SYSK TRENDING -Taking a Tour of the Human Body

0:00What do you want, Chris Reagan? Suck this! I want my life back. A October 23rd. The procedure is causing, traveling, physical changes. What's happening to me? Look fear. You have to learn to control it. In the face. I have no idea who you are anymore. Tell me who you want me to be. Clayface. Only Peter's October 23rd. With your dog. You live inside your body every moment of every day. But how much do you really know about what's going on in there? Your heart beats about 100,000 times a day. Your kidneys are constantly filtering your blood. Your liver performs hundreds of different jobs. And your heart, lungs, brain, bone, blood vessels, and digestive system are all working together in ways most of us rarely stop to think about. But maybe we should. So that's why today's S.Y.S.K. trending topic is taking a tour of the human body.

1:03Dr. Jonathan Reisman is a physician who has explored the human body in ways most of us never will. And he's going to take us on a tour inside to explain what your organs actually do, why they look the way they do, and reveal some truly strange and fascinating things about this body you've been walking around in your entire life. It's an intriguing journey that will begin right after this. There's probably no better endorsement for a company than this. I keep buying their stuff. That's exactly what's happening with me and Quince. It started with their clothes. I've bought sweaters, polos, pants, jeans, shoes, a belt. And Quince has become one of the first places I look when I need something new to wear. And my wife and son buy from Quince too all the time. What keeps bringing us back is the quality and the price. Quince uses premium materials like 100% Mongolian cashmere, organic cotton, marino wool.

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3:13You must have questions or wondered how it is that all the parts of the human body work and work together to get you through the day, through your life. Today you'll come to understand how some of it all works. Let me introduce you to your tour guide today, Dr. Jonathan Reisman. He's a doctor of internal medicine and pediatrics who has practiced medicine in the world's most remote places. He's author of a book called The Unseen Body, a doctor's journey through the hidden wonders of human anatomy. Hey doctor, welcome to something you should know. It's a pleasure to be here. So why don't we start the tour, if you don't mind, with the throat. A lot of people wouldn't consider the throat a body part, but I guess it is. And so what is it about the throat that you find interesting? The thing I like to focus on in the throat is how kind of unnervingly close the food to the esophagus is to the air tube, the trachea.

4:14You know, in our throats, the job of our throats is kind of to deal with everything that we inhale, that we swallow, that everything that comes in our nose and mouth, sort of coalesces in the throat. And then our throats job is to keep everything but air, you know, out of the airway, everything we swallow must go down the food to the esophagus to the stomach. And only air should go down the windpipe to the lungs. The amazing thing is, you know, we swallow thousands of times a day, whether we're eating food or we are subconsciously swallowing. And every time we swallow, whatever that is, food, drinks, saliva is coming within millimeters of the opening to the windpipe. And so one small slip up, if some of that goes in the windpipe, you could, you know, pretty much choke and die. And so when I take a drink of water and choke and people often say it went down the wrong pipe, is that exactly what happened? Yeah, that's exactly what happened. Some of that water went down your windpipe or your trachea and ended up in the lungs.

5:16And the body has evolved many ways of dealing with that because it's sort of inevitable, given how close the two entrances to the tubes are, you know, sort of inevitable, something's going to go down the wrong tube. And when you laugh or speak while trying to swallow, you're kind of opening up the airway. And if you try to swallow, you're opening up the food tube. And so if you do those two things at the same time, both tubes are open, which is why things happen, like things going down the wrong pipe. And coughing, which probably results it after those instances, is one of the ways that we kind of clear out the lungs. The lungs coughing is a mechanism for kind of clearing out whatever goes down the wrong tube. And it's quite effective at getting rid of it. Can you talk about the liver because that's one of, you know, many internal organs that most of us don't know much about. We know we have one and we know it probably does something. So what does it do? Why is it there? So the liver is almost like a hundred organs packed into one. The liver is one of our most complicated organs. It's the biggest internal organ, the skin, which is also an organ is actually bigger. But as far as internal organs go, the liver is the largest. And which is appropriate because it has a ton of jobs. It really in a way oversees all of digestion and all of metabolism.

