Thursday 15 August 2013

Lingua Medica - medical terminology deciphered

It has, of course, been literally the worst week for the English language ever. A bad week for me, certainly; how am I supposed to snigger in a superior and condescending fashion when one of our nurses tells me that 'When the phone rang, I literally turned round and shit myself.'? Sigh.

All is not lost for me, however. Fortunately for me, I have a whole language that was pretty much custom-designed to make me feel superior to normal mortals: medical terminology.

You see (and this may come as a surprise to you, so I'll whisper it) - many years ago, doctors didn't actually know very much. Sure, they could prod you, and prescribe leeches to suck blood out of you, but it couldn't really escape the notice of the general population that your chances of getting better with the treatment weren't dramatically better than the chances of getting better without. A poser. How could one make a living as a quack when it was patently obvious that you didn't know what you were talking about?

The solution: make it sound like you know what you're talking about. Language is, and always has been, a useful tool for those in power to keep the masses subjugated; Orwell's Big Brother understood this, with his doubleplus sinister idea, NewSpeak, and the founders of the Christian religion understood it too. Latin survived as a language largely because it wasn't understood by the poorly educated masses. The bible was always written in Latin so that churchmen (who had a similar credibility problem to the proto-medics) would be able to interpret it for the poor - and thus control the poor. If you know your history, you'll know the violence and consternation that surrounded the eventual translation of the bible into languages that everyone could read, and if you don't - go and read about it! Fascinating stuff.

In a similar spirit, early practitioners of the medical arts realised that suggesting to a prospective patient that 'I'm going to suck out a lot of your blood and hope that you feel better,' tended to garner a less-than-enthusiastic response. However, if you told them 'I'm going to perform a phlebotomy in order to balance the humours within your body,' people tended to nod, smile hopefully, and (crucially) hand over their coins.

And so medical terminology developed largely as a way of keeping knowledge (or lack of it) from the masses. As medical arts slowly transformed into medical science, it became more than that, however; much of medical language has a very specific and precise literal meaning (unlike, ironically, 'literally', any more - in fact, my money is on 'ironic' to be the next one on the list) which can get across a lot of information very quickly, and nowadays it's an invaluable tool to precisely explain your thoughts on a case in terms that, in theory, mean exactly the same thing to any medically trained personnel who reads or hears them.

I've been told a number of times that learning the medical lexicon is like learning another language. I'm suspicious of this claim...

(certainly there's nothing in medical terminology to compare to my excruciating 2nd year French classes, where Mrs McKee used to point at random suspects in the class room and utter the dread nonsensical phrase 'Eresbotty' in a low growl (everyone else in the room seemed to know what she meant, and after a few lessons I was afraid to ask; fortunately, fate never selected me for such punishment and it was only several weeks into term that I realised she was saying 'Error Spotting,' meaning they had to comment on the next pupil's French skills. I'm not sure why I was considered a bright child, to be honest)

... but I can't deny that I get a certain thrill from being able to say that I'm suffering from post-prandial narcolepsy, rather than 'I'm feeling dozy after eating'. However, I am, as you may be aware, a writer as well as a veterinarian, and as a writer it's my job to attempt to make my thoughts as clear as possible. In the spirit of this, I'd like to offer you up a number of medical terms, and explain to you what they mean, how they're useful (and, hopefully, regain some of my sense of patronising superiority that has been cruelly snatched from me by the opening up of the word literally).

1. Shock

I know, I know, it doesn't have ology at the end, or sound particularly clever - but it's a word that arises often in emergency situations - 'Is he in shock, doctor?' (I do get embarrassed when clients call me doctor, but I'm far too polite to correct them. Okay, okay, I get a thrill out of it too).

I chose this one because it's a good demonstration of the preciseness of medical terms - shock, in medical language, does not mean 'surprised' or 'pissed off that a car has just hit them' but that the patient's tissues are starting to run dangerously low on oxygen, because there isn't enough blood getting to them. Shock is further divided into several categories which more precisely define why the blood isn't getting where it needs to be, such as: cardiogenic (the heart isn't pumping the blood around the body properly), hypovolaemic (literally 'low volume' - you've lost a lot of blood), endotoxic (the blood vessels have become leaky due to infection; you've still got all your blood, but it's leaked out of the blood vessels). It's a useful and descriptive word, and nothing at all to do with the emotional shock experienced when, say, discovering that your evil twin brother has been performing an elaborate decade-long revenge against you culminating in them stealing your job and knocking off your wife. For instance.

