New UNOS Website

The United Network of Organ Sharing--UNOS--has just released news of their new and vastly updated website. The new site has tons more information and links for both pre and post-transplant patients. If you are a transplant patient (pre or post) or a caregiver for a transplant patient, please head over to the UNOS website for the incredibly valuable information and resources they provide.

I have pasted a copy of their updated newsletter below. Hopefully, the links and pictures will remain visible.    PLEASE, read this info!

February 2018

February 2018 Transplant Living Newsletter We’re back. You’ve probably noticed the absence of our Transplant Living newsletter in your inbox every month. Our team has been working hard behind the scenes, building and adding new content to our Transplant Living website. It’s been awhile since we’ve shared with you what’s been happening here at UNOS, and we have a lot to catch up on. Be sure to keep an eye out for our revamped newsletter around the last week of every month.  New Transplant Living Website In January, UNOS launched a newly redesigned version of our patient website, Transplant Living. Along with improving website functionality and creating mobile-friendly design, we expanded content in the kids and living donation sections, while adding an entirely new kidney transplant learning center section. Visit https://transplantliving.org/ to check out the new content and features. Please share this valuable educational resource with a friend, family member, or loved one who wants to learn more about the organ transplant process. Public Comment This is your opportunity to share your opinion. The most recent public comment cycle opened on January 22nd and will run through March 23rd 2018. Read this article on UNOS.org for more information. To read policy proposals, submit a public comment, or review previous proposals, visit the Public Comment page on the OPTN website.   UNOS Ambassadors and Spreading Awareness Through Social Media If you are passionate about volunteering, raising awareness, or spreading the word about organ donation and transplantation, there are a number of ways you can get involved. First, learn the facts about organ donation. Our websites offer valuable information from trusted experts and resources. Next, join our volunteer program to become a UNOS Ambassador. As a UNOS Ambassador you will help educate your community about UNOS, organ donation, and transplantation. Learn how to become a UNOS Ambassador and how to be part of this national community of organ donation advocates.    Lastly, be sure to follow us on social to share our posts to raise awareness for organ donation and transplantation with your friends and followers.    Be sure to like/follow us on the following social media platforms:  Facebook Twitter Instagram LinkedIn In addition to the Transplant Living newsletter, did you know we also have four other UNOS newsletters? Follow the link to subscribe. UNOS ENews – Stay up to date on the latest information and updates happening around UNOS. Transplant Pro ENews – Keeps OPO, lab, and transplant professionals informed of the latest updates to policy, education, and professional resources. UNOS Careers ENews – Want to work for UNOS? Be alerted about recent job openings. UNOS Ambassador ENews – Learn about volunteer opportunities and how to promote organ transplantation and donation in your community. Learn more about the program and sign up to become a UNOS Ambassador here. 2017 Record Numbers UNOS had another record-breaking year in 2017. For the first time, the number of deceased organ donors in the U.S. exceeded 10,000. This led to another record of over 34,700 organ transplants performed in 2017, a 3% increase over the previous year. Read the full article on our website for perspective about 2017 organ donation and transplantation data or visit the OPTN website to view data reports. National Observances A number of national observances throughout the month of March touch the organ donation and transplantation community. Below are just a few to mark on your calendar.  National Kidney Month National Social Workers Month World Kidney Day – March 8th UNOS Anniversary – March 21st National Doctor’s Day – March 30th We will observe these on our various social media platforms and hope you will share our posts with your friends or followers. Visit TransplantLiving.org

27 February 2018: BK and CMV Explained

A week has gone by and it is time to fill you in on both the BK Virus and the CMV or Cytomegalovirus and how both affect transplant patients and their transplanted organ. So, let's begin with the BK Virus...


(Definition from the UC Davis Transplant Center)

BK Virus

"In 1971, a  human polyomavirus was discovered  from the urine of a renal transplant recipient whose initials were B.K. This virus has been named BK virus. First time BK virus infections occur in early childhood in many people, typically without any symptoms. Later in life, the virus remains quiet (latent) but present in the kidneys. Almost all illnesses caused by  BK virus occur  in those receiving immunosuppression after an organ transplant or those with other acquired immune system deficiency. BK virus is estimated to cause a progressive kidney transplant injury in 1-10% of renal transplant recipients.

