The Ugly Side Of Coffee

There are hundreds, if not thousands, of books which discuss the wide-range of views concerning the mass use of caffeine in our culture.

From my own research, it does not seem to be much of a debate- nutritionists and scientists have repeatedly shown, in a myriad of ways, that the caffeine chemical is not very healthy for the human body.

In his book Caffeine Blues Stephen Cherniske, M.S goes so far to propose that if caffeine were introduced today as a new food additive, the FDA would never approve it.

He explains that any substance that causes such extreme reactions—heart palpitations, anxiety, panic, insomnia, and even birth defects—would be treated as a new drug and denied status as a food additive.

This is an interesting perspective, and if you are a big coffee drinker I urge you to consider the sentiment. The purpose of this article is to expound on Mr. Cherniske’s insights and explore some unique and interesting characteristics of caffeine that you may not have known.

Before I get to these points, let me say that although I will paint a pretty negative picture of coffee and caffeine, my goal is NOT to scold you and suggest that you stop drinking coffee immediately.

I hope some of the things I explain opens your eyes to the elemental effects of caffeine, but I also understand, and believe, there is a very real enjoyment for many people in a nice, hot cup of Java (for me too, sometimes)!

With that said, here are a few interesting things I bet you didn’t know about coffee and caffeine:

Its a Pesticide

By definition, caffeine is a naturally occurring compound found in the beans, leaves, and fruit of over 60 plants where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants. If you drink a lot of coffee and caffeinated drinks, I urge you to read that sentence again and start seeing caffeine in this light—as a substance produced with the sole purpose to harm creatures that ingest it.

Its Highly Acidic

To date, over 700 volatile substances have been found in coffee, including more than 200 acids and an incredible array of alcohols, aromatic compounds and carbonyl compounds.

It Erodes Your Ability to Metabolize Blood Sugar

Caffeine stimulates the fight or flight stress response in humans and plays a major role in hypoglycemia (a condition where blood sugar levels fall below normal). As part of this response, the liver rapidly raises blood sugar levels. This is felt as a “lift” to the person consuming caffeine, but the body must then deal with the metabolic emergency of hyperglycemia, or elevated blood sugar.

This is accomplished by the pancreas, which secretes insulin, driving the blood sugar down. Over time, this “wear and tear” of our blood sugar metabolism causes the system to become ineffective and can result in hypoglycemia and even diabetes.

There is NO Positive Science

According to Mr. Cherniske: “No scientific study has ever shown that coffee is good for you. The discussion only concerns the degree to which it will harm you”. Interesting.

It Causes Chronic Digestive Problems

Caffeine lowers the stress threshold of our bodies so that the events we would normally handle suddenly become insurmountable. Because of this, coffee consumption is a major contributor to bloating, pain and gas that roughly 50% of Americans adults experience after they eat.

It Leads to “Caffeinism” Which Is Very Serious

In large amounts, and especially over extended periods of time, caffeine can lead to a condition known as caffeinism. Caffeinism is defined on Wikipedia as: “combining caffeine dependency with a wide range of unpleasant physical and mental conditions including nervousness, irritability, anxiety, tremulousness, muscle twitching, insomnia, headaches, respiratory alkalosis and heart palpitations”.

Furthermore, because caffeine increases the production of stomach acid, high usage over time can lead to peptic ulcers, erosive esophagitis, and gastroesophageal reflux disease.

With all this said, nearly 100 million American adults drink three or more cups of coffee a day. But does that make it right? Consider that sometimes we make decisions in our lives based NOT upon what is real, but upon habit, or upon what other people want us to think.

“If five million people do a foolish thing, it is still a foolish thing” –Ancient Chinese Proverb

Here are a few more myths about caffeine, effectively debunked:

Caffeine Gives You Energy

* Caffeine does not provide energy, only chemical stimulation. The perceived “energy” comes from the body’s struggle to adapt to increased blood levels to stress hormones.

Caffeine Gives You a Lift

* Using coffee for mood enhancement is a short-term blessing and a long-term curse. While the initial adrenal stimulation may provide a transient antifatigue “lift”, caffeine’s ultimate mood effect is a letdown, either subtle or profound.

Caffeine Sharpens Your Mind

* While caffeine users may feel more alert, the experience is simply one of increased sensory and motor activity (dilated pupils, increased heart rate, and higher blood pressure). The quality of thought and recall is improved no more than the quality of music is improved when played at a higher volume or speed!

