A Jewish Doctor Prays for His Patient. An Unusual Case of Abdominal Pain.

The limousine pulled into the driveway of a small Georgetown mansion. Ben Kaplan and Joe Trujillo, Ben’s Nurse Practitioner, got out and were directed inside the house to a large combination bedroom and sitting room at the rear of the first floor. A tall elderly man with military bearing invited the 2 visitors to be seated and immediately began his story.

“I very much appreciate your both coming up to D.C. to see me. George, my son-in-law, thought it best. You see, I have this strange abdominal pain and doctors at Bethesda Naval Hospital can’t seem to figure it out. My primary care physician doesn’t know what’s wrong so he referred me to a gastroenterologist. She seemed quite puzzled and referred me to a general surgeon who was equally without a clue. George then arranged for consultations at George Washington Medical Center. No answers there either. One specialist at GWMC told me to go back to my PCP as my problems, he told me, were more of a general nature. So I did that but my PCP said he didn’t know what to do anymore than he did when I first went to see him. He suggested another specialist. Now you may know that I’m a retired Navy Admiral. When there was a problem on my ship, if nobody else knew what to do they came to me. I had to deal with it. The buck stopped with me. And I was usually able to think things through and come up with some sort of plan. I was usually able to grab the bull by the horns as they say, and move forward. My doctors however have not been able to do that.”

“Admiral Smyth, it’s very nice to meet you,” said Ben. “Please tell Joe and me about your pain.”

“It’s a dull but intense ache in the center of my abdomen. I’ve had it for about 6 months and it’s getting worse. But here’s the funny thing. It only comes on when I walk. As long as I walk at a brisk pace it stays with me. When I stop the pain fades away fairly rapidly. I may be 90 years old but I still like to be active. I play golf and I like to walk instead of using the golf cart. But I just can’t manage that anymore because of this pain and nobody seems to know what in the name of all that is wonderful the problem is.

“I’ve had tests galore. They’ve looked down from above into my stomach and they’ve looked up from below into my colon, all with scopes of course. I’ve had an abdominal sonogram and an abdominal CAT scan. Nothing was found on any of these tests according to my doctors. I’ve had tons of blood work and also urine tests. No answers,” said Admiral Smyth.

“Admiral, have you ever had a blockage of an artery anywhere in your body?” asked Ben.

“I had a blocked carotid artery in my right neck. They found that after I had an episode of weakness on the left side of my body. It lasted only minutes. They called it a TIA. The artery was surgically unclogged. They called the procedure an endarterectomy. That was 8 years ago. I’ve never had another TIA. Then I had chest pain about 5 years ago. They found a blocked coronary artery and put a stent in it. No trouble since. And I had a blocked artery in my right thigh. I was getting pain in my right leg when I walked. They did a bypass to correct that, about 3 years ago. I think they called the operation a femoral-popliteal bypass. It worked. No more trouble,” said the Admiral.

“Joe, do you have any questions for the Admiral?” asked Ben.

“Sir, have you ever been a tobacco user and are you currently on cholesterol lowering medication?” said Joe.

“I quit cigarettes 15 years ago Joe. I was a 2 pack per day smoker. I do take a statin drug for my cholesterol,” said the Admiral. “I think you have copies of all my test results.”

“We do sir. Your blood and urine results are remarkably good,” said Joe.

“Can we do a physical examination on you Admiral?” asked Ben.

“Of course,” said Admiral Smyth.

Ben and Joe then did a hands on physical examination on their patient. The only abnormal finding was that of slightly reduced pulses in both feet.

Ben was now ready to have a conference with Admiral Smyth.

“Admiral, Joe and I would like talk about your case with you present. Is that OK?” said Ben.

“Yes indeed, Dr. Kaplan. Go right ahead,” said Admiral Smyth.

“Thanks Admiral. Joe, I believe that the answer to the Admiral’s case is to be discerned entirely from his medical history. The fact that his abdominal pain comes on when he walks suggests to me that the pain is due to lack of blood flow to his abdominal organs,” said Ben.

