CHRONIC POSITIVITY – Life with Polycystic Kidney Disease

BK Virus Increasing

November 19, 2009 · Leave a Comment

I had my monthly labs this week, and the level of BK virus in my blood has increased the past 2 times.  It started out at a level of 7200 this summer, reached it’s lowest in September at 961, was 1200 last month, and on Tuesday it is 2500.

The Transplant Nurse called me today, and I’ll start on a 10 day course of Cipro.  Even though Cipro is an antibacterial, and BK is a virus, the Cipro has the effect of inhibiting viral replication (the process of a virus making copies of itself).  I will have both my blood and urine levels checked in 2 weeks again, and hopefully, the level of virus will decrease.

My other labs are good. My creatinine is still 1.2, and my Prograf level is 9.5 (expected range 6-9).  Even though it’s a bit high, it’s acceptable, and they probably are keeping me on the high side, since I’m temporarily off CellCept.

If the Cipro doesn’t work, my guess is that I will then be put on Leflunomide.

The BK isn’t a major problem at this point, as it was caught early, and my kidney function (creatinine) is unchanged. I haven’t had a renal biopsy yet, and am not sure if that’s in my near future; it hasn’t been mentioned.

I’ve managed to survive Swine Flu season without getting the flu.  The only infection I’ve had is a mild cold, and didn’t even get a fever.

I added a new blog to my Blogroll, Because I Can.  It’s the ongoing story of Ashley Baltazar, a 19 year old with Polycystic Kidney Disease who developed a brain aneurysm near her brain stem. It’s written by Lori Schneider, a features editor for a local community newspaper.  Lori is chronicling Ashley’s long journey through this devastating struggle via the blog, and she is also in the process of writing a book about Ashley.

For those who aren’t aware of the various complications with PKD, brain aneurysm is one of them.  They are usually familial and occur in up to 10% of PKD patients.  Other issues include diverticulosis, kidney stones, hypertension, abnormal heart valves, and liver and pancreatic cysts.

→ Leave a CommentCategories: Health · November 2009 · kidney transplant
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Kidney Transplant Month 17

October 18, 2009 · 6 Comments

I had my quarterly appointments with the Transplant Surgeon and Transplant Nephrologist this past week.

The Surgeon was pleased overall.  My creatinine is rock stable at 1.1, my hemoglobin, although still low (I don’t think it will ever be normal), is up from 12.7 to 13.5, and my Prograf level is at 9.5 (still on the high side, but lower than last month’s 9.9).

He also noticed my dialysis fistula, as it’s quite huge.  The other Transplant Surgeon is the one who “specializes” in these, and told me that as long as it isn’t bothering me, he wouldn’t do anything with it, as I asked to keep it for as long as I could.  Not because I plan on going back on dialysis, but because I use it to draw my own blood each month, as the veins in the other arm are crappy. When I do get it “tied off” (it is created by joining an artery and a vein side by side; the arterial pressure enlargens the vein, allowing a large needle to be used for dialysis), I will need to have the vein removed.

The only downside in my labs is the level of BK virus in my blood.  It rose from the 900 level to 1200 this month.  Still not bad, and like anything, there could be fluctuations from time to time.  In conjunction with that, my ICF (Immune Cell Function) is up to expected range of 250.  3 months ago it was 112, which is low, and indicates over-suppression (which allows opportunistic infections such as BK virus to potentially worsen).  Labs again next month; we’ll see than.

The appointment with the Transplant Nephrologist was just a “hi, how are you doing, everything looks good,  see you in 3 months” visit. (although we did chat about non-medical things)

I’ve made the decision to get the Swine Flu vaccine.   I did ask the Transplant Coordinator (RN) what the recommendation is, and the answer she gave me was non-committal.  The bottom line is that whatever we do is our decision.  For me, that’s no problem, but I think they should provide better guidance, as many patients don’t have the knowledge base to make an informed decision on it (I don’t say that demeaningly)

Judging from the phone calls I take at work from worried and confused parents, not only is there an overwhelming amount of information on Swine Flu vaccine, and quite a bit is misinformation.  I do my best to give them the information available, and help them to sort things out.

Back to my decision, if I were to get Swine Flu, it could be more serious due to being immunocompromised, as well as having a chronic neuromuscular disorder.  I have a higher probability of infection as well, given that I work as a nurse and am thus exposed to it more  (although I’m diligent with handwashing and using a mask when needed).

