Boy oh boy… still reeling – as I am sure you all are – from all of last month’s revelry over (no, not March Madness) National Kidney Month!

Of course you know that no  kidney transplant would be complete without the concomitant twice daily dose of pharmaceuticals.  Mmmm… immunosuppressants… almost like ice cream with sprinkles.  Am I sensing a certain jealously amongst the readership??

On the timeline of medical history, renal transplants are a very recent achievement.  Scientific research and documented procedures were just beginning to be used for this procedure near the start of the twentieth century, and success was meager (short lived) even with the animal “volunteers”.  Not until 1954 was the first truly successful kidney transplant completed between two identical twin brothers in a Boston hospital. The brother’s identical tissue match helped eliminate the rejection that would normally occur by introducing non-matching tissues. This became the great hurdle for genuine long-term success with kidney transplants: rejection due to tissue mismatch. By the 1980′s great strides had been made in the development of anti-rejection drugs (immunosuppressants).  These medicines, along with the continual improvement in transplant procedures have greatly improved the success rate of kidney transplants.  For which I am forever thankful.

A few minutes each weekend are now dedicated to organizing my little box of pharmaceuticals for the week ahead. A far cry better than organizing my schedule to accommodate three times weekly dialysis.  One more thing for which to give thanks.

Each of the two anti-rejection drugs must be taken on schedule morning and night.  And while there are only two of them, the correct dose requires several pills of each drug along with some vitamins and an anti-viral medicine.  Colorful and a bit daunting.

Early on I secured a wristwatch with an alarm to remind me to take this medicine at the appropriate hour. Unfortunately the watch chime is not unlike the unceasing ring in my ears (another bonus from this whole experience).  It is not uncommon to have my watch beeping away at 8am or 8pm while I carry on in my natural state of blissful ignorance.  And receiving subtle reminders (nudges, stares and “Ahhh-hem”!) from family and coworkers that my dopey alarm is annoying them.  Rumors have been floated that they may fit me with a canine shock collar.

8am and 8pm don’t always arrive at the most opportune times… work, church, concerts, meetings… but I usually remember to silence my watch alarm or sometimes not.  I remembered to silence it last Friday night at the Gammage Center while we heard the ASU Symphony Orchestra and Choir.   At the intermission I nimbly tripped past half a row of concert-goers to find a water source.  I found a pair of drinking fountains near the hall entrance, poured my little packet of about nine brilliantly colored pills and capsules into my palm, deftly thrust the entire fistful into my mouth and bent to wash them down…

I just used nimbly and deftly in same paragraph.  I apologize for this egregious overuse of these lesser known adjectives.  Sometimes that happens with some of the more unruly adjectives that sneak onto the page and parade themselves shamelessly about as though we could not live without them.

Gammage opened in 1964 and is the only public building in Arizona designed by famed architect, Frank Lloyd Wright.  The concert hall has terrific acoustics and none of the three thousand seats on three levels are beyond 120 feet from the stage.  Broad sweeping walkways inside and out make it accommodating to all.  And by all we need not limit ourselves to the human variety, for apparently I had in my haste to locate a drinking fountain stumbled upon the drinking fountain designated for Tempe’s burgeoning population of gerbils.  I gave the rotating handle on the bubbler a mighty twist and out of the polished brass spout rushed about six little drops of water.  Plenty enough for a domesticated thirsty rodent, but scarcely enough for a slightly less domesticated adult human male with a bag of pharmaceuticals beginning to stick to his tongue.   Again and again I twisted the fountain handle, each time producing a mere glimpse of the precious liquid before receding back into its underground vault.

Surely the adjacent fountain would not be a Gerbils Only fountain.  I glanced at the man next to me as he raised his head from the fountain and gave a look that said, “I’ve no longer any compassion for gerbils”.  Gammage’s sweeping walkways are looking very very narrow and very very crowded as I wend my way through the masses in pursuit of some liquid relief.  Could I just swallow them? I wonder as I move through the crowd.  I could try, but if I fail and this gradually dissolving array of pills stops short of my stomach we may be watching more than Beethoven tonight. Finally, there it was: a real drinking fountain with a real gushing stream of water and real humans drinking from it.  A few gulps and the drugs were freed from the roof of my mouth and my tongue.  On this night I am especially thankful for cool clean water.

