Reducing Falls in Seniors Using Technology

I've written many articles and blog posts about home safety for seniors - how to reduce the risk of falls by changing the environment and by managing health and medical issues. Falls at any age can be serious, but as we age, one fall can start a domino effect, leading to severe disability or even death.

Over the years, researchers have been trying to find ways to predict who is at highest risk of falling and how we can best prevent these accidents from happening. There have been studies that use scores, assessing mental and physical ability, for example, but nothing seems to be too effective yet. Now, with technology advancing as it is, perhaps there is a solution.

According to this press release, researchers have developed sensors that monitor a person's gait and stride, and could predict if the person is at risk for falling within the next few weeks. The sensors kept track of regular motion and walking, and picked up on any changes that could indicate weakness or an irregularity.

"Results from an analysis of the sensor system data found that a gait speed decline of 5 centimeters per second was associated with an 86.3 percent probability of falling within the following three weeks. Researchers also found that shortened stride length was associated with a 50.6 percent probability of falling within the next three weeks."

If something like this is successful in predicting falls, this could not only help reduce falls, but reduce the worry of family members who are concerned about their older relatives living alone. Good news all around. Kudos to the researchers who are working to keep our seniors safe. After all, it could help us one day too.

HPV Vaccine Study Shows Reduction in Cervical Cell Abnormalities

Gardasil, a vaccine that helps prevent four human papilloma viruses (HPV) known to cause cervical cancer and cervical warts, was approved in the United States and Canada in 2006. Since then, millions of doses have been given, and probably an equal number of debates about its utility and safety have been argued among both the general public and healthcare professionals.

New study findings 

A new study published last week in the Canadian Medical Association Journal reviewed the efficacy and safety of the vaccine over the past eight years. The study included 10,204 women, aged 18 to 24 years, who had undergone Pap smear testing for cervical abnormalities. Most women in the group, 8,723 (85.5%) did not have any abnormalities, but 1,481 women (14.5%) did; 1,384 of these women had low-grade cervical anomalies and 97 had high-grade abnormalities.

The researchers found that 56% of the women were not vaccinated with Gardasil and 16.1% in this group had cervical abnormalities. Forty-four percent of the women received at least one dose before their screening test; 84% in this group were fully vaccinated, having received 3 or more doses; 11.8% in the fully vaccinated group had cervical abnormalities. In other words, women who had received the full dose of Gardasil had a lower incidence of cervical abnormalities that could lead to cancer.

But is the vaccine safe?

Tara Haelle did such a good job last year in her article about Gardasil vaccine that I thought it was better to refer you to her piece: Gardasil HPV Vaccine Safety Assessed In Most Comprehensive Study To Date.

But what about long-term efficacy, some people ask? What if it stops working? Yes, it's true that we don't know if the vaccine's effectiveness will last - but we didn't know that about the other vaccines we took either. I was vaccinated with the hepatitis vaccine when I first began working as a nurse. It was hospital policy and we didn't really have a choice. At the time, we weren't told that it was only effective for 25 years. We didn't know.

The morality argument

Just a few weeks ago, I read a respectful debate between a group of people who weren't sure if they wanted to vaccinate their teens, both male and female, with Gardasil. Most were in favor of the vaccine, while a few others were either hesitant or against it. I do realize that some parents are distrustful of vaccines, particularly one that appeared to come onto the scene as quickly as Gardasil. But I was surprised to see someone pull out the morality argument in the discussion - that if you gave your daughter Gardasil, you were condoning early sexual behavior.

That argument always bothers me. We will never control how or when our children have sex simply by not giving them a vaccine for a sexually transmitted infection. That just isn't going to happen. And what about all those whose teens and children whose first sexual experiences aren't their choice? We can never forget the number of teens and children who are abused, who are victims of sexual predators. Using sexual morality as an excuse to not give the vaccine just doesn't hold water.

So is Gardasil a good thing for our children?

Happy Canada Day! Let's Give Everyone Something to Be Grateful For

In this time when bad news is hitting us from all sides, I want to take a moment to wish my fellow Canadians a happy Canada Day. I hope that you are able to spend the day as you wish, whether it be with family and friends, or taking some time to yourself. If you're one of the many Canadians who are working today because you are needed, like my fellow nurses, I hope your day is a smooth one, with as few problems as possible.