In all, caffeine is substance that purports to give you energy by stimulating your nervous system. But it really isn’t giving you anything, and is in fact harming you! That’s because caffeine creates tension, and the ultimate result of tension is always fatigue.

So how can you start “getting off” caffeine? There are a million and one ways to do this, and I plan on writing a follow-up article on this subject within the next week. Here are some basic suggestions you can start with right away:

SUGGESTIONS

- Brew your coffee with 50% decaf

- Switch to an herbal tea, herbal coffee or another caffeine alternative

- Get a smaller coffee mug

- Spill half of your favorite Starbucks concoction out, before you start drinking it

- Make your coffee weaker by adding more milk

- If you must drink coffee, have it after eating a big meal (preferably after lunch)

- Start eating foods high in minerals

- Try Gingko Biloba

- Drink more water

- Do not drink coffee first thing in the morning

- Do not drink coffee before you go to bed

- Try coffee substitutes

- Drink less potent caffeinated drink

I hope this article was informative, and opened your eyes to some of the very real dangers of continuous caffeine consumption. Look for a second article next week which goes into some more detail about how to weed yourself off caffeine, or better yet, please share your thoughts and experiences in the comment field below!

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Key Facts You Need To Know About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus

This is a fact sheet by Centers for Disease Control and Prevention, dated January 18, 2006, provided for general information about bird flu and information about one type of bird flu, called avian influenza A (H5N1) that is infecting birds in Asia and has infected some humans.

What is avian influenza (bird flu)?

Bird flu is an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Infection with avian influenza viruses in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production). However, the “highly pathogenic” form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100%, often within 48 hours.

How does avian influenza spread among birds?

Infected birds shed influenza virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated excretions or with surfaces that are contaminated with excretions or secretions. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

Do bird flu viruses infect humans?

Bird flu viruses do not usually infect humans, but more than 100 confirmed cases of human infection with bird flu viruses have occurred since 1997. The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1). Please visit these and previous WHO situation updates and cumulative reports for additional information.

How do people become infected with avian influenza viruses?

Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretions and excretions from infected birds. The spread of avian influenza viruses from an ill person to another person has been reported very rarely, and transmission has not been observed to continue beyond one person. During an outbreak of avian influenza among poultry, there is a possible risk to people who have direct or close contact with infected birds or with surfaces that have been contaminated with secretions and excretions from infected birds.

What are the symptoms of avian influenza in humans?

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.

How is avian influenza detected in humans?

A laboratory test is needed to confirm avian influenza in humans.

What are the implications of avian influenza to human health?

Two main risks for human health from avian influenza are 1) the risk of direct infection when the virus passes from the infected bird to humans, sometimes resulting in severe disease; and 2) the risk that the virus – if given enough opportunities – will change into a form that is highly infectious for humans and spreads easily from person to person.

How is avian influenza in humans treated?

Studies done in laboratories suggest that the prescription medicines approved for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to determine the effectiveness of these medicines.

Does the current seasonal influenza vaccine protect me from avian influenza?

No. Influenza vaccine for the 2005-06 season does not provide protection against avian influenza.

Should I wear a surgical mask to prevent exposure to avian influenza?

Currently, wearing a mask is not recommended for routine use (e.g., in public) for preventing influenza exposure. In the United States, disposable surgical and procedure masks have been widely used in health-care settings to prevent exposure to respiratory infections, but the masks have not been used commonly in community settings, such as schools, businesses, and public gatherings.

Is there a risk for becoming infected with avian influenza by eating poultry?

There is no evidence that properly cooked poultry or eggs can be a source of infection for avian influenza viruses. For more information about avian influenza and food safety issues, visit the World Health Organization website .

The U.S. government carefully controls domestic and imported food products, and in 2004 issued a ban on importation of poultry from countries affected by avian influenza viruses, including the H5N1 strain. This ban still is in place. For more information, see Embargo of Birds, http://www.cdc.gov/flu/avian/outbreaks/embargo.htm .

We have a small flock of chickens. Is it safe to keep them?

Yes. In the United States there is no need at present to remove a flock of chickens because of concerns regarding avian influenza. The U.S. Department of Agriculture monitors potential infection of poultry and poultry products by avian influenza viruses and other infectious disease agents.

What precautions can be taken to reduce the risk for infection from wild birds in the United States?

