Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, April 30, 2017

Head Trauma : Serial Concussion

"[Hemingway fell victim to] an illness whose cruelest trick was to incapacitate the mind, yet all the while preserve insight into the sufferer's plight."
"We all think of the Hemingway persona, but what the CTE [chronic traumatic encephalopathy brain disease] did, later in life, was it simply solidified and locked in the very worst aspects of that persona. It made him irritable, volatile, difficult, challenging, all that."
"People talk about how, psychologically, he was trapped by the persona like a spy out too long, believing his own cover, or acting that way because people expected it of him. I think he was biologically incapable of breaking free from the nastier aspects of that persona, simply because of the CTE."
"They [scientists involved in posthumous studies] wouldn't have known what they were seeing anyway. In fact, in 1961, the year he was getting his shock therapy, there was an article in the British Journal of Psychiatry, and it described post-concussive syndrome after motor vehicle accidents, but it was called 'accident neurosis', in which the author argued these were people just seeking attention, and they were not really sick in an organic way. And now we know that just poisoned the well and made people look for years at these people as malingerers."
Andrew Farah, chief of psychiatry, High Point Regional Health System, University of North Carolina, Chapel Hill


It has only been in the last decade that research has been done in depth on concussions and their post-accident impact on the lives of those who had sustained serious head injuries where the brain was injured through being badly jolted. Stories of sport figures involved in physically strenuous and violent extreme sports like rugby, football, hockey, boxing, snowboarding, skiing, sustaining concussions and grimly carrying on regardless until the end of the game. Sometimes never seeking medical help. Often going on to play another game, and sustaining injury on injury.

The author of the newly published book Hemingway's Brain, Andrew Farah, is well credentialed as a health professional. As such he is intimately aware of all the most recent literature in brain injuries and the ubiquitous nature of concussions and how those injuries make life extremely difficult for many people struggling through long and sometimes complex recoveries. These people now have professional help in their recoveries. There is a recognition in the health community of concussion impact on the brain.

In Ernest Hemingway's time, such was not the case, even though it was well recognized that boxers in particular, suffered perceptibly the injurious after-effects of repeated and violent blows to the head through their popularized sport. Dr. Farah writes his professional opinion that the adventure- and action-seeking Ernest Hemingway was often in harm's way. He elaborates in his book, on the number and frequency of Hemingway's brushes with violence that left him repeatedly concussed.

File photo
File photo    Ernest Hemingway helps a soldier unjam his rifle during the Spanish Civil War at the Battle of Teruel between December 1937 and February 1938.
 
From the first event when he sustained a serious head trauma during the First World War in Italy as a result of a shell landing mere feet from him, to a later event in Paris when he inadvertently pulled a skylight down on himself, to a London car crash during the Second World War, then a fall on a fishing boat, and finally a plane crash in East Africa, all impacting on Hemingway's skull and brain. Dr. Farah notes that medicine did its best to serve America's most famed novelist, in the framework of what it knew at the time.

But it was felt by medical professionals that Hemingway was suffering from depression and related psychosis, psychiatric illnesses without an organic component. He had been subjected to electroconvulsive therapy which, had he really been bipolar disorder or manic depression, might have helped him. But since it was instead the then-unrecognized condition of chronic traumatic encephalopathy that tormented the writer, exposure to electroshocks stressed his vulnerable nervous system toward further decline.

One recognized symptom of CTE is the growing intolerance to alcohol. And Hemingway was famously alcoholic. And suffered as well from high blood pressure. Dr. Farah's theory makes sense, but it will always remain a theory. When Hemingway committed suicide, he shot out his brain, leaving nothing for medical science to study as is often done on the posthumous brains of people considered in the popular realm to be of genius mettle.

File photo
File photo     Ernest Hemingway fishing with an unidentified friend in an undated photo.


