Category Archives: Human Interest

Dim Mak: the Touch of Death. Is it real?

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As a skeptical physician, I am slow to accept that this entertainment trope could be real.  But the Death Touch has found its way as a trope into so many popular movies (Executioners from Shaolin, 1977; Clan of the White Lotus, 1980; Bloodsport, 1988; and, as the ‘five point palm exploding heart technique” in Kill Bill Volume 1 and 2, 2003 and 2004) that it is almost as well accepted as the familiar trope of the knockout punch to the head (short of a severe injury, rather than being asleep for 30 minutes, most people would be briefly stunned and woozy, then really mad after being punched in the head).  

In the Touch of Death, practitioners achieve their goal either with one touch at a specific point or with a series of precise strikes.  There can be instant death or, for better cinema, the victim survives for a short period to time, aware of his or her fate.

There is a subtype of the Touch of Death that is non-lethal, The Paralyzer.  Any Star Trek fan is familiar with this, as Mr. Spock used this special technique (The Vulcan Nerve Pinch) to give his victims long, non-damaging naps.

Beyond entertainment, there are a number of historical and current practitioners of martial arts who have claimed knowledge of this closely guarded secret.

These practitioners take themselves very seriously and some have built a career surrounding teaching this mystical technique.

There are even Dim Mak masters who appear to be able to knock people down, non-lethally, without physically touching.

There are also websites that state that many of the special locations around the body that are used for healing purposes by practitioners of acupuncture and acupressure (“Stomach 7”, for instance) can also be exploited for the dark art of Dim Mak.

Here is a website selling charts of Dim Mak pressure points, complete with testimonials!

So, numerous popular movies and thousands of years of Chinese culture must be based on SOMETHING, right?

Well, this time, at least, the answer is a carefully qualified “yes.” The real Touch of Death is accidental and very tragic and is a condition called commotio cordis (Latin for “agitation of the heart”). Here is the definition of commotio cordis from a thorough review of the condition from the New England Journal of Medicine:

“Ventricular fibrillation and sudden death triggered by a blunt, nonpenetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (and in the absence of underlying cardiovascular disease).”

Commotio cordis has been described in the medical literature since the 18th century, but has been largely unrecognized as recently as the mid 1990s.  Since then, awareness of this condition has grown. Commotio cordis primarily affects children, adolescents, and young adults and most often occurs during participation in sports.  For example, about 50% of cases have been reported during such competitive sports as baseball, softball, ice hockey, football, and lacrosse, typically (but not always) after a blow to the chest delivered by the projectile used to play the game.  About 25% of cases occur during recreational sports, like playing catch or being struck by a snowball.  The remaining roughly 25% of cases have been reported during non-athletic activities.  Examples of these include blows to the chest from falling into a body of water, from an attempt to terminate hiccoughs, and from being struck by the head of a large pet dog.

Tragically, commotio cordis is usually fatal.  In the first decade of this century, the survival rate was only 35%.  However, it appears that survival rates have been increasing, as public awareness of this condition has risen, there has been more accessibility to automatic external defibrillators, and bystanders have been faster to initiate the “chain of survival” (call 911 or a similar rescue phone number, then start cardiopulmonary resuscitation, defibrillation, and other life support measures).

While this is not the theme of this article, there is an essential take-home point:

If you see someone collapse after a blow to the chest of any kind, DO NOT HESITATE TO RESPOND!

Commotio cordis, fortunately, can only occur under very narrow circumstances.  The blow must be directly over the heart and it must occur during an electrically vulnerable period of 10 to 20 milliseconds when inhomogeneous dispersion of repolarization is greatest.

This brings me to the second, essential, take-home point:

Commotio cordis is NOT a game or something that anyone should EVER try to induce!  

With regard to prevention of commotio cordis, a great deal of effort has been devoted to finding balls and pucks (projectiles) that are less dangerous but that will not change the nature of the games for which they are used.  Effort has also gone into designing appropriate chest protectors.  However, as of the time of the review that I have been using for this article (from 2010), suitable projectiles and chest protectors were not yet available.