As a general rule, the public should observe wildlife, including wild birds, from a distance. This protects you from possible exposure to pathogens and minimizes disturbance to the animal. Avoid touching wildlife. If there is contact with wildlife do not rub eyes, eat, drink, or smoke before washing hands with soap and water. Do not pick up diseased or dead wildlife. Contact your state, tribal, or federal natural resource agency if a sick or dead animal is found.

What precautions can hunters take to reduce the risk for infection when hunting birds in the United States?

Hunters should follow routine precautions when handling game, including wild birds. The National Wildlife Health Center recommends that hunters:

* Do not handle or eat sick game.
* Wear rubber or disposable latex gloves while handling and cleaning game, wash hands with soap and water (or with alcohol-based hand products if the hands are not visibly soiled), and thoroughly clean knives, equipment and surfaces that come in contact with game.
* Do not eat, drink, or smoke while handling animals.
* Cook all game thoroughly.

Avian Influenza A (H5N1)

What is the avian influenza A (H5N1) virus that has been reported in Asia and Europe?

Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them.

Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia , China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control.

Since late June 2004, however, new outbreaks of influenza H5N1 among poultry have been reported by several countries in Asia (Cambodia, China [Tibet], Indonesia, Kazakhstan, Malaysia, Mongolia, Russia [Siberia], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Influenza H5N1 infection also has been reported among poultry in Turkey and Romania and among wild migratory birds in Croatia .

Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, Turkey, and Vietnam. For the most current information about avian influenza and cumulative case numbers, see the World Health Organization website at http://www.who.int/csr/disease/avian_influenza/en/.

What are the risks to humans from the current H5N1 outbreak in Asia and Europe?

H5N1 virus does not usually infect people, but more than 140 human cases have been reported. Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 virus have occurred.

So far, spread of H5N1 virus from person to person has been rare and has not continued beyond one person. Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population.

If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily from person to person.

How does H5N1 virus differ from seasonal influenza viruses that infect humans?

Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 virus has caused the largest number of reported cases of severe disease and death in humans. In the current situation in Asia, more than half of the people infected with the virus have died. Most cases have occurred in previously healthy children and young adults. However, it is possible that the only cases currently being reported are those in the most severely ill people and that the full range of illness caused by the H5N1 virus has not yet been defined.

Unlike seasonal influenza, in which infection usually causes only mild respiratory symptoms in most people, H5N1 infection may follow an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure have been common among people who have become ill with H5N1 influenza.

How is infection with H5N1 virus in humans treated?

Most H5N1 viruses that have caused human illness and death appear to be resistant to amantadine and rimantadine, two antiviral medications commonly used for treatment of patients with influenza. Two other antiviral medications, oseltamivir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies are needed to demonstrate their current and ongoing effectiveness.

Is there a vaccine to protect humans from H5N1 virus?

There currently is no commercially available vaccine to protect humans against the H5N1 virus that is being detected in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine that will protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way. For more information about the H5N1 vaccine development process, visit the National Institutes of Health website .

What does CDC recommend regarding H5N1 virus?

In February 2004, CDC provided U.S. public health departments with recommendations for enhanced surveillance (“detection”) of H5N1 influenza in the country. Follow-up messages, distributed via the Health Alert Network, were sent to the health departments on August 12, 2004, and February 4, 2005; both alerts reminded public health departments about recommendations for detecting (domestic surveillance), diagnosing, and preventing the spread of H5N1 virus. The alerts also recommended measures for laboratory testing for H5N1 virus. To read the alerts, visit Health Updates on Avian Influenza .

Does CDC recommend travel restrictions to areas with known H5N1 outbreaks?

CDC does not recommend any travel restrictions to affected countries at this time. However, CDC currently advises that travelers to countries with known outbreaks of H5N1 influenza avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. For more information, visit Travelers' Health update.

Is there a risk in handling feather products that come from countries experiencing outbreaks of avian influenza A (H5N1)?

The U.S. government has determined that there is a risk to handling feather products from countries experiencing outbreaks of H5N1 influenza.

There is currently a ban on the importation of birds and bird products from H5N1-affected countries in Asia and Europe. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the following countries: Cambodia, Indonesia, Japan, Laos, Kazakhstan, Malaysia, People's Republic of China, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, and Vietnam (current as of December 29, 2005). This prohibition does not apply to any person who imports or attempts to import products derived from birds if, as determined by federal officials, such products have been properly processed to render them noninfectious so that they pose no risk of transmitting or carrying H5Nl and which comply with the U.S. Department of Agriculture (USDA) requirements. Therefore, feathers from these countries are banned unless they have been processed to render them noninfectious. Additional information about the import ban is available on the USDA website.

