Fistula Revision is Healing

I saw my vascular surgeon yesterday afternoon. I went in for a follow-up appointment to the fistula revision that I had done at the end of November. He ran the sonogram wand over my arm for about 15 minutes, and he said that the revision is healing very nicely. He also said that I would be ready to use it again in about three weeks.

So, that is some exciting news. In about three weeks, I will go back to the painful needles in my arm, rather than just tubes hooked up to my chest catheter. I know, it doesn’t sound all that great, but if the fistula is working correctly, then I should start getting an even better dialysis treatment. I also will get to have my chest catheter taken out a week or so after they start using the fistula again, so that will be nice. I am growing tired of covering the bandage in plastic every morning so that I can take a shower. Also, I am going to enjoy not having tubes in my chest that keep me from sleeping on my stomach. I’ll just tell you that it is not all that great to have a large bandage on your chest. My chest is small and the catheter is right in the middle of the right side of my chest. This means that the bandage has to try and curve around under my arm and attempt to stick. I usually have to tape it up (again) every morning so that the catheter stays covered up (and clean). It will not be a problem for me to stop tending to an open wound on my chest.

Our company is celebrating New Year’s Day on January 2, so I do not have to come to work that day. My mother and sister are coming to town for a short visit, so that will be fun. My mom came down at Thanksgiving and she got to see me at the dialysis clinic. I think that helped her get a better idea of what I am doing for 12 hours every week. I don’t know when they will get here, but if it is early enough, then my sister can come see the clinic as well. She also has Polycystic Kidney Disease, so dialysis and a transplant may one day be in her future as well.

So, since I am going to have some family in town, I don’t know how soon the next post will be. Stay tuned to your RSS readers, and I will update when I get a chance.

Thanks for reading today!!

Merry Christmas

It has been about a week since the last time I posted. I will try to update everyone here quickly. I got my treatment moved up on Christmas Eve so that Jenny and I could go to the Christmas Eve service at church. I had off Friday of last week and Monday of this week, so I have been enjoying some vacation time at home with Jenny. We got to watch TV, play some games, and just spend time together. It has been quite nice.

I noticed that I have a couple of new comments that have been posted since the last time I wrote them out. Here they are:


At 12:58 PM, anu said...

Hi Nathan,

I wish you Merry Christmas and a healthy, happy new year 2006.

I pray that you get a kidney and the transplant is successful and you lead a happy life:)

god bless.

Anu, thank you for your well wishes. I did have a great Christmas, and I am looking forward to an entire happy 2006. I will be tested for transplant next year, and that can only lead to good things. I am looking forward to the day I get my transplant, and hope that it will improve my quality of life. Thanks!


At 2:28 PM, Vlademar said...

Nathan,
This is Vladc***@***.com,aka Lee Vlademar AKA Lee Batchelor.
That last name should bring back ancient memories from Sunnymede. I see Angela and your mother here at Coleman Pharmacy often. I am no retired and work there part time. It's a lot of fun. Almost as much fun as the old days at Sunnymede. I wanted to let you know how proud I am of you and how your are handling your situation. I know that God is leading you through your life as a responsible, productive part of society who happens to have a temporary handicap. You will beat this and be totally healed. Have fun with your mother and Angela while they are down there this weekend. You will always have my prayers. I want to thank your wife for taking care of one of my Kids. You know how I am about My kids.

Love,
Miss Batchelor

Well, for those of you that don’t know, that was one of my fourth grade teachers from back in Fort Smith, AR. I see that she is working at the local pharmacy where my mom and sister both go. It is always good to hear from someone that has known me from long ago. I have yet to write her back, but I will do so (most likely this week, in case you are reading!) I am thankful that my mother continues to share my story with those around her that know me, and that everyone has the ability to catch up on my life through this blog.

Well, that’s about all for today. I am heading off for another four fun hours of dialysis. But, it won’t be too bad. Jenny is off work and is supposed to visit me today. Yippie!!

December Lab Report

It is time, once again, for Nathan’s Lab Report. I have noticed that the web site does NOT like me to submit my labs in a table, so I am just going to do a bulleted list today. I will put the test and my results first, with expected values in parenthesis. And, I am going to try to put low values in blue and high values in red. I’ll see if I can find my old report to discuss the changes after the list.

