Posted on September 15, 2017February 17, 2023 by Ashley Davidoff

Pancreas – Hermit of the Abdomen

Ashley Davidoff MD

O’ Dear pancreas

You have been called the hermit of the abdomen
By whom I do not know
But in your dark and hidden way, you have
spoken without a word
from the gurgling depths of the abdomen
Yes – you have earned this lonely title
and a coin should be tossed
to the person who coined the phrase

But it took a long time to understand who this hermit was – and what he was doing in the darkness of the abdomen

From the day of antiquity
You have been looked upon by many
Herophilus, the father of anatomy had the first incisive insights into you
As he was one of very few who had the guts to explore the guts in open fashion

Aristotle at the same time seemed to have known something about you
But then you lay unharmed and unexplored for almost 500 years
Until Rufus mistook you for a piece of meat –
You must have laughed at the “pan kreas” thing
How wrong he was – you evasive little trickster

And then the Talmud – always seeming to be right
Thought you were the finger of the liver –
Little did they know how independant you were

While Vesalius was up to your “hide and seek” game
The magical eyes of da Vinci missed you completely
Even though he saw the serpiginous splenic artery snake right above you

Your ducts seemed to have intrigued the next generation, Wharton, Wirsung, and de Graaf
As you sustained the pain of the quill penetrating your inner gut
(I forget you were already dead but it must of hurt just watching!)

A little later it was that man called Vater and the little Italian Santorini found your minor duct and your nipple
And so by this time we had a good understanding of you in your nakedness
But of course, as said – you were dead

And so young Bernard explored your factories, and got a sense of your canine workings,
But you were able to hold on to your sweet secret for just a little longer
Until the Langerhans found the family jewels in the famous 2% of your population-
The islets – those beautiful eyelits – governess of all things sweet in the body

Eberle Bernard Danilevsky, and Kuhne joined up across the world to expose your antacid and enigmatic enzymatic brew
And once again your wonderful workings for a better world were exposed –
And we knew then, that you were the quiet and effective type –
A hermit who did good
But did not want the limelight

To see you as you lived and breathed in the flesh
was the mission of Wilhelm the X-Ray man
who crusaded the path to visualise 40,000 Angstroms under the skin

abdomen, pancreas, liver, gallbladder, kidneys, CT scan, Art in Anatomy, Ashley Davidoff MD

And then there was a slew of heroes who learned to slew your sickened parts – including the famous Whipple who was able to Whipple you in an inimitable way

And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
Exposed the insular chemistry of you insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was borne

And so we try to understand your form as our scans explore you as you live and breathe
And we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue
And we are happy – so happy for you that you are well nourished by a double blood supply
And we wonder why you have no skin – we thought all the organs had a skin
Except for your tail – almost a foreskin

And you are off axis on two planes – what is that all about? – kinda crooked

And your twin origins and the intimacy with the duodenum, of the ventral twin
And the strange fusion of the Wirsung guy excluding the little Italian Santorini
It seems to me that your matrimonial fusion with Wirsung and the bile duct has led to more problems than the merger was worth
It does not seem in the long run, to have been a marriage made in heaven
What was that all about? Is there a grand plan to come?

And so we try to understand your diseases
And in some way we understand that the guy glugging down the bottle
Could be punished by your reaction
But why Oh why are you so nasty to those whose misfortune it is to have stones roll down and get no satisfaction.. down the green vile bile route
Have you not learned to live with the green secretion by now
And did you not know that by reacting the way you do, that you are cutting off your nose to spite you head?

While type 2 seems remote from you
We don’t know about this Type 1 business
Why are you made to suffer so much at the hands of your own body on your own body?
We feel sorry for you – to have your own buddies reject you – must be awful
And then to see so many young ones suffer because you don’t work
And we once again see and understand what power you control from that deep dark hermit home of yours

And the cancer thing … so silently it creeps on you causing your collagen to counter
And only making things worse as it strangles nerve, blood vessel, and your spouse duct – the green one, – without regard

And then I think of you in your prime and in your happiness
When you are with you two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever

Posted on September 29, 2016February 17, 2023 by Ashley Davidoff

The Common Vein: Clarity in Complexity

Introduction

The Common Vein (TCV) is a learning process that clarifies the complexities of biology and medicine.

