Very often, medicine is very territorial. You have this vast field subdivided into subspecialties as if the gods of medicine designate diseases that carry invisible labels reading “Cardiologists only” or “Only Dermatologists Should Visualize This Rash”.
Although many diseases do conform to one organ, if not one part of an organ, this concept of territoriality is oh so wrong for total medicine appreciation. And after all, that’s your goal out there: Total medicine appreciation.
Multiple Sclerosis has a special place in this reformulation of traditional disease paradigms. After all, it’s about neurology and immunology. Many cynics would argue that any condition can involve more than one field, but MS is especially in this category since disease pathogenesis in MS is so vitally related to not only the underlying immunological problem but where in the nervous system same process strikes.
And MS has both an extremely complicated immunology and neurology. By that I mean that the immunology is still beyond our complete understanding. In addition, neurological syndromes in MS are some of the most complex in all of medicine. An MS patient may have a combination of jerking eyes, unstable gait, semi-willful forgetfulness of Presidents’ names and left leg numbness. A far more straightforward kidney patient may be in the next bed with not much more than a case of drinking too little water and getting dehydrated.
And then there are these types of issues:
- MS and Urinary Tract Infection
- MS and Cardiac Arrhythmias
- MS and Respiratory Failure
- MS and Depression
- MS and Stress Ulcers, Pancreatitis or Intestinal Obstruction
- MS and Thyroid/Parathyroid problems, Diabetes or Adrenal Cancer
Though it’s an old saw in medicine that most people get one severe disease per lifetime, this is not true in many with MS who may have a companion illness more dangerous to their health than the MS itself. However, having MS doesn’t protect the patient from a rare adrenal cancer. On the other hand, because one has MS with bladder difficulties, one frequently develops infections in the urinary tract.
The Fusion model, which I developed for use in teaching pathophysiology of disease, focuses on some of the interspecialty domains not necessarily in the knowledge base of students involved in learning about a disease like MS. Is it important for neurologists to know microorganisms that cause bladder infections in MS patients? You betcha. A few can be associated with spinal fluid infections (meningitis) or brain infections (encephalitis).
Territoriality is indeed important in medicine. For a difficult lung problem such as emphysema, you want someone with overwhelming knowledge of that arena. That person is called a pulmonologist. However, one can have a pulmonary problem in an MS patient largely related to a disturbed neurological control of breathing. Fusion is in the house- NeuroPulmonology combines the key inputs from both the pulmonologist and the neurologist.
Published On: November 20, 2008