6:27So whenever you eat or drink anything, it comes into your intestines and then is absorbed into the bloodstream. And the first place it goes from there is to the liver where the liver sort of checks out, you know, what is this thing? What did we just take into our body? Is it nutrition? Is it poison? And what do we do with it? So the liver from there will sort of sort of sort and package. It's almost like, you know, the Amazon sort of sorting and packaging center where it determines where everything is going to go. It packages up all the protein, all the fat, all the cholesterol, sends it to appropriate organs somewhere else in the body. And it also obviously detoxifies, you know, famously detoxifies poisons, including our favorite poison alcohol. And so really the liver just does a tremendous amount every day to keep us alive. And you know, the best illustration of how important it is is when it fails. And people with cirrhosis of the liver, everything kind of goes wrong with the body in those cases. So that's one of the things it's always fat. There's so many things like what you just described about the liver and then there's all these other organs.

7:29It's a wonder. Things don't go wrong more often. I mean, things do go wrong, but there's so much to us that you would think we would break down more than we do. You're right. And that in many specific instances, I got that same feeling while learning about the body. For instance, there's bacteria right all over us, even in us in our throats, our noses throughout our intestines. Many of those bacteria could kill us if they got into our bloodstream and perhaps landed in the right organ, you know, landed, let's say in our central nervous system causing meningitis. I mean, there's bacteria that could kill us if it got to the right part inside our body. And yet here it is sort of millimeters, you know, it's on us or even inside our gut perhaps yet it's sort of only millimeters away and kept that day by, you know, various parts of the immune system, white blood cells, also just membranes that sort of prevented from invading. And so sort of like I always think of the body as sort of the barbarians are right at the gate and any moment they can sort of slip in not only can you aspirate choke and die with any swallow, but you know, if your guard is let down for a moment, these, you know, virulent bacteria can invade and kill you.

8:39And yet we go about our days or happily for decades at a time, perhaps suffering no ill consequences from these things. So since the skin is the largest organ in the body or of the body, I guess we have to talk about that. So what is it you find so fascinating about the skin? There's kind of the social aspect of skin where we, you know, skin is what we see in other people when we look at someone's face that we recognize, you know, mostly what we're seeing is skin and that that's how you know people. But on a biological level, the skin is really amazing. It's almost doesn't get credit for being a very intelligent organ almost predicting the future, you know, when when sun rays bombard your skin. The skin is smart enough to want to become tan and tanning involves producing a dark pigment and putting that pigment right in front of the nucleus of every cell in the skin. Because the nucleus where the DNA is and that's where the harmful sun rays, the UV radiation can disrupt the DNA and result in the skin cancer. So it produces these little plugs of dark pigment right in front of the DNA, almost like putting sunglasses over, you know, your eyes.

9:45In the same way it's building this wall in front of all of its DNA, knowing that more sun might be coming in the future and it will want to protect its DNA from the harmful radiation. And the same kind of amazing ability when the skin creates a callus. So if you get a repetitive friction on your skin, the skin thickens and hardens into a callus, almost to anticipate future, future friction in a way, you know, and sort of will be better protected against that future friction. So not to mention when people get cuts or lacerations when they come to the ER, you know, I usually will repair them with sutures or stitches, but skin really has an amazing ability to repair itself, you know, any wound almost as long as the person's healthy and well nourished will, you know, the skin cells will invade from all sides of the wound and fill that defect and just kind of fix the hole in the body that shouldn't be there. So skin is really amazing for all those reasons. Talk about the eyes. The eyes are a really peculiar organ. I mean, their function is incredible. Obviously everybody knows that the fact that they can, you know, allow us to see the world around us.

