COMING BACK TO NORMAL
I am a 76 years-old surgeon living in Mumbai. My problems of Kidney disease were diagnosed accidentally during a general executive profile blood test in 2000. It showed a serum creatinine level of 3.1. I had no symptoms, whatsoever. On detailed investigations, it was found that I have an Auto Immune disease called Interstitial Nephritis. While I started consultations here in Mumbai, I also sent my reports to an American Nephrology team and they suggested to let the kidneys die naturally without any medication and then go for a kidney transplant; this was suggested to save the body from the damaging side effects of high doses of cortisone which needed to be taken to suppress the immune system.
Here, it was decided to save the kidneys as long as we could. Accordingly, my earlier treating nephrologist put me on high doses of cortisone. It prevented further damage to the kidneys but it worked havoc on my muscles and, in due course, I lost my left hip joint due to Avascular Necrosis of the head of the femur bone. So, I had to undergo total replacement of the left hip joint with an artificial implant in 2002.
With a renal diet and blood pressure control, I could check further deterioration of my kidneys. I always had to keep my blood pressure in the range of 120-140 systolic and restrict proteins in the diet. Following this regime, I further controlled kidney damage for about 18 years. I had several surgeries during all these years – Glaucoma, Angiography, CABG, Omentoplasty and Diaphragmatic Hernia repair.
Unfortunately, none of these went off smoothly; all had complications; these would be too many to enumerate here but suffice to say that through all of these surgeries, my Kidneys did not deteriorate any further and were kept stable enough with a lot of vigilance from the medical teams.
However, my advancing age and other medical factors saw my kidneys beginning to deteriorate by 2017. It was decided that in case I need a transplant, we had to be sure that my cardiac status was normal. Accordingly, an angiography was done in September 2017. This too led to medical complications but it proved that the grafts were still working and the cardiac status was reasonably good enough to undergo transplant.
A few years before all this, I had registered myself at the Civil Hospital, Dr. H.L. Trivedi Institute of Renal Sciences, Ahmedabad, for a cadaver transplant. Gradually, in due course of years, I then came up to Number One on their waiting list and they started calling me for confirmation. All this time, my nephrologist here kept me very comfortable medically with no panic or desperation, whatsoever. I was keen on going to Ahmedabad for the transplant but my wife never liked the idea from the beginning. She always insisted that we should do the kidney transplant here in Mumbai and soon after that she started looking at herself as the potential Donor. She brushed all other family members requests aside!
My nephrologist managed my case very well; he started me on Dialysis, twice a week at the Global Hospital. The A-V Fistula that was created for Dialysis, failed, so I was put on a Triple Lumen Dialysis Neck Catheter – again complications arose from that insertion in another hospital in the city. This catheter has a very limited usage time and we now knew that transplant was imminent.
Eventually, I had to agree with my wife who was absolutely certain that she would give the kidney. Accordingly, a kidney transplant surgery was planned at the Global Hospital, Parel. We started the Recipient and Donor protocol at the Hospital itself. The entire transplant team handled this very smoothly, with proper counseling. Thorough investigations were done on both of us.
Fortunately, the tissue typing and cross matching showed that our Kidneys matched well. The medical tests were done and then the medico-legal formalities and police clearance protocol was also completed in weeks. We both really appreciated the level of professionalism in dealing with all the pre-transplant paper work.
Eventually, the kidney transplant was scheduled early in the month of January 2018. Unfortunately, due to high doses of immunosuppressant drugs that were started before surgery, the blood levels (tachrolimus) were not optimal for surgery; so there was a delay and the operation had to be postponed till the functions come back to normal. Finally, on 17th of January, 2018, we were both admitted and the renal transplant was done with my wife donating the kidney.
Postoperative, it was smooth and I was discharge after 9 days. My wife was discharged after 3 days. I had to observe a lot of precautions and the renal team properly instructed us about these details. Since I was (and still am) on immunosuppressive medication, I have to be careful about the cleanliness of the food and water and of course, infections. I now enjoy all foods, no renal restrictions whatsoever.
It has been four months since my transplant. Slowly and very surely I have started recovering well; my wife always says she has been fine after three days, post-surgery! Of course, she also does her blood tests and reports to our Nephrologist; so far, all’s well. My creatinine level, post-transplant, never went above 0.8 mgm. I underwent tests for renal function every week for the first 6 weeks and then once in two weeks. I am recovering very well, my hemoglobin slowly went up and in the last test it was 14.5. My energy levels are definitely showing signs of improvement and now, I find myself almost normal.
My very personal thoughts as a surgeon and a kidney recipient – I highly recommend transplant, of course, in those who are candidates for it, depending on your Nephrologist. It gives a new lease of life and the recipient can almost lead a normal life. At the same time, the donor does not have to suffer ill effects due to kidney donation and can also lead an absolutely normal life. There are certain precautions to be exercised but that will not dampen the quality of your life. Of course, Dialysis is imperative up to a point but whenever the chance for a transplant is there – do take it. In a country like ours, which is steeped in old traditional beliefs, there are still lots of myths and misconceptions surrounding organ donation. With proper awareness and a good counseling team, all these unnecessary fears can be allayed. One must encourage organ donation.
I must place on record the highly professional way the entire process of kidney transplant was handled at the Global Hospital with medical competence of the Nephrologist and his team, the transplant surgeons and their teams, the dietician and her team and the entire support staff. Also, being a member of the Narmada Kidney Foundation is a very good way of keeping in touch with all kidney related activities and more recent updates.
Written By: Dr. Padam Raj Singhvi (Kidney Transplant Patient)