Thursday, April 24, 2008

Lots to celebrate

Following up on the entry made three days ago, let me summarize what I learned earlier today from Dr. Frederike Bemelman, a kidney specialist at the AMC.

The main item was more detail about the results of the kidney biopsy done last week: there is no indication of any degree of rejection; no toxicity (a possible consequence of using Neoral, one of the anti-rejection medications I’ve been taking); and no problems with the filters of the transplanted kidney.

Other results of recent tests: no indication of diabetes (those with kidney illness are more at risk of diabetes); creatinine level good (97); cholesterol okay (5.5); LDL level okay (3.2); liver function excellent; hemoglobin very good (8.5); and, finally, no warning signs in my urine (no trace of sugar, protein or abnormal cells ).

In brief, lots to celebrate!

One consequence of the various tests is that my medication can be changed. Instead of Neoral, I’ll switch to a new anti-rejection drug, Certican (Everolimus). At the same time, I’ll stop taking Myfortic, another anti-rejection drug that I’ve been on since the transplant. About a quarter of the patients using Certican experience some side effects the first few weeks, such as skin rash and slightly swollen feet. (If I am one such patient and negative side effects persist, I’ll be switched back to Neoral.) The medication changeover will start a week from Saturday. In mid-June I’m due back at the AMC for a checkup and the usual blood and urine tests.

This journal hasn’t been used to record much detail about medication, but on this one occasion it seems worth saying a little about this aspect of living with a transplanted kidney. It’s likely that the day is coming when other solutions will be found that will no long require a lifelong regimen of drugs for those who have organ transplants, but for now that’s not the case.

I made at stab at saying how grateful I was for the outstanding work she and her colleagues have done for me and Nancy, but tears prevented me from getting very far. Finally all I could do was kiss Dr. Bemelman on the cheek, a surprise for both of us.

Note: Instead of a photo, I’m posting with this the latest kidney-related cartoon from The New Yorker. A real-estate agent is telling prospective buyers of a house that there is one additional selling point. The present owners are “willing to throw in their kidneys.”

Monday, April 21, 2008

"Nothing to worry about..."

News for this journal doesn’t come thick and fast at this point. It’s now three weeks since the last entry.

In ten days it will be exactly half a year since one of Nancy’s kidneys migrated to my body. Six months is a time, at least in Dutch medical practice, when a major evaluation of the transplant is in order.

One element of the process is a biopsy. But I had some doubts about this, having heard that a biopsy can cause some degree of damage to the organ being checked. As things seemed clearly to be going so well with the transplant, was a biopsy really needed, given that slight risk? I decided before agreeing to it to put my hesitations in writing.

I quickly got the attached response from one of the AMC kidney physicians, Dr. Frederike Bemelman:

“The biopsy is the most sensitive readout telling how your transplant is doing: We can judge your transplant for having a light form of rejection, which cannot be diagnosed either in your blood or urine. We can see whether your transplant is being harmed by the medication you are now taking. If your transplant looks good, we plan to taper the immune suppression medication, which would be a direct advantage for your whole body.

“As for your concerns about the procedure, taking a transplant biopsy is quite easy. The transplant is positioned much more superficially than native kidneys. It can easily be done at the bedside, and in renal patients is often more easy than drawing blood. The complication rate of the procedure is less than 1 in a 1000.

“In other academic medical centers in the Netherlands, such as in Leiden and Groningen, a six-month transplant biopsy is a routine procedure done with all transplant patients. The advantage of the information from the biopsy is considered to outweigh by far the annoyance of the biopsy.”

This was helpful information. Without further hesitation I agreed, and the biopsy was done six days ago, last Tuesday. It meant a long day at the hospital because there is the slight danger that bleeding might occur.

A scan was made -- see the above photo. Using it, Dr Bemelman was able to draw an outline of the kidney on my abdomen and choose the best point of entry for the procedure, meanwhile telling me stories of her two years as a student living in Oxford.

All went well -- no complications, no bleeding, just a quiet day of reading with a hospital breakfast and lunch thrown in. At the end of the day supper was also offered, but -- now free to leave -- I preferred to hasten back to Alkmaar.

But what were the results of the biopsy? Once it was done, I was very much hoping to learn that there is no indication of a “slight degree of rejection.”

Well, now comes the headline:

In the hospital today for several hours of blood tests, the nurse who was helping me told me she had asked about the biopsy and was told: "He has nothing to worry about."

Alleluia! This really made my day.

I will get more detail about the biopsy and other recent tests when I meet with Dr Bemelman three days from now.