Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) [email protected] Clinical homeopathy: scien1fic research and prac1cal applica1ons 1 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) A guideline An1cipate ! « There is no good wind for the one who does not know which port he heads for » Sénèque 2 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) The law of similarity Homeopathy Similar suffering 3 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Possible ways of prescrip1on -‐ Pathogene1c approach -‐ Approach through the chronic reac1onal mode -‐ Approach through the sensi1ve type -‐ E1ologic approach Whenever it is possible, give priority to the Toxicological, anatomopathological or physiopathological approach 4 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) « … as regards lesional pathology, the signs of anatomopathological similarity have to be considered first. The characterisNc signs of the individual reacNon oOen diminish when faced with the clinical evidence of the lesion… » Pharmacology & homeopathic materia medica (Ed. CEDH) 5 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) 6 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) 7 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) ConsultaNon n°1 Care strategy ProbabilisNc treatment Chemotherapy n°1 ConsultaNon n°2 ProbabilisNc treatment CuraNve treatment Chemotherapy n°2 ConsultaNon n°3 ProbabilisNc treatment CuraNve treatment Chemotherapy n°3 8 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) The same principle can be applied in pallia1ve medicine Ex : in case of treatment with opiates for a pain: -‐ Opium 9 CH 5 pellets morning, noon and evening -‐ Alumina 9 CH 5 pellets morning, noon and evening 9 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Par1cular case of fa1gue of pa1ents at the end of life 10 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) FaGgue in cancer and non cancer palliaGve care paGents is under-‐recognized, under-‐assessed and under-‐treated. …inadequate assessment skills and insufficient knowledge about mulNdimensional treatment opNons can lead to non recogniNon, under-‐ assessment and under-‐treatment of faNgue in the vast majority of paNents PalliaNve Medicine 2008; 22: 13–32 11 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Physiopathology of faNgue Indirect causes Kurzrock R. The role of cytokines in cancer-‐related faNgue. Cancer 2001; 92: 1684–8. 12 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Physiopathology of faNgue Directly related to cancer -‐ InflammaNon -‐ DysregulaNon of the hypotalamic-‐pituitary-‐ adrenal axis -‐ DysregulaNon of the metabolism of serotonin -‐ Vagal hypertonia Bull Cancer. 2006 Dec;93(12):1213-‐27. SOR SAVOIR PATIENT Cancer and faNgue. Dielenseger P, Dilhuydy JM, Brusco S, Chazot L, Blay JY, Bové B, Colcanap B, Ferrandez JC, Floquet A, Jane Gledhill, Hubert N, Meslier M, Rosman S, CarreNer J, Delavigne V, Fervers B, Leichtnam-‐Dugarin L, Philip T 13 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of Homeopathic treatment faGgue in cancer palliaGve care paGents 14 Pr CURE Hervé (InsNtut Godinot, Reims) Journées scienNfiques du pôle de cancérologie du centre hospitalier de Troyes le 26-‐04-‐2008 Les causes organiques de la faNgue Cancer asthéniant Traitements (métastases hépaNques et cérébrales) Troubles du sommeil ANEMIE Age et Co-‐morbidités Troubles de l’alimentaNon Douleurs chroniques Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of faGgue in cancer palliaGve care paGents -‐ Anaemia -‐ Cancers leading to asthenia -‐ Advanced cancers 16 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ -‐ Cancers leading to asthenia Advanced cancer 50% before treatment, 80% during treatment, 46% are treated étude ECAS Peter J.Barret-‐lee et al 2006 Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, et al. Impact of cancer-‐related faNgue on the lives of paNents: new findings from the FaNgue CoaliNon. Oncologist 2000;5:353–60 Fa1gue, main repercussion of anaemia Impairs response to treatment Affects quality of life, extends the periods between treatments Prognosis factor on survival (Hb comes into the prognosis of diseases) Shortening of life expectancy for 65% of anemic paNents Favours tumour resistance to hypoxia =Improvement resistance to treatments Inflamma1on +++ (sequestraNon of iron by an increase in the producNon of hepcidine and a decrease in the producNon of EPO) Limited indicaNons of EPO Nutri1onal causes Blood loss… 17 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Blood loss Severe anaemia Cinchona (China rubra) Kalium carbonicum Carbo vegetabilis Arsenicum album Aceticum acidum ± Natrum muriaticum ± Silicea ± Phosphorus if haemorrhages Congestive Ferrum metallicum ± Calcarea phos ± Silicea ± Phosphorus if haemorrhages Digestive cancer Cadmium sulfuricum 18 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Ace1cum acidum Important asthenia Weakness Signs of anaemia : pallor, waxy complexion Sudden loss of weight Intense thirst, polyuria, diarrhea, sialorrhea Heavy cold sweat Œdema 19 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Cancers leading to asthenia -‐ Cerebral tumours and metastases Advanced cancer Asthenia Ideomotor slowing down Sluggish flow of ideas Headaches 20 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ Cerebral tumours and metastases -‐ Advanced cancer The cerebral œdema Apis mellifica Natrum sulfuricum 21 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases Advanced cancer The idea slowing down Gelsemium sempervirens Opium Helleborus niger 22 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases -‐ HepaNc tumours and metastases Advanced cancer A first-‐line medicine Chelidonium majus Icterus Intolerance to fats Pain at the lower angle of the right scapula Discolouring of stools Right laterality 23 hvp://www.apcd.info/iso_album/ metastase_hepaNque_d_un_adenocarci nome_du_colon_1_760x570.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases -‐ HepaNc tumours and metastases Advanced cancer One first-‐line medicine: Chelidonium majus 5 CH 2 medicines with hepatorenal acNon Solidago virga aurea Biver taste in the mouth Pain in the right hypochondrium Ballooning ConsNpaNon, discoloured stools Oliguria, pigmented urine 24 hvp://www.apcd.info/iso_album/ metastase_hepaNque_d_un_adenocarci nome_du_colon_1_760x570.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases HepaNc tumours and metastases Advanced cancer -‐ One first-‐line medicine: Chelidonium majus 5 CH 2 medicines with hepatorenal acNon -‐ Solidago virga aurea -‐ Berberis vulgaris Icterus Nausea, discoloured stools Biver taste in the mouth Pain in the right hypochondrium Yellowish diarrhea or consNpaNon with clear stools Major urinary tropism Renal, vesiculary and uric lithiasis 25 hvp://www.apcd.info/iso_album/ metastase_hepaNque_d_un_adenocarci nome_du_colon_1_760x570.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases -‐ HepaNc tumours and metastases Advanced cancer 1 first-‐line medicine: Chelidonium majus 5 CH 2 medicines with hepatorenal acNon: Solidago virga aurea 5 CH Berberis vulgaris 5 CH Medicines of serious condiNon Sulfuricum acidum ExhausNon SensaNon of shivering without trembling Improvement : from heat SensaNon of « brain being loose in the skull » Haste and asthenia, psychic deterioraNon Hematomas and ecchymoses which do not resorb. Haemorrhages of black blood StomaNNs, gastriNs,digesNve ulceraNons, sialorrhea, inappetence, vomiNng and 26 diarrhea hvp://www.apcd.info/iso_album/ metastase_hepaNque_d_un_adenocarci nome_du_colon_1_760x570.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases -‐ HepaNc tumours and metastases Advanced cancer 1 first-‐line medicine: Chelidonium majus 5 CH 2 medicines with hepatorenal acNon: Solidago virga aurea 5 CH Berberis vulgaris 5 CH Medicines of serious condiNon Sulfuricum acidum Arsenicum album Nausea, vomiNng, digesNve burning pain Diarrhea with extreme weakness Quick weight loss, degredaNon of the general condiNon Intolerance to mulNple types of food UlceraNons, then necrosis of the mucous membranes Deathly-‐smelling secreNons Improvement : from heat, hot food and drink by changing posiNons AggravaNon : 1 a.m. 27 hvp://www.francelymphomeespoir.fr/ medias/illustraNons/cancer-‐cell2.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ Cerebral tumours and metastases -‐ HepaNc tumours and metastases Advanced cancer 1 first-‐line medicine: Chelidonium majus 5 CH 2 medicines with hepatorenal acNon : Solidago virga aurea 5 CH Berberis vulgaris 5 CH 5 pellets 3 to 6 Nmes a day Medicines of serious condiNon Sulfuricum acidum Arsenicum album AceNcum acidum Severe asthenia Weakness, pallor, waxy complexion Sudden weight loss Diarrhea, sialorrhea, profuse cold sweat Œdema ascites 28 hvp://www.apcd.info/iso_album/ metastase_hepaNque_d_un_adenocarci nome_du_colon_1_760x570.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ -‐ -‐ Cerebral tumours and metastases HepaNc tumours and metastases Hematologic cancers Advanced cancer General signs : fever, night sweat, weight loss, degradaNon of the general condiNon Tumour syndrome : liver, spleen, axillary and inguinal lymph nodes, Impairment of the three blood lineages: Anaemia Leucopenia Thrombopenia 29 hvp://www.francelymphomeespoir.fr/ medias/illustraNons/cancer-‐cell2.