The Surgery

This post will walk you through the surgery from my (Josh’s) point of view. Candi will do a guest blog entry later to share her perspective regarding the surgery and hospital recovery.

I must start by saying that I received the most wonderful gift from my friends at the News & Messenger & Culpeper Star Exponent Monday night. When I arrived at the hotel, Susan (Executive Editor) was there with a gift bag with a Kindle! There were also gift cards and puzzle books – great hospital items! Thank you SOOOOOO much to all of these friends for the wonderful gifts. I even got a little teary eyed while reading all of your messages on the card!

Arriving at the hospital at 6 AM Tuesday morning, I checked in at the surgery center and filled out some paperwork. A short while later, I was called back to pre-op. I had to strip down to nothing but a hospital gown (and some cool non-slip socks) and hop up on the hospital bed they would use for the surgery. We talked with a lot of the surgery team members from doctors, to nurses, to the anesthesiologist. Just after 8 AM, I said my goodbyes (you could have one visitor with you in pre-op) and was wheeled back to the surgery room to begin anesthesia. Unfortunately, I don’t remember much between this point and when I woke up in my hospital room, but here are some of the pieces that I do know.

My surgery was performed by the surgeon I met with at the 30-day blood work. This was a good thing as I really liked him and was confident in his skill level. They did end up doing the surgery laproscopically and took out my left kidney. One conversation with the surgeon seemed to indicate that they ran into some issues taking it out. Apparently, they had to cut through more blood vessels than they anticipated which may explain why my incisions were more tender after the surgery than expected. Beyond that, the surgery seemed to go quite well from my standpoint. My incisions haven’t bled since the surgery and are no longer as tender. The surgeon has commented that they are coming along quite well.

Here are a couple pictures of the incisions.  Click on the pictures for larger versions.  I'll post some updated versions a few weeks from now to show how the healing is going.

Today's the Day!

We leave for the hospital in 45 minutes and the surgery is set to start at 8 AM this morning!  I go first with Candi following about an hour and a half after me.  We should be done sometime after noon.

My mom is going to be posting updates throughout the day on our Facebook page.  You should be able to view them, even if you do not have a Facebook account (it will ask you to log in at the top but if you scroll down you will see the updates).  Just go to www.Facebook.com/thekidneyproject.  Thanks and keep praying!

Kidney Walk - November 7th

Some of the wonderful O&DS folks at Media General have decided to put together a team to raise money and walk in the Kidney Walk in Richmond on November 7th in honor of Candi’s transplant (aren't they sweet?). The Kidney Walk supports the National Kidney Foundation’s efforts behind education and research of kidney disease and transplants.


I will be participating and we are hoping that Candi will be able to participate as well (it is 6 weeks after the surgery so we will have to see). If you are a Media General employee (or a friend of a Media General employee) and would like to participate, you can sign up at: http://donate.kidney.org/site/TR/Walk/Virginias?pg=entry&fr_id=2850. Just click on “Join a Team” and select Media General.  If you have any questions on the walk, feel free to ask!

Can’t walk with us but still want to help? Please consider supporting our effort through a donation to the National Kidney Foundation by going to my page here: http://donate.kidney.org/site/TR/Walk/Virginias?px=1712248&pg=personal&fr_id=2850. Every gift, big or small, helps!  If you make a donation online, the National Kidney Foundation will instantly send you a thank you email with a pdf receipt that you can use for tax purposes.

I will post some pictures from the walk after November 7th. Thanks for your support and please keep praying for a successful transplant!!!

7-Day-Out Visit

Today, Candi and I made our final visit to the transplant center before our September 21st transplant day. This visit had three purposes:

1. The 7-day-out blood work

2. Final blood work and EKG testing to make sure we are fit for surgery

3. Meeting with our Transplant Coordinator to go over some of the specifics for surgery week.

The 7-day-out blood work is the same test we discussed in the 30-day-out blood work post. They will send the blood samples off to Johns Hopkins and Hopkins will do a final test to make sure Candi’s blood doesn’t reject mine. This test period will obviously be a lot quicker than the last one. If they see a problem, they will typically notify the Transplant Coordinator the day before our surgery. Chances of there being a problem with this test are even slimmer than with the 30-day blood work, so most likely we will just not hear anything back until surgery day.

