Bri (00:00):
Thank you so much, ladies, for taking the time to sit down with us today. I can imagine that there are several factors at play when you’re trying to ensure that you’re staying healthy, Tiffany, in your recovery process, and that you, Dr. Corpier feel like you have all of the data and information necessary to be able to make the best recommendations for the care of a patient like Tiffany, for example. Dr. Corpier, I’d like to start with you, how long have y’all actually known each other? At this point?
Dr. Corpier (00:30):
We met in December of 2015. Tiffany was, was about two years out from her second living donor transplant which is her spouse donated to her the second time. And she relocated to our area. And so happens someone moves and they need to find, they need to find new follow-up care. And so she came to our practice in our north office around that time.
Bri (00:58):
Fabulous. Well, now you get to actually formally work together with your Dr. / patient, but also, you two are formally colleagues. Yes?
Dr. Corpier (01:05):
I know it’s a bonus.
Bri (01:07):
It’s fabulous. So at that time being to out two years in terms of post transplant, how often were you seeing Dr. Corpier at that point and how has that changed over time?
Tiffany (01:20):
I think that I was seeing her quarterly, so every three months and that’s pretty typical, the timeframe that I was, , out of my transplant. And also it goes into how your labs look, because if there’s something alert that alerts her, I would need to come in sooner than that. But for the most part, it was every three months.
Bri (01:44):
Well, and so if someone’s really just right out of surgery, what does that look like in comparison?
Dr. Corpier (01:50):
So typically now in a, in a fairly straightforward transplant, particularly a living donor transplant, the patient may go home at day four day five. This is dramatically different than it was two, three decades ago. But now patients go home very quickly. And so we begin seeing them in the clinic shortly, shortly thereafter. If you go home on Friday, you’ll be back in clinic on Monday, have your labs done. And so we follow a pretty intensive schedule at transplant clinics that the patient usually comes in for the first couple of weeks, about three, three times a week, and then down to two times a week and then down to one time a week and then monthly out for the first several months. And then we sort of wean it off. Shall we say? Down by the end of the first year, we hope to be at a quarterly schedule. It very much depends on what’s going on. If someone is having infectious complications or other problems, blood pressure issues , immunosuppressive comp complications, then we may see them more frequently.
Bri (03:06):
I was gonna say, so are some of these appointments quick, like a quick in and out, or, , when you’re, when you were going once a quarter, like, is it just a quick check-in or is that something where you’re continuing to do labs?
Tiffany (03:19):
It’s definitely not quick.
Tiffany (03:22):
And then, especially with Dr. Corpier, she literally, I’ve always had great doctors, but she’s at the top because she’s so detailed and she takes that time. And I know a lot of patients when they’re seeing primary care other specialists, they just feel like it’s a conveyor belt and the physicians are knocking on the door coming in, but no, you go in and for me as a patient one of the things I always suggest is if there’s something, , you’ve changed in your diet or your energy or anything. So I always go in, notes in my phone so that I know that whatever she’s going to address based off of my lab results and my urine and things like that, and, , reviewing my medication, then I also have my own questions as well. So
Bri (04:09):
That’s a huge piece of it. I know for myself, from a patient perspective, I can go into a doctor’s appointment and feel like I know exactly what they just told me and have a really great idea. So I leave feeling confident and then I immediately realized that I seemed to have blacked out. And I don’t remember anything as to what was discussed in this appointment. So Dr. Corpier, I’m curious, , do you have any recommendations for PA patients to be able to come into some of these appointments, to be able to make the most of them and help you as a physician?
Dr. Corpier (04:37):
I think that Tiffany’s method, and it doesn’t matter how you take your notes, right. Sometimes it involves bringing someone with you. Sometimes it involves now, , we FaceTime with, , with mama or we FaceTime with the wife, , or we FaceTime with whoever we need to so that, , two heads are better than one sometimes. Yes. And, but , bring in, , write things down if that happens to be a problem. The one thing I learned as a fellow a very long time ago is that the thing that is foremost in the mind of the patient is not necessarily at all the thing that’s foremost in my mind. Okay. And so, and so we have to rest both things. So if, , I mean, as mundane as it may sound, the thing most bothering the patient and the patient that I learned this on more than any other, it was constipation. Okay. Well, I was like thinking about the, , the 30 lab tests that we’re looking at, everything else is immunosuppression his meds of his, I mean, there’s a whole long list of things we’re, we’re looking at, but I mean, he could care less, right. Until I fix that, or if it’s pain or if it’s , nausea, or if it’s, if it’s problems getting medicine, I mean, there’s a bunch of different things.
