Pain and Brokeness . . . A Source of Strength - The Musculoskeletal System

Pain is an inevitable fact of life. Sooner or later we will have to face it. But how do we react when we do? I would like to discuss this in context of the physiological process of muscle adaptation and repair, which I feel accurately reflects the true reponse we need to take.

Unless your name is Mark, most of us need to work out in order to be buff. That is we must put in the pain, sweat, and tears of an intense weight workout if we want to gain muscle strength. It's this pain and soreness of working out that tends to keep busy med students unmotivated to exercise. But why must there be pain? And what is happening to create that soreness? Gossh!

Well, what you may not know is that when you work out intensely you are actually causing damage to your muscles - mechanical damage of muscle contractile proteins, surrounding collagen damage, inflammation, and lack of oxygen transfer (ischemia) to be specific. This response by our muscles creates a delayed soreness even a day or two after a workout. There is also that nasty "burn" that we feel as an immediate response to lifting weights, which is lactic acid spilling around our muscles due to lack of oxygen during energy metabolism. This is painful to even think about. No matter how counterintuitive it may seem though, muscles have to go through this pain, damage, and soreness if they are to gain strength. Why?

When muscles undergo damage from exercise they adapt by generating new contractile proteins, oxidative enzymes, collagen fibers, so that it will be prepared for next time. This increases the size of the muscle cells (hypertrophy). It does not necessarily increase the number of muscle cells (hyperplasia) though some studies indicate there may be a small percentage. Thus, our muscles are like an army battalion that, when under attack, has the insight to call for more troops and artillary to increase the size of the army.

Some may call our muscles' ability to adapt an "evolutionary" development to help us survive; I call it a design to help us be who we need to be. If I need to be a construction worker, repeated stress on my muscles by moving concrete over time will actually increase my strength so that I can work harder. If I'm a doctor though, chances are that I won't place that much stress on my muscles as much and thus will not develop the same amount of strength as a construction worker. But that's okay because I don't need it. My brain will help me survive more than my muscles. Remember, "it's our wits that makes us men," (Malcolm Wallace) not out muscles! Of course, this could be a defense mechanism for skinny med students like me.

Seriously though, just as our muscles need to undergo damage and pain to become stronger, so must we become broken at times to gain strength or perseverence to become who we need to be. I don't need to quote scripture to prove this (though I could - Ps. 34:18, 51:17, Ecc. 7, Is. 52-53, Ezk. 34:16, Rom. 5:3-5, I. Cor. 1:27, 2:3, 4:10, II Cor. 11:16-32, Heb. 2:10, Jam. 1:2-3,12). Even before I took my faith seriously, I endured the crap of having patches of hair loss during junior high and beginning of high school. This broke me deeply, I hated it. To avoid belaboring my personal experience with depression, addiction, and loneliness; I'll just say that by God's grace I got through it and I'm stronger for it. I would never take my experience back. I'm sure we all have our stories or, if not, we will.

So how do we react to painful experiences? Okay, I'm not trying to provide an easy answer here. The crap we each have to deal with is different. Sometimes resolution never takes place and we're left in the dark. Also, going back to the muscle analogy, permanent damage does occur that does not result in increased strength. There is no simple equation that pain and suffering = strength (eventually). Does that mean we should avoid pain though? I don't think so. I think we should face it, accept it, and have hope even if the answer never comes. I think we should talk about it with others who love us and be open. Yes, this does require that akward character of vulnerability that we stubborn, unconfrontational Scandinavians and Northern Europeans seem to struggle with. It's being weak. It's letting go. It's patience, for that time of recovery and strength to come.

This requires community. Hmmm, interesting, I didn't think about that. You see, muscles recover and become stronger only because of the blood vessels, repair cells, nutrients, and biochemicals that flee to support it. In fact, when muscle cells are missing these supportive structures (as in muscular dystrophy when the protein dystrophin is not produced), muscles will progressively self-destruct over time. Obviously without community it's hard to be vulnerable. You are opening yourself only to be slammed down and judged.

If anyone has read this blog to this point, my condolences. Yet I want to take this opportunity to state that my friend Jordan does not infact have HIV, nor has he encountered any bacterial infection in his hair. I apologize for any confusion.

I realized this weekend that though I am an introvert, I can only be alone for so long. I was in Fargo this weekend with my parents gone so that I could get some studying done. However, after one night, I couldn't take it. Imagine, I actually desired to come back to Grand Forks. Very strange.

