Cedars-Sinai consult update

First of all, I wanted to let you know that I'm trying to figure out a way to upload the Bronch video to show those of you who are interested in watching it. I tried uploading it to YouTube, but it told me after the 20min long upload that the video couldn't be published. If anyone has a suggestion for a better place to upload a 5 minute long iOS video I would be forever in your debt. Thanks! Now, on to our previously scheduled program:

I owe a much anticipated update about my Cedars Sinai appointment to you all... This is going to be long and may be hard to understand, so please let me know if you have questions after you've read through it.

My amazing friend Michael Adams, whom I met 11-12 years ago on a CF forum, has been speaking on my behalf to the lung transplant team at Cedars Sinai (where he got his double lung transplant 12 years ago). When I found out that UCLA was not willing to meet with me after seeing my bronch video which shows the extent of the stenosis issue I am struggling with, I was devastated. I had already been told by all the other lung transplant hospitals in CA that they were not willing to see me for different reasons, but "you're too high risk" was becoming a very familiar answer. The one hospital that didn't dismiss me immediately was Cedars, but when their financial department called me to discuss insurance coverage before scheduling a consult appointment I was told they do not accept Medi-Cal (a government assistance insurance coverage that I've had all my life). At that point I didn't see how I would be able to even see what Cedars' transplant doctors thought about my high risk issue because I couldn't be seen simply because of my insurance. Insert my friend Mike and his ever insistent love for Cedars and his friends. He began speaking to his transplant coordinator, doctor, and even surgeon there at Cedars whenever he saw them, or emailed them on a regular basis telling them that he had this friend who has been turned down everywhere else and he just KNEW Cedars would do whatever they could to help me, only my insurance was an issue. So one day Mike sends me a text message and says that Cedars wants to see the bronch video I'd sent to UCLA. I could send the video and have them review it without actually having to be seen there first. Then I got sick with the CMV infection and ended up in the hospital before Christmas...

   After I was discharged, Christmas and New Years passed, and things began to settle down, Benito copied my bronch disc and I put it in the mail to one of Cedars' lung transplant coordinators. I got a call from the coordinator only a few days later! He said that the whole team watched my bronch video and they feel like they can help me and that they've found a way for me to come in for a consult via pulmonary consult rather than a transplant consult because basically all of their departments contract with MediCal except their lung transplant program. So the plan was that I'd gather the list of medical records they want me to bring in with me, when I had all the records with me, I would call to schedule an appointment. 

I was able to get scheduled quickly for the full set of pulmonary function tests and 6 minute walk that they required I bring recent results of, then after those tests I walked over to my doctor's offices there in the hospital and was able to pick up a manila envelope full of all the other records Cedars had requested. That afternoon I called and told the transplant coordinator at Cedars that I had all the records they requested and I was ready to schedule the appointment! So they put me on the schedule for March 19th. I let my friend Mike know the date of my appointment because he had told me a few times already that he really wanted to be there at the clinic to support me when I got to meet with them.

So Benito and I left early in the morning (this last Thursday, March 19th) for our 7 hour drive to Beverly Hills, full of anxiety and excitement for this very important appointment that could quite possibly change our lives. We got to the clinic with maybe a half hour to spare (we gave ourselves 8hrs for a 6hr trip, but stopping for food and gas took quite a bit chunk of time!). My friend Mike met us once we got out of the elevator there at the clinic and he looked just as nervous and excited as we felt. So Mike points me in the right direction to sign in, introduces us to a friend of his that works there that had an amazing story about her father becoming a famed artist. Honestly, being able to listen to her story was a nice opportunity to breathe and take my mind off of my nerves for a few minutes. Before long my name was called and they took Benito and I back to get my vitals and put us in a room. A doctor (fellow) came in and talked to us about the history of treatment and intervention that's been done to my stenosis issue. He listened to my heart and lungs, then we discussed a little about the hurdles I've had with trying to look for a center for retransplant. Then he took my folder full of records and said he'd be back with Dr Chaux (the director of the lung transplant program there at Cedars). After a few minutes Mike walked in and sat with us until Dr. Chaux came in.

Dr Chaux introduced himself and said that he was able to look through my records as well as seeing the bronch video weeks prior. After reading the bronch notes that my doctor at UCD had written, Dr Chaux does not think that there is anything that Cedars can do as far as helping with my stenosis issue. He said that my doctor is already doing everything that he would do, so there's no point in coming all the way to LA to get bronched every three weeks when my doctor at UCD is able to keep doing them for me. So I asked him about retransplant... Did he think there was a way to get a second double lung transplant? Like I'd been told plenty of times before, my stenosis has gotten so bad that it does not leave enough space at all on my native airway to attach a right lung. (I'll attempt to attach a photo or a link to a video of the bronch so those of you who are curious and not grossed out by blood can see exactly what I'm talking about when I say there is no room.) I asked him if a single left lung transplant would be possible and he said that yes, I could get the left lung, but I would still have the problem with my right airway shutting down, causing the right lung to collapse and get pneumonia. That would put my immune system into overdrive, which could very well cause me to reject the left lung very quickly. So really it's not an option. As far as I knew, those were the only options out there and after he explained how each one of those options won't work, Benito and I were sure we had made the trip for nothing...

Then Dr. Chaux threw us a curveball and said that there is one more option for me and he would be willing to try and make it work... He wants to try and list me for a double lung and domino heart transplant. Basically, in order to attach a new set of lungs to me, it needs to still be attached to the heart, giving the surgeon more room to attach the heart and lungs in one piece onto my trachea, rather than attaching one lung at a time to the right and left main bronchi like a typical double lung transplant is performed. My heart is healthy (as far as we know anyway), so when I get a call for the heart/double lung transplant I'll be able to donate my own healthy heart to someone who is on the waiting list for a heart. Crazy, right?!? To be honest, as soon as Dr Chaux said I could be a donor at the same time I'm receiving my own transplant, I just knew that I wanted to do it. Being able to donate my heart to someone in need takes a lot of the scary out of a retransplant. Given the chance to give back and giving someone the chance to live again like I was given (and will be given again), I'm just so happy to be able to do it. This domino heart transplant bit is rare, but has been done before at a few hospitals throughout the country (per the research I've been doing on my own online). Dr Chaux admitted that he has not yet done this type of transplant at Cedars, but assured me that it HAS been done successfully at other transplant centers and he would be happy to give me a chance at it, especially since he can't offer me any other options there Cedars. 

