Friday, April 28, 2006

April 2006 Lab Reports and More

As promised on Tuesday, I am bringing the rest of my long-overdue update. I apologize for the wait, but I have been quite busy at work and at home, so I haven’t had a lot of time for blogging recently. I will try to be better about it in the future (isn’t that what they all say?).

  • ALBUMIN: 4.3 (goal is 3.8 to 4.5)My albumin (blood protein) is normal.

  • POTASSIUM: 4.3 (goal is 3.5 to 6)My potassium level is normal. I am doing a good job with the potassium in my diet.

  • CORRECTED CALCIUM: 8.7 (Goal is 8.4 to 9.5)My corrected calcium is normal.

  • PHOSPHORUS: 6.6 (Goal is 3.5 to 5.5)My phosphorus is high (up from 4.3 last month). The dietician recommended that I watch my diet and make sure to take my phosphorus binders with all meals and snacks.

  • HEMOGLOBIN: 11.2 (Goal is 11 to 12)My hemoglobin is normal, and my anemia is under control.

  • AVERAGE FLUID WEIGHT GAIN: 2.31 kg or 3.3% (goal is 3 – 5 % of dry weight unless you have sign and symptoms of fluid overload).This is Acceptable.

  • HEMOGLOBIN A1C: 4.9 (Goal is less than 7.5) My hemoglobin A1C is well-controlled. This means that my average glucose (blood sugar) has been normal for the last three months.

  • PTH: 415.6 (Goal is 100 – 300)The parathyroid hormone is too active. This means that I started receiving Hecetor (Vitamin D) during dialysis.

So, the lab report was not all good news like it normally is. My phosphorus was way up, which is not a good thing. Too much phosphorus can make your bones brittle. The other problem was the parathyroid hormone, which I have no control over. Hopefully the Vitamin D that they inject into my blood each week will help balance that number out. The only negative side effect is that it can cause your phosphorus to go up. I guess I’ll find out in May how I did with my diet and see if I can get off of that Vitamin D shot.

On Monday, April 24, I went to see the endocrinologist. I actually just saw a nurse practitioner who wrote me three prescriptions for blood work to be drawn at dialysis. They want to see my thyroid hormone levels in April, June, and July, and then to follow-up with me after that. She said that since I have not been exhibiting any symptoms, that I am probably doing okay, but she needs to see the lab reports to make sure.

On Tuesday, April 25, I went to see my vascular surgeon to follow-up, one month later, on my new fistula surgery. He removed all the stitches (not so pleasant) and then ran an ultrasound over the fistula. He said that it looks like it is healing nicely and is developing at a good rate. He scheduled another appointment for one month later, and said not to use the fistula before then. I guess he will check it at the end of May to see if it is ready for dialysis. If so, then I can get off of the chest catheter, and I can go back to using a fistula like a normal dialysis patient. The fistula is a little easier to care for, and gives you a better treatment, so I ultimately want to get back to using a fistula.

I have had dialysis on Tuesday and Thursday this week already. The treatments have been going fine, right up until the very end. After I have finished my treatment and have been removed from the machine, they like to take one final blood pressure with you standing up. On Tuesday night, the pressure was only 93/61, and they wait about fifteen minutes for me to get up to 110/69. Thursday night, my pressure was 94/58, and they waited about ten minutes to get me up to 113/60. My standing blood pressure (at the end of dialysis) has been low since Tuesday, the 18th. I wish this would balance out so I could go home when dialysis is finished.

My gastroenterologist called this week. She thinks that my stomach-ache problems might be caused by my gall bladder. There is a test that can be run (inject a dye and watch it go) that will tell her if the gall bladder is the culprit responsible for my pain. I have this appointment scheduled for Monday.

Here are my prayer requests for today:
  • Pray that the gall bladder scan goes well, and that the GI doctor will learn what she needs to learn to help me

  • Pray that my blood pressure will get to where it needs to be at the end of my dialysis treatments

  • Pray for my dad as he is being scheduled for testing as a kidney donor.

