Shocking!!

One of the most important concepts in medicine is shock.

The term has been "borrowed" and, in addition to applying to the passage of electrical energy through the human body, it has come to mean "freaked out". Laypeople are always saying, "He's in shock!" if the person they are confronting seems dazed and confused.
WRONG!
Shock is the state of being HYPOPERFUSED--not enough blood volume is being delivered to tissues such that sufficient
oxygenation or nutrition is maintained. Real shock, if not reversed, leads to organ failure and death in short order.
Being freaked out, dazed, and/or confused are uncomfortable, but rarely fatal.
So, unless there is no blood pressure, IT AIN'T SHOCK!

Not really all that scary....

The chairman of the department of medicine at my residency program at the University of Colorado was a nephrologist (kidney specialist). He demanded we have a thorough knowledge of renal function, which includes fluids and electrolytes ( we also had to do our own urinalyses). I am grateful for this, despite the terror with which I often faced morning report (where I had to give a rundown of patients' complete acid-base,volume, and electrolyte status). Hindsight is a wonderful thing....
Nothing is more important to human homeostasis than volume status. The simple concept of "dehydration" doesn't begin to cover it; if you don't have sufficient intravascular volume to perfuse your tissues with oxygen and glucose, all the rest is irrelevant.

Exams?! HELP!

Students have a hate-hate relationship with tests, as do teachers. Everyone agrees that it is important to assess the status of the learner's knowledge (and the teacher should use exams to assess his effectiveness) but everyone hates the process. I am giving exams this week and can sense the tension--in us all.
I try to make exams reasonably painless, but they do require effort. While I am more interested in how one uses her knowledge, there are some facts that have to be (arrrggh) memorized. I cleverly disguise these by saying, "YOU HAVE TO KNOW THIS-WRITE IT DOWN!"
Practical exams seem to cause a special kind of anxiety. In science there comes a point at which you have to relate to real objects, and think "on the fly", and practicals are (hopefully) designed to encourage this. My experience is that, lacking the ability to look things up, students often second-guess themselves on practicals and "overthink" their responses. This almost always results in choking....
In any case, I actually have learned to like exams. I think high-level students need their complacency stressed, and I need to know if I am getting through. Let's hope we all end up better for the process.

Not totally barbaric....

As Terry Jones points out in his discussion of what was called "natural philosophy" in medieval times, not all science and medicine was based on superstition and a priori thinking (a la Aristotle).
The chart is a uroscopy chart. Examination of urine was a relatively sophisticated methodology, and, yes, they did taste it (which was how they discovered diabetes).
Observation has always been the key to successful scientific inquiry, and whatever their faults, humans of the past were good at observation.
Perhaps better than we?

Glomerulus and Remus?

Not a relative of the homunculus (though looking a little shriveled), this wondrous piece of art is the filter supreme. Allowing only nitrogenous wastes and certain unneeded salts and toxins through, this baby keeps us in perfect balance.

It was life that evolved filters--here in the kidney, in the liver, in the nervous system, in the lung, in fungi, in plants--and no artificial one works as well.
It was lead in Roman wine that damaged glomeruli and caused the resultant gout (as just one example of bad behavior causing bad results) in the past.
Be nice to your glomeruli today--stay off the heavy metals.

Winner and still champion

Despite its tendency to get a little deranged, the human brain is still the best there is.

Stay warm....

...and be grateful for your diencephalon, which controls thermogenesis!

Ode to the Urinary System

O, kidney thou art wondrous,
In complexity so fair.
From nephron to collecting duct,
Thou art always there.

To monitor my pressure,
Thou measurest my flow.
Thy delicate components
To my continence I owe.

O, bladder thou art plastic,
To prevent me from distress.
Without thy sphincters tightly closed
I would often make a mess.

But 'tis the whole that makes thou lovely,
Complete in every way.
Without thy tubules, tufts, and densa,
Wouldst I scarce get through my day.

Neurophysiology redux....

The beauty of the nervous system is really beyond description.Exquisitely balanced, finely tuned, perfectly adapted--with the crown jewel of evolution, the human brain.
Given this, it is hard to accept that evolution is NOT directional. The human being in all our complexity is but a branch on a bush, not the apex of a pyramid. But that means that we are, in fact, both integral and special to all of life. Rather than making us "only" anything, it makes us unique and privileged.
I love studying the brain and nervous system with my students--neurophysiology is at the very leading edge of biological reserach and I get to learn new things every day! Retirement? Bah!!!

Sex: the good, the bad...

...and the terrifying.

The good is, biologically, that it combines genes and furthers the process of natural selection. We literally wouldn't be who we are today without it.
The bad is that the parasites, a la the Red Queen, use sex to propagate and evolve THEIR species.
The terrifying is that HIV, transmitted sexually, has killed millions and continues to devastate the poor and disenfranchised.
We know sex is required and that almost everyone participates; but in our strange human way we stigmatize it, laugh at it, and in the course of doing these things demonize victims.
People with STIs (sexually transmitted infections) deserve them, we say; if they behaved they wouldn't get such nasty diseases.
The fact is we are all just a parasitic mutation away from getting HIV or another of these diseases and should treat them like any other--prevent them and look for cures, and practice mercy among the sufferering.

