bump in the road

Mom developed a fluid collection around the new kidney, which caused an "indentation" on the kidney, because of the pressure. The kidney appeared to be functioning well, however the surgeons recommended drainage of the fluid because so much was leaking from the wound. The drain was placed by interventional radiology on Friday 7/18 and seems to have worked. Now we're just waiting to see if the collection reaccumulates.

Mom feels quite well, and is going on four walks a day and has a good appetite.

Mary Jean and Max arrived yesterday from Cedar Rapids. Welcome to Baltimore, hons.

Hon is short for honey, and it's the quintisential Baltimore word. We even have Cafe Hon and Hon-fest.

That's all for today!
Sarah

update

Mom's still admitted to UMMS, working on getting her medication doses adjusted. She's very stable, with a good appetite, and the kidney is working well. She's working on resting and recuperating, and we expect her home in a few days.
-Sarah

Back to UMMS

Mom was re-admitted to UMMS tonight in order to adjust some of her medication doses. She is in good spirits and will get in touch with everyone when she is discharged in approximately two days. Kidney is functioning well :)
sarah

all's well that ends well

Well the living related renal transplant is Complete! On July 2, 2008 I went to the hospital. Mom had been admitted 6/30 for a heparin gtt, immune suppression rx and bowel prep, all of which she handled like a champ. I had pre-anesthesia testing on 6/30 which showed a low k (3.3), and trace hematuria (although only 0-2 rbc--i think it was myoglobinuria from the hard work of moving) so the tranplant nurse called 7/1 and threatened to cancel the whole thing. I had a major tantrum, and they agreed to repeat the labs on the morning of surgery. I ate bananas until I yacked (literally) and drank oj, and rested and drank about 4 liters of water to try to get rid of any myoglobin.

I got to UMMS a little after six on 7/2, and gave a urine sample and got an IV and blood work. I was still pretty uncertain about whether we would be having surgery or not. My senior surgery resident was my friend Jared from medical school, who'll be joining me at Hopkins for his fellowship next year. Coincidentally, Mom's senior resident was a surgery resident I knew from residency and fellowship. After almost two hours the student nurse anesthetist showed up with a syringe of versed and said we were a go with a k of 3.5. all i said was high-five for 3.5. I found out 3 days later that there was still trace blood in the urine, but I guess it didn't matter. I hugged by dad and stepmom and that's the last thing I remember until 6 pm in the pacu.

The nurse kept telling me to quit crying and my belly would hurt less. I wanted to see my mom, but they said no. Apparently she was still intubated, and pretty combative herself. I told the nurse Michele that she was a very mean person and to get OUT. I was nice to my tech, Toni, who was nice back. The charge nurse, Randy came over to yell at me and tell me Michele wasn't mean, but he was FOS. She was mean. Lots of people are teary as they come out of anesthesia, that doesn't mean you should be mean to them. Thankfully she was a rare exception to a generally kind group of doctors and nurses.

Anyway, I did finally get to see mom in the PACU before I went to the floor. She was still intubated, I guess because she was acidotic, but she was able to communicate. That night on the floor I stayed in bed. I had 3lpm NC and kept desatting to the 80s, I guess from sedation and mild OSA. At 6 am, my nurse came in and took out my foley, took of the nasal cannula and I walked (without assistance!!) to my mom's room. She was pretty chipper and quite pink from the 3 units of packed cells (her pre-op crit was 24, but they hadn't planned on txfusing her because they didn't want to expose her to more antigents). Matt stayed at her bedside all night long, and then heroically drove to Essex to feed Ally and let her out.


I was discharged on post-op day 2 in the care of my brother, Matt. He and I went on a trip to the grocery store, then home to my house on the bay. The next morning we picked up Dora from the kennel at Rocky Gorge, and I started to try to get back to normal. The first two nights my aunt Kathryn cooked fabulous dinners for me, and the third night my friend Alexa brought her two adorable kiddos and an excellent black bean lasagna. Now it's post op day 6, and I'm off the oxycodone, taking tylenol only, and thinking about driving to the hospital to see my mom. They said I could drive in a week, and technically the week is up today! We'll see, first I'm planning a test drive around my neighborhood.


Thanks so much to Dad, Matt, Chris, Kathryn, Heidi, Grandad, Cathy, Carol, Trisha, Teddy and Bill for visiting :) It was great to see all of you.

Thanks to ALL of the Zimmers/Franks/Fleishmans/Spencers/Leibels who sent Mom and I each our own beautiful arrangement in our favorite colors (the bouquet is the lovely white and purple arrangement above).

Thanks to my fellow fellows for the bouquet you sent me, I loved it!

Thanks to Kathryn and Heidi for the cheerful daisies and colorful houseplant for my new place, they're both great! Also, thanks for bringing dinners to me, they made my day.

