Chapter 14: You Must Be This Vaccinated…..

Filed under: @ 8:38 am

I don’t know why it never occurred to me that people with transplanted organs need to be immunosuppressed life long. Somehow, despite my scientific training, I had it in mind that after the transplanted organ had been in-situ in the recipient for enough time, the recipient’s system would replace the cells that wear out in the transplanted organ making the transplant “self” after a certain amount of time.
But that’s not an accurate vision.
If worn out or dead organ cells could be replaced by a person’s own new tissue there wouldn’t be the need for transplants that there is.

So for the rest of Andrew’s life he’ll have a piece of Curt inside him and his immune system will be trying to remove it.

It’s made me more than a little anxious being that I work with the general public.

I don’t like getting vaccinated. My mother tells me that when I got my first measles vaccine at the age of 2 or so I spiked an enormous fever and was miserable for 2 or 3 days. It was that reaction, and the fact that the Bellevue school district sent out a notice prior to the beginning of the school year in 1982 or so indicating that kids vaccinated for measles prior to 1971 would need a booster, that made Mother grab me by the scruff of the neck and haul me off to the doctor to get a booster that summer. I resented the fuck out of it at the time, even though I didn’t spike an enormous fever, and I resented it with a great deal more vigor when the same notice came out the next summer. Protest as I might that I’d gotten a measles booster the previous summer, Mother didn’t remember and somehow (thus adding to the persistent resentment nearly 40 years later) the previous year’s booster hadn’t been noted in my medical record. So I got a measles booster for the second summer in a row.
Beyond that persistent resentment, I’m allergic to horses. Granted that allergy only pertains to tetanus vaccines (the genesis of tetanus vaccines is horse serum), but that little fact makes tetanus vaccines a trial for me. My arm swells up and aches for 3 or 4 days and I run a low grade fever which leaves me achy, listless, and snappish.
Besides, says my previous self, I’ve HAD all the childhood diseases. That’s not entirely true. I had scarlet fever, then mumps and chicken pox in quick succession. And I’m not afraid of the flu.

Except now I am.
I got my first flu shot a little over a year ago. I was cranky about it but resigned. When my MD checked my vaccine titers this spring and found me wanting (HOW?!) in antibody levels to measles, I was a little more cranky. Especially when I realized a month later that the sore knot in my left tricep was residual inflammation from the measles vaccine.
I got my second ever flu shot about a month ago. Followed, probably too quickly, by my first ever shingles vaccine about two weeks ago. I am made persistently resentful by the fact that my left tricep and deltoid will probably continue to be achy just in time for me to get the booster for the shingles vaccine.

I am emphatically pro-vaccine. Vaccines have been safe and effective at preventing disease since the 1600s. I am also maniacally frustrated by those anti-scientific twee folk who claim that vaccines are the root of all evil when really the root of all evil is a slavish repetition of ‘facts’ that aren’t substantiated by anything or anyone with any reason.

But it doesn’t mean that I like getting them!

That said, vaccines and people’s vaccine status, have become high priority in my life. Andrew’s company employs anti-vaxxers. And because vaccines are part of a person’s medical information, an employer can’t really ask whether or not their employees, or their employees’ children, have been vaccinated.
So Andrew is restricted in which of his company’s employees he can interact with personally. This is fine, actually, since the folks that he needs to interact with the most are mostly the ones he’s known the longest and who are friendly enough with him to reveal their vaccination status. It’s fortunate, too, that Andrew’s job has mutated over the years to the point where he does’t actually need to be physically present at the company offices terribly regularly. Also, technology. A lot of the in-person stuff can be done via Skype or some other computer/video assisted tech.

Me, however… Oy. I’m familiar enough with my staff, and we’re a small enough organization, that I know my co-workers have been vaccinated. Staff is safe. Clients are another matter. That said, since we see a lot of animals to administer vaccines I suspect it’s probably rather rare to for their owners to be anti-vaxxers.
I don’t ask, of course. But I do wash my hands and use hand sanitizer before I leave work.

It makes interacting with the outside world a little anxious. When Meg was here in October we took her to Vashon island to see the Betty MacDonald farm (from which we were promptly slung out, but that’s another story) and since the Vashon school district has one of the lowest vaccination rates in the state I was more than a little concerned just about being there.
Similarly Lopez island. Andrew and I spent some time in the San Juans as part of our honeymoon and we’ve wanted to go back, but since Lopez has the lowest vaccination rate in the state I don’t think we’re going to be repeating that trip.

Immunosuppression isn’t going to keep us from traveling, but it’s definitely going to influence our choices of destination.


Chapter 13: Now What?

Filed under: @ 9:03 am

I never meant for this to be a blow-by-blow detailing of the whole surgical/hospitalization experience so I’ll only fling in a few details of the 3 days that Andrew was hospitalized.

First being the utter and complete blank confusion on the faces of the nurses in Andrew’s room when Curt, attended by Laura and one of his nurses, went wandering past the door to Andrew’s room proving that he could be mobile without falling on his face.
Being Curt, of course, he started belting out the Spam song.
Which is why Andrew’s nurses were a little, shall we say, disconcerted. I’m fairly certain that Curt’s nurse was convinced that he’d thrown a clot somewhere and was in imminent danger of falling on his face.
We got much the same reaction when Laura, coming to stick her head in and find out how Andrew was doing, stood outside Andrew’s door (door open, can’t knock) and called out “BURGLARS!”. *We* knew she was asking to come in, the nurse was utterly foozled.
It’s a sad thing when the younger generation has to be introduced to Monty Python.