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Complexity is the prodigy of the world.

Simplicity is the sensation of the universe.

Behind complexity, there is always simplicity to be revealed.

Inside simplicity, there is always complexity to be discovered —

Gang Yu

The Common Vein is a tree of knowledge that brings simplicity to the complexity of human biology and medicine. Its arborized organization enables a stepwise, progressive approach to self learning. Any student who can read, and who is motivated, will advance through this rich network of material. Most principles begin with a simple word or concept, within which resides encyclopedic complexity. The root elements of that word can be explained in a sentence, which then progresses in volume and complexity to a paragraph, then a chapter, then a book, and beyond.

Imagine a library with all of its books strewn over the floor. It would be nearly impossible to navigate the available information. Efficient organization of information is the key to understanding it. This concept holds true in any field of education.

Organizing Information

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From a Background of Complexity to an Organized Simplicity

The above art-piece shows a background of extensive, pixellated, and seemingly inaccessible information. As it organizes into the central, conical figure, it begins to make sense. The word at the bottom of the cone becomes defined into its key elements (the 5 different colors of the circle). A definition follows, which succinctly describes the essence of those principles. These elements advance to greater complexity at the next level: the paragraph. Each elemental principle is further expanded in a chapter. The ladder of organized information progresses, while remaining connected to its source. Roots and branches, origins and growth, are recurring themes in The Common Vein.

As we learn, we acquire new knowledge. At the same time, we modify and enhance preexisting knowledge. Education should therefore be viewed as a process, rather than a collection of facts (Learning Wikipedia). TCV’s cumulative approach reinforces previous knowledge as it advances existing knowledge. With the understanding that memory and its application are so key to the learning process, TCV encourages beginning with the roots (basics) and building to the branches (details) in a logical fashion.

The Tree of Knowledge

Below is a diagram of knowledge in its bare form. From the central trunk extends an arborising framework, from roots to branches, which represents advancement, or growth.

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Roots and Branches: Sources and Growth

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Roots and Branches: Sources and Growth – Advancing Complexity

The trunk reflects a single idea or concept (tree), which is part of a continuum belonging to something beyond it (branches) and something before it (roots). The tree’s roots and branches again exemplify the concept of building upon previous knowledge. The trunk’s extensions, in the form of roots and branches, are complex yet logical in their organization. A tree’s growth is multifaceted, yet progressive. The parts work together for the sake of the single element: the tree. In the tree, complexity and simplicity coexist.

Principles

A distinct focus on principles, especially as a starting point, provides a useful framework for learning. The Common Vein’s is founded upon principles that grow in complexity, which helps the student navigate the daunting mass of biological and medical information.

Principles of Human Biology

The image below diagrams human biology in its basic parts:

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This diagram of human biology is structurally identical to the diagram above. This diagram shows that the roots of human biology lie in both the structural and functional sciences. Combined, those two sciences enable the miracles of the working body and working mind. This simple diagram captures the entirety of human biology. Beyond these base elements lies magical complexity, which we can never fully grasp.

Principles of Medicine

This diagram, again identical in structure to the two above, explains that the roots of human disease originate in the disorder of the structural and functional sciences. The branches of diagnosis and treatment have evolved in response to the need for order and health of the body and mind.

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This tree illustrates The Common Vein’s central theme. Each biological part has both a structure and a function. When they are in order and work cohesively, there is health. With disorder, conversely, comes disease. The field of medicine attempts to bring order using two major disciplines: diagnosis and treatment.

Because roots and branches remain connected, a change in one element means a consequence in the others. The disciplines of diagnosis and treatment are founded upon the ability to identify and treat disordered structure and function. For example, an obstructed coronary artery causes a heart attack. The clot in the artery causes a structural problem, with a the functional consequence (damaged heart muscle). Coronary arteriography diagnoses the structural abnormality, and a cardiac echocardiogram diagnoses the functional consequence (decreased muscle contraction). The treatment aims to reverse the structural abnormality by dissolving the clot, as it also aims to reverse the functional abnormality.

