Avoiding Blood Transfusion in Liver Surgery

"We spend a huge proportion of health-care dollars on surgery and traditionally it is not studied to the same degree or rigour as drugs would be."
"We need to be critical of what we do and take it to the next level."
Dr. Guillaume Martel, surgeon, The Ottawa Hospital

Close to one quarter of all patients who require major liver surgery have need of a blood transfusion. This type of surgery is on the increase, for a multitude of reasons, and the surgery where there is such a high risk of blood transfusion carries its transfusion-related risks, including allergic reactions and heightened risk of complications such as infections, post-surgery. To side-step these risks research has questioned the need of blood transfusions.

Research has also zeroed in on whether blood transfusions can have the effect of increasing opportunistic cancer recurrence following cancer surgery. And then there is the more practical side of the equation, blood being a remedial tool required for response in emergency situations. It is also an expensive tool, costing the health system substantially, with its limited supply requiring conservation for those times when it must be used to save someone's life.

Dr. Martel is leading research for the study of a technique that is used in some areas of the world, involving the removal of approximately ten percent of a patient's blood before liver surgery takes place. Once the surgery is concluded that blood which has been set aside for the purpose is replaced back into the patient. Once the patient is under anesthetic, pre-surgery, the blood is removed and stored in blood donation bags for return to the patient at the completion of surgery.

Beyond the simple move to conserve a valuable product for other uses, there is another, very important reason for this technique. It is a procedure that is believed to reduce blood pressure in the large veins leading to the liver. That reduced blood pressure leads to less blood being lost during surgery. And though its successful use has been documented elsewhere in the world, no research data on the procedure and its efficacy exists.

Dr. Martel, an associate professor at the University of Ottawa and his investigative team have set out to study the technique in a randomized control trial, to arrive at a definitive conclusion whether the blood-removal-and-return intervention works as claimed. He points out that surgery in and of itself is generally under-investigated.

Possible risks and side effects: Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have other liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, yet leave enough behind for the liver to function adequately.
A lot of blood passes through the liver, and bleeding after surgery is a major concern. On top of this, the liver normally makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery itself) can add to potential bleeding problems.
Other possible problems are similar to those seen with other major surgeries and can include infections, complications from anesthesia, blood clots, and pneumonia.
Another concern is that because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.
American Cancer Society

Freshwater Lake Acidification

"We're monkeying with the very chemical foundation of these ecosystems."
"But right now we don't know enough yet to know where we're going. To me, scientifically that's really interesting, and as a human being a little bit frightening."
"I'll probably put my money on increased variability from lake to lake. They're just going to be more extreme."
Emily H. Stanley, fresh-water ecologist, University of Wisconsin Madison

"Many fish are not able to detect their predators anymore. They can even get more bold."
"I discovered there was no information [on carbon dioxide levels in fresh water]."
"We didn’t really know what to expect. But the speed of acidification we find is quite fast."
"I think this study we’re publishing is like a door-opener. I hope there will be other scientists who will follow."
Linda C. Weiss, aquatic ecologist, Ruhr University Bochum, Germany

The Sorpe reservoir in northwest Germany, one of four freshwater reservoirs observed in a recent study that found that carbon dioxide absorbed in lakes, rivers and streams can affect entire ecosystems. Credit Mauritius Images GmbH/Alamy

It's not yet clear whether lake waters across the globe are building up carbon dioxide. A study was published in November by Dr. Stanley and colleagues setting out carbon dioxide levels in Wisconsin lakes. The study concluded that no significant change whatever was detected between the years 1986 and 2011. All lakes take in carbon dioxide from the atmosphere, some drawing it in from the soil around lakes and some lakes may have quite a lot of underwater plants that take up the gas, while others harbor microbes releasing more of the carbon dioxide.

Over  time, levels of carbon dioxide can undergo dramatic alterations, in any body of water. Time alone, over the passing decades will determine the level of its presence, as carbon dioxide continues to take its fuller presence in the atmosphere. As the levels progress upward, Dr. Stanley has speculated that the actual presence and what it fully portends will become more nuanced. What is certain at the present time is that very few ecologists have studied the presence of carbon dioxide levels in fresh water.

And that is because it has been the presence of sulfuric acid and allied pollutants that have gathered in freshwater lakes as a result of acid rain, including the environmental impacts of runoff from agricultural lands into lakes that have historically presented as a concern. Variables such as water temperature and the organic carbon contained in a lake also come into play in determining the presence and level of carbon dioxide in lakes.

