Waking the Dead

May 27, 2007

UPenn’s Center for Resuscitation Science

Interesting web site. It’s about how we define the moment of death. They are turning Emergency Medicine on its head.

If you have advance directives, a living will or a DNR order, it’s because you don’t want to wind up a vegetable after a medical emergency or because you have an incurable, fatal condition. Advanced directives are NOT intended to force the ER doctors to let you die when medical treatment can easily fix you right up. With the exception, of course, of folks whose religion forbids medical treatment.

When I was a whitewater rafting guide I had to be certified in Advanced First Aid and Life Support. This program took four weekends to complete. It was hard for me to put in that kind of sustained effort, now that I think about it, but it really helped my confidence on the job. The point of the course was to enable the guides to stabilize someone injured on the river until we could get real medical help. And it wasn’t a far stretch to consider CPR in case a guest had a heart attack on the river.

Read the UPenn web site. Look at the powerpoint presentations. Read the doctors’ curriculum vitae.

Again: it’s about how we define the moment of death.

So.

Google “cellular reperfusion injury” and read a few of the articles that come up.

Your cells don’t die right away when you die. When oxygen-deprived they go into a kind of stasis and even after several hours a doctor can still extract undamaged, living cells. They haven’t stopped, they’ve just slowed down. You don’t fade out in that first magic 5 minutes. You fall into a deep coma, then actual cell death takes hours – or longer.

This is completely different than what the public and most of the medical profession believes at this time. The current belief is that no pulse equals death. Which really sucks for a few folks who have temporary a artificial heart that whirrrrrs instead of beating. But I digress.

So if you want to define death in terms of brain activity as monitored on an Electroencephalogram (EEG), well, the EEG can only measure down to about 0.5 Hz. This is a limitation of our technology. As you fall asleep brainwaves slow from 30Hz maximum down to around 4Hz. If you go into a deep coma, they slow down even more. No brainwave equals death, then. Except that our technology has serious limitations. Well, it turns out that brain cells go into stasis too.

Now here’s where it gets weird.

Think about what they do in the ER. It’s all about reperfusion, getting oxygen back into the brain as quickly as possible. Jump-start the heart, pump oxygen into the lungs, get a cold patient warm. Well, it turns out that if you pump too much oxygen into a cell that’s in stasis, it self-destructs. That magic 5 minutes isn’t the time that it takes the cells to die. The magic 5 minutes is the time it takes for some of the cells to go into stasis, that is, enough that the self-destruction, or apoptosis, causes wide-spread damage to the body on reperfusion. The heart seems to be the most susceptable organ.

The gist of the web page I linked to is that if someone is brought into the ER suffering from cardiac arrest, they have a better chance at survival if the ER doctors immediately cool them down and add some chemicals to prevent apoptosis before beginning slow reperfusion. The Resuscitation Medicine department at the U of P is working on establishing a new set of protocols.

Where it gets scary is here:

If they bring you in after the magic 5 minutes, present ER protocols can’t save you. Not without massive, permanent damage to the heart and to the brain. They declare you, and that’s it. The body is sent to a funeral home and cremated or injected with preservatives, sometimes long before the several-hour deadline (so to speak) is up.

No wonder the Irish hold wakes. The British, after discovering that an unsettling number of people had been buried alive – used to attach bell cords to the wrists of folks they buried. Saved by the bell.

IRL your family can decide to keep your brain-dead corpse alive despite anything you said in life. Witness what poor Terri Schaivo’s parents did to keep her mindless body alive long after her spirit was gone.

I’ll be watching the Rescusitation Medicine story with great interest.

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What Mad Pursuit

April 1, 2007

‘J.B.S. Haldane was once asked what the study of biology could tell one about the Almighty. “I’m really not sure,” said Haldane, “except that He must be inordinately fond of beetles.” There are thought to be at least 300,000 species of beetles. By contrast there are only about 10,000 species of birds.’

