Multiple Sclerosis and the Fishbowl Effect

By Will Connors, ’12

Vince Macaluso seemed to have it all. A sophomore at Cornell University, he was playing tennis and football, and planned to attend medical school. Over Thanksgiving break, he developed a high fever during a Broadway show. Vince spent some time in bed, drank plenty of fluids, and recovered.

But soon his grades began to slip, his athletic performance decreased, and his friends and girlfriends noticed a new surliness in one of their nicest, funniest friends. His girlfriend left him. Although he was struggling, Vince still managed to make it into medical school at Georgetown. His symptoms continued to worsen until at the age of 21, Vince was diagnosed with Multiple Sclerosis.

Today, Vince is Dr. Vince Macaluso, a neurologist specializing in Multiple Sclerosis (MS), a husband and father of two, a graduate of Regis ’86, and a person who has lived with MS for 24 years. He is also brilliantly funny, bringing a vibrant energy into the room as he gave his presentation. He kept his left hand in his pocket most of the time to control a coordination problem, really the only visible sign of the disease because of the medicine Dr. Macaluso takes. Since 1997, Tysabri and Adderall have helped Dr. Macaluso “make up for lost time.”

Dr. Macaluso started off with his personal tale of MS, describing how he had his “mind stolen” by the disease. MS is still a mystery, but it appears to have genetic, environmental, and infectious causes. For Dr. Macaluso, the virus caused a break-down in the blood-brain barrier (which strictly controls the passage of molecules between the vascular system and the brain) .  This allowed white blood cells and the immune system to access the usually sterile brain. There, due to some unknown genetic variations, his immune system attacked the fatty myelin cells (white matter) that coat many of the neurons in the brain. Myelin cells are integral to the speed at which signals propagate through the brain.  Dr. Macaluso showed us MRI photos of the scars in his cortex where the disease had eaten away at his brain.

However, Dr. Macaluso was quick to stress that a picture is only an indication, not the full story. He quoted Socrates: “The only true wisdom is in knowing you know nothing.”

While the lesions are towards the back of his brain, they once caused secondary problems: the disease caused inflammation and swelling in the brain, putting pressure on the prefrontal cortex (responsible for executive functions like decision making and moderating social behavior). Dr. Macaluso told us about how he felt depressed, unable to concentrate, and was often rude without knowing it. How can we explain changes in something metaphysical, like personality, by looking only at something physical, like the brain?  Dr. Macaluso said that we should distinguish between the physical, 3-dimensional world we live in and the transcendent mind that is able to think of abstract concepts like justice as well as prioritize a busy schedule.

“Stress is trying to bring other-dimensional concepts into a 3-d world,” he joked.

He likened the mysterious connection between brain and mind to other disparities between observations and explanations: For example, recent astronomy has shown that matter comprises only 5% of the universe. The nature of the rest is still elusive. On the other side of the size spectrum, quantum mechanics currently requires upwards of 20 dimensions to explain quantum phenomena. Dr. Macaluso likens the disparity between the seen and unseen to a fish bumping up against the glass of its fishbowl—there is most definitely something beyond what we can see, but certain limits prevent us from perceiving it (for now).

Finally, Dr. Macaluso hypothesized that “the soul is the interface between the mind & the brain,” bringing together the very different natures of the mind and brain into what we call a human being.  He also quoted M.C. Escher: “He who wonders discovers that this in itself is wonder.” He encouraged us to seek our own answers to the philosophical greyness of the Brain/Mind/Soul Seminar’s discussions.

As we wrapped up our discussion, the room erupts yet again in laughter at one of Dr. Macaluso’s jokes.  Then we caught ourselves: was it ok to laugh when the man was dealing with MS?*

“It’s ok, it’s good to laugh!” he said.

This comment reinforces the point of Dr. Macaluso lecture: we may discuss these heady issues in theory, but they are still very much contained within the experience of being human. Just as we think, we also feel. Dr. Macaluso may talk about the search for MS treatments, but he’s still Vince, and he’s still “Daddy” to two young children. A rousing end to a wonderful lecture.

http://brainmindsoul.blogspot.com/

*Originally this read: "suffering from MS."

Dr. Macaluso shared the following by email:

I do not suffer. To me, suffering implies a sense of not be able to do anything to improve one's own situation. MS has taught me to value everything that I have, every day that I have it. 

MS is a degenerative disease.

Life is a degenerative disease.

We should all be striving to deal with the stuff that comes up in life each day.

And if someone feels like he can't, that's when the rest of us have to help him see that he can. 

That's one of the things I love about being a doctor.

Just because we don't have a cure for something doesn't mean that we can't help.

In short, I don't suffer from MS - I deal with it.