From 1981 to 2015, Dr. Weiss and her colleagues determined the levels of carbon dioxide in four reservoirs in Germany. Their findings were published in the journal Current Biology, making it clear that amounts throughout that period of time had tripled. Back in the 1980s, oceanographers were continuously measuring carbon dioxide in seawater, chronicling a steady rise, lowering the pH of seawater, so it became more acidic, interfering with chemistry coral use for their calcium skeletons.

Chemical changes in water interfere with marine organisms' ability to find food and to avoid danger. The researchers, curious about the effects on freshwater life of the presence of carbon dioxide, ran experiments on water fleas. These are minuscule creatures filtering algae and microbes from water and they in turn are eaten by small fish, which in the natural order of nature's design, are then devoured by ever larger fish. Were the presence of carbon dioxide to affect the bottom of the food chain, the entire lake ecosystem could be influenced.

Nature has equipped water fleas with a unique capacity to make themselves more difficult to consume, in response to sensing chemicals in the water related to the presence of fish nearby. Some of the water fleas grow a crest on their heads, and others sprout self-defensive spikes, making them less palatable to the fish, and more difficult to swallow. High levels of carbon dioxide resulted in water fleas producing smaller crests and shorter spikes, Dr. Weiss discovered. She reasoned that the presence of carbon dioxide interferes with the water fleas' nervous system, decreasing their capacity to detect predators.

At top right, a water flea with its protective crest; at bottom right, a water flea with “neckteeth.” These defenses may be blunted by chemical changes in water. Credit Linda Weiss and Sina Becker

This new research addressing the question of how much carbon dioxide might harm freshwater life has impressed Caleb T. Hasler, a biologist at the University of Winnipeg in Manitoba. He and his colleagues studied minnows in water rich with carbon dioxide, discovering that the fish fail to respond as swiftly to alarm signals that other minnows release. His team studied two species of mussels, one which relaxed its muscles in high carbon dioxide presence, leaving its shell gaped open. While the other clamped its shell tight shut rendering it unable to filter food.

The filtering actions of mussels are responsible for maintaining clear water in a lake. Such changes as have been detected may in the final analysis impact upon entire ecosystems. "You can have lakes where the carbon dioxide increases tenfold at night", observed Dr. Hasler.

Playground Parasites and Infections

"We know in some cases it is linked to lower intelligence and epilepsy. So if you were to look at disadvantaged kids living in poverty who are also doing lower on tests of school performance, what percentage of that can be attributed to this worm?"
"Nobody is dying here. But it is potentially causing developmental delays that are affecting quality of life, and the economic impact is far greater. It could trap children in poverty."
"[Untreated, the infection could clear after months or even years] but we don't know for sure."
Dr. Peter Hotez, dean, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas

"What we don't see is easy to ignore."
"There isn't a story to wrap around it to make it emotionally salient."
Dr. Lance Erickson, sociology professor, Brigham Young University, Utah

"It's hard for people to accept that it could be having the effect that it is. We don't really know its impact, which is frustrating."
"These are larvae burrowing through the brain. It's not something that any mother or father of a child would welcome."
Dr. Celia Holland, parasitology professor, Trinity College Dublin, Ireland

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A parasitology professor at Trinity College Dublin, Celia Holland found that mice with Toxocara larvae in the brain experienced reduced learning ability with demonstrably less interest in exploration of its surroundings. "We had to terminate the experiments for ethical reasons because their locomotion started to be affected", she said of the impairment seen in mice with extreme infections caused by the presence of the larvae in their systems.

As for the larvae, they are a parasite, roundworms of the genus Toxocara. They live within the intestines of untreated cats and dogs, and most commonly make their homes in stray animals. Toxocara eggs are naturally shed in the feces of these animals, and they contaminate those places where the infected animals tend to be seen; in backyards, in playgrounds and in sandboxes.

Adult Toxocara roundworms stay in the small intestines of contaminated cats and canines. The eggs are excreted of their feces.  Credit Eye of Science/Science Source

When children frequent those places that are meant to entertain and inspire them to play and explore their surroundings, microscopic particles tend to cling to their hands. Children's hands frequently move toward their mouths, and once swallowed the eggs begin to hatch in the moist, warm receptive interior of a human. Larvae are released that make their way through the body. There is evidence that some of these larvae may reach the brain, with the result that cognition and learning become compromised.

