Merry Christmas Everyone

Luke 2: 1-20

1And it came to pass in those days, that there went out a decree from Caesar Augustus that all the world should be taxed.

2(And this taxing was first made when Cyrenius was governor of Syria.)

3And all went to be taxed, every one into his own city.

4And Joseph also went up from Galilee, out of the city of Nazareth, into Judaea, unto the city of David, which is called Bethlehem; (because he was of the house and lineage of David:)

5To be taxed with Mary his espoused wife, being great with child.

6And so it was, that, while they were there, the days were accomplished that she should be delivered.

7And she brought forth her firstborn son, and wrapped him in swaddling clothes, and laid him in a manger; because there was no room for them in the inn.

8And there were in the same country shepherds abiding in the field, keeping watch over their flock by night.

9And, lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them: and they were sore afraid.

10And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people.

11For unto you is born this day in the city of David a Saviour, which is Christ the Lord.

12And this shall be a sign unto you; Ye shall find the babe wrapped in swaddling clothes, lying in a manger.

13And suddenly there was with the angel a multitude of the heavenly host praising God, and saying,

14Glory to God in the highest, and on earth peace, good will toward men.

15And it came to pass, as the angels were gone away from them into heaven, the shepherds said one to another, Let us now go even unto Bethlehem, and see this thing which is come to pass, which the Lord hath made known unto us.

16And they came with haste, and found Mary, and Joseph, and the babe lying in a manger.

17And when they had seen it, they made known abroad the saying which was told them concerning this child.

18And all they that heard it wondered at those things which were told them by the shepherds.

19But Mary kept all these things, and pondered them in her heart.

20And the shepherds returned, glorifying and praising God for all the things that they had heard and seen, as it was told unto them.

Merry Christmas everyone. It has been a few days since I posted, so I thought I would give out a quick update. Last week I mentioned that I had the nurse turn my dialysis machine up from 400 ml/min to 450 ml/min. That means that the machine can now clean about 12.5% more blood during each treatment. Since the doctor was not there this week, I spoke to the Nurse Practitioner that was doing rounds at the clinic. I had her write in my orders that my machine should run at 450 ml/min (whenever possible). My fistula has been working properly, and that is always nice. I have enjoyed having the machine run faster and getting more blood cleaned during my four hours. Hopefully, my arm will continue to cooperate and I will continue to receive better treatments.

No new news about Kala, yet, for those of you still wondering. Her tests are scheduled for January 2 and January 18. After that, we should hear from the transplant committee and be able to set up a surgery date. Then, I will switch from dialysis to "post-transplant" doctor's appointments, all the time, at least for a couple of months. Hopefully, you will be able to enjoy my "I had to give another urine sample today" posts as much as you have enjoyed the dialysis postings!

That's about it for today. I have been getting quite a few e-mails from my readers (all over the world!). It is nice to hear from you every time you write. And, if I have not replied to you, that is not because I am ignoring you. It is because I have not gotten to you yet in the e-mail queue. And, you can always post comments on the blog (which everyone can read). I will try to reply to you (if you leave an e-mail address).

Thanks for coming by today! Enjoy your Christmas with your family.

A Few Updates

Hello everyone. I have a few updates to make this evening before I go to bed.

First off, I got an e-mail from Kala this week. She has her two appointments scheduled, for January 2 and 18. So, hopefully, once the transplant people get her results from the 18th test, we should be able to set up a date for the surgery. This is great news, I'm glad that things are moving forward.

I had dialysis on Thursday night. I got a good stick, which is always nice. About half-way through my treatment, the technicians turned the machine of the guy across from me, and I saw that he was running at 450 ml/min. Now, I had been previously told that it would not do you any good to go faster than 400. When the nurse came to check on me (like they normally do), she asked if she could do anything for me. I told her that I wanted to run at 450 like that other guy and get a better dialysis treatment. She was able to turn the machine up to 440 (my fistula wouldn't let it go any faster). She said I need to talk to the doctor and have him up my prescribed dialysis to 450 so that they always set it higher. I was able to get a 1.73 Kt/V (as opposed to the 1.4 that I normally have been getting).

The Kt/V is how well your dialysis is doing. The K is the amount of waste removed, the t is the time you dialyze, and the V is your blood volume. The goal for most patients is 1.4 or above. The only way to increase this number is to increase the K or the t, or to decrease your V. Since my volume is not going down, and they are unlikely to give me longer dialysis treatments, the only thing I can do to get a better dialysis is to remove more waste. Since my flow rate is around 1300 or 1400, I don't see any problem with running the machine faster than 400 (as long as the needles end up in the right places). The faster the machine runs, the greater the amount of my blood that gets cleaned, and the higher my K value becomes, thus increasing the Kt/V. That's it for the math lesson for tonight.

