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Monday, May 7, 2007



Dr. Lester CN Simon

One of the secret joys of growing up and growing old should be made public. It is the quiet realization that the words of wisdom that members of your family, neighbours, friends and even perfect strangers, uttered to guide you along, are universal concepts that you have discovered to be true. It is now your sacred duty to pass them on.

Too much of a good thing can be bad for you. If you do not take kindly to advice from elders and others, you should read on and take counsel from hard scientific facts.

Pathology literally means the study (logos) of suffering (pathos). It is concerned with the causes of disease and well as the mechanisms underlying the causes of disease and how they lead to the signs of illness and the symptoms of patients. Television has presented the pathologist as someone who deals exclusively with matters related to the dead. Some pathologists, known as forensic pathologists, do that almost exclusively. Most general pathologists spend much more time and effort working in a lab overseeing technologists and examining and reporting on all sorts of specimens from the living. Indeed the motto of the Royal College of Pathologists is that pathology (including forensic pathology) is the science behind the cure.

The Newsweek magazine issue of May 7, 2007 carries an article by Jerry Adler in which he writes that doctors are changing the way we think about heart attacks and even death itself. The remarkable thing here is that the rethinking doctors are doing is based on a fundamental concept that would have made my dearly departed maternal grandmother smile knowingly. In fact many Antiguans and Barbudans are intimately familiar with the concept that, under certain circumstances, too much of a good thing can be bad.

When parts of the body are injured, they may adapt, suffer or die. A particular form of suffering occurs when the tissues of the body are deprived of blood. The flow of blood to and through the tissues is called perfusion. If loss of perfusion is massive and sudden, death can occur. If the loss of perfusion is not massive and it is gradual and prolonged, adaptation or suffering can take place. The decrease in perfusion is called ischemia (holding back of blood).

The news celebrated in Newsweek is based on the seemingly contradictory concept that when normal blood flow is restored to ischemic tissues that were chronically starved of blood, the suffering tissues can be injured more severely by the return of the formerly vital blood flow! This is called reperfusion injury. There are many mechanisms at work here. One such mechanism is that compromised tissues in their accustomed state of deprivation or chronic ischemia cannot suddenly adapt to the high concentration of vital chemicals that the renewed blood flow is bringing in. Do you see members of a united political party smiling?

In retrospect, we should not be surprised by the concept of reperfusion injury. We have all been suddenly awakened from deep, lovely sleep and had to snooze for a while before getting up. Or we recall being in the dark and suddenly exposed to very bright light. Worse, some may recall getting used to the blues of a lost relationship when all of a sudden the ex-lover reappears out of the blue bringing old tidings of great joy and new tales, fears and tears of rekindled injury.

One of the lessons from the remarkable research into reperfusion injury is that we may be treating some forms of heart attacks incorrectly. Many heart attacks occur because the heart is starved of blood beyond its ability to compensate. When we try to jolt such a weakened heart back to life we may be doing more harm than good. Instead of the jolting, heavy handed approach of almost literally beating the heart back to normal, we should reduce the demand on the heart and adjust the way it functions so that it can be coaxed safely and gradually back to normal. This slowing down, or slow waking up approach may require
lowering the body temperature to decrease the amount of energy required and using other practical methods currently under research.

But my grandmother knew all of this high science and technology long ago. I am sure she smiled in heaven and begged pardon for me when I got into trouble in biochemistry class at university. The lecturer was going on and on about the structure of large, complex protein molecules and how scientists used an enzyme called papain to break down these complex protein molecules into smaller, “digestible” pieces to study them. Unable to contain myself, I busted out laughing and disturbed the entire class.

My excuse was that I had recalled Granny cooking cow heel with green pawpaw on Saturday evenings for soup on Sundays. Green pawpaw is a natural source of the enzyme papain, which breaks down muscle protein. Despite what some fellow students would say, I swear I did not tell the lecturer, whose initials were E.V.E., that he reminded me of my grandmother.

Were Granny alive today, she would demonstrate reperfusion injury in double measure by cautioning me, on the same Saturday evenings when I wanted to run off to too much of whatever, to tarry a while after turning on the pipe to get clean water from a public utility authority.


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