Role of Ultra-High Dilutions of Homoeopathic Medicines in Increasing Blood Oxygen Saturation Levels in Patients under Palliative Treatment– A Case Series Study Using Pulse-Oximeter Levels

Introduction

Hypoxemia is a condition in which there is decrease in partial pressure of oxygen in blood PaO2 [1]. The normal PaO2 level is between 80-100 mmHg which corresponds to 95-100% of SpO2, which is the oxygen saturation in arterial blood and can be assessed using a pulse-oximeter. Thus when PaO2 level falls below 80 mmHg and SpO2 level falls below 95% it causes hypoxemia [2]. There are several mechanisms that attributes to the development of hypoxemia, which includes; ventilation perfusion mismatch, right to left shunt, diffusion impairment, hypoventilation [1].

The causes of hypoxemia include Acute Respiratory Distress Syndrome, COPD, Asthma, Pulmonary edema, pulmonary embolism, interstitial lung disease, atelectasis, pneumonia, pulmonary fibrosis, High altitude sickness, respiratory failure, cardiovascular diseases and anemia [3].

The common symptoms of hypoxemia include dyspnea, coughing and wheezing, rapid heartbeat, headache, cyanosis, feeling of confusion or disorientation [3]. Many homoeopathic literatures have described how well homoeopathic medicines can be used in palliative care as well as in cases of hypoxemia. In “The collected work of Arthur Hill Grimmer” he describes about Carbo vegetabilis as “At the end of life’s journey, when racked with suffering and anguish, cold, pulseless, blue and gasping for breath; wants to be fanned that more of the life sustaining oxygen may be wafted to his air-hungry tissues, what a comfort and power is released in the administration of this remedy” [4].

This study is focused on signifying the role of homoeopathy in increasing blood oxygen saturation levels in patients under palliative care. This study will substantiate the therapeutic value of various homoeopathic medicines which have its effect on increasing blood oxygen saturation and in turn help to sustain patients vitality. With the help of pulse oximeter the values of blood oxygen saturation can be recorded at even intervals and along with that the subjective as well objective symptoms of the patient will be recorded. By considering all the factors similimum is prescribed. This will pave way for the complete analysis of the improvement of the patient.

Methodology

Study was conducted in 7 subjects under Palliative treatment, from IPD’s of Sarada Krishna Homoeopathic Medical College, whose oxygen saturation in arterial blood (SpO2) falls between 95%-80% particularly in patients whose SpO2 level remains constant for a specific period of time.

At first the oxygen saturation is assessed using a pulse- oximeter and if the SpO2 level falls between 95%-80% and the hypoxemic state remains constant for at least 5 consecutive minutes, the patients were administered with ultra-high dilutions of homoeopathic medicine considering the symptoms.

For patients whose SpO2 level was between 95%- 90% they were administered with ultra-high dilutions of homoeopathic medicine alone, whereas patients whose SpO2 level was between 89%-80% were administered with ultra- high dilutions of homoeopathic medicine along with oxygen therapy. After administering the medicine, the SpO2 levels were recorded till it reached ≥90% for every 5 minutes and for the patient whose SpO2 level reduced to 65% or below, they were referred to higher center and was considered drop out of the study. The quality of life was assessed before and after the treatment using 15D-HRQoL [5]. After administering the ultra-high dilutions of homoeopathic medicine, the SpO2 level will be monitored continuously every 5 minutes until the oxygen saturation of the patient becomes normal.

Results

Seven cases that met with the inclusion criteria have been considered for the study. Table 1 summarizes the outcome of the review of these cases. The cases have been described below.

Table1: Clinical details of the patient considered for the study.

Discussion

Hypoxemia is a medical emergency, should be treated on the nail. Failure to initiate supporting therapy can result in serious harm to the patient or may even lead to death. The samples for this study are seven cases, which were identified to have Hypoxemia and were admitted under Palliative Care IP of Sarada Krishna Homoeopathic Medical College. Based on the analysis from seven cases of Hypoxemia in palliative care treatment, following observations were made comparing with the available literature.

In a sample of 7 cases, 71.42 % (n=5) belongs to male patient, 28.57% (n=2) are female patients. Existing cancer incidence shows that male is more affected than females. Here in this study males are affected more. This finding supports existing theories.

Based on age, 57.14 % (n=4) cases belongs to 60-69 age group, 28.57 % (n=2) cases from 50-59 age group and 14.29 % (n=1) case from age group of 70-79 years. According to the most recent statistical data from NCI‟s Surveillance, Epidemiology, and End Results program, the median age of a cancer diagnosis is 66 years. The median age at diagnosis is 61 years for breast cancer, 68 years for colorectal cancer, 70 years for lung cancer, and 66 years for prostate cancer [6]. This study supports existing data’s in prevalence of cancer age.