Is there a risk to importing pet birds that come from countries experiencing outbreaks of avian influenza A (H5N1)?

The U.S. government has determined that there is a risk to importing pet birds from countries experiencing outbreaks of H5N1 influenza. CDC and USDA have both taken action to ban the importation of birds from areas where H5N1 has been documented. There is currently a ban on the importation of birds and bird products from H5N1-affected countries in Asia. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the following countries: Cambodia, Indonesia, Japan, Laos, Kazakhstan, Malaysia, Peoples' Republic of China, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, and Vietnam. (current as of December 29, 2005) .

Can a person become infected with avian influenza A (H5N1) virus by cleaning a bird feeder?

There is no evidence of H5N1 having caused disease in birds or people in the United States . At the present time, the risk of becoming infected with H5N1 virus from bird feeders is low. Generally, perching birds (Passeriformes) are the predominate type of birds at feeders. While there are documented cases of H5N1 causing death in some Passeriformes (e.g., house sparrow, Eurasian tree-sparrow, house finch), in both free-ranging and experimental settings, most of the wild birds that are traditionally associated with avian influenza viruses are waterfowl and shore birds.

Influenza Pandemic Preparedness

What changes are needed for H5N1 or another avian influenza virus to cause a pandemic?

Three conditions must be met for a pandemic to start: 1) a new influenza virus subtype must emerge; 2) it must infect humans and causes serious illness; and 3) it must spread easily and sustainedly (continue without interruption) among humans. The H5N1 virus in Asia and Europe meets the first two conditions: it is a new virus for humans (H5N1 viruses have never circulated widely among people), and it has infected more than 100 humans, killing over half of them.

However, the third condition, the establishment of efficient and sustained human-to-human transmission of the virus, has not occurred. For this to take place, the H5N1 virus would need to improve its transmissibility among humans. This could occur either by “reassortment” or adaptive mutation.

Reassortment occurs when genetic material is exchanged between human and avian viruses during co-infection (infection with both viruses at the same time) of a human or pig. The result could be a fully transmissible pandemic virus—that is, a virus that can spread easily and directly to humans. A more gradual process is adaptive mutation, where the capability of a virus to bind to human cells increases during infections of humans.

What is CDC doing to prepare for a possible H5N1 flu pandemic?

CDC is taking part in a number of pandemic prevention and preparedness activities, including:

* Providing leadership to the National Pandemic Influenza Preparedness and Response Task Force, created in May 2005 by the Secretary of the U.S. Department of Health and Human Services.
* Working with the Association of Public Health Laboratories on training workshops for state laboratories on the use of special laboratory (molecular) techniques to identify H5 viruses.
* Working with the Council of State and Territorial Epidemiologists and others to help states with their pandemic planning efforts.
* Working with other agencies such as the Department of Defense and the Veterans Administration on antiviral stockpile issues.
* Working with the World Health Organization (WHO) and Vietnamese Ministry of Health to investigate influenza H5N1 in Vietnam and to provide help in laboratory diagnostics and training to local authorities.
* Performing laboratory testing of H5N1 viruses.
* Starting a $5.5 million initiative to improve influenza surveillance in Asia .
* Holding or taking part in training sessions to improve local capacities to conduct surveillance for possible human cases of H5N1 and to detect influenza A H5 viruses by using laboratory techniques.
* Developing and distributing reagents kits to detect the currently circulating influenza A H5N1 viruses.

CDC also is working closely with WHO and the National Institutes of Health on safety testing of vaccine candidates and development of additional vaccine virus seed candidates for influenza A (H5N1) and other subtypes of influenza A viruses.

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Qualitative Alternatives To Blood Transfusion

You might feel, 'Transfusions are hazardous, but are there any high-quality alternatives?' A good question, and note the word "quality."

Everyone, including Jehovah's Witnesses, wants effective medical care of high quality. Dr. Grant E. Steffen noted two key elements: "Quality medical care is the capacity of the elements of that care to achieve legitimate medical and nonmedical goals." (The Journal of the American Medical Association, July 1, 1988) "Nonmedical goals" would include not violating the ethics or Bible-based conscience of the patient. —Acts 15:28, 29.

Are there legitimate and effective ways to manage serious medical problems without using blood? Happily, the answer is yes.

Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their use of blood dropped rapidly. An editorial in Mayo Clinic Proceedings (September 1988) said that "one of the few benefits of the epidemic" was that it "resulted in various strategies on the part of patients and physicians to avoid blood transfusion." A blood-bank official explains: "What has changed is the intensity of the message, the receptivity of clinicians to the message (because of an increased perception of risks), and the demand for consideration of alternatives." —Transfusion Medicine Reviews, October 1989.

Note, there are alternatives! This becomes understandable when we review why blood is transfused.

The hemoglobin in the red cells carries oxygen needed for good health and life. So if a person has lost a lot of blood, it might seem logical just to replace it. Normally you have about 14 or 15 grams of hemoglobin in every 100 cubic centimeters of blood. (Another measure of the concentration is hematocrit, which is commonly about 45 percent.) The accepted "rule" was to transfuse a patient before surgery if his hemoglobin was below 10 (or 30 percent hematocrit). The Swiss journal Vox Sanguinis (March 1987) reported that "65% of [anesthesiologists] required patients to have a preoperative hemoglobin of 10 gm/dl for elective surgery."

But at a 1988 conference on blood transfusion, Professor Howard L. Zauder asked, "How Did We Get a 'Magic Number'?" He stated clearly: "The etiology of the requirement that a patient have 10 grams of hemoglobin (Hgb) prior to receiving an anesthetic is cloaked in tradition, shrouded in obscurity, and unsubstantiated by clinical or experimental evidence." Imagine the many thousands of patients whose transfusions were triggered by an 'obscure, unsubstantiated' requirement!

Some might wonder, 'Why is a hemoglobin level of 14 normal if you can get by on much less?' Well, you thus have considerable reserve oxygen-carrying capacity so that you are ready for exercise or heavy work. Studies of anemic patients even reveal that "it is difficult to detect a deficit in work capacity with hemoglobin concentrations as low as 7 g/dl. Others have found evidence of only moderately impaired function." —Contemporary Transfusion Practice, 1987.

While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says: "With few exceptions, infants born prematurely will experience a decline in hemoglobin in the first one to three months . . . The indications for transfusion in the nursery setting are not well defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration with no apparent clinical difficulties." —Pediatric Clinics of North America, February 1986.

Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery. If the loss is rapid and great, a person's blood pressure drops, and he may go into shock. What is primarily needed is that the bleeding be stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation.

Volume replacement can be accomplished without using whole blood or blood plasma.* Various nonblood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn] patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989) Such fluids have definite advantages. "Crystalloid solutions [such as normal saline and lactated Ringer's solution], Dextran and HES are relatively nontoxic and inexpensive, readily available, can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease." —Blood Transfusion Therapy —A Physician's Handbook, 1989.

You may ask, though, 'Why do nonblood replacement fluids work well, since I need red cells to get oxygen throughout my body?' As mentioned, you have oxygen-carrying reserves. If you lose blood, marvelous compensatory mechanisms start up. Your heart pumps more blood with each beat. Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels. As a result of chemical changes, more oxygen is released to the tissues. These adaptations are so effective that if only half of your red cells remain, oxygen delivery may be about 75 percent of normal. A patient at rest uses only 25 percent of the oxygen available in his blood. And most general anesthetics reduce the body's need for oxygen.

HOW CAN DOCTORS HELP?

Skilled physicians can help one who has lost blood and so has fewer red cells. Once volume is restored, doctors can administer oxygen at high concentration. This makes more of it available for the body and has often had remarkable results. British doctors used this with a woman who had lost so much blood that "her haemoglobin fell to 1.8 g/dlitre. She was successfully treated . . . [with] high inspired oxygen concentrations and transfusions of large volumes of gelatin solution [Haemaccel]." (Anaesthesia, January 1987) The report also says that others with acute blood loss have been successfully treated in hyperbaric oxygen chambers.

Physicians can also help their patients to form more red cells. How? By giving them iron-containing preparations (into muscles or veins), which can aid the body in making red cells three to four times faster than normal. Recently another help has become available. Your kidneys produce a hormone called erythropoietin (EPO), which stimulates bone marrow to form red cells. Now synthetic (recombinant) EPO is available. Doctors may give this to some anemic patients, thus helping them to form replacement red cells very quickly.

Even during surgery, skilled and conscientious surgeons and anesthesiologists can help by employing advanced blood-conservation methods. Meticulous operative technique, such as electrocautery to minimize bleeding, cannot be overstressed. Sometimes blood flowing into a wound can be aspirated, filtered, and directed back into circulation.#

Patients on a heart-lung machine primed with a nonblood fluid may benefit from the resulting hemodilution, fewer red cells being lost.