Canada is far from perfect. We have serious issues that we need to not only acknowledge, but address in an effective and fair manner. There are Canadians who suffer needlessly as the result of current conditions, such as those who live in impoverished First Nations communities or those who are homeless in our bustling cities. There also many Canadians who are suffering the effects of events that occurred in the past, including residential school survivors and their families. These too, need to be resolved to the best of our ability.

I don't get political on this blog - it's a health-related project. But often the two cross over. Poverty, illness, illiteracy, abuse, violence - these all affect mental and physical health. For a country to be truly strong, these issues must be dealt with equally for all citizens, regardless of who they are and where they may have come from.

But how do we do this? It's a huge task and it's not something one person or one organization can do alone. But one person and one organization can be pieces of the bigger puzzle. I try to work on literacy. I strongly believe that the more effectively people can communicate and understand, the better the chances that they can tackle the problems life throws at them.

However any of us choose to try to help others, we have to remember that we are in this together. We can't allow petty things and small differences divide us. We need to remain a community and reach out to those who need us. This is what makes us strong.

So Happy Canada Day to my Canadian friends, colleagues, and readers. Let's spend the next 365 days finding ways to help each other, so when our 150th birthday rolls around next year, we have something even more special to celebrate.

Lack of Sleep Makes for Cranky Teens, Says Study - You Think?

I'm on the duh-study trail again. My latest find is "Adolescent sleep duration is associated with daytime mood." Well then. What a shocking finding from a National Institutes of Health supported study.

According to the news release (I don't have a copy of the study findings), the researchers studied 97 healthy teens from 14 to 17 years old to follow their sleeping habits. The teens were allowed only 6.5 hours in bed per night for five nights in a row (sleep restriction), then a two-night break (a "washout period") and this was followed by five nights straight of 10 hours in bed per night. The researchers looked at the teens' daily self reports on nervousness, sadness, anger, energy, fatigue, ability to concentrate, and sleepiness.

According to the news release:

Results show that adolescents showed increased variability in sadness, anger, and sleepiness when sleep was restricted compared to when sleep was extended. This effect was not moderated by age, sex, race, or the order in which participants underwent the sleep conditions.
The study also showed that nightly fluctuations in sleep in healthy adolescents predict worse mood the next day, and worse mood any given day largely predicts unusually bad sleep the next night.

So here we have it - less sleep equals less happy teens. Any parent could have told us that.

In all seriousness, the authors do say that the research is necessary because they are concerned about the mental health of teens - an important issue to be sure. But their conclusion, that these findings indicate that by promoting healthy sleep habits, we may be able to reduce the risk of mental health problems among some teens, is too simplistic. We know that lack of sleep causes problems, particularly if it's chronic. We also know that teens need a lot of sleep, as they did when they were infants - a teen's body is growing and changing at incredible rates.

My issue with these Duh Studies is that they're sent out into the media world without any real meaning. Yes, teens need sleep. Yes, they're crabby and don't function well without sleep. Now what?

Senior Moment - Memory Clutter?

We all have our forgetful moments, a word we can't bring to mind, a name we've forgotten, or an appointment that slipped past us. We can't remember everything. Those who can, like actor Marilu Henner, are few and far between. But, as we get older, we seem to take more notice when we forget things, often making jokes about aging and memory loss, or perhaps fearing that this is what is happening.

While memory loss and the fear of dementia are concerning, they don't affect everyone who gets older. Forgetfulness though, is different, and researchers from the Georgia Technical Institute in Atlanta, Georgia, believe that a good part of the aging forgetfulness is merely a matter of us just having too much information to store. In other words, our hard drive has run out of space and certain files have to be archived.

The researchers used EEG to study the brains of two groups of subjects, those over the age of 60 years and college-age students. Both groups were shown photos of every day images and told to focus on certain things and ignore others.

At first, both groups were able to remember what they were told to focus on, and both had trouble ignoring what they were told pay attention to. But when the older subjects were questioned further about what they were supposed to focus on and remember, over time they became less sure of their responses and the other objects in the photos interrupted their memories. "[W]hen we asked if they were sure, older people backed off their answers a bit. They weren't as sure," lead author Audrey Duarte said in a release. The brain activity, recorded by EEG, showed that the older group put more effort into sorting out the appropriate memories.

