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Page A24 SEPTEMBER 2017 FUNERAL HOME & CEMETERY NEWS S ec t i on A
By Matt Black
Embalming
Tips & Tools
The Challenges
of Edema (Part 1)
Over the past several months we have discussed the pre-
embalming treatment of hands at length. Hopefully, we all
agree on the importance and impact that the condition of
the hands and arms have on a viewing. Whether in a pri-
vate setting for only family or for a public viewing, condi-
tion of hands is extremely important. Routine neglect of
the hands and arms is not the correct protocol for care of
the deceased and will undoubtedly result in reduced over-
all satisfaction from the family and public.
As we move from embalming tips of the hands and arms,
I will focus on a condition that is very common but often
fails to receive the special treatment it demands. Edema
is frequently found in the hands and often in the entire
body. Edema is also referred to as dropsy, anasarca and as-
cites. Due to medical advances that have allowed signifi-
cant increases in prolonging life, the embalmer can expect
increased challenges during his or her clinical work.
Edema is swelling caused by fluid that is trapped in the
body’s tissues. The condition results when capillaries (tiny
blood vessels) leak fluid into the surrounding tissue caus-
ing swelling. This commonly occurs in the hands, arms, an-
kles, legs and feet. Leaking capillaries cause the kidneys to
accumulate higher than normal quantities of sodium (salt)
and water to compensate for the capillary fluid loss. This re-
sults in more blood circulating in the body, which in turn
causes even more capillary leakage into the surrounding tis-
sue, which produces additional swelling - a vicious cycle.
All tissues of the body are made up of cells and connec-
tive tissues that hold the cells together. The connective tis-
itself has had some sort of drug therapy, regardless of the
source of the drug. These drugs will influence the PH and
protein cell wall makeup of the bodies we are trying to
embalm. Recall that a high alkaline PH in body has a
neutralizing effect on formaldehyde. Some drug therapy
can cause the body PH to change to an alkaline condi-
tion. In time, this alkalinity will dissipate if the body is
not embalmed due to decomposition of the body. An un-
embalmed body with edema and showing signs of de-
composition will complicate the embalming process. If
we look at the way formaldehyde bonds with protein, as
the progression of decomposition takes place; hydrolysis
of protein in the body exposes more and more amino acid
groups. (Thanotchemistry Dorn and Hopkins). Please re-
member that amino acids are the building blocks of pro-
tein in the body. This effect is showing us that our form-
aldehyde demands have increased drastically.
While it is always preferred that embalming take place
as close to the time of death as possible the demand for
prompt treatment of an edema case increases dramatically.
A traditional approach won’t be sufficient to preserve ede-
ma cases. Why gamble if you’re going to lose? You can pro-
tect yourself with just a bit of prevention. Your future busi-
ness stands on the quality of your embalming.The number
one enemy for edema cases is lack of need
to remember preservation is both bacterial destruction and
stopping the enzyme action in the body. In our next install-
ment, we will continue the discussion of edema.
sue around the cells and blood vessels are known as the inter-
stitial tissues. Most of the body’s fluids that are found outside
of the cells are normally stored in two spaces; the blood ves-
sels (as the “liquid” or serum portion of your blood) and the
interstitial spaces (not within the cells). In various diseases,
excess fluid can accumulate in either one or both compart-
ments... Anasarca (generalized) refers to the severe, wide-
spread accumulation of fluid in all the tissues and cavities of
the body at the same time.
Edema can be associated with: Alcoholism, burns, Cirrho-
sis, Carbon monoxide poisoning, Congestive heart failure, al-
lergic reactions, inflammatory reactions, extended drug ther-
apy, drug use, Renal Failure, Trauma, Lymphatic obstruction,
steroid therapy, venous obstruction, phlebitis, malnutrition,
cancer, hepatic failures and/or obstruction, and surgical and
transplant procedure. (Mayer)
Edema can be localized or generalized. The location of the
edema is an important consideration when planning treat-
ment. The approach and decision we make in edema cases
sets the tone for the grieving process and services for the fami-
ly we are serving. Thorough case analysis is a must when deal-
ing with an edema case.
