Thursday, Nov. 13 - the saga continues

Dan is still in Mayo. He is breathing better, and his new liver is working well, that's the good news.

Yesterday's chest xray showed his lungs are worse, meaning more fluid surrounding the lungs. This morning's labs showed elevated heart enzymes, elevated creatinine level. So 3 teams are working on this - liver transplant, cardiology, and nephrology (kidneys).

The main problem keeping Dan in the hospital is the fluid that won't go away, resulting in shallow breathing, swelling in his abdomen, legs and feet. Dan's kidneys are not functioning well, and we were told this morning that he has had kidney disfunction even before transplant, which makes sense since he had so much leg and feet swelling for so long. There are several solutions to this problem, one they tried on Sunday, to drain the fluid via thorocentesis and pericentesis. The doctors do not want to continue this, as it is risky for Dan's liver. Another solution is meds, this is the plan now, to give Dan a high dose of lasix round the clock now for 24 hours, along with the metolazone, these work in different parts of the kidney. We also learned that Dan's kidney problem may not be "cured" even after the fluid is under control. Which brings me to another solution - dialysis and kidney transplant - they tell us this would be considered if nothing else worked and it is a decision to be made "way down the road." Let's hope so. The doctor said 5-10% of liver transplant patients need this done, since the liver disease can cause kidney problems.

The echocardiogram showed Dan's heart is only pumping at 35% (normal is 55-60%) so that's not at a danger level but it is a decrease. This could be caused by the anti-rejection meds Dan is taking, along with the stress and trauma of Dan's transplant. The cardiologists will follow on Dan's labs, they are more concerned with getting the fluid moving through the plumbing, and more tests may be needed once this is better, including a nuclear stress test.

The liver doctors changed one of Dan's anti-rejection meds (cyclosporin) to prograf last night, in case the cyclosporin is hurting the kidneys. Both can do so, but prograf is less likely to do so, but it has other side effects including confusion, so I'll be watching this carefully.

Dan and I both were busted yesterday for Dan eating way too much sodium. He needs to be on a low-sodium diet, which means less than 2 grams (2,000 mgs) of sodium a day, or about 600 mgs. per meal. I was eating salad with honey mustard dressing last night and noticed the sodium in the dressing was around 550 mgs. by itself, that puts this in perspective. Or as Dan says, he is allowed to eat air. The dietician gave me a booklet on how to cook and eat with this limitation, and the nurse is examing everything he eats and drinks now. Between this dietary restriction and others for transplant patients, life as we knew it is now over - aloha fast food, pizza, shoyu, soda, salad bars, salsa - and hello to no-salt or low-salt everything, Mrs. Dash seasonings, and homemade meals.

All this to say they are getting Dan healthy enough to do another procedure on Monday, to remove the stent they put in his bile duct about a month ago, and put in another stent if needed. So not sure if Dan will get to come home before that.

This is all pretty depressing, and Dan and I have been praying and trying to encourage each other. Dan occasionally talks in his sleep, most of the time I ignore it, but last night I enjoyed listening to him PRAY in his sleep! He doesn't remember it, but I'll never forget it.

A BIG mahalo to our ohana in Hawaii (Roger, Joy, and Clyde) for the surprise package from Bath and Body Works - bubble bath, here I come!

Aloha,
Debbie and Dan