The new resident

This is what my kidney transplant looks like. See the light-colored "bagel" on the left side of the screen? It's a transplanted kidney, cradled in the "iliac fossa" of the right hipbone, probably in a safer spot than it had been originally!

This is something that's puzzled lots of people -- "So which kidney do they take out to put Cheryl's in?" I still have both my monsters -- the nephrology fellow was somewhat surprised to encounter them today where no one expects to find a kidney -- and this one has been tucked into my hip and is the third connection to my bladder. This is done mainly because the right iliac blood vessels are easiest to attach to the new kidney. I'm told my "native kidneys" will soon realize there's a new, avid worker in town and will gladly give up their fight. They'll still be alive, attached to their original blood vessels, but they'll probably stop producing urine.

Cheryl, thank goodness, also just had abdominal surgery, with about a 3-inch incision next to her navel. Years ago, removal of a donor's kidney involved an 8-inch incision from your back around your side -- LOTS of muscle involved -- and removal of a back rib! The only thing Cheryl had to worry about was whether she was subject to back pain -- once she was out on the operating table, the surgeons twisted her hip back and chest forward so that the kidney "popped" up as other organs pushed against it.

I found my incision is a little bigger than I expected when the nurse held her thumb and finger about 5 inches apart during one of my "T - 1" (the day before transplant) appointments.When I finally got to a mirror where I could see the whole thing, I found out it's at least 8 inches long. And you know what? There's not a stitch or a staple in it!

That's thanks to the brand-new world of surgical adhesives. Where do you find a glue that works on admittedly wet -- and constantly generating more wet -- surfaces?

I haven't been able to run into a surgeon at my lab appointments, but I suspect it's "BioGlue." It's a biologic (based on purified matter from cows) system where two materials are mixed together as they hit the wound, and knit it together within 2 minutes. Hmm. . . sounds like my father's favorite kinds of epoxy!

Thank heavens for advances in medicine.

image from www.medcyclopedia.com
Components of BioGlue:http://www.cryolife.com/products/bioglue-surgical-adhesive
New fields in surgical adhesives, including slugs (!) and mussels:
http://www.sciencedaily.com/releases/2009/05/090501200853.htm
http://www.sciencedaily.com/releases/2009/03/090318085923.htm

Prayers from all over

This is my smallest prayer warrior, my niece Maggie.

She's Randy's sister Karen's daughter and, her mom reports, has developed a real empathy over the last year.

"I sat down with her and explained what people's kidneys do for them and the fact yours weren't working well anymore," Karen told me. "And I told her that because people can get along with one rather than two, your friend Cheryl volunteered to give you one of her kidneys.

"She looked up at me and said 'I'm so glad Miss Cheryl could help Aunt Holly!'"

Maggie and her older brother Michael have been praying for Cheryl and me with their classrooms at school. Being the recipient of prayers from those direct minds, those pure hearts, is just awe-inspiring.

I'm not good at praying for myself, and am just so grateful to everyone who is keeping us in mind. People I knew as a girl in Crystal Falls, people my in-laws have known since college, people at Bethel and at Cheryl's and our church, people I've never met. The reassurance of knowing all of you out there are lifting us up goes beyond words.

And you know what? Cheryl may have given me a "great little kidney." I may be a pretty determined (or "bullheaded") patient. But my progress is astonishing health professionals across the board.

Your prayers are working!

Knitting up the raveled sleave of care

Thursday, April 29 was the first night I was able to sleep through the night, rather than moving from bed to couch to futon trying to get comfortable -- or wear myself out enough to override the steroids.

It's incredible how even after an hour or two of sleep I have noticeably less pain than when I lay down. Apparently a lot of things are being knit together during these times.

A handful of pills in the morning, a handful of pills in the evening, and things seem to be going OK.

I was back at the U only once for a "booster" IV of steroids to try to get my immunosuppression up to therapeutic levels, thank goodness. Life's a lot easier to deal with without steroids on board!

That 'new kidney smell'

At my "T-1" appointment, the head procedure-room nurse explained what happens in a living-donor transplant:

"Cheryl will go into the operating room first, about 15 minutes before you. They'll start surgery on her to remove her kidney, then carry it in a tray over to the operating room where you are.

"Then they "bench" the kidney -- I don't know why they call it that -- but they take it out of the tray and run saline through it and clean off any excess tissue that might be on the outside.

"That part always makes me think of when you take your car to a really good mechanic and get it back all cleaned and detailed."

Here's to really good "mechanics" !

A week. . .

wasn't even what it took to notice the change.

