Sunday, October 9, 2011

Coxsackie, Foot Binding, and Other Pathologies

The wet season is here.  I saw the sun peeking out of the clouds yesterday and C and I basked in its rays for a few minutes.  I hadn't seen it for about two weeks and I didn't realize how much I missed it until I saw it again.  C had a nasty coxsackivirus infection this week.  I'd never heard of such a thing, but during General Conference weekend she had a rather high fever and we didn't think much of it.  Then, over the next few days she developed swollen and inflamed gums that bled easily on top of a series of canker sores on her tongue.  She wouldn't eat hardly anything and brushing her teeth was impossible so she lived on milk and juice.  The only option was to let it run it's course and she is doing better now, but she was not her happy self while it was going on.

On a happier note, US Preventive Services Task Force released recommendations that abolish prostate screening exams (including digital) on healthy males.  This is an independent medical branch that receives government funding to discover which procedures prevent deaths and they have added prostate screenings to the same list as breast screenings with the statement, "In men younger than age 75 years, the USPSTF found inadequate evidence to determine whether treatment for prostate cancer detected by screening improves health outcomes compared with treatment after clinical detection."  That is a wonderful statement for a person like me who never wants to undergo something like that.

We finished Gross Anatomy and have moved on to Head and Neck.  I wound up passing GA which is a relief (a wonderful testament that I do belong here and that I can overcome impostor syndrome), and I hope to do well enough in HN to pass with honors.  I am sure it will be this way with every class, but it doesn't seem like a doctor can ever learn enough anatomy.

The professor for the lower limb anatomy was probably the most engaging and interesting lecturer we've had yet.  At the end of his lecture about the foot, he showed the x-ray below taken from a Chinese female who had had her feet bound.  It was a common practice for hundreds of years to repeatedly break the toes of 2-5 year old girls and then bind them tightly with cloth in a figure eight to force them to grow into the desirable, beautiful shape you see below.

You don't have to be an anatomist to realize that this would cause some serious pathology in a person.  Likely, the girls couldn't walk very far or stand for very long so it was probably a significant status symbol to marry a woman with feet like these.  The reason why he brought this up was to talk about self mutilation that goes on all the time in which people alter the structure of their bodies for the sake of status.

Again, you don't have to be a doctor to explain why this person's feet hurt.  They have essentially taken the arches of a bridge, suspended the bridge from the on ramp, and created a pillar.  This hyperextends the toes, hyperextends the knees (making the legs appear longer), forces the hips to increase rotation to accommodate the diminished toe off and heel strike, increases the curvature of the lumbar vertebrae (forcing the tupus and chest to become more prominent), and Shelli tells me it increases the sensation of pain from the belly button down. He also showed a picture from a cadaver  who must have worn high heels for decades.  Her big toe was sideways so nail was facing the other foot, the second toe was curled under toes three and four, her third toe was normal, her fourth toe was almost fused with her third toe, and her fifth toe was lying on top of toes three and four.  I can only show you pictures that are either public domain or mine so I can't post that one. I  I learned in my ethics class that I can't become an effective doctor unless I refrain from judging people for their self-destructive behavior so I can recommend a shoe change, administer pain relief or counseling, but I shouldn't laugh or roll my eyes.

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