Oh, so you think my story a stretch… ASU.  Maybe a little bent out of shape over the use of their fountain.

One year ago there we were… waiting, praying, talking, trusting, hugging, preparing, and finally rolling down the hall on a (God Willing) once in a lifetime journey.   What an amazing story we have to tell of Divine providence and mercy, of friends and family that have surrounded us with untold prayer and kindness, and of good health and recovery that has exceeded our highest hopes.

Last week I visited Mayo Clinic and Hospital for my one-year follow up exams.  Day one was a visit with the dermatologist.  This is made necessary due to the immunosuppressants that are now part of my daily dose.  These tend to compromise my ability to resist skin cancer.  The dermatological department has their own special supply of “gowns”.  More like bibs.   Like you were headed for the Outback Steakhouse to get a plate of ribs, but in your undies.  In spite of the apparel the results were good, but strong precautions in the sunshine will be a way of life from here on out.

Day two was a fasting blood test and a follow up biopsy. They must have been experiencing a shortage of blood samples to test, ’cause they drained about a dozen vials off before I ran dry. The biopsy was accompanied by a renal ultrasound.  The ultrasound really is a fascinating procedure as they squoosh the transducer (probe) over the site of the new kidney.  The monitor displayed a vivid (shadowy sort of oval) image of the kidney in bright red, blue and yellow colors and the shooka-shooka-shooka sound of blood coursing through the arteries.  The biopsy is a lot less fun, but its all part of the package.  The biopsy syringe draws a pencil-lead diameter by 3 centimeter sample of tissue from the kidney.  Ow.  From this sample the doctors will be able to detect any signs of rejection, inflammation, viruses or DingDongs.  A one hour trip to the recovery room and we are on the way home.  Lunchtime.

Day three was a short trip to the Clinic for bone mineral analysis (BMA). There is apparently some connection between transplant recipients and decreased bone strength.  Was this in the fine print? The BMA test is short and requires laying on a table while a giant arm moves slowly back and forth over the patient, and since the technician didn’t run from the room during the procedure I’m guessing it did not include x-rays. From here I was off to the hospital to collect my 24 hour blood pressure cuff (murse).

Day four was to return my blood pressure cuff and a final visit with the doctor to review the findings from all of the tests.  His assessment: a great success!  The blood test showed all of the many factors tested were within the acceptable ranges.  The creatinine level that had before the operation been hovering above 4.5 (dangerous), has now fallen to 1.5 (good).  The biopsy showed no indicators of rejection or inflammation. Basically, he was just about as pleased as could be with the overall results of our transplant.

How good is God that He should pour out such goodness on us?  How good is God that He should provide me with such a bride?

Oh, the depth of the riches and wisdom and knowledge of God! How unsearchable are his judgments and how inscrutable his ways!

What mercy we have that every 52 weeks we get to recount all the blessings and mercies we have received over this last year.  And this is one forgiven sinner who has drawn more from the springs of grace, mercy and providence of God than ever I could have ever imagined.

2010 started with just a touch of trepidation – having scant experience with actual kidney transplants – and ended with the joy of welcoming our first grandchild into this world.  And in between we experienced the comfort of a thousand friends and family that prayed for us and cared for us, the happiness of celebrating our 30th anniversary, and the triumph of ending the year with considerably better health than that which I started.  And sprinkled throughout many more blessings than I could count.

2011 looms large before us… hmm… what wonders has the Almighty in store for us in this new year?

“Who is like you, O Lord, among the gods?

Who is like you, majestic in holiness,

awesome in glorious deeds, doing wonders?

1.  Tomorrow at 4:02am at a Walmart somewhere in Indiana an anxious black-friday customer will have a near death experience in aisle 33 involving a Barbie Range Rover and a George Foreman Grill.