Thanks for coming by to read. I’ll try to be better about updating next week.

Tuesday, April 25, 2006

Two Weeks Later: An Update

Hello everyone! I know what you are thinking. It has been nearly two weeks since I have posted to my blog. Just so you know, I have not died, so you don’t need to delete your bookmarks just yet. I have been extremely busy at work, and I’ve had my share of ups and downs with dialysis, so it’s been quite eventful. I will try to summarize the goings on today.

The last time you heard from me was on Wednesday, April 12. I had spent three hours (overnight) in the emergency room thanks to a terrible dialysis treatment. I was dehydrated, feverish, and nauseated (which is not a good combination). They treated me and sent me home. The ER doctor said that he really didn’t know what was wrong with me and was sorry that he could not help more.

On Thursday, April 13, I had another treatment. It went much better. We upped my dry weight from 69.0 kg to 69.5 kg, which seemed to help quite a bit. My heart rate was still higher than it should have been after my treatment, but I think that had a lot to do with my medication being wrong. When I stood up at the end of my treatment, at about 8:45, I had a blood pressure of 88/55 with a pulse of 151. They kept me for observation for almost an hour. They gave me some water and had me sit back down. When I left around 9:30, my blood pressure had gone up to 127/60 with a pulse of 104 (while seated) and a blood pressure of 90/51 with a pulse of 135 (while standing). I promised that I would go to the ER if there were any problems, and I assured them that I had a cardiology appointment the next day.

On Friday, April 14, I had an appointment with my cardiologist. I brought her a list of my blood pressures at dialysis, which showed that my pressure was low with a high heart rate at the end of my treatment (ever since I had stopped taking Toprol XL about two weeks earlier). So, my cardiologist changed my blood pressure medications, again. She told me to stop taking my 5 mg per day of Norvasc. She said to reduce my 320 mg per day of Diovan down to 160 mg per day. She also added in 25 mg per day of Toprol XL. In addition, she set me up with a 30-day event monitor to watch my heart for the next month to make sure I am not having any “real” problems. The heart monitor isn’t difficult, it just makes showering that much harder.

So, my dialysis on Saturday, April 15, went a lot better. My pulse was still in the 100’s when I left, but since it was not in the 150’s, so they were not as worried about me. The treatment on the 18th (Tuesday) went well, as did the Thursday treatment (April 20). The next problem I had, with dialysis, was on Saturday.

On Saturday, April 22, my chest hurt around my catheter all day long. Every time I moved my arm, or used the muscles in my chest, I had shooting pain go from the catheter out towards my sternum. I thought it might not be so good, so I decided to complain at dialysis. I went to dialysis, and they cleaned the catheter insertion point like they always do. While the nurse did this, I mentioned how much it hurt for her to touch it or for me to even use those chest muscles. She told me that there was not redness, swelling, or pus, so I should not worry about it. I told her that it still hurts, even if it doesn’t look like it.

At the end of the treatment, the nurse did quite a bit of tugging on the catheter tubes while unhooking me. This was very unpleasant (as you might imagine). I winced and decided to give it a few minutes to get better. I took some Tylenol when I got home, but my chest was still bothering me. I called the insurance company 24-hour, toll-free nurse line and gave them my symptoms. The phone-a-nurse said I should probably go to the ER, even though she didn’t think there was a problem. It’s one of those “better safe than sorry” policies that you are always glad exist when you DO have a problem.

Jenny and I went back to the emergency room (this time, it was only about 10:00 pm). The nurse at the registration desk was the same one who checked me in last time, so she moved me into a room within about 15 minutes, even though I told her that my chest pain was NOT heart related. I laughed when I saw the doctor, because he was the same doctor that I had seen a week before that didn’t know what my problem was with my elevated temperature and blood pressure. This week, he ordered an x-ray and had me sit for a while. When he came back, he told me that he was again dumb-founded. I had presented him with symptoms that he could not quantify, and he said to take some pain medication and get some sleep. I told him that I would try not to come back next week with yet another impossible problem.

