Diagnosed with ESRD - End Stage Renal Disease in 2010 with 28% kidney function left. In January 2013, it dropped to 5%. Started twice a week Hemodialysis in February. My beautiful and courageous wife, Ninette, came forward willingly to be my donor and we started with the work-up in March. We finally finished everything and got approval 08 July 2013. We had the procedure the 25th of the same month.

Our journey continues...

Wednesday, August 21, 2013

Under House Arrest

The nephrologist was strict: Stay at home the next 3 months. You are not allowed to go out/anywhere but home. You are only allowed out on Tuesdays for your weekly blood extraction and check up.

I'm home, feeling much better; wounds have healed, edema gone, very much mobile and feel like I am already able to drive and go to the supermarket, drugstore, bank, hell… even the mall. But I gotta heed the doctor's order. The eve before I was discharged from hospital, my neph gave an hour's worth of lecture on post-transplant home care. He verbally outlined everything complete with examples of past patients who followed his instructions vs those who did not and what the consequences were. If he intended to scare me so that I will follow his instructions, he succeeded. 

The 2 things I must avoid during these months are:
Rejection
Infection
Of course there are other things he discussed like proper diet, living a healthy lifestyle, managing NODAT(New Onset of Diabetes after Transplantation), mental, even sexual health, etc. But his focus was on the 2 above.

Rejection
Transplant rejection is caused by the body’s immune response to foreign material. The body naturally tends to attempt to destroy encountered foreign matter. Leukocytes(white blood cells) serve our bodies very well. They identify viruses and bacteria that have entered our bloodstream and begin to eliminate them.When someone receives a transplant, leukocytes also work against the new organ. They immediately recognize the organ as foreign, and set about to destroy it. When the white blood cells are effective, this causes transplant rejection. So leukocytes have to be reduced in order to allow the new organ to do its job.

Acute Rejection
This is a sudden reaction of the body's immune system against the kidney transplant. This type of rejection is usually seen in the first year after transplant and will require hospitalization. If treated early, kidney function will usually improve. If your body totally rejects the transplanted kidney it's back to dialysis. The goal is to stop the immune system's attack on the kidney.

Chronic Rejection
This is a gradual decrease in kidney function. This type of rejection usually occurs several months or years after the transplant. Because this rejection is a slow process, dialysis may not be needed for some time. The cause of this rejection is unknown and treatment with medication is often less effective than with acute rejection.  

This is why I have to take anti-rejection medication to reduce the body's immune system response. These are expensive medicines to be taken at exact intervals in order to maximize their effect. Aside from these anti-rejection meds, I'm also on corticosteroids, blood pressure maintenance, calcium, iron, amino acids, blood thinners and a host of other pills. I call them my M&M's. All in all, I take around 35 pills a day… wait, no it has been reduced to 33 as of yesterday… doctor's instructions via SMS.



Infection
The anti-rejection drugs I take put me at greater risk for developing an infection. The most common infections after a kidney transplant are of the respiratory system and urinary tract. Infections are treated with antibiotics, anti-virus or anti-fungal medications.

Among the 33 medications that I take daily, are anti-bacterial, anti-virus, and anti-fungal medications to prevent infection especially during the first few months after the transplant. Also strict common sense instructions on:
proper hand washing
wearing a mask
avoiding contact with others who have colds/flu
practicing good personal hygiene
no pets, no plants/flowers
maintaining a well-balanced diet
all food must be cooked; no salad, no raw meats, no sushi :(
eat only freshly cooked food, no leftovers; not to eat food whose freshness is in question; keep hot food hot and cold food cold
avoid crowds, limit visitors

As a side effect of these medications, I developed NODAT or the Onset of Diabetes After Transplantation. I check my blood sugar level and record it 3 times a day before meals then I inject myself with insulin unless I get a normal reading. My blood sugar levels should improve as the dosage of corticosteroids is reduced in the next few months. Hopefully, I will just need to take maintenance medications.

I lost a lot of blood during the 3 surgeries that I have undergone and I counted 7 units of blood transfused when I was in the ICU. I think aside from that, they used up 4 bags during surgery. Because of this, my hemoglobin level is a little bit lower than normal. To help it up, I inject myself with 5000iu of Epoetin Beta 3 times a week.

Yesterday was supposed to be my check up day. I was at the NKTI Laboratory for blood extraction at 8am despite the torrential rains. But later I found out that clinic hours are suspended. So I've been rescheduled tomorrow.

Every morning, I report the previous day's stats to my neph via SMS. And he replies with his instructions, if any. He's on my speed dial… we're close like that :)
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