So, whenever the heart is involved in a multiple organ transplant, say someone needs a liver or lungs very badly, and their heart is only beginning to fail, the patient would be listed as on the heart transplant waiting list, their second organ not taking priority because the heart Always takes priority. That being said, even though my heart is healthy, I will be listed on the heart waiting list and the fact that my heart is healthy puts me as a tier 2, very low priority. There is no other way to list me with my lungs being priority. Dr Chaux said my small size gives me an advantage because there are not as many smaller stature patients waiting for hearts as their are larger stature people. I also have a very common blood type, so that's in my favor. Dr Chaux expects me to be on the waiting list for "a year, give or take". Of course that does not mean that I could not get a call for transplant the day after I'm officially listed, if everything lined up just perfectly, or, I could be waiting much longer than a year... It's very hard to tell. What is very important to understand is that my lungs could ultimately fail me while I'm waiting for a call saying they have a heart and double lung donor for me. That's something I have to come to accept, but fight hard to stay as healthy as I can so I am still here to receive this amazing transplant and donate my own heart when the time comes. A very interesting fact about all of this is that how I understood it, the recipient of my own heart will be a patient of Cedars, who is waiting for their call for a heart while I'm doing the same (but mine will be coming with lungs!). This is so when the right organs are available for me, they will be able to have the heart only recipient on call and ready to receive my heart as soon as it's removed from my chest. This also means that there's a good chance my family will be sharing a surgical waiting room with the recipient of my heart... They not knowing their loved one's heart is coming from a living donor, but my family of course knowing. There are strict rules set up to make sure a recipient does not have personal details of his/her donor, and vice-versa. So, it will be quite amazing to see someone recovering from their heart transplant next door to me in the ICU, knowing my heart is beating in their chest. I know that at that moment, all the pain, struggle to breathe, stress and anxiety I've ever had in my entire life had been worth it because I gave someone else a second chance to live again. How many people get to say they were able to give someone their heart- literally? 

So our first step is to figure out financing. I've been assigned a very sweet and helpful financial counselor that is working with me to find an insurance that I can switch to that will be accepted at both Cedars-Sinai AND UC Davis Med Center. I will definitely need to continue the every three week bronch and laser at UCD to keep my right lung from closing up completely and causing my lung to collapse.

Some of you may already know this, but some of you may have probably been wondering WHY on earth Benito and I have been engaged for 4 1/2 years and haven't gotten married already?!? Well, the truth is that we were afraid to lose the insurance I currently have now (which covers All my hospital stays, procedures, tests, and medication) once my insurance began to figure in Benito's salary as my husband. So, we've been content on staying engaged and not fixing something that isn't broken. Now that I'm in need of a new insurance that Cedars accepts there is a very good chance that Benito and I will finally be able to marry and I'll transfer on to his work insurance. So that's what we're looking at for the time being... We're trying to get a list from Benito's health insurance rep that lists all the different insurance options his work gives him, then I'll have Cedars and UCD take a look at that list and tell me which ones they accept and then it should be as easy as picking out of the final list of insurance options that Both hospitals accept! Fingers crossed it's that easy... We all know how difficult dealing with insurance can be!

Once insurance is no longer an issue, Dr Chaux will refer me to Cedars' heart transplant doctor and that doctor will begin ordering tests to see if my heart really IS as healthy as we are hoping it is. If it is, they'll have me spend 3-4 days down there for a bunch of eval testing that if all goes well, will ultimately be my ticket to being listed there for their [and my] first double lung & domino heart transplant. Dr Chaux said that I'm welcome to stay living at my own home while I wait for my call (6-8hrs away from Cedars, depending on traffic), then after I'm discharged I'm given the choice to go back to my home or rent a place to stay for a couple months  that's close to the hospital. He said that as long as I made it to my once weekly transplant clinic I can live wherever I wanted. He even has patients who live in Colorado and Utah that fly in the night before, go to clinic early in the morning, then fly back home that afternoon. My only worry is how much I'll be able to stand the sternum pain while I travel back and forth. The 2mi drive from UCSF to the hotel my mom and I stayed at post transplant in San Francisco (10 1/2 years ago!) felt like the longest car ride with all the bumps on the road. It was so painful and squeezing a pillow only gave so much relief. For anyone that doesn't know, bone pain is Horrible. I wouldn't wish it on my worst enemy.

Part of the reason why I have taken so long to get this blog update posted is because it was important for me to talk to my immediate family in person about it before they had to read it online. This is a very scary, but hopeful turn of events for us and I wanted to be able to see their faces and cry with them instead of hearing later that they cried alone while reading my blog. So I apologize for the long overdue update, but I also thank you for your patience and allowing me to spread this news the way I needed to.

There has been a lot of tears and hugs between Benito and I this last week, but I can assure you they are tears of relief and amazement. We have been so happy together all these years, but the years have also been filled with a lot of grief, worry, and pain. I can not wait to start a new chapter to our story and it be all about how much we get out and do things instead of spending our time watching every tv series Netflix has to offer, while eating dinner in bed because I'm not feeling good enough to do much of anything else. 

