by Mark Leyner
Now, this is some serious medical humor. The “funny bone” refers to the superficial site where the ulnar nerve crosses the elbow. The name funny bone apparently came from a pun in the 1800s. It’s a play on the word humorous and the upper arm bone, the humerus.
Try and contain your laughter.
The pain that you get from banging the funny bone occurs when you bang the nerve against the bony prominence of the humerus, the medial condyle. A simple bang of the elbow is painful, but there are some severe problems that can come from injuring this vulnerable nerve. Cubital tunnel syndrome is a condition that is also known as ulnar nerve entrapment neuropathy at the elbow. This is the second most common condition where a peripheral nerve gets compressed. The most common is carpal tunnel syndrome.
Ulnar nerve entrapment neuropathy at the elbow typically has an insidious onset—the cubital tunnel syndrome causes numbness in the ring and small fingers of the hand, elbow pain, and hand weakness. The symptoms are worsened by any activity that involves repeated flexing of the elbow. It is three times more common in men than women. Sometimes it even requires a surgical decompression to take pressure off the nerve.
Not so funny.
HOW DOES ASPIRIN FIND THE PAIN?
Aspirin is really a magical little pill and probably one of the most important medications available. Aspirin has a very powerful preventive effect associated with strokes and heart disease. But most of us know it for curing pain, and it’s common for people to wonder just how aspirin knows how to find that aching area.
The answer is that it doesn’t! Aspirin is not the pain-seeking bloodhound it appears to be. Pain is a very complex process, and although we would love to avoid an explanation, here is a simplified version….
Let’s say you’re bowling with your friend Barney and you drop the bowling ball on your toe. Although the pain is felt in the throbbing toe, it is really processed in the brain. After the ball crushes the toe, the cells and nerve endings are damaged and release chemicals. These chemicals send messages along the pain fibers to the brain where they are registered as pain. One group of chemicals involved is called prostaglandins, and aspirin works by stopping the cells from making prostaglandins. Prostaglandins are also responsible for inflammation and aspirin also blocks this effect.
So now you need some pain medication. When you take aspirin, it is absorbed in the stomach or intestine and it enters the bloodstream. From there it goes throughout the entire body, not just the injured area. It works its magic wherever prostaglandins are being made. The result—temporary relief of pain and inflammation.
WHY DO FEET SMELL?
The fancy term for smelly feet is bromohydrosis. Hyperhidrosis refers to sweaty feet. In our family we call it “swamp foot.”
Foot odor is caused primarily from sweat, and the feet contain an estimated quarter of a million sweat glands. Just as in the armpits, foot sweat is odor-free when it comes out, but the bacteria on the surface of the feet act on the sweat and the stink begins. It becomes more of an issue down there, because our shoes and socks create a dark and moist environment that allows the bacteria to flourish.
The two solutions to the smelly foot problem are to keep your feet clean and to keep them dry. In the ER, we have a lot of experience with smelly feet. When caring for a particularly unkempt patient, an experienced ER doctor or nurse knows that the smell gets worse when the socks come off. There is a special name for this condition—we call it “toxic sock syndrome.”
DOES ARTHRITIS FLAIR UP IN BAD WEATHER?
Here we go again. We know what’s going to happen when we say that there is no relationship between weather changes and arthritis. It will happen on some obscure radio program in Scottsdale, Arizona. The host will take calls, and some angry senior will call in, get all indignant, and berate us about the misinformation that we are irresponsibly spreading. He will tell us how he was hobbled by arthritis while living in Walla Walla, Washington, but now plays three sets of tennis a day. When we explain that the research literature has found no connection, he will become even more incensed.
There is no conspiracy here. Studies that have looked at the subjective perception of pain have found that changes in barometric pressure have caused increased pain, decreased pain, or no change at all. There is no consistent pattern. When researchers tried to look at objective measures of inflammation with weather changes, no study was able to find any connection.
