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Monday, November 28, 2011

Love on the transplant list

 Kirstie Mills was 21 when a lung transplant became her only hope of survival.

During the previous two years her health had deteriorated rapidly. The cystic fibrosis which had made her ill all her life had finally taken hold.

She regularly used a wheelchair, she was on oxygen to help her breathe and was spending longer and longer in hospital.

By that time, Kirstie had met and fallen in love with Stuart.

She had introduced him to her daily dose of medicines, chest infections and hospital visits, all part of the incurable condition's cruel regime.

But soon that regime changed for the worse.

"I had a stair lift fitted and what was once my fitness room, became a dedicated treatment room, full of medicines and devices to help me breathe. I knew we were running out of time"

"I didn't expect to be so near the edge of life"

Faced with the prospect of little time left together, they planned their wedding in Cyprus only to relocate it to Somerset when Kirstie became too sick to travel.

"We got married three weeks before my transplant. There were numerous medical staff there as well. Stuart had a Do Not Resuscitate card in his pocket because if I had collapsed I did not want to be ventilated, because that would have ruled out a transplant.

"It was the best day of my life but we thought it was going to be my last too."

Agony of waiting

Two weeks later she was airlifted to Harefield Hospital in London to wait for a transplant - a last-resort operation which can extend life expectancy but can be very risky too.

Kirstie was hooked up to an ECMO machine which imitates the job done by the lungs

Kirstie says waiting for the transplant was the worst time imaginable for her family and new husband.

"At one point I tried to beg them to switch off the machines that were keeping me alive but, because I had a tracheotomy in, no one understood me.

"I was in agony, I felt like I was constantly drowning or suffocating. The number of tubes attached to me was incredible so I couldn't move, couldn't do anything. I felt desperate.

"I didn't think my transplant would come and, if it did, it would surely be too late because I was so weak."

Kirstie wrote an emotional letter to Stuart in case she did not survive.

With her life ebbing away, Kirstie was finally given a new pair of lungs in July 2011.

"It was just in the nick of time," she says. "I had hours left."

But the aftermath of the operation was far from easy. Kirstie still felt very ill when she came round and was still being ventilated.

"I'd had a major operation and it was like starting from scratch again. I thought it was a sick joke. I still felt like I was dying."

Return to fitness

Kirstie's new lungs needed time to function fully and properly and that meant constant pain and a steady diet of painkillers for several weeks.

Before the transplant: Kirstie with Stuart and comedian Russell Howard on a good day

Intensive rehabilitation got her back on her feet, breathing on her own and with Stuart by her side she knew she would recover.

Her lung function is now at 100%, which Kirstie's doctors are very pleased by.

She maintains that it is down to all the exercise she is doing - six fitness classes a week and three to four hours in the gym - which is key to making the lungs work well.

She is returning to fitness pole dancing and is soon getting back into teaching.

Now she is looking forward to really celebrating Christmas with her family, for the first time in years, and to taking part in a 180-mile charity bike ride.

Yet she is keenly aware that the transplant does not mean she is cured.

"I still won't have the same life expectancy as you, but the transplant will give me maybe 20 more years. I just have to keep managing and controlling the condition as best I can."

In the meantime, Kirstie and Stuart are enjoying the freedom of having her health - and her life - back.

Why anything can be addictive

 University  Even work can be addictive, according to Dr Griffiths For many people the concept of addiction involves taking drugs such as alcohol, nicotine, cocaine and heroin.

But in this week's Scrubbing Up, gambling studies expert Mark Griffiths warns that if the rewards are there people can become addicted to almost anything.

For the past 25 years I have been studying gambling and I passionately believe that gambling at its most extreme is just as addictive as any drug.

The social and health costs of problem gambling are large and have many things in common with more traditional addictions, including moodiness, relationship problems, absenteeism from work, domestic violence, and bankruptcy.

Health effects - for gamblers and their partners - include anxiety and depression, insomnia, intestinal disorders, migraine, stress related disorders, stomach problems, and suicidal thoughts.

If behaviours like gambling can become a genuine addiction, there is no theoretical reason why some people might not become genuinely addicted to activities like video games, work or exercise.

Research on pathological gamblers has reported at least one physical side effect when they undergo withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart palpitations, muscle aches, breathing difficulty, and chills.

In fact, pathological gamblers appear to experience more physical withdrawal effects when attempting to stop their behaviour when compared directly with drug addicts.

'Most important thing'

But when does an excessive healthy enthusiasm become an addiction?

Excessive behaviour on its own does not mean someone is addicted.

I can think of lots of people who engage in excessive activities but I wouldn't class them as addicts as they don't appear to experience any detrimental effects from engaging in the behaviour.

In a nutshell, the fundamental difference between excessive enthusiasm and addiction is that healthy enthusiasms add to life whereas addiction takes away from it.

For any behaviour to be defined as addictive, there have to be specific consequences such as it becoming the most important activity in the person's life or being the way they improve their mood.

They may also begin to need to do more and more of the activity over time to feel the effects, and experience physical and psychological withdrawal symptoms if they can't do it.

This may lead to conflict with work and personal responsibilities, and people may even experience "relapses" if they try to give up.

The way addictions develop - whether chemical or behavioural - is complex.

Addictive behaviour develops from a combination of a person's biological/genetic predisposition, the social environment they were brought up in, their psychological constitution - such as personality factors, attitudes, expectations and beliefs, and the activity itself.

Many behavioural addictions are "hidden" addictions. Unlike, say, alcoholism, there is no slurred speech and no stumbling into work.

However, behavioural addiction is a health issue that needs to be taken seriously by all those in the health and medical profession.

If the main aim of practitioners is to ensure the health of their patients, then an awareness of behavioural addiction and the issues surrounding it should be an important part of basic knowledge and training.

