psyche

As someone leaning towards primary care, I found this blogpost quite interesting. In it, the doc states that ~85% of the ten most common ailments brought to the attention of family docs has no definite material cause. http://acountrydoctorwrites.wordpress.com/2009/09/13/the-power-of-words/ In other words, it's all in their head, which is the phrase that many use to dismiss it. My response is that most people have some degree of fear of public speaking. Stage fright is absolutely "just in your head" but explain that to someone who's about to lose their lunch before a speech. It's every bit as real as a material pain like a broken bone. Over the past ten years, I've become more interested in some eastern modalities. Western medicine is great at putting Humpty Dumpty back together but not so good at dealing with chronic disease. In other words, if I get into a car wreck, I want a top notch Western trained surgeon. But for my periodical shoulder pain which has both a material cause (old football injury) as well as a psychic component (stress), nevermind external causalities such as cold fronts, or the odd hurricane (holy crap did hurricane Ike last year kill my shoulder), Western medicine has been horrible at helping me to deal with it. Two rounds of physical therapy and a sports medicine orthopedist gave me no relief. Accupuncture, however.....that had some surprising effects. I'm becoming fascinated by the mind-body connection and how it relates to health and healing.

dream

A foul mood has set in upon me of late and much of it centers around frustration with this grand journey of becoming a doctor. I'm probably being a bit impatient with both it and myself. I knew this would take time. I know that I'll be better off for going through it. One way I knew that it was time for some introspection was that I started dreaming again. Normally, either I don't dream or I don't remember them. I'm not sure which it is since the end result in the morning is the same. I used to be skeptical of dream interpretation, and still am to a big extent....except the times that I've tried it. Have you ever written down your dreams and honestly asked not what they meant, but what they felt? That's after all their way of communicating. My dreams are so bizarrely nonlinear as to be quite absurd so understanding in the logical sense is pointless. But I finally started writing them down (I had done it once before in my life) and I focused not on how ridiculous they were but what I felt in the images. It's made me a believer that it's pretty good tool to get in touch with your soul. It helped me realize what exactly was bothering me. There's a lot of fluff out there with respect to dreams. The best source of information for me was the psychiatrist Carl Jung. A fascinating man with fascinating ideas. There's a museum down in Houston near the med center that I visited once a few years back. It's called The Jung Center. So I took a step back and looked at the bigger picture. And that's one of the problems. I'm a big picture kinda guy. As such, I hate getting bogged down in the details when I can see the end result. I'd rather just up and head to the end result via a shortcut. Ain't gonna happen in this instance. So I have to just let it go and keep my kinetic energy going. I will keep trying ways to get this interesting and fun, like trying the low carb thing to make biochem, er, fun. And on a good note, I'm up to an 85 and an 86 on today's two biochem practice exams. The last one would've been higher had I not circled the wrong answer despite clearly knowing the correct answer. Time for a beer or three at that point. 93 on histo so I'm done with that one. I need to focus on studying for the practical on that one.

Liver

I mentioned in a previous post that the liver is an altruistic organ. It's true if you think about it. It detoxifies the crap we shouldn't put in our body, it packages lipids (calories) for the periphery, it makes glucose for the snooty and picky brain which won't touch lipids, it handles excess ammonia from other tissues, nevermind what it does for alcohol. It puts up with all the metabolic pickiness of the other organs. And true to form, if you take that analogy to it's logical conclusion, any purely altruistic organ (or person) is going to get walked all over. Drink too much? The liver takes the hit. Eat too much? The liver jumps on that grenade as best it can, too. Hell, even when it's hurting, it's a wallflower not wanting to draw attention to itself. It's not like if your lungs hurt. You KNOW when those hurt. Liver? You'll pick it up on a physical, maybe. Or you'll pick it up only when it's severely damaged. The liver should stand up for itself once in awhile. Meanwhile , it strikes me that the intellectual brain is probably the most selfish as it needs glucose and will maintain oxygen perfusion at all costs, even to the detriment of other organs (come to think of it, the kidneys and heart do, too, those greedy bastards!). But it's also the one that determines if you're dead (it ain't liver-dead that makes you dead, it's brain-dead that's dead-dead so I guess it can justify it's self centered view. I've got a lot of time to think on my commutes to and fro school. Hey, it's better than cursing at the reject who just cut me off.

studyin'

Not much time for blogging as this block of biochem is kicking my butt. My practice test scores yesterday? A 60 on the first and a 72 on the second. D'oh! I got up to an 82 today (or 86 if the answer key is wrong, and, yes, they can be wrong which makes studying fun). That makes me feel a little better. I wasn't looking forward to failing biochem. That'd put a damper on my mood.

