Day 62 - 2nd Month Post-Transplant Update

Image courtesy of medscape.com

Today is the second month of my new life, having received a kidney from Ninette, my wife, last July 25. What do young people call this occasion? A monthsary?

I went to see my nephrologist yesterday as a follow up on the oral steroid pulsing he started me on 4 days ago.(See previous post) I had a Renal Allograft Doppler Ultrasound done plus blood tests: Creatinine and BUN. Both the neph and I are happy since the results indicate that I am responding very well to the oral steroid pulsing. 

The Doppler Ultrasound did not show any adverse abnormalities and my blood numbers have improved a lot. My Creatinine level went down to 1.9 ml/dL, my best number so far after the transplant 2 months ago. And there's no need for me to be admitted for steroid pulsing via IV.

I'll stay with the current Prednisone level of 60mg per day to check this mild rejection episode and will see the neph again after a week. Then, hopefully, I can again be weaned from steroids. Among the common side effects of high-dose Prednisone are: mood swings, irritability, thrush, increased risk of infection, joint discomfort, high blood sugar, "moonface", acne, high blood pressure, increased appetite, weight gain and fluid retention. So the sooner the dosage is decreased, the better.

Day 58: Alarm Up!

It was rather a busy week for me doing blood tests and consulting with my nephrologist. My serum creatinine level results show an increasing trend contrary to what was expected. And there is a need to identify what is causing it.

My usual weekly lab tests include

1. Creatinine - indicator of kidney function; an elevated creatinine level signifies impaired kidney function
2. Complete Blood Count - used to evaluate overall health and detect a wide range of disorders; abnormal increase/decrease in cell counts indicate that there is an underlying medical condition that calls for further evaluation 
3. BUN(Blood Urea Nitrogen) - measures the amount of nitrogen in the blood that comes from the waste product urea which is passed out of the body via urine; if kidneys do not remove urea normally, BUN level rises
4. Lipid Profile - measures levels of lipids/fats, including cholesterol and triglycerides; it assess risk of developing cardiovascular disease or to monitor its treatment
5. FBS(Fasting Blood Sugar) - indicates the amount of glucose/sugar present in the blood; levels outside the normal range may be an indicator of a medical condition, diabetes in particular  
6. Urinalysis - checks different components of urine, a waste product produced by the kidneys; minerals, fluids, and other substances from blood are passed in the urine; what you eat, drink, how much you exercise and how well your kidneys work can affect what is in the urine; it helps find causes of symptoms of health problems one may have
7. Hemoglibin A1C - diagnoses Type 1/Type 2 diabetes; gauges how well diabetes is managed; reflects the average blood sugar level for the past 2 - 3 months; the poorer blood sugar control, the higher risk of diabetes complications
8. Potassium - detects concentrations that are too high(hyperkalemia) or too low(hypokalemia); hyperkalemia may indicate kidney disease
9. SGPT- ALT (Serum Glutamic-Pyruvic Transaminase - Alanine Aminotransferase) - give doctors important information about how well the liver is functioning and whether a disease, drug, or other problem is affecting it 
10. CYA C2 BY CMIA - monitors immunosuppresant/anti-rejection drug levels for management of organ transplant patients; levels below the range indicate lack of immunosuppresant drug dosage, higher than range numbers indicate drug over toxicity

Since the transplant, almost all my numbers have improved and most of them are within the normal range now except for BUN, Creatinine and CYA which needed tweaking by increasing or decreasing medication dosage. Weekly neph consultations are important to monitor symptoms of rejection or infection, both being the banes of transplant patients.

The neph is positive that the increase in creatinine is not caused by rejection or infection because I am asymptomatic of both. No fevers, no edema, no decrease in urine output, no cough/colds, no pain in the graft area.

My anti-rejection drug range is 1000 - 1300 nanograms/milliliter. The table shows my CYA levels and Creatinine the past month:

Date	Cyclosporin Dosage mg/day	CYA C2 nanograms/milliliter Range 1000-1300	Creatinine milliligrams/deciliter Range 0.5-1.3
13 Aug	250	366.5	2.1
20 Aug	300	721.2	2.3
03 Sept	350	994.1	1.9
18 Sept	350	2538.7	2-4
21 Sept	250	1018.6	2.5

            
Other possible causes of increased Creatinine are dehydration, diet excessive in protein and strenuous exercise. I take lots of water, my diet is well-balanced and my exercise consists only of toing and froing an 8-meter carport for 20 - 30 minutes on days when it's not raining. The task now is to identify what causes these irregular levels. 

Therefore I'm in for more visits to the lab and neph this coming week. I'll do repeat Creatinine and BUN tests plus a Doppler Ultrasound of the Renal Graft on Tuesday. To further isolate the results, I was ordered to a low-protein diet and to stop exercising for the meantime.

