Empathy is invaluable while practicing healing
Advanced ageing can be detrimental to a lot of things; To mention a few it can make traveling hard for you, restrict your diet and even impede your natural health. A lot of people across the globe struggle with health woes particularly after a certain age. Healthcare professionals usually determine that this decline takes place anywhere between 45 and 50 years.
As a Multi-organ Transplant Surgeon, I find the transplant procedure to be of high-risk in most of the cases that I get to handle, as the patients usually come with complications from alcohol,Hepatitis infection or obesity the so called “Metabolic syndrome”. In the normal course, we generally prescribe the patients with either antivirals or put them on specialised diet regimen ,deep breathing exercise and physiotherapy. This course of treatment naturally helps, as it makes the patients feel more prepared, especially physically for the rigors of the surgical intervention.
Non-alcoholic fatty liver disease (NAFLD), if not treated in its earlier stages may possibly lead to scarring of the liver and inevitably pose a serious risk for liver failure.
There are studies which reveals that Liver transplantation has higher mortality rates amongst elderly patients and that they end-up with a prolonged hospitalization post transplantation. Besides, it’s been reported in the recent research works that Liver transplants are successful in older adults, even for those in their 80s. Most hospitals and doctors choose not to do surgical intervention for elderly patients as the risks associated and the recovery success margins are minimal.
But what do you do when the patient comes with advanced age and other comorbidities?
The challenge is, I often land up finding an alternative solution while we receive patients in their later stages of NAFLD for admission. For instance, we had a 72 years old patient diagnosed with NAFLD who managed to travel all the way from Agra to meet us at MGM Healthcare, Chennai for the only reason that he was rejected by several hospitals citing his old age, risk to recovery, obesity and hypertension.
Under my guidance, the team performed various diagnostic investigations which involved preliminary fibroscan, all the required blood tests followed by Cardiopulmonary assessments. The results of these investigations deemed him fit for surgery while his advanced age and obesity were the two major concerns that could set back his recovery and post operative care. Despite these risks, we decided to move ahead with the surgery.
In the process of transplantation, a portion of the patient’s whole liver was removed and replaced with the donor’s liver which took hours together as the procedure involved numerous moving parts. Post transplantation, the patient was put under immunosuppressants, so called anti-rejection drugs, to suppress his immune system and prevent it from rejecting the graft (Donor’s liver).
Put together my hands-on experience in geriatric transplantations, the surgical care and MGM’s stellar success post-operative management, helped us swing in favor of the patient which resulted in a resounding success and we found the patient to be lucid.
This case helped me realize that as a medical professional it is not conducive in writing off patients as a rule of thumb based on the challenges exhibited. We as Medicos it becomes our responsibility to provide the patient with the right support and care as the patient is obligated to a fighting chance irrespective of any impediments.
During the post operative care, 48 hours from the surgery when the patient took his first steps there was a certain level of spring in his steps, which made me feel that we were able to give the patient a new second lease in life through surgical intervention setting aside the age factor, complexity and the risks involved with the case. As a surgeon, moments like this provides me with the most rewarding experiences.
The post-operative care was so effective that the period of hospitalization was around 14 days and post which we did not see any difficulties such as graft rejection, for the patient.
We guided the patient on the below mentioned parameters by counselling him on how to manage his daily well-being post-transplantation:
Process to be followed in taking new medications
Managing self to monitor blood pressure and pulse measurements
An eye for any signs of infection or rejection
To visit hospital when feeling critical for further diagnosis