People find the idea of going without toilet paper a bit shocking, but lots of people around the world do it, and there are good technologies available now to replace your toilet or add on to it. It is cleaner and healthier, and counterintuitively, saves a lot of water. Making a roll of toilet paper uses 1.5 pounds of wood, 37 gallons of water and 1.3 KWh of of electricity.A lot of these bidet style toilets are expensive, as are may of the toilet seat add-ons. The Blue Bidet is only US$ 69, C$79 when I saw it at the local Home Show in Toronto.Peter Gallos explains the Blude Bidet from Lloyd Alter on Vimeo.Peter Gallos tells me that it can be installed in under half an hour. They make a cold water model that just uses the line that supplies the toilet, and a version that uses hot and cold water but needs a more elaborate installation. I wondered if our 40 degree F water would not be a bit of a jolt to the butt, but he says it is such a short blast that it isn't a problem. TreeHugger Justin tried one earlier and wrote in his post Bidets: Eliminate Toilet Paper, Increase Your Hygiene:Interestingly, Blue Bidet does not say that they are eliminating toilet paper, just cutting its use by 75% and using the remainder to dry yourself off.

Perhaps it is too hard a sell to say you don't need any. I will give the thing a try and let you know.More on the Blue BIdet in the USA and in CanadaMore on giving up toilet paper:Plush Toilet Paper: Soft on Your Butt, Hard on the EnvironmentBidets: Eliminate Toilet Paper, Increase Your HygieneUpdate on No Impact Man: The Year Without Toilet Paper Think Like a DoctorVacuum Cleaner On Breast Think Like a Doctor: The Blue Girl Solved!Hot Tub Repair Supplies Think Like a DoctorSolve a medical mystery with Dr. Lisa Sanders.Rustic Aluminum Patio Furniture On Thursday, we challenged Well readers to solve the mystery of a 17-year-old girl who was turning blue. We received more than 400 colorful responses that ran from Smurfitis and the occasional reference to Willy Wonka to the very serious suggestion of methemoglobinemia, a disorder in which patients turn blue intermittently because of abnormal red blood cells that cannot hold on to oxygen.

The correct diagnosis is… Only two of our readers got the right answer, although several others came very close. Of the two, Dr. David Feingold, a pediatric emergency medicine doctor in Paterson, N.J., was first. He said that most of the diseases he could think of that cause a blue discoloration affect the skin all over, whereas this young woman had very patchy involvement. That suggested that it was something on the skin and not in the skin. Strong work, Dr. Feingold! Chromhidrosis, from the Greek for colored sweat, is a rare condition in which people perspire a darkly pigmented sweat from specialized glands on the cheeks, under the arms and around the nipples. The pigment, called lipofuscin, is made from the breakdown products of blood and results in sweat that is usually brown or black, though there have been cases in which it is orange, red or green. Treatment provides only temporary relief. Topical capsaicin, a cream made from hot peppers, can reduce the release of this chromatic sweat, as can injections of botulinum toxin, or Botox.

But basically, chromhidrosis is something that people simply have to learn how to live with. This young woman, though, had pseudochromhidrosis, which is a lot easier to manage. In this unusual disorder, the sweat produced is clear, but it interacts with something on the skin that causes it to turn blue, or sometimes black or red. The most common cause is a bacterium that lives on the skin called Corynebacterium, though other bacteria can do it as well. Antibiotics — either topical or oral — will get rid of the bacteria and the colored sweat. There are also drugs (rifampin is one) and environmental factors (the dust in copper mines, for example) that can cause sweat to become colored; in those cases, treatment involves avoiding the environmental cause. How the Mystery Was Solved: Dr. Jacobien Hoogerwerf, the internist-in-training who examined the anxious young woman at the Academic Medical Center, noticed that the bluish pallor was visible across the patient’s cheeks, chest, arms and back, but not under her arm, in the axilla.

Nor was there any blue discoloration under the girl’s bra. The doctor took an alcohol wipe out and rubbed it hard against the girl’s skin. (You can see a picture of that here.)This was not a condition like cyanosis, or low oxygen, that was causing the skin to turn blue. Whatever this young woman had, it was on the surface of her skin and not within the body tissue. And if that were the case, then the patient’s other symptoms — the shortness of breath, the fatigue, the tingling — weren’t part of some serious systemic disease. Instead, it seemed much more likely that they came from the patient’s worry that she might have something terrible. So where did the blue come from? The patient had worn a dark shirt to the appointment. The doctor asked her if the shirt was new. It wasn’t, the patient told her. She had worn a new pair of jeans the first day the blue coloring appeared, the young woman volunteered, but had stopped wearing them after that. Still, she kept turning blue.

Dr. Hoogerwerf had no idea what was causing the strange discoloration, but she felt like she was close. By now she’d spent over an hour with the young woman and had other patients to see. She referred her to a dermatologist at the same medical center and told her she would read up on problems that can cause the skin to turn colors and call her when she figured out what it was. Turning to Dr. Google: At the end of the day, Dr. Hoogerwerf returned to the puzzle of her blue patient. She checked a few derm books and then turned to her computer. She wasn’t really sure what she was looking for, so she didn’t think the medical search engines she usually used would be helpful. Instead she turned to Google. She entered several terms she thought might be pertinent: sweat; Seconds later she saw the answer. There on the page were entries for two diseases she had never heard of: chromhidrosis and pseudochromhidrosis. She read through the articles quickly with a growing sense of recognition.

This young woman clearly had pseudochromhidrosis. She called the patient as soon as she had read enough to understand what was going on and what the patient could do about it. In some of the cases she read about, patients were given oral antibiotics to treat the chromatic skin bacteria. Dr. Hoogerwerf thought that a topical antiseptic might be enough for a bug that lived on the skin. She suggested that the patient try Hibiclens, a soap that patients are often asked to use before having surgery. They would talk again a week later. It worked, the patient announced to Dr. Hoogerwerf when she called the next week. The blue was gone and hadn’t come back — at least not so far. She had also passed the soap on to her mother, who had developed some blue spots on her hands and fingers that came and went, especially when she was having a flare of her eczema. The patient thought this soap might help her mother get rid of her “blues” as well. Apparently they had both been infected with the same skin bacteria, and the topical antiseptic did the trick.