von Willebrand Disease - Bloody Interesting!

Have you ever had a nosebleed or a cut that felt like it just wouldn’t stop bleeding? Von Willebrand disease (vWD) is the most common inherited bleeding disorder that is involved with hemostasis, or the ability to stop blood flow. Von Willebrand disease gets its name from the Von Willebrand factor (VWF), which is a glycoprotein in blood that has implications in platelet aggregation to the subendothelial tissue. More concisely, VWF allows for platelets to collect at the site of an injury, leading to a thrombus which blocks blood flow. VWF also binds to coagulation factor VIII in the blood, which doesn’t allow for factor VIII to be degraded. This helps facilitate clotting. Following an injury, both endothelial cells and platelets secrete VWF, which binds to collagen and initiates a conformational change. This change exposes the A1 binding site to which circulating platelets in the blood bind to and create platelet adhesion. This structure (platelets adhered to VWF) moves along the endothelium until it is able to bind, aggregate, and form a platelet plug which blocks blood flow.

There are three main subtypes of von Willebrand disease – types 1, 2, and 3. The type of vWD is determined by measuring the amount of VWF in the blood. The less VWF present, the more severe the disease. Type 1 is characterized by partial deficiency in VWF and is the mildest version. Type 2 has significant defects in VWF, and type 3 has an almost complete deficiency of VWF. Patients with mild versions of vWD may be asymptomatic and unaware of their condition. The prevalence of symptomatic von Willebrand disease is much lower, at about 0.1%. Most patients who have von Willebrand disease have mild/minimal symptoms, including nosebleeds, gingival bleeding, heavy menstrual bleeding, or hemorrhage following surgery or childbirth. As you can imagine, some patients may never be in these situations, thus, VWD may go undiagnosed. Rarer subtypes of the more severe forms of this disease can cause life-threatening bleeding.

Though VWD can be inherited through a family history of bleeding disorders, it can also be acquired secondary to underlying conditions. For example, having hypothyroidism or taking valproic acid can cause reduced synthesis of VWF. The clinical manifestation of both versions of von Willebrand disease are virtually identical. It is important for healthcare professionals to consider the possible downstream effects of any condition or treatment and look at a patient holistically.

Swami, A. & Kaur, V. (2017). von Willebrand disease: A concise review and update for the practicing physician. Clinical and Applied Thrombosis/Hemostasis, 23(8), 900-910. https://doi-org.dml.regis.edu/10.1177/1076029616675969.

Echahdi, H., El Hasbaoui, B., El Khorassani, M., Agadr, A. & Khattab, M. (2017). Von Willebrand's disease: case report and review of literature. PanAfrican Medical Journal, 27(147), 1-7. doi:10.11604/pamj.2017.27.147.12248.

Cycling and Blood Doping

Lance Armstrong, just this name brings up an intense conversation and opinion to come out. However, for those of you who don’t know who he is, Lance is a former American road-racing cyclist. He is known for elevating the cycling community to global popularity. He won 7 consecutive Tour de France races, and he defeated cancer then came back and still was on top of the race, this is what makes him a very iconic person in and out of the bike seat. However, in 2012, the US anti-doping agency accused him of doping which he specifically was injecting Erythropoietin (EPO). EPO is a growth factor for red blood cells (RBC). It begins by stimulating RBC production (Klein 2009).  EPO is synthesized by cells in the kidney which is regulated by O2 and helps the body adjust to different physiological situations (Klein 2009). EPO has a lifespan of 120 days so the spleen removes old erythrocytes and begins erythropoiesis which starts in the bone marrow (Heuberger 2013). These stem cells create identical copies of themselves and they specifical target a receptor called CFU-Es, this promotes the survival of these cells.

In cycling, this helps performance, because they bike at all different altitudes for miles on miles. In the medical world, EPO has a recombinant version (rHuEPO), which is used to treat anemia in chronic renal failure patients (Heuberger 2013). However, the harmful side effects of EPO have not been researched enough to be used as much as it is (Heuberger 2013). The use of EPO increases specific factors of an increase in blood pressure and enhancing coagulation, platelet reactivity, and inflammation, which increase the risk of thrombotic events while completing in endurance athletes (Heuberger 2013). The increase of Hct lowers the cerebral blood flow which limits O2 supply to the brain, which increases the risk for cerebral infarction (Heuberger 2013). Overall EPO can be dangerous and needs to be prescribed medically and watched so prevent any long-term effects.