Direction

How many times do we wonder if it's even worth it There's got to be some other way Way to get me through the day Keep going on till dawn How many times must another line be drawn I found my mind wandering the other day and it kept coming back to this whole process. If I'm honest with myself, I have to admit that never in my life have I gone deliberately into something and had absolutely no clue as to where it might end up. Marriage, parenting, college...sure I was clueless as to how it would go, especially maybe in the beginning, but I could see what was at the end. This? I have no idea. I started this road winter of 2006. That's nearly three years just in the decision making process. And here I am knowing that I'm capable of it all but it feels a bit like I'm already just going through the motions. For instance, next week are the Block II exams. Unlike last time, I'm not the least bit stressed. I'm actually pretty indifferent towards them. I'll pass. The hard part is winding myself up to even study for them. Throughout a lot of my life, I would often feel a bit of a thrill with mastering materials. I've done it enough times that it's starting to get a bit wearisome. A sort of been there, done that and how many more times do I have to prove that I can regurgitate this stuff? From the song above, how many times do I draw another line. It always happens in the end but this time it's taking a little bit longer to get psyched up. I'm hoping that once I get into the actual doctor stuff down the road, that will change. That was certainly true of my undergrad degree. I pretty much hated most of my first few years. It wasn't until my senior year when I got into the upper level classes that I thrived. Straight A student once that happened. So I suck down the nasty tasting medicine and draw another line in the sand.

Medical training

I was once told that in order to truly offer insightful criticism to a process or institution, one had to be a part of it. To some extent, that's true. Since reform of the way doctors do business is so much on everyone's tongues lately, I thought that whenever I saw something of note, I'd comment on it. So one complaint I've heard is how hard it is to find good doctors. Personally, my family had this problem. When my dad went through some heart difficulties, I figure the rate of finding good doctors was about 50%. It was true of family practice and it was true of highly specialized electrophysiologists. To make it worse, those in the lower 50% weren't just not good. Some of them were downright dangerous. So here's my question. Any population has a bell curve and down at the bottom are the idiots. Do doctors have a disproportionate (less or more) number of idiots in the field or is just that the idiots are just so much more obvious? One might expect that a field that supposedly weeds out the lesser talented would have less idiots. I'm not convinced of that. I don't think that the process necessarily cultivates idiots, but I do think that it may cultivate the wrong sort of talent. Doctors aren't doctors because they're good at being doctors. They are doctors because they are good at taking tests. Obviously, I've just over generalized about a huge profession of which I hope to belong to someday. But my point is that test taking weighs HEAVILY on deciding whom can become a doctor, not on skills. There are so many standardized tests along the way as to be ridiculous. But let me not go off on generalities. Here's a specific example that might help illuminate the point. In histology, three times during the semester we undergo what is dubbed "Team Based Learning". It's essentially a very basic patient history with a biopsy slide of the relevant organ. The goal is to get people thinking very basically about diagnoses. Well, today it was liver and the hypothetical patient was an alcoholic. Pretty clear case of liver disease due to over indulgence in spirits. One look at the slide and the liver had a TON of inflammation, ie lymphocytes. Everybody in our group said the same thing after looking at the slide. One of the questions inquired as to which cell type was increased. Pretty easy to say lymphocytes. Apparently, one group didn't put the correct answer because the peripheral white blood cell counts were not increased. No biggie. Everybody gets things wrong. But the student proceeded to argue their case to the professor that "how were they supposed to know that peripheral counts didn't correlate with tissue activity?" And in my head, I am thinking, this kid is falling into the fallacy that doctors more and more are falling into and that is treating numbers rather than disease. With the advent of all these new fangled technologies, there is a temptation to rely too heavily on these high tech diagnostics. They are powerful tools, to be sure, but they are replacing the art of thinking critically. Had this student taken one look at the liver, it wouldn't have mattered what the peripheral blood looked like. Think critically and ask, should the liver be full of inflammation under normal circumstances? Which gets to my original point. The class is selected based on their ability to take tests (myself included). This student was clearly arguing from the standpoint of test taking. At no point where they actually interested in learning why alcoholism leads to inflammation. They just wanted the points. At the end of the course, I'm going to go talk to the professor and give my two cents. I think he should expand on these situations and get these kids to start thinking rather than regurgitating. I'm starting to see why some med schools have forgone grades for a pass/fail paradigm. Stop worrying about points and start thinking about how you'll treat patients.