Thanks to Alexa, Aiden and Sam for bringing a delicious dinner, and wonderful company. A special thanks to Aiden for the beautiful handmade potholders he brought--they're brightening up my kitchen already.

--Sarah

back to square 1

We got a call yesterday at about noon about what sounded like a good cadaveric kidney that mom's nephrologist recommended we accept, but no further instructions. Initially, it sounded like the kidney would have less than 12 hours of "cold time" which is very good. However, we called the transplant division back at 6 and at 9 pm, and they finally told us to come to the hospital at 11 pm, and the surgery would either be overnight or first thing in the morning.
We waited, and waited and waited. We waited at home, in the admitting waiting room, and finally in a telemetry bed on 3D. At about 9 am the OR transport team showed up to take mom to the PACU, leading us to believe everything was ready. However, as mom was being wheeled out on a stretcher, they got a call not to bring her. No explanation. The only person who ever knows anything is the attending, who is almost never available. Finally at about 10 am Dr. S arrived. It turned out the initial biopsy of the cadaveric kidney was insufficient but had signs of significant long standing hypertension, which could significantly shorten the useful life of the graft. A this point there was still a few hours left until the kidney was 24 hours old, so we elected to re-biopsy the kidney while Mom had an ultrasound of the iliac vessels where the kidney would be attached.

The repeat biopsy came back with some signs of hypertension, although with much less severe damage than the initial biopsy had suggested. However, at this point, Dr. S had told us that the medical history of the patient was not very comprehensive, and there was no way to get more information. At this point, Mom, Nathan and I talked and we decided to pass on the kidney and continue with our original plan for a living related donor transplant on 7/2/08.

It was not an easy decision for any of us because there isn't a crystal ball to tell us what the future will hold as a result of our decisions. Lots of tears, especially since we hadn't eaten or slept all night. In fact, it was Wednesday and I hadn't slept for more than two hours since Sunday, because I was working nights. After our last all-nighter in the hospital, I bought a Coleman air mattress and a pump and stored it in my car. It was definitely more comfortable than a chair or the floor, and I would definitely recommend it.

Now, I'm reviewing my schedule to see when I can pay back the fellow who kindly and generously covered my Tuesday and Wednesday night shifts.

The only outstanding issue prior to our transplant 7/2 is whether or not the transplant surgeon will require mom to get an MRI followed by dialysis prior to the surgery. I truly hope not, because I believe that benefit of the diagnostic information does not outweigh the risks of the study.

Well, take care blog readers, and we'll update again as soon as we know more.

Sarah

Here's Mom on the phone with the transplant division. Looks like we have a possible match for a cadaveric kidney. We're going to UMMS at 11 pm to be admitted for heparinization, and to start immune suppression. As soon as we know more we'll post. We love you all!!

Laura and Sarah

A day at the doctor's

Mom and I went to Dr. Zimrin's office on 5/23/08 for a hematology consult. Dr. Zimrin is mom's regular hematologist. The transplant surgeon wanted her advice about mom's anticoagulation pre-op/post-op. It was a pretty fun day. First we stopped by Hopkins (my work) so I could check on an experiment in lab and get my annual TB test read.

Then we motored over to UMMS. We parked in the Redwood garage, and mom walked all the way to the Weinberg cancer center. Then mom had vital signs and we went to an exam room. Much to my surprise, my friend from medical school, Amy K. was our fellow. I was completely reassured. Amy is a very intelligent, but also very kind woman. Going with the small world theme, she knows Bev, a nurse in the NICU where I work. Pretty funny. We talked with Dr. Z and Amy about our concerns regarding the MRI, and they recommended we talk to the transplant people. I'm working on a letter to email them, because that seems to be the most reliable method of communication. I'm going to finish it by this weekend.


After our appointment, we went to Donna's for lunch. Much to our surprise, mom's friend Amy is now the manager of the UMMS Donna's. They were really happy to see each other. Mom met Amy 5 years ago, when she worked at the Donna's in Columbia. We were glad to hear she delivered a healthy (but ornery :) ) baby boy, who is now 13 months old. Very kindly, she made our lunch complimentary.

Next we dashed back to my house to wait for the stove repairman, who fixed the electrical part of my *new* stove. We got the stove back in October, and about a month ago the electrical element caught fire. I quickly turned of the electricity to the gas stove, worried that the gas line could explode, and the fire went out. Apparently the position of the knobs on our fancy stainless gas stove allows water in, which shorts out the electric. Next time, buy a stove with knobs on the front. Live and learn.

Mom got to spend time with her grand-dogs, and work on her knitting. Then Nathan came home and we had Indian food leftovers for dinner (yum!). All in all, a very nice day.

Sarah