What if somebody came up to you and said the words, “you can’t do it?” What if somebody came up to you and pushed you down, kicked you, forced you to stop moving forward, and forced you to stop trying? What if this same person knocked you down time and again, reminding you that you are a failure, and that you can never do anything with your life? What if this person told you that you’ll never make it over this next obstacle, or that you can never climb that mountain, or that you can never cross that canyon? Well, look up, because that person is you.

Here you are. The mountain is large, and looms over you with such height and width that you start to second guess yourself. You stand at the base of it and simply stare. The snow hits you in the face, and you can feel the trembling cold that seeps in through your coat and gloves. Maybe you should turn back? Maybe you weren’t ready for this. You look at the top, and realize with a start that you can’t even see it. Clouds surround it so thickly, to the point that you aren’t sure if the top even exists. The doubts start flying in, and you have no choice but to listen to them. And, the more you listen, the more you start to believe them. Giving up, at this moment, seems like the best option in the world. The mountain seems too big anyway. Who even knows whether you’d be able to make it all the way to the top or not?

The problem with facing a disaster is not the obstacle, but our mindset. It’s easy to say, “I’ll cross the valley,” but harder to back up words with actions. It’s easy to say to a mountain, “get up, and move” without having the belief that it will. Soon, as we move through life, we understand that the obstacles and disasters are nothing compared to the problems that you pose to ourselves. It is us; it always was us. We continue to be our biggest obstacle. We are the disaster in our own lives. If we can face ourselves, our doubts and fears, then we can surely face any other thing with ease.

“I can’t get through it.” If you keep telling yourself that, you’ll soon believe it. Our perspective is severely flawed. When we look up and see an obstacle or hardship, that’s all we can see. We are unable, incapable, of looking beyond the negativity. It surrounds us, haunts us, and pushes us down, to the point where we believe we cannot ever stand again. We don’t see the reality of our situation: we are the ones holding ourselves back. What we see before us, that disaster we are so afraid to face, is only a single dot in the ever expanding timeline of our lives. Sure, that disaster may look big now, but soon, we will forget we have ever faced it. The important thing to remember is this; that not everything lasts forever. Our eyes have been deceived; they make the obstacles of our lives look bigger than they really are. So, let’s put the blinders on and go out there, face our fears, face ourselves, face the obstacle, and win.

So okay: you’ve managed to convince yourself to attempt and climb this huge, snowy mountain. You’ve begun to trudge up its side, your feet following the ridges so that your boots have something to grip. It’s harder than you imagined it would be: your fingers are already numb, you can barely see the hand in front of your face, and the cold has managed to find a way underneath all of your protective layers. You’ve already lost one bag of supplies, after an accident when you took to a ridge too steep and put the bag down for a moment to catch your breath. Now, it’s just you, a smaller sack, and your ever-weary determination. You hadn’t thought it’d be this difficult, and you start to make promises to yourself that you aren’t sure you can keep. “Oh, I think I should turn around and try another time,” or “I’ll get more supplies and training and come back in a few years.” You pause your climb and start to wonder if turning back is perhaps that is the best course of action at the moment. Besides, it’s too cold, you’ve already lost one bag, and a huge tiredness is suddenly overcoming you. Maybe next time.

Don’t make excuses. Another problem we face is the fact that we often try and get out of facing a certain obstacle. “It’s too hard,” or “I’ll never win,” or “I’ll face it some other time.” Something we must understand is that, when we procrastinate like this, we have already lost. We have given control over to the disaster and are content to sit there and let it attack us on every side. We’ve given up, became soft and lazy. Since when did we become content with doing nothing? Since when are we comfortable with throwing up our white flag every time we meet something we don’t want to face? Get up! This is not a walk in the park! These are our lives, and this is our time. We’ve been given an opportunity to face a disaster other people have been fighting for years. We need to take it into our own hands and believe in ourselves. Enough with the “do it later”’s and “not for me”’s. It’s time to climb harder than we ever have before. Strive to make it. Believe we can make it. Will ourselves to make it.

Without warning, you’ve run into another problem. You settle down on a flat part of ground to make camp for the night. Then you hear a menacing and intimidating growl from behind you. You quickly turn and come face to face with narrowed feline eyes. A giant snow leopard has followed you and, judging by its demeanor, it doesn’t look friendly. You can feel yourself starting to tremble, and your mind goes blank. You hadn’t expected this kind of threat at all, and with your unpreparedness, you are sure to die if you don’t act quickly. How do you act when faced with such an unexpected disaster as this?

In school, we are taught a number of things. We are taught to work with equations, to memorize dates, to know the steps of a number of different processes. We are expected to test on the curriculum, and to learn, memorize, and be familiar with the assigned material. But, I can promise you this: nothing taught in school can ever prepare you for the obstacles ahead. In math class, we are taught to solve for x, yet never taught how to solve our own problems, just somebody else’s. The truth is that you can never be truly prepared for a disaster. There is no textbook to read, no line to memorize, no equation to plug in. There is no single way to solve the problem. And that scares us. We face our obstacles, trying to solve them in the ways that we have been taught all our lives, but we can’t. We have to learn that sometimes, there is no answer. We can’t always solve the problem. What we can do, however, is to get through it. Face it, and then move on. We won’t ever be prepared for the disasters that are coming our way, but we don’t need to be. Everything we ever needed will not be taught to us in a classroom, or from a book, or even from this essay. Everything we will need is inside us, so use it.

