The profile of the month is chosen by the MSIF editor from those submitted.

Dr Jorge Rosquillas

Email:Jorge Rosquillas
Country of Residence: Mexico
Year of Diagnosis: 1981
Occupation: Paediatrician
Type of MS: Relapsing Remitting/suspected Secondary Progressive

In October 1980 I was in my last year of paediatrics. The shifts were completely exhausting but very satisfying I had to divide my time between the hospital and my wife, Gilde, and my two sons, Jordi and Dirk, then 6 and 3 years old.

The first sign that something was wrong was the paresthesia [spontaneously occurring sensation of burning, prickling, tingling, or creeping on the skin] on the right side of my body especially when I was lying down or not doing physical work. I did not give it any importance, attributing it to stress or fatigue. I examined myself and my conclusions were not optimistic but I decided to ignore them. In the middle of January 1981, faced with the persistence of the problem, I consulted the internal medicine service of the Hospital Centre where I was studying - the National Medical Centre - in Mexico City, and they attributed it to fatigue. The problem disappeared. In February 1981 I finished my residency in paediatrics in Mexico City and moved with my wife and sons to the city of Tijuana, across the border from San Diego, California. The paresthesia came and went so I did not pay attention to it. I decided to ignore it completely.

When I arrived in Tijuana, I started working at a children’s hospital that was still in the planning stage, so my work was planning. I had enough free time for activities that had not been possible during my years of formal study, among them jogging in the morning before going to the hospital. On March 25, 1981, when I got up to go jogging, I noticed that the right side of my body did not respond and I felt weak and spastic.

In Mexico 20 years ago MS was considered to be an exotic illness. Its prevalence, according to a domestic publication, was one in every 100,000 inhabitants, so that when I went to the neurologist that day, he considered that a vascular cerebral accident was the most viable diagnosis, despite the fact that I was only 30 years old. In Mexico it was more common to think about cerebral cysticercosis [a parasitic infection] or vascular accidents than about demyelination processes. Mexican neurologists did not think about MS.

I did not agree with this diagnostic hypothesis and I was frustrated and very depressed. My wife comforted and supported me; she was as confused as the doctors of Tijuana and me. The test results were absolutely normal, including the CT scan, so I decided to go to La Joya, California, to consult an American neurologist. He, from experience, told me after speaking briefly, that his first diagnostic impression was MS, that they would do some tests on my cerebrospinal fluid and treatment with dexamethasone [a steroid]. The prognosis was unpredictable but he told me, for example, that even if I could type now, I would never be able to type again. I should get used to the idea of living with a chronic illness and not worry about it. The results of the spinal tests were normal, so they suggested that I enter the hospital to undergo general diagnostic tests. Given the expense of medical care in the United States, I decided to return to Mexico City. By this time one side of my body had been paralysed for a month.

Suspecting that I had MS, Gilde and I went to Mexico City. I was in the National Medical Centre, the hospital where I had studied, for 6 weeks, totally sedated and treated with steroids. I went from the hospital to a rehabilitation clinic where I stayed for a month. One afternoon I noticed that I could pinch my index finger and thumb together and the next day I managed to lift my arm above my head.

Partly recovered, with my sons who had arrived from Tijuana, the four of us moved to Gilde’s birthplace, San Cristobal de Las Casas, in the southern state of Chiapas, near the Guatemalan border. There I looked into the possibility of working outside the hospital environment, but the hospital atmosphere and its challenges still attracted me intensely, so finally the four of us returned to Tijuana, the other end of Mexico, there I re-established myself at the paediatric hospital with the satisfaction of having the economic support of he state government and the latest technological equipment.

All was well but in February 1982 came the second great economic devaluation in this country, with galloping inflation. Salaries were not enough to cover basic necessities. I started to work in other hospitals but it was not enough and I was totally withdrawn from my family, seeing my sons only for a while at night when they were asleep. So in 1984 we decided to sell our house and belongings and moved again to San Cristobal de Las Casas where I began to work as a rural paediatrician with good results from an economic and family point of view. I began to enjoy the tranquillity of a small town, and life together with my wife and sons.

By 1985 I had forgotten about MS, but it had not forgotten about me. On the third anniversary of my debut as an MS patient, I had an optical neuritis in my right eye. Since there was no one to go to, I started to take oral steroids that I prescribed myself but when I saw no results, I went to Mexico City where puzzled neurologists told me there was nothing else to be done. So with vision in only one eye and the effects of the steroids on my body, I returned to my consulting office and continued living my life the same as always, without worrying about tomorrow, living the present. My wife’s family, town people, told me with great simplicity: "If your illness has a remedy, don't worry about it, and if it does not have a remedy, don't worry about it". So with this simple philosophy I continued enjoying life in the pleasant atmosphere of a small town, sacrificing all my academic aspirations of high technology medicine, discovering the value of human communication through daily treatment of mothers concerned about healthy babies.

However, despite the fact that I had forgotten about MS, it was still there. In 1988 I woke up with the vision in my left eye greatly diminished. Knowing what was happening, I went to a local hospital where with the help of some friends, I began a treatment with high dosages of methyl prednisone. After a few days, I was taken to Mexico City where I was hospitalised for one month, again with steroids. In the end, I had no vision in either eye, but I gradually noticed a certain clarity in my left eye. I noticed that I could perceive movements, shadows.