PS. If you want to learn more about this stud you should watch the Lance Armstrong Documentary it is very interesting.

Heuberger, J. A., Cohen Tervaert, J. M., Schepers, F. M., Vliegenthart, A. D., Rotmans, J. I., Daniels, J. M., Burggraaf, J., & Cohen, A. F. (2013). Erythropoietin doping in cycling: lack of evidence for efficacy and a negative risk-benefit. British journal of clinical pharmacology, 75(6), 1406–1421. https://doi.org/10.1111/bcp.12034

Klein, E., Georges, A., Brossaud, J., Bosredon, K. d., Bordenave, L., & Corcuff, J. B. (2009). Erythropoïétine : Quand la prescrire ? Pourquoi et comment la doser ? [Erythropoietin: indications and measurement]. Annales de biologie clinique, 67(5), 505–515. https://doi.org/10.1684/abc.2009.0356

PRP to save the season.

 

After a horrendous start to the 2022 NFL season, the Denver Broncos are looking for answers to their offensive woes. The man in charge of it all, Russell Wilson the Broncos quarterback has a partially torn latissimus dorsi in his throwing shoulder from the Thursday night game against the Indianapolis Colts. To treat this injury Russell used his autonomy and a private jet to fly all the way back to Los Angeles to receive a medical treatment called protein-rich plasma injection commonly known as PRP on his throwing shoulder.

PRP is performed by taking a patient’s blood, spinning it to separate in a centrifuge, and aliquoting the portion of the plasma that is high in platelets. These platelets are condensed into a plasma that is then injected into an area in need of healing. The belief is the injection helps encourage the body to heal the area of concern faster than it would normally do so. In Russell’s case that was his throwing shoulder. PRP can also be used on post-surgical sites, as a hair growth treatment, muscle strains, and teeth removal to name a few procedures. When targeting a specific area, the injection can be guided by ultrasound to ensure the plasma reaches the correct location.

The science behind these injections is that by introducing high concentrations of these platelets they will perform their natural function but at a greater rate. The platelets start to release their bioactive molecules that are involved in the body’s natural healing process. These released natural anabolic growth factors are believed to accelerate the healing process. It will not turn a patient into the Wolverine but in theory, it should reduce the recovery time. Therefore, it is an attractive treatment for athletes that is minimally invasive with few side effects considering it is their own blood.  

There is some controversy on how effective PRP truly helps the healing process as there are many ways the plasma can be prepared. For hair restoration, we would spin the blood and take the high-density platelet portion by eyeballing it. For surgery, they can get an even higher concentration with more volume of blood and specialized lab equipment. Some treatments have the presence or absence of many factors including white blood cells, exogenous thrombin, and calcium chloride. These all play important functions in the effectiveness of the injection. As well as each person’s blood has different ranges of platelets and other blood factors. The bottom line is there are a lot of ways to prepare a patient’s blood before injecting it. This makes it hard to compare healing time and effectiveness as no two injuries are the same         

After starting this blog, it was reported that Russell had a hamstring injury as well following the lost to the Los Angeles Chargers. It will be interesting to see if he chooses to get PRP done on his legs as well. One thing PRP cannot cure is losing. The Broncos lost to the Los Angeles Chargers the following week in overtime. Making the Broncos fall to 2-4 on the season and in desperate need of a cure for losing.

 

Arnoczky, S. P., & Sheibani-Rad, S. (2013). The basic science of platelet-rich plasma (PRP): what clinicians need to know. Sports medicine and arthroscopy review, 21(4), 180–185. https://doi.org/10.1097/JSA.0b013e3182999712

Hospital for special surgery. “Platelet-Rich Plasma (PRP) Injection: How It Works: HSS.” Hospital for Special Surgery, https://www.hss.edu/condition-list_prp-injections.asp.