Actual damage in the kidney can be detected by a kidney biopsy.  Kidney  injury develops late in the course of BK virus disease and screening and early treatment is beneficial for long-term transplant survival.  Screening for the BK virus in kidney recipients usually occurs via blood or urine tests. [Our] Programs routinely screen for BK virus to allow for early detection and treatment. Reducing the amount of immunusuppressive (anti-rejection) medication can help to decrease the virus. A medication called leflunomide has also been shown to inhibit  BK virus in the blood which prevents injury to the transplanted kidney."

(From the National Kidney Foundation)

What is BK virus?

"BK virus is a virus that most people get in childhood. Symptoms can feel like a common cold. Once you get a BK virus infection, the virus stays in your system for good. But it does not cause a problem for most people. This is called latent, or like being ‘asleep’ in your body.  Sometimes, when your immune system is not working well, the virus wakes up. Then it can cause symptoms of infection. BK virus is also called polyomavirus.

What increases the risk for BK virus infection?

• Organ transplant, like a kidney transplant
• Kidney surgery or injury
• Older age
• Health conditions that weaken your immune system (HIV and Diabetes, to name a few)

How does transplantation increase the risk for BK virus problems?

After your transplant, you will take special “anti-rejection” medicines.  They cause your white blood cells not to work as well.  White blood cells help your body fight infection. When you take these medicines, your body has a higher risk for infection.  You can have BK virus in your system and not be aware of it.  After your transplant, the virus may become active again. This is from the anti-rejection medicines. It can damage your new kidney and cause your body to reject it.

How will I know if the BK virus is in my system?

Your healthcare provider will check for signs of the virus in your system. They will check both before and after receiving your kidney transplant. Since BK virus can “wake up,” it is important to watch for signs of infection.  Symptoms may include:

• Changes in vision, like blurred vision 
• Changes in the color of your urine (urine that is brown or red in color)
• Pain when you urinate
• Difficulty urinating 
• Needing to urinate more than is normal for you
• A cough, cold, or trouble breathing
• Fever, muscle pain, or weakness
• Seizures

Having any of these symptoms could be a sign of infection. This can affect the success of your kidney transplant. It is important to tell your healthcare provider if you notice any signs of infection.

How will I be monitored for BK virus infection?

After your transplant, your blood and/or urine will be checked on a regular schedule.  Your healthcare provider will decide how often to check you for BK virus and other infections.  This helps make sure your transplant is not at risk."

Now, let's define CMV, or Cytomegalovirus...

(From Ohio State University's Wexner Medical Center)

Cytomegalovirus (CMV): Risk for the Transplant Patient

"Cytomegalovirus is part of the herpes virus family. It is usually harmless to people with healthy immune systems. After the transplant, you will be on several drugs to prevent rejection of your new organ.  These drugs suppress your immune system so you may be at higher risk for CMV infection.

How do I know if I have CMV? 

Blood is drawn during your transplant work up to check for CMV in your system. A careful screening also is done to check for this virus in the donor. Even if you have never been exposed to CMV, the person who donated your organ may have been exposed. Knowing if one or both of you have been exposed helps the transplant team take care of you after the transplant. 

Most people with strong immune systems do not know that they have been exposed to CMV. CMV may remain dormant in your body for life but can reactivate at any time when your immune system is weak or suppressed.  

CMV is spread by close contact with body fluids. Body fluids are urine, saliva, blood, tears, and sexual fluids.

Signs of CMV infection CMV can infect any organ.

Some signs of CMV infection include:



*Fever greater than 101 degrees F (38 degrees C) 

*Muscle weakness 

*Fatigue 

*Headache, confusion, seizure 

*Arthritis pain in joints 

*Blurry or loss of vision in one eye 

*Shortness of breath 

*Blood in stool, abdominal discomfort, nausea and vomiting

How is CMV diagnosed?

Sample of blood, urine and sputum may be cultured to see if the CMV virus is active. Other blood tests also may be done. In some cases, a biopsy of the infected organ is done. This means a sample of tissue is removed from the organ for testing.  

Prevention and Treatment

If blood tests show that you have CMV before your transplant, antiviral medicines are given. Additional tests may be used to check your condition.  Because this virus lays dormant in your body, it is possible that you may become infected at any time during your life after transplant. Even if you show no sign of infection, you may be given antiviral medicines after transplant to reduce your risk of infection.  Not every transplant patient develops CMV. However, an infection can be very serious. Antiviral medicines may be given to prevent the spread of infection, but do not cure it.

