April 7, 2017

Dr. Bloom's Matula Thoughts for April

Here is the latest edition of Dr. Bloom's monthly Matula Thoughts "What's New" newsletter.

One.              

April, the first 30-day month of the year, opens up the northern hemisphere spring with welcome visibility of diverse flora and fauna. It should surprise no one that the diversity of life sustains all life on the planet and loss of that diversity imperils everything. A multitude of critters share our space and today it is the wombat that comes to my mind. Australian newspapers The Sydney Herald and The Age reported a wombat attack this day in 2010 when a man named Bruce Kringle ended up in the hospital after mauling by the marsupial. The worldwide British Broadcasting Corporation quickly picked up the news. These sizable animals average over 3 feet and 60 pounds as adults. Territorial infringement was likely in play in this instance, as the victim was living in a camper when he stepped out the door and encountered the angry wombat, unusual behavior for the animal and ultimately self-destructive after Kringle found an ax and made short work of it.

The Wombat coincidence this day on this April day peaked my interest, because in a previous April, 1998, the British Journal of Urology (BJU) published an article on wombat uroflowmetry. [D. Johnson. Case report. Observations on the uninhibited bladder of the common wombat. BJUI. 81:641-642, 1998.] For those readers uninitiated regarding matters of scientific micturition, uroflowmetry is the measurement of the flow rate of urine during the process of emptying the bladder. Mankind is naturally curious about its personal byproducts and inspection of sputum, urine, feces, etc. has offered clues to understanding disease since the times of the earliest healers. Of course most mammals have olfactory interest in their own urine and that of others, as evidenced in the canine world. Uroflowmetry provides true facts about urination, thanks to our ability to measure time and volume, as well as understand velocity.

My interest in uroflowmetry preceded the wombat stories and goes back to Walter Reed Army Medical Center where my chief, Ray Stutzman, introduced me to the concept of timed uroflowmetry and we wrote a paper comparing it to instrumental uroflowmetry. [J. Urol. 133:421, 1985] I then wondered about uroflowmetry in other species and the elephant seemed a good place to start. Discussion with the elephant-keeper at the Washington National Zoo taught me something about pachyderm urologic habits, but we never completed the project, mainly because of a difference of opinion on the distribution of the tasks required by the methodology. Timed uroflowmetry requires a collection device and a stopwatch to measure the volume during 5 seconds of mid-flow. All of the elephants at the Washington Zoo at the time were female and their streams therefore required a collection device both large in volume and wide in aperture– basically a big bucket. The unpredictability of elephant micturition required someone standing in place with the bucket. Since the uroflowmetry idea was mine and the elephant-keeper was on better terms with the pachyderm than I was, it seemed reasonable for me to hold the watch while the other guy held the bucket. The elephant-keeper disagreed with that assignment and claimed the stopwatch. Given that stalemate, the study has yet to be performed and awaits an ambitious medical student or resident, or a more flexible elephant trainer.

Another elephant crossed my path around this time of year after Ed McGuire brought me to Michigan. A child with gross hematuria presented to clinic with her grandparents and we diagnosed urologic malignancy. After surgery she remained in hospital for further treatment and by this point the parents had come to town. They were circus people and owned a number of animals including a young female elephant. Domino’s Farms graciously allowed the family to camp out on their property for the weeks of therapy, and one spring afternoon the child’s family invited our pediatric urology team and kids for elephant rides.

Two.            

Planarial detour. Scientists crave facts and know their job is to ferret out true facts. Bill McRoberts, colleague in Kentucky, friend, and our third Duckett Lecturer at Michigan used to tell his residents “a little fact trumps a lot of myth,” an idea parallel to Coffey’s advice to trainees:  “you have to understand the difference between facts and true facts.” Evidence, analysis, and experiment are the ways we come to verifiable truths and enduring realities that constitute true facts. While all biological creatures deal with facts of their environment, many facts are only transient realities. A planarium, for example, may sense that its world is 20°C and that food is available straight ahead of its momentary motion, but those facts may change quickly. We humans can examine myths, discover momentary facts, create hypotheses, and perform experiments in search of something we call the truth, an aspiration we think is unique to our species.

Planaria, by the way, are among the simplest animals to manage their waste with a dedicated excretory system.  Paired flame and tube cells ending in a pore assemble as protonephridial tubules along the length of the flatworm. These are capable of regeneration. [JC Rink, HT-K Vu, AS Alvarado. The maintenance and regeneration of the planarian excretory system are regulated by EGFR signaling. Development. 138:3769, 2011] Planarial flow rates could be a topic for a future study. More practically, the mechanism of planarian excretory regeneration could be turned to human renal replacement therapy, thus proving the point that today’s obscure fact may be tomorrow’s revolutionary insight.

When the wombat uroflowmetry paper in the BJU caught my attention in 1998, I suspected a prank, something not unknown in British medical publications, particularly around the month of April. Thinking a clever reply might be appreciated by the journal, I resorted to limerick form in a letter to the editor, Jeff Chisholm. Surprisingly, my letter was published and now constitutes the only “poetry” of any sort to find its way into my CV. [DA Bloom. Re: Wombat uroflowmetry. BJU 83:365, 1999.] Chisholm annotated my reply: “Edited versions – apologies to the author!" The annotation was in this limerick:

“Lo, the wombat – it all must be true

So free when it’s not in the zoo

Pees lots when it poops

By well-used neural loops

As told in the new BJU”

[If you want to read more of the What's New this month, please open the attachment herein or go to matulathoughts.org.  The full 3674 words are too much for the fast thinking we bring to email.]

Postscript.

John Barry, in response to the picture of the Olds 88 last month wrote: “Looks like a 1951 Oldsmobile 88 K-body 2 door sedan with a V-8 engine and a Hydramatic transmission. I had one when I was a senior in high school. Great car. I used to buy cars, fix them up and resell them from my parent’s driveway.

Last month's internal weekly "What's New" profiled: a.) Development Update by Vince Cavataio; b.) Dr. John Stoffel’s reflections on time as Acting Chair; c.) Partnerships with Athletics; and d.) AUA Preview. [https://medicine.umich.edu/dept/urology/march-2017-whats-new]

Thank you for reading Matula Thoughts this April, 2017.