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Posts Tagged ‘immune cell function’

BK Virus

July 15, 2009 6 comments

I had my quarterly visit to the Transplant Surgeon on Monday, and everything at the visit was good. My creatinine is 1.2, hemoglobin is stable, and blood sugar normal (sometimes Prograf can cause elevated blood sugars).

However, I received a call today from the Transplant Nurse, and my urine tested positive for BK virus.

For those unfamiliar with this, BK virus is present in 80% of humans, but remains “latent” due to the immune system keeping it at bay. In those like me who are immunosuppressed, BK can “reactivate”. The problem is that BK can cause damage to the kidney.

So, I just gave a urine sample which will be a quantitative test for BK (they will count the amount of the virus present in my urine). If the number is over 2,000,000, they will then check to see if it’s in my blood. The treatment is usually to decrease the CellCept dose. However, since mine was just decreased from 2 capsule every 12 hours to 1 capsule every 12 hours, they may stop mine for now, and I’ll just be on Prograf.

My guess is that when I was over-immunosuppressed this past spring (my immune cell function was in the 70’s, which is very low, and an indicator of over-suppression), and that is how it reactivated; my last immune cell function was in the 200’s, which is where they want it. It is what it is, and I’ll just deal with what I have to. However, I’m not too worried, as I’ve talked to patients who this happened to, and they did fine.

Sister’s Transplant Update 5/13/09

May 13, 2009 Leave a comment

My sister is still in the hospital (she’s 2 weeks post-transplant today), and awaiting placement in rehab (physical rehab).  The Rehab Hospital on campus can’t take her, because she needs a private room, so the plan now is a local Rehab/Nursing Home until she is able to walk.  In addition to the weakness brought on by 2 weeks of being in bed, her feet are swollen at least 3 times the normal size, so she can’t get her Orthotic on her foot, and thus can’t walk well.

She’s also not eating and drinking very well, and still has the central line (IJ line) in her neck.  They were going to put a PICC line in, but the nurse didn’t do it, due to it being in a vein that formerly was a fistula site (that didn’t “mature”).  The doctor cleared her for that, so the plan is apparently to remove the IJ line and insert a PICC for intermittent IV fluids, blood draws,  and to give IV Lasix (to get rid of excess fluid).  Her creatinine is still in the 7 range, but the docs apparently are confident that the kidney is working, and just needs to “wake up”.

The chronic constipation that she had (that most, if not ALL dialysis patients have, including me) is now the opposite, thanks to good ole’ CellCept (one of the drugs used to suppress the immune system).  The fluid retention and diarrhea are both things that happened to me, and I assume are normal.

Since she isn’t drinking well, she had a NG tube (Feeding tube) put in from her nose to her stomach, and they are giving her water every 4 hours through it).  I was there to visit today, and she is urinating more than before, so that’s good.

I had my last of 3 weekly labs last week, and just found out the results of my Immune Cell Function; it was 243, which is right where it should be.  They cut my CellCept dose in half when it hit 71 back in April, so that apparently did the trick.

Immune function update

April 15, 2009 1 comment

As I mentioned in my previous post, my Immune Cell Function test was low 2 months ago, with low equating a higher level of immunosuppression, and I just had another done this week.

I emailed my doctor, and today, his nurse told me that it was lower than the last time (it’s 71, and IIRC, they want it around 2o0), so they cut my CellCept dose in half to 250 mg every 12 hours.

A lower dose means less chance for problems. Too much immunosuppression (low ICF) can lead to nasty fungal infections that could be fatal, viruses that can cause failure of or damage to the transplant, as well as an increased risk of cancer.  CellCept also has a potentially nasty adverse reaction called progressive multifocal leukoencephalopathy, so a decreased dose is fine with me.

I’ll be getting “regular labs” (which includes a CBC, BMP, and Prograf level) weekly for the next 3 weeks, and another Immune Cell Function test  the 3rd week.  My Prograf level is fine at 5.9 (they want it 6-8).

I was also retested with my “high risk labs”, and my Hepatitis B and C are negative, as well as my HIV (remember the HIV scare?).

