More Information from my Lab Reports

I received some more information about my labs last night at dialysis. The dietitian prints up a set of graphs to show you how you are doing in nine key areas (that she can help with). Most of the information I already knew from my lab printout, like my potassium had gone down between August and September. The new information that I got was that my average fluid weight gain was 1.22 kg (or 1.8%). The goal is to not gain more than 3-5% of your dry weight. That tells me that I am doing a great job on watching my fluid intake. The blood work had not revealed that.

I am still using the 15-gauge needles. I could not find out how large of a diameter the 15 gauge needle is, but I know that it’s bigger than most needles that you ever have to be injected with at the doctor’s office. My arm hurts longer now that I am using the larger needles. It is about 9:00 am right now, and my arm is still a little sore (that’s 12 hours after being removed from the treatment). Hopefully my arm will get used to this soon and it won’t be quite as bad. I bleed a little more with the larger needles as well. In fact, there has been a little bit of blood that escaped during my last two treatments (which isn’t terrible, but it’s not great either). As long as I don’t start freely leaking blood during the treatment, they aren’t too worried. Thanks for reading today!

Another Good Dialysis Treatment

I had a good dialysis treatment on Tuesday. They are still using the 15-gauge needles. My blood is being processed at 400 ml/min. The only problem that I had on Tuesday was some cramping in my feet close to the end of the treatment. They stopped removing fluid for fifteen minutes to cut down on the cramping. I am not sure if I have gone up in weight or not, I was 70.2 kg when I went in (they were only scheduled to remove 2700 cc of fluid, and they took off about 2500).

This is the second time I have wondered about my weight in the last couple of weeks. Last time, it was a tingly feeling in my fingers the day after my dialysis. This time, it was some cramping while I was there. Both of those can be signs of dehydration. If I continue to have more problems, then I will ask the doctor to raise my dry weight.

I have the following prayer requests:

• Pray that my transplant paperwork will be processed quickly and that they will let me know what I need to do next.
• Pray the my morning nausea will get less (or go away all together).

No Power on Saturday at the Clinic

I went to my normal dialysis treatment on Saturday evening, and it seems that the clinic had lost power earlier that day. They said that they could get emergency power by 7:30 pm, but that was too late for them to run a bunch of four-hour treatments. The charge nurse came out at almost 5:00 and told us that we should all come back Sunday morning at 7:30 am. So, I guess I will be missing church tomorrow to have my blood cleaned out. It's kind of sad to have to miss church, but I don't want to miss out on dialysis.

At Thursday's treatment, they used the larger needles. I am now using 15-gauge needles like everyone else in the clinic. With the new, larger needles, they will be able to run my treatment at 400 ml/hr (which is the full-speed treatment). This means that more of my blood can be cleaned out during my four-hour treatment. I still have to be there for four hours (having more blood moved through doesn't mean you get to stay less time). I guess that this is a good thing. Having a full-sized access is a good thing, it is what all of the people at the clinic want me to have.

I guess I'll enjoy my crazy Sunday dialysis, which I am not really looking forward to. I would much rather go to church.

3500 milliliters on Tuesday

I had another decent dialysis treatment on Tuesday. When I went in, I weighed 71.0 kg, which is 3 kg more than my normal weight of 68.0 kg. They had to take off 3.5 liters of ultra-filtrate to get me back down to my normal weight. They add 500 ml because of the saline that has to be added to get all of your blood out of the dialysis machine. I don’t know if I have gained weight, but I do know that I had a tingly feeling in my fingers most of the day on Wednesday. If I find that I have gained a lot of weight today when I go in, then I might have to ask about having my dry weight adjusted again. I’ll know more after tonight’s treatment, based on how I feel. I certainly don’t want to go back to being dehydrated (which was no fun at all).

Here are the prayer requests that I have:

• Pray that I would get to feeling better more often. I am still fighting with nausea several mornings a week, and that is not a good way to start the day.
• Pray that my paperwork will process quickly so that I can know my status on the “road to transplant”.
• Pray that my insurance will work out. I am having to work with Blue Cross to get them to pay for anything that I had done in July. I am getting bills from July that say that my insurance was cancelled, which did not happen until August. Pray that everything will get worked out and that they will pay the amount that is their responsibility.