The Swine Flu infection has thus far proven to be fairly benign, based on what I see clinically in our outpatient Pediatric Clinic, but the virus can always mutate, and become more virulent.  Granted, the vaccine wouldn’t be composed of the mutated strain, but there’s a possibility (theoretically)  that it could provide some cross protection.  The Swine Flu virus is comp0sed of 3 different influenzas: swine (pig flu), human, and avian (bird flu). It’s that last one that’s particularly scary.

As I understand it, the Swine Flu vaccine is the same base vaccine as that for Seasonal Flu (there is now a Seasonal Flu vaccine shortage as they had to suspend production to switch over to producing Swine Flu vaccine).  I’ve gotten Seasonal Flu vaccine for years now, and never had a problem. The difference between the 2 is strictly the difference in strains of influenza that it contains. If you do decide to get it and have a chronic illness, be sure to get the injectable vaccine;   the nasal spray vaccine (FluMist) contains a live virus.

Last weekend, I worked a double shift in the hospital; it took 2 days to recover!  Anyway, one of my patients was an infant who had congenital blindness, but also newly diagnosed chronic renal failure.   Amazingly, she survived a potassium level of 9.2!  It was found on a routine screening lab by an eye doctor. When Jackie and I took my sister to the Emergency Department for weakness, she had a potassium of 7.3, and was in complete heart block (the electrical signals to the heart weren’t able to fire right due to the high potassium), and probably almost coded.  They had the external pacer pads attached to her, the code cart in the room, and she had to have emergency dialysis.   That just goes to show how resilient kids can be.

→ 6 CommentsCategories: Health · October 2009
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New addition to the family

October 14, 2009 · 5 Comments

Our son Kevin phoned my wife a week ago, telling her he was on his way home, and asked if we wanted a new dog.  When he got home 5 minutes later, he brought home a puppy.  Of course, there was no decision to be made;  it was a done deal before he even got home.

He was at a friend’s house, when an acquaintance of his friend pulled up to the house with a dog in his car.  The acquaintance was a 19 year old living in an apartment on his own, and “couldn’t afford to feed her anymore” (or so the story goes).  We found out later that he was probably going to shoot her rather than take her to the SPCA, as there was a waiting list for dropping off dogs, and a cost as well. We also found out that she spent the majority of time in a crate.  (it’s not uncommon in this rural area for farmers to shoot a dog once it’s outlived it’s usefulness-NOT something I would ever even consider)

Kevin didn’t want to see the dog put down, so he asked if he could have her.  And that’s how we got Chloe.

She’s a Laberaner (my term); that is, a Labrador Retriever/Weimeraner mix.  You would think that she would be huge, but she’s actually very petite.  I’d say she’s about 50 lbs at most, and undernourished as well.  Her ribs are clearly visible, but we’ve had her for about 10 days now, and she eats like a horse.

The only potential problem is that we have a 3 year old male GoldenDoodle, who wasn’t neutered.  Digger went  to the vet this past Monday and that’s since been fixed (pun intended).

Digger and Chloe get along GREAT.  They play together until they’re exhausted (good for both of them); Digger LOVES his new playmate.  Our 13 year old Springer Spaniel is a different story.  She let Chloe know early on that she will not tolerate any nonsense, and Chloe steers clear of Kelsea.

We keep Chloe in a crate during the day when we are at work.  Based on experience, sporting dogs can’t be trusted (as far as chewing) until 2-3 years of age.  Chloe will be 1 year old on Halloween, so she still has another year or 2 of the crate.

Here are pics of our dogs:

Chloe

Chloe

Chloe

Chloe

Chloe and Shamrock

Chloe and Shamrock

Digger after ridding our yard of a rabbit

Digger after ridding our yard of a rabbit

Kelsea, our elderly Springer Spaniel

Kelsea, our elderly Springer Spaniel

→ 5 CommentsCategories: Dogs · October 2009
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September Transplant Labs

September 21, 2009 · Leave a Comment

I had lab work done last week, but just got the remaining results today.

The level of BK Virus in my blood continues to drop.  It started at 7,260 copies in July, and after stopping CellCept at that point, was 2,257 in August, and this month there are 961 copies.

