Creatine Basics

What Is It?

Simply put (we're protecting that last brain cell, after all), creatine is an organic acid found in vertebrates, made from amino acids in the kidney and liver, and located mostly in skeletal muscle. Existing in fish and meat, creatine is not found vegetables. Because the body can make it, it's considered a non-essential (not needed in the diet) nutrient.

What Does It Do?

Naturally occuring creatine is transported in the blood to tissues, like the brain and muscles, that demand lots of energy. In those muscles, creatine combines with a phosphate to become phosphocreatine (creatine phosphate) and making rapid energy production possible. In other words, it helps feed the muscles during brief, high-intensity exercise such as sprinting and resistance training.

Creatine Supplements

Creatine has become a very popular supplement with athletes, leading to many research studies into its effectiveness. Reviews are decidedly mixed.

Do They Work?

Several studies report an increase in muscle mass with creatine use. However, because creatine tends to raise fluid levels in muscle tissue, some experts question whether this is true muscle building. In addition, many of the studies have been small (40 participants or less), so the results are generally deemed insufficient to draw conclusions.

It's interesting to note that there is no evidence that creatine provides any benefit for a) aerobic exercise, b) people over 60, and c) endurance athletes. Which, given how creatine aids in rapid energy creation, makes a great deal of sense.

Are They Safe?

Heads? They might be. Tails? They might not.

Most of my sources mentioned some level of concern about kidney and liver damage. Those sources also indicate that people with underlying kidney or liver disease should probably not take creatine supplements. At the same time - often in the same paragraph - they state that no significant changes in kidney function markers or liver enzymes were noted.

Are There Side Effects?

Digestive system upsets, muscle cramps, heat intolerance and/or dehydration, changes in insulin activity, abnormal heart rhythms, and blood clots in the legs are consistently listed as possible side effects. Less serious issues include headache, dizziness, increased thirst, anxiety, and irritability. Allergic reactions, particularly asthmatic symptoms, were also mentioned.

Conclusions?

Who knows?

From what I've read, there's no definitive proof that creatine supplements are effective, beyond a very narrow group of younger athletes. And there isn't definitive proof that they aren't. {POP!}

Aw, shoot! There went that last brain cell.

• http://www.mayoclinic.com/health/creatine/NS_patient-creatine
• http://www.ncbi.nlm.nih.gov/pubmed/12184144
• http://www.ncbi.nlm.nih.gov/pubmed/12701815
• http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html
• http://en.wikipedia.org/wiki/Creatine
• http://en.wikipedia.org/wiki/Creatine_supplements

Blood Brothers  "Sign of Seven Trilogy" by Nora Roberts

Every seven years, in the seventh month, for seven days madness takes over the peaceful town of Hawkins Hollow.

It starts with Caleb, Fox, and Gabe - born on the same day and close as brothers - sneaking off to celebrate their 10th birthdays by camping out at the Pagan Stone. When they make it out of the forest the next morning, each has perfect health and the gift of Sight. And a powerful evil, held captive for centuries, has been set free.

The first book fills in the last twenty-one years and tells the story of Cal, who can see the past, and Quinn, the writer who has come to investigate the strange happenings. What follows is just a whole lot of intense, scary ... fun.

I have gotta get those other 2 books! Cuz even though the genre (romantic suspense) virtually demands a happy ending, the stuff that happens between now and the end is just too good to miss.

Born in Fire  "Born In Trilogy" by Nora Roberts

This is one of the Ireland trilogies; she's done more than one. Nothing supernatural, mystical, or magical. Just three really good stories about three very different women - the daughters of Tom Concannon, a dreamer with an angry bitter wife.

The first book is about the oldest: Maggie Concannon, a West County glass-artist (I guess that's the term) whose work catches the eye of Dublin gallery-owner Rogan Sweeney. It follows Maggie's rise from obscurity, her battles with her mother, and her romance with Rogan. (This is a romance novel, so that isn't actually giving anything away.)