Setayesh, K., Villarreal, A., Gottschalk, A., Tokish, J. M., & Choate, W. S. (2018). Treatment of Muscle Injuries with Platelet-Rich Plasma: a Review of the Literature. Current reviews in musculoskeletal medicine, 11(4), 635–642. https://doi.org/10.1007/s12178-018-9526-8

Syed, U., Shridharani, S.M. (2021). Controversies in PRP. In: Sadick, N.S. (eds) Platelet-Rich Plasma in Dermatologic Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-66230-1_9

 

Genetic Testing: Pros and Cons

Understanding a person's genome is an important part of of knowing who a person is; though the genome one can know their traits, ancestory, risks for disease, relatives, and many other intersting and scientific tidbits. When considering the risks for disease it can become increasingly important for those trying to make big life decisions. 

A person may choose to undergo genetic testing for themselves for many different reasons. One of the reasons is diagnostic: testing to identify a specific condition, or preventative, identify specific gene variants to determine a person’s risk for developing a condition (National Academies of Sciences, 2017). Here we are using the genome to predict how likely it is that someone will have altered physiology from what is considered "normal". Additionally, there is reproductive genetic testing where parents can identify if a child, fetus, or embryo is at increased risk for certain genetic disease (National Academies of Sciences, 2017). Since everyone is very interested in their personal health, genetic testing has become very popular!

So how beneficial is it for a person to have their genome tested? On one hand it seems like a very good idea. If someone recieves genetic testing for a certain genetic related disease they can have better chances at diagnosis and preventative treatment (Majumder et al., 2021). Additionally, they will be able to warn their relatives to also be aware of this disease (Majumder et al., 2021). Also it has been shown that those who recieve genetic testing are giving a greater autonmoy over their health and are more liekly to meet with a provider and life healthier (Marzulla et al., 2021). This shows that genetic testing is having a postive effect on some people. 

Although, there is other research that claims that genetic testing can actually be harmful to a patient. It has been shown that these tests are not always accurate and there are false positives and false negatives (Majumder et al., 2021). Additionally, genetic testing can increase behavior changes including regret, anxiety, and other physcolgical and emotional harm (Marzulla et al., 2021). And even though for some people genetic testing does make them go to their primary care doctor more the numbers are quite low; only 27% of people who are genetic tested actually share the results with a doctor (Marzulla et al., 2021). Whether or not genetic testing is more beneficial or detrimental has yet to be determined. 

Majumder, M. A., Guerrini, C. J., & McGuire, A. L. (2021). Direct-to-Consumer Genetic Testing: Value and Risk. Annual review of medicine, 72, 151–166. https://doi-org.dml.regis.edu/10.1146/annurev-med-070119-114727

Marzulla, T., Roberts, J. S., DeVries, R., Koeller, D. R., Green, R. C., & Uhlmann, W. R. (2021). Genetic counseling following direct-to consumer genetic testing: Consumer perspectives. Journal of genetic counseling, 30(1), 329–334. https://doi-org.dml.regis.edu/10.1002/jgc4.1309

National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Care Services, Board on the Health of Select Populations, & Committee on the Evidence Base for Genetic Testing. (2017). An Evidence Framework for Genetic Testing. National Academies Press (US).

Why Are Yawns Contagious?

    The act of yawning is often associated with drowsiness and boredom. A lack of sleep or interest often triggers an involuntary opening of the mouth with a long, deep inspiration and slow expiration. When we are exposed to constant uninteresting stimuli or are simply tired from a lack of sleep from the night before, our body utilizes yawning as a response in order to increase our arousal level and sharpen our cognition and attention. This is something that many of us know, but the bigger mystery is why many people yawn when they see someone else yawn. An article that was published in the PLOS One journal discussed the relationship between the contagiousness of yawning and empathy in humans. We as humans enjoy sharing emotions, having conversations, and engaging in social interactions. Because of these, we gain trust and develop relationships with the people that we care about the most. The social-emotional bond that humans develop along with the characteristic of empathy bonds people together. Therefore, the contagiousness of yawning can be linked to the relationships that we create with the people around us. In this article, the researchers found that “there is an empathic gradient increasing from strangers to kin-related individuals”, meaning that people are more likely to yawn when they feel like they have a deep bond with someone. So, if you want to know if someone cares about you, you should have a conversation with them, yawn, and then look to see if they yawn as well. If they do not yawn back, I am sorry to say that there is probably not a connection there.

