Another Fistula Surgery on Monday

I went and saw my vascular surgeon on Thursday afternoon. He had looked at the results of my vein mapping, and agreed with the technician that my larger veins were in my upper left arm (not the upper right arm). He said that the best looking vein is actually kind of deep in the arm, so it might be problematic. He said he will operate on Monday to create a new fistula. The old fistula does not need to be removed.

The surgeon will cut in a fairly large incision from the inside of my elbow, up my arm towards the arm pit (probably 6 inches long). From there, he will dig deep into my arm to get to the vein. He will lift it out close to the surface of the skin, and lay it in an arc across the top of my arm, linking it to an artery near the elbow (to create the fistula). In doing this, he will make the access easier for dialysis (on top of the arm instead of underneath), and he will bring the vein closer to the surface for easier sticking.

The surgery is scheduled for 11:00 am Monday, and should last 1 ½ to 2 hours. Jenny and I are both taking the day off (so she can drive me). I hope to be able to return to work on Tuesday, but I’m not sure. It all depends on how quickly I recover from having my upper arm taken apart (which doesn’t sound like it will be fun, but at least it will be something new that I haven’t done before).

I would really appreciate all the prayers that I can get for Monday during the surgery and for Monday and Tuesday when I am recovering. Please pray for the doctors and the surgery team, and also pray for Jenny as she has to take care of me.

In transplant news, my dad and aunt both mailed in blood that was drawn on Tuesday to be tested against my blood. My guess is that if they do not match, then the transplant office will move out and test non-family donors. Maybe I’ll find out more about that next week, too.
Thanks for coming by to read today. I’m sorry this was so short. I’ve got the surgery scheduled, and I’ll let you know more if I learn more.

I am going to attempt to attach a picture of my arm. You can seee the stiches on my elbow, and the drawing on my arm indicating where the veins are. The numbers in the picture are the width (in mm) of the vein. You can see it numbered from 71 to 44 in the picture (my elbow is on the right).

Fistula Perils

Hello everyone. I have had quite the adventure this week. I'll start out with last Saturday. I had my dialysis treatment at 6 am so that I could spend the rest of the day with Jenny. The dialysis technician that I had told me that it looked like my regular-shift technicians were using the same area of my fistula too much. He suggested that they try and move the needles a little farther up my arm (away from the original surgery point). But, he was new to my arm and he didn't want to try anything strange, so we just did my dialysis in the same place.

On Tuesday night, I went in for my treatment and mentioned to the tech that I would like to try and move the needles up my arm a little bit, if she could. My fistula vein is very twisty, so I did not know if there was a long enough straight section available to put the needles in farther up. She hunted around for several minutes and thought that she found a place. Unfortunately, the section of vein was not quite long enough, and she ended up infiltrating my vein (which is just a fancy word that means that the needle poked all the way through the vein, in one side and out the other). So, she couldn't use that needle, as blood was seeping out of the vein into my arm. She picked another space higher up and did my treatment from there. The dialysis treatment did not go as well (my kt/V was 0.90 rather than 1.40) and she said that we probably shouldn't try and move the needles again.

They sent me home with an informative sheet that told how to reduce the amount of bruising that I would get. It said that for 24 hours, I was supposed to use an ice pack in 15-minute increments. 15 minutes on, then 15 minutes off, and repeat for 24 hours. I went ahead and tried that at work the next day, which wasn't too bad. The second step was, for the second 24-hour period, to put a warm, damp compress on the area in 15-minute increments (the same as with the ice pack). Since I work full time, I didn't really have time to head back and forth to the sink every 30 minutes to warm up a rag and then try not to drip water all over myself. So, I only did the washcloth once, then I gave up on it.

When I got to dialysis Thursday night, they checked my access like they always do to make sure that there is a strong pulse. Unfortunately, there was no pulse that could be felt in the whole fistula. So, they decided that the vein must have become clotted and said that I had to go home. They called the hospital and got me set up with an appointment for Friday with the vascular surgeon. He would have to go and take a look at my arm and see if there was anything to be done.

Friday morning, I went to the vascular surgeon and he did a quick sonogram of my arm. He said that it was going to require surgery, and he scheduled me for that afternoon. I went in for vascular surgery on Friday afternoon. The doctor opened my arm up in one place, but he wasn't able to get to the clot. So, he moved to a second spot, opened the arm up again, and was still not able to help. He saw narrow veins and blockage, but he could not clear it out. So, he decided not to do any more blind cutting.

