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Posts Tagged ‘phosphorous’

Transplant Day 25, Appointments

May 28, 2008 5 comments

Feeling better each day. The minor issues I’ve had along the way; edema, arm pain, diarrhea, incisional pain, etc are all but resolved.

My daily vital signs are all good today. I also updated my labs, since they are now finally available to me online.

I had my weekly appointments today, which is why I’m posting later than usual.

They had difficulty drawing my blood today, but with what they had to work with, I’m not surprised. They ended up using “old faithful” (a small vein on the outside of my arm just below my elbow).

The Transplant Nephrologist was in first. His main concern is my anemia, and he is right on top of it. He thanked me for being “proactive”, as I had emailed him over the weekend to explain my ongoing iron situation, and had requested labs to check on it. Since he’s only seen me once since my transplant, I wanted him to know of the ongoing iron problem. He took the time to explain that due to my gastric bypass surgery, I probably malabsorb iron. Iron requires an acid environment (most of my stomach is stapled off, and my “pouch” may not produce enough acid to absorb iron; in addition, my acid secretions are decreased due to the Prilosec), and it also requires the parietal cells in the ileum (portion of the small bowel) as well (my bypass is before the ileum).  The plan is to watch the trend of my iron studies, and if still abnormally low, that I may need monthly IV infusions of iron.

As it turned out, my studies are all normal today, with the exception of my iron binding function, which is minimally below normal. So that is good. My hemoglobin is stable but low, and my hematocrit is fairly stable, although a bit lower than last week. I think that they said that I would need Procrit if the hematocrit goes to 25 or below, so there’s still some room there.  And I’m less concerned, because my hemoglobin is unchanged, so maybe the new kidney is producing erythropoietin now.  Also, he discussed my white blood cell count, which is low. That is due to the Valcyte and CellCept. However, he explained that since my segs were high, I’m more or less protected from viruses, but since I had “Campath Induction” , my T cells were essentially wiped out, making me more susceptible to bacterial infections such as TB.

The Transplant Surgeon was in last, and was very pleased with both my labs and my progress. They did a lab called an Immune Cell Function last week. As it was explained to me, this is a guideline for them to use to determine the amount of my immunosuppression, and it is “right on” where they want it. My phosphorous and magnesium are now both within normal, so I can stop the Magnesium Oxide-yea! My Prograf level (FK-506) is finally normal, so I assume my dose stays the same (this wasn’t back until after my appointment).

I did print out my “daily vital signs” spreadsheet, and the Transplant Nurse told the surgeon I’m “anal”. I agree, however, I also did it to occupy my time as well. But I think that the surgeon is more comfortable with me making sure that I do what I need to do, because he told me that I can come back in 2 weeks, instead of 1 week.

I also asked him about my cystoscopy next week (I’ll be getting my stent out). My concern is that I may get an infection, which will travel to my native kidneys. He said that he would  prefer not to give an antibiotic beforehand, because that promotes resistance. If I had a problem with my heart valve, then yes, he would, but not in this case.

I’m excited about a new blogging opportunity. I will be writing for a website that will have multiple bloggers writing on various aspects of kidney disease. I will be writing as a new transplantee. There are also future plans to expand the site, and I will probably be writing as a medical professional. I will post more details when things are up and running.

Transplant Day 21 (3 weeks!)

May 24, 2008 1 comment

Today is my 3 week anniversary of my kidney transplant! It’s hard to believe how much better I feel than compared to the morning of the surgery when I was at dialysis.

I had a good day yesterday. The arm pain for the past 24 hours is practically non-existant.  I did have diarrhea again today, and took 2 Imodium; I hope to soon get that under control. BP good, weight stable, no fever, and a bit more in than out, but factoring in the diarrhea, it’s probably OK. I’ve been drinking well (better than the other day). Appetite fair, but not great (that’s OK, I could stand to lose a few lbs in addition to the fluid weight loss).

