health

How one of the world’s longest-living heart transplant recipients would fix Canada’s organ donation system

As COO, Keith helped transform the Nevada Donor Network from one of the country’s worst organ procurement organizations to one of its best. (Emily Wilson For The Globe and Mail)

As COO, Keith helped transform the Nevada Donor Network from one of the country’s worst organ procurement organizations to one of its best. (Emily Wilson For The Globe and Mail)

ANDREA WOO – LAS VEGAS

It is late afternoon on a sweltering day, and a group of doctors at the University Medical Center of Southern Nevada has gathered around the body of a teenage boy. His accidental death days earlier cut short a life of potential – but his parents’ decision to donate his organs is giving a second chance at life to others.

In operating room 17, three teams of surgeons get to work. For more than two hours, eight white-gloved hands at a time carefully cut, position and irrigate as others look on. On a table behind them, silver bowls of sterile ice await. A cardiac monitor beeps.

After examining the organs and arteries for abnormalities, the doctors are finally ready to remove the heart. They administer a solution for organ preservation and an anti-coagulant to prevent blood clots. To one side, a team member calls the receiving hospital. “We’ve just heparinized and we’ll cross-clamp within five minutes,” she says.

At 7:29 p.m., doctors place a clamp across the aorta and sterile ice into the body cavity. No longer beating, the heart is quickly removed, cleaned up and packed for transport. There is a sense of urgency; the heart must be transplanted within four hours of removal.

It is rushed down the hall and into a waiting vehicle bound for the airport, where it will then be loaded into a private jet. In all, seven of the boy’s organs will go to five recipients between the ages of 34 and 68, in Nevada, California and Utah.

From the corner of the operating room, Simon Keith has followed the entire operation. He is chief operating officer of the Nevada Donor Network (NDN), the not-for-profit organ procurement organization (OPO) that brought together the doctors in the operating room today. And the procedures he just witnessed have personal significance: Nearly 30 years ago, Keith himself received a life-saving heart transplant. He went on to become the first athlete to play a professional sport after such a procedure, and today, at 50, he’s one of the world’s longest-living heart-transplant recipients.

Keith – who was raised in Victoria, B.C., but had to look elsewhere for his transplant – is now using his unique position to call for improvements to what he describes as a “fragmented” organ-donation system in Canada.

Continue reading at The Globe and Mail 

Showing promise in B.C., prescription heroin now in peril

Larry Love, 62, a participant in the SALOME study, is photographed at the Providence Crosstown Clinic in Vancouver's Downtown Eastside. (Rafal Gerszak For The Globe and Mail)

Larry Love, 62, a participant in the SALOME study, is photographed at the Providence Crosstown Clinic in Vancouver’s Downtown Eastside.
(Rafal Gerszak For The Globe and Mail)

At 59, Doug Lidstrom says he is close to overcoming the heroin addiction that has dominated three-quarters of his life. Participation in a groundbreaking clinical trial has helped stabilize his habits and, perhaps within weeks, he will be among the first in North America to receive prescription heroin to help further combat his addiction.

But a swift decision by the federal government announced this week has halted Health Canada’s authorization of doctors to prescribe the drug. This means when doctors run out of Mr. Lidstrom’s three-month supply of diacetylmorphine (heroin) – which hasn’t arrived yet – the Vancouver resident must turn back to the conventional treatments that have failed him many times before.

In her announcement Thursday, Health Minister Rona Ambrose described the change as the closing of a “loophole” that allowed for the exploitation of a federal program. By banning doctors from prescribing “dangerous drugs like heroin, cocaine, ecstasy and LSD,” effective immediately, Ms. Ambrose made good on a vow of two weeks earlier, when her department first authorized the applications: to ensure it never happened again.

“This is turning me into a yo-yo,” Mr. Lidstrom said. “It’s playing with people’s lives.”

The Pivot Legal Society, which is representing Mr. Lidstrom and others in his position, will be exploring legal options that could include a constitutional challenge, said lawyer Scott Bernstein.

While illicit injection drug use in Vancouver has declined over the past 15 years, it remains a hot-button issue, largely due to the longstanding epidemics in the Downtown Eastside and politically charged harm-reduction measures such as Insite, the supervised injection site that recently marked its 10th anniversary.

The issue was again thrown into sharp focus mid-week with the release of a B.C. coroners report into the death of actor Cory Monteith, confirming he died in a Vancouver hotel room from a combination of injected heroin and alcohol. Ms. Ambrose invoked his name in her announcement – “to make the point it touches on all aspects of our community,” she said.

Continue reading at The Globe and Mail.

So I have a “pre-cancerous lesion.”

A couple of months ago, I received the results of my pap test, and the news that I have a “pre-cancerous lesion” on my cervix. I didn’t know how serious this was, or whether I should be worried, and the doctor’s expression wasn’t giving me any clues. He was calm, chatty and almost jovial — not that a nervous, sweaty, hand-wringing doc would have been any better. Moments earlier, I had heard him laughing with the receptionist about being starving, and just having to get through one more patient (me) before heading out. I equated it to journalism, where reporters cover so many murders, deaths and other tragedies that you can’t help but become desensitized, to some degree, when dealing with sensitive matters.

He said I have what is called a high-grade cervical squamous intraepithelial lesion, or HSIL for short, CIN (category) 3. At this point I still had no idea whether I should be concerned. I asked him what this meant and his response was: “It’s basically the last step before cervical cancer.” I’m thinking, “Alright, I guess I can start being worried now.”

Weird cells and lesions are disturbingly common findings in pap tests, he said: About one in 10 women get them, for no reason at all. There are different categories of severity; some weird cells and lesions go away on their own and others get progressively worse, culminating in cancer. He said of the 10 per cent of women who have this, if left untreated, 20 per cent (of that 10 per cent) develop cervical cancer. I know of five women — close friends — who have the same thing. I’m sure if I asked around, the number would grow significantly.

My only reason for posting this is to remind and urge women to go for their annual pap tests. I’ve skipped mine often for no good reason: busy, don’t feel like getting a cold speculum jammed in me today, etc., but I ended up going at a critical time. If I would have skipped out for the next year or two, I could have become part of that 20 per cent (of the 10 per cent with HSIL) to develop cervical cancer. Those numbers are nothing to dismiss.

On Monday afternoon I will go for a colposcopy, during which they will look at the abnormality further and do a biopsy. From there, they will either destroy the abnormal area (ablation) or remove it (resection). Following this procedure, 10 per cent of women will have a recurrence. Whereas I used to loathe going in for a pap test once a year, I’ll now have to loathe going in for checkups two or three times a year. One of my best girlfriends has had a recurrence and she’ll have to go back in January. I don’t quite know what that means yet.

Anyway. No need to send me messages saying you’re hoping for the best, etc. At this point I’m still not worried, per se, and I don’t think I really have reason to be. I’m just a little nervous about the procedure — friends have described it as being very uncomfortable — and annoyed at the idea of follow-ups several times a year.

Please do go get your pap tests done, ladies. Timing is crucial.