And there are other ways to help. Cooling a patient to lessen his oxygen needs during surgery. Hypotensive anesthesia. Therapy to improve coagulation. Desmopressin (DDAVP) to shorten bleeding time. Laser "scalpels." You will see the list grow as physicians and concerned patients seek to avoid blood transfusions. We hope that you never lose a great amount of blood. But if you did, it is very likely that skilled doctors could manage your care without using blood transfusions, which have so many risks.

SURGERY, YES —BUT WITHOUT TRANSFUSIONS

Many people today will not accept blood. For health reasons, they are requesting what Witnesses seek primarily on religious grounds: quality medical care employing alternative nonblood management. As we have noted, major surgery is still possible. If you have any lingering doubts, some other evidence from medical literature may dispel them.

The article "Quadruple Major Joint Replacement in Member of Jehovah's Witnesses" (Orthopaedic Review, August 1986) told of an anemic patient with "advanced destruction in both knees and hips." Iron dextran was employed before and after the staged surgery, which was successful. The British Journal of Anaesthesia (1982) reported on a 52-year-old Witness with a hemoglobin level under 10. With the use of hypotensive anesthesia to minimize blood loss, she had a total hip and shoulder replacement. A surgical team at the University of Arkansas (U.S.A.) also used this method in a hundred hip replacements on Witnesses, and all the patients recovered. The professor heading the department comments: "What we have learned from those (Witness) patients, we now apply to all our patients that we do total hips on."

The conscience of some Witnesses permits them to accept organ transplants if done without blood. A report of 13 kidney transplants concluded: "The overall results suggest that renal transplantation can be safely and efficaciously applied to most Jehovah's Witnesses." (Transplantation, June 1988) Likewise, refusal of blood has not stood in the way even of successful heart transplants.

'What about bloodless surgery of other types?' you may wonder. Medical Hotline (April/May 1983) told of surgery on "Jehovah's Witnesses who underwent major gynecological and obstetric operations [at Wayne State University, U.S.A.] without blood transfusions." The newsletter reported: "There were no more deaths and complications than in women who had undergone similar operations with blood transfusions." The newsletter then commented: "The results of this study may warrant a fresh look at the use of blood for all women undergoing obstetric and gynecological operations."

At the hospital of Göttingen University (Germany), 30 patients who declined blood underwent general surgery. "No complications arose that could not also have arisen with patients who accept blood transfusions. . . . That recourse to a transfusion is not possible should not be overrated, and thus should not lead to refraining from an operation that is necessary and surgically justifiable." —Risiko in der Chirurgie, 1987.

Even brain surgery without using blood has been done on numerous adults and children, for instance, at New York University Medical Center. In 1989 Dr. Joseph Ransohoff, head of neurosurgery, wrote: "It is very clear that in most instances avoidance of blood products can be achieved with minimal risk in patients who have religious tenets against the use of these products, particularly if surgery can be carried out expeditiously and with a relatively short operative period. Of considerable interest is the fact that I often forget that the patient is a Witness until at the time of discharge when they thank me for having respected their religious beliefs."

Finally, can intricate heart and vascular surgery without blood be performed on adults and children? Dr. Denton A. Cooley was a pioneer in doing just that. As you can see in the medical article reprinted in the Appendix, on pages 27-9, based on an earlier analysis, Dr. Cooley's conclusion was "that the risk of surgery in patients of the Jehovah's Witness group has not been substantially higher than for others." Now, after performing 1,106 of these operations, he writes: "In every instance my agreement or contract with the patient is maintained," that is, to use no blood.

Surgeons have observed that good attitude is another factor with Jehovah's Witnesses. "The attitude of these patients has been exemplary," wrote Dr. Cooley in October 1989. "They do not have the fear of complications or even death that most patients have. They have a deep and abiding faith in their belief and in their God."

This does not mean that they assert a right to die. They actively pursue quality care because they want to get well. They are convinced that obeying God's law on blood is wise, which view has a positive influence in nonblood surgery.

Professor Dr. V. Schlosser, of the surgical hospital at the University of Freiburg (Germany), noted: "Among this group of patients, the incidence of bleeding during the perioperative period was not higher; the complications were, if anything, fewer. The special view of illness, typical of Jehovah's Witnesses, had a positive influence in the perioperative process." —Herz Kreislauf, August 1987.

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