The transplant nurse called yesterday; my Prograf level is even higher; 10.3 on Monday, and now it’s 12.7! My creatinine is 1.7, but the increase is probably due to the high Prograf level. I’m cutting my dose to 3mg in am and 2mg in PM. Another concern (of mine) is my blood count. My WBC (white blood cells) is 2.26; this lowering can happen with the meds-I believe the Valcyte and CellCept do that. A count that low increases risk of infection.  Also, I’m more anemic; my hemoglobin is 9.7, and hematocrit is 29.9. Could there be Neupogen (to increase white count) and Procrit (for hemoglobin) in my future?  On dialysis, I was always getting Venofer (IV Iron) infusions. I just sent an email to the Transplant Neph to see if he wants studies checked related to this.

Nutritionally, my magnesium level is still low; 1.2, although I’m cutting my Magnesium to 400 mg twice a day (from 800 twice a day) due to the diarrhea.  I suspect the low level is due to the high Prograf level.  My phosphorous is also low at 1.3. So I started eating cottage cheese, drank chocolate milk, and bought some cocoa roasted almonds (yum). Foods high in phosphorous include Biscuits, Nuts,  Dairy Products, Cola, Chocolate, Beans, Meats, and Liver and Organ meats; I can do all of that except the liver and organ meats.

Hands are shaky; surprise, surprise (high Prograf again).

Not much else going on. It’s a beautiful day out today, so Jackie and I are going to take the dogs for a walk this afternoon. I’m definitely going to walk now every day (I did yesterday and the day before); I feel so much better doing that. And when I go back to work, I will walk at lunchtime. I used to go for a ride at lunch, since I’m deskbound all day, but the walk is better; it’s exercise, and with the price of gas, is a lot cheaper.

 

Transplant Day 14

May 17, 2008 2 comments

Today is my 2 week transplant anniversary. Yea! It’s hard to believe it’s been 2 weeks. In one respect, 2 weeks seems like it was long ago, and in another respect, it seems just a short while ago.

My “vitals” are stable. Wt up a 1/2 lb to 218.5, although overall, it’s stable. BP 138/78 (so far, the Magnesium hasn’t helped with that), no fever, and my ins yesterday was 3590 cc and outs 3800. My bladder is finally stretching; 2 days in a row where I had 600 cc out at one time! (previous high was 500 cc). May not seem like a big deal, but the more that comes out at 1 time = more room = less trips to the bathroom!

I got my labs back yesterday afternoon, and everything is stable (posted below). Creatinine and BUN stable, and Prograf at upper end of desired range, so no change in dose. Potassium remains at upper end of normal, yet I’m not overdoing it on high potassium foods. Maybe there’s a diuretic in my future.

I’m doing well GI wise. No more constipation; we’ll leave it at that 🙂 Occasional nausea, but that may very well be from my gastric bypass; hard to say. I did throw up a tiny bit about 20 minutes after taking my meds, but I took some on an empty stomach, so that’s probably why. I’m figuring that I got most of them in, so I won’t repeat them.

The one thing that sticks out (figuratively speaking) since transplant? NO MORE ITCHING! I used to have itching constantly; increased phosphorous is notorious for doing this. But now, my Phosphorous is below normal, and the itching is gone.

My right arm is still bothersome. I’ve found that a heating pad works well, but I’ve also had to take Tylenol #3 at times to help with the pain. It’s a different kind of pain than I have with kidney cyst ruptures; more like an intense ache. It’s not related to exertion; if fact, it’s worse when I’m sleeping and wake up. Don’t misunderstand; I’m not whining about it, just reporting it. I’m able to “suck it up”; in relation to everything else, this is minor.

LABS

Lab

Reference Range

Value

Flag

BUN

6-20

27

H

Creatinine

0.7-1.5

1.6

H

Potassium

3.5-5.1

5.0

 

GFR

>60

50.2

L

WBC

4.0-10.8

4.52

 

Hgb

14.0-16.5

10.5

L

Hct

40-47

32.4

L

FK-506 (Prograf

 8-10

10.3

 H