The Common Vein

The Common Vein finds clarity in complexity. It navigates the learner through complex information in order to understand, remember, and apply the knowledge. Two major elements are used:

Basic principles, which are connected and advanced through
An arborised organization.

The “common” in the common vein refers to basic principles, while the “vein” represents the arborised connections creating a tree of knowledge.

Learning starts from the most basic element, and with careful progression, advances in detail. Learning evolves over time, as it builds upon and enhances previous knowledge. The tree’s roots of knowledge reflect the learner’s existing knowledge. They are connected to the branches, which symbolize the paths of growth.

The Common Vein requires requires the ability to read, and passion for the subject material. With those, the whole field of biology and medicine opens up, and eventually, students learn to apply this network of knowledge as thoughtful thinkers and practitioners.

Posted on March 28, 2016February 17, 2023 by Ashley Davidoff

I am the Colon- In the Bowels of the Body, I Reside and Work

A Poem about the Colon

I am the Colon

I have not captured the imagination of poets, artists, and historians.

Unlike my brothers and sisters the heart, liver, and the brain,

I am usually a subject that is avoided in cultured circles,

And commonly the butt of coarse jocularity in casual circles.

My contents are usually used as expletives of disgust and disagreement,

While my tail end is used in reference to the last and the least.

Let me tell you my story …..

I am the colon – they also call me the large bowel.

Some call me the “large howl” because of the noises that I make.

I do make noises – most of the time I sing a droning song while I go about my work,

Almost like a bass or double bass.

Sometimes I have to let off steam and then the wind instruments take charge,

With sounds that range from a piercing bleat to the beautiful alto furtive blurt.

When my contents are fluid I can tinkle along like a triangle in a percussion band.

Borborygmi they are called –quite a fancy name for a rather primitive sound.

Talking about music, I was surprised to read that Mozart took an interest in me.

His scatological letters are infamous, though admittedly his music is genius.

I am somewhat proud of his obsession for me.

So much for what people think or have thought. Let me give you my perspective.

My body is unique! No other structure in the body comes close.

With my taenia coli and rounded haustra I am adorned in appendices epiploica.

The three beautiful, graceful and gracile taenia run along the entire length of my body.

I really like these sleek muscles

Sleek Tenia Coli Muscle and Voluptuous Haustra

So symmetrically positioned around my circumference.

They are always a tad tight, giving me my voluptuous bulges – the haustra.

I like those too.

They give me haughtiness and sometimes a naughtiness – those haughty naughty voluptuous haustra.

…and here it comes again: their fancy shmancy name: “appendices epiploica.”

The Ugly Appendices Epiploica

I hate them! I don’t understand what function they play …

What in heaven’s name was God thinking when he put those fatty …things!… on my waist?

I detest them! Do you hear me? D-E-T-E-S-T!

They may have been the fashion in the time of Adam and Eve,

But God, please get with the times – they are way out of fashion.

Now all riled up I continue my rant and rave.

Chyme they call it!

Chyme my ass! (Oops, I should not have said that.)

They give it a fancy Latin name to make you think it is elegant.

What would you feel like if you were dealt the grime and sludge that I am dealt?

It is pure muck with all the good things removed – dirty slimy muck!

And this is only the beginning.

Wait for the obnoxious gas that those bacteria fellows produce.

It presses on my sides and makes the jowls of my bowels howl.

Talk about noxious and obnoxious – we should bring OSHA down here.

I feel a little better now that I have let off some steam,

So I resign myself to my lot in life and I deal with it and in it.

My cryptic workers – God bless mein lieber kinder, the crypts of Lieberkuhn:

God Bless Mein Lieber Crypts of Lieberkuhn

They take that stuff into their crypts and work away at it for hours and sometimes days.

And voila – with bubble, bubble, toil and trouble,

A well molded product of dehydrated debris

Mixed with a tincture of mucus, a bead of sweat, and fermented gas for the rise,

To which I add a drop of color with my stercobilin

To form beautiful compacted nuggets called scybalae.

