Hurts So Good...

 

Have you ever been in pain? Not the annoying pain of a paper cut, or when your hammer misses the nail. I’m talking teeth-gnashing, stomach-churning, cursing-like-a-sailor pain.

Males and females have their own versions of ultimate pain. For females, it’s the agony of childbirth; for males, getting wracked in the testicles. Since I swore off children and lack a scrotum, I’m a virgin in both realms. But that doesn’t mean I haven’t experienced pain.

I suffered a few serious mishaps as a child (see April’s Disfigured), but fortunately the pain associated with those injuries has been blurred by time. Since then, I’ve experienced true pain on only two occasions.

The first was the twelve hours I spent writhing in bed until my appendix finally burst (which ironically brought me a bit of relief). The second was a week later when the swelling in my belly caused my small intestine to crimp. HOLY MOTHER OF GOD!! It made the appendicitis seem like a day at the beach.

What exactly is pain and why are we equipped with such reflexes? Let’s explore…

Pain is a physiological response to noxious stimuli that warns us of danger. It comes in two forms: nociceptive and neuropathic. Nociceptive is what we typically think of as pain – nerves activated by insult or injury that send signals to the brain. Think of burns, trauma, or inflammation. Neuropathic pain is caused by damage to parts of the nervous system and is frequently chronic, meaning it can last for years. I can think of nothing worse…

Well, maybe one thing: the inability to feel pain. Known as congenital insensitivity to pain (CIP), this genetic disorder leaves its victims unable to distinguish true pain. The disorder affects the peripheral nervous system, leaving the person with a disconnect between the central nervous system and the nerves that detect sensation. The result is a shortened lifespan due to an accumulation of injuries and medical problems that go undetected. How would you know you were having a heart attack if you couldn’t feel the chest pain?

Pain comes in many forms and the type or characteristic of pain can aid in diagnosing the underlying problem. Is the pain acute (sudden) or chronic (ongoing)? Radiating or non-radiating? Is it sharp or dull? Pinpoint or diffuse? Stabbing, piercing, throbbing, searing? The answers help weed out differential diagnoses.

As a medic working Orlando’s west side, pain was part of our toolkit. The homeless are crafty when it comes to devising reasons to go to the hospital, where a warm bed and hot meal await (can you blame them?). Delivering noxious stimuli to transients feigning unconsciousness was part of every shift. We were masters at the sternal rub – knuckling someone’s sternum to make them flinch. Only the most skillful actors evaded our assessments.

But what about mixing pleasure and pain? (You were hoping I’d go there). I’ve never ventured into the dark closet of sadomasochism, but apparently there are a whole slew of folks who simply love the leather. So I read up on the subject (I’m up Shit Creek if the FBI ever reviews my Google searches). According to Psychology Today, S&M is all about "power and control" and is far more prevalent than we realize. It comes down to role playing. The sadist wields the pain; the masochist is happy to receive it. Hey, as long as it’s between two consenting adults, have at it.

Although we shun pain, it’s vital to our survival. Imagine navigating life without pain’s subtle reminders. Pain is a red flag for bad decisions. Think you can run a marathon? Give it a try and let me know what your muscles have to say about it. Going skydiving? Better train. I jumped during grad school (adrenaline withdrawals following my departure from the fire department) and hard landings were a reminder to use proper form. Pain is the mother hen of safety. Just imaging pain can sometimes make us pause and reconsider.

I’ll leave you with a curious tale about pain (or lack thereof). A patient of mine, although drunk and with his leg in a cast, decided to take a ride on the back of his friend’s motorcycle. Unbeknownst to him, the fracture had damaged certain nerve pathways in his foot. After a few joyful miles, he happened to look down and realize his foot had slipped from the pedal. He had been dragging his damaged appendage and subsequently ground off two of his toes.

Like I said -  pain is a good thing. So the next time you experience a mishap, remember that pain is your body’s way of communicating. I strongly recommend you listen.

