Drink Water and Defend Strokes

Almost 800,000 Americans have a stroke every year according to the U.S. Centers for Disease Control and Prevention. The vast majority of strokes occur when a clot blocks the blood flow to a portion of the brain resulting in nearly 130,000 deaths annually in the United States. We know that strokes are dangerous – but what you may not know is that your own hydration can have a positive impact.

People who are not well hydrated, when they have a stroke, are about four times more likely to have a worse outcome than people who regularly have more fluids in their system, a new study suggests. When stroke patients end up in the hospital they are often severely dehydrated. When compared with patients who were not dehydrated prior to a stroke, dehydration at hospital arrival was associated with a four-fold increase in the risk of having clinically worsening symptoms between the patients arrival and their discharge, according to Dr. Mona Bahouth, a cerebrovascular fellow in the department of neurology at Johns Hopkins Hospital in Baltimore, who presented her study findings at the annual meeting of the International Stroke Conference in February, 2015. “We have known that a large percentage of patients are dehydrated at the time of their stroke,” she said, adding that it is now clear that this presentation has implications for short-term prognosis. Simply put: it’s better to have a hydrated body than a dehydrated body. But can dehydration be a risk factor for stroke? The study did not address cause and effect, and Bahouth said it is not yet clear if dehydration is an actual risk factor for stroke. “I think we had a hunch that hydration would be a key feature for stroke patients,” Bahouth said. “So it’s not too surprising, but it’s just the beginning.”

A Scottish study in 2012 also found the same thing. Researchers in that study concluded that dehydration is common in patients admitted to the hospital following a stroke and is associated with severe stroke and poor outcomes at the time of their discharge. They suggest that focusing on interventions to reduce the frequency and duration of dehydration have the potential to improve patient outcomes after a stroke. Independent risk factors for dehydration included older age, female gender, and prescribed diuretics, which rids the body of vital fluids.

The John Hopkins study included 168 patients admitted to Johns Hopkins Hospital from August 2013 to May 2014. The patients underwent MRI scans to assess how much damage had been done to the brain by the stroke. Forty-four patients were deemed to be dehydrated at the time of hospital admission. There were not significant differences in hydrated and dehydrated patients with regard to stroke severity or the type of stroke they had, however water consumption showed that healthy hydration had undeniable benefit. “The dehydration group tended to end up in the worst quartile,” Bahouth said. “These were the patients who got worse over further hospitalization or didn't change at all.” And dehydration remained a significant predictor of having a worse outcome after leaving the hospital. “There is a physiological response to dehydration,” she said. “The blood gets sludgy, like thick paint, and this puts stress on blood vessel walls and it changes the dynamic of how blood vessels function.”

Dr. Paul Bendheim, a clinical professor of neurology from the University of Arizona College of Medicine in Tucson, said there are no hard-and-fast rules for staying well hydrated, though recommendations of drinking eight glasses of water each day is still standard policy. “The critical thing is that people maintain frequent volumes of urinary output during the day, that they don't feel thirsty and they regularly consume sufficient liquids,” added Bendheim, who wasn’t involved in the Hopkins study. Dr. Bahouth cautioned that anyone who thinks they might be having a stroke should not try to drink anything since brain damage might make it difficult for them to swallow correctly. That could cause them to inhale fluid into the lungs.

It’s no surprise that being properly hydrated helps with a variety of physical ailments. Water is known to help fight fatigue, eliminate toxins from the body, keep the skin healthy and more. But human nature is such that, though people may know they need to drink more water, they don’t often monitor their water intake. Yes, something as simple as water can provide meaningful long-term health benefits. Water is not a cure all of course, but drinking water at home, at work, at the gym, and on the go is never a wrong choice. Drinking more water won’t protect you from a stroke, heart attack or anything else, but if your body is properly hydrated and these studies suggest you will be helping to protect yourself in the long run.

Tern Island: How to Care About Something No One Cares About

I’m guessing you’ve never heard of Tern Island. I’m also guessing that you may not care that this remote Pacific Ocean Island was just given money by the federal government to clean up marine debris and lead contamination that have heavily polluted it. Allow me to explain this after we get through the set up which is, admittedly, a little tedious.

