Doctor as the detective

The call came again from Mr. Devarajan’s apartment. I had gone there the same afternoon and found him fairly alright though his arm was still twitching a bit. He was able to swallow food and was comfortable and even spoke to me with some optimism which had cheered me. Now, comes this call of distress.

Devarajan was a senior executive in one of the top food processing companies with its head quarters in Bangalore. When this incident occurred some fifteen years ago, I was the company’s medical advisor and would visit twice a week in the afternoon. The company had built apartments next to the office for twenty odd senior officers with all in built amenities, befitting a successful company. Devarajan and his family were occupying one of these. My practice being close by, I got not very infrequent calls from these in house families whenever there was an illness that needed to be attended to at home. Lately calls from Devarajan had become frequent and urgent and what was worrying was that I had not been able to find out what was wrong with him.

I saw him sitting hunched up with head held up. There was uncontrollable twitching of the face and lips with drooling of saliva. His jaws were clenched tightly and he could open the mouth with great difficulty. Neck was held rigidly at a tangent. Lower limb, abdomen and trunk muscles were less affected and he was able to walk without any difficulty. Hands and arms were also rigid but not to the same extent as muscles of the face, jaws and neck. He was not able to speak with any degree of coherence. Going by the past experience I gave him an injection of Diazepam and oral clonezepam with baclofen [all are muscle relaxants].He settled within a few minutes and I was sure he would be ok at least till morning.

Devarajan began having these problems a month ago one evening. Though certain that these were caused by unopposed motor impulses from the brain I did not know the cause. Other conditions which cause rigidity and spasm like Parkinson’s disorder and Motor neuron disease have a chronic course and there is usually a history of many years. Another factor was that he was too young to have any of these. A brain scan did not reveal any abnormality. Elaborate blood studies, opinion from two well known neurologists did not produce any result except the prescription which controlled the acute symptoms as described above. There was even a suggestion for a psychiatric consultation! I wondered how a person can voluntarily bring on these painful spasms just to mimic an illness even if he did have some psychiatric disorder.

The management was worried as the man’s work was suffering and he could hardly attend office as he was doped most of the time [thanks to my ministrations] though during the day his problems were manageable. Devarajan’s misery had me worried and puzzled. Worried because of his suffering and no long term solution in sight and puzzled because I was unable to find a cause even with all the expert help that was available.

This was the state of unsatisfactory affairs when Devarajan had to go to Chennai on some errand for a week. He called me soon after his return. I went to see him. He was not home. I went to his office. He was busy with work and welcomed me with a big smile. He was completely fit and there was no evidence of any illness at all and it was so since a week! Devarajan said when he was at Madras he went to see a doctor who practiced Ayurveda [Native medicine] and since he started the medication he has become free from all the symptoms that has been bugging him for the past one month. He just wanted me to see him free of the spasms and share the good news with me. I don’t know who was more relieved, the doctor or the patient.

I have on occasions, though rarely, come across such cures. Though there is no evidence that alternative approaches have cured a particular condition which we, allopathic practitioners have been unable to cure, the cure itself is most welcome. Though how the medication brought on the cure was a puzzle, I was relieved that I no longer had to worry about Devarajan and see his misery.

This happy state of affairs did not last long. A week later he called me again as the problem had recurred and a telephonic consult with the Ayurvedic practitioner ended in doubling the dosage with no relief. This was the time I started looking for causes other than are normally known. Reference to a text book on advances in neurology made mention to acute onset of symptoms such as experienced by Devarajan, in persons exposed to pesticides, who have a genetic predisposition. But how is Devarajan, living in the well appointed flat, be exposed?

The flats are treated once a month for vermin with insecticides. Could this be a cause? But why is he having this problem almost daily? Then it occurred to me. The possible cause could be the clouding that is being done almost daily to the whole campus to ward off the mosquitoes. The poisonous [to the mosquito] cloud contained organochlorines and there was indeed a reference that these can cause the symptoms.

I saw to that he stayed out of the campus. That cured him. He was one of those rare individuals who had a genetic presdisposition to develop acute Parkinson like syndrome when exposed to pesticide spray!

Before writing this story I did a net search and found hundreds of references! Had there been this kind of connectivity, fifteen years ago, Devarajan’s [and mine] misery would have been short lived!