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INTRODUCTION


R U MEDICALLY CURIOUS? Not just a little, but really curious? You spend your whole life in the same body. Yet, most of you know almost nothing about it. As a physician, what always intrigued me were my patients’ questions. Otherwise very bright people seemed absolutely clueless in medical matters. It’s not for lack of information. The Media and the Internet supply tons of that – both good and bad. No, the problems are language and understanding.

Here’s how it works: I take your history, do a physical exam, and review your tests. Then, I slowly nod my head as I tell you my diagnosis. To be polite, you slowly nod your head, even when you have no idea what I just said. Your mothers would be proud. You always nod politely.

So, language is the first problem and doctors get full blame. We created a whole new secret lingo called “Medicalese”. It’s not your thigh bone. It’s your Femur. You didn’t have a heart attack. You had an Acute Myocardial Infarction. Even a simple toothache might be an Anaerobic Gingival Abscess! (see Chapter 3 – Translating Medicalese)

But, not understanding? You get full credit for that one. Why? The Media and Internet feed you a steady diet of medical oddities, rarities, and misleading information. You swallow those like vintage champagne. You eagerly discuss them with all your friends. But, when’s the last time you pushed your doctor so you could understand something? Hmmm… Old saying: An expert who can’t explain his expertise is not an expert.

R U MEDICALLY CURIOUS? is written at a high school reading level to present Evidence Based Medicine on common medical topics.

TED is Ted Heyman, the Editor. He’s a computer guy from Florida who’s known Larry since high school. He edited Larry’s respiratory textbook Simple as ABG and created the e-version of it.

LARRY is me, Dr. Larry Romane. I’m board certified in Emergency Medicine, worked as an ER doc for 35 years, retired, and now teach and write about medicine.

Can you answer these simple medical questions in 10 words or less?

  • Exactly what is a heart attack?

  • Why are strokes so disabling?

  • Aren’t brand name medicines safer than generics?

  • Why is everybody I know getting Diabetes?

  • My diet is terrible. Shouldn’t I be on some vitamin or supplement or something?

If not, maybe you’re more medically curious than you thought.

APOLOGY: Sorry healthcare professionals, this book is not for you. It’s written for laymen. You’ll say “it’s over-simplified”, “numbers are rounded off”, “pictures are only schematics”, “averages can be misleading”, etc. And… you’re RIGHT! (But, before you get too condescending, please review the “References” section at the back of the book.)





WEIGHT TIPS

One third of all Americans are obese. Another one third are overweight. (See Height/ Weight chart at end of this chapter) When 2/3’s of the population weighs too much, it begins to look ‘normal’. Things like Diabetes, High Blood Pressure, and knee replacements should remind us - it’s definitely not normal.

A few weight loss tips:

  • A pound of fat contains about 3,500 calories. Cutting back 100 calories every day for a year, takes off about 10 pounds.

  • 3 basic food groups: carbohydrates, proteins, and fats. Carbohydrates and proteins have the same calories per ounce. An ounce of dietary fat has double the calories.

  • Exercise is great for your heart, your blood pressure, your brain, etc. But, the human body is a very efficient machine. Exercise only burns about 200-300 calories per hour.

  • 2 body parts cause 98+% of overweight and obesity. The Thyroid Gland and the hands. If a simple TSH Thyroid test is normal, you’re hands are putting too many calories in your mouth.

BITE WOUNDS

We own about 70 million dogs and 75 million cats.3 We also get more than 5 million mammal bites every year4costing over $100 million for treatment! What bites are most likely to get infected? About 5% of dog bites get infected, 60% of cat bites, and 90+% of human bites. Another reason why dogs are man’s best friend.


ALCOHOL – NECTAR OF THE GODS?

Alcohol has been around since ancient times. Drunken chariot drivers were killing people long before there were drunken motorists.

Wine? Whiskey? Beer? Regardless of what form it’s in, we like the feeling. In fact, a little may even be beneficial. Most risk assessments for heart attack or stroke list “1-2 drinks per day” as a positive influence.

Ah, there’s the rub. Exactly what is ‘a drink’? It’s not, “just a 6 pack, doc”. Nor is it, “just a little Jack on ice, Your Honor”. ‘A Drink’ is:

  • One 12 oz. can of beer or
  • One shot of 80 proof whiskey (1 ½ oz.) or
  • One 5 oz. glass of wine.


 CLEANING EARS WITH Q-TIPS

3 good reasons to never ‘clean’ your ears with Q-Tips:

  • Ear wax is as normal in your ear canals as saliva is on your lips – and just as protective. The wax is secreted by cells deep in the canal, dirt and dust stick to it, daily cell growth pushes the wax out the canal, showering washes it away when it gets to the outside. Perfect design.

