Stupid Question ™
July 5, 2004
By John Ruch
© 2004
Q: How come when I wake up in the morning I am conscious but can’t hear the TV for a few seconds?
—Chris Walker, Columbus, Ohio
A: As always, I can’t answer about you specifically, but I can talk generally about sleep phenomena that sound much like what you are describing. They may or may not be relevant; you can ask your doctor.
I also must issue the Official Sleep Question Caveat my readers have heard many times before. While I could easily write 100 pages about sleep studies, the fact is that nobody knows why we sleep, and barely anything about how. Just about everything involving sleep is a mystery, worsened by its connection to definitions of the mind and consciousness.
So, I can give a name to the phenomenon you’re describing. And science has made some efforts to quantify its frequency and physical effects. But no one can really give you an explanation at this point, I’m afraid.
It isn’t sexy and exciting, but the strength of science is its willingness to admit its ignorance. (Well, most of the time anyway. You can still find a lot of sleep-disorder discussions that seem to think slapping a Latinate name on something equates an explanation of it.)
I’m going to make a presumption about your condition, and challenge one of your own. I’m presuming your auditory-blocking experience occurs while you’re still lying in bed. And I’m proposing that you are not actually conscious—that is, not fully conscious—when it happens.
These vast presumptions in place, your experience sounds like a mild form of hypnopompic sleep paralysis.
“Hypnopompic” just means “during waking up.” Its flip side is “hypnagogic,” which means “during falling asleep.” (“Hypnagogic” is often used generically to describe both states.)
When we fall asleep, the mind and body seem to shut down in fairly discrete stages. Consciousness wanders and fades, then the body begins a deep relaxation of the skeletal muscles. The process reverses, more or less, upon waking up.
The mind, of course, never stops working completely and in most people produces dreams and so forth. Sometimes, the conscious mind can even become active and self-aware while the body remains deeply relaxed—with the sleeper even looking around at the room and so on. This state is called sleep paralysis, because the body “can’t” move even though the mind is there thinking about it. (This is a stronger version of what almost everyone experiences when they wake up—a period of drowsy, not-quite-awakeness that gradually becomes full consciousness after a few minutes.)
Various studies show that perhaps 5 percent of the population suffers sleep paralysis on a regular basis, and as much as 50 percent experience it at some point in their lives.
People who suffer from narcolepsy are especially prone to it, and it correlates with disrupted sleep schedules and panic attacks. (I was going to make a joke about your propensity for sleeping with the TV on, but on second thought I wonder if it indicates problems getting to sleep, which could produce a sleep paralysis effect.)
The consciousness that becomes active in sleep paralysis is still not full consciousness. (Studies show it sometimes accompanies a Rapid Eye Movement, or deep dreaming, state.) It is most famous for being accompanied by hallucinations (and often a sense of fear or panic) that undoubtedly explain stories of fairies, alien abductors, “night hags,” and the like.
Auditory hallucinations are most common, but visual hallucinations aren’t rare. Most people can open their eyes during the experience.
Hallucinations are colorful and exciting stuff to write about and thus dominate the sleep paralysis literature. However, some people experience a shut-off of some of their senses—including hearing—during the paralysis state. In short, they could lie there and look at the TV, but not be able to hear it.
A less extreme possibility is that for some reason—sleep schedule disruption is the most common cause—you are waking up in the middle of a deep dreaming state, similar to what sleepwalkers experience. You are conscious at a functioning level, but your mind is still shutting out external stimuli and churning away on your dream material.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
March 29, 2008
Ringing Ears
Stupid Question ™
Jan. 19, 2004
By John Ruch
© 2004
Q: What are you actually hearing when your ears are ringing?
—Toaste, Columbus, Ohio
A: The real question is, what are you “actually” hearing when you hear anything? Fact is, whether we’re detecting actual sound waves in the atmosphere or just plain hallucinating, we experience sound in our brains, not in our ears. And that may be the key to the weird mystery of ringing ears.
You’re talking about tinnitus, an umbrella term for any disorder in which the sufferer hears a persistent noise for which there is no apparent cause. It tends to center in one or both ears. It can be permanent, or it can be temporary, such as the ringing induced by loud rock concerts or gunfire (though the damage caused by such sound may bring the tinnitus back in a more permanent form later).
