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Wise Regional performs its first therapeutic plasma exchange; Patient doing well following lifesaving procedure

By Alyssa Yancey | Published Saturday, August 23, 2014

John Foster of Chico was the first patient to receive a therapeutic plasma exchange at Wise Regional Health System in Decatur.

This lifesaving procedure “deep cleans” a patient’s plasma, the fluid that carries red and white blood cells and platelets around the body.

Lifesaving Machine

LIFESAVING MACHINE – (from left) Katherine and John Foster and nurse Lisa Lambert, RN, show off the machine used to perform a therapeutic plasma exchange on Foster last month. Messenger photo by Bob Buckel

The procedure is necessary when a patient presents with critically high protein levels in their blood. High protein levels can be caused be a variety of conditions involving the blood, nerves or kidneys.

Previously, patients had to be transferred to Dallas to have this advanced procedure.

When Foster was admitted to Wise Regional July 15, his creatinine, or protein, levels were 22 milligrams per deciliter. A typical adult has a creatinine level below 2 mg/dL.

“John had the highest creatinine levels I’ve personally ever seen in more than 20 years of practice,” said Dr. Aamir Zuberi, medical director at Wise Regional’s dialysis clinics.

Initially, Foster had only presented with recurrent diarrhea, but soon after being admitted he began developing additional symptoms, including neuropathy, or numbness, in his hands and feet, as well as vision problems.

“I went to see my family doctor first because I’d been having digestive issues on and off,” Foster said. “[Dr. Richardson] sent me to Wise Regional for blood work. After the blood work, I went to the pharmacy to pick up some medicine he had prescribed.

“Before I even left the pharmacy, the lab at Wise Regional had called me to say I needed to come back and be admitted.”

Zuberi ordered emergency dialysis to filter some of the toxins from Foster’s body, but dialysis alone wouldn’t remove the proteins that were quickly clogging his system. Zuberi also performed a kidney biopsy, which led him to diagnose Foster with multiple myeloma, a condition that results in high plasma cell production.

The plasma cells produce protein, so as their numbers increase, so does protein production.

After consulting with the Critical Care Unit staff and Dr. Maddukuri, medical oncologist with The Cancer Center at Wise Regional, Zuberi decided Foster was a good candidate for Wise Regional’s first use of therapeutic plasma exchange.

Wise Regional acquired the equipment to perform TPE several years ago, and several members of the CCU staff recently underwent training to learn how to administer the treatment. Katy Anderson, RN, and Lisa Lambert, RN, both attended the training and were on duty when the decision was made to treat Foster.

Foster received a total of six plasma exchange treatments over the course of a week. Each time, his blood was removed through a catheter in his neck, filtered and simultaneously replaced with fresh, frozen plasma and human albumin – a common protein important in the growth and repair of tissue.

“During the first treatment, the waste that we filtered out of John’s blood was milky white,” Anderson said. “The process took close to four hours, and we went through three filters.

“The final treatment took about half the time, the waste was clear and we only had to use one filter.”

Foster said other than being cold during the treatment, he experienced little discomfort. After the third treatment, his symptoms had improved significantly. He went from being unable to hold a pen to being able to hold and drink from a cup. His vision also returned.

“When we saw that he was able to read the numbers on his remote control, we were all a little choked up. It was amazing to see how quickly he improved,” said Lambert.

Foster also began receiving additional treatments to eliminate the abnormal plasma cells. He was discharged July 31. He’s continuing dialysis and he and wife Katherine are confident he’ll make a full recovery.

“We trust in God, not only that he’ll heal John, but also that He gave the doctors and nurses the wisdom they needed to provide the best possible care,” said Katherine. “It’s exciting to see that this kind of technology is available so close to home.”

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