So whether you live in New York City; an Amazonian rain forest; Tucson, Arizona; Piscataway, New Jersey; or the Gobi Desert, science cannot predict any changes with your arthritis with the climate. Check them all out and see which locale you prefer. ( We would choose New York—the take-out is better.)
WHY DOES IT FEEL SO HOT OUTSIDE WHEN IT IS 90 DEGREES IF OUR BODY TEMPERATURE IS 98.6?
This is a great question that we have been asked many times. There is a relatively simple explanation.
It’s all about the thermoregulation. Doesn’t sound very simple, does it? That’s why we’re here. Our bodies are constantly producing heat from our metabolism. This heat needs to go somewhere. Thermoregulation is the mechanism by which our body attempts to balance heat gain and loss in order to maintain a constant body temperature. This becomes more complicated when we are dealing with rising outside temperatures. It is much easier to release this heat when there is a large gradient (a bigger difference) between body and outside temperature. When it is hot outside, the body ends up having to work harder to lose heat. That makes you sweat and flush, as you try to increase blood flow to the skin and allow heat loss.
This just goes with the territory of being the warm-blooded animals that we are. Cold-blooded animals only get as hot or as cold as it is outside—which could be trouble for a rattlesnake trapped in an ice-cream truck.
WHY DOES SUCKING ON HELIUM MAKE YOUR VOICE SOUND FUNNY?
Helium is a colorless, odorless noble gas. The noble moniker doesn’t make sense when you imagine a grown man at a child’s party taking a balloon, inhaling, and then giggling like a five-year-old when he hears his own squeaky cartoonlike voice.
Helium causes this voice change by altering the environment where sound is formed. In normal conditions, the voice makes sounds using the vocal cords. The cords or folds vibrate, releasing pulses or waves of air into the throat. These waves are interpreted as sound. If we change the composition of the air, we change the way the vocal cords vibrate. Helium is lighter than air so our vocal cords will vibrate faster in this environment. The speed of sound in air is approximately 350m/s, but the speed of sound in helium is 900m/s. The faster vibration causes the higher pitch.
List of our favorite high-pitched voices:
Tweety Bird
Tiny Tim
Alvin and the Chipmunks
Megan Mullally
Mike Tyson
WHAT TURNS SNOT GREEN?
People are obsessed with the color of their secretions. In the hospital, you often get detailed descriptions about the color changes in a person’s stool, urine, or sputum. Stool color changes can reflect illness, but urine color is rarely helpful unless blood is present. As for snot, indentifying the rainbow of possibilities may be helpful in some patients. Green is the only potentially worrisome shade. The green color comes from white blood cells called neutrophils. These immune cells appear when bacteria starts infecting the nasal passages or airways. When the white cells start fighting the infection, they produce an enzyme called myeloperoxidase. Myeloperoxidase is green because it contains a lot of iron.
Now, the hint of a green tinge doesn’t necessarily mean that you need antibiotics. If it is just in your nose at the beginning of an illness, it will probably pass. But if you are coughing it up, have underlying lung disease, or symptoms persist, go see your doctor.
So don’t take umbrage with people who blow their noses and then carefully inspect the tissue or handkerchief to evaluate their production. They are just being vigilant.
WHY DO OLDER PEOPLE FART MORE THAN YOUNGER PEO
PLE?
We tried to find the derivation of the expression “old fart” but were unsuccessful. We will have to assume that is has something to do with an older person’s propensity to let his flatulence fly without any regard for where he is when he is passing wind.
There are some reasons why the elderly would be more flatulent than their younger counterparts. Even if older folks are not actually producing more intestinal gas, loss of muscle tone occurs with the aging process and this includes the muscles around the anal sphincter. Therefore, an older person has less ability to hold gas in.
Other suitably ripe euphemisms for flatulence include:
Cutting the cheese
Sneezing in one’s pants
Floating an air biscuit
Doody burping
Sphincter whistling Killing the canary
Colon bowlin’
The scented scream
CAN BALD MEN GET LICE?
