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
Update #8 on Lanna (6/30/09) June 30, 2009