Tuesday, August 19, 2014

How to manage your child's asthma at school

The following was published 1/11/13 on healthcentral.com/asthma

24 tips to manage your child's asthma at school

So you have a child with asthma and want to make sure he or she gets the best care possible once school starts.  As a former child asthmatic who endured asthma attacks in school, I have compiled the following tips just for you. 
  1. Work with your child's asthma doctor to obtain the best asthma control possible
  2. Meet your child's teacher before school starts. 
  3. Make sure your child's teacher understands asthma and how to recognize the symptoms.  
  4. Work with your child's teacher to create a school asthma action planso she knows exactly what to do in case your child shows asthma symptoms
  5. Buy at least two new rescue inhalers before each school year.  Your child should carry one (if allowed) and the teacher should have one.
  6. The inhaler should be in such a place that the child can access it in less than five minutes.  A child shouldn't have to wait in line to get access to a life saving medicine
  7. In an age appropriate way, educate the child about asthma
  8. Make sure your child knows that it's okay to ask for help anytime.  
  9. Make sure your child's teacher knows of any allergies or asthma triggers, and discuss methods of avoiding them
  10. Remind your child often when to ask for help and that it's okay to ask for help
  11. Encourage teachers to reinforce to your child often it's okay to ask for help any time.
  12. Provide the school staff with a peak flow meter to use as a guide to help them make decisions when to use the rescue inhaler, when to call you, and when to call 911.
  13. Talk to the gym teacher so he knows your child's limitations.  
  14. The gym teacher should also know your child's asthma action plan
  15. Your child should be encouraged to participate in gym activities on mostdays.  Exercise is good for asthmatics.  Be aware of Actor Asthmatics
  16. However, the gym teacher should be aware of any pre-treatment your child needs before exercise
  17. You're doctor should know about exercise induced asthma
  18. And obviously he must know when it's not a good idea for the child to participate
  19. Make sure the teacher monitors your child for bullying, as wheezing, sniffling and sneezing can result in good material for bullies (If you don't believe me, just watch iCarly).  
  20. If your child is unable to participate in certain activities, such as gym class or field trips or other outdoor activities (perhaps due to weather), make sure to have a plan for appropriately entertaining your child.  For example, one of my friends was allowed to stay in from recess with me and we were given free reign in the library with the librarian to read or play games.  
  21. Know when it's best to keep your child home from school
  22. Meet with the teacher often to reinforce your child's school asthma action plan
  23. Make yourself asthma smart by reading as much as you can about asthma.  
  24. Make yourself asthma smart.  The more you know about asthma, the more you can help your child both at home and at school.  You can do this easy just by hanging with us.
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Sunday, August 17, 2014

My thoughts on Robin Williams and suicide

The world has become so politically correct now that we can't even say the truth about suicide.  It used to be that the "default" thing to say when someone committed suicide was that he "took the cowardly way out."  Sheppard Smith said that on Fox a couple days ago, and he had to apologize and retract his statement.

Now political correctness has consumed our culture. Before this heightened sensitivity to not offending anyone consumed our society, we used to be able to speak the truth.  When we turned on the TV we would get the truth  Now the only way to be sure we are getting the truth is to read a column, blog, or watch or listen to the many political commentaries.

The reason people said "it was the cowardly way out" was because most people commit suicide rather than face the challenges of life.  We said it because there are people that you leave behind when you kill yourself, and you are leaving them with the grief, agony and pain that you are gone.  Maybe you are also leaving them with all the burdens you didn't want to face anymore, be they financial or other.

When people wrote about suicide they talked about the torturous effect it had on the spouse, children, parents, and friends.  There was talk about "what did I do that might have caused that person to commit kill himself.  There is the regret that they should have noticed the signs and done something to prevent it.

As a Catholic, we believed that suicide was a mortal sin.  If you got to the point in your life that you had to kill yourself, you were doomed to hell.  This was the disincentive to do it.

Today suicide is glorified, and mainly due to social media.  Instead of walking around that Robin Williams killed himself, they seem to glorify it.  They talk about all the accomplishments in his life, and how the world around him was so bad that it forced him to do it.

The truth is, the world around us has never, is not, and will never be easy.  There will always be challenges that we have to face.  Suicide is a permanent solution to a temporary problem, but those who are sick with severe depression do not see that.