So everything is going well; now if I could shed about 10-15 lbs, I’ll be doing even better!

Transplant Week 50

April 13, 2009 Leave a comment

I’m about 50 weeks out from transplant now, and it’s hard to believe, but I actually feel better and younger now than I did 10 years ago!

I had my appointment today with the Transplant Surgeon, and he was very pleased. You may remember back to shortly after my transplant, and I posted that my new kidney was a 3 out of 6 antigen match. However, today they told me it’s a 1 out of 6 match (or a 5 mismatch). Dr. Varma told me that it’s inconsequential, because the immunosuppression is so effective, the only thing that really matters is the blood type. Dr. Varma remembered that my kidney was from a 16 year old, and once again said that I got a great kidney.

My kidney labs are rock stable; my creatinine is 1.2 and BUN 25.  My hemoglobin dropped a bit. It’s down to 11.8; not sure what’s going on there, but I’m not too worried.  My weight is stable as well; I lost 2 lbs since my last appointment 2 months ago. Not a great loss, but better than a gain.

My last Immune Cell Function was low, meaning that I may be over immunosuppressed. Depending on how today’s is, he may cut my CellCept dosage down to 250 mg every 12 hours (it’s currently 500 mg every 12 hours). My Prograf level isn’t back yet either; my current dose on that is 3 mg in am, 2 mg in pm.  My BP was 132/72, and they are pleased with that as well (and that’s without ANY anti-hypertensive meds!).

I continue to walk several days a week. In fact, I’m now consciously trying to park further, rather than closer, so that I get as much walking in as possible.

Jackie and Kevin tell me my fistula is getting larger. I’m afraid that I may have to have it tied off soon, and the vein removed. I’m hesitant to do so, because I don’t really want to mess with it unless it’s giving me problems.  But I will call the surgeon if it does start causing pain or circulation problems.

I’m enjoying my weekends off. I did fill in at my old weekend job last Sunday, and they sent me calendars to fill in for available shifts for May, but I doubt I’ll be working for the nursing agency much in the future.

The Pediatric Rheumatologist I work with has a patient that he had on his service in the hospital who was diagnosed last fall with an extremely rare disease called Pansclerotic Morphea. She’s not even adolescent-aged, and is dealing with a disease that is potentially fatal.  She’s going to another medical center for a procedure that will hopefully at least arrest the disease.  But since there are so few cases, everything that is done is guess work.  Another reminder of perspective; my medical issues are miniscule in relation to this….

I have so many books to read, and I’m trying to go through them now.  I’ve been reading Ayn Rand’s Atlas Shrugged, but the type is so small, I don’t think I could get through the almost 1100 pages.  So I got the audiobook, and am listening to it on my MP3 player in my spare time.

With spring comes a lot of rabbits. I think of them as a nuisance, especially when they dig up the yard, or burrow under our fence. Our GoldenDoodle, Digger, thinks of them as toys. So far, he’s gotten three of them within the past 2 months. He’s very proud of his catches, and when we go out to try to get them off of him, he thinks we’re playing, and proudly and playfully runs around the yard with the dead rabbit hanging out of his mouth.  The only good thing is that unlike our first dog, a cocker spaniel, Digger isn’t interested in eating them.

My sister hasn’t had any more episodes of life-threatening potassium levels. She came close to getting a kidney, but the surgeons refused it. They did say to me today that she is close, as her name is now coming first on the list when an available kidney is her blood type.

I was in the Emergency Department last Tuesday with Jackie. She had excruciating lower abdominal pain. Entering the ED in a wheelchair crying loudly and saying that you can’t stand the pain is one sure way of getting a room ahead of the other 20 patients waiting for one.  Once they gave her 10 mg of IV Morphine (a HUGE dose), her pain went from a 10+ to a 4.  A dose of Dilaudid an hour later did the trick to totally relieve the pain. A CT scan showed a 1mm kidney stone in the ureter, and she passed it last Thursday, but not after a fair amount of vomiting, constant sleeping, and intermittent severe pain. She’s fine now, but hopes she NEVER has to go through that again; she says it was worse than labor.