Gupta, S., & Mittal, S. (2013). Yawning and its physiological significance. International journal of applied & basic medical research. Retrieved October 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678674/ 

Norscia, I., & Palagi, E. (2011). Yawn Contagion and Empathy in Homo sapiens. PLoS ONE, 6(12), 1-5. https://doi-org.dml.regis.edu/10.1371/journal.pone.0028472

Add Some Spice to Your Life

Both the tolerance and preference for spicy foods and chili peppers varies from person to person (personally, I cannot handle the heat, though I do like the taste). However, recent research suggests that spicy foods may have more than just a taste benefit for those who consume them. 

Spicy foods, particularly chili peppers, contain the chemical ingredient capsaicin. Capsaicin targets the receptor TRPV1, which is highly expressed in the taste buds. Many will say that the enjoyment of spicy foods can be attributed to an “endorphin rush” that is caused by the burning sensation of capsaicin. However, there is actually little empirical evidence that supports this idea (Spence, 2018). 

Instead, what is being suggested more and more lately is that spicy food and capsaicin can have biological health benefits. Studies have found that regularly eating spicy foods is associated with decreases in cardiovascular mortality and increases in metabolism (Ao et al., 2022), potentially due to the activation of pain and thermoregulatory responses such as sweating. 

Further, it was found that capsaicin may have clinical potential in treating autoimmune disorders, such as rheumatoid arthritis and multiple sclerosis (Deng et al., 2016). Treatment with capsaicin in rats has been shown to reduce levels of neuropeptides that are known to induce inflammatory responses associated with arthritis (Ahmed, 1995). Thus, there may be an ethical consideration necessary in how further research is conducted, specifically by pharmaceutical companies if they are hoping to sell capsaicin in products. It is important the the research remain unbiased and accessible to ensure that it maintains justice.

For those of you who like spicy foods, lucky you! You might be receiving some health benefits along with those hot peppers! (And for those of you like me who don’t, don’t worry, you can still get health benefits from eating well and exercising.) 

 

References 

Ao, Z., Huang, Z., & Liu, H. (2022). Spicy Food and Chili Peppers and Multiple Health Outcomes: Umbrella Review. Molecular Nutrition & Food Research, 2200167. 

Ahmed, M., Bjurholm, A., Srinivasan, G. R., Lundeberg, T., Theodorsson, E., Schultzberg, M., & Kreicbergs, A. (1995). Capsaicin effects on substance P and CGRP in rat adjuvant arthritis. Regulatory peptides, 55(1), 85-102. 

Deng, Y., Huang, X., Wu, H., Zhao, M., Lu, Q., Israeli, E., ... & Shoenfeld, Y. (2016). Some like it hot: The emerging role of spicy food (capsaicin) in autoimmune diseases. Autoimmunity Reviews, 15(5), 451-456. 

Spence, C. (2018). Why is piquant/spicy food so popular?. International Journal of Gastronomy and Food Science, 12, 16-21. 

Push It to the Limit - MOA of Pitocin

 Push it to the limit – and I’m talking about labor, not a song from the 2007 Disney Channel movie “Jump In!” from our childhoods. Pitocin is a synthetic form of the hormone oxytocin that is often dubbed “the love hormone” due to its release during sexual arousal and intimacy. However, oxytocin has crucial functions which include stimulating contraction of the myometrium to start labor, and effects on lactation such as the movement of breast milk from ducts to nipple. Oxytocin is a peptide hormone that is synthesized in the hypothalamus and released from the posterior pituitary. Its release acts in a positive feedback loop to continually strengthen contractions in labor. Sometimes, there are clinical implications that call for administering synthetic oxytocin, or Pitocin. Pitocin is used to induce uterine contractions in uterine inertia, which is when the uterus doesn’t contract strongly/rapidly enough to progress labor. Another use is a patient with preeclampsia or gestational diabetes who needs to be induced preterm due to medical complications. Third is in the management of second-term abortions. Pitocin can also be used to control late-stage uterine contractions and manage postpartum hemorrhage by preventing blood loss.

