Post-Transplant Update: 04 March 2019

Following my recent Parathyroidectomy--the excision of Parathyroid glands--I am finally up to getting this blog update written.

To start...my most recent Labs...

19 Feb 19 Labs

*Creat:   2.74 (+0.47) High

*Hct:   35.3 (+1.4) IR  (Low End)

*Hemo: 11.0 (+0.4) IR

*Lymph:   14.2 (+3.7) IR  (Low end)

*Lymph ABS:   4.2 (-0.4) IR

*Neut:   78.2 (+0.5) High

*Neut ABS:   4.2 (-0.4) IR

*RBC:   3.9 (+0.15) Low

*WBC:   5.3 (-0.6) IR

*BUN:   47 (+12) Extremely High

*CA:   9.9 (+0.2) IR

*GFR:   25 (-6) Extremely Low

*Gluc:   87

*K+:   4.5 (NC) IR

*NA+:   138 (NC) IR

*Prot:   6.7 (+0.1) IR

*MG:   1.9 (-0.3) IR

*Phos:   3.6 (+0.2) IR

     NC= No Change     IR= In Range

I am highlighting only the Hematocrit, Hemoglobin and Lymphocytes because all three rose significantly. The effects of last Springs' anti-thymo treatment are finally loosening their grip on my labs. With the rise in  my Lymphocytes I can once again --FINALLY--stop wearing a mask everywhere I go. That only took about eleven months! 

In all, these three lab values represent a stronger, healthier immune system, and improved RBC production in my bone marrow. 

In total, these labs have twelve values that are within the desired ranges. This is a big improvement over my January labs!

Urinalysis 19 Feb 19

Appearance:   Normal

Color:   Normal

Glucose, UR:   Negative

Hgb,UR:   Negative

Ketones, UR:   Negative

Leuk Esterase:   Negative

Nitrite:   Negative

pH, Urine:   5.5 (Normal Range is 5.0-8.5)

Prot, UR:   Negative

Specific Gravity, Urine:   1.01 (Normal Range is 1.003-1.030)

The only number on my UA that changed was the pH, which dropped slightly. So, my kidney looks to be working nicely.

Next, as is now usual, the afternoon that my labs were drawn was my February Belatacept infusion. There were no issues with the cannulation or the infusion itself, and there have been zero side effects.

I had the surgery (Parathyroidectomy) to remove up to three of the four Parathyroid glands on 20 February, as scheduled. 

(Pointing to where the surgery would be. 20 Feb 19)

(Ready for another surgery. 20 Feb 19)

After all the now all too familiar pre-surgical prep was done, I spoke with the surgeon and the anesthesiologist; all info was exchanged, and I was taken to surgery.

The surgery itself lasted only about 1.5 hours--easy compared with my last two surgeries!

Of the four Parathyroid glands, there were indeed a total of three of the four glands removed. In general, all three were about five times larger than normal, while the fourth parathyroid was only fractionally larger, which the surgeon left alone.

While I had been told where the incision would be, the actual location was about two inches lower on my neck. This was simply because my larynx (and thyroid gland--which is what the parathyroids sit on) is lower on my neck than was expected.

(Surgical incision site, post-operative. 20 Feb 19)

The surgery went on without any issues; aside from the actual location of the incision.  

  

As I already knew that I would be in-hospital overnight, my stay was expected. I did well post-op, and was resting comfortably that evening. My labs (for PTH and calcium) came back dramatically reduced from 275 (PTH) to 103, and 10.4 (Calcium) to 8.6. 

For this surgery, I was NOT given any special diet--Thank goodness!--and was able to eat whenever I was ready. 

Also, the anesthesiologist had used some steroids to aid in reducing surgical inflammation, so my blood sugars spiked to a high of 188, which was treated with 2 IU of insulin. This only happened a single time. After this, my blood sugars returned to normal.

The day after surgery, the surgeon came to visit and stated that he'd like for me to stay one extra night as a precaution against a sudden drop in my calcium, which could lead to a massive calcium deficiency; which in turn could cause cardiac, renal, respiratory and bone issues. This happens when, following parathyroid surgery, the body is unable to compensate for sudden calcium deficits due to what is called "Bone Hunger." You see, high PTH levels can cause too little calcium from reaching bones and maintaining bone health and integrity. Once the PTH levels drop, the bones can then begin to take all the calcium out of the blood in order to improve the health of the bones. 

This stripping away of the blood calcium in turn can have serious deleterious effects on a number or internal organs any systems within the body including renal issues, cardiac arrhythmias (and possible arrest), etc. 

My doctor was concerned that with the length of time that I was on dialysis, combined with the lengthy PTH increase, my body would indeed go into sudden and severe Bone Hunger. So, I ended up with a second day of observation. 

