Work Goes Well

Just a quick blog update. I went back to work today. My boss is letting me work 7:00am – 4:00 pm so that I can go to my dialysis treatments after work. My first day back was pretty easy, though they didn't having me do too much. I am scheduled to be working with someone for at least the next couple of weeks. That way, if there are any problems with me, they won't have any problems at work. I did not get tired at work, and now that I'm home, I still feel pretty good.

In other news, one of my friends told me that it was hard to comment on the blog because you had to register before you could post. I found the setting so now anyone should be able to post comments without registering. Thanks for the information. Enjoy reading!

Wedding Photo

Here is a picture of Jenny and I at our wedding (July 10, 2004). I attempted to upload this picture earlier with Hello, but it did not work the way I had expected. So, people with the automatic update probably saw a blank e-mail. Everyone else, this is what my beautiful wife looks like.

This picture was posted by request of one of my faithful readers. Enjoy!

Excellent Early-Morning Treatment

I had my dialysis treatment early on Saturday morning so that I could help our Sunday School class with our service project with the Buckner organization. The clinic runs three shifts per day, so I went in at 5:45 am to have my blood cleaned out. The technician that I got was extremely proficient at putting in the needles. She managed to get a good stick with both needles that really didn't sting too much after they went in. This was great, since my arm usually stings for about an hour after the needles are inserted. The treatment went well, and they only took off 1500 cc of fluid. I really am enjoying being kept at about 68 kg.

The other piece of news is that I might start using the normal-sized needles soon. Right now, I am using the small needles because my fistula is still so new. The charge nurse on the morning shift at the clinic said that she thought that I could go ahead and start using the normal needles like everyone else. The advantage of the normal needles is that they can run the dialysis machine at a higher rate. This means that more of your blood can be processed during your treatment. I told the nurse that I would wait for the larger needles until I was back on my normal shift. I guess I'll ask on Tuesday if they want to start using them.

The service project at Shoes for Orphan Souls went well Saturday afternoon. We had eleven people from our class come. We worked from 2pm – 5pm sorting out shoes for three different orphanages. I'm glad that I was able to get my dialysis treatment moved so that Jenny and I could participate. It was an excellent opportunity to serve God in a tangible way.

An Easy Evening

I had dialysis again Thursday evening. The charge nurse (rather than the technician) took care of putting in my needles. She did not have any problems with either needle, so I don't know what the problem with my arm is. The technician had said that the vein curves near the extract side. I guess she will just have to try and get it from a different angle or something. But, I did not have any problems with the treatment. They took off 2 liters of fluid last night, and it did not cause any problems.

That's about it for today. I am going back to work on Monday, so please pray that I will be healthy enough to make it all week. I am also set up to take an early treatment on Saturday so that Jenny and I can go to Shoes for Orphan souls.

Thanks for reading (it's a short post today).

Movin' on Up

I received another successful dialysis treatment Tuesday evening. They had a little bit of trouble sticking me, but my arm does not seem any worse for the wear today. They are still having troubles with the arterial side, and I was afraid that they had infiltrated it last night, but it doesn't look that way. I was also finally able to get my dry weight moved up. They are now allowing me to stay at 68 kg (which is up from the original 66 kg in the hospital). This means that I hopefully won't feel dehydrated at dialysis for quite a while. Well, at least until my weight goes up enough that I start to notice again. But, it is good to know that I can talk to the doctors and get my weight adjusted as needed to keep me feeling well. And, since I am eating well once again, despite my restricted diet, I plan to get my weight up to something more normal for my height.

I'm going to try something new this week. Our Adult Bible Fellowship class at church has a service project planned for this Saturday. They have scheduled to go to the Buckner Shoes for Orphan Souls from 2pm – 5 pm. Since my dialysis is supposed to start between 4:00 pm and 5:00 pm, and the Buckner organization is about 45 minutes away from the dialysis clinic, I would not be able to attend this event. But, the dialysis clinic does allow you move your treatment if you are not able to come in at your regularly scheduled time. On Thursday, I am going to ask to have my Saturday treatment done during the early morning shift rather than at my usual evening shift. I talked to the clinic last Saturday and they said that it was possible, but I would have to check back on Thursday. So, I will. This would be a great opportunity to serve God in a tangible way. I am looking forward to going to Buckner to help out.

If you want to find out more about the Buckner program, please visit them on the web at http://www.shoesfororphansouls.org/.