I had a friend commit suicide once.  He told me the day before he was going to do it that he was going to do it.  We were at hunting camp where we all joke around and have fun, and here he spawns this on us.  One of the campers was a counselor, and he talked with Jim.

I remember everyone taking pictures of Jim, just in case.  I remember Jim saying to me that his wife had her children living in the house, and he was so depressed about it."

I said, "Why don't you tell them?  Why don't you just leave?"

He said, "Because I can't.  They count on me.  I'm trapped."

I completely understand how he feels.  As a parent I often feel trapped.  Here my kids get all the attention, and all our money is spent on them, and what is left for my wife and I.  Sometimes I feel trapped.  Sometimes we all feel this way.  It's normal.

I think that one of the greatest challenges to our society is depression, mainly because you can't just look at someone and know they are depressed.  And when you are the person who is depressed, you feel embarrassed to say anything about it. So it goes untreated.  So I can see how it can spin out of control.

What if the fact that we have glorified the suicide of Robin Williams -- the world around him caused it, some reports claimed -- other people whose worlds are falling apart, people seeking attention, people who want to be the center of attention, take the same route and kill themselves.  They will be talked about as heroes among their community.

The solution, however, is not to get all politically correct about it.  The solution is to call it what it is: a horrible act of desperation due to a medical condition that did not get treated.

Further reading:

  1. Depression alone rarely causes suicide
  2. Mrs. Doubtfire did it?


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Saturday, August 16, 2014

30,000 B.C.: The dawn of medicine

The first humans in Europe were cro magnums.  They are thought
to have marched into Europe sometime around 40,000 B.C. 
So humans must have developed empathy early on.  They must have made sacrifices to help the suffering in any way they could.  Perhaps this meant something as simple as pulling out a splinter.  Perhaps it meant sacrificing a meal so a child could eat.  Or perhaps it meant pulling out an arrow that pierced a brother or friend.  Or perhaps it meant providing a sympathetic shoulder to a child suffering from respiratory distress.  By around 30,000 B.C., such empathy would reach a culmination of sorts, into an era that many refer to as the dawn of medicine.

Once again, it's hard to know what internal ailments man suffered from 2.5 million years ago, let alone 30,000 years ago.  It's highly probable, or so I would think, that heart and kidney failure plagued mankind since the beginning, and Lord knows these ailments cause shortness of breath, even air hunger, or what the ancient Greeks referred to as asthma (and what later was referred to as dyspnea, allowing the term asthma to be redefined).

It's hard to imagine what it would be like to suffer from heart failure, bronchitis, tuberculosis, pneumonia, or any such respiratory disease 2.5 million years ago, let alone 30,000 years ago.  The asthmatic boy leaned up against a tree or rock and dealt with the agony as best he could, trying hard to keep up with his clan, performing the duties expected of him.  But as his breathing worsened, or failed to get better, he'd more than likely become a burden to his clan, and they'd have to go out of their way to help him, to guide him along, to feed him, to provide him with drinks, to provide him with incantations and magical words of healing. If he died it was because he was poisoned, if he lived it was because of the magic.

By pondering about the world around them, by learning from events they observed and experienced, and speculating about that of which they could not learn by empirical means, these people created the first myths about what happened before birth, and what happened after death, and why a person got sick.

Perhaps it was by this means that fears of the unknown lead to evil spirits abounding all around, peering amid the trees, and in the dark crevices of caves, and in the fields, and in the sky, even lurking in dreams. Some of these possessed friends and family members, and no doubt one of these had entered the asthmatic boy.  Other spirits became real beings in the Heavens, and these turned into the first gods, and these gods became the first physicians who were responsible for health and healing.