I’ve got good news: You’ve fended off the snow leopard. Out of desperation, you took your last remaining bag, containing the rest of your food supplies, and threw it far away from you. Without hesitation, you ran in the opposite direction, abandoning your temporary campsite and every other thing you brought on this adventure. You are now alone, cold, on a mountain, with no supplies or rations of any kind. While escaping, the snow leopard managed to cut you. The blood has soaked through your bandage, and it drips to the ground below you. It stings like crazy. You finally have processed the predicament that you find yourself in, and conclude that there is no way to turn this into a positive. You tried, you failed, and now you will pay the penalty for it. You can’t help it: you press your cold face into your even colder gloves, and cry. Defeat has overtaken you, and you can think of nothing else except to sit and wait, hoping for a rescue of some kind, or, if not that, some kind of relief. Regardless, you’ve lost. It’s all over now, and the snow has turned red.

 Failure. It is the one thing that every person in the world can say they’ve experienced. But we mislabel what our failure really is. We view our loses as a bad thing. We mess up, we make mistakes, we don’t always make it. Anything that goes awry is a failure. We fear it. We always talk about how much we fail, how we just couldn’t do it. We fail to recognize our true error. Our failure is not messing up. Our failure is giving up. When we fail to try, when we get the notion in our head that we can’t do something, or that we can never get out of the situation we are in, these are the true failures. The belief that something cannot be done is the only mistake we could ever make. The disasters in our lives make it seem as though the impossible cannot be done. But this is not the time to give up. Don’t you dare quit. This is where you are your strongest. It’s not over until you allow it to be over. Stand up. Remember why you set out to conquer this disaster or obstacle in the first place. Find your motivation. You want to get over this mountain? Great, now tell me why. What is your why? Why bother setting out in the first place? You have gotten so far, that the only failure you could possibly have is giving up now. But you are not a failure. You can succeed. The final piece of advice I can give you is this: find your why. Once you can answer this question, you have already faced half the battle. Your motivation is your sword, so use it. Fear isn’t your biggest obstacle; it’s your lack of why, which becomes a lack of motivation. So find it and continue forward.

The snow is white now. The bleeding has stopped, as has your crying. You’ve managed to continue forward. Step after step brings you deeper and deeper into the unknown. You’ve fallen into a rhythm now. Step, step, step, pause. Step, step, step, pause. Step, step … an irregularity. You find you cannot go any further. You quickly lift your head up and your eyes are met with the sight you only believed you could achieve. The most wonderful scene is before you, and as you look around, you realize you know exactly where you are. The clouds have cleared, the snow is white, and you have made it. The top does exist after all. Your faith has become sight. Enjoy the view, for you have earned it. It is yours. You have conquered, you have overcome, you have won.

Sleep is a period of renewal that prepares us for the new day and enables our brain and body to perform duties that they cannot while awake.

Growing numbers of businesses are including good sleep in their wellness programs for their employees. Many of them now have sleep pods in their offices to improve productivity. In addition to diet, weight, exercise and smoking cessation, sleep wellness is now becoming part of our tools to prevent health problems; and this is a good thing.

Sleep is a period of renewal that prepares us for the new day and enables our brain and body to perform duties that they cannot while awake. Having a sufficient amount of high-quality sleep is vital for us to be healthier and to feel better during the day. Yet the number of people experiencing sleeping problems is on the rise.

The duration of healthy sleep varies from person to person. If the night’s sleep lacks quality –say, for instance because of frequent interruptions for the need to go to toilet – the total duration spend in bed extends. The craving or need for more sleep as a result becomes a sleep problem.

Sleep deprivation prevents certain brain functions that are enabled only during sleep. Sleep is necessary for learning and memory. Moreover, healthy sleep is crucial for appetite regulation, so insufficient sleep may result in weight gain.

In the general sense, sufficient and quality sleep is also essential for overcoming diseases and disorders. Therefore, many patients in the intensive care unit, especially those suffering from cerebral bleeding, edemas, or a heart attack, are put to sleep with drugs. Studies have shown that sleep is crucial for fast recovery of post-operational scars. It is essential that long hospital visits should be avoided so that the patient can have the much needed sleep.

Because metabolism slows down during sleep, all the bodily energy is redirected towards curing the brain and the body. Sleep is the time for repairing any part damaged during the day. Sufferers of sleep problems run a higher risk of developing illnesses such as Alzheimer’s and dementia. The number of neurons is important for memory as well. Their number decreases with age, weakening our memory. Age-related memory impairment stems from a breakdown of the brain’s communication network and can be prevented by healthy sleep. In addition, sleeplessness correlates with depression and cancer, too. The immune system also deteriorates in people experiencing sleep deprivation because it cannot be renewed and strengthened during sleep.