Day 8

Weight - 220.8 (-4.2 lbs) Nothing much to note except that even three starches a day (muesli for breakfast, garlic mashed potatoes at lunch, pita at dinner) is still leading to weight loss. I even had a bowl of ice cream. Incidently, have you ever measured out a true serving of ice cream? It's worse than a true serving of wine. 1/2 a cup of ice cream ain't much. I turn it into health food by dumping cocoa, not hershey's chocolate milk stuff, 100% cocoa powder in addition to walnuts and coconut (unsweetened as I'm obviously counting calories with my dessert). That rinky dink half a cup probably runs 300-400ish calories. And my exercise capacity is abyssmal. About 1 mile of jogging and I'm about to keel over. I'm going to have to up the healthy carbs just a bit more because the 2nd block exams are coming up and I've got to be able to use my brain. I don't have time to train my brain to work on ketones. My gluconeogenesis process must be off, which is to say, I could have less efficient burning of fats or catabolism of proteins. And now the weekend where I tend to not really fall off, so much as jump off the wagon. Last weekend was the Renaissance Festival. Two words - funnel cake. I think I ingested 8,000 calories that day. This week is OU vs UT. One word - beer. Maybe I'll touch that light beer crap. Yeah, right.

Day 7

Weight - 221.2 (-3.8 lbs) Attitude - still trying to find that sweet spot where I balance capability with weight loss. At this point, I'm not limiting fruit intake (fructose) at all, I drink milk (lactose), still eat chocolate but that still wasn't enough glucose fuel for me. So I had to start adding truly starchy items like breads or potatoes and I think that for me, having 2 starchy items a day allows for weight loss but my metnal cupasity ain't quite firing on all cylinders yet. I'm going to allow for three servings on days I exercise. Biochemical lesson - Ketosis, finally. I pause to admit it, but the whole way one's body fits this together is actually kinda cool. Our body cobbles together our metabolism out of bits and pieces. To me, it is NOT some highly tuned fine machine. It's some organism that has managed to keep afloat despite itself. I think that it all starts with the brain (and red blood cells). The brain requires glucose. Why, I don't know. From what I can tell, fatty acids can cross the blood/brain barrier. Red blood cells (RBC) require glucose because they have no organelles, ie they have no mitochondria (the little factories) in which to burn fats. So they must utilize glucose. Why they don't have organelles? I suspect it's because RBCs are essentially there to transport oxygen and that's it. After about 4 months, they breakdown and die. They really don't need any DNA or organelles to do that job so it must give some advantage to not waste the materials on them. Kinda analagous to replacing some factory workers with a robot. A brain is not really required to perform the task. So back to ketosis. Those two NEED glucose. Well, let's take an ancient ancestor of ours named Mog. Let's say he can't kill anything for a few days and has yet to find any good fruits around. The brain has to keep going and the RBCs have to keep carrying oxygen or he's going to run into a world of hurt when trying to avoid a predator. The body has cobbled together a clever solution to deal with it. It needs glucose so why not make it? For that to happen, two main elements are required. #1 - a carbon skeleton to build a glucose molecule (think of it like a frame on a car) and #2 - the energy to drive the process. Our body uses fats to drive the energy and protein to use as the carbon framework. It seems strange to consume energy to make energy but we do that all the time. Think gasoline. It takes energy to find, extract crude oil and refine it into useable gas. The net result is that we get more energy from that process. That's one of the complaints about corn based ethanol - it consumes as much, if not more, energy than it provides. Our bodies, are like the corn scenario, not the crude oil. We burn calories (in this case fat) in order to build glucose. It's a net caloric loss which is one of the reasons that weight comes off so quickly with these low carb diets. Like I said, not the best of designed systems but it works. But your body can only burn so much fat for 2 important reasons. First, fat breaks down into a compound called Acetyl CoA. It then goes into a process that everybody saw in high school biology called the Krebs Cycle (or TCA cycle for tricarboxylic acid cycle). It's a cycle so the beginning is the end. The CoA is liberated and recycled to join up with more fat and keeps going. Two problems occur when Mog is cruising through fat to make glucose. He pulls intermediates out of the Kreb cycle to synthesize glucose whole cloth. It's a cycle. If he keeps pulling things out, it doesn't cycle anymore. So it slows down which means less glucose and less energy. Enter the second problem. There's only so much CoA your body has. It's a finite pool and when Mog hasn't eaten, it's all tied up in breaking down fats (in financial terms, it's not a liquid asset at the moment). So he has to free up some of that CoA. Enter Ketosis, your body's last resort at keeping things moving. He changes Acetyl CoA into molecules called Ketone Bodies. Those can exported from the liver and used in the muscle as a source of energy (the brain eventually will use them after prolonged periods, something like 6 weeks). So Mog's liver has saved the day. He has provided the muscle with an alternative source of energy while still allowing for the synthesis of glucose. It's an energy wasting process in the long run which makes it a useful tool for losing weight in the short term. Long term weight loss with any means is a different story.

