Sunny Transplants?

A few years ago, when I wrote only about Chronic Kidney Disease, the representative of a transplant group asked me to write about transplantees and skin cancer. I respectfully declined. As you may have noticed, my topics have become more wide ranging this year, from PKD to the Chronic Disease Coalition and all things in between. This week, I’m going to add skin cancer and transplantees to that list.

For me, that means going back to the basics since I was surprised that this was even an issue. The logical place to start was The Skin Cancer Foundation at https://www.skincancer.org/prevention/are-you-at-risk/transplants:

The most common skin cancers after transplant surgery are squamous cell carcinoma (SCC), basal cell carcinoma (BCC), melanoma and Merkel cell carcinoma (MCC), in that order. (See Table Below) The risk of SCCs, which develop in skin cells called keratinocytes, is about 100 times higher after a transplant compared with the general population’s risk.  These lesions usually begin to appear three to five years after transplantation…. While basal cell carcinoma is the most common skin cancer in the general population, it occurs less frequently than SCC in transplant patients. Even so, the risk of developing a BCC after transplantation is six times higher than in the general population….

Risks of Four Types of Skin Cancer After Transplantation

Risks of Four Types of Skin Cancer After Transplantation

You could have knocked me over with a feather. From this stunning information, I extrapolated that it looks like the anti-rejection drugs are the source of the skin cancer.

Let’s see what these drugs are. The National Kidney Foundation at https://www.kidney.org/atoz/content/immuno explains.

Immunosuppressants are drugs or medicines that lower the body’s ability to reject a transplanted organ. Another term for these drugs is anti-rejection drugs. There are 2 types of immunosuppressants:

  1. Induction drugs: Powerful antirejection medicine used at the time of transplant
  2. Maintenance drugs: Antirejection medications used for the long term.

Think of a real estate mortgage; the down payment is like the induction drug and the monthly payments are like maintenance drugs. If the down payment is good enough you can lower the monthly payments, the same as for immunosuppression.

There are usually 4 classes of maintenance drugs:

  • Calcineurin Inhibitors: Tacrolimus and Cyclosporine
  • Antiproliferative agents: Mycophenolate Mofetil, Mycophenolate Sodium and Azathioprine
  • mTOR inhibitor: Sirolimus
  • Steroids: Prednisone

Okay, got it. But I still don’t understand what that has to do with skin cancer. The Department of Dermatology at Oxford University Hospital of the National Health Service Trust (in the United Kingdom) at https://www.ouh.nhs.uk/patient-guide/leaflets/files/11710Pimmunosuppressants.pdf offers this information:

“These drugs work by reducing your immune (defence) system. However, these treatments also increase your risk of skin cancer….”

Now it makes sense. While saving your life via preventing the rejection of your new life giving organ by suppressing your immune system, other conditions like cancer are sneaking passed that suppressed immune system. So you need to take these drugs to keep your new kidney, but they could shorten your life by letting the cancer cells multiply.

PATIENT CHARACTERISTIC FREQUENCY OF
DERMATOLOGY EXAM
No history of skin cancer or Actinic Keratosis Every 1-2 years
History of Actinic Keratosis Every 6 months
History of 1 non-melanoma skin cancer Every 6 months
History of multiple non-melanoma skin cancer Every 3 to 4 months
History of high risk SCC or melanoma Every 2 to 3 months
History of metastatic SCC Every 1 to 2 months

Hmmm, but maybe not. There must be a way to at least help guard against this… and there is. Actually, there are several including avoiding the sun, using sun block, wearing the newish sun blocking clothing, and simply wearing clothing that blocks the sun. (The chart above comes from the same site as the quote below). As the University of California San Francisco Skin Transplant Network phrases it at http://skincancer.ucsf.edu/transplant-patients:

“Clothing is a simple and effective sun protection tool. It provides a physical block that doesn’t wash or wear off and can shade the skin from both UVA and UVB rays. Long-sleeved shirts and pants, hats with broad brims and sunglasses are all effective forms of sun protective clothing.”

There’s quite a bit of easily understood information about the different kinds of skin cancer that affect transplantees at the above URL. By the way, this request for patient participants also appears on their website:

We need transplant recipients to please help us by participating in our brief survey study about your skin.

Please click here to access our online consent form to learn more about the study.

After electronically signing the consent form, you will be directed to a short questionnaire about your health.
There will be no cost to you; your participation is entirely voluntary and will not influence your care or your relationship with your doctors.

Thanks so much for your help in skin cancer research!
UCSF IRB approved, #16-20894

Not only do you find the information you may be looking for about skin cancer and transplantees on this website, but you also have this opportunity to help with skin cancer research.

Whoops! I neglected to define UVA and UBV rays. Encarta Dictionary apprises us that UVA is “ultraviolet radiation, especially from the sun, with a relatively long wavelength,” while UBV is “ultraviolet radiation, especially from the sun, with a relatively short wavelength.” Not very helpful, is it?

Let’s try this another way. Many thanks to Cancer Research UK at https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer/how-the-sun-and-uv-cause-cancer for clearing this up for us:

“There are 2 main types of UV rays that damage our skin. Both types can cause skin cancer: UVB is responsible for the majority of sunburns. UVA penetrates deeper into the skin. It ages the skin, but contributes much less towards sunburn.”

Another way to help yourself avoid skin cancer after having a transplant is to learn how to monitor your skin for cancer and then to do so on a regular basis. If you notice any abnormal spots or growths, get thee to thy dermatologist quickly. Apologies to Mr. Shakespeare for suborning his line.

You’ll probably be taught the ABCDE of Melanoma detection, too. The American Academy of Dermatology at www.aad.org is another good source of skin cancer information.