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Saturday, April 29, 2017

When In Doubt

"The procedures carried out by Ian Paterson on vulnerable patients were unnecessary and caused physical suffering, scars and wounds to the patients."
"Also, as a result of his greed and arrogance, many of the patients have suffered psychologically, believing they needed to undergo the procedures because they were at risk from breast cancer."
"Of the 11 victims he was charged with in relation to this case, none had breast cancer, and yet he led them to believe they were at risk. This was cruel and unnecessarily led to many people suffering and living in fear."
Chief Superintendent Mark Payne

"I think he's a psychopath. Why would anyone in their right mind do operations to people knowing that they didn't need them?"
"[I hope he] rots in hell."
Frances Perks, mastectomy patient

"I, for one, trusted him with my life."
"To realize that I was betrayed makes me question my own judgment and I feel like I cannot trust any doctor."
Carole Johnson, surgical patient
Marian Moran, a GP and victim of Paterson testified in court against the rogue surgeon
Dr Rosemary Platt, a GP and victim of Paterson testified in court against the rogue surgeon telling the court she was left in agony following the pointless surgery  SWNS SouthWestNewsService

It is elemental, isn't it, that patients whose diagnosis leads to surgery are so often cautioned that they would do well to seek a second professional opinion before agreeing to proceed. It makes good sense, after all, before proceeding to surgery, to take all steps necessary to determine that the original diagnosis was correct and the doctor that will perform the surgery is correct, through the simple enough expedient of requesting a second opinion. None of Dr. Paterson's patients, it seems, went to the trouble. The amazing thing is that one of his patients was herself a general practitioner.

It would seem, therefore, that this health professional held the trust of his patients. His word as a professional examining them and diagnosing them with the dread word: cancer - was all they needed to fall into line and meekly accept his verdict that they required surgery. Of course the very diagnosis of cancer, that dread, deadly disease, is enough to strike fear into anyone's consciousness, and with that fear follows a decrease in executive autonomy, the transfer of decision-making agency to the individual with the professional certification whom you trust.

Eleven women trusted too unrestrainedly. And they have all suffered grievous harm for their naivete, an all-too-human failing to place belief and trust and hope into the capable hands of someone you believe will solve your problem. But 59-year-old Dr. Paterson, a breast surgeon with an obvious reputation as reliably dependable, may also have had an impulse to control and to do harm to others; if indeed such was his ambition he succeeded very well indeed. And now he will pay the price. Of course, 'paying the price' in another way entirely might also have been at stake here.

He is the owner of a luxury home in Birmingham. Properties in Cardiff, Wales, in Manchester and the United States as well, clearly a cosmopolitan jet-setter, a surgeon who is capable of infusing fear and hope in vulnerable women for whom a diagnosis of "breast cancer" fulfills the dread of their worst nightmares. Concerns relating to unnecessary or incomplete operations occasioned hundreds of his patients to be recalled in 2012. Nine women and a male testified during his succeeding trial relating to surgeries that took place between 1997 and 2011.

He was found guilty of 17 counts of wounding with intent to cause grievous bodily harm, and with three counts of unlawful wounding, by the Nottingham Crown Court jury. His skills in persuading patients to whom he outright lied to deliver false diagnoses, then persuade that they should undergo surgery, must have bee considerable. The sentence for his crime has not yet been handed down, but it is conceivable that he will face a life sentence after his recent conviction. Some of his victims had undergone four and six surgeries by their trusted surgeon.

Breast surgeon Ian Paterson has been convicted of performing needless operations on women in his care
Breast surgeon Ian Paterson has been convicted of performing needless operations on women in his care  SWNS SouthWestNewsService

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Friday, April 28, 2017

Transplants in the Realm of Fiction

"[One] problematic [issue with brain transplants, however, would be that] no aspect of your original external body remains the same."
"Your head is no longer there, your brain is transplanted into an entirely different skull."
"At the moment, I can only disclose that there has been massive progress in medical experiments that would have seemed impossible even as recently as a few months ago. The milestones that have been reached will undoubtedly revolutionize medicine.
"[Experiments on a number of different animals in South Korea and China have been conducted] and the results are unambiguous: the spinal cord -- and with it the ability to move -- can be entirely restored."
"In a few months we will sever a body from a head in an unprecedented medical procedure. If we bring this person back to life, we will receive the first real account of what actually happens after death, whether there is an afterlife, a heaven, a hereafter or whatever you may want to call it or whether death is simply a flicking off of the light switch and that's it"
Italian surgeon Sergio Canavero
Sergio-Canavero Xiaoping Ren Xiaoping Ren and Sergio Canavero, the surgeons behind the plans for the world's first human head transplant. OOOM-Sergio Canavero
"[Canavero's latest theory of merging head transplants with] resurrecting [the frozen dead is absurd]. People have their own doubts about whether anything can be salvaged from these frozen heads or bodies because of the damage freezing does."
"Then saying that he has some technique for making this happen, that has never been demonstrated in frozen animals, is absurd."
"[Canavero plays on people's fantasies] that somehow you can come back from death, fantasies that you can live forever if you just keep moving your head around. [He manipulates and contorts science] That's why I pay attention to him."
Bioethicist Arthur Caplan, head of ethics, NYU Langone Medical Centre, New York City

