M Hey everybody, it's Josh and for this week's select, I've chosen our two thousand fifteen episode on therapeutic hypothermia. It sounds weird and boring and it's a really super science EPP. But sometimes sometimes those can be the best ones. This topic is super interesting. It's a look at how science can stave off death and hopefully it's the direction that modern medicine is heading. Plus, if you get bored, you can thrill the hearing us. Try to say cellular level here or there. It's hilarious. Enjoy. I command you. Welcome to Stuff you Should Know, a production of I Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Eager Beaver, Chuckers Bryant ready to get its therapeutic hypothermia on. Yeah, baby, I'm chilling. Yeah, moving at a glacial paste today, right, I am um, I'm sorry for that. That was actually a poke at the author of this article. Yeah, that's uh. That stood out to me as well. I'm not telling you Jerry's over there and stuff you should know. No, I'm done. Um. Yeah, we were goofing off about this article and how stuff works. That there were way too many cold puns for my liking. There was a lot of puns, you know, a lot lots of them. Yeah, this article stinks of punt it reeks. So how you doing, man, how you feeling? I'm good? Uh, it seems there's a sickness going around the office. Yeah, which I thought we knew here in two thousand and fifteen that if you're sick, you don't come into work, especially when you have a liberal telecommune policy right like we do. I realized, Um, I realized that people need to come in and shoot video and recording all that. But come in, you do that, and you leave, and you wear like a plague doctor's mask the whole time you're here too. Yeah. I mean, I have a biohazard suit at my desk, but has a RiPP in it. Anyone can wear it, has a ripping. It's very small rental and cleaning fee. You're going to take a blood sample of mine wearing that thing. And it occurred to me as you were about to put it on, like I don't know where that thing has been, Like, that's a real biohazard suit and Chuck's going to use it to open my skin. Yeah, this sounds very odd. Um, we don't just do this in the office. We did our blood Types episode live here in Atlanta, and we actually took Josh's blood type on stage because you didn't know it. No, I when we recorded the version in the studio, I genuinely did not know it. Yeah, so I took your blood on stage. You trusted me. I did not wear the contaminated suit. No, you. You just used your dirty hands with no like rubber gloves or anything. Look at you. You're fine ish and you know your blood type now, which was a positive like Jarius, So we should release that whole live show. Is a just a special yeah little bonus. Yeah bonus. That was the word I was looking for. There's something special about it. It's just a bonus. That was special. Yeah, it's a good idea. Look for that soon people. So, uh, today, Chuck, we're talking about therapeutic hypothermia and I am very excited about this. This is my idea of this article. Yeah, Um, it's pretty neat. I don't remember. I guess I first heard of it from that Mosaic article that we both read to the big sleep awesome article. And uh, if you haven't figured out by now we have started to on the podcast page for each episode, put related links on there on our site stuff you should know dot com, so that articles on there. There's a bunch of other stuff on there too that will cover UM. But be sure to check out that mosaic article. It's very neat um and that article first introduced me to the concept of therapeutic hypothermia or medically induced hypothermia as another another term for it. I don't prefer target targeted temperature management. That sounds yeah corporate, Yeah, very corporate. You know the HMO term for it, like we'll we'll call it this because it'll less than the likelihood that we'll get sued or something exactly. Yes, yeah, I agree. But it's been around for a while, and the the idea that exposing people to lower temperatures to allow for better medical interventions, which is the whole basis of therapeutic hypothermia UM, has been around at least since the Napoleonic Wars. Yeah, it's pretty neat. I was interested to find that out. They noticed way back when in the eighteen hundreds early eighteen hundreds, uh that troops in battlefield trauma, wounded soldiers would the ones who were not kept warm and cozy by the fire or in their tents, right, they're just left out on the battlefield and the coals. Yeah, they actually fared better. And they were like, wait a minute, is uh And of course they had no idea at the time what was going on. No, they're like, did you notice that? Yes, I did notice that the heart well back to our brandy, Yeah, pretty much. But they did notice that the ones who were warm did a lot worse than the ones that were left out in the cold, which is super interesting. Yeah, But the the real investigation into what was going on there didn't start until the thirties with a guy named Dr temple Faye, and he was actually the first guy to write about using therapeutic hypothermia. I think in n was the first paper about it. But he was using it for a full decade or so before then, basically putting his patients in ice baths, opening the windows to their room during the winter, and um, just basically using any means he could to lower the temperature for I think I think he had he was using in a traumatic brain injury patients. Yeah, and I'm sure he did a lot of explaining along the way to family members that were like, hey, can you close the window and warm up my husband here? And that. He was like, all right, you wanted to I think back then too, he was like, it's the thirties and this guy is a traumatic brain injury. Really, there's nothing I can do to make it worse, the