CBD: What’s the big deal?
By: Cassidy Shaver, MSW, LSW, Transplant Social Worker
CBD stands for cannabidiol, a chemical compound found and extracted from cannabis and hemp plants. It is the second most prevalent active ingredient in marijuana (after THC), however, on it’s own, CBD does not have psychoactive affects. CBD can be purchased in many forms—oils, extracts, vaporized liquid and capsules.
How is it legal? CBD is mainly sold and available as an unregulated supplement, which makes it difficult to know exactly what you are getting. The US FDA considers hemp oil (and CBD) to be a dietary supplement, not a medication. The government classifies hemp as any plant in the cannabis family that contains less than 0.3% THC. Any amount over 0.3% is considered “marijuana.” You therefore need no prescription and can legally purchase and consume CBD in any state, though the debate over CBD legality and regulation continues within the federal government and may be subject to change.
What is it supposed to help? CBD is said to help with a host of things from anxiety and depression to chronic pain, epilepsy, and insomnia.
What’s the risk? There is a large risk of unreliable purity, dosing, content, and concentration in CBD products. “You cannot know for sure the product has active ingredients at the dose listed on the label and the product may contain other unknown elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition” (Grinspoon, Harvard Health). Long term safety data on the use of CBD is not available as it is not widely approved for medicinal use. Additionally, CBD could potentially interact with other medications (similar to the effects of a grapefruit). Side effects can reportedly include nausea, fatigue, irritability.
Our best advice? Talk with your doctors and consume at your own risk!
Living donor transplant from a caregiver’s perspective
By: Deb Wright
Transplant is an all-encompassing experience not only for patients, but also for their loved ones, caregivers and support persons. Support from family and loved ones is one of the best predictors that we as health care professionals have of how a patient may do following transplant, and it can be a tough job. What can be even more difficult is supporting and loving two patients who are simultaneously a part of the transplant process.
Please meet Deb Wright, the mother of living donor Kevin Wright and the spouse of kidney transplant recipient John Wright. On Tuesday, September 18, 2018, Deb and her daughter in law Devon, along with several other family members, waited anxiously as their loved ones underwent living kidney donation and kidney transplant surgery. Read on to hear a little more about how as a family, the Wright’s got through the process of transplant.
“Our son Kevin went to John’s first appointment with the transplant team. I think from that appointment on, Kevin knew he wanted to donate to his father if it was possible. Our other son Michael also wanted to donate, though he was ruled out as a donor for medical reasons.
He was so upset he couldn’t even get tested but was a strong support to all of us as his brother and father went through the process.
Kevin and his wife Devon spoke a lot about the possibility of donation. Devon was fully on board and supportive the whole time. She asked the right questions and attended most of his evaluation appointments with him. She said that she would do the same thing if it were her dad. Kevin talks about the workup process bringing its own hope and changes at each step. He states he would wonder if all the time and energy he was putting into being evaluated and completing testing was going to be worth it or would lead to his clearance for donation.
Kevin was ultimately a match, and when we did find out, I was so grateful and so nervous about the whole idea. I remember thinking, he is so young, he has a wife and a young son, but I knew there was no way I would be able to change his mind. He saw firsthand how his dad’s health was declining, and he wanted to help. Kevin and John didn’t talk much about the transplant beforehand. I think they were both nervous. John says the hardest part of the whole process was this anticipation.
The morning of the transplant was rough. I was a mess. John and I arrived at the hospital before Kevin and Devon, and when they arrived, there was a lot of quiet. I think the nerves really got to us all. Kevin and John were in rooms right next to each other getting prepped for surgery and I was walking back and forth between them, trying to be in both places at once. I didn’t really know where I should be, I wanted to be with both my husband and my son, and as the clock ticked towards surgery, Kevin started to get emotional.
