The Second Lupus Story
Lupus on Heels of Mom’s Death, Multiple Sclerosis on Those of Divorce
Majid Ali, M.D.
Tammy, a woman in her late forties, consulted me for multiple sclerosis. She had experienced abnormal sensations in her limbs with “pins and needles” and weakness of muscles for a few months. She became very frightened when she started losing her balance and had difficulty walking. MRI scans ordered by one neurologist showed demyelinating lesions in her brain and spinal cord. A second MRI scan ordered by a second neurologist confirmed the diagnosis of multiple sclerosis.
“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?”
“I just know.”
“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 surprise.
“They did all the tests. ANA, LE prep and a test for proteins in the urine. You know, everything the rheumatologists do.”
I had gotten used to such stories by then. The first few times had been different. It had been hard to believe patients who told me such stories. It literally meant throwing out all my medical texts. Patients with serious autoimmune disorders such as lupus and multiple sclerosis are not supposed to get better by simply taking vitamin pills, at least not according to our medical texts. The hard-nosed pathologist in me had great difficulty in believing what medical texts said couldn’t be believed. Then things changed for me. My patients forced me to think differently. With the passing years, I saw too many patients who’d positive lupus and rheumatoid factor tests go on to recover and lived healthy lives for years. I realized the tests simply indicate signals of stresses on our immune defenses. Nothing more. How many times does one have to be hit on his head?
“Tell me something about the stress in your life.” I returned from my own thoughts.
“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 had sat silently listening to us.
“Yeah, he is supportive,” she replied after a slight initial hesitation.
We physicians do learn with time. Minor delays in answers often tell us more than many carefully crafted answers from our patients. I smiled at her husband and returned to my questions.
“What was the year they told 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 in 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 sat up. 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 is 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. Was there a chance for some wound healing there? I wondered. Serious illnesses sometimes break good marriages. Sometimes they also mend broken ones. If the latter was going to prevail, it would not be the first time I had seen a major disease lead to healing of deep wounds of lost love. Those things just seem to happen.
“Tell me, how do you react to perfumes and formaldehyde and tobacco smoke?” I changed the subject. Tammy slumped back into the chair.