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With a normal transplant hospitalization, patients today are expected to be in hospitalization recovery for no more than 3-4 days--which to me is way too short. However, I also understand that hospitals aren't exactly germ-free, which is exactly why post-transplant stays are so brief. The longer you are in the hospital, the greater your risk of infection.
I bring this up because I learned just yesterday the reason why a transplant recipient is so incredibly immuno-compromised for the three months post-surgery. Every transplant recipient is given a round of "Thymoglobulin" at the time of transplant. This is to prevent the body from immediately attacking the transplanted organ, giving the body and the organ time to adapt to each other.
When I went into surgery, the key indicator of the strength of my immune system was at 19% (20% is normal for immuno-compromised patients, such as myself)). After the surgery, my immune system was nearly gone at 0.06%! Over the following three months of recovery, the strength of your immune system gradually rises. So now, after just six weeks post-surgery, my immune system has increased to 12%! (a HUGE rebound!). After three months, the doctors are hoping for a 19-20% immune response, which is about where it should stay. Any more than that and the body will start attacking the new organ--which we do NOT want!!!
Anyhow, as stated in the previous entry, I was moved out of ICU early on Saturday evening. The tenth floor at Intermountain Medical Center is only for transplant patients. This is because all staff on that floor are specifically trained for the care of said transplant patients and their specific medical needs, precautions and overall care. These rooms are only for a single patient for obvious reasons related to infection precautions. However, each room has a nice fold-out couch under the window for spouses or parents to sleep on if they choose to stay in the room. Additionally, this hospital has a terrific food service area on the main floor (for doctors, nurses, staff and patients and families) that serves fresh foods on numerous varieties. So, my wife did not have to suffer any patient-type foods while she was there.
That first evening was spent getting me setup in the new room, hooking me up to the numerous monitors (BP, HR, O2, Arterial Line pressures, Urinary Output, Cardiac Electrical Conduction, On-Demand Pain Meds--those are the things I remember...), going through nurses evals, seeing several doctors, and my just trying to get comfortable enough to get some sleep in the middle of all of this. :o)
Each patient has a nurse who has just four patients on their round, and a nurses aide (again, with just four patients ea.), and vitals were initially conducted every two hours, which made it difficult to get that sleep I was wanting.
Any movement on my part was still extremely difficult, and my nurse had me walking the halls that first evening. Having been through several previous abdominal surgeries, I knew this walking was normal, and was able to push through the pain. Those first few walks on the tenth floor were with a lot of help from my nurses a/o aides. Most of that evening was still a bit of a blur due to the pain meds; but as the nighttime passed, I noticed the nurses had started coming in for vital less often, going four hours between. This was because my vitals were stable and the doctors agreed that two hour vitals were no longer necessary. Yay! More sleep!!!
On Sunday morning I was informed that because I was doing so well, I would be allowed to start a full liquid diet. Before anyone gets excited, the "food" I was given that day was, well, let's just use the term 'repugnant.' I mean, NASTY doesn't even begin to describe the "hot cereal, soup or other so-called foods" that were presented. About the only things I downed were juices, milk, hot chocolate and water. (I'm shuddering just thinking about what was called 'potato soup!')
For most of the day on Sunday I was again sitting up, getting off of my back because the titanium hardware on my spine just doesn't allow me to be comfortable laying down for more than five of six hours...even with heavy pain meds. And since I could not yet lay on my sides, sitting up was the only way to give my back any relief.
Plus, because of the intubation I had during surgery, my TMD (Temporo Mandibular Dysfunction) was triggered in a massive way--which always happened when I'm intubated because of the stress my jaw has to endure. The TMD causes migraine-type headaches that, on a scale of 1-10, can cause headaches that hit a 15 on that scale! No kidding! So, in addition top all the abdominal pain, back pain and overall post-surgery discomfort, I had a TMD headache that was a solid 11, and would not go away or be knocked down to a reasonable level, even with the meds I was on. Add to that the fact that, in my haste to suddenly prepare to get to the hospital pre-transplant, I forgot to grab my NTI devices--an oral device that goes over the front of the teeth to prevent clenching, which helps to relax the jaw and prevent further "bruxism" of the Temporomandibular muscles; the band of muscles that start at one ball joint of the jaw and extend over the scalp to the other ball joint.
