CASE HISTORY 15
Name: Shyam
DOB: 03.04.1958
Sex: Male
Occupation: Forest Officer
Complaints and duration:
January 1998: Numbness, inner aspect of upper limbs when performing certain movements.
March 1998: Weakness at the level of both knees. Difficulty in walking. Occasional shaking and trembling with weakness in lower limbs.
May1998: Difficulty in climbing steps more while going down than climbing up. Numbness right leg. Hyperesthesia left leg: burning sensation when in contact with cold water.
Decrease in sensation which was from the lower limbs up to the hips is gradually reaching mid thorax. Loss of sensation in the sacral region specially noticed when passing stools. Feeling of stiffness in abdominal muscles.
Movements were uneasy with lack of coordination, ‘stamping gait’.
There were several episodes when all of a sudden all sensation in the lower limbs was lost, resulting in collapse. Patient was able to struggle back to his feet after some minutes.
Past History:
There were vague symptoms for the past 5-6 years: numbness in upper and lower limbs on and off at long intervals, thought to arise out of fatigue.
Diabetes Mellitus since patient was 26 years old; More or less under control with insulin.
Treatment History
Non-specific analgesics and multivitamins, over the counter.
Antidiabetic treatment from government hospital.
Diabetes was at first well controlled with tablets.
In 1995, sometime before he came for meditation, his disease went out of control. He had to be put on daily insulin injections.
Social and occupational History
Occupation: Forest officer.
Routine works required walking in forest areas with difficult topography.
Diet: Vegetarian. Non-smoker. No alcoholic drinks.
Investigations:
MRI Cervical, Thoracic and Lumbar spine, 21.05.1998 (see report)
At C 6/7, there is a large central/right paracentral disc herniation causing severe canal stenosis. The cord is severely compromised and there is a focal area of intramedullary high signal change (T2 images) suggestive of myelopathy. A smaller left posterolateral disc herniation is also seen at C 4/5, again indenting the cord.
Impression: Large central/right paracentral disc herniation at C 6/7. The cord is severely compromised and there is evidence of myelopathic change at the same level. The cord is also moderately impaired at C 4/5.
X-ray cervical spine, 26.05.1998: (see report)
Loss of cervical lordosis.
‘Claw osteophytes present at C 4/5 & C 6/7.
Posterior osteophyte formation is also seen at C 6/7.
No obvious calcification of the posterior longitudinal ligament.
Prognosis
The prognosis is very poor. Patient was explained by treating doctors that there was pressure on the spinal cord in the cervical (neck) region, leading to degeneration of the nerves. The disease being progressive in nature, there would be gradual paralysis of lower, then upper limbs. This could progress to a total paralysis below level of the neck, resulting in quadriplegia.
There is no treatment for this condition. Only some decompression procedure could be envisaged in an attempt to prevent permanent damage to the compressed nerve fibers. Doctors thus advised urgent operation or else there was high risk of paralysis or even death. But they warned, even with any operation there was no guarantee of success. There was always the danger that the condition may even worsen. The patient might end up bedridden or severely handicapped, wheelchair bound.
His condition was further aggravated by his long history of diabetes mellitus, more than 15 years, then. Retinal complications were present. This is a sure sign of degenerative changes already present in the whole body: heart, lungs, kidneys etc. Any operation entailed added dangers of complications such as excessive bleeding during surgery and higher risk of infection, post operatively.
DISCUSSION
The two main issues in this case are:
- Myelopathy
- Diabetes Mellitus
- Myelopathy
The cervical spine is made up of the first seven vertebrae in the spine. It starts just below the skull and ends at the top of the thoracic spine. The cervical spine is much more mobile than either of the thoracic or lumbar regions of the spine.
Between each vertebra are the intervertebral discs which act as cushions and also permit some movement between the vertebral bodies. They are made up of a strong outer ring of fibers and a soft center. The outer layer helps keep the disc’s inner layer intact. When the outer lining gets torn, the soft center squeezes out through the opening, creating a ‘slipped’, or ‘ruptured disc’.
