Organ Transplant

“Don’t take your organs to heaven. Heaven knows, we need them here.” This is a slogan used by the Kidney Foundation of Canada.

Recently, we had “Organ and Tissue Donor Awareness Week”. This is a good way to remind people like me to sign the Universal Donor Card. So I check with my wife if I have signed one. She couldn’t remember.

I check my driver’s license. The new one has no donor card at the back. I check my Alberta Personal Health Card. I see my wife has witnessed my signature where I make “anatomical gift” of organs and tissues for transplantation and research upon my death.

Well, memory is one thing my wife and I should not donate to anyone!

In any case, events like “organ donor awareness week” reminds us of many things in life which we take for granted.

Donation of solid organs and tissues does not start when life ends. During their lifetime, family members and relatives of potential organ recipients help their loved ones when there is a need for liver, kidney, lung, and bone marrow transplants.

But lot more work needs to be done to encourage such donations after death for potential organ recipients who have no family attachment and are not emotionally related to deceased donors.

Why do we need to do this?

Because 150 Canadians on waiting list for organ transplants die every year. In 1997, more than 3000 Canadians were on the waiting list. Only 1600 transplants were performed due to shortage of appropriate organs.

Alberta has done little better. According to Alberta Health, our provincial donor rate has remained on average about 2 percent above the national rate.

Alberta Health’s Province-Wide Services 1998 Annual Report says that in 1997-98, there were 22 heart, 128 kidney, 31 liver, 126 bone-marrow, and 10 lung transplants in Calgary and Edmonton. This is a total of 317, compared to 291 for the previous year. But this is not enough.

How can we improve the situation?

This can be done by: 1) improving public’s awareness and acceptance of the importance of organ donation, 2) adequately train health care professionals to handle the sensitive issue of discussing the options with a grieving family.

There are 4 major stages to be undertaken before the organ or tissue is available to a potential recipient. These are: recognizing and declaring brain death, notifying the organ procurement organization, presenting the option of donation to the grieving family, and clinical care of the brain dead donor.

This is where the Palliser Health Authority (PHA) has made a difference by setting aside $15,000 to formalize the organ donation process in our region.

“Palliser’s contribution is significant indeed. The program is now up and running,” says Mr John Boksteyn, chair of PHA. Medicine Hat will be the first regional hospital to do this.

So, how can we help? 1) Make a decision to be a donor and share your wishes with your family. 2) Decide if you want your organs and tissues for transplant and/or for research. 3) Sign a Universal Donor Card on the other side of Alberta Personal Health Card.

Organs and tissues which you can donate are: heart, lungs, kidneys, liver, eyes, skin, bone marrow, veins, and pancreas. The list may not be complete. Age restrictions are now minimal. People over 80 years may still be good candidates.

So, think carefully. Make up your mind. Discuss with your family and sign the donor card. Otherwise it will never happen!

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Coronary Heart Disease

A good heart is better than all the heads in the world. A healthy heart is, of course, better than all the sick ones!

But how many of us can claim to have a healthy heart?

Not too many!

Although over the past 30 years, death rate from coronary heart disease (CHD) has decreased by 50 percent, the number of people who have heart attacks has not declined. CHD remains the leading cause of death among adults. One of every 5 deaths is due to heart disease.

Our capacity to keep people alive after a heart attack has considerably improved, but heart disease can be very disabling.

How can we change this?

There are certain risk factors over which we have no control. You cannot change your age or genes. Changing sex may not prove worthwhile.

But there is hope! About 40 years ago, researchers recognized that high blood cholesterol level, high blood pressure, and cigarette smoking to be main risk factors for CHD. The good news is that these risk factors can be modified to improve our health.

In the last 7 years, the role of cholesterol in prevention of heart disease and heart attack is better understood and recognized. In most cases, cholesterol lowering diet is the first line of treatment.

If this fails then there are now newer and better drugs to treat this problem. Besides lowering cholesterol levels in the blood, the drugs also work on blood vessel wall and blood cells to reduce clot formation and narrowing. This results in better blood and oxygen flow to heart muscles.

High density lipoprotein (HDL) is good cholesterol. Low density lipoprotein (LDL) is bad cholesterol. And there is triglyceride. All three need to be modified.

When is the best time to have cholesterol level checked? Some experts suggest screening asymptomatic males in their 40s and females in their 50s. Your doctor is the best person to guide you through this. He knows your risk factors and decides at what age screening is justified.

The next modifiable risk factor is high blood pressure. The risk increases progressively with increasing blood pressure. And blood pressure increases with age. It is believed that after the age of 50, high blood pressure may be more dangerous than high cholesterol level.

About 20 percent of population have high blood pressure. Half of these people will have associated heart disease. The vast majority of people with high blood pressure go undetected or untreated. This is dangerous.

It is important that you have your blood pressure checked out by your doctor on a regular basis. He will be the best person to advise you on appropriate diet or medication if there is a problem.

The third important factor is cigarette smoking. Active and to some extent passive (second hand smoke) cigarette smoking is one of the most important modifying risk factors for CHD.

We are well aware of the fact that smoking is a habit hard to break. But Stanford University of California has a success rate of up to 70 percent among people who previously had a heart attack, says the Canadian Medical Association Journal.

