Sunday, July 21, 2013

(Being reworked) Implanting a Magnet II: Trephination, Ancient Aliens, and Spanish Fly

Master, cut away the stone, my name is Lubbert das

The earliest evidence of surgery unearthed by archeologists has been dated to between 5100 and 4900 BC. The remains of a fifty year old man were discovered in a dig in the French Village of Ensisheim which shows evidence of having undergone a procedure called trepanation. Trepanation consists of a hole being drilled through the skull to expose the dura mater beneath. This man had undergone the process at two different times in his life and one of the holes had healed over completely at the time of his death. The second site was nearly finished healing and showed no indications of infection or complication. Although the oldest, these
remains weren't a novelty. Evidence of trepanation has been found in neolithic remains worldwide. Some
theorize that these trepanations were performed to relieve intracranial pressure related to head trauma; however, the remains more often than not show no signs of injury and the purpose of these stone-age surgeries remains unknown. The motivation is most often attributed to an attempt to release the spirits of madness and epilepsy, but with such scant evidence it's unlikely we'll ever really know. An interesting alternative theory is that these trepanations were performed in order to return to the higher state of consciousness enjoyed by children.

Prehistoric Trephinated Skull, Peru
In 1965, Dutch librarian Bart Hughes used an off the shelf Black and Decker brand drill to treppanate himself. In his work, “Trepanation: A Cure for Psychosis” Hughes explained that a hole in the head allows for a more pronounced flow of blood through the brain. This in turn allows for a higher metabolic rate, which he claims we were all gifted with at birth but is lost to us by age two with the closing of the anterior fontanelle. The word Fontanelle, meaning little fountain, was chosen to describe the soft spot on babies heads because they can be felt to pulsate. After all the fontanelles have closed, it's not merely our ability to feel this pulsation that's lost. The cranium becomes a rigid enclosure filled with brain, blood, and cerebral spinal fluid. The surging pressure of systole is opposed by the intracranial pressure of the cerebral spinal fluid and brain matter. Although pressures and flow continue to fluctuate, we lose the heartbeat. Hughes claims that along with this loss of heartbeat, we lose our ability to connect with a higher level of consciousness.

  In 2005 a study was conducted which measured the cerebral circulation of patients who were having minor brain surgeries which required an opening in the skull. Measurements were taken before and after the skull was opened and the results were astounding. Bart Hughes was correct. A hole in the head provides us with what we lost at age two; a heartbeat in the brain. 
Before going any further, I have to interject with my own criticisms. While a select few, such as Amanda Fielding in the video above have trephined themselves and perhaps regained this cranial heart beat, this still doesn't lend any credibility to claims about increased intelligence or consciousness. Do two year old children really represent a higher level of consciousness? From my limited experience, two years of age is the era of mine and I poo-poo-ed. I really do find the idea of drilling a hole in my head... fascinating. Perhaps even tempting, but this is not what this blog is about. Discussing how it was performed however, provides us with insight as to the possible complications a person takes on when performing the far less risky and mundane implantation of a magnet into their finger, which is what this blog is about. The three primary considerations that are common to all surgeries are pain, bleeding, and infection. This blog will explore how we can ameliorate these three factors and will describe and explain the equipment necessary to surgically implant a magnet into a finger.
Immortality, Aliens, and Pain Control