Nobel Laureate Prof. Francis Crick
in “How I Got Inclined Towards Atheism,” an excerpt from What Mad Pursuit: A Personal View of Scientific Discovery


Remission in Bipolar Disorder

November 3, 2006

If someone figures out how to “cure” genetics, let me know. You can’t exactly pick up a bottle of Grecian Formula for Brain at the local pharmacy.

Remission is another thing altogether. That simply means that you are having an extended symptom-free period. Given that the DSM-IV bipolar criteria only require that the patient have ONE episode of mania or hypomania, some folks may remain in remission for the rest of their lives even without meds.

Science *is* empiricism. I would like to suggest that a large percentage doctors are not particularly careful in their application of the science of medicine. If they were scientific, they’d test and retest the bipolar patient’s continued need for meds instead of following the bizarre rule of thumb that once you’re on meds you need them forever. The killer is that as long as the illness is masked by drugs, it is impossible to practice “evidence-based medicine” as they disparagingly call it.

None of us on meds is being treated in an scientific manner. It isn’t scientifically valid to say that bipolar disorder causes cognitive deficits if a large percentage of the patients in the study were on meds. Antipsychotics have been *proven* to reduce the IQ by affecting the short-term memory. They aren’t the only drug to cause cognitive deficits. Lithium makes you feel as if your brain is wrapped in cotton wool.

I don’t believe that it is scientifically valid to say that bipolars must be on meds for life. If the patient stops the meds and experiences a return of symptoms… well, you’ve rewired the brain. The drugs themselves create a continued need for themselves by reconfiguring the brain’s neurons to need higher levels of serotonin in the synapses. The symptoms are bound to return, and much worse than before the drug did its damage.

Another thing about remission is that so many things besides bipolar disorder cause mood swings. Bipolar disorder has periods of remission. Things like the personality disorders, schizophrenia, schizoaffective disorder, PTSD and any of a hundred organic illness all cause mood swings. But they don’t necessarily have periods of remission, and in many cases remission just doesn’t occur.

Here – this is my particular manifestation of bipolar disorder. Three-year cycles. They come no matter what, but fortunately the meds attentuate the episodes. On the other hand, until I was on meds the cycles didn’t seriously impact my salary.

I think that it’s important, if a bipolar isn’t having remissions, to figure out why. Ultra-rapid cycling could be caused by an antidepressant, particularly in women. Newly-diagnosed bipolars often experience a great deal of fear or anxiety that might be better treated with therapy than with additional meds. Antipsychotics may ruin the patient’s ability to effectively manage the illness by dumbing them down. Sometimes it isn’t the illness, it is the meds that make bipolars disabled.

Are your drugs masking periods of remission?

Sometimes I get tired of the reverse stigma that I get for taking fewer meds so that I can continue to have a life. Isn’t that the purpose of treatment? If not, what is?

Most bipolars have the so-called milder varieties of the illness, and many of them are unfairly overmedicated and isolated from society for no good reason. It is unbearably sad to see that happening. So if I can tolerate psychosis instead of trying to medicate away every little nuance of mood or emotion, does that make me somehow inferior? I don’t f*cking think so. It isn’t pathological until it has a negative effect on my life.


dDaylight/dt

September 4, 2006

The Autumnal equinox is in a couple of weeks, and during this time the days are getting shorter at the fastest rate they will all year, with the biggest change right on the day of the equinox. This graph is intended to compare the rate of change of the number of hours of daylight at two times during the year. At the Summer Solstice, light blue, there are a few days when the length of the daylight changes very little. But at the Autumnal Equinox, shown in dark green, the slope is very steep, showing that the amount of sunlight we get in a day is falling quickly. This has great implications for anyone with SAD (Seasonal Affective Disorder).
Graph of the length of days
I used Juergen Giesen’s Daylight Applet to generate the numbers and graphed them in Excel.

Update 10/28/2006:
Juergen has since added a graphing function to his Daylight Applet. Do go take a look at it.
Thanks to Saheli Datta for adding a blue dimension to the topic.


