We interrupt today’s wailing and gnashing of teeth to bring you some good news. Naturally there is a lead in.
I was sitting around on Saturday thinking of all the places I’d most not want to be. This is unusual because for the most part I think of the places I’d most want to be. Usually it involves water, sand, palm trees, a boat, and female companionship. Specific female companionship if you must be that nosey (or nebby as we would say here). But last Saturday the thought was of the least desirable place, even with the right companionship. Not surprisingly, the place I’d least like to have been on Saturday would be a dialysis clinic.
Let’s think about that for a minute, then we will move on to the news. My county as many other cities, counties, states, and countries, now has a shelter in place order. The rule is pretty simple, don’t go out unless staying in endangers your life. And don’t go anywhere if you are experiencing symptoms. For the everyday ordinary dialysis patient (or more appropriately the every other day ordinary dialysis patient) it’s a no brainer that staying in is more hazardous than going to the clinic. And the everyday ordinary dialysis clinic staffer needs no fewer brain cells to also conclude that staying home endangers lives. But it’s the second part that is difficult to reconcile. No matter how you might be feeling, that trip is one of life sustainability. You can’t get somebody to pick it up for you while they are at the store.
I was in a good place to think the last place I’d want to be is at a dialysis clinic, the extreme dedication of the staff and their love of their mission to serve a population defining the area between a rock and a hard place notwithstanding. I was in a good place because I was in my own livingroom recliner rather than the one I spent so many Saturdays in at the clinic.
Yes, no dialysis. Okay, if you’ve been following along with me over the years you have a right to be confused. The last thing I wrote about my kidney health was that the transplant last summer did not take and I was back on dialysis. By the way, after still more scans and tests they are no closer at determining why the transplanted kidney clotted so rapidly and completely. But what they had noticed last fall was that my renal function lab tests were stabilizing. Then new questions arose. Everybody’s tests go up and down as function fluctuates, particularly in a patient like me whose renal dysfunction is induced by factors elsewhere in the body. But these were not fluctuating. They were improving. Steadily.
Adjustments in treatment were made, ultimately pared down to only 2 three hour treatments per week, fully half of what a weekly treatment total had been not too long ago. Weeks went by and weekly labs continued to return surprisingly encouraging results. On January 23 I left the nephrologist’s office a free man, well perhaps more a dialysis parolee ordered weekly outpatient lab test and every other week appointments with a call-in on the off weeks. Last week after nearly two month of that routine I was given a appointment three months in the future. I had stabilized! At least for the near future. At that point I thought comfortable enough to tell somebody other than my daughter and sisters and you guys get elected.
There is no good reason that kidney function should improve. It’s not unheard of but it is rarer than correctly picking all five numbers plus the white ball. I’m crediting my reprieve to Someone Up There showing a particular kindness to me and expending a miracle on that.
I feel particularly grateful, the break coming at a time when going to dialysis could be just as life threatening as life preserving, and pray that the patients and staff at clinics around the world will be safe and free of all complications, even those not COVID-19 related.
And I know now I have to figure out why me and what I am to do with this unexpected opportunity. Sitting around thinking of the places I’d rather not be is not it. I’ll keep you posted.
Now go wash your hands!
Don’t worry, be happy!
While the donor’s surgeons are finishing their procedure the recipient’s receiving location is prepared by a second surgical team. The recipient surgery is performed through an open incision and two attending transplant surgeons, in my case one of them also a urological surgeon, will operate. Unless there is a medically necessary reason, the recipient’s native kidneys are not removed. The donated kidney will be placed in an abdominal lower quadrant, usually the right although in my case because of previous surgeries and that space already occupied, it will be placed in the left lower quadrant. The renal vessels and ureter from the native kidneys are transpositioned and the recipient is closed up and sent off to recover.
So now that it took you so long to read about the process you may better understand why it is taking so long to complete the process. Each of my donor candidates was stopped at some point in the evaluation. One proceeded all the way to the CT Scan when a shadow was noted on a neighboring organ. The transplant committee interrupted the process and referred her to a specialist who in turn determined the shadow was not clinically significant and recommended her to continue which the transplant committed approved. One was held at the renal function test when the IV mediated glomerular filtration rate returned a slightly elevated result. The committee referred the result to one of its own nephrologists who recalculated the result and determined due to her physical structure it was within normal limits for her height, weight, and age and recommended to continue. One potential donor returned elevated 24 hour blood pressure results. She was allowed to move on to the renal function tests but had to reschedule a repeat 24 hour blood pressure monitor. The second 24 hour blood pressure results also returned elevated and she was referred to her cardiologist. Pending his review and finding, even though by this time she had passed the renal function tests, she was held from further candidate progress. Ultimately her blood pressure could be maintained within the standards expected for a kidney donor only with the use of two medications thus she was removed from the candidate pool.
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