All I can say is, thanks to this book, every thought I had for days came with the lovely lilt of a West County brogue. Now I just have to get my hands on the rest of the books and I may never speak 'American' again.

The Last Enchantment  "Merlin Trilogy" by Mary Stewart

Worse than having only the first book in a series, is having only the third. Or the middle of five. This book is both.

As with The Crystal Cave and The Hollow Hills, the tale is narrated by Merlin and imagines his life from the crowning of Arthur as High King of Britain. Although admittedly drawn from a questionable historical source, the author creates a fascinating story of peace coming to a land and magick going from a man.

It tells of Arthur's legendary uniting of Britain, the equally well-known treachery of Morgan and Morgause, and puts a much kinder spin on Merlin's relationship with Niniane/Nimuë than most versions. The book stands well on its own, with enough references to what came before that one doesn't need to have read the first two books to understand the story.

Nonetheless, the absolute best way to experience the life of Merlin is in order - from start to finish. Throwing in  The Wicked Day for the story of Mordred is a fine finish to the legend.

Apparently, I'm going to be doing a lot of book-shopping for the foreseeable future. Especially, when one takes into account that:

• I have only read the first book, Ritual Bath, in the Peter Decker/Rina Lazarus series by Faye Kellerman - out of about 19, as of 2010.
• I have only read one Inspector Lynley novel, Careless in Red, by Elizabeth George - out of about 17, so far.
• I have only read two Alex Delaware novels, Bad Love  and The Clinic, by Jonathan Kellerman - out of 26, and counting.
• I am already 4 books behind on the Virgil Flowers series by John Sandford, having only read Heat Lightning, the second book from 2008.

But then, Ed went, for me, a step too far. His idea of helping was to provide arms to the Libyan 'freedom fighters' - an idea that I cannot ever  see as a wise one.

The problem, as I see it, in arming one side of a conflict lies not in the conflict - but in the outcome. If the 'right' side wins, what will they become, with the power of their new control? Will they be better - or much, much worse - than the regime that they have risen to replace?

And - always a possibility - what if this 'right' side loses their war for freedom? How swift and vicious will the winning side's retaliation be - and against whom?

As I sit here, thinking these thoughts, I wonder if I am simply a coward. Or if I am right.

The culprit is ... wait for it ... Nicotine.

What I found interesting is the phrasing found in of some of the news stories. (Emphasis is mine.)

... their tests showed concentrations of nicotine on the order of what is generally found in smokers causes HbA1c levels to rise.

... found that nicotine, when added to human blood samples, raised levels of hemoglobin A1c (HbA1c) by as much as 34%.

Using human blood samples, the scientists showed that nicotine concentrations typical of those in smokers appeared to raise long-term blood sugar levels in diabetics.

I have to say - hmmmm? Either all of the sources I read - or there's an interesting point here.

The study, as best I can surmise, was not done on diabetic or pre-diabetic smokers. Or even on the blood of diabetic or pre-diabetic smokers. It appears that the study involved adding nicotine to blood samples - in an amount that was judged to be "typical of those in smokers." Hmmmm?

Not being a scientist, I can only question what I read. As a curious soul, with a ... questioning ... mind, I do have to wonder. Is adding nicotine - a lab-created solution, I assume - to blood samples, in whatever quantity, the same as what happens to the blood in the body of a smoker?

What do you think?

• http://www.endocrineweb.com/news/type-1-diabetes/5042-researchers-uncover-first-hard-evidence-nicotine-raises-blood-sugar-levels
• http://healthland.time.com/2011/03/27/why-smoking-is-a-bad-idea-for-diabetics/
• http://www.nursingtimes.net/nursing-practice/clinical-specialisms/diabetes/smoking-linked-to-serious-complications-with-diabetes/5027831.article

When you think about it, there are several reasons why scrubs work as casual attire.

First, they're lightweight. In Arizona, that's a must. We've already had weather in the 90s and it's heading back that way with a vengeance. Summer everywhere calls for clothing that breathes, but doesn't wilt. Hence - scrubs. (When was the last time you saw a wrinkled, frumpy-looking nurse?)