I am supposed to go back to the hospital on Monday for a vein mapping. The radiology department will do an intensive sonogram of the veins in my upper arm to see if there is a new place to use for a fistula. The vascular surgeon had them put in another perm-cath into my chest, as I will not have a working fistula for a while. I am hoping that they will find good veins in my upper left arm and will not have to operate on my right arm.

Please pray for the doctor as he looks through my arm on Monday to try and find a good place for dialysis. Pray for quick healing for me (as I have just had two procedures and am soon to have at least one more). Thank you for caring about what happens. I always like to hear comments and e-mails from everyone.

Thanks!

March 2006 Lab Report

Hey there everyone. It is Friday afternoon, and I have decided to update my blog and let everyone know how I am doing. Things have been going decently this week. I have felt well every day (except this morning, when I felt a little ill). I have had good dialysis treatments and the technicians have not injured my arm in a while.

I went to the cardiologist’s office on Wednesday and had a nurse take my blood pressure. I also gave her a chart from my last two weeks at dialysis. The machine takes my blood pressure every half hour, so I have a fairly complete record. Since I have been experiencing a little bit of dizziness and some occasional near-blacking out (right after I stand up, not while driving or anything), the doctor said I should try and even out my meds. So now, instead of taking one 200 mg Toprol XL once a day, I am supposed to take one 100 mg Toprol XL twice a day (once in the AM and once in the PM). I started that yesterday, so there has not been a chance for any changes yet. Give it a week and I’ll see.

I have been enjoying my new dry weight of 69.0 kg (which is about 151 lbs). I had been having more cramps at home between treatments, and those are much fewer now. It is not any fun to be awakened in the middle of the night when your foot feels like it is trying to escape from the bottom of your leg. I had one last night and it was not enjoyable. I am hoping that we can figure out my proper weight and I’ll get back to feeling normal again.

As the title of my post suggests, I got my March lab reports back yesterday. The dietician is once again pleased with my report. All of my charts fell within the accepted ranges. I am pleased because my phosphorus went back down ½ a point. So, without further ado, here are the March labs:

• ALBUMIN: 4.6 (goal is 3.8 to 4.5)


• eKdrt/V: 1.47 (goal is greater than or equal to 1.2)1.47 is down a little from last month, but still is good.What this means is that my eKdrt/V is adequate, so I am receiving enough dialysis.


• enPCR: 0.59 (goal is greater than or equal to 0.8)This says that my protein catabolic rate (protein intake) is low. It recommends that I eat more fish, seafood, chicken, turkey, lean red meat, lean fresh port, eggs, or cottage cheese. The dietician says that has always been low because my one kidney still makes urine and passes some of that out of my blood stream.


• POTASSIUM: 4.3 (goal is 3.5 to 6.0)My potassium level is normal which means that I am doing a good job with the potassium in my diet (and the 3K solution at dialysis helps, too).


• CORRECTED CALCIUM: 9.0 (goal is 8.4 to 9.5)My corrected calcium is normal.


• PHOSPHORUS: 4.5 (goal is 3.5 to 5.5)My phosphorus was 5.5 last month, so this is exciting. This means that my phosphorus is normal and that I am doing a great job limiting high phosphorus foods and taking my binders with my meals and snacks.


• HEMOGLOBIN: 12.9 (goal is 11 to 12)Hemoglobin levels show how anemic I am, so this is always nice to be high (so I have some energy)


• AVERAGE FLUID WEIGHT GAIN: 1.86 kg or 2.7% (goal is 3 – 5% of dry weight)This is acceptable, and it feels good to me.

I again did not get my full lab report. Maybe I will be able to get a hold of it Saturday (and the one from February). I’d like to see my BUN, creatinine, and URR (all of which I was told are important).

Please continue to pray for my health. The longer a patient is on dialysis, the worse it is for them (overall). They say that you best chances for a transplant to work is if you can get one with as little dialysis as possible. Please pray for the donors and for the transplant office that all of the appointments and schedules will work out right. And, please pray for healing. If God chooses to heal me rather than to use a transplant, I will be VERY excited. I know that we do not get to pick the way that God chooses to deal with our requests, but I would like to pray for healing. I know that it is possible and that God will do what He knows is best for His glory in this situation. Thank you all for coming by to read and for offering your prayers with me. I really do appreciate it.

See you next week!

