Archive for the ‘Medicine’ Category
TV and Computer Screen Time May Be Associated With High Blood Pressure In Young Children
At first glance, this study isn’t very interesting. We know that fat, sedentary kids have high blood pressure. What is interesting about this study is that researchers found a corrleation between high blood pressure and specifically TV and Computer Screen Time independent of body composition or sedentary lifestyle.
The researchers conclude,
it appears that other factors, which occur during excessive screen time, should also be considered in the context of sedentary behavior and elevated blood pressure development in children.
So, I’m left wondering: what the hell!?! What could the mechanism behind this phenomena possibly be?
One idea that popped into my head: children get excited by video games. This is likely to lead to significant catecholamine release, which would lead to increased release of renin. A subject with elevated renin levels would naturally have elevated blood pressure. Hmmm…it kinda makes sense…
Anyone have any other ideas? Or is it more likely that the study is just flawed?
I think I know how this can be done. Of course, I am in Medical School, and haven’t got the time. If there is anyone out there with a background in immunology or something else who could further develop my idea, get in touch with me.
In my previous post someone calling himself Bruce Alan commented,
A hypoglycemic person is also more likely a hypersensitivity-prone person. Have you read the December 2007 warnings the FDA ordered Cephalon to place, in bold large-type print, on its Provigil labels?
Keep promoting Provigil and you’ll soon be killing patients unnecessarily just like a real doctor.
This is obviously one bitter individual. It isn’t necessary to analyze all of the drug warnings. I’ll leave that to the academic journals. All I need to say is that every drug, indeed everything in life, has risks and benefits. If you were to get paralyzed in a car accident on the way to work you wouldn’t advise people to stop driving. You might advise them to exercise more caution, but you would recognize that the benefit of driving outweighs the associated risks. Likewise. it is irrational to advise individuals to forswear a drug entirely because of rare side-effects. People can be killed by almost every drug; this is why doctors carefully examine an individual prior to issuing a prescription and then monitor that individual’s health afterwards.
I did a google search on Mr. Alan, and discovered details he has publicly reported of his case. The most detailed I found was posted on WebMd.com. Mr. Alan alleges,
PROVIGIL KILLS. Read this again: PROVIGIL KILLS…For over a decade, Provigil’s manufacturer, Cephalon, has been promoting this drug as a safer alternative to Dexedrine or Adderall for ADHD. One of their sales reps talked my doctor into switching me from Dexedrine to Provigil because it was safer. At the time (2 years ago) I had taken Dexedrine for 12 years with no side effects. Within a week after I reached the ‘target’ dosage I went into psychotic delusions, my blood pressure went down to 75/40, I went into cardiogenic shock, acute kidney failure, acute heart failure and suffered significant brain damage. I spent 20 days in the ICU and my doctors estimated that, simply for not dying within 24 hours, I had overcome odds of 200 to 1…My advise [sic]? Take Dexedrine if you are diagnosed with narcolepsy or shift sleep disorder. The amphetamines in pill form are FAR less likely to cause side effects and infinitely less likely to kill you. Believe me — I know; I am now permanently disabled because of Provigil.
What Mr. Alan has alleged is powerful; powerful enough to garner the interest of a personal injury attorney and the US Department of Justice. If what you said is the truth, and the whole truth, you would be a multimillionaire today. Of course, I highly doubt that you have given us the entire story.
If your story were true, you would have taken the following action:
- Sued Cephalon (because the drug rep “convinced” your doctor to change your medications.
- Sued your prescribing physician (because your physician changed your medications for no legitimate medical reason and it cause you harm)
- Urged the Justice Department to press charges against the drug rep in your case.
I am sure that Mr. Alan is aware that legal proceedings are a matter of public record. If his claims are something other than a mixture of exaggeration and fiction, I am certain that he will have no problem accepting my challenge: Put up, or shut up! Provide us with links to the court documents that you have filed. If you claim that you settled without ever filing a single document in a court of law, give us a link to the documents showing that you sued your lawyer for malpractice. What you describe is serious impropriety, and that merits a large judgment, not some petty settlement. We will then have a look at the what you claim to be the case.
