Backin2018,UniversityofCambridgeProfessorEdwardBullmorepublishedhisbook,“TheInflamedMind”.Aradical newapproachintotheunderstandingofdepression.Thisconceptmaysoundalittledeepforsomepeople,but pleasetryandbearwithme.WhatProfEdwardhasdiscoveredisalinkbetweendepressionandourbody’simmune system.Thisthencanhaveseriousconsequencesforthosepeoplewhomayhaveenduredsomeformofphysical injury, who then go on to suffer from depression. Thisisthefirstbreakthroughintheunderstandingofdepressionwithinthepast40-50years.ProfessorBullmoreis alsoVice-PresidentofExperimentalMedicineatGlaxoSmithKlineinLondon,soitishopedthatinthecomingyearsa different range of medication will become available in the treatment of depression.Totryandunderstandthisconceptfurther,ProfessorBullmorehasputtogetherarathernice,easytofollowvideowhichsomemayfindinteresting (this video is best viewed in full-screen mode). What ProfessorBullmorehasidentifiedisaconnectionbetweenthebody’simmunesystemandthecauseofdepressioninsomepatients.Ithinkit’s safetoassumethatalthoughthebodyisfullyunconscious,theimmunesystemisstillverymuchawake.Theveryfirstcutofthesurgeon’sscalpelcan cause the immune system to release loads of cytokines, which in turn travel up to the brain, and affect the change in mood. Evenpost-transplant,thebody’simmunesystemisturnedrightdowntopreventorganrejection.This in its self could very well cause the immune system to respond in producing more cytokines,whichinturnbringaboutafeelingofmelancholiaanddepression.IhavewrittentoProfessor Bullmore about this possible scenario, which at the time I am still awaiting a reply.
So What about the Liver Transplant then?
MostpeoplewillrealisethathavingaLiverTransplantisaverybigordeal.Theperson’slivermaywellbesobadlydamagedthatalivertransplantisthe onlyrealviablecourseoftreatment.Becausetheliverisresponsibleforcarryingoutover500differentfunctions,anyoneofthesemaywellbehaving an impact upon other parts of the patient’s body.Thisthenbecomesaverystressfultimeforthepatientastheirlifeishanginginthebalance.Beforeapatientcanbeconsideredforatransplant,there isastrictcriterionthathastobefollowed.Thedecisionastowhetherapatientshouldbeaddedtothewaitinglistismadebyareviewpanel.Theseare normallymadeupofaroundfivedifferenthealthcareprofessionals.Itisunderstandablethereforethatapersonwithahistoryofalcoholabuse,will undergo a greater amount of further scrutiny, as assurances have to be made that this organ will be respected and not abused.So,apersonnotknowingiftheyaregoingtobeacceptedontothetransplantwaitinglistisofenormouscauseforconcernandworry.Thisthenhas animpactnotonlyforthepatientbutalsofortheirpartnerorrelatives.Itmustalsoberememberedthatthereareothercultureswithinour community and these often have a much stronger bond with others. Evenwhenapersonisacceptedontothewaitinglist,thestressandconcernsdon’tletup.Thewaitinggamecangoonforyears,anditisasadfact thatsomepatientswilldiebeforeasuitableorganbecomesavailable.Itshouldalsoberememberedthatadultsaren’ttheonlyonesthatmayrequirea liver transplant. This can also be a very traumatic time for children too.So,yourover-nightbaghasbeenpackedformonthsandyourwaitingforthatphonecalltotellyouthattheynowhavealiverwithyournameonit. Theclockistickingasyouracetogettothetransplantcentrebeforetheliverstartstodeteriorateandbecomesunviable.So,whileyouareallexcited andonroutetothehospital,theliverisbeingtested.It’sonlywhenyougettothehospital,thatyouareinformedthattheliverisn’tsuitable.Thiscan happentimeandtimeagain.Themoodchangefromexcitementtodisappointmentcanhappenalmostinstantly,andforsome,thedrivehomecanbe a silent, empty one. But then the day finally arrives and it’s all systems go.So, I’ll be alright once I’ve had my transplant - Right?Thenextthingyourealiseisthatit’sallover,theporteriswheelingyouonatrolleyfromtheICUuptothelivertransplantward.Youbegintotakein where you are and then WHAM, the enormity and the reality of your situation hit’s you. You’venow been reborn. You’d think a person would be elated and full of happiness and joy. However, for some, there is a deep feeling of sadness. They start to think about their poor donor. Who was this person who has now saved their life? This unselfish gift from a total stranger becomes an overwhelming pressure. This can be made even worse, as in my case. I realised that I didn’t deserve this gift, I felt I wasn’t worthy. I suffered from horrendous guilt. There is a transplant technique that can be used on young children who require a liver transplant. Here they can perform what is known as a split liver donation. This is where one liver can be split in two, and save the lives of two small children. I became very aware of this and felt so sad, I blamed myself and cried in my hospital bed for two days. It took me over ten months to come to terms with this.Once a person walks out of those hospital ward doors they are very much on their own. Oh, they may well have a family member there to help them when they get home, but they can only really help the physical person, The emotion wreck that hides behind a mask inside is another issue. Nearly three years on, I have only recently learnt of the existence of these little-known mental conditions. It would appear that a post-transplant person can suffer from a form of PTSD and that there is now an internationally recognised medical condition called, “Survivors Guilt”. (Click on picture for more information)Sadly, there remains little or no support available to address these conditions in the whole of the West Midlands - until now. This is just one of the issues the, “Liver Life Cafe” hopes to address.
By the time Dr Erin Walker turned 20 she was on her third liver transplant
In January 1986, aged of just 4-years old, and with primary sclerosing cholangitis, Erin had her first liver transplant. She now lives here in the UK. Erin knows only too well the emotional and mental strain that having liver disease and a transplant can bring. Here she talks about the impact that her physical health has had on her mental health. At the time of this recording, Erin was still on her second transplant. Erin’s story can be found on the British Medical Journal article: https://www.bmj.com/content/364/bmj.l1004 Further information can be found at UCL Partners: https://uclpartners.com/blog-post/three-livers-transplants-gave-life-back/