Preview: Get out your notepads, boys, for next week we’ll be delving into the female anatomy. Join me as we learn all about the lady-parts.

From Oral to Anal: A Gastrointestinal Journey

Recently, I presented a lecture at Jacksonville’s Museum of Science and History. My friend, Paul, is the new Curator of Education and he was kind enough to usher me through their wonderful exhibits.

To my utter delight, there was an excellent exhibit featuring the human body. We entered via a giant mouth and moved through a corridor lined with exhibits – an oversized cross section of the skin; videos featuring bloody surgical procedures; and my all-time favorite, preserved organs in jars! It was a nerd’s paradise.

It also got me thinking…

Every morsel of food we ingest follows the same pathway: in one end, out the other. So I thought it’d be fun to trace food’s journey through the body. Come with me as we take a magical mystery tour of the gastrointestinal system!

We tend to think of digestion as the processing of food once it hits the stomach. But lo and behold, it is far more complex. The stage is set before we even take a bite.

Cutting up our food initiates the process. For starters, it makes it easier to cram into our mouths, but it also makes foodstuff more manageable. Once we take a bite, the magic begins.

Three primary components tackle the initial phase: teeth, tongue, and saliva. The teeth tear, grind, and crush, thereby prepping the food for digestion and enabling us to swallow. The tongue helps usher things along, moving the food around to facilitate mastication (a fancy word for chewing). The saliva moistens the food and starts breaking down carbohydrates, so as you’re chewing, you’re actually digesting!

The food then begins its long journey through the body. It leaves the mouth and enters the pharynx – that area between the mouth and esophagus. But this is where things can get tricky, for we not only feed through this passage, it also assists another vital bodily function: breathing. To guard the trachea (windpipe), a little flap called the epiglottis slams shut as food passes. We’ve all experienced the hacking that accompanies fluid “going down the wrong pipe.” That’s when the epiglottis falls asleep on the job and allows a trickle into the trachea.

Because of the tenuous positioning of the trachea and esophagus, the pharynx is ground zero for choking. If a bite is too large, it can get trapped in the pharynx, blocking the trachea and making it impossible to breathe. My partner and I once pulled a ham hock the size of a tennis ball from a guy’s throat as we fought to restart his heart. Unfortunately, the ham  hock won.

Food passes from the pharynx downward by the contraction (peristalsis) of the esophagus - a muscular tube that ushers the food into the stomach. Serving as gatekeeper is the cardiac sphincter, which closes off the stomach once food has been deposited.

The stomach is where the heavy lifting of digestion begins. It is a flexible sac, normally, about the size of two fists, filled with digestive enzymes and hydrochloric acid. Indigestion, commonly called acid reflux, occurs when the acid escapes upward through the sphincter, causing that common burning pain in the chest. (Personally, I’ve never experienced the joys of indigestion. I was lucky enough to be born with a cast-iron gut.)

As the food leaves the stomach, it passes into the small intestine. This magical coil of innards is about twenty-two feet long and takes up most of the space in your abdomen. Gory side note: I once worked on a guy who took a shotgun blast to the belly. When I got to him, he was fully conscious and lying in the garage, clutching a mountain of glistening guts that had been expelled following impact. Ah, the beauty of eviscerations - but I digress.

The small intestine contains ridges and folds which facilitate absorption of nutrients. As the food moves through this lengthy tube, other organs get in on the action. The liver produces bile, which it dumps into the intestine to digest lipids. The gallbladder picks up any excess bile and stores it for future use. And the pancreas provides a final squirt of enzymes to complete the digestive process.

Now comes the nasty biz of poop assemblage. The food enters the large intestine where a zealous colony of bacteria eagerly breaks it down, extracting the last bit of nutrients and magically transforming it into a turd. As we all know, feces come in a range of sizes, shapes, colors, and consistencies, so when you think about it, each bowel movement contains a delightful element of surprise.