That pretty much catches you up to today. I’ve got a few more updates, but I think I will wait and try and get those posted tomorrow so that this post doesn’t go too much longer. Look forward to a riveting account of my visit with my vascular surgeon, my endocrinologist, my April Lab Reports, and hopefully a fistula update.
Thanks for bearing with my long absence and long post. Enjoy your day!

Wednesday, April 12, 2006

Bad Tuesday Dialysis

Tuesday night's dialysis treatment did not go all that great. I was okay for a little over three hours, but during about the last fifteen minutes of my treatment, I started to not feel so well. I was kind of light-headed and dizzy, with a bit of a headache, and I felt slightly nauseated. I told the technicians, and they gave me back some of my fluid. At the end of the treatment, I was still not feeling well, so they gave me back some more saline (500 ml in all). I stood up to give my final blood pressure and it was 90-something over 50-something with a pulse around 140 bpm. The nurse told me to sit down and to wait to see if it would balance out.

I stayed at the clinic for another half an hour waiting for my blood pressure and pulse to get within their normal ranges. The blood pressure remained low each time I stood, and my pulse was always much too high (usually in the 130's or 140's). The nurse wanted to call an ambulance, but I had my wife come to dialysis and pick me up, instead. I assured the nurse that I would go to the emergency room if I felt worse or did not start feeling better.

When I got home, I laid in bed for about 30 or 45 minutes waiting to feel better. I finally decided to check my temperature, thinking that I would go to the hospital for anything over 100.4. It turned out that I had 101.1, so we hopped in the car, and we went to the emergency room. I guess I had not been to the hospital with a problem in too long, and my body must have just missed it there.

We got to the hospital around 11:30pm. They got us in to see a doctor right before midnight. We talked about my symptoms and my dialysis, and we figured that a little more saline would probably help with my light-headedness. So, they gave me 250 ml of saline, and I laid on the short, uncomfortable ER bed for another hour. When the nurse came back, I was feeling less dizzy, but now I was much more nauseated than when I had come in. The doctor gave me some nausea medicine and let me lay there for a while longer.

He finally came in to say that he could either send me home, or admit me to the hospital for observation. He said it would be observation only has he had no idea what was wrong with me. By this point, I was feeling mostly better, albeit tired, and was ready to go home. I told him to just send me home, and that if I got to feeling worse after having some sleep, that I would come back to the ER to see him.

I went ahead and went to work today, even though I was a bit tired. I did not have any dizziness symptoms, though there was some nausea. The nausea did not bother me as it is not infrequent in the mornings for me. I took my temperature when I awoke and after I got home, and both were normal. Even now, right before I typed this, I was only up to 98.8 degrees.

Please pray for me that Thursday night's dialysis treatment will go better. I think I am going to ask them to raise my dry weight another half a kilogram to 69.5 kg. That will mean that I get to keep a little bit more fluid, and hopefully will help prevent me from having to take another trip to the ER. I appreciate and need your prayers. Thanks a lot!

Tuesday, April 11, 2006

New Fistula Follow-Up

I just got back from the vascular surgeon. Today was my one week follow up for the new fistula that he put in (back on Monday, 4/3/06). He unwrapped my bloodied bandages, and felt around my bruised skin. He then put the ultrasound wand over the fistula (which is a few centimeters above the incision) and took a look inside. He said that he liked what he was hearing and seeing, and he said that the fistula looks like it is doing just fine.

I am scheduled to come back in two more weeks (three weeks after the surgery) to have my arm looked at again. He said that at that time he may remove the stitches (depending on how well I am healing). It is not a problem that my incision is still leaking a little blood. In fact, it’s just part of the healing process, and my arm is healing fine. It takes several weeks for a surgery like the one I had to heal completely.

