Veterans Day and Suicide etc.

Today, 20 military veterans will commit suicide.  I heard that on NPR’s Morning Edition.  Our country’s treatment of, or failure to care for, veterans is a long-standing shame.

I’m a veteran though I don’t think of myself that way.  I was in the army for 21 months in the late 1950’s when there seemed to be no war, though the U.S. was active in Viet Nam and dropped paratroops on Lebanon when an election didn’t go our way. My weapon was a typewriter and my battlefield was  the compound of the Corporal Missile (training) Battery in Oklahoma. I drew the veteran benefit for courses I took when I got out.

Who’s a real veteran?  My nephew Jeffrey Nugent who served in Iraq and our new Senator Tammy Duckworth who lost her legs there. My brother John who graduated from the Naval Academy and transferred to the Marines.  And my friend Larry who served in Viet Nam.   And a lot of those people sleeping in a park or on the warm grates of city sidewalks, asking for change on street corners, talking to themselves in public libraries.  Or sitting in jail cells with no hope.

What’s being done for all those suffering as a result of military service? Not enough..

Mental Health Concerns
  • Postraumtic Stress Disorder (PTSD). Traumatic events, such as military combat, assault, disasters or sexual assault can have long-lasting negative effects such as trouble sleeping, anger, nightmares, being jumpy and alcohol and drug abuse. …
  • Depression. …
  • Traumatic Brain Injury (TBI).

RJN

 

 

 

 

Good Things to Do With Your Body

Donating body for research

People’s reasons and science’s uses are many

Students from Texas State University’s Forensic Anthropology Center search for the remains of a missing person. ( Texas State University)
Image 1 of 4

By Kay Manning  Chicago Tribune 10.26.16

Patricia Kelly had to watch her husband, William, descend into dementia, but he never wavered from a desire to give his body to science, and what followed his donation inspired her — and now their daughter — to not only pledge to do the same but to become fierce advocates of the idea.

When William Kelly died in 2011 and Patricia Kelly in 2015, they became part of an unusual program at the Indiana University Northwest in Gary, which teaches anatomy while encouraging communication with donor families through letters, visits and a memorial service.

Her mom cherished the letters she received from International Human Cadaver Prosection Program students, said daughter Susan Ellingsen, of Munster, Ind., “taking a big magnifying glass (she was legally blind) and reading them over and over. They were very personal and told us all they discovered about my dad.”

“My mother made a video to let students know why she donated her body and what hope she had for them to be the best they could be and to always take their patients’ lives and families seriously,” she said.

Ernest Talarico, who runs the prosection program, said he was troubled in medical school when all he knew about a cadaver was a number and maybe a cause of death. Fellow students disrespectfully named bodies, he said.

“The tradition in anatomy lab is to focus on the science, not to get too attached,” Talarico said. “What we do is a new paradigm. And research shows it makes better doctors.”

Many bodies donated for research have poignant back stories. William Kelly had a number of ailments and wanted science to more fully explore them.

Judy Clemens, of Hebron, Ind., had a progressive form of multiple sclerosis that so frustrated her that she took her life, but not before asking that her body be studied to better understand the disease.

Other donors are educators, scientists and members of law enforcement who know the importance of hands-on learning to solve crimes, find missing people or bodies, and bring closure to aggrieved families. They even designate that their corpses be used for such studies as how fast vultures decimate a body, or how cold or hot weather affects decomposition. Still others specify that their remains be used to train cadaver dogs.

Some bodies are donated by families seeking to save money since many programs pay for transportation and stage a memorial service for the deceased or return the cremated remains.

A future purpose for donated bodies involves recomposition, the turning of human bodies into nutrient-rich compost. A prototype for what the project director sees as an environmentally friendly alternative to burial and cremation is expected to be built in Seattle in the spring and will accept bodies for a pilot program to fully test the process.

“There’s scientific value to donating your body, but there’s a huge educational value,” said Cheryl Johnston, director of an outdoor facility at Western Carolina University, where eight bodies are in various stages of decomposition. The training they afford “is benefiting people by applying things in the real world.”

Daniel Wescott runs the largest so-called body farm in the country at Texas State University, where researchers and cameras document the rate of decay of 70 bodies above and below ground, bodies clothed, unclothed and wrapped in tarps, bodies protected by wire cages and bodies left vulnerable to scavengers. When reduced to skeletons, the bones become part of a permanent research collection.

The Forensic Anthropology Center simulates conditions under which bodies or people may be found if they are victims of crime, or are missing after wandering off or a natural disaster, such as a flood. A decomposed body produces soil that’s darker in color and vegetation that reflects light differently, allowing a drone to pinpoint a location to be searched. That saves time and money, Wescott said, and then experts can determine how long a body might have been there, leading to quicker identification and finding or eliminating suspects in criminal cases.

“It’s all for justice, not just for law enforcement, but to keep somebody from going to jail if innocent,” he said.

Decomposition research and technology have better prepared Texas to handle the border-crossing deaths of immigrants, Wescott said. Bodies are buried without names, leaving loved ones uncertain as to the refugees’ fate. The facility is trying to identify some 80 corpses, but “the very, very slow process” has led to only 10 names so far, he said.