So, the only relief I could find for my headache was for my wife to fill surgical gloves with hot water and place them on the back of my neck. She did this about every 15 minutes for about three hours straight on Sunday night/Monday morning. This was able to allow my neck to relax, which helped decrease the headache to a tolerable 8, or so. We continued to use the hot water gloves throughout the remainder of my stay at IMC.
Also on Sunday I had several visitors show up. They were almost all family friends who we essentially consider to be a part of our family. In addition, two of my wife's coworkers brought a gift basket of treats for me to enjoy once I arrived home.
For any transplant patient, anyone who arrives to visit must sanitize their hands any time they leave the room, use the restroom or touch their hair or faces excessively. Plus, whenever I have visitors, I must wear a surgical mask. Anyone who visits must be cold or sickness free, or run the risk of infecting not only myself, but other patients as well. So remember, if you go to visit a transplant patient in the hospital (or at home during the first three month especially), they, their kids and any spouses or coworkers etc. must all be free from any type of sickness.
IF a transplant patient becomes sick with a cold, the flu or any other type of illness, that patient runs a huge risk of losing the transplanted organ, and if serious enough, they could even die! This is NOT an exaggeration!! It is a very real danger! After the first three months the risk is reduced, but it will forever remain a concern for the patient.
Anyhow, it was nice to visit with everyone, despite the fact I was drifting in and out of sleep.
Later on Sunday, because I was doing better with each passing day, I was taken off of IV pain meds and put on oral meds only. At this point I was being given 15 mg of immediate release Morphine--the ONLY pain med my body can tolerate. I cannot use any synthetic pain meds due to severe anaphylactic reactions.
Also on Sunday evening, because my urinary output was so good--and consistent (at around two liters per day, with good color and no blood or cloudiness) the urinary catheter was removed--NOT fun! (Thank goodness I was asleep on the OR table when it was put in!) :o( As a result of this, and the fact that, after not being used for three and a half years, my bladder was, as the surgeon put it, "incredibly small," I was having to walk to my restroom every 45 minutes, like clockwork. Having to keep track of my output by using a urinal, I knew that each time I went, I was peeing out anywhere from 75cc to 150cc. Over the course of a day, that small amount really adds up!
Despite my drinking nearly two liters of water, I was still getting a bit dehydrated as my body was continuing to rid itself of the excessive fluid buildup that occurs in any long-term dialysis patient.
I believe I already told you in my last blog that I lost nearly three liters of fluid (about a gallon of water!) while I was in ICU. Now that I was off the catheter, I was ridding more than the two liters I was taking in. Over the course of my hospital stay, I lost a total of about four and a half liters of fluid, despite my increasing intake.
Because of the fluid loss, my feet, which had for so long looked like Hobbit feet, now appeared normal in every way! I could see veins and ligaments for the first time in years, and my toes were looking normal again! So weird!
When my Sunday 'dinner' was brought, I was informed that on Monday, I would be upgraded to a full, normal diet. This was fantastic news! I eagerly filled out the meal card for the following day!
The remainder of Sunday evening was uneventful...aside from the TMD headache, or course. I eventually got some sleep, which was nice.
Monday found me walking several times--one loop around the floor equaled 1/10 of a mile--doing some physical therapy, continuing my use of the breathing exercises, getting LOTS of doctor visits, eating some far better food (!!), and getting some decent sleep throughout the day. Other than that, Monday was rather uneventful, aside from being informed that Tuesday was my day to go home.
Throughout the day my urinary frequency and output both remained consistent. Like I said...every forty five minutes, like clockwork.
On Tuesday, the doctors finalized the plan to send me home. But before that could happen, I had to see several Transplant Team members including my post-transplant Coordinator, the Cardiologist, the Nephrologist, the Surgeon, and most importantly, the Team Pharmacist.
Now, I bring up the Pharmacist last because it is now time to talk about the plethora of meds I had been taking since the transplant. I'm not referring to the pain meds; I'm talking about the Immunosuppressants and associated meds. During my stay I did not ask about these meds I was given twice every day because I already knew their general purpose. Add in the fact my brain was too foggy to remember much of anything, and it is easy to understand why I hadn't asked too many questions up to this point.
