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Focus Article - Latest Issue

FOCUS - 12 December 2017

TRANSPLANT NEWS.

The Health Secretary is urging people to overcome their ‘fatal reluctance’ to discuss organ donation, says Sarah Boseley in The Guardian.  She adds: “Health secretary Jeremy Hunt is to launch plans for an opt-out system of organ donation, asking people to overcome their “fatal reluctance” to discuss the issue with family and friends.  Under the plans, everybody in England and Wales would be presumed to be happy to donate their organs on their death, unless they have signed up to a register stating that they do not want that to happen.  In practice, however, it is unlikely that organs would be taken against the wishes of the family.”

This is a controversial move. Everybody agrees that more organs are desperately needed - shortage of organ donations led to 457 deaths last year – but is this the best way to go about it?  In Wales where this system already exists, organ donation numbers seemingly went down.  Spain is the big success story – and this has been achieved on the back of a major campaign to educate potential donors and their families.

Every time you register with a new practice you sign a form which invites you to be an organ donor – but even in practices like mine where patients are encouraged to consider donation, the uptake is poor.  Those who have been on the receiving end, however, are far less blasé than the rest of us.  Liz Gourley, who lives up the hill in Old Woodham, knows the importance of transplantation at first hand having received kidneys and a pancreas.  She says: “I'd be dead without it – I watched people who’d been on dialysis dying – or I’d be loopy.  And I wouldn't be a mum!”

Shelley Coleman (née Boyce), whose mother has lived in South Woodham longer than I’ve been here, is also someone who has benefitted hugely from transplantation.  She says that, without it: "Life would have been completely different. I wouldn’t have been able to go to school – I'd have been tied to a machine."  Not literally tied to it, of course, but we know what you mean, Shelley.  You'd have spent so many hours and days on a dialysis machine that your education would have gone by the wayside and the Willy D would have been deprived of one of its more popular pupils.  She is "VERY grateful to the donor and his family" - without them she says: "I wouldn't have had my boys."

So, if organ donation saves lives, why don’t more people sign up for it?  Cole Moreton writes in The Guardian (again): “I used to be squeamish and not want to think about organ donation – ugh, no thanks – until I saw something truly extraordinary that changed my mind.  The mother of a boy who had died reached out to touch a stranger who had been saved by him.  Sue Burton put her hand on the chest of Marc McCay and felt a flutter under her palm.  The beating of a heart that had been born inside her.

The heart that had given life to her son Martin for 16 years, until he was suddenly struck down by a brain haemorrhage, without warning, in the middle of the night.  The heart that had been removed from his body, packed in ice and flown across the country in a race against time, to be put in the body of another 16-year-old, called Marc.  Now here he was, 13 years later, the boy grown into a man. “To be able to feel the heart that Martin was born with still beating, that’s incredible,” said Sue.  Tears were shed, including mine.”

To be a donor, Google ‘organ donor’ and fill in a form NOW.  It takes less than 2 minutes of your time – and it may give someone a new life.

 

PREGNANT WOMEN URGED TO HAVE FLU JAB.

The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) are reminding all pregnant women to take up the offer of a free flu vaccination this winter.

Mark Gould writes in Onmedica: “The reminder comes as statistics published by Public Health England (PHE) reveal just four in ten (43.1%) pregnant women have received the vaccine so far this winter.  While this is a slight improvement on uptake in 2016 (40.8%) and 2015 (35.6%), the RCOG and the RCM say it is vital that more pregnant women come forward for the vaccine.”

So what’s all the fuss about?  Mark explains all: “Between 2009 and 2012, 36 pregnant women died from flu in the UK and Ireland, accounting for 1 in 11 of all maternal deaths during this period.  The flu vaccine has been routinely offered to pregnant women in the UK since 2010.

Recently the RCM published a survey which found 44% of pregnant women will avoid vaccines during pregnancy because they are worried it will harm their unborn child’s health as well as their own.  However, studies have shown that the flu vaccine is both safe and effective.  Pregnant women who have had the flu vaccine while pregnant also pass some protection on to their babies, which lasts for the first few months of their lives.”