Immediately, I didn't need to chew ice anymore.

Immediately, my blood pressure (which was 189/118 the last time I dared to go without drugs, some 15 years ago) dropped into normal ranges without medication.

Immediately, my mouth didn't taste like the bottom of a birdcage.

And save for a couple incision-jolting full-body cramps, my calcium level seems to be recovering -- no more cramps and twitches!

I haven't seen a change in energy yet -- recovering from surgery will do that to you -- but I'm sure it's to come.

Boy, am I glad it's not a week ago. A week ago tonight, I woke up in the step-down unit to see a rather damp Randy, who immediately got up to stand next to the bed and hold my hand. "It's OK, honey -- you should sit down," I told him. Finally convinced him to pull up a chair.

Two fabulous nurses, Jay and Lydia, came in and out of my field of vision to check vitals and refill icewater. There was pain, but there was also the security blanket of the self-administered pain pump. I really don't know if there's anything on the other end of that line but a quiet "beep," but at the time it seems like you're in control.

Going backward, I recall waking up in the recovery room and being wheeled into an elevator. . . being awake for a few moments in the operating room. . . and before that lying on a gurney in the pre-op suite with the anesthetist saying "We'll just give you something for anxiety here" as she depressed the plunger on a syringe. Although that's the last I remember before the operating room, Randy tells me I was awake after this: "You were really sweet when I got weepy saying goodbye to you in the hall." He doesn't think he would have reacted so dramatically if the anesthetist, a non-native English speaker, hadn't announced that this particular intersection was "the goodbye corner."

"I got mugged by my emotions a couple times," he told Cheryl the next day.

Cheryl's kidney is one of the faves of the U team this week, it seems -- "You've got a great little kidney there," my coordinator told me on the phone today. It apparently realized immediately it was doing the work of two. After a couple days of loading up on IV fluids, they began cutting me down -- and I was unable to keep up my fluid levels sufficiently. A few more IV bags and we seem to be reaching an equilibrium.

Cheryl's doing well -- we compare notes by phone daily and are enjoying having permission to take afternoon naps. And sometimes morning naps. And, in rare cases, evening.

It hasn't all been peaches and cream. I had two hellish nights in which I couldn't sleep due to the steroids. Picture yourself on two nights without sleep -- immediately after being discharged from the hospital. My eyes watered constantly from fatigue, although I lay in bed with every limb vibrating like a cell phone on mute.

I've diagnosed and treated my own nausea at 11 p.m. and I've finally figured out the only place I can sleep comfortably is on the futon on our three-season porch; thank goodness we didn't do this in February!

There've been a lot of desperate prayers sent up -- and answered.

George, our newsroom wag, wrote on the office card, "I hope you and your new kidney form a long-lasting relationship." He's closer than he may realize -- I'm in what they call the honeymoon period, when both the kidney and I are well-protected by high med levels. As these are tapered off to a balance I can better sustain over the long haul, there will be bumps in the road -- complications, illnesses, rejection episodes. So I have to pay close attention to everything from temperature to blood pressure to liquid intake, keeping track of small signals to prevent bigger problems.

But we're off to a good, good start.

Changes

Folks have been asking if we've noticed any changes since Holly received her new team member. Its been hard to tell in some ways because of the post operative recovery. The first day she could only have an ice chip every five minutes or so since she could not handle drinking normally yet. Since then, I noticed no more pica for ice. Even when I offered to go get her some later she wasn't interested. This makes my life hard since that used to be an easy way to make someone happy. Holly was just telling someone that once she was drinking on her own they took her IV away but the new kidney was working so hard she started to dehydrate so they kept the extra drip. Those were probably the first things I noticed that things were changing.

One recurring theme for both of us is how important sleep has been for our well-being through this recovery process. Of course in the land of hourly vitals and under the rules of steroids Holly had some rough times. I had some trouble sleeping both with anxiety and schedules. At times we were both a little raggedy. After the clinic visit today we had naps and since are feeling more on our respective games. Mine being a quicker more sprightly one to support hers as she comes little by little back up to speed.

For the first time in almost exactly a week Holly is checking her e-mail. See... ....yet more progress.

Back home is still work

Holly's still busy recovering, doing labs and trying to sleep so I'm going to do an update. Tuesday Holly had tests and another bag of anti-rejection drugs. The steroids have meant that she's not able to sleep when she wants. All that being said she is really glad that she is home and things are getting more comfortable. She's working on getting a schedule for her medications and the continuing labs for the next few weeks.

I have found that she has draft entries that she plans to be working on as she begins to feel better.