For this 57-year-old, the past year has featured major surgery, recuperation, health challenges, medical mysteries, weird drugs and hand washing -- lots of hand washing.
Still, it's been one of the best of my good life.
Free at last from 45 years of the tyrannical type 1 diabetes and 25 years of kidney-disease terrorism. Energy and outlook restored. Interest in hobbies and projects renewed. Dreams once melting away are intact and upgraded to goals.
It all began Oct. 25, 2011, when I received a kidney and pancreas transplant at UPMC's Thomas E. Starzl Transplantation Institute after spending 23 months on the waiting list. My diabetes, diagnosed Nov. 1, 1966, led to kidney disease in the mid-1980s. The transplants, performed by UPMC transplant surgeon Henkie P. Tan and his team cured both, by replacing the failing kidney and a pancreas that failed to produce insulin.
The donor organs came from Kevin Hager, 31, of Harrison City, who had hydrocephalus and died unexpectedly from an infection the day before the transplant occurred. His mother, Denise Ord, and her family nobly decided to donate his organs and turn their tragedy into health miracles for others.
Besides the organs I received, a 3-year-old received the other kidney, a 77-year-old man got his lungs, a 23-year-old received the heart and a teenager received the liver. I have new friends in Ms. Ord, and Kevin's brother, Rocky Ord, who now are blood (tissue, organ) relatives.
No longer on insulin, I am now focused on preserving the donated organs, avoiding infection, which explains the hand washing, and regaining strength and stamina. My goal is to live a normal life. On the recent anniversary date of the transplant, daughter Georgia greeted me with "Happy Frankenstein Day."
Out of the operating room I did develop a problem. Antibiotics I received to prevent infection after the surgery together with a suppressed immune system from anti-rejection drugs led to a dastardly bacterial infection known as Clostridium difficile (C diff), which causes severe diarrhea. Antibiotics kill off protective gut flora, leaving one vulnerable to it.
For two months, I was weak and dizzy from big-gun antibiotics including Flagyl eventually coupled with vancomycin. I had a colonoscopy that confirmed the infection. Eventually I visited an infectious disease specialist, who finally concluded, as did Dr. Tan, that I no longer had C diff.
But by then, my toes were tingling and feeling numb.
Uncontrolled diabetes often causes circulation problems in the extremities, resulting in nerve damage. But mine seemed to be linked to capillary constriction caused by the main anti-rejection drug, tacrolimus, commonly known by the brand name Prograf. My endocrinologist, Vijay Bahl at UPMC Shadyside, prescribed Metanx, a methylated folic acid that reduces symptoms of neuropathy. But there's no cure.
Organ transplants require suppression of the immune system to prevent destruction of the foreign tissue. Toxic anti-rejection drugs are the downside of transplants, especially when patients, including the one named Templeton, don't react well to them. I also wasn't tolerating CellCept, another anti-rejection drug that reduces white blood cells that battle foreign invaders. It caused me severe diarrhea and lowers my white-blood-cell count too low. Fluctuating levels of medications in my blood work have required constant changes in dosage.
Still, these challenges are minor compared with the health threat of brittle diabetes -- unpredictable blood sugar trends requiring closer maintenance -- and near end-stage kidney failure.
Threats of organ rejection were of my own doing.
Tingling in my toes convinced me to take the supplement alpha lipoic acid, known to reduce symptoms and severeness of neuropathy. Clinical trials are underway to test it.
But blood-test results brought an emergency call from my transplant coordinator, Jessica Hughes Kassner, warning that pancreatic enzymes, which can indicate organ rejection, were elevated. Was I doing anything differently?
Well, yes, I told her. That's when I quit using alpha lipoic acid. Enzyme levels returned to normal.
More recently, I noticed that creatinine clearance levels, indicating kidney function, had edged up. The normal range is 0.7 to 1.4. Beginning this summer, mine began climbing from 1.1 to 1.47 on Oct. 10. That's above the normal range. Ms. Kassner asked me to get blood work, adding that Dr. Tan likely would schedule a biopsy if my levels climbed above 1.5. "A biopsy is no fun," she said.
My next set of blood work proved worse: 1.52.
I had a regularly scheduled appointment with Dr. Tan the following Tuesday. Ms. Kassner recommended one last blood test before then as a last chance to get levels back to the normal range and avoid a biopsy.
Sherlock Holmes would have been proud of my powers of deduction. It made no sense that I was rejecting my kidney. I'm a good patient. I follow rules, at least medical ones. I take my pills. I also was drinking as much as 80 ounces a water each day, to flush the kidney.
I began reviewing everything new that I was consuming in recent months. Transplant class had warned me to avoid grapefruit, pomegranate and mango, which can counteract anti-rejection drugs. I'm vegan and eat few processed foods. I checked ingredients in beverages I drink to rule out grapefruit, pomegranate and mango flavoring.
But I also recalled the training nurse's other caution: Avoid hydrogen peroxide. Some people drink a small amount to kill infections and boost the immune system.
That's when it struck me. In recent months my wife, Suellen, and Georgia had been using a tooth-whitening mouthwash that I also began using. I went to the bathroom, rubbed my hands together and picked up the bottle. My aging eyes strained to read the active ingredients, but I could see a word looking something like "hydrogen" followed by one that seemed to be "peroxide."
Bingo. Hallelujah. I read the bottle its rights.
Three days later I went for telltale blood work, with ongoing thoughts about the impact of organ rejection: Back on the transplant list. Dialysis. Resumption of insulin injections and compulsive blood-sugar testing.
During my appointment the next day, Ms. Kassner went to the computer to check results and I think there actually was a drum roll.
"Numbers are down -- 1.27!" she said. I was in the normal range.
"We were ready to do a biopsy," she said.
I told her my hydrogen-peroxide theory.
But the mystery would take one more unexpected turn.
That very day I studied my blood-work results and noticed C-peptide numbers near the bottom end of the normal range. C-peptide disconnects from naturally produced insulin and remains in the blood, so its levels reflect how much insulin the pancreas is producing. My numbers had been falling steadily.
Was the fragile pancreas undergoing rejection? Was it dying?
Dr. Tan said low C-peptide levels can result from laboratory testing procedures. But I was thinking: "hydrogen peroxide." I had more blood work done after the appointment and Ms. Kassner reported the next day that C-peptide levels had returned to normal.
What a year.
Both organs are functioning normally and not necessarily because of me. I continue getting monthly blood work and will continue routine appointments with Dr. Tan, Dr. Bahl, a dermatologist, a urologist and a nephrologist -- and that's if everything is going well.
It's well worth it. I might not act it but I do feel normal. While rejection brings a series of unwelcome consequences, my biggest fear would be telling Denise and Rocky.
I now feel the responsibility of perpetuating Kevin's life and legacy. It's an obligation. It's an honor.
So I am glad to report, his organs are thriving, providing Frankenstein Dave great relief, renewed health and a whole bunch of unexpected happiness.
David Templeton: firstname.lastname@example.org or 412-263-1578.