So to those of you who pray, please pray that my heart is healthy so I can be a heart donor, pray that we can find an insurance that is accepted at both hospitals and doesn't require huge copays that will put us in debt, pray for the donor who is right now living their life, completely oblivious to the fact that he/she will be the second hero to save my life. To those of you who do not pray, please send me your positive energy, and love. I've said it plenty before, but I'll continue to say it: I owe my life to you, my family, friends, nurses, doctors, respiratory therapists, and of course my fellow CF/transplant friends. Your love keeps me going and I promise I will never Ever give up on this miracle of life I was given twice so far. I love you all SO much!!!

I'll update again once I know more... In the meantime, please talk to your family and friends about organ and tissue donation and sign up to be a donor on the national organ donor registry if you have not done so already. Thank You!!! <3 div="">

www.donatelife.net

Bronch Photos

Attached is the printout of images that I was given yesterday after my bronchoscopy. If you get grossed out with seeing graphic photos of someone's lungs then do Not scroll down.
I thought it might help to send this so everyone gets an idea just how bad I am when I say that my breathing is tight. 
My right lung was completely closed off so I wasn't getting Any air to it for about a week. When it's closed off like this I'm literally only breathing with approx 12% lung function and with no supplemental oxygen, which I really need (the test to determine whether I need oxygen was done 3 days post bronch, when my airways were open, so they won't order oxygen for home). The scary part is that this complete closure is happening much more frequent and is becoming much harder to open back up. I still do not have an answer from UCSF whether or not they'll be willing to retransplant me.
I'm spending the day in bed sleeping or watching Netflix because my lungs hurt too much for me to move around. 

Here we go again.

Forgive me because I don't know where to begin this blog entry that I've put off for as long as I possibly can.

The last update left off just after I was discharged from the hospital with another week of IV Meropenem to finish up at home. 5 days after I was done with the IV antibiotic I had a CF clinic appointment in which I brought Benito with me and was preparing to have a serious talk with my doctors about how much I want to be more aggressive toward finding out what's going on with my liver and the trouble I've been having with my stenosis getting worse. What I wasn't expecting was the talk my doctor was planning on having with me.

I was happy to see the younger CF doctor that day because I've been butting heads with my other doctor lately and there was so much that needed to be said, by both sides, to get caught up in disagreements.

As always, I did my PFTs first and was shocked to see that they were down from my baseline of 34% to 26%.  When my doctor made is way in to see me, he acknowledged that the large drop in my PFTs was very worrisome and that he was also concerned with the amount of pain I was in with pretty much no relief with my pain medication. He then went on to tell me that he knew I wasn't stupid, and we all know that my disease is progressing and that now is the time to get in touch with UCSF again if I intended to get back on the transplant list for a second lung transplant. He decided that the best option was to go ahead and admit me that day and while I was in the hospital we could have the Palliative Care team consult and see if they can come up with a way to control my pain. I'll also get started back on IV meropenem and once I've been on the antibiotic for a few days then I'd get a bronch to open up my stenosis again (even though the last bronch was only 2 weeks prior). We were all hoping that we could blame at least some of the lost lung function on my stenosis being closed off again.

I had my bronch 3 days later and was very surprised to find out that my stenosis was wide open, in fact it looked as well as it did when they finished the last bronch. So what that told us is that I'm definitely losing lung function to rejection again. I have a feeling the complete closure of my stenosis and my right lung not getting any air to it for a good week a few weeks prior is what shocked my immune system into rejecting again. What's done is done though. 9 days after my PFTs in clinic I did another set in the hospital and I was down to 22%. I was discharged the next day with plans to get over to UCSF as soon as I can.

As far as the pain management goes, the Palliative Care team in the hospital was very nice and tried very hard to help my pain. We attempted a nerve block first with them injecting lidocaine on and around the area that I have the chronic lung pain, but the injections really only caused more pain.  They put me on a PCA (pain med delivered directly through my IV each time I press a button) after my bronch - the day before discharge in hopes of it bringing my pain to a level I can live with before relying only on oral medication. The PCA and oral med combo helped, but I was so sleepy and out of it. They sent me home on my old pain med at a 3x dose along with Oxycontin to give me more of a long term relief so I wouldn't have to take my other med as often. Unfortunately my insurance refused to cover the Oxycontin at discharge, so the discharge planner managed to get me 3 days worth that "should" last until the insurance issue got smoothed out. Three days later we heard back from my insurance and they declined coverage, so I was back to only my old med by that Tuesday (1 week ago now). It took me about 4-5 days, but I've been weaning myself back to my old dose of my old pain med because it really doesn't help, no matter the dose, so I'd rather take less (just to keep from withdrawl, really). I can't believe how sleepy and foggy I was for the past 2 weeks on the Oxycontin. I'm still finding out things I've seen (tv shows), said, or did while I was so dopey and can't remember doing them! I am grateful for the time my pain was lessened, but I REALLY don't like living in such a fog and would rather not. I [think] I was supposed to get in touch with the pain management team once I was discharged, but I can't remember who exactly I was supposed to contact. I'm hoping they can eventually find a medication that will both help my pain and Not make me feel like I'm drugged up and forgetful. The pain I have is in my right lung, so God willing, this pain will not be an issue once I get new lungs.

I got a phone call the Monday following discharge from the Pre Lung Transplant Coordinator checking in with me and letting me know that they are waiting for some test results to be sent over from UCD before they schedule a clinic visit/consult with one of their doctors. Yesterday I got a phone call scheduling the consult visit for March 6th @9am with one of the doctors I'm familiar with already. Today I got a chest CT with contrast done that UCSF is requiring me to bring a copy of to my visit. I went ahead and purchased a personal pulse oximeter that tells me my oxygen saturation whenever I need to know (it's super small and I can keep it handy in my purse for whenever I need to check my o2 sats). Today while I was walking from the hospital's parking garage to the radiology department I was getting especially short of breath and dizzy so I put the sat monitor on and was surprised to see my oxygen saturation down to 85%. Once I sat down and rested for even 30 seconds my sats came back up to 97-98% on their own, so that's good news, but the desatting is definitely upsetting. I'm not ready to admit to myself that I am as sick as I really am right now. I prefer denial to be honest because every time I allow myself to think about it, I panic and get very scared that I either won't be accepted as a lung transplant candidate again, or I will just run out of time waiting for the eval and listing to be done. I'm trying my best to stay positive, but it's not always easy when I feel so helpless just waiting around doing nothing to speed things along.