Second, styles have changed. Scrubs come in a myriad of shapes, styles, colors, and patterns. The nurses on Mark's floor at the VA had some great outfits that started me thinking about this years ago. Just look at the black hearts jacket. This is not the olden days - white uniform, starched cap, and {shudder} those shoes.

Last, but perhaps most important, is the laundry-factor. Scrubs are designed to wash up often and well. Think about it - or maybe not - nurses and doctors come in contact with some, um, interesting substances on any given day. The clothes they wear must be easy to get clean. We've got some pjs from the VA that still shed any and all stains, even after 7 years.

So, see? Not such an odd idea, after all.

There are a lot of pros and cons floating through the Webverse related to this potential merger. As a consumer, I can't say that I'm finding too many pros. Let me amend that - as an urban  consumer, there aren't many positives for me in this melding of companies.

So, I'll start with:

The Negatives

Increased Cost

Any time corporate mergers thin the options for consumers, there is little incentive for providers to be financially competitive. When you're the only game in town, people either pay what you charge or do without your products and services. Great for companies- and shareholders; crappy for consumers.

Currently, T-Mobile has the best rates (that we've been able to find) in the industry. Periodically, we check; just to make sure that we're not getting hosed. We're not. (I doubt that that will be true if the merger goes through.)

Decreased Innovation

Again, if you're the only game in town, why waste potential profits by creating/acquiring the latest and greatest products for your industry? It's simpler, and cheaper, to just barely stay ahead of the competition. And, if you're AT&T, you probably have a lock on most of the infrastructure. (Although, to be honest, my experience comes from the days of divestiture and landline service.)

Again, T-Mobile phones are some of the best out there - with the exception of those phones that are not made available to them.

Customer Service

If customers have nowhere else to go, do CSRs really have to be nice? Probably not. Will they, anyway? Probably not.

One of the reasons that we have stayed - for 7 years - with T-Mobile is customer service. When Deutsche Telekom came in, things got a little iffy; but it's still possible to find someone who knows what they're doing and - critically - cares about doing it. I have serious doubts that this will continue under the AT&T umbrella.

The Positives

Shareholders will make bundles; AT&T will make bundles; Deutsche Telekom will make bundles. (It's all goood.)

It is possible that T-Mobile USA and AT&T Merger Means Faster and More Widespread Broadband - or not. And I quote "AT&T is committing to build out to nearly every part of the U.S. within six years." I am so ... impressed ... by the organizations that are jumping on this bandwagon.

But, you know? I could be wrong. Still angry; but wrong.

We'll see what happens - if the merger goes through - and my service ... changes.

When Mark was sick, he'd crawl into bed - every night (and day) - and fire up his favorite game. For weeks, months, years - music and dialog screamed through my dreams. In fact, You are wrong!  has become a permanent part of our vocabulary.

From a gamer standpoint (and when you aren't one, it's hard to give a ... care), headsets are bound to offer better sound quality than most TV speakers. If nothing else, having dialog and directions beamed directly into the brain improves game play and reaction times. Or so I've been assured. (Okay, beamed  may be my take on it.)

What I didn't think of, since we've never used a game system online, is that there is a lot of chatting involved in some of these games. Apparently, with a headset, one can literally talk with fellow players and team members. Interactivity on a major scale.

Not sure that's a great idea for us, though. It's one thing to tune out lilting music. Quite another to tune out the old man screaming "Move your sorry @$$, you fricking moron!" at 3:00 am.

Cellphones and Brain Cells

I know it seems backwards, but I'm presenting the results before the method. Frankly, because I find the method more interesting.

Study Results

This study showed that the brain reacts to the electromagnetic radiation from a cellphone. With less than an hour of contact, brain activity increased by 7 percent in the area nearest the antenna. Whether that change was good or bad for brain health, was not a goal of the study; so we just don't know.

Study Method

In a randomized study from 2009, forty-seven participants had their brain activity measured after holding cellphones to their left and right ears for 50 minutes. Not too exciting, you say? Just you wait.

