Welcome to my blog. When I was first diagnosed with kidney failure and learned I could qualify for a kidney
and pancreas transplant, I scoured the internet for information and didn't come up with much. This is a big step
for me; I'm pretty reserved naturally and most people who know me are not aware of my medical conditions.
So, here's my experience…read, follow, comment, share…support me in turning over this new leaf.

(If this is your first visit and you'd like to read the events in order, click here to start at the beginning.)

Tuesday, February 26, 2013

Surprise Inspiration

Today has been challenging.

Bone pain is difficult to describe. It hurts from deep inside, aches and its unreachable. Massage and heat make it worse, laying still is not an option and moving around isn't helpful.

It's simply present and not going anywhere. The pain medication I'm on makes me a little loopy, light headed and just yucky. My head gets dizzy with standing and I feel the weight of a headache putting my head down.

The agitated, unable to be still or comfortable feeling is the kicker, though. I'm tired but unable to rest. I keep getting up, walking around in hopes of relief...it hasn't come yet. 

I try to cheer myself with a favorite treat, dried mangoes. Trying to apply enough pressure to chew mangoes makes my jaw ache in a way that makes my reward feel more like punishment.

And...my daughter is sick! Vomiting and fever all morning. She looks horrible and has been unable to keep anything down. I do not feel especially maternal caring for her, masked and gloved and completely aware of desperately trying to care for her and keep my distance at the same time.  

~.      ~.      ~.      ~.      ~.      ~.      ~.      ~.      ~.  

She's been over an hour now with water and pepto staying down. Her fever's not gone, but no longer increasing. We're taking a positive turn...

Watching her reminds me she's watching me. 
She's got a 24 hour bug and so do I. 
She's  going to get through and so am I.
This moment will pass, her inspiration will remain. 

Monday, February 25, 2013

This Too Shall Pass

This morning, I went back to clinic. Well, I tried to, but on the way, I popped a tire, found out my spare wasn't functional, got towed, had two tires replaced, got the car aligned and finally left the mechanic's with a much lighter wallet three hours after my scheduled clinic appointment

I knew i had to go in. My white blood count is still dangerously low at 1.6...ugh.  Linda instructed me to ALWAYS wear a mask in public until its back over 2.5.  WBC's fight off infection and without a safe WBC count level, I am at risk for infection all the time and have no ability to fight it off.

I am in need of a neupogen shot to stimulate my bone marrow to produce white blood cells. I received this shot in hospital on my previous stay and the bone pain that ensued was unbelievable.  I was treated with a morphine derivative and Percocet just to get through.

I am not looking forward to the shot, but I understand the necessity of it. When I ultimately get to clinic, my nurse and doctor are relieved I made it. They make some medication adjustments and I receive the neupogen shot. Linda tells me it should take about 8 hours for the pain to kick in. I am to take Vicodin to try to keep it at bay. The pain and need for Vicodin should last between two and five days.  It's difficult to accept, but I realize acceptance is my only option.

I do everything I can to get everything I can done before I need to be safely in bed and medicated. I got the shot at 2:15. The pain didn't take 8 hours, it started up by 6:30. Uh oh, I am now chasing the pain instead of acting first.

So I'm writing this BEFORE the Vicodin kicks in and renders me less-than-mentally capable. I'm feeling the bone pain, getting shaky and agitated, and sweating like I'm in a sauna.


My girlfriend let me know yesterday that her new mantra is "This too shall pass."
I'm borrowing this one from her tonight and hoping its going to be quick.

Saturday, February 23, 2013

10 Things Kidney/Pancreas Transplantees Should Know (But no one tells you)

10 Things Kidney/Pancreas Transplantees Should Know (But no one tells You)

I started this journey alone and without information. I never want anyone to experience this without help and support. To that end, here is my list of things you should know, but probably don't...


1. Do not expect your dialysis staff to educate you about transplant and life beyond.
I was surprised that my dialysis folks shared almost nothing about post-transplant experience. It's not because they are lacking, simply that they are experts in their field and not the correct resource to turn to. I had a wonderful, intelligent, resourceful and genuine dialysis nurse(Thank you, Frida!), but she could literally give me no help in regards to what to expect with transplant and life afterwards. Find a support group online, in person, read a blog, ask questions of people who've done this before.  If you're reading this now, send anyone you know the link to my blog. Contact me directly, I will answer. I don't want anyone going through this with unanswered questions like I did.

