Death Stymied by a Moving Target
- Lifesaving Treatment for a Heart Attack-A Chair
- Let the Patient Get Well
- Books on Healing
- Colds and Flu Home Remedies
- Coming Soon
Lifesaving Treatment for a Heart Attack-A Chair
Have you ever heard of the Chair Study? It changed cardiac care dramatically, has saved millions of lives, and yet is something physicians found very easy to forget.
In the early part of the 1900s we had no effective medications to treat people with heart attacks. So doctors decided it was best to keep them in a hospital bed for four to six weeks while nature did the healing. Patients were not even allowed to turn from side to side without a nurse's assistance. They had to use bedpans. For the first week, the nurse fed them with a spoon.
The idea behind this was that we treated a sprained ankle by taking the weight off it and a broken bone by immobilizing it in a cast. Nature did the rest. So, when a person had a heart attack, we needed to keep that heart beating as slowly as possible. Thus, the treatment plan.
Even with this, about a third of heart attack patients died. Just being in bed for a long time causes blood clots. So one out of 10 heart attack patients died of a pulmonary embolism. Others died from fluid in the lungs-this accumulated because they were horizontal and prevented from being active. Most became discouraged and depressed. Force your type A heart attack patient into bed and tell them what they can do every minute and happiness will not follow! Plus, no matter what their personality was, everyone's muscles got stiff and every joint complained. They hurt-a lot. (You try lying in bed for days.) So, doctors gave them relief with morphine and they got constipated.
Looking back, you might be amazed that doctors even thought this up and patients went along with it. But they did, for decades-a testament to us doctors' allegiance to tradition and the old-time patients' great respect for physicians.
In 1950 a brilliant young cardiologist named Bernard Lown fought for permission to try something different. What he wanted was to get heart attack patients up in a chair for an hour or less each day to see if this could reduce the blood clots and depression. It wasn't easy to convince the older doctors. They grudgingly let him prove himself wrong. He let 80 patients at Peter Bent Brigham hospital sit in a chair part of each day. Patients rejoiced, especially when they realized they would no longer have to try to take care of their constipation while sitting on a bedpan with a nurse standing by.
Dr Lown wasn't wrong. Twice as many people survived their heart attack. Deaths from pulmonary blood clots fell to zero. Treatment costs were slashed.
No cardiac advance since then has made this much difference.
Let the Patient Get Well
Some years later came the Korean War and the Mobile Army Surgical Units made famous by the MAS*H television series. Wounded soldiers didn't get private rooms, nor double rooms. In Korea they recovered in tents sheltering 200 men at a time. Nursing staff were too shorthanded to keep track of them all-so those that could disobeyed nursing orders, got up, walked around, and visited. Doctors found that these men recovered far faster than patients with similar surgeries recovering in bed back in the States.
When someone comes to the doctor with discomfort, we have a natural urge to do something for them. Sometimes this leads to harm, as described above. Other times the narcotic prescription leads to addiction, or a medication to an unexpected side effect, or a back surgery to increased pain instead of reduced pain. To that last point, it'll probably surprise you that today the leading cause of back pain in the United States is previous back surgery. Back pain is common and it's much more likely to harm you if you slow down. The best treatment, almost always, is to keep going.
Many emotional problems respond best to acceptance. No one leads a stress-free or pain-free life. Lean into life's discomforts, realize that intimacy comes with suffering and that there is no joy without antecedent despair. Whatever happens, you are not alone. Keep moving!
Many diseases-sore throats, colds, certain cancers and even eye diseases-do better with watchful waiting. Let nature do the work and the doctor keep an eye out for trouble in case it shows up.
Sometimes we docs find that the less we slow our patients down, the faster the suffering goes away.
Books
You can read more about Dr Lown's work in The Lost Art of Healing: Practicing Compassion in Medicine.
He emphasizes that we docs need to slow down and pay attention to the details. We need to do as much as possible for the patient, and as little as possible to the patient.
For more about the Army hospitals in Korea, you may enjoy MASH, by Army surgeon Otto Apel. His book was one of the inspirations for the TV series.
Colds and Flu Home Remedies
Here's a summary of home remedies for colds and flu https://www.nytimes.com/article/flu-cold-home-remedies.html from the New York Times. They've got a good summary of the best remedies.
Coming Soon
For many years I got this newsletter out once a month, probably because I led the monk-like existence of a single man. Getting married changed that. My wife wants me to talk to her, listen to her, etc, and has made other such unreasonable requests, so I've had less time. (I'm joking, honey!)
More importantly, she's taken over the editing of this newsletter and she's encouraging me to write as frequently as I'd like to.
If I am going to write more, I need to address social determinants of health because they so strongly impact wellness and medical practice.
Stay tuned!