Dr. Kevin Most: The Rodney Dangerfield organs, and how important they actually are
We always talk about the cool parts of the body like your heart or your brain, isn’t it time we showed a little respect to some of the lesser known organs and what exactly do they do. The body is so complex and the amazing way it works should be a wonder to all of us. The advances of science have also helped us when we have an organ that is failing or is cancerous.
So just a quick question, of the following organs, which one could we remove and still have us survive. The Pancreas, The Spleen, the Thyroid, or the Kidney? Kind of a trick question, the answer the way it is written is the spleen and the kidney. The reason being is we are born with 2 kidneys and are able to like with just a single kidney, and although it is great we don’t need to have a spleen to survive. The others we could remove but without some medical treatment we would not last long.
The spleen is an organ that really gets no respect, it is an organ few know about, most can’t identify where it is in their body and probably have no idea of its function. The spleen is part recycling area and part storage site to make it simple.
Although the spleen is not absolutely needed to survive it does play a very important role in our health. The normal red blood cell lives for approximately 120 days, after that time it has lost its effectiveness to carry oxygen and sugar to the muscles and brain. The spleen removes these older cells from the circulation and recycles the nutrients to be used again in new cells. The spleen is also a storage facility for us, it holds White blood cells, needed to fight infections, and platelets needed to stop bleeding. So the spleen is valuable but not necessary. The spleen at times needs to be removed. Although it is well protected by the rib cage, trauma to that area can cause the spleen to rupture and need to be removed. Other illnesses can enlarge the spleen and make it more prone to trauma and need for removal. For those of you wo like fun facts, the normal spleen size is about 4 inches by 2 inches and weighs about 5 ounces, however when it is enlarged due to infection it can get to be 8 inches by 3 inches and weigh over 2 lbs., so quite a change and when enlarged a much higher chance of rupture from trauma. This is why individuals with Mono are taken out of gym class and physical sports. If it is removed we need to take some precautions with these individuals. As it is important in helping us fight infections, pneumonia for example, these individuals need vaccinations and an increased awareness to possible infections. They need to be aware and look for early signs of infections.
So what about the other answer the kidney? The kidney is very important as a filter system for the body. This filters eliminates excess water and chemicals. It is an amazing organ, it knows when we are dehydrated, it knows when we have too much fluid in our system. It helps to adjust our blood pressure. We certainly cannot live without the function of our kidneys. Unfortunately diseases like untreated high blood pressure or diabetes can cause kidney damage or failure. Fortunately science has advanced and since the 1940’s we have been able to offer dialysis to patients. This is a machine that acts as a kidney. It is a filtration system that the patient is hooked up to and it acts as the kidney. This is used in individuals who have long term kidney issues and also used temporarily in some patients who may only need the help for a short time as their kidney improve or until we can find a donor for a kidney transplant. We have close to 500,000 individuals on dialysis in the United States currently with this number only looking to increase.
Kidney disease is a big issue, we have over 100,000 individuals waiting for a kidney transplant and unfortunately 13 people die each day waiting for a kidney transplant. Each year there are close to 20,000 available kidneys for donation. The cool thing about the kidney is, we have 2 of them and only need one to survive. This has allowed many individuals to actually donate a kidney to a loved one while still alive. This is a live donor and you often see stories of live kidney donors and the impact they made. In fact recently here in Chicago Police Superintendent Eddie Johnson had a kidney transplant and the donor was his 25 yo son. Please make sure you are signed up to be a donor, it only takes a minute and is on line thru the sec of states web site.
Although dialysis has been a life saver for millions of people, it is also a hassle, as the patient is hooked up to the unit for an extended time and thus taken away from normal daily life. It also is troublesome for any individual who would like to travel as arrangements would need to be made to receive dialysis away from their normal center. So although we just take for granted our kidneys, they play an important role, this is another reason for patients to be treated for high blood pressure and diabetes it protects your kidneys.
There are some promising studies going on now where an artificial implantable kidney is being developed. Currently this is being reviewed at Vanderbilt and UCSF. It essentially is a device that is placed in your abdomen and acts your kidney, the science has been perfected to a point where they are ready to start clinical trials this year. This is fascinating as patients would not have to wait for a donor, they would not be hooked up to a dialysis machine or center and they would not need to take anti-transplant rejection drugs. I think this will be fascinating to see as we advance this over the next few years. The prototype being touted is small and would be placed in the same position as your kidney is now.
We have discussed diabetes and the impact it makes on individuals health and life expectancy, but we never discuss the foundation for the problem, the pancreas. The pancreas is another organ that is not well understood or known, we all have heard of insulin and the need for insulin to help us regulate our blood sugar, well insulin is made and released from the pancreas. In patients with Type 1 diabetes the pancreas will not make enough insulin so we have to supplement it with insulin shots in order to control the blood sugar. We have been able to supplement insulin to patients for almost 100 years, in 1921, insulin was identified by Dr Banting. He did an experiment with a dog with diabetes and with insulin injections he kept the dog alive for 70 days. It was less than a year later when a 14 yo boy in Canada who was dying from diabetes had his life saved by receiving and injection of insulin. Prior to that we treated diabetes with calorie and carbohydrate restrictions which did not work well.
We all know it is a big problem and growing, the largest growth in diabetes is Type 2, this is also adult onset diabetes, for these individual they make insulin but it is not effective and needs medications for it to work. This is often a consequence of being overweight, we have close to 30 million individuals who are considered Type 2. The less common diabetes is Type 1, where the body for some reason has attacked the pancreas and damaged its insulin production, the number of those individuals in the US is 1.25 million, but for some unknown reason we are seeing an increase in the number of type 1 diabetics
We know that lack of control of blood sugar causes problems with our heart, our kidneys, our circulation and some cancers. We also know what a hassle it is for patients to have to stick themselves to check their blood sugar each day and adjust their diet and their insulin injections, as type 1 diabetics must do daily. Well the Cleveland Clinic is working to develop an artificial pancreas. This device would eliminate the need for many diabetics to measure the blood sugar a few times a day and adjust the insulin dosing, instead the device would do it. The concept is quite simple, take all the steps we do today and build them into a device that can be worn. This device would monitor your blood sugar throughout the day not only the few times you remember to check it, it would automatically deliver the insulin needed thru the day based on the results. It allows for the diabetic to get a continuous insulin infusion based on your blood sugar thru the day instead of 2- 3 times a day a large amount given at one time. It protects the body from wide swings in blood sugar and acts more like a normal pancreas thus minimizing the effects of the disease on your heart, kidneys etc.
In a few years I imagine both the artificial kidney and the artificial pancreas will change the way we look at complications or life expectancy limits from both these diseases. Unfortunately the 6 million dollar man may cost a bit north of 6 million