Bri (06:00):
You have the open line of communication.
Dr. Corpier (06:02):
Right. And so, , and so I advise patients , if there’s something that’s bothering you lead with t
Dr. Corpier (06:12):
That’s great, and as far as how to handle, how to handle this, , our standard is to provide patients with their lab results. At every visit now some of them get their labs on , our portal. And don’t, don’t necessarily want the hard copies. And occasionally after many years, people are less interested in the hard copies, but we give them their lab results. And if I make changes, , my sort of procedure typically is I write that stuff down. . And so hand, , hand it to you with, , this is your homework. Okay. And , basically this is your homework.
Dr. Corpier (06:57):
And because, , and, and also let them look and say, okay, does this make sense to you? Right. , is this written in a way that it makes sense to you? And I think that, that gives us the best chance, because this is very complicated.
Bri (07:10):
I was gonna say, that’s my next question is really, how did you two work together to approach rejection prevention? You that’s a, I can imagine a, a really critical component. , what you’re really focused on is keeping a healthy kidney now that you have this transplant. So Tiffany, what do you remember in terms of approach and , how it was relayed to you about how things were gonna be moving forward?
Tiffany (07:34):
I think, like she said, having an understanding of your lab, having an understanding of what your baseline is and having basic knowledge, I think patients may, like you said, if you go to appointment and you’re black, you black out, you’re not gonna remember that. She said, okay, , your creatinine’s kind of, , creeping up. I want you to do a, B and C or we need to follow up doing D and F you have to be able to retain that information and, , keep that open line of communication. So I think that’s pretty key on discussing, , any potential, , rejection and things like that. And I think for her and I , pretty smooth sailing for the most part, but I know last year, , I had some, , issues come up and it was a lot of testing and ultrasounds and x-rays and this and that, and then ended up in biopsy. It was, it was pretty crazy last year. And so with that being said, just being able to, , confidently and consistently communicate and then have that understanding, because like you said, patients can’t go into these appointments because a doctor’s gonna provide you with the knowledge. You have to be able to be the one to follow up and then, , ask the questions that still remain.
Bri (08:53):
I like there’s something bothering you lead with that. Dr. Corpier, I know anti-rejection medicines are important, , and critical reminders of what to take and information that you share with patients like Tiffany, what are some of the things that you recommend when it comes to setting expectations around?
Dr. Corpier (09:16):
So we begin, we begin typically, , in the pre-transplant period setting these expectations. So our patients , my patients in the office now that are preparing that we’re getting prepared for transplant even before they have their initial transplant consultation, we do education with them so that this introduces these concepts and make it very make it very clear that in 2021 the, there is still a necessity for daily medication to maintain your graft. And and then when they go for their transplant evaluation at whichever center they choose in the area, then they get another layer of education and then about that. And then before they leave the hospital, when they’re transplanted, there is another layer of education about that. And then at pretty much every visit then, , , tell me, do you have your medicines? Are you having trouble getting your medicines? And then are you taking your medicines? And then are you taking your medicines consistently? . And so, and so it is a, it is a, it’s a continual thing because, , it’s, it’s sort of like I mean, we can’t guarantee the longevity of a transplant, but I can guarantee you that if you stop taking those medicines . You will not maintain your transplant. . Okay. Those, the people that get away with that are .
Bri (10:58):
Why test it? Why testate?
Dr. Corpier (11:00):
Well, and I’ve told patients that exact thing, I tell them this experiment has been done many, many times. We are more than 50 years into kidney transplantation. I personally, I almost have to choke to say it, but I personally have been working with patients more than 30 years. Okay. And the medicines have changed. Things have gotten much better. The surgical procedures are dramatically better. I mean, there’s so much that is, that is better than it was when I started my fellowship in 1987. But one thing that hasn’t changed is the necessity for meticulous, management of your anti rejection medicines.
