Pre-partying for India

I mentioned in the last entry that I had been a bit sick and laid low, true and all, but that doesn't quite do justice I don't think, and as Corinne is spending some time studying I am left with my Acer, an internet connection and my stories, which I will indulge to share with you, hopefully with more manageable sentences.

I'll start with something innocuous - photos from Ayvalik and a few from wandering around Istanbul these past few days (yesterday really, I didn't really venture out for a day or two).

Ayvalik was a hilly port town, as I mentioned, and quaint as hell, so here are a few photos to hopefully represent some of that.

Lots of the streets looked like this - very picturesque

See?

We sat here, had some tea and played backgammon - pretty sure C was on a grand winning streak at this point

View across at the Roman harbor

Fishing boats!

Istanbul, Taksim area

The main street from Taksim to the Golden Horn

View across the Horn at sunset - that's the 'New' Mosque (built 1665)

What follows here will be prattling health stories - so those of your pressed for time or attention are excused.  After returning to Istanbul on Monday evening, we had an easy re-entry day on Tuesday - checking out the Grand Bazaar in search of backgammon sets, and enjoyed some quite time at an Istanbul library (highly recommended!).  That evening I think I started to slip a bit, feeling the usual precursors to a cold / flu type thing (small fever, tired etc).  I woke up the next morning feeling pretty beat up - achy and so on, and was carrying a fever that floated around 100 for the whole day.  I napped, was a lazy layabout, and killed the day watching shows.  The next day, Thursday, I felt the same, complained and rolled around and started to worry about the bigger health picture.  There were a few curveballs that I had worried about and thought about since leaving the Twin Cities - mainly how were these feelings related to the kidneys?  Most likely, they weren't - it almost never is - but the risks of it being kidney related are exaggerated by their consequences, which are a bit scary for this guy (and some of you I'm guessing, which is why I'm writing about this when the all-clear has been called).  



Curveball number one - I have heard that a rejection would feel something like the flu - fever, aches, without cold symptoms.  This is exactly what I was experiencing.  


Curveball number two - viral infections like the flu or a cold will make me sick, like any other mortal, but it would not necessarily make me too sick, as the physiological 'sick' feelings (fever, runny nose, cough, etc) are immuno-responses to a virus, not the virus itself - and I am immuno-suppressed.  So it seemed like a flu, but stronger than what I have experienced.  If I had a bacterial infection, the bacteria would, given a head of steam, make a run for it, go 'septic,' and I would be in real trouble (ER).  This means that when I get sick, I spend fever-addled brain energy trying to suss out if it is viral or bacterial - basically guesswork.  This seemed viral - steady fever for a full day rather than a spiking fever over a few hours.  But that thinking, trying to figure it out, was hard - and it was hard on both of us.  Me trying to figure out how bad it felt, C trying to help me remember what fevers I had had when (she made a chart).  


For those two reasons I have the blanket mandate that anytime I had a significant fever (I took this as over 101 or so) I should get my fevered ass to the ER to ensure that I wasn't (1) in rejection or (2) about to go septic.  


Curveball number three - when I had my blood levels checked in Cairo, my traco level was on the low side (Tacrolimus (along with mycophenolate) is the main immuno-suppressants between me and a kidney rejection).  It was within what's called the 'theraputic level' for the Cairo folks (indicated on the report), so I didn't think much of it, but I mentioned that to the folks back home at the TC Kidney Clinic when I called to check in about being sick this week and turns out the theraputic levels in the states is higher than those of Egypt.  Oops.  So my 2.6 (fine on a 2 - 15 scale) was pretty low on a 5 - 15 scale.   This was a bit of a red flag.


Finally, deliciously, I was on the gravy train, sliding into home, heading to the bathroom every half hour or so, though not feeling the crampies I'd associated with bad water bacteria - I let them run their course so to speak until Friday afternoon when I figured I was probably out of the woods enough to not worry about complicating any clinic or hospital treatments.  I took some cipro - the miracle drug when travelers' diarrhea is concerned, but it did nothing for me, which again indicated virus.  While it didn't feel bad per se, it did slow me down enough to factor into everything else.  


