Tuesday, June 27, 2006

Another Week

I see that it has been almost one full week since I posted last, and I apologize. I should post more often, because it keeps people from having to ask me (in person) over and over how I am doing. I don't mind telling everyone, but I do think it is probably easiest if they can just read my update as it happens.

The technicians were able to stick my fistula on Tuesday, Thursday, and Saturday of last week. Each time, they did the two needles both pointing up. This results in a slightly slower treatment, but they got better through the week. My kT/V went from 1.02 on Tuesday to 1.28 on Saturday (with the machine running at 300 ml/min for nearly 2 1/2 hours). The target rate is 1.4, so I am getting closer. The technician also showed me another number, but I don't recall what the number was or what it means, so I won't try to list it here.

I've got another treatment scheduled for this afternoon. I'm going to stay with the 17-gauge needles for at least one more week. I am not quite ready to stress out my squiggly fistula with big honking needles. I'd rather the fistula develops for at least another week before we try and stick anything bigger in it. If nothing else, I have an appointment with my vascular surgeon on Thursday, so I can ask him what he thinks.

I might also ask the vascular surgeon if he thinks that they should be able to go up/down with the needles like they are supposed to. If so, I will suggest it to the technician on Thursday night (if I trust her). Hopefully, I will get a good tech tonight (and all week) that will not cause me any harm.

So, please pray that my treatment will go well tonight and that there will not be any problems. I have been doing well, with the machine running fairly quickly (the max with this sized needles is 300, so that's is the goal).

Please pray 3 John 1:2 for me this week: "Dear friend, I pray that you may enjoy good health and that all may go well with you, even as your soul is getting along well."

Wednesday, June 21, 2006

After Tuesday's Treatment

I am posting today to let everyone know how Tuesday night's treatment went. The technician brought out the 17-gauge needles, and was ready to stick me. I had prepared my arm with the Emla cream, and it had a small numb area. The technician put in the first needle, the venous, and it did not pulse. This is a problem, as the blood needs to flow in order to have dialysis. So, she poked around for a little while, and finally pulled that needle out.

She decided to give the arterial needle a try next. She stuck it in, and some black goo oozed into the needle. This isn't good, she said, it's already clotted. So, we pulled that needle out and decided to start again. By this time, the first spot had stopped bleeding. The technician decided to run both needles in an "up" direction, since there didn't seem to be enough room to go down. I'm not exactly sure why there would be room to go one way and not another, but I guess that's what makes me a patient and not a dialysis technician.

So, the tech stuck in the first needle facing up instead of down. This is alright, but does not give the best treatment. She had to quickly flush the line with saline, because my blood wanted to clot right away. It was very thick Tuesday night, and I am not sure what caused that. I wonder if it had to do with all the bruising that has recently gone down in that area.

She ended up finding a spot to put in the second needle, also facing up. She had to quickly dilute that needle with saline as well, since my blood was still attempting to clot. She got some Heparin into my line, and then hooked me up to the machine. She ran the machine at 230 ml/min for most of the night with no problems. My only real complaint was that my arm still does not quite bend all the way out, so it wasn't exactly comfortable to sit in the chair with my arm at a funny angle.

So, thank you all for your prayers. Keep praying that they will be able to stick me correctly and that my blood won't try to clot the second that I am hooked up. I'd also enjoy having the machine slowly run a little faster, so that my blood gets a more thorough cleaning. Thanks for checking in on me. E-mail or comment if you have any questions!

Special thanks to Connie Parr for letting me know that she was praying yesterday!

Tuesday, June 20, 2006

Tuesday, 6/20/06

Well, today is Tuesday, June 20, and I have another dialysis treatment tonight. The treatment went slowly all last week, and on Saturday, the nurse suggested that it might be time to go back to my fistula on Tuesday (today). The bruising went down quite a bit over the weekend, and I can stretch my arm almost all the way out today. I imagine that, barring any problems, it will be fully healed by next week. That's only three weeks of pain for one bad stick, I guess that's okay.

I brought my numbing cream with me to work today. It contains Lidocaine 2.5% and Prilocaine 2.5%. I put this cream on my fistula approximately one hour before my treatment. It numbs the area under it which helps with being stuck. When I was using my fistula on my lower arm, it did not hurt too much. But, on my upper arm, the skin is more sensitive and is hurt more easily. So, I am using this cream to help reduce the pain of the needles going in.

I am praying that the treatment today will go well. I am praying that the technician will be able to get a good stick and that there will not be any problems with the fistula. I plan to use the small 17-guage needles for at least two weeks, to help the fistula mature (but at a slow steady rate).

If you read this Tuesday before 4:30 pm CDT, then please pray that I get a good treatment and good sticks tonight. If you read it after, then just pray that my fistula will work properly all week and that there will not be any problems.