Stimulation of the uterus by oxytocin is not a new phenomenon (offspring have been produced forever), but the mechanisms by which oxytocin does its job is still being studied. The myometrium has oxytocin receptors, which are a type of G-protein coupled receptor. Binding of oxytocin causes activation of the GPCR and a cascade of enzyme/molecule binding including phospholipase C-β, phosphoinositide-bis-phosphate, inositol-trisphosphate, and diacylglycerol. These compounds cause the release of Ca2+ from storage in places like the sarcoplasmic reticulum. Calcium release stimulates Ca2+-dependent calmodulin as well as myosin light chain kinase (MLCK) which causes smooth muscle contractions. This is the generally accepted pathway by which oxytocin works, but the pathway is likely more complicated.

While the use of synthetic hormones in medicine has been lifesaving technology (e.g., levothyroxine), it does not come without ethical implications. One main ethical dilemma surrounds the use of Pitocin to induce contractions in patients getting an abortion. Many people against abortion would object to the use of a synthetic hormone to induce birth of a fetus that would not be viable outside of the uterus. Another ethical complication is the use of synthetic hormones in medicine at all. This leads into complex ideas such as gender-confirming hormone treatments or synthetics like ethinyl estradiol in contraceptives.

Copy and paste link for a surprise: https://www.youtube.com/watch?v=A3-JA49q-0o&feature=share&utm_source=EJGixIgBCJiu2KjB4oSJEQ

Arrowsmith, S. & Wray, S. (2014). Oxytocin: Its mechanism of action and receptor signalling in the Myometrium. Journal of Neuroendocrinology, 26, 356-369. doi: 10.1111/jne.12154.

United States Food and Drug Administration. (n.d). Pitocin® (Oxytocin Injection, USP) Synthetic [Fact Sheet]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/018261s031lbl.pdf.

Walter, M.H., Abele, H. & Plappert, C.F. (2021). The role of oxytocin and the effect of stress during childbirth: Neurobiological basics and implications for mother and child. Frontiers in Endocrinology, 12(742236), 1-10. https://doi.org/10.3389/fendo.2021.742236. 

Watson, S. (2021, 20 July). Oxytocin: The love hormone. Harvard Health Publishing. https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone.

Does Breastfeeding increase your IQ?

Breastfeeding has been in question forever when should you stop? How long should you do it for? What are the short-term and long-term benefits? I found a couple of studies that look at the duration of breastfeeding and the correlation of intelligence quotient (IQ), income at the age of 30 years old, and years of schooling. 

This study by Cesar Victora used information about breastfeeding in early childhood, then at age of 30, they studied the IQ, education attainment, and income of participants. Then using multiple linear regression with adjustment for 10 confounding variables to look for correlations. The results show that the identified dose response that was associated highest with the increased IQ level was 12 months or more had higher IQ scores, more years of education, and an increase in monthly income (Victora 2015). 

Other studies looked at how there was a positive correlation between the duration that a child was breastfed and the performance in secondary school test scores (Horwood 1998). Another study reported that breastfeeding also had a positive correlation with blood pressure and body mass index as well as a higher IQ (Brion 2011). 

Now breastmilk (BM) is very important for the growth and maturation of the organs, especially for infants.  BM has macro and micronutrients for infants to develop. An important part of BM includes antioxidants, to counteract the negative effects of oxidative stress in babies (Yuksel 2015). These antioxidant compounds include alpha-carotene, beta-carotene, lycopene, retinol, alpha-tocopherol, and y-tocopherol (Yuksel 2015). Overall breastmilk encourages neuronal growth factors to increase brain development (Yuksel 2015). Also increases vascular Endothelial growth factors to help all of the organs and tissues grow and develop (Yuksel 2015). 

The more the baby develops in a normal way the most natural way, the brain can develop with the most nutrients possible which could be the link to an increase in IQ score. However, this is a hard claim to prove, because no matter how alike each participant is, there is always a possibility of environmental factors affecting the IQ scores. 

Brion, M. J., Lawlor, D. A., Matijasevich, A., Horta, B., Anselmi, L., Araújo, C. L., Menezes, A. M., Victora, C. G., & Smith, G. D. (2011). What are the causal effects of breastfeeding on IQ, obesity and blood pressure? Evidence from comparing high-income with middle-income cohorts. International journal of epidemiology, 40(3), 670–680. https://doi.org/10.1093/ije/dyr020

Horwood, L. J., & Fergusson, D. M. (1998). Breastfeeding and later cognitive and academic outcomes. Pediatrics, 101(1), E9. https://doi.org/10.1542/peds.101.1.e9

Victora, C. G., Horta, B. L., Loret de Mola, C., Quevedo, L., Pinheiro, R. T., Gigante, D. P., Gonçalves, H., & Barros, F. C. (2015). Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. The Lancet. Global health, 3(4), e199–e205. https://doi.org/10.1016/S2214-109X(15)70002-1

Yuksel S., Yigit A.A., Cinar M., Atmaca N., Onaran Y. Oxidant and Antioxidant Status of Human Breast Milk During Lactation Period. Dairy Sci. Technol. 2015;95:295–302. doi: 10.1007/s13594-015-0211-z.