A young girl was excited to see her mother give birth, and after her brother was born, her mother became very sick and she died.  That night the girl did not sleep, instead she was haunted by the creepy sounds in the night.  She decided the sounds must have been made by her mother, who died too soon.  Her mother was now a ghost or spirit, and she was ever present and probably very unhappy because she died too soon.  She might protect her family, or she might be too blind sighted by her own death and haunt those she loved when she was alive. As noted by Henry Sigerist in his 1951 history of medicine: (6, page 137)
Particularly feared are the ghosts of people who died without having fullfilled their mission on earth, young children, brides, women in childbirth or childbed. they more than any other dead must be eager to return to life or, feeling lonely, they may wish to kill some who were close to them so as to enjoy their company in the world of the spirits. (6, page 137)
One early man or woman realized a sharp bone could be used to slice into prey, and another learned to attach this sharp object to a stick to be used as an ax for killing prey or cutting down brush or trees for making shelter.  By cutting up food the heart was found to still be beating, and the heart was learned to be the best target when hitting prey with a knife, spear or arrow.  The head was learned to be the best target for the blunt ax as it shattered the skull. As noted by Plinio Prioreschi in his 1999 history of medicine: (5 Prioreschi, page 29)
Neolithic man must have noticed that the results of the wounds inflicted by the two kinds of weapons were quite different. Deep wounds of the abdomen and chest inflicted by piercing weapons were always mortal either soon or after, or some time later (in the later case because of infection -- e.g. peritonitis). On the other hand, head blows delivered with blunt weapons often had strange results: the animal (or the enemy) would immediately fall "dead" and whereas sometimes it (or he) would stay dead, sometimes, after a short period, it (or he) would revive, that is, would become "undead." The individual who became "undead" after a head blow had always a small head wound, whereas those who failed to revive usually showed a massive injury. (5, page 29)
It must have been assumed that the "undead" was a person with magical powers, or who was blessed by the demons, spirits or a god.  He was thus "brought back from the dead." He was "cured." Those who came into contact with this "cured" person were blessed. This was probably where superstitions and religion were started. Yet it was also by these observations where people learned what weapons were best for what purpose.  In this way, people learned by trial and error, and they speculated, and they came to conclusions.

People learned early the benefits of bathing in the rivers, lakes and streams to keep themselves clean and pure, because purity was the way to keep the body in balance and to keep the evil poisons out of your body.  This may have been the first observation that cleanliness resulted in better health; the first hygienic practices.  Some men washed daily, and maybe had their wives check them for ticks and fleas or whatever bugs crawled onto them while they were busy hunting in the forest.

Slowly the tree of knowledge blossomed and grew.  Mankind learned that by working together they could accomplish more in life, and as part of working together they learned how to socialize.  They therefore learned to have empathy for a fellow human who was suffering, as was evidenced by the efforts to emphasize and help the ailing boy.  They learned they could make a difference in the lives of others by the love they offered, or simply by offering a kind shoulder to lean on.  Although the earliest help was primitive indeed, this was the beginning of medicine. (1, page 2)

Perhaps a dad provided pressure on a cut to stop bleeding, or made a splint out of stick to aid the healing of a broken finger, or used wool of a sheep to produce a basic bandage, or used a sharp stick or stone to pluck out a sliver.  When the cause of suffering was unknown (as was the case with internal ailments), incantations were chanted to suck out the evil spirits and demons.

So while allaying illness may have originally been a personal task -- each man or woman for him or herself, it eventually became a task of the many.  People developed consciences; they learned to love, care and appreciate the people in their lives.  They cared for and doted the sick, young and old.  Each person becoming pseudo nurses, physicians and respiratory therapists. So in essence, all of these jobs were born amid the primitive or prehistoric world by savage humans.

An elderly man, perhaps, found relief for his ailing back when he stood by the hot fire.  He learned that by removing the splinter of wood in a boy's hand this would speed recovery of the wound. Perhaps by the quest to find food when hungry, early humans discovered the poisonous and medicinal properties of various herbs.  An elderly lady must have mixed some herbs with berries and learned it didn't make such a good meal, although later she rubbed some on her skin and found it to have soothing or healing properties. (6, page 115-116)

Perhaps by such experimentation, these early humans came up with the first herbal remedies, creating the first recipes that turned into salves, ointments,  potions, pills and even inhalents. Perhaps, just perhaps, an elderly lady was experimenting with poppy seeds.  It is believed by many historians that poppy seeds, or opium, was one of the first remedies used by mankind for its hallucinogenic and pain relieving effects.  Perhaps this was one of the most important drugs of the primitive world (5, page 7), as it relieved pain and suffering.