I asked him one last time if he was sure he wanted to do this and told him he could still change his mind. He said, “no way”. He was going to do this! Finally, Kevin was taken to surgery, and we told him we loved him and wished him luck. The day seemed to last forever from that moment on. Our whole family was in the waiting room, visiting, talking, and drinking a lot of coffee. The support of our family was huge for me during that day.
Finally, both Kevin and John were out of surgery and did a wonderful job. We were told the kidney started working right away for John, and I tell everyone now that I’ve never seen so many people so excited about urine. Every nurse, doctor, and provider made comments about all the urine in his bag. We were very happy.
It was a short stay in the hospital for both Kevin and John. They were discharged on the same day, Kevin about two hours before John, and were both happy to be going home. We made lots of trips to Lankenau after the surgery over those next couple of weeks- at first appointments every couple of days and then eventually we graduated to every other week, once a month, and now every couple of months. I think I can do the drive in my sleep! The first couple of weeks were rough for John, with lots of blood work and medication changes, but he was such a trooper through it all.
Now, about nine months later, Kevin is doing great. He had some pain and discomfort while he was recovering but nothing extraordinary. He felt he was almost back to normal (besides some soreness) after about a week. He says he feels no different now than he had prior to donation. He thinks it’s so awesome he was able to help his dad and sees it as a win-win. He remembers vividly the lack of energy and constraints of dialysis affecting his dad and says to see him now is totally worth it.
Today John really can do so much more than he could nine months ago. He is back to his old self- walking every day, mowing the grass, and being more social. He didn’t have any energy to do these things before transplant, he didn’t want to go anywhere and couldn’t walk distances because he would get so tired. Now, he looks forward to spending time with his grandson, being outside, going for walks, and even hopes to fish and go deer hunting when the season arrives. He hasn’t been able to do that for a couple of years. And we just attended our son Michael’s wedding in Maryland!
Overall, our experience was very positive. As a family, our biggest advice to other patients who might be facing similar concerns is to get as much information as possible and talk with as many people as you can. Doctors, other medical providers, and patients or family members that have been through the process can provide such valuable insight. Get your questions answered and follow the recommendations of your doctors. Lean on your support system and family members, and though it may be hard at times, try to keep a positive mindset.”
By: Naomi Barton, MSN, CRNP
The first successful pregnancy in a solid organ transplant recipient occurred in 1958 in a woman who had received a living donor transplant from her twin sister. Since then many women with transplants have become mothers but there are some special considerations to keep in mind.
Can I get pregnant after getting a transplant? Yes. In most cases, a woman of childbearing years who was not getting her period before transplant will resume getting her period a month or two after the surgery. It is very important to use birth control, in some cases two different forms, before you begin having sex. In most cases it is recommended to wait at least a year after transplant before planning to have children to ensure that your medication doses are stable, and your kidney is working well.
It is extremely important to discuss your family planning goals with your physicians. Once you and your doctor decide it is a good time to grow your family, you will most likely need to adjust some of your medication. Mycophenolate (aka Cellcept) in particular, is dangerous to fetuses and will need to be stopped before conceiving. Some of your other medications may need to be adjusted, and throughout the pregnancy levels need to be closely monitored. In a small number of cases organ rejection has occurred during pregnancy but most of the time, pregnancy is safe for the kidney. And in most cases, if the mother is in good health with a good working kidney, it is safe for the mother as well.
What about the baby? Babies of transplant recipients are more likely to be born early. However, if the mother has stopped any unsafe medication, there is no increased risk of babies being born with birth defects, and overall most babies born to transplant recipients are healthy. Because we just haven’t been studying this long enough though, we don’t really know if there are any long-term risks to those babies.
What about breastfeeding? The answer is complicated. There are pros and cons to breastfeeding and formula feeding. But if breastfeeding is you goal, discuss it with your doctor to see if it may be the right choice for you and your baby.
What about male recipients of transplants who want to become fathers? While there is one immunosuppression drug which may reduce a man’s chances of getting a woman pregnant, most of the time, men who have received transplants do not have any problems with fertility and their babies are just as healthy as those of men without transplant.
