Filed under: @ 8:06 am

We finally got a call from the transplant center yesterday evening about the afternoon’s labs.

Andrew’s blood tacrolimus levels (tacrolimus is the primary immunosuppressant drug) are within therapeutic levels so he can stop taking prednisone.
Prednisone is another immunosuppressant drug and since large doses of prednisone can also really mess with a diabetic’s blood glucose levels the fact that Andrew can stop taking it so soon after the transplant is freakin’ fantastic!

He seems to be tolerating the other medications fairly well so far.

I was awakened at a completely stupid hour this morning because the neighbor’s damn dogs were barking and continued to bark fairly consistently until about half an hour ago. A.K.A. early for a Saturday but not an entirely unreasonable hour. This upcoming week I plan on going down to city hall and speaking with someone in charge about those dogs. The neighbors have one tied to a tree in their back yard, the other one wanders free in the yard, and put out food in large volumes for them 2 or 3 times per week. Which means that my vegetable garden is absolutely ALIVE with rats who feast on dog food, dig up my potatoes, and gnaw on my bean plants, pumpkins, and corn stalks. And it means that the raccoons, opossums, and probably skunks that tiptoe in after dark to partake in their share of the feast wake the dogs who then bark at the intruders for hours at a time.

The dogs didn’t wake Andrew, for a wonder, but he didn’t sleep particularly well. The primary incision is oozing serum fairly constantly. The subcutaneous pressure of this ooze is uncomfortable enough to keep him awake, but not, apparently, uncomfortable enough for him to want to take a pain pill.
We’re both a little on the grouchy side this morning.


Filed under: @ 7:08 am

Andrew was diagnosed diabetic in November of 1995 which was the winter before we were married.

Andrew had proposed to me, using a ring that had belonged to his grandfather, the February previously when we were in Hawaii for a visit.
On telling my parents that we were, at long last, getting married my mother asked if I wanted to wear her wedding dress. Sure! Why not! And since I was the youngest unmarried grand-daughter at the time of her death I had inherited the elbow length kid leather white gloves that Gram Do, my Aunt Do, and my mother had all worn when they were married. I figured adding Mom’s wedding dress to the mix would be appropriate.
Mom got the dress out of storage and because she is garrulous and ran a book store at the time, she knew a local woman who did wedding tailoring.
The first dress fitting was not what one would call ideal. Because I rarely wore dresses and had never had anything professionally fitted it didn’t really occur to me that I’d be asked to strip to my skivvies. So in addition to showing up at this Very Proper Bellevue Matron’s home wearing cutoff shorts and Birkenstock sandals I was wearing the bottom-of-the-drawer “I’ve really got to do some laundry” raggedy purple underwear. So I was moderately shocking to this Very Proper Matron, a condition that was exacerbated by the fact that I told her we (gasp) had no plans of having wedding attendants as part of the ceremony and (swoon) I WASN’T GOING TO WEAR A GARTER.
Also I was, still am in fact, a little sloppy around the middle and the dress couldn’t be zipped.
The tailor hummed and hawed and measured and wrote things down in her little book and as we were taking our leave she patted my shoulder and said to me “Honey, do yourself a favor. Between now and January lose 25 pounds.” I could feel my mother growing big ugly porcupine spines at that. Weight shaming is NOT something that you do to one of her daughters. As we walked away, and as soon as we were out of earshot, I made sure to tell her that it made no difference what the tailor had said. The tailor could make the dress fit regardless and if I decided I wanted to lose a few pounds I would and if I didn’t I wouldn’t.
That was in July.
Well, in between July and January, of course, came Andrew’s diabetes diagnosis and since the easiest way to manage type 2 diabetes is through weight loss we both went on a significantly calorie restricted diet. I don’t remember how much Andrew lost, but I lost 18 pounds and when I went for the next dress fitting in January the tailor was properly confused because the wedding dress fit a lot better than it had previously and all her measurements were wrong.

