Medical replacements for heart, lungs, liver, pancreas

 Medical replacements for heart, lungs, liver, pancreas, and other important organs become routinely feasible. For your convenience, the diseases are arranged in alphabetic sequence and thus the order in which they are presented has nothing to do with I heir frequency or seriousness. In this part of our book we tell you about a number of diseases-some potential killers, others disablers, some just nuisances. You may be puzzled by our approach and by use of some words new to you in discussions about your health. For example, you will find mentioned scenario, also primary, secondary, and even tertiary prevention of disease.

We use the word scenario because it conveys the idea of the dynamic picture the physician can foresee for the course of a disease after he completes his questioning to understand the patient's symptoms, his physical examination, and his study of x-ray and laboratory reports. Sometimes, there can be no valid scenario until the physician sees the patient in several return visits. For example, two patients may have high blood pressure. 

Mr. One has a pressure reading of 164 over 98; so does Mr. Two. But in subsequent measurements of blood pressure, Mr. One's has settled down to 150 over 86 whereas Mr. Two's has gone to 190 over 110. Mr. One has no signs and symptoms, whereas Mr. Two shows a small hemorrhage in his retina and slight enlargement of the heart.

The physician will see very different scenarios or possible future courses for these two patients, and his preventive treatments will be much more active for Mr. Two than for Mr. One. By primary prevention, we mean measures that can be used to prevent a disease completely. A good example would be the use of the Sabin vaccine to keep polio from developing. By secondary prevention, we mean the use of measures to keep a disease that is already present from progressing.

 For example, for a patient with a definite ulcer of the duodenum, the physician can foresee and wants to avoid a scenario in which hemorrhage, perforation, or scarring and obstruction may take place; so he institutes diet and medical therapy as part of a secondary prevention program. We may be the first to employ the word tertiary for preventive medicine.

 Our concept is that when every type of secondary prevention may fail, there is still a chance of providing new health for the patient in a special way-that is, by giving him a new organ to replace the destroyed organ. For that, however, the patient's general health must not become so undermined that the new organ would be of little use. 

For example, suppose every effort has failed to stop the ravages of nephritis (Bright's disease); the kidneys have failed; the patient is in uremic poisoning. If the physician institutes tertiary preventive measures at this time to avoid damage to the heart and brain and eyes, then at a suitable time he can save the patient with a kidney transplant. In the future, this type of tertiary prevention may become very common as transplants or mechanical

Pancreas and diseases

A disease of the pancreas may be involved. Diabetes tends to run in families. Some authorities on this disease believe diabetes is present at or shortly after birth, although it does not necessarily show up for many years. They suspect that a person destined to develop diabetes undergoes continuous abnormal and hidden body changes until, finally, the symptoms become apparent. Diabetes occurs most frequently in over- weight people; the islets, trying to make enough insulin for the large amounts of sugar and starch that fat people consume, may be unequal to the task and so falter on the job. An additional discussion of diabetes will be found elsewhere in this book.

This much can be said here: Until about 1923, when insulin was introduced, the only thing that could be done for diabetics was to use diet. Today, with insulin, diabetics can live virtually normal, active lives. More recently, too, other agents, taken by mouth, have been employed for some diabetics. The Thyroid Gland The thyroid, in front of the throat below the Adam's apple and just above the breastbone, is roughly U-shaped, each end of the V flaring out to a lobe about the size of a big toe. The gland is extremely important for all-round health of the body. It regulates the rate at which the body utilizes oxygen; it also controls the rate at which various organs function and the speed with which the body utilizes food.

 In effect, the thyroid, through its secretions, acts as a kind of thermo- stat. Every cell in the body is like a tiny power plant, burning food and setting energy free, some of the energy coming off as heat. Thyroid hormone can be said to determine how hot the fires get in the cells. The term "metabolism" refers to the fires-the speed of activity in the cells. An overactive thyroid is a thermostat set too high. Food is burned up almost as fast as it is eaten, and even some body tissue may be burned up.

Loss of weight with excessive appetite is a symptom. Too much thyroid secretion produces a general speed-up so that the patient becomes overactive and nervous; the heart may palpitate, and there may be sleeping difficulty. In some cases, the eyes bulge and have a staring look. Today, of course, several methods of treatment are available for hyperthyroidism. 

Part of the gland may be removed surgically. In some cases, medications that block thyroid activity may be used. In others, radioactive iodine may be employed; it is picked up by the thyroid, and the radioactive particles destroy some of the gland to reduce the secretions. With too little thyroid activity, hypothyroidism, food is not burned fast enough; much of it is changed to fats causing weight gain. A sluggish thyroid also makes the patient drowsy, slow moving, easily fatigued. 

GALLBLADDER, PANCREAS, AND SPLEEN

GALLBLADDER, PANCREAS, AND SPLEEN 

The gallbladder, already discussed, is a kind of "side pocket" in the channel through which bile flows from the liver into the intestine, serving as a storage place. The pancreas, which weighs about three ounces, lies high up in the abdomen, deep behind the stomach. The pancreatic duct carries the digestive secretion, pancreatic fluid, through a common opening with the bile duct, into the duodenum. 

The fluid contains three important enzymes: amylase acts on carbohydrate foods; lipase functions in fat digestion; and trypsin is a protein-digesting agent. Equally important are the islets of Langerhans which are contained in the pancreas and produce insulin, a lack of which causes diabetes. 

The spleen, although often bracketed in people's minds with the pancreas, is not an organ of digestion. Roughly fist-shaped and about six inches long, it lies high up behind the stomach. In the unborn baby, the spleen plays an important role in producing red and white blood cells. After birth, it no longer manufactures red cells but still makes white cells.

 In adult life, it makes neither but does serve by doing the opposite-destroying old blood cells. The spleen is not vital; it can be removed without harm. While it is a useful organ, its functions can be performed elsewhere in the body. Normally, the spleen cannot be felt from outside unless it enlarges considerably.

It usually does so when affected by disease, and in extreme cases may increase fifty fold in size. Enlargement may carry some hazard since the spleen, when engorged with blood, may produce severe internal bleeding after a bump or knock that ordinarily would be trivial.