Thursday, November 27, 2014

2600 B.C.-1200 A.D.: The Mayan will cure your asthma

The natives of Mesoamerica had specific remedies for asthma which included healing rituals, curing steam, and herbal remedies. (3, page ?) Even if these didn't immediately give back the breath of the natives, it provided a means of keeping their minds sharp and allowing time for their lungs to naturally heal.

In their 2010 book "Empires of the Maya," Jill Rubalcaba and Angela Keller said:
(Mayan diseases were caused) when the soul fell into disharmony. Therefore, curing the illness required shamans (medicine men) to return the soul to a harmonous state. Shamans dealt with disease on both a spiritual and a physical level. They made offerings to the gods, performed spells, burned incense, and examined the sacred calendar to remedy the spiritual problem. But they also attacked the physical cause of the problem." (1, page 125)
Healing Rituals:  It's difficult to determine what these healing rituals would have been like, although we can use our imaginations, or use our references to other native American cultures. Perhaps their was dancing, gesticulations, beating of drums, shaking of gourd rattles, singing of songs, reading of rituals, grunting, and chanting.

The shaman would resort to a book called the "Ritual of the Bacabs."  This was a book or text written by Mayan scribes to preserve Mayan tradition, and contains many references to the Mayan deities called the Bacabs.  The book contains a variety of rituals and songs for specific diseases, such as asthma.  The Mayan physician probably assessed the patient, and made reference to the book based on the symptoms presented.  

Here is one such remedy for asthma:
Four days have passed without the crushing of the large substance. For four days the face of the red Moon Goddess, the white Moon Goddess, the yellow moon Goddess has spasmed. For Four days the face of the red Itzamma has spasmed. Who created you? who hid you?  It's birth, the respectable birth, was created by me. It is he, the asthma, that was born." (2, page 104)
Peter Herman Signal said both the gods Itzamna and the Moon Goddess were needed to give birth to the disease and the cure.  (2, page 104)

Part of the ritual, and part of the healing process, involved bleeding.  The shaman would bleed an area close to the diseased part, although this was probably more with external injuries as compared to internal and "mysterious" diseases such as asthma. Sacrifices, probably mostly animals and plants, were often performed in order to please the gods and goddesses.  (3, pages 336-7)

Bleeding:  Phlebotomy was commonly practiced among the natives of mesoamerica and South America, but less so in North America.  Some North American myths include the act of bleeding, although it's believed this came from the whites and was added into the myths later on.  (7, page 179-181)

Divination:  Omens, or reading of signs of the gods in order to predict future outcomes and prognosis, were common practice among the natives of both North and South America. (3, pages 336-7)

Sucking:  This was actually a common practice of medicine men in all parts of the primitive world, including Mesopotamia, Egypt, Greece, Rome, and America. It's also practiced among modern day primitives.  It involves the medicine man holding an item in his hand or mouth, a bead perhaps, and placing his mouth on the patient and pretending to suck out the poison (in this case the evil spirit).  He makes it look like he sucked the bead from the sick, which would be in the appearance of the bead.  (7, pages 183-184) (8, page 61)(9, pages 193-4)

Enemata:  This was used among most primitive tribes, and is an ideal method of entering medicines into the body.  The medicine man would use a hollow tube (perhaps a bone or reed) to insert with his mouth (or bulb syringe) the medicine into the anus.  The America Indians did this for diarrhea and hemorrhoids.  The Aztecs used wine and the narcotic parica. It was also used for other reasons, such as dysentry.  In North America syringes were made of a hollowed out bird leg, or from the stretched out bladder of a turtle, jauar, or other such animal. The Egptian goddess Isa is often depicted giving herself an enema with her beak, so we know this remedy goes a long way back.  (7, page 184-5)

Steam Baths:  Foster notes that "Masonry steam baths have been excavated at many Maya sites.  They were probably use as part of the preparation of religious rituals, and also as part of the healing ritual. If you were diagnosed with asthma this might be part of the ritual to heal you.  (3, page 336-7)

Herbal Remedies:  There are a variety of herbal remedies used by any member of the Mayan culture to prevent and heal the various ailments that plagued society.

