Monday, January 17, 2011

A Little Set Back

Well...today definitely did not go as planned. Jim had a typical follow up DTI (Dallas Transplant Institute) appointment this morning and we were thrown for a small loop. As usual, we have labs drawn and they closely look at his creatinine and pancreatic enzymes. This morning his pancreatic enzymes were on target but his creatinine had jumped up quite a bit. On Thursday it was 1.6 today it was 1.9. Now this may not seem like a large jump numerically speaking but in relation to function this is a rather large decline.

What does this jump mean? It can mean many different things.
1- Jim is dehydrated
2- His one anti-rejection medication is too high
3- There is a build up of fluid around the kidney preventing it from doing its job
4- Rejection
5- Circulation difficulty
6- A weird fluke
7- His old kidneys are completely giving out

Plan for the following 7 possible causes:

1- Jim is going to drown himself with water over the next two days in the hope that this will lower his creatinine level again.
2- His anti-rejection medication level today was fine therefore the decline in function is not due to this unfortunately. I was hoping for this answer for it would be an easy fix but no such luck.
3- They completed a preliminary ultrasound on the kidney finding a small fluid pocket around the organ but nothing that was concerning or enough to prevent the kidney from working properly thus this cause is eliminated.
4- Rejection- the forbidden word when receiving a transplant- I feel bad just typing it. Well, this is always a possibility. In order to rule this out we have to wait till Wednesday when he gets his labs drawn again and we see what the creatinine level is. If it is still high then he will probably receive a more in depth sonogram and then further treatment as needed. This treatment can be anything from a biopsy of the new kidney, an angiogram, admission for stronger anti-rejection medications, and lots of things I don't even know about yet.
5-While doing the ultrasound they found that one of the arteries going into the kidney has a high amount of pressure behind it. (in general it is currently acting like a hose with your thumb blocking the nozzle so it sprays harder) The surgeon reported that this may just be a small kink or twist in the artery or it may be a thickening of the wall meaning they would need to further explore this for solutions.
6- A fluke...really? Who knows? Stranger things have happened
7- Apparently his old kidneys are still working a bit. (for those of you that don't know- they do not take the old organs out so Jim currently has 3 kidneys and 2 pancreas' (sp) When the old kidneys fail completely there can be a slight spike in his creatinine level.

I am sure that there are other possible reasons as well that I am not smart enough to know about but these are the ones that I learned about today.


On a completely different note, in visiting with the surgeon he approved Jim going to the wound care specialists for his incision. Do not be alarmed by this- I am just over protective. (as if you didn't know this already) Since I have done wound care in the past I was probably a little more demanding than his average patient's family. In order to get the dressings that I want for the incision we had to be referred so I am happy about this event. Jim currently has about 3 places that are not closing completely and in order to pack them appropriately I wanted him to be referred. We should hear from them this week and he will go and be evaluated and hopefully some new dressings will be implemented.

Prayer Requests: Jim is NOT in rejection and this set back is minor, strength that I do not completely lose it, patience while we wait to see what is going on, comfort for the donor family, knowledge for the physicians

Bible Verse: "Therefore as God's chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience." Colossians 3:12

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