"While trying to remember, their brains would spend more time going back in time in an attempt to piece together what was previously seen," she said. "But not just what they were focused on -- some of what they were told to ignore got stuck in their minds," she added.

This was a study environment, but we are faced with situations like this every day - walking to work, going out to lunch or dinner with friends, even shopping. We may be in a grocery store, with music overhead, conversations around us, and displays with food tasting, all while we're trying to concentrate on remember what we need to buy. Younger people who are asked what occurred during that time may have an easier time recalling what they saw or heard, while an older person may have to sort through different memories, clutter, trying to pull out what is relevant.

Why are details like this important to study? Duarte said that such findings could explain why seniors fall for scams that use manipulation. "If someone tells you that you should remember it one way, you can be more easily persuaded if you lack confidence," she said. "This memory clutter that's causing low confidence could be a reason why older adults are often victims of financial scams, which typically occur when someone tries to trick them about prior conversations that didn't take place at all."

It's an interesting look at memory as we age.

Let's Talk Adult Vaccinations

There's a lot of talk about vaccinating children, but we don't hear a lot about vaccinations for adults. The conversation drops off the map, as if once a child has finished his or her scheduled vaccines, that's it, that's all. But that's not it, and that's not all.

The need for vaccines continues as we age, and then become even more important again when we enter the so-called senior years. And for those who want to travel to other parts of the world, some countries won't allow you to visit if you haven't had their required vaccines.

What types of routine vaccines should adults have? Health Canada and the Centers of Disease Control (CDC) have similar recommendations. To make things easier for me, I'll focus on Health Canada.

In general, Health Canada recommends that adults who have been vaccinated as children, should continue with the following schedule, unless recommended otherwise by their physicians:

• Tetanus toxoid- reduced diphtheria toxoid (Td): 1 booster dose every 10 years.
• Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis (Tdap): 1 dose 
• Pneumococcal polysaccharide 23-valent:  1 dose at age 65 or older
• Herpes zoster (shingles): may receive 1 dose at 50 to 59 years of age, recommended 1 dose
• Influenza:  1 dose annually recommended for all adults without contraindications

There are also other vaccines, such as those for hepatitis A and B, which are recommended for people who are at risk of contracting the diseases.

Tetanus: Many people I speak with don't realize that they should get a tetanus booster every 10 years. I've heard many times, "Oh, I get a tetanus shot in the ER or at urgent care if I get a bad cut." But tetanus doesn't need a bad cut to take hold, so the booster route is a really safer route. I won't kid you, the tetanus shot does tend to be a bit more "uncomfortable" than many vaccines. But it is only once a decade. Perhaps you can bribe yourself with a nice treat after?

Pneumonia: The pneumococcal vaccine is primarily to help prevent pneumonia, although it does prevent other infections too. According to the National Foundation for Infectious Diseases,

It is estimated that about one million US adults get pneumococcal pneumonia each year. About 5-7% of them will die, and the death rate is even higher in those age 65 years and older. Fewer people will get pneumococcal meningitis or bloodstream infection, but the mortality rate for these infections is even higher.

So, while pneumococcal vaccine doesn't prevent all pneumonias, it does reduce the risk of this one, which can cause serious illness. It's particularly important for people who smoke, or who have respiratory diseases, such as COPD.

Shingles: I've had shingles; I was 44. One of my kids had shingles at only 21. I've known several people who had them before the age of 50. You don't want shingles. If you've ever had the chicken pox as a child, you are at risk of getting shingles. Remember, you don't want them. It's a horribly painful, uncomfortable virus that can knock you flat. There is also a complication called post-herpetic neuralgia, which can leave you with constant pain along the nerve line for years.

There is a treatment for shingles, but you have to recognize that you have the virus early enough for the treatment to work, and it really just knocks off a couple of days of suffering. It doesn't just get rid of the shingles. If you're on the fence about getting the vaccine, remember, you do not want to get shingles.

Influenza: The influenza vaccine seems to be the most controversial of the adult vaccination recommendations. Many people I know and love don't believe it in and refuse to get it. It's true that the vaccine isn't always effective. But I've seen what the flu can do, so the annual flu vaccine is a personal choice I make. Because I get so ill so fast with anything respiratory, I try to reduce my risk as much as possible.