PUT UP OR SHUT UP
I doubt that you will provide us with such links because I doubt that they exist. Your fantastic story is not to be believed!
N.B. Mr. Alan would be well advised to refrain from making blanked drug recommendations. He is not a doctor, and he has not ever examined those who might take his advice. I don’t know whether not Dexedrine is “safer” than Provigil, and I don’t have to to climb through medical journals to compare benefits and hazards. Moreover, to label a drug as safe or unsafe is to oversimplify the issue. Mr. Alan may have a simple mind, but I do not.
Note this well: I am not a doctor (yet). I am specifically not an endocrinologist. This is not medical advice. This is not a scientific paper or intended as such. Do not change anything you are taking or doing on the basis of this post. ANY AND ALL changes in medications should ALWAYS be approved and supervised by a licensed physician. This post is pure speculation based upon my current level of knowledge and personal experience. I cannot, and AM NOT making any scientific claims here. If you find what I have to say interesting, DO RESEARCH, DO NOT ACT ON MY SPECULATION.
Hopefully I’ve said enough to dissuade anyone from taking doing anything based on what I say without consulting their physician. This is very, very important. I do NOT want to be the cause of anyone’s death, and I don’t want to mislead anyone into harming their health. I also don’t want to get sued. So, to reiterate: this is not medical advice, it is speculation about biochemsitry and pharmacology.
Disclaimer Over!
I think there may be a useful off-label use for Provigil (Modafinil), and I think I’ve been experiencing its benefits.
Among the many effects of Modafinil, one is to promote the release of norepinephrine. Norepinephrine inhibits the production of insulin.
Here is a basic rundown of postprandial reactive hypoglycemia (the sort from which I suffer) in a sexy USMLE vignette format:
A 23 year old male patient goes to a convenience store and buys a slurpee, coca cola and snicker’s bar. Twenty minutes after quickly consuming all three he becomes very tired. He describes it as though he feels drunk and reports that he cannot function normally unless he naps for several hours. The situation is repeated in the lab, and lab tests reveal a hyperactive response from the beta cells of the pancreas. Blood glucose initially rises normally, but blood insulin levels rise drastically. Within thirty minutes the patient’s blood glucose is much lower than normal and he feels lethargic.
Note here that in this quasi-vignette I said nothing about a hypoglycemic coma or anything of the sort. This is because the vignette is about me (not the lab part…or the gluttony part). All it takes is a candy bar or a sugared soda to disrupt my day. I cannot stop myself from taking a nap. Sometimes even a meal containing simple carbohydrates (rice, white bread or potatoes). I often skip lunch entirely in an effort to avoid an afternoon crash. It is really quite a problem. Luckily it has never been a dangerous problem; it has imperiled only my day to day activities, never my life.
But…the problem isn’t as bad…when I am on Provigil. I will be the first to say that this could well be due to its appetite suppressing effects leading me to eat less, and also due to its stimulant effects. The latter, however, is unlikely, because I can tell from experience and from a scientific standpoint that the wakefulness promoted by Provigil is quickly overcome by a precipitous drop in blood sugar (if I really binge, i.e. the emotional eating of large quantities of cookies while on Provigil, I tend to have a problem). I overcame my former objection with a totally unscientific and clinically useless experiment of my own. One morning before my biochemistry class, I decided to eat three scoops of ice cream and drink two bottles of Ting (a very sugary local soda). I then went to class. I fully expected to leave during the first break and have to go home and sleep. This was not the case. I did not feel any more tired than usual, and my ability to concentrate on the boring lectures was, judging subjectively, roughly the same as any other day.
Could this be due to Provigil’s indirect inhibition of the production of insulin? Could it be that an appropriate does of Provigil timed properly could prevent the afternoon slump that is so typical during a workday? Could people like me, who have a hyperactive insulin response benefit from this property of Provigil?
