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Health & Fitness

Depression that stalks near-death survivors

Your greatest cheerleader is someone who has
Your greatest cheerleader is someone who has walked in your shoes. FILE PHOTO | NMG 

Qn: “I recently underwent an organ transplant but I have been left with a feeling of extreme indebtedness to the donor who happens to be my boss at work. I overwork myself for fear of upsetting her. How can I overcome this feeling?”

It is rather unusual for one to receive a living donation from a person who is not a relative in Kenya. It might be that the person who is both your boss and donor is a close relative, say a sister or even a mother. In this case you might be working in a family business with the woman as the boss.

You do not tell us which organ you got from your boss but most likely is a kidney, and here we start our journey of exploration as to why you might feel “extreme indebtedness”.

In truth, the likelihood is that you might be feeling in debt not just to the donor, but also to all those who played any part in your journey to good health.

The doctors, nurses and all those who may have contributed to the surgery are all people you owe a debt. It may also be worth your while to reflect on the reason you needed to get a kidney in the first place. The most common reason, again in the Kenyan setting, is where one has end stage renal disease, most often as a complication of diabetes.

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As you already know, diabetes is not simply a disease of the control of sugar in the body. It also manifests itself as a condition that sometimes leads to the damage of the very small blood vessels. In this regard, the damage can be (as in your case) to the small vessels of the kidney leading to kidney failure. Other vessels commonly damaged are in the feet, legs and the brain.

What you might not know is that depression and diabetes often occur in the same person, one making the other worse. Indeed, there is a worldwide campaign to let doctors and patients know of this link.

As often happens in medicine, we first make the observation (of the link) and then proceed to explain the cause (if any) of this apparent linkage. The current conversation is about which comes first and what leads to the other. Recent evidence (inconclusive) suggests that the two conditions (depression and diabetes) are inherited together.

A year or two ago, we saw a man in his forties. He had a good job, supportive family and lived in Nairobi with his immediate family. Before seeing us, he was reported to have changed a great deal. At work his performance had deteriorated and he had received a number of warnings for poor performance. His wife was complaining about his increased alcohol consumption. He also had all manner of sexual difficulties. He was obese and did not exercise.

With time, a diagnosis of diabetes was made and he was advised to cut down on alcohol as well as his food intake. He was also told to do more exercise. His frustrated doctor sent him to us with a note that simply stated “kindly see this man who seems to want to kill himself with poorly controlled diabetes.”

His was a good doctor who knew how to treat diabetes, but had not made the link with depression. A diagnosis of depression in a patient with diabetes was made and he was put on antidepressants. He continued with treatment for the diabetes.

Eight weeks after antidepressants were started, the man was changed. He had lost weight, was no longer drinking alcohol and exercised regularly. The dosage of his medication was then reduced and as he said he felt fit as a fiddle.

Sadly, by the time we saw him, his kidneys were showing early signs of damage from the poorly controlled diabetes. He talked about the debt that he felt he owed the team that had linked him with the mental health experts and expressed commitment to the programme of treatment for fear of ending up with talk of transplant if the kidney became worse!

At one point he had become much like you are now. He kept sending messages of gratitude and also sending all manner of gifts to the doctors and nurses. He said they had saved his life. He was right. The antidepressants had helped him avoid a kidney transplant!

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