prospects worse, So why don't you just lighten up their family member? So there was another pioneer in the fifties named Dr Peter safar Um s A f A R. And he actually began experimenting around with this in the e er as well, trying to reduce tissue injury uh and brain image from a lack of blood flow. Uh. And this was mainly at the time in like stroke patients, cardiac arrest patients and what we'll talk more about it. There's all sorts of well not all sorts. There are several uses like cases where you would want to use this and UM ranging from cardiac arrest to like a gunshot wound to I think, what is the infant situation? Come again, it is called chuck. It's a type of encephalofy were ummic encephalofy. Yeah, where your natal basically the blood flow the lack of blood flow to the brains cut off for whatever reason, like maybe the umbilical cord gets rappidly on the baby's neck or what have you. Um, it leads to a swelling in the brain, and they started using it to medical the hypothermia to treat that. That's right, And that was in the fifties, right, Yeah, the fifties and sixties is when Dr Safar was doing his work. So this this is all kind of going on on the side and um experiments into hypothermia had kind of a bad name thanks to the Nazis, and a little bit also the Japanese and World War Two. But the Nazis, especially at Dock how the concentration camp or the death camp there um experimented using unwilling human subjects. Uh, they experimented on the effects of hypothermia in people's bodies. They did all manner of horrible, grizzly, gruesome stuff for they recorded the data and there was a long debate over the years over whether that data could be ethically used. And on one hand, people were saying, no, it's the Nazis. They used unwilling subjects. Is it amounted to torture in the name of science, and I just used air air quotes, right. And then other people said, well, wait a minute, these people died, um whether and we're whether they wanted to or not. They were made to be these test subjects and they gave their lives. We can honor them at least by using the data that was cold from it. Well, once they really dug into the data that the Nazis had accumulated, it was just like rank amateurs performing scientific experiments. They followed like almost no protocol. They did terrible record keeping of descriptions of subjects and things like that. So um, it's almost like you just have to toss it out because you just can't trust it scientifically the data. But but the idea that people were exposed forcibly to hypothermic conditions kind of gave hypothermia a bad name. So these guys experimenting with the stuff, it was fringe science for a while. Yeah, and then it started to come into the mainstream and then everybody said, well, wait a minute, hypothermia has all these bad side effects. Let's just table it for now. Yeah. In the in the fifties to NASA was doing a lot of work during the Space Race because the idea was and this is really sort of two parts. There's the the modern day uh cooling like that's not freezing somebody basically, and then we also have what's called suspended animation, which we'll get too later. Those are totally different things, totally different things, but they follow the same process initially, right yeah, um, well sort of, I mean the methods are different, but the same idea basically is to slow the body down, sown the heart rate, slow down everything, your metabolism. Yeah. Um. But NASA was doing this because they put a lot of money into it because they thought two things. One you could protect astronauts from cosmic rays and the other is basically straight up alien like we can freeze people on long journeys into space and then unfreezing when they get there, which is not just alien. That's a bunch of sci fi movies. But there was a doctor named James Lovelock back in the day who was um freezing hamsters until they froze and then basically until he couldn't hear heartbeat frozen, yeah, they were clinically dead. Yeah, and then they would he would put a little, uh, a little hot teaspoon against their belly and warm him back up, and he found that they were actually okay, and he was able to revive them some of them. Well sure, yeah, I'm sure there were losses along them, but I mean even one coming back to life and seeming normal again, it is pretty significant. It's a significant finding, Yeah, because basically the idea was planted all of a sudden that hypothermia can kill you or it can preserve you and keep you from dying in an extreme situation, right, which is kind of counterintuitive. Like you think of people who undergo hypothermia or you know, being exposed to extremely cold temperatures, they're dead. I mean, we've all seen the shining, we know the end. Yeah, But apparently there's a rule of thumb among the er physicians and staff that there's no such thing as a cold dead body. I thought it was measured twice cut once. It's a little different. That's for the surgeons. Um, No, there's no such thing as a as a cold dead body. You're only dead when you're warm and dead, right, Because well, there's been some some cases throughout the years. The one that spectacular one. Yeah, this lady um was she with Norwegian on a boggenhorn. Um, I don't even know what that is. It's not an oom out, it's a single circle above that A. That's a it's a very Norwegian. Yeah, death metal band name totally. Uh So she was skiing and um, actually I think she was Swedish, but she was on holiday skiing in Norway. Um fell headfirst into a frozen stream and was trapped under ice, submerged for eighty minutes, stopped breathing, heart stopped. Yeah. I mean she was well known. She didn't drown. They thought she drowned until they reheated her. Ten days they reheated her and she was fine, Like