Anyhow, the Transplant Team Pharmacist came to see me to go over the meds I would shortly be given to take home. (I use the term 'given' loosely because patients must purchase their first month of meds before going home. In my case, they cost (after insurance) $193.00 and some change.) Now, before any future transplant patients get upset at that cost, it was far, far LESS that we thought it would be! We were actually expecting to pay anywhere from $600 to$2,000! So $193 was nothing compared to that!
Once I had the meds, the pharmacist returned to go over the meds again, and the schedule I needed to follow. Plus, I had to demonstrate my ability to follow the schedule by using the provided pill box, which was easy for me as I had been using a pillbox for the entire time I was on dialysis. So, there was no learning curve except for the new meds I would be using. And what exactly are the new meds? Read on....
I will be listing the Trade and Generic names for each med, the dosage, times and purpose for them. It is a lot of information, so if you are truly interested, please read carefully! **Remember...this list contains only the meds and dosages that I am on. Each individual patient will be different, so if you are looking at transplant, only your physicians will determine the meds and dosing schedule best suited to you!
1) Trade Name: Prograf (Generic: Tacrolimus) 1 Mg Capsules
Dosage: 2 Caps q (every) 12 Hours.
*Prevents organ rejection. If taking on a lab draw day, the Morning dosage should ONLY be taken after the blood draw has occurred! Be sure to check with your Transplant Team before taking any new medications as there might be contraindications in regards to the Prograf for the new meds. In other words, the new meds might produce side effects with the Prograf that could be serious and endanger the organ a/o your health.
2) Prograf (Tacrolimus) 0.50 Mg Caps
Dosage: 1 Cap q12 Hrs.
Prevents organ rejection.
3) Cellcept (Mycophenolate mofetil) 500 Mg Tabs
Dosage: 1000 Mg q12 Hrs.
Prevents rejection. Take or delay antacids, iron, magnesium or aluminum at least 1 Hr before or 2 Hrs after this med.
4) Prednisone (No Generic) 5 Mg Tabs
Dosage: 3 Tabs in the A.M. only
Prevents rejection. *Follow the Prednisone Taper Schedule.
*Dosage gradually decreases to 1 Tab 1x/day where it will stay permanently.
5) Bactrim (Sulfamethoxazole; Trimethoprim SS) 400 Mg Tab
Dosage: 1 Tab 1x/day in the A.M. only.
Treats/Prevents Bacterial infections. Specifically, transplant induced pneumonia.
6) Acyclovir (Generic only) 400 Mg Tabs
Dosage: 1 Tab q12 Hrs
Treats/Prevents Viral infections.
7) Coreg (Carvedilol) 25 Mg Tabs
Dosage: 1 Tab q12 Hrs
Heart Med. Controls Blood Pressure.
8) Imdur (Isosorbide Mononitrate) 25 Mg Tabs
Dosage: 1 Tab q12 Hrs
Treats Angina
9) Prilosec (Omeprazole) 40 Mg Capsules
Dosage: 1 Cap in the A.M. only.
Treats/Prevents Stomach Ulcers a/o Heartburn.
10) Aspirin Generic or non-generic) 81 Mg Tabs
Dosage: 1 Tab in the A.M. only.
Prevents Blood Clots.
11) Calcium w/Vitamin D (Generic or non-Generic) 600 Mg Tab
Dosage: 1 Tab q12 Hrs
Treats Low Levels of Calcium.
12) Phospha 250 Neutral (Phosphorous) 250 Mg Tab
Dosage: 1 Tab q12 Hrs only if labs indicate it is needed!
Treat Phosphorous Deficiency.
13) Mag Ox 400 (Magnesium Oxide) 400 Mg Tabs
Dosage: 1 Tab at 1200p and 1 at 600p only if labs indicate!
Nutritional Supplement. *Separate from Cellcept by at least 2 Hrs.
14) Sennosides/Docusate Sodium (No Generics) 8.6-50 Mg Tabs
Dosage: 1-2 Tabs q2x/day
Laxative plus Stool Softener.