You need to contact your transplant team right away when you are not feeling well."
 

Post-Transplant Update: 20 February 2018

Some terrific news was received last week that was a long time coming...

I had my [now] monthly Kidney Clinic visit last Wednesday morning (14 Feb). My weight was good at 112.2 Kg, my vitals were all in line, and the clinic pharmacist was pleased with my current meds, my schedule for taking meds and how I am tolerating all of my meds. Here is my current list of meds:

Anti-rejection Meds

*Tacrolimus (Prograf): 1 mg 2x/day

*Prednisone: 5 Mg 1x/day

*Mycophenalate (Celcept): 250 mg 2x/day

Heart Meds

*Isosorbide: 20 Mg 2x/day

*Hydralazine HCL: 25 Mg 3x/day

*Atorvastatin: 20 mg 1x/day (at bedtime)

*Aspirin: 81 mg 1x/day

Misc

*1-A-Day Men's Vitamin: 1x/day

   *I have to take the non-50 Years+ version as that one contains Iodine, which I am allergic to, internally.

I also will be changing the Celcept to a comparable med called Myfortic because of my inability to tolerate higher doses of Celcept, which cause me a lot of diarrhea.

The Myfortic should not have any appreciable side-effects, but carry the additional benefit of my being able to lower my daily Prograf dosage. This is important because a significant side effect of Prograf is hand tremors. The lower my Prograf intake, the less my hands shake.

I should be starting the Myfortic in the next week or two. Of course, I will let you know how the new med goes...

As I grow stronger, some of these meds will be adjusted a/o eliminated; depending on how I am doing. Other meds may also come into play in the future as my health dictates.

After the Pharmacist visited, my main clinic doctor--and the Kidney Clinic's Medical Director--came in. He was very pleased with my progress! My vitals are looking wonderful, my weight has increased proportionally, my kidney is performing beyond expectations (FINALLY!), my heart is in excellent shape and I am finally healing properly from both surgeries [this year], which means I can now begin lite exercising which will further my overall progress.

(And here's the terrific news I referred to at the beginning of this post...)

So, because things are doing better and better, my doctor has released me from the Kidney Clinic's care to that of my local nephrologist! 

Normally, this would happen between 1-3 months post-transplant; but because of everything I've had to deal with since the transplant, I took a full 9+ months to get that clearance!

My next visit with the clinic is around the anniversary date of my transplant, and about every year thereafter.

Now, getting that clearance does not mean I am finished with other doctor visits--besides Nephrology. From now on, I must have regular follow-up visits (and a few new doctor visits) from  Cardiology (obvious reasons), Oncology (check for potential cancer development), Dermatology (check for skin cancer), Radiology (Renal biopsies, renal artery check etc.) Neurology (look for deficits), Gastroenterology (colonoscopies), Immunology (immune system health), Primary Care (general care) and Dental (oral health and free of germs). These appointments will happen every six months, or so, depending on physician instructions. Collectively, all of these various medical disciplines will help ensure my best health possible.

In addition, I must get a flu shot every year from now on so that I avoid any influenza virus from attacking my new kidney. Boosters needed for pneumonia, hepatitis, etc will be determined by my nephrologist.

In other good news...

Over this past week, my appetite has been good, the nausea decreased, I am sleeping decently and my urine output has been consistent. Overall, I am doing and feeling much better. I finally feel like I am on the upswing.

My next labs will be drawn tomorrow (21 Feb), and I will post the results here as an addition to the end of this post.

So, there you have my fantastic news! 

I hope that you have an excellent day, no matter your circumstances! 

Good Health to All!

ScottW

22 Feb 18
**This update is later than I expected because all these most recent lab results did not get posted until this afternoon. The +/- represents comparison vs two weeks ago.

*Tac:   6.7  (No Change--NC)  In current target range (6-8).
*Creat:   1.56  (-0.02) In Range--I.R.

