Consequences of Wrong Choices and End of Life issues.

Quality of health is directly proportional to the health of arteries.

Essential Knowledge for Nurses and Medical students.

Abstract: This article is written by a Lecturer in Health Sciences of a Major University . It is for Student Nurses enrolled in the second year of the Bachelor of Nursing Degree progamme. However, it will also make interesting reading for patients, parents and qualified Nurses.

The objectives of this lecture are to convey a balanced understanding of the prevalence of arterial diseases in relation to other diseases and to explore quality of life issues associated with artery disease.

“The quality of life is directly proportional to the health of an individual’s arteries”. This is a sweeping statement now let us look at the facts.

Top killers of human beings are diseases are coronary artery, cerebro-vascular disorders and various ischemic conditions of the heart and brain. These issues were discussed in earlier articles. If you wish to explore these please see http://www.quazen.com/Health/Aging/Open-Secrets-of-a-Healthy-Long-Life..1111/2 The data is from very reliable sources like the World Health Organization, Australian Bureau of Statistics and Department of Health, US. These studies support my view that health of arteries influences life expectancy. However, medical interventions, to date focus on treating the ill and do not focus on the healthy.

Signs and symptoms of coronary artery diseases have been reported as early as 20 years. Coronary artery diseases begin to deteriorate the health of our blood vessels at an early age. It is on a continuum. In most patients the first signs and symptoms will appear around the 40 year age group. By the time the first sign appears, occlusion has already occurred and the damage is already done. Again, for some patients this may be an opportunity to change habits and life style, for others it may be too late. An examination of the death figures in Table 1 show that in the under one age group congenital malformations is the major causes of death. This is followed by low birth weights/short gestational periods and sudden infant death syndrome. In the 1 – 14 year age group there were 11 deaths attributable to heart diseases. In the 15 to 24 age group there were 18 deaths due to heart diseases. Now look at the death figures for the 45 to 64 age group. There were more than 2000 deaths due to cerebro vascular diseases and coronary artery diseases.

These figures are the death figures; Some accidents are the direct result of coronary artery disease and/or stroke and may be reported as accidents or work place injuries. Not included in these figures are the huge numbers of individuals who survive a heart attack or a stroke but are disabled from work and useful enjoyment of life. One needs to keep in mind, when looking at these figures, the fact that most individuals in this age group are employed and are in the most productive stages of their life spans. The impact of coronary arterial diseases does not end with an examination of individual losses. There is a huge social cost paid by families, for example, the loss of mother/father to young children. The local community also looses a productive member who would have contributed economically and socially to the community. The employer has lost an employee which will create a vacancy to be filled by another individual who may need retraining etc. Last but not least the Federal Government has lost a tax payer.

The impact of death is greatest on the individual’s family. This is because they have lost the head of the family or a significant contributor to family economics. The person in this age group is usually the role model and provider of direction of growth for the family. In some situations, an established family unit may become dysfunctional and become dependent upon the state. This is a huge economic cost.

An individual who has a heart attack in his/her most productive years of life suffers greatly from economic and social growth. In addition, there are the economic costs of obtaining treatment, time lost due to illness, time spent on rehabilitation, and the endless amount of hours spent on caring and supporting the person who has had a heart attack.

Most economic models fail to examine the economic costs to children of their parents’ disability. When a parent becomes disabled the children end up caring for the parent. Children quickly “grow up” due to pressure of circumstances. Play time with peer groups and education are the major casualties.

We know that from the time of conception to about the age of 15 years there is cell growth. Growth of different specialized areas stops at different times. After about the age of 15 years we begin to deteriorate collectively. In other words, the process of death starts.

The human body is made up of millions of living and dead cells. The cells communicate and organize themselves into tissues. Groups of tissues organize themselves into organs and systems. Finally, the systems connect to one another to make up the organism. Each system has it’s unique function but is dependent upon other systems. At any give time there is a balance between the needs of that system and the needs of the organism as a whole. Generally, this balance is achieved without the individual knowing anything about it, at an unconscious level. However, there are certain situations when the individual, at a conscious level becomes aware of the fact that something is not right. For example, the patient might say he is feeling hungry when he is hypoglycemic. This area has been taken care of by medical sciences. Medical sciences and treatment modes have changed significantly over the last 50 years and continue to make progress.

Mankind has always wanted to prolong life and improve quality of live. In this article I explore current literature life expectancy, discuss the current theories and suggest a new theory on prolonging both quality and quantity of life.