I didn’t bother to tell her why, but then I’m mean like that sometimes.

Unregulated diabetes of any type is one of the surest ways possible to create renal dysfunction there is. The kidneys are a series of microscopic filtering tubes and since molecules as big as glucose aren’t supposed to push through those filters chronically elevated blood glucose basically wears the filters out or gums them up. If you add to that chronic hypertension, which results in decreased blood flow to the kidneys, and the predisposition of anyone with a lot of glucose in their urine being much more susceptible to urinary tract infection, diabetes delivers a triple slam to kidney tissue.

Another reason, should anyone need it, to try like crazy to avoid developing unregulated diabetes.



Filed under: @ 5:01 pm

Apologies to those who have been checking for daily updates. When I mentioned via e-mail that I’d post something new here every day I had ZERO idea how much time and energy the first week of this would take.

Long story short, Andrew’s surgery went gangbusters on Monday, they discharged him Wednesday evening, and we’ve been adjusting to yet another new reality since.

Today was the first recheck appointment. There will be approximately four trips to the transplant center every week for the next several weeks.

We’re still waiting on the lab results from today’s visit, but they should be calling us this afternoon. The last lab report I saw, which was Wednesday morning, showed that Andrew’s BUN (blood urea nitrogen) and creatinine had been cut in half as compared to the most recent pre-surgical values. BUN and creatinine are metabolic waste products that are usually excreted by kidneys. They’re two of the main parameters we use to evaluate renal health so a drop of 50% over presurgical levels is kaleidoscopic. Still high, but WAY better! I didn’t know, since most of my patients are never on dialysis let alone for any length of time, that dialysis doesn’t necessarily normalize BUN and creatinine. No wonder renal patients feel lousy!
We’re also evaluating immune status and blood levels of the immunosuppressant drugs. Wednesday’s CBC (complete blood cell count) showed white blood cells still inside the normal range of values which is expected at that point. We will be looking for significantly sub-normal white blood cell levels however so I’ll be interested to see what today’s values show.

The transplant nephrologist that we saw this morning, an east Indian dude who reminds me a lot of my freshman endocrinology professor from WSU, was very pleased with Andrew’s progress so far. Apparently everything he saw on exam and everything we reported to him was normal.
And I’ve now had three people wax poetic about the organization job I did on Andrew’s post-transplant information binder. Apparently controlling what I can of my environment to help deal with stress and uncertainty is an admirable trait when dealing with circumstances so detail ridden as post-organ transplant can be. The house may be a mess, but god DAMN that binder is tidy!

Curt keeps saying that we shouldn’t feel indebted to him in any way for this incredible gift. That he did what he did, literally gave a part of himself so that Andrew could live, out of completely selfish motives because he needs us in his life.
So I say this, and will continue to say so for the rest of my life, that I don’t owe Curt any material thanks, but my gratitude is endless.


Test Test Test

Filed under: @ 7:12 am

Let’s see if I can manage to get this baby working without significant chaos.

Obviously I’ve just logged back on to WordPress for the first time in a long time and I pushed a whole bunch of “update” buttons that were asking to be pushed.

Ideally I’ve not made a hash of things by requesting updates for things about which I have absolutely zero idea. I don’t know what a PHP is, or plugins (although I could guess at that one), or themes. But they’re all updated at this point.

If this works, well great. If it doesn’t then Andrew will have some untangling to do when he gets home which will be made somewhat more complex by the fact that I have ZERO idea what I did to which portions of our interaction with WordPress.

I’ll get more detailed about the last couple of days later — maybe tomorrow.
Right now this morning’s home update is that Pogo is starving and if I don’t go feed him breakfast right now there will be drama and pathos.
This morning’s Andrew update is that he’s probably still asleep, but they’re talking about discharging him from the hospital today so if I want to go hear what his surgeon, transplant nephrologist, and pharmacologist have to say I’d better get a wiggle on.

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