Donated bodies also help train dogs that can detect human remains. Lisa Briggs, a professor of criminology at Western Carolina University, started training her golden retriever Laila at 7 1/2 weeks, and the 2-year-old has found three bodies and several people alive.

Briggs said she feels fortunate to have whole bodies with which to teach Laila because using synthetic versions of decomposed remains or even a single body part such as teeth or a placenta, as some trainers have to do, is inadequate.

“Drug dogs are trained on one scent — maybe marijuana — but with humans, there are so many variables, such as what they had on, whether it was cold or hot, medicines they were taking, if they drowned,” Briggs said. “No one can understand how important it is” for dogs to be exposed to all those factors.

She said she remembers an instance in which Laila was looking for two people presumed by police to be dead. The dog found the bodies in water by smelling the gases bubbling to the surface, Briggs said, adding she can be asked to help on up to 20 cases a year.

She’s seen the pain families go through when a loved one is missing. “I can only imagine what it’s like not knowing,” she said.

Brittany Winn said she knew her adopted “nana,” Clemens, was donating her body to Indiana University Northwest in hopes that something could be learned about multiple sclerosis. But Winn was unprepared for Clemens’ suicide in 2011 and the quick disappearance of her body.

“We didn’t know where her remains were. It was heart-wrenching for us,” Winn said.

Months later, a Manila envelope arrived from Talarico’s program, and his students’ first contacts with the family “had us in tears,” said Winn, who has gone on to participate in the program for four years as a student and team leader and is working as a medical scribe for a Fort Wayne, Ind., endocrinologist. She wants prosectors to understand the donor and those closest to him or her.

“It’s not just a cadaver but a person who meant the world to my family,” Winn said. “Words from the prosectors are the beginning of closure. And seeing that they get everything they can from the program makes me feel better. What they learned will be with them for life.”

She has registered as a donor, she said, but donations also can be arranged after death. Requirements vary, but programs generally will not take the bodies of severe accident victims, those with infectious diseases or bodies that have been autopsied, embalmed or had organs removed. Some have weight limitations; some will take cremated remains and body parts, such as amputated limbs.

Katrina Spade, founder and executive director of the Seattle-based Urban Death Project, started searching as an architecture student for a new way to look at death, out of concern that the existing options of burial and cremation are expensive, harmful to the environment and often shortchange traditional rituals surrounding a death. She realized the method used to compost dead livestock could be adapted for humans.

“All of nature is based on dead material being turned into new life,” Spade said. “It’s a renewal, but we’ve destroyed it through cremation or by pumping bodies full of chemicals and burying them in concrete boxes. It couldn’t be farther from what nature wants to do.”

She envisions nonprofit recomposition facilities being built in urban areas where land is scarce and there are unused structures such as churches or warehouses. Bodies could be carried by family members in a quiet candlelit ceremony or to the accompaniment of a brass band, she said, and then covered in wood chips to begin the transformation into soil.

“It’s a really beautiful way to treat bodies after death,” Spade said.

Kay Manning is a freelancer.

Eating Deer, Elk, and People Spreads Disease

A sign said DEPOSIT DEER AND ELK HEADS HERE at a government building next door to our hotel in Fort Collins, Colorado.  The heads were to be used in the study of chronic wasting disease which is related to mad cow disease and kuru.  RJN

___________________________________________

WHEN PEOPLE ATE PEOPLE, A STRANGE DISEASE EMERGED

In 1962, a local leader in the Eastern Highlands of Papua New Guinea asks Fore men to stop the sorcery that he believes is killing women and children.  Courtesy Shirley Lindenbaum

Most of the world didn’t know anyone lived in the highlands of Papua New Guinea until the 1930s, when Australian gold prospectors surveying the area realized there were about a million people there.

When researchers made their way to those villages in the 1950s, they found something disturbing. Among a tribe of about 11,000 people called the Fore, up to 200 people a year had been dying of an inexplicable illness. They called the disease kuru, which means “shivering” or “trembling.”

Once symptoms set in, it was a swift demise. First, they’d have trouble walking, a sign that they were about to lose control over their limbs. They’d also lose control over their emotions, which is why people called it the “laughing death.” Within a year, they couldn’t get up off the floor, feed themselves or control their bodily functions.

Many locals were convinced it was the result of sorcery. The disease primarily hit adult women and children younger than 8 years old. In some villages, there were almost no young women left.

“They were obsessed with trying to save themselves because they knew demographically that they were on the brink of extinction,” says Shirley Lindenbaum, a medical anthropologist with the City University of New York.

But what was causing it? That answer eluded researchers for years. Afterruling out an exhaustive list of contaminants, they thought it must be genetic. So in 1961, Lindenbaum traveled from village to village mapping family trees so researchers could settle the issue.

But Lindenbaum, who continues to write about the epidemic, knew it couldn’t be genetic, because it affected women and children in the same social groups, but not in the same genetic groups. She also knew that it had started in villages in the north around the turn of the century, and then moved south over the decades.

Lindenbaum had a hunch about what was going on, and she turned out to be right. It had to do with funerals. Specifically, it had to do with eating dead bodies at funerals.