2. Cranial/caudal/medial/lateral/dorsal/ventral/left/right

These are among the first medical terms I learned; they're all terms used orientate yourself anatomically so that you can describe exactly where on the body you have encountered a lesion or abnormality. Fans of Jaws (and this will, presumably, include all my readers, as it is literally the greatest film ever) may be familiar with 'dorsal', due to the terrifying image of that grey triangle slicing silently through the water, signifying the arrival of Bruce the Shark. The triangle is Bruce's dorsal fin, named because 'dorsal' means 'on the same side of the body as the spine'. Ventral means the opposite - the side of the body opposite to the spine, so that your belly button is on your ventral abdomen (and if it isn't, a trip to the doctor's may be in order, if you haven't been already).
'Cranial' means, perhaps unsurprisingly, 'towards the head', whereas 'caudal' means towards the tail - so your stomach is cranial to your colon, but caudal to your lungs (unless you really are in trouble) - and you'll see that these terms can refer to internal as well as external anatomy.
'Medial' means towards the midline (i.e. towards the spine) and 'lateral' means away from the midline - so your thumb is (usually) medial to your little finger, and both your eyes are lateral to your nose.
I include left and right as an anatomical point of order - such terms are always from the patient's point of view, so 'left eye' means 'the patient's left eye'.

There's a whole load more of these, for more precise localisation - 'buccal' and 'lingual' for 'on the same side as the cheek' and 'on the same side as the tongue', for instance. Hopefully you can see these terms are very useful for medics, and this help you to understand such gobbledygook as '3mm ulcerated lesion approx 2cm caudal and 3cm medial to most cranial nipple right hand side'

3. Acute and Chronic

A little like shock, these terms are occasionally used correctly, but more frequently abused, by the general public. Taking a history, I often see acute and chronic used as descriptive terms for how severe a condition is, so let's be specific - from a medical point of view, these words say nothing about a condition's severity - all they tell us is about is how long you've had the condition.
'Acute' means the condition appeared suddenly, and has tended to change rapidly - this means, of course, that acute conditions also tend to be more severe when we see them, and more likely to be a crisis - but the term in itself merely means sudden onset, rapid change.
'Chronic' conditions are the opposite - slow to develop and cause symptoms. There can be mixing of the terms; often a chronic disease will arrive in our practice in an acute crisis, because that tends to be when you notice something going wrong.

4. ...otomy/...ectomy/ ...ostomy

Ahh, now we're getting to the good stuff - the Greek. The above are suffixes that we apply to parts of the body to explain what we've done to them, only to do it in such a way that makes us sound clever.

'...otomy' means to cut a hole in something. So, instead of saying 'I have cut a hole in your dog's stomach', we can instead gravely pronounce the far sexier 'I have performed a gastrotomy.' It works with anything you can cut a hole in - bladder (cystotomy), small intestine (enterotomy), large intestine (colotomy), chest (thoracotomy) and so on. To perform a phlebotomy, as mentioned above, you make a hole in your patient's vein so the blood can leak out - usually done nowadays with a collection tube to send the blood for analysis.

'...ectomy' - remove entirely. So, no languishing in the 'I cut your cat's kidney out' for us - nope. We performed a nephrectomy. Works for anything you can chop out, so enterectomy (section of intestine), hysterectomy (uterus), orchiectomy (testicles). The ancient Incas were, of course, skilled practitioners of cardiectomy, although this is generally not good news for the patient.

'...ostomy' means to create a permanent hole in something. We don't do this very often in veterinary medicine - possibly the most common operation (and it's not all that common) would be a urethrostomy, a procedure where we permanently open up a male cat's urethra (the tube that runs from the bladder down through the penis) to prevent it getting blocked (stop wincing, men! It's a life saver) although you may be more familiar with a colostomy, performed in humans with damaged or blocked bowels.