weeks and months later she fully recovered. And basically, if you're underwater warm water, you have a few minutes at most. But what they discovered was if you actually go into hypothermia, it can preserve your body. Um, which was amazing and a big breakthrough into like, hey, maybe we can use this right. Yeah, she was one of a few a handful of people and we'll talk about some others too, but um, that what researchers into hypothermia I've learned and why they figured out that they're you're not cold and dead you're just warm. And debt is that it's not the the the addition of cold or the exposure to cold that kills you. It's warming back up in the wrong way too rapidly under the wrong circumstances stances that that's what can kill you. Yeah, it seems like it's a very fine line between well, we'll talk about the process, but you have to do it just right on the cooling side and the warming side if you want to be successful right exactly. You know, it's they haven't quite figured it all out yet. This is in the very uh nascent stages. Still. It is ridiculously primitive and and to the point where it's kind of like if you're a doctor experimenting with this, you you would be like, there's a d chance that your dad is going to die under normal circumstances. We have this one radical technique we can try that might help. Can we try this? And that that that whether they had lives or dies after being given medical hypothermia, he's still going to end up as like the subject of a major paper that would be written, because that's where it's at right now. Yeah, And I read one doctor said that they they think they pretty much know, it's super possible and we'll work, he said, But it's the the doing of it that's just really really hard. Exactly. Yeah, I mean like it makes a complete sense intuitively, we understand like what it's doing. It's just yeah, the fine tuning, the nuance behind it that it's still kind of mysterious. The most brilliant doctors say, it's just really hard. He said, it's really dog gone hard to do. It kind of makes you go, yeah, you know, is that the quote? He know, his quote was, it's really dog gone hard. And then my quote was, but we'll talk about medical hypothermia and what it is specifically, uh, in just a minu alright, so therapeutic hypothermia. Hypothermia is basically when you lower the body temperature for various reasons to keep it alive. And right now, what they're mainly doing now, this isn't the second wave, which is freezing somebody. This is just cooling a body before and after surgery to help them increase their chances of survival. Basically, right, your your body. Um, and they're doing that now on this side, they're just not doing the other quite yet on humans. Yes, um, so under normal circumstances, your body maintains a normal core body temperature, normative temperature because what it's called, right, and um, that's somewhere between like nineties in nine point six degrees is a normal human core body temperature. And all of this is and dude, do you remember and like when I went on that crazy, weird metaphysical tangent and does the body replace itself? Somebody wrote in and said, check this article out, like here's a really great explanation of why things live, where life comes from. And it was this, um, this idea, it's a physics based idea of life and evolution. And it says that because of entropy, because of one of the laws of thermodynamics, that atoms will arrange themselves in a way that they can take in energy and dissipate heat in a really efficient manner. And so of course they're gonna atoms are eventually going to arrange themselves into life. It just makes total sense. Right, So, being living things like we are, we take in energy and we dissipate heat, and that's what forms our core body temperature. Right. With therapeutic hype of thermia, what you're doing is lowering the metabolic rate through the addition of cold, and so we put out less heat, and by doing that, we're also lowering our energy demand, so that that that little engine that's going all the time and our cells and our body in general gets slowed down. And it's not altered in any way except for the speed and the energy consumption. It's just slowed down. It's doing everything slower. And you can do that simply by lowering the temperature of the person. Yeah, and it's it's not just lower, it's um it doesn't need to be faster. Does that make sense, Like the heart beat slower because it doesn't need to beat any faster, not like your body is struggling. Your body is still doing fine. It's just reducing the demand for stuff like blood flow and neurotransmitter action and stuff like that exactly. And ultimately, what your heart does is pumps blood. And what your blood has this, among other things, oxygen, and your cells need oxygen to carry out these metabolic processes to burn energy, right, So if they need less, then your heart doesn't have to beat as much. It's like you said, it's just the normal processes, but on a much slower scale. Pretty awesome stuff. It is, and it's just through the application of colder temperatures. Oh yeah, and in this case UM, and we'll get to how to do it. But in this case you're not I mean you're literally cooling the body with like ice packs and cold blankets and stuff like that pre surgery and post surgery. It's not the suspended animation one that we'll get to when they're actually like pumping frozen saline through your pains. No, there are, but there are some UM techniques for medically induced hypothermia that do put in like chilled saline to chill your body down very quickly. But it's not like replacing your blood. Yeah yeah, yeah, I hear you. So there's a couple of applications at this point. End the cases are either involved intervention or prevention, and