Coffee, tea, energy drinks, and other substances containing caffeine can prevent sleep for as long as six hours. That is, black coffee or strong tea you have in the afternoon may make it difficult for you to fall asleep at night. Similarly, if you have food that is high in fat and protein at a late dinner, you may experience problems drifting into sleep.

Working hours

Some people have to work at night so they can sleep during the daytime. People doing night shifts, for example doctors, nurses and police officers, frequently develop serious heart and brain problems. Our brains are created so as to stay asleep at night and awake during the day, so people who go to bed late at night experience more health problems. Sleeping during the day after a sleepless night leads to sleeplessness the following night. However, a nap (siesta) in the afternoon is extremely useful in that it virtually enables renewed morning freshness thanks to re-regulation of hormones.

Our body clocks are influenced by sunrise and sunset. Modern people are exposed to less sunlight during day and more artificial light at night, which has an impact on the time we fall asleep. Increased exposure to the morning sun and decreased exposure to artificial light (especially from phones and computers) can help our body clock readjust to a normal sleep schedule and hence help us sleep earlier.

Fixed waking hour

One of the most critical conditions for healthy sleep is to have a fixed waking hour. You should wake up at the same time no matter what time you went to bed the previous night. In fact, as a rule of thumb, you should get up from your bed at the same time in the morning whether it is weekend or weekday, work day or holiday, so that you can have a good sleep the following night.

The more tired you are when you go to bed, the harder it gets to drift into sleep. You should therefore avoid vigorous physical activity within a few hours before bedtime.

Contrary to widespread belief, reading books in bed, watching TV, or spending time on the mobile phone or computer makes it harder to fall asleep. Such activities should be done out of bed in another room, if possible, and the bed should be used for sleeping. In fact, sleeping somewhere other than your bed may also harm your healthy sleeping cycle.

Residents in big cities generally wake up very early to arrive at work or school on time and get back home quite late due to traffic. Sleeping late during the weekdays and waking up too early lead to an accumulation of sleeplessness, which needs to be made up for. Some research studies also have shown that late risers run higher health risks than early risers.

Certain regulations can be put into effect to help reduce sleep problems. For one thing, flexible working hours would enable more employees to start work later but more refreshed. Moreover, some businesses can arrange work schedules of their employees according to their body clocks. As a result, the performance and efficacy of the employees could be improved. Buildings can be made to let in more sunlight and thus dependence on blue light can be reduced.

Our need for sleep, daily and weekly, is more or less stable. This need is also related to your age. Sleep duration increases with your age: it peaks in your twenties and then your body clock tends to move back as you get on in years. As you get older, you need less sleep.

Sleep for physical formatting

Sleep used to be considered to be a time of rest until recently. Today, however, sleep is accepted as a time for restructuring and physical formatting. Snoring, sleep apnea, and frequent visits to the toilet prevent high quality sleep.

Growth hormones are produced the most during deep sleep. We should therefore be particularly careful about ensuring that children get enough and healthy (deep) sleep schedules.

Position

Sleep position is important, especially for the elderly. A position should be chosen that is least painful. For instance, the heart is believed to be more at ease when one sleeps on the right side. In this position, breathing takes place more through the left nostril rather than the right, enabling the sympathetic system to rest and the parasympathetic system to take over. When the parasympathetic system starts to work, drifting into sleep becomes easier and the duration as well as the quality of sleep increase. Sleeping on the right has been reported to be the tradition of the Prophet Muhammad, peace be upon him.

When you lie in bed, gaps remain between the bed and our neck, waist and knees. These gaps may need to be filled particularly for the elderly and those who suffer from pain in one’s back or neck. Herniated discs have become more common in employees doing desk jobs. A pillow can be folded slightly to support the neck, or special pillows that take the shape of the head and neck can be used. It may not always be necessary to fill in the gaps but if you have backache or hernia it might be necessary to support the waist. The support of a small pillow can be helpful in some cases of knee problems. In other cases, a soft pillow placed between the knees can be helpful.

Numerous studies in recent years have reported that cupping (hijama) and foot reflexology therapy can increase sleep quality. These two methods reportedly help discharge excessive static electricity and psychological stress that have accumulated in the body and thus make it easier to drift into sleep.

Oversleeping is as dangerous as sleep deprivation. It has been found that people who sleep more than eight hours a day have a higher risk of heart failure. A Norwegian study has shown that sleep that is more than eight hours or less than four hours increases the risk of heart failure. Conducted at the Norwegian University of Science and Technology, the study included 50,000 subjects aged 20-89 whose sleep patterns were monitored for 11 years. According to the results, people who slept more than eight hours or less than four hours had a 35 percent greater risk of dying from heart failure than people who sleep between six and eight hours. People who slept less than four hours were reported to have a 34 percent higher propensity for dying from heart failure.

It is important to make sure we have enough amount of sleep for both our physical and spiritual health; not more, not less. Having a siesta for 1-1.5 hours during the day can also prove useful. Oversleeping numbs the human mind, may bring gloom to the heart, and may cause us to lose our ability to make good judgments. Going to bed immediately after eating and drinking may also be a cause for various illnesses, including obesity.