• WBC: 4.68 – 1000/mcL (4.80 – 10.80)


• RBC: 3.20 – mill/mcL (4.70 – 6.10)


• HGB: 10.3 – g/dL (14.0 – 18.0)


• HCT: 29.2 - % (42.0 – 52.0)


• MCV: 91 – mcm3 (80 – 94)


• MCH: 32.1 – pg/cell (27.0 – 31.0)


• MCHC: 35.2 – g/dL (33.0 – 37.0)


• HGB X 3: 30.9 - % (42.0 – 54.0)


• Pre-dialysis BUN: 29 – mg/dL (6 – 19)


• Pre-dialysis CREATININE: 7.1 – mg/dL (0.5 – 1.2)


• POTASSIUM: 4.0 – mEq/L (3.3 – 5.1)


• BICARBONATE: 22 – mEq/L (22 – 29)


• ALKALINE PHOS: 87 – U/L (40 – 129)


• AST/GOT: 20 – U/L (13 – 39)


• TOTAL PROTEIN: 6.6 – g/dL (5.9 – 8.4)


• ALBUMIN (BCG): 4.2 – g/dL (3.8 – 5.2)


• CALCIUM: 9.2 – mg/dL (8.4 – 10.2)


• PHOSPHORUS: 4.6 – mg/dL (2.6 – 4.5)


• Ca X P PRODUCT: 42 – (<55)


• SODIUM: 139 – mEq/L (133 – 145)


• CHLORIDE: 102 – mEq/L (96 – 108)


• IRON: 59 – mcg/dL (45 – 160)


• UIBC: 184 – mcg/dL (110 – 370)


• TIBC (CALC): 243 – mcg/dL (228 – 428)


• TRANSFERRIN SAT. (CALC): 24 - % (20 – 55)


• Post-Dialysis BUN: 8 – mg/dL (6 – 19)


• UREA REDUCTION RATIO: 72 - % (65 – 80)


• HBsAg: Negative (Negative)


• CORRECTED CALCIUM: 9.0 – mg/dL


• CORRECTED Ca X P PRODUCT: 41

As always, the important numbers to see are the post-dialysis BUN and the Urea Reduction Ratio. My BUN is 8, which is about the same as I have been seeing the last several months. My URR is 72, which is a bit worse than what I have been seeing, but I attribute that to the fact that I was receiving dialysis through the neck catheter on the day they took my blood for the labs. The neck catheter did not provide as good of a treatment.

My phosphorus shows that it is high, but it is an acceptable value for a dialysis patient. They want us to score between 3.5 and 5.5, so I am right on target. I would like to try to get it below 2.6, but I don’t know what the likelihood of that is, given that I am on dialysis. My hemoglobin is low (meaning anemia) and that is normal. They lowered my anemia treatment last month, and I guess they will have to raise it back up again this month. My potassium is still lower than they prefer, so they continue to dialyze me using the 3K solution. Of note, my average fluid weight gain is 0.76 kg (or 1.1% of my dry weight). A good fluid weight gain is between 3% and 5% of your dry weight, so I am not having any problems with fluid overload. In fact, the dietician said I could drink some more if I want to.
That should be about it for today. I go to see the vascular surgeon next week, and he will tell me how well my fistula revision is healing. Hopefully, we can go back to using it soon and see if I will receive better treatments. Not that I miss the needles, because I don’t. But, I do want the best treatment possible.

I also learned that I will have to keep my chest catheter covered for as long as I have it. For some reason, I though I could remove the bandages at some point, but I guess not. They will keep changing the bandages and cleaning the site at every dialysis treatment until the catheter is removed. Also, I got my treatment moved up to the lunch-time shift for Saturday so that I can go to the Christmas Eve service at church.

Thanks for coming by to read. See you all later!

Thyroiditis

I went and saw an endocrinologist on Thursday afternoon. He told me that I have what appears to be a simple inflammation of my thyroid. I guess this is not uncommon, and he made it seem like my kidney disease may have been the cause, though they could never tell for sure what caused it.

