Vitals & Bits #20: Cellulite
“A plague on both your butt cheeks!”
I have a recurring nightmare. In this nightmare, I am running around my former high school stark naked. I dash into the bathroom and frantically MacGyver an outfit out of toilet paper. But my makeshift frock falls apart. It’s then that I notice the urinal, and realize I’m not in the girls’ bathroom. I’ve accidentally ducked into the wrong bathroom, and numerous pubescent males are gawking at me.
Now, I’m not some closet Freudian who believes the mind buries its urges in obtuse dream riddles. But there is one minor detail of my recurring nightmare that always leaves me shaking my head when I finally wake up. In the dream, I never attempt to cover my breasts or groin with my toilet paper garment. Instead, I fashion a little backflap to conceal what my dreaming self is so urgently desperate to hide: cellulite.
My cellulite and I have a … complicated relationship. I’ve been trying to break up with my cellulite for years now, but the stubborn bastard just won’t take a hint. It doesn’t matter how many hours I spend at the gym. Cutting back on calories doesn’t do the trick. For seven years now, I’ve been telling myself that if I just work a little harder, I’ll finally achieve the smooth lifted backside I want so badly.
One night in the not-so-distant past, I found myself in tears over the dismal rear view in the mirror, despite my years of hard work and persistence. After wallowing in my self-pity for awhile, I became angry. I wiped away my tears defiantly, and marched to the medical library. “Screw you, cellulite!” I hissed. “I’m going to blast you away once and for all, with science!!!”
I pored over textbooks and journal articles, attempting to understand the evil dimples colonizing my backside. I searched, high and low, for the best weapons to demolish my enemy. Liposuction! Cryosurgery! Laser beams! Take that!!! I expected to find a smorgasbord of fat-blasting options. But much to my horror, the scientific literature on the topic was strangely sparse.
Despite the fact that humans possess the technological sophistication to land a robot on Mars, we still don’t really know exactly what cellulite really or how it differs from “normal” fat. What we do know is that cellulite occurs almost exclusively in women and usually on the lower body. Though the exact mechanism behind cellulite has yet to be discovered, it probably results from the complex interplay of numerous factors like hormones and circulation. This condition, defined by doctors as “a localized metabolic disorder of subcutaneous tissue that provokes an alteration in female body shape,” affects up to 98% of women.
The media often portrays cellulite as a shameful side effect of weight gain, but in reality, there is little correlation between body mass index (or ratio of weight to height) and cellulite. Although extra weight can exaggerate cellulite, not all heavy women have cellulite. In some cases, weight loss improves the appearance of cellulite. But weight loss can also worsen the appearance of cellulite, when previously plump skin hangs loose. The vast majority of lean women have cellulite, and this condition is not associated with any health problems at all.
If cellulite affects up to 98% and women is a completely benign condition, should we really be defining it is a metabolic disorder? Metabolic disorders, like diabetes and hypothyroidism, are pathological conditions that cause significant illness. Cellulite is a complete wimp compared to these health wreckers. Even defining cellulite as a cosmetic disorder is a bit of a stretch. Some cosmetic problems, like balding and varicose veins, can come with risks such as increased chance of skin cancer or blood clots. Not so with cellulite. Physically speaking, cellulite is a total pacifist.
Since the jury is still out on what cellulite is and why it happens, I feel at liberty to offer up my own interpretation. Starvation was a very real problem for our ancestors. Now imagine trying to breastfeed throughout those lean winter months, when you’re already low on fuel. The thighs, hips, and buttocks are known fat storage sites in the female body (FYI, women who store fat in these areas rather than on the abdomen have a lower risk of heart disease). In fact, research shows that the fat stored on the lower female body is much more resistant to lipolysis (or the process of breaking fat down for fuel) than other areas on the body. This means that the body only burns those stylish saddlebags in times of significant calorie deprivation. I think that cellulite is probably some sort of vestigial skin/fat configuration that makes it easy to pack fat on to that area of the body and tough to break it down. Is this good for breastfeeding hunter-gatherers living off of berries and squirrel? Yes. Is it good for spring break on Padre Island? No!
Just because cellulite is normal and harmless doesn’t mean we all need to commune beneath the moonlight to embrace the organic beauty of our cellulite. Personally, I believe that whoever invents a completely safe, cheap, effective cure for cellulite deserves every damn penny of the billions of dollars she’ll make. Yet, by the same token, whining and crying over one’s less-than-perfect backside as I’ve done in the past is a lame waste of energy that our ancestors probably didn’t have the time for. This self-hatred is a form of self-obsession, which is the real modern plague with consequences far more dire than a little smattering of cellulite.
When it comes to modern women, the world is too full of perils and wonders to get caught up in the cellulite shame spiral. This is not something that will ruin your eyesight or land you in a wheelchair (unless you experience some adverse reaction to an anti-cellulite treatment). It won’t even ruin a romantic date, unless low self-esteem robs you of your enjoyment. A leg with cellulite can still dip a toe into a summer lake, or enjoy the warm sunshine, or run a marathon every bit as well as a leg without cellulite. So I guess what I’m trying to say is, if you’re a woman with cellulite, it’s your birthright to bypass the stages of grieving that I’ve subjected myself to… denial, anger, bargaining, and depression… and skip right to the acceptance part. Yup. There it is. Cellulite. Now tear yourself away from the mirror and go enjoy your life.
The Daily Word: Giffords, Libya defections, bug-eating
A woman who let her friend drive drunk is being charged with a DWI.