intervention is when they're trying to prevent further damage from an incident like a stroke or cardiac arrest or sort of the two main ones UM and then preventative wise, it's to extend operating time because back in the day you could not operate on UM. Well, back in the day you couldn't stop the heart to operate on it. No, which was I do remember we did like this day in history about the first guy to ever do open heart centuries of Black surgeon in Chicago the early twentieth century, I think, and he did an emergency open heart surgery with a beating heart. That guy was totally awesome, champion. UM. This was the case for a very long time, and you couldn't stop the heart. They finally invented a machine UM that basically does the work of the heart and the lungs, called the Heart Lung machine. Exactly where you're transferring blood through this machine and UM, it's removing c O two, it's adding oxygen, and it's pumping it back into the body while the heart and lungs are stopped. Revolutionized open heart surgery. There's problems with it. One of the problems is um when the blood comes back in the body, since it's been through this machine, it may have picked up some sort of foreign in bacteria, and the immune system sometimes mounts an attack on the blood. So this this machine poses its own problems. And alternatively, an alternative method for stopping the heart or slowing the heart is to use medically induced hypothermia. So that's an intervention, no, a prevention preventative use of medically induced hypothermia. But intervention is another way, like you said, and it can have to do a stroke or heart attacks or cardiac arrest. Right, aren't those two different things? I think so technically, but in some sort of cessation of the heart pumping blood. And the big problem with that it doesn't really matter whether your hand is getting blood for a while. The big problem that comes from a heart attack is your brain not getting blood for a while. Right, So here's what happens when blood stops flowing into your brain. Right, And we we covered this somehow in the How Dying Works episode. Yeah, the dying process. Okay, because it's not a it's not a black and white thing. Uh, you're not alive and then you're dead. It's comes in many many stages. And we talked about the stages of death. Yeah, so there's when what they've discovered is that, yeah, you're not like I'm alive and now I'm dead. Is what we covered in the How Dying Works episode? Right, Like dying in your sleep? I mentioned that the other day. How like nobody dies in their sleep. That's just a nice thing. That's a nice way to say they died in their bed. Yes, overnight, overnight, Yeah, exactly. Um so, yeah, there's with medically induced hypothermia, they've been able to extend that that time between when you appear to be dead and when you're actually dead, and by extending that time they can intervene UM better. And Yeah, even a little bit of time can go a long way. So one of the one of the things that medically induced hypothermia has been shown to really help is what's called return of spontaneous circulation after uh, you have a heart attack. The problem is is your heart and lungs can your cardio pulmonary system can start working again, but you might not regain consciousness. And in that case, that's a sign that your brain may be in trouble, your cognitive function, you may be suffering brain damage at that moment. Yeah, And isn't the stat one and ten cardiac arrest outside of a hospital has a like goes on to live like a without brain damage. Yeah, ten, only because you have a very small window and that window is usually longer than it takes to get to the hospital. Right, So if they bring you in and you are showing signs of um r OSC without return to consciousness, too um. They may induce medical medical hypothermia. And the reason why is the heart pumps blood, and blood contains things including oxygen right um. And one of the organs that uses probably the most oxygen of all, is the brain, and the brain uses its oxygen to um burn energy. Basically, it uses it to oxidize glucose. And when it does that, the reason it does is because you're neurons, your little neural cells that fire. The way they fire is because their chemical battery, their chemical battery with the stored potential charge, and they do that by keeping a lower concentration of electrolytes inside the cell than outside. So this difference creates the electrical charge that your neurons used to fire. Right on normal circumstances, that's all well and good, but when they stop, when they stop getting oxygen, they can switch to anaerobic mode for a little while, so they're still burning energy, but they're like, you need to start breathing again, because this is not very efficient. It's like the like when the emergency lights go on exactly exactly. So um. As a byproduct of anaerobic um respiration, you get the stuff called lactic acid. Lactic acid in and of itself isn't bad, but it can build up. One of the other things that happens to when these um when this uh, when that runs out, is the difference between electrolytes inside. Now inside the cell stops like it, it evens out, and now all of a sudden you have things like calcium, potassium, sodium coming in and out of the cell as much as they please, and the cell is like, what is going on? This isn't good and releases its store of glutamate. And glutamate is a neurotransmitter that excites neurons, and again in very small amounts, totally fine, it's needed. But when a neuron just freaks out and dumps all that into a synapse, it sets off that neuron and all these other neurons and makes them go totally crazy, and it also um lowers their structural integrity. So all of a sudden you have neurons going nuts, dumping