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July 22, 2010
Compensation, Decompensation, and Awareness
The first two words in the title have specific meanings which are quite different when used in Medicine as opposed to ordinary speech. Medically, they refer to a phenomenon in which mild or moderately impaired function of an organ or organ system may be made up for temporarily by compensatory change. However, there is usually a price to pay; if the impairment is mild enough, it may only become apparent with increased activity. For example, when a young, otherwise healthy, cigarette smoking golfer plays a round on a hilly course instead of his usual flat one. Even then, he may relate early shortness of breath to a cold he just got over, rather than to cigarettes.However, as time goes by smoking will induce changes in his airways: chronic bronchitis with cough and sputum along with changes in his body habitus that may remain unnoticed by him and family members who see him every day, but would immediately be recognized by most medical chest specialists as early COPD: reduced muscle mass, overinflated lungs, a wet cough. More subtle signs may follow: ending most coughs with a soft laugh, the avoidance of exercise; or purchase of a golf cart, for example.
These changes and the speed with which they develop will also depend on his genome and the numbers of cigarettes smoked, but they will be ultimately be found to some degree in a majority of regular smokers and when compensation fails (decompensation), it may be either rapidly or slowly: as with a sudden fatal heart attack or a lingering dependency on others.
All of which explains why laws punishing use of a safe herbal remedy that regularly diminishes alcohol and cigarette use by its chronic users has been a terrible public policy and those guilty of supporting it for years are either fools or scoundrels.
But don't expect them to admit that; it wouldn't be consistent with their human nature.
Doctor Tom
Posted by tjeffo at July 22, 2010 07:04 PM