Rep. Pearce says something something "constitutional" something "don't' give money to public broadcasting."
Charges against the local nonprofit that sent human heads to a Kansas medical waste facility were dropped.
Someone put an explosive near an APD car this morning.
Do you know this guy? He stole a computer from UNM by picking it up and walking away.
Secretary of State says the guv may have breached campaign law.
Arizona outlawed abortions that are performed because of the sex or race of the fetus.
Maybe we will eat bugs when there's no more meat.
Is it too soon to ask: Will Giffords run for Senate?
Spoiler: The "Top Chef All Stars" winner.
Birth rate in the U.S. dropping fast.
Google makes baby steps toward social networking and "liking."
The cosmonaut who fell to earth.
Vitals & Bits #19: The Kidneys
Deconstructing our federal government is pretty similar to dissecting one of the waxen cadavers from my college anatomy lab. Peel back the layers and you’ll find judicial brains, and military muscle, and convoluted channels funneling money, the lifeblood of government, to all its various parts.
If government were an organism, however, it might look like some freakish homunculus with an oversized mouth and a huge anus. The vitals parts, like the heart and the hands, would appear atrophied, leaving us with a system that’s incapable of doing much besides talking, eating, and squeezing out feces. What are we supposed to do with such an obnoxious patient? Is our government, like a cadaver on the table, already dead, or is there some kind of life support that would help reanimate the precious organs and return our system to dynamic, efficient functionality?
Perhaps we should take a cue from Mother Nature and invest in a beefy pair of kidneys for our dying system. In the human body, the kidneys have about a zillion hobbies, but their day job is filtering waste products from the blood and preventing a toxic overload of metabolic byproducts like urea. They also excrete or reabsorb water and electrolytes as needed in order to keep blood pressure normal. For instance, if a person is dehydrated, the kidneys sense the drop in blood pressure and begin reclaiming every spare water molecule in sight. As such, they play a major role in maintaining homeostasis, or the stable internal equilibrium of a living system.
The kidneys know that fiscal responsibility has more to do with sustainability and recycling than tightfisted, miserly budgeting. The kidneys never hesitate to spend, but they spend wisely, always keeping an eye on the wellbeing of the whole organism. They secrete the hormone calcitriol when they sense the body is low on calcium. They regulate the body’s red blood cell production via the hormone erythropoietin, and they manufacture a hormone called renin in response to dropping blood pressure. They reclaim important molecules, like sugar and protein, and return them to the body for reuse. They’re like waste management, recycling, manufacturing, and the EPA all rolled into one, or rather two, sweet little bean-shaped organs. They’re located towards your back, flanking your spine on either side just underneath your two lowest ribs.
The kidneys have always been my favorite organ. Like a good Sophia Coppola film, the kidneys have a kind of quiet, indie appeal to me. The heart thumps predictably, the guts squish and squirt without regard to decorum, and the lungs wheeze and rattle and cough. The music of the kidneys, however, is an ambient, internal whirr. And the pieces of the kidney have the best names, like nephron and glomerular tuft and distal convoluted tubule and minor calyx. Yesssss. Plus there are two of them, and who doesn’t like twins?
I think that our country’s founders tried to build a solid set of kidneys into the infrastructure of our government with a series of checks and balances. But, like human kidneys, disease and aging take their toll. Human kidneys are vulnerable to infection, injury, and the devastating consequences of systemic illnesses like diabetes or high blood pressure over time.
A diabetic patient in kidney failure must go to dialysis three times a week, sit in a chair for half the day while their blood is pulled from the body, filtered through the dialysis machine, and returned to the body via the largest, scariest needle you’ve ever seen. People often die on dialysis, awaiting a kidney transplant that never materializes. I think, in much the same way, cultural and social illnesses have disabled the homeostatic apparatus of our government, and we must wait on dialysis until the dead parts are removed and replaced with shiny new organs. What will the government’s new kidneys look like? Congressional overhaul? Economic restructuring? Massive investments in education and the environment? I don’t know. But I know we can’t sit here for the rest of time, with a damn needle in our arm and a body full of waste. Let’s clean this mess up before the grip of death turns our society into a cadaver, useful only for future generations to cut open and identify the diseased parts.
Vitals & Bits #18: The Amygdala (Special Flu Shot Edition)
Be afraid. Be very afraid. At least, that’s what your amygdalae are telling you to do. These two almond-shaped neural hotspots are groups of nuclei (or clustered neurons) deep in the middle of your brain, one on each side.
One of the best ways to learn about what a specific brain region does is to study a person in which that region has been destroyed. People with a damaged prefrontal cortex lose judgment and personality, while people who’ve knocked out Wernicke’s area can’t understand language. The hippocampus is often obliterated in Alzheimer’s patients, which is why they suffer memory dysfunction. And the amygdalae? These little puppies play a role in learning and emotion, particularly fear. Injure your amygdalae and conquer your fear!
JK. Seriously. Don’t do that.
Today, my amygdalae began tweeting to me as I pondered the onslaught of the upcoming flu season. It’s supposed to be a bad one, and there I’ll be in clinic, being coughed upon, sneezed upon, barfed upon, yelled at by cranky patients, and scolded by overworked colleagues. Flu season really activates my fear response, as it should yours.