While Andrew was hospitalized I learned that it is actually possible for one to run out of levels of Candy Crush. This isn’t to be an exegesis on Candy Crush or other freemium games, nor yet what I choose to spend my pin money on. I play Candy Crush because I find the puzzle solving challenge of the game to be calming, hypnotic, and highly addictive.
Anyway, running out of levels, right.
Literally. I’ve cleared more than 5000 levels of Candy Crush and was on a heck of a roll while Andrew was hospitalized. So much so that I got to a point where there were no more levels. Instead I got a message stating that new levels were coming soon. So I switched to Crunch Time.

The day after surgery I had to pull a Mamma Bear on Andrew’s co-workers.
(Steve, if you ever read this I’m sorry I was so crabby with you. I wasn’t crabby about anything you were doing, but crabbiness needed to happen.)
Andrew’s hospital packing included one pair of fleece jammies, two tank tops, the shorts, button up flannel shirt, and fleece socks he was wearing when he was admitted, a toothbrush, and his diabetic supplies. As well as two tablets, a mobile phone, appropriate charging stations for all of them, a multi-outlet strip, and half a dozen random cables that I never will know the use of.
Because Andrew had been in charge of the FP fall catalogue up until the day he was admitted to the hospital, he was part of e-mail and text chains about the catalogue and various other work related things.
I could literally see his blood pressure getting higher (multi-parameter vitals monitors can be handy sometimes) when he read some of them and then he felt like he had to respond. Which is maybe not the best thing to do when you’re pinned to two or three different machines and up to your follicles in dilaudid.
I knew that I had absolutely zero chance of removing his electronics from his ken so the only thing I could do was to have the office manager stop the flow of work related information on his end.

So I did.


But they discharged Andrew eventually and we got to go home for dinner and a night’s sleep in a proper bed without either being checked on by a nurse no less often than every four hours AND without Andrew having to hook himself to an annoying laser printer.
Pogo was beside himself to have us home.

The pre-transplant folks are superb at training transplant recipients for the pre-surgical stuff.

The transplant folks and the hospital transplant staff are superb at training transplant recipients for the hospitalization and surgery part of it.

The post-transplant folks take the bloody cake!
We had one day at home before we had to start going to Andrew’s post surgical appointments. Two lab draws and two doctor’s appointments (on different days than the lab tests) per week.
Have I mentioned recently how glad I am that we’re fortunate enough to live within driving distance of a major transplant center? We met a dude during that first four weeks that had had surgery only two days after Andrew did. Dirk and his wife live in Tacoma so they were staying in a long term stay hotel in Seattle instead of driving back and forth. I can’t even BEGIN to think about how much more complicated their experience had to have been!
Anyway, the post-transplant folks.
We walked into the transplant center for that first appointment and while none of the staff knew us on sight (yet)… Damn they were organized. The right people came to see us to give us the information that we needed. They had all the right paperwork in the right place — although granted some of that was my doing (more on that later) — and before we left we were scheduled for something like another two weeks worth of visits. We got to see the transplant nephrologist who was cool about showing me the lab results and discussing them on a professional level with me (that earns you a star in any veterinarian’s book, by the way).
One of the things that Andrew was handed before he left the hospital was a Big Bag Of Post Transplant Information. Two bags, actually. One containing a binder full of information and monitoring parameters, along with a pile of things like sunscreen, hand sanitizer, a blood pressure machine, a thermometer, and other medical stuffs of which we now have multiples. The second bag contained medications. LOTS of medications.
Because I am who I am and I deal with stress and tension by wanting to have all the facts in order and all the details of everything laid out in plain view I’d taken the binder, removed all the extraneous stuff we didn’t need (information about pancreatic transplants for instance), added tabbed dividers to each section, and put in some additional Andrew specific stuff that I thought might be helpful.
Every single person who saw what I’d done with the binder thought it was a. brilliant and b. (although they didn’t say this to my face) absolutely hysterical.

We got to be very familiar, not surprisingly, with the folks at the transplant center including some of the patients who had had surgery around the same period of time.
The second day we were there Dr. Transplant Nephrologist’s medical assistant commented on how much better Andrew’s color was that day as compered to the previous visit. I’d noticed the same thing — he’d gone from a skimmed milk sort of color to being pink again — but Andrew, not surprisingly, hadn’t. It wasn’t until we ran across Dirk from Tacoma while we were waiting in line for Andrew (and Dirk) to have their lab tests drawn that Andrew realized that difference. We first met Dirk and his wife on their first visit to the transplant center. At which time Dirk, who’d had a kidney and pancreas transplant and had spent several days in the ICU with a bout of pancreatitis, had a greyish skimmed milk sort of color to him. When we ran across them again waiting for the lab technicians Andrew actually didn’t recognize Dirk he was so changed. Once again, there was the difference between skimmed milk and someone who actually feels good.
I don’t think I ever realized that dialysis doesn’t normalize one’s kidney function. When Andrew’s kidney values dropped from about 3 times normal to about 1 and 1/2 times normal in the first 24 hours after the transplant it was obvious to me how much better he was feeling.
Dirk had been a Type 1 diabetic since the age of 7 and had been waiting for a kidney/pancreas transplant for something like 4 years. The visible-to-a-virtual-stranger difference in his quality of life within such an astonishingly short period of time is yet another reason for me to be in awe of the fact that this crazy ass organ transplant thing actually works.

And that the person whom I love most in the world was able to take advantage of that.

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