Altitude matters! did you know where you grew up might affect your levels of hemoglobin?

 I was born and raised in Colombia a country in South America which is very near to the equator, I moved to Denver around seven years ago, I remember that a couple of years ago after having routine tests ran on my blood, my primary care giver saw something unusual on my results, very elevated hemoglobin levels. After careful consideration they decided to send me to Anschutz's oncology wing, after more tests and a little scare, hematologists explained to me that the elevated levels of hemoglobins in my blood where thanks to where I grew up, since the moment I moved to colorado the drastic change in altitude caused my body to adapt to the altitude and the lack of oxygen by producing higher amounts of hemoglobin in my blood.

did you know that Hemoglobin levels increase in response to higher altitudes primarily due to the body's adaptation to lower oxygen availability?. At elevated altitudes, the reduced oxygen pressure prompts the body to enhance its oxygen-carrying capacity through increased production of erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow. This rise in red blood cell count leads to higher hemoglobin levels, improving oxygen transport throughout the body. But this higher levels are not only seen in South American people that move to states like Colorado, Notably, populations from South America, particularly Andean highlanders (the highest mountains), exhibit a more pronounced increase in hemoglobin levels as well compared to other ethnic groups. This adaptation is influenced not only by environmental factors but also by genetic traits specific to these populations, allowing them to thrive in high-altitude conditions with greater oxygen efficiency.

Elevated hemoglobin levels, particularly in high-altitude populations , can have significant health implications. While increased hemoglobin improves oxygen transport, it may lead to chronic mountain sickness , This can strain the heart and complicate oxygen delivery to tissues. In pregnant women, improper hemoglobin monitoring can affect maternal and fetal health. Moreover, using standard reference ranges without considering altitude can result in misdiagnosis of anemia which I found interesting taking into consideration that this is what almost happened to me. All of this information further proves that understanding the variability in hemoglobin levels among different ethnic groups is crucial for accurate health assessments and effective management strategies. 

References:

Gassmann, M., Mairbäurl, H., Livshits, L., Seide, S., Hackbusch, M., Malczyk, M., Kraut, S., Gassmann, N. N., Weissmann, N., & Muckenthaler, M. U. (2019). The increase in hemoglobin concentration with altitude varies among human populations. Annals of the New York Academy of Sciences, 1450(1), 204–220. https://doi.org/10.1111/nyas.14136

Stressed even in your Dreams? Here's Why!

Have you ever been stressed about something right before going to bed and then find yourself still stressed while dreaming? Whether it's an exam, a family conflict, an upcoming sport's game, or just a really demanding homework problem, it is not uncommon to fall asleep thinking about these things and dream about it. Here's why. 

One area of study is that when one is in REM (rapid eye movement) sleep, acetylcholine is often alone when monitoring brain activity while we are in such a state. However, it has been seen that corticol levels can be as high in a sleeping state as they were in an active state. So, if one goes to bed with high levels of stress it can then translate to higher levels of stress when one is asleep, and even when one is sleeping. 

Another area or scope of study is looking considering that the brain can be in different states of sleep. REM sleep is one that is largely talked about and this is typically the state in which an individual will dream. The second state, is NREM (non-rapid eye movement) sleep. In this state the individual is entering deep sleep. So, essentially this area of study is taking into consideration that different parts of the brain can be in these two stages at the same time. This would explain how an individual is able to sleepwalk (but that's for another day!). If an individual is experiencing both of these at the same time, it could potentially lead to these two stages not necessarily being exclusive and potentially allowing the individual to experience stress while still in the dream state (REM sleep). 

Now, here are some ways you can hopefully avoid being stressed out even in your dreams:

1. Spend time relaxing and preparing yourself for bed. 

2. Practice relaxation/meditation techniques.

3. Avoid exposing yourself to the thing that is making you stressed right before going to bed. 

4. If you wake up because of the dream, don't check the clock or your phone and try to practice the meditation techniques. 

5. If you cannot go back to sleep, get out of bed and try to find something boring to do (funny right?); this will help your brain activity to decrease and essentially lull you back to sleep.

This topic is still being heavily researched and it isn't clear if there is a singular reason why an individual can experience stress even in their dreams. However, if you're someone who experiences these kinds of dreams, hopefully something here will provide some kind of answer or even some tips on how to manage your stressful dreams. 