Hepatitis A and B: I received this vaccine many years ago - it was required that nurses be vaccinated. I'm due for it again though, as it's supposedly worn off by now. The risk of getting hepatitis A is mostly for people who travel, but there is a combination vaccine that will protect you from both A and B at the same time. There is no vaccine for hepatitis C.

So, just because we're all grown up now doesn't mean we don't have to think about vaccinations.

Bigger Wine Glass = More Wine Consumed. Duh Study Time?

Long-time readers of my blog know that I live for finding Duh Studies. Those are studies that make me wonder how on earth the researchers received approval and funding for certain types of research. I found another one this morning.

Did you know that if you use a bigger wine glass, chances are you will drink more wine? I know. I was shocked too. Just as shocked as I was to learn years ago in nursing school that if we served meals on larger plates, people would want or add more food to these plates.

This new study from the University of Cambridge measured how much wine people bought/drank when they used larger glasses than when they used standard glasses. According to the press release:

Over the course of a 16-week period, the owners of the establishment changed the size of the wine glasses at fortnightly intervals, alternating between the standard (300ml) size, and larger (370ml) and smaller (250 ml) glasses.
The researchers found that the volume of wine purchased daily was 9.4% higher when sold in larger glasses compared to standard-sized glasses. This effect was mainly driven by sales in the bar area, which saw an increase in sales of 14.4%, compared to an 8.2% increase in sales in the restaurant. The findings were inconclusive as to whether sales were different with smaller compared to standard-sized glasses.

Ok, in all fairness, I did not read the study and I do only have this press release to go on, but seriously - is it really big news?

I have to say, I disagree with the researcher's quote here:

"We found that increasing the size of wine glasses, even without increasing the amount of wine, leads people to drink more," says Dr Rachel Pechey from the BHRU at Cambridge. "It's not obvious why this should be the case, but one reason may be that larger glasses change our perceptions of the amount of wine, leading us to drink faster and order more. But it's interesting that we didn't see the opposite effect when we switched to smaller wine glasses."

We do know. We know it's human nature. We see a lot in a small glass and a bit in a large glass, and we unconsciously believe that the amount in the smaller glass is more than in the larger glass.

Here are some earlier Duh Studies I wrote about:

It's Duh Study Time Again
Duh studies, not just for the public
Duh Studies, This Is News?

My interest in Duh Studies goes back to when I first worked as an online editor, and I came across a study that screamed, Bottle Feeding Dangerous For Babies (or something like that). It turns out, that the researcher had two case studies, both eerily similar. The first one involved a woman who boiled some water in a pan to heat up a bottle of formula. She took the freshly boiled pot of water over to her bed. Yes, to her bed. She placed the pan of water, freshly hot boiled water, ON HER BED. She put in the bottle of formula. She then GOT ON THE BED WITH THE BABY. As they were getting comfortable - you guessed it - the pot spilled freshly boiled water on the mum and baby, and baby was severely burned. Conclusion: Bottle feeding is dangerous.

I'm going to go have a cup of coffee in my enormous mug. Seems like I drink so little coffee that way. ;-)

Diseases, Deaths, and the Celebrity Effect

The world loves its celebrities, whether they be from sports, entertainment, or politics, or they're just famous for being famous. The celebrities rake in the money that many mere mortals are willing to pay so they can catch a glimpse of fame. Some of the celebrities embrace this adoration and use it to further causes they believe in, some mock it, and yet others try to live below the radar, avoiding the extra attention sent their way.

The attention focuses on, among other things, how celebrities live their lives, what they eat or don't eat, if they vaccinate or don't vaccinate, and what surgeries or procedures they may have had to keep their youthful look. But what fascinates is me the times when members of the public takes these celebrities as experts.  It's one thing to want to know what someone is wearing or how they decorate their home, but it's another to think that their celebrity makes them an expert on anything other than maybe being a celebrity. Is Gwyneth Paltrow really a nutrition and detox expert, or Jenny McCarthy an expert on vaccinations and autism?

And then there is the subject their health. When a celebrity announces a battle with an illness, their fans take notice and this drives awareness of conditions that may otherwise go unknown or misunderstood. Look at Angelina Jolie, and her decision to have a prophylactic double mastectomy and removal of her ovaries. She did this because she has a genetic mutation that greatly increases her risks of developing those cancers. This action and the publicity resulted in the Angelina effect, with many women with the same gene wondering if they should do the same thing - and experts appeared in all forms of media debating her approach.

