Sunday, June 30, 2013

Body Art

Have you noticed lately, tattoos are everywhere? You can barely walk down the street without encountering some form of body art. What was once relegated to military personnel and scary bikers is now common among teens and seniors. It seems everyone is sporting paint these days.

I doubt the trend is restricted to America. I was recently in London and Paris and didn’t recall such a plethora of paint, but then again, it was winter and naked flesh was hard to come by. I’m betting they’re inking up just like us… 
Tattoos have a long and varied history. One of the earliest examples was discovered on the five thousand-year-old desiccated body of the Tyrolean Ice Man, who was found in the Italian Alps where he died and froze (or perhaps froze and then died). He sported a total of fifty-seven tattoos, which were probably made by rubbing charcoal into lacerations made on his skin. Some of his tattoos may have been linked to a form of acupuncture, since they parallel the traditional Chinese meridians.

The Egyptians apparently practiced the art. Tattoos are found on their mummified remains and show up on artwork dating to over four thousand years ago. The Romans didn’t share the Egyptians' enthusiasm, instead using tattoos to brand their criminals. It wasn’t until they went up against the fierce Britons, whose painted bodies scared the bejesus out of them that they came to appreciate the intimidating nature of tattoos. 

But it was the Pacific Islanders who really set the trend. In fact, the word “tattoo” originated from the Tahitian word “tatau,” meaning “to tap a mark into the body.” The facial tattoos of Maori warriors were so impressive that a burgeoning trade in their decorated heads cropped up among Europeans in the early 1800s. The heads were in such demand that traders would capture members of the tribe, tattoo their faces, kill them, decapitate them, and trade the heads for guns. Ain’t Colonialism grand?

Tattoos are not always permanent. Henna tattoos, which are created using the pigment of the Lawsonia tree, have also been in use for thousands of years across Africa, the Arabian Peninsula, and parts of Asia. The decorative painting of hands and feet is commonly tied to marriage customs. In fact in India, the longevity of the tattoos is believed to be directly tied to how well the bride will be treated by her in-laws. If the paint fades quickly, she’s in for a rough ride.

My father, a captain in the Navy, sported numerous tattoos. His were gray and faded, but I can still picture the rooster inscribed on his calf – a talisman against drowning. When he underwent bypass surgery, the surgeon tasked with harvesting the veins from his leg was careful to suture the rooster back together. The bisection made the bird that much more interesting.

But tattoos are just one of many ways humans throughout the ages have adorned their bodies. Native Americans chose a more temporary route. They would create colorful paints from various plants and decorate their bodies with beautiful geometric designs (check out the beautiful artwork by my friend, Theodore Morris). And they didn’t stop with the skin. They would also use parts of animals – feathers, teeth, claws – to hang from their bodies, as a way of symbolically associating themselves with attributes of the critter.

Body art is directly tied to self-expression and has deep roots in human culture. Tattoos, like other forms of adornment, are a means of sending social signals. They say something about our beliefs, our world view, and how we view ourselves. 

As for me, I inked up a few years ago, once I had reached the point where my stint as a bioarchaeologist equaled the years I spent as an Orlando firefighter. So I had a gifted artist, Cesar, create a symbol of my two careers. What does it look like, you ask? You see it every time you visit my site. It’s a seven thousand-year-old skull sporting my leather fire helmet and it exemplifies two of my greatest achievements in life: the grueling years I spent as a firefighter and the sweat and toil it took to obtain my PhD. I wear it with pride.

Sunday, June 23, 2013

It's Nice to Share...

Last week, a ten-year-old girl received a lung transplant from an adult donor. What amazed me about this story – aside from the fact that surgeons were able to successfully fit a child with adult lungs - was that her case barely made news. Thus a procedure once relegated to wishful thinking has now become commonplace.

According to the Organ Procurement and Transplantation Network, almost seven thousand transplants were performed in the U.S. between the months of January and March alone. So let’s take a brief stroll down memory lane and recount the history of these amazing procedures.
One of the oldest transplant stories is that legendary tale of Adam and Eve. According to scripture, Adam was gracious enough to donate a rib to procure himself a partner, yet was betrayed when Eve’s propensity for fruit landed them both in hot water. Transplantation was off to a rocky start.

