rose

august 23 was week one of bio 203.

we met our cadaver, who we named rose.  i felt overwhelming gratitude to have such a special opportunity - both the immeasurable gift of her body to my education and the invitation to be a part of this small lab class.

within the first few minutes we noticed:
-she is an older woman, probably early 80's
-she has a 6" incision on her abdomen which is half taped closed and half sewn closed with a thick twine-like material
-she has a lot of fat, probably borders on overweight and obese
-she has an iv gauze and tape on her wrist
i am excited to learn more about how her disease and distress manifested in her physical body.

the first chapter in grant's dissector instructed us to start with her back.  there were a lot of protocols and techniques to learn, but we had enough time to clean the surfaces of the superficial back muscles.

the most interesting thing i saw was the impact of her kyphosis.  there is no way to tell (yet) if it is a result of a damaged vertebra or poor posture (or a combination).  for now, we can determine that she had kyphosis for a long period of time because all of the tissues along her upper thoracic vertebrae (approximately T2-T4) has hardened to the point that it almost feels like bone on the surface.  i can't wait to see what other effects we will see when we get into her thorax!

change of course

for the past several months i have been questioning 'nursing' as my career choice.  i don't know that i want to be on the crisis management side of health care.  i don't know that i want to experience disease and distress every day.  i think i would rather be on the proactive, promotional side of health care.  and isn't that what i am doing right now?  when i encourage residents to ride more and educate people about bicycle maintenance, aren't i essentially a community health nurse?  that begs the question: why would i go back to school to get back into this position?

anyway, i decided to apply for nursing school to buy myself some time to consider my decision.  unfortunately, in august, i received a "regretful" letter from nursing school.  after only 24 hours i had recovered from my disappointment and felt thankful for the opportunity to reconsider all of my options.  when one opportunity ends, all others are possible again.

that led me to my current interest in chinese medicine.  i can't wait to read books, interview practitioners, and learn more about the possibilities...

family time

it is estimated that 605,479 women get pregnant each day.


in a traditional pregnancy, hundreds of thousands of sperm swim achingly toward one egg.  if successful, one sperm will penetrate the egg and start the pregnancy cycle.





but what if the couple who wants a baby is sterile?  what if they are gay or lesbians?  what if they don't want to have a traditional pregnancy?

artificial insemination is the least expensive option; it is the process by which sperm is inserted into the vagina or uterus.

in vitro fertilization involves combining egg cells and sperm cells outside the uterus.  the fertilized egg is then implanted in the woman's uterus and, if successful, begins the pregnancy cycle.  the first baby realized from this fertilization method was born in 1978.

in vitro is sometimes used in tandem with surrogacy.  a surrogate mother carries and delivers a baby for another couple or person.  this woman may be the child's genetic mother or she may carry an embryo conceived from two other individuals.

adoption is another alternative in which a couple can take on all rights and responsibilities of a child from the original parent or parents.

perhaps one day, not too far off, doctors will be combining two human female eggs to make an embryo.  wouldn't that be something?!  they are already practicing this procedure with mice.

if none of these options don't work for a couple, they can always call the stork...

we only have one liver

it is common knowledge that excessive alcohol consumption can result in serious liver damage.  how does the disease develop?

first, it is not completely understood how alcohol damages the liver.  researchers know that alcohol produces toxic chemicals which can damage liver cells, but don't know why this only occurs in a small percentage of people.

the stages of disease are well documented.  first, alcoholism causes the development of large fat deposits throughout the liver and can cause liver enlargement.  at this point strict abstinence can lead to a full recovery.  second, scar tissue forms and causes liver fibrosis; recovery is possible, but the scar tissue will remain.  amazingly, the liver has a tremendous ability to regenerate and even if up to 75% of the liver is damaged it will still function as normal.  and finally, cirrhosis is the late stage of serious liver disease marked by inflammation, fibrosis and damaged membranes, ending in scarring and necrosis.  the liver fails.  this damage is irreversible.

be nice to your liver!

energy!

the word 'metabolism' makes people think about weight loss, thyroid, diabetes, and nutrition.  and these are inextricably linked to metabolism - they are all results of our metabolic process.

metabolism is the chemical process of converting food into energy.  it allows organisms to grow, reproduce, maintain structure and respond to their environment.  there are two steps in metabolism, catabolism and anabolism.  these two processes work in tandem to balance the building up and breaking down of body tissues and energy stores for optimal body function.

when food is eaten, catabolism breaks down the organic material to produce energy.  proteins, fats, and carbohydrates are digested into their respective subunits (or monomers) and are then processed by the cell to produce energy (acetly-coa).  when the cell no longer needs energy, it is converted to fatty acids which are stored in adipose tissue.

