When Amanda arrived at the cardiac step-down unit at Vandy, she saw many familiar faces. Most of whom couldn’t stop saying how good she looked compared to when she was inpatient. Before they got to step down, they stopped by the pharmacy for Jenny to run in and pick up a new pain patch. Over a month ago, a new pain specialist switched Amanda to a twice-a-day patch for pain versus the pills she’d been taking. After a recent visit, they swapped her to a longer-acting patch that is only swapped once a week. With all our hospital wisdom, she knew it was best to get that prior to being admitted. Surprisingly, pain management in a hospital is a real pain itself, but more so in the rear end area if you know what I mean!
A PA was the first on the team to speak with Amanda. As we already assumed, they’d start high-dose steroids to knock the rejection down. That word, rejection, was scary before, but after what we’ve been through, it’s terrifying now. I had read in a pathology report on Amanda’s MyChart that it was antibody mediated rejection (AMR), the type that got her a new heart. I wasn’t too worried about the 2R cellular rejection because we’d beat that a few times, but when I saw the AMR, my heart sank. I was taken aback, but the PA had said that one of the reactive proteins that indicates AMR was negative. That was a significant relief, to say the least!
The next to come by was the nephrologist. They had to see Amanda before they could schedule Friday’s dialysis. She’d missed her Wednesday appointment and had an early morning Thursday session. She was wiped afterwards, too. She and Jenny had been busy with appointments and such and were planning to make Thursday a playday before Jenny swapped out with her relief. That was all canceled with her feeling like junk from the cath medication, followed by the early morning dialysis. Then, to boot, she got the dreaded rejection call and was promptly admitted. Nephrology was able to get her on the next day’s schedule quickly. They also mentioned that her admission would likely be for only a few days.
Amanda’s B-type natriuretic peptide (BNP) had trended up a bit, and they were watching it and had scheduled her to have it checked just a couple days after her biopsy. BNP can be a sign of heart failure and is the level of a specific protein in the heart. When the heart has to work harder to pump, it can cause the BNP to rise. The level they got yesterday after admission had skyrocketed even since the biopsy. So, we now know that a rise in BNP level is a good indicator that she should be checked for rejection. This is good to know, as we now have a marker for early signs of rejection. In the end game, this worked for good, as God’s word has already told us. Sometimes we just need a reminder!
Amanda was scheduled for an IVIG treatment next week. This is an infusion of immune-supporting antibodies. She had this as a treatment for the AMR back in Texas, and as a precaution after the transplant in July, as well. They wanted to check some numbers, and if it still indicated she needed the infusion, they would just give it to her while she was inpatient. It is a longer infusion, over 5 hours, so it was good they got it taken care of early. They loaded her premeds before the infusion last night, including more steroids. She was pretty wiped when I talked to her and super tired, yet she wasn’t able to sleep through the infusion much, though. They kept waking her up every 45 minutes or so to check things, she said. When I checked in this morning, she was ready for a nap!
Jenny is heading back home to Houston today. She’d received a message that there may be issues at the Houston airport because of the government shutdown. Thankfully, her original flight wasn’t canceled, and she didn’t have to fly into another city after all. Leann, a friend from church back home, is Jenny’s relief starting today. She’s already been in Nashville for a few days. She came in a little early and is staying late to get some loving in on her new grandbaby, who happens to live in Nashville! I’m positive Jenny gave Leann a good turnover report. Jenny is overly prepared, just like me. I wouldn’t be surprised if she made all kinds of notes in the “Amanda Manual” I made! Being a heart patient herself and not new to the hospital world, she was a good one to have while Amanda was admitted and went through this hiccup.
Leann is now headed to the hospital after her debrief and dropping Jenny off at the airport. I made sure we overlapped caretaker flights so each could show the other the ropes. Amanda is being discharged, and hopefully she’ll be back home by early afternoon today. With the IVIG treatment off the books, I think it should be a light week for them. Well, lighter than what we were doing in previous weeks. She still has cardiac rehab and dialysis, both 3 days a week, plus a couple of PT sessions for her knee. I do think she has a home sleep study to do as well, at least she doesn’t have to go in for that, though.
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