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Approaching my 22nd month on the transplant list, I must remain patient as I face serious problems trying to control my blood sugar. At this point, I’m glad to have survived some recent episodes.

On the transplant front, all has gone silent.

For I haven’t had a call from the Thomas E. Starzl Transplantation Institute with a worthy offer of a kidney and pancreas for seven months after having been called in eight times — three times in one week in February — with potential offers for donor organs that, as it turned out, did not meet quality standards for transplantation.

I’ve been told I’m at the top of the list for my blood and tissue type.

So what’s the hang up?

When I went to UPMC Montefiore for monthly blood work, a UPMC official told me that organ donations, for some reason, have fallen off in recent months. The transplant institute also has had problems with its live-donor program, but that was not supposed to affect the deceased-donor program. I’m can only speculate that suspension of the live-donor program also affected the deceased-donor program.

Survival continues to be my goal. That’s been a real challenge of late.

Two weeks ago, I got on a bus in Oakland after an newspaper interview.  My blood-sugar levels were dangerously low, and I failed to get off the bus Downtown. I ended up in the Swissvale at the end of the bus two unconscious hours later. There the driver got my attention and told me I had to leave the bus.

I can only remember sitting on a curb when a Port Authority police officer asked if I needed help.

“Diabetic” was all that I could say.

I ended up on an ambulance that rushed me to the UPMC Shadyside Emergency Room, where my wife and daughter eventually stopped by to scoop me up and haul me home.

Oh, it gets worse.

I was on our riding mower over the Labor Day weekend and wife Suellen went off to buy paint.

My sugar again dipped too low. I failed to stop mowing to test my sugar. I ended up on a harrowing roller-coaster ride on the mower all over the yard, up and down hills and around steep slopes, and down through little valleys before ending up running the mower into a creek and being dumped over the side into the creek bed.

When Sue returned home, she suspected problems when she could not find me or the mower and my car still was in the driveway. (Dramatic music.)

Soon she found me wallowing in the mud, face down in the creek and covered with crawdads.

She rushed to the house, got the Glucogon kit and returned to inject me with glucose. Finally able to walk again, but not yet fully conscious, I emerged from the creek bed completely covered in mud save for my wide-open eyes. She said I looked like a character from the movie “The Deer Hunter.”

She took me to the side yard, undressed me, and hosed off the mud. She threw away my pants they were so laden with mud. Then I got sick, and couldn’t keep down the juice she gave me.

Then she helped to bathe me -- twice.

So how was your weekend?

•

As a result of these “challenges” — Sue isn’t happy with me and isn’t as diplomatic in describing my misadventures — I’ve lowered my insulin by a full quarter of a dose. Still I’ve have had some low blood-sugar episodes.

Part of the problem is that I’ve improved my diet dramatically. Not as much processed foods and no sugar, dairy or meat. I could be wrong, but I think it’s my best chance of preventing dialysis with my creatinine levels at an abysmal 6.3, although down from the previous reading of 7.0.

I’m currently at 9 percent kidney function. My doctor said I must begin dialysis at 7 percent.

Yes, the waiting game continues. No, I’m not giving up or growing frustrated.

I now test my blood sugar before I mow, then multiple times while mowing. I mowed the entire 5 acres of the farm last weekend successfully while avoiding wallowing in the creek and visiting my crawdad friends.

Survival with more erratic blood sugar levels and ever-declining kidney function has turned into a life-threatening puzzle. I know the transplants also will be a big-time challenge, but they will be a welcome change from living with type 1 diabetes coupled with end-stage kidney disease.

At least, I hope.

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I had some troubling news last week but it was nothing unexpected, especially since I’ve felt more tired lately.

My creatinine levels worsened to 7.0, which calculates to only 8 percent kidney function. I also have higher than normal phosphorous levels, which requires a prescription to reduce the amount. My parathyroid and potassium numbers — numbers typically of concern to us people with kidney disease — remain in the normal range.

My nephrologist, Dr. James McCann, said my creatinine results are beginning to make him nervous, and he said I’ll need to begin dialysis if my percentage of kidney function drops any lower.

I’m concerned because no one ever wants to begin dialysis.

But I only have myself to blame.

With kidney function declining I’ve had to deal with more volatile blood-sugar levels in recent months. To control dramatic lows I resorted to eating sugar more often, with a preference for candies and pudding. True confessions.

Sugar, as I already know, is the worst philosophy for controlling sugar while maintaining healthy kidney function.

Sugar is poison. Every time I’ve resorted to routinely using sugar to offset hypoglycemia it has produced dramatically worseneed creatinine levels. I should know better, but the idea that I didn’t want to meet an untimely end from low blood sugar while awaiting the transplants, I took the easy route, thinking the transplants were just around the corner.

As it turns out, the transplants have remained miles away.

