Post-Transplant Update: 19 December 2018

To start, this is likely my last entry for the year due to my upcoming Caribbean cruise. 
I leave two days after Christmas, and won't return until the morning of January 7th.
So, let's get to it...

I had my initial acupuncture Tx (treatment) on my feet [to treat the neuropathy], and it actually did some initial good. A couple of days later, while on a walk, I noticed that my feet actually felt cold...something that hasn't happened in at least five years! Additionally, I felt less heat in both feet while walking around the house, and more numbness...again, something I haven't experienced in years. So, the acupuncture has helped. I've already had a second Tx [with more positive results], with one more on Friday, then one last one (before the cruise) next Wednesday.
Also, I began acupuncture to help the TMD headaches. This one, as I've already stated, will not be so easy to resolve. It will take some time to see any positive results; but at least the Tx's have begun.
I also asked about acupuncture for the kidney, and my doctor stated that, seeing that it is a transplanted organ, and in a different location, he was unsure about any Tx, but would research any possible needle placements. If we can proceed, I will certainly let you know.

And on the subject of my headaches, they have been in a severe uptick all month. Right now, my daily average headache ranges between 6-8. As a result, I get no breaks--even brief ones--and my med usage (Tylenol and T3's) is up. The NTI devices are doing little to curtail the pain, and all of my efforts to mitigate the TMD effects are merely brushed away by the resilient, intense pain. When I previously got the TMD under control, back around 2000, I remember the headaches getting extremely intense before what became the actual decline of the pain had begun.  So, on I go; hoping for better days ahead in this area. 

Next, my December visit to the Kidney Clinic went well. The doctors are please with my overall progress; so much so that, barring any unforeseen complications, my January visit will be my last one with the Clinic. After that, I am to be turned over once again to my local Nephrologist. I must admit that I am more than a little trepidacious about that transition. After all, the last time I was handed over to my local doctor, I had a full-blown rejection episode about one month later. Let's just hope that nothing else happens to set me back even further.

11 Dec 18 Labs:

*Creat:   2.67 (-0.14) 

*HCT:   33.8 (-2.5) Low

*Hemo:   10.6 (-0.7) IR

*Lymph:   1.8 (-6.5) Extremely Low

*Lymph ABS:   0.2 (-0.5) Extremely Low

*Neut:   84.1 (+1.1) High

*Neut ABS:   7.1 (+0.6) High

*RBC:   3.72 (-0.27) Very Low

*WBC:   8.4 (+0.6) IR

*BUN:   62 (+20) Extremely High

*CA:   9.7 (-0.5) IR

*GFR:   26 (+1) Extremely Low

*Gluc: 98

*K+:   4.4 (NC) IR

*NA+:   141 (NC) IR

*Prot:   6.7 (-0.4) IR

*MG:   2.5 (NC) IR

*Phos:   3.9 (+0.2) IR

*BK/CMV:   Not Checked


The Creatinine is coming down. However, the clinic doctors stated that my final creatinine level may simply be higher than expected. Time, exercise and personal body chemistry will all be determinants in where this settles as a final range. Until then, it will likely vacillate from lab draw to lab draw.

The Hematocrit, Hemoglobin and Red Blood Cells all seem stable; at this point.

The Lymphocytes took another nasty plunge after a short period of stability. I was told that with the White Blood Cells holding steady, I should be fine, so long as I continue with precautions. Both Lymphocyte readings should soon stabilize, as well.

And Lastly on the labs, I am essentially done with the BK and CMV checks. Aside from once per year, the BK will not be looked at; and, contrary to what I had previously believed (and NOT accurately whatsoever), the CMV is only checked once or twice following transplant to assure this organ-killing virus was not transferred to the recipient. So, unless I have another transplant, there are no more CMV checks.

My next Belatacept infusion is on Christmas Eve. I do not anticipate any side effects at this point.