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On an off-topic note, Google released their instant messaging / voice chat program called Google Talk today. This IM program requires that you log in with your GMail user name and password. That makes it kind of difficult for me to use it to chat with anyone as I only know a handful of people that are using GMail. Oh well, as more people find out about it I should get a chance to try out this new technology.

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That's all for today. Please feel free to post comments online or to send me an e-mail. Since I am still off of work this week, I will have lots of time to read and respond to anyone that writes.

Photos of the Kidney

I finally got a chance to scan the photos that the doctor took of my giant kidney. That's right folks, you are looking at a genuine kidney, completely gross and not at all what you want to have trapped in your abdomen and growing. Enjoy!

That small white thing in the bottom of the picture is a ruler, which is 15 centimeters long. The kidney is 10 x 20 x 30 cm and weighed 15 pounds. Ewww.

Not Dehydrated Last Time

I had another successful dialysis treatment on Saturday. Whenever I go to dialysis, they always take my weight before and after the treatment. The goal of this is to help maintain my “dry weight”. This dry weight was determined at the hospital, before I started my first dialysis. They decided that I should weight 66 kg. Now, that isn’t much at all, and during my first outpatient dialysis treatment, they took off too much fluid, dehydrating me, and ended up having to add some extra fluid at the end of the treatment. So, they decided to up my weight to 67 kg. Since then, I am eating better (even on my restricted diet) and have gained a little weight. So, I think it’s time to up my dry weight again.

Thursday’s treatment left me with low blood pressure and a light-headed feeling. I saw my cardiologist on Friday. She told me that I had most likely gained weight and needed to let the clinic know to increase my dry weight. She said that I was probably having too much fluid filtered out of my blood, and I agreed. When I went to dialysis on Saturday, I only weight 67.7 kg (which is 0.7 kg above my weight). They ended up filtering off about 700 cc of fluid that night, and my weight when I left was 68.2 kg. They seemed a bit confused of how I could gain weight during a treatment, but I mentioned that they had had to add more fluid this time to keep my blood pressure and heart rate at a normal level and not drop too low.

I should get to see the nephrologist at the clinic next week and let him know that the cardiologist recommended increasing my dry weight on record. I used to weigh 165 pounds (which is 75 kg) before my surgery, so maybe I can get my dry weight at least back up into the 70's.

Here are some prayer requests I have for this week:

• I am scheduled to go back to work on Monday, August 29. Please pray that I will be well enough to perform my duties at work and that I will continue to stay healthy enough to keep up a full work and dialysis schedule after not doing anything all summer.
• Now that my insurance card has arrived, please pray that the transplant paperwork will be processed quickly so that I can get tested and put on the transplant list.
  

Low Blood Pressure

My dialysis treatment didn't go quite as nicely as I had hoped. It started out well with me getting a nice stick and a good flow rate. But, after about three hours, my blood pressure dropped really low. They had to stop the treatment and give me some fluid. They only took off about 2700 cc of fluid, instead of the 3000 that they had originally intended. I ended up weighing 66.7 kg, which is about 0.3 kg under my original preferred dry weight.

I saw the cardiologist today. She said that my problem with my blood pressure and heart rate was all due to me being dehydrated. She is going to call the dialysis clinic and instruct them to not take off quite as much fluid any more. She is going to recommend a dry rate of 68 or 69 kilograms to try and keep my better hydrated. She also said I should stop taking the beta blocker as that was not what I needed for my problems. I am hoping that this will help. I see her again in about two weeks. Hopefully Saturday's treatment will be better.

Going back to Work Soon

I talked with my boss today, and he said that he is excited about me coming back to work on the 29th (which is just a week from Monday). I call my human resources contact down in Houston, and she said that she would take care of the paperwork for me as long as I remember to send her a copy of the doctor’s note. This is great news, as I have been on disability for nearly 90 days. I don’t know if you’ve ever had to take an extended leave from work, but I know I won’t be complaining about having to work too much any time in the near future.

Several people have asked for e-mail updates when I post to the blog. I am using a feature of GMail that lets me forward certain messages to people. After I post today, I’ll know just how well this feature works. Comments are always welcome!

August 17

Well, my dialysis visit yesterday wasn't too terrible. I got to visit with the nephrologist and he said that I can go back to work on August 29. This works out perfectly with my disability, because the short term disability claim period ends on August 28. All I have to do now is to talk to my boss at work and to talk to the human resources department. They should have no problem approving me to come back to work, so I can start to get back into some kind of a routine.