Meanwhile, just to rule-out rejection, I am placed on a pulsed infusion of oral Prednisone, an increase from 20 to 60mg/day. If the test result still indicate a rising Creatinine level, I may be again confined so intravenous pulsing can be administered. Of course I wouldn't want that. Hopefully, it doesn't happen. 

The journey continues.          

Update + Gratitude

Day 43, post-transplant and I am feeling great. My weekly blood results show a remarkable improvement compared to when I was in dialysis and immediately after the transplant. Just to summarize some relevant numbers:

	Pre-transplant	2 Weeks Post-KT	Most Recent	Normal Range
Hemoglobin	10.2	9.7	11.9	12 - 16 g/dL
Potassium	6.20	5.20	4.20	3.5 - 5.10 mmol/L
Calcium	1.90	2.15	2.28	2.2 - 2.55 mmol/L
Creatitine	14.4	2.3	1.9	0.5 - 1.3 mg/dL
CYA C2 BY CMIA		366.5	994.1 ng/mL	Target: 1100

     
Also, urine output is ideal with no traces of blood or proteinuria. Ninette, my beautiful, generous and ever-loving wife and donor, is doing great with all her test results within ideal levels. What I'm watching for now is on managing NODAT(New Onset of Diabetes after Transplantation). The neph said this will taper down slowly as the doses of steroids are reduced. I should also guard against weight gain and developing a moon-face.

Staying home and going out only once a week and only to see the doctor is not easy. You gotta find ways of killing time. I watch TV and DVD's, read novels and the paper, and dabble in social media. For exercise, a walking regimen, back and forth, using the length of the garage. When the wonlds(cholecystectomy and KT) have completely healed and I do not anymore feel the swelling and numbness in the area, I will setup my cycling trainer and start spinning again; something I haven't done in nearly a year. After another 45 - 50, days, and I shall be cleared to go out of the house and resume more regular activities. But to get back to work, the neph recommended another 4 months. 

I would like to dedicate this next part of this post to everyone,; family, friends and friends of friends, colleagues, medical and hospital staff… everyone of you who supported us in this quest for a new life.

1. The Jesuit community in Ateneo de Manila University and Xavier School, who offered our petitions during their masses; Fr. Ben Nebres who answered Ninette's 4:00am phone call and prayed with her at the time the doctors had to open me up again to evacuate the bleeding.
2. The Ateneo and Xavier communities who included, and continue to include, us in the daily mass intentions.
3. Frs. Ari Dy, and Johnny Go of the Society of Jesus.  
4. Ninette's colleagues and friends in from the Ateneo Math Department; Ninette's close friends: The 'Searchers'. 
5. Ninette's graduate students past and current; Fr. Eko Budi Santoso, SJ, who visited and prayed for and blessed me in the ICU and after.
6. My Xavier School colleagues, especially the NExT Team for bearing some of the weight due to my absence and for the prayers.
7. To my sister-in-law Pica, her daughter Lysyl, and Louren who travelled from Bacolod to be with us during the time when both Ninette and I were confined.
8. To my sister-in-law Elgee, and Ben who helped us to do most of the hospital legwork and transactions during our confinement.
9. My Kuya Noel, the De Las Peñas' in California who helped in prayers as well as the finances.
10. The Nono's, my cousins for the moral support.
11. The Peña's who spared some time out of their busy schedules to visit.
12. Our UP friends Joey, Marian, and Agnes and all the others who have extended their support.
13. Benny Lim and Xavier School Batch 2003... you surprise me. Thank you very much.
14. The Coyiuto's and Revita's for their generosity. 
15. Facebook and Twitter friends from all over the world who flooded my timeline with prayer pledges and encouraging words; we were overwhelmed with all your responses.
16. To Claudette, my caregiver, who took care of me from the time I was released from the ICU until being discharged. 
17. Our attending physicians who took, and continue to take very good care of us: Dr. Alberto Frederick Celestial IV, Nephrologist;  Dr. Sergio Simangan, Transplant and Vascular Surgeon;  Dr. Nelson Patron, Urology Surgeon; Drs. Dodee Niño Rigor and Rody Sy, Cardioligists; their fellows who respond to our immediate needs when the attendings are not available. 
18. The ICU and 3C nursing staff who displayed competence and professionalism as well as their genuine concern, warm smiles and soothing presence. 
19. To Robynne for the love.
20. To Ninette with whom I will be forever grateful.       

This list is by no means complete. I might have missed someone. Please remind me. We'd like to express our appreciation to all of you.
    
Thank you for all your prayers… singly and collectively, the most powerful reason I was able to pull through. Maraming Salamat po.  

Photo credits:

sono-system.com

thefellowship.info

flickr.com/photos/roland