Make your brain hurt

 Which horizontal line is the shorter one? 

    Ehh, wrong! Go ahead, line them up and you’ll see they’re the same size. This is the Muller-Lyer illusion.

    Now try this one. Focus your eyes on the center dot and move your head closer to the screen or away from it without taking your eyes off the center. Why are the circles counter-rotating? The speed at which the circles rotate also depends on your motion. Perhaps it's the angled shapes or the black and white edges that's confusing our brains. But we know that there is no real motion, so what is going on? 

This image is called the Pinna-Brelstaff Illusion and it’s a great example of rotation perception in the absence of real motion. The visual areas mediating false perceptions in illusions are not well identified, but there are associations of both primary visual systems and higher-level processing (Tabei et al., 2015). Complex motion patterns such as rotation, expansion and contraction are encoded by a class of neurons in the dorsal region of the medial superior temporal area (MSTd) and receive signals from the medial temporal region (MT) which is sensitive to global motions (Tabei et al., 2015). An fMRI study done on macaque monkeys shows that rotation-sensitive neurons in the MSTd also encode illusionary motion, but there is a delay of about 15 milliseconds to distinguish the illusion reliably (Luo et al., 2019). 

Let's go back to the image. The earliest cortical stage of visual processing occurs in the primary visual cortex (V1) and these neurons are stimulated by their preferred orientation through its receptive field (Pinna, 2008) . In the Pinna figure, they’re stimulated by the implicit orientation of the rhombuses in each concentric layer, giving it “direction.” Although this seems to explain the basis of this illusion, the rotational motion is processed by higher cortical areas such as MT and MSTd (Pinna, 2008). 

There is obviously a disconnect and in this case our brain fails to re-create the physical world. Here are more illusions for funsies. 

Tabei, K.-ichi, Satoh, M., Kida, H., Kizaki, M., Sakuma, H., Sakuma, H., & Tomimoto, H. (2015). Involvement of the extrageniculate system in the perception of optical illusions: A functional magnetic resonance imaging study. PLOS ONE, 10(6). https://doi.org/10.1371/journal.pone.0128750 

Luo, J., He, K., Andolina, I. M., Li, X., Yin, J., Chen, Z., Gu, Y., & Wang, W. (2019). Going with the flow: The neural mechanisms underlying illusions of complex-flow motion. The Journal of Neuroscience, 39(14), 2664–2685. https://doi.org/10.1523/jneurosci.2112-18.2019 

Pinna, B. (2009). Pinna illusion. Scholarpedia, 4(2), 6656. https://doi.org/10.4249/scholarpedia.6656 

Alvarez, B., & Laliberte, M. (2022, September 30). 30 optical illusions that will make your brain hurt. Reader's Digest. Retrieved October 17, 2022, from https://www.rd.com/article/optical-illusions/ 

"Lost"

Female athletes endure more stress than men. There is no argument there. The cycle of hormones during a menstrual cycle puts their bodies and minds to the test. If that wasn’t enough, the situation changes week to week with different levels of these hormones causing different physiological conditions. 

The menstrual cycle has two distinct phases separated by ovulation. Long story short, there is the follicular phase that lasts roughly two weeks, ovulation, and then the luteal phase that lasts another roughly two weeks. The high levels of hormones, specifically progesterone, keeps the corpus luteum or endometrial lining of the uterus nourished until implantation. If implantation does not occur and human chorionic gonadotropin is not released by the fetus, the corpus luteum degrades which gives rise to vaginal bleeding known as one’s “period” (Reid, 2017).