True transplants began with that largest of organs, the skin. Hindu physicians back in the 6th century experimented by grafting the skin of a patient’s arm and using it to reconstruct his nose. Apparently the procedure was in great demand, thanks to the extreme judicial punishment of lopping off the noses of convicted thieves.

The transplant technique was later adopted by the Italians in the 16th century, who would create a flap of skin, leave it attached to the arm until it sprouted the necessary blood vessels, and then use it to create the nose.

It took another four hundred years for doctors to attempt kidney transplants. Unfortunately, they acquired the organs from an array of barnyard donors, namely pigs and goats. Not surprisingly, their patients didn’t survive, although I bet the hospital cafeterias remained well stocked.

In 1912, the French physician Alexis Carrell developed suture techniques he later used in the transplantation of blood vessels and organs. He practiced on dogs, successfully transplanting kidneys from one pooch to another. He also perfected methods of keeping tissues and organs alive outside the body, famously nursing one of his samples along for over thirty years.

It wasn’t until 1954 that a successful kidney transplant was performed on a human. The donor and recipient were identical twin brothers, Ronald and Richard, so rejection was not a issue. But it would take another six years for a British immunologist to receive the Nobel Prize for his discoveries in acquired immune tolerance, which opened the door for the creation of drugs that prevented rejection following transplants.

The 1960s also saw the first liver, pancreas, and lung transplants and, in 1967, the South African surgeon, Christiaan Barnard, made medical history by performing the first successful heart transplant. Unfortunately, the recipient, Louis Washkansky, died of pneumonia eighteen days later, but it was still a good effort.

In the 1980s, Congress passed the National Organ Transplant Act, which addressed ethical issues of transplants (who gets what, when) and also established a national registry for those awaiting organs. Folks at the Organ Procurement and Transplantation Network tell us there are currently over 118,000 anxious people awaiting organs, the majority keeping their fingers crossed for a kidney (over ninety-six thousand). Over three thousand are awaiting hearts, sixteen hundred are awaiting lungs, and forty-five truly desperate individuals are awaiting both. (And we complain about sitting in traffic.)

Today, transplant surgery has surpassed even sci-fi expectations. Facial transplants are becoming more common, providing victims of horrific trauma and devastating malformations the means to more normal lives. And as transplants become more common, the need for donors skyrockets.

This has bred a whole new industry: the illicit organ trade. In April, five people in Kosovo were arrested for running a clinic that procured kidneys from impoverished victims who came from as far away as Turkey to sell their organs. The victims were promised fifteen thousand euro; the recipients, mainly from Israel, were paying up to one hundred thousand euro for the transplants. Desperation lives at both ends of the organ trade spectrum.

In America, the majority of donors are those who die and leave their organs behind, and I am proud to be an official, card-carrying donor. I figure if I’m hit by a train or carried off by a twister, they can salvage whatever is left and harvest some much-needed body parts. Granted, my organs are exposed to frequent doses of gin, but aside from that, they’re in pretty good shape.

Here's an interesting read on the history of organ transplantation. Enjoy!

Sunday, June 16, 2013

Critters and Contagion

Let me tell you the story of my encounter with a wild animal.

It was the middle of the night and I was standing in my parent’s kitchen, a glass of water in hand, looking out over the pool when I noticed the telltale ripples of a drowning critter. I headed out back, expecting to find the usual desperate frog, but as I approached the water’s edge, I realized the ripples were far too big.

I peered through the darkness at a creature the size of a small dog. It was dark in color, and kicking up quite a wake as it desperately paddled the shallow end. I crept forward and could just make out a small, pointy snout protruding above the waterline and a pair of clawed forefeet chopping at the surface.

It wasn’t a frog. It wasn’t a dog. It was a large armadillo that had somehow fallen in, his escape hampered by the heavy shell encasing his chubby body. 

I grabbed a net and gave chase. He quickly veered toward the deep end, dropping a trail of turds to show his appreciation. I managed to corner him, then scooped him from the pool, flipping him onto the deck where he proceeded to hiss like a viper before turning tail to run. 

Armadillos are a strange sort of creature, their anatomy an amalgam of many different critters. Their pointy snout is rimmed by tiny sharp teeth, perfect for crunching insects, and their vision is quite limited, which explains why so many of them end up as roadkill. They sport long claws from their toes and have mangy tufts of hair on the undersides of their bodies. Their ears, like their snouts, are porcine and their shells are made up of dermal plates that enable some species to roll into a protective ball when threatened. They are related to sloths and anteaters and I must say, are sorely lacking in personality.

