Yours truly made it onto the stage for Hardball, and sat right behind The Governator. Arnold’s a politician all right; he was able to dodge and laugh through most of the tough questions. I was particularly disgusted with Arnold’s handling of steroids:

MATTHEWS: Are steroids bad for you?
SCHWARZENEGGER: What?
MATTHEWS: Are they bad for you?
SCHWARZENEGGER: Steroids can have side effects, if people don‘t do it under supervision with a doctor. I‘ve seen people in our own sports that have died because of it.
MATTHEWS: Yes.
SCHWARZENEGGER: That have had side effects, health side effects.
MATTHEWS: Right.

Even though he’s publicly admitted it , I’m sure he’d like to try to bury that 1977 article if possible. Steroids have plenty of side effects (note: HIV and hepatitis are on that list due to IV injections, they are not directly linked). I remember being really confused about steroids and my brother being “prescribed steroids” for his asthma, so I thought I’d take a minute to procrastinate explain what people mean by steroids .

Okay, so technically, a steroid is just any chemical with a certain structure. But the body uses 3 main types of steroids. Physicians usually prescribe one type, body builders usually use another, and while the third type is very important, you probably won’t run into it much. All three are made in the adrenal glands . And here we go:

1. Glucocorticoids. These are what are generally prescribed by physicians. They’re usually prescribed to lower a person’s immune system. Cortisol, hydrocortisone, prednisone. They reduce inflammation. They’re commonly used for autoimmune disorders, or transplant patients-both need to supress their immune system, because it’s either hurting them or their transplanted organ.
2. Sex hormones. These are the steroids you hear about all the time: testosterone, estrogen, progesterone. First, testosterone . Body builders will use testosterone to get bigger muscles. This is the “anabolic steroid”-anabolic just means metabolism that builds, like building muscle. Other chemicals can work too-either things that the body can turn into testosterone, or things that look like testosterone, so that the body thinks they’re testosterone. These have a number of scary side effects-“roid rage,” shrunken testicles, gynecomastia (male breast tissue development). Not hot. There’s also estrogen and progesterone . These are the hormones found in birth control pills and hormone replacement therapy during menopause. These are also the hormones involved in RU-486 and “the morning after pill.” These are made in the adrenal glands, but they’re also made in the ovaries and testicles. (And yes, men and women have both in their systems, just different amounts.)
3. Mineralocorticoids. These you probably won’t hear a whole lot about. Aldosterone is the main one, and it makes your kidney reabsorb water and sodium. If you’re getting dehydrated, your body releases this to tell your kidneys to make less urine, so you save more water and sodium. Some people’s diuretics (water pills) block aldosterone, so you pee more.

So there you have it. Now it’s back to neuropharm for me.

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5-10% of alcohol is removed from the body through the breath. This fact, of course, lead a classmate to ask if you can sober-up by hyperventilating. “Theoretically, yes,” said the lecturer.

Seeing as though this’ll be Valentine’s Day #2 without a significant other, I may just have to try it.

Speaking of V-Day, there’s a really nice piece at the end of this week’s This American Life about Johnny Cash, his wife, and the song Ring of Fire . Told by Sarah Jewell, one of my favorite contributors. It starts at about 47 minutes in, and it’s so sweet and romantic that it even made me feel a little less jaded and bitter about the whole thing.

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Aldehyde dehydrogenase is the enzyme in your liver that helps you get rid of alcohol (actually, it’s the second step in the process, but I digress). Some people of Asian decent have less of this enzyme, so when they drink alcohol, they can turn red; in most texts, this is a mutation that decreases alcohol metabolism.

Turns out that everyone else is the mutation. If you look at animals’ versions of aldehyde dehydrogenase, they’re more similar to the Asian version of the enzyme; so somewhere along the way (Germany? Russia? England?), I evolved the ability to drink more. (Disulfram, a drug that can help alcoholics stop drinking, blocks this enzyme, making you flush, and not enjoy the alcohol as much.)

So no, I can’t control the weather, shoot force beams out of my eyes, or read minds… but I can drink more alcohol. Better than nothing, I guess.

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Twelve to twenty-four hours of heroin withdrawal can make a person restless and develop goose bumps. That’s where “quitting cold turkey ” comes from.

