Dr. Creed: Dyspnea Redefined

Warning: What follows is top secret information surreptitiously leaked to me via one of the nations elite pulmonologists from an elite teaching hospital. Read at your own risk. This is not edited, yet explains the reason for needless bronchodilator for patients with no respiratory disorders.

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Section B8

Primitive medicine going as far back to the dawn of medicine, 30,000 B.C. and perhaps earlier, defined disease as the symptom. In this sense, the following were diseases:

• Chest pain
• Headache
• Dyspnea
• Excess sputum
• Wheeze
• Diarrhea
• Stomach pain
• Itchy neck

The symptom that was the most prevalent was the diagnosis.  Treatment was to figure what god or spirit was mad at the patient and inciting the appropriate incantation or prayer.  

Dypnea was not defined until the the Ancient Greeks wrote the Corpus Hippocraticum around 400 B.C. Dyspnea was defined as anything that causes shortness of breath.  That was it.  All short of breath was defined as dyspnea.

This definition stood until around the 17th century when various categories of shortness of breath were determined, such as cardiac asthma, kidney asthma, and lung asthma. You also had tuberculosis and pneumonia.

The definition of dyspnea, thus, until 1950 was shortness of breath.  This is the definition that is still used by most of the medical industry today.  It is this definition that RNs and DRs must continue to use today.  

However, this definition is incomplete. In this fine book I'd like to inculcate in the minds of physicians that there is a new definition of dyspnea that is not fully understood beyond the industry of medical schools.  It is, in essence, knowledge.

Speaking of esoteric knowledge, most primitive medical wisdom was esoteric.  In order to get medical help you had to seek out a physician who swore not to share medical knowledge.  The reason for this was that if such wisdom got out the physician wouldn't have a raison d'etre.

So among our esoteric wisdom is the following revelation that occured to Dr. Ven Tolin in 1955.  He observed one of his patients was not short of breath but was likewise sick.  He had no medicine to give the patient, yet he had to do something.

"Ah, I'm going to give Isuprel," he duly noted to himself, according to the "Biography of Ven Tolin," a book he wrote in 1962 yet was never published. (It is, however, available to the medical community.  You can view it by being accepted to medical school. Note:  You will be sworn to secrecy. This explains why doctors deny its existence.)

He got the idea when he attended a meeting of the physicians assembly at John Hopkins University.  Satisfaction surveys were sent out to former patients and the University received Good marks.  So the physicians decided to raise the standards; raise the bar so to speak.

They decided to make excellent the new good.  In order to meet expectations, they expected patients to mark excellent instead of good.  At the meetings physicians were no longer happy just to be good.  They wanted to be excellent.  Yet this frustrated physicians, because patients rarely marked "excellent."

Dr. Ven Tolin thought he could use this idea regarding beta adrenergics to justify what Inhalation Therapists called frivolous beta adrenergic abuse.  His creative mind decided to raise the bar so to speak regarding dyspnea.  In that sense he developed the following redefinition of Dyspnea:  

Dyspnea:  Normal Breathing.

You see, Normal Breathing is the new Dyspnea.  From henceforth the patient doesn't have to be short of breath to get a treatment.  He can be breathing just fine, have no respiratory history, and so forth.  He can be breathing fine; dyspneic.