15) MSIR (Morphine Sulfate Immediate Release) 15 Mg Tabs
Dosage: 1/2 to 1 Tab q4 Hrs prn (as needed for pain).
Treats Acute and Chronic Pain. Taper off as symptomology allow.
Each of these med descriptions had a picture next to the names so identification was easy for putting your pill box in order.
After our thorough discussion [with the Pharmacist], it was easy to put a 1 week dosing schedule in the pill box. The Pharmacist then checked each day's dosing, counting each pill and checking it against my personal schedule. After getting everything perfect, he signed off on my ability to set up my meds; especially with my paramedic background!
*Now, these meds will be gradually reduced/eliminated until I only have a few to take every day. As time goes on I will keep you up to date on those eliminations until I get to my maintenance-level meds. Even those might be altered from time to time, depending on how I do.
Once the Pharmacist was finished, the nurse came in to remove my art and neck lines, and the drainage line. All monitors were turned off, all monitor connections removed, and all I was left to do was get dressed, relax and await discharge.
For final instructions my nurse went over several things including not bending over, no straining for two weeks, no lifting more than 5 pounds for at least two weeks, leave the abdominal binder on for a full three weeks post-discharge at which time I could leave it off at home, and another three weeks of wearing the binder whenever I was in a car or walking outside. I was also briefed on attending the twice weekly Transplant Team Kidney Clinic (Monday and Thursday mornings), and doing labs at IMC between 600a and 800a on those days with also bringing a Urine Sample on Mondays.
And with all of those instructions--and probably more that I don't recall now--I awaited my discharge. As with my double radical nephrectomy in Nov 2013, the nurse have me a swag bag filled with supplies I would need over the next few days including a new abdominal binder, trauma pads (for under the binder to reduce discomfort over the incision), stretch gauze tape, gloves, compression socks (if needed), surgical masks, urinals (New, clean ones, of course!), and other such supplies.
I was also taking home a big Kidney Pillow that Nurses, Doctors, PS and other staff can sign as a reminder of your new lease on life. My pillow is pretty much covered in signatures and well-wishes.
As far as my "Go Bag" is concerned, I did not use most of its contents, but was grateful for the items that I did have at my disposal such as Toothpaste, Lip Balm, Q-Tips, Hair Brush, Deodorant, Slippers, PJ's, Baseball Cap, Socks and Teva's. I had put the Go Bag together anticipating any needs that might arise. Everything that wasn't used simply gets absorbed into my everyday supplies and clothing.
And with everything now completed for discharge, I was taken by wheelchair to our car where I very gingerly eased my way in, while my wife and daughter helped me get settled and comfortable. After that was a 44 mile drive home, and my wife made sure the ride was as smooth as possible. Once at home, she helped me out of the car, and very slowly up the twenty steps from our garage to our living area. She then eased me gently down onto the couch and got me comfortable; even lifting my legs up so they could rest on the ottoman.
Aahhhh...it was great to be home!
(Next Up: Home routine and Kidney Clinic)
Good Health to All!
ScottW
That first evening was spent getting me setup in the new room, hooking me up to the numerous monitors (BP, HR, O2, Arterial Line pressures, Urinary Output, Cardiac Electrical Conduction, On-Demand Pain Meds--those are the things I remember...), going through nurses evals, seeing several doctors, and my just trying to get comfortable enough to get some sleep in the middle of all of this. :o)
Each patient has a nurse who has just four patients on their round, and a nurses aide (again, with just four patients ea.), and vitals were initially conducted every two hours, which made it difficult to get that sleep I was wanting.
Any movement on my part was still extremely difficult, and my nurse had me walking the halls that first evening. Having been through several previous abdominal surgeries, I knew this walking was normal, and was able to push through the pain. Those first few walks on the tenth floor were with a lot of help from my nurses a/o aides. Most of that evening was still a bit of a blur due to the pain meds; but as the nighttime passed, I noticed the nurses had started coming in for vital less often, going four hours between. This was because my vitals were stable and the doctors agreed that two hour vitals were no longer necessary. Yay! More sleep!!!