Twenty-four to seventy-two hours of heroin withdrawal typically leads to flu-like symptoms, and thrashing and flailing of the arms and legs. That’s where we get “ kicking the habit.”

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Michael Paulus’s gallery of cartoon character skeletons is not to be missed.

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In the spirit of conservation, recycling, and urine fetishes comes Repronex , a drug that comes from the concentrated urine of post-menopausal women. It’s used to stimulate the release of FSH and LH, two pituitary hormones important for sex hormone release and maintenance of most things sexual in the body.

Apparently it’s been around for quite some time, but, like my used car, it’s new to me.

Also in the “abusing nature for all it’s worth category”: Miacalcin , a salmon version of our body’s natural hormone, calcitonin . (The salmon version is much more potent than the human version. Go figger.)

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One of the leading Eli Lily researchers on PTH spoke to us yesterday about PTH and its actions. A good lecturer, but raised a couple thoughts in my mind:

• Should companies be able to patent drugs (hormones) we make naturally in our own bodies? Sell it, fine, but patent it?
• After he talked about the wonders of PTH (and glossed over calcitonin), I would’ve appreciated it if he had told me that it’s been found to cause osteosarcoma in rats . While there’s no indication that it causes bone cancer in humans, it seems a little suspect that we had to learn the fact from our pharmacology lecture today.

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Note : do not read this whilst eating, thinking about eating, or just having eaten.

This was, by far, the most disgusting week of medical school, and Monday may just be the most disgusting day of my life. I’m not ready to proclaim this until I’ve been through the hell that is residency, but it’s gotta be top 5 at least.

Monday we started off with our intestinal tapeworms and nematodes (roundworms/helminths) GI lecture. This included whipworm , which causes, OHMYFREAKINGGOD, rectal prolapse (don’t click that!). We also learned about all the other fun ones, including ascaris (I wouldn’t click that one either), which can lay 200,000 eggs every day inside your stomach.

So that’s always a pleasant talk, I’m sure. Next, since I’m an anatomy TA, and we’re starting the pelvis, we have to pre-dissect the bodies for the students. This involves separating the abdomen from the pelvis and legs, and then hemi-section–separating each egg, by cutting down the middle. Along with vessels and nerves and muscles, you have to tie off the large intestine and cut it, so you can separate the top from the bottom. When you die, unfortunately your poop doesn’t magically disappear. It says right in the body. And, say, if you’ve never done this whole “hemi-secting” thing before, and you and your friend are sawing through a hip bone, you might just accidentally saw through a bit of bowel.

Yes, Monday not only did I see prolapsed rectums, but I got to clean a ton of shit out of a dead person’s rectum. This was, by far, the most traumatizing thing in medical school. We hit the bowel in two places, so we had to basically remove all the feces from the body and throw it away. No, they do not pay us enough.

And then, to wrap things up, for our GI test on Monday, I was studying Hirschsprung’s disease . This keeps you from pooping, because some of your nerve cells don’t make it down all the way to the end of your intestines, so feces can build up. I also learned, according to a review book, that the poop can build up so much… that you poop out your mouth. There’s a South Park episode where this happens, but it’s just that much grosser that it actually does.

And yes, I’m paying $50,000 a year for this wonderful life.

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Not a whole lot of interest in blogging right now–in the middle of GI and wanting to do a 1,000 things, and blogging’s 1,001. Although 2nd year is a pain in the ass, and information overload, I actually feel like I’m becoming a doctor. It’s kinda cool. I know some of the most common drugs, I know most of the organ systems. What a great feeling.

Try to beef up on my auscultation (stethescope) skills, which is proving quite challenging, but here’s a couple of excellent tutorials for any students out there reading: Blaufuss Multimedia’s Heart Sounds and The Auscultation Assistant .

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Farting-I mean, flatulence -is due to poor absorption of carbohydrates.

Beans contain raffinose and stachyose, tri- and quadrupe saccharides, and cannot be digested by humans. They get passed along through your large intestine, where your normal flora (bacteria living in your colon) feast on them. (They do this anaerobically, fermenting the carbs, so that’s where the gas comes from.)

This is clearly why I went to med school.

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