References

1. Munshi, Neil. “Sleeping on the job can improve your work.” Financial Times, September 13, 2017.
2. Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I, “Insomnia and the risk of incident heart failure: a population study”, Eur Heart J. 2014 Jun 1;35(21):1382-93. Epub 2013 Mar 5.

Discussions over personal liberty and government intervention are as old as modern governments, as J.S. Mill’s writings show.

John Stuart Mill was among the many philosophers, both before and after, who attempted to determine when government intervention in the private lives of individuals was legitimate. The authoritarian regimes of 19^th century Europe triggered thinkers to study citizen’s rights and state powers. Mill attempted to regulate the actions of these authoritarian regimes by distinguishing between legitimate and illegitimate government intervention in his book On Liberty. Mill’s ideas were one influence among many on the structure and laws of the modern nation state. Using his ideas on freedom and government as a starting point, we can discuss psychological harm, human fallibility, and social responsibilities.

Mill, in On Liberty, identifies two mechanisms for determining legitimate government intervention: the harm principle and utilitarianism. The harm principle states that government can only legitimately interfere with the actions of individuals if the actions of the individuals harm others against their will. Thus, if an action does not harm another against their will, the government cannot interfere. Notice that an individual can harm themselves or even other people with the appropriate consent. Effectively, the harm principle constitutes an absolute bar to government intervention on unharmful private action.

The second mechanism, utilitarianism, comes into play after government intervention is considered to be legitimate due to harmful consequences of private actions. At this point, the government must do a utility calculation, or a cost-benefit analysis, in which it must determine whether government intervention will result in more harm than the private action it will attempt to stop. If the analysis indicates that government intervention will result in more harm, government intervention would be considered illegitimate, and vice versa. Thus, while the harm principle constituted an absolute categorical bar, the utilitarianism mechanic requires a case-by-case determination of the legitimacy of government intervention.

In order to apply the harm principle it is important not only to know what the principle is, but also what constitutes harm. The broader the definition of harm becomes, the larger the pool of actions that the government can interfere with becomes. In general, the classification of physical damage to body and property as harm is generally accepted by society as well as by Mill. However, the definition of harm can include things other than just physical damage. In order to properly apply the harm principle, it must be determined whether psychological harm and failure to act can be classified as harm, warranting government intervention.

Psychological Harm

Can feeling distress, being upset, or experiencing psychological harm due to another individual’s actions be categorized as harm? If one were to accept distress as harm, then the definition of harm has effectively been broadened to include every instance in which one feels discomfort or is upset by another’s action, expanding the sphere of legitimate government intervention.

Mill does not determine distress or psychological harm to be harm. The distress or psychological harm Mill refers to is one originating from a disagreement of values between two individuals. For example, one individual may like the color blue while another dislikes it. The distress, anger, resentment, or any other negative feelings the other may feel when the first wears a blue shirt is the psychological harm that Mill refers to. A more consequential example would be the distress that a Democrat may feel about the ideas expressed at a Republican rally. The views expressed at the rally are clearly contrary to the individual’s beliefs, yet the distress originating from this ideological difference cannot be categorized as harm. If it was categorized as harm, then the government could intervene whenever actions or speech was contrary to the ideology and beliefs of the most powerful or the most vocal.

Mill, in On Liberty, states that “unless we are willing to adopt the logic of persecutors, and to say that we may persecute others because we are right and they must not persecute us because they are wrong, we must beware of admitting a principle of which we should resent as a gross injustice the application to ourselves” (1). Here he attempts to stop the use of the harm principle in attempts to impose beliefs or one’s own moral values on others. He argues that imposing views on another is wrong, because one would not want others to impose their views on them. Additionally, Mill emphasizes the fallibility of human reasoning and preferences, stating that despite one’s conviction in one’s own position in an argument, there is always the possibility of error.

Admittance of the fallibility is not only a sign of humility and recognition of possibilities, but also a very real demonstration of understanding one’s own limitations inherent in being human. This principle has been recognized and applied by many scholars and thinkers in addition to Mill, like Socrates and Said Nursi. For example, in The Republic, Plato quotes Socrates as exclaiming “[a]s for me, all I know is that I know nothing” (2).

Similarly, Said Nursi demonstrates the same recognition of the fallibility of human beings in his Risale-i Nur and attributes true knowledge only to God. This is clearly displayed in his use of text from the Quran at the beginning and ending of all the chapters in The Words. Thus, Nursi begins his work by drawing from what he considers the true source of knowledge and ends with that same infallible source.

Lastly, English philosopher Thomas Hobbes seems to support Mill’s position against persecution by arguing in Leviathan that “do not that to another, which thou wouldst not have done to thyself” (3). Hobbes’ view is in effect a version of the golden rule, limiting social interaction to only actions one would deem acceptable if done to him/her. In congruence with Hobbes’s golden rule, Mill argues that imposing one’s views on others is wrong, and that feeling upset due to the failure of others to conform to those views is not harm. Thus, even if the actions of an individual upset or cause psychological harm to others, the government cannot legitimately interfere.