When I left EMS to pursue archaeology, I thought my days of dealing with poop were behind me. But alas, it turns out paleofeces (aka ancient poo) are veritable treasure troves for archaeologists! They hold evidence about past diet, environment, and, on rare occasions even contain the eggs of parasites. All that from a teeny tiny turd!

Prepare yourself for a squeamish sidebar: let’s talk diarrhea. Diarrhea occurs when there is too much water in the stool. Is that it, you ask?? Hardly! One of the joys of writing this blog are the fascinating information trails I stumble upon during research. It turns out, diarrhea comes in several varieties, but by far the most fascinating and image-provoking has to be “chewing gum diarrhea”! No, it’s not what you think. Chewing gum diarrhea is the result of consuming sugar substitutes, such as sorbitol, commonly found in sugarless gum, which are not readily absorbed by the body. A side effect of this sweet treat is the overproduction of water in the large intestine, leading (quite literally!) to Hershey squirts.

The final stage in the digestive process is the elimination of waste. Since you’re probably still reeling from the mental image of chewing gum diarrhea, I’ll spare you the gory details. Let’s just say that exodus occurs via the anal canal and the end result is defecation.

I hope you’ve enjoyed this titillating trip through the body. As you sit down for your next meal, think about the journey each bite is about to embark upon and pause for a moment of silent reflection at the wonder of the gastrointestinal tract.

   Post script: Last weekend the blog went viral. I’m sure the word “penis” in the title helped, but I wanted to thank all my dedicated readers. Your enthusiasm contributed to over 1,100 hits in the first 24 hours! Thank you, thank you and please keep sharing.
Have a great week and I'll see you next Friday.

A Natural History of the Penis

Ah, the penis, that most essential male organ. No other aspect of the male anatomy demands such attention. Stop for a moment and consider the plethora of names men have conjured for this illustrious male member. It’s kind of like the Eskimo and their hundred words for snow. Priorities, I guess.

As a firefighter, I was surrounded by penises. They were everywhere. At the station, on the trucks, fighting fires… I was completely at ease waking up in a dorm full of woodies.

So let’s take a closer look at this enigmatic appendage.

Sex, of course, is determined before birth by the joining of the sperm and egg and the blending of their associated chromosomes. X plus Y and Poof! - you have a boy. The recipe for a penis is embedded on the Y chromosome, but it takes about eleven weeks of gestation before the genital tuber (from which the penis will sprout) emerges. Ironically, at this stage in development, the genitalia of both sexes look about the same.

But by thirteen weeks, the penis is a penis. This is a lonely stage in its development, for the testes are still tucked away in the abdomen. They’ll descend and join the party by the seventh or eighth month. The descent of the testes leaves behind a weakness in the abdominal wall, thus laying the groundwork for future hernias. So if you’re diagnosed with an inguinal hernia, you have your balls to blame.

We’re all pretty familiar with what the penis does. First off, it’s a conduit for urine (let’s get the dull stuff out of the way). The bladder empties into the urethra before traveling the length of the penis to exit. Since the urethra runs in close proximity to the prostate, many men suffer from incontinence when the prostate is damaged or removed.

But urine is not the only fluid carried via the urethra. Let’s talk semen.

The male reproductive system, at its most basic, is composed of the penis and testicles, but includes all the organs, ducts, and vessels that allow it to do what it does. Let’s start with the testicles and work our way forward.

The scrotum is a fleshy sac that holds the testes. It is composed of skin and muscles and forms two side-by-side pouches: one testis per pouch. It’s the smooth muscles of the scrotum that allow it to magically rise and fall. Body too hot? Scrotum drops. Body too cold? Scrotum draws up. Temperature extremes wreak havoc on sperm production. It’s the scrotum’s job to keep things comfy.

The testes (testicles) are responsible for sperm production. They also produce testosterone, which is why boys destined for the opera in 18^th century Italy were castrated. That way, they could continue singing in those beautiful falsetto voices.