Tears in the outer lining of the disc can be very painful by themselves. Pressure from everyday activities helps to push the disc’s nucleus out. Disc herniation can cause different patterns of pain, numbness, and weakness in the body.
Degenerative changes in the cervical spine happen because the intervertebral discs that act as shock absorbers wear out as we grow older. As the discs wear out, they begin to collapse, or herniate, and become less flexible.
Stenosis is narrowing of various parts of the body. Cervical stenosis is a degenerative disease where the spinal canal and neural foramina narrow and compress the spinal cord and nerve roots.
Myelopathy is a term that means that there is something wrong with the spinal cord itself. This is usually a later stage of cervical spine disease, and is often first detected as difficulty walking due to generalized weakness or problems with balance and coordination. Myelopathy is most commonly caused by spinal stenosis: a progressive narrowing of the spinal canal.
Those who have myelopathy will begin to have difficulty with things that require a fair amount of coordination, like walking up and down stairs. Changes in coordination, recent weakness, and difficulty doing tasks that used to be easier in the past are definite warning signs.
The diagnosis of a herniated cervical disc begins with a complete physical examination of the neck, arms and lower extremities. An MRI is used to determine spinal cord pathologies.
Surgery is advised for myelopathy with muscle weakness caused by nerve root or spinal cord compression. This aims at relieving the pressure on the nerves. Delaying surgery may cause irreversible damage. It depends on how badly the nerve/s is/are pinched.
However, the benefits have to be weighed against the risks of surgery, specially for those with medical problems such as diabetes, hypertension etc. All treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, or nerve damage are some of the potential adverse risks of spinal surgery.
- Diabetes Mellitus
Diabetes mellitus can pose several problems: chronic pain, repeated hospitalisation, and need for lifestyle and vocation change, physical disabilities, and early death. Psychological consequences may arise from one or more of these factors.
Eye complications
Diabetes mellitus is a major cause of blindness in the world. Diabetic retinopathy is present in about 50% of patients having the disease for more than 10 years and 70% of those above 20 years. People with diabetes are 25 times more at risk for blindness than the general population. About 70% of people with insulin-dependent diabetes mellitus develop proliferative diabetic retinopathy, and 40% will develop macular edema. Both are serious complications.
Cataracts. Cataracts are about twice more common in diabetics than in those without diabetes. Furthermore, cataracts occur at a younger age and progress more rapidly in people with diabetes.
Open-angle glaucoma. This serious blinding disease is 1 ½ times more common in the diabetic population. The prevalence of glaucoma increases with the patient’s age and with the length of time the patient has had diabetes.
Kidney problems
Diabetic nephropathy represents a distinct clinical syndrome characterized by albuminuria, hypertension, and progressive renal insufficiency. Diabetic nephropathy can lead to end-stage renal disease.
Cardiovascular Disease
Cardiovascular disease is the leading cause of morbidity and mortality among diabetic patients. The annual risk for death from cardiovascular disease is 2-3 times greater for diabetics than non-diabetics. The risk for cerebrovascular disease and for coronary artery disease is 2-3 times greater, and the risk for peripheral vascular disease is 5 times greater.
Neuropathy
Approximately 12% of patients have this condition when diabetes is diagnosed. Nearly 60% have it after 25 years. There is significant risk for lower extremity amputations: 15 times more common among persons with diabetes. The risk is greater for patients over 40 years old who have had diabetes for more than 10 years.
Effects of Yoga and Meditation
Patient already had vague symptoms since 1992. He attributed it to fatigue or overwork. As a forest officer he had heavy field work. He never paid heed although there was family history of diabetes and other congenital disease.
Patient suffered from Juvenile Diabetes Mellitus since the age of 26. This was being treated with antidiabetic tablets until it went out of control. In 1995, just before coming for meditation, doctors had put him on insulin injections.