In many villages, when a person died, they would be cooked and consumed. It was an act of love and grief.

As one medical researcher described, “If the body was buried it was eaten by worms; if it was placed on a platform it was eaten by maggots; the Fore believed it was much better that the body was eaten by people who loved the deceased than by worms and insects.”

Women removed the brain, mixed it with ferns, and cooked it in tubes of bamboo. They fire-roasted and ate everything except the gall bladder. It was primarily adult women who did so, says Lindenbaum, because their bodies were thought to be capable of housing and taming the dangerous spirit that would accompany a dead body.

“So, the women took on the role of consuming the dead body and giving it a safe place inside their own body — taming it, for a period of time, during this dangerous period of mortuary ceremonies,” says Lindenbaum.

But women would occasionally pass pieces of the feast to children. “Snacks,” says Lindenbaum. “They ate what their mothers gave them,” she says, until the boys hit a certain age and went off to live with the men. “Then, they were told not to touch that stuff.”

Finally, after urging from researchers like Lindenbaum, biologists came around to the idea that the strange disease stemmed from eating dead people. The case was closed after a group at the U.S. National Institutes of Health injected infected human brain into chimpanzees, and watched symptoms of kuru develop in the animals months later. The group, whichwon a Nobel Prize for the findings, dubbed it a “slow virus.”

But it wasn’t a virus — or a bacterium, fungus, or parasite. It was an entirely new infectious agent, one that had no genetic material, could survive being boiled, and wasn’t even alive.

As another group would find years later, it was just a twisted protein, capable of performing the microscopic equivalent of a Jedi mind trick, compelling normal proteins on the surface of nerve cells in the brain to contort just like them. The so-called “prions,” or “proteinaceous infectious particles,” would eventually misfold enough proteins to kill pockets of nerve cells in the brain, leaving the cerebellum riddled with holes, like a sponge.

The process was so odd that some compared it to Dr. Jekyll’s transformation to Mr. Hyde: “the same entity but in two manifestations — a ‘kind’, innocuous one and a ‘vicious’, lethal one.”

The epidemic likely started when one person in a Fore village developed sporadic Creutzfeldt-Jakob Disease, a degenerative neurological disorder similar to kuru. According to the Centers for Disease Control and Prevention, about one in a million people in the U.S. develop CJD the difference is that others rarely come into contact with infected human tissue.

Though the Fore stopped the practice of mortuary feasts more than 50 years ago, cases of kuru continued to surface over the years, because the prions could take decades to show their effects.

According to Michael Alpers, a medical researcher at Curtin University in Australia who tracked kuru cases for decades, the last person with kuru died in 2009. His team continued surveillance until 2012, when the epidemic was officially declared over. “I have followed up a few rumoured cases since then but they were not kuru,” he wrote in an email.

When Shirley Lindenbaum visited a South Fore village in 2008, one man said excitedly, “See how many children we have now?”  Courtesy Shirley Lindenbaum

But while they remain rare, transmissible prion diseases did not die out with the last kuru case, as people have found repeatedly in recent decades. People have developed variant CJD after eating the meat of cattle infected with mad cow disease. Dr. Ermias Belay, a prion diseaseresearcher with the Centers for Disease Control and Prevention, says that’s the only scenario in which there is “definitive evidence” that humans can develop a prion disease after eating the infected meat of another species.

But, he says, there are still a lot of open questions about how and why humans get prion diseases.

For one, it’s still a mystery why animals, including humans, have those proteins in the first place — the Jekylls that can be so easily turned into Hydes. One leading hypothesis, described recently in the journal Nature, is that they play an important role in the protective coating around nerves.

But here’s the bigger question, says Belay: “How many of these diseases actually jump species and affect humans?”

Kuru showed that people could get a prion disease from eating infected people. Mad cow disease showed that people can get a prion disease from eating infected cow. But what about other prion diseases in other animals? Could, say, hunters get sick from eating infected deer? That’s what researchers in North America, including Belay, are trying to find out right now.

Chronic wasting disease in North America is spreading fast,” says Belay. The disease causes infected wild deer and elk to starve to death. “In early 2000, we had about three states that reported CWD in the wild in deer and elk. Today, that number is 21.”

Belay says the disease is “a little bit concerning” because, unlike mad cow disease and kuru, where infectious prions were concentrated in the brain and nervous system tissue, in an animal with chronic wasting disease, the misfolded prions show up all over the body. They can even be found in saliva, feces and urine, which could explain how the disease is spreading so quickly among wild deer and elk.

The CDC is working with public health authorities in Wyoming and Colorado to monitor hunters for signs of prion disease.

“Unfortunately, because these diseases have long incubation periods, it’s not easy to monitor transmission,” says Belay. He says he and his colleagues have yet to find any evidence that hunters have picked up chronic wasting disease from the meat of infected wild animals.

“And that, in itself, is good news for us,” he says.

But, as with kuru, it will take years — maybe even decades — before he can know for sure.

 

The tissue-engineered robotic sting ray

 

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VIDEO at source

Synthetic Stingray May Lead To A Better Artificial Heart

(Left) The tissue-engineered robotic ray, made of gold, silicone and live muscle cells. (Right) The titanium molds that scientists used to create the rays.

