Blog Post #73 - Primum non nocere - Idiopathic - Bacteria ,Virus and Doctors!!!!

The art of medicine consists in amusing the patient while nature cures the disease.
Voltaire

1. Doctors and Specialities

2. Understand Bacteria and Virus

3.Sleep well and wait for next post 

If you know a doctor or have visited a doctor in your life time(who hasn't?) then you should know that every Doctor practising Allopathic/ western/English Medicine has taken Hippocratic Oath.

They raised their hand (mostly right) and took this pledge to 'First, do no harm' - Primum non nocere.

Why would the father of English/Western medicine - Hippocrates(I will refrain from calling it Modern)  make every doctor say these words in Greek and ask every Doctor who may or may not understand 'Greek or Latin' to refrain from doing any harm to patients?

Doctors by nature are in the profession of saving life,enable us to live quality life and if needed - help us die peacefully(part of their profession). Bioetchics  - dictates

(from where else - wikipedia)
 "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." 
           It reminds the health care provider that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

Medical specialties can be classified along several axes. These are:


Surgical or internal medicine - Doctors can do surgery on the body or treat with medicines.. Simple. You always need the friendly Anesthesiologist who can help patient get in and out of sleep  while the surgeon works on the patient. Anesthesiologist  do this using medicine but they will always be on the side of the surgeons. So is the Anesthesiologist a Surgeon or not? (Debatable and check online for debates like these)
Age range of patients - Pediatric doctors are an example of this. They might work only a certain age group.
Diagnostic or therapeutic - Is the doctor figuring out what is wrong or treating what is wrong? So the x-Ray Radiology will be diagnostic while Radiotherapist  will be a Therapeutic specialty. 

Organ-based or technique-based - is the doctor working on a single organ - eye or heart .Is the doctor working on a technique... check Da vinci technique (the highest paid doctors in US need to master this technique) which includes minimally invasive robotic technique.

Again from wikepedia...

Allergy and Immunology	Allergic reactions, asthma, and the immune system
Anesthesiology	Anesthesia
Cardiology	Disease of the cardiovascular system
Cardiovascular surgery	The operation of heart and major blood vessels of the chest.
Clinical laboratory sciences	Application of diagnostic techniques in medical laboratories such as assays, microscope analysis.
Dermatology	Skin and its appendages (hair, nails, sweat glands etc.).
Dietetics	Food and nutrition
Emergency medicine	The initial management of emergent medical conditions, often in hospital emergency departments or the field.
Endocrinology	The endocrine system (i.e., endocrine glands and hormones) and its diseases, including diabetes and thyroid diseases.
Family Medicine	Continuing, comprehensive healthcare for the individual and family, integrating the biological, clinical and behavioral sciences to treat patients of all ages, sexes, organ systems, and diseases.
Forensic Medicine
Gastroenterology	The alimentary tract
General surgery
Geriatrics	Elderly patients
Gynecology	Female reproductive health
Hepatology	The liver and biliary tract, usually a part of gastroenterology.
Infectious disease	Diseases caused by biological agents
Intensive care medicine	Life support and management of critically ill patients, often in an ICU.
Medical research
Nephrology	Kidney diseases
Neurology	Diseases involving the central, peripheral, and autonomic nervous systems
Neurosurgery	Disease of the central nervous system, peripheral nervous system, and spinal column.
Obstetrics and gynecology
Oncology	Cancer and other malignant diseases, often grouped with hematology.
Ophthalmology	Diseases of the visual pathways, including the eyes, brain, etc.
Oral and maxillofacial surgery	Disease of the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.
Orthopedic surgery	Injury and disease of the musculoskeletal system.
Otorhinolaryngology, or ENT	Treatment of ear, nose, and throat disorders. The term head and neck surgery defines a closely related specialty that is concerned mainly with the surgical management of cancer of the same anatomical structures.
Palliative care	A relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses   including cancer and heart failure.
Pathology	Understanding disease through examination of molecules, cells, tissuesa nd organs. The term encompasses both the medical specialty that uses tissues and body fluids to obtain clinically useful information and the related scientific study of disease processes.
Pediatrics	deals with the medical care of infants, children, and adolescents (from newborn to age 16-21, depending on the country).
Pediatric surgery
Physical medicine and rehabilitation Or Physiatry	Concerned with functional improvement after injury, illness, or congenital disorders.
Plastic surgery	Elective cosmetic surgery as well as reconstructive surgery after traumatic or operative mutilation.
Podiatry	Elective podiatric surgery of the foot and ankle, lower limb diabetic wound and salvation, peripheral vascular disease limb preservation, lower limb mononeuropathy conditions.
Proctology	(or Colorectal Surgery) Treats disease in the rectum, anus, and colon.
Psychiatry	The bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
Pulmonology	The lungs and respiratory system. Pulmonology is generally considered a branch of internal medicine, although it is closely related to intensive care medicine when dealing with patients requiring mechanical ventilation.
Radiology	The use of expertise in radiation in the context of medical imaging fordiagnosis or image guided minimally invasive therapy. X-rays, etc.
Rheumatology	Autoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.
Stomatology	Diseases of the mouth
Surgical oncology	Curative and palliative surgical approaches to cancer treatment.
Thoracic surgery	Surgery of the organs of the thoracic cavity: the heart, lungs, and great vessels.
Transplant surgery	Transplantation of organs from one body to another
Urgent Care Medicine	Immediate medical care offering outpatient care for the treatment of acute and chronic illness and injury
Urology	Urinary tracts of males and females, and the male reproductive system. It is often practiced together with andrology ("men's health").
Vascular surgery	The peripheral blood vessels – those outside of the chest (usually operated on by cardiovascular surgeons) and of the central nervous system (treated by neurosurgery)

Now to the critical question - what are virus and bacteria?