Resources:

https://health.clevelandclinic.org/stress-dreams-why-do-we-have-them-and-how-to-stop

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814941/

Investigating Traumatic Axonal Injuries

    Traumatic axonal injury (TAI) is a form of a traumatic brain injury where there is shearing to the white matter neurons. Damages to these neurons can lead to neurological, psychological, and or cognitive deficits, and this type of injury most commonly occurs in the corpus callosum, the midbrain, and the space between white matter neurons and gray matter neurons. The identification of TAIs is of great importance for the care of the patient and for forensic purposes. Through the use of various techniques, TAIs can be better identified and understood. 

    Typically, in trauma related injuries to the head, a CT scan is procedural in order to visualize any internal damage or abnormalities as a result of the trauma. CT scans are ideal for this as they tend to be fast scans and they are more accessible to most patients. Additionally, this type of scan can help in determining the treatment path for individuals. This can include, a more extensive laboratory work-up, or other types of imaging. When it comes to TAIs, in many cases, a hemorrhage visualization on a CT scan can point towards a TAI. However, the mechanical parameters of a CT scan present as a challenge when attempting to visualize TAIs due to their complexity. For this reason, obtaining an MRI might prove to be more effective.

    MRI scans are a good method of imaging particularly when a patient begins to decline unexpectedly. and they become more critical. Due to their mechanical sensitive, MRIs are better for detecting TAIs, and there are various MRI techniques that can better localize the damage and improve diagnosis. One of those techniques is known as fluid-attenuated inversion recovery (FLAIR). This MRI imaging technique is most effective in visualizing injuries that are near accumulations of CSF such as areas around the ventricles. This is done by decreasing the signal that is produced by CSF, and in doing so, contrast is reduced (Kates et al., 1996). Another type of MRI imaging technique is known as diffusion weighted imaging (DWI). This particular technique utilizes contrast to further examine molecular function and composition of structures (Baliyan et al., 2016). This also includes analyzing the amount of water molecules within the brain. Susceptibility Weighted Imaging (SWI) is considered the most effective imaging technique as it focuses on portions where there is a hemorrhage since they appear less dense. Other techniques such as diffusion tensor imaging, analyzing places where there is water blockage which is indicative of a TAI, tractography which recreates bundles of nerves to visualize damage, and spectroscopic MRI which looks at changes in the chemistry within the brain, are all various ways to attempt to diagnose a TAI. When it comes to TAI, imaging is useful for determining the care of the patient and the next steps. However, not all of these imaging techniques are give to patients with suspected TAIs all the time. A CT will be the first step and if there are any changes to the patient's health then an MRI will be considered. What makes diagnosing TAIs challenging is they are used to assess how severe a traumatic brain injury (TBI) might be. A patient will not be directly diagnosed with a TAI, instead, the finding of a TAI can indicate a severe TBI, yet there are different methods to measure that. 

    In addition to imaging, there are also certain tissue staining techniques that can be used to identify a TAI. The only challenge is it can only be done after someone has passed away, and typically this is done in an attempt to confirm the presence of a TAI. In a TAI, due to the damage to the axon there are problems with molecular transportation along the axon. Additionally, it also very characteristic of a TAI to have a breakage of bundles within the axon with causes the process to retract to the cell body, forming a retraction ball. There is then demyelination that occurs as the lesion worsens. This can be observed with immunohistochemical staining. Due to the trauma to the axons, there is an increase in amyloid protein precursor (APP) as this protein is involved in helping with neuronal repair. To visualize, a APP Beta immunostaining can occur. 

    Although modern imaging and tissue staining have been effective in identifying a TAI, they still are not effective in determining the mechanisms that led to a TAI. This challenge also arises as TAIs are complex, so determining their mechanisms are also hard. If however, TAIs are thought of as a risk for a more severe head injury, then a finite element (FE) model, which uses information such as brain strain and stress to predict a mechanism. It is important to note that this model will use stressors and strains related to any tension, shearing, or compression not only to at the level of the cortex but also at the axonal level. In general, there must be some deformation to the tissue and based on the damage, a percentage relating to the damage can be derived. This ultimately will be used to mathematically determine a TAI and predict a mechanism mainly by considering it as a risk. Using this technology, in combination with imaging, it allows for personalization of models where the brain geometry and mechanisms are considered, resulting useful in determining the cause of a TAI. 