“In 1983 aged 26 yrs I started having health problems. Apparently, unknowingly I had been suffering from diabetes for some time. Doctors diagnosed me as an ‘unknown diabetic’. I had to take anti diabetic tablets to control the disease. It was more or less under control until early 1995. My blood sugar levels got out of control. They would remain high in spite of maximal oral medication. Doctors had to put me on daily insulin injection. I was started on 30 units insulin daily.”**
“A few months later I would join the ashram and have the rare privilege of learning Hatha yoga from Yoginiji in the first three months after initiation. Since then my daily insulin intake has remained stable. Sometimes the dose even had to be decreased. It is a well known fact that for young diabetics like myself, the dose of insulin has almost invariably to be increased over time. I know of many whose daily doses had to be doubled.”**
Yoginiji was aware of the problems without being told. She exceptionally started him on hatha yoga in 1995, even before he had come for the mandatory three months. He never mentioned about any of his problems as he was not aware himself. Meditation was unknowingly helping him. At that time he was not regular with either meditation or yoga. It was his fortieth birthday when he mentioned some problem.
“In early 1998 I started having some health problems which I brushed aside as normal, being a diabetic for over a decade. Shortly afterwards, it was my fortieth birthday. Yoginiji jokingly teased me, “I hope you are younger Shyam!” Nodding my head, I narrated my recent health incident to her. With all concern, she suggested I have a medical checkup at the earliest. What followed would turn out the greatest upheaval of my life. A severe crippling spinal cord disease was diagnosed. It required immediate surgery or running the risk of total paralysis to the limbs.”*
At the time of diagnosis in 1998, according to doctors, he should have already been severely crippled, probably quadriplegic. The three years of yoga and meditation had probably blocked the spread or worsening of the disease condition.
But something had to happen to make him know about the severity of his problem.
“Some 12 yrs back, in 1998 I started having serious crippling spinal cord disease and doctors advised urgent surgery. I was given two weeks to decide for surgery. I was told there were all the chances that I would suffer total paralysis of the limbs. Already I was having mobility problems. I was stricken by fear of becoming crippled. The future seemed nightmarish. A few weeks after having done an MRI (Magnetic Resonance Imaging) at the City Clinic, I was standing and looking for a magazine at a hypermarket. All of a sudden I lost all sensation in my lower limbs. The next moment I collapsed. For some long seconds I remained on the ground. I struggled to my feet. I was shocked! Dazed, I wondered what had happened. A few days later I was standing amid a crowd at a funeral. Again, suddenly I could not feel any sensation in my legs. I had no control over my lower limbs and was falling down. I knocked into a lady standing in front of me and I just caught hold of her shoulders. She too almost lost balance because of my body weight. She looked at me annoyed. I did not know what to tell her. I apologized saying that I slipped and was about to fall. I was in a panic. What if this situation persists? Doctors had warned me of paralysis if I do not undergo surgery soon.” **
Once he understood the gravity of his disease and the extremely poor prognosis he panicked and spoke about his problem.
“Sadgurumata quietly told me that I have this disease since birth. Whatever the damage I should not worry. No further damage will happen. Only two years later a new treating doctor will confirm to me, it was a rare congenital crippling spinal cord disease.”*
He was advised to be serious about meditation and yoga. Then only there were chances of some cure. Medical treatment or surgery could not guarantee any improvement. In fact doctors had warned him about the eventual risk of paralysis or even death in spite of the best treatment.
He decided not to go for surgery and put all his faith in meditation and yoga. He then started doing daily meditation and yoga. Symptoms all disappeared. Instead of his case worsening, he was becoming better and better.
“Eventually my health started improving gradually and considerably. Treating doctors who had predicted complete paralysis of the limbs in the near future, were surprised and perplexed to see my condition improving day by day. The loss of sensation in the lower limbs never occurred again. Some months later I was examined by a visiting Consultant Neurosurgeon from abroad, Dr Prashad. After going through my medical records and a physical examination, he shook his head and said: “How is it possible? This guy is stronger than me! His physical examination does not at all corroborate the findings in the records. The MRI shows something quite different!”**
He could resume all his activities normally.