2.  Get a care partner NOW.
You need a care partner, spouse, friend, sibling, adult child, SOMEONE to go with you, to be available, to help you interpret, take notes and be your second set of eyes and ears, especially when you are not feeling well and are talking about drug changes and side effects. It is possible without one (I did not have one), but I recommend identifying one now and having a back up.
3. Prepare yourself and your children; this is a ROUGH  ride.
A. Consider sending kids to Grandma's for your surgery and hospitalization. You will be unavailable for at least a week in the hospital. For the first couple weeks when you go home, resting, taking medicine, going to clinic and sleeping will literally fill your whole day.  
B. If this is your plan, practice, practice, practice. Have the kids spend weekends here and there with Grandma. Make it a fun excursion, get them looking forward to it.  
C. Prepare your children's teachers, bus drivers, day care providers, friends' moms, etc. Make sure they've got Grandma's phone number, that they're ready to help your child when you're gone and that they'll go the extra mile when your family needs it most. 
D. Let your kids know you'll need time to get better, just like when they get sick; they have to stay in bed and you take care of them.  Assure them that you'll be in bed getting better and you'll have lots of people to take care of you. Give them a job to help with while you're gone so they can contribute. 
E. Have a plan for communicating with your children while you are in the hospital recovering. Kids will not be allowed to visit, so find a way to Skype or call, exchange cards back and forth each day. This is as good for you as it is for them. 
F. If you've always been a hero to your children, believe it or not, this is the greatest opportunity to continue that example. Heroes persevere in the face of challenges, heroes are vulnerable and strong, heroes are positive role models. You will be all of these things. Your children will see you physically weak and emotionally strong. They will witness the strength of your soul despite a challenging journey. Remember who's watching as you bend but don't break. Your children will see, because of you, that it does not matter how many times they fall, it only matters how many times they get up.   

4.  Prepare your home BEFORE you go.
A. Have lots of pillows at your disposal. In the hospital, you will always be propped up on their "state of the art" beds. Your abdomen will be in shock the first time you lay flat in what you expect to be your comfy bed. 
B. Invest in a heating pad for soreness. They will move around all of your internal organs to make room for the newcomers. These organs are NOT designed to be touched, ever ... so, in addition to your grafts and scar, your back and starter kidneys will be sore.  I rotated 20 minutes on, 20 minutes off for over 2 weeks. 
C. Stock your pantry with soup, bland foods and lots of water. You will need to ease your stomach back in to real food. Take your time. Your digestive system will be out of whack. There will be constipation and diarrhea. Find out from your doctor before leaving how to counter these. (I also had to stock up on salt-laden foods as, post-transplant, my über-high blood pressure dropped and I have difficulty keeping it high enough now.)

5. Stuff to pack in your hospital bag.
First, a disclaimer: This is NOT a complete list, just the stuff nobody told me about ...A. Waterless shampoo, conditioner, wide toothed comb, pony tail holder.... You will be in bed for a week and you will be too tired to brush your hair (I didn't have the strength to lift my arms) and unable to shower. I literally had to cut the knots out of my hair post-discharge. 
B. iPad, phone, charger, etc. ... A week in the hospital is a long time. Be sure you're technologically prepared. 
C. Hard candy and gum.... For the first couple days after surgery, you cannot eat, but you will be incredibly nauseous. Your stomach will lurch uncontrollably, constantly and painfully, you will both vomit and dry heave. Chewing gum or sucking on hard candy can relieve this some. Don't make the mistake I made ... you've probably been diabetic for a long time, get the sugar-free gum and candy to keep your taste buds from going into shock. You'll have plenty of time in the future to experiment with sugar.

6. Memorialize your journey, even if it's just for you. 
Take pictures, from Day 1, even before transplant. As hard as this is to believe, you will WANT to remember and see your improvement. Take pics of your face, take pics of your scar. You will look scary for the first couple days, sporting an NG tube and really drugged up. Your whole body will swell. You will likely leave the hospital weighing more than you started. (It's added weight from everything you've been flooded with, and it's necessary. It will come off as your body normalizes.)You will be impressed at your body. Your scar, which will start as scary and horrid, will become a part of you, something you'll take pride in, a badge of honor evidencing your struggle and triumph. You will eventually see the inherent beauty in the gift of your scar.