    TAIs can be complex to analyze as it can be hard to diagnose or visualize them; however, using the right imaging, their identification can help to improve patient care and treatment. In combination with mathematical models, it is also possible to determine a mechanism when it might not be clear. 

References:

Baliyan V, Das CJ, Sharma R, Gupta AK. Diffusion weighted imaging: Technique and 

    applications. World J Radiol. 2016 Sep 28; 8(9):785-798. Doi: 10.4329/wjr.v8.i9.785.

    PMID: 27721941; PMCID: PMC5039674.

Delteil, C., Manlius T., Bailly, N., Godio-Raboutet, Y., Piercecchi-Marti, M. -D.,

    Tuchtan, L. Hak, J-F., Velly, L., Simeone, P., & Thollon, L., (2024). Traumatic axonal

    injury: Clinic, forensic, and biomechanics perspectives. Legal Medicine, 70. 

    https://doi.org/https://doi.org/10.1016/j.legalmed.2024.102465.

Kates R, Atkinson D, Brant-Zawadzki M. Fluid-attenuated inversion recovery (FLAIR):

    clinical prospectus of current and future applications. Top Magn Reson Imaging. 1996

    Dec;8(6):389-96. PMID: 9402679.

Endocrine Connection to PCOS

Polycystic Ovary Syndrome (PCOS) is known as a highly prevalent disorder, characterized as the single most common endocrine-metabolic disorder in reproductive-aged women. If this is the case, why is it commonly underdiagnosed and misunderstood? PCOS is a disorder affecting the endocrine and reproductive systems. More specifically, it is a hormone imbalance in the ovaries, creating excess hormones. When this is the case, the ovaries produce incredibly high levels of androgens, commonly known as the male sex hormone. This results in a hormone imbalance. These high levels of androgens restrain the ovaries from releasing eggs and lead to irregular menstrual cycles, acne, obesity, and excessive hair growth (facial/body) in women.   

Most patients with PCOS experience oligo-anovulation, characterized by menstrual cycles longer than 35 days, which is linked to ovulatory dysfunction. It is the first reason for female infertility and often includes other etiologies. 

 

Alongside these symptoms, insulin levels increase due to the release of androgens. The majority of patients presented with PCOS have demonstrated chronic insulin resistance. This insulin resistance makes patients with PCOS more likely to have Type 2 diabetes mellitus. In addition to Type 2 diabetes mellitus, metabolic syndrome increases, leading to an increased risk for cardiovascular disease. 

 

Overall, PCOS demonstrates a reduced quality of life, showing an increased risk for anxiety, depression, and other mood disorders. PCOS disorder commonly remains underdiagnosed, and within the clinician community, it is needed to be better understood, educated, and knowledgeable. Future and current clinicians should be able to understand the pathophysiology, diagnosis, and treatment within the female reproductive age group.

 

Azziz R. (2018). Polycystic Ovary Syndrome. Obstetrics and gynecology, 132(2), 321–336. https://doi-org.dml.regis.edu/10.1097/AOG.0000000000002698

Supernumerary Kidneys

  According to Rehder et al. (2019), the term for normally 1, but can be two, additional kidneys are supernumerary kidneys (SK), with the estimated number of occurrences being 1:26,750. Most people, if they have supernumerary kidneys, only have one additional kidney, which is normally on the left side. It is hard to know, however, truly how many people have supernumerary kidneys because unless there are additional problems, people normally do not have the scans needed to reveal the additional kidneys. Some of these problems could include kidney infections or problems with the ureters. Supernumerary kidneys are much rarer than the more common duplex kidneys, with the latter being fused with the regular kidney and having the same blood supply. With the additional kidneys, the ureters, which drain the kidneys, can also have variation, with some ureters joining to the ureter of the kidney below, which is more common, or each kidney having its own ureter. Altogether, to show the rarity of this condition, Rehder et al. (2019) looked at scans of 461,500 people taken between 2000 and 2017 and found 9 with the condition. 

