Bangkok heat: cause of death?

A friend of mine, Greg Baecher, has spent much of his academic career analyzing risk for complicated failures. He recently wrote to me as follows:

I am increasingly of the opinion that failures seldom occur as we have analyzed and predicted them. They occur from system interactions which are essentially unidentifiable ahead of time: the odd combination of usual events which taken together in a particular order become malicious. The probability of any such set approaches zero, but their combinatorial number is extremely large; hence, one such might happen with non-neglibible probability.

Now thinking as one does at times at this time of life on the subject of mortality I propose that this comment is applicable to problems to be reckoned with by us elders. As our fragility increases with age, so do the potential causes of our demise become more complex and similar to the "system interactions" Greg describes.  The man who sat next to me in The Londoner a year ago fell and broke his hip, or perhaps, as another version of the story has it, was knocked down by a bag-snatching thief while returning unsteadily from the pub. In any event a month later he is dead. Rendered immobile, he could no longer spend his evenings at The Londoner talking with his friends. "He lost his point," we mumbled gloomily at the bar.

John Updike's unforgettable character Rabbit (in the novel Rabbit at Rest) tries to recover past glory by playing basketball on a hot day with a teenager in the local Florida park; a fatal heart attack follows.

Hot weather in Bangkok, late April 2015

In this entry I want to describe what happened to another pub friend of mine, I'll call him Hector, dead now two days ago at the Police Hospital but not yet buried or burned as is done here in Thailand.

Hector drank a good deal of beer like many of us and was perhaps a few pounds heavier than necessary, but his better daily habits included a brisk 5 km dawn walk around the local park on Sukhumvit, the one established by a famous Thai politician as penance for his former deeds as a world-class brothel keeper and briber of police.

Now it is evident from the daily weather chart above for Don Muang airport that the humidity and heat in the early morning has been quite high here, and we would expect that toward the end of April Hector would have been sweating profusely at the end of his walks, with a tendency toward dehydration, perhaps exacerbated by the dehydrating effects of his beer the previous evening. (The latter contributing factor would be triumphantly overemphasized by those moralizing but otherwise minimally useful "health newsletters" so beloved in the nanny states of America.) Now it happened that Hector made much of preferring beer and Coca Cola to water, and out of deference to the time of day and maintenance of his weight he would avoid these preferred beverages at seven in the morning when he finished his walk but at the same time be less inclined to drink the amount of fluid, namely water, that might have been optimum for his condition.

It is well known that dehydration increases the level of salt and other wastes in the bodily fluids and urine which not surpisingly changes the electrical properties of the body and its organs, specifically the electrophysiology of the cardiovascular system. This promotes irregular heartbeats not infrequently causing one and sometimes several skipped beats, sometimes resulting in cardiac arrest for several seconds. Spontaneous refiring of the heart is the norm, but syncope, or fainting, may occur, with a serious hazard of falling. This was explained to me patiently by a cardiologist at the Samitivej Hospital (see my previous entry on this for details).

Hector was not so lucky.  (To be continued)

Bangkok heat: cause of death?

A friend of mine, Greg Baecher, has spent much of his academic career analyzing risk for complicated failures. He recently wrote to me as follows:

I am increasingly of the opinion that failures seldom occur as we have analyzed and predicted them. They occur from system interactions which are essentially unidentifiable ahead of time: the odd combination of usual events which taken together in a particular order become malicious. The probability of any such set approaches zero, but their combinatorial number is extremely large; hence, one such might happen with non-neglibible probability.

Now thinking as one does at times at this time of life on the subject of mortality I propose that this comment is applicable to problems to be reckoned with by us elders. As our fragility increases with age, so do the potential causes of our demise become more complex and similar to the "system interactions" Greg describes.  The man who sat next to me in The Londoner a year ago fell and broke his hip, or perhaps, as another version of the story has it, was knocked down by a bag-snatching thief while returning unsteadily from the pub. In any event a month later he is dead. Rendered immobile, he could no longer spend his evenings at The Londoner talking with his friends. "He lost his point," we mumbled gloomily at the bar.

