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Dermatologist Dr. John Moseley goes to work on Dennis Pickard's body, holding a canister of liquid nitrogen.

He aims the liquefied gas, 320 degrees below zero, at the cancerous growths and sprays.

Dennis is still — not even a flinch — as Moseley freezes and burns a couple dozen growths considered the earliest stage of skin cancer.

Some other, thicker growths are cut out under local anesthesia. The incisions are cauterized, a smell of singed flesh wafting through the room.

"One bad guy down and gone," the doctor says. "Just like the Old West — vigilante justice, show no mercy."

Dennis has undergone these treatments for more than two decades, and it's all because of kidney failure.

Suppressed immune systems and the life-threatening conditions that result are facts of life for people with renal failure — including those who are kidney transplant recipients, like Dennis.

The anti-rejection drugs he began taking in 1989 so his body would not reject the kidney his sister gave him cause havoc. "It's a double-edged sword," says Dennis, 50, a former power plant operator for Pima County.

Now he is being weaned off some of those drugs because the transplanted kidney failed in January. "It worked for 19 years," he says. "I was like a new man. It was a good ride."

Now his suppressed immune system is allowing cells to go wild and do whatever they want to do, causing squamous cell carcinoma, the second-most-common skin cancer.

"All transplant patients are subject to skin cancer because they are all immunosuppressed, and kidney transplants are the most common," Moseley says.

He praises Dennis as a model patient who undergoes treatment without protest. "You have been sticking with it, and that is the key," he tells him.

"You have to be in charge," Dr. David Whittman, another of Dennis' physicians, urges his patients. "It is your life, and you must advocate for yourself."

A baseball injury

In May 1982, at age 24, Dennis was diagnosed with a rare disease: rapidly progressive glomerulonephritis, or RPGN.

The disease causes damage to the small structures, or glomeruli, inside the kidneys that help filter waste and fluids from blood to form urine.

Dennis had gone to the doctor for a swollen knee, the result of getting hit with a baseball bat during a game with co-workers from IBM. He worked there as a senior laboratory specialist and was the team's catcher.

He mentioned to his doctor that his urine was rather dark that summer, thinking he probably wasn't drinking enough water. The doctor ordered tests, which showed the RPGN.

Toxins began building up in Dennis' system and doctors prescribed steroids, orally and intravenously. His body began retaining fluids, and at one point he was retaining 5 pounds of water a day.

"I went from 140 pounds to 185 pounds," he recalls.

He started dialysis in 1988 and received a kidney the following year from his older sister, Kathy Martin.

"I never regretted my decision, and I absolutely wish I could give him another kidney," says Martin, 58, who lives in Gold Canyon, east of Phoenix.

After the transplant, Dennis suffered an infection that caused his liver and new kidney to shut down. He was in the VA Hospital for two months and at one point was taking 47 pills a day, including anti-rejection medications. The drugs, including steroids, led to the problems Dennis lives with today.

In addition to the skin cancer, side effects from his medications include severe dry skin, shingles, warts, acne, depression and sleeplessness. He averages three hours of sleep a night.

"Many of the newer drugs don't cause the skin cancer that Dennis has. Many of the drugs that were given to him are not used today. But the damage is irreversible," says Whittman, a nephrologist with Arizona Kidney Disease & Hypertension Center.

"Even though Dennis suffers from skin cancer, the quality of life with a transplant is much better for him. That cannot be dismissed," the doctor says.

Several daily treatments

Dennis is back on continuous peritoneal dialysis — doing four treatments a day — and getting stronger. The treatments are done every four to six hours.

At his home near Davis-Monthan Air Force Base, Dennis logs in his temperature and blood pressure in a binder.

He washes his hands and wipes down the living room with antiseptic spray before he undergoes his 30-minute treatment, usually while sitting in a recliner watching television.

He hooks a bag to an IV pole that is filled with 5 pounds of a special solution called dialysate. The solution, prepared to meet each patient's needs, is delivered monthly to Dennis' home. If he travels, he has a supply sent to his destination.

Rather than using a machine to filter and clean the blood outside the body as in hemodialysis, peritoneal dialysis all takes place within the body. The solution is injected through a surgically placed catheter into the abdominal cavity.

The peritoneal membrane, which lines the cavity and covers the abdominal organs, becomes the filter that the dialysate permeates, helping remove waste, minerals and extra fluids from the blood. The solution with the waste is then drained through the catheter into a bag for disposal, and new solution is injected back into the abdominal cavity to be drained at the next exchange.

Nephrologists favor daily dialysis treatment because it is more efficient in ridding the body of toxins that build up from excess minerals such as phosphorus, sodium, potassium and calcium that come from diet. But few people in the United States choose it because they are scared, and doubt they can stay on top of their treatment, Whittman says. They feel it is easier to go to a center.

Dennis is his own strongest advocate. He keeps daily records of his medications and dialysis treatments in a binder, which he takes to all his medical appointments.

He weighs himself daily to ensure that he is removing adequate liquid from his body. His goal weight is 131 pounds on his 5-foot-5-inch frame.

Removal of too much liquid can cause weakness, affect blood pressure, cause severe cramping and shift the electrolytes in the system. Leaving too much fluid can increase blood pressure, which can strain the heart and lead to congestive heart failure.

Roughly 500,000 people in the United States have end-stage renal disease. About 90 percent are on hemodialysis, usually going to centers three times a week. The other 10 percent, like Dennis, are on peritoneal dialysis.

Wants new transplant

Dennis hopes for a shot at receiving another kidney.

His eldest son, Christopher Pickard, 30, has agreed to get tested, but the young husband and father has reservations.

Dennis' youngest son, Jesse, 21, wants to get tested, but Dennis won't hear of it because Jesse has high blood pressure.

Most likely, a kidney would be harvested for Dennis from someone who dies, although he still hopes to find a living donor who is a perfect match.

The average wait for a cadaver kidney in Arizona is four to five years, while the wait for a kidney from a living donor is months.

On July 28, Dennis began the process to see whether he is a viable candidate for transplant. He passed a psychological evaluation and a battery of physical exams and was approved in August as a candidate at University Medical Center.

Medical costs for the first year after a transplant are $120,000 to $140,000.

Dennis is one of the lucky ones. He is covered under the county's medical insurance and by Medicare. However, he still must come up with out-of-pocket medical expenses and budget carefully for his monthly bills.

Desire to live

It's all worth it to Dennis.

He wants to help care for his 82-year-old father who has emphysema and recently suffered a second mini-stroke. Bernard Pickard lives in an assisted-living community not far from Dennis' home. Dennis' mom, Mary, died of ovarian cancer 13 years ago.

Dennis wants time with his sons, daughter-in-law and 2-year-old granddaughter. He wants to visit relatives in Phoenix.

He wants to be with his girlfriend, Ruth Reed. The two find pleasure in just sitting on the sofa watching their favorite movies and ballgames. Ruth, 51, a certified nursing assistant, will be his caregiver once he receives a transplant.

He wants to ride his silver Harley-Davidson into the desert after sunset or up Mount Lemmon and feel the breeze.

He wants to visit friends at neighborhood pubs and shoot the bull with guys he has known for 15 years. He wants to hang out with Lucky, the 7-year-old dog he rescued from the pound.

It's nothing fancy. But it's his life — and more than anything, Dennis wants to live it.