I am very interested in supernumerary kidneys because I was diagnosed with two additional kidneys when I was younger. What led to this diagnosis was that I would constantly have kidney infections, which were caused by a problem in one of my ureters. While my parents don’t remember much of what the doctors told them about the condition, I do have a scan of my four kidneys. Mine are currently all still functioning, which according to the article is pretty rare since only two of the people that they found with SKs had fully functional ones. As well as having two SKs, on one side I have two separate ureters, while on the other side, both kidneys are connected to the same ureter. This article highlights how SKs can have an increased morbidity rate, but it explains further that this increase is normally caused by complications from unneeded surgery due to misdiagnosis because of how rare they are. I almost experienced this, with the first set of doctors misdiagnosing and telling my mom that I had cysts on my kidneys and would die within a year. Luckily, the next doctors discovered the problem and fixed the small issue with my ureter by stretching the tube out at the connection to the kidney. 

Reference:
Rehder, P., Rehwald, R., Böhm, J. M., Grams, A. E., Loizides, A., Pedrini, M., Stühmeier, J., & Glodny, B. (2019). Supernumerary kidneys: a clinical and radiological analysis of nine cases. BMC Urology, 19(1). https://doi.org/10.1186/s12894-019-0522-0

How Fast Do You Really Wanna Be!

    It’s widely accepted that altitude training is highly effective for distance runners. Training at higher elevations allows the body to adapt to lower oxygen levels, significantly enhancing endurance and overall performance. The increase in red blood cell production and improved oxygen delivery to muscles are just a few of the numerous benefits. This strategy has been embraced by many elite athletes seeking a competitive edge.

    Recently, I came across an article that sparked a new perspective. After years of training, I had never considered the impact of sleeping at high elevations while training there as well. The article explored the concept of "training low, living high." While not many places can facilitate this, I learned that Flagstaff, with its elevation just under 7,000 feet, is nearly ideal for distance training. Coach Mike Smith from NAU mentioned that he can drive just two hours to reach about 3,000 feet above sea level, a significant drop from 7,000 feet.

    The premise is that this approach can enhance performance at sea level by increasing red blood cell mass, which allows for greater oxygen transport. Simply put, more oxygen to the muscles equals improved performance. By sleeping at higher elevations, you can stimulate red cell volume while mitigating the challenges of reduced VO2 max and training intensity at altitude (and let’s be honest running at 8,000 feet is tough!).

    This concept resonates with me, though the results can be inconclusive due to variables like diet, sleep, and mental state. I would be very interested in trying this training method if resources allowed for daily travel. As for the secrets behind East African dominance in distance running, that mystery may remain unsolved.

Cited:

Lundby, Carsten & Millet, Gregoire & Calbet, Jose & Bärtsch, Peter & Subudhi, Andrew. (2012). Does 'altitude training' increase exercise performance in elite athletes?. British journal of sports medicine. 46. 792-5. 10.1136/bjsports-2012-091231.

Is Moisturizer bad for your skin?

Truly it depends on what sort of moisturizers you use, but all moisturizers can change the barrier function of the epidermis. The epidermis is the outermost layer of skin that protects and hydrates our body. Moisturizers are made up of many things but i believe moisturizers that are rich in dimethicone and glycerine are best. My all time favorite is Lubriderm because it has repaired my dry skin like no other and leaves me feeling silky smooth. Especially when I pair it with a white gardenia oil it's quite amazing and is a natural perfume. 

Using moisturizers that are rich in dimethicone and glycerine can thicken the average epidermis by 0.019 mm and can improve the barrier function by reducing permeability and subsequent allergen penetration and sensitization. This allows skin to look younger because moisturizers support optimal enzymatic function, increases ceramide production, and facilitates ideal conditions for commensal microorganisms that repair and help maintain homeostasis of the skin and body. 

Although old age will get us all in the long run, we can reverse the effects of the cruel sun and keep our skin looking extra glowy and brand new for an extra decade by moisturizing everyday and using dimethicone and glycerine in our favor. 

GO BUY MORE LOTION AND OILS TO KEEP THAT SKIN YOUNG GUYS!!!!

Short, R. W., Chan, J. L., Choi, J. M., Egbert, B. M., Rehmus, W. E., & Kimball, A. B. (2007). Effects of moisturization on epidermal homeostasis and differentiation. Clinical and experimental dermatology, 32(1), 88–90. https://doi.org/10.1111/j.1365-2230.2006.02297.x

Jeffrey Rajkumar, Neha Chandan, Peter Lio, Vivian Shi; The Skin Barrier and Moisturization: Function, Disruption, and Mechanisms of Repair. Skin Pharmacol Physiol 13 November 2023; 36 (4): 174–185. https://doi.org/10.1159/000534136