Case Studies

Progressive systemic sclerosis (Scleroderma)

This is about 43 year old female patient who is a known case of progressive systemic sclerosis (PSS) or scleroderma. PSS is a generalised disorder of connective tissue in which there is thickening of dermal collagen bundles, fibrosis and vascular abnormalities in internal organs.

Her complaints started with smaller joint pains of hands in the year 2004. Her ESR levels were very high in the year Jan 2004. She was diagnosed as scleroderma somwhere in the year 2006.

She visited Rheumatology Centre, to Dr. C. on 22nd Jan 2007. She took treatment there for almost on year till Feb 2008. She was started with Azoran 50 twice daily from Oct 2007 to Jan 2008.

But her symptoms did not improve and she started complaining of stress aggrivated pain, loss of appetite and generalised weakness.

Her blood report showes anemia with hemoglobin 8.8 gm/dl. She complained of burning sensation in both feets. Then in April 2008 she changed her doctor and consulted Dr. S in Advance Rheumatology Clinic. At that time her hemoglobin was 6.8 gm/dl and her C reactive protien was 46.9 mg/dl. She was managed with methyl prednisolone 5 mg and was again started with Azoran 50 from Aug 2008.

Then in Nov 2008 she complained of left sided chest pain. In March 2009 she was diagnosed as PSS with TB lymphadenopathy. She was started with anti tubercular treatment.

But her joint pains increased and she started developing finger deformities in both hands. She continued with that doctor till Jan 2011, i.e., almost 3 years but with no positive results.

At this juncture she has visited Dr. Appa Rao and started his treatment. She has recovered from her pains and all her movements are improved and the deformities occured erlier were arrested and no more further deformities occured thereafter. She is taking the follow ups and leading a normal life till date.(01-11-2017)

(Psoriatic Spondyloarthritis (PSA) + Reactive arthritis.)

A 44 year old male patient, Mr. R, who is a civil engineer by profession came to Dr. Appa Rao’s clinic on 30 Nov 2011 with complain unable to walk and swelling of left knee and left ankle and severe pains in shoulders, elbows and wrists.

He gave history of RTA (Road Traffic Accident) fall from bike on 8 Oct 2010 – 1 year back. Since then history of polyarthritis involving ankles, knees, wrist, MTP joint since 6 months. He also had Joint swelling with early morning stiffness since 3 months and history of pain at back and sacral region since 1 month.

He had taken various treatments from various doctors but without any improvement from those treatment. Dr. T. on 11 Oct 2010 after accident with injury in right knee and right ankle. He was managed symptomatically with analgesics and crepe bandage for ankle and knee. He again visited him after 15 days i.e., on 26 Oct 2010 with c/o vomitings, loose motions, fever, headache and myalgia. Was investigated for malaria and urine routine.

Then he visited Dr. G, on 10 Nov 2010. He was advised MRI left knee which revealed – medial meniscus tear and planned for Arthroscopy if complaints persists even after 2 months of treatment.

Then referred to Dr. J, Rheumatologist, on 26 nov 2010. Patient gave h/o low grade fever and diarrheoa at the beginning of polyarthritis of knee and ankle thus diagnosed as Reactive arthritis + ligamental injury, Post viral fever and post enteritis.

Meanwhile his disease progressed and he also developed Stiffness of both knee, bilateral pedal edema bilateral 1st metatarsophalangeal joints tenderness. Was adviced for physiotherapy and he continued there till 30 March 2011

Then he visited tertiary care hospital on 11 April 2011 By the time he developed bilateral Saccoilitis, peripheral arthritis and came with complaint of severe back pain. Then he was diagnosed as Psoriatic Spondyloarthritis (PSA) + Reactive arthritis.

He was started on with methotrexate and took physiotherapy too for almost 8 months. Mean while he was tested positive for Montoux Test with latent KOCHS.

On 28 Nov 2011 – very disappointed with the treatment he gave history of “NO CHANGE IN PAINS WITH MEDICATION”

And then he visited Dr. Appa Rao’s clinic on 30 Nov 2011 and started his immunonutrition therapy and improved gradually.

Dr. Appa Rao took two months time to reduce his inflammation and also seen that the ESR comes down to 50-100mm. Day by day he kept improving and became totally fit in a period of 3months. He improved so much that in 2 weeks only he was able to walk without limping.

The patient is well recovered and resumed job. He is on maintenance therapy and is doing well since then till date(01-11-2017).

Medduloblastoma; WHO grade IV; cerebellum.

This is about Mr. M 41/M who came to Dr. Appa Rao and started his treatment in April 2014. Earlier he gave the history of giddiness-June2012 and vomitings-Feb2012. He was adviced MRI brain on 4 Feb 2013 which showed – hyperintensities in vermis, cerebellar hemispheres and midbrain.

He was taking treatment, but for persistence of symptoms he was again adviced MRI brain in Aug 2013 which showed – ill defined hyperintensities in superior cerebellar hemispheres B/L, vermis and middle cerebellar peduncles. MRI spine in Aug 2013 showed degenerative changes in cervical vertebra with indentation of cord in C5 – C6, C6 – C7 levels. CSF analysis was negative for malignant cells.

He was furter evaluated – right suboccipital craniotomy and biopsy was done on 2 Nov 2013. Biopsy report was in favour of small cell carcinoma. Biopsy material was sent for second opinion to NIMHANS, Bangalore on 27 Nov 2013. Final diagnosis of medduloblastoma; WHO grade IV; cerebellum.

He received radiation therapy for 45 days from 16 Dec 2013 to 28 Jan 2014. He was not able to tolerate radiation, then adviced for chemotherapy but did not want to go for chemotherapy.

He started treatment of Dr. Appa Rao and within a week he was 50% better and half the symptoms was gone. He improved so well in just 3 months and his later reports of MRI done on 20 Dec 2014 was completely normal. He is now completely normal and just continuing with the maintenance therapy of immune nutrition once in 5-6 months and he is very much happy with the treatment till date(1-11-2017)

Seronegative Spondyloarthopathy

This is about 25 year old male patient Mr. P suffering from Seronegative Spondyloarthopathy came to Dr. Appa Rao’s Clinic in severe pains and unable to walk.

A 25 year old young male, police man by profession suffered severe back ache and difficulty in walking in September 2011. He consulted an Orthopedic Surgeon who after doing preliminary tests advised him for MRI of both the Hip Joints and Lumbo-Sacral spine. The reports revealed increased signal seen in the sacrum and ileum adjacent to the left sacro-iliac joint on lR images suggestive of SACRO-ILITIS. There was a Degeneration of D12/L1 and L5/S1 inter vertebral disc. His ESR first hour was raised and He was RA Factor Negative. Thus he was diagnosed as seronegative spondyloarthopathy. He was put on Methotrexate and sulfasalazine with folic acid.

As his symptoms were not improving he came to know about Dr.Appa Rao and came to him in January 2012. He started his Immunotherapy and to his surprise he improved in one month. When he came he was in severe pains. He took leave from his job as he could not walk even. But then after starting Immunotherapy he was almost 75% better and relieved of his symptoms in just 2 months.

He completely recovered in 4 months and could jump infact without any pain. He joined his duty back in April 2012. He is on intermittent therapy now and doing well till date i.e 01-11- 2017……in 2017.