Sperm produced in the testes then move into the epididymis – a network of thin tubules, several feet in length, that are bundled on the top of each testicle. This is where the sperm mature before being transferred up into the abdomen to the seminal vesicles – a pair of lumpy glands located on the backside of the bladder. The vesicles produce some of the liquid portion of the semen, which contains proteins and mucus, and has an alkaline pH. This enables the sperm to survive that oh-so-acidic environment of the vagina. And here’s an interesting tidbit: the liquid also contains fructose, which provides a snack for the sperm should there be a lag time while awaiting an egg.

The ductus deferens carries the semen from the vesicles and joins the urethra at the ejaculatory duct (things are getting interesting). It’s this amazing little duct that propels the sperm up and out during ejaculation. In fact, it’s so effective that it can propel semen up to two feet away (please don’t try this at home)!

Enabling all the magic is the penis itself. This mesmerizing cylinder of flesh contains large pockets of erectile tissue which, when aroused, fill with blood, making it stand at attention. The erectile tissue also increases the size of the penis (goody!) and assists with insertion. Once inside, movement and friction along the shaft provide just enough gumption for the ejaculatory duct to do its thing and voilà! Ejaculation!

Recent research has shown that boys, like girls, are reaching sexual maturity earlier; by approximately two and a half months per decade since the 1800s. Scientists attribute it to better health and nutrition. As boys hit puberty, though, their chance of death increases, mainly due to higher levels of risky behavior. When testosterone production peaks, apparently you guys go bonkers and your tendencies for "dangerous and reckless shows of strength, negligence, and a high propensity to violence" increase your chances for fatal accidents; what researchers call the “accident hump” (let the snickering commence). So for you youngsters out there... should you have the urge to jump off a building, try masturbating instead.

Lastly, we must address the issue of size. And how do our males fare when compared to our closest primate relatives? Quite well, actually. Compared to chimps, humans are much more endowed. Even gorillas can’t measure up, although I’d pay good money to see a side-by-side comparison. And while we’re talking size, let me clarify a misconception. Bigger is NOT always better. The female body can only accommodate so much girth before pleasure morphs into pain, so quit your bragging.

I’ll close with a fascinating bit of information from evolutionary biologist, Jerry Coyne. His website provides a world map of penis sizes, compiled by Dr. Eduardo Gomez de Diego. Keep in mind, lengths are based on self-reporting (and we know how you boys exaggerate!) and the sizes are in centimeters (didn’t want the Americans to fall out of their chairs). So take a look and see how you fare. Without going into detail, I’ll simply say for my readers in Thailand and India: don’t sweat it. As for my readers in the Congo – give me a call!

I'll leave you with a video tour of your junk. Have a great week and don't forget to share the blog!

Remembrance...

Twilight now, we reach the shore

and raise the oaring high
move like dark familiar ghosts
against a grainy sky

We draw the boat upon the beach

ignite its brittle bones
and breathe the ash of smoldered wood
our shattered link to home

We claim a small deserted rock

proud kings upon the shore
and rule a dense, secluded patch
of ocean’s level floor

And here we build a craggy nest

a dream among the sea
an island in a salted flood
a white eternity.
                           
 

Biting Bling

In 2006, after six grueling years of grad school, I finally graduated with my PhD. Having made the transformation from firefighter to ultra-nerd, I was quite impressed with myself. It was short lived.

I had to find a job. But first, I had to pack. I was part of a research team heading to Ukraine to investigate a two thousand-year-old Scythian burial mound. As team bioarchaeologist, I would analyze the skeletons pulled from that ancient mound of earth.

At the time, I had only a vague notion of Ukrainian geography. I knew it was somewhere in Eastern Europe; a region that looms dark and mysterious to most Americans. As for the Scythians – I didn’t even know who the heck they were. As a North American archaeologist, I had limited knowledge of classical archaeology (and between you and me, those classicists are a buncha’ weirdoes).