The Immune System Part II - HIV/AIDS

How many of you have heard of AIDS? Can I get a show of hands? Ok good. How about HIV? Ok. So what's the difference? I mean aren't they the same? Well, actually they are not, though you cannot have one without the other.

HIV stands for Human Immunodeficiency Virus. Therefore it is a virus. AIDS stands for Acquired Immune Deficiency Syndrome. Therefore it is a syndrome or a combination of symptoms resulting from disease or infection. HIV is the virus that causes AIDS. Thus, as you probably figured out, if one can prevent getting HIV then this will stop the spread of AIDS.

The key to understanding HIV and AIDS is knowing what an immune deficiency is and what it results in. If you recall from last week, our immune system is what protects us from foreign substances that damage our body's normal function. Normally, our immune system is fighting off microscopic bacteria, fungi, single celled organisms called protozoa, and, more rarely, viruses (collectively referred to as "germs"). These germs are unavoidable contaminations from other people, door handles, hookahs, and anything else that is contacted by many different individuals (Jordan Raney's nest of hair for example was a highly susceptible environment for these germs, though no longer since his haircut - thanks Jordan). It does this through a variety of mechanisms that include those wonderful antibody producing B cells and T cells. Last week I covered B cells (see part I) so this week I will introduce to you T cells. Then, I will discuss what happens when they malfunction or disappear and how that contributes to HIV/AIDS.

T cells, like B cells, are first formed in the bone marrow and then, like B cells, go through a maturing and selection process so that our body doesn't produce immune cells that will attack itself. Unlike B cells, much of the T cell maturation process occurs in an organ of the body right on top of our heart called the Thymus (hence "T" cells).

Also like B cells, the mature T cell is transformed during its maturation into different forms that differ in function. There are essentially two forms of mature T cells, helper or CD4 T cells and cytotoxic or CD8 T cells. Helper CD4 T cells do precisely what their name implies, they help other cells. Namely, they help B cells to produce antibodies and another cell, called a macrophage ("big eater"), to consume and degrade foreign organisms. Cytotoxic or "killer" CD8 T cells release chemicals that kill infected cells in the body. Both CD4 and CD8 T cells work in concert to control infection so the body can return to its normal function.

When a person gets infected with HIV the virus actually infects CD4 T cells. But this takes time since T cells and B cells are not activated until several days later after an infection. This is why it usually takes over a week or two to get over a flu virus, if not longer. During this time lag the immune system is constantly producing new T cells and other immune cells to fight off the infection. Also, after HIV infects an individual, it is frequently mutating into different forms. This is part of the reason why it takes such a long time before symptoms of HIV actually develop in someone who's been infected, anywhere from 2-15 years. The number of CD4 T cells infected and killed increases significantly during this lag period as the amount of virus or the viral load increases. Remember that T cells play an important role in the immune response so as their number decreases so does the body's ability to fight infection. It's when the CD4 T cell level drops below a certain number, 200, that someone can be then diagnosed with having AIDS.

It is precisely the lack of ability to fight infection that makes AIDS an immunodeficiency. And as you can imagine the lack of immune ability means there is a greater opportunity for the body to be infected and damaged. Remember when I said that your body is continually, daily fighting micoscopic organisms; well when your immune system becomes deficient your body can no longer prevent these organism from infecting you. These infections are termed "opportunistic" since they only infect when they have the opportunity. Once infected, an immunodeficient person cannot stop the infection and it will progress to present various symptoms that fall under the "syndrome" part of AIDS. Eventually the infection or group of infections will progress to a point when an individual cannot repair damaged cells and will die.

So the take home lesson is DON'T GET HIV! And if you have it, don't spread it. Obvious no? Well why does this horrible virus still persist if preventing it's spread was so easy? Why is in fact growing at a rapid rate in some areas of the world like India and Southern Africa? Why is it spreading more and more among the heterosexual population here in the US? Why am I not the leader of the free world? Hmmm . . . sounds like a future blog to me. I hope this was a little more simpler than my last blog. Let me know if it wasn't.

This marks the end of my immunology course in two weeks at medical school. The next two weeks we'll be venturing into that marvelous, dynamic machinery known as the musculoskeletal system. Being as buff as I am, I think that I would be an expert in that system already. I guess we'll find out . . .

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