On Sunday morning I was informed that because I was doing so well, I would be allowed to start a full liquid diet. Before anyone gets excited, the "food" I was given that day was, well, let's just use the term 'repugnant.' I mean, NASTY doesn't even begin to describe the "hot cereal, soup or other so-called foods" that were presented. About the only things I downed were juices, milk, hot chocolate and water. (I'm shuddering just thinking about what was called 'potato soup!')
For most of the day on Sunday I was again sitting up, getting off of my back because the titanium hardware on my spine just doesn't allow me to be comfortable laying down for more than five of six hours...even with heavy pain meds. And since I could not yet lay on my sides, sitting up was the only way to give my back any relief.
Plus, because of the intubation I had during surgery, my TMD (Temporo Mandibular Dysfunction) was triggered in a massive way--which always happened when I'm intubated because of the stress my jaw has to endure. The TMD causes migraine-type headaches that, on a scale of 1-10, can cause headaches that hit a 15 on that scale! No kidding! So, in addition top all the abdominal pain, back pain and overall post-surgery discomfort, I had a TMD headache that was a solid 11, and would not go away or be knocked down to a reasonable level, even with the meds I was on. Add to that the fact that, in my haste to suddenly prepare to get to the hospital pre-transplant, I forgot to grab my NTI devices--an oral device that goes over the front of the teeth to prevent clenching, which helps to relax the jaw and prevent further "bruxism" of the Temporomandibular muscles; the band of muscles that start at one ball joint of the jaw and extend over the scalp to the other ball joint.
So, the only relief I could find for my headache was for my wife to fill surgical gloves with hot water and place them on the back of my neck. She did this about every 15 minutes for about three hours straight on Sunday night/Monday morning. This was able to allow my neck to relax, which helped decrease the headache to a tolerable 8, or so. We continued to use the hot water gloves throughout the remainder of my stay at IMC.
Also on Sunday I had several visitors show up. They were almost all family friends who we essentially consider to be a part of our family. In addition, two of my wife's coworkers brought a gift basket of treats for me to enjoy once I arrived home.
For any transplant patient, anyone who arrives to visit must sanitize their hands any time they leave the room, use the restroom or touch their hair or faces excessively. Plus, whenever I have visitors, I must wear a surgical mask. Anyone who visits must be cold or sickness free, or run the risk of infecting not only myself, but other patients as well. So remember, if you go to visit a transplant patient in the hospital (or at home during the first three month especially), they, their kids and any spouses or coworkers etc. must all be free from any type of sickness.
IF a transplant patient becomes sick with a cold, the flu or any other type of illness, that patient runs a huge risk of losing the transplanted organ, and if serious enough, they could even die! This is NOT an exaggeration!! It is a very real danger! After the first three months the risk is reduced, but it will forever remain a concern for the patient.
Anyhow, it was nice to visit with everyone, despite the fact I was drifting in and out of sleep.
Later on Sunday, because I was doing better with each passing day, I was taken off of IV pain meds and put on oral meds only. At this point I was being given 15 mg of immediate release Morphine--the ONLY pain med my body can tolerate. I cannot use any synthetic pain meds due to severe anaphylactic reactions.
Also on Sunday evening, because my urinary output was so good--and consistent (at around two liters per day, with good color and no blood or cloudiness) the urinary catheter was removed--NOT fun! (Thank goodness I was asleep on the OR table when it was put in!) :o( As a result of this, and the fact that, after not being used for three and a half years, my bladder was, as the surgeon put it, "incredibly small," I was having to walk to my restroom every 45 minutes, like clockwork. Having to keep track of my output by using a urinal, I knew that each time I went, I was peeing out anywhere from 75cc to 150cc. Over the course of a day, that small amount really adds up!
Despite my drinking nearly two liters of water, I was still getting a bit dehydrated as my body was continuing to rid itself of the excessive fluid buildup that occurs in any long-term dialysis patient.
I believe I already told you in my last blog that I lost nearly three liters of fluid (about a gallon of water!) while I was in ICU. Now that I was off the catheter, I was ridding more than the two liters I was taking in. Over the course of my hospital stay, I lost a total of about four and a half liters of fluid, despite my increasing intake.
Because of the fluid loss, my feet, which had for so long looked like Hobbit feet, now appeared normal in every way! I could see veins and ligaments for the first time in years, and my toes were looking normal again! So weird!