Failure to Act

Though Mill prevents distress or psychological harm from being used to legitimize government intervention over an individual’s actions, he permits failure to act to be classified as harm. In situations where a failure to act causes a negative or harmful outcome, government intervention would be legitimate. For example, the government may prosecute a firefighter if his negligence allowed a building to burn down. However, classifying failure to act or inaction as harm is dangerous, because people are not capable of infinite actions in a moment. The jurisdiction of government intervention is expanded tremendously by this classification. Why would Mill, who constructed a mechanism for limiting government intervention, expand government power in this way? And what restraints can be applied to the failure-to-act classification?

Socrates’ ideas, as expressed in The Republic by Plato, provide some insight into answering the previous questions. After examining Plato’s views in The Republic, it is possible to claim that Socrates would agree with Mill in including the failure-to-act as harm. His definition of a just society is a society in which everyone is doing their job or role in society (4). From this, one can assume that a just action within a society would be whatever action is in accordance with the job of the individual as determined by his soul and position in society. Thus, failure to perform one’s job would then be classified as an unjust action by Plato, open to government intervention for the restoration of social justice.

Socrates’ view seems to emphasize the nature of the action that the individual is failing to do. If the failure to act involved the failure to do one’s job in society, then the failure to act would be considered unjust. On the other hand, if the failure to act involved inaction about an issue that was not the individual’s responsibility, then it is possible to conclude that the failure to act in this instance is not an unjust action. Thus, this approach distinguishes between a firefighter who chooses not to stop a fire from a regular citizen who chooses not to stop a fire. The firefighter neglects his responsibility, opening him to criminal prosecution, while the regular citizen’s inaction is not open to prosecution. By allowing the failure to act to be considered as harm, Mill avoided conflicting with the conditional nature of determining whether the failure to act is just or unjust as extrapolated from Plato’s views.

Socrates’ and Mill’s analysis regarding the failure to act is based solely on the legal and formal responsibilities of the individual. The police have a responsibility to stop crime, and parents have a responsibility to take care of their children, etc. Each nation’s unique constitution and laws make legal responsibilities country-specific and unique. For example, many European states, like Germany and France, require citizens to provide assistance to persons in danger (5). However, the duty to rescue those in peril does not exist in other countries, like the United States (6). Of course, most people call the authorities for help and attempt to provide first-aid, but the fact remains that in most of the United States, there is no legal obligation to rescue. Each country determines the legal responsibilities of its citizens, some choosing to expand and some choosing to restrict the extent of responsibilities.

For many people, informal responsibilities extend beyond formal responsibilities; these are often based on the individual’s religion, culture, and ethics. While government intervention may not be legitimate for failures of informal responsibilities according to Mill, informal responsibilities constitute an important piece of the society. For example, children have an informal responsibility to care for their parents, especially during their old age. If children ignore this responsibility, the government cannot and should not intervene. After all, the government is not the ultimate solution for every social problem, and each member of the country may not believe in the same informal responsibilities due to different culture, religion, and ethics. Instead, the true solutions to failures in informal responsibilities are education in social values and decency, social structures, communities, and institutions.

Mill’s principles on government intervention in the lives of free people provided a platform to discuss psychological harm and social responsibilities. Government can provide solutions for certain social issues, but not for all. In recognition of this, Mill wrote of an alternative limited government to the authoritarian regimes of his time. In this alternative, conflicting and controversial ideologies could co-exist, and government would only regulate formal responsibilities. The burden rests on the society to care for the informal responsibilities.

Notes

1. Mill, John Stuart. On Liberty, 155
2. Plato, The Republic, (Plato 354c, book 1)
3. Hobbes, Thomas. Leviathan. Pt. 1, Ch. 15, para. 35
4. Kara, Mahmut. “Rethinking Plato: Philosophical Idealism and Political Totalitarianism.” Fountain Magazine, April-June 2001.
5. Weinrib, Ernest J. “The Case for a Duty to Rescue.” The Yale Law Journal , Vol. 90, No. 2 (Dec., 1980), pp. 247-293 Published by: The Yale Law Journal Company, Inc. URL:<http://www.jstor.org/stable/795987>.
6. Yania v. Bigan, 397 Pa. 316, 155 A.2d 343 (1959)

Heart Failure

The heart is basically a pump that provides the force needed to circulate blood and its contents to the body. It consists of four chambers: left ventricle, left atrium, right ventricle, and right atrium. The right ventricle and atrium collect the blood from the whole body and pump it to the lungs for removal of carbon dioxide and replenishment of oxygen. On the other hand, the left ventricle and atrium are responsible for collecting the blood from the lungs and pumping it to the body through the aorta (main artery). Non-stop blood circulation requires life-long and unfailing heart muscle power. Common symptoms of heart failure include waking up at the middle of night with shortness of breath and decreased ability to walk a few steps upstairs. Heart failure could arise due to any condition that decreases efficiency of the myocardium (heart muscle – Figure 1) through myocardial infarctions (death of muscles due to lack of oxygen, also known as heart attack) or overloading, such as hypertension, that requires increased contraction force. Loss of function in the ventricles (lower chamber of the heart) may require the use of ventricular assist devices (VAD).