So you are going bald, but trying to look on the bright side, right? You make a list of all the positives; no wasting time in the morning with hairstyling, less money spent on products, no more hat head, no dandruff, and of course, no head lice.
Well, you may not be so lucky. You don’t have to worry about the styling, the hat head, or the typical head lice, but you might still have dandruff and there are other crawling creatures that could attack your bald scalp.
There are several different types of lice: head lice (Pediculus humanus capitis), body lice (Pediculus humanus corporis), and pubic lice (Pthirus pubis). Head lice are the most common of all lice and are often seen in the heads of schoolchildren. Pubic lice are often referred to as “crabs” and body lice are known as “the cooties.” Crabs are frequently spread by sexual contact and body lice are most often found in people who don’t wash or change clothes often. In the ER, we often see homeless patients who are unfortunately infested with body lice.
Head lice probably won’t have anything to grab onto on the bald head, but body lice might spread to affect a bald head. Scabies is another creepy crawler that is often confused with body lice. Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabei. These mites are much tinier than lice. You can get scabies from direct contact with a person already infested with scabies. Infestation can also occur from sharing clothing, towels, or bedding.
DO HUMANS REALLY USE ONLY 10 TO 20 PERCENT OF THEIR BRAINS?
There are many different nonscientific answers to this question. A wife might argue that her husband uses less than 10 percent of his brain at times, a coach often tells his players that they aren’t using their heads enough, and we often think that our politicians don’t use their brains at all. The truth is that there is no way to quantify how much of our brains we use at any given time. Humans definitely use more than 10 to 20 percent of their brains, so this myth is definitely false.
We are getting closer to understanding how we use our brains. Functional magnetic resonance imaging (fMRI) is a new technique that is being used to investigate which parts of the brain are active during different mental activities. Functional MRI measures changes in blood flow within the brain in response to various stimuli.
This isn’t a direct measure of brain-cell activity but it gives us a better idea how the brain works.
So maybe someday we can place George Bush and Bode Miller in a functional MRI and really find out what’s going on inside their noggins.
WHY DO ASIANS TURN RED AFTER CONSUMING ALCOHOL?
We thought about cutting this question because of the risk of sounding racist, but before anyone jumps to conclusions, go do some reading about the metabolism of alcohol and specifically the low-Km mitochondrial aldehyde dehydrogenase (ALDH2) isoenzyme.
Yes, that’s right. There is a physiological reason that some Asians, including Chinese, Japanese, and Koreans, get flushed in the face after drinking alcohol.
Here’s what happens: alcohol (ethanol) is metabolized in the liver. In the first step, it is broken down by an enzyme, alcohol dehydrogenase, and forms a toxic compound known as acetaldehyde. After that, a second enzyme called aldehyde dehydrogenase 2 (ALDH2) converts the acetaldehyde into acetic acid (the main component of vinegar), which is nontoxic and can be readily converted by your body to provide energy.
Certain Asians lack this second enzyme and the acetaldehyde builds up. The side effects include: skin flushing, increased heart rate, and severe nausea and vomiting. The severity of these symptoms depends on the degree of the enzyme deficiency.
IF YOU DREAM IN COLOR, DOES IT MEAN YOU ARE CRAZY?
I dream in color. Mark, on the other hand, dreams in high-definition IMAX, and the dialogue in his dreams is dubbed in poorly synchronized staccato Portugese. But this doesn’t mean that either of us is crazy.
Dreaming in color is a perfectly normal phenomenon. Scientists have always reported that people dream in both color and black and white, but the concept that dreams were primarily in black and white evolved in the 1950s. At that time, television, movies, etc., were almost entirely in black and white, and this probably led to the false perception that dreaming also followed this monochromatic pattern.
