Update on Lanna #9 (7/9/09) July 9, 2009
Last week’s kidney biopsy revealed that Lanna was experiencing both types of rejection, acute and chronic. The doctors have gotten the acute rejection (lesser of the two) under control via steroids, and they are working to reverse the chronic rejection.
This means that Lanna’s body has developed antibodies against the kidney. A level of 250,000 antibodies indicates enough present to cause concern — Lanna’s level is at 400,000.
She is on her second round of plasmapheresis, which is a process similar to dialysis in which her blood is cycled through a catheter, only it is targeted at removing plasma from her blood. The plasma is what carries the antibodies. In between each treatment of plasmapheresis, Lanna is intravenously receiving a drug (rituxan, I think) that specifically targets the antibodies by binding with and dissolving them. The treatment consists of 4 times alternating between plasmaphereis and the drug. She had received this treatment last week with a different drug, which seemed to work well but didn’t quite decrease her antibodies enough. Her doctors then put her on an experimental drug, IVIG, that only succeeded in raising her blood pressure and raising her creatinine level (it had gone down to 2.5, but now it’s back up to 3.1 where it is holding steady), making her doctors stop that drug and decide that a second round of plasmapheresis was necessary.
The puzzling thing is that Lanna is not showing any other signs of rejection. She is still urinating and the kidney is working to remove excess fluid, so it hasn’t stopped its functions. She has started to retain some fluid, but it seems to be mostly in areas where she has an IV or catheter. Her blood work is also pretty stable right now, which generally would get out of balance with rejection, not to mention the treatments she’s receiving.
Emotionally, Lanna is faring well. She was fairly distraught when she was first admitted into the hospital, but now she’s handling treatments more calmly, even though the current treatment saps most of her energy.
Thus the waiting game continues. We don’t know what’s in store for Lanna, but this much we do know — many things have worked out so far to show God’s intervention regarding this transplant and its timing. To recall a few:
- Lanna was in a mindset to receive a transplant, had gotten all of her required tests up to date, had even mentioned something to her boss about needing time off if she did get a transplant because a friend had offered to get tested to give Lanna a kidney (that didn’t work out, but a few days after the friend’s test came back negative, Lanna got the call about this kidney).
- just 3 days before she got called, we’d had our church-wide fast.
- it occurred after cold & flu season, decreasing her potential exposure to disease.
- her dialysis was no longer functioning well, so she was at the point of needing something to change drastically regarding her health.
- the transplant itself only took 3 hours, with no complications, although the doctors were concerned about the amount of scar tissue she has.
- her bladder has adapted amazingly after 8 years of no use, and it can now hold almost a normal capacity and continues to do its job.
- her blood pressure has steadily been at a very healthy 117/70, where before it was usually at 60/40, and most transplant patients have problems with high blood pressure.These are just a few of the reasons to believe that God is very much involved in Lanna’s health right now. There are so many of you praying, too, that I don’t doubt He is listening and will intervene again on Lanna’s behalf.
In Christian love,
Rachel Keesee
Grocery Store Wars. July 9, 2009
It’s been a long time since I saw this. Good stuff.
I like the Urban Homesteaders’ philosophy on homegrown vs. local vs. organic:
If not FROM BACKYARD then locally produced.
If not LOCALLY PRODUCED, then Organic.
If not ORGANIC, then Family farm.
If not FAMILY FARM, then Local business.
If not a LOCAL BUSINESS, then Fair Trade.
As much as I want to be a farmer’s market groupie, it’s been challenging because the big market is on Saturday. Yesterday, though, I managed to make it to the short local Wednesday market (4-6pm) and was able to pick up lettuce, zucchini, yellow squash and cherry tomatoes. I’m excited about my first farmer’s market purchase.
Poconos. July 2, 2009
What a funny name.
Whenever I mention that we’re going to the Poconos, Cindy laughs and conjures up this visual:
Apparently when she was getting married 20 years ago, the bridal magazines were full of advertisements for the Poconos with a picture like this.
This is not where we will be staying in the Poconos.
Still working. July 2, 2009
Purchased slate tiles for the backsplash in the kitchen. Here I’m sealing some of them and making some into coasters for our new end tables.
Coasters! With non-slip backing on the bottoms.
And here’s what the house looks like now. Pictures taken to show my family and grandparents.
