Peeking At Transplantation

ringLadies and Gentlemen: welcome to the first blog by Gail Rae-Garwood (Mrs. Paul A. Garwood), formerly Gail Rae.  Thank you for all your congratulations and good wishes! I have more former names than I’d like to admit, but I’m sticking with this one, just as I’m hoping to stick with my own two kidneys for the rest of my life… or as I say to Bear “whatever time we have left.”

I am not morbid but I’m also not the blushing bride my dear cousin Steve Bernard caricatured me as.  I’m just plain realistic. And that’s why we’ll take a little peek at transplantation today.  Remember that I’m not a doctor and I didn’t want to know anything about this ever.  But it is a fact in some lives.  Sure I don’t want to have one of those lives and I’m doing everything I can to avoid it, yet….

Do you know about the TransplantCommunityOutreach page on Facebook?  They asked me to be their kidney ‘expert’ right after What Is It And How Did I Get It? Early Stage Chronic Kidney Disease                         was published.  I balked since I certainly didn’t feel like an expert and knew nothing about transplantation.  Linda and Rex Maus went back and forth with me until I understood they didn’t expect me to know everything, just to remind the transplantees what it had been like in the early stages and keep them informed about what new discoveries have been made since their own time in the early stages of chronic kidney disease.  I was comfortable doing that.

You already know that when your kidney function decreases to 10 or 15%, depending upon your nephrologist’s views, you need outside help.  By this I mean, from outside your body.  We timidly explored dialysis last week.  A word about that.  There is so much more that I’ve learned about dialysis while I was researching for that blog. If you’d also like to learn more – whether you’re at the point of needing it or not – I urge you to do more research on your own.The Table

Or, if you’re not comfortable researching, go to one of the national kidney organizations.  They will give you clear, simply stated explanations with diagrams and will list other sources. I would start with Medlineplus, a service of The National Institute of Diabetes and Digestive and Kidney Diseases at http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=renal+dialysis .

I went to Medline at http://www.nlm.nih.gov/medlineplus/kidneytransplantation.html for a definition of renal (or kidney) transplant:

“A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis.

During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working.

Many transplanted kidneys come from donors who have died. Some come from a living family member. The wait for a new kidney can be long.

If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney.”

I find people cringe at the thought of taking drugs for that long, but think of the alternative… or lack of one.  There is quite a bit of information packed into that concise definition.

Diagrams always help me understand when the words don’t.  You’d think that wouldn’t be the case for a writer, but I like to think of myself as the exception to the rule. (It saves face when I don’t remember what some of the terms in the definition mean.)  This is the clearest, simplest diagram I could find.faq_kidney_transplantation

A couple of reminders (taken from the glossary of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease):

  1. Arteries are the vessels that carry blood from the heart.
  2. Veins are the vessels that carry blood toward the heart.

In the last decade, there has been experimentation with taking the donor kidney laparoscopically. That means using extremely small instructions which require extremely small incisions into the abdomen of the donor. I haven’t seen any articles that are negative about this and it cuts down on the recovery time for the live donor.  Since we each have two kidneys and it is possible to live with one, someone who matches may donate a kidney to you.  Otherwise, you will receive something called a cadaver kidney, meaning one which comes from someone who has just died.

Recently, according to ScienceBlog at http://scienceblog.com/56571/donors-like-giving-up-kidney-through-belly-button/ , this marvelous procedure of removing donor kidneys laparoscopically has been further improved by using only one incision in the belly button which is lost within the navel folds once it is healed. The idea is to make it more comfortable for the living donor so that more living donors can be found.

As for the person receiving the kidney, you will be on anti-rejection drugs for the rest of your life.  Your body is designed to reject foreign bodies – including organs.  You’ll also need to pay attention to exercise, diet, sleep, and stress sort of like with ckd, only this is not a life or death matter…  not a keeping your GFR up matter.

Some people choose not to take on that challenge.  It was only through Cheryl’s death that I came to realize not everyone wants to prolong their life if it means doing what they don’t feel they can.

I know, I know, here I am a newlywed (one day now, folks) and I haven’t told you a thing about the wedding or the reception.  I simply felt that, logically, a blog on transportation had to follow the one on dialysis.  Again, I haven’t told you much more than the basics so if you want more, research.  Or comment and I’ll help you find more information.

Expect to cry and laugh with me next week as I weave highlights of the wedding into kidney information.  To my European readers, thank you so much for the volume of sales there!  To my US readers, don’t forget this Kidney Walk season.  Contact your local kidney organization for info on the walk in your area.Az. Kid Walk

Until next week,

Keep living your life!