(Yeah, I have a picture in my head of a bunch of people, with electrodes stuck to their heads, cellphones on each ear, sitting around doing nothing else for nearly an hour.)

Fearing that if the subjects of the study knew when/if the phone was active, it would stimulate brain activity, researchers created a blind: On the first day, none of the phones were on. The second day, only the right was turned on - and muted. No auditory stimulation.

I think that's pretty cool. But, perhaps, could have been a little ... cooler.

Study Modifications

First, the study could have been larger. The more bodies, the better - when it comes to scientific studies. Surely they could have found a couple hundred people, or more, with nothing better to do for a couple of hours. (Pick me! Pick me!)

Second, just to increase the randomization, why not have some of the phones on the left ear active on the second day. I know, activity is activity - but, again, this is supposed to be science. Randomize the randomization.

Lastly, were certain types of brain cells stimulated? Or all cells within a specific range? The report doesn't say, so we don't know if this was part of the research.

All in all, pretty interesting stuff. (Okay, I've officially become a science nerd.)

I had heard that putting apples in a brown paper bag with unripe fruit would accelerate ripening. Yeah. Sure. Right. Well, ummm, perhaps I was wrong.

We noticed the bananas getting riper, so we moved the apples. 'Nanners' getting more yellow; put the apples in a brown paper bag. Still getting dark - moved the bag of apples.

It was, within recent memory, one of the oddest situations I'd ever witnessed. The closer we placed the apples to the bananas, the more the bananas ripened. While it may not work for all fruit, it certainly appears to work - in spades - with bananas.

Kinda fun, all in all.

What I found is something called Lampwork, a method where artists heated their glass over oil lamps - hence, Lampworking. It dates back to ancient Syria, but became most popular in 14th Century Italy, specifically Murano. Those beautiful French paperweights, with colored decorations inside and out, are Lampwork.

The beads, since this is what grabbed my curiosity, start out as molten clear glass wound around a coated steel piece called a mandrel. (The coating allows the bead, once finished, to be easily removed.) A variety of shapers, molds, and picks are used to roll, smooth, add details, and bore holes.

Most of the tools, it seems, are made of graphite; although molds can be wood or brass, and shapers are often steel. Graphite is important because of its structure: it quickly grabs and holds heat, so it doesn't shock the glass and cause cracking.

I think I was most surprised by the fact that not all colors of glass are compatible. According to an article I've been reading, because of chemistry and something called Coefficient of Thermal Expansion (COE), mixing (in very simple terms) soft glass and hard glass leads to problems.

Adding metals - silver or gold - gives interesting colors, but takes extra steps. Building colors on top of colors, then 'lapping' the ends shows all of the colored layers. Absolutely fascinating stuff.

Here I was, just hours ago, thinking about getting into beading and now  ooh, shiny!   I'm wondering where I can learn how to make glass beads. Unlike glass blowing, bead-making wouldn't take a furnace and tons of room.

All I need is to hit the lottery - and I'm good to go.

1. http://kids.niehs.nih.gov/lyrics/tin.htm

Seven years earlier, undoubtedly in an attempt to drum up support for the *&()$@! that was Vietnam, Hollywood made a movie. How much John Wayne had to do with the success of the movie is anyone's guess. Me? I'm betting a lot of it lay at his feet.

It was an odd mix of propaganda for America and the reality of life for the Vietnamese - if memory serves. (Tried to find and watch it; no luck, yet.)

What haunts me, to this day, are the emotions that this film evokes in me. Including one of the most moving ballads of the era:

Ballad of The Green Berets ^[1]

I can't even begin to imagine how difficult it would be to have an RV breakdown. That's a whole lot different than getting a tow for a little hatchback or finding a mechanic with parts for your mid-sized sedan. No, an RV is a whole 'nother situation.

Seems to me that it'd just be asking for trouble to head out without some kind of protection. Especially when there are companies that offer 24-hour service, all over North America, with no mileage restrictions.

But, hey. That's just me. I'm a worrier.