Day 4

Weight - 224.0 Attitude - better now that I'm figuring out exactly the balance in my body of carbs and ketosis.

Observation - Between day 2 and 3, I was pretty well into ketosis (dropped down to 222.8). An interesting observation was that I felt warmer. I mean considerably so. I noticed it especially while sitting still studying for awhile. Usually, when I sit still for decent periods my metabolism must shut down because I get cold really easily. Didn't happen. In fact, I had to knock the air temp down a bit. I don't know if basal metabolism increases on this diet or perhaps ties into uncoupling protein. I'll have to look those up.

Biochemical lesson - Uncoupling protein. Wow, applied knowledge. In turns out that a quick search of the literature revealed that high protein diets do indeed increase expression of uncoupling proteins....in rodents. It turns out rodents have a high amount of brown adipose tissue (or BAT). BAT, unlike the white adipose tissue (WAT), is common in rodents but no so much in humans, well adults. In newborns, it's critical. Newborns are not able to shiver but they've obviously a way to generate heat. It's through these uncoupling proteins. Your body generates energy by a process called the Electron Transfer Cycle. Think of it like a dam generating electricity hydrologically. Instead of the water flowing away, though, we have a process by which we would put the water back up behind the dam to go through the turbines again and again. Sounds like a self perpetuating machine, right? It's not. We obey the laws of thermodynamics. We get the energy from our food to drive the process to convert the energy it forms that are useable to our body.

Well, with these UCPs, it's like a hole in our dam. The water comes back through the dam, bypassing the turbine so no electricity is generated. Even worse, our body then spends energy putting that water back up behind the dam. The energy is then lost as heat. Hence, weight loss. People thought this a great way to lose weight. Back in the 30s, a compound called dinitrophenol was used. Not a good idea as it was a bit toxic. You can still buy it on the internet, though I would NOT recommend it. It can actually induce fatality by.....too high of a fever.

The other issue is that much of this heat generation/weight loss occurs in BAT. In rodents, BAT is pretty common so they can lose weight quite easily this way. In adults, BAT is quite minimal so it's not really applicable to humans. That's not to say the UCPs don't function in other tissues whereby weight loss could occur. I'm definitely feeling warmer, though. I'll have to do some more digging to see if these diets can induce uncoupling in humans.

Day 1

Weight - 225.6 Measurements - NA Attitude - light headed Observation - increasing protein content and cheese certainly slows down the ol' bowels which probably explains why I gained weight. My colon is probably impacted. Biochemical Lesson - How important glucose is. I really can appreciate how much your brain is dependent on glucose. Despite eating fruit, chocolate and drinking some wine, I'm still pretty foggy. I'm guessing that means I depleted my glycogen stores pretty quickly. What's glycogen? A huge polymer of glucose chains, it's essentially your body's way of storing glucose. After a meal, the glucose that is not used by tissue for direct energy is stored as glycogen in the liver and muscle. As an aside, whenever we looked at liver histology we always fasted the animals in order to deplete the glycogen stores. It made the liver a lot easier for the pathologist to read. Your liver is the main source of glycogen synthesis since it can make it from dang near any metabolite....except fat as we learned previously. There's another critical tissue to 'fogginess' that can ONLY use glucose (the brain eventually will use ketone bodies but more on those later). Red blood cells have no mitochondria so they are completely dependent on glucose for energy. I'll have to double check but I suspect that they'd get their stores from Mr. Liver. I don't know how much oxygen transport decreases as glycogen stores are depleted. You do need glucose in order to make 2, 3-BPG which is a regulator of how oxygen is bound to hemoglobin (it makes it easier for your RBC to kick off oxygen and deliver it to peripheral tissues like the skeletal muscle). Less 2, 3-BPG, I would imagine would mean the hemoglobin would tend to hold onto the oxygen a bit longer thereby decreasing the amount of O2 delivered. But what the threshold is for that and if the ketogenic diet approaches that, I have no idea.

