– diabetic patient tells her story

SHANTI Persaud thought her diabetes was under control. Months later, she was on the brink of death from kidney failure.

Deep in the throes of renal failure, barely able to eat, move or talk, and on the verge of total exhaustion, Shanti had no idea that her struggle for life would become an incredible survival story.

How she beat the odds, survived and eventually moved on to live a normal life is a story of incredible luck, a determined and highly-skilled doctor and his team, and a pioneering medical procedure at one of the nation’s leading hospitals that can save the lives of countless productive Guyanese.

Looking back on the illness that almost cost her her life, Shanti could hardly remember a time when she had not suffered from a combination of high blood pressure and diabetes. As such, her routine included monthly visits to her community health clinic for medical check-ups.

She did not worry too much as she always took her medications and was able to live a relatively normal life and do many of the things she loved, such as exercising, taking care of her family and even indulging in an occasional fast-food treat.

When she visited the clinic monthly to keep track of her conditions, her check-ups often included a kidney function test. But one day, her quietude was shaken.

She got her kidney function test results and found out that her kidneys were not working at maximum capacity. The results indicated that the problem was marginal, but it explained the recent feelings of fatigue that she had noticed. Still, she and her family, though concerned, were not alarmed as they did not fully understand the danger or consequences.

But the deterioration [of her health] was rapid and Shanti’s condition deteriorated from marginal loss of kidney function to chronic renal failure. Shanti was not at all prepared.

With chronic renal failure, her tiredness and weakness grew worse. It was as though all the strength, all the vitality had been sucked from her body.

Bathing herself had become impossible without assistance from her daughter. Shanti could not have stood up for the time it took for her to prepare a meal. Climbing stairs had become difficult as she lost her breath quickly.

WORRIED AND CONFUSED
“I was always tired. Everything was difficult. It was tiring to even put my clothes on. My daughter used to help me. I was really swollen; my feet, my hands, my face, my entire body. I was just swollen. I was worried. Not really scared because I didn’t know too much about it. But I was worried and confused,” Shanti said.

Her kidneys were almost gone. That was the reason for her fatigue, pain and bad feelings; and to make matters worse, Shanti was going blind.

Shanti started dialysis treatments in which she was hooked up to a machine that rid her body mechanically of impurities as well as excess fluids and salt. This invasive procedure became an essential part of Shanti and her family’s routine because, without it, she would simply die.

Everything in her life seemed to revolve around this artificial system of filtering impurities from her blood, which is called hemodialysis. Three times a week, her family had to take her to the hospital for the sessions. For four consecutive hours, a machine would pump her blood through a filter outside the body and pump it back into her body.

A bleak future of interminable dialysis treatments stretched before her. It was expensive too, costing nearly $50,000 a week. Additionally, every two months she had to be admitted to the hospital for blood transfusions and to treat complications caused by undergoing dialysis.

There were terrible side effects. The treatment left her feeling lightheaded and weak. After receiving it, she would be taken from the hospital in a wheelchair, lifted into the car and later, up the stairs to her home. This continued for about eight agonising months. It is a period Shanti tries to forget.

As her dialysis ordeal continued, there was a ray of hope. It came from Dr Kishore Persaud, a transplant surgeon at the St Joseph Mercy Hospital who urged Shanti to consider undergoing a kidney transplant. He was experienced in this area, having performed several such surgeries with a high success rate.

The surgery would require a willing donor whose physiological makeup would be compatible with Shanti’s. Shanti’s brother was a perfect match.

Such transplants are generally done at the Georgetown Public Hospital Corporation (GPHC), but Shanti was more comfortable doing hers at Mercy Hospital. Little did she know that it would have been a first for the privately-operated institution. The Mercy Hospital rose to the occasion and a series of prudent actions followed to facilitate a successful surgery.

LITTLE NERVOUS

It was a quiet Saturday in October 2017 when Shanti and her brother arrived at the Mercy Hospital for the surgeries. She was a little nervous, but Shanti trusted her doctor.

