Mexico Medical Student |

I was gathering all the notes scattered about from our pathology exam yesterday, starting the process to get ready for our partial exam in pharm on Monday (with a comprehensive final three days later–go figure). In doing so, I came across an unintentional joke our visiting professor made while lecturing on the pathology of the male reproductive system.

To set this up for the non-medical readers, a few basic points on anatomy. We have a blood-brain barrier formed by special capillaries that don’t allow any passage to/from the cerebrospinal fluid and brain of anything from/to the circulatory system except those things which normally diffuse across all cell membranes (O₂, CO₂, alcohol (whee!)) and channels/pores for other ubiquitous nutrients, like glucose, sodium, potassium, etc. It’s slightly more complicated than that, but that’s most of it for sure. A very similar thing exists in the testes, believe it or not, and separates the goings-on in the gonads from the blood circulating around it.

While talking about hematogenous spread of metastases from testicular cancer, there were some special points made regarding this by the professor with respect to the “blood-brain barrier” that exists in the testes. The prof turned beet red and apologized profusely, swearing it was an innocent mistake, not an insult. I laughed out loud, but as I kept looking at most of the class (I sit in the back, like a good slacker), it was clear that not everyone got it, or were too distracted/asleep to care. Sad, because for all the cracks made about men thinking “with their other head,” it was a classic moment.

In a post this week on Medscape’s “official” med student blog, Pin-Chieh Chiang, a 2nd year osteopathic student, asked the question if med students use drugs to boost their performance. After a lot of yatta yatta about student behaviors and who does or doesn’t show signs of “use,” she then says the following:

At my school, the emphasis on osteopathic philosophies shines a different light on this issue. If my head is feeling clouded, I can easily ask any classmate to perform a suboccipital release on me (one of my favorite treatments).

Well, I can’t speak for the osteopathic options, but at allopathic schools, we prefer a pudendal nerve release. There are many tried and true manipulations regarding structures innervated by this nerve that you will not find in Barbara Bates’ book but have great therapeutic value, nonetheless. Consider it our “folk medicine” for those “cloudy head” days. Getting a willing classmate…ah, now there’s the rub.

From our pathophysiology professor’s notes that were made available to us yesterday:

Does this mean MAT hurts? It looks more like torticollis than an arrhythmia. Anyway, this shows I’m easily amused.

Coming soon: Tales of Surgery II: The Suture Strikes Back!

I volunteered to write a story to be included in a collection of “joke” stories by other medical bloggers. Our instructions were simple, but included the fact that it had to relate an encounter of some kind (not necessarily between people) and, “Make it cheesy, cheesy, cheesy! We want drama! More drama than that!” So here is my slice of the “Literary Cheese Wheel,” or in my case, “Literally Cheesy Wheal” when you swell with disgust at what follows.

Apologies to all who read this, but especially to Dr. Charles, a far better writer (conspicuously missing on this wheel of fromage) whose first name I shamelessly used to further the cheesiness of my story. Perdóname, por favor!

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It was a dark and stormy night, and his journey was a long one. Undaunted by unforgiving elements, Aiden pressed further on the winds of the storm, freed from his previous captor in a violent escape, almost killing him. How he longed for the supple flesh of a woman–perchance on a night like this, even one to give him shelter. No sooner than thinking this, he saw her: a visage so beautiful he could hardly believe his luck. In this case, luck was a lady tonight–a lady named Farah.

He approached gently, even stealthily, so as not to frighten her with the primal plans he had in store. A primitive creature, Aiden had one thing and one thing only on his mind…the absolute ravishing of Farah’s rosy, pink flesh. Like so many women, she acted as though he never existed, yet another in a long line of refusals and rejections.

But Aiden always got his way.

In a sudden, but sure-fire manner, he mounted on top of her. He deftly exposed his massive spike and threw off everything he had on, totally exposing himself to her as he positioned himself for his moment of truth. Before she knew what was happening, he had entered her.

Farah’s response was an avalanche of physiologic dominoes. Overcome by these wild, exotic events, her soft flesh engorged with increased blood flow: arterioles dilating, pink turning to red. Her defenses made a meek attempt to ward off this strange violator, but Aiden was too much. Her temperature raised a couple of degrees, but it was a pittance to how on fire he was. He took full control, working almost every cell he could manage to touch to do his bidding. Farah was powerless to resist.

He persisted for a good while, but the time for him to leave finally came. Instead of going quietly out the back door, the conquistador chose instead a more dramatic exit, bolting out with a flourish, not even looking back to the spent victim he left behind. Oh, she’d know he’d been there all right: the fatigue, the soreness, the still elevated temperature…

No one knows where Aiden O. Virus went from there, but he left Farah N. Gitis behind.

heh.

I was looking up something regarding ulcerative colitis and treatment in the Merck Manual while studying pathology (was convinced it was caused by C. difficile; I was quickly corrected as C. diff causes pseudomembranous colitis) and poking around, I found this link on intestinal gas. I admit; I clicked with a twinge of juvenile expecation. I was skimming through when I saw this at the bottom of the page (emphases mine):

The following piece appeared in the Gastrointestinal section of past editions of The Merck Manual, and is being reprinted here because of reader demand.

