The Hidden Enemy

 

"Ajatashatru" is a very lucky person. The word literally means "a person whose enemy is not born". There are many friendly people around us. Some may claim that they have friends everywhere and they have no enemies. Yudhishtira, one of the Pandavas, was considered an Ajatashatru. It is said that even Duryodhana was well disposed towards Yudhishtira and would not have minded his becoming the King, but for his brother Bheemasena who was Duryodhana's sworn enemy. History tells us that there was a King by name Ajatashatru, son of King Bimbasara, who ruled a large area of our country some 2500 years ago. This Ajatashatru fought many battles and had many enemies as well. He was an Ajatashatru only by name.

Having enemies is thus a reality for most of the people. The number of enemies and intensity of enmity may vary, but enemies would always be there. Once a person knows there is an enemy, identifies the enemy and level of hostility, some remedial action can be taken to protect one's own interests. What happens when there is an enemy lurking behind, but it is not known? The situation indeed turns dangerous.

The above position is true of an external enemy. What happens when the enemy is from within? When someone expected to be our protector turns and betrays us? A close friend or protector turning into an enemy and taking us by total surprise? 

People hire watchmen to protect their houses and properties from outside forces and enemy elements. The one who has hired the watchman feels secure and relaxes in the comfort that the watchman takes care of the attackers or intruders. But we often read in the newspapers and media that the watchman himself has turned hostile and brought tremendous misery to the master. There are instances where watchmen or security guards have turned out to be responsible for various undesirable happenings in the area they are expected to guard and take care of!

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The three letter sentence from the play "The Tragedy of Julius Caesar" by William Shakespeare is often quoted when an enemy strikes from within. The date was March 15, 44 BC (nearly 2066 years ago). There is the mention of Ides of March as well. Act 3, Scene1 of the play gives out the details. Julius Caesar is attacked by a group of senators and stabbed to death. At the moment of being stabbed Caesar identifies his associate and friend Marcus Brutus as one of the persons in the conspiracy to stab and kill kill him."'Et tu, Brute" he says and falls. The Latin sentence meaning "Even you, Brutus!" has become immortal and often used to represent betrayal by someone who was expected to protect in the normal course. Decimus was much more trusted by Caesar and was the only one to who could be called close to Caesar. But the reference of betrayal is done to Marcus Brutus as the three words in the play have made history.

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Present generation may not concern with Caesar and Brutus, but they certainly remember Kattappa and Amarendra Bahubali. Kattappa ws a slave and initiated into serving the Royal family of Mahishmati. The internal politics of Mahishmati conspires to utilise Kattappa to kill Amarendra Bahubali. Amarendra is killed by a trusted lieutenant Kattappa, though Kattappa later realises that he was fooled and used as a tool to kill Bahubali. Kattappa was an unwilling element in the big scheme of things, but he did kill Bahubali in the most unexpected circumstances. Kattappa did repent later but the action was irreversible by then.

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Mukunda Rao was unable to see things clearly and went for an eye check up. The Optician identified that cataract had developed in both eyes and surgery was required. As the first step in the direction of surgery, the retina of the eyes had to be scanned. He was directed to the optometrist for this purpose. The Optometrist asked Mukunda Rao to place the eye in place on the scanner and open the eye widely for a proper scan. As the scanning was in progress the eye got narrowed and closed. Optometrist tried three times but each time the eye drooped and scanning stopped. The Optometrist got frustrated and harshly told Mukunda Rao to keep the eyes wide open. Mukunda Rao said he wants to keep the eye open but it is getting closed involuntarily. The Optometrist summoned an assistant and made her hold the eye open and finished the scanning!

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Scanning was done, date for surgery was fixed and completed successfully. After the post-operative care was completed and the time came for prescription of glasses Mukunda Rao sat again before another Optometrist. As the examination of eyesight was in progress, Mukunda Rao asked the Optometrist which of the two images he should concentrate on. Optometrist was baffled and asked whether he was seeing two images all the time. Mukunda Rao said it happens sometimes and he can see a single image clearly at other times. Optometrist said the vision will stabilise once the spectacles are used regularly. Mukunda Rao paid a heavy amount for the fancy new spectacles and started using it. He was now seeing fancy double images and could not understand how many steps are there on the stairs or whether the footpath was even or uneven. The problem of double vision remained despite cataract surgery and the new fancy spectacles. Mukunda Rao now knew a new word - Diplopia. Diplopia is the name for double vision.

