bummer

After training in Kali, 2 years ago I moved home to SWK to take care of my people & the area I grew up loving. About 8 months ago, I started a pheresis program specifically for one 38 year old male with homozygous Type II Dyslipidemia (cholesterol about 1200, LDL about 650)--this procedure involves using a continuous centrifugal plasma/blood separator, removes his cholesterol, returns his blood cells & "fresh" 5% albumin.

He had had a 4 vessel coronary bipass procedure at 32 years of age, but we had his LDL down to 120-150 & things were looking up. Since I was apheresing him once/week, I got to know him well, including all of his personal/family problems.

Well, for some reason, he skipped his treatments over the last month, started smoking, & died a couple days ago, suddenly. Most likely cardiac arrest. :ugg:

38 years old. I'm having a real hard time with this one. Sure, I take care of a lot of youngsters on dialysis, & see them frequently as well, but this one really bothered me. I'm not sure why I'm saying anything here, but just wanted some here to know what I go through. It's not easy. And despite what many think of docs, we do care. For me, when someone like this dies, it's almost like losing a family member. Certainly, like losing a friend.

I'm going to his funeral today.:(

Thanks guys.

Didn't want to sound like a whiner, or win any hearts. That wasn't the goal. Just wanted to share, so thanks for the replies. Of course, I've got plenty of people to unload on, including my family. And I do.

He was an ornery fart. :) Quite a good little fella. Great personality. Everyone here is pretty bummed.

He was getting frequent upper respiratory tract infections. Plasmapheresis involves removing the plasma & replacing it with 5% albumin. Well, your antibodies live in the plasma, so with removal of it, you become immunosuppressed.

Because of that, I was in the process of setting up a filtration separator followed by LDL-exchange columns (columns covered in LDL receptors)--when the separated plasma runs across these filters, only the LDL is removed via the LDL receptors bound to the membrane latching onto the LDL in the plasma. The rest of the plasma is returned to the patient intact--including the antibodies.

He was taking a "self-advised" break, which I couldn't argue with in light of the low immediate/interval risk. The only thing that might have changed acutely (besides LDL level) would have been endothelial function. However, I have the feeling he hastened the process by smoking, which is the most endothelial toxic substance you can put into your vascular system. ie, the endothelium weakens, becomes spastic, & becomes predisposed to plaque rupture and thrombus formation--total vessel occlusion.

Who knows, maybe it would have happened anyway. :(