their contents everywhere, and then creating also free radicals, which are um atoms with unpaired electrons, and they run up against the cellular structure and the cell walls and start borrowing electrons from those atoms, and that weakens the structure even more so, even more stuff gets dumped out into the inter cellular matrix, and you have a problem. This is a really big problem in and of itself. Right, you're still with me, Okay, that's what happens when you stop getting blood flow. It's just as bad, if not worse, when you start getting blood flow again, because you have all these damaged cells. You have dead cells. And when you have dead cells that have dumped their contents, one of the roles that your white blood cells, your immune system plays is to come clean up dead cells because that's toxic stuff. That's bad stuff, and you need to get it out of your body. So when blood flow reach turns again, all of those white blood cells come to the site of this problem, your brain, and they start cleaning up. Well. When they do, and inflammatory reaction happens, and all of a sudden you have swelling in your brain and the process gets even worse. So these these um structurally challenged neurons don't just erupt immediately. They do immediately, but it can continue for hours and days afterwards. And all of this happens from a heart attack. But by applying cold temperatures and bringing hypothermion and somebody you can actually stop this process. You can stop the glutamate from ever being dumped. They're finding and so give time basically for your brain to to rebuild itself in the way it needs to by lowering that metabolic rate that your your neurons need. That's what it does for for a heart attack, cardiac arrest. They're definitely two different things. I looked it up and someone's gonna say, you guys should do a podcast on that because you don't know what you're talking about. Right, it's coming. So probably after that we should take a little break, huh, I think. So you want to get some tea, yeah, and uh we'll be back with more cool stuff. All right, So how is this magic done? It's pretty easy. Actually, yeah, it's easy in theory. But there are generally three stages UM for therapeutic hypothermia, and they are induction, maintenance, and rewarming, and they are all very carefully monitored and have to be done just right. Uh. So when they go to cool the patient, um, they will first thing you'll do is sedate them because shivering. Uh, shivering is the body's way of trying to stay warm. Like your body wants to be warm, is going to do everything it can until you die, like Jack Nicholson outside the maze and the shining exactly to stay warm. Yeah, and you can't have a body shivering because number one, it fights off that hypothermia you're inducing, right. Number two, that uses a lot of energy, which is what you're combating right there. You're trying to slow the metabolic right, not increase it, right, and you want a patient that's still as well. Like one of the problems I've seen is the problem with doctors like performing in these conditions because like stop squirming. Well that too, and they have to keep the room very cold. It's not like they're in like an eighty degree room and they're trying to keep them like everything is cold. So the doctors have to perform under those circumstances too, so they may shiver themselves. But to keep the patient from shivering, they just solve that problem by injecting them with the paralytic exactly, so now they're nice and still they're cooling down. Uh. The cheap way to do it, which is um and they're not doing it because it's cheap, but um ice packs basically armpits growing chest. They're basically wrapping your legs up and everything they can with ice packs, and that's just gonna cool you down pretty quickly. Um. Like you said, they will sometimes use like catheters or a chilled saline solution. Those are more invasive and more dangerous. They also work a lot quicker. Yes, very much. And I think they want to cool people down pretty quickly too, um, which is I don't think they want to do the cooling parts slow. No, And that's a really good point. I'm glad you brought that up. Especially if you're bringing a patient's body down, um to a really low temperature, you have to protect against ice crystals forming in the cells because that can erupt your cells and that's a whole set of other problems. Right, So if you bring the temperature down very quickly, you can prevent ice crystals from forming, that's right, because they require time to form. Yeah, if it's so, if it's super fast, they won't they won't form. That's the impression I have. Okay, So during the maintenance phase, it's you know exactly how it sounds, are just maintaining that temperature, keeping a very close eye again, using these cold water packs or forced cold, forced air blankets and things like that. Um huh, they sound kind of cool, the forced cold their blanket that. Yeah, they'd be nice for these Atlanta summers. Get ahold of one of those. Uh. And there are a lot of risks along the way. Arrhythmia is a very big risk. Uh. And electrolytes leaving like potassium, which is necessary for the heart muscle to function as it should. Um, so they're they're pumping the electrolytes back into you because you're losing them. So again they're just maintaining everything. And then the rewarming part has to be done very very slow. Uh, otherwise you know, very bad things can happen. And we're talking um point to seven to point nine degrees per hour fahrenheit fahrenheit point one five to point five degrease celsius per hour. Yeah, those super very slow rewarming process, that's right. But if you've got a good forced air blanket, you can really control the warming. You get a good brand, not some off