I went down to Columbia today to see Dr. Jai, my nephrologist, and got some good news. My creatine level is down to 1.2 (normal is less than 1) and I don't have to come back for a month! I'll have blood taken locally but it'll be nice not going down there every week. Unfortunately my hemoglobin is still low. It's actually lower now than it was pre-transplant. Normal is 12, pre-transplant i was at 9.8 and right now I'm at 9.0. So before I left, they gave me a shot to help with that (which hurt like HELL). That'll kick in right before school starts so that makes me happy.
On a side note, I realized that I often to refer to my biopsies and annuals without really taking into consideration that a lot of people just don't know what the heck they are. So I thought I would take a moment to explain exactly why I go off to the hospital every 4-6 months for a procedure.
The purpose of a heart catheterization is to see if my body is rejecting my donated heart by accessing the coronary circulation and blood filled chambers of the heart. A similar biopsy is performed for other types of transplants as well (kidney, liver, etc). A regular biopsy for me is when they go through the neck to check pressures they can't check from the outside (namely heart and lung pressure), ejection fraction (how much is pumped out of the ventricles with each heartbeat) and test for tissue rejection. The annual is when they do the biopsy and in addition to that, perform an angiogram which is when they inject an x-ray visible dye to visualize blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. This helps detect any blockages in the veins and arteries.
The procedures is thus: the first thing they do is prep the site (either the neck or groin) with lydocaine, a local anesthetic to numb the area. Then a puncture is made via needle into the carotid artery and a guidewire inserted into the artery. A plastic sheath is threaded over the wire and pushed into the artery. The wire is then removed and then the side-port of the sheath is aspirated to ensure arterial blood flows back. Once in position above the aortic valve the guidewire is then removed. The catheter is then engaged with the origin of the coronary artery (either left main stem or right coronary artery) and x-ray opaque iodine-based contrast is injected to make the coronary vessels show up on the x-ray fluoroscopy (i.e real time) image. The procedure is recorded via the fluoroscopy for later reference.
I was really surprised when I went for my first adult one. In pediatrics, they give you a mild sedative to help you relax before the procedure but on the adult side they don't give you anything. It's almost better, because you're not as groggy afterwards and you don't have to hang out in the recovery room. However, being aware of all the weird sensations wasn't the greatest feeling in the world. They did a great job though, and all of my pressures and heart function are in great shape! The doctor actually said if he hadn't seen me before he would not have known it was a transplanted heart. How much better can it get?
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