Posted in Psychology & Medicine


Among the thousands of signs and symptoms in the field of medicine, there is one that every doctor and medical student knows since the development of medicine. Clubbing is an easily noticeable sign in a patient’s fingers that can have wide implications on their health.

Clubbing is essentially when the angle (gap) between the fingernail bed and finger disappears. The formal definition is much more complicated, such as “the loss of the normal <165° angle, or Lovibond angle between the nailbed and the fold”, but for all intents and purposes the simple definition is sufficient.

To see if a patient has clubbing, the physician carefully studies the fingers against light. There are a few ways to check for clubbing but the most popular methods are holding the fingers out straight and holding them parallel to the ground, checking the angle between the nailbed and finger, or the Schamroth’s window test. The latter test is done by holding two opposing fingers (such as the left and right index fingers) against each other nail to nail. The fingers are then held against the light so that the light can shine through the “window” that is made. If the window is not seen, the test is positive and the patient has clubbing.

What does clubbing suggest? Clubbing was first noticed by Hippocrates, the father of Western medicine, who observed that people with clubbing tended to grab their chest and fall dead. This is one of the most common associations to clubbing – a congenital cyanotic heart defect such as tetralogy of Fallot or patent ductus arteriosus. Other common associations are related to the lungs, such as lung cancer (one of the most common causes) and various other lung diseases such as interstitial lung disease, tuberculosis and other chronic infections. There are also a myriad of other diseases associated to clubbing, including but not limited to: Crohn’s disease, ulcerative colitis, cirrhosis, celiac disease, Graves disease and certain types of cancers (lung, gastrointestinal and Hodgkin’s lymphoma mainly). Clubbing can also be idiopathic, where there is no apparent cause for the clubbing and the person just has it (possibly just born with it).

Despite knowing about clubbing for over 2000 years, we still do not know the exact reasons for clubbing. There are theories that it is related to a fall in blood oxygen content leading to vasodilation in the peripheries. As the pathophysiology is not clear and so many diseases are associated with it, when clubbing is found in the patient the physician should investigate the related organ systems (heart, lungs, GI mainly) to narrow down the possible cause of it. As many of the causes (such as lung cancer) carry a rather morbid prognosis, it is quite important to notice whether the patient has clubbing when doing a physical examination.

Posted in Science & Nature

Fainting Goat

There is a very interesting breed of goats called the Fainting Goat. These goats suffer a genetic condition called myotonia congenita, which produces fascinating yet hilarious situations. When startled by the sudden presence of another animal or even a loud noise, these goats all suddenly freeze and fall to one side. This phenomenon can occur even while running, which causes the goats to crash into the ground, lying on their backs with their legs straight up. This can even occur from the excitement of seeing food and starting to run towards it.

The reason for this peculiar phenomenon is that myotonia congenita damages systems that allow muscles to relax, causing it to become easily excited. Ergo, when a goat is startled, its muscles tense reflexively, causing it to contract suddenly while taking longer to relax. This results in the goat becoming paralysed and falling. Young goats tend to be helpless when this occurs, but more experienced goats prop their legs apart quickly or lean against something to prevent falling (they can even be seen hopping on their stiff legs). These “fainting spells” are painless.

Although this kind of trait is often removed by natural selection (for example, in nature these goats would freeze when they meet a predator, and then proceed to be eaten), humans have bred these goats specifically to save their trait. In old times, these goats were used as “sacrifices” so that they would get eaten first when wolves struck, but nowadays they are bred in certain farms for no particular use. 
Myotonia congenita also affects other animals such as cats, and there are many people in the world affected by this condition too.