Tomorrow we’re flying out to Phillie and going to NJ for a few days and the Poconos for a few days to visit with family and relatives. Pictures and stories to come.
Top 50 Canadian Inventions. July 1, 2009
Basketball, the goalie mask, electric oven, light bulb… We is smrt folk.
Phthalates associated with low birth weight. July 1, 2009
Chemical Used in Plastics May Affect Newborn Size
Low birth weight infants have higher levels of phthalates, study findsThe report, to be published in the upcoming issue of The Journal of Pediatrics, found notable levels of the compound — which is used to make hard plastics soft and flexible — in the cord blood and first stools of more than 70 percent of infants included in the study. Higher levels of phthalates were found among those born with a low birth weight.
http://www.nlm.nih.gov/medlineplus/news/fullstory_86085.html
Update #8 on Lanna (6/30/09) June 30, 2009
Lanna is still in the hospital and will likely remain there the rest of this week or longer.
When she was admitted, the staff tried 6 or more times unsuccessfully to insert an IV into her arm. They could get it in enough to withdraw blood, but any time they tried to flush in a drug, her vein beveled and did not allow anything in. Saturday she had a central line put in near her neck so she could receive high doses of steroids to decrease her creatinine level. She still has bruises all over both arms from the attempts to put in an IV.
Yesterday, her doctor performed a kidney biopsy (those of you who watch House know this means a needle was inserted into her side to withdraw tissue from her kidney for analysis), the results of which will not be available until tomorrow. What her doctors suspect, though, is that she is in the beginning stages of one of two types of rejection, either acute or chronic. They won’t know until the results are back which type of rejection it is. If it is the lesser of two evils (acute), she will continue to be treated with high doses of steroids until her creatinine level is below 2.0. If it is chronic rejection, she will receive more strenuous treatment that will require a catheter inserted into a major artery, likely in her chest area, where her dialysis catheter was before. However, she has a lot of scar tissue in that area already, and the radiologist who placed the central line had trouble getting it in and was concerned about how long it would be usable. One of the two tubes there now was already not allowing anything into it today.
Worst-case scenario, if Lanna is going into chronic rejection and cannot get a catheter put in, she would have to have a fistula (the combining of a vein and artery for access to the blood stream) put into an arm or leg, rendering that limb almost useless.
The good news — her creatinine had increased to 3.0 Sunday, but it dropped back to 2.8 today, where it was last Friday when she was admitted. Her white blood cell count is up from 1.7 to 3.0 (should be above 5.0 but has not been above 2.5 for several weeks). Her kidney is also still doing its job well, as far as the doctors can tell, aside from the increase in her creatinine.
The doctors believe that this potential onset of rejection is a direct result of their alterations to her antirejection drugs in the past few weeks. Her dosages had been decreased to try to push up her white blood cell count, without success, and now those dosages will have to increase again. This means Lanna will be back where she was two months ago — advised to stay away from work, shopping, large crowds, church and any other type of exposure to germs — indefinitely.
One other item of note — Lanna did have a build-up of fluid on the opposite side to her kidney that the doctors plan to drain either today or tomorrow. They have speculated that this fluid could be putting pressure on the kidney and could be the culprit for what’s happening, although they are more likely to suspect rejection as the cause. They don’t know where the fluid is coming from, so Lanna will have an ultrasound done of that area later today. It very well could be caused by one of the other health issues she has, related to cysts that form occasionally on her ovaries. We shall see.
Thank you so much for your continued prayers and support. I’ve passed on your good wishes to my sister, and we continue to ask that you will pray for God to intervene (quickly!) so that she does not reject this kidney or have to experience any more suffering related to it.
In Christian love,
Rachel Keesee & the Moluf clan
Prayer Request: Lanna Moluf (6/26/09) June 30, 2009
Lanna is being admitted to Research Hospital this afternoon. Her creatinine level has gone up enough to cause concern w/ her doctors, so they want to monitor her and readjust her medications. (High creatinine is one key indicator of kidney failure.) The rest of her blood work has also continued to be out of balance.
The good news is that she had an ultrasound of her kidney this afternoon, and no fluid is collecting around it, which would have been an indication of rejection.
We would appreciate your continued prayers.
Much love,
Rachel Keesee and the Moluf clan