Actually, I take that back. I don’t want to steal the politicians’ strategy of the manipulating you with fear. Flu season shouldn’t activate your fear response as it does mine. After all, you won’t be facing the waiting rooms crammed with unhappy people (unless, of course, you fail to get your flu shot and wind up in a waiting room yourself). Instead, flu season should activate the above-mentioned prefrontal cortex. This is the executive center of your brain, the planner and decision-maker, the smart librarian-looking lady with the black-rimmed glasses who, like a calculator, can look at a situation and weigh the pros and cons, the risks and benefits, the good and bad, without messing up even one little hair in her perfect French twist. Yes, the prefrontal cortex, your brain’s inner librarian lady. She can tell you the cold hard facts about how the benefits of the flu shot outweigh the risks. She can do so coolly, objectively, without emotion or fear. Here are the facts, my child. At the very least, even if you were never destined to get sick, a flu shot can prevent you from being a carrier that spreads the virus to others. The flu shot can save you a miserable weekend spent in bed, or an ER bill, or a hospital bill. It can even save your life. And the risks are nanoscopic. Now go in peace, my child.
One more thing. When you go get your flu shot, don’t forget to take granny and the kids with you. A new study found that kids who contracted H1N1 last year were more likely to suffer neurologic problems than kids who just got seasonal flu. A second round of H1N1 is predicted to make a comeback this year, and the new batch of flu shots contain protection against H1N1. Another study found that flu shots actually decrease risk of heart attack in older adults. So maybe crazy Great Aunt Agnes can avoid that third triple-bypass she’s been working on.
For those of you who develop an overly stimulated amygdala at the thought of shelling out money for a vaccine, relax. The University of New Mexico is offering free flu shot clinics to the public. Here’s a list of time, dates, and locations you can swing by to get your annual free poke.
The University of New Mexico Health Sciences Center 2010 schedule for free flu shots for the public:
Saturday, Sept. 25, 9 a.m. to 2 p.m.
UNM LoboCare/Senior Health Clinic
1101 Medical Arts Ave. NE
Saturday, October 2, 9 a.m. to 2 p.m.
UNM Family Health Clinic - University Area
1209 University Blvd. NE
Saturday, October 9, 9 a.m. to 2 p.m.
UNM Westside Clinic
4808 McMahon Blvd. NW
Saturday, October 16, 9 a.m. to 2 p.m.
UNM Southeast Heights Clinic
8200 Central Ave. SE
Saturday, October 23, 8:30 a.m. to 5 p.m.
This is UNM's annual drive thru clinic
UNM Family Practice Center (parking lot)
2400 Tucker NE
Saturday, October 30, 9 a.m. to 2 p.m.
UNM Northeast Heights Clinic
7801 Academy Blvd., NE
Vitals & Bits # 17: Saliva
Think of your favorite bar. It might be an unpretentious dive bar, a kitschy sports bar, or maybe it’s a faux-swank establishment crawling with coked-out LA types. Perhaps it’s one of those pervasive Meccas of cultural rot where popped collars abound, or some cooler-than-thou hipster hangout. I care not. The point is that you’re sitting there at your favorite bar, deciding what you’re going to drink. There’s a special on well liquor, but you find yourself eyeballing the shelf selections appreciatively. A bloody Mary? Scotch on the rocks? Some nauseating lametini concoction? If liquor isn’t your thing, you night turn your attention to the wall of beers on tap. Or perhaps your closeted wine-enthusiast wants to come out and play. Even if you’re a twelve stepper or teetotaler, you’ve got plenty of options. Hey, there’s no shame in ordering a champagne flute of maraschino cherry juice. Wait, yes there is.
Chances are, you’re no idiot. You see that this article is about saliva, so you maybe you think I’m going to describe the medical implications of drunkenly French kissing the herpetic bar patron sitting next to you.
The human body is analogous to a bar in that many of its most vital components are liquid. With water comprising up to 75 percent of the human body, it’s no wonder that the story of life is written in aqueous characters. There are some old familiars, such as urine, sweat, and tears. Other bodily fluids remain mysteriously aloof. What’s in blood plasma, anyways? And where the hell does bile come from? Still others fall into that category of the beautifully exotic. Ghostly lymph circulates silently through the lymphatic system, while cerebrospinal fluid courses through the ventricles of your brain and your spinal canal. And there’s about a billion more, from stomach acid to the thin layer of fluid between the membranes lining your lungs (pleural fluid) to semen to pancreatic juice to snot. Each and every one of these fluids has a at least one job. Pleural fluid allows the lungs to expand smoothly when you breathe. Vaginal secretions protect the vagina against pathogens and provide lubrication during sex. Pancreatic fluid contains enzymes that help digest food. And urine, well, urine exists so that we can continue making jokes about R. Kelly.
Of all the bodily fluids, though, saliva might be the hardest working. This multitasking oral tenant contains digestive enzymes, antibacterial compounds and antibodies, lubricants, sex hormones, and even a pain-killing substance. Its various jobs include softening food for digestion, facilitating taste, and protecting the teeth. Saliva allows us to talk, kiss, and play musical instruments. In this sense, it not only plays a role in survival but also in the experience of being human.
Medically, saliva can tell us a lot about someone’s health. We can measure someone’s drug or alcohol level using saliva. Saliva production requires adequate hydration, and so health care providers should always look inside the mouth of a sick person to make sure they’re not dehydrated . Certain autoimmune disorders destroy the salivary glands, producing chronic dry mouth. There’s even a whole segment of the dental market dedicated to artificial saliva for people with dry mouth.
What does this all mean? It means, mon frère, that you should go out to your favorite bar tonight. Order a margarita and lick the salt off your lips. Chew on the mint leaves in your mojito. Laugh and talk with your friends. Spit on that one rude guy. Drool over your nachos. Make out with someone cute. Summer is almost over, so there’s never been a better time to enjoy all your fluids while you can, before you dry up and flutter to the ground like the last leaf of autumn.