As a precaution, I have been prescribed an antibiotic to take each day during the cruise. This will simply help my body to fight anything I might be exposed to. Aside from that, I will be wearing masks as much as I can. This will be at any airports, hotels, on the ship, on shore excursions etc. Basically, any time I am around a lot of people--aside from whenever I eat--I will be wearing a mask.  Additionally, I will be freely using hand sanitizer at any and all opportunities. While I do not anticipate any issues arising, I will NOT be taking any unnecessary chances with my kidney.

My weight has increased again. As of this morning, I am up to 121 Kg's. I have already been instructed to reduce the Lasix to 40 mg/day (in the morning), plus, to increase my water intake to 2.5 Liters every day; in addition to any other fluids. So far, my weight, though up, has held fairly steady. Let's hope this continues...

Despite my weight gain, I have noticed that I am unconsciously holding my abdomen in nearly all of the time. This is extremely good news! This basically means that I am finally regaining some of my core strength following the long hernia repair recovery. Though that numbness throughout the abdomen still exists, the fact that I am able to develop core strength without realizing it is incredible! This fact gives me tremendous hope for furthering my ability to begin core exercises sooner than I had anticipated.  Plus, I am walking better, stronger and a bit faster. Even though my daily walks are not consistent right now, what I have done so far has proven to be muscle-building, and I am getting excited for what lies ahead.

I think that that is about all I have.

Again, I will not post another entry until after the New Year. 

May you all have a Very Merry Christmas! 

And Happy New Year!

Good Health to All!

ScottW

Post-Transplant Update: 05 December 2018

After last weeks' biopsy, the Kidney Clinic doctors asked me to cut down on the Lasix from 80 mg/day to 40 mg/day; taking the med in the morning. Also, that I was to limit my fluid intake to around 2.5L/day. Last, that I re-do my labs on Monday morning.  
Here are those results...

03 Dec 18 Labs

*Creat:   2.73 (-0.11) Lowering

*HCT:   36.3 (+2.7) IR

*Hemo:   11.3 (+0.38) IR

*Lymph:   8.3 (+0.3) Low

*Lymph ABS:   0.7 (NC) Low

*Neut:   83.0 (-0.8) High

*Neut ABS:   6.5 (-0.4) IR

*RBC:   3.97 (+0.35) Very Low

*WBC:   7.8 (-0.5) IR

*BUN:   42 (-9) Extremely High

*CA:   10.2 (+0.4) IR

*GFR:   25 (+1) Extremely Low

*Gluc:   103

*K+:   4.4 (-0.3) IR

*NA+:   141 (-3) IR

*Prot:   7.1 (+0.2) IR

*MG:   2.5 (+0.3) IR

*Prot:   3.5 (-0.9) IR

*BK:   Not Checked

*CMV:   Not Checked

     NC= No Change     IR= In Range

As highlighted, the Creatinine lowered, which is great news!
Alongside that, the BUN dropped nicely; getting out of the danger zone.

Lastly, the Hematocrit, Hemoglobin, Red Blood Cells and Lymphocytes all display more stability!  There are also a total of TEN lab values that are now in their current ranges! THAT is terrific news!

For the second lab draw in a row, I am finally seeing stabilization in these critical numbers.  (Deep sigh of relief!)

The TMD headaches continue unabated. However, I am finally going to get acupuncture for the headaches this coming Friday afternoon. I will need a number of treatments before I make any significant headway in relieving the headaches.
Also that day, I will see about acupuncture to help heal the remaining neuropathy in my feet. And, being the traditional medicine that acupuncture is, I will also ask about the possibility of helping the kidney work better. I'll try to remember to update you on things in these fronts.

My sleep has been off schedule this week for some reason. I took long naps on consecutive days both Monday and Tuesday. Though I got too little sleep last night, I am staying awake today in an attempt to turn my sleep cycle around...again.

Lastly, on Sunday evening I suddenly got sick to my stomach after feeling fine all day.  
I had a total of four episodes of emesis (vomiting) that evening. One was after dinner, and I have no idea if I ejected my PM meds. Whenever this happens, a transplant patient cannot chance doubling any meds that may have gotten into your system. Instead, you act as if you had missed a dosage and simply take your next scheduled dosage on time. 