  • Shoving a Q-Tip down a tapering funnel makes no sense. You push in more wax than you get out. You may even push it right thru your eardrum (bad idea)

  • Otitis externa – ‘Swimmer’s Ear’ is a painful, smelly, draining infection of the ear canal. What starts it? First, Q-tips wipe away protective wax. Then, they scratch and scrape the delicate canal lining. Finally, water from the 'ole swimmin’ hole may not be exactly sterile… As the “International Journal of Pediatric Otolaryngology" put it, “Use of cotton tip applicators to clean the ear seems to be the leading cause of otitis externa in children and should be avoided.”   


MELANOMA's   A, B, C, & D

MELANOMA: A very dangerous skin cancer. Early treatment has over 95% cure rate. Late disease is almost always fatal. Most common in fair-skinned patients with a family history of melanoma. As with most skin cancers, sun exposure is a key risk. Any suspicious or changing lesion needs biopsy.

Melanoma's 4 Classic Warning Signs are A, B, C, and D
.


National Weight Guidelines *



Height

(feet, inches)


Overweight

(pounds)

Obese

(pounds)
5' 0"
128
153
5' 1"
132
158
5' 2"
136
164
5' 3"
141
169
5' 4"
145
174
5' 5"
150
180
5' 6"
155
186
5' 7"
159
191
5' 8"
164
197
5' 9"
169
203
5' 10"
174
209
5' 11"
179
215
6' 0"
184
221
6' 1"
189
227


Normal Weight  =  Body Mass Index (BMI) under 25

Overweight  =  Body Mass Index (BMI) 25 – 30

Obese  =  Body Mass Index (BMI) 30 and over

* This chart is compiled from data on the National Institutes of Health’s “Body Mass Index Table 1”. (www.nhlbi.nih.gov/health/educational)




GLOSSARY


A1-C : Indirect measure of blood sugar over prior 3 months. (normal = less than 5.7%)

ABSTRACT: Summary of a medical journal article – usually available on-line.

ACETAMINOPHEN: Generic for Tylenol and less expensive.

ACETYLSALICYLIC ACID: Chemical name for aspirin.

ACUTE MYOCARDIAL INFARCTION: Heart Attack (see below).

AEROBIC INFECTION: Infection from bacteria that require oxygen to live.

ANAEROBIC INFECTION: Infection from bacteria that don’t need oxygen.

ANEMIA: Too few Red Blood Cells.

ANNULUS FIBROSIS: Tough outer ring of a disc between vertebrae.

ANTIBODY: Immune system protein designed to engulf a specific antigen (see below).

ANTICOAGULANTS: medicines that slow down blood clotting (also called blood thinners).

ANTIGEN: Foreign protein causing an immune response in the body.

ARTERIOSCLEROSIS: Hardening (narrowing) of the arteries by fatty deposits.

ARTHRITIS: Inflammation of a joint.

ASTHMA: Disease that constricts and inflames breathing pipes in the lungs.

ATRIUM: The 2 upper chambers of the heart – Right Atrium and Left Atrium

ATMOSPHERIC PRESSURE: Weight of the Earth’s atmosphere.

ATRIAL FIBRILLATION: Abnormal heart rhythm when the upper chambers wiggle instead of pump.

AUTO-IMMUNE DISORDER : Body develops immunity against normal body tissue.

BETA BLOCKERS: Medicines used to slow fast heart rhythms and lower high blood pressure.

BETA CELLS : Pancreas cells that produce insulin.

BMI (Body Mass Index): Estimate of body fat. Normal=25; Overweight=25-30, Obese=30+.

BRONCHUS: Cartilage breathing tubes from the windpipe into the lungs.

BRUIT: Sound of turbulent blood passing thru a narrowed artery.

BURSA: Collapsed water balloon to pad bony angles (knee, elbow, hip, etc.).

BURSITIS: Inflamed bursa.

CABG: Coronary Artery Bypass Graft (see below).

CAPILLARIES: Tiny blood vessels between the end of an artery and the beginning of a vein.

CARDIAC ARREST: Complete heart stoppage with no blood being pumped.

CARDIAC CATHETERIZATION: Thin tube slid into a heart blood vessel for x-ray or procedure.

CARDIAC ENZYMES: Specific heart proteins that may leak into the blood after a heart attack.

CARDIO-PULMONARY ARREST: Complete stoppage of breathing and heartbeat.

CARDIO-PULMONARY RESUSCITATION: Various temporary techniques to circulate blood and artificially breathe for a patient after a Cardiac-Pulmonary Arrest. CPR for short.

CAROTID ARTERIES : 2 arteries in the front of the neck that are the brain’s major blood supply.