The sound can be a ringing, hissing, clicking, whining, whistling, rumbling—basically anything you can think of. It can have single or multiple tones; it can be continuous or jump on and off; it can range widely in volume.
One thing certain about tinnitus: noise damage to the ear (either to the auditory nerve or to microscopic hairs within the ear that help make hearing possible) induces it. Another thing we know is that auditory neurons in both the ear and the auditory center of the brain appear to fire constantly at a low level whether sound is present or not; thus hearing may blot out sound that otherwise covers up this general this general fake noise created by the buzzing brain itself. (That is, if these neural firings actually take place and actually take the form of hallucinatory sound in the brain.)
The idea that tinnitus is revealing this ongoing, underlying buzz is supported by the fact that some tinnitus can be treated by blocking it out with white noise produced by a hearing aid device, or by electrode stimulus of the nerves.
However, in other cases, even severing the auditory nerves doesn’t do anything to stop tinnitus. Likewise, tinnitus has been correlated with other conditions such as ear wax build-up, medicine side effects and even high blood pressure.
Audiologists like to classify tinnitus as either “subjective,” meaning there is no organic cause, and “objective,” meaning there is an organic cause. They say the vast majority of cases are subjective.
This is basically nonsense because nobody really knows what makes tinnitus happen in the brain. Some rogues even claim that all tinnitus is objective, caused by an ability to hear blood flowing in the ear or a similar oddity. There’s no doubt that some strange noises can be ascribed to jaw problems and the like, but it’s not clear if this is really tinnitus as we know it. In any case, these theories struggle to explain “subjective” tinnitus.
Another suggestion is that tinnitus is related to the “phantom limb” phenomenon in which people who lose a limb (or, less drastically, have all nerve connections to a body part severed) experience a feeling (ranging from normal sensation to just blinding, abstract pain) that appears to be located in the missing/detached body part.
The idea is that the dead hair cells or nerve cells in the ear may result in a sort of phantom sound.
It’s an intriguing theory, though not very helpful since the phantom limb phenomenon is itself far from understood. Also, the phantom limb syndromes seem to be much more complex in nature and effect than tinnitus.
What are all these people feeling and hearing if there’s nothing there to feel or hear? The answer quickly leads you away from “Gray’s Anatomy” and closer to Kant’s metaphysics.
Both phenomena are great reminders that biology and physiology can be hard to reduce to a simple organic answer, because the mind/body duality and the riddle of the senses still stump us. To really find out what tinnitus is, we may have to ask if there’s a doctor in the house—a doctor of philosophy, that is.
Jan. 19, 2004
By John Ruch
© 2004
Q: What are you actually hearing when your ears are ringing?
—Toaste, Columbus, Ohio
A: The real question is, what are you “actually” hearing when you hear anything? Fact is, whether we’re detecting actual sound waves in the atmosphere or just plain hallucinating, we experience sound in our brains, not in our ears. And that may be the key to the weird mystery of ringing ears.
You’re talking about tinnitus, an umbrella term for any disorder in which the sufferer hears a persistent noise for which there is no apparent cause. It tends to center in one or both ears. It can be permanent, or it can be temporary, such as the ringing induced by loud rock concerts or gunfire (though the damage caused by such sound may bring the tinnitus back in a more permanent form later).
The sound can be a ringing, hissing, clicking, whining, whistling, rumbling—basically anything you can think of. It can have single or multiple tones; it can be continuous or jump on and off; it can range widely in volume.
One thing certain about tinnitus: noise damage to the ear (either to the auditory nerve or to microscopic hairs within the ear that help make hearing possible) induces it. Another thing we know is that auditory neurons in both the ear and the auditory center of the brain appear to fire constantly at a low level whether sound is present or not; thus hearing may blot out sound that otherwise covers up this general this general fake noise created by the buzzing brain itself. (That is, if these neural firings actually take place and actually take the form of hallucinatory sound in the brain.)
The idea that tinnitus is revealing this ongoing, underlying buzz is supported by the fact that some tinnitus can be treated by blocking it out with white noise produced by a hearing aid device, or by electrode stimulus of the nerves.
However, in other cases, even severing the auditory nerves doesn’t do anything to stop tinnitus. Likewise, tinnitus has been correlated with other conditions such as ear wax build-up, medicine side effects and even high blood pressure.
