Go green (burial, that is)

A green burial is one in which they wrap you in a cloth or stick you in a cardboard box and bury you in the ground. The tricky part is finding a cemetery that will have you. Unfortunately, burial in your back yard isn’t allowed.  

Neither traditional burials nor cremation are earth-friendly body disposal options. Here's why: 

Traditional burials. Here’s what goes into the ground each year in the U.S.:

• 4.3 million gallons of embalming fluids
• 1.6 million tons of reinforced concrete
• 17,000 tons of copper and bronze
• 64,000 tons of steel.

Cremation. Here's the energy required and pollutants emitted from burning one body:

• Uses the same amount of energy required for a 500-mile car trip; roughly the same amount of energy as a single person uses in an entire month.
• Releases 400 Kgs of carbon dioxide into the atmosphere  plus a host of other pollutants and carcinogens, the worst of which is mercury from dental fillings.

Maybe by the time you die more green burial sites will open up. One can only hope.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

How your thirst gets quenched

Being dehydrated means not having enough water in your blood. If this happens, you get thirsty and you go for a drink, after which you’re not thirsty any more. But wait a minute! It takes ten or fifteen minutes for the water to make its way into your bloodstream. You certainly don’t continue gulping water for ten minutes waiting for your thirst to be quenched. So what stops you from continuing to drink water—which can actually be dangerous?

If we’re like mice, on whom new research was conducted, we have cells in our brains that regulate thirst. But those cells don’t respond to the water itself. They respond to the speed at which the water is ingested—that is, the gulps. In the mice, feeding them water-saturated gel or giving them sips didn’t stimulate those cells. They would continue to drink even when they’d had enough. They needed those big swallows to quench their thirst.

Regulating water in this way was surely an evolutionary benefit. Drinking too much water dilutes the blood, which throws off the sodium balance, which causes cells to swell. (The condition is called hyponatremia.) If the swelling occurs in the brain, you can die, as happened to several football players who overdid it (as I mentioned in an earlier post).

Because your gut has a brain of its own, it probably has similar sensors, but the scientists haven’t figured out that one. In the meantime, enjoy those big gulps.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Lessons learned at urgent care

I was naïve in the extreme. I had a bunch of stitches in my head that needed removing. The stitches were the result of Mohs surgery for basal cell carcinomas. I didn’t want to make the 40-mile drive to the surgeon’s office—an hour and a half in rush-hour traffic—to have them removed. I couldn’t remove the stitches myself because some of them were in a hard-to-see places, such as down my jaw and behind my ear. I had no luck trying to talk my husband or friends into removing them. I didn’t want to go to the local doctor, five minutes away, because I thought there’d be too much rigmarole with setting the appointment, getting weighed, having blood pressure checked, and so on. I thought I could just breeze into an urgent care place and they’d remove the stitches. That’s where the naivete came in.

The facility, about a 25-minute drive from my home, was large. (It’s part of the Sutter conglomerate.) When I walked into the building around 10:30 AM, the waiting room was filled with obviously sick people—drooping heads, coughing, masks over faces. Three receptionists manned the counter, which had a “Wait Here” sign in front of it. The receptionist told me that the wait was at least an hour. She gave me a clipboard with four pieces of paper for me to read, fill out, and sign. After about half an hour, I was called in (oh boy!). Alas, I was only to be weighed and vital signs checked. I protested: “I’m just getting some stitches out!!.” My blood pressure was high—no surprise. The technician also checked my temperature, heart rate, and blood oxygen and asked a bunch of routine questions.

An hour later, I finally saw the doctor, whom I liked. After assuring him that my surgeon gave the OK for someone else to remove the stitches, I lay on the table, and he made use of his special tools, light, and magnifying glass to remove the stitches. He applied an ointment and bandages. During all of this I asked him if this crowd was normal. He assured me that it was—especially in flu season. Apparently, people are unable to get immediate appointments with their primary care physicians, so their only recourse is urgent care. By the time I’d arrived that morning, three people had been sent to the emergency room.

I left feeling guilty for taking the spot of someone who was really sick, and stupid for thinking that a simple procedure might actually be simple.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Your interstitium: an “organ” you didn’t know you had

A couple of years ago--but just recently reported--some scientists were using a new type of microscope to examine patients’ bile ducts, looking for the spread of cancer. The microscope is a type that is inserted into the body and allows scientists to examine living tissue rather than wait for the preparation of slides. In checking out the bile ducts, the scientists were surprised to discover that the tissue appeared as a fluid-filled, net-like pattern that did not correspond to any previously described anatomical structure. Even though scientists had looked at slides of this tissue for years, what they’d seen was the result of a slide-preparation process that collapses the lattice-work and removes the water. The tissue just looks crackly and dense.

Now, seeing the structure in vivo, scientists could see what they described as “a series of spaces,” and a “highway of moving fluid.” The scientific paper that described the “organ” called it a “widespread, macroscopic, fluid-filled space within and between tissues.” It is referred to as the interstitium (pronounced inter-STISH-um). It’s found all over our bodies—in or near lungs, skin, digestive tracts, and arteries. In the images, it looks fluid—something that ebbs and flows like the ocean. It may act as a shock absorber, or a conduit for fluids to enter the lymphatic system.

At the moment, there’s plenty of disagreement on whether the insterstitium can be considered an organ. But it can be considered, as one scientist called it, “an entire system that is interfacing between the vascular system and the lymphatic.” For this reason, a study of this system could give scientists a better understanding of how cancer metastasizes. As one pathologist noted, “we’ve never understood the mechanism of how that happens.” All agree that more study of the interstitium could lead to breakthroughs in cancer treatment.

Now we must wait and see and see what happens, including whether the interstitium can be considered an organ. In the meantime, you can practice pronouncing it.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

The state of hospitals today

According to oncologist Ezekiel Emanuel (Rham Emanuel’s brother), hospital numbers are shrinking. Dr. Emmanuel believes it’s a good thing. The shrinking has partly to do with the fact that some rather complex care can be provided elsewhere, including at home. Also, many services have been shifted to surgical centers, imaging facilities, and “doc in the box” clinics.

Hospital numbers may be shrinking, but those remaining have been consolidating into huge, multi-hospital systems (where I live, it’s Sutter). These mergers create local monopolies that raise prices to counter the decreased revenue from fewer occupied beds. (Hospital costs here are 12 times higher than in the Netherlands.) Dr. Emanuel believes that antitrust regulators should be more vigorous in opposing such mergers.

Another doctor, Sandeep Jauhar,  is opposed to hospitals being run by corporate executives rather than by medical personnel, as was the case a generation ago. Today less than 5 percent of America’s roughly 6,500 hospitals are run by chief executives with medical training. In fact, the number of non-medically trained hospital administrators has gone up 30-fold in the past 30 years, while the number of physicians has remained relatively constant. With business people at the helm, decisions are based on business—not clinical—imperatives. For example, doctors are being pressed to discharge patients quickly to maintain “throughput.” Doctors’ status is often based on the number of patients they admit. Some of the best hospitals in America are still run by physician chief executives, such as at the Cleveland Clinic and the Mayo Clinic. In 2011 a study found a “strong positive association between the ranked quality of a hospital and whether the CEO is a physician.”

A famed cardiologist, 96-year-old Bernard Lown, recently spent time in a hospital. His experience—which included those middle-of-the-night checks for temperature, blood pressure and the like—led him to remark that a hospital is more like a factory.  “It tests every ache and treats every laboratory abnormality, but it does little to heal its patients. Care is supplanted by managing.” Is this what they mean by “managed care?”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.