. There is just one point there, however-if my patient says eating relieves, I usually examine the symptoms very carefully because although that is a cardinal indication for several of our remedies, nevertheless, it often has a simple chemical cause, because pain in gastric ulcer is usually due to eroding effects of the increased acid in the stomach, and taking food,especially milk, dilutes that, and the pain is relieved.

I would have been very grateful to have had one or two of these little hints that the doctor had in his paper, during the last past years. At the present time there is no gastric ulcer patient on my list,but I should link to mention one case which illustrates the after effects and how they may even persist for years, when they do not take on a malignant form. I once was talking with a tall,rather spare policemen in a parking place on the Chicago lake front, on a windy day in March, and he said, “Doc, you know this wind is just killing me. I have a terrible pain in my right side. It runs up into my arm and down to my fingers, and, strangely enough (and he offered this himself) if I take a glass of orange juice or a few crackers, it entirely disappears”.

Wilbur K. Bond