Bri (11:46):
Well, and you add another layer on top of that and it’s the food regimen and the, the diet that comes as a part of the lifestyle. And we talked a little bit about that, Tiffany, as well, but what are of there there’s maybe an approved foods list, right. That you’re given after surgery, , what was your experience like with the approved list?
Tiffany (12:08):
Yes, I was gonna lead with that. Everyone is unique. And so me, , I’ve all, like I said, after my first transplant, I studied got a holistic health coaching certification, all of that. So I knew that this, your nutrition is essential to the functioning of this kidney, but I feel that a lot of patients that I do talk to and mentor that is their biggest struggle. That’s their biggest struggle is understanding that these are the foods that because, if they were on dialysis prior, I doubt that they were, , following the food guidelines because, they just figured, oh, well, I’ll go in and they’ll flush my butt and I’ll be fine. So this transplant, you’re gonna have to be responsible for maintaining those dietary restrictions and consuming the foods that you should avoiding the foods that could cause some issues.
Tiffany (13:00):
So I think that’s a a big issue. And it’s funny, you were talking about, , patients listening and food, because I had a patient call me. He was a, he had attended some summits when I was with the K literally two weeks ago, he was calling me from the hospital before his transplant, when he got outta transplant, his wife called, he called me again, he’s literally asking me questions. And the nurse is in the room with him telling him. And so I’m like, well, who is that talking? He’s like, oh, that’s the nurse. I said, well, she, she has all the answers like she’s right there. No, no, but I know like, I wanna hear from you, I wanna hear from you, but it, like, I, I spoke earlier, it’s that happens a lot.
Tiffany (13:48):
What do you eat? I wanna know your diet. Can you text me? I got another new patient that she’s gonna be seeing. He’s a former athlete. So he literally text me yesterday. Like, what do I take for my energy? And what can I, use to I’m drinking coffee. I really supposed to be drinking coffee.
Bri (14:12):
We’re gonna double down on the importance of the relationship between patient and physician here.
Tiffany (14:17):
I literally went in my pantry and I text him some, I said, these are all approved because you need to see a renal dietician. You need, , you can ask me, but like she said, just that follow up and their understanding of how food is just so important.
Bri (14:34):
Well, and there’s an important piece, two of this in terms of tracking it and what you are, how you’re doing that, there’s a, is there a resource or a tool that you use to be able to do that?
Tiffany (14:44):
As far as food or just in general? So we have a DNA it’s called my health.
Tiffany (14:52):
My health. . Follow my health. And so with that that’s extremely helpful because she puts her laps. She puts her notes. If I wanna know, did they, did they call my new prescription in, or my refill? It’s all right there. So that’s how you follow all of the medical advice and things that, but as far as what you do for your dietary, I mean, there’s a, there’s a to ton of apps out there that people can
Bri (15:18):
Use Absolut your friends to
Tiffany (15:19):
Record . To record. So whether you have an Android or iPhone, I will just suggest following, downloading something free. But for me, it’s so routine, like I almost eat kind of, of like a robot. It’s like, these are my three options that I rotate for breakfast. These are my options that I rotate.
Tiffany (15:41):
Then for dinner its kind of the same thing because you’re eating to live, not living to eat. And so people have to get that concept and yes, oatmeal gets boring and yes, coconut yogurt and granola and fruit, but, you’re healthy, you’re active, you’re staying in shape. So you just have to kind of make those sacrifices and make those adjustments and find ways to eat.
Tiffany (16:17):
And so just giving patients those options, that it’s a healthier alternative. .
Bri (16:23):
So, well, and you talked about extra.
Dr. Corpier (16:25):
Well, I was just gonna say, this is a huge challenge in America. I’ll reveal some of my bias, but , we are living in a toxic food culture, that is driven by tends to be driven by, , profit more than nutrition. And so with our patients who have who, who have a range of kidney function and diabetes, hypertension, I mean, these are, the common things that we’re dealing with than trying to help them maneuver their way through all of these very sort of seductive products and marketing that are out there. , this is very challenging. Most people are not as, are not as disciplined as Tiffany, or people who’ve been high level athletes, they’re just at a different level of discipline than the average than the average person.
