Monday, July 29, 2013

Kidney Quest: Last Tests

In the last week, you will have the last tests. For us, the test came five days before the transplant. Alan and I returned to Mount Sinai for final testing. Since the HLA (Human Leukocyte Antigens) can change, within a week of the transplant, the recipient and donor must be re-matched to be sure we were still negative antigen reactive--i.e. he won't reject my kidney.

Alan had to have an X-ray and CAT scan. We both needed to be examined by an anesthesiologist. Alan had to be seen by the doctor who would do his surgery. I had to see mine.

So on surgery minus one week--you can expect:

  1. an additional cross matching
  2. and X-ray and CAT scan
  3. a check-up by an anesthesiologist
  4. a check-up with the surgeon
Site of kidney extraction:

Formerly, ribs had to be removed and the kidney was taken out from the donor's back. This left the donor in a lot of pain and often produced unsightly bulges in the muscles. Donors complained, so doctors began taking the kidney from the front. Still, ribs had to be removed.

Once laproscopic surgery became feasible, the kidney had generally been removed near the navel and no ribs were taken.

My doctor took it one step further. He would remove the kidney near the pubic bone. This would leave the scar hidden by bathing suits or underwear. I nice thought for a single, fifty-year-old!

It took us three months to complete everything. However, all the tests can be completed within three weeks. Most of the time and effort is spent before the surgery.

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Saturday, July 27, 2013

Kidney Quest: Interlude--The Last Days--Perspective

Night lights
Night lights (Photo credit: dlanham)
Our kidney transplant would take place shortly after the results for the MRI and sonogram came in. I returned home. Within a week, I knew everything was a go, and I needed to make my final journey back to Mount Sinai for our last tests scheduled for November 13. My brother-in-law flew his Cessna up to Malone, and whisked me back to New York City.

I sat in the back of the plane and studied the world beneath my feet. The sky was dark, the ground studded with lights. I watched the cars snake along mountain roads, watched light pool in towns like Lake Placid, saw them flood Albany. This scene always mesmerized me, made me realize how small we are, how vast the world.

Inside those tiny lights lived people, many with big problems, but how small they seemed up here. The perspective made me remember Isa 55:8-9. "'For my thoughts are not your thoughts, neither are your ways my ways,"  declares the Lord. As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts.'" We struggle here on earth and forget the big picture. We forget our suffering, in the scheme of eternity, is slight and is short in duration. Life hurts everyone. No one is left unscarred. We have to remember that God sees all, has all in perspective and cares more about each of us than we can fathom.

The peace in the sky lulled me to sleep. I awoke as we flew over the Long Island Sound, a black desert with no boat lights on this dark and foggy November night.

We descended through clouds, trusting instruments to make a safe landing. In a few days, I'd be trusting more technology to keep me and my brother safe. My life would be in the hands of a skilled physician. 

No matter what trial we face we have to remember two things:
  1. Keep all in perspective.
  2. Keep all in God's hands
How about you? Have you let life distort your vision of the bigger picture? How have you let go and trusted God?

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Monday, July 22, 2013

Kidney Quest: The Final Sonogram and the MRI

Once blood tests have been completed, two additional tests remain: an ultrasound of the kidneys and an MRI.

an image of kidneys from an MRI
Most people today have had ultrasounds. The most difficult part of this test is the cold jelly. Like stethoscopes, I believe the jelly is stored in the freezer before use. But the ultrasound test is surprisingly comforting. The cool gel relaxes. The tech kept the lights dim, and the slow rotation of the trandsducer probe--the probe that sends the sound waves to the computer, felt like a soft massage--a belly rub which lasts about fifteen minutes.

The ultrasound checks the health of the kidneys, but a more detailed test must follow. This is the MRI or magnetic resonance imaging. This will test, in depth, the blood vessels and the kidney.
An MRI representation

How the MRI Works:
  1. You are slid into a large open tube so that the kidneys are central to the imaging
  2. The MRI can make images along any plane. The CT can only take it alone one plane and then the patient needs to be re-positioned.
  3. The magnet in the MIR is one-thousand times stronger than the earth's magnetic field. Thus stethoscopes, paper clips, pens, etc. can be unexpectedly pulled out of pockets and hurled toward the magnetic center.
  4. Patients are screened for metallic implants. If a patient had a staple or pin implanted at least six weeks prior, he or she can safely withstand the magnetic field because scar tissue builds up and holds the pin in place.
  5. The MRI works with hydrogen atoms.As the magnet of the MRI works, the atoms essentially line up along the magnetic field, with the MRI either pointing toward the patient's head or feet. However, enough don't, and it's from these that we get the image.
  6. MRIs have no radiation. The only drawback is for those with claustrophobia. Since can be in the machine for over an hour, the closed space terrifies some people. But today, we have open MRIs--so essentially, no complications from the MRI unless the patient develops an allergy to the dye.