YOUR HEALTH Dr James Le Fanu: 7 December
Modern medical advances can pose tricky problems of etiquette. Do those, for example, knocking on 70, with a dicky heart or failing kidneys, ask whether they might be put up for a new organ – or wait to be offered one? There are those younger than oneself to consider, whose call might be thought greater.
When working in the kidney transplant unit at the Royal Free Hospital back in the 1980s, the accepted, if never articulated, policy was that all those over 50 were ‘too old’. Since, the survival rates have improved markedly, thanks mainly to better immunosuppressive drugs.
This matter has been further clarified by Mr Raymond Tesi of Ohio State University, who analysed 1,200 transplants. He found, unexpectedly, that the older the person, the more likely a successful outcome. Those over 60 were three times less likely to reject the new kidney, presumably because, with time, the immune system becomes more tolerant.
This does not necessarily mean that the older transplant recipient necessarily lives longer because they are more likely to succumb to another problem, such as a stroke or a heart attack. Still, impressively more than three quarters are fit and well five years after the operation. ‘It can no longer be justified to prevent access to renal transplants based on age,’ Mr Tesi observes.
But with transplant kidneys in such short supply, it seems a bit wasteful to offer one to someone, only for that person to drop dead from a heart attack. This problem can be minimised, however, by first medically assessing potential recipients and performing a bypass operation in those found to have narrowed arteries to the heart.
‘Since introducing this policy,’ writes a transplant surgeon, ‘we have not had a single unexpected death in our transplant patients.’
This week’s medical query comes courtesy of a lady from Halifax who recently had an attack of cystitis (her first for 20 years) warranting treatment with the antibiotic trimethoprim. This did the trick, but she went on to have two further episodes requiring further courses of the same antibiotic.
Her problem is that, since all this, she has been troubled by an extremely sore tongue – it does not look abnormal, but anything vaguely acidic, such as wine or citrus fruits, makes it hurt for up to four days. Might, she wonders, the trimethoprim be responsible – and what, if anything, can be done?
The short answer is almost certainly yes. Trimethoprim works as an antibiotic, killing the bacteria causing cystitis by interfering with the metabolism of the vitamin folic acid. However, this vitamin is also involved in the continual renewal of the cells on the tongue’s surface, thus ‘blocking’ its action can cause the symptoms described. With luck, this should just get better, but a month’s worth of folic-acid supplements might speed it up.
drjames@lady.co.uk
When working in the kidney transplant unit at the Royal Free Hospital back in the 1980s, the accepted, if never articulated, policy was that all those over 50 were ‘too old’. Since, the survival rates have improved markedly, thanks mainly to better immunosuppressive drugs.
This matter has been further clarified by Mr Raymond Tesi of Ohio State University, who analysed 1,200 transplants. He found, unexpectedly, that the older the person, the more likely a successful outcome. Those over 60 were three times less likely to reject the new kidney, presumably because, with time, the immune system becomes more tolerant.
This does not necessarily mean that the older transplant recipient necessarily lives longer because they are more likely to succumb to another problem, such as a stroke or a heart attack. Still, impressively more than three quarters are fit and well five years after the operation. ‘It can no longer be justified to prevent access to renal transplants based on age,’ Mr Tesi observes.
But with transplant kidneys in such short supply, it seems a bit wasteful to offer one to someone, only for that person to drop dead from a heart attack. This problem can be minimised, however, by first medically assessing potential recipients and performing a bypass operation in those found to have narrowed arteries to the heart.
‘Since introducing this policy,’ writes a transplant surgeon, ‘we have not had a single unexpected death in our transplant patients.’
This week’s medical query comes courtesy of a lady from Halifax who recently had an attack of cystitis (her first for 20 years) warranting treatment with the antibiotic trimethoprim. This did the trick, but she went on to have two further episodes requiring further courses of the same antibiotic.
Her problem is that, since all this, she has been troubled by an extremely sore tongue – it does not look abnormal, but anything vaguely acidic, such as wine or citrus fruits, makes it hurt for up to four days. Might, she wonders, the trimethoprim be responsible – and what, if anything, can be done?
The short answer is almost certainly yes. Trimethoprim works as an antibiotic, killing the bacteria causing cystitis by interfering with the metabolism of the vitamin folic acid. However, this vitamin is also involved in the continual renewal of the cells on the tongue’s surface, thus ‘blocking’ its action can cause the symptoms described. With luck, this should just get better, but a month’s worth of folic-acid supplements might speed it up.
drjames@lady.co.uk