Audiologists like to classify tinnitus as either “subjective,” meaning there is no organic cause, and “objective,” meaning there is an organic cause. They say the vast majority of cases are subjective.
This is basically nonsense because nobody really knows what makes tinnitus happen in the brain. Some rogues even claim that all tinnitus is objective, caused by an ability to hear blood flowing in the ear or a similar oddity. There’s no doubt that some strange noises can be ascribed to jaw problems and the like, but it’s not clear if this is really tinnitus as we know it. In any case, these theories struggle to explain “subjective” tinnitus.
Another suggestion is that tinnitus is related to the “phantom limb” phenomenon in which people who lose a limb (or, less drastically, have all nerve connections to a body part severed) experience a feeling (ranging from normal sensation to just blinding, abstract pain) that appears to be located in the missing/detached body part.
The idea is that the dead hair cells or nerve cells in the ear may result in a sort of phantom sound.
It’s an intriguing theory, though not very helpful since the phantom limb phenomenon is itself far from understood. Also, the phantom limb syndromes seem to be much more complex in nature and effect than tinnitus.
What are all these people feeling and hearing if there’s nothing there to feel or hear? The answer quickly leads you away from “Gray’s Anatomy” and closer to Kant’s metaphysics.
Both phenomena are great reminders that biology and physiology can be hard to reduce to a simple organic answer, because the mind/body duality and the riddle of the senses still stump us. To really find out what tinnitus is, we may have to ask if there’s a doctor in the house—a doctor of philosophy, that is.
March 28, 2008
Pacemaker Recycling
Stupid Question ™
Sept. 8, 2003
By John Ruch
© 2003
Q: When pacemakers are removed, are they recycled or reused in another patient?
—anonymous, Columbus, Ohio
A: In the US, these invaluable devices that keep a diseased heart beating at a normal rate typically end up on the junk heap when their users die.
“Most of the time the device is scrapped,” Scott Papillon of Minneapolis-based Medtronic, a premiere pacemaker manufacturer, told me. Not even the parts are reused.
But pacemakers certainly can be reused. They were in this country from their modern debut in 1960 until 1976, when the Food and Drug Administration (FDA) put a stop to it. And they still are reused in patients in many countries around the world, from China to Israel, Australia to Canada.
The one place they’re reused in the US is in pets—a rising field in veterinary medicine thanks to donations from the families of dead pacemaker users.
While aging pacemakers aren’t good enough for you and me, they’re apparently good enough for the rest of the world. With FDA approval, Heartbeat International of Tampa, Florida donates oodles of devices to “pacemaker banks” (there are about three dozen around the world) which offer them to poor patients. (Heartbeat uses only old-model devices taken from manufacturers’ inventory, not from corpses.)
The FDA regulation barring reuse in humans cites worries about the difficulty of sterilizing the devices, which are too fragile for hardcore germ-killing. More recently, the FDA has cited concerns about battery life and product testing.
For a variety of reasons, nobody takes the sterilization worries too seriously anymore. The quality control issue is still debated.
International experience and many studies have shown that reused pacemakers (cycled through as many as six patients) have no more primary complications or failures than brand new devices. In fact, they typically get an even better inspection and obviously have the advantage of a proven track record.
The bigger reasons behind the US no-reuse policy are industry profitability and potential lawsuits in our especially litigious society.
In the US, it’s extremely easy to sue a manufacturer for product failure and win. A used pacemaker market could be a legal nightmare. It just sounds bad.
Pacemaker companies have said they don’t want to undercut their own market with used sales, and worry that reconditioning used devices could be expensive.
Many of the pro-reuse countries have socialized medicine, under which the government owns the pacemaker after the patient dies, and can therefore reclaim it easily for reuse. But in the private-ownership US, the patient’s family owns it. Getting pacemakers back for a regular reuse program could lead to a pricey buy-back market.
If this all sounds cynically profit-driven, keep in mind that the reuse debate in the US has typically been framed, especially during a mid-1980s Congressional hearing, as lowering the price of pacemakers, not as a donation program or a more efficient use of resources.
As things stand, Papillon said Medtronic tries to get pacemakers back for “evaluation” and will provide a “return kit” for that purpose. Other times, the pacemaker just stays in the body—though the titanium casing and lithium-based battery are a no-no for cremation.
