Category: Medicine

Of course there will be medicine. I am The Grumpy Doc.

Vaccinate! Vaccinate!

On December 29, 2021

I’m going to climb on my soap box to thank those of you who are either fully vaccinated against COVID or who are in the process of becoming so. The only chance we have of putting this virus behind us is to reduce the population of non-immune, so that the possibility of new variants is limited. Hopefully, we can accomplish this by increasing the immune population through vaccination rather than decreasing the non-immune population through COVID related deaths.

The vaccine is safe. Yes, there have been reports of serious events and even death among people who were vaccinated. However, these events are approximately equal to their occurrence in the general population and with very few exceptions the vaccination could not be attributed to their death. Additionally, risk factors for adverse reactions, which can happen with any medication, have been identified and those people likely to have a reaction are not being vaccinated until further studies can be done.

The number going around on the internet is that 14,000 people died from the COVID vaccination. This is a blatant misstatement of the facts. Fourteen thousand people who had been vaccinated died during the study period. After careful review of each case, it was determined that the vast majority of deaths were attributed to other causes and for many of the others a proximal cause of death could not be identified. This is out of the more than six million who had been vaccinated at the time the number was first reported.

The bottom line is this: there have been over 800,000 COVID deaths in the US and over 5,000,000 deaths worldwide. This disease will continue its rampage until everyone does their part to stop the spread.

I find the argument about personal freedom to be disingenuous. We all give up some degree of personal freedom to live in a civil society. We get a drivers license. We stop at red lights. We don’t steal. We don’t go shopping in our underwear (except possibly at Walmart, but that’s a topic for another day).

I have to ask, “Do you consider your concept of personal freedom so important that you are willing to put the lives of others at risk?” If you do, then this is not about freedom, it’s about selfishness.

This is more important than politics. This is life and death. Please, get vaccinated.

A Deadly Blood Clot: AKA The DVT

By John Turley

On November 22, 2021

In Medicine

Blood clots, mainly in the legs, also known as deep vein thrombosis (DVT), are a major health risk for older Americans. They can lead to serious health complications and potentially even death. Learning to recognize risk factors for DVT as well as the warning signs that you may have developed one is vitally important. Equally as important is understanding the things you can do to minimize your risk.

Risk factors include prolonged periods of immobility such as hospitalization or broken bones, as well as a long-distance travel, particularly air travel. Prevention of DVTs is the reasons many hospitalized patients are put on anticoagulants (blood thinners) either by mouth or by shots in their abdomen. Other risk factors include smoking, obesity, orthopedic surgery, use of oral contraceptives or hormone replacement therapy, cancer, heart failure and age greater than 65.

DVTs form in the deep veins of the legs. These are the large veins that communicate directly with the lungs. When small pieces of blood clot break off, they can travel to the lungs and cause what is known as a pulmonary embolism (PE). This can be a major threat to life and may require long term treatment with anticoagulation medicines. While not every DVT leads to a PE, It is important to recognize the warning signs that you may have a DVT and even more important to understand how to go about preventing them.

First, we should recognize the difference between DVTs and their unattractive cousins, varicose veins. We’ve all seen varicose veins and many of us have them. They are unsightly and sometimes can even be painful. However, they do not present the same risk to health and life as DVTs. Varicose veins are superficial veins and even if clots are formed in them, they cannot make it to your lungs.

There are several things to look for that may indicate you have a DVT. The most common is unilateral calf swelling where one leg is about two inches larger than the other measured at a point about four inches below the knee. Since most of us don’t carry a tape measure, be concerned if one leg looks larger than the other. Swelling may also consist of an entire leg. Occasionally both legs may be swollen but that is unusual. The swelling is often what is called pitting edema. In pitting edema, you can press your finger into the swollen area and remove it and a dent remains. Calf tenderness in the swollen leg may also be indicative of a DVT. If the swelling is significant, numbness may also be present. Pain with walking is also common and, in some cases, the swollen leg feels warm to the touch. Some of the same symptoms can be found in complications of varicose veins known superficial thrombophlebitis, a painful but not usually life-threatening condition. If you have any of the above symptoms you should immediately visit your family physician or other medical provider to ensure that a DVT is not missed.

And now, the most important part, what can you do to keep from getting a DVT? The easy things first. Wear loose clothes, drink plenty of water, and avoid anything with alcohol or caffeine. The best way to prevent a DVT is to get up and walk every couple of hours. Of course, this is easier said than done on a transcontinental or international flight. So, let’s look at a few things that can be done in your airline seat, or even in your car, to reduce your risk.