The earliest examples of trepanation may have been found in Europe, but no one did cranial modification like the Meso-Americans did cranial modification. One study found that out of 1500 Mayan skulls, at least 88% exhibited some intentional form of deformation. These deformations ranged from trepanation to molding through cradle-boarding and binding. The Paracas culture developed skull binding techniques so refined that they could change the very volume of space within the skulls. This increased capacity hasn't been found in any other head molding cultures. Paracas skulls from the Chongo dig site have much larger than normal eye orbits and a 25% greater than normal cranial capacity. Chongo skulls always exhibit two additional holes that don't exist in normal skulls, which may or may not have been the result of drilling, and the skulls weigh up to sixty percent more than a normal cranium. Some have gone so far as to suggest that these are not human skulls at all, but are instead the remains of extraterrestrials. The popularity of this idea is furthered by the fact that the Paracas directly preceded the Nazcas and had began creating the giant Geoglyphs known as the 
Nazca lines before the Nazca culture had ever emerged. The Von-Däniken-free explanation for these modifications being so common amongst cultures such as the Mayans, is that they maintained a set of unique cultural values and incorporated cranial modifications as a mechanism of cultural identity. In other words, they were peer pressured into Bonsai-ing the heads of their children. Whether the result of alien invasion or motivated from peer pressure, I think all this head molding was at least partially influenced by drugs. I'm completely serious. The use of Coca leaves in Mesoamerica has been dated back as far as the holocene. Even without being processed into cocaine it's a powerful local anesthetic and people are likely more willing to undergo strange surgeries when they can be performed without pain.
Coca wasn't introduced in Europe until the 16th century and it's effects on cognition wasn't widely recognized until the mid 19th century. In 1859 the cocaine alkaloid was isolated and was immediately recognized as an incredibly powerful topical anesthetic. Even today, cocaine is the anesthetic of choice for eye and nasal surgeries. It's addictive and mind altering properties were soon discovered as well. Less than
a year after its development, cocaine was being marketed and sold by the Parke-Davis company in forms ranging from saturated cigarette wrappers to elaborate cocaine injection sets. Parke-Davis claimed that cocaine “can supply the place of food, make the coward brave, the silent eloquent and... render the sufferer insensitive to pain.” A number of high profile events involving cocaine, including a doctor who had an adverse reaction while performing a surgery which he subsequently botched, soon tarnished cocaine’s reputation and by the turn of the century, cocaine was only being dispensed under order of a physician. 
Cocaine was replaced in 1905 as the topical anesthetic of choice by the synthetic drug Procaine. Procaine isn't addictive, but strangely enough it too became a so-called drug of abuse in the nineteen fifties. Over the years, rumors had developed that Procaine injections could more than merely alleviate pain to the extent that a person would feel years younger. Physician found that patients receiving Procaine experienced a regrowth of hair and the return of hair color. Many patients verbalized relief of arthritis symptoms in joints no where near the site of injection. Some began to theorize that Procaine could reverse aging itself.
A doctor of Geriatrics in Romania began marketing a Procaine containing product called Gerovital H3, which she claimed stops all aging phenomena from occurring and increases a persons intelligence. It

prompted a large number of studies with mixed results. Procaine use without order of a physician became
a serious crime in the United States and new a black market arose that persists even today on sketchy websites and craigslist offerings. The Romanians though have unique cultural values and much like the Paracas shaping of skulls, they incorporated Gerovital H3 as a mechanism of cultural identity. Romania is to Gerovital H3 what Amsterdam is to Marijuana. An entire Gerovital Resort Industry exists in Romania, catering to those hoping to extend their lifespans and expand their consciousness through the use of a substance legally unavailable elsewhere. The Hurculane Resort for example offers access to thermal springs once used by emperors, underground thermo-salt mine baths, massage, and Gerovital H3 injections provided under strict medical supervision. 
Lidocaine was synthesized in 1943 and proved an even stronger anesthetic than cocaine or procaine without those pesky anti-aging and pleasure inducing side effects. In fact, Lidocaine is so mundane that a person can buy it over the counter in topical products that numb the burn of hemorrhoids and prevents premature ejaculation. The injectable form of lidocaine is of course only available for sale or use under the order of an physician but then again so is saline. It's not entirely insipid; if a large dose is administered centrally, such as if injected directly into a vein, Lidocaine can cause seizures, cardiac arrest, and death. Fortunately, these effects are easily avoided by not injecting into a vein and by not using ludicrous amounts. 
Amal Graafstra
Amal Graafstra is a well known grinder and the author of RFID Toys, which explains how to use Radio-Frequency Identification chips to control door locks, disarm car alarms, and effortlessly log in to computers. Graafstra wasn't content to merely carry these RFID tags around. His site, Dangerous Things sells the
equipment necessary for RFID implantation. This includes the injectors used by veterinarians for tracking chips, and lidocaine hydrochloride crystals to manage pain. These crystals can be dissolved in the included tube of saline, yielding our needed 1% solution for injection. These kits only contain 35 milligrams so it's very unlikely anyone would experience any adverse effects. Keep in mind, Graafsta isn't technically selling these things for use on humans so a person can't really recommend actually reconstituting this stuff and injecting it. Or he's at the very least vague about it. It's something like Cathinone containing bath salts which are clearly labeled not for consumption; if you smoke the Ivory Wave and then eat someones face, you can't really blame a vendor.