(Left) The tissue-engineered robotic ray, made of gold, silicone and live muscle cells. (Right) The titanium molds that scientists used to create the rays.  Karaghen Hudson and Michael Rosnach

Scientists have created a synthetic stingray that’s propelled by living muscle cells and controlled by light, a team reports Thursday in the journalScience.

And it should be possible to build an artificial heart using some of the same techniques, the researchers say.

“I want to build an artificial heart, but you’re not going to go from zero to a whole heart overnight,” says Kit Parker, a bioengineer and physicist at Harvard University’s Wyss Institute. “This is a training exercise.”

Previous artificial hearts have been versions of mechanical pumps. An artificial heart made from living muscle cells would behave more like a natural heart, Parker says, and would be able to grow and change over time.

“The heart’s built the way it is for a reason,” he says. “And we’re trying to replicate as much of that function as we possibly can.”

A heart and a stingray may seem pretty different. But both need to overcome problems that involve fluid and motion, Parker explains. A stingray has to propel itself through the water. A heart has to propel blood through the circulatory system.

And all of that was on Parker’s mind a couple of years ago when he visited an aquarium with his daughter. At an exhibit where visitors can touch rays as they swim by, his daughter put her hand in the water. “The stingray was coming at it,” he says, “and with a quick flick of its pectoral fin it just smoothly evaded her hand.”

The coin-sized synthetic stingray (left) next to a skate that nature made, Luecoraja erinacea.

The coin-sized synthetic stingray (left) next to a skate that nature made, Luecoraja erinacea.  Karaghen Hudson/Science

Parker realized that this sort of split-second adjustment is something the heart does all the time as it senses changes in blood flow or pressure.

“The idea just hit me like a thunderbolt,” he says.

By building an artificial stingray, Parker figured, he could learn how to replicate the animal’s ability to respond instantly to changing conditions.

So he came up with a strategy and presented it to Sung-Jin Park, a researcher in his lab.

“I sat down with him,” Parker says, “and I said, ‘Sung-Jin, we’re going to take a rat apart; we’re going to rebuild it as a stingray; and then we’re going to use a light to guide it.’ And the look on his face was both sorrow and horror.”

Parker’s lab had previously built an artificial jellyfish. But a ray was much more complicated. And the team was facing tough questions like, how do you to take cells from a rat and make them swim like a fish?

Park and the rest of the team started working, though. And, eventually, they succeeded.

Their synthetic ray, which is about the size of a nickel, has a transparent body made of silicone and a rudimentary skeleton made of gold.

The ray is propelled by 200,000 heart muscle cells taken from a rat. The cells have been genetically altered to allow the hybrid creature to follow a pair of blue lights.

“We can guide this thing around,” Parker says. “It swims through obstacle courses.”

And the creature displays the rhythmic, undulating motion of a real stingray. Replicating that motion is one of the project’s key accomplishments, says John Dabiri, a professor of engineering at Stanford who worked with Parker on the artificial jellyfish.

To get the ray’s tail to undulate, the team had to come up with a way to trigger muscle cells in sequence. The effect is similar to when the crowd at a ballgame does the wave, Dabiri says.

“You have one group standing up and then the next and then the next. Well, in the case of the muscle here, they’re doing the same thing,” he says. “They’re able to get a certain section of muscle to contract and then the next and then the next.”

That coordinated movement is necessary for many biological functions, like swallowing. It’s also the way the heart beats, with areas contracting in a precise sequence.

Another advance is the ability to activate muscle cells with light rather than electricity, Dabiri says. That allows scientists to control precisely which part of a muscle contracts. So light could act as a sort of pacemaker in an artificial heart that’s made this way.

The artificial stingray is likely to make some people uncomfortable, Dabiri says, because it raises questions about when a machine becomes a living organism.

In this case, the artificial ray pretty clearly isn’t an organism, he says. It can’t grow, adapt or reproduce. But scientists should be considering the possibilities as they pursue other projects like this, he says.

“We want to make sure we think about the ethical issues hand in hand with just asking what we can do,” Dabiri says.

Worst Threat to Women

 

Hidden Heart Disease Is The Top Health Threat For U.S. Women

Tracy Solomon Clark didn't realize that the shortness of breath and dizziness she felt at age 44 was actually serious heart disease.

Tracy Solomon Clark didn’t realize that the shortness of breath and dizziness she felt at age 44 was actually serious heart disease.  Benjamin Brian Morris for NPR

Tracy Solomon Clark is outgoing and energetic — a former fundraiser for big companies and big causes. As she charged through her 40s she had “no clue,” she says, that there might be a problem with her heart.

It was about six years ago — when she was 44 — that she first suffered severe shortness of breath, along with dizziness. She figured she was overweight and overworked, but never considered heart disease.

“That was the furthest thing from my mind,” Solomon Clark says. “I was young!”

But it was her heart. Her doctor sent her to the hospital emergency room, where physicians diagnosed a blockage in a key artery. They inserted a stent to open it up and ease blood flow to her heart.

