Life without a Lung and other Vital Organs

Listening to the new Pope Francis address the crowds on a cold, wet and emotional night  in St Peter’s Square you’d never have known he had only one lung.

We all know now of course. Thanks to intense press speculation and the power of the internet there’s barely a detail of his pre-pontiff life that has not been published in the 24 hours since the cardinals signaled their decision with plumes of white smoke emanating from the chimney of the Sistine Chapel.

And while no one is saying exactly why he underwent a pneumonectomy (surgical removal of a lung) back in the 1950s, there’s been plenty of speculation.  Back then, before antibiotics, removal of a lung wasn’t that uncommon in cases of severe pneumonia, whooping cough or TB.

Whatever the reason, living with one lung is not entirely uncommon. In America alone, it’s estimated that more than 40,000 people have only one lung. And most of them do just fine because the body tends to compensate by making the other lung grow larger.

Which got us to thinking, which other organs can you live without?

Top of the list would be the kidney.  Most humans have two kidneys, but need only one to survive. However some people may be born with only one, while others agree to part with one for donation. Generally, people can live with one kidney with few or no health problems. People can even live with no kidneys, but they of course require frequent renal dialysis.

Then there’s the appendix. Nobody is exactly sure what the appendix is for and no one is really ever aware that they have an appendix until it becomes inflamed or ruptures and has to be removed. Once gone, after a brief period of recovery, life goes on as before.

And, as one in three women over the age of 60, who have undergone hysterectomy know you can live quite comfortably without a uterus. For younger women, there may be some wrench over the loss of fertility, but for others the cessation of monthly periods may be the cause of celebration.

Men can also survive without their reproductive organs – should cancer necessitate removal of either the testes or penis.

Humans can also live without their spleen should it have to be removed because of trauma or medical conditions such as thrombocytopenia. However because the spleen is part of the immune system, those who have undergone splenectomy are more prone to infections.

We can also survive without most of our gastrointestinal tract too. The stomach, gallbladder, pancreas and colon can be removed and although each is associated with it’s own challenges and problems, loss of these organs is not incompatible with life.

And the list goes on…  Today thanks to advances in biomedical engineering, people can even live without a heart.

While we wouldn’t wish the loss of an organ on anyone, it’s good to know just how dispensable most of them are! Turns out our vital organs may not be so vital after all.

Sexy Treatment for Traumatic Brain Injury?

Traumatic Brain Injury (TBI) is a serious public health problem that affects more than 1.7 million Americans each year.  It is the leading cause of death and disability in children and young adults worldwide and is responsible for more than 52,000 deaths, 275,000 hospitalizations, and 80,000 cases of long-term disability in the US alone.

Caused by a bump, blow or jolt to the head or a penetrating head injury, a TBI disrupts the normal function of the brain. The severity of a TBI may range from “mild” – a brief change in mental status or consciousness to “severe” – an extended period of unconsciousness or amnesia after the injury.  Contrary to most media portrayals, the leading cause of TBI is not injuries sustained during war or football, but road traffic accidents.

Despite significant efforts over the past 20 years, there is still no approved treatment to reverse the damage caused by TBI. However, there is a growing body of research to suggest that the sex hormone progesterone may be a powerful neurosteroid that can protect against the effects of TBI.

Discovery of progesterone’s neuroprotective properties began with the observation of a gender difference in response to experimentally induced traumatic brain injury (TBI). After noting anecdotal reports that female rats recover better than male rats following TBI, researchers conducted studies which showed that the hormone might account for this discrepancy in outcomes.

And while progesterone initially may seem like an unusual choice as a neuroprotective therapeutic agent, there is abundant evidence suggesting that this is a normal role of this steroid hormone. In addition to its well-known effects on the reproductive system, progesterone is a potent neurosteroid.  Progesterone receptors are abundant and widely distributed in the central nervous system. Moreover, unlike other sex steroids, progesterone is not only synthesized in the gonads and adrenal glands, but also produced by glial cells in the brain and by Schwann cells in the peripheral nervous system.

BHR Pharma, based in Herndon VA, has developed BHR-100, a novel intravenous formulation of progesterone for treating TBI.   The company’s Phase III multi-center SyNAPSe clinical trial is currently underway and has enrolled 500 of the 1,180 patients suffering from severe TBI needed.

BHR Pharma, is also studying BHR-310 (intranasal progesterone powder) a ready-for-use, nasal spray TBI treatment.  The compound is being developed so that it may be administered to wounded warriors at the site of injury, without the help of medically trained personnel. Studies of progesterone for TBI show that the earlier progesterone is given the better the chance to prevent further damage and improve recovery. A simple nasal spray device would therefore allow the progesterone to begin working before patients are admitted to a hospital.

The FDA has granted Orphan Drug designation to BHR-100 and the drug is on a Fast Track status designed to accelerate its potential approval.  SRxA’s Word on Health will continue to follow these developments and bring you news as it breaks.