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Vamana Murthy attended all social and religious functions in his circle. He was often called upon by his friends and relatives to speak to the gatherings on such occasions. Being a teacher and trainer, he was comfortable in such roles and could speak extempore and keep the gatherings occupied during such events. He was also invited as a speaker or chief guest at many functions. Of late he started feeling that the spoken words were not clear sometimes and the speeches were slurred on occasions. This was more pronounced towards the evenings. Vamana Murthy now started to avoid attending the social and cultural gatherings.

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Madhusudana Rao took fancy to the new generation of smart watches and purchased a premium model that recorded various daily activities. The watch spurred him into longer walks in the morning at the friendly neighbourhood park. The statistics on walking show that the average number of steps taken by people allover the world is about 5000 in a day. Madhusudana Rao started with this goal and progressively increased the daily limit. He crossed 15000 steps on most of the days and took pride in his achieving daily goals. He observed that things were not the same of late and he got exhausted and felt shortness of breath even with small walks. Walking that was such a pleasure now became a tedious exercise.

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Narendra Rao was fond of savouries with a liberal spread of cashew nuts, almonds and groundnuts. A small quantity of mixture would accompany the evening cup of tea or coffee. All the teeth were in good shape and chewing these items leisurely and enjoying with coffee or tea was a pleasure especially on weekend afternoons. Things changed suddenly and Narendra found it difficult to crush and chew the almonds in his jaws. Groundnuts were alright, but harder nuts like almonds were a different nut to crack. He slowly started to remove the almonds and throw them away when other members of the family were looking elsewhere. Swallowing the chewed food also became difficult in due course. When he tried to push the liquids through the gullet, instead of going through the throat the liquid came out through the nose! Quantity of food consumed came down drastically and weakness in the muscles set in slowly. Swallowing the daily dose of tablets also became a big task.

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Kumaran was very active and would get ready to go to office or outdoor visits in a jiffy. The process started taking more time now. Buttoning the shirt sleeves needed more efforts. Picking things kept in the higher shelves also started posing problems. Spreading cloth for drying and similar chores took more effort now. Hours spent in sound sleep got reduced and there was a general dullness in the routine. Breathing became a strenuous exercise and would disrupt the sleeping pattern.  

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With the increase of awareness about physical fitness and health care, one would normally run to a doctor when confronted with the above problems. These symptoms are generally treated as originating from stroke or ENT issues. Ophthalmologists are expected to identify this promptly, but that is not always the case. Treatment for cataract is often confused for setting right double vision which is not true.

Myasthenia Gravis (MG) is a disorder that worsens after periods of activity and improves with rest. The symptoms mentioned above are worse as the day progresses and the persons dealing with these are better off in the mornings. But the situation would aggravate if not diagnosed early and remedial action initiated.  

MG is an autoimmune disorder, in which the immune system of the body that is expected to protect the body from outside organisms mistakenly attack the body itself. This is similar to the situation where the watchman attacks the master. Myasthenia Gravis is caused by an error in the transmission of nerve impulses to the muscles. It is said to occur when normal communication between the nerve and muscle is interrupted at the neuromuscular junction, where nerve cells connect with muscles they control. Technical details are  available on the internet and medical journals.

The typical symptoms of MG are:

• Drooping f the muscles of one or both eyes.
• Double vision or Diplopia.
• Impaired speech, especially towards evenings.
• Difficulty in chewing and swallowing.
• Shortness of breath even in cases of short walks or physical activity.
• Difficulty in breathing and shortness of sleep.
• Weakness in hands, legs, fingers and neck muscles.

Myasthenia Gravis cases are rather rare and only some 15 to 20 cases per million population are said to carry this disorder. It is not contagious and does not run in the family. It can happen at any age group or gender. Though the disorder is itself rare, extensive research is done on this and advanced treatment is available.But unfortunately many cases go undetected and patients suffer silently and lead to what is known as Myasthenia Crisis.

When the muscles that control breathing weaken Myasthenia Crisis develops and the person requires ventilator support to breathe. Infections, stress or surgeries may trigger this crisis. Care must be taken to prevent slipping into such crisis.

Despite the issues relating to MG, people can lead a normal life by suitably changing life style and proper medical care. There are many prominent personalities with MG disorder and yet managing successful lives and leading in their respective fields.

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Anyone suffering from the symptoms mentioned above would do well to take a precautionary test after getting suitable medical advice.

The hidden enemy can be managed and controlled once identified!