Alcoholic Liver Disease Stages

i felt totally renewed after thetransplant. like day and night - absolute day and night. the things that i can do now are joyful. i can hardly believe it, really, it's so much better. in terms of energy, and freedom. i think the experience has made me awareof so many more things in life, things i always took for granted, especially the people in my life. thetransplant experience has made that happen.

for patients and their families thewhole transplantation experience can be overwhelming. there's a lot of information to take in, there's a lot of decisions to be made, but the most important thing patients andtheir families need to remember is that the whole transplant team is here tosupport them. following transplantation, patients areat risk of developing additional health complications.thesecomplications will vary from patient to patient and are not only related to theimmunosuppressive medication you are prescribed,

but also to your risk factor profile. the purpose of this video is to help you understand which riskfactors are changeable, which ones are not, and also what healthcomplications to look for, and what they might mean to you. the most important complications are osteoporosis, cancer, diabetes, high blood pressure, and high cholesterol.let's look first at osteoporosis. osteoporosis is a disease where there is a decrease in the bone density or a loss a bone mass. over time, this makes the bones brittle

and susceptible to fracture. it's also more common with females related tohormonal changes, also the medications that we give after transplant can cause osteoporosis, so it's a side effect of the drugs thatwe give. we are still learning a lot about osteoporosis in the transplant patient, and we know that the greatest risk is in the first six months when steroids are highest. and it may well bethat therapy will not be necessary long-term. so, if wecan treat during high-risk period, we can

prevent the problem. the outlook for osteoporosis can be good. it's something that we need to treat early, and we are trying to treatit in a preventative fashion, right now, monitoring our patients pre-transplant, in some cases, as well as post-transplant andcontinuing along the way. we know that one in four women over theage of 50 have osteoporosis, and we know that one in eight men overthe age of 50 have osteoporosis. there are clear-cut risk factors for it,

and apart from the risk factors that youcan't change, like being a woman, having history of osteoporosis in the family, and getting a bit older, there are otherrisk factors that play a role such as inactivity, which is importantwhen we think the transplant patient, diet, excess alcohol, history of smoking, calcium intake and drugs, and this is really where thebig role comes in in the transplant patient. we clearly know that steroids orprednisone,

plays a role in the development ofosteoporosis. the treatment for osteoporosis can be a simple treatment. in some cases, injust a minor decrease in bone density, exercise is very important. walking is great. in the non-transplant patient, it's clearly been shown that physical activity, weight-bearing activity, allowing themuscles to pull on the bones, will help to promote the bone mass staying steady.

secondary, is actually looking atdiet, and we know that calcium is one of themost important things to maintain bone mass in terms of your diet. generally, it's best done throughincreasing the natural calcium in the diet. calcium is found in foods suchas milk and cheese and and other foods. but oftentimes it's difficult to getthe amount you need straight from foods, and another it wayto go was to calcium supplement. the third area that we can get into than hisactual drug treatment, and there's a

variety of different drugs. clearly, before any are started, youneed to have a lengthy discussion with the transplant team that is lookingafter you, because certain drugs are going to be better for certain populations who have osteoporosis. i was diagnosed with osteoporosis just under a year ago. it's in my spine, and that hasn't made a bigdifference or a big impact in my life either. i've just kept on with most of what i'vedone. there have been a few changes.

they have me on a drug that builds bone density. i'm a little bit more conscious of my diet. i always drank milk and had lots of calcium products, but i'm especially careful now tomake sure that i get them. and the other thing is that i make surethat i get weight-bearing exercise at least a couple times a week. you want to remain active, you have justundergone a transplant and you want to now get back to life asbest you can. one of the most important

postoperative complications is an increased risk of cancer. it comesbecause of the use of immune suppressive agents. the job of theimmune system is to recognize parts of the body that ought not to be there and then to attackthem. that obviously is important in terms oftransplanted organs, so we have to suppress the immunesystem's ability to do that. unfortunately, that also interferes withthe immune system's job in other respects.