My dialysis treatment wasn't all that great last night. The technician was not able to get a return access needle into my fistula. It seems that she scratched the vein wall on Saturday of last week and that caused some problem with access on Tuesday. She had to call over the nurse to get the needle into place, which took about 30 minutes. It seems that my fistula is still not quite as large as the dialysis clinic would prefer. I am still working out my arm by squeezing a stress ball hoping to make the fistula the size that the clinic would like to see.

I think that going back to work is going to be good for me. I am thankful that God has allowed me to get back to a point, health-wise, that I am going to be able to work. Even a month ago, I was feeling sick every day. It was a good day when I could stand up for an hour or take a 15 minute walk. I am looking forward to the day that I get a transplant and can actually have a nearly-normal life again. I mean, dialysis is going to allow me to have a dependable schedule, but it is not a normal life. I am trying not to complain, since I really am thankful for where I am today, compared to three months ago. I have not figured out the ultimate good that will be worked out through these circumstances, but I do know that it will be worth it. I only hope that I can be a good steward of the circumstances that I've been given.

Thank you for reading. Keep praying that I will stay healthy and be able to go to work. Also pray for Jenny as she continues to watch over me and to work. It is going to be harder on her once I start working again. I'm sure that I'll be tired that first few weeks of working.

“ But, "Let him who boasts boast in the Lord." For it is not the one who commends himself who is approved, but the one whom the Lord commends. ”- 2 Corinthians 10:17-18

An Overwhelming Response

Wow. I finally told all my friends and family about this blog that I've been writing. There have been nearly fifty visitors since I sent out that inviting e-mail. I appreciate the interest that shows and I will do my best to keep current posts online for everyone who is praying.

Also, if you want to get an e-mail whenever I post a new entry, please let me know. I can add your address so that you automatically get a copy of each new post, which might be something that you want. If it is, tell me and I'll add you to the list. And, of course, if you tell me you like it and it turns out that you don't, then tell me that and I'll take you off (everything is easy to do on the Internet).

As for an update, I received a call today from the company that supplies my disability benefits. It seems that my short-term disability benefits have been extended to 08/28/2005 (which is the maximum benefit period for my policy). If I have not returned to work by that date, then my benefits will switch over to long-term disability. I am hoping that the doctor will say that I can go back to work before that date so that I don't have to worry about any of that.

The thrill, or feeling of blood flow, in my fistula, is not quite as strong as it was before dialysis on Saturday. I guess that is a result of my vein being scratched by the input needle. My fistula is still not large enough to use the normal-sized dialysis needles. They are still doing my treatments with the small needles (17 gauge). I've been told that if I squeeze a stress ball several times a day that it will help develop the fistula. I've also been told that using a light tourniquet on my left arm for ten minutes once or twice a day will help the fistula mature. I'm trying to do both of these things with the hope that my fistula will soon be strong enough to support the normal sized needles.

August 14

Dialysis on Saturday went well. I went weighing 68.2 kg and left weighing 67.0 kg. They took off 2000 cc of fluid, as well as balancing my blood chemistry and removing wastes (which is what normally takes place in dialysis). There was only one small problem. When the technician put in the needle for the return access (the arterial side), my vein started to swell up. She called over the nurse who merely moved the needle over a little bit. She said that the technician had probably scratched the wall of the vein. They were worried that they had poked the needle all the way through the vein (called infiltration), which is a common problem for dialysis patients. This would be a problem as I would then have bleed all into my arm. Fortunately, this didn't happen. In fact, once they started the treatment, the swelling went back down to normal.

Just to compare, a friend of mine from church just had her baby. She ended up getting a C-section done. Her son was 9 pounds, 12 ounces at birth. We talked about how uncomfortable it was to have something that large stuck inside your abdomen. I'll have to ask her (when she gets out of the hospital) how many staples she ended up getting. Her bonus is that she ended up with a baby, while all I got was to not be in horrible pain anymore. I don't recommend the nephrectomy to anyone, in case you're wondering.

Here are my current Prayer Requests:

• Jenny started teaching last Monday, which puts me at being home alone again (until I get back to work). Please pray for her as it has been a stressful summer and she was not ready to get started working again.
• I have an appointment with my cardiologist on Friday. Pray that she will be able to figure out what is going on with my blood pressure and heart rate and to get them under control so that there aren't any problems.

Insurance Problems Solved?

Well, I might have solved the problem I've been having with my insurance card. It seems that I live in an apartment (complete with apartment number) and that the address that the insurance company has on record doesn't include that apartment number. Very sad. Well, my HR agent made the change in the system, so I should have a new card by next week. And, she also gave me my insurance number, so at least I can fill out my prescription order form. Good news!