Genetically, mankind’s life expectancy is believed to be around 85 years however there is no evidence of a genetically determined lifespan of around 85 hears (CHRISTENSEN, 1996 #3). The oldest well documented maximum lifespan for females is 121 years and for males it is 113 years. In a large study of English doctors it was found that the age at which half of cigarette smokers had died was 8 years less than the age for non-smokers, and for heavy cigarette smokers 10 years less (Doll, 1994 #4). Since, we are given our genes and we cannot change our DNA make up I will concede that we cannot change our genetic make-up but is some instances some genetic deficiencies will be correctable by interventions later on in life.

There were some studies which showed that intra-uterine conditions, pre-natal and post natal circumstances influenced life expectancy. These have not stood the test of time.

Table 1. Determinants of mean lifespan in the industrialized world ( CHRISTENSEN, 1996 #3).

Many studies show that life expectancy is influenced by several factors. Factors which are known to increase the probability of a long life are as follows:

1. Family history : If your parents lived a long life, the chances are that you will have a long life. However, a better predictor is the life expectancy of ones’ brothers and sisters. If your siblings lived a long life, you will have a long life too.

2. Environmental factors like place of birth and the socio-economic status of your family play a very important role in determining your life expectancy. Also, the country in which you are born will to some extent influence your life expectancy.

3. Our actions and inactions will dictate how long you and I will live, at least statistically. For example, if you smoke, you are less likely to live as long as your sibling who does not smoke. Certain, diets also influence how long you will live. As already discussed these affect the health of the arteries which affect the health of the organ which is being supplied. Since all organs and body systems are interrelated, the failure of one system quickly leads to the failure of the next system and so on, until all the body systems collapse. And death occurs.

4. Medical treatments are directed at all the signs and symptoms which we know and we can complain about to our treating physicians. There are many processes which are not known, understood, or examined.

5. Psychologists often equate smoking and other risk taking behaviors as a slow form of suicide. This implies that risk taking behaviors will eventually lead to death, because the cumulative effect of risks will eventually become 100%, which is an absolute certainty. I wonder which behaviors are not risky?

6. We know that growth occurs from the time of conception to maturity. Then our body starts to deteriorate . Human beings have been remarkable good at glorifying each and every stage of life. For example, the terms, “senior citizen, the golden years” imply that there is something to look forward to when we get there. The reality is different. By the time we get to our senior years, many of our best functioning organs have passed their peak and we are loosing millions of cells each day. The number of healthy cells declines continually.

7. According to this theory, death is not sudden , as we know it. Death is gradual process which starts at about the age of about 6 to 15 years. Some processes mature earlier than others. Collectively, by about 15 years human beings are fully mature and begin to deteriorate, In other words we begin to die slowly. Each day we loose a certain number of cells. Slowly, but surely the numbers decrease. Some of our actions actually speed up the slow dying process. There are no known processes which regenerate dead tissue.

8. The exact mechanisms / processes involved in learning / behavior development are not clearly understood. The process of death is similarly not clearly understood.

9. Modern medicine analyses tissue states, enzymes, and electrolytes as a measure of an individual’s health. It dictates that prior to collective death, individual tissues/organs must become dysfunctional and fail. This theory recognizes that in some instances this is indeed the case.

10. In this article, I am implying that we are naturally programmed to die slowly. The evidence for this comes from the following well known facts:

a. Our body is highly specialized, once a tissue dies, it does not re-grow except for skin and liver tissues. For example, if you loose your finger, at any age, you will never grow a new finger.

b. The perception that after surgery your tissue will grow again is the result of misinformation. The healing, that has happened in not due to new healthy tissue. It is just scar tissue which is fibrous in nature , is devoid of life and does not have a blood supply or nerves.

c. There is some evidence that liver cells can regenerate grow in certain conditions . The interesting thing is that about one quarter of the liver must be available for the liver to regenerate. What happens and why regeneration does not occur, if less than one quarter of the liver is left, will have to remain a mystery for now.

d. skin tissue is the other tissue which is capable of regeneration but it is also one of the least specialized. Therefore it is obviously not able to produce genes/hormones/chemicals which bring about cell growth.

d. For death to be put off / delayed new cells must be formed to replace old and dying cells. This has been demonstrated in experimental “super mice’.

e. As of this date there is no known method which measures the health of individual cells. Yet, all doctors, nurses and scientists will confirm that the human body is made up of individual cells.

f. I postulate that when we are able to predict the ratio of living to dead cells in the body we will be able to better predict the death of the whole individual.

g. Lastly, I predict that being able to measure the collective health of cells will be better predictor of life expectancy and death than present systems which measure pathological states after the disease has set in.

