Anal Incontinence, PBL, and Diabetes Diet Seminar

There's nothing quite like having "anal incontinence" in your post title to grab someone's attention. Alas, I have nothing all that interesting to tell you about anal incontinence except that it was the subject of our anatomy lab case today. This is actually kind of gross, but the case was about a woman who has an episiotomy during childbirth. An episiotomy is a cut that the obstetrician makes in the woman's perineum if the baby's head is too big to fit through the vagina. The idea is that it will prevent the perineum from tearing with a ragged edge and being difficult to repair. As it turns out, performing episiotomies actually makes perineum tears MORE likely to happen, not less, so they aren't performed very often any more. The surgeon told us that sometimes the perineum tears all the way back to the anus like unzipping a zipper. Yuck. And then, you guessed it. The patient can have complications like anal incontinence if her anal sphincter is damaged.

Even after that rather unappealing beginning, anatomy lab was pretty interesting today. One of the stations was a female cadaver set up like she was having a Pap smear done again. The resident made all of us feel her cervix and try to feel her ovaries. Yes, you have to stick your fingers in the cadaver's vagina in order to feel her cervix. And if you were wondering, the cervix felt kind of hard and almost like rubber. I couldn't feel the ovaries at all, which isn't surprising since the cadaver was post-menopausal. The ovaries atrophy after the woman hits menopause.

Our new PBL case is really interesting too. The patient comes into his doctor's office complaining that his testicles have gotten smaller and softer. There are several other interesting symptoms too, but that's the most interesting one. My learning objective for Wednesday is to review the male gonadal histology and embryology, along with what happens when male genital development goes wrong.

After class, I went to a Wellness Grand Rounds seminar. This was the first time I had ever gone to one of these. The speaker was a physician from George Washington University who studies how to use diet to treat type II diabetes. It is a pretty extreme diet: you basically have to become a vegan, meaning that you eat no meat, no dairy, no eggs, no animal products whatsoever. In addition, you are also eating a lot of complex carbs. This diet is so low-fat and high-fiber that the patients can't help but lose a significant amount of weight, even without exercise. The results are unsurprisingly excellent. Some of the patients could reverse their diabetes altogether and stop taking their medications. Others were able to reduce the doses. I bought one of his books and got a few of his peer-reviewed studies. Really, the only downside of his research is that 99.999999999% of all human beings on this planet are not willing to spend the rest of their lives eating an extremely low-fat (less than 10% fat), high-fiber vegan diet. Bummer, huh?