brand. And again they're not like, oh well if we um, if we heat the person back up at point one five degree celsius per hour, then this is what's going to happen. On a cellular level, like they're not quite there yet. They just know that that's the sweet spot for rewarming somebody, So chuck. One of the really um problematic side effects with rewarming a person is um. Yeah, they're like, why you start to get gaming while you were under um is uh blood clots. So when you're when your blood stops pumping because your metabolic rate is so low, the blood inside you starts to form clots thanks to your red blood cells and your platelets and um. When you warm back up, all of a sudden, you have clots all over your body. And that's a real problem that that alone can kill you. And that's part of the problem with the rewarming process. But it turns out that investigation into animals that hibernate, they found that animals have some sort of technique to where their red blood cells just kind of disappear, and then once the animal comes out of hibernation, it reappears. They don't even know where they go, no, but they do know that they don't get rid of them somehow and then regenerate some other ones because their reappearance is so fast that they just think the body somehow absorbs them and then releases them again. Yeah. And the other really cool thing and we're kind of into hibernation right now, which we'll talk about in more detail, but um, white blood cells. Uh, Hibernators remove white blood cells from their blood and storm in the lymph nodes and then about an hour and a half after these animals awake, they reappear. And this has a couple of functions. One is, when you're an animal undergoing hibernation, Uh, your immune system is going to be compromised because as white cells are in storage. Right, that's a problem. Yeah, it's a problem. But just knowing that animals can do these neat little tricks with their platelets and white blood cells, uh, could have like big effects on us if we can figure that out for ourselves. Well yes, specifically also chuck, because remember when we were talking about, um, your your neurons dying. Yeah, and when you reperfuse, when you bring blood back to the brain again, one of the things that brings with it is those white blood cells and they start going on the attack. So if you can figure out how to take white blood cells out of the equation, it's going to reduce things like post warming swelling, which can give you brain damage itself. Yeah, and you talked about the heart lung machine. One of the big dangers with that machine is a septic sepsis. And if you have those uh white blood cells stripped away, then you're not going to be at risk for that, right and um, they'll be able to uh hang on to blood longer. Right now. Blood donations can only be kept a weak um it goes rank quick, yeah, and um transplant organs can be UM basically cryo protected for longer too, which is pretty neat. So uh, I guess we should talk about hibernation for a minute because it's one of the neatest things in nature. I think, uh in torp or basically torpor short periods of hibernation reduced body temperature and inactivity. And when you link a bunch of torpors together, that's full on hibernation. So yeah, it's also like a like hibernation light too, Yeah, you know what I mean, Like you can you can be I think a bear inners torpor where it's it wakes up like every once in a while and eats or poops or does something. And then there's some animals where you can just shake them like this and they will not wake up and they're in full on hibernation. Yeah, and the animals have to prepare for this. They just don't go betty by and stay asleep for a long time. First, they become diabetics basically by gorging on food and becoming obese. It sounds familiar, uh and um, but it doesn't affect like humans does. It doesn't make them unhealthy, like their body knows it's preparation for hibernation, knows what to do with it exactly. Plus they're probably also eating unprocessed foods too, which I think makes a difference. Yeah, you know, I think so. Um, they don't atrophy like humans do. Like when we lay around in bed, we don't our muscles will atrophy. Um. Animals can go months and months without moving. Spectacular spectacular. It also kind of suggests that humans aren't supposed to hybridate. Yeah. Well, although you know, when they found some of these frozen people, they start to think maybe human hibernation isn't such a bad thing. Um. Their lungs when you hibernate, become covered at the really thick like mucacy uh deposits um. It basically looks like a human with asthma, but it's you know, a protective measure. Again. Uh, they go in their brains kind of um go into a stage that looks like early Alzheimer's. Again, not a bad thing, it's just preparation. Uh. And it's weird. I mean, it looks like animals are almost dying when they're preparing for hibernation. Well some cases, and sometimes they do, especially when they're forced to come out of hibernation and then go back in. Their energy stores aren't aren't built for that kind of thing, like, so they probably will die because they'll start to death because it required so much energy to wake back up again. Or they're also vulnerable to predators too. Yeah, good point, which makes you wonder, like, what's the point of hibernation, And the point is, well, it's they don't have enough energy to go elsewhere when temperatures get cold, so they just kind of shut down their metabolic demand when food becomes years. Yeah and um, for the longest time, we didn't think that any um uh primates could hibernate until two thousand four when they found a lemur from Madagascar that could hibernate and uh, well at least go into the regular torpor hibernation light