Technological Advances.

Bioelectrical Impedance Analysis. This is a new technique for estimating body composition has been developed using the same principles as under water weighing techniques. The technique uses air, as opposed to water, and is known as air displacement plethysmography (ADP). The patient enters a sealed chamber that measures his/her body volume through the displacement of air in the chamber. Body volume is equated with body weight (mass) in order to estimate body density. This method then estimates the percentage of body fat and lean body mass through known normal values.

This method of evaluating human body composition is gaining acceptance is the fields of research, military and athletic disciplines because it is fast, accurate and safe.

The Human Genome Project. The human genome project was completed with much fanfare but it has not provided mankind with many answers which were expected. The project has shown that human beings have about 30,000 genes, twice as many as the humble fruitfly and 10,000 more than the simple roundworm found in our gardens. It showed that there are only 300 unique genes in the human genome which are not found in the mouse. Lastly, it confirmed what ordinary people have been saying for years, “There is no genetic basis for race; humans all over the world share 99.9% of their DNA”.

USE of Statins. These are in may similar to cholesterol lowering medicatons but recent publications have suggested that statins probably reduce stroke by a variety of mechanisms, including modulation of precerebral atherothrombosis in the aorta and the carotid artery, thus preventing plaque disruption and artery-to-artery thromboembolism. This is specific finding an can have impicalitons for the prevention of strokes. Statins also improve endothelial homeostasis by increasing the bioavailability of nitric oxide at cell level. This then orchestrates the paracrine antiatherosclerotic functions of the endothelium at cell level. Putative anti-inflammatory actions of statins may also contribute to neuroprotection and stroke prevention.

The Pleiotropic effects of statins extend beyond cholesterol reduction and are involved in non-lipid–related mechanisms that modify endothelial functions, immunoinflammatory responses, smooth muscle cell activation, proliferation and migration, atherosclerotic plaque stability, and thrombus formation.

Lastly, in addition to reducing stroke risk statin usage data suggests that statins may also reduce dementia.

THE GENOME PROJECT. The "complete" sequence is still riddled with significant gaps. We do not know when those gaps will be filled, if ever. I do expect progress to be made but it is obvious that life is more complex than survival of the fittest and one size fits all.

When does life begin ? Pro-life groups will have me and you believe that life begins at conception. This is their perception and this has been manipulated for non-scientific purposes. Biology says that any organism, plant or animal, is alive, if it displays the characteristics of living things. Any decent biology book will list the seven characteristics of living things. I have listed them below for the purposes of this discussion. The point I am making here is that life is present even before conception. If someone tells you life begins at conception he/she is deliberately lying or manipulating the situation, knowingly or unknowingly.

Characteristics of living things

1. Movement : This refers to the organism’s ability to move from one part to another. Amoebae bacteria and fungi can move, however, very slowly in human terms.

2. Excretion. This is the ability of the organism or cell to get rid of the waste products from within itself. In a multi cellular organism the excretion process takes on a whole new meaning because a whole body system is designed to get rid of the waste product and each cell also retain some excretory function.

3. Reproduction . Reproduction is the ability to conjugate, and produce off spring who are similar but yet different from the parents.

4. Respiration . This refers to the metabolic processes which occur at cellular level.

5. Irritability. This is often called sensitivity, it refers to the fact that organisms respond to the environment positively or negatively. If you irritate someone, or a cell for that matter, it will likely move away from the irritation.

6. Nutrition . This refers to the need for energy, of the organism. Each and every organism needs energy for activities of living and processes of living. These include running away from unhealthy environments, just breathing or hibernating or reproducing.

7. Growth . Weight gain or increases in numbers are referred to as growth in biological terms. Growth is said to occur when the numbers of organisms increase or body mass increases.

THE STRUCTURE of ARTERIES. No study is complete without addressing the structure of the arteries because these blood vessels are essential for the health of the whole organism. Arteries are elastic because they are made up of several distinct layers of muscles and tissues.

The tunica intima lines the lumen contains some fine elastic fibers and collagen. The largest and most prominent layer of the wall of the aorta is the tunica media . This layer extends from the tunica intima to the tunica adventitia. The tunica media consists of multiple fenestrated sheets of elastic tissue which in your slide appear as dark blue or black fibers. Between the elastic layers are pink-staining collagen fibers and smooth muscle cells. The tunica adventitia has relatively more pink staining collagen and less elastic tissue. Also, numerous small blood vessels called vasa vasorum are present here. After you have identified several of these vessels in the tunica adventitia, you should re-examine the tunica media and confirm that these "vessels of vessels" can be seen in this layer as well. The presence of RBCs will confirm your find.

