What Transplant Recipients Don’t Tell You

Follow-up care, side effects, and related illness require hundreds of hours from transplant recipients.

I am blessed with the most wonderful and loyal readers (and editors and publisher) here at The American Spectator. In eight years, many have come to regard me almost as family, and — as long as they don’t ask me to help with college tuition — I feel the same toward them. So when I go a spell without publishing, emails of concern arrive. Am I OK? Alive? And at the world-class hospital where G-d, in His grace, led me for a lung transplant, to be diagnosed the day I otherwise apparently would have died, the pulmonologists follow up with me constantly: “Rabbi, our goal is that you outlive all expectations.”

Uh, OK. Hmm.

Those who know me also know I am not a victim. I do report evil and wrongdoing, but I do so to teach and learn. For me, as an example, the Holocaust is not a victimhood to perpetuate with museums and mandatory Holocaust classes. I see where a psychology of Perpetual Victimhood has led others down a rabbit hole from which there is no return. That is why I believe Holocaust museums are a waste of hundreds of millions, and are counter-productive. Since October 7, more people than ever before have acknowledged I was right all along. Two generations have been reared on Holocaust museums and mandatory Holocaust classes. Seen the results?

The public does not need to be educated that Jews have been mass-murdered. If others want to out-victim the Jews, have a good time. I hope you are right. (READ MORE from Dov Fischer: Toby Keith’s Songs Touched My Life)

So I do not write this article from victimhood. I rejoice that G-d has given me a new chapter of life, seen me through an amazing rehab, and has blessed me with doctors, meds, and procedures to augment health and, by G-d’s grace, to extend life.  Rather, I write because, as a lung transplant recipient, I have learned how little I previously understood and how little others do about what really goes on after a serious transplant. We don’t know because the details — call them “Organ Recitals” — are TMI, too personal, and seem like whining. So people don’t tell. But their employers, customers, clients, patients, and family should know why they seem to miss work days or skip out early even two years later. I write this as a favor for transplant recipients too proper or self-conscious to discuss of their own accord.

1. We all have antibodies that ward off foreign invasions like flu, virus, and bacterial infections. Antibodies do not discern that implanted organs are good “foreign invaders.” Therefore, they attack implanted organs to reject them. That is why early transplant patients died so soon after successful surgeries. To ward off organ rejection, transplant doctors severely suppress their patients’ immune systems. I take Prograf (Tacrolimus) and CellCept or Myfortik (mycophenolate mofetil). They both get processed in the kidneys and therefore increase creatinine and BUN levels (bad for kidneys ) and decrease eGFR (also bad). But, by G-d’s grace, they ward off rejection. They likewise leave the patient immunosuppressed, typically as part of a lifetime regimen, so even a flu or virus can pose peril.
2. As a result of the above, it is risky, even perilous, for patients on those drugs to mingle nonchalantly in large mixed settings. This is not about masks or vaccines but about germs that do not matter to a healthy person but are perilous to the immunosuppressed. Many of us avoid public swimming pools and gyms. I worked out at a fitness place five days a week, for twenty years. Some people there would cough, sneeze, or sweat on the equipment without cleaning it. Practically, I gave up my gym membership and now exercise with a personal trainer. Likewise, the severely immunosuppressed must weigh carefully how, when, where, and in what circumstances they worship publicly. Same for other public gatherings.
3. Wé are not hermits. So we occasionally go to a restaurant. More frequently to Starbucks. Even an occasional live theater or concert performance. But many of us, despite politics and totally opposed to imposing masks and vaccines on others, will wear masks at certain venues. They don’t work? OK, fine. So don’t wear one. But, likewise, let the immunosuppressed do what makes them happy, and don’t snicker at them. Similarly, if someone behind us is coughing or sneezing — happened once — we leave immediately. Not in a huff. No angry glances. It is what it is.
4. I am 70 and have some spondylosis and degenerative disc stuff in my back. I never cared because one daily Meloxicam pill made it disappear. However, because non-steroid anti-inflammatory drugs (NSAIDs) like Meloxicam, Celebrex, Ibuprofen, Advil, Motrin, and Naproxen get processed in the kidneys — as do the Prograf and CellCept anti-rejection meds — I may no longer take my back-pain pill. I may take Acetaminophen (Tylenol), but it’s not the same. Therefore, I had to find a pain-medicine specialist. Note, through the rest of this article, that every single thing takes two hours: 30 minutes to get there, 30 back, and an hour to wait, fill out forms, see the medical assistant, then the doctor or undergo the exam or procedure.