Parasitic infections such as toxocariasis "likely account for a substantial yet hidden burden of mental illness in the United States", wrote Dr. Hotez in 2014, in a paper published in a mental health journal, JAMA Psychiatry. Two researchers at SUNY Downstate Medical Center in New York conducted a study to examine cognitive achievement correlated with Toxocara infection in people. It was published in the international Journal for Parasitology.

They discovered that the mean test scores, with the use of a cross-section of national data, were lower among children testing positive for Toxocara exposure, with another study published in 2015 finding a similar association in adults representing the investigative work of researchers at Brigham Young University in Provo, Utah.

The latest report by the U.S. National Health and Nutrition Examination Survey published in September in the journal Clinical Infectious Diseases, pointed out that roughly 5 percent of the population analogous to about 16 million people, carry Toxocara antibodies in their blood, revealing they had ingested roundworm eggs. This is a risk more common to poor neighbourhoods than to the general public in the United States.

Among African-Americans, as an example, the rate was closer to 7 percent, according to the Centers for Disease Control and Prevention. And for people living below the poverty line, the infection rate came in at ten percent. There has been little research conducted on the phenomenon, and Dr. Erickson points out that since the impairment produced by the infection is not severe in its presentation, no urgency is given to the need to research the phenomenon.

Dr. Hotez, on the other hand, speaks of Toxocara as one of the most common of parasitic infections and one of the most neglected by scientific enquiry. It is unknown how frequently ingested eggs go on to full blown infection, for example. And while studies reveal that pets receiving veterinary care rarely carry Toxocara, poorer neighbourhoods are home to a disproportionate number of strays most likely to carry roundworm.

Infections in humans can indeed progress from the mild symptoms of slight fever, fatigue, abdominal pain and cough, to Toxocara larvae entering eyes and causing blindness, or infecting the liver and lungs where damaging inflammatory reactions could result. If a child is taken to a pediatrician with the common symptoms of Toxocara infection, so common they could be mistaken for any number of illnesses, that Toxocara may be involved, rarely comes to mind for most doctors.

If its presence is, however, correctly detected and a diagnosis produced, it can be readily and effectively treated with the anti-parasitic drug albendazoic, according to Dr. Hotez.

A playground in the Bronx. Toxocara eggs or larvae had been present in 9 metropolis parks, together with three-quarters of these examined in the Bronx.   Credit Gregg Vigliotti for The New York Times

Free Enterprise Out of This World

"After close consultation with our five finalist Google Lunar X Prize teams over the past several months, we have concluded that no team will make a launch attempt to reach the moon by the March 31, 2018, deadline."
"This literal 'moonshot' is hard, and while we did expect a winner by now, due to the difficulties of fundraising, technical and regulatory challenges, the grand prize of the $20M Google Lunar X Prize will go unclaimed."
"As a result of this competition, we have sparked the conversation and changed expectations with regard to who can land on the moon. Many now believe it's no longer the sole purview of a few government agencies, but now may be achieved by small teams of entrepreneurs, engineers, and innovators from around the world."
"X Prize is exploring a number of ways to proceed from here. This may include finding a new title sponsor to provide a prize purse following in the footsteps of Google's generosity, or continuing the Lunar X Prize as a noncash competition where we will follow and promote the teams and help celebrate their achievements."
Peter Diamandis, founder, chairman -- Marcus Shingles, CEO, Google Lunar X Prize competition

No private teams will meet the deadline of March 31, 2018 to launch a rover to the lunar surface, bringing the Google Lunar X Prize to an end. Credit: NASA

"The competition was a sweetener in the landscape of our business case, but it's never been the business case itself. We continue to focus on our core business plans of collapsing the cost of access to the moon, our partnership with NASA, and our long-term vision of unlocking lunar resources for the benefit of life on Earth and our future in space."
Bob Richards, CEO, Moon Express

"SpaceIL is committed to landing the first Israeli spacecraft on the moon, regardless of the terms or status of the Lunar X Prize."
"We are at the height of our efforts to raise the funds for this project and to prepare for launch."
Ryan Greiss, Space IL spokesman

Five remaining teams were still competing to win the Lunar XPrize's $30 million grand prize. Pictured, a rendering of team Moon Express' spacecraft. U.S.-based Moon Express had secured a contract with the Federal Aviation Administration to send its payload to the Moon

It was a challenge that intrigued and motivated the entrepreneurial spirit of space enthusiasts, astrophysicists and astronomers; private enterprise would have no problem matching the ability of governments to attract the engineering professionalism it would take to design and put together a spacecraft the equal of anything that could be produced for government. Perhaps without fully appreciating that governments of economically advanced nations have the financial wherewithal to invest in military-space enterprise given their expertise in draining public funds from their captive donors, the universal taxpayer.

