Health Matters: Transplants

MAY 21-27, 2012

HEALTH

MATTERS PATIENTLY AWAITING TRANSPLANT

The Voice supplement › page 25 /26/31/32

CANCER › SEXUAL HEALTH › HEART › OBESITY › STRESS › DEMENTIA...

INSIDE: › WOMAN’S WAIT FOR KIDNEY

The story of undeterred hope

› PROSTATE CANCER REVISITED A doctor's guide to prostate health

› Fizzy makes fat Are high sugar drinks increasing obesity?

26 THE VOICE JUNE 21 - 27, 2012

Connie dreams of a normal life as she waits for a kidney match

By Bart Chan

just one of those things which is part of the parcel.”

T

HE MACHINE that keeps Connie Simmons alive hums like it has a life of its own. From time to time enigmatic beeps pierce the hushed atmosphere of the St Pancras Hospital ward, where a dozen or so patients are undergoing dialysis treatment.

Simmons lies on her hospital bed watching television on a mini-portable device. When there is nothing worth watching she leafs through a newspaper or reads a book. It can get boring, she admits, however it is the reason she is alive.

“What the machine is doing for me is taking the place of my kidneys, so this is my kidney.” The dialysis machine begins beeping again, Simmons makes an effort to lean out of her bed and press a button to silence it. “It is taking the poisons and toxins out of my body, because as I’ve gone into kidney failure I’m not able to do that on my own anymore. So the machine takes over.”

ROUTINE Simmons has known for the last 21 years that her kidneys would fail. It was only in November of last year that she had to receive dialysis, when her kidney function dropped below 10 percent. Dialysis has become a significant part of her routine; she must undergo 12 hours a week, which requires that she comes into hospital three days a week, and having to lie in bed for four hours each time while the machine does its job. “For ordinary people, their kidney is constantly working for them 24 hours,” she says, knowing that it has been much too long a time since she could take her kidneys for granted.

The treatment does wonders though. “I feel well and I am able to carry on my day as normal,” Simmons says, and it allows her to keep working as well. She works in a bank as a Customer Accounts Manager, and on Tuesdays and Thursdays, after her early start at the hospital (she arrives at 6:30am), she goes back to the career she has had for the last 34 years. She says being at work is a good thing, her colleagues are supportive and the ordinary aspects, like talking to her customers, help. “It takes my mind of my problems.”

The bank manager became aware of her kidney problem during the early stages of her pregnancy 21 years ago. Three

MODERATION

TREATMENT: Connie Simmons gets treatment on dialysis machine.

“

Just to be able to get up in the mornings, do my daily things and not be thinking about dialysis that is just really what I want

”

weeks into her pregnancy it was discovered that she had a high amount of protein in her urine, indicating that “there is a problem with the kidney, I had high blood pressure which is another sign of a bad kidney.” She believes her kidney failure is a result of an infection she may have contracted in that area. Nonetheless, the early diagnosis of her condition has enabled her to be closely monitored, greatly decreasing further risks.

DIFFICULT In addition, having gone 21 years knowing that her kidneys would eventually fail gave Simmons all the time she needed to learn about her condition. “It was very difficult, but I realised I used that time to become very knowledgeable about kidney failure, learn about all the importance of food, the ones that are good for your kidney, the ones that are not good.” She carefully

adjusts her body position in bed, tubes dark red with her blood like a spaghetti junction spiral from her right arm to the machine. “I just really read up everything about the disease and was well prepared when I did go into kidney failure.”

Dialysis has meant her life must be interrupted, yet Simmons strives for normalcy.

“It has changed my life dramatically, but the way I go about the dialysis is that I just have to be positive, and I just think positively that one day something will happen for me, one day I’ll get some help somewhere and I’ll be able to live normally.” The emotion is evident in her voice. “At the end of the day it’s a treatment that‘s helping me, and that is what keeps me going. It lets me lead a normal life, and that’s what I’m grateful for.”