*CA:  10.1  (NC)  I.R.
*RBC's:   4.2  (+0.09)  Low
*WBC's:   7.4  (+0.3)  I.R.
*HCT:   37.4  (+1.1)  Low, but improving steadily
*Lymph:   11.8  (+1.2) Low
*Lymph ABS:   0.9  (+0.1)  Low
*Neut:   71.2  (-3.2)  I.R.
*Neut ABS:   5.5 (NC)  I.R.
*GFR:   49  (NC) High
*BUN:   29  (+5)  High
*Gluc:   95  I.R
*Phos:   3.7  (+0.8)  I.R.
*Hemo:   11.9  (+0.3)  Low
*K+:   4.4  (-0.1)  I.R.
*NA+:   138  (-3)  I.R.
*BK Virus:  NOT Detected
*CMV:  NOT Detected

The majority of these results are either in line, or getting there. As I've stated before, surgery messes up your lab results, and it takes time to get your numbers back to where they need to be. Mine are coming along very nicely!

**The BK Virus and CMV checks are done once each month (post-transplant, of course!) to examine the presence of either of these viruses. Having one or both in your transplanted organ can kill the organ, and endanger the patient's life. I will explain both of these issues in my next blog.

Post-Transplant Update: 07 February 2018

My first gap of two weeks between lab draws has passed without a hitch!

06 Feb 18 Lab results:

Tacrolimus :  6.7 (+0.2)  **Current Target Range-- 6.0-9.0

Creatinine:  1.58 (-.03)   **Current Target Range-- 1.40-1.70

Calcium:   10.1 (+0.1)     **Target Range-- 8.4-10.4

Red Blood Cells:   4.11 (+.06)    **Target Range-- 4.50-5.90

White Blood Cells:   7.40 (+.01)   **Target Range-- 3.60-10.60

Hematocrit:   36.30 (+.60)   **Target Range--  41.0-53.0 

Lymphocytes:   10.60 (-0.70)   **Current Target Range-- 24.0-30.0

Lymphocytes ABS:   0.80 (-.10)   **Current Target Range-- 1.00-1.50

Neutrophils:   74.40 (+2.60)   **Target Range-- 36.00-66.00

Glomerular Filtration Rate:   49 (+2)   *Current Target Range-- 60+

Blood Urea Nitrogen:     24 (-2)   **Target Range-- 8-20

Blood Glucose:   105 (+5)   **Target Range-- 80-100

Phosphorous:   2.90 (-0.3)   **Target Range-- 2.30-4.70 

Hemoglobin:   11.60 (+0.2)   **Target Range-- 13.50-17.50

Potassium:   4.50 (+0.3)   **Target Range-- 3.50-5.00

*Sodium:   141   **Target Range-- 137-146

*I just added Sodium (NA+) because this lab value is watched by the Transplant Committee due to the detrimental effects that high sodium can have on any    transplanted organ.

My labs are looking great! Everything is coming back in line with my pre-hernia repair numbers--whether those lab values need to rise or fall accordingly to their target ranges.  I included the ranges for all labs as a reference point for my readers. Note the labs marked with **Current Target Range. I added this distinction because the target values of these labs will change as meds are adjusted the further we go along.

Everything for me has been terrific the last week. My abdominal pain is reducing, and I am better able to move about. Even with the binder on, I still begin to hurt after a time; but without the binder at all, the pain comes on much faster.

So, during the day, the binder stays on. During the night--unless I am hurting too much--the binder comes off.

My plan for reducing the surgical pain is working. Over the past two weeks I have felt much better than during most of January. There is still a long way to go, but I have gotten past that bump that was keeping me from better healing. I anticipate accelerated healing from here on out.

Urine output has been good. I did a 24-hour draw this past Sunday that lasted from Sun 9a-Mon 9a. In that period I drank 3.4 Liters of fluid, and excreted 2.9 Liters. That puts me exactly at the 500cc (1/2 Liter) buffer between what I consume and what I excrete, just as my transplant doctors want. This target is there so as to avoid possible dehydration of the kidney. I have previously explained that some renal transplant patients become dehydrated because they fail to consume more fluids than they excrete, thus leading to the dehydration. The result of any dehydration of a transplanted kidney is a high probability of organ rejection, leading the patient back to dialysis and starting the whole process over once more. 

For me, I will consume whatever amount I need every day to avoid such an outcome!

Food-wise, my appetite is coming along nicely; continuing to recover from the effects of surgery and pain meds. I know I will be eating even better once I start walking regularly, then better still once I get the clearance to begin exercising. Consummately, my metabolism will also increase which will both drop fat and add muscle weight. Soon...soon. 

