Space Mountain, The Ride Part 2: Ng Dahil sa Pigsa

Image from whatisall.yolasite.com

It was in December 2 when I again started to report for work; 4 months after the transplant. It was not easy adjusting to a new schedule. Suddenly, the pace quickened with alarm clocks going off at dawn, fighting daily traffic wars driving to and from work, contending with Metro-Manila's blown out population numbers and the mere stress of city living. I'm very thankful though to my bosses and colleagues at work who welcomed me back with open arms. It is a good feeling to be with them again. And they were very sensitive in making sure I'm not given a demanding workload. It is such a pleasure to be a little bit more productive than just recuperating at home. But, like most, I welcome every weekend and holiday that comes.

Spondylosis and Herniated Disc

It is some years now that I have been having a little pain in my lumbar area. It usually comes after long walks or after lifting heavy objects. But a few weeks after the transplant, the pain has more than doubled in frequency as well as intensity even when not doing anything. And because of the pain, I tend to slouch forward and tend to favor one side when walking. Sometimes, it gets unbearable. 

So I consult a spinal surgeon with Xray results in hand. The main cause of the pain is degenerative bone disease and some prolapsed disc possibly due to wear and tear(aka age), overuse, misuse or abuse. The pain intensifying after the transplant due to atrophy of the lower back and abdominal muscles. For a time and up to now, overloading these muscle groups are contraindicated for me to aid in healing of the transplanted organ.

The spine doctor prescribed, muscle relaxants, pain meds and posture modification.He told me to keep my back erect when standing, seating or lying down. Good thing therapy and surgery are not options yet. But still, I find myself slouching sometimes as it eases the pain a bit.

Infection Episode

A few days after Christmas, I felt that I was developing a blister in my perineal area. I attributed it to too much sitting amidst Metro-Manila’s December traffic and thought nothing of it. It turned out to become a furuncle complete with tenderness and swelling; that’s right, a boil… a pigsa. It was uncomfortable but bearable. Then a few hours before midnight on new year’s eve, I was burning with a 39º temperature. So I texted my neph to inform him as well ask for instructions on what to do. He prescribed paracetamol and antibacterial tablets and he had special instructions… and I quote: Paputukin mo yang pigsa mamayang alas dose!  

The paracetamol and antibiotics helped, but my high fever would often recur and I felt really weak and sick. When I went for a checkup, my creatinine was elevated and my urine was positive of protein. An indication of an uncontrolled infection. That same evening, I checked in hospital. Because of my immunosuppressed state, oral antibiotics did not work... I needed mainlining(antibiotics through IV).

The fever gradually went away and the urologist ordered an IND or incision and drainage procedure. So they scheduled the OR and prepped me. But when we found out that I will be under general anaesthesia, we had second thoughts for I had some bad reactions to anaesthesia after my transplant in July. After due deliberation, the doctors decided against the IND and just concentrate the treatment on pumping in the antibiotics to fight off the staphylococci.

I ended up spending 10 days in hospital and 2 weeks of being sidelined from work. And all just because of a pigsa. 

Breaking

I got my latest test results and consulted with my neph earlier today. The numbers are good and creatinine is down. An indication that I am in the correct immunosuppressed level. Hoping for more improved results in 2 weeks.

Note to self: DIET!    

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 :)