As if their cranky disposition and freakish bodies weren’t enough, they also hold the distinction of transmitting that most famous of biblical diseases – leprosy.

Leprosy, also known as Hansen’s disease, is caused by Mycobacterium leprae and results in muscle weakness, nerve damage, and those terrible sores that spring to mind at the mention of this dreaded disease. Apparently our friend the armadillo has recently been passing it on to us humans, especially in Texas and Louisiana where it is hunted and, for some strange reason, eaten (don’t ask me why).

But leprosy is just one of several zoonoses - diseases that have jumped from animals to humans. HIV is another. HIV is believed to have originated among chimpanzees in the West African rainforest of Cameroon. Apparently the chimps contracted the disease by eating infected monkeys. The chimps then passed it on to the humans who ate them. 

During the colonial period in the early 1900s, natives were conscripted to build railroads to facilitate the booming rubber industry. The natives received vaccinations within the labor camps, and were inoculated using glass syringes. Unfortunately, there were not enough syringes to go around, and sterilization was not an option. Autoclaves are hard to come by in the jungle.

Natives who fled the camps by escaping into the jungle were forced to eat chimps to survive. Many of those natives were caught, brought back to camp, and inoculated along with everyone else; thus the spread of the disease from chimps to humans to more humans. 

Other infectious diseases, such as swine flu and SARS, were also passed from animals to humans. And whether it’s from eating infected flesh or simply living in close proximity to animals, germs have developed keen strategies for survival. Their ability to mutate and jump species is a testament to their fortitude.

But we can’t blame the armadillos. Apparently, leprosy originated in the Old World and was part and parcel of European colonization of the Americas. Since armadillos are a New World species, they must have contracted it from humans and are now simply repaying the favor. 

And, in their defense, I’m sure the number of armadillos squashed by our cars far exceeds the number of humans they've bumped off via leprosy.

For those of you who have never experienced the intriguing beauty of an armadillo, one of our 'dillo-munching friends from Texas has kindly videotaped one. I wonder if the little guy ended up on the dinner table…

Sunday, June 9, 2013

Talking Heads

The young man was working as part of a survey crew when he was hit by the speeding truck. The truck’s driver, tired of sitting in traffic, tore through the median, striking the young man and running over his body. I was a new medic; the patient was one of my first. He was alert and talking despite missing a large chunk of his forehead. The pale grayish surface of his frontal lobe glinted in the late afternoon sun.

During transport, I stabilized him as best I could - oxygen, cardiac monitor, two large-bore IVs - before concentrating on the open wound. I flushed it with saline and wrapped his head in a bulky bandage as we rushed full-throttle to the trauma center. 
His prognosis was grim. The surgeon explained to me they would have to remove a significant part of his frontal lobe to rid the area of grit and debris. The patient would probably never be the same.

This call was the first of many head injuries I treated during my career as a medic. It launched my fascination with brain trauma because, unlike other injuries, those to the head can result in a completely different person and steal one’s identity – their personality, warmth, humor – leaving behind a shell of an individual.

 I’ve witnessed a wide range of head injuries, both as a paramedic treating live patients and as a bioarchaeologist examining ancient skeletons. As a medic, head injuries commonly came in the form of shootings, crashes, and blunt force trauma. Barely a week went by without some significant trauma call, for the transients of Orlando’s west side never passed up an opportunity to exchange thorough thumpings.

As a bioarchaeologist, I’ve examined head injury among people living thousands of years in the past. And although these ancients lacked the modern weaponry of today’s gang violence, their skulls indicate they pummeled each other on a regular basis.

It doesn’t take much to damage the brain. Those handy-dandy containers our brains reside in are actually quite fragile. 

We tend to think of the skull as a singular bony compartment. Not so. The skull is actually composed of eight cranial bones that are joined via fibrous articulations known as sutures. There are four primary sutures of the cranial vault – the coronal, sagittal, lambdoid, and squamous. At birth, the sutures are not quite joined, thus the “soft spot” atop of a newborn’s head. Over time, the sutures fuse and are eventually obliterated, if the individual lives long enough. Bioarchaeologists use this “degree of suture closure” to get a rough age estimate at the time of death.

