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 :)

In my hospital room

I was wheeled back to a regular room after 5 days in ICU and stayed there for the next 6 days. The first 3 days I was like a baby whose every need was taken care of by somebody else… you know… sponge baths, diaper changes and all. We were lucky to get the services of the same caregiver we employed before when Ninette's 96-year old granny was bedridden(God bless her soul). Claudette was with me 24/7 those 6 days. Both my lower extremities were bloated. The skin tight and shiny. This is due to some fluid retention when the transplanted kidney did not, due to the surgical complication, produce urine right away. Even my left hand was swollen courtesy of an ICU cardio fellow who inserted an IV line in the wrong place.

My beautiful wife and donor, Ninette, was home and recuperating well. I needed to get stronger and better so I could join her at home too. I actually started a little bit of exercising(if you can call it that) when I was at the ICU. I'd do repeated plantar flexions and arm raises. So I just continued with those while in bed as I was not allowed to strain my abdominal muscles. Then I was able to seat up and feed myself. When I was able to stand and leave the bed the next day, they took out the catheter. From then, slowly, I was able to walk around the room and do more personal activities myself but always with assistance. 

When I was able to tolerate standing, the nurses would slide a heavy weighing scale everyday at 5am to record my weight. They didn't have to do that in the ICU because the bed there had it's own weighing scale. When I left the ICU I was at 80 kilos; around 8 kilos over my weight pre-surgery. That's 8 kilos of fluid retained and 8 kilos of fluid I need to pass out via urine. The next day, the nurses encouraged me to walk to the station to weigh myself. My legs were heavy as logs. Because of the low center of gravity, I felt like a Sumo wrestler just before tachi-ai. That was my first trip out of the room. And at certain times during the day, I'd make a few small loops around the quiet corridor, happy to be moving about and see other things and people. During 1 such trip, I met my neph who was on his way to see me. I thought he would be happy to see me moving about. But he told me to get back in the room and stay there. I felt like a child caught redhanded. He reminded me that I was taking immunosuppressants and that my immune system is compromised. And that hospital corridors are not safe loitering areas for me.

Although I had borderline and controlled Type II Diabetes when I was on Hemodialysis, I developed NODAT(New Onset of Diabetes after Transplant). So my blood sugar is checked and I get insulin shots 3 times a day before meals plus another shot at bedtime. This is due to the numerous medications I am taking including the anti-rejection drugs and steroids. Hopefully, this is can be reversed.

A day before my discharge, I was again wheeled to the OR where my surgeon removed the staples as well as my Permcath access. It took longer than I expected and it was a bit and several sutures before they could control the bleeding. The OR nurses were happy to see me doing quite well. They were there during my stormy episode after the surgery.

That afternoon, they brought me to the adjacent building for ultrasound. My neph just wanted to rule out DVT(Deep Vein Thrombosis) since the swelling in my lower extremities has not abated. That evening he told me that ultrasound results were clear and I was to be discharged the next day. He then gave me an hour's worth of lecture on post kidney transplant care and that I have to strictly comply with them. He gave examples of past patients who did not and what the consequences were. I had some advanced reading on that during my stay in the hospital. That helped in making me understand every word he said.

Then it dawned on me… I am not doing Hemodialysis again. If I take care of Ninette's kidney indside me, dialysis disappears forever.