Are You Experienced: Local Anesthesia and Digital Nerve Blocks for the Skill-less

The term Nerve Block refers to the injection of an anesthetic directly onto a nerve to block the transmission of sensation. A few quick injections with a local anesthetic can immediately and completely eliminate the pain of broken ribs, migraines, and herniated discs for up to twelve hours. It's an underused modality. Nerve Blocks are often more effective and in many cases safer than a systemic analgesic like morphine; however, for the average physician performing such a nerve block comes with a heightened risk of lawsuit not justified by mere pain. Additionally, many physicians simply aren't called upon to perform nerve blocks often enough to feel comfortable. The exception to this is with digital nerve blocks. It's so simple and low risk to block the nerves of the fingers that no one would even consider stitching up a laceration without numbing the digit first.

There are two different approaches to a digital nerve block: the Volar/Dorsal approach and the Transthecal approach. An excellent step-by-step pictorial guide on digital nerve blocks is available online from the New York School of Regional Anesthesia, which demonstrates both techniques. Don't let this guide intimidate you though. I've seen plenty of finger laceration repairs and seldom does an ER doctor first contact the bone and then pull back. An effective digital nerve block can be accomplished simply by injecting 1 to 2ml of lidocaine into each side of the finger distal to the metacarpophalangeal joint.
Digital nerve blocks are pretty simple but do come with risk, so as always, I'm certainly not advocating that a person do this to themselves. I'm primarily writing this up because I've seen youtubes of people doing such damn bad jobs on themselves and I hope to provide those foolish enough to perform self-surgery with enough information to avoid permanent damage. Lidocaine does have a cardiac effect and so injection into a vein must be avoided. The way to ascertain whether or not a needle is in a vein is through aspiration. If one pulls back on the syringe plunger and blood enters the syringe, it's in a vein. Pull out and start over. Some nerve blocks use lidocaine with epinephrine, but this isn't good for use in fingers, so use an anesthetic only. Of course, a digital nerve block should only be performed with aseptic technique, and finally, don't force anything. If there is resistance to injection, you are likely someplace your not supposed to be.

Steps of a digital nerve block:
  1. Using blunt draw needles, draw up Lidocaine solution into a 5ml syringes and then attach a 25-gauge, 1” or less length needle.
  2. The first needle is inserted at a 45 degree angle to the skin into the appropriately cleaned webbing lateral to the finger of choice and distal to the metacarpophalangeal joint and 0.5ml of lidocaine is injected just beneath the skin. Do not remove the needle.
  3. After waiting 20 seconds the needle is advanced ¼ to 2/3 of an inch deeper. Traditionally, the needle is advanced until the phalanx bone is reached, but ¼ of an inch will more than suffice . The needle should be angled so that if it were to be fully advanced, contact would occur near the antero-lateral surface of the phalanx.
  4. Aspirate (pull back) the plunger of the syringe. If blood is aspirated into syringe, then the needle is in a vein and the procedure should be aborted and begun again at a different location.
  5. If needle is not in a vein, inject 1-2ml of Lidocaine. Resistance to injection should be small. Do not be forceful. If resistance to injection occurs abort the procedure and begin again at another site.
  6. After injecting, needle is removed of disposed of into an appropriate receptacle such as a sharps container (Gatorade bottles work well).
  7. Insert needles into the second site at a 45 degree angle to the skin into the appropriately cleaned webbing medial to the finger of choice and distal to the metacarpophalangeal joint and 0.5ml of lidocaine is injected just beneath the skin. Do not remove the needle.
  8. After 20 seconds advance the needle ¼ to 2/3 of an inch and aspirate. If blood is aspirated into the syringe, abort the procedure and begin again.
  9. If needle is not in a vein, inject 1-2ml of Lidocaine.
  10. After injecting, needle is removed of disposed of into an appropriate receptacle such as a sharps container.
Within 5-10 minutes, a person will have a completely numb finger, ready for magnet implant. Always keep in mind how exceedingly dangerous a lack of sensation is. Pain prevents us from injuring ourselves. Without sensation, one can casually lop off, burn, mangle, or otherwise destroy their finger merely through inattention. An anesthetized finger should be thought of like a sterile field: don't let it out of your sight.

