Derek’s Two-Week Check-up

We arrived at Lahey around 9:15a this morning for blood labs and right when we got there we ran into one of my surgeons fully decked out in scrubs! He gave us both a great big grin, gave Derek a once over and told him he looked great. “See? You’ve turned the corner.” Then he gave me a big hug and said, “Ah, there she is! My patient!” He wished us well and rushed down the hall to catch up with his colleague. Derek turned to me, smiled and said, “I’m not sure it’s standard for surgeons to hug their patients, but it sure is nice.” Derek got his blood drawn and then we made our way back upstairs to the clinic. The rule on clinic visit days is Derek is supposed to take all of his meds EXCEPT his Prograf. Once his blood is drawn, he takes the Prograf. We sat in the lobby for a minute so he could take the pills and a big gulp of water.

We were a little early, but we went to the Department of Transplantation to wait for his surgeon. The receptionist greeted us before we even made it through the door. Every time we go in Derek has to confirm his medications and take a little survey. The survey asks just a couple questions, like what is your current physical ability? Derek checked the 70% which meant he could do some physical stuff, still needed help with some activities and was able to handle his own personal care. They checked his vitals soon after and his resting pulse rate was still high, around 100-115 bpm. His blood pressure was good, and the scale showed his weight at 144lbs so he is slowly adding weight back on to his frame. They brought us back to the exam room a little later and his surgeon arrived, shook hands with us, and then made a bee-line for the computer to check his blood test results. Derek’s transplant nurse was also in the room and I shared all of the vitals we had been tracking since he’s been home, with her. We learned that his bilirubin is currently at 3.2 and his albumin is at 3.5. So a little ways to go on the bilirubin, but the albumin number is amazing.

Albumin is a protein that is produced by the liver and indicates healthy liver function when it is in the 3.5-5.4 g/dl range. You may recall Derek discussing his ascites, or liver sweat? Ascites happens when the liver isn’t able to produce this vital protein and ends up creating an excess amount of fluid. While Derek was in the hospital his albumin levels were very low and he was given supplemental albumin through his IV, but he still produced a ton of ascites. It’s a good indicator of liver function that his albumin is in the normal range, and that his bilirubin is still on the decline.

Derek’s surgeon then asked about the bile bulb. They knew we had called in over the weekend, and said it was time to cap the tube since the bile was now doing its job. Derek had also been leaking some fluid from the drain port and his surgeon mentioned that was likely a small amount of ascites. That has all but stopped in the last 24 hours. Then his surgeon proceeded to tug and pull on some of Derek’s stitches. He has a few stitches where the 3 other drain ports were and I guess he decided they needed to be removed. Surgeons are such pickers! Poor Derek was wincing and the surgeon said, “Oh sorry, does that hurt?” “Yeah it hurts, some guy is yanking on my stitches.” To which his surgeon said, “Some guy? SOME GUY? Sheesh, you act like we’re at some little hut in the mall and I’m some random guy pulling out your stitches.” Surgeons can be so touchy. We all laughed a bunch, and imagined him working at a hut in the mall and then laughed some more.

The surgeon put some betadine on the spots where he’d pulled out the stitches and then all along the incision, just for good antiseptic measure. He looked at the rest of the numbers and told me to stop giving Derek the Magnesium Oxide, stop giving him the CellCept, and drop his Prednisone to 1 pill per day. That’s a 4 pill reduction in the morning regimen so that’s good. They were still waiting on the results of his Prograf numbers, so that might get reduced as well. He mentioned a couple of things about the medications: initially they pump people up with the immunosuppressants and then gradually back them off. It turns out that immunosuppressants are fat soluble, so as Derek’s fat stores ramp back up, his ability to absorb the drugs will increase. As that happens, they’ll need to back off the drugs. I can vouch for the fact that Derek has little or no fat on his body right now.

The last thing he told us was that Derek’s white blood cell count is a little high. This could mean a whole lot of things, but most likely a little something is brewing. There’s a chance that eliminating the CellCept and backing off the Prednisone might let his own immune system fight whatever might be lurking. To be safe, they asked us to come back on Friday so they can check his levels again. Derek and I are more than happy to take a little drive down to Lahey if it means a stress free weekend of not worrying about a lurking infection. He told Derek to keep walking as much as he could, and to lift some light weights to get his arms back in shape. As we left the office he yelled at Derek to, “Stand up straight!” Easier said then done, but Derek did straighten his back a little after that. Doctor’s orders. Derek is currently zonked out on the sofa after eating a Philly Cheesesteak, so I would say that some things are definitely feeling more normal around here.

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