Without Guts, but Not Without Glory

As a TPN (Total Parenteral Nutrition) patient of more than twenty one years, I take exception to the statement in "Right in the Gut" [Aug. 3] that people on TPN do not have a good quality of life.

I lost most of my small and part of my large intestine due to an automobile accident, but I have led a rich, full life. Since becoming dependent on TPN, I raised my two children, completed a college degree, worked almost full time, traveled over much of the United States, and to Scotland, Israel, Jordan, France and New Zealand. Now retired, I work out several times a week, go hiking with my husband, sing in two choirs and enjoy new experiences.

Yes my life has had its challenges. During the first few years on TPN, I had several catheter-related infections; however, I have had only one in the last 18 years. The risk of liver damage exists, but my doctor monitors my liver closely and has successfully dealt with elevated liver enzymes by changing one of my oral medications and by decreasing the frequency with which I add iron to the TPN bag (too much iron stresses the liver).

Most of the TPN patients I know lead active lives. Last year, I met a young lady of 18 who has been on TPN her entire life; she has now completed her freshman year in college. I also met a young, newly married microbiologist who enjoys skiing with his wife. At meetings of support/educational organizations such as the consumer oriented Oley Foundation for Home Parenteral and Enteral Nutrition or the research-oriented American Society for Parenteral and Enteral Nutrition, we TPNers enjoy swapping "war" stories.

The people I have met are incredibly inspiring. We may not have the guts, but we know how to enjoy the glory!

I am glad that intestinal transplantation is an available option, should I need it one day. but I am in no hurry to subject myself to a procedure that has the potential of causing diabetes, high blood pressure and elevated cholesterol levels. Nor do I want to take immunosuppressive drugs for the rest of my life. Not everyone with intestinal failure is a candidate for transplantation, and my goal in writing this is to make people aware that those who need to be on TPN can have a great life.

Davria Cohen


A Mature Solution for Growing Up

Imagine my amazement when I read in "Growth Factors: Elusive Adulthood" [Aug. 3] that the study's authors "...recommend expansion of military and alternative national service programs to help more young people cross the bridge to adulthood."

That's the timeliest recommendation I've read in many years. Frank J. Furstenberg, Jr., and members of the Network on Transitions to Adulthood and Public Policy deserve an accolade for pulling no punches in making their recommendation.

James V. Dolson