My cholesterol is 156, but I need to get my HDL up, as it’s low.  My Prograf level is elevated at 9.9.  I’ve asked several nurses and doctors what the level is, and I get different answers.  The doctor told me 6-8, but the nurse today told me 6-9.  I’m going to hold off on more blood work for now, and discuss it with the Transplant Surgeon at my appointment next month.

I had been exercising daily up until my episode of phlebitis in July.  I’ve really cut back since then, hence the low HDL.  I started back up this week by riding my recumbent bike, and then will get back to walking again.

You may have noticed the SiteMeter map on the sidebar.  I get various statistics on visitors (I use the free version), and it’s interesting to see the locations of some of my visitors.  Other countries include (in the last 100 visits) Netherlands, Peru, UK (several different locations), Costa Rica, India, and Jamaica.

→ Leave a CommentCategories: Health · September 2009
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It’s a small world-twice this week

September 20, 2009 · Leave a Comment

It’s been a strange week alright.

Yesterday, I worked an overtime shift in the Childrens Hospital-my full time job is in a Peds clinic. I was talking to a doctor I hadn’t seen in awhile out in the hall, and then entered the room of one of my patients to check on her.  Her mother said to me “That’s Dr. R.  He was my doctor when I was 9 years old.  I had meningococcal meningitis, and was in the hospital for a month.  My brother had it too, but he died”. I asked her if her brother’s name was Paul, and sure enough, it was.

It was 13 years ago and I was working in the clinic evening shift on a Friday in July, when an adolescent came in to be checked out (we have a lot of patients referred to us for acute care problems, as well are open 7 days a week as well as evenings, and we are on the campus of a large medical center).  The story was that his sister was in the Peds ICU with suspected meningococcal meningitis. He was mentally delayed, and without knowing a baseline, it was initially difficult to get a good read on his neurological status, but that changed quickly.  I had a difficult time drawing his blood (I’m usually very good at that), because his blood pressure was lowering.  We did a spinal tap, and in the short time he was in the clinic, he became more drowsy, and upon leaving, he started with petechiae and had a BP of 70’s/30’s.  He had meningococcal meningitis and sepsis (bacteria in his bloodstream).  He died early Sunday morning.

The 2nd “small world” incident was through my wife Jackie.  In order to understand this one, I’ll explain my transplant.

The transplant coordinator called me on a Friday night with an offer for a kidney (my 7th such call).  The only information I got was that a 16 year old girl had been on life support for a drug overdose, and had been in a long term treatment facility for adolescents with substance abuse problems.  (he also gave me other info, such as that her labs were good, etc).  I accepted the offer, and had the transplant the next evening after dialysis.

When Jackie was making phone calls to tell everyone the happy news, my roommate from college told her that there was an article about this incident in the local  newspaper (he was home visiting his family).  It gave other details, such as the specific company whose facility she was in, and what had happened (her and another girl were taken to the dentist, the worker taking them had a bottle of pain killers in her purse, they stole them, took the pills when they got back, were found barely breathing, and taken to the hospital).

Jackie is a Special Ed teacher, and she has an aide in her classroom that was recently hired.  On Friday, he was telling her who he previously worked for, and she mentioned to him about my transplant, as well as the circumstances behind it.  Here, he was working in the same group home at the same time that my donor was there, and apparently heard that her organs were donated (but obviously didn’t know to whom).

The right place, the right time, and the right conversations lead to these “small worlds”.  What are the chances?

(I changed the patient’s name to breach of confidentiality)

→ Leave a CommentCategories: September 2009
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It’s always darkest before the dawn

September 11, 2009 · 5 Comments

My wife Jackie and I were talking about the past 10 years and what has happened to her career-wise.

We met in a Psychiatric Hospital (we worked there), and at the time, she had an undergrad degree in Psychology, and was completing a graduate degree in Elementary Education.  She completed it, but in our area, teaching jobs are difficult to obtain based on one’s merits and abilities.  If you are willing to pay a bribe, or are politically “connected”, it’s possible to get a job, but otherwise, it’s not likely to get a full time position.

We got married, eventually moved to our current home, and she got a position as a Mobile Therapist and then as a counselor working with children.  That job led to another position as a quasi-Social Worker in our school district.  After 8 years, the school cancelled the contract of her employer, in order to hire more guidance counselors to do the work she and her co-workers had done. As an aside, and keeping with the rampant nepotism of the area, the guidance counselors were all in one way or another related to school district administrators, and costing the district much more than the contract they cancelled.