So Benito and I wanted to let our family know about my need for another transplant before I made it public on here or Facebook and they found out via social media. Now that our families know what's going on I wanted to share the news with you all and ask for your positive thoughts, prayers, and whatever else you feel can help me get the lungs I need before it's too late. My first transplant was scary, but this need for a second puts a whole new level to "scary". This decline is so much more sudden and it has shaken myself and my family to the core.

I'll update again as I hear more. I'm not sure I'll have any news to share until after my appointment on the 6th, so don't get worried if you don't hear from me before then. I'll update after that consult though... I promise!

Lots of love to you all. And a big THANK YOU for all the support and love you've shown me and continue to give. I couldn't do any of this without the strength I get through your love!

XoXoXo

The end of a rough year leads to a rough new year.

I've had a pretty tough few months, but the last few weeks have been a doozie. I've been complaining to my doctors via phone about having more and more trouble breathing, fevers rising, and my pain getting worse. Finally, just before my birthday I got a phone call back saying that they'd like to admit me because they thought I may have a virus (although my symptoms had been going strong for Weeks). I told them that I had a 4 night "getaway" planned for my birthday - New Years that I really needed to go to, even though I wasn't planning on anything more than laying around and just spending some time away from home with Benito. So we cancelled our plans because my doctor was supposed to call me on Saturday to discuss admit, but after not hearing from him, we decided to check and see if our reservation had been rebooked by someone else yet. Luckily the place was still open so we went ahead and spent 3 nights in the East Bay. We literally spent the entire time watching rented DVDs, sleeping, or just laying around talking, but we did it together and had a great time away from home for those few days.
Once we got home I called my clinic to see if I can go ahead and be admitted, but my nurse was out of the office until the following Monday (Jan 6th). So we spent the next few days preparing for an admit and Benito getting a lot of work done at his office.
I wasn't allowed to say anything before, but Benito was offered a management position at his office and his first day at Operations Manager of the entire production part of the company was Jan 2nd! I'm just so darned proud of him for all the heard work he's put in over the past 5 years. He's such a hard worker and just LOVES this company, so when the previous VP of the company decided to buy out the company from the family who started it 20+ years ago, he knew he wanted Benito to run production. It's all so very exciting now that we can actually tell people! We've had to keep this secret for nearly 3 months before the big announcement on Jan 2nd!

So I called my nurse on Monday morning (Jan 6th) saying that I really need to be admitted. CF clinic is on Mondays, so I knew it would be a while before I would get a call back about getting a bed. I spent the day making sure I had my ducks in a row... Bills paid, laundry done, library books renewed or ready to return, etc. Toward the late afternoon I took a quick shower and by the time I got toweled off I was Bright RED, shaking, and super weak. I pulled out all my equipment and took my vitals... My temp, blood pressure, and heart rate were high, while my oxygen saturation was at an all time low since transplant. I called my nurse again and left a voicemail letting her know the update. Within a few hours my dr called me saying that the hospital was full because of how hard the flu has hit everyone this year, but he's trying to get me a bed. If a bed didn't open up then he'd look into getting me in to a different hospital until I could be transferred. The ideal ward I prefer to be put at my hospital is the transplant ward... The nursing staff is extremely kind and so knowledgeable about all of my medications and needs while I'm in the hospital.

Fortunately by 6:30pm I received a call saying they had a bed for me at my hospital, unfortunately for me, that only open bed was on the orthopedic floor, not the transplant or even the CF floor. So Benito accessed my port at home before we left because the nurses on the Ortho floor are so unfamiliar with central lines and I don't like having to coach someone through something while I'm feeling so awful to begin with.

So we got to the hospital at around 8pm and ended up getting put on supplemental oxygen right away because my oxygen saturation was 91% on room air. It took a long time before my nurse was allowed to do anything beyond that because nobody knew who my doctor/hospitalist was and who to ask. So no orders got written for quite a few hours. Eventually they drew blood, got an xray, started me on IV Meropenem, and respiratory treatments every 4 hours.

What we know now:

My xray showed that my lower right lobe of my lung is shrunken up, but they can not hear ANY air moving throughout my entire right lung. We believe that the stenosis has completely closed off and has caused my lung to "collapse". Because donor lungs have a strong tendency to "glue" themselves to the recipient's chest wall with scar tissue, my lungs won't look like they've collapsed via an xray. They can't physically collapse while they're stuck to the chest wall, but it's giving me so much more pain than my usual lung pain. Attempting to take a deep breath is Very painful and I get a feeling not unlike trying to inhale through an empty balloon. Not comfortable.

Once my oxygen sats came up enough to where I could be taken off the supplemental oxygen there was no longer anything they were doing in the hospital that I couldn't be doing at home. I needed to come home. Most of the nurses on the orthopedic floor were very kind, but every night and day was a struggle with my medications. It got to the point that they were just having me skip the meds that they weren't sure of, so I ended up having some Awful acid reflux every night, which for a transplant recipient, it could mean rejection (yes, reflux CAN contribute to rejecting lungs). I had Benito sneak in my own acid blocker med that I normally take at home (by prescription, so no funny stuff) so I could get my reflux a little more under control.

