by Mark Leyner
Now we’re not talking about a cold-induced shiver here…the camping-in-the-Arctic-and-taking-an-early-morning-whizz-inthe-woods shiver. We’re talking about something a wee more mysterious….
Although this is a common male physiological phenomenon, there has been, to our knowledge, no scientific research conducted to explain its basis.
It is thought, though, that the pee shiver is related to the autonomic nervous system (ANS). The sympathetic subdivision of the ANS keeps the bladder relaxed and the urethral sphincter contracted so we don’t wet our pants during an episode of fight-or-flight anxiety. When you go, the parasympathetic side of the ANS causes a contraction of the bladder and a relaxation of the urethral sphincter, enabling you to take a piss.
Dr. R. James Swanson, professor of biological sciences at Old Dominion University—and one of the only scientists intrepid and curious enough to publicly weigh in on the subject—muses that “the sympathetic outflow of action potential…would include the release of the adrenal medulla catacholamines epinephrine, norepinephrine and dopamine. When the opportunity arises to allow the parasympathetic side of the ANS to take over, the change in catacholamine production might be the cause of the shiver.” Dr. Swanson adds that, in addition to the shiver, you will also notice a momentary “euphoria” shortly after relaxing the urethral sphincter.
Some yoga-oriented folks have compared the pee shiver to an orgasmic Kundalini energy flow. And the term “mini-orgasm” comes up with surprising frequency in discussions of this simultaneously mundane and esoteric subject.
Leyner and I think the fact that a man could have a quasiorgasmic response to merely relaxing his urethral sphincter shows just how ridiculously easy we are.
1:25 P.M.
Gberg: Leyner!!!
Leyner: WHAT?????!!!!!!!!!
Gberg: Don’t throw all those question marks at me.
Leyner: Sorry, Charlie.
Leyner: This day is whack.
Gberg: Why?
Leyner: So much bullshit to deal with on Mondays.
Gberg: Tell me why you don’t like Mondays.
Gberg: Just checked Amazon and Barnes and Noble again….
Leyner: Mondays…just lots of stuff to attend to, and e-mails that piled up, and house stuff…
Gberg: 217 and 235.
Leyner: That’s nice.
1:30 P.M.
Leyner: I’m gonna call Carrie this week and talk to her about the schedule and deadline.
Gberg: I also was scouring the reviews. I can’t control myself.
Gberg: We can talk to her tomorrow.
Leyner: I know you can’t.
Leyner: I want to tell her that we might need a couple of extra weeks.
Gberg: I still want a piece of that guy who called the book mindless pablum.
Leyner: Let’s find out where he lives.
Gberg: He wrote “It’s a dough-grab attempt to top the NY Times best-seller list by appealing to jackasses.”
Gberg: How dare he insult the jackasses that buy this book!
Leyner: I like that phrase: “dough-grab.”
Gberg: Sounds like a molestation of the Pillsbury Boy.
Gberg: Did you see that video that was circulating that has the Pillsbury Doughboy laughing so hard that he craps himself?
Leyner: I guess I should go work some more…I want to do some more research…I’m trying to gather all the stuff on puberty…and then write them up. I wanna get the funny kicker to your peeing question done and the goose bump q and a for the catalog too. I’m also trying to get some work done each day on my script.
Leyner: I haven’t seen that Doughboy thing…sounds funny.
1:35 P.M.
Gberg: Man, you really are out of it.
Leyner: I know, right.
Gberg: Script?
Leyner: Script.
Gberg: I thought you were dedicated 100% to Why Do Men Fall Asleep After Sex?
Leyner: The script I have to write…that’s due by the end of April.
Leyner: I am. Just trying to lay some groundwork so I can get that finished in time.
Gberg: I know what it is. I feel like you are cheating on me.
Gberg: Brutus.
Leyner: I’m not writing it. Just trying to begin to get some idea of what the movie is…Don’t ever call me a Brutus again.
Leyner: I’m really the most loyal person you’ll ever know.
Gberg: I meant Brutus from the Popeye cartoons, not Ceasar’s Brutus.
Gberg: I would never question your loyalty. You are freakin’ sensitive today.