From there, she began substitute teaching.  The work wasn’t steady, and it was far from the ideal job, but she did what she had to, in hopes of somehow getting a full time teaching job.

She did this for 2 years, and then landed a job in the district teaching Alternative Education.  For those unfamiliar with this, Alternative Ed is a fancy name for a classroom used to place students that were simply unmanageable in a regular classroom.  She was experienced enough to handle this well, as she had worked with these types of students at the Psych Hospital we worked at.  Of course, while the “contracted” teachers received full pay and benefits, she was hired without a contract, and at a daily rate that was slightly higher than that of a contracted teacher, and didn’t receive any benefits. On top of that, the classroom was in a trailer, and the administrators had the attitude “out of sight, out of mind”.

It wasn’t the safest job, as the students were sometimes physically aggressive. She was subpoened to court twice because of arrests of her students related to things they did in the classroom that ended up in charges, and the school district wasn’t even going to pay her for the court appearances.

After 3 years, the district pulled another fast one, changed the job description in order to hire someone who apparently had “connections” (she lasted a year), and she was once again unemployed.

After 2 job losses within 5 years, she was very disheartened.  In addition to this, she was also dealing with me going through my kidney failure, dialysis, and eventual transplant.  I’m sure my readers who have experienced this with themselves or a family member can fully appreciate this stress.  But she was fortunate to get a summer job for a private provider of Mental Health and Special Education services, and that lead to a position as an assistant in an autism classroom (it was a position above an aide but below a teacher).  That was a year ago, and late last Fall, a teaching position opened.  She doesn’t have Special Education certification, but her supervisor hired her with the understanding that she would get certification.

So, in January, she started graduate classes to get her Special Ed certification, and was hired for the middle school Emotional Support class.

The certification will only require 6 classes (since she already has a M.S. in Education), and she’ll be certified at the beginning of the 2010-11 school year.

Now, she’s working at a private school, she’ll have her Special Ed certification at this time next year, and the salary she is making is the same as a teaching job in the school district that axed her job twice.

We were talking about this last night, and in retrospect, the best thing that happened to her was losing her job.  She persisted, and ended up landing a job that she loves.

The lesson here is the title of this post; it’s always darkest before the dawn.

Remembering back to when I was first diagnosed with Polycystic Kidney Disease, I experienced similar despair to what  Jackie did when she lost her jobs.  Based on what I saw my mother go through 30 years ago when she was on dialysis, my mood at the time was doom and gloom.  My mom was on dialysis for 3-1/2 years, had a very rough time throughout those years, and died of peritonitis related to surgery to remove her spleen as well as her kidneys (from what I can gather, the splenectomy was due to a problem with aplastic anemia, and the kidney removal was to prepare her for an eventual kidney transplant).  In addition, dialysis wasn’t nearly as advanced as today, and she would be in bed sick with nausea the day after dialysis, and “perk up” right before the next treatment.  This was probably due to the fact that back then, they only used an “acid bath” with dialysis treatments, causing acidosis; today, modern dialysis uses an acid and a base bath, which does away with this problem.

And yet as my kidney failure progressed, I kept on going, continued working full time even through dialysis, and although I had some rough periods, I persisted as well.  I put off dialysis until I had a kidney cyst rupture, causing my BUN to shoot up to 118, and was forced to start dialysis at this point.  My BUN was 80-90 for about a year prior to dialysis, and my GFR (percentage of kidney function) during that time was 8-10%.

And here I am today, living life with a kidney transplant, and having to remind myself that I actually had a transplant.  The reason I say this is that today, I feel 10 years younger than I did at the point I went on dialysis. When I was going through all of this, I was fortunate enough to be able to block out my initial apprehensions, and today, I’m thankful for treatment I received that allowed me to do so.

I probably will have more speed bumps along the way, but I’ve handled those that were thrown in front of me, and will likely be able to drive over those as I’ve done in the past.

Some readers of this blog are probably newly diagnosed with kidney disease, some are facing dialysis, some have chosen to remain on dialysis rather than transplant, some are awaiting a transplant, and others have gone through a transplant.  In my opinion, attitude and persistance can overcome a lot of what we have thrown at us, and I hope that for all of those that are in a position of facing challenges, that they do their best to look at the good, and do your best to overcome the bad.