Getting rid of the product and passing it on into the free world is yet another story.

Some wondrous interactions are going on between me and my muscles (and you and your muscles, and your marvelous mind and body).

To cut a long story short, the coordination is quite something until we finally get the job done.

I heave a sigh of relief when I see the fruit of my labor out of the door.

In the end I am very happy to be part of your body,

To do my little thing, retrieve some water, and earn my keep.

So that you can experience another wondrous day, enjoy another meal,

And live to tell another tail … end story.

The End

This poem has been modified from its original version published in the module on The Colon in the The Common Vein web site

Posted on November 20, 2015February 17, 2023 by Ashley Davidoff

Anatomy of Circadian Rhythms in the Body

To every thing there is a season, and a time to every purpose under the heaven:

A time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted;

Ecclesiastes 3:1

What is a season?

A season in the classical sense, is a natural division of the year and relates to the position of the earth to the sun. The sun is a source of light, warmth, and energy. A season is a continuum of time divided by the rhythmicity of four seasons. The seasons are characterized by changes in light and dark cycles as well as temperature cycles. These factors impact life in all its aspects.

Cycles Around and Within Us

This image shows the seasonal cycle that occurs within a year. The top left image is the spring when rebirth and restoration of life occurs. The summer (top right) follows where light and temperature are high. The mature mellow autumn follows with orange reds and yellow colors (bottom right) . Light starts to fade and temperatures start to fall Autumn is a time for introspection and recognition of mortality. The bleak and cold winter follows with a silence of impending death (bottom left). The dancers with their own cycles are incorporated into the larger cycle, inferring the intimate integration of internal biology with the changes in the environment. They are positioned like the hands of a clock – again incorporating the element of time.

Spring is a time for birth, freshness and renewal
Summer brings energy, blossoming, productivity and maturation and is the prime of life. Light is brightest during this period and the weather is warmest
Fall brings mellowness and maturation and warns of decline. Symbolically it is a time for introspection during mid life
Winter is the time of aging, bleakness, decline and death. It is characterized by darkness and cold and symbolizes quietness, contemplation, and reminds us of our impending old age and death.

“To every thing there is a season” What does that mean to the structures of the body?

The changes of the seasons have parallels in the internal environment of the body down to the cells and molecules. This implies that “everything” in biology experiences a season.

The annual cycle of the seasons is experienced physically by the body, its organs, cells, and molecules throughout the year. They sense the cold and the warmth, and the light and dark of the external environment.

Seasons of the Feet

The AiA rendering is a collage of photographs with superimposed CT scan of the feet as they walk through the seasons. The four seasons created in a sphere provide a sense of wholeness in time, while the footsteps represent a walk in time. The top left image of the sphere shows the magnolias of Spring, the next (going clockwise) is green forest of Summer, followed by the Fall and finally the deathly cold of winter.

Seasons of the Abdomen

This AiA rendering shows the abdominal structures reflecting the seasons. The spring is in shades of pink, the summer in green of the forest and the blue of the sky, the fall in oranges and red, and the winter in ice blue and white.

Seasons within Seasons and Cycles within Cycles

The cycles of the body range from nano seconds per cycle to a lifetime. Each cycle is part of another cycle. Each cycle consists of a beginning that evolves to full speed production, progressing to a winding down phase and finally a phase of rest and restoration. The Krebs cycle, heart cycle, circadian cycle, menstrual cycle, are all part of the wheel within a wheel concept and in the grand scheme of a single life it revolves around the process of maturation. These same cycles occur within the cycles of evolution with improvement in processes over time.

Biochemical cycles are responsible for growth, and reproduction. The clock has to be rewound, restored to step one so that it can do its duty again. All of these have been optimized by the grand Darwinian cycle of reproduction, generation after generation, picking up fortuitous improvements over the eons.