Thursday and Saturday

Friday was a very busy day at work, so I did not get a chance to post to the blog then, sorry about that. I am still not really feeling any better than I have been all week. I wake up and usually feel nauseated within an hour or so (which is awfully sad). This feeling lasts several hours most days. I talked to the nurses and the doctor at dialysis, and none seem to have any advice on how to make me feel better or get to feeling better on a regular basis.

I went to early-morning dialysis Saturday morning so that Jenny and I could go out tonight. The early morning treatment isn't that bad, but I wouldn't want to try to work all day after having it done. I definitely like having the dialysis after work rather than before. I don't think I could do that.

Both of my dialysis treatments (Thursday and Saturday) went well. I did not have any blood pressure or heart rate problems either day (unlike Tuesday when I had on the heart holter monitor). Perhaps my body is getting used to whatever was going on wrong before and my heart is now playing nicely with the machine.

Please pray that I would find out what is making me feel sick and that I would get to feeling better. Thanks for coming by to read!

Lab Results - 09/14/2005

I think that Tuesday went pretty well. I have been experiencing a slow heart rate (less than 50 beats per minute) during dialysis for the last few weeks. My cardiologist gave me a Holter to wear which is designed to record all of your heartbeats for 24 hours. It hooks up the same way an EKG does (if you are familiar with that procedure). It has a small pager-sized box that records all of your heart beats and you are supposed to write down if you have any problems while wearing it. I am going to return it today, and maybe I’ll find out the results in a few weeks.

Also, in exciting news, I finally got my lab results for September. I am going to attempt to paste a table in here that will show my results comparing the August and September numbers. Numbers in BLUE are below the reference rage. Numbers in RED are above the reference range. For the medical students in the crowd, this might be exciting. For everyone else, I will try to explain the important numbers after the table.

