And now for this week's BK Virus Update.
Started Monday morning with a trip to Baylor for a blood draw to check the viral cell count. Which is to say it started with aggravation. Checking in for the lab work (just a needle stick and 1 vial of blood) took an hour and a half. The check in was the same as checking in to the hospital, only just one woman seemed to be working. Maybe others were on vacation. Sign countless consent forms, get a bracelet, the whole nine yards. It wasn't like I hadn't this just two weeks ago and had a biopsy done two weeks before that all over the same diagnosis...
The good news is that I am now checked in for a series of tests (I guess that makes me a serial patient.) When I check in at the desk, they should give me a copy of my orders and a bracelet right there at the gitgo and off I go dancing down the hall to the lab. We'll see if that works.
So today I went to the Transplant Clinic for the rest of the story.
The best news was that the creatinine did not go up. It's been stable the last three visits at 2.7, 2.6 and 2.7. There was little expectation that it would go down, there was fear that it would go up. It stayed flat, so that means we can concentrate on the virus.
The viral cell count went up. From the initial count of 497,000 copies of the cell, the first reduction of immuno-suppressants combined with a dose of ciproflaxcin dropped the count to 73,000. This week, two weeks after the cipro treatment stopped, the count has risen up to 156,000. The suspicion is that the cipro reduced the count to below the 'new' normal level with just reduced immuno-suppressants. What we don't know is what the new baseline count should be. We'll know a little more about that next time.
So, what's the next step?
There's a little more room to play with the immuno-suppressants, so that's what Dr. Melton wants to do next. We're cutting the Prograf by 25% and cutting the Myfortic another 50%. If the kidney had been a 6 antigen match, there would have been even more room to play, but it's been 21 months since the transplant and no sign of any rejection, so he feels comfortable with the reduction.
And we check everything again in two weeks. Hopefully the creatine will remain stable and the BK cell counts will start going down. If not, he will probably begin treatment with cidofovir. Cidofovir is an antiviral agent developed as treatment for AIDS. Its drawback is its nephrotoxicity. So it is carefully administered in low-dosage to renal transplant patients fighting the BKV. It is infused via IV over several hours in a hospital on an out-patient basis. Once a week for several weeks.
So that's the news for today. Time to stop here, get dressed and get to work!
Added later that afternoon.
Janet just called from the clinic. My prograf level was up today, so they're cutting my dosage by 50% instead of 25%. All these numbers and levels and dosages. Just watching the gauges and making the adjustments to keep everything in balance!