7. Doctors and Surgeons and Communication in the Hospital
A. Sense of urgency.... First, when you get The Call, you will be told to come IMMEDIATELY. This is serious and you should, but please be ready for the hospital, the nurses, the surgeons, the residents and everyone else you run into to take their time. Waiting in a hospital bed for transplant surgery is painstakingly slow. I arrived at 5 a.m. ... my surgery was ultimately not started until 1 p.m.   
B. Doctor Time vs Real-people Time.... I recommend doubling, maybe tripling, a doctor's estimate of time. My surgeon once told me I'd be admitted immediately and three hours later it came to fruition. He also told me a transfusion takes a couple hours. I have yet to complete one, start to finish, in less than 6 hours, not including time for admission and discharge. They mean well, but real-people time and doctor time are not equivalent. 
C. Residents vs. surgeons.... This is very frustrating. Agreeable residents and well-meaning med students are much more readily available than your surgeon. You will only see your surgeon once a day, at morning rounds, and it is difficult to get all your questions ready and answered in this short period. Write your questions down, take notes when your surgeon is there. Residents may answer your questions when the surgeon is not around, but in my experience, their answers not only don't match, but are often directly contradictory to, the surgeon's ... and the surgeon makes ALL the decisions.

8. Learn the ropes on the logistics of getting your medications
Doctors write prescriptions and they are done. Getting Medicare to cover them can be challenging. Certain post-transplant medications (ie Prograf, cellcept, prednisone and mepron) are only covered under part B, not part D.  These drugs will require copays and additional doctor approvals that you cannot take care of ...you need help from your nurse. This back-and-forth can take a while.  Be prepared, ask your nurse what the workaround is while you wait for approvals, or be ready to pay out of pocket up front. Just remember, Medicare/Medicaid will probably never reimburse you for anything you pay for up front.  Also, it always seemed like I was being discharged on a Sunday evening, when pharmacies are closed or can't fill your scrip until the next day. Do NOT leave the hospital on a Sunday without the meds in hand that you need to take that evening and Monday morning (or have a workaround approved by your doctor in place).

9.. Some type of Rejection is practically guaranteed ...Ugh.
You will probably have multiple bouts of rejection and it will probably be ok. Thus far (I am 4 months out, I have had 3). I understood I would be treated if rejection became an issue. No one told me treatment for rejection required week-long hospital stays, steroid treatments with stressful side effects and a guess-and-check/wait-and-see methodology that is painstaking and unnerving. You will get through, but fending off your immune system is a necessary, very time-consuming task.
10. Transplantation is a lifelong commitment (This is not news, but bears repeating …)
A. Be your own best advocate. Learn to read your lab results. Drill your nurse and doctors for info. You are your best, and, sometimes only, advocate. They see oodles of patients and all the paperwork looks the same. If you don't get it, ask. And research. And email. And document. And be sure they know you want to be in the know.
B. Immunosuppression is forever. You will be immunosuppressed to save your grafts for the rest of your life. You will require frequent blood draws and constant medication adjusting and lots of side effects in this journey. You will never be able to sit back and ignore the drugs in your system. It is frustrating and scary, but worth it. Be patient, be flexible and give yourself time because, now, you are blessed to have so much more of it than you probably ever planned. 

Saturday, February 16, 2013

Pros, Cons & Opportunities for Strength

Dr Wali came to see me this morning with reasonably good news:
Before steroid

  • I will not need a biopsy
  • Graft rejection has been confirmed by improved kidney function and improved Prograf level after one treatment of rejection-attacking Solu-Medrol/steroid
  • I will need a total of 3 Solu-Medrol/steroid treatments(final one tomorrow) to treat existing rejection
  • Cell cept(drug causing decrease in WBC via bone marrow suppression) is still necessary, but will be dosed at half of my current dosage
  • Bactrim(antibiotic that can also decrease WBC) has been replaced by another antibiotic
  • Finally: plan is to go home on Sunday after 3rd treatment!

After steroid
I will need to be continuously monitored for bone marrow suppression. The replacement antibiotic is liquid only and tastes like the nasty orange medicine my mom used to give me as a kid. My prednisone steroid treatment will be increased again and this means moon face swelling and weight gain.

I am concerned that monitoring of my lab results was getting spaced out further than I am comfortable with. I will discuss my transplant team keeping closer tabs on my lab work. I understand there are plenty of red flags to look for on my lab work and I can be especially demanding if the situation calls for it.

All in all, a good outcome. :)
Pros definitely outweigh the cons, and everything is completely doable. I'm up for the future.

Another opportunity to be, as my blog title implies, Strong Like Water.

Friday, February 15, 2013

Careful, She's Headstrong

Yesterday, the nurse brings me a neupogen injection. I have never heard of this before, and she assures me it is the same as epogen, an injection I've had plenty of times to increase production of red blood cells.

