Monthly Archives: November 2011

Dialysis Downtime up in the “air”

Life away from the BigD machine can be pretty good sometimes.  Julie gave me a birthday present in August which was booked out three months ahead – a Boeing 737 Airliner flight simulator.  My trip was for an hour, flying into and from our local airports and then into and from an airport of my choice.

I have flown plane (non-simulated) before.  I learned to fly a Cessna 150 in Albury, about 35 short years ago.  (It is only since I reached my 50s that I have been able to say 30 years of this, 35 years of that.  It gives me a funny (not Ha Ha) feeling, because I always thought that people who said that kind of thing were old.  I don’t feel old; in my head I feel around 25, but with some occasionally useful, occasionally embarrassing experiences.)

Still, I digress.  I learned to fly when I worked for a small defence electronics company in Albury.  It was a private company, owned and run by the founder, Lindsay Knight.  His products were smart target systems for anything that went bang, from pistols and rifles to vehicle mounted guns and tanks.  He had offices in London and South Carolina and travelled everywhere selling.  He had his own plane, a Beechcraft Baron and which he and his pilot flew around the country.  I was writing his technical manuals and I became friendly with Warren, his pilot.  Warren had invented a nifty little device for helping people land small planes safely and he wanted to patent it.  So I helped him write the patent for flying lessons.  The device was a clever design and worked really well, but like many smart inventions, it didn’t get the exposure it needed.

I well remember my first solo flight.  I met Warren at 0630 on a cool autumn morning for my usual half hour lesson.  We did some touch and go circuits and unexpectedly, Warren said: “You’re ready, do a solo circuit.” He jumped out, and deliberately without thinking, I pushed in the throttle lever and took off.  It was surreal, flying in cool, still crystal clear air all alone, the only one responsible for my safe landing.  It was a perfect circuit and a perfect landing.  And I was still on a high when I went home from work that afternoon.

A little after that we had out third child and Julie suggested that no matter how safe it was, I would be more likely to be there for the kids if I stayed on the ground.  And mostly I have done so, apart from a few lessons in an ultralight (something like a lawn mower attached to a sail) a couple of years ago, and a joy flight in a Tiger Moth last year.

Still, I’m very glad I learned to fly when I did.  I can’t fly now, because after the last transplant I lost much of the sight in one eye, and you need two working eyes to be a pilot.

However, I wanted each of our kids to understand the thrill of flying a small plane, so on their 17th birthdays I took each of them to a local flying school and arranged a half-hour flight, where the instructor gave them an introductory lesson.  None of them have taken up flying – yet – but they have at least had a go.

So last Sunday I climbed into the 737 simulator cockpit (with, for the first time, Julie and my daughter Kathy as passengers in the seats behind me).  I had a briefing from the instructor and when I looked up, we were sitting on the tarmac at Melbourne Tullamarine.

On the runway at Tullamarine

I pulled back the throttle, gently touched the rudder pedals and within a minute, we were airborne.  It only took a moment to believe that we were flying, and as we turned for Avalon airport, much of the feel and responses I haven’t felt for so many years came back to me.  It is so much like the real thing my heart was racing and I was sweating to get aligned for the landing.  The first half hour, touching and going at Avalon, Moorabbin and Essendon airports and landing aback a Tullamarine was a great way to get back into groove.

Innsbruck airport between the mountains

For the last half hour, I chose Innsbruck airport in Austria.  It is a difficult airport, located in a river valley with very high snow-capped mountains all on both sides.  Take off involves getting high very quickly while flying left in a gentle arc that follows the valley.

Getting above the snow line

Mountains get very close.  But the 737 is very powerful and the plane lifts easily over the peaks.  Landing is similarly cramped and the runway is short.  But again, the plane design, air brakes, landing gear and flaps make it relatively smooth.  Luckily there was no wind shear or turbulence.   However we did simulate losing one engine.  That was fun.

In fact the whole thing was a real buzz.  It’s over week now since the flight and I am still enjoying it.  Hopefully I can afford a longer flight next year!  Alternatively, I wonder if they can set up a BigD machine in the co-pilot’s chair, so I can benefit on two fronts?

The one hour flight cost A$275.  The simulator is part of the Flight Experience group. www.flightexperience.com, with simulators in Australia in Melbourne, Sydney, Brisbane, Adelaide and Perth, and in Hong Kong, Bangkok, Singapore, Kuwait and Europe.