Tobacco:  It was probably ingested in one form or another, as opposed to being smoked, as a remedy for asthma and a variety of other ailments.  (4, page 118)(3, page 337)

Sap of Ramon Tree:  Dried sap was inserted into gourds in order to make rattles for medicine men.  Perhaps in the process of doing this someone drank the sap, and realized it worked well for asthma.  (5, page 28)

Kanlol:  This was a herb that was probably ingested as a draught as a remedy for breathing ailments such as asthma.  While the Maya would not have known this, it is a diuretic that would have worked well for edema and dyspnea caused by heart failure. (3, page 337)

Strong Back:  Aztec men and women were known to carry large loads, and as a result suffered from back aches.  This herb got its name because it was used as an analgesic (pain killer).  Along the way it was also determined to be good for a variety of other ailments, such as asthma.  While the Maya would not have known this, it was an anti spasmotic medicine that relaxed muscles, including the muscles that wrap around the lungs that spasm and cause asthma.  (6, page 48)

Life Everlasting:  This was a plant that got its name from the fact that as its leaves land on the ground new plants spawn.  It was found useful as an asthma remedy.  (6, page 48)

Purslane Poultice:  This is a "pesky plant" that seems to grow everywhere: gardens, curbsides, doorsteps etc.  Many people get rid of it not knowing it's a remedy for asthma.  While the Maya would not have known this, it was an antiinflammatory good for back aches and asthma.  It's Spanish name was verdalaga. (6, page 48)

Surely there were many other remedies for asthma, although these are some of the main ones.  Chances are an asthmatic did not need to call a medicine man in order to feel better, because the American natives of both South and North America had medicine chests or bags that contained natural remedies.  There was also some degree of separation between supernatural and natural medicine, with an obvious overlap.

For example, if the disease was obvious, such as a cut on the foot, a mother might place a salve with a known herbal remedy on the cut.  If the person had asthma and the remedy was known, then perhaps a mother, or a wife, would utilize this natural remedy.  However, when the cause was not known, or if the natural remedy did not work, one did not hesitate to call for the shaman, or the medicine man.

There were obvious differences between the Maya, Aztec and Inca, although some of the culture was shared.  So there is a good chance that medicine among the Aztec and Inca, along with many of the tribes of the region, had a similar health and healing system.

References:
  1. Rubalcaba, Jill, Angela Keller, "Empires of the Maya, 2010, Minnesota, Inforase Publishing
  2. Sigal, Peter Herman, "From Moon Goddesses to Virgins: the colonization of Yucatocan Maya sexual desire," 2000, University of Texas Press, page 104
  3. Foster, Lynn Vasco, "Handbook to life in the ancient Maya world," 2002, New York, Oxford University Press
  4. Sidney, John Eric, "Maya History and Religion," 1970, U.S., University of Oklahoma Press
  5. Nations, James D, "The Maya Tropical Forest: People, Parks and Ancient Cities," 2006, university of Texas Press
  6. Arvigo, rosita, nadine Epstein, "Rain Forest home Remedies:  the Maya way to heal your body and replenish your soul,", 2001, 1st edition, New York, Harper Collins
  7. Vogel, Virgil, "American Indian Medicine," 1970, London, Oklahoma University Press
  8. Prioreschi, Plinio, "A history of medicine: Primitive and ancient medicine," volume 1, 1995, NE, Horatius Press, 
  9. Sigerist, Henry, "A History of Medicine," volume 2, 1961, Oxford University Press
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Tuesday, November 25, 2014

10 things asthmatics can be thankful for

Originally published 11/ 26/12


Well, it's Thanksgiving time of year, and as usual I think it's time to sit down and ponder all the things we should be thankful for.  Being that this is an asthma site, I'm going to give 10 reasons we asthmatics should be thankful.

1.  Doctors today have a pretty good understanding of what asthma is, that it's a disease of acute airway spasms, yet it's a disease of chronic airway inflammation.   
2.  Doctors have rescue medicine they can prescribe for you to use during an acute attack.  These medicines (which include your Albuterol inhaler) will help you get quick releif when you're feeling sick.  

3.  Doctors have access to asthma controller medicines like Advair and Symbicort that, when used daily, help control asthma and prevent acute asthma attacks.  