Ancient Antisepsis and Modern Barbarism

Speaking of sterility, another fascinating aspect of ancient trepanations is the procedures high survival rate. It's easy to identify those who didn't “make it” because no healing of the bone occurs. Our neolithic surgeon friends used antibacterial agents to clean the area to be trepanned, as evidenced by a survival rate in some regions being higher than 90%. This is amazing when one considers that as late as the 1850's, physicians in the western world didn't so much as wash their hands. More than one in ten who gave birth in Vienna General Hospital during the early nineteenth century contracted an infection called puerperal fever and died. This wasn't even because of surgical procedures; doctors regularly performed vaginal exams after handling cadavers. The Mayans were a 2000 B.C. culture that never mastered metal or wheels and which worshiped corn as a god. They performed a procedure that equates to brain surgery and yet the patients had better outcomes than women in labor a mere 150 years ago.
Emmanuel Semmelweis was amongst the earliest of western physicians to recognize that clean hands save lives. Semmelweis introduced the use of a chlorinated lime solution to clean the hands between working on mothers and the dead. In spite of the rate of fatal infections falling from 10% to less than 1%, Semmelweis and his hand washing was largely ignored. He began writing scathing letters to prominent doctors accusing them of being murderers for infecting their patients. Semmelweis was subsequently committed to an insane asylum where he was horribly beaten and ironically died from an infection. Within a year of his death, Pasteur conducted experiments demonstrating a relationship between disease and germs. Semmelweis was vindicated although it was a sadly empty postmortem kind of victory.
Semmelweis was amongst the first in the modern western world to recognize the value of handwashing and antiseptic agents, however; it had been discovered and used in many far older cultures. Egyptian Papyrus have been found that dates back to 1600 BCE which describes not only the ol' rooker cheest, but also the use of antiseptic agents such as honey. The Mayans used an antiseptic tinctures from the bark of the cinchona
tree from which quinine would later be isolated. Pre-surgical cleansing with such a tincture explains how the Mayans managed such a high rate of survival. The Mayans were skilled surgeons. Of that, have no doubt. But they were also quite deserving of their “barbaric” reputation. They scarred and bled themselves and sacrificed the lives of prisoners, but
I'm not sure that I consider cutting out someones heart with an obsidian blade to propitiate a god significantly more barbaric than having a man beaten to death to appease ones bruised ego. Similarly, the Chongo were perhaps a tad barbaric for all the skull drilling and binding, but your sitting here reading this with the intent of cutting open your finger to put a magnet inside. It's simply a different location on the barbaric caveman spectrum.
Quats and Chlorhexidine Gluconate Products
Semmelweis used Calcium Hypochlorite. It's still used to disinfect drinking water but has been replaced in medicine by more effective agents. The two classes of antiseptic agents used to prepare for a magnet implant are the Quaternary Ammonium Compounds and Chlorhexidine Gluconate. The Quaternary Ammonium Compounds, also known simply as Quats, are highly lethal to nearly all infectious agents including bacteria, amoebas, fungi, and many viruses. Quats is excellent for use in disinfecting the surfaces and objects to be used for surgery. It's available in a product called Super Sani-cloths, which also contains iso-propyl alcohol making it lethal to an even broader number of pathogens. Quat wipes should be used according to the directions on the products labeling. The stuff doesn't provide an instant kill, but rather requires a certain period of “wet time.” This is usually 2 minutes or so, but it varies depending on the pathogen. MRSA for example requires up to five minutes of wet time, while TB and HIV only require one minute.
Chlorhexidine Gluconate is optimal for use as a topical antiseptic. It's safe enough that it can be used in mouthwashes and contact lens solutions, yet strong enough that it's the most commonly used agent in pre-operative skin preparation. Chlorhexidine Gluconate acts slower than agents such as Quats. It's real advantage is that it has a very prolonged action. Once applied, it continues to function for a number of hours. A person can take advantage of this prolonged action by cleaning the surgical site 3 times prior to making an incision. The first application of Chlorhexidine Gluconate should be preceded by a good ol' fashioned hand scrubbing as chlorhexidine is deactivated by remnants of soaps and oils that can accumulate on the hands. This first application should occur an hour prior to the procedure. The second application should be thirty minutes prior, and the final application should be immediately prior to incision which is to occur as soon as the third application of Chlorhexidine Gluconate is dry.
One element used to prevent infection which has no ancient corollary is the use of sterile barriers such as surgical gloves, gowns, and masks. A gown isn't necessary for our procedure but one should use a pair of surgical gloves and a face mask. The face mask doesn't need to be anything special; a cheap painters mask will work. The gloves on the other hand, really should be a set of sterile surgical gloves and not merely cheap exam gloves. Unlike exam gloves which come in small, medium, and large, sterile surgical glove are available in sizes ranging from 5.5 to 9.0 and it's important you find the correct size. The above chart can help you estimate the right size and I advise to always go up a size if unsure. 