You might be asking, what does the thyroid gland do? Well, I went and searched for that answer, and found it at: http://www.bestdoctors.com/en/askadoctor/b/blum/mblum_061200_q1.htm
The gland produces a hormone -- thyroid hormone -- that regulates the metabolism of the body. That is, it influences the ways oxygen is utilized at a cellular level and in many of the body's organs.

This in turn is expressed in various ways, including effects on a person's body temperature, excitability and mood, pulse rate, digestive function and other processes which are required for the support of life.

So, my thyroid is sick (or, was sick). It got inflamed and spit out all of the hormone that it was holding. A normal thyroid gland will produce hormone, and store it until the body needs it. Then, it releases that hormone in a timely manner, and produces more to always have a full store. When the thyroid gets inflamed, it releases all of the hormone that it was storing into your blood stream. That causes your thyroid hormone level to be too high, and then the thyroid stops producing hormone. That is where I am right now. My level of hormone is too high, and my thyroid is producing almost no hormone to refill its stores, as it does not think that I need any more in my body. Once the levels in my blood stream go down, the thyroid will have to play catch-up to get my levels back to normal. This may involve my thyroid hormone level going up and down around the normal level for about one year until it is settled out.

I am supposed to get blood work done in January and February to check my hormone levels, and then go back to the endocrinologist to see if everything is working out the way he thought it would and to see if I will need any medication (in case my levels get too far out of sync).

I have received two comments recently that I would like to share with everyone:


http://nmccart.blogspot.com/2005/12/pre-transplant-orientation.html
At 6:18 AM, Joeski said...
I too have PKD, and found your site thru google's blog search. I went thru dialysis via the chest catheter for 10 months before I was transplanted. That was almost 4 years ago- yet your words make is seem like yesterday. This is the first post I have ready, so I will look back to see more of your story before I comment further.
At 11:17 AM, Joeski said...
I have just read your entire blog since yesterday. Your situation is very much like what I went thru before my transplant almost 4 years ago. I too have PKD. I had one kidney removed in 1995 that was as large as the ones you posted. My other one limped along until 2001, when it had to be removed also. Same size. I was only on dialysis for 10 months before a match came up. My blood type is B+. I live in the Richmond, VA area. The transplant is well worth the time and testing involved. I did not like dialysis at all. I was constantly fighting to get my dry weight increased, as I lost a lot of weight in the hospital while they tried to save my last kidney. I just want to wish you good luck, and you will be added to my prayers. Remember to thank your wife every day for the support. I would never have made it thru everything as well as I did without my wife's love.

It is good to hear from someone that also has PKD and has had a successful transplant. I have only been in dialysis for about five months, and I would love to be able to get a transplant that quickly. I am guessing that Joeski had a living donor (which is the best way to get a transplant, as far as I can tell). I’ve had the fights with getting my dry weight increased just 1.5 kg since I started at the clinic. I am also waiting for my fistula to heal so that they can go back to using it for dialysis. Thank you for your prayers, they are much appreciated. And, I am also very thankful for my wife. She provides me with physical and moral support on a daily basis. I do not know how I would be coping in all of this without her.


http://nmccart.blogspot.com/2005/12/perm-cath-placed.html
At 8:44 PM, Anonymous said...

I am 24 and have ESRD. I also have a catheter in my chest and have a fistula. I've had problems every dialysis session with the fistula, so I've been using the catheter for four months, which is how long I've been on dialysis. Good luck with everything.

For me, the dialysis in my fistula was going great (as far as I was concerned). My nephrologist was the one that said I needed to get it revised so that I could receive a better dialysis treatment. I am only hoping that once my fistula heals, it will work even better than before. I know that since this second surgery, I have been able to feel the thrill in my arm above my elbow, which is new for me. I do not enjoy my catheter, as it makes it hard to shower and to sleep. I imagine that they will leave it in for a while even after they start using my fistula, just so it will be there in case of any problems. Thank you for writing and for coming by to read my blog. I hope that my experiences have been helpful to you. Hopefully your dialysis will get better soon.


