Saturday, October 25, 2008

WE DON'T APPRECIATE OUR GOOD FORTUNE

I was fortunate for my career to have covered the truly golden age of medicine. As a medical student, the only true antibacterial drugs were a few sulfonamide compounds. By the time I had retired, there were multiple generations of antibiotics as well as some anti-viral drugs available,

The surgery of the 50s was crude compared to the sophisticated techniques at the end of the century. Micro-surgery and the use of laparoscopes, computers, micro-robots and similar devices have made procedures easier, less painful, and shortened the morbidity period. Organ transplants were a science fiction dream.

Intravascular catheterizations and open heart surgery saved many lives. Physicians can now abort heart attacks under favorable circumstances.

Instead of simple x-rays, the advent of first the CAT scan, Isotope imaging, ultrasound, and the MRI have not only increased our diagnostic skills but have also enhanced our capabilities for therapeutic procedures.

As late as the 60s, brain tumors could only be diagnosed by inference through x-rays using air injected into the spinal canal, a painful, hazardous, and most often inadequate procedure. Patients now survive and are even cured from malignancies which were always fatal in first few decades of my practice. Even brain tumors can be operated upon with an increasing degree of success. One of the newest tools is the gamma knife, a very specific focus high voltage xray technique that protects normal tissue.

Today's miracle diagnostic and therapy techniques are the result of "free enterprise" medicine. The regimented profession that is developing would have stifled most of these advances. Today stem cell research, a basic need to find new ways to prolong good life is being restricted by laws.

It is also unfortunate that economics are beginning to deny many of the benefits of modern medicine. I fear that in the near future there will be greater delays and more denials in receiving the best treatments. That will be one of the dangers of that we must guard against. Muhlenberg was one of the early victims of this trend.

Addendum; 10AM Upon reflection I realize how incomplete, disjointed and poorly written I have prepared this subject. There is no mention of mammography which was an unknown technique when I began to practice. How many lives has it saved by early diagnosis? Likewise, the "PAP" stain to diagnoses Cervical cancer did not exist in the 40-50s. Sigmoidoscopy was done with a short "pipe", now we can see the bowel up to the appendix. There can be no excuse not to pick up early bowel cancer.

I had inherited an EKG machine, and was one of the very few,about 3, doctors in Plainfield that understood the EKG of that era. This machine use a roll of photography paper, which had to be removed and developed like a photo or xray in a dark room. The 30lb machine was "portable" and I would take it to the home! Often when the tracing was developed the paper had not rolled and the tracing had to be repeated.

The original EKG had only 3 extremity leads, by 1950 a chest lead was added. now there are a minimum of 6 chest leads,improving diagnostic capabilities. Today's machines are direct writers and produce 4 simultaneous tracings- 3 leads and a rhythm strip. They are computerized and print out essential information and even a workable diagnosis. The cardiologist in reviewing the strip relies on his own interpretation.

During my 1946 "refresher course" at Mt Sinae I became acquainted with Dr. Master's 2 step test, which he had developed during the war to rule out aviator candidates with potential heart problems. The equipment was built of wood and was designed that the subject took two steps up to a platform and the down the other side (2 steps) turned around and repeated the crossing a specified number of trips. I had a local carpenter build me one and routinely used it for diagnosis until the treadmill test which was more specific became common place. At least the first dozen patients I sent to Cleveland or Houston for by-pass surgery were diagnosed on the two step. A few are still living.

Some day I may revisit this subject, but next week I would like to share some of the best days of my life, my college years.

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