“Ben, are you saying that because when the Admiral walks, his leg muscles demand more blood flow, and that because of that increased demand for blood by his legs there is then a reduction of blood flow to his abdomen?” asked Joe.

Admiral Smyth then piped in excitedly, dropping all formalities. “Ben, are you saying that my leg muscles, when I walk, are stealing blood from my intestines and that this lack of blood is causing my abdominal pain?”

“Exactly Admiral! You’re a genius sir! When you walk, the lack of blood and the oxygen that it carries is being shunted away, or stolen, from the arteries that supply your intestines and instead is delivered to your legs. There isn’t enough blood flow to adequately supply both your legs and your abdominal organs when you’re walking. This is causing you to have ischemia of your abdominal organs. That ischemia causes pain. We call that pain abdominal angina.” said Ben.

“Ischemia, doctor? What is that? And how do you pronounce it?” asked Admiral Smyth.

“It’s pronounced isskeemia Admiral. It’s what happens when the flow of blood, with the oxygen that it carries, is reduced. So ischemic colitis occurs when the colon is deprived of blood. Ischemic heart disease, which can cause chest pain or angina, occurs when the blood supply to the heart muscle is reduced. That occurs when coronary arteries are blocked,” said Ben.

“Ben, doesn’t your theory require the presence of an artery or arteries connecting the abdominal circulation with the circulation to the legs?” said Joe.

“It sure does Joe. You’re right on target! One or more of the three major arteries that come off the aorta in the abdomen to supply blood to the stomach and intestines are likely blocked. Let’s just refer to those organs, the stomach and intestines, as the gut. Sometimes a small artery or even a network of small arteries run between one or both of the internal iliac arteries, which supply blood to the legs, and one or more of the 3 arteries that supply blood to the gut,” said Ben.

“Ben, are you describing collateral circulation?” asked Joe.

“Exactly Joe,” said Ben. “These small arteries, collateral arteries, can enlarge and become a vascular bridge between the gut circulation and the leg circulation when those circulations have chronically reduced blood flow due to atherosclerotic blockages. So when the legs demand more blood as they do when a patient walks, there is less blood available to the gut through the collateral vessels. That causes ischemia of the gut and the pain that results is called abdominal angina.

“So what do we do Ben? How do we move forward?” asked Admiral Smyth.

“We need an imaging study to definitively map out the circulation in your abdomen and pelvis. Because your kidney function is slightly abnormal I’m going to recommend a magnetic resonance angiogram, an MRA, with gadolinium as the contrast agent. I think that will give us the detail we need to map out your circulation including the collateral arteries. Gadolinium is easier on your kidneys than the contrast agent we use for CAT scan imaging of arteries.

“After this MRA study has been completed we’ll know what your options for treatment are,” said Ben.

“Ben, you’ve given me hope. You’ve listened to my story and come up with a hypothesis to explain my pain as well as a plan for the next step. You know Ben, I don’t know why the other doctors that I saw could not have done this. It seems to me that a doctor needs to work through the tough cases like mine and not just refer out all but the easiest cases.

“Ben, can I ask you a personal question?” said Admiral Smyth.

“Sure, Admiral,” said Ben.

“What is the most important thing in the world. What is the thing against which everything else, everything, pales in importance?” asked the Admiral.

“That’s an easy one Admiral. A personal relationship with the Messiah, the Lord Jesus Christ, is the most important thing,” said Ben.

“You don’t know how glad I am to hear you say that Ben! None of my other doctors are Christians. George told me you’re a Christian, a Jewish believer in Yeshua, but I wanted to hear it for myself. I’ve known the Lord Jesus for 60 years now,” said the Admiral.

“I’m so glad to know that Admiral,” said Ben.

“Now, if you and Joe will just wait a minute, George wants to thank you for coming up from South Carolina, and I think he also wants your opinion on the pre-tribulation rapture,” said the Admiral.

“Sure. And we’ll talk with you further soon, Admiral,” said Ben. “But Admiral, how about a word of prayer before Joe and I leave you?”

“I would really like that, Ben!” said the Admiral.

The three men joined hands and Ben asked the LORD to provide peace and a good outcome for Admiral Smyth. All three men then praised God.