→ 5 CommentsCategories: Health · September 2009 · Uncategorized
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BK update for August labs, Swine Flu

August 22, 2009 · 3 Comments

Good news; the BK level in my blood went from 7,260 copies last month to 2,257 copies of the virus this month.

A co-worker had BK as well (coincidentally, she has Polycystic Kidney Disease as well), and she was off the CellCept for 7 months, the virus was finally controlled (it never leaves the system), and she’s back on her CellCept.

Everything else is going well.  The episode of phlebitis that I had hasn’t reared it’s ugly head since last month.  I think it happened due to a problem with my orthotics.

The pic above is similar to what I wear.  However, I had a strap put on right above the ankle as well.  I had been doing some intense walking during my lunch hour every day, and the strap was too tight.  It caused the vein in my inner ankle to become inflammed.  I’ve since took the strap off, I’m riding my recumbent bike instead, and no more phlebitis (phleb=vein and itis=inflammation).

Another problem I had in my left foot is some significant pain from an old injury.  About 12 years ago, I fractured the outermost foot bone.  A callous formed on the bone, and juts out of the side of my foot.  It constantly presses against the side of the orthotic.  I’ve dealt with it now for a while, and finally came up with a solution.  I bought a Dr. Scholl’s gel heel pad, cut it to fit, and have it placed so that it cushions the bone.  My pain is much less now (it will never be pain free), and those 12 hour shifts in the hospital should be a lot more tolerable.  I’m stuck as far as pain relievers, as I can only take Tylenol and narcotics.  I don’t like to take narcotics unless I’m desperate, so I was trying to get by with Tylenol Arthritis.  It helped, but the cushion will be much better.

In the kidney patient community, Swine Flu (H1N1) is certainly on our minds. As of now, it is a worldwide pandemic.  Bill Peckham’s blog (Dialysis from the sharp end of the needle) has an interesting post regarding how an overwhelming surge of cases will be handled (basically, who is treated, who is not treated).   Bill’s blog is also a great resource for other issues related to dialysis, and he has a regular listing of blogs in the kidney community.

The Department of Health and Human Services has a website that also may help answer questions at flu.gov.

I must admit that I had a misconception that I cleared up through flu.gov.  I thought that all of the vaccines for Swine Flu were live viruses, therefore making me ineligible for the vaccine. However, it appears that the injectable form will not be live (the same as the vaccine for seasonal flu), and there will also be a live virus vaccine as a nasal spray.

As with any decision, it’s risk vs. benefit.  I’m concerned that although there are clinical trials being carried out on the vaccine, they are not as comprehensive as normally would be done – obviously due to the time factor.  I haven’t decided yet whether I’ll get it, but after finding out that it isn’t a live virus vaccine, I may end up getting it.

→ 3 CommentsCategories: August 2009 · Health
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Transplant Meds – Brand vs Generic

July 30, 2009 · 6 Comments

As many of you transplantees may already know, CellCept is now available in generic, and Prograf has lost patent protection (although I’m not aware of any generic versions yet; correct me if I’m wrong).

I discussed this with my transplant surgeon at my last appointment (BEFORE I found out I had BK virus and was taken off CellCept). He said he preferred me to take brand CellCept, but that if my insurance didn’t cover it, I’d have to take generic.  I pressed him as to whether there is an appreciable difference between brand and generic, and he eventually said “no”, but that he preferred I’d take the brand.  (huh?)

I discussed this with a pharmacist I work with, and he explained that in some drugs, if there’s a narrow therapuetic index (the difference between therapuetic and toxic), then it may be an issue, but with CellCept, it shouldn’t be an issue.  (I hope I got that right)

Anyway, I had read somewhere on an internet forum that there may be up to 15% variability between brand and generic as allowed by the FDA, but this is apparently FALSE. Given that there is only a low single digit difference between the 2, it’s not a concern, especially as there are OTHER factors with absorption, such as interference from foods and minerals. In other words, your drug levels will be pretty close each time you take a med, but never exactly the same.

I plan on taking generic when I’m back on CellCept.  My rationale:

  • My insurance has a “lifetime limit” of drug coverage. By taking the lower priced med, I will reach that later rather than sooner
  • I have periodic ICF’s (Immune Cell Function) done; this should pick up on any problems

For those who will stay on brand CellCept, here is a link to some help with co-pays (unless you are on Medicare or Medicaid):  click on “Click here for details” at the CellCept for Living website.