infections, recognizing that, and also recognizing abnormal cells and controlling their growth, which is part of what the immune system also does. consequently, on immune-suppressiveagents, there are certain cancers which are justmore frequent. there are four cancers the transplantpatients need to be most aware of. skin cancer, cervical cancer, lymphoma, and colon cancer. the most common of these skin cancer, and although it doesn't develop right away,it can develop in patients many years post-transplant.there are specific signs and symptoms

that will help us to detect cancer. in terms of skin conditions, any changein a mole development to the new mole, should be looked at carefully. you shouldalways watch your skin, look at your arms, your hands, your face,and ears, and watch for any developing new spotswhich don't look normal to you. if you notice any abnormal spots orlesions on your skin that are new or are worrying you, it's important toimmediately contact you transplant team, either your physician or your transplantcoordinator. these are very treatable kinds of cancers if they detect it earlythey need not cause a huge problem.

it's important also for patients to beaware that these conditions are associated with sunlight exposure and to takeprecautions when they're out in the sun, either wearinga hat or using sunblock. so, early detection and prevention arethe best ways to manage that. a second kinda cancer that's more common in our patients is cancer of the cervix. naturally, it's only female patientsthat need to be concerned about this. it's important that women on on immunosuppressive agents have regular gynecological examinations,

including a pap smear. there's anotherkind cancer which is more common in transplant patients as well, that's cancer called lymphoma. that one is much more likely tohappen earlier in the course of the transplant, and we believe it's related to theamount of medication that we have to use to suppress rejection. with the lymphomas, those are often seen as changes in lymph nodes andthe swelling of the lymph node.

so, these sort of things, when they become present, should bediscussed with the transplant coordinator or with physicians at their visits. it's a more serious kind of cancer but can be treated by chemotherapy in the waythat any other patient would have it assessed.colon cancers are more difficult, but changes in bowelhabit or the presence a blood in a bowel movementwould have to be taken seriously. tumors in a patient onimmunosuppressive agents, even if they're not have thisgroup, but

just occur, as might happen in therush to the population, are harder to treat. one of the problems is that with immune suppression they tend togrow more rapidly. secondly, the use of chemotherapeutic agents, which are the standard therapy formany types of cancers and other tumors, is more difficult. the presence of immunesuppression already can put patients at risk with chemotherapy for a marked change in their bone marrow

and open them up to more problems withinfection. i think that the patient has a majorrole to play in the management of tumors, primarily in the cancers by early detection. by noticing and bringingto the attention of the transplant team, those changes inthe, skin, or possible changes in bowel habits that can then create asituation which investigations take place. althoughtransplant patients may be more at risk

for certain cancers, they are just as susceptible to othercancers as the rest of the population. part of a healthy lifestyle shouldinclude a regular prostate exam for men and regular breast self-examination and mammograms for women. about two years ago during one of my assessments i had a bronchoscopy and one of the biopsies they had taken frommy lungs showed some abnormalities in the cell tissues, it turned out that itwas a lymphoproliferative disorder, which is a type of lymphoma than can occur after transplantation.

they think it's due to being immunosuppressed in combination with the epstein-barrvirus. that was a tough one to hear. you hear lymphoma and you think cancer and all that goes with that. however, you know that was two years ago andi'm still here, and still feeling fantastic. but it definitely is something that has beendifficult to deal with at times. diabetes is a serious complication that

all transplant patients need to be awareof. it will affect patients who already have it and those that do not. the risk ofdiabetes varies from patient to patient depending on certain risk factors thatinclude family history, age, and weight. patients who have beenliving with diabetes before the transplant will probably need to adjust theirinsulin and diet. the signs and symptoms of diabetes include increased urination, increasedthirst,

weight loss, and blurred vision. diabetesis a medical condition that results from the pancreas not being able to produce enough insulin, or the insuilin is not being usedproperly. diabetes has its own set of complications, this includes higher-risk a heart attack and stroke, visualdisturbances, and also problems with the circulationto the small blood vessels in the fingers and toes. our patient population has an increasedrisk of diabetes related to the drugs that they're on

to protect their transplanted organ. in the early transplant period, when patientsare on high doses have these medications, this is when we may first see the onset of diabetes. these patients arecoming for frequent blood tests and abnormal blood sugar levels arepicked up very quickly. if our patient population have a history of diabetes pre-transplant, then we watch them closelypost-transplant again, but we also work with them to adjust to insulin accordingly. if a patient is a new

onset diabetic we would try and control their blood sugar initially withdiet or pills. if we had difficulty controlling theirblood sugars they might require insulin injections. patients who arediabetic before the transplant, if they've been on pills, and diet control before the transplant,they could probably anticipate being on insulin injections after the transplant to maintain good blood sugar control. knowing these factors we can try and reduce

