Mr. Best is a minister in Canada.
Greetings,
I just received a call from Louise Hay that Mr. Best is out of surgery
after going through a quintuple bypass. The doctor said the family
can see him for a few minutes in about half an hour. The next 24
hours are critical as complications can occur so your prayers are
important.Regards,
Gerald Weston
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
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
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
I’ve delayed sending an update on Lanna while we wait for her blood work to improve, but it seems as though she could use your prayers that her labs will start to get better.From my sister Laura today (6/22/09) who is living with Lanna this summer:—————–“Lanna went in for labs today and got a printout of her labs from last week. She was complaining of pain in her kidney on Friday and part of Saturday. I don’t know if that’s gone away or not (as she doesn’t really like to tell me if anything’s wrong), but today she looked like she was retaining water in her face and was acting pretty tired… The most concerning would be the GFR (glomerular filtration rate)– this is basically a read of how the kidney is functioning. While Lanna is still peeing and everything, I think this GFR value needs to go up, and I get the feeling that’s she thinks she might be experiencing acute failure…“The doctors are still playing with her medication, trying to find a combo that works. They changed it 3 times last week. That may be the cause of the kidney pain, I don’t really know.”—————–Basically, Lanna’s blood work is still not balanced in the critical areas. Since my last update, her hemoglobin has not gotten up even to 10 yet (11-15 is a normal range), her white blood cell count is down at 1.9 or lower (normal range is 4.7-11.1), her creatinine is high (2.5 when it should not be above 1.5), and her glomerular filtration rate (GFR), which indicates how well a kidney is cleansing the blood, is really low, at 29.7, when it should be greater than 60 (if it dropped to 15 or lower, that would mean Lanna was in rejection).Her doctors are adjusting her medications almost every week to try to balance these numbers out. Some of the adjustments also have uncomfortable side effects, such as one week when Lanna’s stomach was hurting.Lanna has also started going into the office 3 days a week, even though her immune system is still pretty low. (Her doctor approved this because she is not in the main office and works directly with fewer than 10 people.) She’s feeling stressed about work and does not have as high of an energy level as she would like. I think she just wants to get back to a normal routine (to be expected, considering it’s been 3 months almost). This is wearing on her emotions and a little bit on her outlook, as she’s concerned she might reject the kidney.We ask that you’d pray that Lanna’s doctors will figure out the right combination of medications to balance out her blood work with the least amount of side effects, that her energy levels will improve, that her outlook will be positive, and that she can start to live the abundant life that is so close but not quite in her grasp yet. Knowing how merciful our Creator is, I’m sure He will hear and answer.With Christian love,Rachel Keesee
Lanna has been doing very well at home these past three weeks. Two weeks ago she had her dialysis catheter and incision staples removed, both of which were mental victories, indicating the doctors’ confidence that things are going very well.
Her energy levels had been improving, even with the frequent trips to the restroom during the night, but this week she started feeling a little drained. Her labs on Monday showed that her hemoglobin levels were low (7.1), and labs today showed they had dropped further to 6.7 (a normal level is 12). Hemoglobin indicates how much iron is in the blood (this is what they measure if you’ve ever donated blood), and is how the blood transports oxygen from the lungs throughout the body. Low levels of hemoglobin inhibit blood flow, which for a kidney transplant patient is a dangerous problem. In healthy people, it can cause dizzy spells and lightheadedness when you stand up, both of which Lanna has felt a few times this week, but for transplant patients, it could be an indication of rejection.
A critically low level of hemoglobin would be 5, and Lanna is getting too close to that level, so her doctor has asked her to get her blood work done again tomorrow (Friday) morning and to see him Friday afternoon. We ask your prayers that her lab work will come back pristine tomorrow and that God will heal whatever is interfering with her hemoglobin levels. (My family typically has anemia and trouble absorbing iron, so Lanna’s problem with her hemoglobin right now is likely partly hereditary. Anti-rejection drugs can also contribute to anemia.)