Ventricular assist devices

A VAD is a mechanical pump that is implanted into the chest of patients to support the heart function through bridging the blood flow from the lower chamber to the aorta (Figure 2).^2,3 A VAD is usually useful during or after cardiac surgeries until recovery of the heart or while waiting for a heart transplant. VADs could also be used long term if the patient is not eligible for a heart transplant due to other complications. A VAD has several components, including a tube carrying blood out of the heart into a pump, a pump with another tube carrying blood to the aorta, and a power supply connecting to a control unit that monitors the VAD`s functionality.

There are different designs of VADs such as HeartMate, HeartWare, DuraHeart, and so on. Some VADs pump like the heart does, using a pumping action, and others use continuous blood flow. Intriguingly, VADs with continuous flow lead to a loss of normal pulse, but this has been found to decrease complications and increase survival. Two types of VADs include left ventricular assist device (LVAD) or right VAD (RVAD). LVADs are the most commonly used ones due to higher incidence of left ventricular function loss. If both LVAD and RVADs are used together, they are called a biventricular assist device (BVAC). VADs nowadays could be used not only for people with end stage heart failure, but also earlier stages of heart failure, including children. A VAD takes ninety percent of the pumping function of the heart. When using a VAD, your heart will still beat and have a rhythm. If none of these works for a patient, this requires the use of a mechanical or artificial heart, also known as total artificial heart (TAH).

Total artificial hearts

An artificial heart is a mechanical device that substitutes for the failing heart.^4,5,6 They are commonly used during heart transplantations to bridge the blood flow temporarily or to replace the heart permanently during a shortage of transplantable hearts. Early studies with artificial heart trials go back to the 1940s. Since then, various groups worldwide have invested in development of artificial heart prototypes and performed animal and human trials. Total artificial heart prototypes include, but are not limited to, SynCardia, ABIOMed (AbioCor), and Carpentier (CARMAT).6

SynCardia is developed from the Jarvik-7. It was first implanted in 1982. Dr. Robert Jarvik originally designed the Jarvik-7 (Figure 3). Barney Clark underwent the first artificial heart implantation at the University of Utah and survived for 112 days. This was followed by other implants. The longest survival with the Jarvik-7 is 620 days. However, the device is more commonly used on patients as a bridge during heart transplants. It has two pumps that resemble the two ventricles of the heart and is pneumatically (air) powered. The pump of SynCardia is covered with polyurethane. A pneumatic driver used in the US is a non-portable console, and requires patients to stay in the hospital. However, a portable version has been developed in Europe that could be carried a backpack while a patient waits for a donor heart.

The ABIOMed (AbioCor) is a completely self-contained, total artificial heart, which avoids the need for an external console or having wires or tubes piercing the skin to power the device. It uses a wireless energy transfer system, also known as a transcutaneous energy transmission system. This decreases the risk of developing infections due to implants.

CARMAT, on the other hand, is designed by Alain F. Carpentier.⁷ It is a fully implantable artificial heart with embedded biomaterials that make the device more biocompatible. In addition, the CARMAT includes valves made from cow heart tissue and has internal pressure sensors. This allows a person to adjust the flow rate in response to increased demand, such as during exercise. This feature distinguishes the CARMAT from other artificial hearts that provides a constant flow rate.

Biological artificial hearts

Synthetic replacement of organs is one of the long-sought dreams of modern medicine. To this end, there are efforts to develop biological artificial hearts in the laboratory. One recent study took the approach of producing a decellurized (empty from cells) scaffold of a mouse heart and recellurized it with human cardiac cells, and showed that lab-grown human heart tissue can beat on its own (about 40-50 beats per minute) in as short as a few weeks (Figure 4).⁸ They took the advantage of induced pluripotent cell (iPS cells) technology to produce multi-potential cardiovascular progenitor (MCP) cells, which could give rise to all three types of cardiac cells found in the heart. This area of research is still in its infancy but in the future, at least, it may provide tools to generate patches of heart tissue to replace damaged parts of the hearts. Given the success of a mouse heart cellurized with human cardiac cells, it’s possible that scientists will also try to decellurize the heart of a monkey or another animal and then cellurize it with human cardiac cells to produce a beating human heart in the laboratory as an alternative source to a full heart transplant.

Another approach to a biological artificial heart is to genetically modify animals in a way that their hearts will be compatible with a human body. Genetic engineering is a rapidly evolving field that one day could provide such tools for scientist to grow necessary organs in monkeys, dogs, or maybe even horses. Genetic modification may overcome tissue rejection issues when they are transplanted into a human body. For instance, one study tested the possibility of a heart transplant from genetically modified pigs into monkeys and showed the applicability of heart transplants between different species.^9,10

Until the development of biological artificial hearts, ventricular assist devices and mechanical artificial hearts seem to the best options. However, artificial heart implants have had various complications, including infections, pneumonia, high fevers, and multiple organ failures with variable survival rates based on the type of device and materials used. Another issue is the necessity of artificial heart to meet requirements of the body in terms of heart flow rate. For instance, the required flow rate of someone walking or exercising is different than someone at rest. In addition, the possibility of mechanical or computerized systems to fail may be a source of distress in patients implanted with artificial hearts or assist devices. This reminds us of that as long as we take care of our heart’s health, we won’t have worry whether its battery could fail – and what a mercy that is.