Let’s NOT Go Surfing Now

When the Beachboys sang ‘Everybody’s Gone Surfin’ I’m fairly sure they were thinking about waxed boards, shaggy blond hair and ocean waves.

50 years later surfing is a term also associated with browsing the web and more recently with the increasingly popular teen past-time of clinging to the exterior of a speeding car.

The “sport” of car surfing is alarming health experts. National statistics have shown a steady rise in car surfing fatalities. According to the Centers for Disease Control and Prevention (CDC), since 1990, at least 99 people have died or sustained serious injuries as a result of car surfing.

“Broken bones and road rash – severe skin abrasions caused by impact from a fall – are minor injuries from car-surfing,” said Thomas Esposito, MD, chief of the Division of Trauma, Surgical Critical Care and Burns in the Department of Surgery at Loyola University Medical Center. “Head injuries are very prevalent and the effects are devastating.” Young people believe they are invincible but several seconds of thoughtless, risky behavior can lead to a lifetime of permanent disability or even death.”

The national rise in car surfing fatalities corresponds with the introduction of media depictions of the activity in movies, video games and in social media “For those desiring their five minutes of fame, social media such as YouTube and Facebook offer perceived fame and instant gratification,” said Esposito. “Replicating a dangerous stunt and capturing it with a cellphone may seem like a cool idea but can have serious long-term consequences.”

According to the CDC, males are more likely to car surf than females and the average age of persons injured as a result of car surfing is 17.6 years. A larger than average proportion of injuries occur among teen males ages 15 to 19. Injuries have been reported in 31 states, with 39% of these coming from the Midwest and 35% from the South.

Esposito notes that one of the key risks is sudden, unanticipated car maneuvers such as accelerating, swerving or braking, that can force a car surfer off of the vehicle. “People who fall off a moving vehicle may suffer brain contusions, broken bones, fractured skulls, loss of consciousness, internal bleeding, paralysis and death.”

Parents take note! If your teenage son asks to borrow the car to go surfing, just check he’s got his board and is headed off to the beach.  Car surfing is a dangerous game with stakes that are too high if they lose.

Bad day for your bowels?

Having one of those days…weeks…months?  If so, you should consider getting help before you end up with toilet troubles.

Seriously?   According to the results of a study unveiled this week at the American College of Gastroenterology’s (ACG) 76th Annual Scientific Meeting, the psychological and emotional traumas experienced over a lifetime, such as the death of a loved one, divorce, natural disaster, house fire or car accident, physical or mental abuse, all may contribute to adults with irritable bowel syndrome (IBS).

Researchers from the Mayo Clinic in Rochester, MN, found that adults with IBS reported more traumas over a lifetime than matched controls .

“While stress has been linked to IBS, and childhood abuse has been reported to be present in up to 50 percent of patients with IBS, most studies of abuse have focused on sexual abuse with sparse detail and also have not looked at other forms of psychological trauma,” said Yuri Saito-Loftus, MD. “This is the first study that looks at multiple forms of trauma, the timing of those traumas, and traumas in a family setting.”

IBS is a chronic gastrointestinal disorder marked by abdominal discomfort, bloating, constipation and/or diarrhea and may be caused by changes in the nerves and muscles that control sensation and motility of the bowel. Trauma may sensitize the brain and the gut, according to Dr. Saito-Loftus, who said that the results of this study indicate that patients with IBS experience or report traumas at a level higher than patients without IBS.

In the United States, it is estimated that 10-15% of the adult population suffers from IBS. The burden of illness for IBS is significant and can have such a severe impact on Health-Related Quality of Life that it has been linked to an increase in suicidal behavior.

“Patients and their families frequently wonder, ‘why me?’, ‘why did this happen?,’” said Dr. Saito Loftus. “This will help them understand why IBS happened to them.”

Our advice?  Do not “underplay” the role of stress. Even if you think you can cope with life’s little traumatic experiences on your own, your bowels may not agree.

Generic drug could save lives of accident victims

A study just published in The Lancet suggests that routine use of the generic drug tranexamic acid in trauma patients could save as many as 100,000 lives a year.  Lead researcher, Ian Roberts, commented: “This is one of the cheapest ways ever to save a life,” adding that the drug “should be available to doctors treating trauma patients in all countries.”

The CRASH-2 trial was undertaken in 274 hospitals in 40 countries and included  20,211 adult trauma patients.  Those with, or at risk of, bleeding received either tranexamic acid, or placebo, within 8 hours of injury. Results showed that treatment with tranexamic acid reduced deaths from hemorrhage by 15% percent, and deaths from any other cause by 10%, compared to placebo.

Tranexamic acid is an antifibrinolytic agent.  In other words, it prevents breakdown of blood clots.  It is routinely used to control bleeding in women with heavy menstrual periods, bleeding associated with uterine fibroids, to control blood loss in orthopedic surgery and as a mouth rinse after dental extractions or surgery in patients with prolonged bleeding time from acquired or inherited disorders.

Following the study, Roberts and colleagues submitted an application to the World Health Organization to include tranexamic acid on its essential medicines list.