Post-Transplant Update: 09 January 2020

Happy New Year {and New Decade}, Everyone!

I cannot believe that another year has so speedily passed. I am now swiftly approaching three full years since my transplant!

Before I get started on this blog entry, it is time for me to remind my readers that this blog reflects my personal experiences with PCKD, dialysis, transplant and post-transplant life. My journey has been very atypical in how it has all unfolded, and it should never be inferred that anyone else going through this process will have the same issues regarding their pre and post-transplant progression. However, if this blog can help anyone better their experience in some way, then I am grateful to have been of service.
Remember, you should always consult your physicians and other healthcare personnel regarding your treatment, then follow their directions and advice at all times, and exactly as given. Only they can know what is best for you!

Alright, let's get going...

My little vacation went by too quickly, and I returned just in time to make my latest appointment with the Kidney Clinic.

The visit was actually much quicker than usual, and we made two changes to my meds in addition to ordering an additional test on my next monthly lab draw; which is coming up on 21 January.

First, the so-so news...

Although I was unable to do my vitals with any consistency during my vacation, the results I did get showed that additional tweaks in my meds were necessary. Since my previous visit and the increase of Hydralazine [to 75 mg 3x/day], my blood pressures remained elevated despite the routine usage of Clonidine (.05 mg morning, and .1 mg evening). The A.M. systolic readings averaged in the 130's, while the P.M. reading were in the 140's. While the readings were at least stable, and without wide swings, my blood pressure remains too high which, of course, stresses the kidney and inhibits it from working at the best possible efficiency.

Second, the good news...

Most of the edema caused by the Amlodipine has left my body. The greatest loss of the fluid happened within this past week. As a result, my feet almost look normal, my lower legs are thinner, and my face, which I had not realized was also affected, is less rounded; leaving me looking a bit healthier.

Third, the great news...

Since getting off of the Isosorbide and Amlodipine on 17 December (the date of my last Kidney Clinic appointment), I have now lost a total of 3.2 Kg's !
Do you remember how I was telling you that the Isosorbide can cause unremittent weight gain? Well apparently now that it (the Isosorbide) is out of my body, the weight is dropping...and I'm not even trying to lose any! Plus, as of this morning, I had dropped an additional 3/10's of a Kg from yesterday.
Also, the doctors are extremely pleased that my latest labs finally show great overall stability. We are hoping with the weight sloughing off that my next labs will look even better.

Now, following my Clinic visit, here's the latest approach...

All of my meds will stay the same aside from two differences. First, the Hydralazine has been increased once again; this time going from 75 mg 3x/day to 100 mg 3x/day.

Second, to help further eliminate additional fluids from my body, I have been placed on a temporary regimen of Torsemide 50 mg 1x/day in the morning.
Torosemide is a diuretic similar to Lasix, but its effect lasts longer; being effective from 6-8 hours after onset of diuresis. The hope is to eliminate as much extra water on my body as we can, thus helping to lower blood pressure on top of the increase of Hydralazine.
I will continue with the Torsemide for one month; at which time I will have another visit with the Kidney Clinic doctors, and my progress re-examined.

Lastly on the visit, I off-handedly remarked that it would be nice to stop being cold all of the time, and the doctor asked if I'd had a Thyroid test since the transplant. I did not recall having had that, so a test was ordered that will be included on my next lab draw. The reason for this test is to determine if the thyroid is producing enough of two chemicals that help regulate heat in the body. The Thyroid is stimulated by the Pituitary gland, which itself is regulated by the Hypothalamus; also known as the body's thermostat.
I do not yet understand the entire interaction between the three, but I am including a basic explanation at the end of this blog. As far as what will be done if the labs reflect an issue, I do not know. I will do some studying on the matter in the coming days.

So, for the next few weeks I am hoping to see additional weight loss, lowering BP's, increased energy and better overall progress. I'll keep you updated.

And with that I am going to go ahead and finish this entry. I will have a new one done next week that will keep you apprised of my progress.

Upcoming appointments: Lab draw and monthly Bletacept infusion on 21 January.

Until next week...

Good Health to All!

ScottW



*(Basic explanation of the Thyroid, Pituitary and Hypothalamus Interaction)

Your thyroid gland is a small gland, normally weighing less than one ounce, located in the front of the neck. It is made up of two halves, called lobes, that lie along the windpipe (trachea) and are joined together by a narrow band of thyroid tissue, known as the isthmus.

The thyroid is situated just below your "Adams apple" or larynx. During development (inside the womb) the thyroid gland originates in the back of the tongue, but it normally migrates to the front of the neck before birth. Sometimes it fails to migrate properly and is located high in the neck or even in the back of the tongue (lingual thyroid). This is very rare. At other times it may migrate too far and ends up in the chest (this is also rare).

The function of the thyroid gland is to take iodine, found in many foods, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine. These cells combine iodine and the amino acid tyrosine to make T3 and T4. T3 and T4 are then released into the blood stream and are transported throughout the body where they control metabolism (conversion of oxygen and calories to energy).

Every cell in the body depends upon thyroid hormones for regulation of their metabolism. The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone "strength" as T4.

The thyroid gland is under the control of the pituitary gland, a small gland the size of a peanut at the base of the brain (shown here in orange). When the level of thyroid hormones (T3 & T4) drops too low, the pituitary gland produces Thyroid Stimulating Hormone (TSH) which stimulates the thyroid gland to produce more hormones. Under the influence of TSH, the thyroid will manufacture and secrete T3 and T4 thereby raising their blood levels.

The pituitary senses this and responds by decreasing its TSH production. One can imagine the thyroid gland as a furnace and the pituitary gland as the thermostat.

Thyroid hormones are like heat. When the heat gets back to the thermostat, it turns the thermostat off. As the room cools (the thyroid hormone levels drop), the thermostat turns back on (TSH increases) and the furnace produces more heat (thyroid hormones).

The pituitary gland itself is regulated by another gland, known as the hypothalamus (shown in the picture above in light blue). The hypothalamus is part of the brain and produces TSH Releasing Hormone (TRH) which tells the pituitary gland to stimulate the thyroid gland (release TSH). One might imagine the hypothalamus as the person who regulates the thermostat since it tells the pituitary gland at what level the thyroid should be set.