Perhaps she experimented with the leaves and roots of a belladonna plant, and she laid them out in the hot sun for days to dry, and then after they dried she tried to make food or a potion from them, and she learned that when ingested the result was soothing to the mind, definitely a gift from the gods.  And one day, when the asthmatic boy was huffing and puffing over the fire, she inadvertently discarded the remaining roots and stems into the fire, and the smoke created by them was inhaled by the boy, and his breath returned instantly, his mind at ease by the hallucinogenic effects.

The boy's father investigated this remedy, and he remembered the recipe, creating easy to remember lyrics so the recipe could be shared from one generation to the next.  By trial and error, in this way, they learned what remedy worked best for what ailment.  If an elderly lady was sick, for example, her husband, or sister, or friend, used knowledge obtained by lyrics sung by the campfire late at night to help in any way they could.  Perhaps an elderly sister rubbed salves on her aching back, or made her drink a soothing potion (perhaps containing a drug such as opium). And it was rationalized these remedies had powers of healing because they were gifts from the gods above. (5, page 35)  

If the magic available to these folks didn't work, it was time to call for the medicine man, who was able to form a link between the patient and the spirits, demons and gods. He was the wisest member of the tribe, the one who remembered all the recipes, and held all the esoteric knowledge of the privileged few. He was the earliest magician/ sorcerer/witch/priest/physician all rolled into one, who had the ability to create a link between the sick and the spirits, demons and gods that were ubiquitous and invisible.  He would dress in animal skins to mimic a spirit or demon, he'd use rattles and drums to set the milieu, and he'd suck out the evil spirit from the sick woman. He had different names in different places of the world, although some called him Shaman or Seer, because he had the ability to "see" into the netherworld. (3, page 22)

If this magic didn't work, there were other options the medicine man, or woman, might experiment with, and one was was called trepanation. Experts have shown this can be easily done using flint knives and "scratching the (parieetal) bone (of the scull), or by making a circular incision that was gradually deepened, or finally by drilling a series of small holes arranges in a circle and then cutting the bridges between them." (6, page 110-113)

Many such sculls have been found by archaeologists in various parts of the world,  and no one knows exactly why this procedure was performed, although many speculations have been made.  Perhaps the patient was driven insane or possessed by demons, and this was a last ditch effort to cure the person. Perhaps the person was seizing due to epilepsy.  Perhaps the person had end stage emphysema, or was having a severe, prolonged asthma attack. (Lord help the boy with asthma if this was the remedy.)(6, page 110-113)

The medicine man may provide the sick lady, or her family, with an amulet and an incantation to recite at various times of the day.  An amulet was blessed with magical powers of healing, and could be made of the teeth of animals, claws of eagles, knives, axes, dried rabbits heart, dried rabbits foot, the bone fragment from trepanation (called rondelles), or just about anything. He may also provide such an object as a talisman, and these would be for good luck, to keep you healthy, and to keep you alive. Such objects may also be just about anything, from a wood carving or replication of an eye, heart, liver, kidney, liver, arm or leg. It could be a dried rabbits foot, necklace, bracelet, etc. (6, page 145)

In times when suffering and death inflicted several members of the clan, in times of epidemics of disease, the medicine man would use his magic on the entire family or clan.  They would gather around the fire at night, under the moon-lit sky, and the medicine man would shake his rattles and beat his drums and hum magical incantations and prayers, and he would toss the dried and crushed herbs of opium or belladonna onto the fire, and the smoke would be inhaled, and the recipients would sit around the fire and hallucinate about the world around them. These hallucinations would surely be revelations from the gods, and they would be interpreted by the medicine man.  These were the first mass inhalations, or fumigations.  In times of trouble, in times of great plagues, such fumigations would provide an explanation for the suffering, and a divination of the end of the suffering, or what could be done to end it.  

Much of this knowledge had matured into a flourishing tree by 30,000 B.C. Knowledge that was slowly picked up by previous generations was now habitual.  Basic methods of maintaining health, and for offering healing, were standard. The cause of illness, and the reason for healing, was by the wishes of the ubiquitous spirits, demons and gods.  Some historians consider this period as the dawn of medicine.

