Keeping balance very essential to health

Shahar Madjar, MD

Ralph wasn’t himself. With each passing day, his fatigue intensified.

He had morning headaches every single day and he became progressively confused. Barbara, Ralph’s wife, told the doctors: “There is something wrong with my husband, he lost his stream of consciousness.” Professor Fine, the attending physician caring for Ralph, pushed his heavy glasses up his nose and passed his fingers through his thinning hair.

He looked at his computer monitor for clues regarding Ralph. What is the matter with Ralph?, he asked himself.

Whenever Professor Fine confronted a challenging medical case (he referred to these cases as riddles), he looked back, for inspiration, to the time when he learned, as a medical student, about Claude Bernard–the French physiologist who was the first to coin the term milieu interieur (internal environment).

It was Claude Bernard, professor Fine learned in the History of Medicine class, who noticed, through countless experiments and observations, that the body maintains a stable internal environment. It was Claude Bernard who understood that keeping the internal environment constant is critical.

Giving lectures to medical students, Professor Fine explained the different ways the body keeps its own environment stable: “The body uses the nervous system and the hormonal system to regulate itself,” he told the students. “It uses sensors to “feel” for changes in the internal environment of the body–the body senses its own temperature and the pressure within its blood vessels, it measures its own levels of water, it monitors the levels of sodium and glucose, and the acidity of the blood–and then through a command system, it modulates organs and systems in the body to keep the environment stable: in response to increasing levels of glucose, for example, the pancreas would release insulin to bring the level of glucose back to normal; at the same time, the kidneys would clear the blood from toxins and from waste products that the body creates during its metabolism, and take part in maintaining the body’s blood pressure–all in the name of keeping every cell exposed to a stable, constant internal environment.

It helped Dr. Fine to think in these terms because, for him, every disease was a disturbance in the normal balance of the body–a deviation from a steady state. If he could find the cause for that disturbance, if he could correct it and bring the body back to its own stable state of affairs, then the patient would heal, and, just like that, the riddle would be solved!

Confronted with Ralph’s deteriorating health, Professor Fine asked himself: “What is the cause for Ralph’s failure to maintain a stable internal environment?

Ralph’s blood pressure was very high (203/102 mm Hg), his heart was pounding hard and fast, and he was breathing fast. Ralph’s blood tests indicated that his kidneys were failing. An imaging study, an MRI, of his brain showed patches of cerebral edema–swelling of Ralph’s brain. Professor Fine thought that this could be an explanation for Ralph’s impaired cognition.

The medications the doctors gave Ralph for his blood pressure didn’t work. His blood pressure remained high, and Ralph’s consciousness continued to ebb and flow.

When Ralph’s ultrasound images came back, Professor Fine was finally able to solve the riddle. Ralph’s bladder was enormously distended–the bladder usually holds about 300 ml, but Ralph’s bladder was filled with 2900 ml. In Professor Fine’s mind, it all became clear: Ralph’s prostate was enlarged to the degree that it blocked the channel that drains the bladder. Ralph wasn’t able to void efficiently. The pressure within his bladder rose and it back-flowed into his ureters and then to his kidneys. The kidneys could no longer function: they couldn’t filter the blood of toxins and waste products; they couldn’t regulate the body’s blood pressure. These changes, in turn, must have affected Ralph’s brain.

Dr. Goldwater, a urologist, was called to the scene. He stood next to Dr. Fine and while they examined the ultrasound images, Dr. Goldwater mumbled: “Praise God, King of the Universe, who fashioned Man with wisdom, and created within him openings and orifices, pores and hollow passages. And if but one of them were to be ruptured, or but one of them were to be blocked, it would be impossible to survive, and to stand before You.”

“Beautifully said,” Dr. Fine responded. He knew the ancient Jewish prayer that Dr. Goldwater had just quoted, and was amazed at how wonderfully it matched his own understanding of the human body. After all, if one opening is closed (in Ralph’s case, it would be an enlarged prostate that blocked the urinary flow), how can one maintain a stable environment?

Dr. Goldwater placed a catheter in Ralph’s bladder and drained his urine. Later, he took Ralph to the OR and performed surgery to open the prostatic urethra. After surgery, Ralph was able to void and to empty his bladder. His kidney function returned to normal. Ralph’s milieu interieur was balanced and stable again. And his stream of consciousness returned to normal.

EDITOR’S NOTE: Dr. Jim Surrell is the author of “The ABC’s For Success In All We Do” and the “SOS (Stop Only Sugar) Diet” books. Requests for health topics for this column are encouraged. Contact Dr. Surrell by email at