I have my now once per month Kidney Clinic appointment next Wednesday, 14 Feb, at 0945a. I will let you know how that goes, any med changes, etc.

Until that time, have a fantastic week!

Good Health to All!

ScottW

Post-Transplant Update: 24 January 2018

That cardiology visit I had right after my last post went extremely well! The doctor is very pleased with my vitals, as well as how I am doing overall. He has no further tests at this time, and I will continue to use the heart meds on the same dosages for at least the next few months. My next cardiology appointment isn't until June!

My healing continues to be slow. Though I am off most of the pain meds, it is not because the pain has dissipated, but because I decided to wean myself off of them. Now, I only take those meds if I am hurting a whole lot.  I often push myself too much and end up with a lot of pain, but I am trying to minimize that day by day. Along the pain med lines, I have had zero withdrawal effects because I did a slow draw-down on the meds which allowed my body to adjust to diminishing meds without the awful effects of going cold turkey; which I had to do following my back surgery in 2000. That was a terrible 24 hours of ridding the narcotics from my body. I'm talking the full blown symptoms of cold turkey withdrawal...chills, fever, excessive diaphoresis, vomiting, diarrhea, complete exhaustion. And I was only on heavy meds for a month back then! I certainly don't want to repeat that episode...  :o(

I think I stated in my last blog that I was going a bit of time without by abdominal binder both during the day and at night. Unfortunately, I had to once again wear the binder 24/7 after sneezing several times one day, causing me to tweak something that caused extra pain. In addition, my sides still hurt (the intercostal gap muscles), as does my lower abdomen. Plus, a small area just R of the incision and near the now indistinguishable belly button, has a lot of pain. It doesn't help that I have been sneezing frequently this month. 

*On an aside, I don't know if I ever mentioned that when I sneeze, I usually do it just one, powerful time, then I'm done. This causes my entire abdomen to tense, tighten and seize up, which is what causes so much pain. OWW!!

So anyhow, I am wearing the binder both when awake, and while sleeping. This helps my muscles to be a bit more relaxed. Then there's the fact that I continue to sleep in a supine position, and most on my sides. Doing this still causes me pain, but not so much that I can't sleep.

The neuropathy in my feet is getting better....very, Very, VERY slowly. With winter here, the cold weather helps to keep the burning down, but I still have to soak them in an ice bath. Those ice baths are no longer nasty cold, though. Ever since the transplant, and my feet losing so much water volume, I can no longer bring my feet to the point of cold injury. I must now use only a handful of ice; otherwise my feet become painful from the cold within a minute or two.

On my last visit to the weekly Kidney Clinic, I was instructed that I am doing well enough to cut my lab draws to once per week. IF my labs are good for two consecutive weeks without any med changes/adjustments, then I could reduce those lab draws to once every two weeks. Well, today was my second lab draw, and my numbers are looking terrific! 

The Tac reading is at 6.5 (excellent!), my creatinine is fantastic and the rest of my numbers are nearly back in line.
My latest labs values:

*Tac-- 6.5 (Normal Range)
*Creat-- 1.61 (-.02)
*CA-- 10 (NR)
*RBC's-- 4.05 (-.03)
*WBC's-- 7.3 (NR)
*HCT--35.7 (No Change)
*Lymph-- 11.7 (-0.8)
*Lymph ABS-- 0.9 (-0.1)
*Neut-- 71.8 (-1.5)
*Neut ABS-- 5.2 (NR)
*GFR-- 47 (No Change)
*BUN-- 26 (+2)
*Gluc-- 100 (NR)
*Phos-- 3.2 (NR)
*Hemo-- 11.4 (No Change)
*K+-- 4.2 (NR)

Speaking of Kidney Clinic, I am finally doing well enough that I am now going just once per month! A couple more months of doing well and I might be allowed to go for two months between visits.

I think I'll stop there for today.

Great overall progress; the kidney continues to work well and my med schedule is finally stable! I'll take all of that!

So then,...until next week...

Good Health to All!

ScottW

P.s  This weeks' lab draw was my second of once-per-week-draws. With my numbers being great I was given authorization [this morning, 26 Jan] that allows me to now do labs just once every two weeks! YAY!!!