2. Today marks ten months since I received my new kidney!  Wow, that went by in a hurry!  These last months have sped by with nary a hiccup.  Okay, a couple of insignificant little hiccups and maybe a burp, but mostly just nary.  Nancy and I have healed up wondrously and my most recent blood tests have shown that the new kidney is performing just as it ought.

and

3. Thanksgiving has arrived.  Not that we should find but a single day in 365 to make known our gratitude, but rather a single day of the beginning of 364 more to follow that will each one be full of wide-eyed wonder and thanksgiving more heartfelt, more joyful and more full of praise than the one that went before. Happy Thanksgiving!

Oh give thanks to the Lord, for he is good; for his steadfast love endures forever! (1 Chronicles 16:34)

How about that!  Maybe I can get another fifty years out of this new kidney.

Yes, I have wandered away from this blog for the last few weeks, but I have some excuses.  Not good excuses, more like weak alibis like … work … and well … other stuff.  Okay it was mostly just blogger’s block and laziness. In a word: sloth.

I’ve been back at work for more than a month now and in many ways it feels like I never left.  Time now for a vacation that doesn’t include doctors.

Spring has sprung here in the desert Southwest.  Our orange trees are loaded with more fruit than we could possibly consume ourselves. Any visitors are required to take a bag or two with them. Plenty more to be had for anyone that wants to stop by. Recently the orange blossoms made their annual appearance covering the trees like a blanket of snow and flooding the neighborhood with their intoxicating aroma … unless of course you are one afflicted with pollen allergies, then it was just misery.

My recent visit with my regular nephrologist went very well, all of the blood tests show the critical measurements to be right where they ought to be at this stage.  We have so very much for which to give thanks.

So good in fact … that yesterday morning Kristen and I participated in the Sixth Annual Pat’s Run, a 4.2 mile charity run/walk (jog, slog, waddle, dawdle, creep, crawl and sprawl). The Run is named for the Arizona State University and Arizona Cardinal allstar football player, Pat Tillman who left a very lucrative NFL career to seek a higher calling as a US Army Ranger.  Pat lost his life in the line of duty in Afghanistan in April 2004.  This is the first time I have ever participated in an event like this. It really is pretty amazing to see about 20,000 people lined up for about a half-mile in the street waiting to run the course. We ran down the street across from the ASU football stadium, across Tempe Town Lake (pond by midwestern standards), through a neighborhood (stopped momentarily to take my schedule-specific medicine), back across the lake, and back to the stadium where the run finished by running through the tunnel and crossing the 42 (Pat’s college number) yard line. Now, before any disillusionment should set in, let me confess that for me a distance run is anything further than home-to-first on a softball diamond.  So 4.2 miles is really approaching marathon distances as far as I can tell.   It took Kristen and I about ten minutes just to get to the Starting Line, which was also the last time I saw her as her ponytail bounced off into the distance ahead of me.  I was able to jog the first mile, but after that it was a bit of walking and a bit of jogging for the rest of the distance.  I finished in a little under an hour, or about 20 minutes behind Kristen, or about 40 minutes behind the front runners, or just before sunset, but… I finished! Again, it was fascinating to see the flood of participants on the field and in the stands of the stadium, every size and shape and age to be had.  And when those seven and eight year old dwarfs would streak by me with their dads, I would try to console myself with - yeah, but I just had a kidney transplant – knowing full-well I couldn’t run four miles on the best day of my life.  Maybe next year I’ll run the full 4.2.  How very good God has been to me that I have this strength to continue this life’s journey, may I use it for His glory.

One week hence (04.25.10) Kristen will be presenting her Senior Recital at Arizona State.  This is her final recital for her bachelor of music degree and will include works by Liszt, Beethoven, Bach and Schumann.  Come for the Music, stay for the cake.  If you can make it, it will be worth the trip.

And finally, all the more to give thanks for … Nancy and I are going to be … drumroll …  Grandparents! Yes, our daughter-in-law, Heather is expecting our first grandchild.   Congratulations James and Heather, God bless you on this amazing journey! “Behold, children are a heritage from the Lord.”

Welcome to Kidney Month (Kidney).  Be sure to take your kidney(s) to lunch and express your appreciation for all their tireless labor on your behalf by tossing down a tall cold glass of water.

And … yesterday was National Potato Chip day! Potato chips only get a day, kidneys get a whole month to celebrate. Party on, dude.

