Home > Health, October 2009 > Kidney Transplant Month 17

Kidney Transplant Month 17

I had my quarterly appointments with the Transplant Surgeon and Transplant Nephrologist this past week.

The Surgeon was pleased overall.  My creatinine is rock stable at 1.1, my hemoglobin, although still low (I don’t think it will ever be normal), is up from 12.7 to 13.5, and my Prograf level is at 9.5 (still on the high side, but lower than last month’s 9.9).

He also noticed my dialysis fistula, as it’s quite huge.  The other Transplant Surgeon is the one who “specializes” in these, and told me that as long as it isn’t bothering me, he wouldn’t do anything with it, as I asked to keep it for as long as I could.  Not because I plan on going back on dialysis, but because I use it to draw my own blood each month, as the veins in the other arm are crappy. When I do get it “tied off” (it is created by joining an artery and a vein side by side; the arterial pressure enlargens the vein, allowing a large needle to be used for dialysis), I will need to have the vein removed.

The only downside in my labs is the level of BK virus in my blood.  It rose from the 900 level to 1200 this month.  Still not bad, and like anything, there could be fluctuations from time to time.  In conjunction with that, my ICF (Immune Cell Function) is up to expected range of 250.  3 months ago it was 112, which is low, and indicates over-suppression (which allows opportunistic infections such as BK virus to potentially worsen).  Labs again next month; we’ll see than.

The appointment with the Transplant Nephrologist was just a “hi, how are you doing, everything looks good,  see you in 3 months” visit. (although we did chat about non-medical things)

I’ve made the decision to get the Swine Flu vaccine.   I did ask the Transplant Coordinator (RN) what the recommendation is, and the answer she gave me was non-committal.  The bottom line is that whatever we do is our decision.  For me, that’s no problem, but I think they should provide better guidance, as many patients don’t have the knowledge base to make an informed decision on it (I don’t say that demeaningly)

Judging from the phone calls I take at work from worried and confused parents, not only is there an overwhelming amount of information on Swine Flu vaccine, and quite a bit is misinformation.  I do my best to give them the information available, and help them to sort things out.

Back to my decision, if I were to get Swine Flu, it could be more serious due to being immunocompromised, as well as having a chronic neuromuscular disorder.  I have a higher probability of infection as well, given that I work as a nurse and am thus exposed to it more  (although I’m diligent with handwashing and using a mask when needed).

The Swine Flu infection has thus far proven to be fairly benign, based on what I see clinically in our outpatient Pediatric Clinic, but the virus can always mutate, and become more virulent.  Granted, the vaccine wouldn’t be composed of the mutated strain, but there’s a possibility (theoretically)  that it could provide some cross protection.  The Swine Flu virus is comp0sed of 3 different influenzas: swine (pig flu), human, and avian (bird flu). It’s that last one that’s particularly scary.

As I understand it, the Swine Flu vaccine is the same base vaccine as that for Seasonal Flu (there is now a Seasonal Flu vaccine shortage as they had to suspend production to switch over to producing Swine Flu vaccine).  I’ve gotten Seasonal Flu vaccine for years now, and never had a problem. The difference between the 2 is strictly the difference in strains of influenza that it contains. If you do decide to get it and have a chronic illness, be sure to get the injectable vaccine;   the nasal spray vaccine (FluMist) contains a live virus.

Last weekend, I worked a double shift in the hospital; it took 2 days to recover!  Anyway, one of my patients was an infant who had congenital blindness, but also newly diagnosed chronic renal failure.   Amazingly, she survived a potassium level of 9.2!  It was found on a routine screening lab by an eye doctor. When Jackie and I took my sister to the Emergency Department for weakness, she had a potassium of 7.3, and was in complete heart block (the electrical signals to the heart weren’t able to fire right due to the high potassium), and probably almost coded.  They had the external pacer pads attached to her, the code cart in the room, and she had to have emergency dialysis.   That just goes to show how resilient kids can be.

  1. October 20, 2009 at 9:39 am

    Hi, Jeff!

    Interesting choice on Swine Flu vaccine.
    To me it’s a tough call.
    I’ve read so much conflicting info, I’m not sure what I’m going to do.

    Obviously, I wish you the best!

    Coch Richie Perl

    • October 27, 2009 at 6:51 pm

      I’m still going to get it, but I really wonder how necessary it is, having seen many kids with Swine Flu, and the illness not being as devastating as the media and government are leading us to believe.

      There is an animal study out that those infected with H1N1 may be better protected against bird flu. Would that also carry over to the vaccine for H1N1 vaccine providing some cross protection against bird flu? So many things to consider.

  2. Janet
    October 20, 2009 at 9:54 pm

    I’m wondering if you would still get the vaccination if you were not a nurse and did not have another medical condition? It’s so difficult to know what to do!

  3. October 21, 2009 at 5:47 am

    I saw something on the Yahoo Kidney Transplant Board that a professional transplant society (can’t remember the name) IS recommending H1N1 vaccine.

    I personally would still probably get the vaccine, as the risks from it aren’t that high (the base flu vaccine has proven safe over the years).

  4. October 21, 2009 at 10:21 pm

    I always find it shocking everything I hear about a kidney transplant patient… June 25, 2009, apart of a kidney paired exchange program I donated a kidney to a stranger so my sister would receive one from an altruistic donor. I seen my sister on dialysis for four long years, it was never easy nor is hearing other dialysis patients. God bless

    • October 27, 2009 at 6:43 pm

      Wow; that’s great! I hope everything is going well for all 4 of you involved.

  5. sarah lloyd
    November 20, 2009 at 9:44 am

    Have you had the vaccine because my mother has a kidney transplant, heart stents and brain aneurysms and am wondering how you got on?

    • December 3, 2009 at 6:56 pm

      Yes, I got the vaccine several weeks ago, and haven’t had any problems at all.

  6. December 4, 2009 at 1:49 am

    Jeff, At my appt. last week, the dr. asked if I’d had a flu shot. Told him it was last Nov. so he said they would give me one, but not the H1N1 as they weren’t too up on giving them. I told him that was ok with me because I didn’t want one anyway. Can’t get you textbook reasons but I am just not comfortable taking it. The dr. said if everyone who got symptoms would go to the dr. immediately they’d be fine in a couple of days.

    Concerning your fistula: I hate mine as every tiny vein has gotten big, even across my neck and chest. The veins in my arm keeps getting bigger. I asked my dr. if I was going to have to join a circus. This is the second one I’ve had. The first one was kind of flubbed up so the second one was done by a different dr. He went underneath my arm and deep within to get a “big” vein. He re-routed it from underneath my arm up and over the top of my arm. It’s pretty strong. Is there any such thing as reversing the procedure? Why or why not? Wish I could reverse a lot of things. sigh!

  7. December 4, 2009 at 9:22 am

    The fistula is created by joining an artery and a vein. The pressure from the arterial flow increases the size of the vein, making it suitable both size-wise and flow-wise for dialysis. It can be “reversed” by tying off the part between the vein and artery. However, I don’t know if the vein totally “shrinks” back to normal size. I have several pseudo-aneurysms in mine, and if/when I get mine done, the doc said that the vein would need to be removed.

    As for the Swine Flu shot, it’s the exact same vaccine as the Seasonal Flu vaccine, except it contains the H1N1 strain, rather than the strains contained within the Seasonal vaccine.

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