One of the last things that the doctor and I talked about was the priority of a renal diet, over a diabetic diet. So, given the 5,000 other options, I decided to focus on food.

Electrolytes

Just as with the liver, electrolyte imbalances seem to be indicative of renal problems. In hepatic conditions, sodium and potassium balances are critical. Apparently, with kidneys, it's a phosphorus and calcium disconnect that triggers red flags.

Source: bettercancersolutions.com

Phosphorus and Calcium

The body needs phosphorus to build and maintain bones and teeth, as well as nerve and muscle function. However, too much phosphorus keeps the body from absorbing calcium. When that happens, the body starts stealing calcium from bones to make up for it.

This leads to weak bones, as well as itchy skin, and bone and joint pain. Eating less peanut butter, cheese, nuts, and ice cream - foods high in phosphorus - is recommended. Non-cola drinks, sherbet, zucchini, broccoli, and non-dairy substitutes for milk products are preferred.

Calcium supplements may be required, with the addition of vitamin D to help maintain proper balance. Cutting out foods that are high in phosphorus may negate the need for calcium pills - something that your doctor should decide, after careful review of lab results.

Sodium and Potassium

Sodium is required by the body to manage fluid levels, regulate blood pressure, and control muscle contractions. Potassium keeps nerves and muscles working properly, especially the heart. Excess of both electrolytes are cleared through the kidneys.

When the kidneys aren't functioning properly, sodium levels may rise; leading to fluid retention in the hands, feet, and face, and an elevation in blood pressure. Excess potassium, found in greens, tomatoes, potatoes, bananas, broccoli, and chocolate, can cause irregular heart rhythms.

It's fairly easy to control salt intake. Simply take away the shaker and carefully read food labels. Obvious items to avoid include bouillon, canned soups and vegetables, salty snacks, bacon, cold cuts, and boxed dinner or side dish mixes. Colas tend to be rather high in sodium, as well.

Proteins and Carbs

This is where diabetes and kidney disease crash - violently.

The body converts carbs, which are hiding everywhere, into sugars. Therefore, a diabetic diet counsels low carbs, more protein. Not too difficult, until you factor in kidney disease.

One of the waste products created when the liver processes proteins is urea, a substance that contains nitrogen and clears through urine. When kidneys don't function properly, excess urea and nitrogen build up in the system. This condition, called uremia, can cause itching, mental impairment, nausea, and fluid build-up in the lungs or around the heart.

(One source indicated a direct correlation between excess urea and muscle loss.)

Obviously, too much protein is detrimental for anyone with kidney disease; just as it is for those with liver disease. But the alternative - carbs - are a no-no for diabetics. As with everything else, a balance between proteins and carbs is critical.

Our Dilemma

With the exception of calcium and phosphorus, these dietary restrictions aren't all that new to us. When Mark was dying from end-stage liver disease, we doled out milligrams of sodium and grams of protein like a miser pinches pennies. It wasn't easy, but we learned and got pretty good at it.

These days, we've got to factor in diabetes. That means the foods he ate, in massive quantities, to make up for being denied proteins are now (pardon the pun) off the table.

Frankly, I'm not quite certain how we're going to put all of this information together (and it's only a small part of what we have to consider) to create a diet that will not aggravate Mark's liver and kidneys, or shoot his blood glucose through the roof.

But I'm working on it. Any and all advice is extremely welcome.

If You Drive

I'm talking about that four-letter-word: walk. One of the reasons that we continue to live here is convenience. Most of what we need on a regular basis, as well as a few emergency items, are within walking distance.

Dollar store, smoke shop, beauty salon, bakery, two convenience and one drug stores, auto parts store, a few fast food places - all within a quarter- to half-mile of our apartment. There's even a clock repair shop, lighting store, and a chiropractor in spitting distance.

Naturally, if you don't have a little shopping community at your back door, shop-walking (walk-shopping?) isn't an option. If you're in better shape than I am, your walk-to-shop range may be a little wider.