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ -‐ -‐ Cerebral tumours and metastases HepaNc tumours and metastases Hematologic cancers Advanced cancer Natrum muriaNcum Weight loss AlternaNon between dryness and inflammaNon of the mucous membranes Asthenia alternaNng with irritability Leucopenia Mercurius cyanatus Very acute inflammaNon of the ENT mucous membranes UlceraNon of the mucous membranes Deep and rapid prostraNon 30 hvp://www.apcd.info/iso_album/ metastase_hepaNque_d_un_adenocarci nome_du_colon_1_760x570.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ Anaemia -‐ Cancers leading to asthenia -‐ -‐ -‐ Cerebral tumours and metastases HepaNc tumours and metastases -‐ Hematologic cancers Advanced cancer Silicea Toxicity to macrophages AcNon on the immune system AOer-‐effects of immunosuppressive treatments SensiNvity to the cold Asthenia, faNgability Clinophilia Profuse perspiraNon SuppuraNons 31 hvp://www.francelymphomeespoir.fr/ medias/illustraNons/cancer-‐cell2.jpg Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Ace1cum acidum OOen indicated, enNrely reliable Pale, waxy complexion (Anaemia) Intense thirst, polyuria with clear urines Diarrhea– sialorrhea – profuse cold sweat œdema of the extremiNes Weight loss DeterioraNon and weakness of general condiNon Low but maintained appeNte Following long and major surgery Ace1cum acidum « the parasympathicotonic anemic type» 32 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Natrum muria1cum Thirst DeterioraNon of general condiNon, weakness Low but maintained appeNte Fewer signs of Anaemia: œdema – pallor Weight loss in the upper part of the body SensiNvity to the cold, intolerance to radiant heat DehydraNon, body fluid loss Natrum muria1cum « the dehydrated, 1red type » 33 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Arsenicum album Exhausted, drawn features, agitated, anxious AggravaNon at 1 a.m. with anxiety and fear of death DeterioraNon of general condiNon with weight loss Icteric or gray complexion Cutaneous ulceraNons and /or ulceraNon of the mucous membranes Foul-‐smelling secreNons Improvement from hot drinks– hot applicaNons Less œdema, less sweat, less appeNte Medicine of the aggravaNon, of the end of life 34 Arsenicum album « the agitated, anxious and exhausted type » Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Silicea Weakened, clinophilia +++ Asthenia at the end of treatments (chemo-‐radio-‐ corNcosteroid therapy) Coldness and sensiNvity to the cold+++, always wrapped up (socks at night) General hyperesthesia, MulNple, calcified nodes Indurate, retracNle, scleroNc and calcified scars Silicea «the weak, clinophile type, sensi1ve to the cold» 35 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Ace1cum acidum « the parasympathicotonic, anemic type» Natrum muria1cum « the dehydrated, 1red type » Arsenicum album « the anxious, agitated and exhausted type » Silicea « the clinophile, weak type, sensi1ve to the cold » 36 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Ace1cum acidum « the parasympathicotonic anemic type» Nausea SensaNon of unbalance sweats Cold face, vagal faintness Pale Tremour Mental confusion AggravaNon from movement, Improvement in the open air Adynamia with hypervagotonia Clouding of consciousness, pale face, vagal faintness No improvement in the open air Nausea with verNgo AggravaNon from smell and thought of food 37 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Natrum muria1cum « the dehydrated, 1red type » DehydraNon from fluid loss (bleeding, diarrhea, vomiNng …) Bluish rings under the eyes Profuse sweat at the slightest effort Œdema from anaemia and hypoalbuminemia 38 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Arsenicum album « the agitated, anxious and exhausted type » Excessive sensiNvity to the cold Weight loss Depression, feeling of incurability, Despair FEARS: of misery, of diseases, of abandonment… 39 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Silicea « the weak, clinophile type, sensi1ve to the cold » collapse with cyanosis cold perspiration hippocratic face icy-cold body icy-cold, blue-coloured extremities weak and hardly perceptible pulse blood pressure difficult to measure vomiting and diarrhea 40 Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) Homeopathic treatment of fa/gue in cancer pallia/ve care pa/ents -‐ -‐ Anaemia Cancers leading to asthenia -‐ Advanced cancer Ace1cum acidum « the parasympathicotonic anemic type» Cocculus indicus & Tabacum Natrum muria1cum « the dehydrated, 1red type » China rubra Arsenicum album « the agitated, anxious and exhausted type » Psorinum Silicea 9 CH « the weak, clinophile type, sensi1ve to the cold » Veratrum album 41 Clinical homeopathy: scien1fic research and prac1cal applica1ons Best suppor1ve care in Oncology Jean Claude Karp (Troyes -‐ France) [email protected] 42
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