Other than that, Lanna has been doing well. She has started working a few hours a week from home, and she has been ramping up her exercise (we walked 45 minutes together Tuesday). Her spirits are still good, although someone should probably get her sense of humor under control — she’s cracking jokes at everything.
Thank you again for all of your prayers, cards and help — it’s a tremendous blessing to have so many family members to count on.
In Christian love,
Rachel Keesee
From Jesche Family: Jeremy Mueller Update:
Thanks to all who are keeping my brother in your prayers. If you do not know what is going here’s the info. and update.
My brother “Hoss” Jeremy, was in a farming accident a few days ago. . A sweep auger swung around while he was scooping grain in a bin and sucked his leg in it.
He was rushed to Hiawatha hospital and then by ambulance on to St. Joe hospital where he was taken in for surgery. He has 3 breaks in his bone, some muscle and nerve damage. They are confident he will not lose his leg. He is in a tremendous amount of pain. The biggest concern now is infection because the bone was exposed to the environment. They packed his leg and left it open until Thursday when they will try to sew it back together. They will know at that time whether or not he will need any skin grafting done. They thought he would be in the hospital until Friday or Saturday.
He is at [...] in St. Joseph, MO.
Thanks for your prayers and concern.
Elizabeth
Lanna got to go home yesterday.Her blood pressure got as high as 117/73 yesterday, and has been steadily above 110/70. This is an amazing improvement from 60/40, which was her regular blood pressure just 10 days ago. Thank you for your help praying for this vital (excuse the pun!) part of her health to improve. This alone eases one of the major concerns I’ve had about Lanna’s health for a long time now. Her low blood pressure had been causing her to have dizzy spells and occasionally slight seizures in the past several months, and it is also responsible for her loss of 80% of her vision in her right eye, which happened two years ago when her blood pressure dropped so low that her eye had a stroke, cutting off blood to it and damaging it permanently. I’ve been worried it would happen again, which would leave her blind in both eyes, and am grateful God has provided a solution before that happened.Right now, Lanna is still feeling the effects of her surgery, with some continued swelling around her midsection, a little extra water weight yet, and some discomfort with her digestive system. She’s also not sleeping more than 2 hours consecutively at night, thanks to her now-active bladder. However, she’s glad to be home and antsy to start being productive with her time.During the next two months, she cannot be around large crowds (including church and grocery shopping) because of the high dosages of anti-rejection drugs she’s on. She will gradually get to decrease those dosages, with her doctors will be keeping a close eye on her. She will have to have her blood work checked at the hospital 3 to 5 times a week for the next two months, then gradually tapering down to once a week, then to once a month after she hits the 12-month mark past her transplant.In two weeks, assuming everything continues to go well, she will get to have her dialysis catheter removed. The procedure will be an outpatient surgery that shouldn’t take more than an hour or two.Her home address and phone number, if you would like them, are: [...]Thank you again for your prayers, cards and encouragement this past week and a half. It has strengthened Lanna and our family tremendously.In Christian love,Rachel Keesee
Update #2 on Lanna (4/2/09)
Lanna is in much better spirits today, practically no pain, and is getting feisty and tired of lying around in bed. She was up and walking this afternoon, making several laps around the floor she’s on (which really impressed the nurses).The kidney has started producing a little bit of urine, which means it’s functioning, but not more than 5 CCs (a normal person would have about 400 CCs) has been collected. Lanna is hooked up to several bags of fluids and medications, so she’s been putting on a lot of water weight.The doctor may opt to run dialysis again in the morning (she had 3 hours of dialysis this morning to help decrease her potassium levels). We were told even before Lanna’s transplant not to worry if she had to run dialysis once or twice after the transplant — it seems to be a normal occurrence.The surgeon did a standard ultrasound of her kidney this morning to see how it was doing. He said it had good blood flow, no fluid collecting around it, and overall looks pretty good. A good point he made was that Lanna’s blood pressure, which is normally a crazy low of 60 over 40, is so low that this kidney, which came from a healthy person, is