Missing pieces: It’s easier than ever to get by with fewer body parts thanks to modern medicineFARGO - Every part of the human body has some purpose, but it’s easier than ever to get by with a few missing pieces. Rhonda Ketterling, Sanford Health’s chief medical officer for the northern region, said even organs like the appendix commonly thought of as useless have been shown to play a role in the body’s development and maintenance.
By: Ryan Johnson, INFORUM
FARGO - Every part of the human body has some purpose, but it’s easier than ever to get by with a few missing pieces.
Rhonda Ketterling, Sanford Health’s chief medical officer for the northern region, said even organs like the appendix commonly thought of as useless have been shown to play a role in the body’s development and maintenance.
“It’s just a matter of whether our life is truly dependent on their function,” she said.
And when disease, infection or malfunction wreaks havoc on an organ, it often needs to be taken out to prevent bigger problems, according to Perham (Minn.) Health surgeon Randel Stolee.
“It’s pretty surprising to me if I see somebody who’s in their 50s that hasn’t had something removed,” he said.
So which of the more than 70 organs can we live without? Ketterling said with modern medicine, artificial hormones, high-tech medical devices like external heart pumps and treatment options such as dialysis, a person can lose or suffer damage to just about any organ, or at least a piece of it, and still survive – but they might not enjoy the same quality of life.
“The brain is the one that we really just cannot replace,” she said. “We’re stuck there.”
Cut it out
While the removal of organs is hardly a new thing – the tonsillectomy, or removal of the tonsils, has been around for about 3,000 years – Stolee said there have been changes in what surgeons remove today.
The thyroid, a gland in the neck that produces hormones that control metabolism and level of energy, is still taken out if a goiter becomes big enough to obstruct the airway. But he said that’s less common today because salt, breads and many common foods now contain iodine, reducing the risk of iodine deficiency that can cause goiters.
A bout of strep throat could pose serious risks in the past, Stolee said, which is why the tonsils were almost an inevitable target for removal in the 1920s before antibiotics were available.
“They just went around house to house and removed all the tonsils of just about everybody,” he said.
But times have changed, and Stolee said surgeons now only consider removing the tissues in the back of the throat if a person suffers recurring bouts of strep throat or tonsillitis, an inflammation of the tonsils that can block the airway.
The adenoids, another part of the lymphatic system located just behind the nasal cavity, work with the tonsils as the body’s first line of defense against diseases and infections coming in from the mouth. The tissue used to be taken out along with the tonsils, but Stolee said surgeons might leave it in if the real problem is just strep throat or tonsillitis.
But cholecystectomy, or removal of the gallbladder, is becoming more popular, and Ketterling said America’s obesity epidemic means that probably won’t change in the near future. The Centers for Disease Control and Prevention reported 403,000 Americans had the procedure in 2007.
The gallbladder is a small organ that stores bile, which is produced by the liver and aids in the digestion of fatty foods.
But if it’s taken out to alleviate the severe pain and risk of infection that comes with gallstones, the bile instead directly flows into the small intestine. For most people, there’s no noticeable difference, but she said some patients suffer from chronic diarrhea that can be improved with medications.
The appendix has long been one of the most maligned parts of the body, often considered a “vestigial” organ that’s a remnant left over from evolution that used to have a purpose but has since become functionless.
But Ketterling said research has given new life to the pinky-sized organ that hangs off the end of the colon. The appendix accumulates lymphoid tissue after we’re born and reaches a peak in our 20s or 30s, she said, and it’s thought the organ exposes white blood cells to bacteria to build up proper antibody response.
“But because many of the systems in our body are redundant, we have lots of things for our immune system,” she said. “We can obviously function quite well without our appendix.”
About 326,000 Americans underwent an appendectomy in 2007, most frequently for appendicitis – when the organ becomes clogged and inflamed, often leading to an infection that can be lethal if the appendix bursts and leaks into the abdomen.
A report from the CDC estimated the lifetime risk of developing appendicitis at 8.6 percent for men and 6.7 percent for women, and Ketterling said researchers haven’t pinpointed anything thought to prompt the possibly fatal condition that requires emergency surgery.
She said one of the most common procedures in America remains the hysterectomy, or removal of the uterus, which often includes the removal of the ovaries to deal with benign tumors, cancers or other conditions. The CDC reported 517,000 such procedures in 2007, and it’s estimated that one-third of American women will undergo a hysterectomy by the time they’re 60.
Men have their own unique issues with organs – Ketterling said many men will undergo a partial or total removal of their prostate as they age. The CDC estimated 156,000 of those procedures in 2007.
Missing vital organs
Stolee said it’s much less common to remove the spleen, an organ in the upper left side of the abdomen that filters red blood cells and kills bad cells. That could cause big problems for people with blood cell disorders like sickle cell anemia, and the organ sometimes is removed because it’s too inflamed or getting rid of too much blood.
But he said the main reason it’s taken out is trauma, such as a car accident, that can rupture the hard to repair, thin-walled organ. The spleen also plays a role in the immune system, so people who are missing it need vaccinations for types of pneumonia, meningitis and influenza.
Stolee said many other organs could be on the cutting board if they become cancerous or diseased. That’s the case with the thymus, a gland behind the breastbone that helps develop the immune system in fetuses but gradually shrinks until it’s nearly undetectable after puberty.
The same goes with other organs that play a more vital function. The pancreas, which produces insulin and enzymes that help digest food, can be partially or fully removed if necessary; surgeons can take out a bad lung if the other one is still fine; people frequently donate one of their two kidneys and can get by without it; even the liver, a vital organ that produces bile and breaks down toxins, can regenerate if surgeons take out a bad lobe.
Ketterling said humans are able to survive despite missing organs like this for two reasons: modern medicine and the “redundant” nature of the body, with other organs picking up the slack for the missing pieces.
“We’re beautifully engineered,” she said.
Advancements in medical science have helped, too. Ketterling said insulin can help replace the vital function of the pancreas, artificial hormones can make up for missing glands, and medical devices like external heart pumps and dialysis units can keep people alive with issues that would have been fatal just decades before.
“When you think about what we’re able to do now with pacemakers to keep the heart’s rhythm functioning better, things we’re able to do with dialysis, it’s pretty outstanding the pace that is happening, and now robotic surgeries,” she said. “I think with genomics and nanotechnology, all those things will just escalate the rapidity of change.”
Stolee said he’s taken out as much as two-thirds of the colon in one patient, who still had normal bowel function after the procedure. Humans can lose up to half of the 40 feet or so of small intestine and survive, he said.
But he said these pieces shouldn’t be seen as nonessential just because we can survive without them.
One blogger likened it to the human body’s two legs – people can live after having one removed, but no one would consider the missing leg to be nonessential because of the profound changes they face without it.
“You could probably cut out some fat and people won’t care; you could cut out the appendix and they’re not going to care that much,” Stolee said. “But the others have a function. How obvious is it they’re missing it? That’s probably how some people decide whether they can go without it.”