The Mercy Hospital team had left no stone unturned. According to Dr Kishore, “We would have reviewed the protocol and discussed it with the administration at the Mercy Hospital… spoken to all the specialists and… made a clear plan of how to proceed in this aspect because it was the first-ever transplant we would have been doing at this hospital.

“After setting all the parameters in place, we then proceeded to do her transplant. We partnered with the … university in Miami which gave us a backup to our laboratory service in terms of proceeding with [conducting] all the tests that are not available in Guyana,” Dr Kishore explained.

Shanti and her brother spent over eight hours on the operating tables beneath the skilled hands and watchful eyes of Dr Kishore and a team of medical experts who worked intently on the transplant.

After the operation, Shanti recalled waking up on a bed in one of the hospital’s rooms.

Relieved, she looked over and saw her brother awake on the other bed. The surgery had been a success and her new kidney had begun to function while she was still on the operating table.

Dr Kishore left nothing to chance. He stayed with Shanti throughout the night after the operation to ensure that the kidney was fully functioning, and afterwards, he and other doctors made frequent follow-up checks.

Shanti marveled at Dr Kishore, remarking, “I was amazed by his commitment and dedication. He stood there until the kidney was fully functioning before leaving the room.”

Shanti experienced none of the pain she had expected in the recovery phase and, after one week of ‘top-notch’ after-surgery care by the hospital’s staff, she was able to walk, on her own out, of the hospital. Her brother had left the hospital four days after the surgery.

“Currently, she is doing exceptionally well…since she was discharged she was never admitted again,” Dr Kishore said recently.

VISION REGAINED
To top it all off, Shanti has regained most of her vision. Dr Kishore explained that a benefit of this surgery is a reversal of some of the retinopathy caused by diabetes.

“She has enjoyed nearly all the benefits of renal transplants…no admissions since; no dialysis since; she never had to get blood a transfusion; she is on minimal medication; she can see… her blood sugar is well controlled… she is living a normal life, a better quality of life, except under some intensive monitoring.”

Dr Kishore said many people with renal failure would like a kidney transplant, but it’s not easy to get a compatible donor.
“Not everyone has a generous friend or relative that wants to donate a kidney. And then the public [is not aware] that a person can live a perfect life with just one kidney,” he said.

The surgeon remarked that some persons are, in fact, surviving on just one kidney and are not even aware of it because they have not experienced any symptoms indicating that a kidney has stopped working.

Underscoring that donating a kidney is safe, Dr Kishore explained that the screening process for donors is thorough, following rigid guidelines.

“When we take a kidney from someone, we ensure that person is capable of living a normal healthy life for the rest of their life on one kidney. We would never take a kidney from someone if we know we would cause harm to that person. That is our main objective when we screen a patient thoroughly…”

Shanti’s brother, for instance, is enjoying an active life after the successful operation. This includes working hard, going to gym and active social interactions. Until he heals fully, his only inhibition is lifting heavy weights.

One of the ways of increasing the availability of kidneys for persons in need is for Cadaveric Legislation to be passed in Guyana, allowing for organs to be taken from patients who are brain dead and implanted into those in need.

Since Shanti’s surgery, there has been one other kidney transplant at the St Joseph Mercy Hospital by Dr Kishore and his team. Altogether, 20 kidney transplants have been done in Guyana by Dr Kishore and his team at the Georgetown Public Hospital Corporation with Dr Kishore as the lead surgeon.

He is a strong advocate of kidney transplants in cases of renal failure, declaring the procedure life transforming for both the patients and their families.

“With transplants, you become independent, you go back to work, you contribute to society, you live a more productive life,” Dr. Kishore said. He pointed out that Guyana benefits immensely from the lives saved by kidney transplants because productive, professional Guyanese recover, go back to work and contribute to nation building.

Back from the brink of death and doing her bit for Guyana, Shanti Persaud agrees fully.