Okay, everyone, thank you for coming by to read today. I know that today’s post was a little longer than normal, but that just makes up for the last two posts which were really short. Thank you all for reading and for continuing to pray. Merry Christmas!! (though, I will probably post again between now and the 25th).

Pre-Transplant Orientation

Yesterday afternoon was my Pre-Transplant Orientation meeting. I traveled down to south-east Dallas to the Dallas Nephrology / Dallas Transplant offices. There, I sat for about an hour watching a Power Point presentation that could have easily been printed out and given to me to read on my own time. The presenter told us that not all kidneys that get transplanted work for all patients. She also said to take your medications, go to your dialysis, and keep up with your pre-transplant appointments. These things will go a long way to helping you secure a spot on the UNOS list.

She also gave some times. It seems that people with type A blood have an average of greater than 1000 days of waiting time before receiving a transplant. So, unless on of my living donors is a match, I can probably look forward to about three years of waiting. And, speaking of living donors, they will be able to be tested once all of my testing is complete. My transplant coordinator said that they will schedule my blood, antigen, and tissue samples in early January, hopefully all on the same day so I only have to miss one day of work. Once all of that is complete, then I can get my potential living donors to get blood work done so that the transplant office can evaluate who will have the best chance at being a match. They will only test one person at a time, which makes sense since it costs approximately $11,000 per person to get tested. I am guessing that the insurance company and Medicare will help with these costs, but I won’t really know until I get into that phase of the process.

So, the time I have been waiting for since this summer is rapidly approaching. They will start the testing in January, and I was told that it can take up to six months to get all of the necessary things tested and approved. So, if you get a call in July from me asking you to get your blood drawn, well, don’t worry. I just want one of your kidneys.

Thanks for coming by to read today. I realize that my posts have been short, but I haven’t had too much to say. I have dialysis tonight, and I will find out if I can get the stitches out of my arm from when they did the fistula revision surgery. I hope they are ready to come out, because they are loose and are starting to itch.

Still Going

I am continuing to have dialysis through the perm-cath in my chest. Saturday’s treatment went well, and I expect today’s treatment to be fine, too. I have said it already, but I much prefer the perm-cath in my chest to the temp-cath in my neck (yuck).

I have a call in to my doctor to ask about my thyroid. She said that I have thyroiditis (which is an inflammation of the thyroid gland). She said that she will have to get me in to an endocrinologist to get it looked at and to decide what needs to be done. I’m sure that it will be okay. At least the thyroid only controls just about every function in the body (boo).

Tomorrow is my transplant orientation meeting. I am going to find out about the transplant process, and I should get set up for my tests to help get me on the list. This is a very exciting time (everyone should cheer now). Hopefully it will be a quick process to get me tested and put on the list so that I can start the search for a kidney. All of you potential donors out there, get your driver’s license up to date!

I realize that today’s post is short, but I don’t have a lot to say. I guess that’s a good thing. There isn’t really any bad news. My fistula revision is healing nicely (I think). I go back to see the surgeon in a couple of weeks. Maybe I’ll start using the fistula again soon. Who knows?

Thanks for coming by!

Perm-Cath: Placed

On Thursday, I was scheduled to have the temp-cath removed from my neck, and I was supposed to have a perm-cath placed in my chest. Let me just describe for you what went on Thursday (the story ends well, so don’t fret).

Last week, I was told that my procedure would begin at 8:00 am and that I would need to arrive at 6:00 am to be processed and prepared for the surgery. Now, as luck would have it, we had a huge cold front and almost no precipitation on Wednesday night, which caused all of the schools in the area to either close or to open late. I was told to base my decision on coming to the hospital per the local school district. So, if our town is closed, then the radiology department will not be open. I watched TV until 5:30, when we had to leave to get to the hospital. The school district was not listed, so we went. The roads had almost no ice on them at all, and driving was absolutely no problem. We listened to the radio on the way to the hospital, and they did not list the school as being closed.

We arrived at the hospital to find that the school district had been closed on our way there. But, since we had already arrived, they called radiology, and said we could go back and that they would take care of us. I got my paperwork completed and had an IV by 6:30. The doctor finally came to see us at 10:00. It seems there was some miscommunication between the nurse and the doctor, and our doctor was the only one that did not show up to work on time that day. So, there was a LOT of sitting that we had to do.