I think its very possible. During my short holiday break from school, I’m going to do some digging around and see if I can find any published research on the topic. If I can’t, I’ll become very curious. I know a number of medical students conduct some sort of research, and I wonder if I might be able to publish a paper on this topic…
Another consideration is that norepinephrine stimulates glycogenolysis, which puts glucose into the blood.
Once again, to cover my ass and yours: THIS IS NOT MEDICAL ADVICE OR A SCIENTIFIC PAPER. IT IS SPECULATION AND I AM NOT A DOCTOR! DO NOT CHANGE ANYTHING YOU ARE DOING BASED ON MY SPECULATION! If you are not a doctor, you are not going to be very successful trying to play with your own medications. There is so much that goes into learning how and when to prescribe medications that it makes it dangerous for the lay person to go at it alone (I think that if they want to they should be legally allowed, but that is due to my political ideology, not because I think it is generally a good idea). Why do I keep reiterating this point? Because I want to make it CRYSTAL CLEAR that I am not giving any medical advice or making any claims. If you read my post Dangerous Voodoo Medicine you will see why I think it is so very dangerous for non-professionals to be giving out medical advice.
I’ll make it even clearer: I am a medical student living in a third world country. Being a medical student means I know a thing or two about medicine, and can understand doctor-speak. This means I can read and understand Harrison’s Principles of Internal Medicine and the prescribing information for any drugs. It also means that I can pretty easily bribe a pharmacist to sell me whatever drugs I want without a prescription. Guess what: I don’t do it! If I am ill, I either call my physician in the United States or visit a physician here and obtain a legal prescription, preferably from a pharmacy in the United States. Just a few months ago I requested a particular medication from my family physician, and he agreed and wrote the prescription. There was a rare drug interaction that 99.9% of doctors would never think about, and he didn’t think about. Guess what?! The pharmacy caught it, and alerted both my physician and I. There are really good reasons to go through professionals and not just play with drugs like they are candy.
I know this post is getting long-winded, so I’ll wrap up: I wrote this post to speculate about a potential off-label use of medicine. It reminded me of my post yesterday, Dangerous Voodoo Medicine, and I am still quite angry about the email that was sent to my mother and her colleagues. Don’t try to be your own doctor. Even doctors don’t prescribe their own medications (generally). Don’t take your life into your own hands by following some random guy’s advice on the internet (except this advice!). Your life is too precious. There is no God, no Jesus and no Heaven (or Hell). When you’re dead, your body rots and it’s over. Don’t hasten that time. Enjoy your life and do whatever you can to make it a long and healthy one because it is the only one you’ve got. There are professionals out there who dedicate their lives to the hard science of alleviating suffering and extending life. Their services are the most useful services you could ever access. You can cut corners on a lot of things, but don’t EVER CUT CORNERS ON YOUR LIFE! It is far too precious.
Today my mother forwarded me one of the most outrageous emails that I have ever seen. I don’t know who wrote it, but whoever it was is a liar and a fool. The email spread a myriad of misinformation about cancer and its treatments. I found its claims quite laughable; I also know a thing or two about medicine. This sort of chain email is particularly dangerous for a vulnerable lay person. When someone is diagnosed with cancer they are terrified (rightly so). They have heard about the hideous side-effects of most treatments, and if someone offers them a more pleasant alternative, they want to believe it. If they believe some unscientific voodoo and choose to ignore the advice of an oncologist, they can expect that their illness will be fatal. If they proceed with the witch doctor’s advice until the symptoms of the cancer have become unbearable, there may be little that an oncologist can do to help them.
The lesson here is simple: don’t listen to unqualified lunatics. If you have cancer, listen to your oncologist. If you doubt the diagnosis or treatment plan of your oncologist, get a second opinion from another oncologist. This is the only rational way to proceed, and is more or less the only way to prevent your cancer from killing you.
Here is the email I received:
Dear All,
Excellent article on cancer. Pls. pass it on.