Following that second day, my labs looked great, and I was allowed to go home to finish my recovery.

(On the pictures below, the intended incision was to be at about the top of the bruising above the surgical site.)

(Surgical site two days post-op. 22 Feb 19)

(Parathyroid Excision site without steri strips. 27 Feb 18)

(Parathyroid Excision scar 01 March 19)

*By the way, the only reason I am wearing a necklace is because it holds my MedicAlert emblem, which I wear any time I am out of the house.

Once at home, I only spent about two days in bed. After that, I was walking around pretty much normally. About the only adjustment I've had to make was wear low-necked shirts so that nothing rubs against the scar as it is still bruised and very tender to the touch of any materials. Even as I write this today, I cannot have even very light-weight shirts rubbing against the site. I expect this to continue for another two or three weeks.

Since my initial recovery, I have already noticed a couple of improvements. First, my daily Blood Pressure (BP) has dropped both morning and night. Second, I already have a noticeable uptick in my energy level. Both are welcomed developments!

One week post surgery, I had my surgical follow-up. The doctor was extremely pleased with my progress. I have a second follow-up on 25 March so that he can determine how my calcium intake should change.

Right now, I am eating a 1,000 mg tums(that's, 1,000 mgs of calcium) every four hours each day, and once during the night. This is to artificially inflate my calcium levels in order to address any lingering bone hunger issues. Once I meet with the doctor again, we will likely decide to place me on regular calcium supplements from that point forward.

All other meds remain the same as the pre-surgical regimen. 

Also during that first follow-up, the surgeon gave me the post-operative pathology report on the three parathyroid glands. Here's a basic breakdown:

"Surgical Pathology Report

Specimens Submitted As:   A) Left Inferior Parathyroid   B) Right Inferior Parathyroid   

C) Right Superior Parathyroid     Pre-Op Diagnosis: Secondary Parathyroidism of Renal Origin

Final Diagnosis 

 A) Left Inferior Parathyroid [via] Parathyroidectomy: Hypercellular Parathyroid Tissue.   B) Right Inferior Parathyroid [via] Parathyroidectomy: Hypercellular Parathyroid Tissue.   C) Right Superior Parathyroid [via] Parathyroidectomy: Hypercellular Parathyroid Tissue

Intraoperative Consultation, Frozen Section Diagnosis

FSA1: Hypercellular Parathyroid Tissue

FSB1: Parathyroid Tissue Present

FSC1: Hypercellular Parathyroid Tissue

Gross Examination

A) Received labeled, Left Inferior Parathyroid is 520 mg, 1.8 x 1 x 0.7 cm tan, soft tissue nodule bisected and submitted frozen as FSA1.

B) Received labeled, Right Inferior Parathyroid is 148 mg, 1 x 0.8 x 0.4 cm tan, soft tissue nodule submitted frozen as FSB1.

C) Received labeled, Right Superior Parathyroid is 252 mg, 1.2 x 1 x 0.4 cm tan, soft tissue nodule submitted frozen as FSC1.

Microscopic Examination

Permanent sections confirm frozen section diagnoses."

...and one last bit of actual medical info from the surgery...

"Pre-op PTH, Intact

Date: 20 Feb 19   Time: 12.33   Final: 229

Post-Op PTH, Intact

Date: 20 Feb 19   Time: 16.15   Final: 48"

*The post-op PTH I stated earlier was later in the evening. The number just above was approximately six minutes after the affected parathyroid glands were removed.

Regarding other areas post-op, I am eating normally; my fluid intake remains the same as before the surgery (3-4 L each day); my sleep is inconsistent as per usual following any hospital stay; my headaches have been elevated due to yet another intubation [for the surgery]; I am less active, though this changes a little each day as I continue to heal, and my weight has been fairly consistent from day to day.
Again, with the PTH levels now normal, and the blood calcium now being about where it should be, I am looking to see increased strength and stamina. Now, I know I have a REALLY long road of recovery ahead, but with Spring nearly upon us, I should be able to get out walking again, slowing building my leg strength; which I am very much looking forward to happening!

So...THAT is all I am willing to type up right now. I am already a day late getting this posted because of all the info I had to pass along. 

I have my next labs and Belatacept Infusion on the 19th. I will hopefully get another entry done before then.

I want to Thank Everyone for your thoughts and prayers during the time of my surgery!

Good Health to All!

ScottW

07 March 19
*After reading through previous entries regarding the whole Parathyroid thing, I neglected to mention an important bit of information that will help to place the size of the now removed Parathyroid glands , into a better perspective.
Each Parathyroid gland is about the size of a grain of rice, and weighs approximately 40 mg. So, comparing that to the size the glands were upon removal (as stated above) helps you to understand just how enlarged they had become, and why they had to be removed.