Biopsy Results! And a full Wedding Weekend!

I'm moving a bit gingerly today, in part due to a full weekend of brunches, lunches and fun wedding times.  The wedding was beautiful - great weather, lots of great family and friends to celebrate with, and a memorable service and reception.  Maggie and Pete were happy throughout.  I was honored to have been in the party, to stand at my sister's side as she made her pledge in front of god and everyone. There are some great photos floating around on Facebook, thanks in large part to my cousin Andy Zimney - great photos Zim!

The other news of the weekend, the biopsy results!  Turns out my creatinine was high because of an 'acute cellular rejection' with some small incident of IgA nephropathy.  Of the various types of rejection, acute cellular is the least dangerous so far as I understand it.  It is also much more hopeful than a chronic failure which would be untreatable.  The nephropathy is likely a slow burn type of issue that may or may not be an issue.  It is not terribly well understood largely because it isn't often an issue.  A cellular rejection tends to slowly raise the creatinine levels as the surrounding tissues attack the transplanted kidney.  As is standard, I got a three day dose of steroids to reduce my immune system and give the transplant a chance to cozy back into my belly without being harassed by my t-cells and what not.  The steroids are not without their side-effects which added to the general excitement of the weekend.  Synthetic prednisone mimics a bodies stress response, which is what we all experience when we are under stress.  The feeling of being on a relatively high dose of prednisone is similar to being totally revved up, where it doesn't take much to start a rambling conversation or to obsess over one thing or another.  Being somewhat prone to rambling conversations and obsessions already, the effects on me were both familiar and a bit tiring.  This is the other source of my ginger movement today.

After bopping around all weekend with visits to the Abbott infusion center, dinners, the wedding and so on, this morning I've been slugging through a fog, where my body feels a bit disconnected from my brain - my self somewhere in limbo between them.  It's a bit tricky to track my thoughts enough to put down something coherent.  There's a thickness behind my ears and eyes and my muscleys are all mooshy.  On days like this it is hard for me to determine cause and effect - to suss out how much of my body is reacting to the drugs or stressful weekend of just a night of bad sleep.  Consequently, being an introspective chap, I lay about searching out how I might respond to this situation - or more simply how I think of how I'm doing.  Am I tired?  Am I reacting to steroids?  Am I coming off an emotional week where I was fairly convinced I was about to re-enter the doldrums of dialysis and waiting?  All of the above?  Maybe this is never a simple question - 'how are you doing?' - and we are only able to fake through it when our circumstances are stable for long enough to present a convincing story.

It is now Wednesday - I gave the thing a few day's space to see if anything cleared, and it has somewhat.  I'm a few days away from the steroid run and my body has somewhat settled out.  I've had a follow-up blood draw yesterday which held the creatinine low enough to keep everyone happy.  Coming off of this will take a few weeks; I remember the feeling of just starting to relax after having the second transplant (the first going so quickly), how it took months before I started to feel like a regular person in the ways it seems to count.  Normal walks through the grocery store and not anticipating taking my morning or evening drugs.  Ellie and I have a few more days at MITY before drawing another great session to a close.

Sorry this took so damn long to post - and thanks for reading!  

Biopsy!

C and I showed up at Abbott at 10:45 and I was admitted to unit 44 - a daytime unit used for overflow and short inpatient procedures.  My blood pressure was a bit high, even after I doubled my metoprolol for good measure.  So after they got an IV in and checked and rechecked BP, we got bumped in the radiology line and didn't have the procedure until 2:30 (it was scheduled for 11:30).  

C and I passed the time with conversation, some reading and a nap.  At this point I was undressed and in my hospital 'gown.'  90% of my stay was lying in a bed - doing nothing, needing to do nothing, and feeling fine.  But just wearing the clothes of the sick and lying in a bed that automatically adjusted to my movements and hearing the soft voices from the hallway was a lot to handle.  I think what got to me was the atmosphere, what the place felt like.  My caregivers were attentive and well-intentioned, but in their absence a person is almost oppressively IN a HOSPITAL without any recourse to leave.  It is this state of suspension, removed from the movement of the world, from the weather, from the normal passage of time that wore me down yesterday, along with my anticipation first of the procedure and then of the results.  The biopsy trip reminded me of what had been so inexplicably hard that first time through ten years ago.  

My Doc put the kibosh on pictures, which is too bad because as C told it, there were some neat images from the procedure.  The biopsy was an 'ultrasound guided biopsy,' which meant that a radiologist (or assistant of some kind) held the ultrasound while my Nephrologist poked in the needle.  The ultrasound is a standard thing - the same used in all ultrasounds and seen in movies - where there's the handheld bit and the grayish projection on the computer screen along with the goop that conducts the ultra sounds.  The needle used in biopsies is a real doozy.  It has a cylindrical handle with a big button on the top and a needle end about eight inches long, about the diameter of a metal coat hanger.  While it is pretty menacing, it doesn't necessarily feel like much as they numb the hell out of the belly area where they go in.

Because the transplanted kidney is in the front of me, located where you might rest your hand if you put it just inside of your pants.  The biopsy, consequently, was about two inches below my belt line.  The helper person, a female John C Riley, located the spot with the ultrasound where my doc would go in and he numbed it up with some lidocaine, which is ironically the most painful part of the process.  A short pinch and he let it set for about 2 minutes.  He then inserted the mega needle saying 'pressure is normal, pain is not.'  I did feel a bit of pressure, but the insertion was remarkable smooth.  I could feel the needle catching my skin on the way out a bit, not to mention see C's face, but I was totally numbed up and could only feel the movement.  

I have to take a brief aside here to say that my first transplant biopsy, in the spring of 2002, was thoroughly awful experience.  I was biopsied by a resident who shook, sweated and needed to make a second excursion into the barely permeable expanse of my belly.  Each journey of the needle through the layers of my abdomen were jerky and hesitant; he struggled to get the needle through and kept telling me to relax.  I'm not sure what kind of patient I was at the time, but I am grateful beyond words for the professionalism and sure hand of my current doctor.  The procedure, from cleaning to band-aid, took about five minutes.  Easy peasy.  

We now wait for the result.  It could go a few directions - everywhere from staring over to nothing changing at all.  I continue to attempt a balance regarding the impact and scope of this episode.  It brings up a lot for me and I'm working through that stuff, here mostly.  But I'm also well aware of how much worse everything could be.  My basement has some water in it after all this rain, but it's nothing compared to Duluth.  

Thanks for reading!