To make sure we are both healthy enough for the surgery, we had to undergo a few of the tests that I went through early in the testing process. The Center did another EKG to check for heart health, drew some more blood, took another urine sample, and did some final chest x-rays. One of the vials of blood they took will be used to find matching blood that could be used in the event that I need a blood transfusion the day of the transplant. They put a medical band on my wrist with a number that matches the blood sample. I cannot remove this band for any reason between now and the surgery. If it comes off, the surgery will be postponed – scary! Needless to say, I will be taking great care of the band!!!

The final step of the day was a helpful meeting with our Transplant Coordinator, Chris. She walked us through the things we need to do pre-surgery, some of the details of transplant day, and then some details surrounding our recovery. I cannot eat anything after midnight the night before the surgery. This is actually better than expected – I thought the cut off would be a lot sooner!

Warning – nastiness alert!!! I committed to include every step of the process in this blog so I guess I can’t leave this part out. One of the steps for the night before surgery is the use of a Fleet enema to clean you out. Apparently this makes the surgery a lot easier for the surgeons. Happy, happy, joy, joy.

Candi and I need to be at the hospital at 6 AM on the 21st. My surgery will begin at about 8 AM and Candi’s will follow at about 9:30 AM. We should both be done sometime after noon. The surgeons will provide updates to my mom and Candi’s husband, so we should be able to keep you guys updated with how the surgery went. We should be moved to normal rooms before the end of the day (unless they have a bed shortage in which case we will stay in the recovery area). It shouldn’t make a huge difference as it sounds like we will sleep away much of that first day.

By day 2 we should be able to get up and start walking around. Actually, it sounds like we will be kicked out of bed and forced to walk around! That will be good – I should be able to pay Candi a visit to see how she is doing. It is possible, if I am doing really well, that I could be released from the hospital Wednesday but it sounds more likely that I will be released on Thursday morning. Candi will likely be released Friday.

Chris emphasized the importance of taking care of ourselves after the surgery. For me, that means taking it easy for about a 2-week period – including no driving. I shouldn’t lift anything heavier than 10 pounds for 6 weeks in order to reduce the risk of hernia. I will need to go back to the hospital around the 10-day mark for a check-up. This visit will be to check my progress and remove the glue holding together my incision (I’ll have to resist the urge to pick at the glue!). Hopefully I will be cleared to go back to work at this check-up. I will then need to check in with my PCP at about the 6-month and 12-month marks to make sure all is still well.

With that, we had our picture taken with Chris and said our goodbyes. Here we are at the 7-day mark:

Weight Loss

As mentioned in some of my previous posts, one of the things transplant centers really focus in on when determining whether or not you are a candidate for donation is your Body Mass Index (BMI). Candidates with a BMI of greater than 30 are generally considered ineligible for donation (there are some exceptions). Candidates with a BMI greater than 25 but less than 30 will be considered for donation but generally need to meet with a dietician to make sure they know how to maintain a healthy weight for the remainder of their lives.

As of my initial testing, I had a BMI of 27.6 so I was within the allowable range but still fell into the overweight category. I was passed through to further testing but encouraged to lose some weight before the actual surgery. I met with the transplant center’s dietician and set out to lose approximately 28 pounds before surgery day. I was sitting at 203.6 pounds and set a goal of 175 pounds. I am happy to report that as of this morning, I broke the 175 pound barrier – 10 days before surgery day!

My sister joked the other day that I should write a book called “How an Accountant Loses Weight.” As a numbers geek, I actually find losing weight to be fairly easy. I didn’t go on any fancy diet, I simply used a program that allows you to calculate your daily consumption of calories and sets a daily calorie limit for you based on your age, height, weight, activity level, and your per week weight loss goal. It’s pretty simple – consume less calories than you burn, you lose weight. I went 105 consecutive days of not once consuming more calories in a day than I burned and hit the 175 mark just in time - tomorrow we are celebrating my birthday and I plan on chowing down on my mom's spaghetti, loads of garlic bread, and some Peanut Butter Perfection from Cold Stone for dessert (which might just exceed my allowable calories for the day).

