Day 2 (Dec 12, 2015)
All days start the same way- an early morning fasting labs, vitals, breakfast and meds before 9 a.m. On Day 2, the nurse spent some describing the meds in greater detail. He wrote on the whiteboard. The categories (meds) once again are: Anti-rejection (Tacrolimus, Mycophenolate, Prednisone), anti-infection (sulfamethoxazole-trimethoprim (anti-bacterial Bactrim), acyclovir (anti-viral) and nystatin (anti-fungal) and other ( entecavir, calcium carbonate-Vit D, pantoprazole, anti-hemophilic Factor, amlodipine, hydralazine). I was informed that the anti-infection meds would be lifelong and I should not miss taking them. The anti-infection would be 1 year for Bactrim, 3 months for Acyclovir and 1 month for Nystatin (to prevent thrush). The Tacrolimus would have to be customized to my rate of metabolizing the drug. This was to be measured every Monday morning via blood draws once I go home. The ideal 12-h trough level should be between 5-10 mg. The Prednisone dose would be tapered over the next 4-5 weeks. The other category meds stay lifelong.
Dr. Paul Stahler, the Fellow transplant surgeon, came by early on his rounds. he inspected the incision and the drain and informed me of the lab results. He also asked the urinary catheter to be removed. The nurse removed the catheter that afternoon. There is an interesting fact I learnt. The nurse brought in a portable ultrasound machine and measured if I was truly emptying my bladder when I started to pee naturally. This was done twice on Day 2. The bladder was empty. Good news.
The clinical nutritionist came by and suggested that for the first couple of months I increase my protein intake upto 90gms.
The lab results were showing a positive trend on Day 2. The creatinine was 2.07 (was 6.23 pre-op), BUN 51 ( 123 pre-op) . Tacrolimus (Tac) was 3 and so the dosage of Tac was increased in the evening. My weight had dropped to 136.0 lbs (was 140 on Day 1). I was allowed to start on light renal diet as the potassium was still 5.2.
The nurses hold a class each day around 10:30 a.m. Each day the topics are different. Day 2 was Home Care. It was mostly about keeping the home environment clean, washing hands etc.
In the afternoon I went down to get the PICC line placed in my right arm. This was done under local numbing and with Ultrasound imaging guidance. The PICC line was used for all i.v drips, blood draws and Factor VIII infusions.
Day 3 (Dec 13, 2015)
Dr. Stahler came by in the morning. The labs continue to promising (creatinine 1.82, BUN 47). My b.p. was high and so was my heart rate ( > 120). The nurse told me that the abnormal vitals were due to the meds and they would settle down over the week. My weight had dropped again, now 130 lbs. Tacrolimus was 5.
Today's class was conducted by the Pharmacist. There was a video on the different categories of drugs; the drug interactions; anticipated side effects. I was told to start using sunscreen (SPF 50 or higher) and the anti-rejection drugs increase my chances of skin cancer. I will need to avoid pomegranate and grapefruit.
I took a shower for the first time after the surgery. The PICC line was wrapped up with GLAD Press 'N Seal and 3M Transpore tape to waterproof the line. I was advised to let the water flow over the incision and to use liquid soap around the incision. This was the first time I had a good look at the incision and the tiny staples. Its about 7 inches long on my left side.
Dr. Fernandez stopped by in the afternoon. He was happy with the progress I was making and asked I wanted to get discharged that evening. Since it was getting late and the discharge process was long and then the 3 hour drive home, we decided to take the discharge the next day. Dr. Fernandez, interestingly, noticed my legs crossed and asked me to uncross them. "Clots might form which could travel to your lungs".
Day 4 (Dec 14, 2015)
The doctor signed off on my discharge after the labs came in (craetinine 1.62, BUN 42, potassium 4.7). I was switched to general diet from renal. Victory No. 1!! My weight was down again, now at 127.8 lbs. I had lost 18 lbs in 5 days.
Discharge at UW is a lengthy process. A number of people have to clear you: the hematologist, the pharmacist, the nurse, the dietitian. The pharmacy brings up a one month's supply of meds. I was advised to transfer my prescriptions to my insurance's Home Care Pharmacy. My conversation with the pharmacist and the nurse was recorded on an iPad to uploaded to a secure site for my review later.
I left the hospital around 3 p.m. Our good friend, Anil Padmanabhan, drove Sridevi and me home. Rajesh, his family, and parents stayed back in Madison as Rajesh's follow-up appointment was later that week on Friday.