still and they said, we share about nine of our genes with the lemur, and they said it's basically like our cousin. Yeah, I mean that. The doctor basically said it would be really remarkable if the ability to hibernate light within that two that we don't have, So basically humans may have more of an ability to do this than we think. It would just have to be medically induced. Well, you know who demonstrates that very well, Chuck. Who's that? A man named mitsu take Uchi Koshi. Oh, yeah, we talked about him. What do we talk about him? And was it cryogenics episode? It was a long time ago. I do remember that one. Yeah, that's a good one. That was a good title. But yeah, I remember this guy though. For so. He is a Japanese man who, at age thirty five, was hiking with some friends in Japan and he decided to turn back by himself to go, I don't know, get something out of his car, and he wandered off and apparently in a meadow, um tripped over a rock and fell and hit his head on another rock and laid there in exposed to these cold temperatures on this mountain for twenty four days, and he was found basically in a state of hibernation. His body temperature was through the floor and um, he had almost no pulse. His temperature was seventy one degrees which is twenty two degrees celsius. That's his body temperature. That's pretty that's like a hypothermic state. And he was in this weird kind of state of suspended animation for twenty four days. He went without food, water, nothing, just laying there um living in some weird way until he was rescued and returned to um complete normalcy. Yeah, it's like the lady the skier who was frozen, not nearly for as long. But these cases where humans bodies are defying what we thought they could do, you can give us insight into, like, hey, how do we manipulate this for good? How do we use this to get to the stars. Alright, So I mentioned earlier that NASA was kind of leading the charge for UM this really cool suspended animation where you're basically freezing a person like Han Solo um in carbonite. Yeah, except it's not carbonite. It's not exactly like that, but it's it's sort of like that. Actually, it's not like that at all. Right, um And where NASA dropped off, the U. S. Army picked back up with some funding because they basically said on the trauma hospitals during wartime are chaos because you're trying to to save a person. You're trying to treat their immediate wound, you're trying to stabilize them, you're trying to make them better, you're trying to prevent blood loss. It's it's not an easy thing to do. It's not like mash you know, where they just make it look super simple. Right, Well, everybody's drunk on homemade gin. Yeah, so they're thinking, Um, I wonder what that stuff tasted like I always wondered. But they're still they seem to like it pretty much pretty well because they didn't have anything, I know, but they really seemed to enjoy it well. The way they handled it was very much like a fine martini. But you know, it's just like swill. I don't know they were at it for several years. Yeah, that's true. We'll have to ask Allan all of the um Man, I'd love to meet that guy. Oh yeah, one of my heroes. For attention, Alan all the reach out to us. So Chuck can meet too, that would be great. My brother met him, I'm sure he did. Probably gets Christmas cards, phone, No, but he did get a picture with him, which is pretty neat. It's nice. Um, So where was I? Oh, yeah, mash operating rooms. Yeah, because if you're a doctor, even in a battle field hospital, you're like, I want a coffee break too, and so to be like, I don't have time for this guy right now. Freeze him to have that ability that would be magnificent. Or if you did have time for the guy, but you literally didn't have time to fix these horrific wounds that he came in with, you could also say, freeze him to buy me some time, and that will let will give you the time to basically operate on this guy and completely repair heart or his brain or what have you. Um. And that's what medically induced hypothermia does. It's just it buys you time for either the body to heal itself in ways we don't understand, or for you, the surgeon to sew somebody up who without hypothermia would just be a lost cause. Yeah. There's a doctor named Sam Tishrman from the University of Maryland chirps working with the University of Pittsburgh. UM, what are they panthers? University of Pittsburgh, pitt panthers. I think so that sounds right. It does, we'll go with panthers. Panthers. Uh. If I got that right, I'm so sorry, Pittsburgh. We'd love you. UM. But he is working hard to UM basically UH put patients into severe hypothermia or suspended animation. And they're calling this emergency preservation and resuscitation. And this is the one that they haven't yet experimented on humans. They think they're pretty close, but this is the one where they flushed the body with freezing cold saline solution UM, which prevents ice from forming. Yeah, and it's worked on dogs, and I think it works on dogs. Got work on humans. Well, they did some experiments on pigs too, because one of the one of the things they think they can do where it's not like if you've had a hard cardiac arrest or a stroke, but again with trauma like a gunshot, you just can't. And I didn't I never knew this. You can't resuscitate a person with CPR that's had blood loss due to trauma it's completely different than cardiac arrest. Why because it's a close circulatory system has been opened. I have no idea. I bet that's it. Because of the dropping blood pressure. It's just not working. It's like sucking through a straw that has a hole beneath your lips. Like a lot of it's escaping, A lot of the air's escaping, so you can't get as much draw. Yeah, I guess that makes I bet that's