Table 2. Signs and Symptoms of Coronary artery Diseases.

1. Coronary artery disease can persist for many years, without any signs or symptoms. This is often called the silent stage of the disease.

2. Initially, the symptoms may be “slight discomfort” in the chest and many male patients tend to ignore these. Female patients tend to seek help but until recently female patients was often dismissed as “psychological”.

3. Chest pain is the most common and earliest symptom. The chest pain is due to the heart not getting sufficient amounts of oxygen rich blood. The intensity or severity of the chest pain varies from person-to-person. Chest pain may be typical or atypical. Typical chest pain is felt under the sternum (breast bone) and is characterized by a heavy or squeezing feeling, it is brought on by exertion or emotion, and it is relieved by rest or nitroglycerin. The onset may be gradual or sudden. In my experience many Canadian men set off their chest pain by snow removal activities of early morning.

4. Atypical chest pain / deferred chest pain can be located in the left chest or abdomen. Differential diagnosis is important in these circumstances. Some patients may complain of pain in the back which is fleeting or sharp. Atypical chest pain is unrelated to exercise and is not relieved by rest or nitroglycerin. Atypical chest pain is more common in women. It is for this reason that it was often dismissed as psychological.

5. Typical chest pain, presentation and age indicate the chance of a person having a heart attack. Any person who is 65-year-old (woman) with typical angina has a 91% chance of having a heart attack. A 55-year-old woman with atypical angina has a 32% chance of having a heart attack.

6. Shortness of breath — This is usually a symptom of a failing heart. The heart at this point is weak because of the long-term lack of blood and oxygen, or sometimes from a recent or past heart attack.

7. If the heart is not pumping enough blood to circulate in the body, because the myocardium is weakened, shortness of breath may be accompanied by swollen feet and ankles. This is the result of back pressure which is building due to left ventricular failure. In some cases, the first sign of CHD is a heart attack. This occurs when atherosclerotic plaque or a blood clot blocks the blood flow of the coronary artery to the heart. The coronary artery was likely already narrowed from CHD.

8. Severe pain is often associated with a heart attack. It usually lasts longer than the chest pain due to angina. It is not relieved by resting or nitroglycerin.

Signs and Symptoms of cerebral ischaemia.

Cerbral ischaemia refers to the fact that the brain is not getting sufficient oxygenated blood. Cerebral ischaemia may be a warning sign of a pending CVA and is indicative of cerebrovascular disease. The symptoms of a stroke occur suddenly but ischemia is usually present for years before a stroke occurs. 50 percent of people who experience a warning sign go on to have a full stroke. Transient ischaemic attacks (TIAs) are caused by a temporary cut or reduction in blood supply to the brain. This is due to the partial blockage of an artery by a blood clot or debris. TIAs have the same symptoms as a stroke, but they are temporary and do not usually cause long term brain damage.

Transient – symptoms usually last for less than 24 hours, and then subside to reappear at a later date, much worse, second time around.

Ischaemic – failure of blood flow to part of the brain or eye.

Attack – sudden onset of symptoms, which vary from person to person, depending on which part of the brain or eye is starved of blood.

•  A numb or weak feeling in the face, arm or leg. This is caused by impaired blood circulation to the affected area of the brain.

•  Trouble speaking or understanding.

•  Unexplained dizziness. This is usually one of the first signs of cerebral ischaemia.

•  Blurred or poor vision in one or both eyes.

•  Loss of balance or an unexplained fall. The patient may say that he/she just passed out or just blacked out.

•  Difficulty swallowing.

•  Headache (usually severe or of abrupt onset) or unexplained change in the pattern of headaches. Early, diagnosis and treatment are most helpful to the patient.

•  Confusion, due to impaired blood supply to part or all of the brain.

•  Unconsciousness, may lead to death.

If your client experiences any of these symptoms, get him/her straight to a hospital. Remember, stroke is a life threatening emergency urgent treatment is your top priority.

Bibliography:

CHRISTENSEN, K. and J. W. VAUPEL (1996). "Determinants of longevity: genetic, environmental and medical factors

doi:10.1046/j.1365-2796.1996.d01-2853.x." Journal of Internal Medicine 240 (6): 333-341.

Doll, R., R. Petro, et al. (1994). "Mortality in relation to smoking." BMJ 309 : 901-10.