Vitals & Bits # 16: Gamma-aminobutyric acid (GABA)
When my older sister and I were around 1 and 2 years old, my parents snapped a photo of us sleeping next to one another. In the quarter century that has passed since then, the deep symbolism that was accidentally captured in that photo has slowly emerged. The photo is now the stuff of family legend, an important historical document that is used to explain why things are the way they are.
You see, my sister Emily is the tidy, polished, pretty, immaculately dressed and expertly coifed fiancé of a famous opera star. And I … well, I like cats. And books. And books about cats. My hair automatically assumes the shape of the ponytail I wear everyday, and every single article of clothing that crosses my path bears some kind of oil or mustard or ink or baby vomit stain.
The aforementioned photo has become a famous family document because it perfectly captures, in one elegant little 4X6 time capsule, Emily’s and my future personalities. Two-year-old little Emily sleeps prettily on her side in a sweet little white nightgown, her blond hair gracefully and neatly spread around her relaxed, angelic face. And there I am next to her, fitfully sleeping with my mouth open, my hair hopelessly deranged and my body awkwardly tangled in a bizarre mountain of blankets and partially removed pajamas.
From this photo and other various scraps of anecdote, I’ve come to believe that a person’s sleeping habits can tell us a lot about that person’s personality, which itself is influenced by brain chemistry. My own brain has always been a tortured little theater of cognitive dissonance.
As the photo of Emily and me exemplifies, my sleep habits reflect this. In the miraculous event that I actually fall asleep, I toss and turn and toil away at unsolvable homework problems and an endless series of nonsensical tasks in my dreams. I wake up numerous times throughout the night, and by morning I’m usually more exhausted than I was the night before. Emily, on the other hand, presses energetically and cheerfully through her day and falls into bed sleepy, satisfied and generally unburdened by the useless emotional heft of global death and destruction. Twenty-five years after that photo was snapped, she still sleeps like an angel, and I like a Tasmanian devil.
I’ve always just kinda dealt with my insomnia. I’ve never sought therapy or anything like that for it. But a few years back, a rogue Ambien crossed my path and I, chronically tired and sick of not sleeping, decided to try it. Around 10 pm, I made a cup of decaf tea and drew a bath. Before entering the bath, I took about a quarter of the Ambien pill, thinking it would take effect just as I was ready to emerge from the bathtub and hit the hay. I washed the pill down with tea and stepped into the tub, closing my eyes.
I don’t remember anything between when I closed my eyes and when I opened them again, startled and shivering in a tub of cold water. I attempted to crawl out of the bathtub but couldn’t. My body was trying to go back to sleep, and I couldn’t find the strength or mental focus to remove my freezing naked flesh from the cold tub. I splashed my face with water and tried again, this time managing to drag myself out of the bathtub. After stumbling to my bed, I fell onto my mattress without drying off and pulled a blanket over me, falling asleep again almost immediately.
Ambien, which is a trade name for the generic drug zolpidem, works by enhancing the action of a neurotransmitter (or a chemical used to transmit signals from brain cell to brain cell) called gamma-aminobutyric acid (GABA). While most neurotransmitters stimulate brain activity, GABA actually inhibits brain activity. The ability to inhibit neural activity is absolutely crucial for brain function. Without it, each thought or sensation or active neuron would trigger a full-blown seizure. The brain must have some mechanism of terminating nerve impulses so they don’t just keep firing over and over again.
Neurons talk to one another via chemicals. If a neuron’s job is to activate other neurons, it’ll usually send out a neurotransmitter called glutamate. Glutamate is like a party invitation, and other neurons get all excited when they receive their glutamate invitation. However, if a neuron’s job is to shut the party down, it releases GABA. GABA is like a cease-and-desist notice. It’s like the cops knocking on your door at 3 a.m., busting up the party. So glutamate and GABA (along with a host of other neurotransmitters) work together to regulate brain activity. When you take an Ambien, the inhibitory effects of GABA take over, allowing the brain to slow down. This helps you fall asleep.
However, the “sleep” you get on Ambien is not the same as natural sleep. This is because natural sleep is a very active process requiring all sorts of highly organized brain activity. Inhibiting brain activity may allow you to fall asleep, but it can also stunt your brain’s ability to progresses through the normal sleep cycles. So, like any drug, Ambien has a bunch of risks along with the benefits. It works great for short-term use, to help quiet a noisy brain so that sleep is possible. It’s not so great to use every night, or to help someone stay asleep. And, as my bathtub experience demonstrates, it’s mighty powerful. Tinkering with the brain’s excitatory/
So there you have it. GABA. Now you can rest easy.
Vitals & Bits #15: The Reticular Formation
Everyone has a dark secret, biologically speaking. Perhaps it’s a mole shaped like Fozzie Bear. Maybe a habitual after-dinner fart marathon. Could be bad breath, or slow sperm, or toe hair.
Even the Adonis-like Dr. Muscles eventually developed a biological glitch. His arrived suddenly one night, in the form of unremitting, head-crushing, intensely sonorous snoring. I’d lie awake next to him, pillow over my head and hands clasped over my ears, quietly emitting an unbroken stream of profanity so foul and hateful that you’d think I was being tortured within inches of my life, rather than just being kept awake by my boyfriend’s snoring. Clearly, sleep deprivation doth make monsters of us all.