My procedure went great once we got started. They took me into radiology at about 10:30, and I think we were home by 1:30. They removed the temporary dialysis catheter from the right side of my neck. They just had to cut the stitches and pull it out, it wasn’t too painful. Then, they held the hole until it stopped bleeding so that they could patch it up. I then felt the knock-out juice going into my IV, and that was all I remembered. When I woke up, the entire right side of my chest hurt, and I now have two small tubes hanging out of the middle of the right side of my upper chest. They sent me home, and everything was great (especially since I finally got to eat).

I had dialysis Tuesday night using this new perm-cath, and it went great. The machine can not run quite as quickly as it can for a fistula, but it runs much better than with the temp-cath in my neck. The treatment went great as compared to last week. There were no problems with the machine the whole night.

About my only complaint at the moment is that the right side of my neck and chest are both hurting from the procedures yesterday. I did not sleep well last night (probably due to the pain). I am hoping that it will be better tonight. I don’t have to carry anything around at work, so I am hoping that the muscles will heal quickly and on their own. Oh, and another bonus, I can take showers again!

The doctor said that the site needs to have the bandages changed in three days and that I need to keep them on for at least 10 days. He said that the stitches could come out in six weeks and that it should be mostly healed by then. Apparently, the wound will form scar tissue around the catheter, which will help hold it in place more securely.

Thank you for all your prayers during my procedure. Right now, Jenny and I would like you to pray about my Saturday treatment time. Our church’s Christmas program is Saturday night, and I have to move my appointment in order to play in the program. Please pray that God will open up a slot for me somewhere so that we can participate in the Christmas program. Thanks!

Chest Catheter on Thursday

I finally have my procedure scheduled to have the temporary dialysis catheter removed from the right side of my neck and to have a new longer-term dialysis catheter placed in my chest. I am set to go in early Thursday morning to spend a half day sedated and to come out of the hospital with new and different tubes in my body. I know this sounds pretty exciting to you all, but I am actually pleased. The dialysis catheter in my neck is very difficult to deal with. I cannot get it wet, and it does not support a very good dialysis treatment. The machine has to run much slower than normal, and I cannot move (at all) for the entire four hours.

I also went to the hospital this morning for my “thyroid scan with uptake.” They radiologist gave me a radioactive iodine tablet, and wants to see me after four hours. I imagine that they are going to scan my thyroid to see how much iodine it has absorbed or possible used up. They told me not to consume any iodine for the next 24 hours. I also have to go back tomorrow morning to get a 24-hour reading on my thyroid. Hopefully, by my next update, I will have more information about my thyroid problems.

I have one more dialysis treatment tonight using the temporary catheter in my neck. I am not really looking forward to it, as it is a giant pain. I don’t like not being able to move, and my neck usually ends up hurting during most of the treatment due to staying perfectly still. I made it about two hours on Saturday before I was setting off the machine alarms every fifteen minutes. I guess I just can’t quite hold still for that long.

In other news, the surgery on my arm seems to be healing well. It is still a little swollen, but the bruising has gone down quite a bit. The stitches are starting to loosen up, and I am guessing that they will be gone in the next couple of weeks. The surgical scar itself seems like it is healing and staying clean, so that is good. I will be looking forward to when it does not hurt at all, as it still has some pain if I move it too much or too quickly.

Please pray for my procedure(s) on Thursday. Pray that it goes well and that there are no problems. Thanks!

Answering Blog Letters

It’s time once again to dip into the old blog mail-bag. I get comments from time to time (all of which are e-mailed to me so that I am sure to see them). However, I know that if you are just reading along through the blog on a regular basis, you may not get to see the comments. So, I am going to take a little time today to read and respond to the comments.

As for dialysis Thursday, all went well. My after-dialysis standing pulse was 129 (which is a little high). I am talking with the radiology department at the hospital about getting the catheter taken out of my neck and having a new one put into my chest. Julie (the scheduler) said that she may be able to squeeze me in as early as Wednesday, but I won’t know for sure until she calls me back (after confirming with the doctor exactly what he wants me to have).