Leyner: I’m feeling a little slammed today…I’m completely sleep-deprived today…I really got NONE. I looked at the clock and it was 4 am and I hadn’t slept at all yet and I figured it was a little late for Ambien…so I just read my Lord Nelson book until it was time to get my daughter ready for school.
Gberg: Take care of yourself. Take a nap.
Leyner: I’m twitchy and misanthropic and needing to be held and loved and fellated by burger waitresses.
Gberg: Burger waitresses? Are you thinking about that girl who served us last week? I didn’t know she made such an impression.
Leyner: I thought she was mighty fine.
1:45 P.M.
Leyner: There was a big Nipples extract today in the Daily Express in England.
Gberg: I refuse to get into a discussion of what you want to do to yourself with burger waitresses. Then we will get more bad reviews on Amazon. Like the guy who called us arrogant and witless.
Gberg: I heard that there was also a two-page story in Yediot Achronot (Israel’s #1 daily newspaper).
Leyner: Arrogant AND witless. Gosh…he makes us sound like brown-shirted fascists.
Leyner: Really, in Yediot Achronot?
Leyner: Does that mean idiotic spider in Hebrew?
Gberg: We also got “Mindless alcoholic ramblings,” “Not worth the buy.”
Gberg: I am so obsessed with the bad reviews I have them all saved in one Word document.
Leyner: Mindless alcoholic ramblings??? You sure he wasn’t reading my other books?
Gberg: I wish I could e-mail him and suggest it.
Leyner: That’s funny. You should.
Gberg: It was probably my ex who wrote that.
Leyner: Hey…guess I should go and do something productive…collate my notes about piloerection.
1:50 P.M.
Leyner: I’ll call you after the interviews are over, OK?
Gberg: You know piloerection is a sign of heroin/opiate withdrawal.
Leyner: It’s also a symptom of temporal lobe epilepsy and autonomic hyperreflexia.
Gberg: You go, girl!
Leyner: Thanks, sweetheart. Later, baby.
Gberg: Ciao.
WHY DOES MY BUTT ITCH SO MUCH?
If you are a sufferer of pruritus ani (itchy anus), you will relate to this question. Nobody likes to talk about it, but many of us know about the overwhelming, irresistible urge to scratch. It often happens at night and after a scratch and sniff, you are faced with one of the age-old dilemmas. Do you get out of bed and wash your smelly fingers?
Pruritus ani is a real and common condition. It is a chronic itching of the skin around the anus. The skin in that area becomes irritated from digestive products in the stool and this leads to an itchy rash. Excessive wiping or scrubbing with soap and water can make it even worse.
For simple solutions, avoid further trauma to the area (no scratching, no scrubbing), don’t use soap of any kind on the anal area, and when wiping, use wet toilet paper, baby wipes, or a wet washcloth to blot the area clean.
Other things can cause itching in the perianal area including psoriasis, hemorrhoids, fungal infections, and pinworm. So if your itching persists, don’t be embarrassed at being bare-assed. Go see your doctor.
WHAT CAUSES A SPLIT STREAM WHEN YOU PEE?
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is the official system of ass
igning codes to diagnoses associated with hospitals in the United States. In case you wanted to know, the code for splitting of the urinary stream is 788.61.
The split stream is a real condition, but this code doesn’t apply to you if you just occasionally wake up and pee in all directions like a sprinkler before it coalesces into a smooth even flow. This is probably cuased by some residual debris in the urinary tube (urethra). Persistent split stream can be caused by a scarring of the urinary opening (meatal stenosis) or damage to the urethra. Prostate infections or enlargement of the prostate can also cause splitting of your flow.
So, if this problem persists, go see the urologist—and, guys, remember to lift up the seat (and don’t forget to put it back down)!
CHAPTER 12
’TIS THE SEASON (TO ASK QUESTIONS)
It was a classic holiday evening in New York. Snow was gently falling, Bing Crosby music was playing, and Wendy was cleaning and decorating the office for the small party that we had planned to celebrate the season. Our exclusive guest list included: Leyner and his lovely wife, Mercedes; me and my wonderful wife, Jessica; and Wendy and her new boyfriend, Dexter, the guy from the bakery. Their relationship had unexpectedly blossomed after Leyner thrust them together.