On the trip home

“That was quite a case Ben. How do you know George or should I say POTUS? How did he decide to call you up here to see his father- in-law?” asked Joe.

“We were classmates in college Joe. It was good to see him again after all these years,” said Ben.


3 weeks later

“Great news Joe! The Admiral just called. He is doing really well. Two of the three arteries to his gut were completely closed off, but the middle artery of the three, the superior mesenteric artery, was not completely blocked and a stent was inserted into it. That increased blood flow to the gut enough so that he is no longer dependent on blood flow through the collateral arteries and he can now walk without any abdominal pain. He started back on the golf course this week!

“The Admiral also sends thanks and regards to us both from George,” said Ben.

“Fantastic! Thanks, Ben,” said Joe.


Who is the Messiah? Part 2

This post is dedicated to Lynn Wright and Aaron Hyman.

My dear Jewish brothers and sisters, I think you know by now that I have an unshakable conviction that Yeshua, Jesus, is our Messiah. If I have this unshakable conviction, why is it that so many Jewish people refuse to believe that Yeshua is the Messiah? I practiced medicine for 46 years and my specialty was making the correct diagnosis in difficult cases. I was successful at it, and to be successful at it, I had to analyze data and weigh evidence constantly. Weighing evidence is a significant part of what we need to do when we approach a question such as “Is Yeshua the Messiah?” Nevertheless, there are reasons why most Jewish people do not believe Yeshua is The Messiah, and in attempting to find out why, I had to sift and weigh a great deal of evidence, both positive and negative. An important piece of negative evidence is something that is important in Judaism today. It is the 13 Articles of Faith formulated by a rabbi who has had a profound influence on Jewish thought and belief for the past approximately 900 years. His name is Maimonides, and there is no rabbi held in greater esteem today by Jewish people all over the world than Maimonides.

Maimonides, also known as the Rambam, an acronym for Rabbi Moses ben Maimon, was born in Spain, where his father was a prominent rabbi. The family was forced to leave Spain because of severe persecution from the Almohades Islamic Dynasty which ruled in Spain and in Western North Africa. The family relocated to Fez, Morocco, where persecution from the very same Islamic sect again forced the Rambam and his family to depart. After a brief stay in Palestine, Maimonides settled in Egypt where the Almohades Dynasty did not rule, and due to his brilliance, kindness, and love for his people, the Jewish people, he became head of the Jewish community in Egypt. It should also be noted that The Crusades started not long before Maimonides was born. So Maimonides lived at a very turbulent time and, in fact, things were so bad for the Jews that there was at that time great yearning for the coming of The Messiah so that peace would reign and persecution would cease. I think it would have been very hard for Maimonides to accept the belief that The Messiah, Yeshua, had already come and would come again at a later date. Maimonides had been taught that when the Son of David, The Messiah, came there would be world peace and that the Jews would never be persecuted again.

This brilliant young rabbi, Maimonides, codified Jewish Law from the Hebrew Scriptures and the Talmud in his monumental work, the Mishneh Torah. It is from the Mishneh Torah that we get the 613 laws that we Jews know about today. The Mishneh Torah is revered by rabbis all over the world.

Maimonides also authored the 13 Principles of the Jewish Faith, mentioned above, which in his eyes every true Jew should know and believe. In fact, The Principles are recited in synagogues around the world today in the form of the Yigdal prayer found in the Siddur. I have it in my very own Artscroll Siddur1. Each of the 13 Principles begins with “I believe in perfect faith”. These Thirteen Principles are taken very seriously indeed. Although Maimonides lived about a thousand years after Yeshua’s time, understanding the Rambam’s 13 Principles can help to explain why many Jewish people today refuse to believe in Yeshua.