10:53Another aspect of the eye that I really enjoyed well, well learning to become a doctor was how I use it a lot in emergency medicine. It's often the most important thing I look at in certain cases. So if someone comes in, let's say comes into my ER completely comatose, unresponsive, even when I push hard with my knuckles and rub their breastbone called a sternal rub, if they don't respond to that, you know, something's really something terrible is going on like why are they combatose. And actually the first thing I'll do in those cases is look in their eyes. So I won't grab my stethoscope. I won't grab anything else. I'll grab a light off the wall behind their bed and I'll peel open their eyelids and try to into their eye. And in a way, I'm sorry, the eyes are telling me what's going on in the brain. So, you know, there's this old saying the eyes are the window to the soul in the practice of medicine. The eyes are actually a very useful window to the brain and can tell me what's going on. So if I peel back their eyelids and for instance see that one of their pupils, not both, but just one is really large wide open and when I shine a light into it, it does not shrink as it should in response to the light.

12:00We call that a blown pupil and that can tell you that there's high pressure inside the skull. If on the other hand, as often happens, my patient comes in, I peel open their eyelids and I see that each of their pupils are very, very tiny black dots almost like a little black poppy seed on both pupils. That actually suggests that they've had opioid overdose, like heroin or fentanyl. Certainly, if we're going to talk about the human body, we have to talk about the heart because that's probably one of the organs people think of the most and the blood, you know, since that's what the heart is doing. So why, and heart disease, I think, is the number one killer in this country. So what's so special about the heart to you that you find so fascinating? It's main function obviously is to push blood. You know, in one way, the heart is sort of a simple mechanical pump, which, you know, maybe is much simpler than let's say the deliver which has sort of all these millions of metabolic biochemical reactions going on all the time.

13:02The heart is sort of in a way simpler in that it just squeezes and pushes literally blood up into the aorta and then into the rest of the branching vascular tree of blood vessels. And what the heart and the blood do together really is just deliver nutrition and oxygen in the blood to the kind of the doorstep of every cell in our body. And we have something like a trillion or more cells. And so each one every moment must be receiving oxygen primarily, but also nutrition of various kinds and also the blood has to then take away the waste from those cells. So in a way, when, you know, our ancestors in the distant past started a single cell organisms, that was sort of easy. The fluid of life was sort of surrounding them all at all times. And so it could, you know, it was they were surrounded by it and it didn't need to get delivered to them. But once you start getting multicellular organisms, especially at trillion cells like us, you know, getting that nutrition, that fluid containing all the things you need to live, getting it to every every cell requires this kind of infinitely branched cardiovascular tree, pushing blood to each to each cell and then bringing away the waste.

14:13And so that's kind of the job that the heart and blood do every moment. In a way, when we, you know, in cardiac arrest, for instance, when the heart stops beating and stops pushing any blood forward, it's all the, you know, the whole body is sort of dead at that moment. We often note the time of death when the heart stops in particular, you know, people, your liver can fail. You might have weeks to live. Your kidneys might fail. You might have days to live. But when the heart stops, you're dead. We are taking a tour of the human body with Dr. Jonathan Reisman. He's a doctor of internal medicine and author of the book, the unseen body, a doctor's journey through the hidden wonders of human anatomy. Starting or growing your own business can be intimidating and lonely at times. Your to-do list may feel endless with new tasks and lists can easily begin to overrun your life. So finding the right tool that not only helps you out, but simplifies everything as a built in business partner can be a game changer. For millions of businesses, that tool is Shopify.

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16:19So doctor often when you go to a doctor visit, they want you to pee in a cup and they want a stool sample. And so what is it that you can tell from that? That's a great question. So I often say, you know, the bodily fluids are kind of the medium of a doctor's craft. Most of the time what what I'm doing as a doctor is getting a patient's bodily fluid, whether it's urine or stool or blood. And sending it to the lab or testing it myself in some bedside manner where you're kind of in a way reading messages from these bodily fluids, you know, urine is urine is a language and blood is a language is talking to your provider, your health care provider, your doctor telling you what's wrong. And so as a doctor, you know, learning about disease meant learning about those bodily fluids and what the messages mean. So when urine turns red, for instance, depending on the clinical context. You know, if I see red urine coming out of the patient or in the cop that they then delivered to me from the bathroom, I could think they have a kidney stone. I could think they have a bladder cancer or a kidney cancer or some other injury.