The kidney-pancreas transplants I’m awaiting are taking longer than anticipated. After being called in eight times for the transplants  — seven times from late November until late February, including three times in one week in February — I haven’t heard a word for four months, save for one call to ask if I was interested in the organs from a donor found dead with a needle in her arm.

No, I said, fearing the risk of undetected HIV or hepatitis C, which can be common among drug addicts.

The reasons for not getting transplants the first eight times include the fact that pancreas quality wasn’t sufficient. Several times I was a backup for the person who ultimately did get the available kidney and pancreas.

As my numbers declined from 5.9 to 7.0 in two months, I feel like I’m in a black hole of the waiting list — a seemingly endless period of dark silence requiring a patient’s full patience.

A word to the wise, if you have diabetes and kidney disease. If you need a quick boost of calories to avoid hypoglycemia or low blood sugar from too much insulin, the best bet is grape or apple juice, with my preference of grape juice. It is healthy and never adversely affected my kidney numbers or any health numbers.

In dramatic response to my creatinine levels, I’ve adopted a no-sugar diet once again, which is the diet I’ve historically followed. It isn’t difficult. I’ve cut back on my insulin a bit. I’m exercising again, this time by waking and spending a half hour each day on an  exercise bike. I’m also thinking positively about keeping my numbers where they are. I’m going to fight this battle with a strong attitude and the best science available and willpower I known I  can employ when back is to the wall.

I’m close to dialysis. I won’t hesitate to go on dialysis once my doctor(s) deem it necessary. Until then, I’m going all out to prevent it.

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Finally, I heard from UPMC’s Thomas E. Starzl Transplantation Institute after three months of echoing silence.

But the offer of a kidney and pancreas involved high-risk organs.

The 25-year-old female donor had been found with a needle in her arm. That always implies added risk of HIV-AIDS or hepatitis infection when the donor is an intravenous drug abuser. If the donor had been exposed to the viruses in the days or weeks prior to her death, it could mean she could be infected even though the infection did not yet show up in blood tests.

It also could mean the organs were perfectly fine.

So transplant officials make such risks known and let the potential recipient decide.

I thought for a while about accepting the organs -- maybe a half hour -- but ultimately decided against it. Family and doctors support that decision. My health is solid enough for now to avoid added risk.

I’m still not on dialysis. At least not yet. I still feel well, although I’ve been dragging a bit lately. I’ve added an exercise bike to the household to increase my activity with hopes of remaining in some semblance of shape prior to the transplants. I remain patient but a bit antsy.

I’m sure that’s the case with most of us on the transplant list.

After being called to the hospital three times in one week in February for potential kidney-pancreas transplants, but unsuccessfully so due to ultimate rejection of the pancreases for quality reasons, I felt confident of receiving the transplants in quick fashion.

But that’s how this game works. About the time you think it’s going to happen, then you face prolonged silence. UPMC officials have assured me that I’m still active on the list. I’ve even called and asked when  I  hadn’t heard from anyone in several months. I was first in line for the recently available organs had the higher risk not scared me away.

My wide-eyed wait continues.

I’ve now been on the list 18 months — ever since Dec. 3, 2009. I have big events in the offing including my daughter Abbie’s wedding on June 25.

She predicts I’ll get the transplant call the day before the wedding.

Let’s see if Murphy’s Law comes into play.

I still qualify for kidney and pancreas transplants, as I enter my 17th month on the transplant waiting list.

No calls for two months.

The good news is, I passed my urology examination in April with a reasonably good PSA of 2.9 and no evidence of cancer.

Concern occurs when the PSA, or Prostate-Specific Antigen test, reaches 4, signifying greater risk of prostate cancer. Any cancer will prevent a transplant from taking place because suppression of the immune system can make the cancer more aggressive.

I also do not have HIV or hepatitis.

Good to go.

There's more good news: Research is showing notable success with pancreas transplants for older adults.

In a news release, Dr. Sandip Kapur, chief of transplant surgery and director of kidney and pancreas transplant programs at New York-Presbyterian Hospital/Weill Cornell Medical Center, announced results of his and his colleagues' research.

• Excellent outcomes for pancreas transplantation in older patients.

He said recent studies have been uncertain about success of pancreas transplants in older patients but found no increase in acute rejection or complication rates. Such transplants in older patients is safe and feasible with excellent graft and patient outcomes.

"They report that with proper patient selection, older patients can safety receive a pancreas transplant without an increased risk of complications, infections requiring hospitalization, or cytomegalovirus or CMV infections. Furthermore, these patients also benefit from a lower rejection rate over the lifespan of the transplant.

Dr. Kapur also said pancreas transplantation remains an important option for patients with type 1 diabetes. Underweight and obese patients have excellent outcomes after pancreas transplantation and their weight doesn't limit transplant success or patient survival.