So, how did commotio cordis become Dim Mak?

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This question is open to speculation, but I think a pretty fair guess is that, during a sparring match, one ancient martial artist struck the other on the chest in the precise location and at the the precise moment to trigger commotio cordis.  Having no knowledge of cardiology, and with no visible damage to the chest, this tragic death was deemed to have been caused by a mystical ability: “The Touch of Death.”

To accentuate the dramatic aspect of this condition, and make it even more suitable to be used as a trope, 20% of victims remain physically active for a few seconds after the blow that caused commotio cordis, with the transient ability to continue to walk, run, throw a ball, or speak, for example.

To be clear, the Touch of Death, Dim Mak, is accidental and tragic, involves no chi or other mystical energy, cannot be taught to be consistently performed (nor should any attempts be made in this regard), and cannot be performed without physical contact.  Any other representation of Dim Mak is bullshido.

Please be safe.

References:

Maron BJ and Estes III NAM, Commotio cordis. N Engl J Med 2010 Aug 18. 362(10):917-927.

http://filmschoolrejects.com/features/real-five-point-palm-exploding-heart-technique-kill-bill.php

http://tvtropes.org/pmwiki/pmwiki.php/Main/TouchOfDeath

http://listverse.com/2014/02/08/10-people-who-claimed-to-hold-the-secret-of-the-death-touch/

Photo Credit: <a href=”https://www.flickr.com/photos/97667017@N05/15710055372/”>dant melys via Compfight cc

Classic Rock And Babies

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Pop music.  Ouch.  My son goes to sleep every night to Taylor Swift. My four girls sing and dance to music from the latest Disney stars or female pseudo-rappers.

I have tried to expose my kids to classic rock. They know how a vinyl LP looks, feels, and sounds. They know the names of a lot of the most important bands. But, alas, I think they are lost to the music of their own generation. One of my daughters calls the Rolling Stones “old-timey.”

As a parent, I would like to pass along some of myself to my children: genetics to my child who is not adopted, religion, ethics, appreciation of fitness, dietary choices, and so on.  For me, the enjoyment of classic rock has been a big part of my life.  I am not a musician or an audiophile, but I often have a song or two playing all night long in my dreams.  When life-events happen, a topical song often starts playing in my head.  For example when my college roommate died 26 years ago, Stevie Wonder’s “Love’s In Need Of Love Today” (from the mega-genius 1976 album Songs in the Key of Life) started involuntarily and played in my head for weeks. This is beyond appreciation of music. Instead, this background music represents, to me, the ability of good music to allow us to capture and explore important emotions.

I would love to pass along some of my love of music to my kids, but manufactured, generic music just does not have the depth or importance to support my kids’ needs as they go through life.

But my wife is pregnant.  I have one more chance!

In the numerous pregnancy websites she has been visiting, she has read that fetuses can start to hear at the start of the second trimester.  Is this true?  Well, geek that I am, I did a search on PubMed and found that fetuses can, indeed, hear.  Perhaps not at 14 weeks gestation, but certainly in the third trimester.

In fact, studies have shown that fetuses’ have some memory of sound.  One example of this is from a study published in 2014 which showed that blood flow in the brain (the middle cerebral artery) statistically increased after a sound stimulation.  However, when the sound stimulation was repeated, the blood flow did not change.  This suggests some level of memory is taking place with that sound.

In another study, from 2013, babies who had been exposed to a specific song while in the womb demonstrated memory of this song.  The researchers followed the infants’ brains’ event-related potentials (ERPs).  In the control group, music was not played.  In the music group, the song “Twinkle Twinkle Little Star” was played five times a week.  After birth and at age 4 months, the infants in both groups were played a modified version of this melody in which some of the notes were changed.  ERPs to both unchanged and changed notes were recorded.  It was found that the infants in the music group had stronger ERPs to the unchanged notes than the control group. Even more interesting, the ERP amplitudes to the unchanged and changed notes at birth were correlated with the amount of prenatal exposure to the music. This indicates that fetuses are capable of musical memory and, with increasing exposure to the same music, the strength of the memory increases.