It is stunning that even with so much need and effort we are still not able to develop something that completely replaces all the functions of a heart. This clearly points that the heart is a marvelous gift granted to us. We are counting on every beat of the heart for our survival, and we should give thanks, with every beat, for what an incredible gift we’ve been given.

References

1. Bui, A. L., Horwich, T. B. & Fonarow, G. C. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8, 30-41 (2010).

2. What Is a Ventricular Assist Device? NHLBI, NIH. Retrieved from www.nhlbi.nih.gov/health/health-topics/topics/vad/ on 1/2/14.

3. Ventricular assist devices (VADs) Definition – Tests and Procedures – Mayo Clinic. Retrieved from www.mayoclinic.org/tests-procedures/ventricular-assist-devices/basics/definition/PRC-20020578 on 1/2/14.

4. Artificial Hearts. Retrived from www.umasswiki.com/wiki/Artificial_Hearts on 1/2/14.

5. Artificial heart. Retrieved from en.wikipedia.org/wiki/Artificial_heart on 1/2/14.

6. Heart Assist Devices. Texas Heart Institute. Retrieved from http://texasheart.org/Research/Devices/index.cfm on 1/12/14

7. Carmat artificial heart patient in good condition: hospital. Retrieved from www.reuters.com/article/2013/12/30/us-carmat-patient-idUSBRE9BS07O20131230 on 1/2/14.

8. Lu, Tung-Ying, Bo Lin, Jong Kim, Mara Sullivan, Kimimasa Tobita, Guy Salama, and Lei Yang. “Repopulation of decellularized mouse heart with human induced pluripotent stem cell-derived cardiovascular progenitor cells.” Nature communications 4 (2013).

9. Heart of genetically modified pig ‘successfully transplanted into monkey’, South Korea scientists claim. Retrieved from http://www.dailymail.co.uk/news/article-2164964/South-Korea-scientists-successfully-transplant-heart-genetically-modified-pig-monkey.html on 12/1/14

10. Pig to human transplants. Retrieved from http://www.theguardian.com/world/2002/jan/03/qanda.simonjeffery on 12/1/14

With this act, the holy Pole meant, “Whenever your son’s spirit prevails over his body, and his heart over his carnal soul, and his intellect over his stomach, and he demands pleasure for the sake of thankfulness, then he can eat delicious things.” (Said Nursi, Nineteenth Gleam, 3rd point.)

I too witnessed a similar incident thirty years ago. With a large group of friends from university I was invited to visit a well-known scholar for whom I had a deep respect. We had the opportunity to attend a dinner with him and among the food served were some delicious cherries. My inner voice said, “If I sit near him, I will not be comfortable enough to eat as many of those cherries as I like.” This was exactly what happened. While I was thinking about how to get a chance to eat more of the cherries, that respected person took one of the cherries, excused himself, and left the table. I still cannot forget how ashamed I was of my thoughts at that time.

As a result of the story of Abdul-Qadir Jilani and my own experience, I started to ponder the activities that function so well in the human body. In medicine, the dynamic balance that entirely governs the body during eating, drinking and digestion is known as homeostasis. The most crucial body fluid in this balance is the blood. All the agents in the blood have a fixed quantity, a fixed measure and are supplied at a constant rate. Blood pressure is stabilized according to the characteristics of each vein. For instance, the average blood pressure of large arteries is about 100 mmHg. If the pressure exceeds this figure, then the result is hypertension. Hypertension can lead to cerebral hemorrhages, paralysis, renal failure, cardiac expansion, cardiac failure and heart attacks, all of which can result in death. As for hypotension, this is when the flow of the blood to the organs, mainly the brain, lessens. Another example of the importance of maintaining balance is that the agents which are responsible for maintaining the concentration of sugar in the blood (glycemia) must be kept at a suitable balance. If the ratio of the blood sugar (glycemia) rises, the person may go into a sugar coma, which is life threatening. However, if the ratio of blood sugar drops, the organs, in particular the brain, are deprived of energy. A hypoglycemia coma (when blood sugar is too low) is even more dangerous for the brain than hyperglycemia (when blood sugar is too high). The concentration of sodium, potassium, chlorine, calcium and fatty acids present in the blood, like sugar, are kept in a dynamic balance. If this concentration is upset, the result may be disease or even death. The Owner of Absolute Will and Infinite Mercy keeps all these in balance thanks to the marvelous mechanisms that He has placed in our bodies. However, we are free as far as actions like eating and drinking are concerned, for we are granted the willpower to choose our actions.

