Nearly every heart transplant recipient encounters insulin management in the immediate post-transplant period. The only question is whether you come home on it—and whether you can eventually come off it. That is not a prediction about individual outcomes. It is a pharmacological reality. The immunosuppression deployed in the immediate post-transplant period produces a glucose load…
Most people have taken prednisone at some point. A five-day dose pack for a bad allergic reaction. A short course after an orthopedic procedure. A week’s worth to quiet a flare. It works fast, the side effects are manageable, and then it’s done. That experience creates a frame of reference that does not apply after…
A note before we begin: The goal of this piece is to make you a better-informed participant in your own care — not to replace your transplant team. They know your numbers, your history, your other conditions, and your specific risk profile in ways no article can. They are the experts. What follows is context…
The immunosuppression regimen gets most of the attention. It should—it is the most closely managed, the most consequential, and the one that never ends. But it is not the only thing in the prescription bag when a recipient comes home from the hospital. For a full overview of the immunosuppression regimen itself, see What We…
The transplanted heart is living tissue carrying someone else’s genetic signature. The immune system was built to recognize anything carrying a genetic signature that isn’t yours—and to treat it as a threat. That is not a malfunction. That is the immune system doing exactly what it was designed to do. Immunosuppression exists to prevent that…
Almost every transplant group has the same recurring post, usually around 2 a.m.: Why am I always low on magnesium, and why doesn’t taking more of it seem to fix it? The answer is not simple. The full explanation runs through kidney physiology, drug pharmacology, metabolic consequences, and the particular frustration of getting a supplement…
There is a reasonable assumption that most people carry into a transplant: that things taken for years without incident are safe to continue, and that anything labeled “natural” or sold without a prescription occupies a different category from drugs. Both assumptions are wrong after a transplant, and the consequences of acting on them range from…
On the morning of October 3rd, 2024, I sent a text to my buddy Eric. I told him things had taken another downturn. That afternoon they were going to implant a temporary LVAD. I told him I might not come back from this. He responded the way Eric responds: with a bad joke about the…
When the ancient Egyptians prepared a body for the afterlife, they pulled the brain out through the nose with a hooked instrument and threw it away. It was waste. The heart they left exactly where it was, because the heart was where the person lived—where judgment would happen, where the self would be weighed against…
