Karin Transplant Journey – Part 1: The Long Decline
I had my first kidney transplant on March 12, 2009, and from all perspectives, it was a great success!
It allowed me to go on to have a pancreas transplant (without a normal kidney function, it would have been hard to go through that very tough surgery), venture out to start a company (Lyfebulb), and conceive a child. Those were the highlights.
But let us not forget everything else that this kidney allowed me to do. First of all, it let me live. Without it, I would most likely have been on dialysis within a year or so, and the life expectancy of a diabetic person on dialysis is less than 5 years. I also traveled to many interesting places, got married, enjoyed new and old friendships, and participated in sports such as tennis and running during these 14 years.
So, to start, I want to thank my donor, my Father, for this life-saving gift.
However, for the past 3 years or so, my kidney has been in steady decline. Likely, some combination of Covid, the stress of the breakdown of my marriage, leaving Manhattan and setting up my life in an old but beautiful house in Westport, CT, balancing the roles of an entrepreneur and single mother, and the effects of the drugs that suppress my immune systems were all contributing factors. Most importantly, the fibrosis caused by tacrolimus truly put my kidney through the wringer. It is so sad that the very drug that is the gold standard for transplant patients (to avoid rejection) is also the one that causes decline of kidney function over time.
Over the past year, I started noticing a few things about my health that were troublesome. First, I was more tired and less social than before. I just didn’t have the energy to embrace situations I craved in the past. Luckily, my daughter is only 5, so she goes to bed early, and that allowed me to go to bed early as well. Importantly, I did not ever let this fatigue affect my attitude at work or the care taking of my daughter. But it did affect my health.
I was also much more sensitive to feeling cold. The only times I was really comfortable were in direct sunlight (which causes skin cancer in people like me) or in my sauna. I would sit in my sauna several times a day just to feel better. It did not do wonders for my iPhone’s performance when I brought it in with me.
It was painful to be this cold and it was due to my grave anemia, which was driven by kidney failure. Despite treatment with erythropoietin stimulating drugs, such as Aranesp, and even a blood transfusion, my hemoglobin would hover around 6-7 (versus a normal range of X – Y). Anemia also impacted my ability to do exercise, since my muscles would not get enough oxygen to function, and even my heart was struggling at high exercise levels.
During this year, I also went through several surgeries for my skin cancer, including one on the tip of my nose, which needed flap reconstruction by a plastic surgeon. He remarked afterwards that my clotting time was quite long. I explained that both my platelets were low and those I had were faulty, due to my low kidney function.
My family noticed my decline as well, and during the summer of 2022, my father asked me to speak to my middle sister, Lisa, who previously had offered to give me one of her kidneys (without me asking). As I was just 40 at my initial transplant, it had always been the plan that my father was to give me the first kidney, and then one of my sisters would give the second.
Lisa has always been of excellent health. She is 5’11’ and runs almost daily, has a resting pulse of 50, and is also an incredibly loyal and lovely person. Her children are 16 and 13 years old, so she was past the physically demanding baby years. I set up a zoom call with her, since I didn’t want to talk to her without seeing her. She immediately said, “I already told you I was going to give you a kidney”. It was such a relief for me that I didn’t even have to ask her.
I have heard stories from other people. Some people worry about that question so much that they avoid family gatherings and getting close to friends.
Now it was a question of when and how to coordinate some important events ahead of time. I needed to have a total hip replacement in August of 2022, and we were discussing whether it made sense to do the transplant before or after that, since that surgery would put additional stress on my kidney. I ended up getting the hip done successfully, but the stress of the surgery caused an additional drop in hemoglobin. So I needed a blood transfusion that September. This procedure gave me the “boost” to make it through the Fall.
Before that surgery and the corresponding impact, my nephrologist had wanted to wait to do the next transplant until my function had declined further. But I was feeling weaker and weaker, so over Christmas, we agreed to do the transplant over Easter, in April of 2023.
My sister Lisa works as a professor at a business school in Barcelona, Spain, and she needed to plan for a month of absence and also of course for childcare during the time she was going to be away.
We both got extensively evaluated from August of 2022, first with respect to matching our blood types, and then our tissue types, and finally making sure I didn’t have antibodies toward her. Our general health, mental health and social and financial support were evaluated as well, and I especially needed to be assessed from a cancer and infection perspective. I also needed to be up to date with respect to vaccinations and dental care as well as any cancer screenings.
Lisa was strong and passed with flying colors. While I had a nuclear stress test that flagged for potential heart blockage. The surgery required for a kidney transplant is serious and cardiovascular clearance is a critical part of evaluation. Since the stress test was abnormal, they required I undergo an angiogram, which involved using a contrast agent. I was very worried about this, since contrast is toxic to the kidney and I was convinced that the stress test was erroneous (I had always had a healthy heart). However, based on the upcoming surgery, and my many years with diabetes, they would not let me avoid the angiogram.
The day of the angiogram I was so nervous. I knew there was a huge risk involved here, since my kidney function was already only 12 percent, and I could not really go lower without extensive problems. My dad took me to the hospital and the procedure ended up showing no blockage; the stress test indeed was indeed erroneous.
However, the effects of the procedure kicked in. The sedation caused massive nausea in me. I could not stop vomiting for the next 24 hours. I tried to treat this at home, but could not keep anything down, and I had to go back to the emergency room the following day to get IV fluids and IV anti-emetics.
The interventions worked on my nausea, but the damage to the kidney was extensive. Between the contrast and the dehydration due to the vomiting, my poor kidney was in acute failure. Within a week I was in hypertensive crisis and severe uremia. My kidney function crashed to 5 percent. Dialysis was the only option for me to survive.
The symptoms I had experienced for the past year seemed like heaven compared to how I was feeling at that time. My head was pounding, I was severely nauseous, and my legs did not fit into any of my pants. My ankles were bloated and my face was unrecognizable. I was severely tired and depressed. I was hospitalized and emergency dialyzed for four days after getting a catheter into my neck vein to link to the dialysis machine that would save my life.
I have never in my life felt as bad as I did in the days before the dialysis. Although it saved my life, the sessions (9 in total, over three weeks) were pure misery.
Two things saved me: thinking about my daughter, and knowing I had to get well for her, and the transplant scheduled for April 13. I knew this was a phase that would endure, and once the transplant worked, I would feel much better again.
Writing about my experiences helped to keep me on track. I have always loved writing and it helped me keep my thoughts from spinning out of control.
My support system kicked in. My sister traveled to NY and came to visit me when I was in the hospital getting dialyzed. My friend and colleague, Leslie, brought food and amazing sweatpants to cheer me up. My family back in Westport were close in touch and took excellent care of my daughter. I truly discovered what a wonderful support system I have, from the mothers of my daughter’s friends to my amazing mother and father.
And we got dealt one more ringer. Shortly after her arrival for Easter weekend and final, routine pre-transplant donor tests, my sister was diagnosed with Covid! And she passed the virus to my parents. None of them had had covid for the past three years, but now they got it! I lost my family network of support for a week, while I was at my weakest.
I had originally been scheduled to do just three outpatient dialysis sessions after being released from the hospital. Now, I was worried about the timing of the surgery, which was deferred until a week later. I needed more outpatient dialysis (6 versus 3 sessions) to make it to the transplant. No one could stay with my daughter and me. My parents used masks and drove me to my dialysis and my daughter to school, and our nanny was very helpful in her support.
Ultimately, the surgery was moved to April 19, and I was as ready as I could be!!
Continue reading part 2 of Karin’s journey: The Dialysis Cleanse