Flatulence, which can cause great psychosocial distress, is unofficially described according to its salient characteristics: (1) the “slider” (crowded elevator type), which is released slowly and noiselessly, sometimes with devastating effect; (2) the open sphincter, or “pooh” type, which is said to be of higher temperature and more aromatic; (3) the staccato or drumbeat type, pleasantly passed in privacy; and (4) the “bark” type (described in a personal communication) is characterized by a sharp exclamatory eruption that effectively interrupts (and often concludes) conversation. Aromaticity is not a prominent feature. Rarely, this usually distressing symptom has been turned to advantage, as with a Frenchman referred to as “Le Petomane,” who became affluent as an effluent performer who played tunes with the gas from his rectum on the Moulin Rouge stage.

Really, there’s no need for this. I can see where this was taken out (hopefully many editions ago) but the fact that it was brought back by reader demand is, uh, scary. “Affluent/effluent” — how clever this author thought he was. “Personal communication?” That was the bar I guess back then for standards of systematic classification. Then again, at least it’s not DSM-style, or else there would be exhaustive (pun!) criteria pages long to determine exactly how each can be labeled. No thanks.

Ok, that’s your time wastage for the day. Happy to have provided a mindless diversion or sorry to have totally ruined your snack-while-blog-reading, whichever is the case.

The new vaginal ring contraceptive, NuvaRing, has found a strong advertising presence here in Mexico as well. I found a brochure on a table in the doctors center where Claudia’s OB is located. It was a polished, well-made pamphlet designed to sucker inform prospective patients about this contraceptive.

Then I saw the back with this URL, which I link here so you know I’m not kidding: http://www.tuvagina.com.mx/. Just in case someone can’t read between the lines, tu in Spanish is “you” or “your” (informal, familiar form). The link will redirect you to entremujeres.com.mx (”among/between women”), and the ad will be ‘anillo vaginal’ which takes you to another site, unavezalmes.com.mx (”una vez al mes” = “once a month”)

Now I’m a guy, so the elevated testosterone in my bloodstream may prevent my brain from comprehending these estrogen-dependent things, but I have a feeling that the idea of promoting that site in English with the commensurate URL wouldn’t even get past the conference table in a marketing firm’s brainstorm room, much less printed on who-knows-how-many million little pamphlets to be distributed everywhere. But that’s just me…I don’t ever recall seeing a yourpenis.com URL associated in any way shape or form with the overabundance of erectile dysfunction drugs (thank GOD).

Just to test my useless theory, http://www.yourvagina.com/ resolves, but it’s “in repair” and owned by a web hosting company, indicating a probable squatted domain or the like. Either way, it’s unlikely you’ll see that link resolve anytime soon to anything resembling NuvaRing….perhaps other things which involve lots of pop-up windows and “over 18″ disclaimers, but I wouldn’t know anything about that.

Sorry to my friends that I’ve already emailed this to, but I can’t stop watching this video, so I have to inflict it on the rest of the world. Hilarious!

It happened before, it’s happened again–Amazon.com needs to start hacking away at the dead wood that obviously draws a salary despite any semblance of best practices. This arrived in my inbox this morning:

From: Amazon.com To: enrico@blahblah.com
Date: 3 Apr 2006 07:49:17 -0700
Subject: [placeholder for winning team] Wins the NCAA Tournament!

[placeholder for winning team] Wins the NCAA Tournament!

Dear Amazon.com Customer,

Congratulations, [placeholder for winning team]! As someone who has purchased sports products from Amazon.com, we thought you should be the first to see our selection of NCAA championship products.

NCAA Championship Cap
Check out our championship hats, tees, and hooded sweatshirts in our NCAA Fan Shop.
http://www.amazon.com/gp/browse.html/ref=pe_sg_ncaa06champ_ftr?node=3386071

Available only while supplies last.

Obviously, this is in reference to tonight’s NCAA Men’s Basketball Championship game between UCLA and Florida. The operative word is tonight, as in future, meaning DON’T SEND THE FRICKIN’ EMAIL YET! (and when you do, you might want to replace “[placeholder]…”)

Bozos.

Ok, enough with the serious posts already before y’all think that I sit around in a corner rocking back and forth under the stress of it all. I will start a new series of things I find in local ad rags, newspapers, etc. that show interesting slices of life here, particularly those things which one would find odd coming from someplace other than Mexico.

The inaugural post is an ad for a cough medicine. Or an expectorant. I’m not sure what it is, but thankfully I don’t have to worry because the ad basically says they have me covered (English translation in the photo was added by me, not in the original).

Let’s see…honey: no medicinal qualities to speak of in terms of cough reduction. Guafenisin: no real medicinal qualities to speak of in terms of cough reduction. Decisions, decisions.

Ah but with an expectorant, when your kids do cough, it’ll be productive, so someone at Vick’s in Mexico said, “Let’s make a phlegm-enabling agent that looks like phlegm so buyers know what it’s for,” and this product was born. Do these people have something against dextromethorphan? You’ll get better results with that if you want to reduce cough, but honestly, I don’t usually see it around here. Codeine works as well, but there might be a little nipity-nip from the parents at bedtime, too.