Thanks for coming by!

Wednesday, June 14, 2006

June 2006 Lab Report

Well, it is time once again for lab reports. This month, everything sounds like good news, so be glad (and thank you for all of your prayers).

Albumin – 4.6 (goal is 3.8 to 4.5)

enPCR – 0.59 (goal is greater than or equal to 0.8)
Your protein catabolic rate (protein intake) is low. Eat more: fish, seafood, chicken, turkey, lean red meat, lean fresh pork, eggs, or cottage cheese.

eKdrt/V – 1.28 (goal is greater than or equal to 1.2)
Your eKdrt/V is adequate. You are receiving enough dialysis.

Potassium – 4.7 (goal is 3.5 to 6)
Your potassium level is normal. You are doing a good job with the potassium in your diet!

Corrected Calcium – 9.4 (goal is 8.4 to 9.5)
Your corrected calcium is normal.

Phosphorus – 5.0 (goal is 3.5 to 5.5)
Your phosphorus is normal. Great job limiting high phosphorus foods and taking your binders with meals and snacks!

Hemoglobin – 13.3 (goal is 11 to 12)

Average Fluid Weight Gain – 2.23 kg or 3.2% (goal is 3 – 5% of dry weight unless you have signs and symptoms of fluid overload).
Your nurse will discuss this with you. (Acceptable)

So, as you can see, my lab reports all looking great this month. My phosphorus went down from over 7 last month to 5.0 this month. This is a good thing, as I do not want to have squishy bones when I grow up. So, I will keep watching my phosphorus levels, and I’ll try and keep them low. I want to watch all of my labs, but that is the one that I’ve had the most trouble with.

Fistula update: my arm is still quite bruised and sore. I cannot straighten my arm out fully, yet, due to the pain. My bicep is bruised from the elbow to the clavicle (all the way over the bicep muscle). I’ve been using a heating pad and an ice pack (though not at the same time) to try and reduce the bruising and swelling. My arm has gone from a very dark patch to a big brown area of pain. I did not let them stick me on Tuesday, and I do not plan to let them stick me until my arm feels better. Thankfully, my catheter worked fairly well Tuesday night, and I was able to have a treatment at about 270 ml/min (which is not fast enough, but it’s better than the machine stopping every two minutes).

I guess that’s all for today. Keep praying that my arm will heal quickly so that I can go back to using my fistula. And, pray that when I do go back to using the fistula that it will work properly and not have any problems with the needles. Also, keep praying that we will get the payments for the transplant testing worked out with the insurance company so that I can get some more people tested. Thanks for coming by to read!

Saturday, June 10, 2006

Catheter Again

So, today is Saturday, June 10, and I am writing to you from the dialysis chair. There are 15 minutes left on my treatment, so this post might be kind of short. I thought I would update everyone on how my treatments have been this week, and what kind of trouble my fistula has been having.

Tuesday night, I was hoping for a better stick in my fistula. Unfortunately, only one needle really got in well. The second needle caused a bit of infiltration, which made my arm swell up a bit (rather quickly) and hurt really bad. I had to do my treatment with the catheter, and it did not run very well at all. It stopped and started all night, and it was hard to keep still while holding a glove full of ice on my swolen and bruised arm.

And, let me tell you, my arm got bruised. The worst pain I had was trying to remove the one needle that they had inserted, and hold it to stop bleeding. It was really not enjoyable, and removing the tape that was holding in the needle was unpleasant to say the least. I left with one bandage taping up the small hole in my arm, and I could barely move it. It felt as if I had bruised my entire bicep, making it nearly unbearable to bend my arm.

I slept with the arm elevated, and it felt better in the morning. When I looked at it, though, it was kind of disgusting. There is a large hematoma (bruise) all around the area where I was stuck, minus a square when the bandage had been pressing, keeping the blood from pooling there under my skin. The pain was less, and a warm shower felt nice. My arm is still sore today, but it is much better than it was Tuesday night.

I used the catheter again on Thursday and Saturday, since my fistula is still quite bruised. The doctor mentioned that we should probably wait a few treatments before we go back to trying to stick me again. I also think I am going to have them use the 17-gauge needles for at least two weeks, since they tried 15-gauge on Tuesday night. Hopefully, using the 17-gauge will help my fistula develop a bit better before I try and use anything larger.

The only other problem was that my catheter did not work on Thursday. They had to use an unclotting medicine (which stays in the catheter for thirty minutes) to get it flowing again for my treatment. This meant that I had to stay later, but at least the machine was able to run better. Previously, it had been stopping every couple of minutes because it could not return my blood. Today (Saturday), I am doing great. The machine ran at 300 ml/min and only stopped a few times during the whole four hours.