Intraoperative Hemostasis
Another consideration common to both trepanation and our far less invasive magnet implantation is the control of bleeding. The amount of bleeding from a hole in the head is less than one might expect. As a student, I observed a physician perform a trepanation (the modern terminology is craniotomy) on a patient at the bedside. The procedure was performed for the placement of a Jackson Pratt drain; beyond this I don't recall the details. The instrument used was similar to a corkscrew and resulted in very little bleeding as the outcome was a very small burr hole. Larger craniotomy procedures require the skin of the scalp to be pulled away, and there are blood vessels within the skull bone itself, all of which lead to a significant amount of blood. Hemostasis is achieved through cauterization, which is the control of bleeding through tissue destruction. Cautery is amongst the oldest of methods to stop bleeding and it doesn't necessarily refer to burning of a wound with a hot iron. Chemical cauterization using Cantharidin was described by the ancient Greek physician Hippocrates. Cantharidin is a powerful vesicant that is still used today to burn off warts and cauterize blood vessels for intractable nose bleeds. This chemical is produced by the infamous Lytta vesicatoria, or spanish fly. The Spanish Fly is an emerald green beetle which has long been alleged to have 

Lytta Vesicataori

aphrodisiac effects. Cantharidin taken orally can cause priapism in men, but in women causes nothing more than blistering and a sensation of burning in the genitalia. When one considers the widespread historical prevalence of cultural practices such as female genital mutilation and enforced chastity, I guess it's not all that surprising to think men historically equated a burning and blistering crotch with feminine arousal.
Another means by which bleeding can be controlled is with the use of a tourniquet. The use of tourniquets seem to have been completely unknown in the western world until Alexander the Great invaded the Indus River Valley. In 326 BC, Alexander faced the armies of King Porus, who would prove Alexanders most successful opponent. During this battle, Alexander the great conquered the very fortress of Aornos which according to Greek legend even the might Herakles had failed to do. Although Porus lost the battle, he won the respect of Alexander who allowed him to retain his Kingship. During this battle a number of Alexanders troops were bitten by snakes unfamiliar to Greeks. The Hindu physicians introduced the use of tourniquets to the Greeks, although their use was contested in the west for centuries to come. Even Galen, the most celebrated surgeon of Rome criticized tourniquets because he claimed they increase bleeding rather than preventing it.
In a way, Galen was correct. The blood vessels which supply oxygenated blood to tissue are the arteries. Arteries are high pressure vessels which lead to the smaller arterioles which then feed the capillaries. Capillaries allow the diffusion of gasses to take place between tissue and the blood before the blood passes into venules and then veins. Veins are low pressure vessels which require a system of valves to move blood upward again to the heart. A loosely applied tourniquet only occludes the vein without affecting the incoming arterial blood supply. This fact is taken advantage of by phlebotomists and junkies alike in that placing a strap around the arm causes the veins to become engorged and easier to find. In the case of a wound, a loose tourniquet is a disadvantage because it increases venous blood loss without preventing arterial blood loss. A millennium and a half later, English physician William Harvey accurately described this circulatory pathway; blood pumped by the heart passes through arteries and is returned by veins. A french surgeon took advantage of this new understanding and invented a better tourniquet incorporating a screw device which one could turn and tighten until full hemostasis was achieved. It's from the french word tourner, “to turn” that we get the name tourniquet.
Fortunately for us, the arteries of the finger are small and we won't need anything fancy. While implanting our magnet, we can prevent any significant amount of bleeding from occuring with a simple hair band looped tightly around the base of the finger. It's easy to figure how tight you'll need the hair band to be using the capillary refill test. If you squeeze the nail of your finger, it presses out the blood. When you release the nail, you can watch it rapidly regain color indicating the refilling of the capillaries. If you have the hair band on tight enough, this refilling is either non-existent or very slow. This will prevent bleeding intraoperatively, but we still need a solution to stop post-procedural blood loss and for wound closure. We'll achieve this closure using sutures.

