Archive for the ‘Biology’ Category

Pain in the Wrist

Saturday, May 23rd, 2009

My earlier bout with tenosynovitis had cooled off several months, but had announced its return soon after my arrival in Wuhan.  After a month of tolerating it, I decided it was time to seek medical help. Secretly I hoped Chinese physicians might have some alternative approaches of coping with the malady — which I believe, without much supporting evidence, to be an autoimmune glitch.

In fact, Chinese medical practice is of two minds:  traditional and Western, without a lot of overlap.  Zhejiang Medical School (where I taught for a year in 2007) is decidedly Western in its M.O., with traditional studies relegated to a separate Institute.  In effect, treatment options are already settled by the time you walk in the door of a particular clinic.

Nor did I choose which door.  That was built into the mission of the Girl-Friday in the International Office commissioned to assist me.  But that’s alright, because the point of this note is not to compare traditional vs. Western outcome in the treatment of tenosynovitis, but to narrate my trip to the clinic.

I’ll begin with the forty-minute bus ride on a typically crowed, bumpy, swerving Chinese bus, which afforded standing room only.  My reasons for including this detail will become obvious later.

A short walk beyond the bus stop brings us to the outpatient clinic of a major, right-bank (of Yangtze) hospital.  Outpatient clinics are the standard mode of primary medical care; private or small-group practices are not permitted, and nobody has thought, apparently, to market HMOs to the Chinese.

Being a newcomer to this clinic, the first queue was to get a “clinic book” — my new, portable medical record.  Five yuan was the fee.  Next queue was to sign up with a particular clinic, based on your complaint.  A quick chat between my interpreter and a nurse (hanging around for the purpose?) suggested “internal medicine” was appropriate.

We find our way to the internal medicine clinic, where a nurse points out the consultation room.  The door was open, and a consultation in progress, but it soon became clear that to maintain ones place in the queue, I had to jostle my way into the room and deliver my appointment-slip to an assistant, who, awkwardly, was sitting at a table on the far side of the physician and his on-going consultation, and that in a none too spacious room. Thus, my appointment slip was put to the bottom of the assistant’s pile, with perhaps three or four above it.

An exact number is hard to ascertain, since body counts are deceptive.  At any one time, there were several people in the room — beyond the physician and his assistant — some, probably most, of whom were on-lookers.  I would surmise that a typical patient was accompanied by several family members, quite willing to add their commentary to the information flow of the consultation.  But I also deduce that there was more than one such patient-plus-entourage groups in the room at a time, for the simple reason that, as one group left, another patient took his seat in the examination chair from among those already in the room.

In fact, I waited in a chair just outside the open door, and was eventually invited in — along with my entourage, Girl Friday.  Her interpretive services really weren’t needed, for the physician spoke excellent English.  This didn’t surprise me, since, from my experience at Zhejiang University Medical School teaching medical students, I knew of the generally high level of English among these students.  Indeed, I got the feeling that he was proud-as-pink of rendering his judgements in English.

That judgement was a high-fidelity echo of the American physician’s pronouncement:  you must immobilize that wrist; it will never heal if you continue to use it.  Though, unlike my American physician, he did not prescribe or suggest a splint to help me with that unrealistic discipline.  He did, however,  scribble out two prescriptions, one for an anti-inflamatory drug, the other for an over-the-counter cortisone creme. The scribblings were mostly not Chinese, but in that quasi-Latin used to describe drugs and dosage.  I daresay any American pharmacist could have dealt with it.  The entry into my clinic-book is in Chinese.

Now dismissed from consultation, and clutching a few addition sheets of paper, we made our way back downstairs to the cashier queues.  Total charge: 55 Yuan, about $8.00, along with a receipt that enabled me to collect the prescribed remedies from the adjacent pharmacy.

