Bye Bye Gall Bladder

Hi, this is Jenny, Nathan's wife. He asked me to write and let everyone know how his gall bladder surgery went this morning. He was in surgery for about an hour. The doctor said things went well and there were no problems or complications. His blood pressure dropped once during the procedure, but it came back up when they gave him some extra saline. They think he was probably a little dehydrated from a combination of not eating and last night's dialysis.

Nathan has minimal scarring; four tiny incisions, two of which are on the kidney scar. He is pretty uncomfortable, but we're at home resting. He's hoping to be well enough to return to work on Tuesday. He was glad to get Monday off as a holiday.

We talked to the transplant coordinator this morning to let her know about Nathan's surgery. She said she temporarily changed his status on the transplant list to Level 7, which is like being on hold. She is going to check for us to see how long he will remain at that level. I would guess 4 to 6 weeks. She explained that even though he is “on hold” that he is still accruing time on the list. He will not have to start over with his amount of time spent on the list.

Please pray that he recovers quickly and will be able to return to work soon. We're hoping to be at church on Sunday if Nathan feels up to it.

Thanks for coming by to read! I'm glad Nathan allowed me to be a guest writer. Maybe I'll get to come back again when he gets his transplant. :)

Laparoscopic Cholecystectomy

I went to see my vascular surgeon Tuesday afternoon to talk about my fistula and my gall bladder. The appointment was originally set up so that the surgeon could say that it was okay to start using my new upper arm fistula. However, since my catheter was not working as well as hoped on Saturday, they used one needle in the fistula then. The appointment turned out more to be us talking about my fistula and us setting up a surgery for my gall bladder.

I’ll start by telling you about the gall bladder. I am having a “Laparoscopic Cholecystectomy”, which just means that they are using four very tiny incisions to remove my gall bladder, rather than slicing me open to fish it out. I have been having a lot of nausea and stomach pain since my kidney was removed last year (it has been almost exactly one year). The gastroenterologist had done several different abdominal scans, and she decided that my gall bladder could be the cause of my problems. A couple of stones showed up on the scans (I saw them) and it seems that removing it would be a good idea. The surgeon said that he would rather take it out now then to have it cause an infection after I get my kidney transplant and cause me to lose the graft (“the graft” is what people in the kidney transplant business call the transplanted organ, just so you know).

I have an appointment for Friday morning (11:30am) to have my gall bladder removed by the same surgeon who has done all of my fistula surgeries. By using the same surgeon, I don’t have to add any more doctors’ business cards to my already full wallet. But, it also gives me the assurance that this doctor knows about my other conditions. I also trust his surgical abilities, as he has not had any problems, yet.

Additionally, the surgeon and I talked about my fistula. My nephrologist had been worried that the new fistula was too short and curvy to be of any use. The surgeon explained to me what had happened. When he laid the vein after moving it closer to the surface of my arm, he put it in a nice smooth arc. He said that after you connect it to the artery (making the vein a fistula) that it can get “scrunched up” a little bit. So, rather than maintaining it’s perfect arc, it ends up with a small curve. He showed me the vein on the sonogram, and it seemed to be fairly straight. He said part of what the nephrologist might have seen was some bulged areas of the fistula. The fistula is a little wider in some places than it is in others, and that might feel like curves if you are in a hurry (which the nephrologist always is). The surgeon said not to worry about the vein. If the technicians do have problems with sticking it, then he can always go back in (another surgery) and tie the vein down in a straighter line. So, the nephrologist said to leave my chest catheter in for a few weeks while we start using this new fistula. That way, if the surgeon needs to put in some ties to straighten it out, I will still have an available dialysis access (regardless of the fact that it does not work too well).

The nephrologist also prescribed Fosrenol for my high phosphorus. Since my calcium was near 10, he did not want to have me add more PhosLo. Instead, he added a new medication to take after meals that will help bind the phosphorus in my diet. I will probably send that prescription off tomorrow and will have it in a few weeks. It won’t be early enough to help on my June labs, but maybe by July my phosphorus levels won’t be so dangerously high.

Please pray for me as I have surgery on Friday. Also, continue to pray for my dialysis treatments. They are running me slowly with this new fistula, and I don’t think I am getting as good of a treatment. I have not felt well since Saturday. Hopefully that will clear up as my fistula matures and it can run a faster dialysis treatment. And, continue to pray for my dad’s lab results. I will let everyone know as soon as I hear something. Thanks!

Started New Fistula on Saturday

I had another exciting dialysis treatment on Saturday. Normally, the dialysis treatment runs without issue for four hours, and then you go home. On Saturday night, however, I was not so lucky. My machine was having trouble with the arterial pressure. The arterial pressure is the amount of suction that the pump has to use to remove the blood from your body. If the pressure gets out of range, that can be very dangerous, so the machine stops drawing out blood. I was having problems with my arterial pressure after about five minutes on the machine.