Bri (17:33):
Be honest with your doctor about why you are eating that way.
Dr. Corpier (17:36):
I mean, the discipline is fabulous. If we can bring you, , if we can just bring you out of eating Jack in the box and taco bell, sometimes that’s the win we have to take. But we have a lot of support for our transplant patients in terms of our dieticians that are invaluable.
Bri (17:57):
There’s another level of discipline here. And she talked about it is exercise and her background as an athlete, but for the, the general population who doesn’t have a background, , as a professional athlete, or just even consider themselves someone who worked out and, and does those types of activities, what are your recommendations for getting moving? What does that look like?
Dr. Corpier (18:17):
I think that, I think that we have to meet each person where they are. Yes. And so that’s the main thing. And so the, in terms of managing hypertension, know this comes under the lifestyle changes and that, , that’s whether you’ve got normal kidney function, and high blood pressure, or whether you’re on dialysis or whether you’re a kidney transplant patient. Right. So you can’t go into the literature and find a downside to exercise.
Dr. Corpier (18:50):
We may try, but you just can’t find it. I mean, but the point is start, start where you are. And if you’re somebody that has not done anything, , for five years, well, then you need to start at a very different spot then Tiffany or even me for that matter. I mean, I try to exercise five times a week. And so sometimes I’m four, , but sometimes I’m six, but I try to exercise everyday because I have this tape in my head now, , that’s, what’s needed. And so what’s recommended is 30 minutes a day, at least five times a week of walking. And if, , and I tell people, if you can’t do that walk 10 minutes and then just work up. And but , I, I don’t tell, I was talking to some patients before I came over here, 80 years old. And they’re like, well, , we try to go to the mall and walk, right. It’s a hundred degrees outside. I wouldn’t tell an 80 year. . To get up and go.
Bri (19:53):
My mom just got a membership at Y M C a cuz they have a, a walk track that’s inside and air conditioned. But something we also talk about is instead of calling it exercise, calling it movement, because sometimes you can get in your mind where exercise is just this. Ugh. You’re not gonna like it. You’re not gonna enjoy it. It’s really just about moving. And what is it? Inertia. . Body emotion stage in motion, right? Yes. Just to work in all the phrases. .
Dr. Corpier (20:18):
. No. And I think, and I think that’s, I think that’s, that’s an even better way to look at it. I mean that, I, I, I, there’s a, I was listening to an interview with with a former model, , , another just of course, beautiful physical, best them in, right. That most of us aren’t and so were asking, well, how do you maintain? And she’s like, I just, , I try to move myself every day. She said something else than that, but That’s what she was saying. She, she says, I, , and I try to break a sweat every day. . And, and and , walking to and from the TV in the kitchen is not
Bri (20:54):
Cut well, I mean, COVID time,
Dr. Corpier (20:55):
COVID times
Bri (20:56):
In particular, , are adding a, a different layer in terms of commute. , if you’re only commuting from your bed to your office space, I think it definitely requires just thinking of about it in an extra way, trying to, to, to seek that out, cuz you’re not necessarily walking into the office or doing stairs in a building potentially. So
Dr. Corpier (21:15):
. But I think the other thing about COVID the other, the other thing about COVID too, is that, , when you were outdoors, the likelihood of when you’re outdoors, particularly by yourself out walking, , if you pass somebody on the street, your likelihood of, of catching that infection in those circumstances is, is infinitesimally small. , gyms are different, that’s different, but outdoors is your friend.
Bri (21:43):
Absolutely. Well, there’s another layer of this. And especially around the immunosuppressants that we haven’t talked about yet, which is how they affect your mood and how they affect you mentally, your disposition, I should say, from your experience, Tiffany, what are some things for fellow patients to keep in mind about this?
