Monday, August 25, 2008
Rejection and Balance
It's great to be back. I am out of the hospital now and doing wonderfully. I wanted to explain a little about the next phase of my recovery.
I have always been averse to rejection, wanting to be accepted by all. My new heart feels the same way. While we were in Rochester, we met with the transplant surgeon, Dr Daly. He did not mince words. He said that a heart transplant will change the rest of your life. It is not if you reject the organ, it is when. He stressed that I would need to take anti-rejection drugs forever. We accepted his guidance as a matter of course.
Rejection occurs because the body views the new organ as a foreign protein. our immune system is designed to fight against foreign invaders that might make us ill or even kill us. These include things such as bacteria, viruses, fungal infections as well as debris like a wood sliver. In each case the immune system recognizes the invasion and destroys it. Foreign protein from a transplanted organ (or allograft) causes the same response.
Two main systems of immune response exist in our bodies: cellular and humoral.
Cellular, as the name implies, is mediated through white blood cells, specifically lymphocytes called T-Cells and B-Cells. This is the type of pathway that most commonly causes transplant rejection, and as such, the therapy is directed to slow down or suppress the cellular response.
Humoral immune responses is directed by specialized proteins called antibodies (or immunoglobulins) These antibodies can quickly recognize and make an antibody that will tag and attract killer cells to eat up the bad guy. This new antibody is then stored in memory for up to a lifetime to prevent reinfection. This is why we only get chicken pox once.
Ironically, for me, amyloidosis is the ultimate manifestation of my warped sense of humoral. (That works on so may levels).
Currently, I have been started on many medication that fall into three broad groups: Anti-rejection drugs, Anti-microbial drugs and body balancing drugs.
The anti-rejection drugs are cyclosporine, cellcept and prednisone. These effectively suppress my immune system but there are costs. I am more suseptable to infections and the side-effects of the drugs mess up my physiology. Thus the need for the other two groups. The antimicrobials are Bactrim (antibiotic), Valcyte(antiviral) and Mycelex (antifungal). In addition, these drugs can causes imbalances such as high blood pressure, kidney problems, fluid imbalance, acid production, cholesterol elevations and mineral imbalances. All of the other drugs attempt to correct this.
This is why today, my first stop after discharge, was to return to the transplant clinic at Kaiser in Santa Clara, to review all of my new medications. In addition, I must remain near the clinic for at least a month so that immediate intervention will be available at the first signs of rejection. This begins tomorrow with my first heart biopsy. They will continue weekly. In addition, I will receive biweekly IV infusions of Dacluzimab, another potent anti rejection drug for at least two months. They will monitor blood levels and chemistries frequently, as well as my general health.
It may seem like a lot, but I accept is gladly, if it insures a healthy heart that will last me a lifetime.
I am so fortunate to have so many good people taking care of me. It's great to be here.
Again, I am so appreciative for all of your words of encouragement and support for Barbie and I on our unique and strange path.
With so much Love