The six of us were gathered in the office and I had raised my glass to toast our prosperous first year in practice, when I heard a knock at the door and then the harmonious sounds of Christmas carolers singing “Silent Night.” Leyner went to open the door. There was a large group of merry, red-cheeked people who entered. I was so stunned that it took me a moment to focus and recognize that these new guests were all patients of ours. There was the couple with the marital problems, Judd Wilson with his body image issues, Stanislav Javenuski, the crying hockey player, the chess-playing chimp and his companion, Isabel Collier and her husband with their newborn baby, little Richard and his singing family, the miniature golfing yakuzas, and Ralph and Cindy Tucker and their pubescent daughter Stacey.
I pulled Leyner aside angrily. “Do you have an explanation for this? You are breaking every single rule of patient confidentiality.”
“Lighten up, Scrooge. I got you something.”
Leyner reached into his ever-present Yak Pak—the black bag he carries with him everywhere—and pulled out a wrapped gift.
“Happy Hanukah, mon frère.”
I shook my head, constantly amazed at these unexpected instances of Leyner’s generosity and good nature.
“And I have something for you too, hermano.”
We exchanged gifts and immediately tore at the wrapping paper.
I’d gotten Leyner an expensive and rare first edition of Robert Louis Stevenson’s Dr. Jekyll and Mr. Hyde in honor of the strange dynamic of our working relationship.
When I unwrapped Leyner’s gift, I found myself holding a glazed ceramic decanter in the shape of a genie’s bottle. The cap was an exact scale replica of Leyner’s head. The bottle was filled with some brackish liquid. Overcome with curiosity, I unscrewed the Leyner “head,” and carefully wafted the bouquet toward my nose. The acrid aroma burned my nostrils.
“What the hell is that?!”
Leyner smiled, winking at me. “I reformulated and tweaked the recipe. It’s MegaProfen-11™. You’re going to love it, dude!”
Wendy poured paper cupfuls of MegaProfen-11™ for all the guests. With cups raised, I began my toast….
“Here’s to a glorious year and special appreciation to all of you who sought out our guidance. It means so much that you had the confidence and trust to allow us into your lives. We have learned as much from you as we hope you have learned from us. Salud.”
ARE POINSETTIA PLANTS REALLY POISONOUS?
With all that yummy stuff to eat during the Christmas season, like roast goose and baked ham and candied yams, it’s a bit of a mystery to us why anyone would eat pointsettia plants. But people do seem to pass on the fruitcake and reach for the Euphorbia pulcherrima (that’s poinsettia for those of you who are botanically challenged). In the 2004 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System, 2,206 poinsettia exposures were reported to poison control centers.
Here’s the lowdown on the poinsettia chow-down. It’s not going to kill you. Rumors of the lethal effects of the plant probably started back in 1919 when the two-year-old child of a U.S. army officer was thought to have died after ingesting poinsettia leaves. Upon investigation by the American Society of Florists, though, it was determined that the leaves were not responsible for the death of this child. But the misconception about the poisonous nature of this much maligned plant has persisted. A recent study by Children’s Hospital of Pittsburgh and Carnegie Mellon University determined that out of some 23,000 reported poinsettia exposures, there was essentially no toxicity of any kind.
If you’re heedlessly herbivorous, plan on eating the mistletoe after kissing your sweetheart underneath. That’s not toxic either.
CAN YOU GET LYME DISEASE FROM A REINDEER?
It looks like Santa’s elves might need to start checking each other for ticks. Leyner and I were unable to find a case report of an elf afflicted with Lyme disease, but we offer the following scientific analysis and deductive reasoning—Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted by the bite of infected ticks. In the northeast of the United States, Ixodes dammini (the deer tick) is the chief carrier of this disease. Thus, we implicate deer in the spread of the ailment.