Glycolysis

I know y'all were dying for some more metabolic diagrams. Honestly, this dry erase board thing is working out pretty danged well. And then snapping a digital photo preserves it for later studying after I wipe it clean. I suppose I could use software for it but for a non-digital native that can remember when computers first came out (they used cassette tapes!), I prefer the feel of the pen in my hand.

Here's glycolysis in all its glory. 10 simple steps and you convert Glucose to Pyruvate without any oxygen. It drives the brain and red blood cells as that's pretty much it for them as far as fuel goes. Skeletal muscle can use both depending on the fiber type (fast twitch use glucose as it's faster and doesn't need oxygen, slow twitch use fat as it lasts longer). Cardiac muscle on the other hand uses more fat (70%ish fat vs 30%ish glucose if my memory from my research days holds true)

Solution to a problem

I'm not real big on abstract learning. I've ALWAYS learned better through real world experiences. After all, there are those who can be told about it, there are those who can read about it, and there are those who have to piss on the electric fence to know what it feels like. Me? I'm that last one. So I'm confronted with a problem of being presented with all these metabolic pathways that amount to strange abbreviations with arrows going off in hundreds of directions with long, strange words over the arrows that often end in -ase as in synthetase, dehydrogenase, kinase and the like. And now I have to commit these to memory. If I were a good student, I could memorize them and regurgitate them like a good little med student. That ain't me. So I needed a way to actually understand and learn them. The instructors especially focus on how these pathways are regulated which to their credit, makes sense because both disease and drugs oftentimes affect these same regulatory steps. As they elucidated pathways, they'd use starvation as an example of how if one path is altered, the body responds by turning up (or down) a different pathway. It's like squeezing a balloon. You compress one side and the other bulges out. As my feeble brain tried to assimilate the info flying at me, it suddenly dawned on me that the changes induced in starvation look similar to those impacted by low carb diets. Ah-Hah! Methinks here's the chance to apply info to real life. I need to lose a few pounds for reasons I'll elucidate in a different post. Low carb presents a quick and relatively easy way to do that (I love food too much to diet, per se) and more to the point, I'll actively begin to THINK about what's going on inside me. In the process, I should hopefully not only learn these metabolic processes well enough for the exam (2 weeks away) but I'll actually understand them to remember later in life. Plus, I hope to actually be a physician someday so I'll have some first hand experience with weight loss to better empathize with my patients. So I will document my experience of a low carb diet (somewhat South Beachish, not really Atkins - it's really a bit of a mix of my own ideas with others). Imitation is the sincerest form of flattery, so I'm going to adopt a similar format as this blog, which incidently, has two very good blogs and they are worth following if you're interested in health. A good source of information. Day 0 Weight - 225.0 Measurents - didn't remember to take any Exercise - very modest as I'm pretty much horribly out of shape and started up weakly a week ago. Attitude - Crappy. I've done the low carb thing before and I hate it. Well, I hate anything that restricts what I can eat. Observation - a great way to avoid studying while not napping! Biochemical lesson learned - While singing to I'm not sure which tune, "Oooohhhhhh, you can't make net glucose from Acetyl-CoA." I'm not kidding. Two professors sang this in the lecture hall. It was great because it sure as hell stuck. I won't EVER forget this lesson anymore than I can forget THIS Sung to pop goes the weasel X is equal to negative B, Plus or minus the square root, Of B squared minus 4 A, C ALL! over two A. What the hell does that mean? See, your picky brain won't, well can't, use fats for energy like muscle can. It needs glucose. Even the slow witted like myself can see the potential problem. Depending on where you get your info, your body needs about 120 grams of glucose daily to just get by. So if you eat less than 120 grams of carbohydrates, a problem arises. Like our government, you're spending more than you bring in. And just like our government, you can print your own! And just like the government, it's at the expense of someone else. The problem is that fat breaks down into Acetyl CoA and that CANNOT be converted to fat. They're kind of like the lobbying class. Amino acids, ie protein, however, can be converted to glucose. Enter in high dietary protein content. Instead of losing muscle mass (which DOES happen in almost all clinical trials of weight loss either through pharmacological means with or without dieting although I don't know about low carb body composition), your body starts using your increased dietary protein to make energy. Apparently, my body is not as good at that as others. You see, by 3pm-ish, I was starting to go into a 'brain fog' meaning I was getting dumber by the minute, presumably due to decreased brain glucose. Sure, I know that the 'experts' say this will pass within a few days. Not me. I tried this once before. I kid you not, it was the 6th day and I was a blithering idiot. So much so that on a trip driving to Dallas (I would have probably been a safer driver had I been drunk), I had a conversation with my wife that went a bit like this: Me: Blah, blah, blah Her: You just told me that 5 minutes ago. Me: Really? No. Really? I did not. You're just yanking my chain. Her: Yes, really. You seriously don't remember that? Me: Ummm.....No. Should I? Her: When we get to Dallas, you're going to go to the sports bar to watch the Michigan game. When you do, please, please, PLEASE drink some beer and eat something with carbs. Me: Thinking to myself (Who am I to ignore a wife that pleads with their husband to drink a beer?) Now just blankly stare off into space as my brain has frozen...... So you can see that decreasing the efficiency of the ol' gray matter during med school is probably not a good idea. So I eat fruit, beans, some chocolate and try to find a balance between ketosis and stupidity (more on ketosis later).