So they got one last xray done and set me up with IV Meropenem to continue for another 2 weeks at home. I was told that my CF dr was going to speak to my other pulmonologist that does my bronchs and get a bronch scheduled for early the next week (this week). So on Monday I called my CF nurse to check in to see how that bronch was coming along... My dr did talk to my other doc, but he didn't tell him that I needed a bronch asap. :-/

So my nurse got in touch with my bronch pulmonologist and I got a call today saying that the soonest I could get scheduled was next Tuesday the 21st. I broke down and cried... There's no way I could wait another week in this amount of pain. She said my doctor is going out of town tomorrow and won't be back until Tuesday, but she'd call him and see if there was Anything we can work out. A little while later she said my doctor agreed to get me in for an early bronch at 8am tomorrow morning. Basically, his flight leaves at 10am and he's swinging by the hospital on his way to the airport so he can help me out before he leaves town. I can't tell you how much of a relief that is! I can't wait to be able to feel again what pain less than an 8 or 9 out of 10 feels like!

For over a month now I've been experiencing some strange new symptoms and they're continuing to get worse. I've had a Lot of itchiness that Benadryl doesn't help, ammonia smelling sweat (yes, very Gross!!), pain in my right upper abdomen, and some others that are a little too personal to share with you all ;-)

So I got blood work done and found out that my liver enzymes have been rising for a few months. It took a LONG time for me to get my doctor to agree to do any further testing, but he agreed to an abdominal ultrasound and a bunch of other blood tests. Everything is coming back negative, so we don't know what's causing my liver to act up, but during this past hospital stay I asked to be referred to a GI specialist so they can help me figure out what's going on (because my CF doctor told me he didn't want to "dwell" on it any longer). It's hard to just ignore all that stomach pain and constantly paranoid that you smell like ammonia... I'm grateful to be seeing someone soon who is familiar with liver issues and won't just ignore me.

I'm totally worn out, but I will try to get on here soon to tell you about what we've been discussing regarding retransplant. Basically the docs and I are worried that one of these bronchs with laser could go from routine, to life threatening because my doc can't see what he's burning once it all goes black with char and he could very easily hit an artery... Scary stuff, but something to think about.

I do hope you all are having a good year so far.

Until next time...

Brachytherapy- Take 2

Hello friends!

It has been about 6 months since I've posted an update, but there hasn't been a whole lot to share in that time.

I've gotten into a somewhat routine of going every 4 weeks to be bronched and having my right main bronchi opened. Due to an overgrowth of scar tissue my right main bronchi gets so small that my doctor can barely thread a tiny wire through it, so you can imagine how difficult it is to breathe through. When it gets that small my dr has to basically guess where the center is and makes a small slit so he can get the bronchoscope through the hole and then balloons it open as much as possible. Most times he'll then use a laser to burn away the scar tissue, which leaves me feeling pretty awful for about a week, then able to really BREATHE for a good two weeks before it begins to tighten back up again. It's a pretty frustrating roller coaster, but it's the only thing we've found that "works". We've tried putting in stents to hold the airway open, but because of the shape of the stenosis it doesn't want to stay put. Having a stent able to move from where it's intended to be can cause a whole lot of unwanted problems, including an increase of scar tissue and choking if it lodged itself sideways. So we've given up on trying to make a stent work. We tried freezing, but it actually made my airways even more inflamed, so we never tried that again. About 18 months ago my bronch / end stage pulmonology doctor got in touch with the radiation oncology team and we tried a brachytherapy treatment. Basically they did a 3 full minute blast of strong radiation directly on the stenosis hoping that the radiation would break down the scar tissue w/out hurting too much of my healthy tissue. It was a tough recovery, but I felt like it gave me a little more time before needing another bronch. My pulm doc wasn't convinced that it worked well enough to try it again, given that it's such a heavy dose of radiation to one specific spot, which increases my risk of lung cancer dramatically. So we never entertained that idea of brachytherapy again. In the last 18 months the time between my need for bronchs have gradually decreased from every 8, to 6, to now needing a bronch no later than every 4 weeks. By week 3 I'm usually struggling pretty bad, so this window of feeling "good" is shrinking.
On Friday I had an appointment with my bronch doctor. I wanted him to see me at my "best" because he only sees me awake for a few minutes prior to each bronch and I'm never feeling well at those times. I wanted him to see how "good" I can feel, and to discuss options to widen the gap between bronchs. After going back and forth about our lack of options, I brought up brachytherapy up again. Because we have zero other options at this point, he's willing to give brachy ONE more try, but he's not willing to do more than that because the risk of cancer I'd be bringing to myself. So he's going to get in touch with the radiation oncology team again and set up a two part treatment this time around. He wants to bronch me one day, then the following day do the first brachytherapy treatment, then no more than 7 days after that, a repeat brachytherapy treatment. He's hoping that a two part treatment will have better results and will continue to break down the scar tissue for a longer period of time. This is our Last ditch effort before we have to agree that the bronchs are our ongoing future of treating the stenosis. If you're a praying person, I'd really appreciate all the prayers that this method works so I don't have to continue this frustrating and scary roller coaster. I've begun having anxiety attacks when my airway is super narrow and I feel like I can't ever get enough air. Sleeping on 5-6 pillows then waking up with an anxiety attack is not my idea of a good night's rest, so I'm really counting on this brachytherapy helping me.

About a month ago, one week after a bronch I was feeling the BEST I have felt in as long as I can remember. I felt like my airway was completely open and I got to feel for the first time what 34% lung function feels like, which isn't all that bad! I have been feeling like I've been suffocating for a few years, but I realized last month that that suffocating feeling is mostly because of the stenosis, not my low lung function. I had NO idea I could still breathe that well to be honest. I thought I lost that feeling forever, but it just took a really good bronch to open things up well enough for me to fully breathe to my capacity. I took full advantage of those couple of weeks of feeling great and exercised on our elliptical every day, painted our dining room and kitchen, and got a lot of small jobs done around the house that have been put off since moving in a year ago. I had high hopes of feeling that great again after this last bronch I had about 10 days ago, but due to a sinus infection and feeling overall pretty blah, I haven't felt too hot this time around. I'm on a 10 day course of an oral antibiotic for the sinus infection, so I'm hoping that the fevers, headaches, and overall body aches go away soon enough so I can have a few days of feeling really good before my airway gets too tight again.