what it is. All right, Well we'll probably find out. Um, but with ellen all with trauma like a gunshot wound or something, or a stab wound where you've lost so much blood you're dying. Um. This is when they're using these super super cold temperatures. Um. It's a tube inserted into the a orda literally And they've done this on pigs. In two thousand six, they examined um deep profound and ultra profound freezing of pigs who had uncontrolled bleeding wounds. And I imagine and then imagine they induced those as well. Piggy grad student. Yeah, there's one creep post doc to get to do you know, all the stabbings. Um, that's why I'm here. I'll get Ronnie. Um and they found that the ones who went underwent the most profound hypothermia had the highest survival rates, like those French soldiers on the battle exactly. And then in two thousand they did the same thing with dogs, except that why they weren't stabbed, it was dogs and cardiac arrest. Um, they may have induced that too though, come to think of it, they'd be like, do you want this bone? Now you can't have it. But they used ice cold ceiling in that case, and their chances of survival with no brain damage really increased. So, um, it's you know, there are risks though it's not the easiest thing to do, like we said, and um, I know pneumonia was one of the risks for years, um, even with just the regular cooling, right. Uh. Yeah, pneumonia slowed heart rate. Apparently you can enter hyperthermia while you're being rewarmed, Like you get way too hot, your body temperature increases too dramatically. There's a lot of problems that. Blood clotting is still an issue and probably will be for a while. Yeah. With Tishrmann's case, trying to use humans though, there's a couple of problems. Um. One is they have to get consent from a person to undergo an experiment like this, but you can't give consent when you're wheeled in there unconscious from a cardiac arrest. So what he's trying to do is just spread the word, literally, just spread the word to the citizens in his area that there's this thing, and if your husband or wife has the cardiac arrest, ask for the cold treatment where we completely pumped their blood out and replace it with frozen sailine. Using cold sailine. It's pretty amazing, it is. And you know, there's a lot of people who are still very skeptical of the idea that medically induced hypothermia can actually work, but there's also a growing body of studies that show that it does that has a significant impact. Like there were a couple there were several in two thousand two that really broke the thing open where it was like, these people have a twenty five percent chance of recovery without it, they have a fifty or seventy five percent chance of recovery with it, And that's really tough to ignore. It's amazing, amazing stuff into the future, Chuck, let's go. If you want to know more about medically induced hypothermia. Check out our podcast page for this episode. It's got a bunch of cool links and you can type therapeutic hypothermia in the search part how stuff works dot com and it will bring up this article of puns. And Uh, since I said search parts, time for listener mail, I'm gonna call this um Josh's theory on satire. Remember that we talked about that in the very recent show Clowns CNN. Uh. Do you want to summarize your position real quick that maybe satire is just a release and does it affect change? Is that the nuts and bolts of it. Yeah, Basically it lets the populace who's angry let off steam at the leadership without actually forcing the leadership to change. All right, So that brings us up to speed. And this is from Chelsea. Uh. She said, I just started listening under a year ago when a change in jobs landed me with a twenty five minute walk to and from work every day. I think she's in dublin. Um, she says, I find myself laughing out loud at your repartee. And my boyfriend is affectionately started referring to you as my nerd friends. But he's a listener. Now to it sounds like Dublin I'm actually writing in regard to Josh's theory on satire. It's a really interesting point, an angle I had not considered myself. I think though, that there's another way to look at it, which is that satire has the ability to plant the seed of dissent in a non threatening way and thus can eventually be a force of change. For example, someone may not be aware of a particular foible of a leader. That satirist points it out in a funny way. Now that someone has an awareness, without feeling preached at, and has it in their mind the next time the leader does something untoward, or perhaps they were just uh, they were aware of said foible, but the satirists opened their eyes to just how ridiculous and or dangerous it is. So while there's certainly a possibility satire connect as a placation or a way of letting off steam, there's also a very real possibility that can spark be the spark that ignites an eventual change. It is a good point. Yeah, that's from Chelsea and Morgan Hoffman. Thanks a lot, Chelsea Morgan Hoffman of Dublin, Ireland. Probably h well, she just said Dublin, Dublin, Georgia. I'm gonna go ahead and assume Ireland. Yeah, and boyfriend, yes, thank you both for listening. We appreciate it. Uh. And if you have a counterpoint, or your own theory or hypothesis, or just want to say hi or whatever, you can tweet to us at s y s K podcast. You can join us on Facebook dot com slash Stuff you Should Know, UH, you can send us an email to Stuff Podcast at how Stuff Works dot com, and as always, joined us at our luxurious home on the web, Stuff you Should Know dot com. Stuff you Should Know is a production of I Heart Radio. For more podcasts my Heart Radio, visit the I Heart Radio app, Apple Podcasts, or wherever you listen to your favorite shows. H