Now for the reindeer connection. Reindeer (Rangifier tarandus)—otherwise known as caribou—are medium-sized members of the deer family. Reindeer are found in many regions of the world, including Sweden. Guess what else is commonly found in Sweden? Buxom blond women eating pickled herring? Yes, that’s correct, but that has absolutely nothing to do with deer ticks. Guess again…Time’s up! You are correct, sir! Lyme disease. We also know that moose and roe deer, among other large mammals in Sweden, are vectors for Lyme disease. So it makes perfect sense that Dasher, Blitzen, and Rudolph might also be complicit.
WHY DOES TURKEY MAKE YOU SO SLEEPY?
You have just scarfed down several pounds of turkey, six scoops of yams, a terrine full of mashed potatoes, eight ounces of tangy cranberry sauce, half a green bean casserole, and several large hunks of pumpkin pie. And you wonder why you just fell asleep on the couch with the Dallas Cowboys pummeling their hapless opponent by forty-three points, as your uncle Howard drones on soporifically yet again about his chance encounter with Milton Berle on a Florida golf course five decades ago.
It’s very common for people to report drowsiness after eating the traditional Thanksgiving meal. And it’s equally common for the armchair expert in the family to blame it on the turkey and the tryptophan. L-tryptophan is an amino acid that helps the body produce the B vitamin niacin, which promotes the production of serotonin, a neurotransmitter that acts as a calming agent in your brain.
L-tryptophan is naturally found in turkey protein, but a typical serving of turkey contains a similar amount of L-tryptophan as found in an average serving of chicken and ground meat. So it’s probably not the turkey.
It’s most likely that the enormity of the meal itself is precipitating that postprandial prostration. Thanksgiving gluttony causes a variety of digestive substances to jump into action and ultimately leads to increased blood flow and metabolic rate for digestion.
WHAT WAS WRONG WITH TINY TIM IN A CHRISTMAS CAROL?
Tiny Tim Cratchit is one of the most poignant characters in the history of Christmas literature and movies. For many people he is the very embodiment of physical disability, and few can forget his sweet and saintly disposition. He represented for author Charles Dickens the wretched state of children in Victorian England. What actually afflicted this character, though, and made him dependent on that crutch and hideous frame of metal and leather on his legs and lower back?
Although Dickens never reveals specifically what ails the poor, undersized lad, medical experts generall
y have three opinions. Tiny Tim possibly suffered from distal renal tubular acidosis (Type 1), a disorder that is characterized by growth failure, and, left untreated, will result in fractures, muscle weakness, and ultimately kidney failure and death. This is an uncommon disease. The two other possibilities were much more prevalent at the time that Dickens wrote his classic holiday tale. Rickets, a vitamin D deficiency, would have resulted in Tiny Tim’s soft bones, muscle weakness, and stunted growth. It has also been speculated that Tiny Tim was afflicted by Pott’s disease, which is tuberculosis of the spine.
Thanks to the reformed Scrooge’s redemptive revelations, Tiny Tim is granted a new lease on life and given the opportunity to celebrate Christmases Yet to Come. “God bless us, every one!”
WHAT IF SANTA WERE LACTOSE INTOLERANT?
So you sneak downstairs to get a glimpse of Santa scarfing the cookies and milk you so lovingly left for him. Instead, you see an empty plate and glass, and you hear a groaning coming from behind the half-closed door of the powder room. You approach the room and peek in…. There’s Santa, his red pants at his knees. Helooks up, grimacing, and says, “That wasn’t soy milk, was it? I just found out I’m lactose intolerant.”
Lactose intolerance is the inability to digest lactose, the primary sugar found in milk. Lactose intolerance is caused by a shortage of the enzyme lactase that breaks down milk sugar into two simpler forms of sugar called glucose and galactose. Common symptoms of lactose intolerance include nausea, cramps, bloating, gas, and diarrhea.
Were our fanciful scenario true and Santa did develop a serious lactose intolerance and subsequent gastrointestinal upset, children of the world need not worry. Lactase enzyme is available over the counter to help people digest dairy products. Lactose-reduced products can also be found today at most supermarkets and grocery stores. Other options include soy milk and rice milk. And some dairy products are naturally low in lactose, like Swiss cheese and cottage cheese.