Dr Alison Wright, vice president of the RCOG, said: “We are very concerned that only four in 10 pregnant women have taken up the offer of a flu jab so far this winter.  Flu can be a very serious illness in pregnant women and the best way to avoid getting this is by having the vaccination.  While we are encouraged that uptake is slightly higher than in previous years, we still want more pregnant women to come forward for the vaccine from their midwife, GP or community pharmacist.”

Why are women so vulnerable during pregnancy?  The usual explanation (but not the only one) is that weakening the immune response is necessary for a successful pregnancy.  The body’s defences attack anything they regard as ‘foreign’ … and babies fall into this category.  So modifying the way the immune system regards a baby is a jolly good idea.  That does leave Mums more prone to infections, however, of which ‘flu is the perfect example.

For more info Google: Flu vaccination: leaflet for pregnant women - GOV.UK

In the bad old days we used to see examples of what happens when the immune system goes wrong.  Rhesus negative Mums would often have one healthy baby and then a succession of ‘unsuccessful pregnancies.’  These were what we GPs called ‘Rhesus babies’ – although you, being more erudite, would probably call the condition from which they suffered “erythroblastosis fetalis.”  The reason was that, if the baby was Rhesus positive, small amounts of its blood would often get into the maternal circulation during the trauma of birth.  The Mum’s immune system would recognise these as ‘foreign’ and would produce an antibody which mopped up the ‘invader’ cells.  That was all very well … but during the next pregnancy, that same antibody would pass through the placenta and into the child’s circulation … so, if the child was rhesus positive (which s/he normally was, the ratio of + ve to – ve being around 85% to 15%) the antibody would attack and destroy the baby’s red cells.  These days this is effectively a thing of the past in first world counties … Rh -ve Mums who have Rh +ve babies are offered an injection of anti-D immunoglobulin within 72 hours of giving birth.  The anti-D mops up the baby’s red cells before the Mum’s immune system gets into gear … so during the next pregnancy, there are no antibodies in her bloodstream to damage her baby’s blood.

 

‘MAN FLU’ IS REAL!

We men have always known this, of course.  Furthermore, it is widely accepted that we chaps make less of a fuss about illness than do our illustrious counterparts.  We have, however, lacked the evidence that Man Flu is a debilitating illness.

Sue Kyle, writing in The BMJ, has realised the gravity of the situation.  She writes: “Mice have long been accepted as good models of human physiology for medical research, with records dating back to William Harvey in 17th century England.  Several studies show that female mice have higher immune responses than males.  This led to the hypothesis that sex dependent hormones have an important role in outcomes of influenza.  Although animal and in-vitro studies are weak sources of evidence, human research also points to different responses to influenza in men and women.  Even the World Health Organization stresses that ‘sex should be considered when evaluating influenza exposure and outcomes.’”

She goes on to say: “The sex difference in immunity has been suggested to be modulated by hormonal differences, with oestradiol being immunoprotective and testosterone being immunosuppressive.  The sex differences extend to other respiratory infections beyond influenza.  In many acute respiratory diseases, males are more susceptible to complications and exhibit a higher mortality.”

Moreover, Prof Kyle reminds us that: “in an unscientific survey completed by 2131 readers of a popular magazine, men reported taking an average of three days to recover from viral respiratory illness compared with 1.5 days for women.  The male authors of this study conclude that caregivers should “go that extra mile to care for us when we are stricken with it, so that future shelves can be erected, cars can be maintained and football stadia throughout the land can be well attended” –listing only a few of the many ways male viral respiratory illnesses can affect society.

The Prof concludes that: “Men may not be exaggerating symptoms but have weaker immune responses to viral respiratory viruses, leading to greater morbidity and mortality than seen in women.  There are benefits to energy conservation when ill.  Lying on the couch, not getting out of bed, or receiving assistance with activities of daily living could also be evolutionarily behaviours that protect against predators.  Perhaps now is the time for male friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort.”

 

HEAR, HEAR!!!

Dr John



 
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