It took six tries to get the right back-pain doctor and treatment. Six different sets of appointments, sets of diagnostic exams, medicines, treatments, and procedures — until G-d led me to the resolution. In total, that process alone consumed over 40 hours over ten weeks. It takes me four hours to write, edit, document, and complete an article. Therefore, ten articles never got written while I went through six rounds to resolve the pain engendered by not being able to take a single daily Meloxicam pill anymore because of the Prograf and CellCept. And that is why your employee needed to miss 40 hours of work and why your friend or family member rescheduled that phone or Zoom or Facetime call five times in two months without explaining why. (READ MORE: America Is Better Off Now That DeSantis Will Govern Florida for Two More Years)

Pain Doctor One (PD1) looked at my lumbar X-ray and prescribed rehab. Remember: each thing is two hours. I went six times: 12 wasted hours. Plus the two hours wasted on that doctor. PD2 (two hours) prescribed swimming or a jacuzzi. I am immunosuppressed; I am not freestyling in a public pool. Moreover, I have nowhere to put a jacuzzi and do not intend to spend $5,000-10,000 putting it there in place of a Meloxicam tablet. PD3 prescribed Lyrica. Lyrica, meant for stroke victims, works off-label for some as a painkiller, but it did almost nothing for my back. However, it generated three side effects, one that I was warned of and two that I was not. It took six weeks for me to clean Lyrica and its effects out of my system. PD4 prescribed an epidural in my left and right L4/L5 lumbar zone. It did no good. (Are you tabulating the wasted hours? The articles I could have been writing?)

PD5 said that PD4 should have been injected at the sacroiliac junction. That did it. In all, some 40 hours from the first X-ray with PD1 to the injection with PD5. But he added that, because I must forevermore take prednisone, a corticosteroid, to prevent lung swelling, that is causing bone loss, osteoporosis, so I cannot get another steroid shot soon after this one wears off. Today I saw highly touted PD6, and he proffered a non-invasive procedure that offers a longer-term resolution without requiring more cortisone than osteoporosis will allow. Nobel Prize to him from me. But so many hours.