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11/26/2005 at 1:05am, Stacy Without an E said…
I was searching for other Dialysis patients and I stumbled on your blog.I've been a Dialysis (I have to capitalize it or Dialysis gets angry) patient for the last 18 months. I'm using a graft (similar to the one you're scheduled for) that's over 10 years old.I wish you nothing but the best for your surgery. I have a venomous love-hate relationship with Dialysis, but lately it's been ok. The problem I have is related to pain issues.Sometimes it burns, but that's probably related to the graft's age. When I used it ten years ago I don't remember having any pain issues, so you shouldn't have anything to worry about.Good luck to you. Are you on the transplant list?

Thank you, Stacy, for taking the time to peruse the blog-o-sphere (I don’t think that should be a word). I am glad that you stumbled across my musings. Well, the fistula revision surgery went great. In fact, it's been about a day, and it hardly hurts at all.Now, I'm not pleased with the catheter in my neck (and I think it will soon be exchanged for a chest catheter), but I guess that its okay.As for the transplant list ... I’m working on it - another slow process I have to deal with. I have a meeting on December 14 that should get the official list-process started.

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11/28/2005 at 10:19am, Conservative Conservationist said …
I wish the best for you today, in your surgery.

The surgery itself went well. You can read the posts Update I and Update II for more information. Thank you for the well-wishes!

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12/01/2005 at 7:41pm, Barbara said …
Nathan,
I was so sorry to hear about your ordeal this week. I hope that you aren't mad at the rest of us in the medical field. I have a question did you make the appointment with the vascular surgeon or did your unit? You might want to ask your nephrologist to recommend another surgeon who treats patients better. The hospital sounded pretty crappy too. I understand that each hospital and states have different procedures but the docs in Canton and here put the perm caths in the chest wall and not the neck. Your surgeon could have easily consulted either your nephrologist or a covering nephrologist at the hospital to do the procedure. Our docs receive consults from surgeons all the time. Was your intact PTH level elevated? Do you have to go see an endocrinologist for the hyperparathyroidism? Our docs have put patients on medicine for elevated PTH before. I can't think of the name of the med now though it might be rocaltrol but I'm not 100% sure.

No, Barbara, luckily, I am not the type of person that will blame an entire group for the actions of an individual. Sadly, the vascular surgeon just seems to be a busy person that isn’t always so good at providing information when unprompted. I made the original appointment with my vascular surgeon for the revision surgery, and he said that my nephrologist should have made it so that he could have also requested the perm-cath in my chest. The hospital isn’t really the problem; I think it is just the surgeon. I am probably going to keep dealing with him until I am finally done with my fistula (after transplant). I guess the surgeon just wasn’t thinking about how long I would need the catheter when he requested the clavicle catheter. The radiologist that put it in did mention that they normally do the chest catheters on patients in my situation. I have not seen any of my lab reports for the thyroid problem, yet. Once the doctors figure out what the problem is, I will probably ask to see the labs just to look over them for myself. My family doctor said that if it is overactive, they can medicate, and if that causes it to be under active, then they can medicate permanently to fix that problem. Thanks for the comments!

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That is all for today. I am in the process of trying to set up my appointment with the radiologist to have a permanent dialysis access catheter placed in my chest (soon, hopefully) and to have the temporary dialysis access catheter removed from my neck. Also, I talked to UniCare today, and they said that I will only owe $4,000 total to the dialysis clinic (as opposed to $16,000) which is what I had hoped to owe them.

I would love any prayers on:

• Getting the dialysis access catheter surgery scheduled and completed without complications


• My fistula healing quickly and easily so that I can go back to using it for dialysis access. Even though it hurts more than the dialysis catheter, it is safer to use and easier to keep clean and safe.


• That the best thing (according to God’s will) that can be done for my thyroid problem will be done.


• That the next 57 dialysis treatments will go even better than the first 57 did

Thank you all for stopping by and for always reading. And, of course, Jenny and I really appreciate any and all prayers that come our way. Thank you!