But the point is that there is someone out there who could return Simmons’ life to what it once was. She has a brother and he could be a match. But the sad thing is that he is not willing. “He’s decided that he can’t help me, which means that now I have to wait for someone on the outside, either someone that’s died or someone coming forward to help me.”

to have accepted and moved on from her brother’s refusal.

She can take heart from her 21 year-old son though, who has already offered his own kidney to his mother. However, that is currently not an option.

Simmons says the medical profession deems her son too young to donate, for boys do not reach full maturity until the age of 25. “They are waiting until he is a bit older to see if he’s a match.”

It is not only her own plight she is concerned with.

Simmons desperately wants more to be done so others like

her do not wait in limbo, unsure if they will get the organ they need. In her opinion, not enough people who could make a difference are in the know. “I think if there was more awareness they would find it in their hearts to come forward. There’s over 7000 people waiting for a kidney transplant, it would help so many people.”

Simmons stops mid-sentence and winces in pain; her legs are suffering from cramp. “Cramps can be quite painful, it’s one of the drawbacks of dialysis, but you kind of get used to it. It’s

TRANSFORM There is no one else on this planet who is as close a genetic match as her sibling, so it is most likely one of his kidneys could transform his sister’s life. Simmons appears

LIFE SAVER: The dialysis machine.

After the pain receded, Simmons talks of the future, a future with a new kidney. She knows what she will do: “I’d start to be able to eat and drink all things I’m restricted from. And I’d have a big party, but all in moderation.”

It is fair to say moderation is not a word she utters with full conviction. “The first thing I will do is eat steak and kidney pie, I will have a steak and kidney pie party.”

A broad smile radiates across her face as Simmons pictures this happy future. Yet the realisation of its uncertainty is upsetting. “I would be just overjoyed to know that I could get a kidney and hopefully that kidney would work for me, and I’d be able to function normally again and do the normal things in life.”

This future where everything works out is what she cherishes; “The dream for me is to be able to be fit and well, and see my son graduate and get married one day.”

Simmons fights back the tears, her artificial kidney hums and whirs, oblivious to its vital function.

The mother and bank worker wants back her old life: “Just to be able to get up in the mornings, do my daily things and not be thinking about dialysis that is just really what I want.” She rests her head back on the hospital pillow, her voice sounding melancholy: “I just wish I could get a kidney.”

JUNE 21 - 27, 2012 THE VOICE 31

Prostate Cancer – An expert tells why testing can save your life

By Dr Frank Chinegwundoh

P

ROSTATE CANCER is the most common cancer in men in the UK, accounting for a quarter of all male cancers.

Approximately 37, 000 new cases are diagnosed each year, which is approximately 100 new cases per day. It affects mainly men in late middle age and old age.

In the UK a man has a 1-in9 chance of being diagnosed with prostate cancer. About 10, 000 men a year will succumb to prostate cancer. The outlook for a man with prostate cancer is good, if the disease is caught early before it has spread. Unfortunately, in the UK approximately 25% of prostate cancer is diagnosed when the illness cannot be cured, although there are treatments that will prolong life.

In 2006, I published a paper, which has subsequently been confirmed in larger studies, showing that black men in the UK had a three-fold greater risk of being diagnosed with prostate cancer than their white counterparts.

This echoed data from the USA. The reason for the racial disparity which holds true all over the world is currently unknown. Research is concentrating on genetic factors.

Whether higher rates of prostate cancer translate into a higher death rate is the subject of debate. American data would suggest that black men are more likely to die of prostate cancer than white men, but preliminary UK data does not support this. Of course the health systems are different.

Dr Frank Chinegwundoh

GP will refer the man to an urologist, who is a specialist in urinary system disorders.

There is an obligation on the NHS to be seen by the specialist within two weeks.