Ultimately Solomon Clark, who lives in Gardena, Calif., got several more stents to treat what turned out to be serious cardiovascular disease. Last year she had double-bypass surgery to replace the left main artery of her heart.

She’s not alone, according to Dr. Noel Bairey Merz, who directs the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles, says she’s not surprised by Solomon Clark’s experience. Bairey Merz often meets young and middle-aged women who have no idea they are at risk for heart disease and a heart attack.

She and colleagues recently surveyed 1,011 women ages 25 to 60, a random sampling from across the U.S. Only about half of those interviewed knew that heart disease is the leading threat to women’s lives, the scientists found. Many thought breast cancer poses a bigger risk. They were wrong.

Every year in the U.S. about 40,000 women die from breast cancer, according to statistics from the Centers for Disease Control and Prevention. Meanwhile, roughly 10 times that number die from heart disease.

Greater awareness and advances in detection and treatment have dramatically decreased breast cancer deaths over the past few decades, Bairey Merz explains. But heart disease now claims the life of 1 in every 4 women.

Many women with heart disease could benefit from effective treatment, including aspirin, statins, beta blockers and the like, says Dr. Laxmi Mehta, a cardiologist at the Ohio State Wexler Medical Center. But they can be helped only if they are diagnosed.

After the stent was placed, Solomon Clark continued to have periodic bouts of dizziness, shortness of breath and even a little pain. The symptoms were eventually traced back to continuing heart trouble.

But not right away. When she returned to an ER to have the symptoms checked out, tests suggested no new blockages, and the emergency room doctors told her she might just be suffering an anxiety attack.

Last year Solomon Clark had double-bypass surgery to replace the left main artery of her heart.

Last year Solomon Clark had double-bypass surgery to replace the left main artery of her heart.  Benjamin Brian Morris for NPR

Mehta chaired a committee of the American Heart Association that this year released the organization’s first scientific statement on the problem of heart attacks among women.

Even after a heart attack, Mehta says, women are less likely than men to be referred to cardiac rehabilitation programs, though these programs significantly reduce the chances of a second heart attack.

Part of the reason women are misdiagnosed or not diagnosed at all is because heart disease looks a lot different in women than it does in men, she says. And men have been the focus of most heart disease research.

For example, men are more prone to blockages in major arteries — these are relatively easy to spot on an angiogram, and are more likely to prompt timely diagnosis, Mehta says.

Women, on the other hand, are more likely to have problems with tiny arteriesembedded in the heart, she says. These smaller blood vessels often are not visible on angiograms, and also don’t fill up with plaque.

“They don’t have enough of a wall to build up plaque,” says Bairy Merz. “That’s how tiny they are.” But these small arteries can lose flexibility and run into problems — constricting too much and cutting off blood flow to the heart.

In her survey, Bairey Merz found that 74 percent of the women had at least one heart disease risk factor, such as high blood pressure, high cholesterol, diabetes, irregular menstrual periods, early menopause or a family history of heart disease. Yet only 16 percent reported having been told by a doctor that they had an elevated risk.

Instead, Bairey Merz says, the doctors, who also were surveyed by the researchers, were more concerned about their patients’ weight and breast health than heart disease.

All primary care doctors should routinely assess a woman’s risk for heart disease, Mehta says. And if they don’t, women should take the lead and bring up the subject of heart disease and their individual risk. (You can start by using this online risk calculator.)

Pay attention to your body, Mehta tells her patients. “If something seems out of the ordinary, it’s best to seek medical attention, especially if something is occurring only with exertion — or worsening with exertion.

“I’d rather be wrong and go to the ER,” Mehta says, “than die at home.”

A Surgeon

 

As I work with the doctors I have now, people I like and trust, I remember a surgeon who was good to me a long time ago.

When I was maybe 35 years old, a neglected skin cancer, basal cell, had grown to the size of a half dollar on my left temple. My internist referred me to a surgeon who removed the tumor and grafted skin from behind my right hear to cover the wound.  Later I wrote this poem.                         {Ever see a half dollar? 1.2 inches across.}

 

Levin, you bound my head too tight about

a knot of gauze that gnawed my scalp as I

emerged from anesthetic murk. When I

complained you blamed it on the fight I gave you

coming through to conscious wrath.  When you,

who’d snipped, and patched and finely stitched,

finally spun off the swath, you called in all

the floor staff, other cutters, cops and cleaners

to my bed to look and wonder, shake your hand, allowed

in friends and neighbors, local merchants and a TV crew

to praise your nifty work. You were proud,

but at the first, when a friend had come to speak

of dread and anger, you could hear,

and in the legal instance you could bend.

Levin, I bitched, I didn’t pay you,

but I loved you and I didn’t want you dead.