August 12

I had another successful dialysis treatment last night. The only problem that I had was that after my treatment, my blood pressure was low and my pulse was high. The nurse at the clinic said that I need to go see my cardiologist about my strange heart rate. When I am seated, my blood pressure is fine and my heart rate is slow. The doctor came by and prescribed a beta blocker to help regulate my heart beat. I'll have to ask the cardiologist what all a beta blocker does when I see her next week.

The doctor visit was not all that great. He arrived at the clinic about 7:00, and must have been gone by 8:00. He buzzed by my chair and dropped off a prescription. I did not get a chance to ask about going back to work. In fact, the nurse came by after 8:00 with a prescription for a phosphorus blocker. The doctor had written a one-month supply. I told her that my insurance company does mail-in prescriptions for 90-day supplies of medicine. She said that I should have mentioned that before the doctor left. It's too bad that I didn't know that the doctor had left or that he was going to give me another medication.

The speed of the doctor's visit reminded me of being in the hospital. If you do not have a list of questions written down and sitting in front of you when the doctor shows up, then you do not get to ask any questions. So, for next week, I am going to write down all my questions and hold them in my hand until I see him. That is the only way that I am going to be able to find out anything, it seems.

The other thing that I am still missing is my insurance card. I called my human resources representative at work this morning to check with Unicare and see why they haven't mailed my card yet. I can't order my new prescriptions or fill out my transplant paperwork until I get that insurance card. Hopefully I will either receive the card today or find out why I haven't received it yet. If it comes before Tuesday then I can turn in the paperwork the next time that I see the nephrologist.

August 10

I had another dialysis treatment last night. This one was not quite as great as the last few, but they are not worried. I only ran at a rate of 230 cc/min last night (and the normally did 300 cc/min). They said that they didn't want to go too fast with the small needles and with my developing fistula. I don't know if that is something to worry about or not. My heart rate was high at the end of the night again today, but not quite as bad as on Saturday. They still don't have any advice for me. They just said to make sure I go see my cardiologist.

They took off 2500 cc of fluid last night (which is a little over a pound). Even at a rate of 230 cc/min, I was still only hooked up to the machine for four hours. The best I can understand it, the machine just calculates the amount of fluid you need removed and pulls it off evenly over the four hours, regardless of how quickly your blood flows through the machine. So, as long as I am on the little needles, I need to keep a smaller fluid intake between treatments.

The hardest part of dialysis is my new diet. I had a restricted diet before because my kidneys did not properly remove sodium or potassium from my bloodstream. So, I have been watching my intake of those chemicals for a couple of years now. But, now that I am in dialysis, I have a new set of restrictions to watch. (This all comes from the renal dietician, whom I saw on Saturday).

Here is my recommended diet:

• 8 to 10 ounces of protein a day
• 1400 to 1600 milligrams of potassium a day
• 1500 milligrams of phosphorus a day
• 2500 milligrams of sodium a day
• 4 cups of fluid a day (plus whatever I output on my own)
• A total of 2400 calories a day

So now, in addition to what I was watching before, I have to take care of how much phosphorus I take in. This is a problem because pretty much all foods contain phosphorus. And, some of the highest foods are dairy products. So, all of that protein that I am supposed to be taking in cannot come from the cheese, yogurt, or peanut butter that I used to eat. I know peanut butter isn't dairy, but it is high in phosphorus. I am supposed to cut my milk intake to three serving a week, which I think is going to be tough. I'm also supposed to be eating 10 to 14 servings of bread/starch a day (I don't know how I'll do that) and 8 to 10 ounces of proten/meat per day. Fun fun.

So, you can invite me over to eat if you like. I'll have a turkey and bread sandwich, no cheese. Or maybe I'll have a few doughnuts and a bagel. I've got to figure out how to eat a little more bread (though I doubt I'll hit that 14 serving mark). But don't worry, once I have my transplant, I'll be enjoying pizza again!