Seasons of the Day – Parallel Changes in the External and Internal Environments

Seasons of the Body in a 24 hour Period

This image shows the parallel of a 24 hour cycle correlating with the seasonal cycle that occurs within a year. The top left image is the dawn when the day is born and the person is restored from sleep and starts to get ready for the the next 12 hour period. The stress hormones start to rise as the body prepares for the work day which reflects the summer time (top right) where light and temperature are high. After the “summer” the mellow and introspective time of the sunset arrives(bottom right) as light and temperature start to fade. The temporary death of sleep provided by the night follows in the bottom left .

Daybreak at sunrise is the birth of the day, and represents spring time in the body. We wake up restored while it is a little light and a little cold outside and are refreshed and reborn after our slumber. As the day warms up, and the light becomes stronger, we enter the summer of our 24 hour cycle. Our cortisol levels are up to deal with the physical stresses of the day and this preparation is felt in our cells and in our psyche. As a result of the stress we are better able to process and produce at work. During the day we reach the height of our wakefulness and are in our productive prime. At dusk, the autumn of the day moves in as we start to wind down and become introspective. The light starts to go down and without the sun, the day cools down. The winter of the day – nighttime arrives. It is colder and darker, and we prepare for sleep, a transient death that helps us restore.

The internal environment of the body also senses the cycles through a hormonal cycle called the circadian cycle, which is executed via the hypothalamus. enabling rhythmic physiological and behavioral events of the body to work in parallel with the natural rhythms of the external environment.

“Anatomy of Sleep”

The central control system for the circadian rhythms is in the suprachiasmatic nucleus (SCN) of the hypothalamus (turquiose blue butterfly shaped structure at the base of the brain) It is responsible for the control of the circadian rhythms of the body.

Seasons of the Molecules

Circadian Rhythm and the Daily Internal Seasons of the Body

There are three main physiological events in the daily human diurnal circadian rhythm; melatonin secretion, cortisol secretion, and temperature variation.

Melatonin

Melatonin is secreted by the pineal body in response to the dark. The retina identifies light and transmits this information to the suprachiasmatic nucleus (SCN) in the hypothalamus. The hypothalamus integrates the light and darkness cycles of the environment with the pineal gland which in turn secretes melatonin in the dark. Melatonin levels are therefore high at night and low in the day. Melatonin is involved in sleep cycles, blood pressure regulation, and in seasonal reproduction.

Cortisol

Seasons at the Molecular Level in the Adrenal Gland

The adrenal gland is an essential component of the circadian rhythm. It produces cortisol which prepares the body for the stresses of the day. The artistic rendering shows background of complex biochemistry artistically incorporated into the gland. This is a featured art piece because of the beautiful manner in which the almost invisible gland transforms the biochemistry into life giving hormones.

Cortisol is a hormone produced by the adrenal gland that is elemental in the control of metabolic function. It prepares the body for impending stresses. Diurnal secretion of cortisol is part of circadian rhythm physiology. The level is highest in the early morning and is at its lowest level at about midnight to 4 am. This high level in the morning prepares the body for the stress of the day. Cortisol is intimately involved in the metabolism of glucose, fat and protein.

Body Temperature

Body temperature is lowest about 2 hours before waking in the morning and highest in the late afternoon and early afternoon. During the night metabolic activity is slowed and the lowered temperature is a mechanism to conserve energy. temperature is elemental to all biochemical processes.

“Body Temp Variation” by user:RHorning – Image Source. Licensed under Public Domain via Commons –

Seasons of the Cells

The molecular changes give rise to cycles in the cells both in a minute to minute variations, hour to hour variations, and eventually into annual variations

Seasons in the Squamous Flower

Cycles in the Columnar Cell of the Colon

What would life be like if there were no seasons?

Although there is a pattern to the seasons – each one is different and as we gain perspective on the cycles.

There are cycles within cycles as time moves on – each not the same as the prior, but having many things in common. The beginning of Spring is so full of life and we soon look forward and want to welcome the blooming of the brighter colors of summer. And then the heat of summer comes and we look forward to the cool and mature fall – and the beautiful first deep snowfall comes and soon grows old, cold, uncomfortable and dreary – and the new cycle begins with our eyes a little changed

Eachseasons bring a lesson of life. We need the seasons to feel the rhythm within us and around us… but each year the seasons are different, and we learn and grow with each season.