*However, we are trying to get a replacement med for the Cellcept called Myfortic. If we can get the OK from insurance, I will have to go back to once every week draws to properly monitor the effects the new med will have on me. This reversal in the lab draw schedule would only be temporary.
On the positive side, Myfortic should be a med that my body can better tolerate. This means that with I can take a higher dose of this med, and reduce the Prograf so that I have less of a chance of getting skin cancer (a side effect of anti-rejection meds), and the hand tremors caused by the Prograf will be further diminished. Both changes would be very welcome!

Post-Transplant Update: 04 January 2018

I know that it has been more than a few days since my first entry about the hernia surgery, but with Christmas and New Years, plus my continued pain from the surgery, it really is understandable that I am just now getting to finish up with that surgery.
So, let's get that wrapped up...

Getting home from the hospital was no picnic. Having to sit in a car for 45 miles with intense abdominal pain is not exactly my idea of a good time. But, we do what we must. Getting up the stairs at home was a slow, painful and laborious process; but once I was at the top of those twenty stairs, I could lay down and just be still...aahhh!

For the first two weeks at home I was on pain meds pretty much 24/7. Between the new scars and the muscle cuts on both sides, any movement at all remained intensely painful, no matter what I did. I had to have help standing, sitting, laying, etc.

For the first month I was forbidden from bending more that 45 degrees, could not pick up anything over two pounds, could no climb or descend stairs alone, or sit up straight for more than a few hours.

Much like my back injury, you do not realize just how many muscles you use for moving your arms, turning your head, lifting your legs, etc. This surgery reminded me just how easy it is to trigger lots of pain...and a thing I did NOT miss from that back surgery in 2000.

That first month, my wife did all the cooking...frightening, to be sure!  :o) ...cleaning, getting whatever I needed, helping me to sit, get in bed, get to the restroom, get dressed, helping me to shower so I didn't fall etc. In addition, I still had to get my blood drawn twice each week for labs, and go to follow-up appointments and kidney clinic.

Two weeks after arriving home I saw the surgeon to have about half of the staples removed, then the other half two weeks later. While the scar has a lot of healing still to do, it is looking less inflamed, and is mostly closed at this point, with the exception of one small area on the lower abdomen that is about an inch long. I am currently putting antibiotic cream on that spot, and covering it with clean gauze twice each day. It is slowly improving.

By mid-December I found that I was a long way from being where I had hoped to be in my healing. I was still in a lot of pain both mid-line and on both sides. It is slowly getting better, but as of right now, I am about a month behind in my healing. I believe this is the case because the hernia repair was my second major surgery in six months and my body is just simply exhausted and unable to bounce back as quickly as I usually do. The doctors and techs I have discussed this with have all agreed that my recovery is just going to take longer that normal, and that I must be patient.

Ever since the surgery I have been sleeping in a semi-recumbent position because this is most comfortable. About a week ago I began sleeping on my side a few hours every few nights....it feels so good, too! However, I am still doing most of my sleeping and napping in that semi-recumbent position. 

My day to day activities have begun to increase a bit. I have started doing some cooking again, getting my laundry done, and even putting in a little work at my computer. I can now walk up and down stairs unassisted, but not unaccompanied. I can walk further now--about 50-150 yards at a time--but wear out quickly, and my pain ramps up quickly, as well. I am going on walks about five times each week (accompanied by my wife, of course), and feel a bit stronger each time I go. Again, improvement is drearily slow, but I am feeling stronger despite the pain.

Speaking of pain, I started voluntarily decreasing my pain meds around two plus weeks ago. Overall, my use of the meds has decreased about 55-60%. At this rate I expect to be off the meds by mid month, or so. It doesn't help my pain level when I have an ultrasound on my kidney and renal artery, like I did yesterday. It was a normal follow-up exam that every transplant patient must do around the six month post-transplant mark.

Unfortunately, the tech pushing on my new scar for twenty minutes made me feel like I just got out of the hospital again! I know the increase in pain is only temporary, but it really hurts!  :o(

Next week I have another follow-up with my Team Cardiologist. I will let you know how that goes.

Oh...I nearly forgot...

With the hernia near by bladder repaired, I am finally able to properly process fluids, and as a result, I have lost 13 Kg's of water weight that had accumulated since my rejection episode in September. The water weight quite literally dropped by 1.5 Kg's per day for a little over a week.