AFTER YEARS OF TELLING PEOPLE CHEMOTHERAPY IS THE ONLY WAY TO TRY AND ELIMINATE
CANCER, JOHNS HOPKINS IS FINALLY STARTING TO TELL YOU THERE IS AN ALTERNATIVE
WAY .Cancer Update from Johns Hopkins :
1. Every person has cancer cells in the body. These cancer cells do not show up
in the standard tests until they have multiplied to a few billion. When doctors
tell cancer patients that there are no more cancer cells in their bodies after
treatment, it just means the tests are unable to detect the cancer cells because
they have not reached the detectable size.2. Cancer cells occur between 6 to more than 10 times in a person’s lifetime.
3. When the person’s immune system is strong the cancer cells will be destroyed
and prevented from multiplying and forming tumours.4. When a person has cancer it indicates the person has multiple nutritional
deficiencies. These could be due to genetic, environmental,
food and lifestyle factors.5… To overcome the multiple nutritional deficiencies, changing diet and
including supplements will strengthen the immune system.6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also
destroys rapidly-growing healthy cells in the bone marrow,
gastro-intestinal tract etc, and can cause organ damage, like liver, kidneys,
heart, lungs etc.7. Radiation while destroying cancer cells also burns, scars and damages healthy
cells, tissues and organs.8. Initial treatment with chemotherapy and radiation will often reduce tumour
size. However prolonged use of chemotherapy and radiation do not
result in more tumour destruction.9. When the body has too much toxic burden from chemotherapy and radiation the
immune system is either compromised or destroyed, hence
the person can succumb to various kinds of infections and complications.10. Chemotherapy and radiation can cause cancer cells to mutate and become
resistant and difficult to destroy. Surgery can also cause cancer cells to
spread to other sites.11. An effective way to battle cancer is to starve the cancer cells by not
feeding it with the foods it needs to multiply.WHAT CANCER CELLS FEED ON:
a. Sugar is a cancer-feeder. By cutting off sugar it cuts off one important food
supply to the cancer cells. Sugar substitutes like NutraSweet, Equal, Spoonful
etc are made with Aspartame and it is harmful. A better natural substitute would
be Manuka honey or molasses but only in very small amounts. Table salt has a
chemical added to make it white in colour.. Better alternative is Bragg’s aminos
or sea salt.b. Milk causes the body to produce mucus, especially in the gastro-intestinal
tract. Cancer feeds on mucus. By cutting off milk and
substituting with unsweetened Soya milk, cancer cells are being starved..c. Cancer cells thrive in an acid environment. A meat-based diet is acidic and
it is best to eat fish, and a little chicken rather than beef or pork. Meat also
contains livestock antibiotics, growth hormones and parasites, which are all
harmful, especially to people with cancer.d. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and
a little fruits help put the body into an alkaline
environment. About 20% can be from cooked food including beans. Fresh vegetable
juices provide live enzymes that are easily absorbed and reach
down to cellular levels within 15 minutes to no urish and enhance growth of
healthy cells. To obtain live enzymes for building healthy cells try
and drink fresh vegetable juice (most vegetables including bean sprouts) and eat
some raw vegetables 2 or 3 times a day. Enzymes are destroyed at
temperatures of 104 degrees F (40 degrees C).e. Avoid coffee, tea, and chocolate, which have high caffeine. Green tea is a
better alternative and has cancer-fighting properties. Water-best to drink
purified water, or filtered, to avoid known toxins and heavy metals in tap
water. Distilled water is acidic, avoid it.12. Meat protein is difficult to digest and requires a lot of digestive enzymes.
Undigested meat remaining in the intestines become putrefied
and leads to more toxic buildup.13. Cancer cell walls have a tough protein covering. By refraining from or
eating less meat it frees more enzymes to attack the protein walls of
cancer cells and allows the body’s killer cells to destroy the cancer cells.14. Some supplements build up the immune system (IP6, Florescence, Essiac,
anti-oxidants, vitamins, minerals, EFAs etc.) to enable the
body’s own killer cells to destroy cancer cells. Other supplements like vitamin
E are known to cause apoptosis, or programmed cell death, the body’s normal
method of disposing of damaged, unwanted, or unneeded cells.15. Cancer is a disease of the mind, body, and spirit. A proactive and positive
spirit will help the cancer warrior be a survivor. Anger,
unforgiveness and bitterness put the body into a stressful and acidic
environment. Learn to have a loving and forgiving spirit. Learn to relax
and enjoy life.16. Cancer cells cannot thrive in an oxygenated environment. Exercising daily,
and deep breathing help to get more oxygen down to the cellular
level. Oxygen therapy is another means employed to destroy cancer cells.(PLEASE FORWARD IT TO PEOPLE YOU CARE ABOUT)
This is an article that should be sent to anyone important in your life.