The first challenge to the immobilization discipline presented itself on the bus ride home.  Packed as usual, with the inertia of erect bodies lurching in unison with the linear and centrifugal accelerations of the bus, my common-sense prescription overrode the professional one:  hold tight with both hands.  We arrived back on campus just at lunch time, and soon faced challenge #2: chopsticking with my left hand. Admittedly, chopstick action does irritate that thumb tendon. But faced with the choice of sinister starvation vs. dexterous pain, I succumbed again to practicalities — though for the subsequent month I walked around campus with a soupspoon stuck in my shirt pocket, which utensil handles Chinese cuisine reasonably well, even with the left hand.

So much for process.  What about outcomes?  Well, eventually my American physician sent me to an orthopedist, whose course of two injections of cortisone gave relief for a few months. The Chinese physician’s anti-inflamatory-plus-external-cortisone gave partial relief as long as supplies lasted.  But, now depleted, the problem is back.  Perhaps it’s time to time to seek out a back-alley acupunturist.  In any case, I just jotted down the Chinese for Ibuprofin in preparation for my next encounter with an apothecary.

As for my indignation regarding medical confidentially, I just swallowed it as I mouse-clicked to publish my medical record on the world-wide-web.

What’s for Dinner II

Saturday, January 12th, 2008

[No prurient photos along with this posting]

In College, my favorite professor was an anthropologist, Earl Count by name, lately deceased, who also held a divinity degree. One of his hobby-researches was into the practice of placentophagia. The dots Count connected were these: 1. the abrupt transition from the pregnant state to the post-partum state requires a huge hormonal reprogramming; 2. in humans, this reprogramming frequently goes badly awry, with the consequence of post-partum depression or insufficient lactation; 3. non-human mammals, including primates, and whether herbivorous or carnivorous, eat their placentas, and don’t, so far as we can tell, suffer post-partum depression; 4. placentas are chock-full of steroid and peptide hormones, growth factors, immunological factors — the biochemical companies know this, and use placentas as a raw material from which to purify several of these substances for sale; 5. most human societies, particularly those you might think of as “primitive”, have strong views, either pro or con, that is either ritual or taboo, on placental disposition. I remember Count’s exposition of the theory particularly well, since it was delivered from the pulpit of the Hamilton College Chapel, with Count in his full ecclesiastic raiment. Not to prejudice the argument further, but I also recall our nickname for Prof. Count was “Noah” , Noah Count.

Not a typical dinner-time conversation topic in China, but, like a cue-ball sunk on an unanticipated cushion-bounce, there it was one day, hardly to be ignored. The upshot of the conversation was that the Chinese, or least a traditional seam among them, advocate placentophagia. Its advantages have been reputed by Chinese traditional medicine from time immemorial, and include promotion of lactation and prevention of depression.

A thorough literature search would require fluency in Chinese, in classical Chinese no less. But an aperitif may be had by googling for “placenta in traditional Chinese medicine”. Among the hits you will find descriptions of the biological bases (echoing Earl Count’s talking points), recipes and citations to National Institutes of Health research publications on the subject.

In reading some of this material, I detect few scruples as to whether it is your own or someone else’s placenta you are eating. Indeed, apparently men have been known to indulge, perhaps unwittingly, though the reputed benefits are hard to extrapolate to males. Who knows? A good dose of estrogen may be salutary in some males; Dick Cheney springs to mind.

Some of the recipes involve cooking or stir-frying. Maybe tastier that way, though most suggest chemically gentler forms of preparation, like drying or freeze-drying — a sort of jerky — with subsequent powdering and encapsulation for the more squeamish. Additional seasonings — ginger seems a favorite — are suggested, with a more or less explicit nod that some of the flavor components could do with a bit of camouflage. As a biochemist, I would concur with the gentler means, and note that even then, the many esoteric, peptidic components are not likely to survive the digestive process. But please don’t construe my view as a suggestion for parenteral administration.

