Hey boxers,

Somehow I overlooked your prior post to me (when I wrote to you before). No matter, i read it now and blab again.

Now, that's making making much more sense, now that you and RC are elaborating ... ie. daily spreads, troughs, precise draw timing and such, quite a few important variables! 

Always sumpin to know and learn for me.

Wounds need lots of cherry tomatoes, I think. Colds too can do with a few. 

My cherry toms are, mm, kinda tart flavour not sweet enough for me, but too thick inedible crunchy thick skins, eat them anyways and spit out half the peel! Weather got too hot all of a sudden at a certain stage they say said.

Hope it is not a zuccini in that pile! Biggest, bestest thing I had ever grown (babysat really) was a displaced re-located pseudo-wild zucinni I found once at the edge of a lake, hoards of zuccini. Best thing was I didn't need to water it! It's feet were in the lake. Oh, these clever plants, they know things!

Well, they say feed a cold and all that but with both of you down, who's doing the cooking! Please, both of you, get to feeling better soon, we need all hands!    C.

Hi All, I want to comment on the wide spread of the TAC levels over a one month time period when Boxers reports that the dosing is 1.5 mg twice a day (12 hours apart exactly)

The one big thing that would explain such a swing in the results would be the timing of the blood test draw. Your blood draw MUST be done EXACTLY 12 hours after your last dosing of TAC. This puts you in your trough. A couple hours too soon will result in a higher Tac, and a couple hours too late will result in lower Tac levels.  You wouldn't think a hour or two either way would matter but it does.

DEB, 1.5 mg 2Xday is a small dose.   I take 3.0 am-3.5 pm and my tac is 4.5 to 5.4 each week.   This week i was 4.2 and I will go to 3.5 am-3.5 pm and see what it is in 2 weeks.Sorry to hear your still dealing with the wound problem.

My tomato plant has lots of fruit set. The first fruit should be ready in a week to 10 days. The tomatoes look really healthy this year.  RC

Boxers, 

Glad you and RC are on it - regardless of dose (mg) per day, I was just looking at the tac graph, showing the spread in dates from beginning to end being a time period over about one month.

June 17 tac was aprox 11.2, in the middle of the month about 6.8, then up again at Jul 15 to aprox. 12.6.

I have read (once) that when they first start you off taking these drugs (like tac) the "intial loading dose" is sort of a weight-based estimate (so many mg. per kg), a rough guide, until they can see and rely on the blood level measurements to titrate the oral mg doses up or down to keep the blood levels where they want them to be. This then allowing oral dose ajustments according to how the body absorbs/metabolizes/accumulates the drug.

Is it always true they only want a "maintenance dose" at around this 5/6/7/8 mark? If so, I guess that is what initially confused me, (not knowing what your  "maintaining" dose is supposed to be) - do they want it higher at times, on purpose.

But, now that you have explained what your oral doses of tac have been, then I am still confused (given the timeline - June 17 to July 15) ... if you have been on 3 mg (total) per day, all along until now, and only today had it decreased to 2 mg (total) per day, what then explains the decrease in tac blood levels on July 1 - just due to how one metabolizes tac? - maybe the weight loss as well may have been a contributing factor, as far as metabolism/accumulation of drug doses? Weird (to me), but as RC outlines maybe it is a seesaw thing, affected by multiple variables. Are you really on all those drugs that RC isted, or just some - I think you posted a list somewhere, but i can't find it.

My main concern is just how you are feeling, how you and yours are doing, and hoping a higher tac level does not equate to feeling more sides for you. Hope you are feeling/doing a wee bit better. C.

