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Blast from the Past: Taco Time

by Rob on July 30, 2010 · View Comments

in Oldies

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Time to lighten things up.  Since I am a bit weary (and more than a bit lazy), I’ll repost one of my favorites:

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Well, let’s get this thing off the ground. Right off the bat, Awesome Mom asked in incredibly good question:

“Why does my husband think that putting ketchup on tacos is a normal thing to do?”

Given the fact that I happen to have spent some time doing basic taco research, and that I have eaten both tacos and ketchup (although not simultaneously, I must admit), I am the perfect person to answer this question (although a guy in a taco suit may also be a good candidate).


Most men do not put ketchup on tacos. It is actually a condition that occurs in 1 in 5,000 people, with a preponderance of these being men. The taco/ketchup combination is what is known as a x-linked recessive genetic disorder.

Genetically, the difference between men and women is that women have two “X” chromosomes, while men have one “X” and one “Y” chromosome. The x-chromosome does not, in fact, look like an “X” at all, but instead looks like a worm with a waistline (as pictured above). Why is it named “X” then? Well, it has a tendency to get tangled up with the other x-chromosome and so when researchers first saw it, it looked like a “X.” Besides, “worm with a waistline” chromosome would just not have sounded very good.

The y-chromosome is much smaller than the x-chromosome, and does not look like a “Y” ether, but instead looks like a much shorter worm with a much lower waistline.

You may have noticed that these chromosomes are striped. Those stripes are things called genes. Genes have a tendency of alternating between black and white, which has made it much easier for scientists to crack the genetic code. Another thing that made it easier to crack the code were the little lines with numbers and letters. Nobody knew what these numbers and letters meant for many years, but through painstaking research, they have determined that these letters are a code that tells your body how to be either a man or a woman.

You may have also noted that x-chromosomes have many more genes than y-chromosomes. Many scientists believe that the feeling by many women that jeans make them look fat comes from the fact that there are more genes in a women’s body, and this is actually a cry for help from the chromosomal level. Other scientists think these scientists are just full of hooey.

We get one set of chromosomes from our mother, including one x-chromosome, and one from our father: either an x or a y. For a trait to be expressed on the outside of a person, it must (in most cases) be present in both sets of chromosomes. X-linked conditions occur when a genetic trait is expressed on the the x-chromosome. The y-chromosome is too wimpy to put up much of a fuss, so a man with a trait on the x-chromosome will have the genetic trait. For a women to express the trait, both x-chromosomes have to carry the gene for that trait.

A good example of this is the most common form of color blindness. If a man has this trait on the x-chromosome, he will be color blind. For a woman to have the same type of color blindness, she must have the gene on both of her x-chromosomes. That means, a man will get his color blindness from the x-chromosome of his mother (since he had to get the y from his dad). This can be seen in the diagram below.

So it should be becoming obvious that putting ketchup on the taco is a x-linked disorder. It is, in fact, carried on the Xp-11,12 gene. This means, Awesome Mom, your mother-in-law is responsible for passing this gene on to your husband. Some have postulated that this too is a bunch of hooey and that the whole x-linked theory was made by some angry woman scientists who wanted to blame things on their mother-in-laws.

What can be done about his taco/ketchup tendency? Gene therapy is something that could help. To do so, you can either take a virus that goes for the x-chromosome and alters the Xp-11,12 gene to no longer favor this combination, or the virus can tell the y-chromosome to stop being such a wimp and stand up to that nagging x-chromosome. Since scientists are not sure what trouble an embarrassed y-chromosome would cause, this latter solution is not favored.

Putting down the toilet seat, by the way, is a trait carried on the x-chromosome as well, but the y-chromosome is sick of being pushed around in most men and makes a stand when it comes to putting the toilet seat down. Sorry, there is little hope for that one.

So that is the first installation of “Ask Dr. Rob.” Hopefully it will not be the last. If you have other questions that need answering, please send an e-mail to dr.rob.questions@gmail.com.

Thanks Awesome Mom!

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Call Off the Dogs

by Rob on July 30, 2010 · View Comments

in Personal Musings

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I’ve been getting a lot of traffic lately…and a lot of comments.  Perhaps you’ve noticed.  Overall I see this as a good thing; I write to be read, not to be a voice echoing in the virtual void.  I want to share my thoughts and ideas and enjoy my interaction with people, even those who don’t agree (especially with them).

