How A Colon Started Me On My Ecologic Thinking Path
Majid Ali, M.D.
My personal perspective of integrative medicine evolved over a period of more than three decades. In 1969, it began with the study of one single pathology specimen that led to the need to think ecologically. As a pathology resident I received a specimen of an inflamed and distended colon. It filled a large basin. Copious bloody fecal matter was spilling out of some tears in its wall. It was not much fun to clean that bowel and take tissue samples for preparing microscopic slides. The next day I examined the slides and observed the expected microscopic features of ulcerative colitis: acute and chronic inflammation, dead and dying immune and other types of cells, ulceration of the lining mucosa, disruption of the general architecture of the colon wall, and pockets of pus. After finishing my study, I took the case to one of my professors. He examined the slides and agreed that it was a case of ulcerative colitis.
The next day, something unexpected happened. Without purpose, I picked another slide of that colon, looked at it, and chanced upon a cluster of large, pale cells forming a discrete round structure. Such a formation is called a granuloma and is considered diagnostic of Crohn’s colitis. “Look at that!” I said to myself in surprise. “Now, that granuloma makes it Crohn’s colitis, doesn’t it? Yesterday it was ulcerative colitis. Today it seems to be Crohn’s colitis. Interesting!” I marked the microscopic field with ink and took the slides to a second professor, since the first one was out of the department. He looked at the case and readily diagnosed Crohn’s colitis.
The next day as I prepared to carry the slides to one of the secretaries for filing, I picked another slide from the same case and started gazing at an area that showed discrete layers of tissue debris covering small patches of the inner surface of the bowel wall. Those are the features of another common type of colitis called pseudomembranous colitis. “Aha! Another diagnosis!” I exclaimed. “Let’s see if I can get someone also to agree with me.” That time I purposefully looked for a third professor and decided not to tell him about the diagnoses made by the other two. I pointed out to him the membrane-like structures and he agreed that we had a case of pseudomembranous colitis. I returned to my desk triumphantly. I knew I had a story to tell. Some time after that a question arose in my mind: Can you make more slides from that colon and see if you can get another professor to diagnose yet another type of colitis from the same colon? The thought amused me. Worth a try, I murmured to myself.
I went back to that colon and took many more sections of tissues. A technician looked at me, a little annoyed because she had to prepare the slides from all those sections. The next day she brought me several trays of slides and I went to work. In one of the slides, I found areas that showed well-preserved bowel architecture, congested blood vessels, pooled and disintegrating red blood cells in the tissue, and small surface erosions. Bingo! I knew those were the features of another type of colitis called ischemic colitis. I continued my search. I was not disappointed. I found some microscopic fields that showed diagnostic features of a type of colitis called collagenous colitis. “Ah! Another diagnosis!” I congratulated myself and continued study of the case with yet other slides. There were many fields which could only be diagnosed as nonspecific colitis. With some more persistence I found other areas qualifying for other forms of colitis. Getting my teachers to agree to those various diagnoses with different slides of the same colon did not prove to be difficult either. I spoke to Talat, my wife, about my discovery: Given sufficient patience and diligence, I could make any diagnosis I wanted from a colon removed for ulcerative colitis. I decided not to tell my professors about it. I did not know how some of them might take it.
Next I turned my attention to my pathology textbooks for a critical study of the causes of those various types of colitis. That turned out to be a yet more fruitful search. I made the second and equally important discovery: The cause of none of those types of colitis was known. It was not that dozens of pages of those texts were not filled with discussion of the etiology of all those types of colitis. For every type of colitis, some immune disorder, infectious agent, or vascular event was suspected or proposed, but in every case the final conclusion was always the same: The cause is not fully understood.
That search led me to a third important discovery: There is such a large overlap in the clinical symptomatology, microscopic appearances, and suspected causes that there was hardly any point in slavishly adhering to the system of classification of colitis which I was being taught as “science.”
The young pathologist in me was jolted by his three discoveries. An image of several blind men surrounding an elephant arose in my mind’s eye. In that story, the first blind man touched the tail of the elephant and thought the elephant was a snake. The second blind man moved his hand on the side of the animal and considered it to be a breathing wall. The third stroked the elephant’s ear, called it a fan. The fourth wrapped his arms around one of the elephant’s legs and yelled, “A tree that’s moving! Amazing.” During the months that followed my experience with the colon described above, with similar studies conducted repeatedly, I became convinced that the same was true also of various types of autoimmune disorders of the thyroid gland, joints, blood vessels, and other organs.
Some time later, a vague, ill-defined notion of altered states of bowel ecology began to evolve in my mind. It took me several years before I could muster courage to begin writing about what I thought were my awkward notions of the bowel ecosystem, expecting to be heartily laughed at.
In the late 1970s I introduced the terms “bowel ecosystem,” “blood ecosystem,” and “liver ecosystem,” to express my view that we clinicians need to think ecologically and focus on the relationships among those ecosystems rather than be bound by the prevailing one-cause/one-disease/one-drug model. In a series of essays published in the Curriculum of the American Academy of Environmental Medicine, I focused on the impact of environmental factors and the body’s redox homeostasis.
Some years ago, I coined the term OxyHealingTM to focus on the two core issues of compassion (the nutrient for the soul) and oxygen (the nutrient for the body).
For a full listing of my books, DVDs, and video seminars, please go to http://www.oxyhealing.org.