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How Not to Die: Surprising Lessons from America's Favorite Medical Examiner - Softcover

Garavaglia M.D., Jan

 
9780307409157: How Not to Die: Surprising Lessons from America's Favorite Medical Examiner
Softcover
ISBN 10: 0307409155 ISBN 13: 9780307409157
Verlag: Harmony/Rodale/Convergent, 2009

Inhaltsangabe

WHEN THIS DOCTOR TALKS, YOU SHOULD LISTEN.

Thousands of people make an early exit each year and arrive on medical examiner Jan Garavaglia’s table. What is particularly sad about this is that many of these deaths could easily have been prevented. Although Dr. Garavaglia, or Dr. G, as she’s known to many, could not tell these individuals how to avoid their fates, we can benefit from her experience and profound insight into the choices we make each day.

In How Not to Die, Dr. G acts as a medical detective to identify the often-unintentional ways we harm our bodies, then shows us how to use that information to live better and smarter. She provides startling tips on how to make wise choices so that we don’t have to see her, or someone like her, for a good, long time.

• In “Highway to the Morgue,” we learn the one commonsense safety tip that can prevent deadly accidents—and the reason you should never drive with the windows half open
• “Code Blue” teaches us how to increase our chances of leaving the hospital alive—and how to insist that everyone caring for you practice the easiest hygiene method around
• “Everyday Dangers” informs us why neat freaks live longer—and the best ways to stay safe in a car during a lightning storm

Using anecdotes from her cases and a liberal dose of humor, Dr. G gives us her prescription for living a healthier, better, longer life—and unlike many doctors’ orders, this one is surprisingly easy to follow.

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Über die Autorin bzw. den Autor

JAN GARAVAGLIA, M.D., is the chief examiner for the District 9 Medical Examiner’s Office in Florida, presiding over 1,100 autopsies a year. She is also the host of Discovery Health channel’s top-rated series, Dr. G: Medical Examiner.

Auszug. © Genehmigter Nachdruck. Alle Rechte vorbehalten.

ONE   

Doctor Dread  

Taking It on the Jaw  
I followed the infection underneath his breastbone like a trail of bread crumbs all the way up to his jaw. The trail teemed with pus, the army of white blood cells that had marched through the walls of blood vessels to fight invading microorganisms. I had never seen anything like it before. Bacteria had waged a protracted war with his body's immune system-and won. I wondered how fifty-year-old Victor Baca could have developed such a virulent infection.  

Ten days earlier, Victor had been in perfect health. Then he started complaining of back and shoulder pain and a sore throat. The symptoms kept him in bed and unable to go to work. Even so, he didn't seek medical attention. But as the pain worsened, Victor realized something was terribly wrong, and he called 911. The dispatcher alerted an ambulance. Paramedics arrived, found him critically ill, and went to work immediately. Despite their aggressive intervention, including cardiopulmonary resuscitation (CPR), Victor slipped away, causes unknown.  

As I often do in cases involving unusual infections, after the autopsy I consulted Dr. Mark Wallace, an infectious disease specialist and an internal medicine physician, who also happens to be my husband. An infectious disease specialist tracks down bacteria and viruses, decodes their defenses and their weaknesses, and figures out what will kill them. Mark believed-and I concurred-that all the evidence proved that a bacterial infection had originated in Victor's mouth, shockingly, from the most ordinary of health problems: a common dental infection.   This infection probably migrated from a decayed tooth into the surrounding bone and tissue in his jaw and caused an abscess, a cavity containing pus surrounded by inflamed tissue. Many of us have probably had an abscess at one time or another. They can show up externally (in the gums or in a hair follicle) or internally (in an organ), and some types are more severe than others.  

Once a pocket of pus breaks through the thin bone surrounding the tooth sockets, bacteria can spread through the tissue planes of the neck and into the chest. By the time Victor sought medical attention, bacteria had likely reached his bloodstream and caused multisystem organ failure. This infection was the source of all his pain-and the cause of his death.   Before penicillin was discovered in 1928, bacterial infections like Victor's were the leading cause of death in the United States. Today, due to widespread use of antibiotics, head and neck infections rarely kill, unless you have no access to, or reject, basic medical or dental care. For some unknown reason, Victor decided not to see a doctor, even as the unchecked infection spread to his chest and the pain became excruciating. What began as a run-of-the-mill oral infection became a fight for survival. Eventually, Victor's organs ceased functioning, and he died. The tragedy was compounded by the fact that Victor's death could easily have been prevented. A routine course of antibiotics provided in a timely manner would have stopped the infection in its tracks.  