When my Sunday 'dinner' was brought, I was informed that on Monday, I would be upgraded to a full, normal diet. This was fantastic news! I eagerly filled out the meal card for the following day!
The remainder of Sunday evening was uneventful...aside from the TMD headache, or course. I eventually got some sleep, which was nice.
Monday found me walking several times--one loop around the floor equaled 1/10 of a mile--doing some physical therapy, continuing my use of the breathing exercises, getting LOTS of doctor visits, eating some far better food (!!), and getting some decent sleep throughout the day. Other than that, Monday was rather uneventful, aside from being informed that Tuesday was my day to go home.
Throughout the day my urinary frequency and output both remained consistent. Like I said...every forty five minutes, like clockwork.
On Tuesday, the doctors finalized the plan to send me home. But before that could happen, I had to see several Transplant Team members including my post-transplant Coordinator, the Cardiologist, the Nephrologist, the Surgeon, and most importantly, the Team Pharmacist.
Now, I bring up the Pharmacist last because it is now time to talk about the plethora of meds I had been taking since the transplant. I'm not referring to the pain meds; I'm talking about the Immunosuppressants and associated meds. During my stay I did not ask about these meds I was given twice every day because I already knew their general purpose. Add in the fact my brain was too foggy to remember much of anything, and it is easy to understand why I hadn't asked too many questions up to this point.
Anyhow, the Transplant Team Pharmacist came to see me to go over the meds I would shortly be given to take home. (I use the term 'given' loosely because patients must purchase their first month of meds before going home. In my case, they cost (after insurance) $193.00 and some change.) Now, before any future transplant patients get upset at that cost, it was far, far LESS that we thought it would be! We were actually expecting to pay anywhere from $600 to$2,000! So $193 was nothing compared to that!
Once I had the meds, the pharmacist returned to go over the meds again, and the schedule I needed to follow. Plus, I had to demonstrate my ability to follow the schedule by using the provided pill box, which was easy for me as I had been using a pillbox for the entire time I was on dialysis. So, there was no learning curve except for the new meds I would be using. And what exactly are the new meds? Read on....
I will be listing the Trade and Generic names for each med, the dosage, times and purpose for them. It is a lot of information, so if you are truly interested, please read carefully! **Remember...this list contains only the meds and dosages that I am on. Each individual patient will be different, so if you are looking at transplant, only your physicians will determine the meds and dosing schedule best suited to you!
1) Trade Name: Prograf (Generic: Tacrolimus) 1 Mg Capsules
Dosage: 2 Caps q (every) 12 Hours.
*Prevents organ rejection. If taking on a lab draw day, the Morning dosage should ONLY be taken after the blood draw has occurred! Be sure to check with your Transplant Team before taking any new medications as there might be contraindications in regards to the Prograf for the new meds. In other words, the new meds might produce side effects with the Prograf that could be serious and endanger the organ a/o your health.
2) Prograf (Tacrolimus) 0.50 Mg Caps
Dosage: 1 Cap q12 Hrs.
Prevents organ rejection.
3) Cellcept (Mycophenolate mofetil) 500 Mg Tabs
Dosage: 1000 Mg q12 Hrs.
Prevents rejection. Take or delay antacids, iron, magnesium or aluminum at least 1 Hr before or 2 Hrs after this med.
4) Prednisone (No Generic) 5 Mg Tabs
Dosage: 3 Tabs in the A.M. only
Prevents rejection. *Follow the Prednisone Taper Schedule.
*Dosage gradually decreases to 1 Tab 1x/day where it will stay permanently.
5) Bactrim (Sulfamethoxazole; Trimethoprim SS) 400 Mg Tab
Dosage: 1 Tab 1x/day in the A.M. only.
Treats/Prevents Bacterial infections. Specifically, transplant induced pneumonia.
6) Acyclovir (Generic only) 400 Mg Tabs
Dosage: 1 Tab q12 Hrs
Treats/Prevents Viral infections.
7) Coreg (Carvedilol) 25 Mg Tabs
Dosage: 1 Tab q12 Hrs
Heart Med. Controls Blood Pressure.