5. Now concerned over how many cortisone shots I can receive when the present wear out, my GP (two hours) sent me for a DXA exam (two hours) to measure bone density. After waiting an hour, I was told to come back in a week because I still had barium in me from a recent food motility test. See two paragraphs down. Two more hours wasted. Came back. Underwent the test. Two more hours (always 30 minutes to, 30 fro, and an hour of waiting room, getting nuked, talking to the medical assistant, telling the same thing to the doctor, and whatever). The DXA confirmed that the daily prednisone, which is needed to retard swelling in the lung cavity, caused osteoporosis, so …
6. For bone density enhancement, a Reclast infusion is prescribed to thicken the bones and torture the Jew. Will be three or four hours next week.
7. The meds challenge digestion. I take 24 meds daily, comprising 34 pills, half in the morning and half twelve hours later. Yummy! That has contributed to gastroparesis and has generated GERD. For the gastroparesis: a food motility test, in which you eat an egg white cooked with some barium, and a cracker or two. Then they X-ray your innards every hour for four hours to monitor the pace at which the barium food is moving through. After 4 hours, if it’s still being processed, they stop and diagnose “Gastroparesis.” That was four hours, not two — an entire lost article opportunity.
8. Initially, for the GERD, a prescription for Protonix. Then an increased dose. Then the maximum. Now to the X-rays, MRIs, and CT scans. (Keeping track of the hours?) It emerges that a previously repaired hiatal hernia has reopened, and a previous fundoplication needs re-tightening. In a fundoplication, they wrap the top of your stomach around the bottom of your esophagus to prevent gastric acid from escaping and traveling up the esophagus, possibly perilously toward the lung. And the hiatus tear (hernia) needs to be closed so that absolutely no acid gets through. But first they must check peristalsis, esophagus motility. Two hours. Also an acid test (two hours, counting travel time) in which a sadist in a white coat sticks a tube into your sinus, then down into your throat, and runs the line down to your stomach while telling you to keep swallowing. They measure the acid. In addition, a gastroenterologist (two hours) anesthetizes you and attaches to your esophagus a BRAVO pill (made in Israel!), measuring two days of gastric acid “events.” The patient wears a belt with an external recorder that receives the data accumulated internally by the pill. The BRAVO box must be returned afterward to the gastroenterologist. Two hours.
9. When too much liquid accumulates around the lung cavity, it can lead to pleural effusion. If the liquid further accumulates, it can overflow into the heart cavity, too. This can cause atrial fibrillation. Off to the cardiologist: two hours. He does an EKG where they costume your chest like The Borg, and afterward affixes a patch to your chest and gives you an accompanying dedicated smartphone. Leave the patch on for seven days, and it sends data to the single-purpose smartphone that transmits your heart rhythm info to your cardiologist. Two new meds, comprising three pills, are added to the prior 21.
10. The prednisone that reduces or prevents lung swelling paradoxically contributes to edema, liquid swelling in the lower extremities. So now a vascular doctor. Two hours. He has you come back the next week for an ultrasound. Two hours. He prescribes a medicine to control the edema. Dutifully obeying the Primary Directive, you never start a new med without getting formal clearance from the Hospital Lung Transplant Team who, by G-d’s grace, extended your life. They tell you not to take the medicine because it counteracts the anti-rejection meds. So you go into compression stockings with a donner and doffer, or Jux-ta-lite wraps.
11. The Cell Cept/Myfortik is associated with a greater predisposition potentially to skin cancers. So the dermatologist you formerly saw once annually now gets visited monthly (two hours per month), with occasional unscheduled additional visits if something suspicious pops up. More multiples of two hours. Some visits end with stuff getting deep-freezed (deep-frozen?). Sometimes, it’s a nothing. Still two hours.
12. During the lung transplant, they detected a very perilous bacterium in the lung. To eradicate that peril, for a week or two I had to wear a belt with a sack that automatically infused a very nasty antibiotic, Amikasin. By G-d’s grace and kindness, the bacterium was eradicated. May Israel be as successful with Hamas and their tunnels. Alas, a side effect: the amikasin left me 50 percent bereft of aural sound for life. That meant having to find an audiologist (two hours), get fitted for hearing aids (two hours), and then several appointments to tinker with them until perfect (eight more hours).  They are top of the line, but I have learned that people with hearing aids will never hear as well as they did.
13. The surgery also inadvertently paralyzed one of my two vocal cords, leaving me unable to generate oral sound. Thank G-d, a uniquely skilled doctor with a six-month waiting list inserted me into her schedule before Rosh Hashanah, and she injected a Botox-like substance into my vocal cord to bulk it up and thereby facilitate the paralyzed vocal cord and the healthy one making contact, thus generating voice. I now teach classes on Zoom four hours weekly, and I post all on my Youtube channel, now scores of classes, hundreds of hours, and a bunch of interviews. Imagine life without a voice, without hearing, without back mobility, without a heart rate, without lungs. The price: two hours times infinity. The benefit: infinity.
14. And of course the mandatory quarterly visit to the hospital Lung Transplant Team for comprehensive follow-up, X-ray, breathing tests, and an opportunity to renew old friendships with life savers.  Two hours each way to and fro the hospital, and four hours there. An eight-hour adventure.

Am I complaining? Of course not. I am thrilled. I wrote this article after a day of three doctors, including the cardiologist chest patch and Pain Doctor 6. To meet them, I had to cancel three telephone meetings that will be rescheduled. In my inbox, several dear emails from wonderful readers wondering why I have not published lately, concerned whether I am alive.

Most of us have no idea what transpires in the life of a transplant recipient. Recipients don’t want people to think they are falling apart because they are not. Successful and emotionally mature people don’t want to seem like complainers and emphasize they are doing great. Every week, I teach those three Zoom classes: one on the Books of the Bible, one on the Jewish legal codifications by Rambam Maimonides (now focusing on Judaism’s laws and ethics of war when fighting anti-Semitic aggressors), and one on each prior week’s news out of Israel, that war, and related prior-week Jewish news around the world, amplified with music and videos selected from Youtube and Israel TV.  I also distribute a weekly 15-25-page compendium and analysis of the weekly Torah portion that Jewish congregations around the world read each respective week. There are people to counsel, prospective converts to mentor, people with personal challenges to guide, and even an occasional marriage or funeral service to conduct. And one of my own to always cherish, respect, and devote time to. (READ MORE: 101 Truths I Never See in the Media)

Most people simply have no idea how many hundreds of hours a transplant recipient must set aside, whether pre-planned or suddenly required, attending to medical appointments, diagnostic exams, and procedures. By my educated guess, now 20 months out of the transplant, it averages 15 hours a week. That’s maybe 5 published articles a week. The articles vanish into a clock.

Time to whip up a new batch before Purim and Passover take over.