And … yesterday was pi day (3.14) for the math geeks.

Well I made it through my first week of work.  OK it was only a three day week, but a week nonetheless. Everything went pretty well, it helped I was able to clear my desk prior to the surgery, so it was still pretty empty on my return.  Except for a bloated email box.  Everyone in the office has been very welcoming and mentioned how much they appreciated the updates they had received from the guest blogger. Many commented on how good I am looking now, which can only mean … I musta looked like death.

There has been a bit of speculation from the sidelines as to certain unintended side effects that may occur as a result of adopting a girl kidney into this steely masculine frame. While it may very well be true that Nancy would prefer that I finally absorb some sort of rogue organizational chromosome, or the find-the-right-parking-space-at-the-mall gene, or the ability to multitask (as in: notice the screeching smoke alarm even in though the game is on). And though the early results are still coming in, thus far the verdict is nah.

Granted, entering into this process was not without a significant number of uncertainties. What if I come out of this throwing like a girl? Will I start thinking about what to wear, before I actually get dressed? Will I someday really get tired of that wallpaper pattern? Will I wonder how I look in these jeans? What if I start talking … about stuff … a lot? Will heading to the bathroom become a team event?

It gives me the shivers just thinking about the catastrophic potentialities.

Now, where’s that chocolate I had in my desk? I know I hid it here somewhere …

good news

Saturday marked the fortieth day of our recovery. And as with a number of other significant Forty’s in the historical record, it marks the conclusion of a period of testing. And, Praise God, we have by His grace passed the tests. This week I went to Mayo for a final blood test, an ultrasound, a biopsy, a twenty-four hour blood pressure test, and a final visit with the Mayo nephrologist, Dr Harini A. Chakkera. Dr Chakkera reviewed the results of these many exams with us and the results all came back with no failures or negative marks.  The ultrasound and the biopsy showed no signs of rejection.  The blood test showed the level of antirejection medicine (Prograf) to be within defined limits for this time in the transplant recovery, and the level of Creatinine to also fall within acceptable guidelines. God has been so very merciful to us.

I was once again up early today for a fasting blood draw, but now I can have them done locally instead of driving to Mayo in North Phoenix which will save me about two hours and 75 miles for each test. These draws are pretty much standard practice for me now, but I still don’t watch. Some of the ladies at Mayo are surprisingly efficient (I’ve yet to see a male phlebotomist). Early on in the qualification process to be a transplant recipient, I visited one phlebotomist (someone trained to draw blood) who had a number of merit certificates on her wall. One of her certificates was for processing above 2000 blood draws in one month. That’s efficient.

Today was the standard – sleeve up, sit, tourniquet, clean, dry, (turn head) stick, gauze, tape.  Except for that momentary interruption when the previous patient, an elderly woman, wandered back into the room carrying her urine collection bottle and the collection “hat” from the toilet. Holding it up in front of the technician, she asked, “Is this enough”, as she offered up the bottle with its very scant contents.

“Yes, that’ll be plenty.  Just set the bottle here on the counter”, came a bit of a flustered response.

“This counter?”

“Yes, anywhere there will be fine.”

“Is my name on it?”, holding it to the light.

“Yes, dear. Your name is on it”

“The hat too?”

“You may put the hat in the trash.”

Welcome to my world. A little bit of Candid Camera mixed with a double portion of Twilight Zone. And all this time I was just operating under the old rules of fill-seal-wash-leave.  I guess once full retirement kicks in you are allowed to break up the old urine sample routine by turning it into show and tell or perhaps a comedy bit. I can hardly wait.

Well tomorrow is the big day. After six weeks and two days it’s time to return to work and make myself productive again. Though I may feel a relapse coming on around 6am in the morning. I feel like a schoolboy returning from summer vacation – except for the new lunchbox. I haven’t had six weeks off since … I was a schoolboy. These several weeks have moved by so quickly it scarcely seems possible that it has been so long. And it will be only a moment before all of this is a distant memory, and aside from these chronicles and a few battle scars all will have faded away. I hope for myself that the lessons learned and the mercies received will not be soon forgotten, but rather a constant reminder of the goodness of God and the blessing of God-given family and friends.

one more needle

The countdown is on for our final followup visit to Mayo, possibly this week. Today we again were up at 500am in order to meet a 645am appointment time at Mayo (YAWN) for a fasting blood draw. The standard blood draw that I’ve experienced over the last five weeks has been three vials, today they went for the mother lode – 10 vials.  Pardon me! I’d like to retain a few ounces for personal reasons that have to do with remaining conscious.