References:
  1. Wilder, Alexander, "History of Medicine, a brief outline of medical history and sects of physicians, from the earliest historic period; with an extended account of the new schools of the healing art in the nineteenth century, adn especially a history of the American eclectic practice of medicine, never before published," 1901, Maine, New England Eclectic Publishing Co.
  2. Netzley, Patricia D, "World History Series: The Stone Age," 1998, San Diego, CA, Lucent Books
  3. Garrison, Fielding Hudson, "An Introduction to the history of medicine," 1921
  4. Unknown reference
  5. Prioreschi, Plinio, "A History of Medicine: Primitive and Ancient Medicine," Vol. 1, 1999, reprinted edition, originally published 1995, Horatius Press
  6. Sigerist, Henry E "History of Medicine," volume I: Primitive and Archaic Medicine, 1951, New York, Oxford University Press
  7. Suter, Joanne, "Fearon's World History," 2nd edition, 1994, U.S., Globe Fearon Educational Publishing
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Friday, August 15, 2014

100,000-70,000 years ago.: The first doctors?

It's possible one member of a Neanderthal clan or family
acted as physician, caring for the injured and aging.
It's possible the entire clan doted over the sick person
stricken with dyspnea due to aging, sickness or injury.
It's difficult for people to understand what life was like on earth 100,000 years ago, although based on archaeological evidence we can make educated guesses.  It's unknown whether asthma, allergies or similar diseases existed back then, although it's known that people got sick due to infections caused by viruses, bacteria and parasites.  Chances are these people got short of breath at times too, and that they simply had to deal with it.  

Or maybe not?  There is evidence that Neanderthals, who roamed the earth for about 60,000 years between 130,000 and 70,000 years ago, grew to love and care for those in their family or clan.  This would be a natural effect of working together for a common goal of surviving the challenges of life; a natural side effect of sitting around the fire in a cozy cave to stay warm on a dark and cold night.  

During the day the women without children, and the men, would use their large, muscular bodies to search for food, and then they'd bring what they could back to the cave to share with the women and children.  They would cook the meat and prepare it in different ways, even sucking the marrow out of the bones.  The women would use wood and stone tools to make clothing from the hide, and ornaments from the bones.

When a hunter wrestled with an animal and broke a leg, the women would take care of him in the cave, and he would be provided a portion of the food.  Those who were too sick or old to work were also taken care of in this way. Evidence suggests they probably didn't live much longer than 30, although those who did must have provided knowledge necessary to survive changes in the environment.

Perhaps the elderly told stories late at night, under the moon lit sky, about what happens before birth or after death.  Perhaps in order to allay the feeling of grief after a mother passed away in childbirth, he explained what life was now like for the person who died, of how she was in a happy place like Heaven.  Or perhaps she was a spirit watching over her children.  By doing this, Neanderthal's created religious beliefs and tradition that were passed on from one generation to the next. 

Before long these stories became realities, and the spirits became living entities. The elderly may even have used these beliefs to the advantage of the clan or family.  He told of stories of how, if you fight with your brother, or if you steal food from the sick, or if you didn't do your share of the work, you would be punished by the spirits.  In this way, he encouraged the young to grow up to be productive and trustworthy members of the clan.

I can speculate like this because there is evidence of Neanderthal burial sites where the dead person was intentionally set in a certain position, and surrounded by items that he could use in the afterlife, such as stick and stone tools. Some speculate this is evidence that these hominids mourned their dead, and believed in an afterlife.  

There may also be evidence some members of the the clan may have specialized in taking care of the sick and injured.

Patricia D. Netzley, in her 1998 book "The Stone Age," quoted archaeologist Richard Leaky's description of a burial site where "dense clusters of fossil pollen show that flowers were arranged around the body making a colorful grave of white, yellow and blue.  The flowers are all medicinal herbs, suggesting the possibility that the man was some sort of doctor and these were the herbs he used in his medicine."  (1, pages 54-55)

References: 
  1. Netzley, Patricia D, "World History Series: The Stone Age," 1998, San Diego, CA, Lucent Books
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Wednesday, August 13, 2014

What is palliative care?

The natural progression of chronic obstructive pulmonary disease (COPD) may ultimately lead to dyspnea, anxiety, depression, discomfort, and pain. When it becomes apparent any of these symptoms is chronic, it's time to make the shift to palliative care.