For those on Prograf, check out the Prograf Value Card program.

Thoughts on this?

→ 6 CommentsCategories: Health · July 2009
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BK virus update and results

July 23, 2009 · Leave a Comment

I received a call from the Transplant Nurse on my way in to work today.  She called to give me the results of my blood work from Monday regarding the BK virus.

On the surface, the results don’t look good-I have BK virus in my blood. However, I expected that, being that there was over 39 MILLION copies of BK in my urine.

But it was actually good news: there are only 7600 copies of the virus in my blood, and the only treatment is that which I’m already doing-stopping the CellCept.  No need to treat with Cipro or Leflunomide; they are just going to monitor my blood monthly for the number of copies of the virus, and once my blood is clear, they will monitor my urine.  When the urine is clear of the virus, I’ll go back on CellCept.

When they didn’t screen for this, BK killed off a lot of transplanted kidneys.  I’m very fortunate to have been screened, as this will prolong the life of my “new” kidney.

Of course, the week wouldn’t be complete without ANOTHER problem popping up; this time, unrelated to my kidney.

On Tuesday morning, I was awakened at 4:30 out of a sound sleep with pain in my lower leg near my ankle. I’ve had a similar pain in the opposite ankle before, and given the problems I have with the Charcot Marie Tooth disease, I passed it off to a musculo-skeletal pain, assuming it was probably tendonitis (I’m a nurse, not a doctor).  I went to work, and the pain increased. When I took off my orthotic (splint) and sock, the area of pain was BURNING like mad, and was red.  At that point, I thought it might be the start of Shingles, given the quality of the pain, the redness, and the fact that I’m immunocompromised.

Working in the same clinic as my primary doctor has it’s advantages (which I do not abuse), and I got an appointment right away. My self-diagnosis was wrong, and it turns out I have phlebitis (an inflammation of the vein). My theory is that the strap on my orthotic was too tight, along with the fact that I do some intense walking over lunchtime, which caused the phlebitis.

It’s still flared up. When I stand or walk for over 10 minutes, the pain returns. In fact, standing in line 20 minutes today waiting for my picture license was a killer, but I elevated it once I got to work, and it was better.  It worsens then when I’m driving, since it’s putting strain on the vein.  Elevating it for about 30 minutes calms it down, so I’ve been limiting walking.

The problem with medication is that the traditional treatment, Naproxen or other NSAIDS, is a big no-no with having the transplant, as these drugs are notorious for damaging kidneys.  So I’ve gotten by with Tylenol Arthritis (great drug; even better than Extra Strength Tylenol), and an occasional Percocet (3 in the past 2 days).

I’ll be sure to post an update with my labs in a few weeks, and will probably have a kidney-related post as well.

→ Leave a CommentCategories: Health · July 2009
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BK Virus – and lots of it!

July 20, 2009 · 4 Comments

The Transplant Coordinator called me today with the results of my urine test for BK virus from last week; I have greater than 39 million copies of the virus in my urine. (they only test up to 39 million, so I don’t know the actual number; whatever it is, it’s a lot).  Anyway, I drew blood today (I still have my fistula and still draw my own blood from it) to check if it’s in the bloodstream (it most likely is).

The plan for now is to totally stop my CellCept, and continue on my current Prograf dose of 3mg in the am and 2 mg in the pm (my Prograf level last week was 7.9, and the desired range is 6-8). Depending on the blood result, I will probably be put on a 10 day course of Cipro, which inhibits the virus.  Hopefully, going off the CellCept will once again allow my immune system enough “power” to prevent further replication of the BK virii (I think that’s plural for virus), and once it is not detected, to go back on CellCept.  There will be a monthly urine indefinitely to monitor the level of BK in my urine, along with my monthly routine lab work to monitor my Prograf level, blood count, and kidney function (Basic Metabolic Panel).

I’m still not worried.  The advantage I have is that I’ve been monitored for BK  since my transplant, and 3 months ago it was negative, so it hasn’t apparently had time to do any major damage, as my creatinine is still 1.2, which is where it has been since getting the new kidney.

I’ll have the results of today’s blood work by early next week, and will post again when I find anything out.

→ 4 CommentsCategories: Health · July 2009
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