hypertrophy

all year i have been hearing the word "hypertrophy" being thrown around but never really understood what it meant. myocardial hypertrophy in simple terms is an enlarged heart. renal hypertrophy is an enlarged kidney. hypertrophy is when cells grow in size in response to a stressor. for example, when someone has uncontrolled high blood pressure for a long period of time, the heart muscle responds by enlarging. this enlargement happens because each cell grows bigger, not because more cells are present. similarly, when we work out, our skeletal muscles enlarge. we can feel a bulging calf on a runner not because they have developed more muscle cells but because each of their cells (and the organelles within the cells) have swelled so that they can work more efficiently. another example of this is when a person donates a kidney to someone in need of a transplant. their one remaining kidney hypertrophies to accommodate filtering all of the blood on its own. smart cells we have!

biceps hypertrophy in response to lifting weight

Food Art

ok, after posting all those magnified images of the body, i cannot help sharing these images of food that i just stumbled across:

http://www.treehugger.com/galleries/2011/03/stunning-food-magnification-photos-reveal-your-meal-in-microscopic-detail.php?page=1

Body Art

i have always loved examining things close up. when i was a little kid i carried around a book titled "Patterns in Nature" and spent hours paging through images of tree bark, pebbles, veins of leaves, and sea shells. i was fascinated by the idea that, when looked at from different angles or magnifications, vastly different things could look so similar to one another. and that ordinary things could be so beautiful. these thoughts were re-stimulated in my histology class, looking at magnified images of different body parts, comparing their cellular structures. here is a smattering of what i have been studying. the slices of tissue have been stained with the different colors so that the cells can be seen more clearly.

esophagus

tendon

fat

hair follicle

heart muscle

bone

bone (closer up)

liver

lung

fallopian tube

nerve cell bodies

nerve cell axons

skeletal muscle 

skin

small intestine

cartilage

loving all bodies

we had the most powerful lecture today by Janet Green, an intersex woman, patient advocate and rockin' activist working with the accord alliance (http://www.accordalliance.org). she spent 2 hours with us sharing her story of multiple surgeries in infancy and childhood trying to sculpt her body, her clitoris, to match an acceptably "female" size and shape. she spoke of her years of secrecy, shame, confusion, and multiple doctors and residents peering between her legs to see how she was different. she held our attention unlike any of our normal lecturers and moved many of us to tears. she is powerful! and she shared with us her story so that we could be powerful and make different choices than her doctors did. so that we could treat our patients and our patient's bodies differently than her doctors did. we are a part of the system that fucked with her body in terrible ways but she stood before us with hope, with expectation that we are a new generation of healthcare practitioners that will think about gender and gendered bodies more openly.

the current pediatric guidelines still suggest performing surgery on infants with congenital sex disorders (the term that the accord alliance coined to replace intersex, but which made many of us uncomfortable in class. does it really need to be called a disorder, implying a need to be "fixed" or "cured"?) the united states condemns female genital mutilation in every country but our own. essentially, this is what is being done on infants whose genitals don't fit into a box stamped "male" or "female". In most cases there is no medical reason to perform surgery - it is purely cosmetic. cosmetic to make the parents comfortable and make the doctors comfortable. cosmetic surgery without the consent of the person whose body is being altered, whose sensitive nerves cut (and sexual function impaired), and who may identify with a different gender than that surgically assigned.

janet asked us to ask questions, to break the silence about this issue, to question our attending doctors. she asked us to think about our patients and leave openness for a wide range of bodies. usually cutting body parts off is not the best solution. i had never really thought about the power the medical community has in defining "normal" sex and gender. how will parents' choices about their child's health differ when the doctor delivers a baby and says "congratulations, you have a healthy baby! we are not sure yet what their sex is, but many babies are born like this and we will figure it out with time" vs. responding with fear, alarm, quickly taking a child away to protect the parents from the shock, and suggesting immediate surgery? Clearly, very differently. what if we regarded the size of babies' clitoris' or penis' as along a spectrum of normal as we do with nose shape or finger length? and if that person wants to have surgery later in life to align their body more closely with their gender identity, they can do that. or perhaps we regard undifferentiated genitals as a disorder, but a disorder can that be dealt with with time, not prematurely sliced into. the child is unique, but healthy. and most importantly, the child is lovable, exactly as they are.

this was what stuck with me the most from janet's talk: model to your patients that every person and every body is lovable as it is. no matter how it looks. the key to achieving health --> being raised with love and acceptance. don't chop it if you don't have to.

i love my classmates. love them for asking such good questions, for pushing the gender binary, and for being so loving. we gave janet a long standing ovation. she was crying. we were crying. we could all feel the love.