One night, a month or so into Dr. Muscles’ nightly snorathon, I found my mind wandering as I listened to his billion-decibel honking. I started to think about a book I had been reading that day, and I began picturing myself as one of the characters in the book. Soon my mind descended into that dim, loose-association cognitive limbo that happens just before sleep. The next thing I remember, I woke up the following morning, well-rested and feeling like the star athlete on a box of Wheaties cereal.
So how did I manage to fall asleep amidst the nocturnal music of Dr. Muscles’ obstructed upper airway? My reticular formation, or a part of the brainstem that acts like a gatekeeper for all kinds of incoming sensory data, can take the credit. The reticular formation is responsible for a variety of functions, from helping to maintain balance and resting muscle tone, to helping the brain integrate sensory data with motor coordination. Part of the reticular formation’s job is to determine which sensory data is allowed to reach the conscious part of the brain. Luckily for me, the reticular formation can learn to ignore repetitive, meaningless stimuli, such as the sound of someone snoring. This allows the brain to quickly process and react to new or unusual stimuli, like a smoke alarm.
Though my reticular formation learned to ignore the sound of Dr. Muscles’ snoring, it never learned to ignore the hundreds of other handsome men prowling around the hospital, with their beepers constantly chirping inside the pocket of some gracefully crumbled lab coat or some overly laundered pair of scrubs. Oh, hospital land. With so much to enjoy, who needs a boyfriend or sleep anyways?
Vitals & Bits #14: The Fibula
So, in the spirit of full disclosure, I’ll tell you right off the bat that the fibula isn’t exactly the most riveting body part. It’s pretty much just your average bone. And as fascinating as bone tissue is, there isn’t anything especially unique to the fibula itself that makes it any more or less fascinating that other bones. But, like people, not all body parts are destined to capture the imagination and adoration of the public. As such, I think it’s worthwhile to focus on the supporting players rather than the anatomical hotshots (like that damned fancy liver) every now and again.
The fibula is one of two long bones in your lower leg that connects the ankle area to knee area. It’s kind of a sidekick to the tibia, which is the larger of the two bones. You can feel your tibia on the front of your lower leg, in the area also known as the shin. The fibula runs parallel and just lateral to the tibia. (In anatomy, the term “lateral” means “moving away from the midline of the body”, i.e. the eye is lateral to the nose, the ear is lateral to the eye, etc. So the fibula is to the right of the tibia in the right leg, and to the left of the tibia in the left leg.) It’s covered by muscle and tissue, so it can’t be felt as easily as the tibia.
Like the tibia, the fibula is involved in the ankle joint and connects to the other bones of the ankle via ligaments. The bony bump you feel on the outside of your ankle, called the lateral malleolus, is the lower end of the fibula.
Unlike the tibia, the fibula is not directly involved in the knee joint.
This means that many injuries to the fibula occur at the level of the ankle. In fact, the majority of ankle fractures in older women involve the fibula.
Whether you’re young or old, male or female, Team Edward or Team Jacob, having a broken bone sucks. A broken ankle is particularly distressing, given that the whole walking and standing and weight-bearing nonsense we normally take for granted becomes extremely painful, if not impossible, for quite a long time. And “a long time” is no exaggeration: bones take forever to heal! This is because they don’t receive very much blood supply. Blood flow is crucial for delivering the nutrients that the body needs to heal itself, and although blood vessels snake in and out of your bones like ivy through a terrace, there just simply aren’t enough of them to make healing an efficient process. This is why bones require immobilization and activity restriction for a prolonged period of time to heal. Anyone who has been in a cast and crutches for six weeks knows how slowly those weeks crawl by.
Because of this, I hereby designate this day as “Help Out Someone with a Broken Ankle” Day. President Obama’s actually considering making this a federal holiday, in which our nation collectively commemorates important broken ankles throughout American history. So, though you probably rarely think about it, take a moment to lavish some attention on your fibula. Touch the bony lateral malleolus, hop on one foot, kick someone you dislike, and savor the feeling of an intact ankle. Coo to your legs about how they’re absolutely fibulous. Then march yourself over to the house of someone with a broken ankle and help them do laundry or make them breakfast or something. It’s OK to tease them about how they broke their ankle while guzzling Jim Beam and trolling around Central in a pair of stiletto heels. So long as you make their life a little easier, you’ll be making America proud.
Vitals & Bits: The Testicle
What follows is the 13th installment of a blog series on alibi.com authored by the illustrious Miss Dx. This week's exploration is being published in print because it's damn good. Each entry features a different bit of anatomical real estate, so prod alibi.com every Friday for more on your various bodily tricks and treats. Until then, enjoy the ball game.
Vitals and Bits #12: The Myelin Sheath
Most neurons (or nerve cells in the brain, spinal cord, and peripheral nervous system) are shaped kinda like a sunflower. In general, neurons have a cell body (the center of the sunflower), projections off the cell body called dendrites (the petals of the sunflower), and one long tail called the axon (or the sunflower’s stem). In order to “talk” to one another, nerve cells pass electrical impulses down their axons and spread the impulse to the dendrites of other nerve cells.
Some nerve axons can be incredibly long. The longest axons in the human body are over a meter in length. Wow! And as we all know, size matters when it comes to neural excitation. The nervous system depends on lightning fast communication to function properly, and we can’t have electrical impulses puttering along limp axons. So in order spread electrical signals quickly, nerve cells have a special insulating substance covering their axons. This insulating substance, known as myelin, is a fatty material that coats the axon and keeps the electrical impulse from dissipating. The coating of myelin around the axon is called the myelin sheath. If it helps you to think of myelin as an electrical lubricant, be my guest.