Sept. 8, 2003
By John Ruch
© 2003
Q: When pacemakers are removed, are they recycled or reused in another patient?
—anonymous, Columbus, Ohio
A: In the US, these invaluable devices that keep a diseased heart beating at a normal rate typically end up on the junk heap when their users die.
“Most of the time the device is scrapped,” Scott Papillon of Minneapolis-based Medtronic, a premiere pacemaker manufacturer, told me. Not even the parts are reused.
But pacemakers certainly can be reused. They were in this country from their modern debut in 1960 until 1976, when the Food and Drug Administration (FDA) put a stop to it. And they still are reused in patients in many countries around the world, from China to Israel, Australia to Canada.
The one place they’re reused in the US is in pets—a rising field in veterinary medicine thanks to donations from the families of dead pacemaker users.
While aging pacemakers aren’t good enough for you and me, they’re apparently good enough for the rest of the world. With FDA approval, Heartbeat International of Tampa, Florida donates oodles of devices to “pacemaker banks” (there are about three dozen around the world) which offer them to poor patients. (Heartbeat uses only old-model devices taken from manufacturers’ inventory, not from corpses.)
The FDA regulation barring reuse in humans cites worries about the difficulty of sterilizing the devices, which are too fragile for hardcore germ-killing. More recently, the FDA has cited concerns about battery life and product testing.
For a variety of reasons, nobody takes the sterilization worries too seriously anymore. The quality control issue is still debated.
International experience and many studies have shown that reused pacemakers (cycled through as many as six patients) have no more primary complications or failures than brand new devices. In fact, they typically get an even better inspection and obviously have the advantage of a proven track record.
The bigger reasons behind the US no-reuse policy are industry profitability and potential lawsuits in our especially litigious society.
In the US, it’s extremely easy to sue a manufacturer for product failure and win. A used pacemaker market could be a legal nightmare. It just sounds bad.
Pacemaker companies have said they don’t want to undercut their own market with used sales, and worry that reconditioning used devices could be expensive.
Many of the pro-reuse countries have socialized medicine, under which the government owns the pacemaker after the patient dies, and can therefore reclaim it easily for reuse. But in the private-ownership US, the patient’s family owns it. Getting pacemakers back for a regular reuse program could lead to a pricey buy-back market.
If this all sounds cynically profit-driven, keep in mind that the reuse debate in the US has typically been framed, especially during a mid-1980s Congressional hearing, as lowering the price of pacemakers, not as a donation program or a more efficient use of resources.
As things stand, Papillon said Medtronic tries to get pacemakers back for “evaluation” and will provide a “return kit” for that purpose. Other times, the pacemaker just stays in the body—though the titanium casing and lithium-based battery are a no-no for cremation.
Colonial Smallpox Vaccine
Stupid Question ™
Dec. 6, 2001
By John Ruch
© 2001
Q: Regarding the demand for smallpox vaccine, why don’t we just make it the way the Colonists did? They were able to whip up plenty of vaccine without fancy equipment.
—Scarface
A: All vaccines are risky, their use being weighed against the risk presented by disease.
The Colonial smallpox vaccine had an abominable risk—1 to 2 percent of recipients died—but smallpox had a death rate of 25 to 30 percent. (A mild strain killed only 1 percent, and two virulent strains killed nearly 100 percent.)
Today, even the much safer modern vaccine is too risky for general use compared to the near non-existent chance of getting smallpox, which hasn’t been seen in the wild since 1977.
The Colonial method, first used in Boston in 1721, would be totally unacceptable today because it involved actually giving people smallpox. An arm or leg was cut open and pus from somebody else’s smallpox blister was inserted into the wound. With luck, recipients developed mild smallpox and produced antibodies that rendered them permanently immune to further infection. But some recipients developed lethal smallpox.
In 1796, English doctor Edward Jenner announced a new vaccine using pus from cowpox, a related but much milder disease that produced lesions on the udders of cows. This method was much safer but had drawbacks.
Cowpox doesn’t exist in the US and is rare in its European home. (Jenner once spent two years searching for a case of it.) Jenner had to ship threads soaked in cowpox pus to his US pals. And cows quickly get over cowpox, making it hard to maintain a reserve of the virus strong enough to use as a vaccine. (The disease is actually native to rodents.)
