How can we die of a broken heart? The physiology.

Back to a less controversial subject, how we die from a broken heart. The syndrome of Takotsubo's cardiomyopathy is interesting since it may account for the death of people who are so upset about a subject for a length of time that they actually die, much like we sometimes see when patients die soon after the passing of a loved one. Takotsubo's was first described in Japan thus it got its name, tako tsubo or octopus trap. An octopus trap is shaped such that the octopus can crawl in the trap but can't get out. It is like a wine carafe where the neck is narrow and the decanter is broad. This is what happens to the heart when someone has a lot of adrenaline floating in their system from stress, the outlet of the heart can remain narrow as the body of the heart becomes bulbous, making it difficult to emit blood. On angiogram the coronary vessels appear normal but there may be a correlation with the length of the front coronary artery, the left anterior descending artery, and risk of developing takotsubos cardiomyopathy. From the adrenaline there may be microvascular obstruction to blood flow in parts of the heart that are important for emitting blood. Patients often present with symptoms of a heart attack but can sometimes present with heart failure for otherwise unknown reasons. The treatment is with beta blockers or calcium channel blockers which can alter the strength of heart contractions and protect the heart from detrimental effects of adrenaline. This is how one could die from a broken heart.

Zoo Seattle

This will be a dark blog today. Last night I watched a documentary called Zoo, "an extraordinary glimpse into the life of a seemingly normal Seattle family man whose secret sexual appetites led to his shocking death". Basically this guy was being screwed by a horse who perforated his sigmoid colon and the guy died of peritonitis. The documentary was shown at the Sundance Film Festival in 2007. My nurse Janet gave it to me awhile ago since we had discussions of the event but I have been hesitant to watch it. The documentary interviews those involved with the secret taping of men having their way with farm animals in the fields of Washington and it seems to dramatize some events with actors. I didn't know what was real and what was staged with actors, but I do know it was the weirdest thing I have seen in some time.

The guy who died was a Boeing engineer and at least one of the perpetrators emigrated from West Virginia. During his bus ride we got to hear his reflective thoughts about of zoophobia. "It's like I really care for the animals". But these guys were sneaking onto the property of others in the middle of the night to have their way with the animals of other people, and they filmed it, and put it on the internet. There were no laws against this practice in Washington State so although there were arrests made the only charges rendered were for trespassing. Animal Rights reps were suggesting that the horses were being taken advantage of but for the first time in my life I agree with Rush Limbaugh, who was arguing on tape that the horse had to be a willing partner in this so it seemed unlikely there was animal abuse. But maybe there is a Mary Kay Letourneau argument here, another Seattle curve ball, regarding a woman who had an affair with her 12 year old student and eventually had two children by him while in jail (huh?). She was arrested and convicted for having sex with a minor but is it rape since he had to be a willing character? I guess so. By this argument it seems wrong that the horse would be put into a situation of being tempted by the pheromones of the man they referred to in the documentary as "Mr. Hands". There are now bestiality laws in Washington State so all you guys hoping for some poke outside the local Starbucks can find something else to do. Maybe the bathrooms at the Minneapolis/St. Paul airport...the Larry Craig (R-Idaho) Memorial Stall is waiting.

So in one of the interviews an organizer of the Zoo or Fun in the Fields suggested that he was an innocent. He was astonished when the County Sheriffs came to get him. As he stated, "I don't see myself as a bad person, I love these animals" but he sure took off when the cops showed up at his door.

A patient of mine in Bellingham had such bad scoliosis that he couldn't breathe but when I told him that his shortness of breath emanated from his severe scoliosis he told me that he "didn't have scoliosis" and stormed out angry. Another patient got angry when I told her she had emphysema, and when she inhaled a peanut in Miami she told me that she wouldn't pay my bill because I had missed a peanut in her lungs that was causing her shortness of breath, not emphysema. I was an idiot. But she did have bad emphysema and she was still short of breath despite the removal of the transient peanut.

Yesterday the New York Times published an article on Alaska. Alaskans were recorded saying that they wanted government out of their life, but when told that Alaska gets the most per capita distribution of money of all the states from Washington D.C. they will say, "Yeh, we sure do get a lot of money from the federal government". What is this all about?!

I have persistently encountered some weirdly contradictory and self-centered individuals that just do not frame the social world in a fashion that's understandable. Maybe this is what the Middle Ages were like.

After living in the Pacific Northwest for about fifteen years I have outlined an analogy that I want to get record: when one encounters a porcupine in the forest one tends to avoid it and each party is happy. But when a porcupine appears like a cuddly house cat and you pick it up and you get "porcupined", this is distressing. Not only that but if you cry out, "You're a porcupine and not a cute, cuddly cat" and the porcupine says, " I'm not a porcupine!" Then it's time to leave the forest that has porcupines made up like cats who don't know they're porcupines. Or at least take some pill that will calm the inner weird meter. Do the guys who screw horses and place the video on the internet really love animals? They don't act that way but they may truly feel that way.