There are only a few minutes left in my treatment, so I will try and wrap up. My blood pressure is 116/63, with a heart rate of 96. If you remember back to a few months ago, this is a huge improvement. I think that my current medications along with the "profile 2" that they are using to remove fluid, has really helped. I hope to continue to do well with this combination.

Please pray for my arm and fistula this week. Pray that the swelling and bruising goes away, and that my fistula will be ready to use again (soon, but not so soon that it causes problems). The insurance company called, complaining about paying for my dad's transplant testing. Pray that that will get worked out so that I can get started on testing someone else.

Thanks for coming to read my chronicles. They may not be as fanciful as Narnia, but they are mine. Enjoy!

Tuesday, June 06, 2006

Saturday's Update

Welcome to Tuesday everyone. I have another dialysis treatment scheduled for this evening, but I thought I’d try and update everyone on what happened Saturday night. My treatment was not as good as it could have been.

When I woke up Saturday morning, my arm was bruised around my fistula. My guess is that it was from Thursday’s treatment, but it just took a while to show up. So, when I went in to dialysis Saturday night, the technician wanted to avoid the bruised area. She put in the first needle, going down, in about the middle of my fistula. Now, I had pointed out that the lower end of the fistula and the upper end of the fistula were really the best places to go. But, she got it in the middle, and had a hard time getting “the flash”. The flash is the blood that initially shoots into the needle when it is inserted into the fistula.

She filled the first needle, and went to work to find a spot for the second one. She could not find one, and after several minutes, decided to use the catheter to return the blood. Unfortunately, by that time, the blood in the first needle had clotted, because it was not pulsing (it was just sitting there). So, they had to use my catheter for both needles, since they did not want to attempt to stick me a third time.

As you may remember, we stopped using the catheter because it was not really providing a good treatment. The only reason it is still in is because the doctor wants it to be available for a “just in case” basis. I guess that is good, since that had to use it Saturday night. But, the machine could not run above 300, so I did not get as high quality of a treatment as I would have wanted.

So, if you read this on June 6, then I’d ask that you pray that the technician is able to get two needles in to my fistula tonight so that I can have a decent treatment. I think they are going to try the 15-gauge needles, so the machine can run up to 400 with those. I think that the technician I have scheduled for tonight is the one that had no problems with my fistula the last time she stuck me. I am hoping to repeat that tonight.

Thanks for coming by to read. I’ll let you know what happened tonight on another day.

Saturday, June 03, 2006

Post Surgery Update

Hi everyone,

It's been about a week since I have blogged, so I apologize for not keeping everyone updated. I am recovering well from the gall bladder surgery. The holes in my belly are healing pretty well, though the one closest to my belly button did bleed a little bit in my sleep last night. It doesn't look like it is having any problems. I think the stuff that they used to close the incisions is probably just starting to wear off, and the incisions are healing fairly well on their own. I haven't had any residual pain from the surgery, so that's been good. I'm eating fairly well, though I have had a bit of upset stomach the last few days. The doctor said that would be normal as I heal from abdominal surgery.

I have some unfortunate news on the transplant front. My dad called last night to tell me that he had been contacted by the transplant coordinator. She told him that they would not be able to use his kidney for my transplant. I think it is mainly age related, though if you want the full story, I can tell you one-on-one.

This means that I will now have to have a second person get tested. I've got a fairly extensive list of people that have volunteered to be tested. All I have to do now is to contact someone on the list and see if they are still willing to go through with the testing. Then, I'll talk to the transplant coordinator and let her know who to go after next.

So, it has been a fairly busy week. I recovered from surgery on Saturday, Sunday, and Monday. I went back to work on Tuesday, and everything went well. I had my follow-up appointment with the surgeon, and he said that everything looked fine. At dialysis, they moved from using 17-gauge needles to using 16-gauge. They prefer to use the larger, 15-gauge needles. I imagine that they will start using those on Tuesday. The larger needles mean that they can run the machine at a faster filtering rate, and that I get a more effective treatment (better clearance).

The techs at dialysis have been having an interesting time with my fistula. I never have the same person more than two treatments in a row, so that makes it a little difficult to get a consistent stick. I've got three or four different areas on the fistula that have been used, so far. Sometimes, the needles end up very close together, and sometimes they are a little farther apart. I think it is easier for the technician to place the needles farther apart, and I probably get a better treatment that way, too. Hopefully, now that I am starting to get repeats on the tech that sticks me, I will get more consistent treatments.

I have a few prayer requests for the week. Please pray for my next possible kidney donor. Pray that God will help me choose the person that He has planned for my kidney donation. Pray that the testing will go easily and that we will find out who is the right donor. Also please pray for my continued recovery from the gall bladder surgery. Pray that the incisions will finish healing and that my stomach will settle down (so that I can enjoy eating again).

Thanks for coming by to read!