Jessica Wants an MRI

April 1, 2006

This is an expansion on a comment I left on The Zucchini Patch.

I think they use PET scans for what you want to do. An MRI isn’t capable of telling the difference between a live brain and a dead brain. It can, however, spot a shrunken hippocampus or amygdala or anomalies in the blood vessels.

An fMRI can see more. They can use tagged glucose or neurotransmitters, whatever they want to study. The fMRI shows where the substance concentrates in the brain, where it is used the most. The NIMH has information about this.

It’s all still under investigation, though. The fMRI is not ready to be used to diagnose.

Did you know that in ADHD, the harder the person tries to concentrate, the more the prefrontal cortex shuts down? Oddly enough, motor areas of the brain work harder at the same time. Can’t we just find a way to teach these kids that will fit with that kind of brain response? Running around in circles shouting out calculus problems, perhaps?

Apologies to my friends of the hyperactive persuasion.

Somewhere in this computer I have a letter I wrote to one of the scientists in the movie “What the Bleep Do We Know!?” who works down at Penn. I met him at the preview and asked him a few questions to correct some of my assumptions in writing the “Putting the Genie Back Into the Bottle” article. The study I was interested in was over, unfortunately. (Yes, dogs and cats *do* have Broca’s and Wernickes areas – it’s not just defined by function, it’s a physical location.)

I have an MRI of my head hanging on the wall next the the desk This is your brain on bipolar to remind me that I have a brain – you can see it, the small pea-sized thing in the center of the glob of mush. 😉 Several years ago I made an animation out of the scan through the layers. Where the hell did I put that?

Oh, here. I see that this one is from after I had my sinuses repaired in uhhhhh 1996 or thereabouts. Refresh the page to see the animation. My favorite part is the eye stalks. We must have had crustacean ancestors.

When did they decide that the Rorschacht test and the MMPI diagnose bipolar disorder? Bipolar isn’t a personality disorder, it’s a mood disorder. My last psychologist told me that when they modified the inkblot test, it was not longer useful in diagnosing borderline personality disorder, either. I question the whole thing at this point.

I took one years ago. The psychologist took my money out of pocket twice a week for over a year and wasn’t able to catch the bipolar disorder. When we did the inkblot test, I thought about what I’d been reading in the psychology books and created a mindset before we started. He had seascapes all over the walls so I picked an undersea theme – so that undersea pictures would be the first thing to pop off the paper at me. Dancing crabs, an octopus in a Jester’s cap. That sort of thing. The MMPI and the Thematic Apperception test were similarly transparent. And drawing pictures of my house and my family and myself. It might have been easier if I didn’t read so damn much. I read a lot more then than I do now.

Anyway, that’s what you want, a functional MRI rather than a plain old MRI.


As The Worm Turns

September 5, 2005

A Worm a Day Keeps the Doctor Away.

“We believe that this research will lead us to develop a new ways of preventing and treating asthma and anaphylaxis, which can then be extended to treat inflammatory bowel disease and arthritis,” says Dr Fallon.

I’ve heard other reports of intestinal parasites helping keep common immune disorders under control. Let me know how it works out for you.


Your Body is Your Subconscious Mind

July 10, 2005

My response to The Molecular Biology of Emotion.
Just listened to Dr. Candace Pert’s new audiobook, “Your Body is Your Subconscious Mind.” Dr. Pert is the scientist who discovered the opiate receptors in the brain. She was prominently featured in the movie “What the Bleep Do We Know?”.” If you haven’t seen it yet, you must turn off your computer right this instant and go rent a copy.
Very kewl stuff. I knew that the R-complex, the hindbrain, took care of autonomic functions. I never considered that the hindbrain was also the interface between the body and the brain as far as integrating the physical experience of a neurotransmitter with the emotional response to that neurotransmitter. And vice-versa.
What we do, then, is to rationalize our “gut-level” reactions and emotions and then either repress, modify, or act upon them.
Wow.
I definitely want to check out another of Ms. Pert’s books, “Molecules of Emotion.”