Benito turned 30 at the end of August, so we rented a car and drove to San Diego where one of this friends and his wife now live. They were wonderful hosts and we had such a blast during the 4 days we were there. We saw a Padres/Giants baseball game, saw a movie at the ritziest theater I have EVER seen let alone been in, enjoyed a beautiful sunset in La Jolla, and got to be tourists with some of the best tour guides! It was a trip we'll never forget and we're both hopeful to go visit again sometime soon. On our long drive home, we were lucky enough to meet up with a very long time friend of mine that I met on a CF forum about 10 years ago, but had yet to meet in person. The three of us had lunch and a very nice visit together. Mike is just as awesome in real life as he is over the internet.

That's it for now. I hope you're all doing well and enjoying the beautiful colors of fall! I just LOVE this time of year :-)

Michael Adams and I - meeting for the first time after 10 years!

Great Strides 2013

This year's Great Strides walk was a huge success!!
Although I was still recovering from a bronch only 3 days before and I was feeling pretty darned sick with kidney/liver issues, I still managed to make it to the walk. I didn't walk this year, but stayed back with my mom and a fellow CFer friend of mine and waited for my team to walk for me. The Iron lungs raised around $3,500 this year that is going directly toward research for a cure for this awful disease! A big THANK YOU to all who donated and/or walked this year! Here is a link to my Picasa album of all the pictures we took at the walk!

Great Strides 2013 Photos

Happy 8th Breathday to me!

This time 8 years ago I was on my way to San Francisco to undergo a life changing [and do I even have to add "saving"?] transplant. I can't believe it's been 8 years!

I have been reminded lately by quite a few people that I'm a lucky woman... Not too many people have been given a second chance to live like I have. One person in fact actually went as far as to say "8 years is a good run, you should be happy with that", as if I should just be content with the 8 years I've been given and not wish for more. Of course I want more! It's the want for more, the need to keep living that's kept me alive this long and I don't plan on being "happy" with anything less than a full and Long life. I deserve that as much as the next guy, right?

So I had CF clinic today and my doctor talked a little about retransplant. My PFTs were down to 26% a month ago and after 2 bronchs I'm only up to 29%, so he's thinking that I'm not just dealing with the stenosis anymore... He's suspecting that I'm in a slow rejection and it's time to start revamping my "resume" for transplant. What I mean by that is that I need to do all I can to make a transplant center WANT to transplant me. Yes, I'm a very compliant patient already, so no worries there. We need to start babying my kidneys, be one step ahead of any possible skin cancers, etc. Basically I need to make sure everything is as healthy as I can get it so a transplant center won't be worried about the rest of my body having problems after another transplant.

On to better news, shall we?

It's been a little over 4 weeks since we got the keys to our new house! We have been extremely busy every day unpacking, painting, organizing, cleaning, etc. We said goodbye to lazy weekends when we got our offer accepted and haven't had a single lazy weekend since! We're excited to be throwing our first little get-together in our new home this coming weekend. It's going to be a small shindig to celebrate our housewarming, Benito's belated birthday (we didn't have time to do much celebrating with the move), and my Breathday (transplant anniversary). We still have so much to do before we're ready for people to see the house, but hopefully we get it all done before the weekend and with time to spare!

I think that's about it for now. I'm sorry I don't update my blog too often, but I'm sure you can understand why ;)

I hope everyone is doing well and enjoying the beginning of a beautiful autumn!

Finally, some hope.

Good afternoon all to all my blog readers!

I'm very sorry I have not updated my blog until now. I didn't have anything new to share (until now), so I didn't really know what to write for you all. I don't want to bore you, so I waited until I had something worth while to share.

Since I last updated, I did a 4 week course of antibiotics (4 weeks oral/ Levaquin, and 3 weeks IV/ Cefapime ). I was feeling pretty junky in my lungs and running fevers while waking up with my sheets drenched from cold sweats, so I had to give in and get some antibiotics on board to help the infections that were cookin'. The IV antibiotic was ordered for me to do 22hrs per day, giving me 2 hours a day free to shower and run errands. After about a week on the IV antibiotic I was feeling pretty sick from the med itself on top of feeling bad from being sick. I finished up the antibiotic still feeling pretty crummy, so I talked to my doctor and decided that it was probably time to get bronched and open up the stenosis I have in hopes to open it up enough to allow me to cough junk up so I can get rid of the infection easier.

I went in on Thursday the 14th for my bronch; the day after a set of photopheresis treatments. My doctor went in expecting to see my airways red and inflamed, with either 1 or both airways stenotic (narrow). What he saw was my airways almost back to the pale color they are supposed to be! Both main airways were stenotic, so he opened them back up via balloon dilation and took some pictures to show me once I woke up.

I'm attaching both a set of photos that were taken back in February of this year, before I started photopheresis treatments, and a set of photos that were taken last week. Note the very red, irritated airways in the first set. This started to appear on my bronchs around the time that my PFTs began to decline a few years ago. My CF doctors assumed the inflammation and redness is due to chronic rejection and we really didn't think it would get back to it's normal pale color.

The second set of pictures are from the bronch I had a week ago. Note how the redness is almost gone! The photos were taken about 10 weeks after the start of photopheresis treatments there at U.C. Davis. We're excited and very hopeful that this is a result of the photopheresis treatments working! Maybe, just maybe, the treatments are stopping the progression of rejection! I have not done PFTs in a while, so I don't know if I have any improvement with that yet, but my lungs sure look better! You'll see that the airways are still stenotic in the first few pictures, before they dilated, then much more open (and even a little more red) after they dilated and messed with them.

So that's my good news! I'm extremely hopeful that these treatments are actually working. I do not feel better, but we really didn't expect for me to feel better with the treatments. We were just hoping I wouldn't get worse, which from the look of my airways, may be the case!