My prayer requests are:

• Pray that I will be able to adjust my diet so that I can remain healthy
• Pray that my fistula will continue to develop properly
• Pray that my cardiologist will have some advice about my high heart rate
• Pray that my insurance card will show up so that I can start my transplant paperwork

Saturday's Treatment

I had my third outpatient dialysis treatment last Saturday. Everything went well through the treatment until after they had unhooked me and were ready to send me home. When they took my final blood pressure, my heart rate was 150 beats/min when I stood up. This is extremely high, as I should have a rate somewhere around 70 or 80 bpm. They had me sit down and drink some water, hoping to get my heart rate back under control. What was strange was that my heart rate was only about 95 when I was sitting down. They kept me there for about 45 minutes checking my heart rate over and over. They even ran an EKG on my heart to make sure that I was okay. The EKG turned out just fine. They told me that I need to go and see my cardiologist to talk about my heart rate. I have an appointment scheduled for August 18 with her.

Aside from my heart rate, my treatment was fine. I think my dry weight is between 68 and 69 kilograms (which is about 149 - 152 pounds). Before I had my surgery, I weighed about 165 pounds. I don't really know how I am supposed to gain any weight with them taking off all the excess fluid I gain every couple of days.

Please continue to pray for my health and that I will keep feeling better. Also, pray that my fistula continues to develop and that they will not have any problems with it. Also, I am still waiting on my insurance card so I can fill out my transplant paperwork.

Second Treatment

Well, I had my second outpatient dialysis treatment last night, and it was great. They took off 1900 ml of fluid, and I did not have any blood pressure problems. My arm is still a little sore in the two places where they stuck the needles, but it only really hurts if I accidentally touch it. They said that since I did better today, they will take off more fluid on Saturday (if I need it).

I talked to my boss at work again yesterday to let him know how I am doing. He said that we can work out a way for me to get back to work once I am released by the doctor. I had been working 12-hour shifts three days a week before my surgery. Unfortunately, dialysis is going to prevent me from being able to do a 12-hour shift. So, my boss said he would be able to start me at working from 7:00am - 4:00 pm five days a week. This is really good news. It means that I will have basically the same schedule as Jenny does and that we will be able to at least see each other on the nights that I don't have dialysis. My previous schedule was 7:00 am - 7:00 pm, which didn't leave much time at home except for eating and sleeping, sadly. My boss also said that once I am feeling better, he would put me back on the every-other-week Sunday rotation. That means that I will work 8 hours every other Sunday, and not work the following Monday. That is okay with me.

So, I should see the nephrologist on Tuesday, and I can ask him when he thinks I might be able to go back to work. If I continue to feel better, I want to get back as quickly as possible. It will help me feel like a more productive person.

The only bad news I have is that my insurance card has not shown up yet. This means that I can't fill out the paperwork to be considered for a transplant. Please pray that this card will show up so I can get that paperwork started. Also pray that my fistula will continue to do well and that I will continue to feel better. Thanks!

Outpatient Dialysis has Begun

Last night was my first outpatient dialysis treatment. It went okay, but I guess it could have been better. I was there for four hours, and they originally had scheduled to remove 3 kg of fluid. It turned out that when they were finished, they had taken off too much fluid and it caused my blood pressure to drop very low. So, they gave me an extra 500 cc of saline solution which helped bring my pressure back up to normal. Hopefully Thursday's treatment will be better.

Yesterday, I got introduced to the world of dialysis. Each night when I arrive, I have to weigh myself in kilograms. This is to measure how much weight you have gained since your last treatment so that they now how much fluid to remove. Since they removed too much fluid last night, I think they said they are going to start a lot smaller tomorrow and work their way back up to a higher number.

So, I go to the clinic, weigh myself, and sit in a recliner next to a dialysis machine. The nurse checks my blood pressure and enters my weight into the computer. Based on my dry weight, they decide how much fluid to remove during that four-hour session. Then, the technician cleans the skin above my access with alcohol and betadine. They put one needle in for venous access and one needle in for arterial access (this needle is closer to where to fistula is tied). Once I am hooked up, they give me a little blood thinner to help the blood flow and then start drawing my blood out into the machine. The machine filters the blood, removes some fluid, and returns the clean blood back into my arm. That describes the next four hours of my night. They also gave me an injection of artificial hormone to help my body produce red blood cells, as I will always lose a little blood inside the machine.

Well, there's dialysis for you. I didn't have any problems with it in the hospital, but they didn't take off as much fluid then, either. I am hoping that tomorrow's treatment will be better. I will see the new nephrologist at the clinic every week, and he and I will talk about (and possibly adjust) my treatment more next Tuesday. Thursday should be better as I know they won't be taking off as much fluid.

Here are my prayer requests:

• Pray that dialysis will go well the rest of this week (no more scares)
• Pray that my fistula will continue to grow so that they can use the larger gauge needles
• Pray that my insurance card will come quickly so that I can turn in the paperwork for a transplant