Saturday, April 16, 2016

Post Transplant Bone Density

Immunosuppressive anti-rejection medications are a permanent part life after a lung transplant.  We take our meds on a fairly strict schedule and submit to routine labs to check blood levels for the meds, the status of our immune system, and check our liver and kidney function.

These medications are so important that my daily routine is basically centered around my med schedule.  Noncompliance with taking immunosuppressents is a major cause of transplant rejection.  One month post transplant I underwent an acute rejection event due to a virus, that is something that I really do not want to experience again.

These life saving medications come with some pretty heavy duty side effects.  Half the pills we take are taken to counteract the effects of the anti-rejection meds.

Eating clean and following the Primal Blueprint are tools that I use to help protect my body from unnecessary inflammation and to help maintain kidney and liver health.  I use daily exercise and walking to help counter the effects of muscle weakness and wasting.  I also take various prescribed and recommended vitamins and supplements to help keep my body generally healthy.

Bone and joint deterioration is one of the many side effects of these medications.  I think the Prednisone is probably the largest culprit in this area, but the immunosuppressents are also contributors as are the proton pump inhibitors (PPI's) that many of us are on as prophylactics preventing micro aspirations and GERD.

From an article on Bone Mass and Solid Organ Transplantation:
To quote Elizabeth Shane, a recognized leader in this field, "Immunosuppression insults an already compromised skeleton.
To counter the bone loss side effect of the meds, my Transplant Team prescribes Citrical to be taken twice a day.

I have a long term n-1 experiment that is a bit more detailed than that.  I need to minimize, or even reverse any bone loss, and definitely prevent joint deterioration.  After surviving the procedure and getting to the point in my recovery where I began to believe that I really could live a healthy and mostly normal life, I began studying how to maintain my bones.

The Transplant Team had the supplements covered with the Citrical, so my little n-1 experiment has to do with diet and exercise.

On the diet side of the equation, I eat fermented milk products like kefir, yogurt and aged cheeses.  I also eat plenty of leafy green veggies, the occasional can of bone in sardines, and lots of home made bone broth.

On the exercise side I slowly progressed from Pulmonary Rehab to light strength exercises with resistance bands, to a beginner's body weight routine, to my current Simple and Sinister kettlebell program.  It is very important to note that each progression was approved, and carefully monitored by, my Team.  I may have pushed things a bit, but I pushed them with my Team's approval. Trust me, if you attempt something that your chest is not ready for after a lung transplant, your chest will let you know.

The recommended exercises for increasing bone density are ones that create stress on the bones.  High impact exercises like jumping and sprinting, and heavy load bearing exercises like deadlifts and squats seem to be the most mentioned.  Both of these were pretty much off limits for most of the first year post-transplant.  I was just approved for jumping this past visit to the clinic.  My exercise plan was not optimal, but was the best under the circumstances.

How what are the results after the first year?  Mixed.

From my first post-transplant annual bone scan:
Percent change in BMD from baseline study: 
Lumbar spine: 1.7%
Left total hip: -9.8%*
Right total hip: -8.6%*
I have to admit that initially I was a bit dissapointed, I was expecting better results.  After looking into it, these are not that bad.  As a matter of fact the lumbar spine numbers are pretty great.  One study found half of the patients in the study lost 8% Bone Mineral Density (BMD) in the first year post transplant.  So actually gaining density is awesome.

It does appear that diet and kettlebells have helped my spine.  So I believe that I am on the right track.  I just have to make some adjustments to my plan.

So what changes to make?

We discussed using a medication to help restore bone density, but decided to go another year with my n-1 experiment including my proposed adjustments.

Historically my Vit D levels have been low.  That's reasonable seeing as how I'm supposed to refrain from getting much sunlight.

To increase my Vit D, which is necessary for calcium absorption in the gut and is needed for bone growth, the Team prescribed a cycle of once/week 50,000 units of Vit D3 for eight weeks followed by a daily dose of 1000 units D3.

I do not plan on making any changes to my diet other than maybe drinking more mineral water.

As for changes to my exercise plan, I will start jumping once my tooth extraction site is healed.  One of our granddaughters is excited that the Team has finally ok'd my jumping on the trampoline with her.  I will also begin doing plyometric jumps daily.  I generally do the Simple and Sinister routine five days a week.  On the other two days I've started doing kettlebell deadlifts and military presses.  I plan on doing heavier deadlifts once I can acquire a (very) inexpensive bar and weight set.

This exercise plan supports my goal of competing in the Tactical Strength Challenge next Spring.

We won't know the results of this little n-1 experiment until my next annual bone density test come January.  I am confident that I will see improvement, and I know I will be fitter for the attempt.

For more on bone health, see 8 Primal Rules for Building Better Bones

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