The Environmental Protection Agency (EPA) and the U.S. Fish and Wildlife Service agree there have been releases of hazardous substances like polychlorinated biphenyls (PCB - man-made organic chemicals which were domestically manufactured from 1929 until they were banned in 1979) and lead from when the military buried it on the island. And? And that’s not a good thing, regardless of this obscure stick of dirt.

Briefly

Tern Island is located 564 miles northwest of Honolulu and comprises part of the Hawaiian Islands National Wildlife Refuge, and Papahānaumokuākea Marine National Monument which is in the Northwest Hawaiian Islands (NWHI), and it lies within the Coral Reef Ecosystem Reserve managed by National Oceanic and Atmospheric Administration (NOAA), and the State of Hawaii’s NWHI Marine Refuge. That’s a lot of titles for a small strip of land that looks like a large piece of bacon. But Tern Island is also home to 7,000 recorded marine species, over 2,000 of which are endemic, existing only in the Northwest Hawaiian Islands. The area is nesting habitat for 95% of the population of the cute Hawaiian green sea turtles. It’s also pupping habitat for 16% of the, also cute, Hawaiian monk seals, and is the nesting site for approximately 6% of the world’s black footed albatross, you know, those less cute birds that literally fly for years without setting foot on land. I hear you asking again…and? And bear with me.

The Making Of Tern Island

Tern is part of an atoll known as French Frigate Shoals consisting of two crescent-shaped reefs surrounding a 140-square-mile lagoon, the outer boundary of which was the perimeter of a once active volcano. When it was first documented in 1786 the island was a small sand shoal and undoubtedly no one really cared about this desolate aggregate plot of dirt…at least until World War II.

The island was artificially enlarged by the U.S. Navy in 1942 and used until 1946 as an airfield and refueling stop, since it was close to Japan, then used by the U.S. Coast Guard until 1979. Tern was originally 1,800 feet long and 450 feet wide, but the Navy dredged 500,000 cubic yards of coral from an adjacent lagoon to construct a landing strip on Tern, and the end result was a new island 3,100 feet long by 350 feet wide. Construction of the island was accomplished by creating a seawall from 5,000 feet of double-walled steel sheet piling. The seawall around the perimeter of the island held the coral in place giving the island an artificial structure. What once was an 11-acre natural island morphed into a 34-acre naval facility with a landing strip, eight buildings, and 21 underground storage tanks each with a 5,000-gallon capacity for holding aviation fuel. Ah, the fuel - stunningly it was left in the tanks after the Navy and Coast Guard left the island. That fuel leaked into the sand and water as the tanks deteriorated, contaminating parts of the island and effecting nearby islands and, sadly, lead and PCB’s showed up decades later in marine animals. During the time that Tern was used by the Navy and Coast Guard each group discarded and buried batteries, capacitors, and transformers in the island. This was nothing nefarious as this was standard policy at the time and a host of WW II bases have been plagued with problems similar to Tern because there was never any foresight into the long-term consequences of burying toxic materials underground to begin with. (Consider Camp Lejeune in North Carolina, Air Force Plant #4 in Forth Worth Texas; and the Fort Wingate Depot in Gallup, New Mexico - all Superfund sites defined as “uncontrolled hazardous waste”).

Tern's sea turtles

Okay, so that’s an interesting tidbit of American history. But who still cares about a fake island in the middle of the Pacific? “Tern Island is home to the Hawaiian monk seal, the United States’ most endangered marine mammal and the official state mammal of Hawaii,” says Jared Blumenfeld of EPA. “We must move forward to protect the seals and all the wildlife dependent on this extraordinary Pacific island.” Some of you might agree, and others might say that they’ve never even seen a Hawaiian monk seal so what difference does it make? I understand that. Tern Island and its surrounding atoll are designated as a critical habitat for the monk seal, whose total population of just 1,200 has been steadily declining, and that’s not meant to pull at your heartstrings, it’s just the reality. The atoll also plays a vital role as a breeding colony for lots of bids and faces loss of land habitat in the wake of climate change and projected sea level rise since Tern barely makes it above the water line.

Still not a convincing argument for why this matters?