High Tech

I'm going high tech now. So the other Saturday, I'm down at the med center for a New to Biochemistry Club meeting (NBC). It turns out that during my undergrad and over a decade in pharmaceutical research, I had managed to avoid ever learning anything remotely similar to biochemistry. I take that back. During my undergrad, I learned the process of fermentation pretty well while brewing mead, but I digress. During this review (how I love to spend my Saturdays!), the prof asked how many people had dry erase boards in their apartment. I chuckled until half the group's hands went up. So my significant other bought a cheapie dry erase board from Wallyworld. It's not as high tech as the laptop screens that I see the kids using but it actually worked pretty well.

The first trick is to have a good study partner. I prefer ones that don't say anything. Talking tends to get in the way of learning.

For those of you who've had biochem before, this is pretty elementary. It's TCA, beta oxidation (both saturated and unsaturated), and the all important alcohol metabolism. That reminds me. They're supposed to be edumicating us on how to be docs. Yet the entire part on alcohol was ALL bad. Here's what ethanol can do wrong, here's what acetylaldehyde can do wrong, blah, blah, blah. Hey, the liver is an altruistic organ after all. What's he whining about? Not ONE thing mentioned about the many beneficial effects of alcohol. Moderate imbibing of alcohol is, afterall, one of the few characteristics that always pops up on lifestyles that lead to increased survival. Surely there's some biochemmie doohicky in there somewhere that helps to wave one's hand in explanation of that fact.

Joys of AP

One of the benefits of taking the Alternate path, aside from my sanity, is that I've been able to attend every one of my son's football games so far. Heck, for one the refs didn't show up so I even helped out by reff'ing one. It brought back a lot of fun memories. He's #44 standing next to me in the red shorts and zebra shirt.

Hey, no whistle, keep hitting. I'm not going to call that a late hit on my own kid....Especially when I told him "no whistle, keep hitting". And neither I nor the other ref (from the other team so it was fair) had blown the whistle. I also taught him how to hold when blocking (he's tight end) by keeping your hands in close. I actually had one of the opposing team members come complain that #44 was holding and could I look out for it. Hey, I didn't see it. He had his hands in. Duh, that's the point kid. Plus, we were getting slaughtered so a few missed calls weren't going to matter.

As I said, an absolute blood bath. Here I am instructing him after they just ran yet another touchdown, this time to his side (linebacker on defense). I think I was politely telling him that the next time, he'd better get his )#(*% off the blocking TE and get in there to deliver a blow to the running back.

Next game. Here you can see the ref signalling the ball going in the other direction. Why you ask this picture?

Because we were winning 13-12 in the 4th quarter and the opposing offense was driving down to take the lead before good ol' #44 (look at those excited arms jumping up) recovered their fumble and halted the drive. They won this one. A rematch against them was not pretty. It was their only win. More fun than a barrel full of NADH going to the Krebs cycle.