Wednesday, May 24, 2006

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!
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