Lab Results: 08/05/2005 compared to 09/09/2005

TEST NAME	08/05/2005	09/09/2005	UNITS	REFERENCE RANGE
CBC
WBC	5.18	4.58	1000/mcL	4.80 - 10.80
RBC	4.11	3.73	mill/mcL	4.70 - 6.10
HGB	11.6	11.8	g/dL	14.0 - 18.0
HCT	34.2	35.8	%	42.0 - 52.0
MCV	83	96	mcm3	80 - 94
MCH	28.2	31.6	pg/cell	27.0 - 31.0
MCHC	33.9	32.9	g/dL	33.0 - 37.0
HGB X 3	34.8	35.4	%	42.0 - 54.0
PLATELETS	242	-	1000/mcL	130 - 400
RETICULOCYTE COUNT	2.48	-	%	0.80 - 2.10
BUN (pre)	39	40	mg/dL	6 - 19
CREATININE	6.6	8.2	mg/dL	0.5 - 1.2
POTASSIUM	4.1	3.7	mEq/L	3.3 - 5.1
BICARBONATE	22	28	mEq/L	22 - 29
ALKALINE PHOS	74	65	U/L	40 - 129
AST/GOT	15	21	U/L	13 - 39
TOTAL PROTEIN	7.4	7.1	g/dL	5.9 - 8.4
ALBUMIN (BCG)	4.8	4.6	g/dL	3.8 - 5.2
CALCIUM	9.5	10.0	mg/dL	8.4 - 10.2
PHOSPHORUS	6.1	4.6	mg/dL	2.6 - 4.5
Ca X P PRODUCT	58	46	-	<55
SODIUM	142	144	mEq/L	133 - 145
CHLORIDE	107	102	mEq/L	96 - 108
GLUCOSE	92	-	mg/dL	70 - 105
CHOLESTEROL	116	-	mg/dL	<200
Reference Range is the Desirable Range as specified by the National Cholesterol Education Program Expert Panel.
TRIGLYCERIDE	127	-	mg/dL	<200
Normal Expected Value is the Desirable Range as specified by the National Cholesterol Education Program Wroking Group.
IRON	66	63	mcg/dL	45 - 160
UIBC	198	181	mcg/dL	110 - 370
TIBC (CALC)	264	244	mcg/dL	228 - 428
TRANSFERRIN SAT. (CALC)	25	26	%	20 - 55
FERRIRITIN	208	-	ng/mL	22 - 322
HEMOGLOBIN A1C	4.9	-	%	4.5 - 5.7
HBsAg	Negative	Negative	-	Negative
Please note, methodology has changed from EIA to Chemiluminescence.
HBsAb	<10	-	mIU/mL	-
<10 mIU/mL - NON-IMMUNE >=10 mIU/mL - IMMUNE The magnitude of the measured result above 10 mIU/mL is not indicative of the total amount of antibody present.
HEPATITIS C (ANTI-HCV)	Negative	-	mcg/L	0 - 10
Please note, methodology has changed from EIA to Chemiluminescence.
ALUMINUM UNSTIM	<5	-	mcg/L	0 - 10
BIO-INTACT PTH (I-84)	109.6	-	pg/mL	12.6 - 53.5
The Bio-intact PTH (I-84) Assay results are approximately 52% of the intact PTH Assay.
VITAMIN B12	3204	-	pg/mL	211 - 911
Verified by Repeat Analysis.
RBC FOLATE (CALC)	1216	-	ng/mL	280 - 791
TSH	2.13	-	mIU/L	0.35 - 5.50
HDL	40	-	mg/dL	-
CLINICAL SIGNIFICANCE NOT ESTABLISHED * Male <35 mg/dL & Female <45 mg/dL suggestive of increased susceptibility to Coronary Arery Disease. * Male 35-55 mg/dL & Female 45-65 mg/dL clinical significance not established. * Male >55 mg/dL & Female >65 mg/dL suggestive of decreased susceptibility to Coronary Artery Disease.
CORRECTED CALCUIM	8.9	9.5	mg/dL	-
Calcuated Calcium is not equivalent to measured ionized calcium
CORRECTED CA X P PROD	54	44	-	-
BUN (post)	-	12	mg/dL	6 - 19
UREA REDUCTION RATIO (URR)	-	70	%	65 - 80

As you can see, they did extensive blood work in August, and only some basic tests in September. I think they do the extensive testing every six months (or maybe every year), but they do the standard tests every month. The numbers that are most important to me are the Phosphorus, Potassium, Sodium, BUN, and Urea Reduction Ratio. The Potassium, Phosphorus, and Sodium are the chemicals that I can work on with my diet. The BUN (blood urea nitrogen) is a test that measures the amount of urea nitrogen (a breakdown product of protein metabolism) in the blood. There is a (pre) and (post) dialysis reading for the BUN, and you will notice that it dropped dramatically. The Urea Reduction Ration (URR) is the number that shows how well your dialysis is working. Since I am on the 16-guage needles, the nurse explained that 70% is about as good as I can get. When I move up to the 15-guage needles, then they can get that cleaning rate up closer to 80%.

Prayer Requests:

• I am still feeling sick in the mornings when I get up for an hour or two. The doctor did not have any help when I asked him about it last night. Please pray that I will get back to feeling better. It’s not any fun to be sick.
• Continue to pray that my paperwork goes through quickly and with no problems.

Transplant Forms Part II Completed

Well, I just mailed in the second set of paperwork for my transplant. I have submitted my health history, my insurance information, and am hopefully being approved financially (by the insurers). The paperwork was long and full of the expected questions, and I’m glad to have it finished and in the mail. Though, I don’t know how quickly the local mail has been sending lately. It took over a week for Netflix to receive the last set of DVDs that I returned.

I did not get a full copy of my labs on Saturday. The dietitian came by, and she had a report on my phosphorus levels. Your phosphorus should be between 3.5 and 5.5, and I had a level of 4.6. Last month, I was about 6.2. This means that my diet it going just right in the area of phosphorus, so I don’t have to cut back any more than I already have. I asked about getting a copy of my labs, and they said that I should be able to get them on Tuesday. The dietitian had my labs on a page with everyone else’s results, and she told me that all of my numbers were looking good. If I get the full list on Tuesday, I’ll let you know how the rest of my blood looks.