But they gave it a good go from the moment all the fanfare accompanied the competition financed by Google that emerged in 2007. Ten years have gone by since that announcement when the Google Lunar X-Prize competition was announced alongside the temptation of a $20-million acknowledgment for the winning team that could produce the first privately funded space venture to arrive at the moon. Ten years, it appears, was not enough; like producing a Hollywood film one must first secure the financing. Then the professional expertise that goes into an imaginative enterprise of this kind can proceed.

There were originally over 25 teams jostling for space as entrants to the competition. Gradually there was a drop-off until there were but five remaining. They were Moon Express, in Cape Canaveral, Florida; Space IL in Israel; TeamIndus in India; Hakuto in Japan; and Synergy Moon representing an international collaboration of hopefuls. By 2017's end, Space IL and TeamIndus both were in the frustrating position of acknowledging that their fundraising prospects had run adrift. As for the Hakuto team, no problem -- by December they had $90-million in the kitty.

As for Moon Express its funding was secure finally, but the inconvenient fact was that it had not yet fully completed construction of its new facility to assemble its lander. As for the progress recognized by Synergy Moon, that data appears to be not available for public comment, portending some problems in their aspirational end of the competition. Originally the deadline to launch was stated to be 2014's end; then extended to 2015, again to 2016, and finally to 2017.

Then in summer of 2017 the foundation once again proffered a final change; the winning team would have until the end of March to complete its mission, and no additional extensions past that point would be contemplated; finis. And finished it is, the competition is over, there has been no successful rocket launch, no winner proudly standing on the lunar surface, no !Wow! photos beamed back for the admiration and amazement of all onlookers.

There may be disappointment in the hearts of the challengers, but there is also in equal measure, determination to go on. Prize money withdrawn no deterrent. It would, in any event represent a relative portion of what it would take to see each of these enterprises to fruition.  Space Il, TeamIndus and Hakuto are all prepared to continue their exertions to succeed in advancing their spacecraft to the moon. Astrobotoc Technology of Pittsburgh and PTScientists, based in Berlin, two teams that had previously dropped out also mean to continue their development of moon vehicles.

Moon Express most certainly hoped it would come out the competition's clear winner, since it would fit neatly into their plan to make a business of their investment in moon landings through the provision of reliable transportation to move payloads to the moon. So, sad as it is that the entire enterprise which seemed so excitingly doable and enticingly competitive occasioning bettors to contribute their own vibes, the show will go on.

Actually it already has. China landed its Chang'e3 spacecraft on the moon in 2013, while China and India are both busy with plans to land robotic missions in 2018 on the moon. Which, it certainly appears, is going to become a very crowded Earth-satellite indeed, in the relatively near future.

The Human Toll of Traditional Religious Chauvinism

"This is what makes me upset. Even people who consider themselves very sophisticated, very educated, very cultured, they are still doing this."
"What this is, is segregation. And we as a society don't talk enough about it. We don't talk about dignity, we don't talk about women's rights."
Radha Paudel, social activist, Nepal

Women in a chhaupadi hut during their menstruation periods in western Nepal, in February. A tradition of isolating menstruating women in huts persists in rural areas despite the dangers and a 2005 court order. Credit Prakash Mathema/Agence France-Presse — Getty Images

Gauri Kumari Bayak, 22 years of age, was a woman determined to be of social use to her community. She was a woman with a social conscience who also had ambitions of her own. One of them was to complete her high school education. And she also took to earning her own money by sewing dresses for people who could pay for the service. She attended school during the day and in her spare  hours taught illiterate women to read. In the evening she did her sewing.

And now, thanks to a tradition in Nepal where menstruating women are accustomed to sequestering themselves away from others until such time as they were no longer 'unclean', she is no longer around to teach women to read, to sew dresses on contract, much less to complete her aspirational challenge of obtaining her high school matriculation before moving on to other things in her life. She died on January 8 of asphyxiation.