Chinese regard for the placenta is such that it has prompted a recent law giving ownership of a placenta to its “mother”, and forbidding donation or sale to other parties without the owner’s consent. (Chinese laws should be seen as acknowledgement of existence of a phenomenon, not necessarily as a political will to abate it, unless the “phenomenon” is defamation of the government, in which case the opposite is true: it is not acknowledged, but strongly abated.)

As a member of a fairly primitive society myself, I cannot help not being neutral on the issue. So many ramifications! I can guess the “Choice” crowd’s answer, but am curious about the “Right-to-Lifers'” line on placentophagia. Or the Church’s. Or Oprah’s. Or George Bush’s. My dictionary fails to qualify its definition of cannibalism to exempt ingestion of placental tissue, cooked, dried, diced or otherwise. Yet I assume there are legal strictures against cannibalism in our fifty states — I can’t cite sections of code — and wonder if criminal code makes exception. Whether criminalized or not, placentophagia seems spiritually aligned with natural foods advocates: Would vegetarians partake? Vegans?

And the Health Care Industry, which I will have to regard as the major “producer” of placentas, what’s its role? Do they recognize the mother’s ownership? Offer it to her? Sell it without her consent? Cook them? Burn them? Trash them?

Ah, Count. Count on a good meal to stimulate a good discussion on eating habits.

Shock and Awe in Hangzhou

Monday, November 5th, 2007

a steam in Xixi wetlandbiodiverse habitatawe-full weapon

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“Xixi Wetlands” is a laudable attempt to preserve some of the original marsh environment in northwest Hangzhou. That has been the direction-of-choice for Hangzhou urban expansion — you’ll recall my earlier note that the new Zhejiang University campus is built on a swamp. The Xixi effort seeks to preserve the area’s biodiversity and to make the terrain physically more accessible with an extensive network of boardwalks and observation platforms.

Also preserved is the biomonotony of mosquitos. The infamy of Hangzhou’s mosquito population is not recorded in the travel guides — not even in the Rough Guide — though mosquitos are one of the roughest features of life here. That I am still doing battle with them in November says something; I killed 12 in my bedroom just this morning. Don’t even broach the topic with Judy!

The white wall next to my desk at the Medical School also sports a mural, “Le Rouge et le Noir” would be an apt title, of smashed mosquito carcasses, corresponding to those engorged and those not.

If the guide books are silent, the rest of China’s 1.3 billion seem to know about the problem, perhaps as a sort of sadistic counter-point to Hangzhou’s self-proclamation as the “most beautiful city in China.” And the local entrepreneurs recognize the problem by way of offering for sale an impressive anti-mosquito weapon. I know no name for this weapon, neither in Chinese nor English, so have only to describe it: it looks rather like a badminton racket, with rechargeable D-size batteries in the handle, and a wire mesh in place of the netting, apparently capable of generating a good wallop.

If you snare one of the little suckers in mid-flight with this device, particularly in the dark and quiet of the night, you are rewarded with a flash and a pop, as their tiny bodies are electrocuted by the hopped-up juice in the grid. I want to believe that the brighter flashes and louder pops are delivered by those filled with my blood.

Even so, the score is not good. I reckon that for every one that I have nailed, five have nailed me. And the spectacle of a 100-kilogram human flailing after a 100-microgram insect might invite speculation on whether the juice is worth the squeeze. I am reminded of an article I read in Scientific American years ago, written by a military historian and claiming that the musket, still four hundred years after its invention, was inferior to the long-bow in virtually every respect: range, accuracy, portability, rapidity of reload, cost of ammunition. Every respect but one — the flash-and-pop! This so enthused the user and terrified the enemy as to compensate for its deficiencies. DEET of course is highly effective, but so cowardly, not depriving the ogresses of their lives, but merely confounding the directions to the dinner table. Lethal injection is altogether too wimpy.

So I shall continue to flail until a God-given change in the weather finally allows the one in His image to triumph over the one with the proboscis (or I fall off a chair trying, whichever comes first.)