Myelin is white in color, thus imparting the characteristic color (or lack thereof) to the brain’s white matter. White matter can be found on the interior of the brain, and comprises trillions of myelinated axons linking all the various parts of the brain.
Myelin is made by a special type of neural support cell called a glial cell. Glial cells and neurons are like BFFs. Glial cells are the Paul Rudd to the neuron’s Jason Segal. They’re the Nicole Richie to the neuron’s Paris Hilton. Like Harold and Maude, or Fred and Ginger, or King Arthur and Sir Lancelot they are. Do you like how my pop culture references just get more and more outdated? Shut up. I’m in grad school. I have no time to keep up with the latest Bromance movies, okay? I don’t even have time to feed myself dinner. I just slurp down old cans of cat food I find in the alley behind my house.
Anyhow, so special glial cells make myelin and deposit it along the axons of neurons, and everyone’s happy because now electrical signals can zip through the brain and body in milliseconds.
Unless, of course, you suffer from a demyelinating disorder like transverse myelitis or Guillain-Barre syndrome. Then your neural transmission slows to a crawl and you find yourself having a tough time, say, moving your limbs or the muscles that allow you to breathe.
The poster child of all demyelinating disorders is Multiple Sclerosis (MS), an autoimmune disorder in which the body’s own immune cells periodically “attack” the myelin sheaths of neurons. More specifically, the body attacks the glial cells that maintain the myelin sheath. After an attack, glial cells can recover and help repair the damaged myelin sheaths up to a certain point. However, the disease progresses when destruction of myelin outpaces repair. The repair process can also generate scarring (or sclerosis). Scar tissue is non-functional, and patients with MS will have characteristic scars or tangled myelin plaques on the white matter of their brains.
MS is a sad, difficult, frustrating disease. Unfortunately, it’s not terribly uncommon, and it’s more likely to occur in women. Before scientists discovered the physiologic underpinnings of the disease, some dismissed it as a psychosomatic manifestation in fragile or hysterical women. You know. Just women being dramatic. Not walking. Not moving. Not breathing. Darn women and their emotions!
Now we know much more about MS, and a slew of new information is on the horizon. You can bet I’ll take time out of my busy grad school schedule to blog about advances in MS therapies when they arise. Until then, put your myelin to use and go make me some dinner or something.
Vitals & Bits #11: The heart
The heart is a rectangular structure in the lower duodenum. It comprises three parts: the medulla, the cortex, and the mysterious outermost layer called the external bladder. While the exact function of the heart has eluded scientists for millennia, modern researchers believe the heart may play a role in defecation and extracorporeal data processing.
C’mon. You should know this one. Your heart is in your chest. You can probably feel yours palpitating away in a state of arousal as you read this brilliant blog entry. Freshly oxygenated blood in your lungs is delivered to your heart via your pulmonary veins. Your heart, which is essentially a massive four-chambered ball of muscle, then pumps this oxygenated blood throughout your body. As red blood cells flow through your tiny little capillaries, they unload their oxygen to your body’s tissues. Deoxygenated blood is then returned to your heart, which pumps it back through the lungs so it can pick up more oxygen. The oxygenated blood then travels back to your heart, which pumps it through the body again, and thus the great circle of life can continue.
Excess “bad” fat (like trans-fats from processed foods and animal fats from industrially produced meats), and toxins (like those found in cigarette smoke) cause inflammation, which damages your blood vessels. The heart has to work harder to pump blood through damaged vessels, which can weaken your heart over time. Fatty plaques can also build up inside your blood vessels. These plaques may eventually rupture and clog the arteries that supply blood to your heart or your brain, causing a heart attack or stroke. Not fun.
You only get one heart. Be good to it. Eat healthy. Take walks. Sleep. Smile and laugh a lot. Quit smoking. For reals.
In conclusion, I am right. As usual.
Vitals & Bits #10: Piloerector Muscles
You know that feeling you get on a beautiful Albuquerque summer evening, when dark purple clouds sit heavily on the northern horizon while the setting sun jettisons the vast western sky with its searing pink and orange afterthoughts? Ok, so I’m no lyricist. But you know what I mean. Our anxiety-riddled, consumption-driven, Facebook-centric modern lives are occasionally punctuated by moments so stunning that your hair literally stands on end.
The “hair standing on end” sensation of life’s finest “Aha!” moments is brought to you courtesy of your arrectores pilorum, or the small muscles attached to your hair follicles. When these muscles contract, they tug on your hair follicles, which causes your hair to stand on end.
The arrectores pilorum, or piloerector (pilo meaning “hair” and erector meaning, um, erection) muscles are not under voluntary control. These muscles are micromanaged by your autonomic nervous system, or the branch of your nervous system that does all kinds of cool crazy shit on its own without you thinking about it (like controlling your heart rate or digestive muscles.)
Certain physical sensations, like cold, will stimulate your autonomic nervous system to activate your piloerector muscles. This is because other furry mammals, like cats and dogs, control their body temperature by puffing up when they’re cold. This allows their fur to trap more body heat. Unfortunately (or rather, fortunately), humans don’t have enough hair to make piloerection an effective method of insulation. Because of this, the ability to piloerect is probably vestigial.