She had built a small fire inside an isolated hut on a cold night, to keep warm. She was in that hut where she gathered firewood nearby because she was impure as a menstruating woman, and was prepared to spend the night in a cold hut. Ms. Bayak is not alone in her victimization by a tradition that rural Nepalese honour. Dozens of women and girls in recent years have met their death upholding this tradition.

There are campaigns to end the practise and the Nepalese government itself has legislated against the tradition. Still, menstruating women prepare to bed down at night outside the family home for fear of offending tradition. They go into grass-roofed huts, or rough stables to sleep with cows or goats. Many of these women have been raped by intruders and some of them die from exposure to the cold.

The tradition was given illegal status last summer when the Nepalese government legislated against anyone forcing a women or girl to leave her home lest it be polluted by her menstruating presence. But the threat of violators being subject to imprisonment or fines does not appear to have made inroads into a tradition that people have been long accustomed to honouring when it comes into effect in August.

In Ms. Bayak's instance, poverty and ignorance could not be blamed since she and others of her family were relatively educated by standards of one of the poorest countries in Asia. Her Hindu religion, strictly enforced particularly in rural areas, must take most of the blame for influencing believers that women are unclean during the periods of their menstruation activity lest they infect others.

In some parts of Nepal, women sleep in huts like these during their periods   AFP

Menstruating women were  held to be toxic, that their presence could pollute a temple, that in handling the family food everyone would become ill, and if they touched a tree it would never again bear fruit. The young woman aspired to become a tailor in Kathmandu. Her village in western Nepal where she lived with her husband's show-owning family, would have expected her to honour ancient tradition. She herself insisted it was her duty to do so.

Her husband, a police officer working in Kathmandu, the nation's capital, now grieves her absence. He had never insisted that his wife follow the chhaupadi tradition, he said. But she was herself faithful to it, in a geography where the temperature drops almost to freezing as it did the night she died. The shed she sought shelter in, according to police accounts, had no windows. Police found fresh embers near her body where she had built a small fire.

It isn't just the environmental elements but the biological hazards as well that can threaten women who follow tradition. Last summer while honouring the chhaupadi ritual of ancient Hinduism, another young woman who banished herself to a small hut died after she was bitten by a poisonous snake.

Women in Nepal face systemic discrimination across a host of issues.  CNN

Coping Mechanisms : Birds and Industrial Noise

"It's something that is really picking up, the idea of noise pollution. We want to see what is that doing for the birds."
"You can hear birds clearly when it's quieter. When you're closer to the infrastructure, you don't hear the birds as clearly. You start to think, if I can't hear, maybe the birds can't hear."
"The birds are modifying their birdsong in response to the noise that's created by this oil and natural gas infrastructure."
"They've actually been looking at a whole lot of grassland species and finding that, in some species, the presence of oil infrastructure is affecting reproduction while in others it's not."
Miya Warrington, researcher, University of Manitoba

A Savannah sparrow sits on a post with Calgary in the background. (Eduardo Matoud)

In the most recent issue of Condor, the journal of the American Ornithological Society, there were several interesting papers. One set out to determine how grouse, a ground bird, adjust their mating calls in the presence of sound emanating from now-ubiquitous wind turbines. The conclusion was that these birds like many others have raised their songs a pitch or so as a result of living in city environments which tend to be noisy and disruptive to the birds' normal rhythms.

The bird research world is fully engaged now in this topic: avian response to human-generated sound.

This is proving to be an existential issue for some birds such as sparrows, particularly at a time of universal stress for songbirds now in decline -- and grassland species are proving to have surrendered to the swiftest decline of all. Attention has focused on the sound pollution affecting Savannah sparrows, a small, common sparrow with a thick beak and a yellow patch over its eyes. It has a complex song with various "syllables", each transmitting information of importance to others of its species.

Parts of the sparrows' song relates to territorial warnings while others invite the presence of potential mates. Others yet announce "I am here", but whatever the message, they all represent critical areas of the bird's survival and each bird has its own special version of the song; sounds that range from trills to buzzes. What has been complicating the lives of these sparrows is the presence on prairies where the birds are to be found in their natural habitat, of noisy machinery such as oil and gas infrastructure located on the plains.

For her research, Miya Warrington brought in 26 sites around southern Alberta where she would collect data; sites with four types of energy infrastructure inclusive of natural gas compressors, pumpjacks, screw pumps powered by electricity on the grid, and screw pumps generator-powered. The songs of 73 male sparrows were accordingly recorded and analyzed between May and July, to compare them with the songs of sparrows resident where no oilpatch facilities exist.