If you are a transplant recipient who has become a parent after transplant, or are considering becoming one, check out the Transplant Pregnancy Registry International.
Staff spotlight: Dr. Adam Bodzin
By: Cassidy Shaver, MSW, LSW, Transplant Social Worker
Meet our newest transplant surgeon, Dr. Adam Bodzin! Adam returned to the Philadelphia area after his fellowship at UCLA and subsequent work in Chicago and joined the Jefferson Transplant Institute Team in September 2018. We have so enjoyed having Adam on our team as he brings charisma, charm, and a plethora of clinical experience. Read on to learn more about our fabulous transplant surgeon.
Cassidy Shaver (CS): How did you decide to specialize in transplant surgery?
Adam Bodzin (AB): I fell in love when I was thrown into it during my first rotation in my first year of residency. We had a skeleton crew and I was involved in a lot of liver transplant surgeries early in my training. It totally altered my mindset in medicine, and I fell in love with the surgical complexity, critical care, and overall life changes transplant can make for patients. That is the best part of my job really, seeing lives transform almost immediately after surgery. Patients are so grateful and thankful for the hope transplant can provide, and I love being a part of that.
CS: What is something our patients might be surprised to learn about you?
AB: I was a bat boy for the Phillies when I was in my teens. I got connected with the team and worked long hard hours during high school. It was a pretty cool experience. Curt Schilling used to help me study by quizzing me when we were on the bench.
CS: What is your vice?
AB: I am partial to all things Vernick food and drink. My best childhood friend Greg Vernick is the mastermind and I’m so proud of him. I love supporting him and he has inspired me to be a little more present in my own kitchen. After a long day, I enjoy coming home and winding down by cooking for my wife, Julia.
CS: What is something you would like to improve about transplant?
AB: I’d like to improve the health disparities we see in transplant. There is a lot of work to be done on this front.
CS: What are you most looking forward to this summer?
AB: Some time down the shore with my family. I have to force myself to take some time off, it’s not really in my nature, but I know it’s important. We will have a nice time with family and our girls.
Joan’s cooking corner
Homemade pan sausage
Homemade pan sausage is a yummy, kidney-friendly breakfast recipe that will help start anyone’s day on a positive note.
A quarterly recipe shared with you from your Transplant Dietitian, Joan Diorio, RD.
Why do I need… to wait for a kidney
By: Kristina Bryson, RN, CCTC
If you ask someone who is waiting for a kidney transplant what the hardest part of the process is, they will most likely tell you, “it’s the waiting.” The average wait for a deceased donor kidney in this region is somewhere between five and seven years from a person’s “qualifying date,” which is either the day they are added to the transplant list or the day they start chronic dialysis, whichever comes first. There are several factors that can influence the waiting time such as blood type, antibody level and what types of donors recipients will consider.
Kidney transplant is one of the only types of organ transplants that is driven by waiting times and not by how sick the patients are. The reason for this is that ESRD patients can use dialysis as a bridge to transplant. Dialysis will maintain patients until they can receive their transplant.
There are some strategies that can be used to potentially decrease the wait for a kidney. The first is to find a living donor. This is a living person that chooses to donate a kidney to someone in need. You do not have to be related to your living donor. Once both recipient and donor are cleared for surgery, the transplant is scheduled. Always be open to living donation. If you do have a potential living donor, please call our Living Donor Coordinator, Naomi Barton, at 484.476.8485.
Another strategy is to consent for all possible deceased donor options for which you are a candidate. This will maximize the amount of offers you receive and can potentially shorten the amount of time you wait for a transplant. Your transplant coordinator reviews deceased donor options with you at the time of your evaluation and at each of your annual visits. If you have questions or would like to review these options now, please contact our Pre-Transplant Coordinator, Kristina Bryson, at 484.476.8485.