John Updike's unforgettable character Rabbit (in the novel Rabbit at Rest) tries to recover past glory by playing basketball on a hot day with a teenager in the local Florida park; a fatal heart attack follows.

Hot weather in Bangkok, late April 2015

In this entry I want to describe what happened to another pub friend of mine, I'll call him Hector, dead now two days ago at the Police Hospital but not yet buried or burned as is done here in Thailand.

Hector drank a good deal of beer like many of us and was perhaps a few pounds heavier than necessary, but his better daily habits included a brisk 5 km dawn walk around the local park on Sukhumvit, the one established by a famous Thai politician as penance for his former deeds as a world-class brothel keeper and briber of police.

Now it is evident from the daily weather chart above for Don Muang airport that the humidity and heat in the early morning has been quite high here, and we would expect that toward the end of April Hector would have been sweating profusely at the end of his walks, with a tendency toward dehydration, perhaps exacerbated by the dehydrating effects of his beer the previous evening. (The latter contributing factor would be triumphantly overemphasized by those moralizing but otherwise minimally useful "health newsletters" so beloved in the nanny states of America.) Now it happened that Hector made much of preferring beer and Coca Cola to water, and out of deference to the time of day and maintenance of his weight he would avoid these preferred beverages at seven in the morning when he finished his walk but at the same time be less inclined to drink the amount of fluid, namely water, that might have been optimum for his condition.

It is well known that dehydration increases the level of salt and other wastes in the bodily fluids and urine which not surpisingly changes the electrical properties of the body and its organs, specifically the electrophysiology of the cardiovascular system. This promotes irregular heartbeats not infrequently causing one and sometimes several skipped beats, sometimes resulting in cardiac arrest for several seconds. Spontaneous refiring of the heart is the norm, but syncope, or fainting, may occur, with a serious hazard of falling. This was explained to me patiently by a cardiologist at the Samitivej Hospital (see my previous entry on this for details).

Hector was not so lucky.  (To be continued)

Bangkok heat stopped my heart

Failure to drink enough water over two hot days made my heart stop for 4 seconds. 

Sounds preposterous, right? I always thought that this water drinking business was an old wives' tale. Or rather, a new wives' tale, since it's mostly young people one sees toting around plastic water bottles.

But last year I learned something new about my body. Dehydration can be serious business especially if you are a bit older. Buildup of salts affects the body electrical circuits including those that produce the so-called "sinus rhythm" that times the heart rate. The result: a static-like and alarming condition called atrial fibrillation, which often leads to "sinus arrest", temporary stopping of the heart (see illustration). This is not as dangerous as it sounds, since the heart has backup beat sytems that usually refire the circuits. But the danger is that you are very likely to pass out for a couple seconds which could result in your falling down the stairs or other accident.

Result? I now have a pacemaker, which gaurantees 60 beats a minute. Effective, but a couple of extra bottles of water would have been a lot cheaper!

This is 4 seconds. How about 6 or 8 seconds? You'll mostly come out of it, but don't fall down the stairs in the meanwhile. Otherwise, a nice way to go.

Bangkok heat stopped my heart

Failure to drink enough water over two hot days made my heart stop for 4 seconds. 

Sounds preposterous, right? I always thought that this water drinking business was an old wives' tale. Or rather, a new wives' tale, since it's mostly young people one sees toting around plastic water bottles.

But last year I learned something new about my body. Dehydration can be serious business especially if you are a bit older. Buildup of salts affects the body electrical circuits including those that produce the so-called "sinus rhythm" that times the heart rate. The result: a static-like and alarming condition called atrial fibrillation, which often leads to "sinus arrest", temporary stopping of the heart (see illustration). This is not as dangerous as it sounds, since the heart has backup beat sytems that usually refire the circuits. But the danger is that you are very likely to pass out for a couple seconds which could result in your falling down the stairs or other accident.

Result? I now have a pacemaker, which gaurantees 60 beats a minute. Effective, but a couple of extra bottles of water would have been a lot cheaper!

This is 4 seconds. How about 6 or 8 seconds? You'll mostly come out of it, but don't fall down the stairs in the meanwhile. Otherwise, a nice way to go.