The resulting analysis concluded that all the pumps and compressors produced sounds on the  same frequencies as those of at least a portion of the songs produced by the sparrows. The recordings, furthermore, revealed how the birds coped with this interference, by adjusting parts of their songs, reflecting the source of the background noise. According to the paper: "All syllable types were significantly affected by at least one infrastructure type".

Savannah Sparrow - Claude Rioux

In response to the ambient noise interference within the habitat of some of the birds studied, it was recognized that birds effected alterations in their songs to enable them to be heard over the equipment noise; in some instances sparrows' songs were entirely produced at higher frequencies, reflecting a transposition to a higher key. It was also found that of the four types of infrastructure involved, it was the generator-powered screw pumps that produced the most disturbing impact, natural gas compressors having the lightest.

Pumpjacks pump crude oil near Halkirk, Alta., June 20, 2007. Noisy oilpatch equipment is causing songbirds to change their tune, concludes a new research from the University of Manitoba. Larry MacDougal - The Canadian Press, 2018

Surviving Winter: Um ... Good Common Sense? 

"Cold weather is just the straw that breaks the camel's back in terms of having more stress and decreasing your immunity."
"Even if it's just walking for ten minutes [outdoors in winter], that's going to get the circulation going, but it's also for stress relief. When people are stressed, their immune system declines."
"Just be mindful of things."
Dr. Renee Miranda, physician, Center for Integrative Medicine, Ohio State University

"Cold is what we call an exterior pathogenic factor. It's an elemental force that can cause a change in the body."
"The terrain [of environmental conditions impacting illness] is tremendously important, and that's exactly how the Chinese thought about it."
"We say that cold invigorates the yang, which means it calls it to the surface. If you stay in the shower with cold water beating on you, at some point you're going to feel some warmth come to the area as your body compensates for that cold."
Brandon LaGreca, acupuncturist, Oriental medicine practitioner, East Troy, Wisconsin

"It makes sense that there's cross-talk between our immune system and emotions in ways that will protect us."
"If your wei qi [a protective layer of energy covering your body; comparable to modern science's identification of the immune system] is deficient, you feel like you want to curl up, stay at home, and not be around people."
"But if your wei qi is prolific, you want to have a party and invite people over."
Dr. Andrew Miles, Chinese medicine practitioner

Life becomes complicated during winter's cold months when we must adapt ourselves to the changing environment adding stress to our lives. We're concerned about keeping warm, and we suffer from a rise in respiratory infections; cold and viruses appear to go together. The increased incidence of colds that occur in fall and winter is related to the increase in time spent indoors where people are crowded in interiors, windows closed and stale air circulates giving those in that area increased exposure to pathogens, creating illnesses.

Researchers have of late noted that rhinoviruses recognized as the most common cause of colds tend to reproduce more efficiently in cooler temperatures. New evidence appears to support the old theory that cold does indeed play a pivotal role in increasing the likelihood of illness. Cold weakens our defences, according to Dr. Renee Miranda. In a world teeming with microbes having infectious potential, few lead to illness and we owe that fact to our efficient immune system warding off invasion of 'foreign' interlopers.

But when we're sleep deprived, dehydrated, overworked and begin eating junk food to excess as a manifestation of stress, the resources our body requires for immunity becomes depleted, according to Dr. Miranda. This, and then the season changing with the introduction of cold weather adds a new stress, rendering  our situation more amenable to infections gaining ground. Ancient healers considered lifestyle and environmental imbalance as causes of illness.

Cold is considered to be a force of nature that we must take pains to protect our bodies against lest we risk developing health problems, according to traditional Chinese medicine. Louis Pasteur promoted the idea of germ theory in 19th-century medicine, while a contemporary of his felt that infections were caused not by microbes but through environmental conditions allowing microbial invaders to flourish and while scientists gave support to Pasteur's theory as the pathogen being the root of illness becoming reliant on microbe-destroying medicines, new research is evolving greater scientific understanding of how the immune system is affected.

The altered view corresponding more closely with Claude Bernard's (Pasteur's medical science peer) theory that environmental conditions impact illness, aligns with the view held by ancient practitioners of Chinese medicine. Cold represents a formidable force for the promotion of stress and it is at times when we must cope with a cold environment that Chinese physicians discourage cold beverage intake noting that the body expends additional energy to warm these liquid intakes to our internal temperature.