Behavioural addictions can be just as serious as drug addictions.

Women can choose Caesarean birth

 A Caesarean section can be necessary for medical reasons Pregnant women who ask for a Caesarean delivery should be allowed to have the operation, even if there is no medical need, according to new guidelines for England and Wales.

The National Institute of Health and Clinical Excellence (NICE) states that women should be offered counselling and told of the risks first.

Ultimately, however, the decision would be made by the mother-to-be, it said.

NICE said this was "a very long way" from offering all women surgery.

The last set of NICE guidelines, which were published in 2004, clearly stated that "maternal request is not on its own an indication for Caesarean section" and that clinicians could decline the procedure "in the absence of an identifiable reason".

The rules on requesting a C-section have been revised. Clinicians say this is to bring the instructions into line with what is already taking place in hospitals.

Birth fear Continue reading the main story
It's not a major operation that most pregnant women are interested in or want to have”

End Quote Malcolm Griffiths Consultant obstetrician and gynaecologist The 2011 guidelines say that women requesting a C-section because of anxiety should be offered mental health support. A phobia of childbirth is thought to affect 6% to 10% of women.

Nina Khazaezadeh, a consultant midwife at St Thomas' Hospital, says she often meets patients who want a Caesarean due to a "perceived lack of control, fears of inadequate care provision and lack of support during labour and delivery".

"But, after a discussion of all the pros and cons of both types of birth, and having been assured of one-to-one midwifery support and an individualised birth plan, they will choose to try for a vaginal birth."

The updated guidelines state that if such women still wanted a C-section, they should get one.

Women with no medical need can also ask for a Caesarean section. The guidance states that they should be told of the risks and discuss their request with a clinician, but their request cannot be denied.

Malcolm Griffiths, a consultant obstetrician and gynaecologist who led the development of the guidelines, said: "Caesarean section is a major operation, it's about as major as a hysterectomy.

"It's not a major operation that most pregnant women are interested in or want to have."

Dr Gillian Leng, deputy chief executive of NICE, said: "This guideline is not about offering free Caesareans for all on the NHS.

"It is about ensuring that women give birth in the way that is most appropriate for them and their babies.

"Offering these women a planned Caesarean section in these circumstances is a very long way from saying that Caesarean section should automatically be offered to every woman."

New rules Continue reading the main story

Planned Caesarean section may reduce the risk of the following in women:

pain during birth and for the next three days injury to vaginahaemorrhageshock

Planned Caesarean section may increase the risk of the following in babies:

Planned Caesarean section may increase the risk of the following in women:

longer hospital stayhysterectomy cardiac arrest

Source: NICE

There will be wider changes to clinical practice.

Being HIV positive will no longer be treated as grounds for an automatic C-section. Improvements in anti-retroviral therapies mean it is now safe for some woman with HIV to deliver vaginally.

There will also be changes to break the mentality of "once a Caesarean, always a Caesarean".

The latest evidence suggests that even for women who had up to four previous C-sections, that the risks of fever, bladder injuries and surgical injuries were the same for planned vaginal and planned Caesarean deliveries.

Also it had been thought that giving women antibiotics to protect against infection during surgery could be damaging to the baby. NICE says medical evidence says this is not the case and that women should now be given antibiotics before going under the knife.

In the UK, about one in four births is by Caesarean section. The rate has been roughly static for the past four years following years of increases. Across Europe figures vary widely from about 14% in Nordic countries to 40% in Italy.

NICE believes that overall, the rate could fall after the introduction of the new guidelines.

Wendy Savage, a retired professor of obstetrics, said women requesting a C-section were not responsible for the rise rather "it is obstetricians that are too keen to do it".

On vaginal births she said: "They don't know how to do it most of them now because they haven't been trained how to do it.

"It is up to us to put our house in order and stop doing Caesareans too easily.

"We're doing too many first Caesars and secondly we're doing too few vaginal births after Caesarean section."

Cathy Warwick from the Royal College of Midwives: 'It doesn't differ from the current practice going on in many maternity units'

The changes will come at a cost to the NHS of around £0.5m, largely from the cost of mental health services for women with anxiety.

The cost of a planned Caesarean section was estimated at £2,369, with a planned vaginal birth costing £1,665.

Maureen Treadwell, co-founder of the Birth Trauma Association, said: "We are delighted that this updated guideline recognises the terrible impact that fear of childbirth can have on women and their families."

Cathy Warwick, chief executive of the Royal College of Midwives, said: "If midwives are able to help women to understand what their choices mean for them and their baby and feel they will be supported in labour then very few women will want an elective Caesarean section.

"They will be making decisions from a fully informed position and from a position of trust in maternity services, not one based simply on hearsay."

Wrong twin aborted in Australia

 An Australian hospital has launched an inquiry after staff treating a woman carrying twin boys accidentally terminated the wrong foetus.

Doctors had told the woman that one of her babies had a congenital heart defect that would require numerous operations, if he survived.

The woman chose to abort the 32-week foetus but staff injected the wrong twin.

The hospital in Melbourne described it as a "terrible tragedy".

"The Royal Women's Hospital can confirm a distressing clinical accident occurred on Tuesday," it said in a statement.

"We are conducting a full investigation and continue to offer the family and affected staff every support."

The woman went on to have an emergency caesarean to end the life of the sick foetus.

'Thorough investigation'

Victorian Health Minister David Davis said the hospital investigation would be overseen by an independent expert.

"I am very much determined to get to the bottom of what went wrong," he said.

State Premier Ted Baillieu echoed his sentiments, saying: "I don't think it's appropriate for anybody to draw any conclusions other than this is a horrible tragedy.

"We'll make sure that the investigation is as thorough as it can be."

In a brief statement, the family asked for privacy "at what has been a very difficult time for us".

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