My family who lives in San Diego, California made an appointment for me with an ophthalmologist, a specialist in low vision. He sent me to the Low Vision Centre in La Joya, California. In that place there is a wide variety of visual assistance and they gave me a special closed circuit TV apparatus used to read in cases of low vision so that with this assistance I have managed to keep myself up-to-date by reading, in spite of my 20/600 vision.

With two sons entering adolescence, it was not the time to think about defeat. Since San Cristobal is a small town, the people soon learned that I was blind and the number of my patients diminished seriously. However, I stayed in my consulting room, waiting for someone to arrive in the waiting room. As Arthur Conan Doyle said, I was waiting in my consulting room and in the waiting room nobody was waiting for a consultation.

In 1989 came the unexpected proposal from the director of the local hospital for me to take charge of the paediatrics service. I hesitated for a few weeks, but faced with his insistence and few of my own patients, I decided to accept. The service per se did not exist, so I devoted myself to establishing a paediatrics ward with outpatients' service and a service of oral hydration for patients with diarrhoea. I noticed that vision, useful of course, is not indispensable; a very good interrogation, and meticulous physical examination and solid knowledge can substitute for almost absent vision.

There is an Arabic aphorism by Abicena which says that "the eyes do not see what the brain does not know" and based on this principle, I decided that I had to know a lot and keep myself up-to-date. I managed to create the paediatrics service, to found the Oral Hydration service and to create the Room-in service which did not exist before, despite the immense benefits of breast milk, that is presently a reality in our hospital.

In 1991 my two sons came into contact with a computer for the first time. I saw how enthusiastic they both were in front of the screen and one day they presented me with a program to learn how to type. My younger son, Dirk, created the program, and with this help a world of possibilities opened for me since I could again communicate with people through writing. Dirk is today a computer systems engineer. Jordi, my older son, who is a communication specialist, has made it possible for me to live with a computer in front of me, which keeps me in daily contact with the world. I smile when I remember the example of the American neurologist who told me that if at the moment I knew how to type, I would never do it again. Although he had been right about the diagnosis, he was completely wrong about the prognosis.

Gilde suffered more than me from the illness, she started to look after me, to divide her time between her work in a school of special education, to take care of the house and my consulting office. Meanwhile, I was learning how to walk around the streets of the town - I always liked radiology and now, almost blind, I perceive shadows, and radiology is nothing else but interpreting shadows, so that I applied the logic of radiology to my way of interpreting with my vision what surrounded me.

I developed an excellent capacity for observation, paying special attention to people's voices, their profiles, way of walking, movements and I always looked in the direction of their eyes. Gradually I started to wander freely through the streets. People, seeing me walking alone, congratulated me because they thought I had recovered my sight. I explained that what had improved was not my sight but my adaptation to my visual limitation. While this process of independence lasted, my wife and sons, fearful, followed me at a prudent distance, taking care of me without me knowing.

In the hospital my work was satisfactory and I wanted to test my skills as a paediatrician so, except for installing an endotracheal tube, which is a high risk procedure for the patient, I managed to install means of access into the blood system in cases of extreme emergency, through a procedure known as "osteoclisis" applying a needle to the tibia of the baby. I continued performing lumbar punctures easily. A nurse asked me how I could put a needle in the back of a newborn and obtain spinal fluid and I replied that it was like making love, a matter of knowing anatomical references. With time, having showed what I was capable of and with the arrival of young, trained medical personnel, it was rare that I found myself obliged to perform such procedures.

A few years later Gilde took time off her work and joined me full time in my consulting office. She has in depth knowledge about breastfeeding and perinatal psychoprofilaxis so that between the two of us we formed a team that managed to deal with the demand of the consulting office. And between this and the hospital, our sons went to university, to the Technological School of Monterrey and now are both professionals.

My last attack per se was in 1988 but since 2000 I feel a daily fatigue and the spastics in my legs limits the possibility of wandering freely through the city. In July 2002 I suffered severe urine retention for which I was obliged to perform scheduled bladder catheterisation. I have experienced until now three urinary infections that required hospitalisation. Most of the urologists that I consulted looked at me with sympathy and frustration... until I met Dr. José Luis Campos, a urologist with an awareness of uro-neurology who supports the Multiple Sclerosis Society of Mexico.

Dr. José Luis Campos, seeing my urodynamics test, suggested that I apply Botox to the sphincter of the bladder. The procedure is simple but it is not covered by my state health insurance, nor did we have the money to pay the hospital expenses. Dr. Campos would not charge a fee, so Gilde's family helped us financially and I went to Mexico City to have the treatment, successful beyond doubt, but the effect is temporary. Presently my most important problem is to empty my bladder.

With respect to my productivity, it is difficult to say how MS affects it. I think that life proposes or imposes alternatives to your destiny. We will never know how our life might have been without MS. I prefer to judge by the results obtained up to now, which are very good.

I think that having multiple sclerosis is a very special condition. I have come to think that it is not an illness but simply a way of life. We all have great, different limitations. The important thing is to recognise them and not to cling to one single goal in life but to have a plan B. For me multiple sclerosis meant the difference between being an absent father, extremely busy, or living in a well-integrated, happy family. I have read Voltaire and I like his work "Candide" very much since he says that the greatest misfortunes in life are to avoid worse ones. I see sadly that multiple sclerosis is more and more present in the lives of Mexicans. Maybe because now doctors think about it, but there seems to be an increase in cases and Mexican doctors are becoming aware of this pathology that should be treated in a multidisciplinary manner and with drugs that promise to be more and more efficient.

By chance I heard a fascinating phrase of a German poet whose name I unfortunately do not remember: "The defeat that does not manage to defeat you is a victory".