All of you who are considering photopheresis,
Like all medical treatments, it's not a sure thing. It does not work for everyone, but we chose this treatment over taking medication that would knock my immune system out and I'm very lucky that we may be seeing positive results from it. I feel so grateful that I found a doctor who would not give up on me and decided to give photo a try on my rejection. If it were up to my transplant center I would be waiting on the transplant list right now for new lungs. A huge thanks to my post transplant friends (especially Christy) for showing me all the options there are for people in chronic rejection and not allowing me to give up on these lungs. I know I may be jumping the gun a little, but I'm thinking positive! ;)

Ray Lamontagne soothes the soul

It's been over a month since I've been told there is nothing left to do but wait to get sicker. A lot has happened since I've last updated, so I'll try to cover everything.

I'm sitting in my bed with my laptop listening to Ray Lamontagne; letting his raspy voice and beautiful lyrics soothe my soul while I recall some of the not so fun things that have happened so far this year.

My last post went over what happened at my last CF clinic appointment. Just a quick recap: After Stanford declined taking me on as a patient, I was relying on my CF doctors to help stop the decline in lung function. Why not have my transplant center (UCSF) take care of me and my possible chronic rejection you ask? Well, my transplant center is one of what seems like a growing group of transplant centers that are very apathetic toward their patients (I should include there are a Few people I've talked to who have not had this same experience with UCSF) and do not have a protocol toward treating chronic rejection. My CF doctors have exhausted all their resources and are not familiar enough with the transplant field to know what to do for the possible chronic rejection(CR). So, I've been left with absolutely no idea what I'm to do about my increasingly fast decline of lung function. In the last month alone Benito and I both can tell a huge difference in my breathing. My last fev1 (lung function lingo) was at 33% prediction, which is at the point where people would be listed for transplant. I was at 17% fev1 at the point of my first transplant, but since the damage CF did to my lungs was so gradual, I was able to adapt to the low lung function. The decline I have now seems to be happening to fast that I'm not able to adapt and it feels like it takes forever to be able to catch my breath after walking just a few feet. Imagine trying to inhale through an empty balloon... That's exactly how my chest feels when I'm out of breath. My sound of my breathing is getting to be so noisy that it keeps me up at night (I sleep with a fan going even if it's freezing, just to try and cover the noise of my breathing).

So after the last clinic appointment at my CF center I had yet another balloon dilatation done on my right narrow airway and after that procedure was over, my doctor came to the recovery room and talked with Benito and I about where we need to go from here. I had brought a printed out copy of a conversation between a very good CF/Transplant friend of mine who goes to Duke hospital. In these conversations she was helping me with what treatments she knew of that hers and others have used to treat chronic rejection. I gave this copy to my CF doctor to read over before my procedure that day and by the time I saw him after the procedure he had read it over a few times and had spent a half hour speaking with the pulmonologist there at UCD that worked my up for my transplant evaluation six years ago. This pulmonologist used to work with the lung transplant team at UCD years ago when there actually was one, so he knows a little more about transplants than my CF doctor. Basically all they came up with, was that I needed a transplant center to administer these treatments because they have never prescribed them and didn't feel comfortable having me be their guinea pig. So, this left me to first go back to UCSF and see what they could do for me, then if I get nowhere with them, I can look into possibly going to UCLA, but it's eight hours from where we live and it would be both physically and financially draining to have to relocate.

Fast forward to February 10-11th. Benito and I went to San Francisco to visit my transplant doctor for the first time in a year hoping they will give us some hope, although I wasn't expecting much. I had my PFT's (which showed my fev1 down to 33%), CT scan and transplant clinic on the 10th and bronch with biopsies the following morning. My doctor basically told me he wasn't convinced what I'm going through is chronic rejection. He's STILL convinced the stenosis I have in my right main bronchi is causing all this decline in lung function. I was willing to believe him for a while, but after 2 years of my lung function getting worse and worse by the month even though I was getting balloon dilatation's to open the airway every month. So I brought up IF what's going on is chronic rejection, what does he usually do for his patients in CR? He basically said that after making sure the patient is on Azithromycin (which I've been on since my transplant), he doesn't do anything. He believes there is no proven treatment for CR. In fact after I brought up a list of treatments that I know other hospitals are using for their patients in CR, he denied that more than one center is using one of the treatments (which I know is untrue), and said the other treatments don't work. *Huge sigh* At that point he said "there is one thing you haven't mentioned yet" and I knew what he meant... Re-transplant. He said he would re-transplant me in a heartbeat because I'm "such a great patient". I can't tell you how upset that made me. I feel like this hospital treats me like a customer and not a patient they need to care for. They are so eager to re-transplant me (where they'll make $200k just for the surgery alone), rather than do whatever it takes to try and treat what's wrong now. It's very unnerving to not have faith that your doctor is doing what's best for you.