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Does this mean that it is possible to influence musical taste?  Who knows?  But I have to try. Bring on the classic rock! Vinyl only, please.

My wife, being a good sport, has allowed me to play our little fetus an album side a day for the past few days.  Of course, we started with Led Zeppelin II (there really cannot be another choice – “Whole Lotta Love”).

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(I have two copies in case of emergencies!).

Next was Cream, Disraeli Gears.

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Last night, Genesis, The Lamb Lies Down On Broadway.

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I think Janis Joplin is tonight.

Lucky baby!

References:

 Jankovic-Raznatovic S, Dragojevic-Dikic S, Rakic S, et al. Fetus sound stimulation: Cilia memristor effect of signal transduction. Biomed Res Int. 2014. 2014 Feb; 273932

Partanen E, Kujala T, Terveniemi M, et al. Prenatal music exposure induces long-term neural effects. PLoS One. 2013 Oct; 8(10):e78946,

Why Is It So Hard To Respect Handicap Parking?

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This article is a departure from the usual subject material of this blog.  It is a rant.  If you feel like reading a rant today, read on.

I routinely see able-bodied people disregard handicap parking.  This makes me furious for so many reasons. First of all, it demonstrates that the able-bodied individual thinks that his or her need for a convenient parking space is more important than the needs of an individual who, because of injury, age, circumstances of birth, genetics, or other causes, is simply unable to walk extra distance.  It is not that the disabled person is being inconvenienced by having to park farther away from his or her destination.  Instead, the disabled person is being PREVENTED from reaching his or her intended destination.

This lack of regard for fellow human beings is appalling. When an able-bodied person arrogantly parks in a handicap parking space, he or she also attacks the dignity of disabled people, because this act communicates the message that the disabled person is of less value than an able-bodied person.

When an able-bodied person parks in a handicap space, he or she is also breaking the law. Now, I can be upset about arrogance and callousness, but the passivity of law enforcement on this issue is especially infuriating to me.

Rather than siting in a highway underpass for hours on end to write fines for speeding, police officers should devote part of their time to patrolling handicap parking spaces.  The posted fine for parking illegally in a handicap-labeled space is $250, in my municipality.  That is a good chunk of money for the community coffers.

Another option, suggested by my brilliant wife, is re-purposing red light cameras.  In the my region, the City of Chicago and some surrounding municipalities have attached cameras to red lights. If a vehicle enters an intersection after the light has turned red, there is an automatic $100 fine.  This has, understandably, led to some controversy.  But what if those cameras were used to observe handicap parking spaces?  $250 fines galore and no controversy!

So why do able-bodied people park in handicap spaces?  Self-importance? Arrogance? Callousness? Stupidity? Or, perhaps, because they simply think there will be no consequences.

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There should be consequences.  People like me should not have to confront or report able-bodied people who park in handicap spaces, just as we should not have to confront people who commit any other crime.  That is the paid job of law enforcement.

So there is is.  This rant is really a plea to my local police to protect the needs and dignity of some of our most vulnerable citizens.  Uphold the law!

Photo Credit: N00/454663030/”>zappowbang via Compfight cc

A Heart Scare In An Amateur Endurance Athlete.

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Last weekend, I completed the Borgess Kalamazoo Half-Marathon.  I had an elaborate training and racing plan and really was expecting to have a strong performance.  However, I felt terrible throughout the race.  I did finish and, amazingly, placed okay in my age group, but it was far from expectations.  Furthermore, I felt much more sore during and after the race than I normally do in half-marathons.  What happened?

I uploaded my race results to my coach, Jennifer Harrison, after getting home from Kalamazoo, but I was just too tired to sit down and analyze them myself.  Soon thereafter, I got an e-mail from Jen that essentially said “Brian, something is weird with your heart rate data, what happened?”

