December 2020

Page A16 DECEMBER 2020 FUNERAL HOME & CEMETERY NEWS Se c t i on A By Wally Hooker, CFSP, MBIE As we face the daily challenges of embalming – which is the temporary preservation, sanitizing and restoring of the dead, back to a ‘natural’ or an acceptable appearance – it should be our goal to ‘pull out all the stops’ to ensure open casket viewing, so that family and friends have the opportunity to say a proper goodbye to their loved one. Often times many difficult obstacles must be overcome. One of the more common challenges we face is moisture content of the deceased. Dehydration and edema (fluid accumulation) are issues we face routinely in our preparation rooms. Both can be extreme and are generally the result of surgical compli- cations, drug therapies or the ravages of disease. As an example, edema can be localized to the face and neck following heart surgery and those areas can be grossly en- larged. Edema can also be generalized (anasarca) and pres- ent in all tissues. The condition where excessive moisture is retained by the cells, is called ‘solid edema’, the tissue is swollen and hard to the touch. It is nearly impossible to overcome with arterial embalming. ‘Pitting edema’ is soft and can be palpated with a finger, leaving a depression that will return when pressure of the finger is relieved. Of the two, ‘pitting edema’ is a more manageable condition we attempt to overcome with arterial embalming, as well as gravity and time, which we will discuss in more detail. It is important to understand the difference between dehydration and emaciation. Dehydration is the loss of body moisture due to disease, sickness and febrile issues. One indicator would be the lips…most healthy adults have vertical lines line on the lips. Dehydration will pres- ent itself in the lips where they become flattened and the lines are horizontal. As we discussed in an earlier column, the pre-case analysis is all-important in these scenarios. Let the body tell you its story! First things first! If someone in our care had gained sig- nificant ‘water weight’ prior to death, we certainly don’t want to compound the situation by adding more water to an already supersaturated body! These bodies are dif- ficult to properly preserve with this additional moisture. Most have been hospitalized for an extended period of time and administered various drugs to fight the disease in an attempt to extend life. As a result, in addition to the edema, their cells will more than likely contain nitrog- enous wastes as a result of the body metabolizing drug therapy. The nitrogenous waste, coupled with edema cre- ates a difficult chemical/physical scenario to overcome. This challenging situation is why it is so important to have a thorough working knowledge of your chemicals. Again, the primary goal in embalming a grossly edema- tous body is preservation and restoration. As we consider mixing our arterial solution for the case at hand much consideration should be given the amount of addition- al ‘water weight’ the deceased has taken on and has re- tained in the intercellular areas of the body. We know water weighs 8.33 pounds/gallon. For example, if the de- ceased had taken on 50 pounds of ‘water weight’ during the final stages of their life, that would equate to slightly more than 6 US gallons. This amount of moisture within the body will certainly be a factor as we prepare our arte- rial solution and select our injection sites. Next month we will look in more detail at the embalm- ing, chemical and physical protocols necessary to man- age edematous cases to ensure open casket results. Until then, stay safe my friends and always go the extra mile in caring for the dead! Dehydration can occur prior to death, as well as following death due to physical or environmental factors. Often the skin is very dry and flaky. Eyelids may be very thin and difficult to close. Following a thorough disinfecting and bathing, I would suggest saturating the face with a humectant. Open the eyelids and attempt to ‘rehydrate’ them by saturating them and plac- ing a small piece of saturated cotton on the eyeball and close the eyelid to the proper position. I use saturatedWebril cotton on the eyelid itself to assist in keeping the eyelids in position. The lips will need humectant as well. As you set the features of the mouth, saturate any cotton you place on the inside with humectant. We don’t want further dehydration caused by dry cotton inside ‘wicking’ the delicate tissues of the mouth. I would suggest a pre-injection using a co-injection, wa- ter corrective (the pH of the dehydrated body will be off) humectant, and enough water to make a gallon of solution. Inject with a low rate of flow with no drainage established and you should be able to introduce the entire gallon with- out swelling the tissue of the face or neck. I would leave the pre-injection solution in the closed vascular system for 20-30 minutes. Let the body tell you what arterial chemical is need- ed and what solution strength. I would mix one gallon at a time and add a bottle of humectant to ‘plump’ the tissue and restore moisture using the restricted cervical injection and restricted drainage. You need extra control over injecting the head. The use of humectants can ‘plump’ and rehydrate the tissue ‘in harmony’ which creates a more natural form. Any shortfall can be overcome using tissue building. Much has been written, spoken about and demonstrated as far as embalming grossly edematous bodies. It remains one of the more challenging cases we face.The goal again is to have the deceased presentable. Often, the families have seen their loved ones in this dreadful condition and look to us to ‘give them back’ their loved one, the way they were before they fell ill. FUNERAL HOME & CEMETERY NEWS www.nomispublications.com Monthly Columns online at Wallace P. (Wally) Hooker CFSP, MBIE, is the owner, funeral direc - tor and embalmer of Family & Friends Funeral Home of Wingate, IN. He and his wife, Janet designed, established and built their funeral home in 2004. Wally is a graduate of Worsham College of Mortuary Science, where he serves on the Advisory Board. He is Past President of the Indiana Funeral Directors Association and board member of North American Division of the British Institute of Embalmers. In addition, he has served as chief deputy coroner/ investigator of Fountain County, IN for the last 24 years. Embalming 101 Moisture Complications www.PremiumQualityUmbrellas.com Buy a Dozen Get a Dozen FREE! Plus FREE 1 Color 1 Panel Print on all 24. No Setup Fee! 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