A clinical story : Black magic or bird magic ?

Mrs Noora,(name changed) the newly wed girl, in her early twenties was brought with acute shortness of breath of one day duration to the emergency room of our hospital, years back . The clinical examination was displaying bilateral wheeze suggestive of acute asthmatic attack. Oxygen at the rate of 4 liters per minute was started in addition to other treatment . She improved and was discharged with an advice for follow up. Unfortunately she continued to have recurrent attacks of shortness of breath in the following months. She was admitted 6  times in two  month with shortness of breath . Every time a different resident doctor would  manage her symptomatically (oxygen , nebulisations) and discharge her. Due to their  personal reasons they denied detailed evaluation in the hospital

Exhausted with the number of hospitalizations,  Mrs Noora went to her father’s home for a change.

Things changed to  a better direction there as she  felt relieved in her father’s home. She had no further episodes of breathlessness there, thus  no more hospitalization  She started scanning her old albums jubilantly, sleeping nicely and enjoying every moment in the company of her parents .Mr Fahad, her loving husband  would visit her  on weekends.

“Could it be black   magic conspired by our relatives or enemies ”,Mrs Sara , the mother of the patient, one day  speculated, while the family was  having delicious dinner along with their son in law . A reputed   Sheikh  of the locality was consulted to fix the black magic . During his interaction with the family, the sheikh  warned  the family that her breathlessness was  due to the highest order, black magic but luckily they were on time .He assured them that the  black magic would be fixed  as soon as possible . I don’t know how much the great sheikh charged them and what he did  but the fact was that Mrs Noora  remained perfectly fine much to the delight of the whole family.

After a few months , the Sheikh gave  a nod that all black magic has been nailed  down and now she could join  her husband back.

Mrs Noora   returned back to her husband’s home after a few months.The young couple started living happily but sadly after a few weeks Mrs Noora developed shortness of breath once again. Similar episode , similar discomfort .

They immediately called on  the great Sheikh who despite all efforts couldn’t help her shortness of breath.

Mrs Noora was desperately rushed  to the hospital once again.

She was immediately started on  oxygen as there was severe  bilateral spasm of airways . Now the couple  agreed admission for a detailed evaluation and she was admitted on the 3rd floor.

After routine investigations and pulmonary function tests , a  CT scan thorax was done .The  CT scan chest was suggestive of  early  interstitial fibrosis and the radiologist  suggested a  lung biopsy for further evaluation.

Lung Biopsy ! Dr Khurshid, the pulmonologist in the hospital exclaimed with astonishment.

“Please tell me her history in detail. She is too young to have interstitial lung disease” , Dr Khurshid said.

While   listening keenly to the clinical history  Dr Khurshid interuppted the resident in between and said, “You mean she remained well at her father’s place”.

Yes Doctor, the resident replied.  

Then something is wrong at her husband’s place ,which is triggering her bronchospasm.

“With due respect to the Sheikh, let us explore beyond black magic”, Dr Khurshid went on deeply in this vein.

Please call her husband. I want to talk to him.

Dr Khurshid asked few questions to Mr Fahad, the anxious  husband of Mrs Noora

“Did you get new curtains recently” ?

“Did you use  some new perfume” ?

Mr Fahad  negated all these questions.

What are you doing?

Daktoor!(Doctor).  I deal with Bird business . We have birds in our attic. Mr Fahad replied.

“Here you go”,  Dr Khurshid vehemently said.

It is not Black magic. It is bird magic  !

Yes, Bird Fancier’s lung (Bird fancier’s lung is an immunologically mediated lung disease caused by inhalation of bird dropping extracts and antigens in feathers)

“Wait for Lung biopsy and start her on steroids” , Dr Khurshid concluded after the discussion.

Then he turned to Mr Fahad and kept his hand empathetically  on his  shoulder , and  said. “ Habeebi (My dear) I give you two options.

Either change your profession or your wife, she is sensitive to bird feathers you are dealing with”

You can not have both.

“Daktoor!(Doctor) Ish haza(what is this?) .

“I better  change my  profession, let us hope she improves. She is so nice, besides marriage in Saudi Arabia is too expensive. It  is sadly an uphill task”

Mr Fahad replied  with a sigh. 

Mrs Noora was  advised to  go to her father’s place till Mr Fahad changed  his profession and thoroughly washed his house. 

As the months passed by

One day Mrs  Noora came smiling along with her husband to our OPD.

She had come directly  from her husband’s home  . Her husband was holding her hand as he had happily   divorced  his profession and both were  living happily thereafter.