Tiffany (22:02):
I think ensuring that your body, but you don’t know your body, do your body? . So I think just being really, , really tuned in to the fact of, , why are my hands tingling? Why are my feet tingling? Why do I feel like I’m sweating more after I eat, , whether’s spicy food or whatever. So I think that’s so something that patients have to start being more in tune with their body and understanding how food lack of physical activity in their moods affect them. So you asked about moods, right? And with the medication, that’s something to discuss with the, if you’re feeling like, and, and for me, I’ve, I’ve been on immunosuppressive for so long that I don’t really notice the difference, but when you first start out, I mean, you’re in the hospital and it’s like a brief case full of medications that you’re given. And so just slack with the appointments over time, over the first two weeks, the first month, the first two months, all of that medication slowly starts to taper because you’re I don’t remember all of the names with some of them that you take for months.
Dr. Corpier (23:24):
Some of the, some of the infection prophylaxis was time limited. If you’re on steroids, the steroids are on a taper schedule. And as far as the mood issues are concerned, I mean sort of classically the steroids have been the biggest issue.
Tiffany (23:41):
And when you get that, when you’re in the hospital, not to cut you off when you’re in the hospital and you get those high dosages, I mean, so it’s so much medication. So mentally you’re already like, this is way too much and you gotta do these at, in the morning and then afternoon, and then at night, and then these are just in the middle. So it’s just, I think mentally that affects your mood, just knowing that you have, so any medications that you’re gonna be putting in your body and then as you taper them off, I think mentally your mood kind of lightens as your medication regimen lightens. And then once you get to that point of stability of, , some people, , they may be lucky and they’re just taking maybe , immunosuppression, , two pills. Some people have high blood, high blood pressure pills. Some people have to take things for diabetics, whatever underlying other medical issues you have, those are gonna be part of your, , your maintained regimen. But so I think that affects your mood just in general, knowing that it is so much that you’re going to have to, I mean, I not exaggerating. It’s like a brief case.
Dr. Corpier (24:50):
Well, initially it’s very initially it’s, it’s, it’s very hard. And so, so some of the antiviral medication can affect, can affect a person’s mental status, the prednisone in particular, the high, the higher doses like Teros and then any of the side effects. And then there’s, and then the thing I wanted to add into is sleep and to the extent that people become sleep deprived for example, I mean, the good news is you’re gonna make a lot of urine after the transplant. The bad news is you’re gonna make a lot of urine after the transplant. And so depending on the patient, for example, this wasn’t Tiffany’s experie because she was transplanted before she ever went on dialysis. So she never experienced what some of the dialysis patients do, which they go, they may go years not making any urine when that happens in the human body, then the bladder actually contracts.
Dr. Corpier (25:41):
And so your ability, , to how much urine your bladder can hold is far less. And so if, once you’re transplanted and you’ve got this beautiful kidney and it’s just like, it’s just rolling. . Right. It’s rolling. And you might be making, , 60 or 80 ounces of urine a day, but what if your bladder can only hold two ounces? Yes. You’re losing, you can do the math. As to how many times you are gonna go, you’re gonna void. And a lot of that’s gonna happen at night. And so people go through a transition with that. So there are a lot of factors and then just the overlying anxiety of yes. Of, is this all gonna work? Is this gonna be okay? Any pain, any early post-op pain, which is usually pretty limited pretty limited that’s not usually a long term thing, but these other things can rag on for a bit.
Bri (26:52):
I’m glad you touched on all that because there are a lot of moving factors. Everyone’s, situation’s gonna be different. Tiffany and I talked about the importance of community and being able to have a community of other patients who may be through similar experiences to, to build on that. But this clearly between patient and physician is a, a collaborative journey. And, , I can imagine on a, on a lasting note, I wanted to talk about, I’ve heard the term, I think adherent patient is it’s. What does that mean to you as a physician doctor?
Dr. Corpier (27:21):
So the word, the language that had been used for a long time in our profession in medicine overall is compliance. Right? And so that means somebody that, does what you ask ’em to do, basically that does what they’re told to do, or they takes their prescribed medicines, et cetera. So, compliance. And so then, and then in the field, we particularly in the dialysis arena that is hard. For a lot of people to do those things. And so then they can get labeled as being non compliant. And then over the last decade or two it’s been come clear, like this has really can be pejorative. , it doesn’t really get at what’s going on. Why is the patient not able to do these things? And so it’s, the language has switched to, we call it adherence.