You want to exercise your legs while you’re seated. First you can raise and lower your heels while keeping your toes on the floor. You can also raise and lower your toes while keeping your heels on the floor. You can tighten and release your calf muscles. A little more advanced exercise is to lift your feet off the floor and twirl them around as if you’re trying to draw circles with your toes. If you have sufficient room in your airline seat you can try extending your knees or doing knee lifts. For most of us though there just isn’t enough room in an airline seat for doing these last two. You should do these exercises for about 30 to 40 seconds each and they should be repeated about every 30 to 40 minutes. This may not eliminate your risk of developing a blood clot but will certainly reduce it. Additionally, while there is some evidence to suggest that aspirin may reduce the risk of developing a blood clot, there are currently no specific guidelines for its use in prevention of DVTs and aspirin therapy does have some associated risk of bleeding. Be sure and contact your family doctor before starting aspirin therapy to prevent DVTs.

If you have any concern at all, seek medical assistance. It is better to be safe than to miss a DVT. Finally, safe travels.

Medicine During the American Revolution

By John Turley

On June 17, 2021

In History, Medicine

We all have an idea of what life was like for our 18^th century ancestors: no electricity, no running water or indoor plumbing, no central heat, no telephone or computers, no rapid transportation. But try to imagine what medicine was like under these conditions. Most things that we take for granted as a routine part of our medical care did not yet exist. There were no X-rays, no lab tests, no EKGs, no antibiotics and no concept of sterile procedure or anesthesia. Surgery was a painful and often fatal process.

In many ways, medicine was more of a trade than a profession. There were only two medical schools in 18^th century America. The Philadelphia Medical College was founded in 1765 and Kings College Medical College in New York two years later. Most physician and surgeons (chirurgiens as it was spelled at the time) who had formal training received it in Europe. By far, most physicians received their training by a one-to-three-year apprenticeship in the office of an established physician. Others, particularly on the frontier, simply declared themselves physicians and set up practice. In some remote areas, surgery was performed by the local barber or butcher because they had the tools.

The first medical society was formed in Boston in 1735. By the mid-1700s most colonies required a medical license of some form. In many colonies the medical license was little more than a business tax with few, if any, enforceable professional standards. The first hospital in the colonies was founded in Philadelphia in 1751 by a group that included Benjamin Franklin.

In 1775 there were an estimated 3000 physicians practicing in the colonies. Fewer than 300 had a medical degree or a certificate from a formal apprenticeship. Early attempts at licensing were resisted as an attempt to place a monopoly on medicine. Massachusetts was the first colony to attempt regulation by issuing a certificate of proficiency for completion of an approved apprenticeship. But even in Massachusetts, as notable a physician as Benjamin Rush reported that the only prerequisite for “…. a doctor’s boy (apprentice) is the ability to stand the sight of blood”.

While modern concepts of disease and sanitation were beginning to evolve in the late 18^th century, many practitioners still ascribed to the almost 1000-year-old ideas of the Greek physician Galan. He believed that the body had four humors: blood, phlegm, yellow bile, and black bile. Good health required a balance of the humors and illness resulted from their imbalance. Attempts to restore balance included bleeding, purging, diuretics and laxatives, and placing heated cups on the back to form blisters and draw out the humors. It was this belief that led to the bleeding that hastened George Washington’s death. Quite literally, the cure was worse than the disease.

The physicians of the time had few effective medicines and often acted as their own apothecary, compounding medications of spices, herbs, flowers, bark, mercury, alcohol, or tar. Opium elixir was marketed to help babies sleep through the night. Mercury was used to treat everything from syphilis to scabies. Voltaire summed up the state of pharmacology when he said “…. a physician is one who pours drugs of which he knows little into a body of which he knows less.”

Disease and hardship were a fact of life in the colonies. One in eight women died in childbirth or from complications of pregnancy. One in ten children died before the age of five. Diseases such as malaria, yellow fever, typhus and measles ravaged many communities. They were especially deadly for American Indians.

Smallpox was perhaps the deadliest disease of the colonial period. Entire American Indian tribes were annihilated. Epidemics repeatedly swept through the colonies in the 1700s killing thousands. George III became King of England in part because of smallpox. The last Stewart claimant to the throne died of the disease and England looked to the House of Hanover for the German born King George I.

Inoculations against smallpox had been widespread in Africa and in Arab countries for many years. In the American colonies inoculation was denounced as barbarian and some clergy preached that it was thwarting God’s will. Despite the support of such notables as Cotton Mather and Benjamin Franklin, inoculation against the disease was not widespread until George Washington, seeing the debilitating effect of smallpox on the Continental Army, ordered massive inoculation of all troops.

Disease and poor hygiene were the greatest foes faced by the army. John Adams reported that for every soldier killed in battle, ten died from disease. On July 25, 1775, the Continental Army Medical Corps was formed. Initially, each regiment was required to provide its own surgeon and there were no established qualifications. Only Massachusetts required examination of regimental surgeons and many colonies did not provide the surgeons with a military rank. To make matters worse, the first director general of the army medical corps, Dr. Benjamin Church, was a British spy.