I did not get any input as to what to do about my nauseated feelings last week. I woke up Sunday and Monday mornings with a bit of a stomach ache, and I am not enjoying it at all. Perhaps I have gained some more weight and am dehydrated again, or perhaps my body misses its phosphorus (who knows?). All they offered at the clinic on Saturday was to give me some medicine if I was still feeling bad during my treatment.

Here are some Prayer Requests that I have:

• Pray that I will stop feeling nauseated every morning or that I can figure out what the problem is being caused by
• Pray that my paperwork for the transplant will process quickly and without any problems

Friday was a long Day

I had another good dialysis treatment on Thursday night. My needles went in well and they didn't hurt too much. They took off 1900 cc of extra fluid. My between-dialysis weight gains are staying pretty steady.

Friday ended up being a long day. I woke up a little sick this morning and I was nauseated at work early in the morning. After that, I felt a lot better. I felt light headed off and on all day at work (which is a little disorienting). I don't know if I have gained some more weight, or if there is another problem. I will ask the nurse on Saturday what they think.

I did not get any lab results on Thursday. My guess is that they will give them to me on Saturday. The dietitian was the one that had my lab tests last month, and she tends to come to the clinic on Saturdays. I will post my results here on the blog after I get them.

For those of you who are familiar with RSS (or Atom), I have posted the link over on the right hand pane. You can use your favorite newsreader to subscribe to the feed at http://nmccart.blogspot.com/atom.xml

Easy Tuesday Treatment - 09/07/2005

I had an easy treatment last night at dialysis. The technician did not have any problems getting the needles in, and one of them did not hurt at all when she did it! I can definitely go for more needle insertions like that one. For those of you that are interested, I was 69.8 kg before treatment last night and 68.3 kg after the treatment. They are attempting to keep me at 68.0 kg, but I had a soda during treatment (and that is about 300 ml of fluid, which weighs about 0.3 kg).

They drew lab work before and after the treatment. I should get the results by next Tuesday (though I’m not actually sure how long it takes, since this is only my second time to have blood work taken). I have been following the diet pretty closely and trying to take my phosphorus blockers with my meals. Hopefully, everything will be in good shape when I get my report.

I received a letter from the Baylor University Medical Center Transplant Program stating that they had received my initial application and need me to complete several steps to move from the application stage to being placed on the transplant waiting list. They need things like my driver’s license and insurance card, which are easy enough to get. I also have to fill out a Health History form, which is nine long pages of fun. And, they are awaiting financial approval from the Transplant Center. Once all that is completed, I will have to take a medical evaluation. Then, everything will be compiled and presented to the Transplant Committee which is composed of Transplant Nephrologists, Transplant Surgeons, and other physician referral sources. The committee will then make a recommendation based on my results. If the committee recommends that I should be placed on the waiting list, then my records will be submitted to the transplant center and my name will be placed in the United Network of Organ Sharing (UNOS) active cadaveric waiting pool. The transplant center will also have to re-submit my medical records to the insurance company for approval of a transplant. At this point, if I have any potential kidney donors, the donor’s medical evaluation can begin after the committee approval for the potential recipient.

I realize that paragraph is long, but it summarizes a two-page letter that I received from the Dallas Pre-Transplant Group. Here are my prayer requests:

• Pray that all of the paperwork portion of my application process will go easily and get to the proper committees quickly.
• Pray that my medical testing can be scheduled around work so that I don’t have to miss any more this year.
• Pray that the committee will be able to make a quick decision.

Thanks!

Monday Brings Changes

Hey everybody. Thanks for coming by to read the blog today. As I am sure you have noticed, I have been playing with my settings. Most noticeably, I got a new site template today. I was tired of the brownish-colored page, so I went with a nice blue page. I also noticed that the sidebar was not displaying correctly in Firefox, but that has been corrected. And, finally, I got a new hit counter (since my old one was not displaying at all in Firefox).