In 1962, in an article in Science, Kahn, Dement, Fisher, and Barmack reported on the “Incidence of Color in Immediately Recalled Dreams.” These researchers woke their subjects up from REM sleep, and asked them if they dreamed in color. Eighty-three percent of their dreamers reported dreaming in color, and then, presumably, went back to sleep.
IS IT TRUE THAT YOU CANNOT DIE IN A DREAM?
So here is the myth: if you are having a dream and you are about to die or be killed, you better wake up. If not, you will die in the dream and remain in that eternal slumber. The reality is that you can die in a dream and be perfectly okay. Death dreams are not extremely common, but they do occur.
There are, however, some reports of true “killer dreams.” It is known that emotional stress can cause an increase in heart rate and that this can occur during sleep, especially in REM sleep when dreams occur. It is also known that approximately 20 percent of heart attacks and 15 percent of sudden cardiac deaths occur between midnight and 6 A.M. Now, not all of these events are sleep-or dream-related, but there may be some risk for those with underlying heart disease.
For those of us who are healthy of heart, an article in the Canadian Journal of Cardiology described four cases of people without known heart disease for whom the emotional stress of nightmares caused their premature demise.
So should we sleep with one eye open for fear of a death dream? No, we didn’t intend to scare you; you are much more likely to have a wet dream than a death dream, so enjoy your sleep.
ARE THERE MORE VIOLENT CRIMES WHEN THE MOON IS FULL?
We already dispelled a similar myth about more babies being conceived when the moon is full. This one has no basis in science either.
Several studies have examined lunar cycles and violent behavior. There is no scientific or statistical support for a connection between a full moon and aggressive or violent behavior.
Now, when Billy goes to the ER for his next overnight, and it just happens that the moon is full, there is no way he is going to convince anyone that there isn’t a relationship. Sometimes we just need something to blame.
ARE YOU MORE LIKELY TO DIE IN THE PASSENGER SEAT IN A CAR ACCIDENT?
In the emergency room where Dr. Billy works, it is extremely common to see patients after a motor vehicle crash. We use the term crash rather than accident because accidents should be avoidable. Seat belt use clearly reduces the number of serious injuries but is there a safer place to sit in the car?
The passenger seat is often the preferred travel seat, with a battle raging for who gets to ride “shotgun.” This term is a reference to the days when stagecoaches would frequently get held up and an armed guard would ride alongside the driver for protection. Others refer to the passenger seat as “the death seat” and this appellation has some truth behind it.
Several studies have confirmed that si
tting in the front seat of a car is more dangerous than riding in the back. Sitting in the back can reduce the risk of death in a motor vehicle crash by anywhere from 25 to 39 percent. The risk of serious injury is also reduced by about 30 percent for those sitting in the rear when compared to the front seat riders. The risk to drivers is about the same as for those who are riding shotgun.
The bottom line is that the “death seat” name is justified, it just applies to both positions up front. So take your choice, sit in back where it is safer or ride up front where you can play with the radio.
Either way, make sure to buckle up.
IS THERE SUCH A THING AS A DEATH ERECTION?
Some people think that when you die you’re bathed in a radiant light, you go to heaven or to hell, or you take up residence in the bodies of other creatures like lemurs or llamas. Others think that when you die, the following occurs:
Your blood will pool due to gravity (hypostasis).
You will gradually stiffen due to a buildup of lactic acid in your muscles (rigor mortis).
You will become bloated by the production of gases caused by bacterial breakdown of tissue.
Oh, we forgot to mention that for men who die facedown, the pooling of blood will lead to a death erection.
Yes, this myth is true!
Some refer to this phenomenon as “angel lust.”
Rest in peace.
WHY DO YOU SHIVER AFTER YOU PEE?
There are probably many sophisticated and urbane women out there who don’t know that it’s fairly common for men to experience a little shiver just as they finish urinating. And there are probably just as many men out there who shiver after they pee, but don’t have the foggiest notion as to why.