I left the hospital in November at just over 121 Kg's. Today, I weigh 108 Kg's! Not exactly a preferred weight-loss method, but I am sure glad that weight came off exactly as I expected!

And, I believe that I am now caught up. If you have any questions regarding anything about my surgery and recovery, please leave a comment for me, and I will address that as soon as I can.

Until next time, the...

Good Health to All!

ScottW

Post-Transplant Update: 20 December 2017 Part 1

After more than a month, I am finally able to get at least a little written about the triple abdominal hernia surgery that I had on 14 November 2017.

I really don't know where to begin, so let's just start with my going to the hospital...

My scheduled arrival time was 1130a at IMC--the same hospital where I had my transplant last May. Once in the prep room, I was only in there a short while for IV placement (in my neck, via the external Jugular--my personal venipuncture site preference), and general surgical prep. Within fifteen minutes I was taken to pre-op where I met the anesthesiologist who went over my surgical and med history, and I gave him info on my TMD and jaw, and asked that he be very careful to avoid craning on my jaw during endotracheal tube placement to minimize the chances of an intense TMD headache once I was awake. After that, I was wheeled into the OR.

Within a few minutes I was pre-medicated and swiftly fell asleep. 

The surgery lasted about 4.5 hours and left me with two brand new scars. The largest scar goes midline from my sternum to my bladder, and required 37 staples to close. The second scar was angled on the R and went from my pelvic girdle to my bladder. This one required 17 staples to close.

(Midline Triple Hernia Scar 14 Nov 17)

Additionally, the surgeons placed 3 drains in my abdomen; one on the L and two on the R.

(NO, I do NOT have a picture on the lower scar as it was a touch too close to things you just don't want to see! And, we'll leave it at that...)  :o)

I got to keep my belly button; thought that now looks more like a small slit in my skin than an actual belly button.

As you can see in the picture above, I now have a totally gnarly scar!

Post-Op recovery was incredibly painful due to the nature of the surgery. Besides the actual incisions, the surgeon had to cut muscles distal to the long scar on both sides of my body that went approximately from the height of the scar and in line with my armpits, down to the top of the pelvis. These cuts were made from the underside of the muscles--yeah...the surgeon had to actually reach into my body, under the tissues and muscles in order to make these cuts!--, and were cut in order to relieve pressure on the muscles surrounding the hernias so that the repair mesh would stay in place on the underside of those muscles and NOT rip away due to any muscular tension pulling from both sides.

The hernia near my bladder was repaired with mesh placed on top of the muscle so as to avoid any contact with the bladder and thereby stopping any chance of the mesh irritating the bladder and any probable infection issues from that contact.

Though I was not aware of it at the time I awoke, the PA had ordered the wrong pain med which ended up causing me far more pain than I should have been in. The med wasn't endangering me in any way, but was ineffective in blocking much pain. My wife discovered the error the next day, and I was switched to the correct pain med that actually worked on the pain and made me more comfortable. Once discovered, the PA came in and actually apologized for me error. That apology was enough, and a lesson was learned. That was the end of it.

The day after the surgery I had to get up and walk...not exactly my favorite thing to do. Plus, with the incorrect pain med still being used, my efforts to log roll into a sitting position were awful. It was around that time that the med error was discovered. A few hours after that first walk, and with the right pain meds in me, getting up, though still terribly painful, was achieved with easier effort. Here's a pic of me on that second walk...

(My second post-op walk 15 Nov 17--tubes and all!)

The tubes I had sticking out of me were a bladder catheter, 3 surgical drains, IV, Oxygen and a Nasogastric (NG) tube. The NG tube is required anytime a surgery involves the manipulation of the intestines, a foot of which had been encapsulated by the largest hernia. 

As each day passed, getting up and walking became easier. Unfortunately, my intestines took longer than expected to "wake up," as they say, so my hospital release was delayed a few days. You see, any time a surgery involves the intestines, every patient must pass gas before going home. This is a terrific indicator that the intestines are working normally again, and there is little danger to the patient from an intestinal standpoint.

Anyway, my intestines took about five days to wake up, followed by two more days of observation and eating. A week after surgery I was finally able to go home.

**That is all I am going to do today. I am tired, sore and ready to go relax. I will finish this entry in a day or two...

ScottW