Every time you are sick you must realize this is a virus,bacteria or fungus. While you may recognize fungus on some skin rashes it is not easy to understand the difference between bacteria and Virus.

First thing - Virus is not a living thing.

So What is Life?

From http://www.virology.ws/2004/06/09/are-viruses-living/

Life is “an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction.”

Wow..

.

So if you say you are living (if you say you are living you must not dead!!!) then 

1. You metabolism works which means you are able to consume food and generate useless stuff. Most of us live our life doing this job of taking what nature has to offer and give back what nature expects us to give back..simple.

2. You grow - yes. When you are young you grow vertical - tall and horizontal - put some weight on parts of your body. Once old you grow horizontal not vertical and your body grows new cells.

3.You react to stimuli - philosophy dictates that you have the ability to choose the response but in any case not responding is also a choice which will be a reaction to the stimuli. If you are Gandhi or Jesus and someone hits you on one side of the face you react to stimuli by showing the other side . For us mortals we show our back and run.....

4.You reproduce  - in all sense including multiplication of your cells. Your body produces millions of cells and you are not the same you that were there last week. This week - you lost millions of cells and got extra millions of cells.

So in short Virus is not a living thing! (if that was short think what might be long....)

Virus is more like a chemical which can go into a living cell and multiply using the host cell. Once in it invites its friend - bacteria to come and infect. 

Bacteria are living things and are single celled organisms. 

From webmd.com

Bacteria are relatively complex, single-celled creatures with a rigid wall and a thin, rubbery membrane surrounding the fluid inside the cell.

They can reproduce on their own.

Fossilized records show that bacteria have existed for about 3.5 billion years, and bacteria can survive in different environments, including extreme heat and cold, radioactive waste, and the human body.

Most bacteria are harmless, and some actually help by digesting food, destroying disease-causing microbes, fighting cancer cells, and providing essential nutrients. Fewer than 1% of bacteria cause diseases in people.

Viruses are tinier: the largest of them are smaller than the smallest bacteria. All they have is a protein coat and a core of genetic material, either RNA or DNA.

Unlike bacteria, viruses can't survive without a host. They can only reproduce by attaching themselves to cells. In most cases, they reprogram the cells to make new viruses until the cells burst and die. In other cases, they turn normal cells into malignant or cancerous cells.
Also unlike bacteria, most viruses do cause disease, and they're quite specific about the cells they attack. For example, certain viruses attacks cells in the liver, respiratory system, or blood. In some cases, viruses target bacteria.
Bacteria are good and bad. Not Virus. Virus always bad!

You always have 2 options in medicine (and even in life) - prevent or fix.

To prevent Virus we have vaccines - inject live virus and let the body develop immunity. 
Polio
measles
Chickenpox
Flu 
Hepatitis A
Hepatitis B
Human papillomavirus (HPV)

Don't forget the common cold is also a virus and there are no cures. 

HIV/AIDS, and influenza are 2 examples of the viral infections for which we have antiviral medicine.

For Bacteria there is anti-bacterial drugs. 

Alexander Fleming discovered Penicillium and named the substance from mold penicillin which is one antibiotic.

So what happens when doctors infect patients with bacteria? (Wikipedia my friend!)
In the 1800s Ignaz Semmelweis noticed that women giving birth at home had a much lower incidence of childbed fever than those giving birth in the doctor's maternity ward. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%. Publication of his findings was not well received by the medical profession. The idea conflicted both with the existing medical concepts and with the image doctors had of themselves. The scorn and ridicule of doctors was so extreme that Semmelweis moved from Vienna and was eventually committed to a mental asylum where he died
If you call a doctor and say I have a high fever(104) ,cold ,cough et all the doctor will first ask 'How long have you had this?" - my theory is if you say any answer more than 3 you will get antibiotics else nothing. Nothing sometimes means treating the symptoms - some zinc chewables, lots of fluids to keep the body from dehydrating,techniques to cool the body - warm/cold cloth/bath etc. This doesn't mean the doctor is not competent.  This just means the Virus is still a virus. There is no known cure to Virus. So wait and watch. 
Once  3 days or more have passed time to check if you have bacteria - strep or something else. 

Doctors rely on  available techniques to analyze the symptoms and identify the cause.

'First, do no harm' - Primum non nocere - principle applies to you too. Once you find symptoms you start self medicating and if you get antibacterial medicine for viral infections - good luck!! If you recommend people medicine without knowing their medical conditions - good luck. In short , don't do it. Always visit your friendly doctor (if you are sick many times you will be friends with the doctor anyways!)

Finally when you hear the doctor mention Idiopathic to another doctor or to you - they mean
 - "I don't know why you're sick."

So I always ask my doctor - "Doctor, is my condition Idiopathic" and they laugh and that is one way to become friends with doctors! - knowing their terms and conditions!!

Keep Learning
Sivakumar Manikanteswaran