5. Hyperplasia/ Metaplasia/ Neoplasia

All to do with tissue growth - or, more to the point, cell growth. If you have hyperplasia, then the organ in question is perfectly normal, but bigger than it should be. This is rarely anything to worry about, but occasionally this can cause trouble if you haven't got a lot of room somewhere. Prostatic hyperplasia - enlargement of your prostate gland - a common ageing change in men - is the reason is gets harder to pee as you get older, owing to the fact that the prostate gland is annoyingly wrapped around your urethra.

Metaplasia is change from one type of cells to another type of cells, usually as a result of some kind of injury or stress. It's reversible (usually if the stress is removed), and benign, and we don't see it all that often - usually because by the time we find out about this, the cells have moved onto the next stage, which is...

Neoplasia. The medical term for cancer. Similar to metaplasia, except that once they get to this stage, the cells aren't going back to their previous state. They're very different cells to the ones that should be there, and unlike normal cells, which know when to stop growing, they just keep dividing. This, as I'm sure you're aware, causes all manner of problems, which I won't go into know. Neoplasia doesn't necessarily mean a malignant tumour - a wart is a form of neoplasia.

For the record, neoplasia, cancer and tumour are all synonyms - none of them mean malignant or benign by themselves, although 'cancer' tends to be used to mean malignant, nowadays (If I'm being pedantic, tumour simply means 'swelling', in the same way that 'rubour' means redness, but almost no-one uses it in this context any more). The difference between a malignant and a benign neoplasm is not clear cut, but it's related to how they behave. Benign tumours tend to stop growing when they reach a natural tissue boundary, and not spread via the lymph tissue or blood. Malignant tumours, unfortunately, are less respectful of tissue boundaries.

6. Idiopathic and ...opathy

And now we really enter the realms of sounding clever, without saying an awful lot. Very, very helpful terms, these. Idiopathic means, effectively, 'we don't know'. More to the point, it means that the consensus of medical opinion is still unsure as to the cause of this problem. So, when I tell you that your dog has 'idiopathic vestibular syndrome', I might be sounding very knowledgeable, but what I'm really saying is that you dog has a condition that no-one in the veterinary world quite understands.

That's not to say this term isn't helpful - just because we don't understand where a condition comes from, doesn't mean we can't treat it, or at least recognise the pattern of the disease - idiopathic vestibular syndrome, for instance, has a well-understood course (i.e. it usually gets a lot better within 24-48 hours) and, if I write it on my notes, other vets who read it will know what I'm thinking. I'm just telling you that it's a shorthand way of us saying 'Oh, it's that thing where their balance centre goes wrong, but usually gets better again'.

...opathy is along the same lines. It's another suffix, and when attached to a particular organ, it means 'something is wrong with it'. Brilliant, eh? Works with anything. Pneumopathy - lung disease. Dermatopathy - dodgy skin. If I tell you that your hamster has an 'acute idiopathic hepatopathy', I'm telling you that your furry friend's liver has gone wrong. I don't know how, or why, but at least I can tell you it happened pretty quickly.

7. Iatrogenic

A classic face-saver. Iatrogenic means caused by medical examination or treatment. In other words - that thing that's wrong with your pet? I did that. So, iatrogenic Cushing's disease is caused by your vet giving your pet too many steroids. In you vet's defence, they may have had no choice, because the disease that they're giving the steroids for is probably more severe than the Cushing's disease they're creating.

Iatrogenic haemorrhage is a euphemism along the lines of a surgeon tell you 'I'm afraid he lost a lot of blood during the surgery'. He didn't lose it - the surgeon did. It's nice that we have a special word for our balls-ups.

8. Borborygmi

Finally, I wanted to make special mention of my favourite word in the whole of veterinary medicine. It's pronounced BOR-BOR-IG-ME. Say it with me, because this word is onomatopoeic - which is to say, it sounds like the thing it's trying to describe.

Borborygmi is the medical term for the sound of stomach gurgles. Say it again out loud, and tell me that isn't the greatest word ever invented. Literally.


  1. Awesome!

    In fact in French, there is a theater piece (written by Moliere, "Le malade imaginaire, among other of his plays) that makes fun of this. One guy has to pretend to be a doctor and just starts mumbling stuff in latin.

    In my case, the latin stuff made me think of being in Harry Potter's world. Pronounce the latin words and ta-daaaa that's your diagnosis! :D

    PS. I'm in vet school though, still a year until I am a full blown wizard!

  2. Best of luck, Mety - Qualificationanus!

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