(Originally published on 11/14/14 on cotaforjensh.com)
Last Friday, Jens went to UPMC for his 5th bronchoscopy since being transplanted in May. The bronchoscopy and biopsy are procedures used to determine if there is any rejection or infection in his new lungs. Here's a run-down of what our bronch. week looks like for the "extra" bronch. stuff.
Monday (or any day before Friday)
8:30 AM Bloodwork, including the normal bloodwork levels, Tacrolimus/Prograf (anti-rejection med) level, IGG, INR
- Bloodwork has to be taken before 9 AM, which is what they call a "trough level." This is taken at this time because this would be the lowest amount (or trough) of Tacrolimus in his system. His doses are adjusted according to this level, if needed.
Thursday
1:30 PM Chest x-ray
(1:45-3:15 PM Pulmonary Rehab.- Jens does this every Tu/Th, so they graciously scheduled his bronch. appointments around this. This can be VERY unusual, as we often end up going to the hospital at different times for the bronch. stuff than the regular stuff.)
3:15 PM Pulmonary Function Test (PFT)- to determine lung function level
3:30 PM* Appointment with Dr. Pilewski (CF transplant pulmonologist) to check-in, go over meds, talk about the treatment plan, discuss any medical issues, stop any antibiotics prior to the bronch., and give information about what meds might be started after the bronch. results are reported.
(*This appointment was actually 3:45-5:30 PM after we talked with a transplant nurse, resident, and Dr. P.)
12 AM Jens is NPO- no more food or drink until after the procedure
Friday
6:15 AM Leave to go to the hospital. (Jens was instructed to take his 1 Prograf pill with a sip of water at this time, since he usually takes it at 9 AM.)
6:30 AM Arrive at hospital; sign-in and go to waiting room
6:40 AM Jens signs initial paperwork/register
6:45 AM Jens goes back with the nurse to get vital signs and place IV. He's supposed to change into a gown at this point, but he always refuses to put it on until the last minute. (It's always cold in there.)
7:15 AM Abby gets to go back to the pre-op area
7:30 AM Jens and Abby go over the med list with the nurse and report what meds he's on and when his last dose of each was. (Yes- this is the same list we went over the day before.)
8:30 AM The bronch is scheduled to begin at this time, but we're still waiting in the pre-op area
This is a picture from the July or August bronch, but you can see why Jens isn't a fan of the hospital attire.
8:40 AM Jens makes a quick switch into his gown, and "transport" takes us back to the bronch. lab waiting room
9:05-9:15 AM Anesthesiologist comes to review Jens's history with him
9:30-9:35 AM The pulmonologist doing the bronch. comes to talk to Jens
9:45-10:45 AM Jens is taken into the bronch. lab for the procedure. He is under general ansthesia for this procedure.
(Abby goes to hang out outside or at a local restaurant during this time. The waiting room is always full and filled of interesting characters.)
10:45-11:45 AM Jens is taken to the recovery room. He has to have a chest x-ray to make sure everything looks okay and to make sure that he doesn't have a pneumothorax (collapsed lung). He is monitored and his vitals are checked to ensure that he's doing okay and awake. Jens has had trouble in the past getting to leave this room, as he's at the mercy of whenever the transport people come. He is usually very anxious to leave and begging them to let him move to the next stage.
12:15 PM This time, he was in recovery room an hour and half, waiting to get to leave that area. Jens is finally taken to the post-op area to get his IVs out, change back into his clothes, and finally drink some water! Abby is reunited with him at this point. He also gets to take his morning dose of pills from 9 AM.
12:40 PM They (finally) bring the discharge papers for Jens to sign. Abby drives Jens home, as Jens is not allowed to drive for 24 hours.
During the past two bronchs, Jens has had to get a boost of iron due to low iron levels. This is done in the post-op area after the recovery room. This is a very (unnecessarily) long process, which involves them confirming or getting the orders (that were probably put in the day before), getting the infusion from the pharmacy, and administering the needed fluids. This process can add well over an hour and lots of back and forth with medical staff.
All of this totalled a 6 hour day. His previous ones were over 7 hours. The hardest part of the day for me (Abby) is to keep my mouth shut when I see the blaring inefficiencies and staffing mis-distribution at this location within the hospital. I have to remember, "No one is asking me [to solve the problems]."
Afterwards
After the bronch, Jens is usually very tired. This is a combination of getting up early to go to the hospital, as well as the lingering effects of anesthesia. It usually takes him 3-4 days, at least to feel "normal" again. His throat is sore immediately after, and this doesn't help when he's very hungry. The night of and following day, he typically complains of neck pain, as well as continued sore throat. This time, he has what looks like a sore from where something was rubbing against his lip, or perhaps he bit his lip. He coughs up sputum dotted with blood for a few days after. He has to monitor for fevers, as well.
The bronch/biopsies begin coming back within 3 days, and it takes about a month to get all of the results back from the cultures. Some of the cultures have to be isolated to "grow" for weeks. After his first post-hospital bronch (in June), they called 6 days later to tell us he was showing rejection; treatment was started the next day. We had to wait 28 days on that bronch to then have an "all-clear" for all of the other things they are monitoring and "growing."
To learn more about the bronchcoscopy and rejection:
http://lungtransplantfoundation.org/patient-resources/lung-transplant-rejection/
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