probably used to an average blood pressure of 120/80 and is probably a little shocked. If it is now experiencing such a dramatic drop in blood pressure, its normal reaction is to retain fluid and stop producing urine, which would normally help push the blood pressure back up.Lanna was put on a drug this afternoon to help increase her blood pressure, but even before they started it, her blood pressure has been steadily increasing all day. The last one I knew of (about 6 p.m.) was up to 90/60, which is a vast improvement. (Side note — I was told that a normally healthy person whose blood pressure dropped to 90/60 would pass out, which indicates how amazing Lanna’s energy levels before the transplant and now truly are.)We know so many, many people have been praying for Lanna, and your prayers are being heard — and acted on. Thank you for your continued support — it’s exciting to see such a dramatic improvement in one day, even without the 100% change just yet.With much love,Rachel Keesee
Update #3 on Lanna (4/3/09)More good news — Lanna’s kidney had produced more than 100 CCs of urine by 10 a.m. today, so it is definitely starting to wake up and do its job. She did have dialysis again this morning for 3 hours to help take off water weight, but the nurses said that is normal and not to think dialysis is a bad sign. The dialysis nurse even mentioned that it usually takes about 2 weeks for a transplanted kidney to be up to 100% functioning, so Lanna is steadily getting there. One thing that might be a concern if it continues – she has had some blood coming from her bladder, but nothing to worry about yet, considering what her bladder and body have gone through, only if it continues more than a day or two more.She has had a little more pain today and is feeling the effects of less than 5 hours of sleep per night since she entered the hospital, but her spirits are still good. Our parents will be coming in this evening, Marshall is flying in, and David is driving it, so the whole family will be there tonight. That, too, is helping keep Lanna’s mood positive.Somehow Lanna also convinced our favorite massage therapist to drop in and give her what has been a 30-minute massage (and counting), so that should also help alleviate some discomfort — and give her something to brag about, since she wanted me to include it.Her blood pressure has also been steadily near 90/60 all day, so that is another consistent improvement.I probably won’t be giving another update until late tomorrow night, so I hope you all have a restful Sabbath. Thank you for your support, your many encouraging e-mails and cards, your prayers, your faith… it is the most awesome feeling in the world to know how many people are pulling together for Lanna right now.In Christian love,Rachel Keesee
Update #4 on Lanna (4/5/09)If you like good news and more good news, keep on reading…
Lanna’s kidney has been kicking into high gear, so she has not needed dialysis again since Friday morning.
Today the nurses clarified that a healthy person will produce anywhere from 500 CCs to 2400 CCs of urine in 24 hours. Lanna made it to more than 1300 CCs today, with very little blood in it. This is a fantastic sign that her kidney is cleaning out everything.
A few things to keep in mind — she is still experiencing edema (swelling), so she would appreciate your prayers that she will continue to improve in that area, but she was already looking much better today than yesterday. Her outlook is very positive too — she’s cracking jokes like a champ, even though she’s still having some discomfort around the kidney (expected). Her incision has also been bleeding a little, but the staff says this, too, is normal.
Her blood count was down yesterday, so she received a blood transfusion to increase that count. The blood infusion also likely helped increase her blood pressure, which got up to 100/60 yesterday, well on the way to normal. With this increase, her doctor has started taking her off dopamine, the drug given to help increase her blood pressure. Today her blood pressure was steady around 95/60, even with the decreased medication, which is another indication that she is improving. Her last dosage of the dopamine will be administered before midnight tonight, then she will not be on any more IV drugs or fluids (she’ll just be taking the bazillion pills of anti-rejection drugs and anti-side-effects-of-those drugs). The medical staff would like to see her blood pressure stabilize at a more normal, healthy level (110/70 would be great, 120/70 even better), but I don’t know how much emphasis they’ll place on that if she remains steady at 95 or better.
Lanna was able to start eating a few solid foods yesterday and more today, but she has to be very careful not to increase solid foods too rapidly, lest her digestive system put too much pressure on the kidney.