17:27So maybe they were just got a punched in the kidney by someone. So it's kind of depends on the context, of course, but those colors are telling me something and I have to interpret them and figure out what's going on with the patient and every bodily fluid has its own kind of messages, you know, whether it's color consistency, smell, you know, and then obviously beyond that things you can measure under the microscope, you see under the microscope or measure, you know, electrolytes or blood cell amounts and other things is sort of a million messages. Contained in these fluids and so reading them is a really important part of figuring out what's wrong with the patient, which is sort of the first step to alleviating it. Yeah, I remember hearing someone talking about this that it's pretty seldom that if you go to the doctor, you know, for your physical and I think this was in a discussion about how necessary is an annual physical that very rarely does somebody go to the doctor feeling fine and find out that there's something horribly wrong with them and they had no idea. That if you've got some condition that's fairly serious, you probably have some inkling that something's wrong.

18:36In most cases, I do think that is correct, not all cases, you know, for instance, high blood pressure sort of considered the silent killer in the mode, but you're right, you're right, there's been a lot of appropriate questioning of the annual physical, you know, a lot of the times to be honest, the doctor puts a stethoscope on a patient's chest. To hear the heart or the lungs, honestly, most of the time it's unnecessary to be honest, not talking about an ER where someone's coming in with chest pain, but you know, in the general doctor's office like you're very unlikely to find something new. And then there's also the question of, you know, if someone goes to their doctor and they don't listen with the stethoscope, they might feel like, well, what kind of doctor is this? You know, I'm just listening to my heart. Are you ignoring my internal organs? You know, how I didn't get my money's worth? Well, I think people feel that a lot because nowadays you go to your physical and the doctor spends a lot more time on his keyboard than he does touching you. And it's like, well, wait, what about me? That is a huge problem. And I've had that experience myself. I've been the patient actually when I was in medical school, which is funny, because I was sort of, you know, supposed to be learning how to be a doctor, how to be a good doctor.

19:43And the doctor I saw for a kind of a general checkup, I don't think he looked me in the eye once. He was a very slow type, which I sympathize with though I'm a fast type, but you know, there is so much the burden of documentation on doctors, especially primary care doctors kind of grows every year. So I understand the, you know, the need to look at their computer and type while they're talking to the patient, especially as the number of minutes you have with each patient gets lower and lower as reimbursements are cut back, you know, needing to kind of finish your notes before you go home and have dinner with your family is a big, bigger, bigger burden. But still, I think, you know, it definitely, I mean, it's dehumanizing, you know, it makes you sort of wonder, do they know I'm here? Do they care that I'm here? Is the opinion on the diagnosis and treatment actually going to be worth anything given how little they're sort of looking at me. And it also point a sort of draw points to the fact of how important eye contact is and just sort of basic human to human interaction, a huge part of medicine is just kind of being a human and having a sort of a normal social interaction between the doctor and the patient where you're hearing their story, they are feeling heard, you're making eye contact.

20:59And sort of, you know, not touching them too much, not touching them too little it's kind of this fine balancing act where you're in the sort of very bizarre social interaction where you just met each other and yet I'm asking you about the color of your stool how often you're sex. What the color of your snot, I mean, everything it's sort of the most intimate conversation you could imagine with someone you just met from all your experience as a doctor and you've had an interesting career. Is there anything or any set of things that you wish people would do that would really help? Yeah, well, I guess that, you know, I think a lot of time is spent in ER is sort of wondering why, why did the patient come? Why didn't they just stay home? You know, you know, and I don't blame the public for this, I feel like sort of the basic medical education for the public is not great. And I wonder if there should be sort of basic courses in high school, you know, instructing people how to deal with their sort of basic, you know, colds and other things like that.