"Unless it is technically possible, and it is not, to replace all the water left in a body's cells with glycol, unfreezing a frozen corpse will rupture the cell walls ensuring that you are mush -- a corpsesicle."
Dr. Eike-Henner Kluge, bioethicist, University of Victoria
No matter; Dr. Canavero -- vulgar showman he may be -- is adamant that his surgical methodology imagined not yet put into action, will serve to demonstrate to the doubting world of science, that a human body can be frozen and then regenerated; it works with frogs after all, why not humans? Perhaps because we are not frogs and nature's design to preserve frogs did not extend to humans....? In ten months' time (while awaiting a donor body), he is fully prepared to transplant a head.

But he is also looking forard to reawakening a cryogenically frozen brain, to transplant it as well into a waiting skull, not its original home.

Dr. Canavero explained his plans in depth in an interview with German-language OOOM magazine recently, that he plans to bring back to life brains frozen in liquid nitrogen at a cryogenics bank, within the next three years. As he sees the situation, a brain transplant would not be as problematical as a full-head transplant, though that is precisely what he plans to undertake in under a year's time.

In transplanting a brain, rejection issues are sidelined since no longer would there be a requirement to reconnect and stitch up severed vessels, nerves, tendons and muscles as occurs when a head is fused to a brain-dead donor body.

This man with his hugely improbable plans to shake up the world of science and transplantation first sketched out his plans to mount a human head transplant in the journal Surgical Neurology International, two years earlier. Fusing the donor and recipient's severed spinal cords, a medical-scientific feat never even before imagined, to restore function while avoiding massive, irreversible brain damage, or death, is the issue that Dr. Canavero identifies as the most critical technical hurdle in achieving successfully in a head transplant.

He explained in an earlier interview that his unique, self-designed protocol relies on a special gluelike substance he calls "fusogen", which was developed by a chemist. It is that "fusogen" that he will rely upon to reconnect the severed spinal cord stumps and persuade axons and neurons to regrow across the surgical gap. He plans his first head transplant surgery to take place in Harbin, China, with the surgical team to be led by Xiaopig Ren, a Chinese orthopedic surgeon whose credits include participation in the first hand transplant undertaken in 1999 in the United States.

Dr. Ren has been practising this type of surgery, performing hundreds of head transplants in rodents, preparing himself for the surgery with human patients. According to Dr. Canavero's vision on how to proceed in  grafting a head on a donor body, the process is to cut off two heads; one the recipient, the other the donor. The donor's brain would be dead, but his body in healthy condition perhaps as a result of some catastrophic accident.

The recipient's head would be transferred to the donor body with the use of a specially designed swivel crane. The procedure must take place in less than an hour to minimize complications.



Skeptics abound. Most scientists scoff at the very idea that such a surgery could be attempted with the expectation of success. As for freezing a human body or body parts, let alone a brain and then anticipating its resurrection, it is the stuff of science fiction, an illusion. And then those who prefer to wait and watch, point out that two years ago 21st Century Medicine researchers (a California cryobiology research company) reported having succeeded in freezing the brain of a rabbit with the use of a flash-freezing technique meant to protect and stabilize tissue.
"This procedure will not work. If it was a good procedure, show me a dog that has undergone it, walking across the stage with a transplanted body."
"Try it with monkeys first. But he can't: the result would be, at best, a shambling horror, an animal driven mad with pain and terror, crippled and whimpering, and a poor advertisement for his experiment. And most likely what he'd have is a collection of corpses that suffered briefly before expiring." 
Biologist Paul Zachary Myers, associate professor, University of Minnesota
"Experts have pointed out multiple problems in every step of the proposed surgery. For example, gluing two ends of severed spinal cords will not make nerve fibers fuse well into each other, as nerve cells immediately form scar tissue. Even if the glue worked, connecting millions of nerves together is not possible. Other big-picture issues include getting the immune system to accept the new head, and keeping the head alive. Scientists are still figuring out how low they can bring the temperature before brain tissue starts to act up."
Brain Decoder


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