A study done in Ontario and California shows that California has the lowest smoking rate in North America, in part because of the state government’s aggressive antitobacco campaigns. Only 19 percent of Californians smoke, compared to 31 percent of Ontarians.

The only way we can keep our heart healthy is to remind ourselves constantly that there are risk factors over which we have control. So have yourself checked out on a regular basis. Exercise atleast 5 times a week, eat healthy, and do not smoke. Having a good heart also helps!

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Skin Cancer (Melanoma)

“Melanoma rates are now rising faster than for any other cancer in men and second only to lung cancer in women,” says Dr. Darrell Rigel, Associate Professor in the Department of Dermatology at the New York University School of Medicine.

There are three types of skin cancers: Basal Cell Cancer, Squamous Cell Cancer and Melanoma. First two are very common and can invade local tissues but are not fatal. Melanoma is not that common but can be fatal if not detected early and excised.

The death rate from melanoma continues to rise about two percent annually. Most skin cancers are due to exposure to sunlight and ultraviolet rays. So, this is a good time of the year to remind ourselves of the dangers of sunrays and ultraviolet radiation.

Skin is not only the largest organ of our body but has many important functions to protect us from environment Skin is constantly exposed to sun, wind, industrial elements and other causes of external and internal injury.

There are more than 25 human disorders that are either caused by or aggravated by exposure of the skin to sunlight.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time outdoors, children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

Can we prevent skin cancer?

Yes! The Canadian Cancer Society recommends the following preventive measures:

1. Avoid prolonged exposure to the sun especially between 11:00 am and 4:00pm.

2. Wear protective clothing, such as long-sleeved shirts, and wide-brimmed hats.

3. Use a sunscreen with a SPF of 15 or higher to absorb ultraviolet rays.

4. For the nose or lips, use a sun block preparation containing zinc oxide or titanium dioxide that will deflect ultraviolet rays.

5. Seek prompt treatment of any skin abnormality.

Skin cancer can be cured if detected early and appropriately treated. If a mole bleeds or is in a place where it gets irritated constantly; if there is a change in size, shape, and colour of a mole then it should be removed.

Prognosis for melanoma depends on the depth of the mole (deeper the mole worse the prognosis). Therefore, full thickness biopsy is important.

Konrad Adenauer, former Chancellor of the then West Germany once said, “A thick skin is a gift of God”. Let us put it this way: “A healthy skin is a gift of God; to be treated with respect and care”.

So have fun but be sun smart!

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Injuries

“Ninety percent of injuries suffered by Canadians are predictable and preventable,” says Dr Barry McLellan, chair of the National Trauma Registry Advisory Committee.

Why are they predictable and preventable?

They are predictable because we know the circumstances under which most accidents occur. They are preventable because, most of the time, the events leading to accidents can be modified.

Injuries can be intentional (suicides, homicides) or unintentional (motor vehicle accidents, falls, poisoning, fires, drowning).

With the weather getting better there are more people on the roads. They are walking, jogging, biking, or driving. Can we do something for them so they can safely enjoy what they are doing?

Yes, the following ten principles of injury prevention are developed from the information contained in the Alberta Motor Association Collision Facts and the New England Journal of Medicine:

1. Do not drink and drive. Why? Because 23 percent of drivers involved in fatal collisions had consumed alcohol prior to the crash. Males between 18 and 21 years old make up the group most likely to have been drinking prior to an accident.

2. Drive carefully on weekends and holidays. Why? The collisions fatality rate usually doubles on long weekends. In 1997, the highest number of fatal collisions happened in August, with Friday being the most collision-prone day of the week.

3. Use your seatbelt. Why? People who do not buckle up are more than twice as likely to be injured as those who wear a seat belt. The current three-point lap-shoulder restraints are thought to reduce the risk of death or serious injury by 45 percent.

4. Avoid common driving mistakes. Why? Running off the road, following too closely and left turns across the path of oncoming vehicles were the most common mistakes contributing to casualty collisions.

5. Be careful if you are young and restless. Why? Traffic collisions cause 7 out of 10 unintentional fatal injuries to people between 15 to 24 years of age. Injuries are the most common cause of death among people 1 to 34 years of age.

6. Be careful on all types of road conditions. Why? Because 60 percent of fatal collisions happen on dry roads. And 70 percent of fatal collisions occur on highways in rural areas.

7. Use children’s safety seat correctly. Why? About 50 percent of car seats are used incorrectly. Air bags can cause deaths of infants in rear-facing car seats. Car seats for children reduce the risk of death or serious injury by approximately 70 percent.

8. Use bicycle and motorcycle helmets. Why? Helmets decrease the risk of head and brain injury by 85 percent.

9. Cross streets at pedestrian crossings only. Why? Injuries to pedestrians are the second largest category of motor vehicle deaths. School aged children are at greatest risk.

10. Do not drive when tired or sleepy. Why? Because fatal car accidents increase by 7 percent in Canada on the Monday after the spring time change. When the Canadians move their clocks back an hour in the fall, collisions drop by 7 per cent. Even an hour of sleep can make a difference!

It was in 1899, U.S. reported the first death related to motor vehicle accident. Are we proud of our record in the last hundred years?

Enjoy the good weather. Be safe!

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