There were also health risks. Dr. Harrison Weed of the Ohio State University Medical Center notes there are recent reports of human deaths from cowpox in the UK. Also, direct cow-to-person vaccination was rare because of the rarity of infected cows and superstitions about being injected with animal tissue. Instead, most people were vaccinated with pus from another person’s cowpox blister—which led to the transmission of other bad diseases, including syphilis.
It was also common to misidentify a blister caused by another disease as being caused by cowpox, which led to other infections. Some people even fraudulently sold their smallpox pus as cowpox pus.
The current smallpox vaccine Dryvax, and another under development, use an extremely benign strain of a virus called vaccinia. Its origin is unknown, though it’s similar to both cowpox and smallpox (which is why it works).
It’s so weak that it doesn’t give permanent immunity, yet it’s still the most risky vaccine available in modern medicine, killing about one in 1 million recipients—and a higher portion of children.
That’s why, even if terrorists released smallpox, the government would vaccinate only those directly exposed (and possibly use the antiviral drug cidofovir as a stopgap).
Statistically, you could expect universal vaccination of everyone in the US to kill at least 300 people.
Dec. 6, 2001
By John Ruch
© 2001
Q: Regarding the demand for smallpox vaccine, why don’t we just make it the way the Colonists did? They were able to whip up plenty of vaccine without fancy equipment.
—Scarface
A: All vaccines are risky, their use being weighed against the risk presented by disease.
The Colonial smallpox vaccine had an abominable risk—1 to 2 percent of recipients died—but smallpox had a death rate of 25 to 30 percent. (A mild strain killed only 1 percent, and two virulent strains killed nearly 100 percent.)
Today, even the much safer modern vaccine is too risky for general use compared to the near non-existent chance of getting smallpox, which hasn’t been seen in the wild since 1977.
The Colonial method, first used in Boston in 1721, would be totally unacceptable today because it involved actually giving people smallpox. An arm or leg was cut open and pus from somebody else’s smallpox blister was inserted into the wound. With luck, recipients developed mild smallpox and produced antibodies that rendered them permanently immune to further infection. But some recipients developed lethal smallpox.
In 1796, English doctor Edward Jenner announced a new vaccine using pus from cowpox, a related but much milder disease that produced lesions on the udders of cows. This method was much safer but had drawbacks.
Cowpox doesn’t exist in the US and is rare in its European home. (Jenner once spent two years searching for a case of it.) Jenner had to ship threads soaked in cowpox pus to his US pals. And cows quickly get over cowpox, making it hard to maintain a reserve of the virus strong enough to use as a vaccine. (The disease is actually native to rodents.)
There were also health risks. Dr. Harrison Weed of the Ohio State University Medical Center notes there are recent reports of human deaths from cowpox in the UK. Also, direct cow-to-person vaccination was rare because of the rarity of infected cows and superstitions about being injected with animal tissue. Instead, most people were vaccinated with pus from another person’s cowpox blister—which led to the transmission of other bad diseases, including syphilis.
It was also common to misidentify a blister caused by another disease as being caused by cowpox, which led to other infections. Some people even fraudulently sold their smallpox pus as cowpox pus.
The current smallpox vaccine Dryvax, and another under development, use an extremely benign strain of a virus called vaccinia. Its origin is unknown, though it’s similar to both cowpox and smallpox (which is why it works).
It’s so weak that it doesn’t give permanent immunity, yet it’s still the most risky vaccine available in modern medicine, killing about one in 1 million recipients—and a higher portion of children.
That’s why, even if terrorists released smallpox, the government would vaccinate only those directly exposed (and possibly use the antiviral drug cidofovir as a stopgap).
Statistically, you could expect universal vaccination of everyone in the US to kill at least 300 people.
Reusing The Blood Of The Dead
Stupid Question ™
Sept. 6, 2001
By John Ruch
© 2001
Q: My son heard a radio report about the shortage of blood donors. His question: Why can’t the blood from dead people be drained and reused like organs are?
—Kevin P. Byers
A: According to Dr. Harrison Weed of the Ohio State University Medical Center, it probably is possible to use blood drained from cadavers. But it isn’t practical.
For one thing, blood starts going bad soon after death. It becomes loaded with the waste products (including carbon dioxide and lactic acid) which in life it dumped into the lungs or kidneys. Its pH balance changes. It clots up.