4.  Most asthma contrller medicines only need to be taken once or twice a day, and this makes it easier to remember to take them.  This was a major breakthrough in asthma treatment.  

5.  Thanks to the Internet, various asthma guidelines, and asthma research hospitals like National Jewish Health, doctors have access to all the up to date asthma wisdom and medicines.  

6.  Asthma is no longer believed to be all in your head.  This was a theory that emulated through the medical community since Galen in the 1st century A.D. It was gradually put to rest between 1950 and 2000.  

7.  Thanks to the invention of the modern nebulizer and electric air compressor, asthmatics can get quick relief of their asthma right in the comfort of their own homes.  

8.  Thanks to the invention of the modern inhaler asthmatics have a neat, handy little container that holds asthma rescue medicine, and they can take it with them anywhere they go.  

9.  Scientists are discovering new asthma genes and coming up with new asthma theories on a daily basis.  This is making possible the eventual ideal asthma treatment and even a possible cure.  

10.  Websites like this where asthmatics can learn about their disease and communicate with other people who also have it.  

So what are some things you're thankful for this year?  

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Sunday, November 23, 2014

The Noninvasive Ventilation Creed

What follows is what will be added to the new addition to the Real Physician's Creed: How to take care of Pesky RTs. Again, this is TOP SECRET information for physician use only, and was never intended to be released among the RT community.

My source for this ESOTERIC information will be kept anonymous, because if his peers find out he is the leak, he will be banned from the medical community at best, or ridiculed at worse. 



Page99

(Section B-3)
Physician's Real Creed: The Noninvasive Ventilation Creed:


Noninvasive ventilation (NIV)systems are complicated systems that require extensive training physicians don't have time for.  So, in lieu of spending thousands of dollars better spent on cigarettes and alcohol, allow me to simplify NIV so it's easy to memorize and requires little thought.  

There are essentially five rules for NIV: 

1. Know the types of NIV and when they should be ordered:

  • CPAP: prescribed for observed apnea or just simply obesity
  • BiPAP: for everything else

2.  Know the indications for NIV and how it works: 

  • Pulmonary Edema: it forces fluid out of the lungs
  • Respiratory Failure: it breathes for them
  • Hypoxic hypoxemia: it forces oxygen into the lungs
  • Hypercarbia/ CO2 >45 It sucks CO2 out of the lungs
  • Annoyed physician:  If either the patient or RT annoys you


3.  Know there are no contraindications, especially if you're too busy to consider intubation: 
  • DNR: put it on anyway
  • Unconscious/ Obtunded: fluid rarely builds up inside the mask, so it's well worth the risk.
  • Restraints: same as unconscious
  • Apneic: use BiPAP because it breathes for them
4.  Know that you can adjust the settings at any time without notifying a respiratory therapists. In fact, this can be done occasionally to boost your ego or tick off annoying RTs.  If they suspect you did it, deny, deny, deny.  

5.  Settings: Always order 10/4.  Increase settings aggressively to reach and maintain a pH of 7.40 and CO2 of 40.  FiO2 should start at 40% and adjust to maintain a PO2 of 106.   


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Friday, November 21, 2014

Albuterol is the current big con

Whenever a physician, nurse, patient, or even another respiratory therapist, tries to explain to me why a patient needs a bronchodilator breathing treatment when they don't, I can't help but to think of the 1973 movie "The Sting.

The movie stars Robert Redford as Johnny Hooker and Paul Newman as Henry Gondorff. Hooker is a young con man who is being groomed by the more seasoned con Gondorff. In explaining how to be a successful con, Gondorff says, "You have to keep this con even after you take his money. He can't know you took him."

This was one of those movies where most of the audience was shocked when the final sting occurred because they had been conned for so long.  Yet for the few who figured out the truth long before the final sting it wasn't as much of a surprise. 

You see, most people, other than the trained respiratory therapist, have been duped into believing that albuterol is the saving grace of dyspnea. They also believe that nebulizers work better than inhalers, even though nearly every study I've ever seen proves they work equally well, even in emergent situations.

"So, who did the conning?" some ask.

"Pharmaceutical and hospital administrators who got rich during the 3rd period of respiratory.  therapy, that's who," I say.  