One of the last procedures that needs to be completed is a biopsy. Or if you prefer, according to Aunt Voula, “So I go to the doctor, and he did the bio… the b… the… the bios… the… b… the “bobopsy.” (My Big Fat Greek Wedding) I had one of these bobopsies done about eighteen months ago when this whole process began and now here I am again, but hoping this time the results are much much different.

While I check in for the procedure, my designated driver Nancy, wandered off to locate some coffee. Which she was able to discover attached to a cinnamon roll. Yes, it is Tuesday at the Mayo cafeteria, which means it is cinnamon roll day (as also Thursday). Little known but useful factoids.  Unless of course you have doctor’s orders to arrive fasting. Mmmm, how’s that roll taste? “Mmmm, yummy, but kind of warm and gooey, I may need a napkin.” … I believe there may be some subliminal (or brazenly intentional) payback here. About 23 and a half years ago we spent a long night in the hospital waiting for the arrival of our son, James. As it closed in on midnight, hunger drove me to hunt down a hot submarine sandwich which I, at great inconvenience to myself, consumed between Nancy’s contractions. Oops.  Lesson learned: women in labor tend to be insensitive to their husband’s nutritional requirements.

A biopsy is the removal of a sample of cells from the body for examination. A kidney biopsy is normally completed by extracting a sample of cells using a large hypodermic needle. When I first had this procedure, I laid on my stomach and the samples were withdrawn from my kidneys through the back using the assistance of xray and ultrasound to accurately guide the needle. The cellular examination of these initial samples showed the deterioration of the kidneys and confirmed the diagnosis of the nephrologist.

Today the biopsy was preceded by an ultrasound of my new kidney. Fascinating to see the shadowy image of the kidney on the monitor as the technician moved the hand held transducer over the new kidney, splashes of red (bloodflow toward the transducer) and splashes of blue (bloodflow away from the transducer), the iliac artery and iliac vein clearly visible.  The imaging machine recorded the pulse of the blood movement and I could hear the shooka-shooka-shooka as the line progressed across the monitor. A radiologist will analyze the recorded data, but it all looked good to my well-trained eye.

Next up the doctor would arrive for the biopsy.  This time, because the new kidney is located toward the right front of the lower abdomen, the sample will be extracted through the front near the healing transplant incision.

“We’re going to wash the area with this brown-orange soap that will take a month to wash off, and then we’ll apply a local anesthetic to numb the area.”  Local, apparently my legendary intolerance of all things painful has escaped them. Why use the local? Why not the regional or better yet the international formula?

With the assistance of the ultrasound, the doctor inserted the needle into the new kidney and with a loud CLICK the sample was extracted. That’s it, all over just like that. Isn’t that just like life, plenty of anxious anticipation, followed by near-disappointment at the painlessness of the moment. “… do not be anxious about your life, … Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they?”

Again I stand amazed at intricacies of the human body and the wealth of information that can be gathered through the examination of a small syringe of kidney cells.  Humans emerged from the primordial sludge; not a chance.

A few more minutes waiting to verify that the new wound is not bleeding then time to go home. I’m wondering if Nancy felt a sting when the needle poked her donated kidney.

conspiracy theories

I am not one that normally subscribes to conspiracy theories, namely because they lead to paranoia and calling in to late-night radio, but there are times when the facts just simply outweigh the contrary probabilities. For instance, there is a stretch of road (Warner, between Priest and Hardy) that runs adjacent to my workplace. There have not been two consecutive weeks in the last ten years that I have worked here that this road has not been decked out in orange cones, barricades and backhoes.  CIA, KGB, stimulus funding … I’m just sayin’. And if you find that theory implausible check this – - I have been home from the hospital for a month now. Nearly every day I have attempted to take a doctor recommended nap (I’m working on a prescription for when I return to work).  Nearly every day, no matter the napping hour, I have barely begun to slip into an altered state when the phone rings or the doorbell rings. Thus far no bugs or hidden cameras have been found. Spies can be very crafty. I’m guessing maybe satellite surveillance.  Simply random opportunists and telemarketers?  I think not.  Though callers should be aware that Nancy (with prompting from our daughter) has mischievously taken to returning affliction for affliction upon the telemarketing community.