Other celebrities who shared their battles with chronic diseases include:

• Selena Gomez:  lupus.
• Charlie Sheen: HIV
• Montel Williams: multiple sclerosis 
• Tom Hanks: type 2 diabetes
• Michael J. Fox: Parkinson's disease
• Jimmy Carter: melanoma

Just last Friday, we lost another celebrity, a world-wide celebrity, to illness: Muhammed Ali. He, too, had Parkinson's disease, but his death was caused by septic shock. Patty Duke died in March from the same cause. (Disclaimer: I am content director for Sepsis Alliance, when sepsis or septic shock is listed as cause of death, it always attracts my attention.)

When celebrities or their families disclose illnesses or causes of death, this starts a conversation about them. How many people, particularly those in the age group who love Selena Gomez, had ever heard of lupus? How many people thought that HIV was still a problem in 2016? Before Michael J. Fox and Muhammed Ali announced they had Parkinson's disease, how many people realized it could affect people so young? And what about the educational benefits that came out from President Carter's announcement that he was undergoing immunotherapy for his cancer? 

I've read a few article comments and social media messages saying that the media shouldn't be writing about or playing up the illnesses after celebrities die, that they should be remembered for their roles in our society. But can't raising awareness of these illnesses be one of those roles? Is using that information taking advantage of the situation?

I believe that if celebrities or their families choose to disclose their health battles, then the idea was to help raise awareness - and that is a good thing. All diseases or conditions that affect our quality of life or that lead to an early death are important. But they don't all have the same amount of air time, of awareness. And if the news of one celebrity with one illness can change things, can help someone go for a diagnosis or maybe not feel so alone, then I think it's a good thing.

Will Prince's Death from a Fentanyl Overdose Change Anything?

To say that the death of Prince a few weeks ago was a shock to the music community would be an understatement. To be honest, I wasn't all that familiar with his music - or so I thought. As I read the ensuing articles and Facebook posts, I came to appreciate the impact this man had on our collective musical soul, a man who was taken much too early.

It's a familiar story, his cause of death - an unintentional drug over dose. In this case, it was the pain killer Fentanyl. Too many people have been killed by unintentional drug overdoses. And every time it's someone famous or influential, there is hand wringing and there are calls for greater control of these potentially deadly medicines, and that things need to change. But what things?

When I worked as a nurse in hospice, Fentanyl was the drug of choice for many of my patients to help relieve the severe pain that end-stage cancer can cause. I saw the difference in my patients before and after they received the medication, misery before, relief after. My mother was on Fentanyl for chronic pain for many years, pain from spinal stenosis. It was the only medication that provided any type of relief and the fact that it was a patch that could last days, not hours, was a huge bonus. But, like many such drugs, there's a dark side to Fentanyl. It is addictive. Very addictive.

So, we have a medication that can help a person live life with less pain and a drug that can destroy a life. Where do we find a balance? And is there a balance?

It's already very difficult for some people with pain to get adequate pain relief. Some doctors are afraid of prescribing such powerful drugs, preferring to err on the side of caution, so they think. So the patients suffer, or look for another doctor. They run the risk of being accused of doctor shopping.

When patients do have a prescription, seeking renewals can be a nightmare; they may be treated like drug-seekers. If these patients present at emergency departments because they are desperate, some staff members don't believe that the pain is real. Some pharmacies don't even carry adequate amounts of the pain killers, if at all.

If we "tighten up" access to these drugs even more, where are those who need the drugs going to get them? Yet, we can't deny the seriousness of the issue of drug abuse. We can't ignore that people are becoming addicted to these drugs and lives are being destroyed because of them.

So, will Prince's death change anything? It's doubtful. If it does, I fear that it will make these medications even harder for people to obtain to relieve their pain. Is there a solution? There has to be. But what?

Old News: Noise in Hospitals Disturbs Patients

If you've ever been a patient in a hospital, you know that hospitals are not where you go to rest. And if you happen to have a room next to a nursing station or the entry to the unit or floor,  you're even worse off because of all the noise.