So, all-in-all, life is going well. My arm is not quite stretching out completely without pain, yet, but that is part of the healing process. My dialysis has been going mostly okay recently. The only exception was a week or two ago. I had what seemed like a good treatment, but I was awake for the next hour feeling hot and nauseated. I haven’t had that problem again, and I think it may have been caused by taking off too much fluid. So, I am sticking with my 69.0 kg weight and hoping that everything works from there.

My work life is going well, too. The person that helped me get my job left the company on Friday, and I am slowly working my way in to covering his old duties. He worked on many things in a lot of areas, so it may be two or three weeks before I feel competent. The good thing is that this job is full of challenges, which is what I really enjoy.

I continue to desire your prayers this week. I have had two family members and two friends get their blood tested for kidney transplantation. The transplant coordinator should contact me soon to let me know the results and have me think about picking someone out to be fully tested. Please pray that God will show me the right person to have tested and that the testing process goes quickly and smoothly. Also pray that I will continue to do well while I am on dialysis.

The pastor at our church spoke last Sunday about bringing glory to God through our lives. He said that glory is just raising the opinions that others have about someone or something. So, I want to live my life, kidney disease and all, so that it raises other people’s opinions about God. I want to be a good example of a Christian. Please pray with me that I will continue to show those around me how wonderful God really is. Thanks!

Friday, April 07, 2006

Fistula Number Two

I told everyone that I was having fistula surgery this week, so I figured it was about time to share an update. On Monday, April 3, I had surgery done on my upper left arm (above the elbow) to put in a new AV fistula. The old fistula (which was done on my left wrist) had stopped working, and they could no longer use it for dialysis. So, the doctors mapped out my veins, and found that the best candidates were in my upper left arm.

Monday, around 11:00 am, I was wheeled into surgery. I don’t remember much after that, but when I came out, my arm was very sore and did not want to straighten out. I wasn’t worried about that, since the surgery I had previously had on my elbow had also made my arm stiff for a few days. The doctor had wrapped my arm in gauze from the elbow to the shoulder, and I could see several dark stains along the wrappings. He said to leave the bandages on and that they could change them in dialysis on Tuesday.

I stayed home from work on Tuesday to help facilitate recovery (and since I was still taking pain medication all day long). I went to dialysis, and the nephrologist came by and felt a strong thrill in my upper arm. It is still pretty sore, but the thrill is very strong and that is a good sign, especially since the thrill had completely died out near my wrist.

The nephrologist said to change the bandages, but did not want to remove the gauze that was directly on the surgical wound. He said I could do that in a couple of days. I changed out the gauze on Thursday night, and the scar is not pretty. I would guess that there is a four to five inch line of stitches holding my upper arm together. It was still bleeding a little bit, so I put on new gauze and bandaged my arm up again. It’s Friday now, and the scar area still hurts. I still cannot stretch my arm out fully without pain, but my elbow does bend all the way out now, which is good.

Let’s see, what else has happened this week. Last week (or two weeks ago) my dad and aunt sent in blood work to be run against mine to try and match up for kidney donation. This week, two non-related friends of mine sent in blood samples, and I sent in another set to be run against theirs. I spoke to the transplant coordinator today about the blood testing. She said that my dad is guaranteed a 3 out of 6 match (because all parents have at least a 3 out of 6 with their children). She did not have the results for anyone with her, so she could not give them to me over the phone. Hopefully she will call when she gets everyone tested.

She said that based on what the four donors that sent in blood test, I will probably just end up having to pick someone to get tested. I’m not sure who that will be, yet, as I have not seen the results. Please pray that God will make it obvious to me who needs to be tested for kidney donation. Thanks!

I would also ask that you pray for my arm to heal. Normally I play the violin at church on Sundays, but I cannot do that with my left arm out of commission. Pray that it will heal quickly, and that the fistula will mature properly for the next eight weeks. I grew tired of my chest catheter the last time I had one, and I know that I will soon stop enjoying this one as well.

Thank you for your continued prayers and support. Just keep praying that God will help me with my transplant decisions that I have to make in the next several weeks.