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Dr. C's Journal, Men's Health, Opinion, Women's Health

DR. C’S JOURNAL: Stress & The Effects Of Cortisol

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Cortisol (hydrocortisone, 17-OH-corticosterone) is produced by stress, and is a bad word these days. When I was a practicing allergist, Cortisol worked wonders with asthma, and as a salve helped my patients with eczema.

It functions in the body as a key part of the stress reaction, which preparers the animal body for “Fight or flight”.  Cortisone raises the blood pressure, heart rate and blood sugar, and shuts down The immune system, which is not as necessary in times of emergency. It is this last function which helped my patients with asthma and eczema, which are diseases of excessive immune reactivity. You may have heard of the use of dexamethasone( A relative of cortisol ) in severe Covid, which is made worse by an excessive immune response.

Modern life is a pressure cooker, requiring continuous activity and deadlines. The blood Cortisone level, which is raised by stress, is helpful in the short term, but deleterious when persisting over the long term. The prolonged elevation of blood Pressure, blood sugar and heart rate, coupled with a decrease in bone and collagen formation can lead to all kinds of problems including weight gain, diabetes, cardiovascular problems, osteoporosis and mental decline.

Although  cortisol in the short term can enhance memory (think of flash – bulb memory), in the long run it decreases hippocampal function, impacting memory.

For these and other reasons, Modern Life makes it desirable to reduce stress and the accompanying elevation of cortisol . Our old friends, Proper sleep, diet and exercise are critical, and help activities such as laughter and yoga to reduce stress. The following reference will cover this in more detail.

—Dr. C.

Dr. C "Comments", Men's Health, Physicians, PODCASTS, Women's Health

MEDICAL PODCAST: “ASSESSING CHEST PAIN” (BMJ)

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Chest pain is a common chief complaint. It may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and non-cardiac causes. James E. Brown, Professor and Chair, Wright State University Boonshoft School of Medicine, Kettering, Ohio, gives us an overview of assessing chest pain in the emergency setting. 

COMMENTARY

Dr. James E Brown of the Wright State school Of medicine in Kettering Ohio gave a very interesting discussion of chest pain.

One interesting takeaway is the value of a very experienced clinician dealing with large volumes of emergency room patients. This would make telemedicine with an emergency room hub in a teaching center a very attractive platform.

The consultant doctor in the center has the advantage of his vast experience in rapidly narrowing down the heterogeneous list of different diagnoses that must be considered- the “differential diagnosis”.

Dr. Brown mentioned the “gestalt”, the incorporation of subjective features such as facial and voice cues which add to the objective parameters in patient evaluation. This of course would be amenable to telemedicine although other old-time clinical information like the changes in breath sounds would be more favorable to conventional in-person evaluation.

Ultrasound would More easily be done locally as well.

An interesting take away from this discussion is the value of The patient’s history and past laboratory data, so undervalued by rushed modern doctors. For instance, Electronic medical records (EMR) could provide past history or a previous electrocardiogram for comparison.

Dr. Brown favors the division of chest pain causes into cardiac and non-cardiac. It is easy  to develop tunnel vision and look at the patient only as a possible coronary thrombosis. In fact it is better to Rapidly consider the non-cardiac causes that would demand immediate attention while waiting for the results of the Troponin-T test.

For instance pulmonary embolism, aortic dissection, tension pneumothorax, cardiac Tamponade should be considered.

These considerations should be running through the head of the clinician as the IV,  EKG, and pulse oximetry are being set up.

In addition to the Troponin-T, bedside ultrasound, and Higher “slice count” CAT machines, and higher “Tesla” MRIs  are becoming available major centers which could support small emergency rooms.

If there is One place where “the Flow” would be Appropriate it would be in the mind of the emergency room doctor evaluating acute chest pain.
I have a hard time imagining artificial intelligence endangering her job.

—Dr. C.