By Monday morning, I felt completely back to normal. I took my AM meds, as scheduled and had no further incidences of emesis.

And that catches you up.

Have a terrific week, and always look for the good in all situations...even when that may be the very last thing you feel like doing.

Good Health to All!

ScottW

Post-Transplant Update: 01 December 2018

Well, I obviously failed to update my blog earlier this week; here's why...

Lt's begin with this weeks' labs.

27 Nov 18 Labs

*Creat:   2.84 (+0.14) Rising (3rd consecutive increase)

*HCT:   33.6 (-0.1) Low, but stable

*Hemo:   10.5 (+0.1) IR and stable

*Lymph:   8.0 (-1.0) Low, but stable

*Lymph ABS:   0.7 (+0.2) Low, but stable

*Neut:   83.8 (+6.5) Very High

*Neut ABS:   6.9 (+2.9) Very High

*RBC:   3.62 (-0.04) Low, but stable

*WBC:   8.3 (+3.1) IR

*BUN:   51 (+6) Extremely High

*CA:   9.8 (-0.1) IR

*GFR:   24 (-1) Extremely Low

*Gluc:   108

*K+:   4.7 (+0.5) IR

*NA+:   144 (+5) IR

*Prot:   6.9 (NC) IR

*MG:   2.2 (-0.2) IR

*Phos:   4.4 (+0.5) IR

*BK:   Not Detected

*CMV: Not Checked

     NC= No Change     IR= In Range

First, the stability of the HCT, Hemo, RBC, Lymph and Lymph ABS are most welcome! Earlier posts had my postulating on hoping the time for fluctuation of all of these labs was drawing to a close. Had one or two of these been stable I would have been pleased; but having all five stable was terrific news! Let's now hope that the stabilization continues.

The big news though, is why I have been delayed getting this post written.

With the 3rd consecutive increase of the Creatinine, I received a call on Wednesday from one of the Kidney Clinic doctors who wanted me to get another Renal Biopsy, just to rule out any possible rejection. The test was set up for Thursday morning.

As I have gone in-depth about previous biopsies, I will skip the details about the procedure aside from a few items.  First, I had no negative or untoward reactions during this latest test. (Excellent news!)   Second, the first kidney tissue sample that was aspirated (drawn) was the only sample needed, which was nice.   Last...and this is one my wife wanted on here...I slept well afterwards...

Following the usual 4+ hour post-biopsy wait time to check for any bleeding, we were on the way home. I then spent yesterday recovering from what is always a painful test. I am still very sore today, but it is improved.

Also, the Clinic doctor called yesterday to state that there is no apparent rejection happening!  This is fantastic news!

(I am posting the official biopsy report at the end of this entry.)

In other news: I had my latest Belatacept Infusion on Tuesday. The stick was good, the infusion was uneventful and I have had zero side effects from the med.

   On Wednesday I met with my local Nephrologist to update him on how everything is progressing. Aside from the while Creatinine thing he is very pleased with my current progress; especially with my electrolyte levels. Also, I asked him why my Blood Glucose reading is always high on my labs (80-100 is normal). He told me that with all the meds, the body responds by releasing extra sugar from the liver to compensate for the toxicity of the meds themselves. (It's a very simple explanation of the why.) So, now I understand why the Blood Sugar is high despite not eating prior to having my labs drawn.

That's all I have for today. There just wasn't much happening other than what I've already discussed.  So, remember to read the post-biopsy report below, if it interests you.

Until next time...

Good Health to All!

ScottW

Surgical Pathology Report

THIS IS AN ADDENDUM REPORT, PLEASE SEE THE END OF THE REPORT FOR ADDENDUM DATA REPORT STATUS:  

Addendum Final REASON FOR ADDENDUM: Ancillary Test Result(s) Addenda listed at the end of the original report

PHYSICIAN:        NP ACCESSION DATE: 11/29/2018 REPORT DATE: 11/30/2018

**** THIS IS AN ADDENDUM REPORT ****  PATIENT: SCOTT W

Clinical History: 55yo M with DDKT 5/4/17 for PCKD; h/o ACR type 2A in Sept 2017, type 1B in Mar 2018; now with Creat 2.8 (has been stable at 2.2). Special Exams Requested:

FINAL DIAGNOSIS:

LEFT RENAL ALLOGRAFT, BIOPSY:
- FEATURES SUGGESTIVE OF CHRONIC CALCINEURIN INHIBITOR TOXICITY. - NEGATIVE FOR ACUTE CELLULAR AND ANTIBODY-MEDIATED REJECTION. - SEE COMMENT.

