Illness and Consciousness – A personal experience

In the absence of such studies, the result is a heavy reliance on signs (lab reports, ECG, cardiogram, scanning, X-rays, etc.,) while downplaying symptoms. The doctors spend more time studying the reports rather than talking to the patient. The net result is that the hospitals are treating illnesses rather than patients. This also makes a good business opportunity for private hospitals in testing and treatment.

By Dr. Gamini Kulatunga

I had a slight fall at home with no injuries. But momentarily I lost my memory and I could not recollect how I fell. This condition is called ‘transient global amnesia’ caused by a sudden disruption of blood flow to the brain. While recovering from this ‘transient ischemic attack’ (TIA), I have been pondering over the experience I had, as a patient, with medicine and treatment, from an engineering perspective.

The diagnosis of a disease is based on objective and subjective aspects namely, signs and symptoms. The signs are quantitative and generally assigned values by the doctor whereas, the symptoms are mostly qualitative descriptions given by the patient. The weights given to signs and symptoms play a vital role in the diagnosis.

Most of the time, the patients do not distinguish the difference between cure and treatment as these terms are considered as synonyms by the non-medical personnel. A treatment is something that healthcare providers do for their patients to control a health problem, lessen the symptoms or clear it up. A cure is when treatment makes health problem go away and it’s not expected to come back. There are idiopathic diseases with unknown aetiology for which cures are replaced by treatment.

In my case, the troponin, an enzyme present in the blood, which indicates plaque formation in arteries and the ECGs showed signs of a mild heart attack. But, I have had a thickened heart muscle called Hypertrophic Cardiomyopathy (HCM) for a long time and I also take treatment for a mild kidney malfunction. These two factors, too, contribute to high troponin level in the blood. There were no other signs in the echo-cardiogram to justify further investigation.

I was to be sent to the ICU for monitoring but as I did not feel that ill, I asked the doctor to send me to a room with emergency facilities. The doctor asked me why I was reluctant to and I said the stress of spending a night in the ICU may trigger a heart attack. I was vindicated by the ECGs taken before and after admission to the hospital. The ECG on admission showed an abnormality which was not there before and after.

When I met the cardiologist, later, he said without an angiogram a definite opinion cannot be given but he asked me to see him in six months’ time. This I took as a green light and I ignored the reference to do an angiogram.

Back at home convalescing, I feel dizzy at times. My blood pressure was measured at home, while lying down and seated, which showed a drop in pressure when the position is changed. I was advised to change my postures very slowly to avoid dizziness and the symptom is called Benign Paroxysmal Positional Vertigo (BPPV).

I am taking things easy and resumed my gentle Tai Chi exercises that concentrate on relaxing muscles to allow body fascia to come into full operation. I feel a remarkable change of interconnectedness of the body and I keep wondering whether it is my experience or belief. David Chalmers in his book “The Character of Consciousness” explains this entanglement. I think it is a moot point to seek the difference as Harvard Medical School Guide to Tai Chi describes how effective motor-imagery is. Further, Bruce Lipton’s “Biology of Belief” describes how placebos and nocebos affect us.

As a mechanical engineer, I imagine the heart as a positive displacement diaphragm pump assisted by the calf muscles acting as a peristaltic pump (it is called the second-heart). The two pumps work as constant volume devices subject to compliance to accommodate slight changes.

The factors that influence blood flow are: volume, pressure, compliance, viscosity, blood vessel length and diameter.

The governing equation is: Volume per beat V = ΠΔPr4/8ƞλ

∆P – pressure difference, r – radius of blood vessel, ƞ – viscosity and λ – length of blood vessel

My speculation, not based on any medical literature, as a mechanical engineer is as follows.

In my old age of 78, the pumping system will be de-rated due to deterioration of the two pumps, the four heart valves, non-return valves in the veins and numerous blood vessels spread all over the body. The lymphatic system has no independent circulation system but makes use of the blood circulation system.

As a result, if less blood flow takes place, the pressure will drop or the viscosity will increase. Generally, then a blood thinning drugs is administered. To accommodate less flow, the blood vessels could reduce their diameter by building up plaque which consists of fat, cholesterol (a substance needed by the body to build healthy cells), cellular waste products, calcium and fibrin. To clear the pathways normally, cholesterol reducing drugs are administered or in the extreme cases, stents are inserted. By-pass surgery is also common in the case of a blockage in the heart. But food control, exercise and relaxation would reduce the inflammation of the inner artery walls.

The body’s homeostasis properties may reduce blood vessels’ diameter, by depositing plaque, if compliance cannot cope with it. The heart may also have redundancy built-in to find alternative pathways in case of a restriction.

More importance must be given to seeking the connection between consciousnesses and functioning of the body’s organs. Psychoneuroimmunology is one such attempt but by and large, placebo and nocebo effects are considered epiphenomena that hinders drug testing. This is the result of heavy dualism still pervading science, despite quantum behaviour. At present, consciousness is treated as a mere epiphenomenon of the brain belonging to pseudoscience. The micro-physical laws need to be expanded to cover psychophysical laws.

In the absence of such studies, the result is a heavy reliance on signs (lab reports, ECG, cardiogram, scanning, X-rays, etc.,) while downplaying symptoms. The doctors spend more time studying the reports rather than talking to the patient. The net result is that the hospitals are treating illnesses rather than patients. This also makes a good business opportunity for private hospitals in testing and treatment.

This is not a critique of the medical care I received, at a private hospital, which was very good. It is more or less my views on what has to be done to improve patient care.

Notes:

Systolic blood pressure is defined as the pressure exerted on the artery walls by the heart. But the measurement is taken when flow stops. This is the maximum pressure that the heart can produce and not the system’s pressure.

The systolic pressure varies with age. At 40 years the average pressure for men is around 110/68 mm Hg and it goes up to 133/69 at around 60 years. These figures are based on statistical studies and individuals could be at the ends of the bell-curve.

The pulse rate in adults remains in the range of 60 to100 beats per minute without much variation with age. However, it varies with bodily changes. If the pulse rate remains constant it is an indication that the heart is not responding to signals from the body, which is not a good sign.

The blood vessels and the diaphragm are pliable and could accommodate slight variation in capacity. The system acts as a surge chamber to even out the pressure waves.

Homeostasis of the body would keep the volume flow the same by accommodating high pressure by restricting the flow through plaque formation on the inner walls of the blood vessels. Unnecessary intervention, through drugs and surgery, may tip the balance with unwanted complications.