A few hours post neupogen, I have intense bone pain thought my upper body, itching, stomach pain and headache. I am unable to sleep or even lay still. At 3 am, I let the nurse know about the pain and that I believe the neupogen is potentially the cause.  The doctor prescribes me dilaudid, a morphine derivative that renders me useless and allows my body to sink into the hospital bed. I gratefully sleep for almost three hours.

When I wake up, I look up neupogen.  And now, I get it. Neupogen is a catalyst to increase white blood cell production by stimulating bone marrow(which produces WBC). A side effect of this drug can be bone pain. I'm frustrated that I was given(and accepted)medication I didn't understand. The resident assures me I won't get it again.

Dr Wali comes by for morning rounds and fills me in some. The whole time I feel like he's talking to the residents and I am just listening to plans for MY treatment.  He's ready to leave. "Wait," I interrupt.  "I need to be sure I understand."

I rehash what I think I heard. 

  • WBC and RBC are not responding as he has hoped. They are both still unhealthily low. WBC, for me, needs to be greater than 2.5...currently 1.8.  Without adequate WBC, I will be unable to fight infections. 
  • My immunosuppressant Prograf level is still 5.3, and has remained in the 5's for past 2 months despite drastically increasing Prograf medication.  
  • My GFR(percentage of kidney functioning/eliminating toxins) has decreased from 84% in Jan to 41% currently.  
  • My creatinine level, in the same time span, has increased from 0.8 to 1.4(trending in WRONG direction).  
  • Despite regular blood thinning treatment, my INR(measures "thinness" of blood) is not increasing and remains below therapeutic level.
Dr Wali believes this combination is worrisome and he suspects graft rejection. He prescribes a biopsy later today to confirm. "See?" Dr Wali grins. "You've got it! You are a good doctor." 

I smile/grimace, equally grateful to amuse him and still concerned at the position in which I now find myself. The doctors leave, and I try to get my head wrapped around the new information. It's not the best news I've received, yet it sounds like he's being proactive.

More unknown medicines come my way. I have to take extra prednisone via IV. The nurse can't exactly tell me why but I do know it enhances immunosuppressant levels and I acquiesce.

Later, she brings a coagulant(all this time I've been taking anti-coagulants to thin my blood). I am confused. A resident explains to me it's preparation for my biopsy to help decrease post-biopsy bleeding...fine... Lab results later show my blood doesn't respond quickly enough(ie still thinner that she'd like) and my biopsy is postponed to the next day.


The nurse returns with a second dose of neupogen. I will not give in on this one, letting her now I refuse to take it and why. She shakes her head and let's me know she will be forced to report this to my doctor. I agree, this is a good idea.

Right before bedtime, the nurse brings in a Solu-Medrol drip. I know I did NOT discuss this at rounds this morning. For me, Solu-Medrol has been prescribed to treat EXISTING rejection. The nurse is not any help in understanding. She reads the doctor's notes and decides its being administered to RAISE my creatinine level(read as being administered to DECREASE my kidney functioning). Even she admits it doesn't make sense. The covering resident, unfamiliar with my case, suggests to the nurse that I take it now and ask my doctor in the morning.

Hmmm. I am torn. Maybe it's a good idea to jump start rejection treatment. I've had Solu-Medrol before and didn't experience negative side effects. It's one dose. I'm in the hospital and want to be better as soon as possible...and yet, I want to understand why I'm being administered medications beforehand. Ugh.

"So, will you take it?" the nurse, with waning patience, wants an answer. Finally, I allow the drip, although not 100% sure. I will get more details from my doctor in the am. 

I am displeased with the lack of reliable communication. I am not a patient who is able to simply trust that the right decisions are being made for me without adequate information. With adequate information, like pros/cons and previous success rates, I can make informed decisions and be proactive in my own health care. Uninformed, I feel defensive, protective and uncooperative.


At change of nurse's shift later this morning, I am laying down, resting but not fully asleep. The departing nurse shares what she knows with the nurse starting her shift. As they walk away, the departing nurse's voice drops to a whisper.

"Be careful, she's headstrong."
It's a fair assessment. :)


Thursday, February 14, 2013

Paradigm Shift

Happy Valentine's Day! :)

Today, I find myself in the company of folks who want me to feel better...at the hospital.

For the past couple weeks, I have not been improving. My hemoglobin level dropped to 6.8 last week, my white blood cell count was down to 1.6 and my need for immunosuppressants was on the rise.