I want to talk with you now about one of The Thirteen Principles, namely the Third Principle. The Third Principle is the negation of corporeality. God cannot have a body. Since Jesus had a body and said that he was God the Third Principle makes Jesus a liar and a scoundrel. Jesus also said that he was the Messiah. How could a Jewish person accept a scoundrel and a liar as The Messiah? There is no way! Except for one thing: the Rambam, as great and good as he was, was dead wrong. Let me show you the evidence for this by looking at a portion of Scripture with you from the New Testament that shows us that Maimonides’s Third Principle is absolutely incorrect. This Scripture portion will show us two things: that Yeshua was, and is, God, and that God can be corporeal, meaning that God can have a body. Here is the Scripture portion:

“And getting into a boat he crossed over and came to his own city. And behold, some people brought to him a paralytic, lying on a bed. And when Jesus saw their faith, he said to the paralytic, “Take heart, my son; your sins are forgiven.” And behold, some of the scribes said to themselves, “This man is blaspheming.” But Jesus, knowing their thoughts, said, “Why do you think evil in your hearts? For which is easier, to say, ‘Your sins are forgiven,’ or to say, ‘Rise and walk’? But that you may know that the Son of Man has authority on earth to forgive sins”—he then said to the paralytic—“Rise, pick up your bed and go home.” And he rose and went home.” Matthew 9:1-7 (ESV)

So what happened here? A number of things:

  1. Yeshua said to a paralytic, who could not walk, “your sins are forgiven”.
  2. Because only God can forgive sins, Yeshua was saying that he is God.
  3. This was clearly recognized by some of the Jewish scribes because they said “This man is blaspheming”.
  4. When a person is forgiven of his or her sins there is no immediate way to know that that has occurred. There is no outward change in the person’s appearance that can be observed.
  5. Therefore, Yeshua offered proof to the scribes that he had authority on earth to forgive sins by doing a miracle which was much more difficult to do than proclaiming “Your sins are forgiven” to a person and which could be verified by an easily observable external change: Yeshua told the paralyzed man to pick up his bed and go home, and the man immediately did this. He was healed.

Please also note that Yeshua referred to Himself here as the Son of Man:

But that you may know that the Son of Man has authority on earth to forgive sins”—

Yeshua did this to call attention to the fact that not only is he God, he is also human, and that would of course be obvious to anyone who saw him. He was and is a man. But because he could and can forgive sins, he is God. He is the God-Man. He has two natures: he is perfectly human in every way, except for the fact that there is no sin in him (unlike each and every one of us) and, he is God, the Son of God, with all the attributes of God. He had to have both natures, that of God and that of man in order to save us. Because to save us required the ultimate blood sacrifice and that means that Yeshua had to die, and as God he could not die. He had to have the nature of man in order to die and the nature of God in order to forgive sin by becoming the perfect blood sacrifice. Please remember that the Torah makes it clear that a blood sacrifice is required to make atonement for sin (Leviticus 17:11) and please also note that the blood of animals could not provide permanent forgiveness of sins. That is why animals had to be sacrificed again and again. Yeshua’s one blood sacrifice provides permanent forgiveness of sins for anyone who will accept it by faith.

Please note one other thing. Jesus proved he is God. God does not lie. Jesus said he is the Messiah. Therefore, he is The Messiah..

So, my dear Jewish brothers and sisters, can you see how Maimonides’s Third Principle can seriously discourage a Jewish person from accepting Jesus as Messiah and God? And can you imagine the effect that this Third Principle could have on a modern Rabbi, who’s job it is to teach people the truth, but who may be unwittingly teaching his people an untruth embedded in this Third Principle? And do you know that because this Third Principle is so embedded in our prayerbooks, teachings, and culture, that you, as a Jew today, can be affected by it even if you have never heard of Maimonides or his 13 Principles of the Jewish Faith? Let me say it once more: The teaching that God can not have a body is incorrect (more about this another time; our Hebrew Scriptures spell this out clearly also). And saying, and believing, that God came to earth as The Messiah and God, as The God-Man (there is only One!), does not make you a heretic. On the contrary, it makes you a truer Jew than you could ever otherwise be!

We will talk about these things more in future posts because there is much more to say. But in the next post, we’ll switch gears and talk about something different. We will talk about something that Yeshua paid the price for us to escape from, if we have faith in Him. We will talk about something called The Time of Jacob’s Trouble and we will also talk about something called The Rapture.

Hope to see you next time!