Choua, Lupus, and Multiple Sclerosis
Majid Ali, M.D.
( A story from “From Healing Voices From the Wild” )
Tammy, a woman in her late forties, consulted me for multiple sclerosis. For several months, she had experienced abnormal sensations in her limbs with “pins and needles” and weakness of muscles. She became very frightened when she started losing her balance and had difficulty walking. MRI scans ordered by one neurologist showed demyelination (loss of insulation sheaths of nerve fibers) in her brain and spinal cord. A second MRI scan ordered by a different neurologist confirmed the diagnosis of multiple sclerosis.
“Is is not that,” Choua spoke in his usual abrupt voice. He had entered the room unnoticed as he often does.
“Choua, keep quiet,” I replied.
“It is not that,” he repeated.
‘It’s not what?” I asked with irritation, then regretted immediately asking the question.
“It is not multiple sclerosis,” he replied in a matter-of-fact tone.
“Oh, shush, Choua. Cut it out. Don’t you see I am with a patient,” I rebuked him.
Choua has attention deficit disorder and is very impulsive. He also thinks for himself, which I find interesting, sometimes even charming. I have strictly, sometimes angrily, forbidden him from speaking to me when I am talking to a patient. But he cannot help himself and regularly ignores my edicts as well as pleas.
I returned to Tammy’s chart, pretending to look for more information, still annoyed that Choua’s violated my rule.
“I know it’s not that,” Tammy spoke after I finished reading her file and looked up.
“It’s not what?” I asked, without really needing any clarification of her words.
“It’s not multiple sclerosis,” she said firmly.
“How do you know?”
“She just knows,” Choua’s voice came from under the desk.
“Please go away, Choua,” I said under my breath, struggling to maintain the pretense of a a clinical conversation with Tammy and hoping she would not read frustration on my face.
“How do you…how do you know? How do you know it is not MS?”I asked fumbling.
“I just know,” Tammy replied calmly.
“How?” I persisted.
“Because that’s what happened the last time,” she replied emphatically.
“What happened last time?”
“They said it was lupus and they gave me cortisone. I threw the cortisone out after a few weeks.”
“Then I took a lot of vitamins and my lupus went away.”
“How was lupus diagnosed,” I asked, feigning ignorance.
“They did all the tests. ANA, LE prep and a test for proteins in the urine. You know, everything the rheumatologists do.”
We looked at each other for some moments. I dreaded Choua’s voice returning. It would have been inappropriate for me to lean over and look under the desk for him.
“Curing lupus with vitamin pills, eh.” Choua taunted, peeping from behind the waste basket under the desk and shaking his whiskers.
“I do. I do, Yes, I do believe in vitamins, but for God’s sake, leave me alone, you little beast,” I replied, exasperated. “Please , please, Choua…… “
“You didn’t believe this stuff,” he cut me off. “Then you were a pathologist and pathologists believe in observable stuff.”’
“I’m warning you, Choua, I will…..”
“Then you became an integrative quack. You got used to such stories. The first few times had been different. It had been hard to believe patients who told you such stories. It literally meant throwing out all your medical texts. Patients with serious autoimmune disorders, such as lupus, multiple sclerosis, and rheumatoid arthritis are not supposed to get better by simply taking vitamin pills, at least not according to your medical texts. The hard-nosed pathologist in you had great difficulty believing what medical texts said couldn’t be believed. Then things changed for you.”
“Stop it!” I nearly screamed.
“Then your patients forced you to think differently.” Choua was indifferent to my anger. “With the passing years, you saw many patients who were told they had lupus with positive lupus tests who went on to recover completely and live healthy lives.”
“Yes, yes,” words escaped my lips.
“You also saw patients with arthritis and positive rheumatoid tests who recovered. Then you realized that the tests merely indicate stress on our immune defenses. The injured and confused immune system begins to make destructive antibodies. Positive lupus and rheumatoid tests were merely that. Nothing more. How many times does one have to be hit on his head?”
“Tell me something about the stress in your life.” I asked Tammy with a calm I didn’t know I had.
“You know how it is. Everyone suffers stress in life,” she replied.
“That’s true. Still, tell me. Is he very supportive?” I asked her, gesturing to her husband who sat silently listening to us.
“Yeah, he is supportive,” she replied after a slight, initial hesitation.
“You physicians do learn with time,” Choua spoke before I could. “Minor delays in answers often tell you more than many carefully crafted answers from your patients.”
I looked at her husband, forced a limp smile, and asked,
“When did they tell you that you had lupus?” I asked.
“1984.” Tammy leaned back in the chair.
“What happened in ’84?”
“What happened in ’83?”
“Nothing in ’84 and nothing in ’83?” I looked into her eyes, persisting with my inquiry.
“What happened in 83?” Tammy sat up.
“Yes, what happened in 83?”
“My mother died.” Tammy’s neck stiffened.
“Were you close?”
“She was my best friend.”
“What happened early this year?”
“What do you mean?”
“What happened in the months before you developed pins and needles in legs and arms?”
A hurt expression crossed Tammy’s face and she leaned forward in her chair. I looked at her in silence. She seemed to read my mind and quickly recovered her composure. Then she turned her face to her husband who glanced at me uncomfortably. I looked back at Tammy.
“We had family troubles.”
“Would you rather not talk about them?” I asked.
“No! There’s nothing to hide. We separated for some months.”
“Then we got together to see if we could make it.”
“And then we realized it had to end. There had to be a divorce.”
Tammy broke down. I didn’t have to look at her husband to learn anything more.
“Is there a chance for some healing here?” Choua asked sympathetically.
“I wonder about that myself, my rodent-friend.” I surprised myself by my civil answer this time.
“Serious illnesses sometimes break good marriages. Sometimes they also mend broken ones,” Choua went on.”If the latter were going to prevail, it would not be the first time you have seen a serious disease lead to reconciliation and healing of the deep wounds of lost love. Those things just seem to happen, don’t they?” he asked with a yawn.
“Tell me, how do you react to perfumes and formaldehyde and tobacco smoke?” I looked at Tammy and changed the subject.
To order a copy of my book entitled Healing Voices From the Wild (2015), please go to http://www.aliacademy.org or call 1-800-633-6226.