This is a time out from the day to day details of Dale’s medical situation and some thoughts about what happens when you donate a kidney. I know that Dale’s sister has been so upset about the possible rejection and problems Dale has been having. All of his sisters have worried about him and have been checking on him but Sondra has been especially upset.

I know she would have been upset even if she had not been the donor but I can only imagine how this changes the depth of a person’s feelings. To offer an actual physical part of yourself to another human being to heal them and then to have it not be working has made her wonder if her gift wasn’t good enough. I know you are reading this blog Sondra so I want you to pay attention!

Matthew 25 tells us:

34″Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’37″Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38When did we see you a stranger and invite you in, or needing clothes and clothe you? 39When did we see you sick or in prison and go to visit you?’

40″The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’

Of course it matters that the kidney should work and that life should be better for Dale but no matter what happens he knows that you did this wonderful thing for him.

1 John “This is how we know what love is: Jesus Christ laid down his life for us. And we ought to lay down our lives for our brothers.”

We love you – Jesus loves you , and you showed your love. Never forget this. Dale won’t.

Dale and the night nurse both encouraged me to go back to the apartment to sleep last night so I got a good night’s sleep and caught up on some laundry. When I got to the room this morning Dale had already been up walking by himself.

Dale’s creatinine level actually went up just a little today so we are still hoping that the trend will turn around. They are still planning on doing the angiogram if it doesn’t come down by tomorrow.

I did some research this morning on Kidney transplant rejection. Here is a quote:

* Rejection – Rejection occurs when the body recognizes the transplanted kidney as not belonging, and tries to destroy it. There are different types of rejection. Most rejections can be treated and reversed. During a rejection, it may be necessary to do a kidney biopsy to identify the type of rejection, so the proper treatment can be started.

Rejection can occur at any time, but the greatest risk of rejection occurs within the first three months after transplant. During these months, higher doses of immunosuppressive medications will be given to prevent rejection, and frequent clinic visits will be required. Occasionally rejection occurs years after transplant, so it is very important that clinic appointments and lab work continue.

This is from http://www.hcmc.org/Depts/transplant/recipient.htm

The docs were here for rounds just now and so it would seem that we are looking at this being either a rejection issue or a blood flow issue. They are going to do another ultrasound and if there is a change in the signal from the last one they will go ahead and do the angiogram today. If not they will wait and see if his labs look better tomorrow and if they do’t they will do the angiogram then. The dye they use in the angiogram is toxic to the kidney so they don’t do that unless they have ruled out anything else.

We got rid of the catheter today so one less hose to drag around.  I just hope they don’t wait hours to take him for the ultrasound.  since there is a possibility that they will be doing angiogram too they won’t want him to eat til after.  When your day consists of doctor’s rounds, walking around the nurses station, and watching tv – meals become pretty important and this patient gets very grouchy when he can’t have one!

I also want to encourage anyone who knows someone who needs a kidney to seriously consider getting tested to donate. Dale’s sister is home and already back at work and doing fine. I am including a copy of a donor card you can download and print. new_dcard.pdf

It is an unbelievable gift.

We had a good night – got sleep. It’s amazing what sleep does to your attitude! We are waiting for them to tell us when they will be taking him for biopsy and he is kind of cranky because they won’t let him have anything to eat.

These posts are kind of fading into each other so I hope I haven’t already explained this but there is a little bit you need to know about rejection. There is acute rejection and chronic rejection. Chronic rejection is what happens more often in long term transplant where you gradually lose the organ. Acute usually happens several days after the transplant and if caught quickly can often be dealt with via medication. Today we find out if we are in acute and what they need to do to fix the problem.

All this was complicated by the fact that he was carrying so much liquid. 8 kilos is like him carrying around an extra 17 and 1/2 pounds or a couple of gallons. This made it hard for him to breath, hard on his heart, he was swollen, and the toxins were building up in his system. The main reason this happened is because the beds at Baylor weigh you and his was never callibrated. He has been saying he had too much fluid. The nephrologist talked to the floor supervisor about it Wednesday, and last night we finally got them to bring in a regular scale and he showed that it was 11 kilos off.

They try to wait because dializing you is kind of like kicking that kidney when it’s down but it had to be done. They just told us the biopsy is at three and if it doesn’t show them anything then they will do an angiogram tomorrow morning. They finally let him eat so he is happier.

Sooooo we are still in a holding pattern. The doc is encouraged that the kidney is making urine (sorry for being disgusting but in kidney transplant everybody gets excited if the patient can pee!) so he is just hoping that the kidney is “stunned” and will start filtering like it should.

They dialyzed Dale and he weighed 92 kilos which is 8 more kilos than he has ever weighed so it’s no wonder he couldn’t breath. He is feeling so much better now, except mad as a wet hen at the doc because he kept saying for two days that he had too much fluid on him. 8 kilos is a lot of fluid weight to be carrying. He can breath and wants to go for a walk in a few moments so I know he is much better.

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Okay, stopped for a short commercial break.  We went for a stroll all the way around the nurses station and then came back to the room and got cleaned up and got fresh jammies.  Maybe we will get to sleep tonight!

I stayed here at the hospital last night and I’m so glad I did. Dale was up most of the night – every hour or so his blood sugar would drop and they would have to give him dextrose.  They say this is from the medicine they gave him yesterday morning to counteract high blood sugars he could have because of the prednisone. It takes about 24 hours for that to get out of your system and we are nearing that mark so maybe it will get better.

They are giving him dextrose which is basically sugar water and they are giving him a diuretic to help him keep making urine,  He is making urine but still feels miserable like he is carrying too much fluid.
Basically it looks like the kidney is producing urine – it just isn’t filtering.  The creatinine was up again but just by a little so there is some hope that maybe this is turing around.

In the meantime he has swelling and that is giving him pain.  They can only stick fingers on one hand because they still preserve the fistula arm in case dialysis is needed again so his fingertips are sore – thank goodness he still has the central line so they can administer everything else there instead of sticking him more.

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They took him to dialysis at 11:00.  He is retaining fluid and it’s causing him trouble breathing.  They are doing the kidney biopsy tomorrow so they can determine what medication to give him that will turn around the rejection.

Today they did an ultrasound and a renal nuclear scan.  It all looks okay but the function is down so it is possible that he is rejecting the kidney.  They will wait and do labs again in the morning and if the creatinine is still high they will do a biopsy which will give them more of an idea how to proceed.  There are medications they can give him but without the biopsy they can’t tell which ones.

We’re worried but hopeful.

Less swelling and less fluid retention so maybe things are going to be better. We will have to wait for the labs to find out if the creatinine clearance is better and that will be more tellng but Dale does look and feel much better. I’m better too – it’s amazing what prayer and a good night’s sleep will do for you! He is hungry and breathing easier, too.
BJ is bringing Jessica over today and I will post again later and by then we’ll have his labs back so I will know more.