According to ancient Chinese medical texts, instructions are given how to live in a healthful manner during the winter season when nature is cold, dark and still. It is at those times that people are encouraged to align themselves more closely with this yin energy; resting more, and consciously cultivating a gentler, more relaxed and introspective spirit as stress-minimizing reactions to the weather. Winter lifestyle recommendations have the purpose of preserving what Chinese medicine names wei qi; defensive energy.

According to Dr. Andrew Miles, a practitioner of traditional Chinese medicine, if we fail to slow down our pattern of living throughout winter, our wei qi withers to the extent that our reaction must be to obey our instinct to slow down. Dr. Miles made reference to a 2016 study on a recent broadcast of Botanical Biohacking, that found when our immunity is compromised our social behaviour becomes increasingly introverted. A healthy wei qi has the effect of preventing cold's damaging influence from invading the body; conversely weak wei qi leaves us illness-susceptible.

Wearing comfortably appropriate winter gear is supportive of the function of wei qi, insulating your body from the effects of the cold in winter. Of particular attention is the need to ensure neck and abdomen are adequately protected; areas considered to be particularly vulnerable to environmental cold. Wei qi is amenable to replenishment with rest and hot, nourishing foods. On the other hand, some exposure to cold can also effectively support our ability to tolerate cold.

One should familiarize oneself with how much exposure to cold is personally tolerable. If one's wei qi feels robust (you feel energetic), it is a signal that time can be spent outdoors in regulated exposure to the cold, adequately dressed for the occasion. Winter may be a time for rest but there is no excuse, when we're feeling well, to entirely avoid the out-of-doors. Dress for the weather and embark on an outdoor excursion in the cold and the snow, an exhilarating little expedition that can become a daily recreational exercise.

Winter is also a time to diligently wash your hands regularly, to slough off germs that may be picked up unknowingly, particularly when out and about in places where people tend to congregate. While hand-washing plays no part in boosting the immune system, it does aid in minimizing exposure to viruses and bacteria that can cause illness that we are unaware of being exposed to. Finally, Chinese medicine encourages balance in all of life's routines. It is what the Greeks called the Golden Mean, and it is analogous to moderation in all things.

Not Too Late for Flu Inoculation

"It's tragic whenever there is a death due to influenza in a child. No question about it, it's heartbreaking. Fortunately, it is a rare event."
"But that doesn't mean that deaths due to influenza in otherwise healthy people -- including children -- doesn't happen. They do. They're just rare."
"Most otherwise healthy individuals are going to fully recover from influenza with no intervention."
"We don't want to set off alarm bells. We need to put this into context."
Dr. Danuta Skowronski, influenza expert, B.C. Centre for Disease Control

"We have a tendency to think that because influenza is so common and because almost all of the time you get it, you feel miserable for a few days and then you get better."
"That's our view of influenza and we don't recognize that there are a small number of catastrophically serious cases in children and young, otherwise healthy adults."
Dr. Allison McGeer, director of infection control, Mount Sinai Hospital, Toronto

There are indeed shocking instances when a bout with influenza ends the lives of otherwise healthy and young people. That's what it did for 21-year-old Kyler Baughman of Pennsylvania who died as a result of septic shock related to the flu he was infected with. With flu it's possible, albeit rare, for a secondary bacterial infection to invade the lungs. Occasionally such a lung infection is capable of finding its way into the bloodstream, and that's where sepsis is introduced, when blood so infected can lead to septic shock.

With septic shock, the body's organs shut down, and death ensues. Infectious disease specialists caution that children and adults with pre-existing health conditions who develop the symptoms of flu, inclusive of high fever, chills, body aches, extreme fatigue, cough and sore throat, should seek out immediate medical attention. Treatment with an antiviral medication reduces the risk of complications. Flu can also exacerbate chronic underlying medical conditions such as asthma and cystic fibrosis both in children and adults.

Chronic obstructive pulmonary disease (COPD) and congestive heart failure in older adults produce a more vulnerable target for the flu virus to wreak its ill effects. Pneumonia rates among the most common complications arising from infection, brought on with one of the influenza viruses in circulation this season: A/H3N2 and B/Yamagata are the dominant strains of influenza in this 2017/18 flu season.