Shawna Strickland, in the April issue of AARC Times, "Palliative Care for the Patient with Chronic Pulmonary Disease," defines palliative care as follows:
Palliative care: the application of care strategies to alleviate the patient's suffering.  Many times, palliative care is confused with hospice care.  
Hospice care: is the shift in care goals from curative to comfort only.  Patients qualify for hospice care when their life expectancies fall to six months.
Curative care:  Efforts are made to cure symptoms and treat the disease.  This is generally done until  
Palliative care is often given in conjunction with curative care, and is generally started when the disease progresses to the point where symptoms such as pain, discomfort, anxiety, depression and dyspnea (air hunger) become chronic

It includes medicines like Ativan to reduce anxiety,  morphine to reduce the feeling of air hunger, or dyspnea, and morphine and other medicines to reduce pain and suffering.  Morphine or other opoids and cough suppressants may be needed to help reduce or prevent excessive coughing.  Oxygen may also be indicated to reduce the feeling of dyspnea.

In her article, Strickland said:  "Researchers have shown that respiratory therapists may have a poor understanding of palliative care principles and may not be prepared for these chronic disease and end-of-life issues.

Well, now you know.  What we do is a part of the palliative treatment.  Oxygen, and bronchodilator therapy may not always have a scientific benefit to the patient, although evidence suggests the placebo effect of albuterol may be all that is needed to sooth the mind of a patient.

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Monday, August 11, 2014

Discussing politics and religion at work

Your question: Do you think it's a good idea to discuss politics and religion at work?  I love to talk politics and religion, but I don't want to offend someone. What are some tips to talking about complicated, or often controversial, subjects at work.

My answer:  Good question.  Most people will advocate not talking politics or religion at work in order to not risk offending someone and potentially losing their business. Of course when you work in a hospital this is of utmost importance because you are in business of helping your patient feel better, not worse because of what you said.

However, I'm of the belief, that if you use common sense, you can talk about just anything.  The bottom line here is you must realize that life is stressful, and every person must do, or believe, what they need to in order to get through life.

The key is, you are best not to just walk into a patient's room and just start rambling about your political and religious beliefs.  It's best to let the patient invite you into a discussion, or find some creative way to encourage the patient to open the discussion.

For instance, if the patient doesn't open up the discussion, I usually look for cues in the room to start a discussion from.  For instance, if I have a patient who has a Bible on the table, that means the person probably believes in God.  So I might ask something like, "What is your favorite passages in the Bible?" Or, sometimes I ask, "If a non-believer came into this room, what one passage in the Bible would you recommend to convince him?"

What is the patient watching on TV?  If they are watching Fox News, chances are they are conservative.  If they are watching any other news channel, chances are they are a liberal.  Still, to make certain, you could ask a simple question about the news program that is currently on.  You might ask: "So, what do you think about that?  If the topic is Obamacare, you might ask: "So, what do you think about Obamacare?"

Of course you will need to be careful, because once you open this bag of worms, you might get an answer you don't expect.  Regardless, even if the person has polar opposite views as you, you can still safely tread these waters.  Just try to be open minded and noncontroversial, until you are invited to be controversial. If you adamantly oppose the person's view, you might say something like, "That's an interesting view."

The thing to remember is that most people love to talk about things that interest them, which means politics and religion should not be ruled out as topics of discussion.  Some people thrive off intelligent discussions, and that does not mean they have to be intelligent discussions with people they see eye to eye with.

Think of it this way, if you have an idea that will make the world better, or help someone feel better about life, what good would it do if you did not share that idea? It would do no good.  So, the only way ideas will be shared is in the arena of ideas.

Just be careful to tread lightly. Feel the waters and see how it goes.  Play it by ear. If the water doesn't feel safe, back away or change the subject.

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Saturday, August 9, 2014

200,000 years ago: the dawn of caring

Modern humans are called homo sapiens sapiens, and started to appear in Africa around 200,000 years ago, and around 100,000 years ago they migrated out of Africa. 