Uh oh.  I’m 47 and have five kids, not to mention my medical practice.  Like anyone in my situation, I fear a cardiac event.

I looked over the data carefully.  My heart rate ran unusually high during the warmup to the race.  Then, during the race, at about the 50 minute point, it suddenly jumped from the 130s to the 180s and stayed there until a minute before the end of the race. I enter zone 5 at a heart rate of about 151 and have never been in 180 territory.

The scary thing, also, is that I was unaware of this abnormality (tachyarrhythmia).  I had planned to follow my pace and perceived effort and never checked my heart rate (even though I recorded it).  All I knew is that I felt surprisingly weak and lightheaded for the pace I was running.  It seemed much harder than seemed justified.

What happens in tachyarrhythmias like this is that the heart’s ventricles do not have time to fully fill with blood.  So, even though the heart is beating faster, it is not delivering as much blood (with its oxygen, glucose, etc) throughout the body as is necessary.

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As much as the prospect of a cardiac event terrified me, the idea of not being able to exercise at a high level and not being able to compete terrified me more.

I immediately scheduled an appointment with a special kind of cardiologist called an electrophysiologist.  He was amazingly calm and reassured me that I am unlikely to have a cardiac event while training or racing.  Essentially, I had a short circuit of the wiring of my heart.  My EKG was normal (and featured a how-low-can-you-go resting heart rate of 33).  The cardiologist ordered more tests which I will complete over the next few weeks, but it looks like I will be okay.

However, he said something to me that struck home.  Essentially, he said:

“It’s great that you are so fit, and I support you getting regular exercise.  But there is a point at which you are no longer doing exercise to be healthy for your family: you are doing it for yourself.”

I used to be 50 pounds heavier, with a resting heart rate twice its current rate.  This is one of the big reasons I got into endurance sports.  But I also have learned to love the experience of pushing my limits.

So, this leads to the important question: is competitive athletics selfish?

Well, yes, it is, in many regards.  Nobody but me really cares about my race results, my running intervals, my fastest freestyle 100 meter, and my watts per kilogram.  Nobody but me cares about me getting faster than last year.  Nobody but me cares about qualifying for elite events.

But, in the most important regards, competing and pushing limits, is not selfish.  I want my kids to see my example and learn that age and talent are not barriers.  Instead, the barriers to success, in any endeavor, are willpower and desire.  I want my kids to learn to enjoy exercise and to engage in competition to learn more about themselves.

My athletic accomplishments are modest compared to many others’, but they also have benefited me as a source of personal strength.  I cannot remember the number of times I have been faced with stressful or physically difficult situations, like seeing a full schedule of patients while struggling with the flu, and have told myself over and over “I am an Ironman, I can do anything.”

My Autistic Son And The Kindle-Swallowing Elevator

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Today, my article is unrelated to science or endurance sports.  Instead, the subject is family. Specifically, my son, who is “high functioning” autistic.  Zachary is cute, sweet, loving, and funny 98% of the time.  The other 2% of the time he is a stubborn, frustrating boy.  This 2% is sometimes predictable.  An example of this 2% is his day a couple weeks ago when his usual teacher was not at school.  That day culminated in him lying in the middle of the hallway at school screaming for 15 minutes.  Sometimes, however, Zachary has completely unpredictable moments.  Such a moment was last weekend.

Zachary goes to gymnastics every week.  This is in part for the physical therapy-like benefits of gymnastics, in part for the socialization benefits, and, in large part, just for fun for him.  He had just had a nice morning in gymnastics.  One of his sisters’ gymnastics class goes for 45 minutes longer than Zachary’s, so he typically sits on a couch upstairs in the building playing with his Kindle for Kids (officially a Kindle Fire HD Kids Edition).  When it was time to get his sister, Zachary insisted on riding the elevator down from the second to the first floor. Anyone with a child on the autism spectrum will identify with the intense need in their children for repeated, almost ritualized, activities.  The elevator, after gymnastics, is such an activity for Zachary.