CARTILAGE: Shiny, slippery tissue covering bone ends.

CDC: Centers for Disease Control & Prevention (adding cdc to web search improves results).

CHF: Congestive heart Failure (see below).

CEREBROVASCULAR ACCIDENT (CVA) : A stroke.

CERVICAL SPINE: Top 7 vertebrae - neck portion of the spine.

CHOLESTEROL: Fatty chemical made in the liver, essential for all body cells, and previously believed to be the cause of heart attacks and strokes.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE: Lung elastic tissue essential for exhaling is destroyed by smoking.

CLAVICLE: Collar bone.

CONGESTIVE HEART FAILURE: Heart’s become too weak to pump out all blood coming in to it.

CORONARY ARTERY BYPASS GRAFT: Small section of arm or leg vein used to surgically bypass a blockage in a heart artery.

C.O.P.D.: Chronic Obstructive Pulmonary Disease (see above).

COCCYX: Tailbone.

CONGESTIVE HEART FAILURE: Heart’s too weak to pump out the blood coming in to it.

CORONARY ARTERIES: Two small arteries that supply the heart.

CONTRAINDICATIONS : medical conditions or reasons when a drug cannot be used.

CONTUSION: Bruise.

COUMADIN: Oldest and most widely used blood thinner – also called Warfarin.

CVA: Abbreviation for Cerebro-Vascular Accident – a Stroke.

DELUSION: Unreal thought.

DEPRESSION: Depleted brain chemicals make patients feel hopeless, helpless, and worthless.

DIABETES MELLLITUS: Sugar Diabetes (mellitus is honey in Latin) – too high blood sugar from too little insulin for body size.

DIAPHRAGM: Dome-shaped respiratory muscle between the lower chest and upper belly.

DIASTOLIC BLOOD PRESSURE: Lower of the 2 numbers in a blood pressure reading.

DISLOCATION: Bone ends come apart at a joint.

DIURETICS: Medicines that increase urine output to help blood pressure, heart failure, edema (swelling), glaucoma, etc.

ECHOCARDIOGRAM: A sonogram of the heart to check the valves and blood flow.

EJECTION FRACTION: % of blood in heart that it pumps out with each beat.

EKG: (see Electrocardiogram below).

ELECTROCARDIOGRAM: Test showing heart electricity from 12 different views.

EMBOLISM: Blood clot breaking free and traveling elsewhere.

EMPHYSEMA: Chronic lung inflammation and destruction from smoking.

EXTERNAL HEMORRHOID: Large intestine varicose vein just outside the anus.

F.E.V. 1 : Amount you can forcibly exhale in 1 second.

FEMORAL ARTERY: Large right and left groin arteries supplying each leg.

FEMUR: The thigh bone.

FRACTURE: Broken bone.

FLU : Influenza.

FRUCTOSE: A simple sugar found in honey and many fruits.

GENERIC : Medication that’s identical to a brand name product but less expensive.

GINGIVAL INFECTION: Gum infection, often from anaerobic germs (see above).

GINGIVITIS: Inflammation or infection of the gums.

GLUCOMETER: Small computer device to measure blood sugar.

GLUCOSE: A simple sugar and the body’s primary fuel.

GLYCOGEN: 30,000 glucose molecules linked together for storage.

GLYCOLATED HEMOGLOBIN A1-C: See A1-C above.

HALLUCINATION: Unreal sensation like seeing or hearing that don’t exist.

HEART ATTACK: Piece of heart muscle dies when its artery clots off.

HEMATOMA: Blood blister.

HEMAGLOBIN : Iron containing protein that fills Red Blood Cells and transports oxygen.

HEMAGLOBIN A1-C: See A1-C above.

HEMORRHOID: Varicose (distended) vein around the anus.

HERNIATED DISC: Soft center of vertebral disc squirts out from pressure.

HUMERUS: Upper arm bone.

HYPERTENSION: High blood pressure, usually from constricted body arteries.

INFLAMMATION : red, hot, painful, tender swelling designed for healing.

INFLUENZA : Serious respiratory virus – 80% prevented by the “Flu Shot”.

INSULIN RESISTANCE : A theory of Type 2 Diabetes - body cells need more insulin to react normally.

INTERCOSTAL MUSCLES: Respiratory muscles between the ribs to lift the chest.

INTERNAL DEFIBRILLATOR: Surgically implanted electric device wired to the heart to shock it if the deadly Ventricular Fibrillation rhythm occurs.

INTERNAL HEMORRHOID: large intestine varicose vein just inside the anus.

- ITIS : Suffix meaning inflamed.

LARYNX: Voice box.

