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And the call finally came

Fri Mar 29 2019 - It finally happened. I received a call from the specialty pharmacy. They received my prescription. They received all necessary paperwork. They received insurance approval. They were ready to send. Was I ready to receive?

YES!!!

A little background. I have Polycystic Kidney Disease - Autosomal Dominant ('ADPKD') to be precise. 'What the heck is that?!?' you may ask. A most excellent question...
ADPKD is the most common hereditary kidney disease affecting over 12 million people worldwide. It's estimated that between 1 in every 400 to 2,500 people has the disease. It can affect women and men, across all ethnic groups. (pkdinternational.org)
An equal opportunity, inherited disease. Gee. Aren't we lucky?
Healthy kidneys are about 10–12 cm long and are found either side of the mid back. They’re filled with about one million special tubes for filtering the blood. These are called nephrons; they filter out waste products and excess water (making urine).

In people with ADPKD, the lining of individual nephrons can balloon out, causing fluid filled cysts to form. Over time, more and more cysts appear and increase in size, leaving fewer healthy nephrons and space to filter the blood. People with severe ADPKD can have kidneys as large as a football. (
pkdinternational.org)
Everyone with the ADPKD gene has a 50% chance of passing this mutation along to each of their children. My family hit the lottery. My grandmother died from PKD (at the time, doctors didn't really know what was wrong with her). The ADPKD gene was passed along to both my mother and uncle (two of two children). Both have had transplants (very blessed). And of my mother's three children, we're three for three. We're still waiting to see how our cousins fared in the lottery.

There is no cure for PKD. None. Nada. As for prevention, all you can do is eat right, exercise, control your blood pressure and wait for things to progress to End Stage Renal Disease ('ESRD'). At that point your choices are dialysis, possible transplant and/or letting nature run its course. Pretty dismal-sounding but don't give up hope!

A year ago, the FDA approved a drug that has been proven to slow the growth of the cysts which will delay the progression to ESRD. Now we finally have hope! And THIS is what my Friday call was all about.

On Monday, a Fed Ex package will arrive at my home with a drug called Tolvaptan aka Jynarque aka Samsca (I swear the people who name these drugs must be altered at the time).

Let the games begin!

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Fresh, ICE COLD water

When I first heard about Tolvaptan, I truly wondered if I'd be able to choke down the amount of water needed to keep my kidneys hydrated and happy. I like water, but TWO GALLONS?!? Yikes. About nine months before starting on the meds, I purchased the Primo Water Cooler Dispenser + Pet Station . I live in a rural area and have well water so wanted to make sure that I wasn't ingesting minerals that could harm my kidneys. Also, I have softened water and wasn't sure if it was increasing my sodium levels - better safe, right? Plus - given that I have three dogs - I loved the idea of tying it together with a water dish for the pups. READ THE DESCRIPTION BEFORE YOU BUY! So somehow I thought it was a self-filling water dish. It is... but only if you self-fill it by pushing the button to fill it. DOH! Oh well. Over the summer, I enjoyed the crisp, clear water but I didn't truly appreciate it. Enter Tolvaptan. Now I CRAVE water. The colder the better. The icier th...

One week down

Just took the last dose for the week and I have to say that it went pretty well. The biggest change has simply been planning ahead and being aware. Bringing water with me when I'm out and about. Scouting for bathrooms before I need them. Keeping a full water bottle beside me when I work. Using the bathroom before meetings, before leaving home, before leaving work. Prepping water bottles to have bedside before i go to bed. Manageable. Totally manageable.

Wear your kidneys

Now how's THAT for a t-shirt?!? I want one. I'm not familiar with the company that supplies it but I believe it's one of those 'if you design it, we will create it and they will buy it' places. The Spreadshirt site offers the shirt for about $20 plus shipping and allows you to select size, shirt color and (I believe) the kidney color. The designer, Emblem Design, has other kidney designs as well. A purchase may be in my near future.

Little Tolvaptan quirks

Due to the risk of 'serious and potentially fatal liver injury', the dispensation of Tolvaptan is very closely monitored and the PHARMACIES THEMSELVES need to be certified under the Risk Evaluation and Mitigation Strategy ('REMS') Program. Because of this, there are currently only three specialty pharmacies in the US that are certified to fulfill Tolvaptan prescriptions: AllianceRx  (Walgreens), Avella (Optum) and PANTHERx . If you're ever in a situation where you need to go through a specialty pharmacy, check out online reviews to see how others have fared from a customer service standpoint. SERVICE MATTERS! I queried members of the Tolvaptan Community on Facebook when I had to choose. Based on their recommendations, I decided to try Avella. As I'm quickly approaching my one month anniversary of taking Tolvaptan, I was pleasantly surprised to receive a call last week from Avella. A very personable customer service rep asked me about my experience so far...

No denying it

So this happened today. Despite being on Jynarque for over a year. Despite increasing the dosage to 90/30. Despite watching my sodium, drinking gallons of water and losing weight. My creatinine levels continue to trend upwards and my eGFR continues to trend down. It's now at 21. Big sigh. Discussions are underway to determine dialysis modality and whether I can do it at home. A fistula consult with the surgeon has been ordered. And I still wait for the transplant evaluation with Mayo (it was rescheduled due to Covid). So if you know anyone who would be interested in helping out a Type O girl with a donated kidney, please send them my way. Take care.