When You Drive

One of the biggest gasoline wastes is idling in traffic. Not to mention the toll that rush-hour traffic takes on mind and body. Getting from A to B, as quickly as possible, is the best solution for everyone.

Work

If you have the luxury of getting in a little earlier, leaving a little later - avoiding the peak drive times in your area - you can save gas and cut stress. Sometimes just leaving 5-10 minutes earlier or later can make all the difference in how long it takes to get there. A total win-win.

Play

It pretty much goes without saying, (but I'll say it anyway) scheduling trips to the supermarket, doctor's office, or post office during rush hour isn't the best idea. By waiting until all the worker-bees get to their hives, you can cut a ton of time from your trip. And, again, de-stress the process.

Where You Drive

Work

There's not much fudge room here. The boss, oddly enough, actually expects you to show up for work every day. But, as things change in the world, there are some possible options.

If your work (and personality) allows it, telecommuting is a great way to avoid traffic and high fuel costs. Even if it's only a couple of days each week. Or perhaps your company would consider 4-day weeks; 10 hour days, instead of 8.

Play

This one's a little easier - don't go, if you don't have to. If you have to, plan ahead. Start at point A, travelling logically from B to C to D to home in one big loop. Know where you need to go and, if necessary, map it out in advance.

Shop online: in many cases, shipping is less than the gas it takes to run all over town. Many grocery stores will shop for you and deliver right to your door. With Safeway, for example, if you schedule delivery in a 4-hour (rather than a 2-hour) window they cut the delivery charge.

How You Drive

Okay, lead-foot - this is for you.

Every 'expert' will tell you that driving the speed limit saves fuel. It also saves money - on speeding tickets. But, from my little corner of the speedway, there's something a little different to consider: consistent speed.

Revving up and slowing down, revving up and slowing down guzzles gas. That's why city driving, with all those stop signs and red lights, is a bear on mileage. If you can't avoid city streets, at least don't race from intersection to intersection. You're gonna have to stop at the corner, whether you get there in 30 seconds or in a minute.

Part of me is relieved that we don't have a working, gas-needing vehicle right now. But the realist in me knows that even though I'm not buying gasoline directly, I'm still paying for the rise in fuel costs indirectly. Anything shipped by truck is going to get more expensive.

And once the price goes up, it takes forever to come down. Actually, in my experience, what goes up, must come down doesn't apply to the cost of anything I need to buy.

What about you? How do you save on gasoline? I'd love to hear your tips and tricks.

The story begins with the chaos surrounding the arrival of the Carpathia at Pier 54 in New York; the only ship to bring back survivors. What follows are the detailed histories of eight men who, had they lived, might never have been famous.

We learn about birthplaces and childhoods, homes and schools, families and fiancées; the choices that led each man to Southampton and an ill-fated cruise. The two brothers who booked the band, the villains of the piece (some would say), are included. As is what came after.

Amid memorials and monument-building, parents were dunned for unpaid alteration bills. One musician was labeled a deserter for failing to answer the call to fight in WWI - two years after his death.

Winding through all of their stories is the influence of the era in which they lived. A time much different from our own.

*****

I chose this book for the very simple reason that I knew little about the Titanic and nothing about her musicians. Filled with quotes, newspaper reports, and pictures, there is certainly no shortage of information. And being a nosy sort, I found the stories fascinating.

However, the errors were off-putting: August, instead of April in some dates; transposing names in a story about one musician's sisters. In an effort, I presume, to avoid sensationalizing a sensational situation, the presentation is often dry and choppy; cramming so much information into so few pages.

Still, I found the book enjoyable. I recommend finding a quiet spot with no distractions. It will require your full attention.

Disclosure of Material Connection: I received this book free from the publisher through the BookSneeze®.com <http://BookSneeze®.com> book review bloggers program. I was not required to write a positive review. The opinions I have expressed are my own.

What Competitors?

Having trouble with other businesses stealing your customers? Take a page from a Philly pizzeria - leave a few mice in the competition's restroom.