Tracking calories can be a pain in the rear but it works. Also being a numbers geek, I kept a white board chart of my weight loss to keep me motivated (I couldn’t stomach the thought of not seeing the line drop every week so I absolutely had to keep my consumption down). My BMI today is 23.7 so I now fall in the normal weight category and am set for the surgery. I will, however, need to make sure I keep my weight in check for the rest of my life (definitely don't want to fall into the greater than 30 category and should try to stay in the less than 25 category).

For those interested, you can calculate your BMI at http://www.nhlbisupport.com/bmi/. To track calories, I used an iPhone app called “Lose it.” I know others who have been successful with on-line calorie tracking programs such as www.livestrong.com and http://www.my-calorie-counter.com/.

30 Day Bloodwork Results!

The results are in from Johns Hopkins and we are still a go! Apparently Candi’s blood and my blood were good playmates and didn’t attack each other so they feel good about her body not rejecting my kidney. This was one of the final remaining hurdles so it feels REALLY good to get this one behind us!


Next up is the exact same test next Tuesday. They do the cross match test with the blood 30 days before the transplant and then again 7 days before the transplant as a final precaution. During this visit they will also do some pre op lab testing as well as some training so we are prepared for transplant day. With less than 2 weeks to go, it feels like we are coming down the final stretch!

30 Day Blood Work & Surgeon Visit

Today, I completed blood work that needs to take place about 30 days before the transplant date (which is actually only 28 days from today) and met with one of the two surgeons that will perform the transplant (Candi and I each get our own surgeon).

The blood work is what I like to call the “go / no go test.” This is the last step in the testing process. The lab drew blood from both Candi and me and will ship the vials off to Johns Hopkins University for testing. The testing will mix Candi’s blood with mine to “make sure they play well together,” as Candi likes to put it. They need to make sure that Candi doesn’t have any antibodies in her blood that will attack my kidney when it is placed in her body. The transplant center has already tested Candi’s blood many times and are confident that she has no such antibodies so they are confident that this test will not present any issues. We are both hoping they are correct! We will have to wait 10 to 14 days for the results so we will have to patiently wait until then! We go back to the lab exactly 7 days before the transplant for the same test to be performed one last time.

The second part of my visit was with the surgeon. The surgeon showed me a picture of an x-ray of my kidneys (see below). He explained that they are going to take out my left kidney (along with the attached ureter and blood vessels). They plan to use laproscopic surgery. This means they will put in a 2 inch incision below my belt line and some small holes in my stomach in which to insert tools and a camera. They will then be able to watch the surgery on a tv monitor. They will pull the two muscles there aside and pull the kidney out through this opening. This saves them from having to cut through any muscles.

If they run into any problems, they could have to switch to an open procedure which would mean a larger incision in my stomach and having to cut through the muscle. This is a very safe type of surgery but requires a longer recovery period, is more painful, and results in more scarring but this is only required in 1-2% of the surgeries they perform. I’m hoping for laproscopic!

The surgery itself will last two to three hours if we are able to go the laproscopic route. The open procedure is actually quicker since they don’t have to work around the muscle. I should be awake before they finish Candi’s surgery. There is some overlap but they won’t start on her until about the 2/3 mark in my surgery. The tough part for me is going to be waiting to hear how the surgery goes for Candi!

The surgeon echoed what I had heard earlier in terms of recovery times. I should be in the hospital for 2 to 3 days and then will need to recover from home for another 2 weeks. I should be able to work from home after the first week. If I can get completely off the pain killers and the pain isn’t too bad, I may be able to start driving and head back to work before the two week mark. This will certainly be my goal.

My final question for the surgeon was regarding how close of a match Candi and I are. From earlier conversations I had with other personnel from the Transplant Center, I was under the impression that we were a close match but I had never heard for sure. The surgeon wasn’t sure how close a match we were but stated that it really wasn’t that important any more. With recent advances in anti-rejection drugs, donors and recipients no longer need to be a close match (but they do still need to have the same blood type). It is amazing how far we have come medically the past few years!

With all of my questions answered, we moved on to signing some important legal forms. I had to state that I was aware of the risks associated with surgery, that I understood what type of surgery was going to be performed, and that I had ample time to have my questions answered. With that, I was on my way. Just 28 days until transplant!!!