Pollyanna Lives… In An Artifical Kidney

It’s amazing how long a week can be sometimes.  This week felt longer because I was not careful about overdoing, overdid, and spent two days in bed (well, that part of it was great: DVDs, books, phone conversations, a little internet).  I’ve learned my lesson… I think.  I have this vague recollection of saying the same thing July 4th weekend when we went up to Prescott for the rodeo and parade but ended up in the hotel room pandering to my neglient energy level instead.  Okay, maybe this time I really have learned my lesson – at least, until next time. Some lessons are hard to learn, but I’m hopeful.  Hmmmm, have I mentioned my kids refer to me as Pollyanna?

Talking about Pollyanna, I found this article in Renal And Urology News and started hopping up and down with excitement – while trying to stay seated at the computer. I’m not exactly a kid and am distressed at the thought of having my children disrupt their lives – if they’re even matches – when and if I need a kidney.  My brothers and my finance are all older than I am and, logically although sadly, might not be around at that time.  So who will donate their live kidney to me should the need arise?  If not a living donor, won’t I be placed on the list to wait… and wait… and wait?  Maybe not.  Here’s hope:

Nephrologists and Urologists Collaborate  on Implantable Artificial Kidney

 
                    Figure 1. An implantable artificial kidney moves closer to reality.
Figure 1. An implantable artificial kidney moves closer to reality.
 
 

Four years ago, a joint effort was established between nephrologists and urologists at the Cleveland Clinic Glickman Urological and Kidney Institute to develop and implant a bioartificial kidney. The bioartificial kidney uses a high-efficiency biomimetic silicon nanopore filter that acts synonymously as a glomerulus, in combination with a kidney epithelial cell bioreactor that allows for reabsorbtion of essential electrolytes from plasma filtrate (Figure 1). A Phase 2 trial of an extracorporeal system utilizing these technologies was completed in 2005. Current efforts have been aimed at miniaturization of technology to facilitate implantation of a miniaturized biohybrid device.

This project has been funded by the National Institute of Biomedical Imaging and Bioengineering, the Wildwood Foundation, Cleveland Clinic, and the University of California, San Francisco. Nephrologists and engineers  involved with inception and initial development of the project include William H. Fissell, MD (Cleveland Clinic), Aaron J. Fleischman, PhD, (Cleveland Clinic), Shuvo Roy, PhD (University of California, San Francisco) and H. David Humes, MD (University of Michigan). At Cleveland Clinic, Dr. Fissell, a clinical nephrologist, has teamed with Matthew N. Simmons, MD, PhD, a urologic oncologist to develop prototypes suitable for surgical implantation.  Dr Fissell has a background in biomedical engineering and oversees design and construction of the components of the device. Together, Drs. Fissell and Simmons work through the processes of design modification, surgical implantation, in vivo device maintenance, and functional monitoring. To date they have implanted four hemofilter devices, the last of which remained in vivo for five days.

This project is a model example of the advantages of direct partnership between nephrology and urology colleagues. Dr. Fissell and colleagues provide expertise in terms of materials engineering and renal physiology to develop a device capable of reproducing kidney function.  In partnership with Dr. Simmons and the urology team, they are steadily advancing the transformation of the device from concept to an implantable reality. It is hoped that the success of this research may eventually impact the lives of millions of patients with kidney disease.

You can find the article at: http://www.renalandurologynews.com/nephrologists-and-urologists-collaborate-on-implantable-artificial-kidney/article/216193/

On the book front, there’s another book signing coming up. Here’s the “official” notice”:

Gail Rae, author of “What Is It And How Did I Get It? Early Stage Chronic Kidney Disease” signs the book while the radio shows she’s guested on play in the background.  Not only are the books for sale, but Next has terrific goodies and – of course – coffee for sale. That’s at Next Coffee Company 19420 N. 59 Ave. Glendale, Az. 85308 on Saturday, Dec. 17 at 2.  Locals, come join me!!!!  This is my hangout place when I need to get away from the computer and out of the office so you know one of my two cups of coffee a day is drunk here — and it’s so good.  They have food, too, even rice krispies treats which you know we can eat.

I am excited about having a book signing right in my own backyard so to speak.  It’s not the now transformed Muddy Cup in Staten Island where I used to hang out while Ingrid Michaelson (yes, THAT Ingrid Michaelson) waitressed, but it’s welcoming and you just might meet an interesting medical student since Midwestern University is right across the avenue.  I’ll be looking for you then.

Oh, I’ve got the link to the last radio show I guested on, the one with the heavy hitters full of information I hadn’t heard about before:  http://www.voiceamerica.com/episode/57739/what-is-your-ckd-experience-with-gail-rae-and-a-medical-breakthrough-with-asea-how-redox-signaling

Until next week,

 Keep living your life!