22:05People just don't know. So for instance, we see a ton of children, let's say coming into the ER with a fever and the overwhelming majority of those fevers are, you know, a viral illness that might get that that will most likely get better on its own doesn't need any antibiotics or any even x-rays or blood work just needs some Tylenol or ibuprofen and just make sure the kids hydrated and that's it. But I think people, you know, understandably don't know that they, you know, most viruses, thankfully are kind of can be ignored. This of course does not count, you know, is it COVID? I need a note saying my kid can go back to big care back to school that I understand. And let me repeat, I don't completely understand if people don't feel comfortable making that call for themselves. But like 90% of what I do for children in the ER is giving them over the counter medications like Tylenol, ibuprofen and sometimes Benadryl for hides and other rashes. Well, I imagine that a big part of a doctor's job and perhaps one of the more enjoyable parts of your job is to let people know there's nothing wrong that yeah, you maybe you have a symptom, but it'll go away or that you'll be fine.

23:12I think that you're right that is a big part of every doctor's job, but it's especially the case with pediatricians partly because usually nothing is wrong with the children, not always obviously, you know, sometimes things are wrong. But for the large part, for the most part, when children let's say come to the ER with a fever, the large, large majority are just viral illnesses that will go away on their own need no workup need no testing and need no specific treatment. And, you know, I get a lot of I'm an internist and a pediatrician, so I see both adults and children and work in the ER. A lot of internists who only treat adults will often say to me, you know, I don't know how you do pediatrics. The parents just must be so difficult to deal with. And I don't find that at all. I find parents, most for the most part, you know, yes, some worry too much. I mean, I'm a parent too. I've worried too much about things that ended up being nothing myself, even though I'm a pediatrician, it happens. But I find parents are very reasonable and very understanding your reasoning and the reassurance really works. That was almost one of the most shocking things was when I became a doctor and I could tell people, oh, it's, you know, for reasons x, y, and z, this is not a serious illness and you don't need antibiotics and just keep an eye on them and they'll get better.

24:24They really responded to that. Like it was sort of this message coming from the mountaintop of the, like sort of universal truth and I sort of was surprised that they trusted me or believed me, but they do and they're just looking for someone who has experienced evaluating trail of dream with fever, which I've done thousands of times, you know, to tell them, you know, I've seen, I've seen tons of deadly infections. I've seen tons of mild infections. This one's mild and they reassured and they go about their life. What's one thing about the human body that you find so interesting that might surprise me? You know, I could say one thing I particularly enjoyed learning a medical school was about urine as a bodily fluid. I can mention that it is my favorite bodily fluid of all and while most people never thought of having a favorite bodily fluid. You know, as a doctor, I mentioned bodily fluids are kind of the medium of our craft. It's what we spend a lot of time analyzing and interpreting to make a diagnosis, but urine in particular, I find really fascinating not only because as a doctor, it tells me so many messages about the body.

25:27It tells me about the urinary track through which it flows from the kidneys to the bladder, tells me about diseases in those organs, but also tells me about body parts that are distant from the kidneys and seemingly completely unrelated to the urinary track. But one thing that I really love about urine is how the salt levels in the bloodstream, the sodium and chloride are high, the potassium is low, and the kidneys are responsible for keeping those salts, those electrolytes in just the right balance. And that balance happens to match the concentration of salts in the ocean. And I sort of love that because our ancestors sort of evolved first in the ocean. And so the only reason that we were able to sort of crawl out onto the land and live as air breathing animals with lungs, the main reason is because the kidneys by making urine carry around the ocean inside of each of us. So in a way, we're each sort of still have that ocean inside of us and our cells, which are fed blood and fed the nutrients and electrolytes in blood.

26:29Almost don't know we ever left the ocean at all because as far as they know, it's everything's still just a salty with the same proportion of electrolytes. So that makes me love urine even more, the fact that as it flows, it's sort of keeping everything in balance and keeping this little bit of ocean inside of each of us. Well, in all my conversations and all the interviews I've done, thousands of them, I've never spoken with anyone about their favorite bodily fluid. So this was fun and unique. My guest has been Jonathan Reisman. He is a doctor of internal medicine and pediatrics and his book is called The Unseen Body, a doctor's journey through the Hidden Wonders of Human Anatomy. There's a link to his book in the show notes. Thanks, doctor. Awesome, it's been an honor to chat with you, Mike. I really, really enjoyed it. My pleasure. And that's today's S-Y-S-K trending episode. I'm Mike Herothers. Thank you for listening to something you should know.