______________________________________

Levin died a year later of a brain tumor.

rjn

 

 

 

Drug Co. Drops States’ Death Business

 The death chamber of the lethal-injection center at San Quentin State Prison in California.CreditEric Risberg/Associated Press

May 13, 2016

The New York Times

NYTimes.com »

Pfizer has blocked its drugs from being used in lethal injections, cutting off the last open-market source of such drugs

Friday, May 13, 2016 4:02 PM EDT  source

The pharmaceutical giant Pfizer announced on Friday that it has imposed sweeping controls on the distribution of its products to ensure that none are used in lethal injections, a step that closes off the last remaining open-market source of drugs used in executions.
More than 20 American and European drug companies have already adopted such restrictions, citing either moral or business reasons. Nonetheless, the decision from one of the world’s leading pharmaceutical manufacturers is seen as a milestone.
Read more »

Charlie’s Heart

Image result for photos human heart

My cardiologists are recommending heart surgery for me.  Makes me remember Charlie P. Anderson, a good guy who taught with us at Niles Township High Schools.

Some 50 years ago, Charlie had just had an artificial heart valve installed (a pioneer!),  when we were both appointed the union’s bargaining team.  For the first  recess in negotiations, the school board team withdrew from the room.

Someone on our side took out a deck of cards and said, “Who’s playing?”

Charlie, several others, and I sat down, and the first hand was dealt. And then, Charlie started ticking . . .and everyone knew he had a good hand.

The sound of Charlie’s new valve was not noticeable until he got excited and his pulse sped up.  A handicap, but Charlie stayed in the game.

rjn

Old Folks at Home–a Zoo

ANTHONY SOUFFLE/CHICAGO TRIBUNE PHOTOS Brookfield Zoo veterinary staff prepare Sabu, a 5-year-old male snow leopard, for X-rays after surgery to remove a tongue tumor.

Caring for zoos’ elderly
Medical advances lengthen animals’ lives but lead to unsettling questions
By Ted Gregory Chicago Tribune  3.6.16

   Ramar the gorilla is on Celebrex. Hiss Majesty the caiman lizard has been fitted with a prosthesis, and Heidi the reindeer eats hay soaked in water.   They’re geriatric animals at Brookfield Zoo and Shedd Aquarium, and their population is increasing, a result of generally improving care for animals in mainstream zoos and aquariums across the country.  

Those improvements have brought a new challenge: higher numbers of age-related health problems in animals. To address those maladies, zoos and aquariums are leaning on human health-care technology and tweaking traditional approaches. But the further institutions evolve in animal care, the deeper they venture into a cloudy ethical landscape of determining when to end an animal’s life.   “We’re not doing it to create longevity records,” Bill Zeigler, senior vice president of animal programs at Brookfield, said of improving care for animals. “We’re doing it because we’re trying to create the best care and welfare.

It’s subtle, but it’s a big difference in how we approach things.”   Like medical care for humans, care for zoo and aquarium animals has been improving steadily through decades of more useful technology, better medicine and growing bodies of research. And the relatively new maladies zoo and aquarium veterinarians are seeing resemble those seen by physicians treating people in their golden years.

In Ramar’s case, it was arthritis in his knees. Hiss Majesty was stricken late in life with a cancerous growth in a foot. Heidi is 14 years old and her teeth are deteriorating. Cardiovascular problems, osteoporosis, failing eyesight and kidney malfunction are other conditions elderly animals share with their human counterparts.  

ANTHONY SOUFFLE/CHICAGO TRIBUNE PHOTOS Brookfield Zoo veterinary staff members move Sabu from the operating table after surgery to remove a tumor from underneath his tongue on Feb. 24.

“If we have a lot of animals that are living longer, we need ways to care for them and also make sure we have enough space for newer animals,” said Lisa Faust, vice president of conservation and science at Lincoln Park Zoo, which is participating in a collection and analysis of species data to determine median life expectancy for all animals in zoos and aquariums. “It’s a balancing act.”  

To reach the point of giving human medications to Ramar, Brookfield performed CT scans on the silverback gorilla to pinpoint specific joints that were giving him the most trouble, said Dr. Mike Adkesson, vice president of clinical medicine at Brookfield. Adkesson then compared Ramar’s scans with those of humans and spoke with the patients’ doctors to get a clearer sense of how much pain Ramar was experiencing.   “A lot of our animals end up on medications that are very similar to what you’d probably find in the drug cabinet of an older person in a nursing home,” he said.   In addition to giving Celebrex to Ramar, zoo staff changed the position of hand holds in his exhibit to allow him to pull, relieving pressure on his knees. They also gave him a rolling stool to sit on, instead of squatting, and separated him from the rest of the group to eliminate other apes’ increased aggression toward Ramar, a typical response to older gorillas.  

Heidi, the reindeer, is arthritic and is on a low dose of anti-inflammatory medication. Her more pressing issue is that she has lost a few teeth, prompting use of the water-softened hay. Keepers at Brookfield’s Hamill Family Wild Encounters, where Heidi is on display, also use fans and misters to keep her cool in hot weather, lead keeper Andy Schertz said. Keepers at Brookfield’s Hamill Family Wild Encounters, where Heidi is on display, also use fans and misters to keep her cool in hot weather, lead keeper Andy Schertz said. 

Andy Schertz tends to Heidi, a 14-year-old Brookfield Zoo reindeer, on Feb. 25. Heidi has already shed one of her antlers for the year, and the other will fall off soon.