So I considered these circumstances, laying in bed, shivering like a leaf in the breeze, feeling like the flaccid piles of poo I was leaving in the Turkish toilets.  At what point would I pack up my 'overnight bag' and head over to the hospital? - and then which hospital?  Every now and then Corinne would check in from her school work, ask how I was feeling.  On Thursday, day two of sicky sick time, we went to a clinic down the street from our Hostel (this is after stopping in the pharmacy next door, asking for a blood test, and confidently being handed a pregnancy test).  While everyone at the clinic was very friendly and helpful, no one spoke English, and they didn't do blood tests.  I was feeling a little better having walked around and eaten a tasty chicken sandwich, and we decided to give it another night.  The longer I didn't feel worse, the less nervous I felt.  


Friday night came.  I took some Tylenol, feeling that the worst was behind me, and C and I watched 'Good Will Hunting' on netflix.  The movie over, my temp floated up to about 101 (after taking the Tylenol) which was kind of high, but feeling alright overall, we called it a night.  I woke up at 3, slippery with sweat, no longer feverish, and feeling like the belle of the ball - the fever had broken!  I went to shower and realized that I had finally had the travel experience so many had talked about - the Indian surprise - poo in the shorts (and some on the bed).  C kindly offered to get us new sheets and I cleaned up, too high on the broken fever to care much about anything else.  We had some laughs about it, I thought about Trainspotting, and we we went back to sleep.  


The next morning we swung over to the German hospital (where they spoke English), to check my hemoglobin, WBC, and creatinine levels.  Side story - in Cairo a quick lab test showed that I was peeing out way more protein than was advisable, and so changed blood pressure drugs from a calcium channel blocker to an ACE inhibitor (the calcium channel blocker allowing for more protien to be dumped, while the ACE inhibitor would prevent that).  HOWEVER, in the inevitable side-effect game, the ACE inhibitor I took earlier also inhibited my hemoglobin production, meaning that while I had more protein in my system, I had fewer red blood cells to make use of it.  Kind of a Catch-22.  But I was assured in Cairo that ramipril (the new ACE inhibitor) was different from lisinopril (note the suffixes!).  White blood cells would indicate infection (or, unspeakably, rejection), and the creatinine which is on the 'always check' list.  


While a little slow up the stairs, I was feeling a world better and we made our way over late morning.  To close the suspense, the labs came back fine - hemo was 11.6 (good for me, though normal is 14 - 18 ish), WBC was normal, and while creatinine was a bit high, 1.9, the nurses back home thought that was normal given the drug changes (tacro increase) and sickness.  This morning (Jan 8) I'm feeling almost good as new - we are hammering away at neighboring computers and looking forward to an afternoon ferry ride to nowhere in particular and maybe a Turkish bath, at long last.  


We (C and I, and you maybe) are extremely relieved that the situation is resolved, and that it wasn't worse than it was.  At the end of the day, the real bitch of this kidney thing is a sunny day dread that sometimes comes over me - this feeling that even though I pass under this threat or have that close call, the next one is just a matter of time.  It feels sort of like the inevitability of death - I might not think of it for days, but it returns, and always will.  After I felt much better, on Saturday or on our Sunday trip back to Stockholm, I felt clouded-over.  I feel brighter now, it is after all just a mood, a passing attitude that I wallow in periodically, same as many of us.  It is hard - this thought is the hardest one I deal with - but it is still just a thought, and it passes.  


The past few days will fade into a succession of similar days, but I thought cataloging them here would give anyone interested a flavor of what it is sometimes like to travel with a kidney transplant.  Well shit, not even that - no impatient, no midnight hospital run, this one was a freebie - though not without a considerable amount of worrying and stress to C and I.  Still, it is always worse for someone somewhere.  I'll take this lot by twos, I'm lucky as hell.  Thanks for reading!