Post-Transplant Update: 21 August 2018

This past week has been fairly uneventful; aside from Kidney Clinic.

So let's start there...

At this stage, my Kidney Clinic visits typically go like this:

-Get called back; get my weight on the way to the exam room. 
   (*An important note...Whenever you are weighed at a doctor's office, be sure to remove your cell phone and anything else that is heavy in your pockets. Remove shoes if possible. This assures a more accurate weight. I usually go to clinic and doctor visits wearing lightweight clothing to help, as well. Plus, I always weigh myself in the morning, sans clothing, so I know my real weight.)

-Once in the room, I have my BP, Pulse Respiration rate and O2 Sats (saturation) measured. I will usually ask to wait about two minutes before these are taken so that (after walking) my heart rate and BP settle back towards a normal range.

-A Clinic PA will come in first. My current meds are reviewed, my weights, pulses and BP readings for the past time since my last visit are noted, and highs and lows of all are noted, as well. Any questions I have are asked, answered or written for physician review.

-A Clinic Pharmacist will occasionally come in to also review meds.

-Finally, a Clinic Nephrologist will come in, review the PA's visit, and give any additional instructions, change meds, etc.

Then the visit is over. Depending on patient volume on any given day, the total visit time can range from 45 minutes to two hours.
*Remember...this clinic schedule is for me and for my Kidney Clinic only. Other systems are highly likely to be different, so be sure to follow your clinic protocols. 

Anyhow, my Clinic visit went well. For now, there are no changes to meds, and I was reminded that my labs settling down will just take time. With the Tac soon to be a thing of the past, it will be at least two additional months before we see the creatinine level reach its new low.

And speaking of labs, here are the latest...
   *I have changed the order of the listed labs based on where each is listed on the readout. The only exceptions are the Tac, Creatinine and BK/CMV.

20 Aug 18 Labs:

*Tacrolimus (Tac):   2.0 (NC) Dropping

*Creatinine (Creat):   2.37 (-0.04) Dropping

*Hematocrit (HCT):   32.7 (-0.7) Low

*Hemoglobin (Hemo):   10.3 (-0.2) IR

*Lymphocytes (Lymph):   6.6 (-0.3) Extremely Low

*Lymphocytes ABS (Lymph ABS):   0.4 (NC) Very Low

*Neutrophils (Neut):   82.7 (+0.2) Extremely High

*Neutrophils ABS (Neut ABS):   4.9 (-0.2) IR

*Red Blood Cells (RBC):   3.58 (-0.01) Very Low

*White Blood Cells (WBC):   5.9 (-0.2) IR

*Blood Urea Nitrogen (BUN):   28 (-7) High

*Calcium (CA):   9.7 (-0.6) IR

*Glomerular Filtration Rate (GFR):   30 (+1) Extremely Low

*Blood Glucose Level (Gluc):   95

*Potassium (K+):   4.3 (+0.3) IR

*Blood Sodium (NA+):   139 (-2) IR

*Protein (Prot):   6.7 (-0.2) IR

*Magnesium (MG):   2.2 (+0.2) IR

*Phosphorous (Phos):   3.7 (+0.4) IR

*BK Virus (BK):   NC

*Cytomeglovirus (CMV):   NC

    IR= In Range     NC= Not Checked

-The Creatinine is continuing to drop nicely. Every week has shown a steady decrease in this value.
-My Lymphocytes continue to struggle after that recent plunge from 11.9 down to 2.0. As previously stated, getting this to increase is just a matter of time.
-The RBC's still lag behind the HCT and Hemo. Despite this, I am feeling a bit stronger every week.
-I had a really nice drop in the BUN! The top end of the range for this lab value is 20, so having a 7 point drop is fantastic!
All in all, decent labs yesterday. Nine of the labs are in the right range, and I anticipate the rest falling in line over the next month or so.
-For now, I will continue doing weekly labs. Once the Tac is gone and my Creatinine drops, this schedule will likely decrease to every other week, then once per month.


