Wednesday, May 15, 2013


    We often talk about the connection between the body and the mind . Most of us have seen some connection at one or other time . I know sometimes we think it is as if the mind , which seems to be the weak component of the entire body seems to act in such a way that it seems to 'take over ' the course of the events .In our text book on a case of asthma . There was this guy , who had asthma . He was allergic to roses . Once he entered the conference room . There was a centerpiece with lots of roses . He noticed them and as the meeting progressed , he started feeling tight in the chest and finally had a an attack of the asthma . As the paramedics came to take him to ER , he realized that the roses were 'silk roses '.As the mind knew that he was allergic to roses , he had the attack , even though there was no physical allergen or stimulus . But I am  going to describe a case in which the mind -body connection that I have noticed in many cases is of  different  kind .
    Bill was my patient for long time . He was 63 years old when I saw him for the first time . He had dry  cough and further work up showed that he ha pulmonary fibrosis , scar tissues in the lungs . He had mildly reduced lung function .I did the usual work up and put him on some steroids .He did OK and I did reduce the dose and took him off the steroids . He continued to do well and continued to come to me . Over period of next 7 or 8 years he was about the same clinically . His lung capacity did go down , little more than what could be accounted for by the age . But he was OK , did the exercise  and was not short of breath .. His cough was Ok and he felt good . Overall he was stable .
    On one of the visits ,he told me that his wife had diagnosis of ovarian cancer . She had surgery and did OK , but needed  the chemo . She finished the chemo and was OK for about 9 months or so . He continued to see me had no change in his lung function and X-ray.He was not short of breath . The cough was minimal . The when he came to see me he told me the bad news . His wife had the recurrence of the cancer and she needed more chemo therapy . She had rough time with it .Over period of next 6 months she continued to get worse and then died . He seemed to take it well , may be because it happened over period of time or he may be expecting it .
    But in the next follow up he was feeling more short of breath , and when I did the lung functions , they were worse . I did the CT scan and it looked worse . I started him on larger dose of steroids and called him to check the oxygen level on walking . I mede him walk for the 6 minutes and he was quite short of breath and his oxygen level dropped I also ordered oxygen check at night and it was low too . So now I put him on the oxygen with sleep and on exertion .He was doing little better and did try to cut down the steroids . He did OK for may be about 3 or 4 months . But then he was again getting worse . He was more short of breath and his need for oxygen increased . I did increase the steroids , with no change .
    He was admitted to the hospital and ended up getting transferred to ICU . His 2 sons came from out of town , We had discussion with them and talked about the poor prognosis . I wanted to know if he wound like to be put on respirator . He and both the sons wanted to 'give it a try '. As I expected , he got more short of breath and went on respirator . On one of the days his lung collapsed . The oxygenation which was a problem got now worse . He had to be not only sedated m but to control the respiration , we had to 'paralyse ' him .I had a lengthy talk with the sons .We decided to stop all the treatment and did the withdrawal of the life support .
   He died in less than one year of the death of his wife .The guy who was stable for several years with the fibrosis , got worse after the death of the wife . Was is due to him giving up , or was there other cause for his deterioration , that we did not know and could not treat ? I feel that this was body-mind connection .

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