“Medical records are available for verification. My physical activities are as a normal someone can be. I can walk with all ease several kilometers at a stretch. I still enjoy swimming, driving my car or motorcycle. I am a forrester and have to do a lot of field work. Today I am 52 years old. Junior officers at work find it difficult to keep pace with me in my daily physical activities. The secret behind all this is the Guru’s grace, teachings, counseling, meditation, a disciplined life and Hatha yoga as taught by Yoginiji.”**
Patient was having eye check up regularly because of his long standing diabetes.
“I have been following regular eye check up and fundus examination by an ophthalmologist. In 1995, before I joined the ashram, it was found that I already had early diabetic retinal changes. I was told these will invariably increase over time and I will probably have to undergo laser treatment within the next 5 years. There was every chance that I might end up with severe decrease or even loss of vision in the next 5 to 10yrs as is usually the case with young diabetics. Surprisingly my eye condition has not deteriorated at all. On the contrary there has been an improvement. This was confirmed by a retinal fundus photograph done last year in the government hospital.”**
His eyes were quite normal. Considering the duration of his disease and the previous eye fundus examination results, he should have had serious complications, if not blindness by this time.
His other treating doctors also confirmed that all his systems were in perfect condition.
Other organs like the heart, kidneys etc also are not the least impaired as confirmed by my tests. Doctors who examine me are all perplexed by these findings. Meditation and yoga have worked miracles for my health!”**
(* Excerpts from Annual Magazine 2000, page 31)
(** Excerpts from article in Annual Magazine 2011, page 39-42)
CONCLUSION
It is a well-known fact that if a patient is unknowingly suffering from some disease or ailment, yoga and meditation will bring to surface some symptoms of the latent condition. This happened in the present case. It is up to the person concerned to be able to interpret the hints and discern the possible illness.
When Shyam told about the vague symptoms, he was advised to immediately have a checkup. He went the very next morning. He was admitted for observation as the doctor discovered something serious. Later this would be confirmed from his investigations. He was explained the seriousness of the condition.
The MRI showed clearly that there were advanced myelopathic changes in the spinal cord which should have corresponding defects on the physical body. But it was not so. Doctors could not understand how his general condition did not corroborate with his MRI findings. He was advised immediate surgery. But he refused any surgical intervention, putting his faith in the yoga and meditation.
Yoga and meditation lead to an inflow of vital energy ‘prana’ into the whole system. This ‘prana’ will do its work on its own. Wherever there are pathologies the ‘prana’ will stabilize the organ. In early cases it may even lead to complete cure. In the beginning when Shyam started meditation and yoga, the advent of additional prana helped to stabilize his system. However, not being consistent in his practice, he could not get enough of prana to prevent further deterioration of the very serious congenital condition he had. Well before coming to the ashram his pathology was quite advanced and the organs had been severely damaged and their functions compromised.
When he became serious about his meditation and yoga, the additional intake of ‘prana’ was instrumental in stabilizing the organ systems damaged by his long standing disease. From then on there was no further deterioration of the system. The whole degenerative process in the spinal cord had been arrested by the energies created, released or increased by yoga and meditation.
The pathological changes in the patient’s eyes, more particularly in the retina were still at an early stage. Instead of further deterioration, the fundus picture over the years has shown marked improvement. As is usual in diabetics, he could by now have ended up with severely compromised vision or even blindness. Instead, it was seen that his eye condition in fact improved. Recently, retinal photography showed minimal fundus changes. The ‘prana’ had been able not only to block further damage in this particular organ system but had reversed the degenerative process.
The same process happened all over the body wherever the particular organ system was not severely compromised. Doctors have confirmed by various tests, that other organs like the heart, kidneys etc are not the least impaired. They were all perplexed by these findings. They still are! Meditation and yoga have worked miracles for his health.
What had been missing or could not be provided by all the treatments he had been following for so many years was now being compensated by yoga and meditation.
Investigations & Medical report