Regards,
(Name Redacted)
Here is my response. I hope that my mother sends it to everyone on the forward list, and that those people send it to everyone who sent it to them. The above nonsense can be deadly if a vulnerable person reads it and takes it seriously.
NO, NO, NO
Please forward THIS to everyone you care about.
There is no one-size-fits-all explanation for cancer. This is an oversimplification and as such represents very dangerous misinformation.
Cancer cells are cells that have mutated DNA which has interfered with the cell’s ability to regulate its multiplication. There are 101 ways for this to happen. Scientists have identified genes (i.e. BRCA1, BRCA2, Familial nonpolyposus Colon Cancer, familial adenomatus polyposis colon cancer), viruses (i.e. certain strains of HPV) and toxins that play a role in cancer development. There is no evidence that there are special “cancer foods” or that some crazy nutritional regimen will prevent tumors.
The author is partially correct insofar as they claim that cancer cells develop multiple times during a person’s life. What actually occurs is neoplasia,d that is, semi-uncontrolled and limited cell growth. One example of neoplasia is a wart, another is a colon polyp. Geneticists explain many cancers by what they call the “two-hit hypothesis,” which holds, in essence, that there must be two genetic mutations in a cell in order for it to lead to uncontrolled cellular proliferation. Quite frankly, cancer is a very complicated subject with a myriad of causes, understood and misunderstood, and the only a qualified oncologist should give anyone advice about what to do with regards to a particular cancer.
I will address specific bits of misinformation contained within the email:
1) A strong immune system is by no means a gurantee against the formation or proliferation of cancer. It is indeed true that a pathologically weakened immune system often precipitates certain forms of cancer. This illustrates the role of a healthy immune system in controlling certain forms of neoplasia; it does not mean that cancer and immunology are inextricably linked–the issue is far more complicated than that.
2) Cancer does not automically indicate that a person has multiple nutritional deficiencies. The vast majority of cancer cases occur in otherwise healthy individuals with no signs of nutritional deficiencies. Those who claim that everyone is chronically nutritionally deprived are generally confidence men with a product or book to sell. They are interested in nothing more than the health of their bank accounts.
3) Eat a balanced, healthy diet and you will get all of your daily vitamin requirements. If you don’t eat right, take a multivitamin. Anythign else is necessary only in certain circumstances and shouldn’t be undertaken without the advice of a physician.
4) Chemotherapy and radiation are but two medical treatments for cancer. There are multiple types of anti-neoplastic drugs, and multiple methods of employing radition for the destruction of tumors. Every drug has its side-effects and risks, and those must be weighed against their benefits. It is irresponsible to try to scare people with oversimplifications about an entire class of drugs and/or medical treatments. There is no substitute for the advice of a qualified oncologist, and anyone else offering advice is very dangerous.
5) An effective way to control cancer cell proliferation is NOT to starve yourself, or to follow any voodoo diet. That is simply not the way the body works. Neoplastic cells will break down healthy tissue (fat, muscle etc) in order to multiply. You will not starve cancer cells by starving yourself.
6) Whoever wrote this nonsense has no idea what sugar is. They advise avoiding sugar, and then advise substituting it with molasses. Both contain sucrose. This sucrose is further metabolized to glucose. Almost everything in your diet is broken down into glucose, and when you don’t consume enough glucose your body produces it by a process known as gluconeogenesis. This whole bit about sugar is utter rubbish on even the most basic scientific level.
7) Cancer cells do not feed on mucous. This is absurd.
