Stress and Health

Stress is a well-studied cause of poor health, and long-term exposure to high-stress environments can cause heart disease and other health conditions. Obviously not all stress is dangerous, and some people have better developed coping mechanisms than others, but there is clearly a connection between mental stress and physical health. Whenever I’m learning about the effects of stress on physical health, I’m always reminded of a story my Dad tells about dealing with a particular kind of stress at work.

My Dad is a retired prospecting mineral geologist, and his job frequently involved exploring the outdoors, taking samples, and looking for evidence that would provide insight into the composition of the geology of an area. On one occasion he was sent to Northern Ontario to do some prospecting in a large wooded area which was also a popular destination for moose hunters. These hunters apparently spent most of the day drinking, and would stalk through the forest firing their guns in between drinks. For weeks, my Dad could hear these hunters and their rifles, and was convinced and frightened that one of these drunk hunters was definitely going shoot him. He also soon began developing a noticeable lump in his throat which, in his already paranoid mind, could only be cancer. To say he was was feeling stressed would be an understatement. He survived the hunters without incident, but the lump in throat persisted for weeks after he got home. In the days before Google and WebMD, my family’s medical encyclopedia was always the last stop before going to see the doctor, and searching for “lump in the throat” eventually led my Dad to an entry on Globus hystericus – a stress-induced lump. It turns out that his symptoms had been completely caused by his own mind, and from the anxiety of having to work with the fear of those hunters. Relief alone was all that was needed for the lump to go away.

 

 

The Evolution of Medicine

Sir William Macewen (1848-1924) with Adolph Barkan (1845-1935), Stanley Stillman (1861-1935). Levi Cooper Lane (1828-1902), Joseph Oakland Hirschfelfer (1854-1920) demonstrating Macewen’s triangle by Stanford Medical History Center CC BY-NC-SA

I was recently given an early birthday present from my sister. It was quite unexpected, especially since our family has always considered it bad luck to open gifts early (knocks on wood). I was even more thrown-off by the gift itself – several volumes of medical journals from 1919. Super cool! The pages are browned with age, and it even comes with old pictures. As I compared it to my notes from almost 100 years later, I was astounded at how much medicine has changed over the past century. Except for the anatomy sections, which other than being translated back from English to Latin for some reason, are bang-on what we understand today.

I occasionally hear jokes about how everything I am learning will become obsolete in 5 years time, but it is not a far cry from the truth. Consider a patient that presents with symptoms of heart attack, or myocardial infarction (MI). This is something that is very well understood. The most common cause of MI is having plaques in the coronary arteries, which are the small vessels that perfuse the heart with oxygen and nutrients. We have three major diagnostic criteria for MI: 1) does the clinical picture make sense (e.g. chest pain, nausea and vomiting, sweating); 2) does this look like a heart attack on our trusty neighborhood EKG (ST segment elevations); and 3) are cardiac enzymes elevated (e.g. high troponins)? If we can say yes to any of the above, we will give the patient a slew of medications (aspirin, heparin, Plavix, etc.) and send them for either stenting or thrombolytics (depending on the center and other factors).

Now lets to back in time a few years to… oh… how about 1919. According to volume I of Health Knowledge, the leading theory behind the etiology of heart attacks was a “neurosis of unknown etiology.” It was diagnosed entirely on a clinical picture (which is based largely on how it normally presents in white males only), and there are no fancy tests that can be ordered. The crux for me was the treatment recommendations: inhaled opiates, ether vapors, and avoidance of movement. Really?!?

There has been such a growth in technology and knowledge in what seems to be a relatively short period of time. Moore’s law transferred to healthcare. Although from a patient’s perspective, I would no doubt prefer to be treated today than when these tomes were written, I have to wonder about the differences in practicing medicine. Unlike in 1919, the dream of being that super doc who knows and treats everything is over. Nowadays we have so many specialties within specialties that we are down to one of two career options: 1) knowing about only a very small fraction of medicine, but being an expert in it; or 2) knowing about many fields, but being an expert in none. There was a single page dedicated to pneumonia in this book, yet there are entire textbooks on my Ipad.

I feel both nostalgic about a time I never knew, and excited about all the things that remain to be learned. But I can appreciate why we still do some of the physical exams we do, even though we can just as easily order a lab test that has better sensitivity and specificity. Medicine is an ancient art. As necessary as it is to continue moving forward, there may always be a place for old, outdated traditions. As long as we still do the new and fancy tests after to confirm our suspicions!