Modern ideas of sanitation were unknown to most colonists. Few people bathed because they believed it removed the body’s protective coating. Most soldiers had only a single set of clothes in which they also slept and almost never washed. Army camps were hot beds of flux (dysentery) and camp fever (typhoid and typhus, the distinction between them was unknown). Camp fever took a huge toll on the army because it left the survivors so debilitated that they required almost constant care and seldom returned to duty.

Sanitation consumed a large part of General Washington’s time at Valley Forge. Latrines, garbage disposal and animal manure were constant problems. Attempts to prevent and treat the itch (scabies) were relentless. At times, several hundred soldiers would be unfit for duty due to infestation. What little clothing and blankets they did have often had to be burned to prevent the spread of the parasite.

Conditions in army hospitals were not much better and could be far worse. Camp fever spread rapidly through the close confines, often killing entire wards, including the staff. Death rates could run as high as 25% in hospitals and many soldiers preferred to remain in camp where they felt they had a better chance of survival. Dr Benjamin Rush stated “Hospitals are the sinks of human life. They robbed the United States of more citizens than the sword.”

The French, as with many things during the revolution, aided the patriots with their health problems. Dr. Jean Francois Coste, chief medical officer of the French Expeditionary Force, was one of the first to introduce strict regulations concerning sanitation and hygiene in army camps. The Americans, noting the significantly better health of their allies, were quick to follow suit.

The revolution was always close to failure. It was made even closer by widespread disease. But as with everything, our patriot ancestors persisted and triumphed.

This post was adapted from my article published in The SAR Magazine, Fall 2020, Sons of the American Revolution.

Sources:

Colonial Society of Massachusetts. Medicine In Colonial Massachusetts 1620-1820. Boston, MA, 1980

Miller, Christine. A Guide to 18^th Century Military Medicine in Colonial America, Self-Published,Lexington, KY, 2016.

Reiss, Oscar, MD. Medicine and the American Revolution; How Diseases and their Treatments Affected the Colonial Army. McFarland & Co, Jefferson, NC, 1998.

Shryock, Richard. Medicine and Society in America 1660 – 1860. Cornell University Press, Ithaca, NY, 1960.

Terkel, Susan. Colonial American Medicine. Franklin Watts, NY, 1993.

Wilber, C. Keith, MD. Revolutionary Medicine 1700 -1800. The Globe Pequot Press, Guilford CN, 1980.

Doctor Google Will See You Now

By John Turley

On May 7, 2021

In Medicine

There are few words that cause more trepidation among doctors than having a patient start off a visit by saying, “I was reading on the internet”. It’s not that we don’t want our patients to be well informed; a knowledgeable patient is an important part of successful health care. It is what we call the therapeutic alliance.

What we worry about is what they may have been reading on the Internet. There is a lot of good information available, and I always encourage my patients to learn as much as they can about their own health issues. There are many professionally researched and peer reviewed medical websites. They include such commercial sites as Medscape and WebMD. They also include patient advocacy sites such as the American Diabetes Association and the American Heart Association. And, of course, there are the government sites such as the Centers for Disease Control and the National Institutes of Health. All these present the best available science and benefit from rigorous research and review.

That is not to say that they won’t change. Science evolves and knowledge improves. What is our best knowledge now may at some point in the future be proven wrong. However, your best chance of getting solid information is on these well documented sites.

What I worry about are the undocumented or unverified websites that provide what can best be called rumor or conspiracy. Any time a patient tells me,” I was reading on the Facebook page “The Truth About….,” I cringe. Any Facebook page entitled “The Truth About…” is unlikely to contain much truth.

False information takes on a life of its own on the internet. The big lie almost always buries the truth. Long after the article that was the basis for a false claim linking the MMR vaccine with autism was withdrawn by the British medical journal The Lancet, and long after the physician who wrote the article was found by the British General Medical Council to have falsified the data and long after he lost his medical license, the study is still quoted by many anti-vaccine people as being a fundamental truth.

Even when the authors of such false information repudiate it, people still believe it. It becomes part of the legend that “they” forced the author to remove it. No one ever explains who “they” are or why “they” want to keep the public in ignorance. Of course, there is never any source documentation or research reference.

The websites espousing false medical information may be second in number only to that espousing false political information. At times it seems that the more outlandish the claim the more readily their adherents believe it. It doesn’t even seem to matter that this type of information is frequently published anonymously. You would think the readers would wonder why a person in possession of such great knowledge would refuse to take credit for it. I have often thought that if I anonymously posted on the internet that everyone who has ever drank water has died, that suddenly a large portion of the population would stop drinking water.

So, in closing, I just want to say I want all my patients to be well informed and take an active interest in their health care. And I encourage you to Google any medical questions you have. Just be sure that what you are reading is accurate and verified and scientifically based. Don’t allow conspiracy theories and “crackpot science” to have a detrimental effect on your health.

If in doubt, ask your doctor. If you don’t trust your doctor to give you factual information and prefer to consult with the anonymous pseudo medical websites then perhaps it’s time to find a new doctor. But please, think twice before disregarding the advice of someone whose entire professional life is dedicated to your good health.