Racial Profiling

Wednesday, October 31st, 2007

Affluent shopperssomething to hideTokyo Rosethese must be Ainuinnocents?fraternizationwould you trust him?old warrior

[mouse click a photo to enlarge it]

My efforts at racial profiling began when a Chinese friend, who like many Chinese still harbor a great grudge against the Japanese, not only on account of Japanese brutality during their aggression into China beginning in 1937, but because of the continuing Japanese denial and historical revisionism…. Anyway, this friend said he could spot a Japanese “from across the room”, and I suppose he meant a room otherwise filled with Chinese. So I thought I must be awfully ethnically insensitive, and should work on it.

By now I had a pretty good baseline on the variations in the Chinese countenance, and even some applied practice in Vietnam. But, anticipating our trip to Japan, it was clear that this would be the real McCoy, and the perfect opportunity to train in physiogonometrics. Of course, as I started observing Japanese in trains and restaurants and on park benches, I realized that clothing and iPods and even mannerisms also provided cues. Any social scientist would have warned me of these confounding variables. In an attempt to neutralize them, I tried to “undress” my subjects, so to say, in the interests of scientific rigor, you understand. Even so, this business of racial discrimination is exacting, and it would have been nice to have had a set of calipers, like Himmler’s people had at their disposal.

After ten days, I had the defining characteristics of the Japanese down pat. Though I did have to consider several angles, which would be hard to implement across a room. Still, I felt pride of achievement. The amazing thing is that, after returning to Hangzhou, with my enhanced sensitivities, I began to realize how many Japanese there were living here in China. The few that I have approached, and addressed with my small vocabulary of Japanese greetings, pretended not to understand me. Of course, if I were a Japanese living in China, I too would dissemble, given all the Chinese observing me from across the room. Dissemblance, denial — they’re a devious race these Japs, the whole lot of them. What with their little gadgets and funny-sounding “r’s”, they’ve got a choke-collar on the whole Asian economy far out of proportion to their diminutive size, and that after we whipped their asses in ’45.

Of Mice and Matriarchs

Thursday, September 13th, 2007

bridal possession

[mouse click on a photo to enlarge it]

On my hotel room wall in Hanoi hung a print of mediocre artistic quality, but provocative content. Stretched out on the long horizontal axis was a bridal procession — I suppose in the Vietnamese tradition, but familiar to me as Chinese tradition. Ranks of musicians and well-wishers and sedan-chair porters, bearing the bride. The figures were all bipedal mice, in human attire. On the far right of the painting sits the expectant groom, with an appropriate gleam in his eye. Unmistakably a cat. Such an apt caricature of the dynamics of traditional Chinese marriage: the bride is virtually delivered up to into servitude, sexual and otherwise, to the groom and his family. What good are girls? You feed them until about the time they might begin to prove useful, and then they get married off. A boy or two, of course, balances things out, and puts you on the receiving end. With a little luck in the horse trading, you’ll end up with a filly of even stronger back and broader beam than you were able to spawn. But this one-child nonsense upsets the equilibrium.

The picture associates in my mind with a unit in my Chinese Reader on the strong Chinese sense of family, the prime example of which was the seriousness given to the matter of a girl’s latching onto a socially acceptable (= financially promising) guy, and, please, by all means (several specified), before 30.

Now think back to LIjiang, in Yunnan, the heart of the former realm of the Naxi people. In the good old days before Han-Chinese domination, the Naxi, so all the guides and guidebooks make a point of instructing us, was a matriarchal society. The girls, confident heiresses that they were, and freed from having to focus their major effort on glomming onto a financially stable guy, spend their spring evenings gamboling on Yak Meadow, granting and terminating audiences with would-be suitors like the Queen of Hearts flicking off heads.

Just imagine a latter day Naxi orphanage filled with cute, but useless, little boy babies awaiting adoption by an enlightened Occidental couple.