These men and women were even more human-like than the homo habilis, homo erectis, and home sapiens who lived before them.  Homo Sapiens Sapiens had better bodies for walking long distances, and they ventured to various places of the earth where food was most plentiful. In the process they created better tools as a means of adjusting to new environments and different kinds of wild game. (1, page 66)(3)

Patricia Netzley explained in her 1998 book, "World History Series: The Stone Age," that:
These new hominids lacked the projected facial features of the Neandertal, and their bodies were taller and less robust; in appearance, they were quite close to today's humans. Longer legs gave them the ability to travel longer distances, which meant that they came in contact with many other tribes of people.  This exposure to other cultures and ideas may be the source of their greater creativity, in comparison to their ancestors. (1, page 66)
She explains that early home sapiens sapiens, sometimes referred to as cro magnum, made a "wide variety of tools" compared to their ancestors.  They were able to put their minds together to utilize rock, bone, antlers, ivory, and wood. They were able to use various materials from animals and plants to connect sharp rocks to make the following weapons: (1, page 66-67)
  • Saws
  • Chisels
  • Knives
  • Flint axes
  • Wooden axes
  • Spears
  • Bows
  • Arrows
They were even able to use thin pieces of bone as needles to sew pieces of hide together in order to make clothing and materials to build crude homes.  They worked together using these tools and fire to hunt for larger game, such as the Woolly Mammoth. And of course they ate all the meat, sucked all the marrow from the bones, and used what was left over to experiment.  The made ornaments and beads to adorn their bodies, clothing, homes and burial sites. They even made fences of ivory. (1, page 70-79)

They probably had a language as well, communicating both by their art and their words. They painted crude drawings in color on the walls of caves, and these would have been available for new generations to learn from.  They also must have had a verbal language so they could share ideas, plan hunts, and relay knowledge of myths, religions, tradition, and recipes of food and medicine.   (1, page 70-79)

Surely they had medicine (although there is no evidence of this, as I noted in the introduction).  It may have been crude, but any form of help they provided to the sick and injured would have been medicine.  Perhaps they helped a man with one leg walk, or provided sympathy for the old man who was short of breath, or the boy suffering from the flu.  They probably experimented with herbs, perhaps at first to find new foods.  Although their poisonous and healing properties would have been learned and shared.

Better yet, perhaps they experimented with magical words in an attempt to expectorate whatever poisons the spirits or demons put into your friend.  Since prehistoric man would have no concept of the inner workings of the body, they would have no concept of internal diseases.  So they would rationalize the only way they could, and this was to use their imaginations.

They mourned the dead, and then they had dreams where a dead relative appeared.  So they came to the conclusion that people have souls that live on as spirits after death.  These spirits watch over the clan or family.  Like people these spirits must be fed, so the living made sacrifices and created words to appease the spirits.  However, when the spirits weren't satisfied, they caused disease.  Or, if one member of the clan or family did something that was considered a sin -- had a bad thought, perhaps, that person was inflicted with a poison. (5, page 131)

As humans do today, these early humans felt pain when they stepped on a sharp twig or rock, and they felt winded and irritable when they picked up germs that caused colds.  They suffered the side effects of ailments like asthma, allergies, and bronchitis, and they yearned for further understanding. It's highly probable these diseases weren't present in the lower paleolithic era, although it's likely people still got short of breath due to airway inflammation caused by infections, or by heart failure, or kidney failure, or some other ailment.

At first men and women were only concerned with themselves, yet as these early human's spent more time together, perhaps at first simply taking care of their children, they learned to love and have empathy.  At some point a woman saw her son step on a twig, and she must have known it hurt by her own personal experience.  So she did what she could to help the child.  She pulled out the thorn, and she massaged the wound, perhaps even rubbed mud or water on it to allay the pain.  Or, at the very least, she provided a shoulder for the boy to lean on.  (5, page 115-116)

She also remembered from her childhood when her mom and dad and brother died.  She remembered feeling sad.  She remembered the bad feelings when she realized for the first time the world is a gloomy place.  The ghosts or spirits of the dead were looming all over, and they had the ability to allow you to get sick or even to die.  Many times they let good people get sick and die, people who did not sin.  It was an unfair world.  And so she provided a soothing shoulder, and perhaps soothing words, to her son when he was old enough to come to this same realization.