Dialysis while waiting for a deceased donor transplant. Waiting, waiting…

Earlier this week I received an email from Charlotte, a renal nurse in the UK, telling me about an excellent podcast on RTÉ Radio 1 in Dublin, called Wanted: Kidney.  The podcast is based around Regina Hennelly, a 29-year-old Dublin journalist who has been on PD for two years.  It covers a lot of ground, beginning with Regina’s story: her kidney failure at 25, her experiences on PD; and its primary theme, how it feels waiting in suspended animation for a transplant.  It also talks with other BigD club members, and provides an excellent overview of the state of kidney transplants in Ireland.

It is well worth the 36 minute investment.

[Regina also writes a blog “about dialysis and other curiosities” called This Limbo.  Her profile says it all: Fun-loving non-smoker, social drinker (29), looking for necessary new lease of life.  WLTM healthy kidney who shares her interest in travel without Peritoneal Dialysis machine and her fetish for midriffs without tubes attached.  GSOH in bad times essential. Only kidneys interested in long-term relationship need apply.  (Not being experienced in matching service lingo, I discovered that WLTM means Would Like To Meet and GSOH means Good Sense Of Humour.)  It’s a good read, especially for fellow PDers.]

Talking of transplant waiting, the time obviously varies depending on where the donor kidney is coming from.  There are two sources: living donors (typically family or very good friends) and deceased donors.  I have been lucky enough to have had both.  My wife Julie donated one of her kidneys to me in 1995. Unfortunately because of rejection that kidney only lasted three months.  As a result I had antibodies that stopped further transplants for nearly ten years (see crossmatch below). Finally I received a deceased donor kidney in 2005, which lasted until 2008.

There is quite a workup time for living donors, which can be 12-18 months.  A lot has to happen and I’ll cover that in a later post.

Like in Regina’s podcast, there has been a rash of transplants here (in Victoria) over the last year, from both living and deceased donors.  But the list continues to grow, and the typical waiting time, if there is such a thing, for deceased donors is 2-4 years plus.

I say if there is a typical waiting time, because it is not just the amount of time you have been on the list, but more importantly, how good a match the donor kidney is.  There lies the rub.  Donor and recipient matching involves testing in three areas: blood type matching, tissue type matching and crossmatching, and you need to pass all three before your position on the list gets you a kidney.

Blood type matching is straight forward: a recipient with blood type O can receive a kidney only from a donor with blood type O; a recipient with blood type A may receive a kidney from a recipient with blood type O or A; a recipient with blood type B can receive a kidney from a donor with blood type O or B; and a recipient with blood type AB can receive a kidney from a person of any blood type.

If the blood types match, the next tests are for tissue type.  For kidney transplants, there are at least six specific blood and tissue types, called antigens, which define how well you may be compatible with a donor.  The best compatibility is a six-antigen match.  This match, which occurs 25 percent of the time between brothers and sisters having the same mother and father, also occurs from time-to-time in a random fashion in the general population.  As the number of antigen matches fall, so the outlook for a long-term transplant falls.  This outlook can be improved with a greater (and sometimes heroic) use of anti-rejection drugs, but these have their associated, cumulative and usually unpleasant side effects.

If you pass tissue type matching, the final crossmatch test mixes donor and recipient cells and serum to determine whether your body will attempt to reject the kidney.  Throughout your life, your body makes substances called antibodies that act to destroy foreign materials. You may make antibodies each time you have an infection, are pregnant, have a blood transfusion or undergo a kidney transplant. If you have antibodies to the donor kidney, your body will destroy the kidney. So the final crossmatch test is to ensure that you don’t have antibodies to the donor. The test outcome is either positive or negative: a positive crossmatch means that you have responded to the donor and that the transplant should not be carried out; a negative crossmatch means that you have not responded to the donor and therefore transplantation should be safe.

(The above info is a summary from the UCSF Health website.)

So, in summary, the deceased donation transplant process works like this:

  • You provide regular (usually monthly) blood samples to your transplant hospital/blood service. Then, when
  • A kidney becomes available to your transplant hospital
  • If your name is at or near the top of the waiting list (based on the time you have been waiting)
  • The transplanting hospital/blood service will check that your blood type matches the donor’s
  • If OK, they will test your tissue type compatibility
  • If acceptable, they will crossmatch your cells with the donor’s
  • If there is a negative crossmatch,
  • They will offer you the kidney.

Then the fun begins, and it’s usually worth the wait.