Bacteria!

random cool fact: our bodies contain more bacterial cells than human cells! we have trillions of healthy (and essential) bacteria in our digestive tracts that help us break down and absorb our food. surrounded by lots of anti-bacterial sentiment (anti-bacterial soap, bleach, pasteurized foods, purell) lets also appreciate the vital importance of the bacteria that live in symbiosis with (and outnumber) our human cells.

Breath

it feels appropriate that the first post of this blog be about breath. most of us take it for granted that we inhale and exhale 24 hours a day for our entire lives, though we do quickly recognize its importance as soon as we feel unable to breathe. both of my moms have a particular appreciation for breath: all of my elementary school friends grew accustomed to taking a breath together anytime barbra came in to lead an activity in the classroom and i have memories of terese, the yogi, teaching my sister and i how to take deeps breaths "down into our feet" to relax before bed. now i have spent the last two weeks immersed in learning about the respiratory system. i am in awe of how smart are bodies are to be able to regulate our breathing in response to whatever we are doing.

i like to think about lungs as big balloons with billions of tiny balloons inside, called alveoli. with all the alveoli together, the lung looks (and feels) a bit like a sponge. note on spongy appearance on the microscopic slide below (the spaces are the alveoli).

when we inhale, we contract our diaphragm (the dome shaped muscle seen at the bottom of the graphic image that separates our bellies from our chests).  when the diaphragm contracts, it pushes all of our abdominal organs down to make space in our chest cavity to draw air in like a vacuum.  the alveoli stretch and inflate with air to exchange oxygen and carbon dioxide with blood vessels that surround all the alveoli. we use muscles that require energy to inhale but a healthy relaxed exhale requires no work. it is simply a matter of relaxing the diaphragm and allowing the elastic alveoli to recoil, like releasing an inflated balloon.

normal lung tissue at 25X magnification

the cooperative task of the heart and the lungs is to deliver oxygen and remove carbon dioxide from all of the cells in the body. the oxygen is needed to make energy to power whatever the cell's job is and the carbon dioxide is produced during this process. the cell uses the oxygen and releases carbon dioxide back into the blood to be brought to the lungs for exhale out of the body. for our bodies to function well, it is critical to maintain certain levels of oxygen and carbon dioxide in the blood at all times.

what makes our bodies decide when to breathe fast or slow, deep or shallow? the primary regulator of our breathing is not oxygen concentration but the level of carbon dioxide in our blood. for example, when you try to hold your breath under water, after awhile you can't hold it any longer and you have to inhale. this urge to breathe is not your body saying "i need more oxygen" but instead "there is too much carbon dioxide, let it out!" this close regulation is because carbon dioxide makes the fluid in the body more acidic. all of our enzymes can only function properly in a very small range of acidity so it is important to maintain a fairly constant concentration of carbon dioxide in our blood. when carbon dioxide builds up and makes the blood slightly more acidic (this happens in a matter of seconds), receptors notice this change and send signals through our nerves telling our diaphragm to take more frequent and deeper breaths so that we exhale more carbon dioxide out. (there are also other receptors that signal us to breathe based on the amount of oxygen in our blood, but these only kick in when out oxygen levels get dangerously low). I find this close regulation fascinating! You can feel this regulation in your own body in just a couple of minutes (i have done this several times this week and think it is really cool!):

1. while comfortably sitting down, notice your easy, relaxed breathing.

2. start hyperventilating: take many fast shallow breaths to try to get a lot of carbon dioxide out of your body. do this for about 20 seconds (really, breathe fast, but, as always, listen to your body - if you start to feel at all light headed, stop. no passing out in this self-learning exercise).

3. stop hyperventilating and relax. notice that your breathing slows way down and you don't feel like taking many breaths. this is because there is a low level of carbon dioxide in your blood so your body slows down your breathing rate until the carbon dioxide builds back up to its normal level. Sit there for about a minute until you feel your breathing rate resume to normal.

4.  now hold your breath for as long as you can. during this time, your cells are releasing carbon dioxide into your blood but you are not exhaling it so it is getting more concentrated. when you can't hold it any longer, take a breath. notice your breathing now. you are likely taking deeper, more frequent breaths to let the excess carbon dioxide out until the acidity of your blood resumes to normal.

*practical conclusion of this exercise: if you want to win a breath-holding contest, hyperventilate right before.