My dialysis treatment on Saturday went really well. They were able to use the usual places to stick the needles, instead of having to move the output needle like they did on Thursday. I guess the vein has healed enough to use that area for the sticks. I still have a small amount of swelling on my arm where the vein was infiltrated on Thursday, but it has not started bruising yet, and I am thankful for that. I am maintaining my weight at 68 kilograms (almost 150 pounds). At each dialysis treatment, they try and remove any excess fluid weight that you have gained since your last treatment. I am averaging about 2 liters (2 kilograms) of fluid gain between treatments, which is great. The most fluid that can be removed in a four-hour treatment is 4 liters, so as long as I stay at 2 liters, there should not be any problems.

I have another treatment Tuesday evening. It is the beginning of the month, so they are going to draw blood to perform lab work on. Apparently, they will draw blood at the beginning of every month to check and see how you are doing. They will check my hemoglobin to see how anemic I am. They will also be checking my phosphorus levels, which will tell me how well I am doing on my new diet. I am hoping that my levels will be much lower than necessary and that I will not have to watch my diet quite as closely as I did all through August. But, if not, I will keep on limiting myself to three servings of dairy a week and filling up on the white bread.

Thanks for coming by to read. Here are some prayer requests that I have for this week:

• Pray that my lab work will go well on Tuesday and that they will not find any significant problems.
• Pray for me as I continue to work full-time and go to dialysis. I notice that I am sleeping very well all week long. I would like to continue at this energy level or better. I do not want to start feeling my anemia again. They treat it at dialysis, but it could still become a problem.
• Pray for the victims of Hurricane Katrina. I live in Dallas, and our church is now sixth on the list of area churches that have volunteered to take in refugees. This is a terrible tragedy that has hit these people. If you are able to get involved through your church or the Red Cross, please do.

Matthew 25:35-36
For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.'

It Takes Three

I had a slightly troubled dialysis treatment last night. My regular technician was not there, so I had someone new. Either my arm is still not quite used to 16-guage needles, or the technician was not familiar with my arm, but I did not get a good stick. The tech was able to put in the return needle (arterial side), but she infiltrated the output side of the vein. It swelled up last night, and they ended up having to use a different spot on my arm. This was a new area, and they had to use the smallest needle on it. The treatment worked fairly well, but they had some problems with the pressure (I think due to having infiltrated the vein). This morning, I have a nice bruise and some swelling where they had the bad stick. It should go down in a few days.

Other than having a new bruise, things are going well. My first week back to work has gone nicely. My job is in a 24x7 internet data center. Since they have to have someone here at all times, they have the week divided in half. One set of people works the first half of the week, and the second set of people works the second half. Before my surgery, I was on one of these teams. Now, with my dialysis, I am no longer able to work 12-hour shifts. So, they are letting me work from Monday – Friday from 7 am – 4 pm (which is good since dialysis starts at 4:30 pm). I had thought that this week was going to make me very tired, but it really hasn’t. I’ve enjoyed getting back to work (which is better than sitting around at home all day).

Please continue to pray that dialysis will go well as they are using these larger needles. Thank you for your thoughts and prayers.

New, Larger Needles

For my dialysis on Tuesday, the technician decided to move me up to using 16-gauge needles. Previously, I had been using 17-guage needles, which are the smallest needles that are used for dialysis. Since my fistula has been developing and working properly on the 17G needles, it is time for me to get moved up. Most of the dialysis patients at this clinic are using 15-guage needles. It seems that it was unusual for me to get started with 17-guage needles, as most of the patients were using the larger sizes.

Work continues to go well. I am writing this at work today on my fourth day this week. I am still basically doing “light duty” right now, but I am working a 40-hour week. Luckily, there isn’t too much heavy work that needs to be done with my job, and if there is, I can get someone to help me.

We’ve been quite busy at work this week helping out one of our customers. They are based in Covington, LA, and are using our data center as a disaster recovery site. They normally have a cage full of equipment here in Dallas, but during this disaster, they have added two new cabinets worth of equipment. They are doing a lot of work to keep their company up and running during this disaster.

I have another dialysis scheduled for tonight. I think they are going to start increasing my blood-flow rate tonight.