The dawn brings us newness and freshness. The day brings us energy in full flight and productivity – the dusk brings quietness and satisfying mellowness and the night brings rest and restoration…. But each day is different, and hopefully we learn and grow with each day

“I think that to one in sympathy with nature, each season, in turn, seems the loveliest.”
― Mark Twain

“Life Cycle of the Uterus”

shows the uterus from birth through maturation to senility

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Posted on November 20, 2015February 17, 2023 by Ashley Davidoff

Emphysema – a Poem

Emphysema

Perspective of an Alveolar Cell

Healthy Alveolus

When I was young my cell buddies and the tissues around us felt invincible

The ease and elasticity with which we opened and closed –

Allowing the breeze of

Beautiful oxygen ….in

And dirty carbon dioxide ….out

Was executed without effort

It really was a breeze – right through our strong bodies

No effort

Alveolus in Healthy Lungs

Then one day – when the guy in charge was about 14

When his hormones started to fill his psyche

He went to a party

Lots of little talk

And “cool” this and “cool” that

And “come on … try this” and “try that”

And in his psyche I read

(though he did not consciously know it )

“I want to fit in”… “I want to look cool”

And suddenly while waiting for my beautiful blue oxygen

A wave of black and gray stink air imploded in my face

“Yech” I shouted

And that was the beginning of the end

Day after day

Smelly smoke continued to come down the pipeline

.. and it took control of him

Even though he knew better

Early morning when we woke up

After breakfast with a cup of coffee

Same after lunch and after dinner

And just before sweet repose

He blew this black-gray muck in our faces

And we had no power

Over the years

We lost our elasticity

And we lost hope

Then and Now

He hid his habit from his children and grandchildren who said “yech”

His breathing had a deathly rattle

He coughed green and yellow stinky mucus

His breath stank

His clothes stank

He aged before his time

His skin wrinkled

His voice was coarse

And his arteries became rigid and narrowed pipes

And our small airways were stretched and stretched

Till we looked like big black holes in a ghost town

Of rotting and stale air that could not move…

What We Were… and Now …Big Black Holes

So when we look back

And try to learn, ……

It all started when he wanted to fit in

A human weakness we need to address at a time

When

The psyche of our children

…. and many adults

Have a need to pursue superficiality to

Look cool and fit in

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Posted on November 19, 2015February 17, 2023 by Ashley Davidoff

Emphysema – What Does It Feel Like?

Emphysema

What does it feel like?

Emphysema?

Take a breath and hold it-

While holding that breath … Take another breath on top of that – and hold it –

While holding that breath .. Take a third breath on top of that – and hold that – and then do it a fourth and a fifth time

and maybe a 6th if you can

That is what emphysema feels like!!!

Big Lungs of Stale Air in Emphysema

No more room in the chest to take in any fresh air

It is beyond discomfort – With no relief …

You cannot take a magic medicine

And wake up the next morning

.. and finally take in a full deep breath of fresh air

Like you used to do

You have lost that blessing of life

Medicine and oxygen may help

But

The ability to feel a full breath of pure fresh air….

That feeling is gone forever…

Why did I not listen?

A lesson taught by Dr Bartolome Celli MD

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ART IN ANATOMY

Category: Physiology

Pancreas – Hermit of the Abdomen

Pancreas – Hermit of the Abdomen

The Common Vein: Clarity in Complexity

Introduction

Organizing Information

The Tree of Knowledge

Roots and Branches: Sources and Growth – Advancing Complexity

Principles

Principles of Human Biology

Principles of Medicine

The Common Vein

I am the Colon- In the Bowels of the Body, I Reside and Work

A Poem about the Colon

I am the Colon

Anatomy of Circadian Rhythms in the Body

Anatomy of Circadian Rhythms in the Body

What is a season?

“To every thing there is a season” What does that mean to the structures of the body?

Seasons within Seasons and Cycles within Cycles

Seasons of the Molecules

Emphysema – a Poem

Emphysema

Perspective of an Alveolar Cell

Emphysema – What Does It Feel Like?

Emphysema

What does it feel like?