In this study, most common conditions associated with the seven (n=7) cases are 16.66% (n=3) cases have Diabetes Mellitus, 16.66 % (n=3) cases have Hypertension, 11.11 % (n=2) cases have Hepatocellular carcinoma, 5.55 % (n=1) cases have Dyslipidaemia, 5.55 % (n=1) cases have Epilepsy, 5.55 % (n=1) cases have Portal Hypertension, 5.55 % (n=1) cases have Ascites, 5.55 % (n=1) cases have COPD, 5.55 % (n=1) cases have CA Uterus, 5.55 % (n=1) cases have CA Prostate, 5.55 % (n=1) cases have CA stomach, 5.55 % (n=1) cases have CA Cheek, 5.55 % (n=1) cases have Glioblastoma. Patients having Diabetes and hypertension are at a greater risk of developing cancer. According to a study conducted by Hiroshi Igarashi, upheld the association between the use of oxygen therapy, in patients with low oxygen saturation and survival of patients with advanced cancer; he concluded that patients with low oxygen saturation with advanced cancer was not significantly associated with increased survival rates [7]. Recent years studies suggest that there is a substantial increase in cancer incidence in Diabetes as well as in Hypertensive patients [8].

Among the seven cases, before treatment all cases were in moderate hypoxemic level, and after treatment 71.42 % (n=5) cases improved from moderate to mild and 28.6 % (n=2) cases became severe. The 71.42 % positive result means homoeopathy has a significant role in managing moderate levels of Hypoxemia. Here role of Oxygen therapy should be discussed, because of ethical issues as well as lack of knowledge and absence of peer studies it is difficult to experiment a patient life without oxygen support during moderate hypoxemia.

From the study, out of the 7 cases, 42.81%(n=3) cases were administered with Arsenicum album, 42.81 % (n=3) cases with Carbo vegetabilis, 14.2% (n=1) cases with Kalium iodatum 30, 14.2% (n=1) cases with Hippozaenium Q, 14.2% (n=1) cases with Apis 1X, 14.2% (n=1) cases with Amyl nitrosum 30, 14.2% (n=1) cases with Aspidosperma Q. The homoeopathic medicine Phytolacca decandra, has an alkaloid namely, phytolaccin, among the many properties, one of them is its capability to reduce the rate of respiration.

Therefore based on the homoeopathic principles it has the efficacy to enhance respiration [9]. In three cases more than one medicine was used, as the most indicated remedy didn’t work effectively. Mother tinctures were also used in managing Hypoxemia. Interestingly, the most used potency was lower potency and it turned out to be the most effective one in this study.

The outcome of the study was assessed with scoring criteria (15D-HRQoL) before and after the treatment and in my study, it was found that the homoeopathic medicines along with oxygen therapy are effective in the treatment of palliative care patients having Hypoxemia. In my study out of 7 cases, 71.42 % (n=5) showed improvement and 28.57% (n=2) cases showed no improvement. According to a study conducted by D L Bowton in 100 hospitalized patients; after assessing the pulse-oximeter levels approximately for 24 hours independent of patient management, 26 out of 100 developed hypoxemia which lasted for at least 5 minutes with an oxygen saturation (SpO2) less than 90%. After an evaluation for 4 to 7 months, 8 (32%) patients suffering from episodic hypoxemia died and only 7(10%) patients without hypoxemia died(from 74 patients out of 100). Thus the severity of hemoglobin oxygen desaturation correlated inversely with survival time [10]. According to an article written by Jeremy R Beitler, ventilation induced lung injury has proven definitively to contribute to the mortality in ARDS patients through mechanisms like barotrauma, volutrauma, atelectrauma and biotrauma. It says that prevention of VILI can help in the attenuation of multi organ failure and can improve survival [11].

In treatment side, the Homoeopathic remedy indication was different in each case. So that selection of remedies are different for different cases. Here, Repertory of Herring’s Guiding Symptoms of our Materia Medica by Calvin B Knerr was found effective for prescribing similimum based on objective signs and symptoms. Most of the prescriptions are made with the aid of Knerr Repertory. The effectiveness of this repertory can be determined by using it for various clinical conditions. So, from my study, we can infer that Homoeopathic treatment with oxygen therapy can improve Hypoxemia as well as Quality of Life (using 15D-HRQoL) in hypoxemic patients under palliative care treatment.

Conclusion

The sample for the study consisting of seven Palliative Care patients with Hypoxemia from inpatient department of Sarada Krishna Homoeopathic Medical College and Hospital and the following conclusion were obtained after statistical analysis. It was concluded that males above 6th decades are more vulnerable to develop various Cancer conditions. Persons with Diabetes Mellitus and Hypertension are more susceptible for getting cancer than others. SpO2 levels are considerably managed through Homoeopathic medicines and Oxygen therapy. The selection of therapeutic similimum has been effective in improving the hypoxemic level and in managing the case as a whole. Homoeopathic Medicines like Arsenicum Album and Carbo vegetabilis seemed to be the most effective. The application of Quality of Life scale is limited in the cases of Hypoxemia. Within the limitation before and after scale of 15D-HRQoL in statistical analysis have shown that homoeopathic intervention was highly appreciable with oxygen therapy. Finally, it can be concluded that with Homoeopathic intervention, we can alleviate the sufferings of Hypoxemic patients in palliative care treatment.

Acknowledgment

I heartfully thank the management of Sarada Krishna Homoeopathic Medical College, Kulasekharam for their valuable guidance, constant encouragement and providing basic facilities throughout the study. I am gratified to our colleges who furnished expertise that greatly aid the research, although they may not assent with all of the interpretations provided in this paper. Also, I would like to thank the Central Council for Research in Homoeopathy (CCRH), New Delhi, for giving me this great opportunity to do the short-term studentship research programme.

Financial Support and Sponsorship

Central Council for Research in Homoeopathy, New Delhi, India.