Look, there is no evidence that albuterol works for anything other than bronchospasm.  Once bronchospasm is ruled out, albuterol will only have a placebo effect

Evidence of the big albuterol con comes when the only argument for giving it is "It can't hurt." And boy do I hear that puerile argument a lot.  

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Wednesday, November 19, 2014

What causes COPD flare-ups

The following was originally published at healthcentral.com/copd on March 30, 2014.

COPD Flare-Up Causes

Chronic Obstructive Pulmonary Disease (COPD) is one of those diseases, like asthma, that flares up from time to time. When this happens your breathing and coughing symptoms suddenly get worse. What causes them and what exactly happens?

There are essentially four things that might cause a COPD flare-up, or what many refer to as COPD exacerbations.

1. Common COPD triggers

COPD lungs tend to be very sensitive due to chronically inflamed air passages, and for this reason they tend to be very sensitive to things that are innocuous (harmless) to other people, such as air pollution, strong smells, temperature changes, gastrointestinal reflux, grasses, trees, pollen, dust, mold, and cold and dry air.

Generally, what happens is the chronically inflamed air passages become even more inflamed, and this causes them to spasm or constrict, thus resulting in narrowed air passages. This causes air to become trapped inside your lungs, making it hard to breathe. Medicines like albuterol, xopenex and duoneb can open up air passages, and systemic corticosteroids may reduce inflammation, both of which may make breathing easier.

2. Lung Infections

Especially if you have chronic bronchitis, large amounts of secretions often become trapped in your lungs. This can make it easy for common viruses and bacteria to collect in your lungs. Some infections may lead to pneumonia, which may make breathing even worse. Lung infections are the most common cause of COPD flare-ups. While antibiotics may help resolve bacterial infections, most infections are caused by viruses.

3. Heart failure

Especially during the end stages of the disease, the heart can become pooped out from working so hard to pump blood through diseased lungs, thus becoming a weak pump. A pooped out heart is unable to keep up with the bodies demands. This causes fluid (blood) to back up into the lungs, thus making it hard to breathe. Various medicine can help remove fluid from your lungs, and strengthen your heart, to make breathing easier.

4. Unknown

Sometimes the cause is never learned; it remains a mystery. Sometimes the cause is all three of the above, or any combination. Because it's unknown, treatment may involve assuming all three causes and treating them all. When this happens, it may also never be known which medicine worked.

So you can see that there are four basic causes of COPD flare-ups. Which treatment your doctor prescribes may depend on which one they presume to be the cause.
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Tuesday, November 18, 2014

Good reading material for asthmatics

The following was originally published at healthcentral.com/asthma on August 13, 2013.

8 Great Reading Materials for Asthmatics

If you have asthma, or if you take care of an asthmatic, you may be interested in learning what people think about it or how it affects their lives. There is a ton of reading material — from books to websites to articles — about asthma.

Here is some reading I highly recommend you check out (besides, you may find them quite entertaining):

1. Asthma: The biography: Mark Jackson recounts the history of asthma, beginning from ancient China to the present.

2. On Asthma: This is a book by fellow asthmatic and doctor Henry Hyde Salter, who details what it's like to both be an asthmatic and treat asthmatics during the 19th century. Dr. Salter was among the first to clearly define asthma as both spasmotic and nervous (yes, it's all in your head). There are also several chapters with old asthma remedies. This was the asthma book for reference during the second half of the 19th century.

3. Breathing Space: How allergies shape our lives and landscapes: This book was written by Gregg Mitman. He grew up with allergies, and through his book traces the ailment through space and time. I think this is essential reading because many people with asthma also have allergies. And, for the record, he provides a great history of asthma medicine.

4. Lord of the Flies: William Golding creates a character named Piggy, an asthmatic, who becomes isolated from the rest of the kids on an island. It kind of highlights how any asthmatic kid is forced to live and think differently.

5. Mornings on Horseback: One of the chapters in this book by David McCullough highlights how Teddy Roosevelt lived and survived asthma in an age where there were no efficient asthma medicines. Dr. Salter (noted above) was his physician, so clearly Teddy's asthma was all in his head.

