By Derek R. Benoit, October 28th, 2021
Breaking down my inevitable return to dialysis takes a rather complex review of the months before this milestone occurred. I began mentally preparing over a year ago. Specifically, I reminded myself in the early stages of the downslide that I must enjoy the adequate kidney function I had left. Additionally, I committed myself to focusing on quality of life, and refusing to stop pushing towards my goals. Hence
Ultimately, my goal of legitimate mountain hunting shape is still in play. The difference now is that I have to go about it in a different way. Sadly, I also contributed, to a limited extent, to the quick final chapter of my transplant’s decline in function.
By Derek R. Benoit, October 28th, 2021
How I prepared mentally for the inevitable repeat of the kidney transplant process is simple. I began preparing over a year ago. Specifically, I reminded myself in the early stages of the downslide that I must enjoy the adequate kidney function I had left. Additionally, I committed myself to focusing on quality of life, and refusing to stop pushing towards my goals. Hence, my goal of legitimate mountain hunting shape is still in play. The difference now is that I have to go about it in a different way.
Dealing with the Return to Dialysis
It’s incredibly easy to focus on the negative of returning to dialysis. In addition to the reality of hours of treatment, more limited diets, and the feeling of pending doom, there’s put right disappointment. I’ve felt at times like I failed, instead of remembering that my transplant simply wore out. Alternatively, I forced myself to remember that I got 9 and 1/2 great years of function and increased potential as a result. The blessing of having a sister as a living donor was in itself an incredible grift; it was a true blessing in every sense of the word.
If one takes time to think, dialysis isn’t all THAT bad. For instance, the “bleeding” is stopped regarding your symptoms. Simply stated, you’ll feel better. Provided that you follow your diet, replenish the protein lost, and pay attention to fluid intake, you will feel much better. Hence the treatments will be easier on your body and you’ll feel better afterward. I promise you, you will likely experience less anxiety.
While I was well prepared ahead of time, given my practice of situation grounding, as I call it, I was nervous during my first outpatient session. In the minutes prior to going back, I felt so nauseated I thought I was going to puke. Fortunately, no pukage occurred. Thus was the bottom, provided no complications arose. As mentally prepared as I was going in, I was okay with the situation after my first outpatient dialysis treatment. The anticipation was finally over, and I could move on.
How the Final Renal Function Decline Played Out
Overall, the decline in function occurred in a stair-stepped fashion. Specifically, long spurts of stable function were interspersed with a number of shocks born from illnesses and incidents. Moreover, the last five months prior to October saw a flat line of stability. The final slide began with a case of Epstein-Barr virus. In a nutshell, this is a common viral infection in the Herpes family. It’s incredibly common in humans and is know to pound kidneys in those with existing renal disease ( Seladi-Schuman, 2019).
Another major shock, essentially the nail in the existing transplant’s coffin, was a prolapse of my ileostomy. Let alone the GI apocalypse of early 2021, the ileostomy itself became a liability. While the summer months saw stability in renal function and ileostomy performance, October was a different animal. I had experienced a couple of prior prolapses. Unfortunately, it’s simply something that ileostomies decide to do.
Normally such would last only a few days, with the stoma retracting to normal size and length within a few days. Unfortunately, this last time was different. In reflection, I did notice myself doing less core work in the prior two weeks to the prolapse. In fact, the weakened muscles may have allows the prolapse to develop, and prevent it from retracting (Stoma Heroes, 2019).
The Lesson Learn Via “Toughing it Out”:
Sadly, I likely could have avoided the shock to the renal transplant, or lessened its impact significantly. In particular, I had a fantastic treadmill session one night. I genuinely regretted not pushing for an additional 15 minutes; I felt that strong. The very next day, attempting to make good on the goal of pushing for 15 more minutes, I had zero gas. I lasted only 15 minutes at the same speed. Accordingly, the following day had the same result. By that time, it was probably too late.
It was the next day that I noticed difficulty breathing in normal daily activities. Not only were daily movements difficult, but also carrying anything over ten pounds became difficult. Hence, I read the writing on the wall and checked myself in to the local emergency room. As a result of waiting a few days, my renal transplant took a major and unnecessary hit.
Notably, the creatinine levels measured in the ER came in at 10.3, versus the stability of 4.5, 4.6,and 4.5 measured during the prior three infusions of antirejection medication. While not “good,” they were stable as such for the months following the EBV infection.
The End Result to my Ileostomy of Waiting too Long to Check out the Prolapse
To summarize, the extended prolapse resulted in compromised blood flow to the stoma itself. As a result, necrosis set in. This was the final nail in the transplant coffin. It was pretty much toast after that. A transfer to BIDMC in Boston and ileostomy revision later, I started Dialysis in house at said hospital in Boston. While I had been able to get the prolapsed stoma to retract in the prior episodes, unfortunately, such was not the case in the BIDMC ER as the the colorectal team tried the best but also failed.
Especially noteworthy was that prior to the prolapse, the workouts I was doing had virtually no effect on the creatinine or any other measure of renal function. Stability before, and after the EBV infection were the common themes, though the EBV certainly had a negative impact. For one thing, prior to EBV, my creatinine levels were consistently about the 3.5 level for months. As mentioned before, afterward creatinine hovered around 4.5.
Coping Strategies Moving Forward
I accept the reality that is a return to dialysis. For any transplant patient, a foreshadowing of such is commonly explained by the transplant team. In particular, the consultation will prominently state that transplants typically have a functional lifespan of roughly 10-12 years at present. At the time of my transplant in 2012, the average lifespan was about 8 years of so. Good living donor kidneys tend to last longer while deceased donor kidneys tend to last less (Allarakha, 2020).
A huge difference between the two is the luxury of scheduling a transplant surgery, versus having to simply wait in line for deceased donor. The risk of death while waiting is certainly lower with a living donor as a result (srt.org, 2018).
I will be returning to a full-on conditioning program. As long as I maintain protein intake and hydration, I will have the energy to do such, albeit in modified fashion. While I will maintain my pursuit of leg and core strength, I will be lowering the resistance and upping the repetitions. I will also continue my archery strength campaign, though I will limit such to my isometric routine, which has continued to progress over the past few months. Pushups are also an important component for my archery work. Finally, I will also be continuing my cardio routine, albeit with less focus on really pushing the top end with intervals.
Such an exercise program will be a work in progress. I nave no choice but to experiment. Noteworthy is that I will be striking a delicate balance of hydration here. I must maintain adequate hydration with the ileostomy, BUT I cannot become overloaded with fluid between dialysis sessions. Specifically, the plan is to find the balance first, and adjust the exercises around that. Then, it’s matter of keeping up with hydration balance around such. We’ll see what I can handle! Rucking may take a back seat, but time will tell.
Allarakha, S. (Medically reviewed November 19th, 2020.) Medicine.net. Health & Living Health Center. How Long do Kidney Transplants Last. https://www.medicinenet.com/how_long_do_kidney_transplants_last/article.htm
Seladi-Schuman, J. (March 27th, 2019). Everything you need to know about Epstein Barr Virus. Health Inc. Healthline.com. Health. Epstein-Barr Virus. Health Inc. https://www.healthline.com/health/epstein-barr-virus
Srt.org. (2018). What do I need to consider to compare a living donor versus a deceased donor? Home. Living vs Deceased Donor. Kidney Transplant Decision Aid. Srt.org. https://www.srtr.org/assets/media/Kidney_Transplant_Website/Living_vs_Deceased.html
Stoma Heroes. (2019). Stoma Heroes. Stomaheroes.com. What is a Stoma? Prolapsed Stoma.