  All animals at Brookfield are on a preventive health program that includes routine checkups and, if necessary, preventive surgeries. In late February, for example, Sabu, a 5-year-old male snow leopard at Brookfield, underwent surgery to remove a mass on his tongue that might have become malignant.  

Animals tend to mask pain to prevent isolation from their herd, flock or school, and to avoid predators looking for vulnerable prey, experts say. They are, of course, unable to tell keepers and veterinarians about the pain they may be experiencing.   Technology helps to close that communication gap.   Brookfield acquired a thermal-graphic camera that detects heat — an indicator of arthritis or inflammation — as well as a pressure-sensitive gait analysis mat that allows veterinarians to track an animal’s walk and determine if it’s becoming lame. In addition, Brookfield officials say they are one of only two zoos in North America with a CT scanner.  

Maggie is a 54-year-old orangutan who has played surrogate mom to several abandoned babies at Brookfield Zoo.

Shedd Aquarium uses a mammography unit to X-ray tiny frogs and is looking at how to take heart rhythm readings of fish by adapting a device designed for human EKGs, said William Van Bonn, the aquarium’s vice president of animal health.  

Granddad, an 85-year-old Australian lung fish, swims in his Shedd Aquarium enclosure on Feb. 26.

Hiss Majesty, the lizard Shedd says is at least 15 years old, developed a tumor in his right rear foot. Tumor and foot were removed in the middle of last year. Today, after being fitted with a prothesis made through the use of a 3-D printer, Hiss Majesty can be seen in the Amazon Rising exhibit, where he sometimes wears his prosthetic and sometimes doesn’t.  

At Lincoln Park Zoo, one of its more prominent, geriatric residents has avoided surgery so far. Maku, an eastern black rhinoceros that will mark his 30th birthday Friday, receives joint-enhancing nutrients in a powder sprinkled on his fruit and vegetables, said Dr. Kathryn Gamble, the Dr. Lester E. Fisher director of Veterinary Medicine at the zoo.  

On a broader scale, Lincoln Park’s Population Management Center is running the Survival Statistics Program, data collection and analysis aimed at finding species’ median life expectancy, with the aim of planning better care for animals as they approach later stages of life.   The program has analyzed data from 297 species in institutions accredited by the Association of Zoos and Aquariums, and compiled median life expectancies for 235 of those species, Lincoln Park spokeswoman Jillian Braun said. It continues to add species and update data as more information flows in, Braun said.  

Finding the balance between caring for older animals while opening space for newer ones raises the sensitive issue of euthanizing animals, a topic that institutions are refining as animals’ health care advances.  

A few weeks ago, Brookfield’s Adkesson and his team gave a presentation on euthanasia to zoo staff. The goal is to start having open, candid conversations about age-related conditions earlier in an animal’s life, and to make sure that discussion includes veterinarians, keepers, nutritionists and welfare assessment teams, Adkesson said.   Those delicate conversations on animals’ quality of life often involve whether they are interacting normally with other animals in their group and care staff, eating normally, maintaining proper weight or experiencing muscle wasting.  

“Euthanasia is a difficult thing to process, and it’s a difficult thing to do,” Adkesson said. “But in many ways, it is a final act of kindness, and it is an ability to alleviate suffering and to let an animal end its life with dignity and some grace.”   He said staff at the zoo prefer never to euthanize an animal too late, not even by a day.   Dr. Vint Virga, an expert on animal behavior and author of the book “The Soul of All Living Creatures,” who has consulted with zoos and similar institutions for years, cautioned against taking too rigid an approach to ending the life of an animal in a zoo, aquarium or wildlife park.   Every situation and every animal needs to be considered independently, he said. Whatever decision an accredited institution makes, it’s almost always more humane than the animal’s fate in the wild — a fact that sometimes gets forgotten.   “A pronghorn losing its life to a cheetah is rough,” Virga said. “Nature is not as kind to these animals as some people might think.”tgregory@tribpub.com    Twitter @tgregoryreports

Cookie, an 82-year-old cockatoo, is fed by her Brookfield Zoo keeper in an off-exhibit area.

 

 

Twins and decisions

An Ill Newborn, A Loving Family And A Litany Of Wrenching Choices

JENNY GOLD

Anne Shamiyeh says grace before a meal with her husband, Omar Shamiyeh, and their two daughters, Zara and Malia. Anne says faith played a strong role in helping the family deal with the death of Malia’s twin brother, Kai, in 2013. Heidi de Marco/KHN

Anne and Omar Shamiyeh first learned something was wrong with one of their twins during an ultrasound, when Anne was 18 weeks pregnant.

“The technician was, like, ‘Well, there’s no visualization of his stomach,’ ” says Anne. “And I was like, ‘How does our baby have no stomach?’ ”

It turned out that the baby’s esophagus was not connected to his stomach. He also had a heart defect. At the very least, he was likely to face surgeries and a long stay in intensive care. He might have lifelong disabilities.

This was only the start of an eight-month ordeal for the Shamiyeh family.

Decisions about how much care to offer very sick family members are always challenging. But they can be particularly wrenching for parents like the Shamiyehs, who face harrowing choices during what is supposed to be a wonderful time — the start of a life.

As doctors and families consider how far to push medical care, a chasm can open between the parents’ hopes and what providers consider realistic.