LEUKEMIA: Disabled, fast growing, cancerous white blood cells take over bone marrow.

LIGAMENTS: Tough soft tissue bands holding bones together at joints.

LUMBAR SPINE: 5 large vertebrae of the concave low back.

MAYO: Short for Mayo Clinic (adding mayo to web searches improves results).

METFORMIN: Type 2 Diabetes pill that lowers blood sugar by a) less sugar absorption by intestine, and b) stops liver from storing sugar as glycogen.

MITRAL VALVE STENOSIS: A narrowed heart valve slowing blood flow and sometimes producing clots.

MUSCULOSKELETAL SYSTEM: Body framework of bones, muscles, tendons, ligaments, cartilage, and joints.

MYOCARDIAL INFARCTION: Heart Attack.

N: The number of people in a study.

NAPROXEN : Generic for Aleve. Top orthopedists’ NSAID choice and least cardiovascular risk.

NIH: Short for National Institutes of Health (adding nih to a web search improves results).

NSAID: Non-Steroid Anti-inflammation Drug.

NUCLEUS PULPOSUS: Jello-like filling of a vertebral disc that can herniate.

ORTHOPEDICS: Medical specialty diagnosing and treating injuries and illnesses of the musculoskeletal system.

ORTHOPEDIST: Doctor who specializes in Orthopedics (above).

PATELLA: Kneecap.

PLASMA: The yellowish liquid part of blood.

PLATELET: Tiny blood cell containing clotting chemicals.

PNEUMONIA: Lung infection when tiny air sacs fill with pus and germs.

PRE-DIABETES: Fasting blood sugar above normal 100 but below diabetic 125.

PRE-PATELLAR BURSA: Collapsed water balloon padding front of knee.

PULSE OX: % of Red Blood Cells carrying oxygen.

PULSE OXIMETER: Small digital device clipped to finger to measure pulse ox (see above).

PURPURA: Rash resembling large areas of bruising under the skin but without injury.

RBC: Abbreviation for Red Blood Cell.

RED BLOOD CELL: Round blood cell that transports oxygen.

RHEUMATIC FEVER: Rare, but dangerous complication of untreated strep infection.

RISK FACTORS: Life style or life events making a disease more likely (not necessarily a cause).

SACRUM/SACRAL SPINE: 5 fused lower spine bones between lumbar spine and tailbone.

SCAPULA: Shoulder blade.

SEPTIC ARTHRITIS: Very serious joint infection.

SHOCK: Blood pressure too low to supply oxygen and nutrients to tissues.

SLIPPED DISC: Soft center of vertebral disc squirts out from pressure.

SOFT TISSUE: All body tissues except bone (all soft tissue is gray on plain x-rays).

STATIN DRUGS: Cholesterol lowering drugs like Lipitor, Crestor, pravastatin, etc.

STENT: Compressed metal coil opened inside a blood vessel to keep it open.

SPRAIN: Stretching or tearing of ligaments holding bones together at joints.

STRAIN: Stretching or tearing of tendons holding muscles to bones.

STROKE: Piece of brain dies when its artery clots or bleeds.

SUCROSE: Table sugar –a complex sugar made of 50% glucose and 50% fructose.

SYSTOLIC BLOOD PRESSURE: Higher of the 2 numbers in a blood pressure reading.

TPA: (see Tissue Plasminogen Activator - below)

TENDONS: Soft tissue bands connecting muscles to bones.

TIBIA: Shin bone.

THORACIC SPINE: 12 back vertebrae between the neck and the low back.

TIA: Short for T ranscient I schemic A ttack, a temporary Stroke.

TISSUE PLASMINOGEN ACTIVATOR (TPA) : A medication given into a vein that dissolves blood clots.

TRACHEA: Windpipe.

TRANSCIENT ISCHEMIC ATTACK: Temporary stroke completely resolving in less than 24 hours.

TYPE I DIABETES: High blood sugar from a pancreas unable to produce insulin.

TYPE 2 DIABETES: High blood sugar when a pancreas can’t make enough insulin for body size.

UPPER RESPIRATORY INFECTION: virus cold.

U.R.I.: Upper Respiratory Infection (see above).

V. FIB.: Short for the deadly heart rhythm, Ventricular Fibrillation (see below).

VENTRICLE: The 2 lower chambers of the heart – Right Ventricle and Left Ventricle.

VENTRICULAR FIBRILLATION: Deadly change in heart rhythm causing the Ventricles (2 lower heart chambers) to stop pumping and just wiggle.

WARFARIN: Oldest and most widely used anticoagulant – also called Coumadin.

WBC: Abbreviation for White Blood Cell (see below)

WHITE BLOOD CELL: Various kinds of blood cells involved with immunity and infection.