COMMENT:

The biopsy is adequate for interpretation and shows frequent arteriolar hyalinosis, striped interstitial fibrosis/ tubular atrophy (about 20% overall), and mild-moderate arteriosclerosis. While donor- or recipient-derived diabetic or hypertensive disease might show some of these morphologic features, the glomeruli in this case are very well-preserved and do not show any of the changes typically associated with such disease. In this context, the features are suggestive of chronic calcineurin inhibitor (CNI) toxicity. 

There is no evidence of active thrombotic microangiopathy. There is also no significant interstitial inflammation, tubulitis, glomerulitis, or peritubular capillaritis, and C4d staining is negative, helping to exclude acute rejection. No viral cytopathic effect is seen, although staining for BK virus will be performed and reported as an addendum.

Intermountain Medical Center, ScottW, Surgical Pathology Report, 12/01/2018 11:22:17 AM

Page 2 of 3

Banff classification: g0, t0, i0, v0, cg0, ct1, ci1, cv1, ah3, mm0, ptc0

GROSS EXAMINATION:

The specimen consists of 1 fragments of renal tissue, measuring 2.5 cm, submitted for light microscopic examination. In addition, small fragments of renal tissue are submitted for immunofluorescence studies and electron microscopy.

MICROSCOPIC EXAMINATION:

LIGHT MICROSCOPY:

One H+E-, one PAS-, one trichrome-, and one Jones silver-stained slide is reviewed. Serial sections through the biopsy show 1 fragments of renal cortex containing up to 24 glomeruli, 6 of which are globally sclerosed with associated features of ischemia and obsolescence (periglomerular fibrosis and collapse with PAS-negative material in Bowman's space). The glomeruli otherwise do not show increase in mesangial matrix nor increase in mesangial cellularity. The capillary loops appear smooth, patent, and do not contain holes, spikes, or splitting. 

Endocapillary proliferation, segmental sclerosis, and crescents are not identified. There is a noticeably striped pattern of interstitial fibrosis and tubular atrophy involving about 20% of the tissue and associated with minimal chronic inflammation including a rare eosinophil and a few neutrophils. There are also very focal areas of tubules with isometric vacuolization and a few with dilated lumina. Scattered luminal calcifications are also seen. The majority of the arterioles present for evaluation show medial hyalinosis in a fairly symmetric circumferential distribution. The interlobular arteries demonstrate mild to moderate intimal fibrosis.

IMMUNOFLUORESCENCE:
A C4d immunofluorescent stain is performed with appropriately reactive internal controls and is negative. Three glomeruli are present in the IF sample.

ADDENDUM:
This addendum is issued to report the results of an immunohistochemical stain* for BK virus (Polyoma), performed with appropriately reactive controls. The result is negative.

The final diagnosis is unchanged.

*This test was developed and its performance characteristics were determined by Intermountain Central Laboratory. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. This test is used for clinical purposes. It should not be regarded as investigational or for research. This laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform high complexity clinical laboratory testing.

Intermountain Medical Center, ScottW63, Surgical Pathology Report, 12/01/2018 11:22:17 AM

Page 3 of 3

Immunoperoxidase procedures are done using a standard autostainer. DAB, AEC, or Fast Red reagent is used as detection. Procedure and dilutions of antibodies are on file. The standard immunoperoxidase protocol was followed. Laboratory extrinsic controls for the antibodies tested exhibited appropriate staining. All immunohistochemical/cytochemical stains (IHC) are performed on separate slides per different antibody.

REPORT STATUS: Addendum Final