For the Shamiyehs, the first major decision was whether to “selectively reduce,” the clinical term for aborting one fetus in a multiple pregnancy. “Omar and I were very uncomfortable with that,” Anne says. “We really wanted to see what he was going to be like, and what life had to offer.”

That decision meant the twins, a boy and a girl, would likely be born prematurely. As it turned out, they were delivered by cesarean section at 30 weeks — about two months early — at UCSF Benioff Children’s Hospital, in San Francisco.

The boy was named Kai, the girl Malia. Each weighed about 3 pounds. They were rushed immediately to the neonatal intensive care unit. That night Kai had his first surgery.

Malia went home after about five weeks. But Kai was far from ready. He was on a ventilator, had to be fed through a tube directly into his stomach and was still struggling to survive. Eventually, he was diagnosed with CHARGE syndrome — a rare genetic condition that can result in severe cognitive and physical disabilities.

Omar looks through Kai's photo book. The charges for the infant's six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate.

Omar looks through Kai’s photo book. The charges for the infant’s six months of care in the neonatal intensive care unit totaled about $11 million, according to the family, though their insurer very likely negotiated a lower rate. Heidi de Marco/KHN

About the time Malia went home, the doctors and nurses sat down with the Shamiyehs to discuss Kai’s treatment. They needed to know whether the family wanted a tracheostomy — surgeons would insert a breathing tube directly into Kai’s neck to ease passage of air into his lungs.

“It seemed awful,” Anne recalls. “We were both really unhappy with that, but we understood it wasn’t a choice. It was something we had to do.”

But Dr. Liz Rogers, a UCSF neonatologist who cared for Kai, saw it as a significant decision.

“To be very honest,” Rogers says, “for many, many of our families, the point of decision around a tracheostomy is a major, major time when families say, ‘This has gone on for too long, and it’s not what I want for him.’ ”

Anne had real hope for Kai’s future, despite the pessimism of some doctors.

“I kept thinking, maybe that doctor’s view of quality of life is different from mine. And maybe, for me, loving my child and having him feel love is enough,” Anne says. “And it’s OK if he can’t talk. Maybe he’ll wear a diaper until he’s 5, and maybe he’ll be in a wheelchair, but that’s OK. Because he’ll be alive, and he’ll be my child.”

Studies suggest that health care providers do tend to have a different view of quality of life than parents do. In Kai’s case, many of his day-to-day caregivers — the nurses — felt Kai was suffering unnecessarily.

Deidre Miller, a registered nurse in the NICU, says she was one of just a handful of nurses willing to be part of his primary care team. It was clear to all of them, she says, that Kai wasn’t going to make it. Miller says she felt comfortable caring for Kai, but faced pressure from other nurses.

“A lot of people thought, ‘OK, well, let’s just offer the Shamiyehs the opportunity to withdraw care today.’ And, as a primary nurse, you knew that the Shamiyehs were never going to agree to that, and you knew that he had joy in his life,” she recalls. “But you go into the break room, and everybody wants to talk about it, and everyone wantsyou to be the person to tell the Shamiyehs.”

There’s often a lag between when health care providers and parents sense a child isn’t going to make it. In one study, for instance, oncologists realized that their young patients would not recover months before the parents recognized it.

“As easy as it is to say we knew Kai was going to die, and we knew he was going to have a difficult life — gosh, what if we had been wrong?” Miller says.

From Anne’s and Omar’s perspective, Kai had many happy moments. They visited every day, always with Malia in tow. He smiled, cooed and connected with them. But he wasn’t getting better.

In May 2013, five months into Kai’s stay in the NICU, the Shamiyehs and their doctors sat down to talk about whether they wanted to go forward with the heart surgery that had been on the calendar since his birth. It would have to be done if Kai was ever to leave the hospital.

The surgery wouldn’t help, doctors explained, and Kai might die during the procedure. This time, Anne and Omar decided not to go forward.

“So that was the day we found out we wouldn’t ever be bringing Kai home,” Anne says.

Two weeks later, Kai developed an infection the doctors couldn’t treat. On June 5, 2013, he died in his mother’s arms.

There were real costs to Kai’s long stay in the NICU. Based on billing statements, the Shamiyehs calculate that the charges for Kai’s care added up to more than $11 million, though their insurer very likely negotiated a lower rate.

There were also consequences for Kai’s twin sister, Malia, whose parents were mostly focused on her brother during her first six months of life. Born two months prematurely herself, she had physical and speech delays; although at age 3, she’s already caught up.

Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU.

Anne Shamiyeh at home with 3-year-old Malia. Twins Kai and Malia arrived roughly two months early. Each weighed around 3 pounds at birth, but Malia was able to go home after about five weeks in the NICU. Heidi de Marco/KHN

Looking back, Omar says he wonders if they went too far. “It’s really hard to think — for five months he was going through all this pain and all this stress,” Omar says. “You wonder if you made the right decision in keeping it going, you know?”

But Anne, who is now studying to become a nurse in the NICU, says she does not regret giving their son the best possible chance at life.

She’s at peace with both their decisions — to try to save Kai, and to let him go.