There are many difficulties the embalmer will encounter.
The most important challenges are: excessive amounts of flu-
ids, swelling, skin slip, leakage, distribution problems, sec-
ondary dilution and formaldehyde demands.
Chemical challenges present when we are faced with high
levels of nitrogenous waste, ammonia, drugs, edema and PH.
By themselves these chemical changes in the body will neu-
tralize formaldehyde. Imagine the feast bacteria would have
in the body in these cases.
With this abundant amount of water in the body, the au-
tolytic enzymes and hydrolytic enzymes could become more
rapid and accelerate decomposition. This extra water gener-
ated by the body could influence the PH, secondary dilution
and formaldehyde demands.
One should remember that in most edema cases the body
Matt Black has been a licensed funeral director and embalmer
in the State of Pennsylvania for over 20 years. He represents The
Dodge Company in Central and Western Pennsylvania. In addi-
tion to being a graduate of the Pittsburgh Institute of Mortu-
ary Science, Matt also holds degrees in Bio-Medical Engineering
Technology and Industrial Management. Matt has also attended
the Fountain National Academy of Professional Embalming Skills,
Springfield, MO, and is licensed in eye and corneal enucleation. He
has presented at Dodge Embalming Seminars as well as numer-
ous local seminars in Pennsylvania. He can be reached by email at
Funeral Home & Cemetery News
Contributors share insights and
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Carriage Services Announces Second Quarter 2017 Results and Dividend
HOUSTON,TX— Carriage Services, Inc.
(NYSE: CSV) announced results for the
second quarter ended June 30, 2017.
Mel Payne, Chief Executive Officer, stated,
“After over five outstanding years of Good To
Great Journey performance records, we had a
relativelyweakearningsperformance inthe sec-
ond quarter of 2017, i.e. GAAP Diluted EPS
of $0.24 (down 20.0% from prior year) and
AdjustedDilutedEPS of $0.30 (down 18.9%)
on record revenue of $63.9million (up 3.2%).
Adjusted Free Cash Flow also decreased $9.8
million in the first half of 2017 compared to
last year. Our earnings underperformance in
the second quarter was primarily related to a
460 basis point decline in our Acquisition Fu-
neral Field EBITDAMargin to 38.0%, a con-
tinuation from the first quarter of weak same
store cemetery sales and margin performance,
a 16.0% increase inTotal Overhead compara-
tive quarter over quarter and a one million in-
crease (6.0%) in the diluted share count for the
second quarter calculated under our convert-
ible subordinated debt formula because of the
share price increase this year versus last.
“We view specific areas of concentrated oper-
ational weakness, i.e. integration of recent fu-
neral home acquisitions and same store cem-
etery sales and margins, as “glass half full”
opportunities for improvement toward our
goal of maximizing the long term intrinsic val-
ue of Carriage. Moreover, we have taken the
opportunity to selectively increase our invest-
ment in quality people within our Corporate
Development, Operational Support and In-
formation Technology teams in order to sup-
port what we believe will be an increased lev-
el of industry consolidation over the next five
years. These specific people investments com-
bined with higher than expected severance
and public company costs led to the $1.2 mil-
lion increase in Total Overhead Expenses in
the second quarter of this year versus last.
“We are only two quarters into the second
five year timeframe of our Good To Great
Journey and have the view that the next five to
ten years will produce performance trends that
confirm the superiority of Carriage’s High Per-
formance Culture Framework as an operating,
consolidating and value creation platform for
the funeral and cemetery industries.”
Carriage has also announced that its Board
of Directors on July 26, 2017 declared the
quarterly dividend of $0.05 per share payable
on September 1, 2017 to common share re-
cord holders as of August 14, 2017.
Carriage Services is a leading provider of fu-
neral and cemetery services and merchandise in
the United States. Carriage operates 171 funeral
homes in 28 states and 32 cemeteries in 11 states.