General Question Re Cornea Grafts and fitness

[Liam]

Hi All,

I have always wanted to ask a Doctor this question but it probably is not relevant to the consultation and is just for my own interest.

Is there a connection between physical fitness and success/failure of grafts e.g. if steroids suppress an individual's immune system would an Olympic level athlete need to take higher doses, and would he/she run a higher risk of rejection.Surely an athlete would have a stronger immune system to begin with than the vast majority of the population.

Liam

[Andrew MacLean]

Liam, you pose some interesting questions!

I am not sure that physical fitness has a discernable effect on recovery time. Topic steroids are usually applied for some time, not to suppress the immune system but as an anti-inflammatory precaution. On the face of it I'd have thought that a very fit person would recover more quickly but I do know one person who is an international athlete who has not had an easy time recovering from graft surgery.

All the best

Andrew

[Loopy-Lou]

being fit wil help recovery from the general anaesthetic and the 'shock' of surgery for any kind of surgery but the healing of a graft, ultimate survival and visual result is in the lap of the gods

[rosemary johnson]

I am not a medic.........
... but i'd guess that fitness could be a two-edged sword.
SOmeone is is generally fit and healthy is more likley to recover better and sooner than someone who is inherently pretty unhealthy.
But someone who is super-fit to the point of elite athlete standard, then they can be so fit they are very vulnerable to picking up injuries.
(SImilarly, racehorses are for ever going lame or getting stiff muscles, becaue they are so fit and on a nife-edge of superfitness. Whereas the old bags who plod round riding schools with little kid beginners on their backs are probably far from fighting fit and wouldn't have a hope of winning a five furlong selling plate let alone a 3=mile handicap steeplechase, but may never have had a day off work in the last three years.)
The steroid eye drops are intended as anti-inflammatories, rather than immune suppressants per se (I think the idea is your immune system is more likely to reject something that is swollen and sore).
If you have a general anaesthetic and are given steroids, that will be (I've been told) as an anti-emetic. How/why i'v steroids wouldhave that effect, I do not know.
I've been told (not by a medic) that skinny people are more likely to get over a GA faster than shall we say solider people because the chemicals dissolve more in fat than water. Mind, being skinny and being physically fit aren't the same thing (see, for example, theBritish Lions forwards).
Having a good healthy metabolism and good circulation will also help to eliminate the drugs from the system.
On the other hand - it one is physically fit and active, the effects of any steroids may be more evident.
That is ..... if you react strongly to the doses of steroids, particulary any i/v ones as eye drops are nlikely to set this off markedly - one of the effects is muscular weakness and atrophy - "no strength and no stamina" - which may be more noticeable, even in small amounts, to someone used to being superfit.
(It's known as "iatrogenic Cushing's syndrome" - the effects you get if the doctors put you on steroid meds. People who have heatrt, kidney etc transplants are more likely to get this prominently because they are on oral steroids for ever after.
Other effects are putting on weight - or sometimes weight redistribution (the books call it the "Michelin Man look"). This also may be more noticeable to someone used to being very fit and not carrying excess flab.
You'd be very unlikely (and extremely unlucky!) to have anything like the severe reaction and OTT degree of symptoms from the steroid doses in a corneal transplant as I did. And a person with a sedentary lifestyle may not notice a bit of strength-reduction or weight gain. I probably woulnd't be half so conscious of my lack of strength and stamina, muscles wlike helly till I try doing stretches when they feel like cast iron - sorry, Jelly! - and running out of energy all too rapidly if I weren't trying to look after horses, carry bbales of hay and straw and wodd shavings, sacks of pony cubes, buckets of water etc etc - not to mention running rounf the field trying to catch the little horrors!
As reagrds survival of the eye itself - after a graft, one is under orders not to overdo it and push the pressure up. A normally cery active person may gind this more frustrating than others! On the other hand, a sportsperson may be more used to listening to their own body and knowing when all is well and when it is telling them that it's done enough, so may be more attuned to their eye itself telling them when to take it easy.
One last thought is that sportspersons who are all too used to getting sporting injuries and having to recover from them, and doing so as quickly as they can to get back on the pitch, track, etc, may be better adapted - physically or mentally - to having something to recover from.
Steeplechase jockeys, who do rather a lot of falling from galloping horses, are infamous for their broken bones mending faster than normal human bones.
Of course, it may be that the people who get to be top sportspersons are precisely those who are good at recovering from sporting injuries, as they others have given up.
There! - lots of possibilities. Which are more to the fore in each particular person? - who knows?
Rosemary