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Stephen Loyd, M.D., FACP Associate Chief of Staff of Education Associate Professor of Internal Medicine Mountain Home VA Medical Center.

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Presentation on theme: "Stephen Loyd, M.D., FACP Associate Chief of Staff of Education Associate Professor of Internal Medicine Mountain Home VA Medical Center."— Presentation transcript:

1 Stephen Loyd, M.D., FACP Associate Chief of Staff of Education Associate Professor of Internal Medicine Mountain Home VA Medical Center

2 There is only one basic human right, the right to do as you damn well please. And with it comes the only basic human duty, the duty to take the consequences.

3 Dr. L. Calhoun is a pleasant 57 year old male Dean at a local college of pharmacy. He presents to your office with a chief complaint of: Im short of breath. HPI: The SOB has been gradually getting worse over the last 3 months. It is worse with lying down and better with leaning up. It is accompanied by lower extremity swelling that is relieved with the raising of his legs. His friends and family have commented on his color and he says that he feels like he looks orange.

4 Past Medical History: hypertension Past Surgical History: none Social History: no tobacco; he is divorced but dating a 19 year old stripper; he drinks moderate alcohol; he has had 2 DUIs in the remote past; denies illicit or IVDA Family History: no premature coronary artery disease, no colon cancer, no prostate cancer Medications: atenolol 50mg once daily

5 Milner and Olds McGill University 1953 Implanted electrodes in rats brains to target the sleep/wake area- they missed the target Delivered a shock as the rat approached corner A Rat continued to preferentially go to corner A Thought that they had found the area of the brain that controlled general curiosity

6 Tried to steer away from corner A Delivered a shock when rat approached corner B Within 5 minutes, the rat preferentially went to corner B to be shocked

7 Rats pressed a lever 1 lever would be reinforcing= food/water 1 lever would be a punishing stimulus= an electrical shock The rats learned very quickly to press the reinforcing lever

8 Take the rats with the implanted electrodes Have a lever that when pressed would deliver a shock to the targeted area This area turned out to be the pleasure center or reward area of the brain

9 Rats would press the lever 7,000!! times per hour to stimulate the pleasure center Rats preferred the stimulus more than any naturally occuring stimulus Preferred over food- even when hungry! Preferred over water- even when thirsty! Females would abandon newborn nursing in order to press the lever Males would ignore females in heat in order to press the lever!!!!!!!

10 The rats had to be unhooked from the stimulation to prevent death from self- starvation Pressing the lever became their entire world- sound familiar?

11 Midline of the brain Ventral tegmental area Nucleus accumbens Medial forebrain bundle Septum Thalamus Hypothalamus

12 What does this mean for humans? Does the stimulation of this area produce a crazy pleasure thats better than food or sex or sleep or even Seinfeld reruns? from Compass of Pleasure

13 Department of Psychiatry and Neurology at Tulane University 1949-1980 Highly unethical studies Performed the same experiments as Milner and Olds did with rats only he did it on humans The humans were institutionalized psychiatric patients that were unable to give informed consent

14 Stimulated the reward center in order to cure homosexuality Showed male/female porn pre-stimulation and during stimulation When allowed free access to stimulation- pressed the lever like a teenager playing Space Invaders!

15 Same thing Produced an intense pleasurable and sexual feeling She stimulated throughout the day Neglected hygiene and family responsibilities Ulcers developed on her finger from pressing the lever Vigorously protested when disconnected from the stimulus










25 Majority is metabolized in the liver First enzyme ADH Acetaldehyde- toxic= nausea and vomiting Is also carcinogen Mutant ALDH= toxic effects of acetaldehyde = antabuse Protected from alcoholism

26 Women have decreased ADH- what does this mean?? Europeans have highly active ADH- what does this mean?



29 Both ADH and ALDH give us increased NAD to NADH+ Increased NADH+ leads to inhibition of gluconeogenesis. What does this mean?


31 Increased NADH+= decreased fatty acid oxidation= steatosis which leads to cirrhosis A cirrhotic liver has trouble conjugating bilirubin. Acetaldehyde leads decreased protein synthesis which brings us to the secret to life…….????......










41 Decreased kidney perfusion leads to: Increased R-A-A which leads to: Increased sodium retention which leads to: Increased water retention which leads to: Increased hydrostatic pressure which leads to: Worsening yin and yang between hyrdostatic pressure and oncotic pressure which leads to:



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