The bronch the following morning was an absolute nightmare. I have chronic side pain, which is assumed to associated with a chest tube and nerve problems. This pain gets a lot worse when I deep breathe and it's forced me to take pain medication every day in order to just get out of bed every day. Well the fellow DR that was in charge of my bronch for some reason was so afraid to over medicate me that I was awake during the bronch, given only a child's dose of Versed (medication which is supposed to help you relax). So during the bronch, the guy who calls himself a doctor was only able to biopsy my left lung because my right airway wasn't open enough to get the tube down through it. Once I got to the recovery area I was in 12 out of 10 pain in my side and stayed that way for 3 HOURS because the doctor was scared to give me any pain medication because somewhere in his tiny brain he thought I might get over medicated. Mind you, my O2 sats were 97%, my heart rate was around 100bpm and my blood pressure was around 160/80, which is too high, a sign of a person in pain and not in danger of being over medicated. After about 30min of crying, the nurse closed my curtain around me so he and everyone else could try and ignore me. 2 1/2hrs later while still in 12 out of 10 pain and still crying, the nurse came in and said "good news! the doctor is allowing you to take half of one of your pain pills!" I was like "You've got to be kidding me! Why can't I take a whole pill? I take a whole pill at home every 8 hours!" The nurse took my bottle and cut one of the pills in half and handed me the half along with a glass of water. I asked him for the bottle and dumped his half back into it and took a full pill. That nurse flipped out! He opened my curtain and told me I'll never be able to take my own medication again (Fine with me! The hospital shouldn't force their patients to treat their own pain! THEY shouldn't allow their patients to be in excruciating pain for 3 hours without trying to help them!). He then demanded that I give him back my pill bottle. Ummm HELL NO! I told him that once he brought my fiance back into the room I'll give the bottle to him. He didn't need to be worried that I'd take more. I've been on this medication for years and I know not to over medicate myself. So about 45min later when my pain was beginning to get better, the "doctor" came in and said that since I took a whole pill against medical advice, he was going to put me in the ER to be watched and made sure I didn't desat and stop breathing because of my excess medication dosing. WHAT?! First of all, it wasn't excess. I had less medication so far that day than I usually do on a daily basis. Second, no doctor who knows anything about transplant recipients would send their patients to the ER where there are God knows what kinds of germs floating around and risk getting me sick. A few minutes after he left, a different nurse started his shift and found out what had been going on and called one of my REAL doctors. Within a half hour my tx doctor had come in and wrote discharge papers saying to hurry up and go before that other "doctor" followed through with his crazy ER plan. It's sad, but events like these are not all that uncommon for me at UCSF. Most of the nursing staff is great, but I can't say the same for their doctors.

Two weeks later I was back to UCSF because my tx doctor wanted me to come in and go under general anesthesia while they go down to open up my airway and take a better look around. Thankfully once I got to the recovery room that time, the doctors and nurses gave me adequate pain control and were very kind. My main tx doctor came in to talk to Benito and I after the dilation with a huge grin on his face saying "I think we did a great job opening that airway". Unfortunately the week following that procedure my breathing got really bad and for the first time I think even scared Benito. It's been almost 2 weeks since the dilation and I'm beginning to get back to my baseline. I have CF clinic on Monday and I'm not sure what to expect.

Onto better news, Benito's sister will be getting married this next Sat 3/12 and I'm her maid of honor! Benito and I haven't really done any major wedding planning for us yet. I want to enjoy my wedding and as of now, my health won't let me. So, I'm hoping to start wedding plans the day after I am feeling better! :)

A plan of sorts

So some of you may know, I was discharged from UCD on Friday night. All the tests that my CF docs wanted to do had been done, so keeping me in there while waiting for results just adds to the risk of me picking up some extra infection that I really don't need right now.
Before discharge I did a 2nd set of PFTs (pulmonary function tests) to compare to the ones done before my bronch where they dilated open my right airway. Pre bronch my PFTs were 37%, post bronch 41%, which we are going to now consider my baseline. Not a whole lot of improvement, but I'll take whatever I can get!
I talked to both of my CF doctors seperately on discharge day about what their thoughts are and what they think we should do. Basically they both agree we're looking at chronic rejection and they want to first increase the medication I'm currently taking for immunosuppression and see if that stops the progression of rejection. If that does not work, they think I should be sent to Stanford for an evaluation with them to see what they think I should do.
Some of you may or may not know that with chronic rejection, the damage done cannot be reversed, but we can only hope to stop the progression of further damage. I have never been in either acute nor chronic rejection since my transplant, so this is all new water for me. One of my doctors brought in a 10 page article for me to read about chronic rejection and all the available treatments (along with their risks). I began reading it while waiting to be discharged and got about 2 paragraphs down where I read that the "median survival after onset is 3-4 years". I stopped reading at that point and will pick it back up when I don't feel quite so overwhelmed.
Since I've been home I've been having a very hard time breathing and dealing with very sharp pain in my sides. While at the grocery store yesterday with Benito my side pain got so bad it knocked the wind out of me and I couldn't move for a few minutes.
Today I stayed in bed as long as I could, sleeping on and off until 2pm hoping that maybe some extra rest is what I need (I sure dind't get any rest in the hospital!). I need to get a hold of my academic advisor about retaking the class I'm currently in at another time because my instructor of this class is not being very understanding about assignments being turned in a little late. I'm also worried about work. I don't want to quit because I love getting out of the house and getting a paycheck, but I don't know how long I'll be able to keep everything going. I think I'm even beginning to get a little bummed out about everything, which doesn't help anything.
A plus is that I have great support from Benito and my family, so I never feel like I'm dealing with all this on my own. Even Roxy helps by snuggling with me when I don't feel good and Benito is busy at work. :)

So for now I go along with the increased immunosuppressant meds I've been taking and wait to go to clinic on the 26th. In the meantime my CF docs are going to discuss my case with a few other doctors including a kidney transplant doctor about what to do for rejection that isn't too hard on the kidneys. So my next blog may not be until after the appointment on the 26th when I should have more to share.

On a much happier note, my mom's birthday is tomorrow and she's coming here so we can go out and get a pedicure and go out to lunch! :D

Take care everyone! Lots of love and thanks for the prayers :)

Biopsy

Had my biopsy yesterday. 24hrs later and the anesthesia has finally worn off enough for me to post an update. My lungs showed a lot of inflammation and suprising enough, my nerves have re-attached themselves in my donor lungs. Every time they would "snip" a little sample off my lungs, I would wake up in pain. For those of you who don't know, donor lungs usually do not have working nerve endings because of the transplant process and not being able to reattach them. I'm unique though! yay me! This explains why my right side has been hurting so bad the past 2 years, it's probably my stent causing the pain.
Anyway, waiting back on both the biopsys and cultures they took. Due to the inflammation and low lung funtion, my docs say that if an infection doesn't show it's ugly head, then it's most likely chronic rejection I've been dealing with all this time. Pretty scary, but not exactly a surprise. I should get results in a week, so prayers would be wonderful. Thanks friends!