And so it begins…..

Today was my pre-op appointment.  I saw the surgical resident, transplant surgeon, social worker, transplant coordinator, financial counselor, had an EKG, chest x-ray and blood and urine tests.  I am now wearing a high fashion plastic wrist band that is my type and cross for blood products.

One of the interesting components of renal disease is the eligibility for Medicare.  Anyone on chronic dialysis is eligible for secondary coverage through Medicare after 3 months, and Medicare becomes primary after 30 months.  For kidney transplant patients, Medicare starts immediately after the transplant and ends after 36 months.  Medicare spent $$26.8 million on ESRD in 2008.

For me, my coverage through Anthem Blue Cross Blue Shield is quite good and I was going to ignore the Medicare coverage – I have already met my out-of-pocket maximum for this year (as of January 5!!) so I didn’t see an advantage.   I learned at Mayo however (again benefit of a second opinion!) that if I signed up now for Medicare part A (the in-patient part, which does not require a premium) when I get to Medicare eligibility age, my immunosuppressant drugs, which could run up to $2000/month, are covered under Medicare part B (professional), as opposed to part D (drugs), which currently has the doughnut hole and copayments.  Now all of this supposes that Medicare will still be around in a similar form when I get to that age, which I think is pretty questionable.  I am younger than the traditional kidney transplant patient and Medicare seems VERY far away.

So my schedule for the next week prior to transplant

Friday: dialysis, IVIG infusion (this is because I have some antibodies to Sarah’s blood.  The IVIG somehow blocks those antibodies and also helps fight infection when I am immune suppressed from all the drugs.)

Monday: dialysis, plasma exchange, (where they remove my plasma and replace it with donor plasma.  This is treatment for the factors that are thought to cause HUS), IVIG and eculizumab (a monoclonal antibody that stops the complement system.

Wednesday: dialysis, plasma exchange, IVIG and eculizumab

Thursday: TRANSPLANT!!

Need to go now to watch Project Runway – I hope Gretchen goes home – she is such a b****!


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