Transplant Bloodwork

I received a question the other day from one of my potential donors. She had been contacted by the pre-transplant coordinator, saying that she and I would need to get our blood drawn at the same time so that they could test her for compatibility. She wasn’t exactly sure why the coordinator had not set up anything, so she asked me for some help. I called the pre-transplant coordinator on March 7 and asked her what was going on. She said that in order to see if someone was a good candidate for the testing (for transplant) that they would need to run their blood and mine at the same time, mixing them to see how my blood reacts. So, she needs fresh blood from me. I told her rather than trying to coordinate everyone’s schedule, that she should send me some blood-draw kits, and I will have the dialysis clinic draw my blood to send to her the day before a donor has a blood draw appointment. That way, my blood is fresh, and their blood is fresh, and I don’t have to drive a half-hour downtown just to have blood taken. They already have needles in my arm at dialysis three times a week, why not take advantage? She agreed to my plan, and said that she will send the kits right out.

So, that might be slightly confusing, but it’s not. It means that I don’t have to go and get blood drawn on the same day as any potential donor. I imagine it will also be easier on my out-of-state donors (though, I can’t be sure). Surely this will simplify the whole process. I want everything to go as smoothly as possible when it comes to my possible new kidney.

I am still busy at work. Being with a “new” company hasn’t changed our work-load much, but I am supposed to receive some documentation about where my job falls within the corporate structure. It should not be much different than where I am now, but it is always nice to know.

Please continue to pray for the potential donors. I am sure that God has the right kidney out there for me, I just have to wait until He shows me which one it is. I am thankful for all of the prayers and support that everyone has been giving me. I always love comments and e-mails. Thank you all for your support and for reading my blog.

February Comment Review

Hey everybody. Thanks for coming by. I don’t have a lot of new news today. My cardiologist just doubled my Toprol XL dosage (again). I am now taking 320 mg of Diovan, 5 mg of Norvasc, and 200 mg or Toporl XL for my blood pressure. Hopefully this will solve my BP problems. I will go by her office in two weeks have my pressure taken again. I will be recording my pressure at dialysis until then (like I’ve been doing for the past 6 weeks).

So, today, I decided to review my comments from the last month. Here we go:

The following comment was left on the Jan 31 post –

At 11:49 AM, Anonymous said...
Hiatal hernias do seem to be fairly common. My mom has had one for years, and on her recent visit to the dr. last week, they said that it has shrunk. She just had her Gall Bladder out a couple of weeks ago as it was only functioning at 28%. Great news about getting on the transplant list! I take it you are on the list from now to this time next year, the have to renew?Michael
As well as –

At 5:01 PM, The Bergers said...
Nathan & Jenny! Great news about the transplant list. I am very excited to hear that. My uncle was on the liver transplant list, but through prayer he has now been moved off b/c he is doing so well and his liver is actually improving! We will pray the same for you as well...Christi & Lucas
Michael is right. I do have to basically renew my place on the list every year until I get a transplant. That way, the doctors can make sure that you still need a kidney. If the Lord does choose to heal me before I am approved for a transplant, then I will be sure to call them up and take myself off the list. My family and friends continue to pray for my health and healing, however God chooses to provide it.

I have an appointment with my GI doctor at the end of March. She did not really give me any information that I did not already know. She did not change my medications, and I did not learn much. I am hoping that she will have more information for me since my labs should be back from the endoscopy.

This comment was posted on my Feb 03 blog –

At 7:25 PM, Anonymous said...
I’ve been on PD 4 years, Congratulations for the transplant. I am 43 years woman who is in the list too. I live in Mexico and my sister lives in Garland, TX and last December I spent Christmas there. Hope you are ok.Alejandra

It’s always good to see other people in the same place as I am. I have yet to actually meet anyone on the transplant list, but it is interesting to know that others are in the area. I am hoping that I will not have to wait for a cadaveric kidney and that one of my donors will be able to donate. That will be the easiest (and best) kidney that I could get.

The last comment was from the Feb 23 blog –

At 11:26 PM, ladybug said...
just came across your website. i have igan, at pre-transplant stage. my husband is donating his kidney to me, and we are just waiting for a transplant date. i really like your blog, am linking to you.
I am glad that my blog can bring some happiness to people. I write mostly for myself, as a place to put out my feelings and thoughts as I am dealing with dialysis and my kidney disease. I also use it as a place that my family and friends can find out what is going on in my life (as pertains to my disease).

I have been reading a bit more of other people’s blogs, and it makes me feel like I have kind of slacked off in writing. When I first began, I was trying to post two or three times a week. Lately, however, I have been much busier and have been lucky to get out one post per week. I will continue to work on putting out posts, so you can keep coming to read.

And, if you link to my site, let me know, and I will come by and at least read through your site. I may not link (especially if I don’t know you), but I do enjoy reading. My Google Reader has been feeding me more RSS every day (it’s great!)

Thanks for coming by today.