What happens to extreme female athletes? Did they just… lose their period? No, of course, it’s more complicated than that. The phenomenon is known as athletic amenorrhea (Pauli and Berga, 2010). It is believed that the stress induced by extreme athletics causes allostasis or the change of physiological setpoints of homeostasis. This change causes less overall drive in the hypothalamic-pituitary- axis (HPA) to produce a large enough spike in luteinizing hormone (LH) and follicular stimulating hormone (FSH) to stimulate ovulation (Pauli and Berga, 2010). No ovulation leads to no progesterone production which leads to malnourishment of the corpus luteum, which of course means it won’t degrade and cause a period.

Why? What is the physiological adaptation to limit the drive of GnRH and therefore LH and FSH from the hypothalamus and anterior pituitary, respectfully, needed to ovulate and reproduce? The literature suggests an unfavorable caloric and lipid profile (Rickenlund et al., 2005). In my eyes, this means the homeostatic mechanisms in the body believe that this athlete is not healthy enough to nourish and care for a second body. Healthy is a loose term because some might think a low body fat percentage and the capability of extreme endurance performance is the healthiest one can be!

To return to the normal cycle, the most suggested mechanism is to choose a less demanding sport… which every healthcare professional should refrain from saying unless you want to ruin the dreams of your female athletes.

Pauli, S. A., & Berga, S. L. (2010). Athletic amenorrhea: energy deficit or psychogenic challenge?. Annals of the New York Academy of Sciences, 1205, 33–38. https://doi.org/10.1111/j.1749-6632.2010.05663.x

Reid RL. (2017). Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) In: Feingold KR, Anawalt B, Boyce A, et al., editors. South Dartmouth (MA): MDText.com, Inc.; 2000-.

Rickenlund, A., Eriksson, M.J., Schenck-Gustafsson, K., Hirschberg,, A.L. (2005). Amenorrhea in Female Athletes Is Associated with Endothelial Dysfunction and Unfavorable Lipid 

One shot to rule them all?

Whether it be Mac Jones high ankle sprain or Russel Wilson’s undisclosed shoulder injury, orthopedic medicine often has a solution. The course by which to get to a solution could vary patient to patient and in severity, but orthopedic medicine offers a variety of methods to help its patients. In particular, the administration of injections can alleviate painful symptoms associated with sports related injuries or arthritis. In my experience working at an orthopedic clinic, the three most administered injections were corticosteroid, hyaluronic acid, and Platelet Rich Plasma injections (PRP). The overarching goal is symptomatic relief, but PRP injections aim to provide that by means of promoting the healing process of the affected area. Now there is a difference between a patient’s perceived outcome and the actual outcome. The table below has a comprehensive list of PRP components and their associated effects, but the idea is to create highly concentrated plasma with these factors and inject it into the site of injury/damage (O’Connell et al., 2019). In doing so, this concentrated plasma can promote the healing process so one may increase recovery time, alleviate symptoms, or avoid surgery completely. While the effects of these growth factors have been shown to promote healing, you’ll find most research on PRP injections have to do with meta-analysis of perceived outcomes or pain scores. So what do we know PRP injections do? We think that the factors in PRP could induce a healing response, but have not been able to provide strong in vitro or animal model evidence that translate to a clinical setting (Everts et al., 2020). We know that in clinical practice, PRP injections can decrease the inflammatory response, which would correlate with one’s level of pain (O’Connell et al., 2019). We know that it can increase perceived outcomes associated with arthritis for some patients (O’Connell et al., 2019). What PRP research lacks is hard data on the extent to which it promotes healing and physical tissue growth. Additionally, PRP can be administered to the shoulder, the knee, an ankle, or even the plantar fascia of your foot. It would seem there are likely differences in each of these areas which further questions research and application associated with PRP injections, especially if procedures for administration don't change based off the site of injury (Everts et al., 2020). Furthermore, PRP injections are often not covered by insurance placing the financial buren directly on the patient. It seems that PRP injections could be beneficial for some patients, but research lacks evidence to suggest this method of injection can actually promote the healing process across the board for every patient.

From: The use of PRP injections in the management of knee osteoarthritis

Table 1.

 

O’Connell, B., Wragg, N.M. & Wilson, S.L. The use of PRP injections in the management of knee osteoarthritis. Cell Tissue Res 376, 143–152 (2019). https://doi-org.dml.regis.edu/10.1007/s00441-019-02996-x

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