On this day, Zachary made up his mind he did not want to leave the elevator.  Finally, after a great deal of arguing, he finally did get out of the elevator.  Somehow, in the process, the Kindle fell out of Zachary’s hand.  Wouldn’t you know it?  The Kindle did not just fall out of Zachary’s hand but through the narrow space between the elevator car and the floor of the building.  That’s right, Zachary’s Kindle ended up at the bottom of the elevator shaft!

My son has a history of sudden, unexplained moments of pique.  Example of this include throwing his great-aunt’s remote control off a balcony (it broke and I had to find the one online supplier in the country, in Texas, from which to buy a replacement), knocking bowls off counters into garbage cans, and pushing his sisters (who are amazingly kind and patient kids).  But this episode was different.  He adores his Kindle and I can’t imagine him intentionally damaging it for any reason.  Furthermore, what kind of aim would be required for Zachary to purposefully throw his device between the elevator car and the floor of the building?  The space is only slightly wider than the Kindle, itself.

As his parent, I was filled with a range of emotions.  Anger that he should throw a fit over something so silly, which, in turn, led to the loss of his Kindle (no matter how unlikely it would be that it would disappear down the elevator shaft).  Amazement and disbelief that the Kindle really went down that space.  Shame that my son could throw such a public fit, which, in turn, would require involving a number of people to try to save or replace the Kindle.  Frustration that, in spite of years of therapy and in spite of being the best parent I can, he still has these unexplainable and uncontrollable fits.  Sadness that Zachary will not have access to this device, which has been a nice source of education and entertainment for him.

A couple days later I communicated with the manager of the gymnastics center.  I was told that the Kindle for Kids would be very difficult to retrieve.  In fact, I was told that the elevator company would charge me much more than the value of the Kindle just to come out and look at the problem, let alone the cost of attempting to rescuing the device.

So, I called customer service at Amazon, the company that makes and sells Kindles.

“Um, I have a story for you that you may not believe.  You see, my son loves his Kindle.  He is autistic and it has been great for him.  But…somehow he dropped it down an elevator shaft a couple days ago and I just learned from the facility manager that it would be very difficult to retrieve.  Help.”

The customer service person was amazingly nice and surprisingly patient with my bizarre story. She then had me speak to her supervisor, to whom I relayed the same story.  Finally, Amazon, very kindly, helped me to replace Zachary’s Kindle.  This was just wonderful customer service.

I waited until today to surprise Zachary with his replacement Kindle.  I have been able to spend the entire day with him and I wanted to connect the return of this device to good behavior. Finally, I wanted him to understand that people, including me, Amazon customer service, and the staff at the gymnastics facility, all worked on his behalf to help him.  Zachary just wrote a thank you letter to Amazon.

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“Dear Amazon,

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I love my Kindle!  Thank you.  You helped me.

Yours truly,

Zachary”

I hope this experience has taught my son some important lessons about behavior, consequences, and thankfulness for the things he has and the people who help him.

Uh oh!  I just heard Zachary behind me saying “look Daddy, I’m an elevator shaft!”  Here he is pretending to be the Kindle-swallowing elevator shaft.  I guess my work is not done…

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Published Valentine’s Day, 2015

An Allergist/Immunologist’s Guide to Living Well

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How often do you hear someone say “I am going to eat … food or take … vitamin to improve my immunity” or “my immune system is weak” ?  A lot of people think in these terms all the time and make real decisions about their lives, involving time, convenience, and money.  Part of this blog is going to be an in depth discussion of this topic including the roles of diet, exercise, rest, stress, supplements, and, yes, vaccinations in modifying immunity.  I also plan to discuss other topics related to my field of specialty, allergy/immunology, and my years of experience as an endurance athlete and father of five.  These topics will include weight loss, understanding the energy delivered by food, concepts of basic immunology, the scientific method, picking a good doctor, picking a good exercise activity, the wonderful world of endurance sports, and the experience of adopting and raising twins from a foreign country.  Please join me and follow me on Twitter and Facebook.  I welcome comments and suggestions.