Emotionally-based sensations, such as fear, excitement, or awe can also stimulate the autonomic nervous system to activate the piloerector muscles. While we humans experience this “hair standing on end” sensation as a rather cosmic sixth sense, it is probably also a vestigial function of our hair follicles. You’ve probably seen a cat puff up when he’s spooked. Aside from being hilarious, piloerection allows cats to appear bigger and tougher when they encounter potentially harmful entities, like a neighbor’s dog or a rogue Tickle Me Elmo. Again, humans don’t have enough hair to make piloerection a very useful method of intimidation (though I am having fun picturing rival sports teams puffing up their hairdos as a form of pre-game posturing.)
Still, thinking of the itty-bitty, eager little muscles attached to my hair follicles fills me with appreciation for the fascinating minutia of the human body. While piloerection may not serve a definitive purpose in the human body, it at least allows me to feel all goosebumpy and electric when I contemplate the mind-warping mysteries of life.
Vitals & Bits #9: The Nipple
As a former maternal-newborn nurse, I’ve witnessed a variety of behaviors from new parents. These behaviors run the gamut from utterly predictable to amusingly zany. Some new moms ask for a beer the minute the baby has exited the birth canal, while others bedazzle their hospital rooms with unlit incense and prayer beads. But “new mom” behavioral quirks pale in comparison to what I’ve seen new fathers do.
While most fathers-to-be offer support, love and respect during the childbirth experience, some men seem to have poorly calibrated barometers for appropriate behavior. These inappropriate behaviors often involve their partner’s breasts or nipples. Why the nipple is so often the target of poor behavioral choices by men is still a mystery to me, but perhaps it has something to do with the fact that in our culture, the female breast is seen more as an iconic sexual object rather than a functional anatomical structure. It might also have to do with general lack of knowledge about how the breasts and nipples work.
For instance, on more than one occasion, I’ve witnessed men try to suck on their wives’ nipples during labor. While it’s true that nipple stimulation can help jumpstart a waning labor, I don’t understand why a man would choose to attempt this maneuver while the baby is halfway out of the birth canal. Nor do I understand why a man, lacking breasts or any medical background of his own, would criticize his girlfriend’s breastfeeding attempts and coach her on doing it “his way.” I’ve also seen men giggle childishly, crack dirty jokes or become visibly angry while their partner attempts to breast feed for the first time.
I was teaching one new mom how to get her baby latched on to her breast with the father reached out and pinched the tip of his wife’s nipple. “Ouch!” she exclaimed.
“Why on Earth did you do that?” I asked the man.
“I wanted to see milk squirt out,” he replied, shrugging.
Like many people, this guy thought that pinching the tip of the nipple would cause milk to squirt out like the stream from a water gun. His behavior betrayed not only a lack of sensitivity to his partner but also a lack of knowledge regarding the anatomy and physiology of the human body. Believing that the tip of the nipple is a singular milk spout is a pretty common misunderstanding, and I have found that lack of “nipple knowledge” occurs frequently among both men and women.
I explained to the man that contrary to popular belief, the female nipple doesn’t contain one hole in the middle. Instead, the whole nipple is studded with pores through which milk exits the breast. These pores are outlets to the lactiferous (milk-producing) ducts within the breast.
A breastfeeding baby doesn’t withdraw milk from the breast by sucking in the way that one sucks through the straw. Rather, suckling is more like a coordinated, rhythmic motion of the mouth, tongue, and jaw designed to compress and “milk” the lactiferous ducts. The baby has to get as much of the areola (or darkly-pigmented skin encircling the nipple) in her mouth as possible in order to compress these ducts and draw the milk out. It’s important that the baby get as much of the areola in her mouth as possible because the pigmentation of the areola roughly delineates where the ducts of the mammary glands are.
A baby who is just hanging on the tip of the nipple won’t have her mouth far back enough to compress the ducts and therefore won’t get any milk, just like squeezing the very tip of a tube of toothpaste won’t get you any toothpaste.
Also contrary to popular belief, breastfeeding isn’t a “natural, instinctual” process for most moms and babies. Breastfeeding is hard! Although I’ve seen a handful of first-time moms successful latch baby on the breast and continue breastfeeding without problems, this seems to be the exception to the rule.
There are a few reasons why breastfeeding is more of a challenge than an instinct. While babies are born with a suck reflex, the coordination of sucking, swallowing and breathing is a learned skill requiring sufficient neurological maturation to achieve. Breastfeeding is also a learned skill for moms, who often face obstacles like anatomical mismatch between the size of baby’s mouth and the size of mom’s nipple. Moms also have to learn how to position baby, latch baby onto the breast and read infant feeding cues (which seem totally inscrutable at first). Anxiety and misinformation don’t help matters.
I’m not trying to compare women to cows here, but we’re all mammals, so anyone who has ever milked a cow will have a good feel for how the lactation process works. Milking a cow doesn’t involve just squeezing the cow’s teat. Instead, your hand gently compresses from top to bottom and then pauses to allow the milk ducts to refill before repeating the motion. Milking a cow isn’t an intuitive, instinctual motion. It’s actually kinda difficult and requires practice before you get the feel for it. Similarly, breastfeeding requires learning and practice. Luckily, most mom and baby dyads, with a little appropriate guidance and patience, will totally rule at breastfeeding after a week or so.
Men who are curious about how lactating breasts work are advised to take a trip the dairy farm. Practicing on a cow is more socially acceptable than trying to suck, pinch or manhandle your partner’s nipples in the labor and delivery room.
Vitals and Bits #8: Bone Marrow
J.R. breezed confidently into the exam room, snapping her gum and chatting up a storm about pedicures with the nurse. By all accounts, she looked like your typical high school cheerleader: ponytail, muscular legs and a quick smile.