6. Inhalatorium.com: OK, so this isn't a book. But it's a website compiled by Mark Sanders filled with pictures of his wonderful antique inhalers and nebulizers collection that you must see. He also displays a variety of antique ads for many of these older products as well. Beware: Once you enter you may never want to leave. It's like a good book you can't put down.

7. Asthma for Dummies: This is an asthma 101 book. This is a mandatory read for anyone new to asthma. It's also a great review for the rest of us.

8. "Divine Stramonium": The rise and fall of smoking for asthma: This is actually an article published in a 2010 issue of Medical History by our friend Mark Jackson. It describes the history of smoking for asthma. Yes, believe it or not, for several thousands of years before the invention of the inhaler in the 1950s, the best way of inhaling asthma medicine was via smoke.

If there is any asthma or asthma-related material you'd like to recommend, please list it in the comments below!
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Saturday, November 15, 2014

870 B.C.: The first description of artificial resuscitation

Elijah resuscitating a child 
Similar to other ancient civilizations, the Jews believed life and death, health and sickness, was the result of the desires of their God, the Lord.  Likewise, in the rare cases when a person was believed to be dead and then brought back to life, this was due to the wishes of their God, the Lord.

No one knows what they called it, although by the 18th century it was referred to as reanimation, and by the mid 20th century it was referred to as resuscitation.

Both terms work equally well, as animate comes from the Latin term anamatus which comes from anima, meaning "to give life to" or to breathe. It may also come from the Greek word anemos for wind.  Likewise, suscitate is a Latin term for "to stir up or rouse." (1)

The first description of an animation or a suscitation was when, through Adam, God created Eve: 
Adam was all alone in the garden with no one to help him. So, God put Adam into a deep sleep and took one of his ribs and formed it into a woman to be Adam's wife. Adam named her "Eve."
The work of the Lord could also be done through a prophet.  The Lord God had many prophets over the years covered in the Bible, among the first was a prophet named Elijah.  He is believed to have lived in the Northern Kingdom of Israel sometimes around 870 or 850 years before the birth of Christ.  

He is described as performing many miracles through the assistance of the Lord. In the First Book of Kings he is described as resuscitating (or reanimating).  A Sidonian widow woman was taking care of him during a drought when her son fell ill and became apparently dead.  She approached Elijah with the body of her son: 
Some time later the son of the woman who owned the house became ill. He grew worse and worse, and finally stopped breathing. 18 She said to Elijah, “What do you have against me, man of God? Did you come to remind me of my sin and kill my son?”
“Give me your son,” Elijah replied. He took him from her arms, carried him to the upper room where he was staying, and laid him on his bed. 20 Then he cried out to the Lord, “Lord my God, have you brought tragedy even on this widow I am staying with, by causing her son to die?” Then he stretched himself out on the boy three times and cried out to the Lord, “Lord my God, let this boy’s life return to him!”
The Lord heard Elijah’s cry, and the boy’s life returned to him, and he lived. 23 Elijah picked up the child and carried him down from the room into the house. He gave him to his mother and said, “Look, your son is alive!”
Then the woman said to Elijah, “Now I know that you are a man of God and that the word of the Lord from your mouth is the truth.” (Kings 1: 17-24)
The Sidonian widow at first appears to be angry at Elijah and his God for allowing her child to become sick and to die. Perhaps she doubts Elijah because she is a Sidonian widow and not an Israelite. Once the miracle is performed, however, she no longer has any doubts that he is a prophet of the Lord.

Elijah "stretched himself out on the boy three times." Why is this such a vague description?  It was because the authors of the Bible were not concerned with what Elijah did, as all the Jewish people needed to know about medicine was that the Lord brings sickness and health.  By obeying the Lord, the Lord will heal.  By disobeying the Lord, the Lord will not heal.  That's all people needed to know.

They did not need to know that Elijah was educated in all the wisdom of the land. They did not need to know that among his education involved knowledge of physics, chemistry, philosophy, mathematics, and medicine.  They did not need to know that the procedure he performed on the boy was a method of artificial resuscitation.   What he did, the method he used, was only eluded to because it did not matter. 

References:
  1. Definitions come from merriam-webster.com,  http://www.merriam-webster.com/dictionary/animate and http://www.merriam-webster.com/dictionary/suscitate, accessed 9/26/2013
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