I was supposed to see my local nephrologist yesterday, but his office called last week to reschedule my appointment to Wednesday, August 29th.


I have set a target date to start walking again. My strength is finally up enough--and will continue to improve--that I can plan on beginning on or around 01 September. At first, any distance I put in will be dictated by how fast I tire. I will try each day I walk to increase my distance even if just a small bit.

Along this line, I wrote up a plan for improving my physical strength. It is as follows:

"10 Steps for Getting Back in Shape"

1) Start daily walks as tolerated.

2) Increase walking speed, distance and/or time as strength and stamina allow.

3) Drink plenty of water. Eat properly.

4) As abdomen heals, do more around the house as tolerated.

5) By Spring 2019, be walking at least 5 miles in a decent time (and utilizing anaerobic respirations). 

6) When abdominal pain lessens, begin core exercises, as tolerated.

7) By Summer 2019, walk 8 miles in decent time; be doing numerous core exercises and begin light weight training.

8) By Fall 2019, walk 8 miles in one hour; be doing numerous core exercises for longer periods/greater reps and be at a moderate level in weight training.

9) By January 2020, continue walking goal, core exercises and increase weight training to a difficult level. 

10) By Summer 2020, be fit, strong, in excellent cardiovascular shape and feeling fantastic!

   *I have no specific weight goals due to my bodies inherent tendency to pack on muscle, which weighs more.

All of the above is contingent on no further setbacks with my kidney or my health.     Being in great shape helps you to feel better, require less sleep and gives you greater   self confidence.
**This schedule is also created to reflect how my body adapts to increasing levels of exercise. (I have been through a similar regimen in the past.) While suitable for me, this could actually be dangerous for someone else. Please consult a physician for an exercise program that is right for you!

Also, when walking/exercising, it takes from 15-20+ minutes for the body to go from aerobic respirations (using oxygen to help power the body and burn energy) to being in anaerobic respirations (the body burns fat to power the body and exercising). The longer you can be in anaerobic respirations, the better. 

In other news, my headaches have finally entered a slow-down stage. I have continued to adjust my jaw at night whenever I lay on my R side, and this seems to be a huge help! While the headaches are still present, my T3 and Tylenol usage have both decreased. 
I don't know how long this slowdown will last, but I welcome every day that has less headache intensity/severity.

Using daily Protonix has kept that nausea in check. At Kidney Clinic I mentioned what I was doing and both the PA and Nephrologist supported my approach.

My sleep remains inconsistent. Most nights, I sleep rather furtively, with occasional nights of good, solid rest. The past week, I have been getting up ever hour and 25 minutes to empty my bladder. I can usually get back to sleep quickly; but not always. As a result of everything, I have been tired most days.
And speaking of my bladder...during the day, my body has been hanging on to fluids I take in; but at night, my body releases those fluids, which is why I have been getting up so frequently lately. I have no doubt that this will turn around to more of a normal daily fluid excretion schedule.

That should be all for today. If anything further of significance comes to mind I will add it to the end of this entry.

Have a terrific week!

Good Health to All!

ScottW

22 Aug:  Yesterday evening it occurred to me that I needed to clarify a point on my exercise regimen that I have prepared for myself. I failed to note this because I know how this will progress. Unfortunately, I forgot to elucidate this for everyone else...

All of the exercises and walking will at first be as tolerated. As time goes on and my strength and stamina improve, I will increase the frequency of these daily exercises each week. 
By Spring 2019, I want to be walking that five miles at least 3-4 times per week, and be doing the core exercises at least that much.
By Summer, be walking that eight miles 3-4 times per week, weight training 3-4 times each week and continue the core exercises at that same pace.
By Fall 2019, I hope to increase that walking frequency to 4-5 times per week, weight training at 5-6 times and the core exercises 5-6 times per week.
After this point, I will continue at this pace and possibly increase each exercise from time to time.