But a few things have happened lately that have saddened me.  The first was the reaction of some to the post about Chronic Disease.  Most of my readers saw this as it was meant: a look into the not-so-perfect psyche of doctors and some tips on how to handle them successfully.  Some, however, accused me of “victim blaming.”  They were offended that I would suggest that patients should be aware of how they came across to doctors.  They felt that I was being patronizing by assuming a I know how they felt (despite the 1st half of the letter dedicated to the opposite).  I have re-read the post several times and am convinced (as are the majority who read this) that my tone was not at all “victim-blaming”

Then came my most recent post on autism.  The whole purpose of that post was to lighten up a little and share a joy I have found in my autistic patients.  It was meant to be a warm and fuzzy post, but was picked up by an autism activist site who read my intent as calling autism the “new normal.”  Again, I re-read the post and see no evidence of that whatsoever.  I have seen that patients like those with autism, Down’s syndrome, and other significant mental/social disabilities can teach me things about myself.  I am not God (despite what some commenters think of my opinion of myself), and I actually believe in the idea of “the last shall be first” – that our greatest victories in life come from humbling ourselves and listening to those the rest of the world shuns or ignores.  I see more of God in the eyes of these people than I do the CEO’s and other “successful” people who come to my office.  I see my own pride and self-centeredness, and I am grateful they show it to me.

So why would two posts that are actually positive in nature elicit such a negative response?  Why would people unleash the guard dogs on someone who comes as a friend?  I can only guess, but I suspect that I somehow reduced their victim-ness by what I wrote.  Some people seem to identify themselves by what bad life has dealt them, and any threat to that identity is met with hostility.  I think that’s what I saw.

I don’t deny the pain they have in their lives, and I don’t deny their victim-ness.  I would not trade places with chronically ill patients or with parents of autistic children.  But things are what they are.  People do have chronic illness and parents do have autistic kids.  That is the pain in life that I know intimately as a doctor.  What is sad to me is that in maintaining their status as victims – avidly defending the reality of the pain in their lives – they attack those who wish to help.

That is sad.  I am very sorry I can’t help.

But it’s time to call off the dogs.

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Arbitrary Normality

July 28, 2010 Being a Doctor

I’ve been practicing for sixteen years now, doing both internal medicine and pediatrics.  One of the joys of that is watching kids under my care grow up and not having to give up their care just because they get older.  The spectrum is wide, with some kids growing up in “normal” families with “normal lives,” [...]

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Show ‘em Your Poem

July 26, 2010 Just Stuff Kind of Thingies

  For those who greet doctors with snarls You should go and read Dr. CharlesHe writes with both thought and compassionAnd his stories can really be smashin’ And if there’s a poet inside youBut accolades have been denied youThen send him your very best versesYou patients and doctors and nurses This contest should give motivationYour [...]

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Previous Posts About My Respect of Patients

July 24, 2010 Just Stuff Kind of Thingies

It’s not our fault Getting Along (Part 1): Doctor Rules Favorite Shame Dear Insensitive Person How to Be A Good Patient Ask Dr Rob: Resilience Joi De Vivre An Open Letter to Consultants These are a sampling of older posts that highlight the fact that I feel the patient, not the doctor, is the center [...]

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To Know and be Known

July 23, 2010 Blogging

A thought struck me when reading an excellent post on Warmsocks’ blog.  The vast majority of responses to my recent posts on doctor/patient relations have been positive.  Yet a vocal minority of people have read what I wrote in a negative light – that I am somehow projecting my doctor arrogance into those posts and [...]

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My Side

July 22, 2010 Being a Doctor

I was planning on leaving behind the seriousness of the past few posts and going back to my usual inane writing, but some of the comments have made it too hard for me to keep quiet.  The response has been largely positive, and overall it has been overwhelming.  More people have read or commented on [...]

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Failure

July 19, 2010 Being a Doctor

I went to a patient’s funeral this past weekend.  I generally don’t do that for people whose relationship I’ve built in the exam room.  It’s a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a [...]

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A Letter to Patients With Chronic Disease

July 14, 2010 Being a Doctor

Dear Patients: You have it very hard, much harder than most people understand.  Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I too can’t understand what your lives are like.  How do you answer the [...]

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My EMR Reality

July 12, 2010 Being a Doctor

OK, I am an EMR fan-boy, I will admit it.  I seem real “rah rah” in my approach to computers in the exam room, and to many I seem to have my head in the clouds; I seem to be out of touch with reality.  In response to posts I have written on the subject, [...]

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