Selection of a Suture
Suturing is likely as old as the use of thread and needles. The earliest reports of wound suturing date back to 3000 BC. The Ancient Egyptian medical papyri are full of incantations but for a nasty cut it seems a catgut knot sufficed. Some African cultures use ants from the genus Dorylus, as “Army Ant Sutures.” The soldier class of these ants have large powerful mandibles. Although still capable of stinging, these ants generally rely on their jaws to tear into prey and threats alike. The soldier ant is pressed to the wound and once it bites, it's head is twisted off. This ant-head suture can hold a wound closed for a number of days before another ant needs to be applied. Were fortunate that we don't have to resort to army ants or strips of intestine. Sterile suturing kits are inexpensive and easy to get. Suturing of a wound however, isn't as simple as shoving a needle and thread through your finger and tying a bunch of granny knots. First, consider the size of suture. The sizing scheme of sutures is similar to the sizing scheme of injection needles and IV catheters; the larger the number, the smaller the suture. For fingertips, a 3-0 or 4-0 will suffice. Anything larger makes scaring more likely and anything smaller may be too weak.
Then there's the choice between absorbable and non-absorbable. Use a non-absorbable stitch, as they are less tissue reactive and less likely to cause a scar. There are braided and non-braided sutures. I prefer a braided suture because the knots seems to hold better but braided sutures come with a slightly increased risk of infection. There are many different material used for sutures each providing a tradeoff of features. Some materials such as Vicryl are relatively weak and short lived. Vicryl is selected due to its low propensity for causing scarring. There are also material like nylon that aren't much different than a length of fishing line. The result from nylon are often unsightly but it's very strong. Silk fills a niche somewhere between these two extremes and is a pretty common choice. Silk is my preference and what I advise other use.
3-0 braided silk with a curved needle
Suture needles come in two varieties, straight or curved. I much prefer the curved variety, although some like
6.25'' Rankin-Crile Forceps
that the straight needles can be used without a needle holder and forceps. This may be the appropriate choice in a fox hole, but otherwise get yourself some tools. There is also a choice between tapered and cutting needles. A cutting needle is preferable to a tapered needle as it makes it easier to pass through the
5.5'' Curved Kelly Forceps
skin, although either will suffice. The optimal type of suture for our application, in my humble opinion, is a 3-0 braided silk with a curved needle. There are a lot of other variables such as the amount of curvature, and whether the tip is reverse-cutting, side-cutting, or conventional. 

These factor are all quite important if one is performing vascular surgery or working in deep wounds with confined spaces. We're dealing with a small incision in the finger, so these features aren't particularly important.  
Placement of the suture requires forceps, a needle-driver, and scissors. A needle driver is essentially just forceps without teeth on the gripping surface so using two sets of forceps works is fine. My preference is one 5.5” curved Kelly forcep, and one 6.25” Rankin-Crile forceps. Of course, picking the right suture and tools isn't enough. You have to know how to use 'em.

Suturing a Wound
Eighty to a hundred bucks will purchase a suturing simulator. There are a number of different models, but they generally consist of a bit of surgical tubing and a weighted base. No really, they're just a bit of surgical tubing and a weighted base for a hundred dollars. For a buck or so, you can make an even better model at home. I've found that a standard kitchen sponge stapled to a piece of 2X4 provides an even more stable surface than that provided by the “professional” simulators.
It's worth the dollar or so investment as you really want to master a one-handed suture knot prior to performing your implant. A person might wonder why they would need to learn some fancy suture knot for such an uncomplicated laceration. Sure! Ten granny knots would hold the wound together just fine, but it lacks finesse and swank. Furthermore, you'll only have one good hand.
A one-handed suture knot is performed as follows:

