Saturday, August 14, 2021

Post-Transplant Rejection Update: 14 August 2021

 This entry is delayed because the Echocardiogram left me feeling like garbage for three days! Unlike what I had thought, this test was not the P.E.T. test, but a simple scan of the heart. 

Unfortunately, this test, done by ultrasound, involves a lot of deep pressing on the mid upper, and left upper abdomen in order to get as many angles of the heart as can be done. Doing this aggravated a LOT of scar tissue in my upper abdomen leaving me really sore and extremely nauseated. Only this morning am I feeling appreciably better.

Following is the bulk of the test results from the Echocardiogram taken on 10 August 2021:


"Adult Echocardiogram Procedure 

 The images were of fair technical quality. Imaging quality was affected by prominent lung artifact. Complete echo, cardiac Doppler and color flow imaging was performed. Resting EKG showed normal sinus rhythm at a rate of 73 beats per minute. 

 M-Mode/2D Measurements and Calculations IVSd: 0.9 cm LVIDd: 5.9 cm AOd: 4.3 cm EF: 60 % +/- 3% LVPWd: 1.0 cm LVIDs: 3.6 cm Asc Ao 3.80cm FS: 39.5 % RVd LAX cm RVd AP4 cm LAs: 4.60 IVC: LV SV: 106.8 ml LV EDV: 176.7 ml LV ESV: 69.9 RV area cm2 LV EDV BP i 73.27 LV ESV BP i 28.98 LV Mass i g/m2 RWT 0.35 LA Vol (MOD) index: 30.82 ml/m² Doppler Measurements AV MV TV LVOT: 2.40 cm E Vel: 0.79 m/s RA press: 3 mmHg LVOT Vel: 1.32 m/s A Vel: 1.11 m/s AoV Vel: 1.6 m/s E/A: 0.7 RV PV Mean Grad: 6 mmHg PHT: 54 msec RVOT VTI: 0 m Pk Vel: 1.26 m/s Pk Grad: 10 mmHg MVA: 4.1 cm2 Pk Grad: 6 mmHg AoV area: 4.0 cm2 Mean Grad: 2 mmHg PV AT: 70 msec LVOT SV: 127.6 ml Decel Time: 187 msec LVOT SVi 52.9 ml/m2 e' Medial: 6.64 cm/s e' Lateral: 5.77 cm/s E/e' Avg: 12.73 

 Left Ventricle  The left ventricular chamber size is mildly increased. There is normal left ventricular wall thickness. Left ventricular systolic function is normal. There are no segmental wall motion abnormalities. Left ventricular ejection fraction is estimated to be 60 %(+/_ 3%). The relative wall thickness is normal. LV basal fractional shortening is normal, as measured by 2D. Normal diastolic pattern with normal left atrial pressure. 

 Right Ventricle Normal right ventricular size and systolic function. Tricuspid annular plane systolic excursion (TAPSE) measures 3.3. Left Atrium Left atrial volume index is 30.82 ml/m² which is normal in size. The interatrial septum appears normal by 2D and color Doppler imaging. Right Atrium The right atrial size is normal. The right atrial area is 17.1 cm2. The right atrial volume is normal at 15.96 ml/m² indexed by BSA. 

 Aortic Valve The aortic valve is tricuspid. Peak transaortic velocity (Vmax) is 1.6 m/s. Peak transaortic gradient is 10 mmHg. Mean transaortic gradient is 6 mmHg. LVOT diameter is 2.40 cm. Calculated aortic valve area and area index by continuity equation is 4.0 cm² and 1.7 cm²/m². Doppler velocity index (DVI) is 0.85. Trace aortic valve regurgitation. 

 Mitral Valve Mitral valve is normal in structure, thickness and function. Calculated valve area by pressure half time is 4.1 cm². Mitral valve pressure half time is 54 msec. Mean transmitral gradient is 2 mmHg. Trace mitral valve regurgitation. 

Tricuspid Valve Tricuspid valve is normal in structure, thickness, and function. No tricuspid regurgitation is present. 

 Pulmonic Valve Pulmonic valve is normal in structure, thickness, and function. No indication of pulmonary valve regurgitation. Aorta The aortic root size is mildly dilated, measuring 4.30 cm. The ascending aorta is 3.80 cm, indexed to BSA is 1.58 cm/m² which is normal. 

 Venous The inferior vena cava was normal in this study. 

 Impression: 

 1. Left ventricular systolic function is normal. The LVEF is 60 %(+- 3%). 

 2. There are no segmental wall motion abnormalities. 

 3. Normal diastolic pattern with normal left atrial pressure. 

 4. The left ventricular chamber size is mildly increased." 

 5. Normal right ventricular size and systolic function. 

 6. The left atrium is normal in size. 

 7. The right atrial size is normal. 

 8. Mildly dilated aortic root. 

 9. Compared to previous echo of 6/3/2020, no significant change."


As a summation, aside from slight enlargement of my L Ventricle, my heart is just fine. 

Now, my August lab results...

03 Aug 21 Labs:

*Creat:   3.22 (-0.04)

*HCT:   34.5 (-1.2) Low

*Hemo:   11.0 (-0.2) IR

*RBC:   3.88 (-0.09) Extremely Low

*WBC:   6.9 (+0.2) IR

*BUN:   44 (+1) Extremely High

*CA:   9.3 (-0.6) IR

*GFR:   20 (NC) IR

*Gluc:   101

*K+:   3.5 (-0.5) IR

*NA+:   140 (-1) IR

*Phos:   3.6 (-0.1) IR

          NC= No Change       IR= In Range


All in all, my labs appear to be steady right now. There is nothing of concern from any of the latest results.

As I had hoped, after returning from vacation, with my Red Cell count up, I finally have the energy to workout once again. I started up again on Saturday, 31 July by using light weights and fewer reps. I referred to it as an "OK, body, it's time to wake up and get going again" workout. I allowed a two day rest before the next session during which I kept the weights light, but increased the reps a bit. Since then, I have exercised every Monday, Thursday and Saturday since--except for this past Thursday [due to my feeling lousy from the Echo.] My next workout is today, and I will be using all of my previous weights (before stopping due to a complete lack of energy from a decreased RBC count), and reps. 

My body has responded well, and I am certainly well ahead of my expected progress following three months of no exercise. 


That's all for today. The things I wanted most to cover have been discussed. 


Stay safe, and keep enjoying your summer and getting back to your lives.


Good Health to All!

ScottW





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