Sometimes I can’t remember whether I’ve thought something, discussed my opinion with others or wrote about it in The Focus or my spiritual journal. Similarly, it’s sometimes hard to remember where I’ve heard or read something because I read extensively and peruse multiple news sites, medical journals and blogs. And for some peculiar reason, I enjoy reading multiple books at the same time. I’m currently reading five books, six if you include the Bible. I don’t mention this as a feat, but as an explanation in case I repeat myself in a Focus essay. However, some things need to be repeated.
Since I’m now semi-retired, I have more time for reflection, and that’s good because I’m a contemplative at heart. During the four decades of my traditional medical practice I was always running to get to the hospital, to my office patients or to finally get home to my family. Often, I longed for time to research a medical topic or explore other areas of interest. I now have time, between picking up grand kids and helping my wife, Becky, with the simple household chores she’s taught me how to do, such as doing wash and cleaning toilets. I even have time to manage my small concierge medical practice, teach medical students and write for The Focus. To quote my wife, “It [remains] a busy life,” and that’s good. I thank the Lord for life as I wake up each morning and get to “reboot” the sophisticated biological computer which sits atop my shoulders.
A friend recently remarked how wonderful it would be if we recognized each other by our character rather than by our skin color. She said that thought derived from Martin Luther King’s I Have a Dream speech. Last week, I wrote about my identifying persona and how I am usually recognized. Fortunately, I’m often identified as Becky’s husband which supports my axiom (Fergism) that “I always look better standing next to a beautiful woman.”
Though I might aspire to be recognized foremost as a Christian, I remain the doctor in our family and the go-to “expert” for medical questions. There are of course exceptions to every situation. Many times I have asked whether someone would prefer Becky or me to answer the phone – 100% of the time the response is Becky. Years ago one of my young nieces was with our family and had a medical problem. Understandably, she turned to the person with grace and asked Becky for her diagnosis.
I now have at my fingertips research tools I never possessed in most of my medical career. Before the internet, iPhones and constantly updated medical resources like UpToDate, I would have to spend hours in a medical library researching complicated questions or arcane medical topics. Now, I can quickly acquire information and focus my time sifting and interpreting the data and then contemplating its meaning.
Recently, a family member was hospitalized with pneumonia and complications; and that’s when the questions began. One question surrounded the medical term “pneumonitis.” Doctors sometimes speak in medicalese or use synonyms, that, to the laymen, cause confusion. Anytime you see a medical term ending in -itis it means inflammation of the organ to which it is attached. The organs of respiration are the lungs. And since the Greek word pneuma derives from the “breath” of life (or soul), doctors refer to a generic inflammation of the lungs as pneumonitis.
Imagine a cluster of grapes attached by their stems to the vine which is attached to the stalk and the latter to the trunk – fed by the roots. By analogy, the tiny air sacs of the lungs called alveoli are the grapes, where oxygen is absorbed into the bloodstream and the waste product carbon dioxide is collected for exhalation. There are 300 million air sacs in the human lungs with a combined surface area comparable to a tennis court. The alveoli connect to alveolar ducts, then to ever larger bronchial tubes and finally the trachea or windpipe.
Pneumonia usually implies an infection of the smaller bronchial tubes and alveolar air sacs. This often causes impairment of oxygen absorption, cough, fever and abnormalities of the chest X-Ray and physical examination. If your hair is long enough pull some strands down next to your ears and roll the hairs back-and-forth between your thumb and forefinger. (Guys, if your hair is too short perhaps your wife will indulge your curiosity and allow you to use her hair for your edification). The high pitched crackling sound you here is what doctors call rales and is the hallmark of inflammation in small airways and alveoli. Interestingly, the same sound can be produced by scar tissue in the lungs or even inflammation associated with radiation. Pneumonia is a clinical diagnosis and made from the patient’s history of cough, fever and the findings on examination and a corresponding abnormal chest x-ray or CAT scan.
We live at the bottom of a sea of air. If you asked a fish about the water in which it swims he might ask you, “What water?” We might respond similarly, because we take for granted our next breath, until the air becomes fouled as in Beijing China or when we ascend a mountain top. At sea level there is 14.7 pounds of air pressure on each square inch of our bodies. The cabins of commercial airlines are only pressured to the equivalent of 8000 feet elevation. This is not a problem for people whose lung function is normal, but the decreased air pressure and oxygen content may be problematic for people with underlying lung disease who have difficulties with oxygen exchange.
Recognizing that you have a problem is even more important than deciphering your doctor’s medicalese. Fever is an extremely important clue to illness. If you learn nothing else from this essay, recognize that if you are north of 50 years old and you have a fever of 101° Fahrenheit you have a high probability of a serious medical problem and need to see to your doctor. A high fever in a child is important, but of less diagnostic import.
My recommendation? Buy an inexpensive digital thermometer at your local drugstore and learn how to use it. Just make sure that the thermometer is not one of those intended for or has been used in the southern reaches!