The nurse tried everything she could think of, including laying my chair down flat and switching the lines on my catheter. Since nothing was working, she called the on-call doctor and asked if she could use one needle in my new fistula. This is the fistula that was placed above the elbow on my left arm almost seven weeks earlier. The doctor said yes, so the nurse placed one needle in my arm, and left the other in my chest catheter. The needle did not hurt too much going in, which was nice. I still had pressure problems with my catheter, and they ended up switching which side of the catheter they used about three more times during the next three hours of my treatment. The bad part of it all was that I don’t think I got as good of a treatment with the machine running slower and it stopping all the time.

Sunday morning when I woke up, I felt sick (which is not abnormal). Before we were ready to go to church, however, I began to vomit. This did not make me feel better, so we stayed home from church. I felt pretty sick for a couple of hours, and did not try to eat again until almost 11:00 am. The soup stayed down, so I figured that I was better. I did not really feel better until after I took a nap (I hadn’t slept well Saturday night). By Sunday evening, I felt better, and I did make it to work on Monday.

I have an appointment with the vascular surgeon Tuesday morning. I’m not really sure how it is going to go. Since they have started using my fistula, I don’t suppose I really need his permission to use it. I have to make him page my nephrologist so that they can talk about my fistula, but aside from that, the fistula information should be easy. I am also supposed to talk to the vascular surgeon about my gall bladder. The GI doctor thinks that it needs to come out, so I have to see if he has read my records and if he agrees. If so, that’s one more surgery that I have to schedule and another delay in the transplant (if my dad is approved as a donor).

Please continue to pray for the transplant team as they process my dad’s results. I would like to know as soon as possible whether or not he will be a good donor for me. Also, pray for my appointment with the vascular surgeon on Tuesday morning. I don’t enjoy talking about having more surgery, but I want to do whatever will be the best for me. And, pray that my arm will finish healing. The needle didn’t cause many problems for me, but the skin is still quite sensitive around the surgical incision, so the tape that holds the needle in place was kind of painful to remove. The skin was red for quite a while. I am hoping that it will heal or toughen up a little.

Thanks for reading with me today.

Friday, May 19, 2006

My last post was last Friday. I’ve had a few adventures in the past week, so I will do my best to describe them for you. On Saturday, May 13, I had my normal dialysis treatment. At the end of the treatment, when it was time to go, I had a very low standing blood pressure of 82/53 with a pulse of 129. I stayed at dialysis for about another hour waiting for my blood pressure to get up. They gave me almost one liter of saline, but it didn’t seem to help. They told me to go to the emergency room because my temperature was up a little bit, I was not feeling well, and my blood pressure was too low. The hospital didn’t really do anything, but I was feeling better by the time I got there. We were in the ER for about three hours before we went home.

Sunday was a pretty good day. I completed my 30-day heart monitor and got to mail it back in. My dad came down to Dallas to be tested as a kidney donor. He had tests all day Monday and Tuesday to find out if he will be a compatible match for me. Please pray that the test results come back quickly so that they will know what they want to do (either use my dad or test another donor).

On Monday, I had an appointment with my cardiologist. I told her of my multiple trips to the ER in the past 30 days and of my low blood pressure, and she decided to adjust my medications again. She changed my Diovan from 120 mg per day to 80 mg per day. She told me to continue taking 12.5 mg of Toprol XL per day as well. I started the new, lower dosage on Tuesday, so I haven’t had a lot of chances to see how if it is helping. The nephrologist also made a change at dialysis, so the combination of the two may be what is working for me (and I am fine with that).

On Tuesday night, I mentioned to the nephrologist about visiting the ER and having the low blood pressure at the end of my treatment. He suggested that I start using UF profile 2 for my treatments. Now, I did not know what that was, so I asked. It is a setting on the machine. Profile 1 is the normal setting. If I come in to dialysis and need to have 2000 ml of fluid removed, then Profile 1 will remove the fluid at a rate of 500 ml per hour for the whole treatment. Profile 2 would start out removing 1000 ml per hour, and drops throughout the treatment so that I am only having 300 or 400 ml per hour removed at the end of the treatment. I would give you the exact formula, but I didn’t record the starting and ending UF rate. When I do, I will plug it in to a y=mx + b type equation and let you know (I know you are excited).

Suffice it to say, the combination of less blood pressure medication and a new UF profile on my dialysis machine have helped. My final blood pressure on Tuesday night was 110/62 and my final pressure on Thursday night was 95/61. I left both nights feeling fine. Oh, and UF is ultra-filtrate, which is the amount of fluid that the dialysis machine removes during your treatment (for those of you that aren’t on dialysis).

I have a few prayer requests for the week. Pray for my dad’s test results. Pray that we will get them quickly so that we will know what to do. Pray for my doctor’s appointment on Tuesday. I go to see the surgeon, and we will be talking about using my fistula and about gall bladder surgery. If I have surgery, it will delay the transplant by about a month (if my dad is a compatible candidate). Pray that all will go well with whatever the doctors decide that they need to do. Thanks for coming by to read today!