Checked Out  
As with the case of Victor Baca, I've seen firsthand the terrible complications that can arise when people don't go to the doctor, ignore a physician's advice, or decide to take medical matters into their own hands. Another example from my case files is that of Kim Atani, age forty-eight. She was a woman who could have lived a long, normal life had she received proper medical care. Kim, who was blind, and her husband, Simon, were living in their Orlando home when Simon found her collapsed on the bedroom floor. He called 911, and Kim was rushed to the hospital, where she later died. Her body was sent to my morgue to be autopsied.  

Some of the most important information any physician-forensic pathologists included-can have is a medical history. But Kim arrived at the morgue without any medical records. I had to rely solely on observation to figure out why she died.   Clearly, something terrible had been happening. Her teeth were fractured at the gum line. She was also covered with bedsores, oozing craterlike wounds that can become seriously infected. Medically known as "decubitus ulcers," bedsores develop quickly as tissue dies when blood flow is impaired by the continuous pressure of body weight on the soft tissues sandwiched between bone and a firm surface. There was also gangrene, or dead tissue, which appeared as large, black, shriveled areas across her left foot. Gangrene is caused by progressive loss of blood to an area, and there are two types: wet and dry. Both are caused by poor blood flow, but in wet gangrene, the tissue is also infected with bacteria. Kim had wet gangrene. Gangrene is often associated with advanced cases of diabetes.  

I dissected Kim's wet gangrene and discovered that the infection had burrowed down to her bone. If discovered in time, a limb so acutely diseased would have been amputated to prevent the spread of a life-threatening infection.   With my scalpel, I made the standard Y incision, a deep cut from shoulder to shoulder across the chest, followed by a straight line down to the pubic bone. I then opened the torso like you'd open a jacket or sport coat. Ribs were cut so I could gain access to the organs, which are removed, weighed, and dissected during the autopsy.   After opening her up, I could see that her body harbored several other possible killers. Her kidneys and liver were damaged, and her coronary arteries were more than 95 percent blocked. These findings were pieces of the puzzle that, along with her blindness, periodontal disease, and gangrene, began to fit a pattern. It appeared to me that Kim Atani had been suffering from long-standing untreated diabetes.  

Diabetes is a metabolic disorder. Its hallmark is a failure to metabolize glucose, or blood sugar, carried by the bloodstream to fuel every part of the body. The failure is caused by problems with the hormone insulin. Either the body doesn't make any (or enough) insulin, or cells don't respond to insulin properly. In either situation, glucose is unable to enter cells. It starts amassing in the bloodstream, where it can reach concentrations over ten times the normal level. Over time, elevated glucose causes widespread organ damage, like that which I observed in Kim Atani.   To confirm that Kim had diabetes, I would need to know her blood sugar levels. Testing for blood sugar is easy to do when you're living-blood is drawn and checked for its glucose concentration-but it's more complicated when you're dead. After you die, your blood sugar begins to drop continuously toward zero. I can't even test for glucose levels in the blood because the blood breaks down right after death and interferes with testing. But I can test for glucose by using eye fluid drawn into a syringe-a procedure that can make you shudder if you've never seen it before. Each adult human eye contains about one-fifth of a teaspoon of jellylike fluid called vitreous humor. This fluid is very reliable for testing because it is isolated and protected, and therefore less subject to contamination or cell breakdown.   I collected eye fluid from Kim's eyes and sent it to our toxicology lab. Glucose levels in the eye decrease after death, too, so a finding of elevated glucose would strongly indicate diabetes. Sure enough, when the toxicology report came back, it revealed that Kim's eye-fluid glucose was 378-massively elevated for a postmortem level.  

Once I put all the facts of the case together and reviewed her tissues under a microscope, it was clear to me that over time, elevated glucose had caused widespread organ disease. It not only left Kim blind but it also caused a loss of sensation in her extremities and impaired...

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Verlag
Harmony/Rodale/Convergent
Erscheinungsdatum
2009
Sprache
Englisch
ISBN 10 
0307409155
ISBN 13 
9780307409157
Einband
Taschenbuch
Auflage
1
Anzahl der Seiten
289
Kontakt zum Hersteller
Nicht verfügbar
Verantwortliche Person
gpsr@libri.de
gpsr@libri.de

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