Balance in nourishment

One of the most often discussed medical subjects in recent years is obesity. This is an important health problem that poses a threat to life, and it is related to diabetes, hardening of the arteries (arteriosclerosis), fatty liver, cirrhosis, cardiac failure and heart failure. Apart from using one’s own will power and eating less, doctors have presented other harmless ways that are appropriate to human nature to treat obesity. Being overweight constrains the ability of a person to move (exercise) and this inactivity, in turn, leads to more and more weight gain. God has enabled us to seek nourishment wherever we like, within certain parameters. Naturally, our stomach has a certain capacity and when this capacity is met, we feel full and do not need to eat any more. Yet, even though we feel full and should not eat, as this is what is necessary for the health of our body, we are overcome by our lower self and tend to overeat extravagantly. The problem of obesity seems to be greater in developed countries.

Our Creator has not put any restrictions on the absorption of food into the blood. All the food we eat is taken into the intestines so that the nutrients can pass into the bloodstream. If the dynamic balance (homeostasis) were to be maintained here as well then the body would take as much as it needed and the surplus of food would be evacuated from the body without going into the blood; as a result, obesity would not be a concern, however much a person might eat. But by allowing all the food we eat to pass into the bloodstream, the Absolute Ruler has set a test for us, challenging our wills and warning us about self-control.

Most of the activity during digestion and absorption takes place in the small intestine. Our small intestine is a duct which consists of three parts, namely the duodenum, jejunum and ileum, each having different functions and structures. The length of the intestine is 3–4 meters, and it measures 2–4 centimeters in diameter, varying according to the position in the body. The area of the inner surface of this cylindrical structure is 1,600 cm2 (0.16m2) at its maximum. The inner perimeter of the intestine is not like a flat tube, but rather it has folds, each measuring about 8 millimeters, that stretch over the inner parts of the canal. These folds allow the absorption surface to be increased about threefold. If the inner surface of this structure were flat, the absorption capacity of the small intestine would not be more than 1/600 of its present capacity. The surface of these folds is also not flat, but covered with protrusions called villi that are shaped like a finger; these stretch into the vacuum of the canal by about 1 millimeter. There are between 20 and 40 villi to every square centimeter on the surface of the intestine. These villi allow for there to be a tenfold increase in surface absorption. The surface of the villi has cylindrical cells that are arranged in a single row and these help in absorption. The surface of these cells has extensions that are quite thin and dense, known as microvilli, or epithelial cells. Thanks to these cells with a brush border surface, the absorption surface can increase by about twenty times. Thus, although the surface area of a flat canal of the same size should be approximately 3,300 cm2, thanks to surface folds, villi and bushy edges, the total absorption surface of the small intestine increases to 2 million cm2 (200 m2). Moreover, some research has suggested that the total increase could be even greater (about 1,000 times as much). Normally, 100 grams of fat, 50–100 grams of amino acid, 50–100 grams of iodine, and 7–8 liters of water (consisting mostly of fluids produced within the body) are absorbed by the intestines daily. Furthermore, if one eats or drinks too much, the maximum capacity of the system allows the absorption of several kilograms of carbohydrates, a half to one kilogram of fat, a half to one kilogram of protein and twenty liters of water per day. Our intestines have been created with the capacity to transfer all this food into the bloodstream. If we do not control our eating, this capacity is abused and we can face conditions like obesity.

In this life, one of whose tests is in our body, and in which we are required to strive hard using our willpower, there is no limit to the absorption of foods that have high calories (lipid, carbohydrate, and protein), and this can lead to being overweight, as mentioned above. However, in the absorption of minerals, which are not normally considered as making up the basic components of nourishment, but which are of the utmost importance for the human body (in all the operations of the nerves, muscles, bones and in the balance of all the electrolytes), the rules of dynamic balance occur in our intestines, regardless of our will, by the help and mercy of God. For instance, hemoglobin, which is found in the red blood cells (giving the blood its red color) and is charged with the task of transporting oxygen, contains iron. When there is surplus iron in the body, hemosiderosis occurs, which leads to the destruction of organs such as the liver and the pancreas, or cardiac failure. If there is an iron deficiency, then a person suffers from anemia. It is for this reason that a quite sensitive iron-absorption balance exists in our intestines. Here, it is evident without question that there is Divine Aid and Mercy. The same mechanism works for substances like calcium.

Prophet Muhammad’s, peace be upon him, advice to stop eating before feeling full is a significant measure against obesity, for it eliminates “false” appetite. This has a psychological truth, for the brain responds to the feel of fullness a short time after eating. In fact, we all know by experience that we actually feel full a short while (fifteen–twenty minutes) after we stop eating even if it is a small meal.

To conclude, the Almighty One warns us against extravagance and orders us to use our willpower. At this point, we can see how important a role the blessing of religious belief and the training of the soul and the will play in eating habits. Likewise, the principles of Islam, which is in perfect keeping with human nature, are crucial for the well-being of the community as a whole; charitable alms and fasting, which urge us to help and think about those with less, are obligatory and all kinds of charity and good deeds are encouraged. In Islam extravagance is prevented, not only in eating and drinking.

Omer Arifagaoglu is a professor of medicine in Turkey.