8) The pH of the body is roughly constant. Unless you consume an inordiant amount of meat and thus induces ketoacidosis, or starve yourself and cause the body to break down muscles, your body will not have an acid environment. Anyone who tells you anythign about altering your body’s pH outside the context of gastric and/or intestinal issues is either grosly misinformed or willfully lying to you.
9) You cannot alter the pH of your body by your diet except in extreme and unhealthy situations. If your pH is altered by your diet, you will become very ill and probably receive a trip to the emergency room via ambulence. Moreover, by pH of the body, what does the author mean? The pH of the blood? The pH of the lymphatics, or the spinal fluid? The body does not have one uniform pH.
10) The pH of distilled water is 7.0, i.e. Neutral
11) Undigested meat does not stay in the intestine. The intestine moves its contents along in a very efficient fashion. It is true that meat can get compacted in the intestine if there is a lack of fiber in your food. This has nothing to do with things that stay in your colon and rot.
12) There is no such thing as a “live enzyme”. Enzymes are not living things. The vast majority of ingested enzymes are destroyed by the hydrochloric acid in your stomach. Whoever wrote that must have meant probiotics, i.e. exogenous bacteria which is sometimes necessary after a course of antibiotics. This is normal gut flora, and it is not necessary to replace it on a regular basis if you are on a balanced diet and not receiving medication that kills your gut flora.
13) Cancer cells do not have “tough membranes”. Protein has very little do with membranes. Cell membranes are made up of two layers of lipids. Proteins are incorporated into those lipid bilayers. The amount of protein in your diet will not lead to more integral membrane proteins. They are not controlled by the availability of proteins but by the expression of genes.
I’ve grown tired of refuting every claim in this email, but suffice it to say that almost every word of it is scientifically invalid. I worry that someone who actually has cancer will take the advice of this email and ignore the advice of their oncologist. If they forgo treatment, they will most likely die. That email has the potential to kill people.
John’s Hopkins University is not the origin of this email. Whoever wrote this email willfully lied in claiming that it comes from John’s Hopkins University. No legitimate medical professional would peddle such nonsense.
Do not take the advice of that email. It is dangerous and could result in your death. Do not forward that misinformation to others; it could kill them. If you have cancer, visit an oncologist and follow their advice. Myths and misinformation cannot save you; if you follow the advice of the witch doctors who peddle in them, you will most likely suffer an untimely death.
I would very much like to speak with the irresponsible lunatic who wrote the original email. If you are reading this, and know who wrote that, please give me their phone number and/or email address. I would like to set my alarm clock to 3:00AM and call them to explain how their misinformation and lies could kill people.
Does this mean there won’t be any pharmacology on step I? Please????
HbC
Deformed Cells
HbC/S
Like Mild Thalassemia
Hb Hyde Park
No one likes Hyde Park due to a lack of Meth
Hb Kempsey
Everyone loves because he is RELAXED
HbE
Mild Thalassemia
Hb Hammersmith
Heme gets hammered out by a blue hammer
Oxyhemoglobin
Reversible Oxidation
Hb Kansas
Everyone hates Kansas because they are uptight
Hb Bart’s
Hydropos Fetalis. Bart dies because of accumulation of fluid.
Alpha Thalassemia
Asia (buzzword), no Lotus Control Region
I have a biochem exam tomorrow, and I need to summarize some of my flashcards in different words. What better place to do it than my blog? Maybe some people will find the post through google sometime and maybe it will help them out. Here’s to hoping!
If you aren’t a doctor or a medical student, you won’t understand most of this. If you are easily offended, please don’t read this, or at least don’t complain to me, because this contains mnemonics. To remember things, sometimes your words have to be a bit rough.
One last thing, just so you don’t think I’m a wanker. This is just my last day’s stuff, so don’t assume this is all I know. I am like Yoda, or House (or at least I want to be).
What is the Function of CN, Azide and CO?
-They prevent electron transfer through complex four
Think of a four bedroom house (complex four), in it someone is getting poisoned with Cyanide and the propane heater is going to kill everyone else with carbon monoxide!!!!
Antimycin A
Prevents Electron transfer through complex three
AAC3….AAC3 Antimycin A Complex 3….stay in my head please!