And I could feel the effects of my blood counts dropping. I was having trouble getting through the day. I tired walking from one room to the next and got dizzy and lightheaded every time I stood up.

Last Friday, I had to take my son first to Urgent Care then the ER because of flu complications. I needed help getting him to the car because I couldn't lift him. Once there, everyone who looked at me thought were there because I was sick, not my son.

My eating and all activity slowed to as little as possible. I forced myself to go to the lab on Tuesday to get checked. By Wednesday, my nurse called me with results. She told me, based on my results, I should feel terrible and she does not know why my counts were so drastically low. I needed to check in to the hospital ASAP.

Disappointed, but aware of the necessity, I obliged. My mind was struggling to figure why I would feel this way and what potential solutions could exist. I didn't have the flu or mono or any infection and yet I felt so worn down. I got winded walking down the stairs. Keeping my head up was difficult and my legs ached just walking. I had to sit down to brush my teeth. My feet and hands were going numb all the time. I got the shakes every time I exerted myself by raising a fork or a glass to my lips. I didn't have any answers; unsettling would have been an understatement.

After struggling to get my kids' care covered (including at alarming call that now my daughter has the flu), I drove to the hospital in snow and traffic. It took more than 2 hours.

The walk to registration was excruciating; I kept having to sit down and rest, lower my head to decrease the dizziness. I was so grateful to sink into the wheelchair they had waiting for me. It wasn't comfortable, but I could rest.

Once in my bed, what's become typical hospital speed took over. I laid down at 7pm, pale, weak and dizzy. A nurse checked my name, got my history and entered me in the computer around 8pm. By 9pm, i had an IV port, but nothing flowing through it. Exhausted, I dozed off until 10:30, when I realized I had been in the hospital for 3 1/2 hours and virtually no action had been taken.

The nurse told me they didn't know which doctor to get orders from, by the time they reached the right doctor, he said they wouldn't start a transfusion until the morning. Frustrated and spent, I passed out asleep by 11:30.

This morning, things still are not fast, but I get blood drawn and my doctor tells me we are set to do a transfusion. My blood counts are dangerously low. He explains to me he believes my body is reacting negatively to my transplant medications, most specifically, an immunosuppressant I'm on(cellcept) is causing my bone marrow to not produce adequate cells. He is planning to design a new cocktail of medications to try out.

So, I'm transfusing...color is beginning to return to my face, my appetite is once again present and I can think more clearly. Standing and walking are still challenging, but I'm pretty sure the dizziness and lightheadedness will subside as my counts and blood pressure increase.

It's Valentine's Day, My frustration is gone. My exhaustion is fading. I am relieved to be alive and grateful there's a viable solution for the way I feel. I'm smiling.

My roommate flips on her tv and it's ridiculously loud. The sound of Annie belting out "The sun'll come out tomorrow!" fills our room.

"Sorry," she apologizes as she fumbles to turn it down.

"Don't worry." My smile spreads to laughter. "I love that song."




Saturday, February 2, 2013

Bring on the feeling better!


Honestly, I haven't been feeling especially well for the past week or so. I haven't wanted to admit it...feeling ashamed of having such good numbers and so much success and yet, not feeling well. People who know me are excited and congratulatory for my success, but I've been hesitant to pat myself on the back and declare victory. I want to FEEL better.

Over a week ago, my Prograf(measure immunosuppressant levels in your blood) dropped considerably and unexpectedly out of healthy range.  My nurse increased my dosage by almost double and told me to expect some side effects, like feeling worn out.

She was right. I've spent this week nodding off in the middle of the day, physically drained and overwhelmed by the daunting physical task of living life. My feet and hands have been falling asleep without real provocation and my hands are constantly shaking; this is disturbing.

I've gone twice for blood tests to check status.  First test showed low hemoglobin level and I had a shot of Epogen to boost my red blood cell count, but this takes a while to take effect.

By Friday, I had to go in for another check. Results came in, my hemoglobin is now 7.3 and a blood transfusion is necessary. Begrudgingly, I checked in to the hospital and I am now in the end stages of my five hour transfusion. Ugh.

I am simultaneously grateful for the treatment, disappointed in its necessity and frustrated at my continued dependency on treatment.

Actually, I'm mostly frustrated. I want to feel better. I want to bounce back. I want to trust my body.  I want to live without fear.

And right now, I really want to go home. Every trip to the hospital comes with a very concrete fear of being required to stay.

The tech comes in to check my vitals and the nurse gives me the go-ahead to be discharged. I can't wait to be disconnected and out the door.

Yay! Bring on the feeling better!