Once a person has a one-handed knot mastered, they should make a nice deep incision in the sponge to learn control of how tight to make the knot. The goal of suturing is to get the dermis from both sides of a laceration to touch. The entry point of the needle should be 3-4mm from the edge of the laceration and the exit point should be 3-4mm from the opposing edge. The suture should pass all the way through the skin into the underlying subcutaneous tissue. Our sponge doesn't replicate the changes in resistance that real skin provides and some people advocate using pig skin as it provides a similar feel to human skin. I don't feel this necessary, but it certainly can't hurt. Practice by inserting the suture needle at a 90 degree angle to the skin (sponge). Once the needle passes through the skin into the subcutaneous layers, the wrist is turned to drive the needle through the tissue and out of the skin on the other side. Once the needle can be visualized exiting, grasp it beneath the tip using forceps and pull it completely through drawing the suture through. Then, perform the above explained one-handed suture. The knot should be tight enough that the edges of the laceration touch, but not so tight that edges start bunching together. While practicing, it's fine to make a few loose knots which are easy to untie, but when actually tying a wound one should make as many as ten knots. The later knots have no impact on how tightly the wound edges are held together so feel free to use a granny knot and make it as tight as you'd like. 
Scalpels and Incisions

10a Disposable Scalpel
There is much to be said about selecting the appropriate scalpel, the proper grip, and different incision methods; however; I won't be the one to explain it. An excellent series of videos and online exercises is available through the Texas A&M University Veterinary Medicine and Biomedical Sciences Division. Sure, it's actually meant for veterinary students but flesh is flesh, and a review of these videos and exercises will definitely help you feel more confident before you start cutting. My preferred implement is a Number 3 scalpel handle, fitted with a number 15 blade. I also advise having a 10a disposable scalpel, which is much like the number 11 blade in the exercises only shorter. This provides you with the ability to make extremely precise and small secondary cuts if your initial incision isn't up to par.
I choose to use a disposable number 11 scalpel in particular, because the body is made of a non-ferrous material which I find useful as a tool to push the magnet into the pouch created. 
There is a lot more to be said about planning where your incision should begin and end, and determining if your cutting too shallow or too deep. These concerns will be addressed in the next blog, which will be a step-by-step performance of a magnet being inserted.

Conclusion: Your Shopping List
Hopefully, at this point you have a rather deep understanding of the tools and supplies a person needs in order to safely perform a magnet insertion into the finger. There is one final consideration which I haven't discussed: Cost. Remember that one can have a magnet implanted by someone such as Steven Haworth for as little as 200 dollars and the cost of travel. Lets tally up the cost of all the above suggested products. Each picture will also link to a site selling this product.

Dangerous Things Pain Management Kit 39$

Super Sani-Cloth Wipes 20.00$

Chlorhexidine Gluconate Swabs 54.00$

Surgical Gloves 26.00$

Hair Bands 2.00$

Sutures 30.00$

6.25'' Rankin-Crile Forceps

5.5'' Curved Kelly Forceps

Product Image
#4 Scalpel Handle
#15 Blades

     Were a person to buy each of the above items at the stated cost above, they could affored to instead have the procedure performed by Haworth assuming they lived somewhere close by. In fact the above stated costs don't so much as include shipping. Of course, you'd be left with a pretty well stocked medical pantry. Alternatively, you could purchase your supplies from my well stocked medical pantry. First of, one has to purchase their Lidocaine Crystals directly from Mr. Graafsta at Dangerous Things. The rest of the supplies, from Sani-Cloth to Scalpel, can be ordered from me for mere... 60.00$ US, plus shipping. And as a special bonus, I'll throw in a free N52 Neodymium Iron Boron magnet coated in Parylene. One might also consider purchasing a Resin and Parylene Coated N52 as describe in this blog.
     Regardless of where you purchase your equipment, remember that everything described here comes with risk. I feel that the benefit of modifying myself through the aquisition of another sensory modality outweighs this risk.  Being able to sense the electromagnetic spectrum through the implantation of a magnet, provides us with a means of feeling the world in a way that no previous generation ever experienced. As such, and in spite of the risk, I feel a magnet implant is an augmentation worth considering.


  1. This comment has been removed by a blog administrator.

  2. This comment has been removed by a blog administrator.

  3. This comment has been removed by a blog administrator.

  4. This comment has been removed by a blog administrator.

  5. This comment has been removed by a blog administrator.

  6. This comment has been removed by a blog administrator.

  7. This comment has been removed by a blog administrator.

  8. This comment has been removed by a blog administrator.

  9. This comment has been removed by a blog administrator.

  10. This comment has been removed by a blog administrator.

  11. This comment has been removed by a blog administrator.

  12. This comment has been removed by a blog administrator.

  13. This comment has been removed by a blog administrator.

  14. This comment has been removed by a blog administrator.

  15. This comment has been removed by a blog administrator.