Here are some things I didn’t know about skin cancer that you may not know either. I picked them up at a local lecture on avoiding skin cancer:

Your lips need sunscreen, too.

The most common spot for men to develop skin cancer is the back; for women, it’s the legs.

Stage 3 and 4 Melanoma can get into your lymph nodes.

Effective sun screens contain both titanium and zinc.

Use SPF 50 on your face.

My transplanted friends always tell me transplant is “a treatment, not a cure.” Now I understand it’s a treatment with some possibly serious side effects.

Until next week,

Keep living your life!

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The Coffee Blog

Last week’s blog discussed different kinds of drinks.  I mentioned that coffee is my favorite.  Since I’m still recovering from the second cataract surgery and we all know how good it feels to be self-indulgent when you’re recovering, this week’s blog is all about coffee.  I won’t be repeating what I included in last week’s blog, but there is quite a bit of medical information about coffee available.  Let me just pour myself a cup and I’ll tell you….

We’re smiling because we’ve just had COFFEE.

Really? Drinking Coffee Lowers Colon Cancer Risk

Over the years, most studies of the subject have been either small or plagued by methodological flaws. But recently a team of researchers at the National Cancer Institute followed half a million Americans over 15 years. The researchers looked in detail at their diets, habits and health, and found that people who drank four or more cups of coffee a day — regular or decaf — had a 15 percent lower risk of colon cancer compared with coffee abstainers. While the researchers could not prove cause and effect, they did find that the link was dose-responsive: Greater coffee consumption was correlated with a lower colon cancer risk. The effect held even after they adjusted their findings for factors like exercise, family history of cancer, body weight, and alcohol and cigarette use.

The address for this article is: http://well.blogs.nytimes.com/2012/07/02/really-drinking-coffee-lowers-colon-cancer-risk/?partner=rss&emc=rss

And to answer your question about what colon cancer has to do with chronic kidney disease, you have to remember you are medically compromised already. Cancer is a disease caused by inflammation, just as chronic kidney disease  is.  By the way, it’s said that alkaline foods are a better way of eating should  cancer rear its ugly head in your life.

But that’s not all  drinking coffee can do for you:

Coffee Drinking Linked to Lower Death Risk

Older adults who drank coffee—caffeinated or decaffeinated—had a lower risk of death overall than others who did not, according a study by researchers from the National Cancer Institute and AARP. Coffee drinkers were less likely to die from heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections.

You can find this information at http://blog.rwjf.org/publichealth/2012/05/17/public-health-news-roundup-may-17-2/

I am an older (thank you for that ‘er’) adult. I absolutely love coffee. I also have chronic kidney disease which may lead me down the primrose path to diabetes.  Perhaps I can prevent that?  Too bad I’m restricted to two cups a day.

This one can get a bit technical so I’ve copied the most easily understood part of it:

Coffee consumption inversely associated with risk of most common form of skin cancer

PHILADELPHIA — Increasing the number of cups of caffeinated coffee you drink could lower your risk of developing the most common form of skin cancer, basal cell carcinoma, according to a study published in Cancer Research, a journal of the American Association for Cancer Research.

“Our data indicate that the more caffeinated coffee you consume, the lower your risk of developing basal cell carcinoma,” said Jiali Han, Ph.D., associate professor at Brigham and Women’s Hospital, Harvard Medical School in Boston and Harvard School of Public Health.

You can find the whole article at http://www.eurekalert.org/pub_releases/2012-07/aafc-cci062612.php

So coffee – formerly universally maligned by the medical community – now can help prevent colon and skin cancer and prolong your life.  I’m liking this very much, but we’re not done, folks.  I’m grinding (love being punny) the sources out right now.

 I am in heaven!  Look what I found at http://www.everydayhealth.com/diet-nutrition/0310/9-healthy-reasons-to-drink-coffee.aspx?xid=tw_weightloss_20120123_coffee (You’ll probably understand my over the top joy if you remember I’ve had both a root canal and a crown replacement so the dentist could reach the cavity underneath the crown  this summer.  Both were so expensive that, even with insurance, I’ll be paying them off well into the new year.)

9 Healthy Reasons to Indulge Your Coffee Cravings

 Coffee gets a bad rap, but study after study shows your java habit is actually good for you. From a lower stroke risk to fewer cavities, here are the best reasons to enjoy a cup or two.

“Coffee is incredibly rich in antioxidants, which are responsible for many of its health benefits,” says Joy Bauer, RD, nutrition and health expert for Everyday Health and The Today Show. Its caffeine content may also play a protective role in some health conditions, but many of coffee’s health perks hold up whether you go for decaf or regular.

According to this article, coffee can help avoid diabetes, skin cancer, stress, cavities, Parkinson’s disease, breast cancer, heart disease, and head and neck cancers.

Parkinson’s disease runs in the family, too.  That’s another reason I’m so happy to have found this article.

One of the most romantic acts my sweet Bear performs is bringing me a cup of coffee to wake me up each day.  Sharing that time as we drink our coffee in bed cements the connection between us.  Could be I’m mixing up coffee and love, but there does seem to be some kind of interaction there.

My neighbor Amy – one of the busiest people I know – makes time to come over for a cup of coffee whenever she can.  She gets an hour’s break from her three kids and household duties or gets to de-stress from her work day and I get the pleasure of her company and hearing what’s going on in her life.

There’s more to coffee than caffeine.

An aside: talk about over problem solving – I just happened to notice that I can link websites from wordpress, too.  I seem to be doing a lot of that over stuff as I get older!

Until next week,

Keep living your life!