Dr. Corpier (28:14):
And so, can they adhere to the prescription? And then the way I approach whatever patient I’m dealing with is if they are, or if they’re not, and it’s clear and if it’s clear that they’re not, and, and for transplant patients, we have drug levels for some of their medicines. And so, , you can, you can, you can tell and , and we check blood pressure. I mean, we can tell. Sometimes. And, and so my issue is always why help me understand what the problem is. And, and so sometimes the problem is financial. They can’t get them or they’re having to stretch medicine. This has been in the news, , prominently with diabetics, right. But sometimes it’s because the patient is having a side effect and they are contributing side effect to a drug that, that may or may not be causing it. And so sometimes they don’t, they get mixed up a little or they don’t know, and they think it’s a pill A when it’s really pill B. And so , that’s one of it sometimes it’s because they’re having cognitive issues. I mean, sometimes it’s because they’re having family issues. And so the issue is to then address it. . Okay. Because, , we’re, we’re, we’re trying to row in the same direction.
Bri (29:38):
Absolutely.
Dr. Corpier (29:39):
That’s sort of very old fashion idea of, , the doctor is removed, do what I say, you’re on your own, , this is not a modern way of, a humane way of approaching this. One of the reasons I do this is because I like the long term relationship.
Bri (30:09):
Well, that touches on, I would love to, on a lasting note, I would love your perspective Tiffany, on just the importance of that relationship between physician and patient.
Tiffany (30:20):
The most important piece of being a patient, but especially a transplant patient, because you have someone who is one has your best interests at hand and are doing everything they can medically to ensure that you keep this transplant. And so then you have to then ensure that you’re doing everything within your power to also keep it. So it’s the constant communication, Dr. Corpier, I’ll probably text her at a time or email her something, or I’m always sending her articles and what do you think of this and that? And so, and she’s always there to, to respond, but patients have to understand that that relat up is, is great to have. And, , I touched earlier about this amazing department that we have now with DNA called patient navigators. That’s also a key element for it’s like, if you can’t get directly in contact with your doctor.
Tiffany (31:18):
Because, , they have, I can’t even, I don’t even know how many patients you guys see in a day, but then you have someone that’s not just a nurse, but also a patient navigator that can talk you through some of these things until you can, , meet with the physician. So my relationship with Dr. Cor has always from the beginning been so very unique. We are strong personality, strong willed. And we both are very in tune with okay, doing research on something. And I know she does a lot outside of DNA at the capital and things like that. So it’s always inspiring to know that you have a physician that’s not just having you sit down, look at your labs, barely make eye contact. , we get in there, she’s relaxed, I’m relaxed.
Tiffany (32:08):
Not only if you see Dr Corpier, but a lot of our physicians at DNA, have that same approach. And so patients have to understand, , they to keep you healthy and keep you safe. So you can’t go in being intimidated. You can’t go in passive, you can’t go in just saying whatever the doctor says, I’m gonna do it. And then like you said, leave and forget everything. So I think the patient physician relationship is, is more important than the relationship you have with your spouse or anyone else, because this is the person that’s keeping you healthy and alive.
Dr. Corpier (32:53):
And I would just add to, I would add to it though. It does with the patient navigators and also our nurses in our clinics. And our other staff. I mean, it really does take a village. Like this is not a one, , this is not a one person show. I mean, this requires an, an enormous amount of, of help and commitment, , and commitment. And at my office, we happen to have a patient navigator who has decades of experience in all aspects of transplant dialysis, and, and chronic kidney disease care. My nurse is one of the best humans and nurses I’ve ever met. I mean, she just, , she will annoy me to death to get things, , finished I’m dragging my feet. I mean, we have the dieticians, , the social workers that work with our transplant patients. I mean our front office people, Ifrom soup to nuts, basically.
Bri (34:01):
Well, I think that’s the fantastic theme for us to end on here. And I’m so grateful again for y’all’s time, but really rowing together is a Fanta rowing together does take a village and really leaning on that in terms of support. Thank you ladies.