Rotenone and Amytal
Inhibits transfer of electrons from complex one to ubiquinone
Amy memorizes things by Rote. Things can be rather ubiquitous in her mind!
Flourine
Besides brittle teeth, what does it do?
It inhibits enolase, thereby preventing 2PG from becoming PEP
You get no pyruvate or final ATP in Glycolysis (which makes glycolysis useless)
Kind of like the government. They put flouride in your water. They are useless. Flourine makes glycoloysis useless…
Arsenate (Arsenic Poisoning) How does it work?
It inhibits Glyceraldehyde-3-p-dehydrogenase, thus bypassing the dephosphorylation of 1,3-BPG. Thus, we are not getting our first ATP in glycolysis. Glycolysis goes on, but it is ineffective. Then, the rich husband without a prenup dies!
Just think of a hot woman poisoning a rich man to get his money. Its the first time that has ever happened!
Malonate
Inhibits succinate dehydrogenase
Thus, it prevents succinate from becoming fumarate. This sucks.
You could also think of a law forbiding oral sex…inhibition of succinate dehydrogenase. That would be bad (MALonate).
Cori’s Disease
Debranching Enzyme Deficiency…can only break down linear glycogen chains.
Glycogen accumulates in the heart, liver and skeletal muscles.
It leads to stunted growth, hepatomegaly and hypoglycemia
I think of Cori, who was a manager at my first job. He was a little man who was an alcoholic who couldn’t afford to eat healthy food (hence the hypoglycemia). He also couldn’t form complex thoughts (i.e. couldn’t break down little chains). I hated that little man. He is probably dead or in jail now.
Fluroacetate (Rat Poison!!!)
Inhibits aconitase, preventing the conversion of citrate to isocitrate in TCA.
Flouracetate Preserves Citrate! Rats keep an orange grove from being harvested!
GLUT-1
RBCs, Brain…uptake
Brain is the first thing that needs glucose. RBCs need it because they can’t use anythign else.
GLUT-2
Liver and Beta Cells
It goes both ways.
If it goes both ways, it is obviously taking it up the place typically associated with number two. Any sugars absorbed there must go to the liver.
GLUT-3
Neurons
We give stuff to neurons for free becuase they are special.
GLUT-4
Muscle and Adipose Tissue
Insulin Dependent Uptake
Yeah, Type II diabetics are usally GLUTons 4 lots of stuff that goes into adipose tissue.
GLUT-5
Fructose
Small intestines
Testes
Imagine sperm having so much energy that they can make five babies in one go!
GLUT-7
Gluconeogenic Tissues
Flux Across ER
Think of a 747 flying into the ER (some kind of 9/11 image there)
Von Griek’s Disease (GSD I)
Glucose-6-Phosphatase Deficiency
Gluconeogenesis is inhibited
SEVERE FASTING HYPOGLYCEMIA (they say this is a buzzword!)
Hepatomegaly
So, we have a guy named Von Griek, and he eats all the time because he always has hypoglycemia. He gets fat, and so does his liver.
It is inherited as Autosomal Recessive like every other GSD except for Phosphorylase Beta Kinase Deficiencey (which is X linked)
I-Cell Disease (GSD)
Deficiency of the ability to phosphorylate mannose. Characterized by: Skeletal abnormalities, restricted joint movement, coarse facial features and death by eight years old (ain’t that nice?)
They can’t phosphorylate mannose on its way to the lysosome
So, some ugly crippled eight year old wants an I-Pod? Kill him! He will never be a MAN
Pyruvate Dehydrogenase Deficiency
Congenital Lactic Acidosis. Brain problems. Failure to Thrive. Deprived of Acetyl CoA.
Wow, that just sucks. I don’t have a way to remember this. That sucks even more.
Chronic Granulomas
Genetic Defect in NADPH Oxidase
Pyrogenic infections and granulomas
North America Drops Plutonium Hell and its is oxidised into granules. Yeah, its dumb. So what, I’ll remember it that way.