J.R.’s parents brought her to the doctor’s office because she’d complained of feeling unusually tired during cheer practice over the past couple of weeks. Other than that, she insisted that she felt fine. Her bright demeanor suggested excellent health. The doctor figured that J.R., like many teenaged girls, was probably anemic. She ran a few tests to check for anemia and for a common viral illness called mono.
When J.R.’s blood test results came back, the doctor stared at them for few minutes in disbelief. The nurse walked into the doctor’s office and saw the doctor sitting there motionless at her desk, jaw agape and eyes wide, staring at the computer screen.
“Oh shit,” the nurse exclaimed. “It must be really bad.”
And it was. J.R.’s white blood cell (WBC) count was through the roof. A normal WBC count doesn’t usually exceed 10. An elevated WBC count, such as 25, suggests infection. But a WBC count approaching 100 suggests leukemia, or a relatively rare type of cancer in which white blood cells undergo uncontrolled proliferation. An extremely elevated WBC count like this is a medical emergency, since the increased concentration of white cells in the blood stream can clog up small vessels like those in the kidney and brain.
The doctor called J.R.’s parents. She told them about J.R.’s elevated WBC count, and instructed them to take their daughter to the emergency room immediately. She hung up the phone with a heavy heart and cradled her head in her hands.
After the emergency room, J.R. would be hospitalized. She would undergo chemotherapy and radiation to kill off the cancerous white blood cells. Eventually, she would need a bone marrow transplant to help repopulate her body with healthy blood cells.
Mother Nature, in her infinitely creative wisdom, decided to utilize the snug, protected space inside of our bones as a nursery for newborn blood cells. Blood cell birth occurs in the bone marrow, or the spongy tissue inside our bones.
There are two different types of bone marrow: red and yellow. Red bone marrow produces blood cells, and yellow bone marrow is composed mainly of fat cells. At birth, all bone marrow is red. As we age, some red bone marrow (such as the marrow inside the long bones of our legs) is replaced with yellow marrow. About half of adult marrow is red, typically found in flat bones like those of the hip and shoulder blade.
A bone marrow transplant involves eliminating the recipient’s cancerous blood-forming cells and replacing them with healthy donor cells. The recipient and the donor must have compatible tissue types. Unfortunately, no one in J.R.’s family was found to be a compatible match. J.R. and her family clung to fervent, anxious hope that her doctors would find her a match in the bone marrow donor registry.
After several extremely tense weeks, J.R.’s doctors identified an appropriate donor. Several weeks after that, an extremely ill J.R. received a life-saving gift of healthy marrow cells from a total stranger.
These days, most bone marrow donation procedures are not all that different from a simple blood donation. If you register to donate marrow and are selected as a donor, you’ll be give drugs for a few days that tell your bone marrow to increase its productivity and churn a bunch of health new cells out into your circulatory system. These cells are then collected through a needle that goes into a vessel in your arm.
Some patients, like children or those with certain types of leukemia, fare better with a more traditional bone marrow transplant, in which donor marrow is harvested directly from the hip bone. If you donate this way, you’ll be numbed up before a doctor inserts a special needle into your hipbone to withdraw marrow cells.
Both procedures are minimally invasive with a very low risk of complications.
If you are interested in joining the national marrow donation registry, visit marrow.org for more information. I joined a few days ago, and it was easy breezy. The registry is especially in need of participants who belong to ethnic minority groups, such as Hispanics, Native Americans and African Americans.
Vitals and Bits #7: The Phagocyte
One liter of my blood harbors 6 billion:
a. Red blood cells
b. Molecules of alcohol
c. Professional phagocytes
d. Estrogen particles
e. Undocumented workers
If you answered C, you’re correct! Yay! Now collect your prize and keep your trap shut whilst I drop some knowledge on you.
Phagocytes are white blood cells that eat bad things like bacteria or dangerous substances. The ability to engulf harmful invaders means that phagocytes play a crucial role in immunity.
Many cells can perform phagocytosis (or the act of engulfing a foreign substance), but that’s not their primary gig. A professional phagocyte, on the other hand, is much like a competitive eater in that its only job is to ingest nasty stuff.
In the human body, professional phagocytes come in several different flavors. These include the roving monocyte, the voracious macrophage, the badass neutrophil, the flashy dendritic cell and the multitalented mast cell. These cells are able to sniff out the bad guys by sensing the chemical signals of invaders like bacteria. Damaged or dying body tissues also release chemical signals that alert phagocytes to move in and help with the cleanup effort. In this way, phagocytes facilitate healing and repair.
Not all invading organisms are vulnerable to phagocytes. Like Jonah sitting inside the whale’s belly, some bacteria have learned to actually live inside the phagocytes that eat them. Others have learned how to evade or injure phagocytes.
Generally speaking, though, the ability to phagocytose, or eat, is a fundamental prerequisite to life. Cellular ability to phagocytose evolved early on in the tree of life and has been incorporated into nearly every single life form since then.
You’ve probably touched a few million of your own phagocytes if you’ve ever popped a juicy zit. Pimple pus comprises a bunch of neutrophils that have eaten bacteria and then died, along with a bunch of dead macrophages that have eaten the dead neutrophils. Phagocytes eating phagocytes! I love it.
I feel a particular affinity for my phagocytes, given our mutual love of bingeing. I daresay my diet of cupcakes and merlot is a tad more delicious than the professional phagocyte’s diet of bacterial toxins and dead tissue. But to each her own, I suppose. Bon Appetit!