Now the main sign the doctor is watching before releasing her from the hospital will be her creatinine level, which is the biggest warning sign of kidney disfunction when the level is too high. (I don’t know enough yet about creatinine to explain any further than that.) We don’t know yet when Lanna will be released, likely not before Thursday. We also don’t know yet when she will be able to have her dialysis catheter removed, which for Lanna will probably be one of the major mental victories of this whole experience.
While Lanna is still in the hospital, she would love to have visitors as often as possible. Please feel free to drop in to see her or call her room directly [...].
Thank you all so much again and again for your prayers, cards, words of encouragement and help. God has been intervening tremendously, making every new hurdle improve quickly. My eyes are getting teary just thinking of how much better Lanna’s life will be in just a few short weeks, God willing, as her improvement continue. May He also bless you for your faith and love as she continues to recover.
In Christian love,
Rachel Keesee
This is going to a long list of people (gotta love BCC). Here’s how things stand today.Lanna’s transplant operation went well, even quickly. No bumps, no problems, no worries about the operation itself. It appears that the recovery process will be the hard part.Key points — she is on powerful drugs to suppress her immune system. The first 3 days will be the most crucial, as this is when the doses will be the highest. This means she absolutely cannot have any exposure to infection, so even though visitors are welcome and encouraged (2 at a time), if you have even a slight runny nose, please don’t visit her. It also means no live flowers or plants while she’s in the hospital. She will not be able to be around large crowds — church, shopping, airplanes, schools, work, etc. — for the next 2 months.Recovery is going to be a long process. Those of us who never experience a transplant first assume that the doctor puts you under, puts in the new organ, sews you up and you’re immediately better. Not exactly the case, as I learned today.For Lanna, today was rough after surgery. It took 3 hours to do the transplant and 3 hours for her to get out of recovery and back into her room. When she woke up, she was in a lot of pain, which they’ll treat w/ morphine for the first 24 hours. The pain comes from the surgery itself and side effects of all the drugs. She was having tingling numbness in her hands, and her mood was, at best, anxious. She has a well-deserved dislike of being in the hospital, so add that to not feeling well after a major surgery AND facing the unknown recovery process AND a long history of bad health and being in and out of hospitals, and you have a worried, somewhat panicky, very scared girl at the moment.We play the waiting game for the next 24 hours to 3 days to see what the kidney will do. When I left at 9 p.m. today, it was not producing urine yet, but the nurses said that was perfectly normal. It is also perfectly normal for transplant patients to have to have dialysis once or twice before the kidney gets up and running. This can take up to 3 days for the kidney to “wake up,” as the nurses put it. She will be closely monitored, even with a nurse exclusively assigned to her, for the next 24 hours or more.An added hurdle for Lanna is having a bladder that hasn’t functioned for the last 8 years and that was damaged when she was an infant. For those of you who have toddlers, you might have a good idea what she will be going through from this perspective for the next few months.She will be on a regimen of anti-rejection drugs from here on out, but at increasingly lower doses over the next year from what she’s on today.Whew!! And we thought it was all solved!
In all seriousness, this transplant is a major blessing. The timing couldn’t be better — she has not felt well for a single day in the past 3 months or more; she had finally put herself in the mindset of being willing to accept a kidney transplant, thanks to a very wonderful friend; all her necessary check-ups were up to date; she’d had the right conversations with her boss; she was anointed; and our recent churchwide fast was specifically asking for more faith among God’s people.A week from today, or maybe even tomorrow, she will have much more energy, more balanced hormone levels, a functioning bladder, a kidney filtering the junk out of her every second, rather than a machine doing it every night for just 4 hours, she won’t have to lug her dialysis machine and supplies to the Feast (Hawaii for us this year, wahoo!)…Meanwhile, she needs all the help she can get, rather than focusing on the pain and coming challenges of recovery, to have a positive outlook toward her recovery AND to help her focus on how much better life will be very soon. Maybe not today, maybe not tomorrow, but soon. Your prayers and cards are very much appreciated.If you care to stop by, please do. She’s in room … [contact me if you need this]For cards:[contact me if you need the addresses]In Christian love,Rachel Keesee