But after a quick trip to the library and a crash course in Ukrainian history (including the fundamentals of the language: “hello,”  “thank you,” and “where’s the bathroom”), I was ready to go. Twelve hours on a plane, fourteen by train, and a two-hour bus ride through the vast countryside of southern Ukraine brought me to the small farming community of Alexandropol. As I stepped off the crowded bus, I was met by our hostess – the woman on whose farm we would be living. Zena was stout, with massive calloused hands and a demeanor that said she could squash me with her boot. But her smile stopped me in my tracks: Zena sported a stunning gold grill. All her front teeth had been capped in gold. Had I wandered into some Ukrainian hip-hop backwater??

What I didn’t know was that gold teeth are common in Eastern Europe – a sign of status, as well as a means of capping or replacing bad teeth. What I did know and could have explained to Zena, had I possessed the proper language skills, was that for thousands of years, people have been decorating their teeth for a variety of reasons, but mostly out of sheer vanity.

So let’s take a quick hop around the globe and sample some of the ways folks have blinged-out their mouths.

Let’s begin with Africa (as everything does). Dental alteration, sometimes referred to as dental mutilation (you’ll see why), goes back over fifteen hundred years in Africa. Seen in many regions as a rite of passage, the practice included the removal of certain teeth (using a stick or spear, or by knocking them out with a rock) or the chipping, incising, or reshaping of teeth. Chipping the teeth meant knocking off edges to create a desired pattern. Incising the teeth – creating crosshatching or linear patterns – was done using sharp stone blades, like obsidian, or metal tools, when available. Reshaping was achieved by filing the teeth into various shapes, and for anyone who has ever suffered under the sadistic hands of a dentist, you can only imagine the pain involved in these traditions.

Extraction among children was also common. In parts of Uganda, a baby’s canines were pulled, since it was believed infantile fevers originated in these teeth. This caused a rash of problems for the baby, including infection of the gums and malformation of the permanent teeth.

On the Indonesian island of Java, the majority of adults participated in dental mutilation. They would file their incisors and canines, apparently as part of a long-held tradition. Engravings on the Buddhist temple, Borobudur, which date back almost fifteen hundred years, appear to depict a person undergoing the mutilation process. The Javanese would also stain their teeth, which is ironic considering the obsession we Westerners have for blinding-white choppers.

The Maya of Central America also chipped and filed their way to beauty, but they are better known for their elegant inlays. They would drill small holes on the surfaces of their teeth and fill the holes with precious stones, such as turquoise and gold. The artists who created such dental dazzle used a small bow drill to make the hole before carefully placing the stones. The result? Looks that could kill (that’s an inside joke - the Maya are famous for human sacrifice).

Today, we see bling of astronomical proportions. From rappers to swimmers, dental bling comes in a variety of gaudy styles; and, it seems, the more ostentatious, the better. Grills (at least the expensive kinds) are custom made to fit the teeth and are made of gold, rubies, and even diamonds, depending on the look you’re going for.

Just blew your paycheck on a new tattoo?  No problem; you can take the economical route. A quick Google search and I was able to locate gold-plated “Hip Hop Teeth Grillz” for a bargain $14.95! Awesome!!

But why should our teeth be any different from other body parts we adorn? We paint and pierce our way to fabulousness, so it only makes sense that our teeth get in on the action. Humans are mad scientists when it comes to self-expression, and adorning, and even mutilating, our bodies are some of the strange ways we achieve it.

So whenever my memory is jogged by an earthy fragrance, I think back to the wonderful experience that was Ukraine. I remember the stunning fields of sunflowers, the gracious generosity of the people, and Zena’s beautiful golden smile.


Click here if you’d like to check out my article, Life on Horseback, which discusses the Scythian skeletons from Alexandropol (International Journal of Osteoarchaeology).
Warning: May cause drowsiness. Do not drive or operate heavy machinery while reading.

  

Before I leave you with a beautiful Ukrainian sunset, here’s a preview for next week:

Gird your loins, fellas, for next week we’ll be discussing them. Join me as we explore that most essential male body part… See you next week!