Fourteen bones make up the face. These bones are also joined via sutures, so, in reality, your head and face are a conglomeration of many flat and oddly shaped bones, all joined together to give you a distinct outward appearance.
But back to the head…

Although the skull provides a protective shell for our fragile brains, simple injuries can have devastating effects. A fall from a moderate height, a minor car crash, even a love tap with a baseball bat can do severe damage to those delicate tissues. And unlike other tissues in the body, nerves are unable to mend. Once they are damaged, they’re done.

Luckily, our noggins contain about eighty-six billion neurons and, because the brain is wired with redundant circuits, sometimes even a serious head injury can be mitigated by the brain’s ability to rewire existing connections. This is why physical therapy is so vital to head-injured patients. They must teach their brains new ways of accomplishing old tasks, like walking, talking, and using their limbs.

My patient was one of the lucky ones. Although the surgeons excised a large part of his frontal lobe, he suffered only minor memory loss and was otherwise normal. I got to know him during his long stay in recovery and it was amazing to sit and play cards with an individual whose brain I had come to know intimately.

So take care with your cranium. A simple blow can have frightening results. My brother fell off his bike years ago and suffered a subarachnoid bleed. He was restless and angry following the injury and, to this day, can be extremely temperamental.
Although some of that may be genetic…

Stay safe and enjoy this awesome video of skull anatomy!

Sunday, June 2, 2013

I feel your pain...

Humans can be amazing creatures. After last week’s post on my impending unemployment, my friends responded with an upwelling of support and compassion. What was also amazing was that so many of my friends actually read my blog. Who’d a thunk it?

The kind words and thoughts got me thinking about empathy – that awareness that enables us to share each other's feelings and experiences.

In humans, empathy shows up around the age of two, just as toddlers become self-aware. This newfound awareness is tested through the prodding of orifices, the male fascination with the penise, and the wonder youngsters experience when they’re able to produce a booger. Even munchkins realize bodies are cool.

Humans are not the only species that has empathy. All mammals are capable of it to some degree, although it’s more prevalent among animals that exhibit greater self-awareness. Elephants, dolphins, and especially primates exhibit empathy to greater degrees. You’d be hard-pressed to find an empathetic camel.

Empathy was an important aspect in our evolution as a species. Without empathy, the ties that bind societies together would quickly unravel. Competition would eradicate the weak, ill, and disabled, resulting in a cold and self-serving world. (Why does Wall Street come to mind?)

Empathy is believed to be the key to altruistic behavior. Altruism – the willingness to sacrifice oneself for another – is found among many animals. Among Vervet monkeys, one brave soul will sound the alarm when a predator attacks. And although the alarm calls attention to himself and may increase his chance of being snatched, it provides a warning to others so that they may scatter and stay safe.

Not all forms of altruism employ immediate self-sacrifice. Among Florida scrub jays, hatchlings often stick around to help out with the next batch, instead of venturing off to find mates of their own. Although this diminishes their chance of reproducing, it improves the chances of family members, thus perpetuating their own line. This is commonly called “kin selection” and is rampant among social insects. Among certain species of bees, only one lucky individual gets to breed. All the others are relegated to worker status and spend their lives toiling to maintain the hive. 

Altruism seems counterintuitive to natural selection. Natural selection is supposed to favor the individual, whose personal attributes are such that they leave behind more offspring. You'd think self-sacrificing behavior would be weeded out, since it decreases the altruistic individual’s chance of reproducing.

But it's believed that altruism is favored through natural selection at the group level, thereby promoting group survival and propagating the species.

It's difficult to imagine a world devoid of altruism. Altruism compels us to help the needy, donate our blood, and fight for our country. Even small acts can be altruistic: giving up your seat on a subway, holding your umbrella over an elderly person, or recycling your plastic. These acts may cost little but are what bind us together as a community, a country, and a species. And frankly, I would not want to live in a world bereft of altruism.

So my dear friends, thank you for your concern. The messages laced with your kind words remind me that all of us share in the frets and fears of daily life. Whether it’s losing a job, facing a diagnosis, or simply wondering what the next day might bring, our ability to empathize binds us as one and will see us through.