the next day… My first night’s sleep in the hospital consisted primarily of an extended series of nods and short naps frequently interrupted by honking machines, pulsating inflatable stockings, intermittent blood pressure cuffs, nosy nurses and twinges of pain.  But the night went quickly and I only needed to use the pain medication button a few times; this I attribute to my extraordinarily high tolerance for pain, Nancy attributes it to the extraordinarily amazing kidney, and others attribute it to my extraordinarily thick head.  Huh?

By 600am I am going on my 48th hour of coffee deprivation, small wonder I don’t feel good, it’s surprising I even have a pulse. At 630am I discover that my babysitters have left my cellphone within reach, surely someone in my directory has to be up at this hour. So I call my sister, Sue, in Colorado. She has to be up for work by now. Except that she, her husband and her cellphone are in Hawaii where the local time is about 330am. Who knew? When the party you have dialed answers the phone with “herrow?“, either they have just knocked down a dual dose of NyQuil or you have just been scratched off of their Christmas card list.  We had a good, though abbreviated visit which she will probably just recollect as a really weird dream.

Shift change at the nurse’s station. My RN for the day is Jim and his trusty sidekick, Student Nurse Regan. Mayo is a teaching hospital, so the full-time staff frequently makes their rounds with a learner in tow. I found the process to be fascinating as he asked Regan the appropriate steps to follow or the reason for a specific procedure.  Good to know she had a competent mentor to lead and instruct her through all of this. I guess they gotta learn somewhere, it’s just more comfortable when the learning is on the patient down the hall.

For breakfast: a veritable buffet of ice chips.

wired

Today marks one month since our surgery on January 25, and to mark this special occasion we went on a date to one of our favorite places to hang out: Mayo Hospital. We’ve got to stop meeting like this. One more blood draw and followup behind us, only a handful more to come.

If my health continues to improve as it has thus far I will have my last followup visit with Mayo on March 5 and be released to return to work on March 8, a mere six weeks after the surgery! In my opinion, nothing short of amazing. There will be some future appointments at the four month mark and the one year mark, but next week will be the end of the multi-visit weeks.  And for the next few months I will need to have weekly blood tests to monitor the health of my new kidney and to monitor the amount of anti-rejection drugs in my system. In the grand scheme of it all, these are small inconveniences, though I do look forward to a time when blood draws are a rarity.

surgery day … As the day wound to a close I was introduced to the overnight RN, Sarah. She would be by every hour throughout the night to check my vitals, measure the kidney output and bring me more of those yummy ice chips. The IV bag hanging near the head of my bed was draining into my neck at a pretty significant rate in order to flush and exercise my new kidney. The kidney’s measured output was recorded on the whiteboard in my room, most of the time at a rate near one-half liter per hour. I’d say my new kidney was getting a good workout. How grand is that. This new kidney that was just hours ago snug and happy and working away for Nancy, is now snug and happy and working away for me. These bodies God has given us truly are astounding in their intricacy, versatility and adaptability. “All things were created through him and for him.“

On my left arm was an automated blood pressure cuff that was activated about every sixty minutes through the night. Attached with adhesive squares across my chest was a six-lead electronic monitoring cable.  This fed the electronic monitor next to my bed displaying my heart rate, blood pressure, and itunes list.  On Tuesday they would remove (tear away) the cable and adhesive squares with the exception of one square that mysteriously appeared when I was finally able to take a shower on Friday.

Attached to the right side of my bed was a special cord with a push button at the end.  Each push of the button provided my system with a dose of pain neutralizer. This came in very handy on this first evening in the hospital. I’m looking into having one installed in my truck to help me deal with the Phoenix traffic.