The urologist will organise a biopsy of the prostate. That is called a transrectal ultrasound guided biopsy (or trus biopsy for short). Commonly 12 samples (cores) of prostate tissue obtained are sent to the pathologist for analysis. If prostate cancer is confirmed, further tests are done to gauge

radical prostatectomy surgery to remove the prostate gland altogether. This removal can be effected through a traditional open operation through the lower abdomen or by “keyhole” surgery or by the new technique of using a robot to assist the surgeon (robotic radical prostatectomy).

DOSES An alternative to surgery is the use of external radiotherapy in small doses daily for seven weeks.

For some patients it is possible to offer brachytherapy, which is a day case procedure implanting tiny radioactive pellets into the prostate, where they lie permanently and give off radiation to destroy the cancer. The radioactivity lasts for a few months but by then the cancer is destroyed.

Other techniques of eradicating the cancer are less widely available but nonetheless sound treatments, such as high intensity focused ultrasound (utilising heat energy to destroy the cancer) and cryotherapy (utilising extreme cold to target the cancer). The patient is advised to discuss availabilities of treatments and the advantages and disadvantages of each. Side effects do need to be considered. These may include sexual problems and urinary leakage issues.

The clinical nurse specialist is in a position to further advise the man, over and above the urologist. There are also charity help lines that can assist.

For those men whose cancer has already spread by the time of diagnosis (metastatic cancer) the mainstay of treatment is hormonal. This is by way of

Further information on prostate cancer and how to combat it is available from Cancer Black Care http://www.cancerblackcare.org.uk/ Prostate Action http://www.prostateaction.org.uk/ Dr Chinegwundoh http://www.urologyconsultant.co.uk Prostate cancer charity http://www.prostate-cancer.org.uk/ Donations to Cancer Black Care to aid in the work of this black led charity, via the website or by post, will be gratefully received.

drugs (or surgical removal of the testes) to reduce the testosterone levels. This is because testosterone fuels the growth of prostate cancer; therefore lowering it stops the cancer in its tracks. There are side effects of such treatment, but these are tolerable. While hormone therapy is effective it eventually fails.

DRUGS Where first line hormonal therapy fails, which can be several years down the line, the oncologists have several new drugs in the locker. Such powerful drugs, such as docetaxel, abiraterone, cabazitaxel and others, prolong survival but are unable to cure prostate cancer.

Voluntary organisations such as Cancer Black Care (CBC) provide a valuable source of information and support. Such groups are an adjunct to the statutory services and are worthy of support from the community.

Awareness needs to be raised in the black community about prostate cancer. Men should be encouraged to get themselves tested annually.

Dr Frank Chinegwundoh is a Consultant Urologist in Harley Street, London and Chairman of Cancer Black Care.

SYMPTOMS It is important to appreciate that prostate cancer may be present even if there are no urinary symptoms. Or it can be linked with urinary troubles, such as a poor urinary flow, passing urine frequently or at night, or having to reach a toilet in a hurry. Recent onset of erection difficulties may also herald prostate cancer. Most men with urinary symptoms will not have prostate cancer, but it is only by seeking expert medical advice that prostate cancer can be excluded.

Crucial to the diagnosis is the blood test PSA, which stands for prostate specific antigen. This is a chemical made by the prostate gland and extruded into the bloodstream.

The normal PSA should be below 4 ug/l. A level above this suggests that prostate cancer may be present. Prostate cancer is also suggested by the prostate feeling “hard” on digital rectal examination as opposed to the normal “rubbery” feel. Many black men are reluctant to have a rectal examination.

The author in talking to

Cancer Black Care is a registered charity since 1996, supporting predominantly black and ethnic minority cancer sufferers and their families. groups of men, on behalf of Cancer Black Care, reassures them that such a quick examination is nothing to fear and indeed can save their lives.

ADVISABLE Every man over the age of 50 is entitled to a blood test on request to their GP. The earlier prostate cancer is diagnosed the more the treatment options and the greater the likelihood of cure. Waiting for symptoms may be too late. As black men generally develop prostate cancer at a younger age than white men, it would be advisable to start PSA testing at age 45. Prostate cancer can be “hereditary,” therefore prostate cancer in the family should lead to a request for PSA testing from the GP. If the PSA is raised or the prostate feels abnormal, the

the extent of the disease. The tests may include a MRI scan or CT scan or bone scan.