Yet it also must be realized, however, that prehistoric men and women did not live their entire lives in fear of the spirits, demons or gods that were ever present. They did not fear them any more than you or I fear the viruses and bacteria that are ever present in our world.  Sure we know they are there, and surely we respect them, but we do not live in fear every day.  We take precautions.  We wash our hand, and we brush our teeth, and we take baths.  We are careful who we come into contact with.  (5, page 442)

In this same way, prehistoric men and women took precautions.  They made sure not to have impure thoughts, and they made sure to teach the same to their children.  They made sure not to take things that didn't belong to them, and to take care of the natural resources they were allowed to live among.  They made sure to take care of the sick who were living, and they also learned to feed and nurture the spirits, demons and gods.  They created words to appease them, and these would become the first incantations and prayers.  In this way, men and women learned to have empathy, and they learned about the importance of caring.

This mom burned her hand, perhaps, in the fire when she was a child, and she remembered how she found relief when she stuck her hands in the mud.  And so when her son burned himself, she found some mud, scooped it up into her cupped palm, and she took it to the boy, and rubbed it onto his burn.  This was, perhaps, the first form of medicine.

Perhaps when she was a child she loved figs, one day she was amid an ample supply and she ate too many.  She got a stomach ache and she threw up the figs. She felt miserable for the entire day, and her mother comforted her by rubbing the base of her back.  So when she was a mother herself, she told her son not to eat too many figs. Or, perhaps, she watched her son eat poison berries, and she thought that if she didn't do something he would die.  So she gave her son figs, lots and lots of figs.  She sat by him while making him eat them until he puked. Her son did not die.  So the poisonous quality of eating too much figs now became a remedy.  (5, page 114-115)

Primitive people, more appropriately termed prehistoric or savage people, were "puzzled if not awed by the rustling of leaves in the forest, the crash and flash of thunder and lightning, the flicker and play of sunlight and firelight, and he could see no causal relation between a natural object and its moving shadow, a sound and its echo, flowing water and the reflections on its surface. Winds, clouds, storms, earthquakes, and other sights and sounds in nature were to him the outward and visible signs of malevolent gods, demons, spirits, or other supernatural agencies. The natural was to him the supernatural, as it still is to many of us," according to Fielding Hudson Garrison in his 1921 history of medicine. (4, page 21)

He continues:
"He therefore worshiped the sun, the moon, the stars, trees, rivers, springs, fire, winds, and even serpents, cats, dogs, apes, and oxen; and, as he came to set up carved stocks and stones to represent these, he passed from nature worship to fetish-worship. Even in his artistic productions, the savage is at first animistic and ideographic, tends to vitalize inanimate objects, and aims at the portrayal of action and movement rather than perfection of form.  Disease, in particular, he was prone to regard at first as an evil spirit or the work of such a spirit, to be placated or cajoled, as with other deities, by burnt offerings and sacrifice. A further association of ideas led him to regard disease as something produced by a human enemy possessing supernatural powers, which he aimed to ward off by appropriate spells and sorcery, similar to those employed by the enemy himself. Again, his own reflection in water, his shadow in the sunlight, what he saw in dreams, or in an occasional nightmare from gluttony, suggested the existence of a spirit-world apart from his daily life and of a soul apart from his body, and in this way he hit upon a third way of looking at disease as the work of offended spirits of the dead, whether of men, animals, or plants." (4, page 21-22)
We can only assume that one early human suffered from asthma, or at the very least from asthma-like symptoms.  Sometimes the symptoms went away in time, and sometimes they lingered until death occurred.  Since men and women are empathetic, they yearned to help in any way they could.  This brings us to around 30,000 years before the birth of Jesus Christ, a time many speculate was the dawn of medicine.

References:
  1. Netzley, Patricia D, "World History Series: The Stone Age," 1998, San Diego, CA, Lucent Books 
  2. Roberts, J.M., "The illustrated History of the World: Prehistory and the first civilizations: volume I," 1999, New York, Oxford University Press 
  3. "Neanderthal: Their bodies were well equopped to cope with the ice age, so why did the Neanderthals die out when it ended," bbc.co.uk, Science and Nature, http://www.bbc.co.uk/sn/tvradio/programmes/horizon/neanderthal_prog_summary.shtml, accessed 4/4/13 
  4. Garrison, Fielding Hudson, "An Introduction to the history of medicine," 1922, 3rd edition, Philadelphia and London, W.B. Saunders Company 
  5. Sigerist, Henry E "History of Medicine," volume I: Primitive and Archaic Medicine, 1951, New York, Oxford University Press
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