Apparently the pizzeria owner, suffering an infestation of mice at his own restaurant, felt he'd been contaminated by the competition and set about settling the score. He's now up on charges for planting little furry creatures at two other area businesses.

Unlawful Pratfall

Dating back to the 1800s, slipping on a banana peel has been a staple of physical comedy. But, it's always funny -- until someone gets hurt, as mothers having been saying for generations.

And that's just what happened to a woman who is now suing a California discount store. The 58-year-old slipped and fell last April, allegedly suffering a herniated disk and tissue damage. Ya gotta wonder, just how did a banana peel end up on that floor?

How It Works

I'm not a transplant expert or a medical professional, but between what we've experienced and what's on the 'Net, here's a brief description of what happens. And where improvements could be made.

Getting Listed

When a patient has an illness affecting what they call a 'solid' organ, i.e., heart, liver, and/or kidneys, doctors monitor the progression of that illness. As symptoms worsen and treatments fail to resolve the condition, a determination is made that the only next step is organ transplantation. But, the patient isn't automatically put on a transplant list.

Tests are done to determine overall health, ability to survive the surgery, mental stability, stable support system, and lifestyle. The results of these examinations are reviewed by the transplant center's committees; people whose job it is to determine the best candidates for transplant. Patients meeting the strict criteria are then place on the region's transplant list.

Patients actively abusing alcohol and/or drugs, living on the street without support from family or friends, or whose cancer (as an example) has progressed to other organs are rarely considered good candidates. Their chances of long-term survival are generally poor.

Organ Allocation

There are 11 geographic regions in the OPTN system. Patients are listed and organs distributed within those regions. This is to guarantee the condition of the organs at the time of transplant^[1] and maximize patient survival.

It's a good plan. Unless the liver that will save your life is in Tennessee and you're in California. Then, it's a problem. (Steve Jobs resolved it by going from CA to TN to 'pick up' his new organ.)

As compatible livers become available in a region, they are offered to those who, based on strict objective criteria, are a) most in need of transplant, b) healthy enough to survive the surgery, and c) least likely to reject the organ.

Crossing Regions

There's no law, that I could find, stating a patient can't be on more than one waiting list. In fact, a patient in New York was recently advised to try getting listed in Ohio, where the wait isn't as long for a new liver. Nice, if you've got the time -- and the money.

When you are on a transplant list, you have to be able to get to wherever that organ becomes available. And get there really, really quick. If you've ever tried to book a last minute flight, you know that that ain't cheap and it ain't easy.

This is why most transplant centers require patients to move to their region and/or center for the weeks and months prior to transplant. Again, not cheap or easy.

Moving Organs

There has been some talk among transplant experts about offering organs to the sickest patients regionally, then nationally. Currently, if the patient at the top of a region's list isn't a good match, the available organ is offered to a less sick patient in the same region.

Naturally, given the limitations on storing organs^[1], if no regional match was found there would have to be a strict limit on how far away the next recipient could be. To this end, some experts have suggested creation of larger super regions, allowing more patients access to the limited number of available hearts, livers, and lungs.

Organ Donation

From 2000 through 2009, (if I'm reading the graphs correctly) 20,000-35,000 new kidney patients were put on organ waiting lists - each year; 10,000-12,000 liver patients were added yearly. For those same years, on average, 5% of kidney patients and 8% of liver patients on those lists died waiting.

As of this moment, there are more than 100,000 people in the United States waiting for a heart, lung, kidney, or other organ. Over 70,000 of them are well enough - right now, today - to have that surgery. All they need is a donor.

Next month, April, is National Donate Life Month, so I'm a little early. Nonetheless, one huge step that can be taken right now - it doesn't require a consensus, quorum, or majority vote - is for each of us to become an organ donor.

1. OPTN states that hearts and lungs need to be transplanted within 6 hours, while livers can be preserved for up to 24 hours.
   An article in eMedicine on Organ Preservation methods states that the liver and pancreas can be reliably stored for 12-18 hours, kidneys for 36-48 hours, heart transplant should occur within 4 hours of organ removal, and lung transplant, ideally, within 6 hours.