I was at UCLA most of the day, getting lab work done, taking an EKG, having chest x-rays, meeting with the transplant coordinator, the nephrologist, and the surgeon, and filling out admissions paperwork. I won't know the results of the final cross-match and the EKG until Thursday, but as of this writing, things look provisionally good.
There is still some concern about my heart. Due to fluid overload and perhaps due to a lingering infection and/or an allergy, I have had difficulty exercising, since excess water has made my abdominal cavity as tight as a drum, thereby putting a lot of pressure on my heart. Last night during dialysis, I was able to pull off 8 pounds of water weight, and yet I am still edemic. Dr. Wong, the UCLA nephrologist, said that I should continue to use strong dialysates in order to pull off more water, even below my so-called dry weight. Just having lost the 8 pounds last night, I feel a big difference. Walking across the room has been difficult for the last few days, but today I walked up stairs and much longer distances with little problem.
My surgeon, Dr. Veale, wants to check with UCLA cardiology to get its go-ahead. I sure hope this is a hand-waving or a cursory appointment that would mean another trip to UCLA this week.
Interesting that both doctors checked my lungs. One found evidence of water on the lungs, the other didn't. The subjectivity of medicine.
Dr. Veale said I looked great, that he wasn't used to seeing patients look as good as I do, and that it was hard for him to believe that I am the person who has such a long, arduous, and complicated medical history. That was nice to hear.
I asked Dr. Veale if there was any way that he could minimize the cut he'd have to make. He said that, given my history, there is a strong possibility that he'll make a cut on one side but will be unable to find any good veins with which to connect the transplanted kidney. That will mean he'll have to make a cut on the other side, hoping to find good veins over there. I asked if there is any way he can find out where the good veins are prior to surgery. He said, yes, with a CAT scan. He said most of his patients are overweight and so aren't concerned about scarring, I guess because their fat covers up the scars. He said he would love it if every patient was given pre-op CAT scans, but they're around $3,000. I asked if he could write the request in such a way to highlight the medical necessity of knowing where the good veins are so as to minimize the risk of infection and excessive bleeding and to reduce the time in surgery. He said he'd give it a try. The fewer cuts on my cute, little belly, the better.
Found out that my donor is a 36-year-old woman who wished to donate to her husband but was incompatible with his blood type. So I'm getting a young kidney. More good news.
The most wonderful news Dr. Veale saved for the end of our visit. He said that recent research, soon to be published, shows that the transplantation of
islets of Langerhans, the cells that are responsible for the insulin-producing function of the pancreas, is now just as successful as transplantation of the entire pancreas. Moreover, the former does not involve surgery, only an outpatient visit in which a syringe full of the cells is injected into the body. They adhere to the liver and begin functioning, producing insulin so that the patient can be free of shots or, in my case, an insulin pump! Transplantation of the pancreas, on the other hand, requires about six hours of surgery, plus the accompanying risk of injection and bleeding, in addition to weeks of recovery. Wow, to think that by this time next year, my body would be producing its own insulin for the first time in 40 years!
So as of this writing, all looks good. Should know for sure by Thursday. Thanks to all who have kept me in your thoughts and in your prayers. Please keep those good vibes coming.