I had the rest of my "transplant evaluation" tests today. I went in for an EKG, and echocardiogram, and a nuclear stress test. These were to complete my yearly evaluation to stay on the transplant list. The EKG is a simple test where they hook up electrodes to your chest and check the electrical activity of your heart for one minute. The echocardiogram is basically a sonogram done on your heart. You lay there, and they "look" at your heart with sound waves on a special machine, similar to how a new mother gets her unborn baby examined. The final test is the nuclear medicine stress test. They inject you with a radioactive dye, and then run some scans of your heart (for 15 minutes). After this, we hooked up another EKG and got a baseline reading. I then started walking on a treadmill. Based on my age, weight, and height, they wanted my heart rate to get to 163. The treadmill got faster and increased its incline every couple of minutes. Once I reached 163 (after 12 minutes), they injected some more nuclear medicine. Then I had to run for 30 seconds longer as they took one last EKG (which they had been doing every minute during the test). After the running was over, they gave me some juice and let me cool down. Then, they had me do one more scan in the machine that checks the radioactive dye in your heart. I almost fell asleep on the table, since you just have to lay there very still and quiet in a dark room.

The doctor went over my results with me. I have a mitral valve prolapse, and have known this for about six years. I get it checked every year or so, and it has never been a problem. Mitral valve prolapse is a heart problem in which the valve that separates the left upper and lower chambers of the heart does not open and close properly. So, instead of blood flowing only one direction, a little bit of blood "regurgitates" backwards to the chamber it was coming from. This is a very common heart condition. The only thing I have to do for it is to take antibiotics before going to the dentist. This keeps plaque from breaking off, getting into your bloodstream, and getting stuck down in your heart (that's bad).

It seems that my prolapse has gotten worse over the past year. Last year's test revealed that I had a "moderate" prolapse. This year, the doctor said that it was severe. He said that eventually, I will need to have valve replacement surgery. This sounded extreme, so I had him explain it to me. He said that they will trim the mitral valve, and then place a plastic ring around the outside of the valve, to make it a little smaller. This way, the blood will not be able to flow backwards. He said that it is a very simple surgery. I asked him what he wanted to do, seeing as I was facing a potential transplant.

He conferred with the kidney transplant team, and they decided that since I was in no immediate danger, that the valve replacement is not currently necessary. He said I will probably need to do it in 5 years or so, but by that time, I should be used to all of my anti-rejection medications and not be having any problems with the new kidney. He said that I am going to need to follow closely with my regular cardiologist on my mitral valve, and that it will probably need to be checked more than once a year. That is fine, since it means they can catch it before anything terrible happens.

Well, it looks like tonight's post was long, sorry about that. Please continue to pray for Kala and I as we wait on her tests in January. And, pray that my mitral valve will not cause any problems for a long, long time. Thanks for coming by!!

December 2006 Lab Report

Hello everyone!

It is time once again for the monthly lab report. That's right, boys and girls. Every month, Uncle Nathan posts his dialysis "patient report" for all the world to see (and taunt). And, since I figured out how to use the scanner at work, I usually post the graphs that the dietitian prints out for us to show us our progress (or not).

First off this month is Albumin. The definition page tells me that Albumin is a protein in my blood that helps fight infections and aids in healing. My albumin was 5.0. The goal is between 3.8 and 4.5. The dietitian said that I am VERY healthy, based on this number.

Next up is the enPCR. This is the protein catabolic rate, which suggests if I am eating enough fish, chicken, beef, and other protein foods to meet my daily needs. The dietitian continues to remind me that this number may seem unnaturally low because they do not calculate the protein output in my urine. My number this month is 0.59. The scale says you should be above 0.8. But, she also told me that I am obviously doing fine and to just ignore this number (as always).

eKdrt/V: Tells how well my dialysis treatment is working and if I am receiving enough dialysis to clean my blood. The goal is greater than 1.2, and I am at 1.46. As you can see from the chart, I have been receiving enough dialysis for the past six months, which is great. I can really feel the difference when I am getting repeated good treatments.

Potassium is a mineral that is needed for normal heart rhythm and muscle function. The goal is between 3.5 and 6, and mine is at 4.2, which is slightly below the half-way point. This is good, since too much potassium can make your heart stop. I am not having any problems with potassium in my diet, which is nice, because I enjoy potatoes.

Calcium is a mineral needed to make healthy bones and muscles. You get it from things like milk, even though I am not allowed to have any dairy products (because of the phosphorus). I did not take any of the calcium-based phosphorus blockers this month, and my number dropped down to 9.3. The goal is to be between 8.4 and 9.5. I have been slightly higher in the past, but I think that was due to taking the other phosphorus blockers.

Speaking of phosphorus, my level was 5.5 this month, which is right at the top of the range (3.5 to 5.5). I think that may also be related to me not taking any of the calcium-based phosphorus blockers. I have two blockers. The calcium-based ones are to take before meals, and the others are for after meals. I almost always take the after meal pill, but did not take the pre-meal pills at all last month. I think I will opt for a slightly higher calcium level than to risk a higher phosphorus level.

Finally on the list is the average fluid weight gains. If you cannot see the chart clearly because of its size, I think you can click on it to see it full-sized. The chart is accurate through November. It looks like my average monthly fluid gains dropped dramatically, even though my weekend gains were about the same as the last six months. I do not know if there was an error in the calculations, or maybe my one lowly kidney was working a little extra in November. Either way, I am within my safe ranges, not having edema or any other fluid-gain problems.