Even as a young nurse, I was aware that noise was an issue, particularly during the night shifts. I tried to speak at a lower level and not move around the rooms as much if I could avoid it. But, patient care still needed to be done and I found myself often waking patients so I could do certain procedures or give medications. I would feel so bad for the patients who had just finally fallen asleep, only to have me wake them up.

I had my three children at the same hospital, and the first two times, I was placed in a room right across from the nursing station. That experience opened my eyes. I got no rest. People were constantly walking past my room, rolling noisy carts and chatting with others. Some people would be calling up the hallway to colleagues as they asked or answered questions. The phone would ring all day long and staff members of all stripes would gather at the station, particularly at the change of shift. It was N.O.I.S.Y. Even with the door closed, I was disturbed. Night time was quieter, but there was still chatter and the noise of all the call bells that would go off all night long. It was anything but restful. I lucked out with my third child though - I was given the last room at the end of the hall. It was so quiet, it was like I was in a different place altogether.

The thing is, we already know that hospitals aren't restful places and that they're noisy. Researchers have been studying this - although they really just needed to speak to some patients to find out. But at least now, they're taking the noise seriously. There was a study presented at a conference earlier this month, showing how loud an intensive care unit can be, Quiet please in the intensive care unit! As a former ICU nurse, I could relate.

What does this all mean? It's hard to say. Patients are limited in power. They could ask to have doors closed, but they can't do anything about the alarms and the need for healthcare staff to communicate with each other in the halls. They also can't do anything about room placements or if they are near a hub of activity.

Hopefully continued research like this ICU one may change some policies - changing how alarms are used and instituting quiet times, when noisy activities stop and patients are encouraged to rest are a good start. Some facilities are already doing this. We know we need sleep to heal, to get better. The thing is figuring out how to provide it in the hospital environment.

Surgeons Perform Penis Transplant, Story Comments Go Wild

It's the nature of the Internet beast. Write "penis" in a headline and you're almost sure get more clicks than usual. Add "transplant," and curiosity will likely get the best of many people.

Last week, surgeons at Massachusetts General Hospital in Boston announced that they had performed the world's third penis transplant, the first done in the U.S. According to the news reports I read, there had been two previous attempts elsewhere - one successful and one not. I have to admit, I admire the bravery of the patient, Thomas Manning, who allowed his team to go public with the news of the surgery, although I suspect that it was part of the deal when they offered to do it, picking up the costs at the same time.

Sure, it's easy to giggle or snicker when one thinks of a penis transplant, and people of a certain age may think of the Bobbitt case, where the angry wife decided to amputate her husband's penis. But in all seriousness, this could be a major breakthrough to men who are injured or who are affected by cancer that requires amputations.

Sure, a penis is not a required part of the body, like the heart, the liver, kidneys, lungs and so on. It's used to transport urine and semen - and urine can be directed from the bladder through other methods. But that doesn't mean it doesn't have a vital role in life and in quality of life. Just as many women who have mastectomies go on to have reconstructive surgery, men may want/need that as well for their own psychological well-being. The difference is transplantation of a penis, with all that's involved, is a trickier and more intensive procedure - and probably considerably more expensive. In addition to the issue of obtaining the cadaver donations to be able to perform the surgery at all, another difference is a man who has a transplant will have to take antirejection drugs, while a woman who had breast reconstruction doesn't face that particular drug regimen, with its associated risks.

What is interesting about this whole thing though is the reaction of people to the news. Some feel it is a waste of time, while others applaud the research and learning that goes into it - after all, medicine and research don't live in a vacuum. Information gleaned from research in one area is often transferable to another. Some commenters make sick jokes, while others say that while this is all good, they don't want to read about a man's penis in the news. I wonder if they feel the same way about articles that discuss better ways for breast reconstruction (just wondering).

Finally, I have to admit, my eyebrows did raise a touch when I first heard the story. But the man had cancer. He survived it. Why would he not want to be as whole as possible again? Plans are for future transplants for men who have been injured in combat or who had traumatic car accidents.

For those who are saying that the surgeons and researchers should be looking at "more important" things, who decides what is more important? And, who is to say what they learn here can't be somehow used to help you one day for another health or medical problem?

There shouldn't be, in my opinion, a "it's either this or that" in research. There is room for so much of it. I wish Mr. Manning well, with smooth recovery and a happy, cancer-free life.

New York Times: Man Receives First Penis Transplant
CBS: Penis transplant glad to be a "complete" man