Atractylosidase (Plant Toxin)
Disrupts ATP-ADP transport
Prevents proper ATP-ADP transport across membrane
Atractylosidase starts with AT, just like ATP
Glycolytic Enzyme Deficiencies
All of them are autosomal recessive
All of them cause hemolytic anemia
Most common is pyruvate kinase deficiency.
This is B/C RBCs only do glycolysis, so they die when it doesn’t work.
NADPH-Dependent Xylulose
Defeciency causes “essential pentosuria”. L-xyulose found in urine.
What is the pH of urine? It isn’t FIVE! Xyulose is wierd. Starts with XY. Guys are sometimes kind of wierd too.
Pompe’s Disease (GSD II)
Cardiomegaly. Leads to death. Can’t break down glycogen. Lysosomal energy defect. Normal blood sugar.
Some pompous man has a big heart. He never dips into his savings, though, and never throws anything away. He always has a normal amount of cash too.
Glycosyl Phosphate Dehydrogenase Deficiency
This one is X-Recessive!!!! There is no hexose monophosphate shunt. There is a defect of NADPH. Inability to maintain gluthione in RBCs. Hemolytic anemia.
Womean bleed once per week, and the pH in their vagina is really low.
2,4 Dinitrophenol
Uncouples the ETC. Makes you BURN UP!
Two nitrus canisters for your car. Burn baby burn!
Group 3 Splicing Mutations of simple Beta Thalassemias
Exon mutations that affect splice site. HbE, exon 1, residue 26, GLU–> LYS
Decrease in normal beta globin
Three rhymes with HbE
Digenic Retinitis Pigmentosa
2 mutations on 2 different UNLINKED genes. Peripherin and Rom1, found it photoreceptor. You must be HETEROZYGOS for BOTH defects to have the disease.
This one is just…memorable. Its like I can see it in my head. Hah! Folks with Ritinitis Pigmentosa see lots of stuff in their heads!
Enzymes Unique to Gluconeogenesis
Pyruvate Carboxylase, Fl6 Phosphorylase, G6 Phosphatase
Yeah, ok. Can I have a USB port put into my head so I can remember this???
Congenital Fructose Intolerence “Fructose Poisoning”
Autosomal Recessive. Aldose B deficiency. F1P builds up in tissues. Inhibits glycogenolysis and gluconeogenesis. Severe Hypoglycemia.
Fructose Poisioning=Aldose B
FPAB
“Frank Porked A Bitch”
Heinz Bodies
In erythrocytes of patients with G6PD deficiency
Impaired ability of RBC to form NADPH.
Heinz….ketchup…contains lots of sodium so it makes you swell, kind of like the RBCs do in this case.
Oxidative drugs and FAVA beans (BUZZWORD), Neonatal Jaundice, Italian People.
Dr. Paul has been fond of saying that he has never seen a medical case in which he would advise abortion.
What about anencephaly? One of the, um, joys of medical school is learning almost every possible horrendous disorder that can take place in babies. Next to nasty professors and even nastier colleagues, this is what I dislike most about medical school. I digress.
Anencephaly results from a neural tube defect whereby the forebrain, overlying meninges, vault of the skull and skin are all absent. Most of these cases result in stillbirths, and those that result in live births lead to the death of the baby usually within hours. This is a unique case because the forebrain is the part of the brain that deals with consciousness. These babies essentially lack the part of the brain that has to do with being human, and there is no chance, whatsoever, that they will survive.
This condition can be diagnosed with both ultrasound (half of the baby’s head is missing) and by detection of high levels of alpha-fetoprotein in the amniotic fluid and serum of the mother.
What I am asking is not a political question, but a moral question: If you believe that abortion is immoral in all cases, why? Why should this pregnancy, which is certain to result in death and is marked by the absence of a forebrain, be carried to term?
I am posting this because I am genuinely curious, so please, post your thoughts.
I will be voting “Yes” on I-1000, an initiative to legalize Physician-assisted suicide in Washington State.
This is a very important issue to me, because I have seen and will continue to see many many individuals die horrible deaths. There is no reason for them to suffer in the way that they do.