their risk by controlling their bloodsugars well. good diet and exercise is important forcontrolling their weight. the duration of the treatment might bedependent on how well the person responds to the medication. certainlywhen the steroids are reduced, there may be an improvement in the blood sugar. so it's very individualized to each patient. with good blood sugar control and aproper diet, in consultation with the entiretransplant team, we hope to be able to give these patients a better quality oflife and limit the complications at the

diabetes. my diabetes was something i had to dealwith before transplant wasn't caused because of transplant. i find now after settling intoroutine, i'm actually on less insulin now than i was before. i've been on and off insulin since the transplant. basically, it depends on howhigh my dose is for steroids. and, as that's lowered, so is myinsulin requirement.

remember to look for the signs andsymptoms of diabetes. they include increased urination,increased thirst, weight loss and blurred vision. your transplant team has information available to help youmanage this condition. high blood pressure is also common formany transplant patients. these patients will need to be monitoredand may require medication. it occurs in transplant patients fordifferent reasons, depending on which up their organs has failed, andwhich organ they received a transplant of. it's common for patients withkidney disease to have high blood

pressure even before they gettransplants. it's common for all groups of patientshave it after transplantation primarily becauseof medications. most patients get no symptoms whatsoever high blood pressure. occasional patientsmay have symptoms such as headache, or feeling unwell. patients who have a tendency to high blood pressure pre-transplant will most likely requiresomething in the post-transplant period. the type of medication for the patientsare treated with varies

from patient to patient. theeffectiveness of the medication in each individual patient is based onthe side effects the patient has and how effective the blood pressurepill is at controlling their blood pressure. we have a variety of things that wecan do to treat. we start with diet, in the sense of optimizing weight. avoiding extra salt, generally avoidingthe salt shaker. exercise may also be helpful, avoidingthings like smoking and alcohol. it's very important for the patients tolet us know immediately, to monitor the blood pressure at home if they have theequipment,

to write down those blood pressurereadings and bring them with them when they come to see their physician in clinic. and to let us know if there are any side effects they are having, headaches, for example, and letting usknow as early as possible. if you do have a problem, either with thechanges in your life style we've suggested, or with side effects from medication,it's critical that you communicate those to your doctor or nurse so that we canaddress the problems with you and to find a regimen that works for you

and your blood pressure. in combination with good diet and exercise, and medications that areavailable, blood pressure can be treated veryeffectively. cholesterol is the measurement a fatty substances in the blood that can increase your risk for heart disease and stroke. risk factors associated with highcholesterol include family history, diet, weight, age inactivity and medication. some of the research that we've done in the transplant population, we have found that about

fourty to sixty per cent of our patients willdevelop high cholesterol after the transplant. some of our patients who are on theimmunosuppressive medications may have high cholesterol because of these medications. cholesterols are regularly monitored in clinic by a simple blood test. what we recommend is diet control, limiting the fat in thediet, and exercise. once you have beenidentified with high cholesterol we ask that you meet with a dietitianand go over the nutrition care plan for

high cholesterol. we're going to be looking at good,healthy eating. we're going to be looking at keeping your weight within the idealrange. we're going to be designing a nutritioncare plan that is individualized and tailored to your needs. there are available many drugs today that lower cholesterol and about to happen the transplant patients are put on me cholesterol-lowering agents.

people should be aware of thecholesterol level and they should be aware of the ways tocontrol the cholesterol to decrease their risk for cardiac disease. the health complications you face as a transplant patient can be managedwhen the signs and symptoms are recognized early. and, although not alltransplant patients develop the signs and symptoms, it is important that you were aware ofthem and learn to recognize them. remember that your transplant team hasthe information you need to know to help you understand what thesecomplications mean to you.

no matter what the patient's circumstances are, no matter where they are in their learning process or in their transplantationexperience, the transplant team is here to help themevery step of the way. you can't even describe it - the feelingthat you have inside. i just knew that something was given tome inside and that it was going to give me a whole new chance to even walk down the road and do some things i still want to do.life is as good as it always has been, as it was without the osteoporosis. you realize that the road after atransplant

is not necessarily all smooth. tthere arepotholes, there are mountains and you have to move around every once in awhile, but you move around them and you go on. i've been given a second chance. people say, "what are your limits?" i don't know. i haven't found them!