The dietitian did not print out a chart showing my PTH, but she said that it had gone up again. It seems that the range is between 200 and 400 or something similar to that. In October, it came up at around 800 or 900, so they decided to give me Vitamin D to bring it down. In November, it showed that it was 100, so they wanted to take me off the Vitamin D. I told them that it might be a false reading and that I should stay on a small dose. The doctor agreed, and kept giving me Vitamin D. This month, the PTH was around 500, which is high, so they are going to increase the dose of Vitamin D. I am glad that I argued for them not to take me off of the medication completely. I had watched the number jump high and low every other month and was able to make the connection that I need at least some Vitamin D. I think now, they just have to figure out how much I need every month to maintain a balance.

My hemoglobin this month was 14.2. The goal range is between 11 and 12. They said that they are going to stop giving me Epogen, which is the hormone replacement that prompts my body to make red blood cells. They told me that it is shown that there is no help to be above 12, I guess the marked benefits don't climb as quickly after 12. That seems strange, since you are much higher than that if you do not have a kidney disease. The doctor was not there on Tuesday night, but if he comes on Thursday, I will try and talk to him to see if I can understand why they want to keep my hemoglobin down (and keep me feeling more anemic).

So, as you can see, my lab reports are overall good, and they have been for at least the last six months. I am glad that the doctor has figured out what I need and has gotten everything in balance. Of course, now that I have it all worked out, I am getting ready to sign up for transplant surgery.

Kala sent me an e-mail, letting me know that she has the first of her two tests scheduled for January 2. After that, it is one test, and then the official "OK" from the transplant committee.

Continue to pray for patience (from me) as we wait for test results and committee meetings. Please pray that I continue to stay healthy so that when it is time to schedule the surgery, that there are no health-related delays.

By the way, I have been getting several e-mails from readers recently. It is absolutely wonderful to hear from everyone that reads my blog. There are some interesting stories, and I am working on replying to you, if you wrote to me. I always enjoy hearing from people, and it is neat to see that there are actually people that stumble across the blog that stop and read it.

So, send me an e-mail if you get a chance, or just comment directly on the blog. I would love to hear from you. Have a wonderful day (and thanks for reading such a long post).

Monday - Update from Kala

Hey everybody! It is the middle of Monday afternoon, and I just finished reading an e-mail from Kala. Val, my pre-transplant coordinator, called her and said that the committee has "conditionally approved" her to donate a kidney. The only thing that they need are two more tests, which she has scheduled in January. She submitted results for them, but they were too old, so they wanted her to get something more recent. Other than those two things, they approved all the other test results and consultations.

This is sounding like a fairly clear answer to prayer. So, unless God presents a different option, it sounds like we will be setting up some surgery for late January or early February (depending on everyone's calendar). For me, it will be a week or two in the hospital, followed by daily lab work and doctor's visits for two weeks, then that slows down as time goes forward. They want to be VERY careful with the new kidney, so they check your vitals a lot at the beginning. That also helps them get you on the right amount of anti-rejection medication. Apparently, the medication dosages get adjusted a lot in the first month or two, until your body balances in its new condition.

Please continue to pray for Kala. Pray that her tests will go well in January and that there will not be any surprises. Also pray for me that I will stay healthy and will be ready to accept the kidney when the time for the surgery arrives. Pray for Jenny, that she will be able to put up with me and will be a good help-mate when it comes time to drive me to the doctor every day. And, pray for my job, where I will be gone for a while. Pray that they will be able to hold my position and that the kidney transplant will not interfere, too much.

Thank you for your continued prayers. I will let you know more as I know more!

Transplant Testing Year II

Hello everyone. Remember when I told you that the Dallas Transplant Institute had scheduled me for tests on Monday and for next week's Friday? Yeah, well, it turns out that those tests are to maintain my status on the transplant list.

I went in Monday and had a chest x-ray done and some blood drawn. Then, I went to eat lunch and have my physician's consultation. The nurse did the EKG (I think, the one with electrodes all over your chest and they scan your heart for about a minute). Then, I talked with the PA. She had my lab results back already, and said that everything looked great (except for the CBC, and the machine was broken, so they couldn't take it). She said that she wished that other patients took care of themselves as well. I have to fax my CBC over from dialysis (which should be ready tonight). I also had to send over my TB test results. But, I should remain on the list for one more year (based on what I have seen so far). I still have to have a stress test done on my heart on the 15th, but I am not worried about that.

They drew our labs on Tuesday (the 5th). I should get back the results tonight, since I need to send them to the transplant people. The charts probably won't be ready until next week, but that's normal. I am not expecting to see any problems, as my labs have been going great for at least the last six months. Thank you for your continued prayers in that area.

In other news, the transplant committee will meet on Friday (the 8th) to discuss Kala and see if they want to let her donate a kidney. It does not sound like there will be any problems. Please pray that the committee comes to a conclusion quickly and that we find out so that we will know what to do next.

Thank you for all of your prayers. Keep my health in your prayers, as you have to stay healthy in order to qualify for a transplant. Keep praying for Kala, that she will not be worried or nervous as Friday and the weekend get closer.

Thanks for reading!