8) Imdur (Isosorbide Mononitrate) 25 Mg Tabs
Dosage: 1 Tab q12 Hrs
Treats Angina
9) Prilosec (Omeprazole) 40 Mg Capsules
Dosage: 1 Cap in the A.M. only.
Treats/Prevents Stomach Ulcers a/o Heartburn.
10) Aspirin Generic or non-generic) 81 Mg Tabs
Dosage: 1 Tab in the A.M. only.
Prevents Blood Clots.
11) Calcium w/Vitamin D (Generic or non-Generic) 600 Mg Tab
Dosage: 1 Tab q12 Hrs
Treats Low Levels of Calcium.
12) Phospha 250 Neutral (Phosphorous) 250 Mg Tab
Dosage: 1 Tab q12 Hrs only if labs indicate it is needed!
Treat Phosphorous Deficiency.
13) Mag Ox 400 (Magnesium Oxide) 400 Mg Tabs
Dosage: 1 Tab at 1200p and 1 at 600p only if labs indicate!
Nutritional Supplement. *Separate from Cellcept by at least 2 Hrs.
14) Sennosides/Docusate Sodium (No Generics) 8.6-50 Mg Tabs
Dosage: 1-2 Tabs q2x/day
Laxative plus Stool Softener.
15) MSIR (Morphine Sulfate Immediate Release) 15 Mg Tabs
Dosage: 1/2 to 1 Tab q4 Hrs prn (as needed for pain).
Treats Acute and Chronic Pain. Taper off as symptomology allow.
Each of these med descriptions had a picture next to the names so identification was easy for putting your pill box in order.
After our thorough discussion [with the Pharmacist], it was easy to put a 1 week dosing schedule in the pill box. The Pharmacist then checked each day's dosing, counting each pill and checking it against my personal schedule. After getting everything perfect, he signed off on my ability to set up my meds; especially with my paramedic background!
*Now, these meds will be gradually reduced/eliminated until I only have a few to take every day. As time goes on I will keep you up to date on those eliminations until I get to my maintenance-level meds. Even those might be altered from time to time, depending on how I do.
Once the Pharmacist was finished, the nurse came in to remove my art and neck lines, and the drainage line. All monitors were turned off, all monitor connections removed, and all I was left to do was get dressed, relax and await discharge.
For final instructions my nurse went over several things including not bending over, no straining for two weeks, no lifting more than 5 pounds for at least two weeks, leave the abdominal binder on for a full three weeks post-discharge at which time I could leave it off at home, and another three weeks of wearing the binder whenever I was in a car or walking outside. I was also briefed on attending the twice weekly Transplant Team Kidney Clinic (Monday and Thursday mornings), and doing labs at IMC between 600a and 800a on those days with also bringing a Urine Sample on Mondays.
And with all of those instructions--and probably more that I don't recall now--I awaited my discharge. As with my double radical nephrectomy in Nov 2013, the nurse have me a swag bag filled with supplies I would need over the next few days including a new abdominal binder, trauma pads (for under the binder to reduce discomfort over the incision), stretch gauze tape, gloves, compression socks (if needed), surgical masks, urinals (New, clean ones, of course!), and other such supplies.
I was also taking home a big Kidney Pillow that Nurses, Doctors, PS and other staff can sign as a reminder of your new lease on life. My pillow is pretty much covered in signatures and well-wishes.
As far as my "Go Bag" is concerned, I did not use most of its contents, but was grateful for the items that I did have at my disposal such as Toothpaste, Lip Balm, Q-Tips, Hair Brush, Deodorant, Slippers, PJ's, Baseball Cap, Socks and Teva's. I had put the Go Bag together anticipating any needs that might arise. Everything that wasn't used simply gets absorbed into my everyday supplies and clothing.
And with everything now completed for discharge, I was taken by wheelchair to our car where I very gingerly eased my way in, while my wife and daughter helped me get settled and comfortable. After that was a 44 mile drive home, and my wife made sure the ride was as smooth as possible. Once at home, she helped me out of the car, and very slowly up the twenty steps from our garage to our living area. She then eased me gently down onto the couch and got me comfortable; even lifting my legs up so they could rest on the ottoman.
Aahhhh...it was great to be home!
(Next Up: Home routine and Kidney Clinic)
Good Health to All!
ScottW
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