Making vaccines isn't always a straightforward process. (Reuters/Lucy Nicholson)

In the United States, thirty pediatric deaths have been recorded from influenza for this season. A ten-year-old boy in Connecticut developed pneumonia and sepsis in the days following his flu infection. His mother described the boy, Nico Mallozzi, as healthy and strong "as an ox", but that condition failed to protect him from death caused by the flu, just as being highly fit failed to protect aspiring personal trainer Kyler Baughman in Pennsylvania.

Nico Mallozzi. Photo courtesy of Mimma Mallozzi

As of January 13, when the latest seasonal statistics became available, fewer than five flu-related pediatric deaths were reported in Canada (bearing in mind that Canada has one-tenth the population of he United States), yet 303 children under the age of 17 had been admitted to hospital in Canada, with 48 of them sufficiently ill with influenza that they were admitted to the ICU, according to the Public Health Agency of Canada, on its FluWatch website.

Even though the vaccine now in circulation -- and widely used to inoculate those who respond to public health agencies' urgent appeals to the public to protect themselves -- happens to have a lower-than-expected efficacy given the flu viruses's confounding ability to transform itself into various strains and combinations of strains, making the vaccine formula as much informed guesswork as the occasion permits, health authorities insist it can still aid in reducing the severity of symptoms in those who may contract the flu.

Cutting Addictions : Saving Lives

"We need to understand that opioid addiction does not occur in isolation. All these social determinants are intertwined: mental health issues, poverty, housing, food insecurity, trauma. All of these are related to addictions."
"So you need an approach that addresses the whole person rather than just the opioid, or just the cigarette, or just their diabetes."
"It's not black magic: There is neurobiology at play. Tobacco is the king of addiction, and it causes structural changes in your brain, in the receptors, and it amplifies the response."
Dr. Smita Pakhale, respirologist, The Ottawa Hospital

'We’re trying to understand if e-cigarettes can be in our toolbox,' said Dr. Smita Pakhalé of trying to find ways to help homeless people stop smoking. Jean Levac / Postmedia

"When I was able to see that I could reduce my nicotine intake, that gave me a good feeling, and the more I reduced, the better I felt. I thought that if I could do that, why can't I reduce my drinking?"
"Unfortunately, I started [smoking after cessation] again, but I'm still working on trying to quit."
Tara Finnessy, 50, client, Bridge Engagement Centre

Tara Finnessy was, she tells an interviewer, nine years old when she first began smoking. By the age of 11 she was a veteran smoker, completely addicted to tobacco. From there her addiction began to escalate as she grew older until she became dependent on cocaine, followed by heroin, all crutches to help cope with personal tragedies in her life. Hoping to cope in a more reasonable, less-death-defying manner, she turned to methadone, and has been on it for the past fifteen years of her life.

And she is a client at the Bridge Engagement Centre in Ottawa whose mandate is to give aid to people living on the streets, to the addicted, the mentally challenged, the drifters. Medical specialists from The Ottawa Hospital donate their time and expertise to this community project to give help and hope to the seemingly hopeless. Out of this group has come a new study published in the online open access journal, BMJ Open.

Researchers at the Bridge Engagement Centre enlisted 80 inner-city Ottawa residents offering them free nicotine replacement therapies inclusive of patches, gum or inhalers, in concert with peer support, mental health counselling and life-skills training, all of which comprised a study in a comprehensive approach to addictions and the background issues that lead people to become victimized. Dr. Pakhale is director of the Bridge drop-in centre and she led this new study.

Over a six-month period, participants who remained in the program were found to have reduced their daily cigarette use from an average of 20.5 cigarettes a day to 9.3. Study participants reported an 18.8 percent decline in illicit drug use. The breakdown: heroin (6.3 percent), OxyContin (3.8 percent, and fentanyl (2.6 percent) declined among those study participants who had acutely reduced their smoking habit.

The study suggests that smoking cessation represents an opening in people's fixed routine dependencies to be treated for their multiple addictions. Both tobacco and opioids are reactive to the brain's reward centres. One addiction reinforces another, pointed out Dr. Pakhale. Among the homeless and marginalized populations, smoking becomes an endemic addiction.

A study of 858 drug users in Ottawa's inner city undertaken in 2013 concluded that 96 percent smoked cigarettes on a daily basis in comparison to roughly nine percent of the city's general population who did the same. While the vast majority of inner-city smokers would like to quit smoking according to research, a persistent belief exists that smoking represents a minor problem in comparison to housing, mental health and other issues related to addiction.

"That translates into a disproportionate amount of disease and premature death -- preventable deaths -- in this population", pointed out Dr. Pakhale.