Debris left on Tern Island stranded this Monk Seal

The Bigger Issue

The real problem is that Tern Island is located within the North Pacific Subtropical Convergence Zone – fancy talk for where a high concentration of marine debris from global sources tends to accumulate. Initial studies conducted by EPA indicated that microplastic marine debris (meaning five millimeters or less in size – that’s 13/64 of an inch, pretty damn small) accumulates and transports contaminants from the marine environment and into the animal food chain, and our food chain. According to NOAA, marine debris can and does injure and kill marine life and poses a threat to human health. “Our oceans and waterways are polluted with a wide variety of marine debris ranging from soda cans and plastic bags to derelict fishing gear and abandoned vessels,” NOAA says, and they define marine debris as “any persistent solid material that is manufactured or processed and directly or indirectly, intentionally or unintentionally, disposed of or abandoned into the marine environment.” Whoa, that could be a lot of junk. And today, there is no place on Earth immune to this problem. “A majority of the trash that covers our beaches comes from storm drains and sewers, as well as from shoreline and recreational activities such as picnicking and beachgoing,” NOAA says. Bluntly put, a lot of people are pigs and never properly dispose of their trash. Discarded fishing gear is a problem because it can entangle, injure, maim, and even drown marine wildlife, both on shore and in the open ocean. EPA wrote an assessment of Tern and suggested “data collected from Tern Island show a clear progression of bio-concentration and bio-magnification of PCBs in the local marine life.” Even areas outside the NWHI are now contaminated. “Microplastics, coupled with other known and suspected PCB sources on Tern Island, present a possible, and an as yet uninvestigated, exposure pathway of contaminants into the marine food web,” Blumenfeld wrote.

Why Care?

This is why should you care about contamination of the food chain and water near Hawaii. But is that really a concern to most Americans? I posed that question to the EPA office in Hawaii. The response from the government? “Plastic pollution in the ocean is a threat not only to the marine ecosystem, but possibly to human health as well. The fish that ingest the microplastic and the associated pollutants will potentially end up on our dinner table. EPA and many other organizations and researchers are assessing the extent to which such pollutants might accumulate in the human body through ingestion of fish.” The problem with this response is predictable - no one still cares about Tern Island. How can anyone on the U.S. mainland think they might “potentially” eat fish contaminated with plastics or lead from a place thousands of miles away in the middle of the massive Pacific Ocean? And that is the crux of the issue. Unfortunately, though not surprisingly, EPA could only provide a typically tedious, disconnected governmental response. Don’t misunderstand; I fully believe that our environment needs to be treated with the utmost respect. But how to convince someone in Iowa, Mississippi, or North Dakota for example, that Tern Island matters to them in a tangible, practical way? I guess I’m on my own to do this.

Here goes: Water migrates where it will and you cannot stop it. As proof of this the collection of marine debris on Tern shows how currents move debris across large swaths of open ocean. Is it possible then that fish, birds and other animals contaminated with lead and PCBs from Tern might migrate over vast distances and find their way into a food chain closer to home? Unequivocally, yes. There is not any place on this globe of ours that does not suffer from any kind of pollution. Currents move, winds blow, water spreads and lead from Tern has clearly migrated to nearby islands. The source of pollution and contamination throughout our world is a collective contamination of epic proportions because it does not stay in one place. As of September 2014, the first case of the Ebola virus in the U.S was reported by the CDC and that virus migrated in the body of Thomas Duncan from Liberia to Texas, almost 5,800 miles away, actually less than the 4,700 miles from the U.S. to Tern Island.

Marine debris from the Japan tsunami

It is the idea that virus, pollution, toxicity can migrate rapidly throughout our world that I want you to understand. We no longer live in isolation. Substantial pollution from Beijing affects other countries. A volcano in Iceland erupts and disrupts air traffic in Spain (I was stuck in Madrid when this occurred). Fukishima radiation flows into the sea in Japan and migrates half a world a way to the California shore. People dump their old medicines in their toilets and it finds its way into our drinking water. An animal feeding operation in Georgia discharges liquid animal manure into Lake Blackshear, a body of water Georgians use for water recreation, which then had unhealthy levels of bacteria.

This is why Tern Island is important. None of us are too far from toxic contamination; we are not immune, even if we deny its very existence. I do not say this to induce fear. Fear does not interest me. Intelligent response to the problems we collectively face is what interests me. Therefore we should care, actively care, about pollution in other parts of the world and the health of our waters. It will be expensive and time consuming to clean up. This is our only planet, our one and only home, and she urgently needs our attention.