Depending on how the person died, it could also be loaded with germs or viruses, medications or poisons.
These and other problems (such as aging and organ damage) also greatly restrict the organ-donor pool. According to Weed, “Almost all people who die are not organ donor candidates, and would therefore not be blood donor candidates.”
When a hospital does have an ideal organ donor—typically a healthy person who has received a fatal brain injury—it’s much more important to get the rare organs than it is to get the blood. And to keep the organs “alive,” you can’t remove the blood. “You need the blood perfusing those organs up to the last few seconds before you remove them,” Weed said.
Collected blood must also be tested and screened for diseases, a process that is very expensive, especially considering that taking blood from a corpse is a “one-time donation.”
“A living donor who gives regularly can give literally gallons [of blood] over a few years with much less fuss and muss,” said Weed. A much better solution to blood shortages, he said, is “more effort, money, time, celebration, etc. put into voluntary donation.”
And there is indeed a blood shortage. According to the American Red Cross, blood donation is increasing, but is being outpaced by demand. As of June, 15 of the Red Cross’s 36 distribution zones were at “critical” lows of type-O blood (the kind that can be used in any patient). It’s estimated that Southern California has a two-day blood supply.
Also, the importation of “Euroblood”—donations from Europe—is being curtailed to prevent the spread of a human strain of mad cow disease. The Red Cross expects to turn down about 4 percent of its 4 million donors for having spent large amounts of time in the UK or Europe.
And currently, 38 percent of donated blood is used by senior-aged patients, a demographic that will only grow larger in the next few decades.
Even without such demands, the Red Cross could use all available donors. They allow a donor to give one unit (a bag of blood) about every eight weeks (sometimes restricted further by local laws); a single car-crash victim can use 100 units.
If you’re interested in donating blood, you can contact the Red Cross at http://www.redcross.org/ or 800-448-3543.
Sept. 6, 2001
By John Ruch
© 2001
Q: My son heard a radio report about the shortage of blood donors. His question: Why can’t the blood from dead people be drained and reused like organs are?
—Kevin P. Byers
A: According to Dr. Harrison Weed of the Ohio State University Medical Center, it probably is possible to use blood drained from cadavers. But it isn’t practical.
For one thing, blood starts going bad soon after death. It becomes loaded with the waste products (including carbon dioxide and lactic acid) which in life it dumped into the lungs or kidneys. Its pH balance changes. It clots up.
Depending on how the person died, it could also be loaded with germs or viruses, medications or poisons.
These and other problems (such as aging and organ damage) also greatly restrict the organ-donor pool. According to Weed, “Almost all people who die are not organ donor candidates, and would therefore not be blood donor candidates.”
When a hospital does have an ideal organ donor—typically a healthy person who has received a fatal brain injury—it’s much more important to get the rare organs than it is to get the blood. And to keep the organs “alive,” you can’t remove the blood. “You need the blood perfusing those organs up to the last few seconds before you remove them,” Weed said.
Collected blood must also be tested and screened for diseases, a process that is very expensive, especially considering that taking blood from a corpse is a “one-time donation.”
“A living donor who gives regularly can give literally gallons [of blood] over a few years with much less fuss and muss,” said Weed. A much better solution to blood shortages, he said, is “more effort, money, time, celebration, etc. put into voluntary donation.”
And there is indeed a blood shortage. According to the American Red Cross, blood donation is increasing, but is being outpaced by demand. As of June, 15 of the Red Cross’s 36 distribution zones were at “critical” lows of type-O blood (the kind that can be used in any patient). It’s estimated that Southern California has a two-day blood supply.
Also, the importation of “Euroblood”—donations from Europe—is being curtailed to prevent the spread of a human strain of mad cow disease. The Red Cross expects to turn down about 4 percent of its 4 million donors for having spent large amounts of time in the UK or Europe.
And currently, 38 percent of donated blood is used by senior-aged patients, a demographic that will only grow larger in the next few decades.
Even without such demands, the Red Cross could use all available donors. They allow a donor to give one unit (a bag of blood) about every eight weeks (sometimes restricted further by local laws); a single car-crash victim can use 100 units.
If you’re interested in donating blood, you can contact the Red Cross at http://www.redcross.org/ or 800-448-3543.