All days start the same way- an early morning fasting labs, vitals, breakfast and meds before 9 a.m. On Day 2, the nurse spent some describing the meds in greater detail. He wrote on the whiteboard. The categories (meds) once again are: Anti-rejection (Tacrolimus, Mycophenolate, Prednisone), anti-infection (sulfamethoxazole-trimethoprim (anti-bacterial Bactrim), acyclovir (anti-viral) and nystatin (anti-fungal) and other ( entecavir, calcium carbonate-Vit D, pantoprazole, anti-hemophilic Factor, amlodipine, hydralazine). I was informed that the anti-infection meds would be lifelong and I should not miss taking them. The anti-infection would be 1 year for Bactrim, 3 months for Acyclovir and 1 month for Nystatin (to prevent thrush). The Tacrolimus would have to be customized to my rate of metabolizing the drug. This was to be measured every Monday morning via blood draws once I go home. The ideal 12-h trough level should be between 5-10 mg. The Prednisone dose would be tapered over the next 4-5 weeks. The other category meds stay lifelong.
Dr. Paul Stahler, the Fellow transplant surgeon, came by early on his rounds. he inspected the incision and the drain and informed me of the lab results. He also asked the urinary catheter to be removed. The nurse removed the catheter that afternoon. There is an interesting fact I learnt. The nurse brought in a portable ultrasound machine and measured if I was truly emptying my bladder when I started to pee naturally. This was done twice on Day 2. The bladder was empty. Good news.
The clinical nutritionist came by and suggested that for the first couple of months I increase my protein intake upto 90gms.
The lab results were showing a positive trend on Day 2. The creatinine was 2.07 (was 6.23 pre-op), BUN 51 ( 123 pre-op) . Tacrolimus (Tac) was 3 and so the dosage of Tac was increased in the evening. My weight had dropped to 136.0 lbs (was 140 on Day 1). I was allowed to start on light renal diet as the potassium was still 5.2.
The nurses hold a class each day around 10:30 a.m. Each day the topics are different. Day 2 was Home Care. It was mostly about keeping the home environment clean, washing hands etc.
In the afternoon I went down to get the PICC line placed in my right arm. This was done under local numbing and with Ultrasound imaging guidance. The PICC line was used for all i.v drips, blood draws and Factor VIII infusions.
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| PICC Line |
Dr. Stahler came by in the morning. The labs continue to promising (creatinine 1.82, BUN 47). My b.p. was high and so was my heart rate ( > 120). The nurse told me that the abnormal vitals were due to the meds and they would settle down over the week. My weight had dropped again, now 130 lbs. Tacrolimus was 5.
Today's class was conducted by the Pharmacist. There was a video on the different categories of drugs; the drug interactions; anticipated side effects. I was told to start using sunscreen (SPF 50 or higher) and the anti-rejection drugs increase my chances of skin cancer. I will need to avoid pomegranate and grapefruit.
I took a shower for the first time after the surgery. The PICC line was wrapped up with GLAD Press 'N Seal and 3M Transpore tape to waterproof the line. I was advised to let the water flow over the incision and to use liquid soap around the incision. This was the first time I had a good look at the incision and the tiny staples. Its about 7 inches long on my left side.
Dr. Fernandez stopped by in the afternoon. He was happy with the progress I was making and asked I wanted to get discharged that evening. Since it was getting late and the discharge process was long and then the 3 hour drive home, we decided to take the discharge the next day. Dr. Fernandez, interestingly, noticed my legs crossed and asked me to uncross them. "Clots might form which could travel to your lungs".
Day 4 (Dec 14, 2015)
The doctor signed off on my discharge after the labs came in (craetinine 1.62, BUN 42, potassium 4.7). I was switched to general diet from renal. Victory No. 1!! My weight was down again, now at 127.8 lbs. I had lost 18 lbs in 5 days.
Discharge at UW is a lengthy process. A number of people have to clear you: the hematologist, the pharmacist, the nurse, the dietitian. The pharmacy brings up a one month's supply of meds. I was advised to transfer my prescriptions to my insurance's Home Care Pharmacy. My conversation with the pharmacist and the nurse was recorded on an iPad to uploaded to a secure site for my review later.
I left the hospital around 3 p.m. Our good friend, Anil Padmanabhan, drove Sridevi and me home. Rajesh, his family, and parents stayed back in Madison as Rajesh's follow-up appointment was later that week on Friday.
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| Going Home!! (with RR, Rajesh, Saniya and Sridevi) |