May 2006 Labs

Well, it’s Friday afternoon, and it looks like it has been over seven days since I last posted. I have my lab reports from May for you today, as well as some information on the stomach ache front.

ALBUMIN – 4.6 (Goal is 3.8 to 4.5)

eKdrt/V – 1.56 (Goal is greater than or equal to 1.2)
Your eKdrt/V is adequate. You are receiving enough dialysis.

POTASSIUM – 4.1 (Goal is 3.5 to 6)
Your potassium level is normal. You are doing a good job with the potassium in my diet.

CORRECTED CALCIUM – 9.9 (Goal is 8.4 to 9.5)
My corrected calcium is high. Check with the doctor for more information.

PHOSPHORUS – 7.2 (Goal is 3.5 to 5.5)
Your phosphorus is high. Your Dietician will review high phosphorus foods to avoid. Take your phosphorus binders with meals and snacks.

HEMOGLOBIN – 13.2 (Goal is 11 to 12)

Average Fluid Weight Gain: 1.78 kg or 2.6& (goal is 3 – 5% of dry weight unless you have signs and symptoms of fluid overload). Your nurse will discuss this with you.

So, as you can see, everything is going fine, except for my phosphorus level. It had been under control for four months, but the last two months it has been high. The dietitian went over all of the high-phosphorus foods with me and discovered that my diet is very good in relation to high-phosphorus foods. I told her that I am taking two of the Phoslo pills with each meal and that I rarely snack. So, she gave me a sample of Fosrenol to try out. Fosrenol is an after-meal chewable pill that helps bind phosphorus without raising your calcium levels. It is apparently very expensive, so she wanted me to check with my insurance to see if it was covered. It is, so we will ask the doctor to prescribe it for me next week. That’s just one more thing to add to my list of medications.

In other news, I had a NM HIDA scan on Monday, May 1. That is a nuclear medicine scan on the gall bladder that tests to see how well the gall bladder is working. Mine apparently has a low ejection fraction (near 30%). I’m not sure what that means, or what a normal ejection fraction is, but mine is low. The gastroenterologist referred me to a laparoscopic surgeon to talk about surgical options for removing my gall bladder.

I saw the surgeon on May 11, and he said that my gall bladder is not working correctly. He also said that he would recommend me having my gall bladder removed because of my upcoming kidney transplant. He said that he would hate to leave the gall bladder in there and for it to cause an infection once I get my new kidney and my immune system is suppressed. He said my best bet was to have it taken out ahead of time.

He also referred me back to the surgeon who did my vascular surgery. It seems that he also does laparoscopic surgeries. I have an appointment with him on May 23 already, so I will just talk with him about my gall bladder then. Hopefully we can schedule a surgery for a Thursday, to give me the most time to recover (the pamphlet says that it can take 5 – 10 days to get back to work after the surgery, even though most people go home within a few hours of the procedure). It is laparoscopic, which means that they cut tiny holes which helps speed the recovery process.

Please pray for the surgeon as he looks over my records and decides about removing my gall bladder. Also, keep praying for my fistula. I go see the surgeon on May 23, and he should tell me whether or not the new fistula is ready to use for dialysis. If it is ready, then I can start using it and eventually get off of this catheter. Pray that the new fistula will work well and not have any problems.

Thanks for reading!

Long Week

Hey everyone. I realize that I have not posted since last week, and I am trying to make up for that today. I am sitting in dialysis at the moment, and I thought I'd take a minute to update everyone.

This week, I spoke to the GI doctor several times. She ran a test on my gall bladder to see if it was misbehaving. The test said that my gall bladder ejection was abnormally low (around 30%). She advised that I go and talk to a laproscopic surgeon to find out more about my options. I have an appointment next week to meet the surgeon. Maybe I'll find out what is going on from him in terms of my stomach problems.

I came in to dialysis almost 4 kg overweight on Tuesday. I don't tolerate taking off that much fluid, so I had them only remove 3500 cc of fluid. That had me leaving dialysis at 69.9 kg instead of my usual 69.5.

Wednesday night, I woke up very sick. My stomach hurt and I vomitted several times (emptying my stomach). I called in sick to work, and eventually got back to sleep. I was sick most of Thursday morning, but felt well enough to eat some soup for lunch. I fell better now, and expect to go back to work tomorrow.

My weight at dialysis was 70.1 kg when I came in today. That means I only put on 0.2 kg in two days (thanks to being sick).

I don't have anything else today. Please continue to pray that the transplant process will keep moving along. Also pray for my health. Being nauseated is no fun. Thanks for reading and for praying.

My blood pressure is still a little low and my pulse remains a bit high. I see the cardiologist in a couple weeks so I hope to know more then.

Good-bye, and good night.