The enemy of science is not religion but irrationality. - Stephen Jay Gould

Rev. Thomas Burnet
We think him a better Artist that makes a Clock that strikes regularly at every hour from the Springs and Wheels which he puts in his work, than he that hath so made his Clock that he must must put his finger to it every hour to make it strike....
-The Sacred Theory of the Earth, 1681

Even baloney...

...has to be broken down into its components.
Nowhere is SCIENTIFIC ILLITERACY more rampant and potentially dangerous than in the area of nutrition. Food faddism, nutritional misinformation, and metabolic charlatanism all have been given new life through the Internet.
Our bodies have evolved to perform maximally based on the consumption of an array of simple and common compounds--simple carbohydrates, fatty acids, amino acids, a few minerals and co-enzymes (called "vitamins"), and oxygen.
In the end, all of these substances contribute to the incredible efficiency of the citric acid cycle (pictured) that generates ATP, the energy molecule, composed also of a simple nucleic acid and a common mineral (phosphorus). Malnourishment can occur in the face of obesity, and starvation in the face of fad dieting. Food is not magical, it is practical.
Don't eat baloney--go for the basics!

Calcium is actually a metal....

...which is why it is so strong, as well as electrically active.
Calcium not only combines with phosphorus to make bones, as well as carbon to make rocks, it activates muscle contractions and facilitates nerve conduction. In its usual fashion, the body has evolved a system (in this case, the neuro-muscular-skeletal) that makes optimal use of a resource in multiple dimensions.
The current "controversy" over vitamin D, which facilitates calcium metabolism, exemplifies how real science can be extrapolated irresponsibly by fanatics and faddists. While a certain level of this vitamin (vitamins are co-enzymes, not primary nutrients) is required, excess levels can lead to a syndrome called hypervitaminosis D--calcium deposits in places they don't belong, such as muscle and nerve tissue, kidney stones, and nerve dysfunction.
Calcium has its uses and also its abuses; if some is good more is not necessarily better.
That's why we have real science--to tell us the facts.

U r ur urine....

Medieval uroscopy chart.
The scope of medieval medical knowledge was limited and mostly based on beliefs rather than empiricism (hence the primacy of bleeding as a "therapeutic" maneuver). One area that was rather more "evidence-based" was the examination of urine, a procedure known as uroscopy. Which did include tasting. (It was through tasting the urine that physicians became aware of the disorder we know as diabetes.)

We still use urinalysis (through tasting is no longer part of the process). It is an important tool in the evaluation of patients with metabolic as well as kidney disorders.
Normal urine is sterile and contains little but amino acids, soluble vitamins and metabolized drugs. Urine can, in a pinch, be "re-cycled" to stave off dehydration.In the early days of antibiotics penicillin was so precious that it was re-crystallized from patients' urine. Kidneys are even edible (steak and kidney pie, anyone?).
And urination is a key process in water and salt balance.
Appreciate your urine today!

Simple but critical....

Despite what the food faddists day, carbohydrates are, with OXYGEN, one of the essential substances required for life. Proteins and lipids are also necessary, but not sufficient--our cells respond best and most rapidly to plain old glucose.
The issue is calories--calories in must be less than calories out. All the rest is baloney (which is protein and lipids). And don't get me started on the "belly fat" hoax....

Talk about "stiff" (...upper lip...?)

A lovely British version....

Thanks for technology!

This view of the carina--the branching of the
bronchi at the distal end of the trachea--illustrates how technology has enhanced our diagnostic abilities in pulmonary medicine (and, of course, other areas).
Compare this to the old standard, the chest xray. Can you see the carina, which is a major site of the development of lung cancer?
No? You ain't the only one!
Thank you, biomedical engineers! Tech geeks rule!

Another elegant system

The digestive system, composed of the alimentary canal and appendicular structures, is another work of art.
Internally balanced and regulated, this system has evolved some of its features based on the fact that we eat only occasionally (hopefully), at which times it cranks up. In between meals it rests--except for the occasional eruption caused by our symbiotic colonic bacteria doing their fine jobs (it's the sulfur produced by these guys that primarily causes the aroma, not methane, which is odorless).

Appreciate your GI system today by comsuming roughage, drinking lots of water, and only eating when you are hungry (which, by the way, is one of the key differences between normal weight and overweight people--the latter eat based on environmental cues rather than hunger only).

It's all about...

...OXYGEN!
The purpose of the pulmonary system is GAS EXCHANGE--in with the good, out with the bad. Oxygen truly is the elixir of life.
It wasn't always that way; we have photosynthetic bacteria to thank for this element without which life as we know could not exist. As we consider the physiology and pathophysiology of the body, always LOOK FOR THE OXYGEN...cherchez le O2!

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FALL B
BIOS 252: Anatomy & Physiology II
BIOS 256 A & B: Anatomy & Physiology IV
BIOS 282: Pathophysiology II