Canuck,

Guess I must getting to be a seasoned transplant person, assuming that you would know what the tac level means. I go for labs and they do a blood test at the (trough) which is the lowest point of circulating tacrolimus, the ideal range is 5-6. I learned a new term today, x-plant, that is what they call my old liver...sounds like a Sci Fi movie...lol! I have a doc. (Hepatologist) here that is part of the Swedish transplant team for our area, he follows me so I don't think I have to go  back to Seattle unless I am sick, apparently no local hospital would want to handle a transplant pt. and Swedish would prefer I came back to them also. Still fighting the cold, now my husband has it, sounds like a respiratory ward around here. Wound is healing nicely but it will still be a few weeks before it is closed, at least the deeper ones. I am eating tomatoes (cherry) now, hoping the other tomatoes mature quickly, we have a short growing season. We have a monster plant growing on  our manure pile...something the horses ate. We are all, including neighbors, dying to see what it is. Looks like some kind of melon or squash....I have feed them cantaloupe and water melon but who knows....Hope all is well with you and thank you for your concern.

Sorry about the crazy graph with no dose information. I was on 1.5 mg  twice a day until today, they reduced it to 1mg twice a day. So the entire graph represents a 3 mg (total) in 24 hours.

Hi Deb.    In order to interpret your graph I need to know how many mgs of TAC you were taking each day the week prior to your results. ideally we want your TAC between 5 and 8 each week. Some folks can be on just 2.5 mg 2X daily and have a tac of 7, and the next guy needs 4 mg 2X day to get to 6.  We are all different in the way we absorb the drug and expell the drug. 

I have in the past been on 4 mg 2X day and been at 9 and backed it back to 3 mg 2X day and seen it drop to 4.5.  Its a crazy dance, dont fret about it, it takes a few months to find you number.  It gets calmer as you come off all the other drugs your on right now. Bactrim, Myfortic,Valcyte,Fluconazole,Prednisone,all have an effect on your system. It gets easier as you start coming off these drugs.  Just write in the mg amount on your graph and re-post it. RC

It works boxers, I can read it fine, but I DON"T understand it!? 

Why, oh why, over the course of about one month would they have you on a fairly high level of tac now - about 11.2 at the start, about halfway through you get down to about 6.8, and then at the end of one month you are back up to a high level at about 12.4??!

I thought the idea was to start you off (perhaps at a high level) then maintain you at a dose right around in the 6's or 7's, and keep you there? Why would it be back up, again, to aprox 12.4 at the end of the month??

Do they do this purposefully, or is it a case of the tac level being something hard to balance, what level have they told you they are striving for?

How are you in every other way, BTW? Gee I hope you are feeling at least tiny bit better in ways, I was relieved to hear your wound was doing better in healing. The numbness must feel very wierd, but how much pain are you still having? Aside from the wound is anything getting better yet, much? Hope you have managed to gain a bit of an appetite back, or at least eat good, and get a few pounds back on.

Kind of you to keep us all updated, otherwise we fret or might just assume things are going well, I am imaging you MUST still be completely shell-shocked (I know I would be - with such things to get your head around, with what you have been through - the living, the healing, bodily pains, struggling with it all, such drastic changes, all the back and forths to doc and labs)!

How did that whole thing turn out with your lungs and the antibiotics? I hope it resolved quickly and that you are OK, did anyone jump on you for starting the antibiotics on your own? 

I still don't get it, (even tho I know you tried to explain it to me) sorry - how often you have to travel to Seattle and how you get there, and how long does it take you to get there. When you go there do you go the day before and stay over? Do you end up getting managed by both your own old family doctor where you live, as well as by the team in Seattle? Are you able to get your labs (or some of them) done where you live, or are you having to present yourself to Seattle/hosp/labs for all your ongoing testing? What do your transplant docs say to you about your progress?

Hope you are feeling OK, let us know as much as you feel like sharing. Tig, RC and SS will likely see at a glance what these tac levels mean. I hope the increase does not equate with increases in sides for you? Always glad to see a post from you m'dear! I hope this will elicit a post from RC or SS now, they should post more, such interesting men and of so few words, keeps us girls pining away for more then I guess.  C.

PS - Both Obs and I are waiting to find out how your tomatoes turned out. 

Just thought I would try and show you an image of my tac levels....try, wish me luck