These will determine if the disease is confined to the prostate or not. Each case is discussed by a multidisciplinary team, comprising urologists, nurse specialists, oncologists (cancer experts), radiologists (imaging specialists) and pathologists, in order to recommend a treatment plan for the patient.

Not all prostate cancers need treating. Especially where the cancer is small and the PSA relatively low, there is a good chance that the cancer may lie dormant and never cause a problem. Thus some cancers can be kept under surveillance.

However, where the decision is to treat the prostate cancer, there are various options when the disease is confined to the prostate. Such options include

We are looking for motivated individuals to join our board of trustees or to volunteer experience and skills in fundraising, grant writing, welfare rights, cancer awareness raising, newsletter production, administration.

If you have some time to commit to four board meetings a year and would like to be part of a well respected, London based, forward thinking organisation, why not give us a ring.

Speak to Natalie on: 020 8961 4151 or contact by email: natalief.cbc.org@btconnect.com

32 THE VOICE JUNE 21 - 27, 2012

Mayor Bloomberg – Food Fascist or Health Hero?

By Jules Jack

O

VER THE last few weeks, a debate has been raging in the US, whose origins are in New York. Mayor Michael Bloomberg has bravely proposed a ban on the sale of sodas and other sweetened drinks in containers over 16 ounces (about 500ml in new money or a pint in old).

He has set himself on the path for a head on battle with a very powerful food and drinks lobby, retailers such as cinemas and consumers who view his proposal as a ‘fascist’ attack on their American freedoms.

Are we attached to our sugary drinks because of the great taste, habit, or perhaps the more insidious reason, addiction? Whatever the reason, there are many like Mayor Bloomberg who believe they are a primary source of many of our recent health problems.

A few months ago, whilst discussing their daily con-

LARGE SIZE: A man leaves a 7-Eleven store with a Double Gulp fizzy drink.

sumption of up to five cans of a popular fizzy drink, a client became extremely emotional to the point of tears. They were adamant about working hard towards agreed goals and that there was no problem with having a ‘treat’ after all the

effort; surely this was deserved?

This particular client is morbidly obese, a type II diabetic on insulin and a cacophony of other aural medication for other ailments.

During his appearance on Jon Stewart’s Daily Show, London Mayor Boris Johnson stated: “The reality is we are all getting fatter. It is a problem in a city like London and it is a problem in New York. If you can stop kids getting fatter by restricting the size of the coke they drink then why not?” Could we soon see the same proposal for areas in the UK and would you, the general public, welcome it?

Mayor Bloomberg has a headwind of academic opinion on his side. There’s a growing belief that we are becoming fatter not because we are less active than 50 years ago, or because we are consuming foods containing more fat, but simply because of the sheer amount of sugar in the food we now eat.

Furthermore, a growing

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school of thought believes sugar is as addictive as substances such as cocaine!

Although table sugar consumption is down since the 1970s, that of high fructose corn syrup consumption is dramatically up. Other clients of mine, friends and family members, who are otherwise fit and apparently healthy, admit to consuming more sugary liquids in a day than water.

I for one would welcome a similar ban in London and would ideally like it applied to the whole country. Not for me the argument of an infringement on civil liberties; no more so than any of the various bans instigated on cigarettes.

For me, there’s no doubt we underestimate the amount of sugar in drinks. I’m interested to hear your views on the proposed ban in New York; would you object to the same being introduced in your city? Drop us a line at The Voice or tweet me.

And what of my client above? No more fizzy drinks,

DOWN SIZE: New York Mayor Michael Bloomberg is proposing a ban on the sale of large sodas and other sugary drinks in the city’s restaurants, delis and movie theaters in the hope of combating obesity.

more herbal tea, a change of behaviour and well on his way to developing a new and healthy lifestyle.

Jules Jack, is founder of a 40rty Weight Management,

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