next, anabolism uses the energy liberated from catabolism to form more complex structures.  it is divided into three steps: first, the production of the precursors, such as amino acids and nucleotides; second, their activation into reactive forms using energy from ATP; and third, their assembly into complex molecules such as proteins and nucleic acids.  in brief, anabolism uses ATP to build complex molecules and stores the rest of the energy for later use.

in summary, metabolism is extremely important to our overall health.  it is essential to every living organism and for humans it is an important component of weight management and thus disease prevention.

so we must ask ourselves...

cystic fibrosis

cystic fibrosis is a hereditary disorder characterized by lung congestion and infection and malabsorption of nutrients by the pancreas.  the genetic defect underlying cystic fibrosis disrupts the functioning of several organs by causing ducts or other tubes to become clogged, usually by thick, sticky mucus or other secretions.

airways - clogging and infection of bronchial passages impede breathing.  the infections progressively destroy the lungs.  lung disease accounts for most deaths from cystic fibrosis.

liver - plugging of small bile ducts impedes digestion and disrupts liver function in about 5% of patients.

pancreas - occlusion of ducts prevents te pancreas from delivering critical digestive enzymes to the bowel in 65% of patients.  diabetes can result as well.

small intestine - obstruction of the gut by thick stool necessitates surgery in about 10% of newborns.

reproductive tract - absence of fine ducts, such as the vas deferans, renders 95% of males infertile.  occasionally, women are made infertile by a dense plug of mucus that blocks sperm from entering the uterus.

skin - malfunctioning of sweat glands causes perspiration to contain excessive salt.  measurement of chloride in sweat is a mainstay of diagnosis.

symptoms vary greatly, but can include salty tasting skin, constant coughing or wheezing, frequent and prolonged cases of pneumonia, excessive appetite, inability to gain weight, and bulky stools.

currently, there is no cure for cystic fibrosis.  treatment is dependent upon the individual's specific symptoms and the stage of the disease.  the cf gene was discovered in 1989 and research focusing on a cure, including gene therapy, has been ongoing since then.  more effective treatments and medications are constantly being developed.

here is an image explaining gene therapy:

1 - cells are removed from patient

2 - in the laboratory, a virus is altered so that it cannot reproduce

3 - a gene is inserted into the virus

4 - the altered virus is mixed with cells from the patient

5 - the cells from the patient become genetically altered

6 - the altered cells are injected into the patient

7 - the genetically altered cells produce the desired protein or hormone

origin of gender

intersex describes people who exhibit atypical physical features which would typically distinguish male and female.  this can be a genetic sex reversal (xx male or xy female), genital ambiguity, sex development differences or a person with physical characteristics of both male and female sexes.

androgyny is different - this refers to people without gender-specific physical sexual characteristics or sexual preferences or gender identity, or some combination thereof.

i just watched a fabulous argentinian movie called xxy.  the lead character, alex, is an intersexed 15-year-old.  she is living as a girl, but she has male and female parts and doesn't know if she likes boys or girls.  she takes loads of pills to maintain her "girlish" characteristics, including corticoid so she doesn't grow a beard.  no one knows her 'secret' except her parents and her best friend, who is a boy.  her parents were faced with the decision about whether to have "corrective" or "normalizing" surgery to the moment she was born.  they decided to forego the surgery and moved their family to a remote area.  they understood that teaching your child to be afraid or ashamed of their own body is one of the worst things you can do.  during the movie, alex is faced with making the decision for herself - does she want to be a boy or a girl?

this movie brought up some interesting questions:  what makes someone male vs female?  how much of our gender is determined by genetics vs environment?  if a baby is born with ambiguous genitalia, who decides if (s)he will have surgery?  if the parents wait, at what age are children old enough to decide their gender for themselves?  why is there so much pressure to assign a specific sex (one of two choices) to a newborn?

assigning sex is an extremely powerful concept.  and it is scary.  and there has not been sufficient long-term studies of people who have had "normalizing" surgery at birth to determine whether this is the best practice.  in fact, the surgery is standard pediatric practice despite having its basis in research done on hermaphrodites and a single set of identical twins originally tracked more than two decades ago.  thus, it is argued that there should be a moratorium on the surgery until more is known about outcomes of past interventions.

in addition, once parents choose to assign a sex (potentially reassign sex), they are told to raise their children without ambiguity.  and, as a result, many adults who have had these operations in infancy have never been candidly informed of their medical histories.

excuse me, i need to call my mom...