Cardiologist Update: April 5, 2011

I had my most recent cardiology appointment back on April 5, 2011. I last saw the doctor about six months ago. I will help you catch up, in case you have forgotten (or not been reading).

I have a mitral valve prolapse. I have been followed by a cardiologist since I moved to the Dallas area back in 2001. The doctor has been following me every six months for a while. When she retired, I got a new doctor. He looked at my echocardiogram and had me come in after three months. But, based on those two scans, he had me come back in six months. There had been a fear that my heart was getting worse, but it turns out, it was not a problem.

So, we are now caught up to April 5. I had my twice a year echocardiogram. The doctor took a look, and he was very pleased. My last three scans all looked exactly the same (the two three months apart and the one in April). So, he was very pleased. He decided that I do not have to be back for another year.

So, it seems that all is well, in terms of my mitral valve prolapse. I have not gotten any worse in the past year, and the cardiologist does not want to see me for another year. It has been my experience, so far, that the doctor NOT wanting to see me is a good thing.

So, you should not hear another heart update from me for at least a year. That will be great! As long as there are not any future problems, then I won't have to go back to see him. I did go and see my nephrologist on April 7. My next post will be about that.

See you next time!

September 15, 2010: Cardiologist Appointment

Hi there, faithful readers (or those of you that just happened to stumble onto this posting). Today is the updated that my normal readers were hoping to see last Sunday. Unfortunately, my free time in the morning was cut an hour short, so I was not able to get online and write up my explanation from my latest cardiology appointment.

I saw my "new" cardiologist about a month ago. I say new because the cardiologist that I used to go see has retired from practice. I think she wanted to spend more time with her family (of which I am in favor). So, the previous visit to my cardiologist, back in June was to check my heart and my mitral valve to make sure everything was still working correctly. You can read that post here: Cardiologist Appointment - June 15, 2010. The doctor thought he saw some disturbing signs, so he asked me to come back in three months, instead of my typical six, to have my heart reviewed again.

The post received a few questions, which I will endeavor to answer below. I did not know the answers myself, so I just asked the doctor to help me out :)

1) Please Explain Ejection Fraction

The ejection fraction is the volume difference between heartbeats. Normally, you would expect to see an ejection fraction of 60% to 65%. My current rating is between 55% and 60%. I asked, and the doctor said that an ejection fraction of less than 50% was very bad, and that they would want to get me into surgery if that were to happen.

2) What is the Thickness of Your Mitral Valve Leaflets?

Normal mitral valve leaflets (shown in the diagram at the bottom as MV) are usually around 5 millimeters thick. My leaflets are slightly thicker than normal, but nothing to worry about at this time.

3) Do you have any enlarged ventricles or atrium?

No, at this time my ventricles and atria are both normal sized. This question is important because the mitral regurgitation can cause the heart to expand in size, over time. If you heart starts to get larger, it cannot be made smaller again. So, part of what they watch for is to make sure that your heart is not getting too big and that your ejection fraction stays within safe tolerances.

4) Please explain regurgitation and prolapse (in regards to the heart).

Regurgitation is blood flowing the wrong way in the heart. In the diagram at the bottom of this post, you can see a rough drawing of the heart. Blood is supposed to flow from the Left Atrium (LA) to the Left Ventricle (LV) and then out of the Aorta (AO). Regurgitation is the arrow that shows blood flowing back across the Mitral Valve (MV) from the LV to the LA.

Prolapse is simply the valve action going back up into the Left Atrium (LA). Normally, your mitral valve (MV) should allow blood flow downward (in the drawing) from LA to LV. The valve leaflets should stop the blood from flowing back up. Mine do not do that quite as well as they should. This reverse action causes the leaflets to be a little spongy, and to eventually wear out.

The doctor is watching the size of my heart as well as the ejection fraction that the valve is allowing. When they start to head toward a more dangerous range, then we will start talking about surgery.

5) What's your current status, then?

OK - big question! I'm still doing fine. The doctor said that he did not see a recurrence of the problems that he thought he noted in June, so I will not see him again for six months (this was my normal schedule). I'm not in perfect heart health, as my Ejection Fraction is down to 55-60% instead of 60-65%. But, until there are any changes, then I will keep my ribcage intact!

Thanks for reading today! The drawing below is my sketch based on the sketch that the doctor gave me at my appointment. Please try an pretend that it looks like a heart.

My next post should be about the post-transplant follow-up that I had on October 7. If I'm lucky, I will write it up next Sunday. See you later!

Cardiologist Appointment - June 15, 2010

Today is Thursday, July 08, 2010, and I am sitting at the Nephrologist's office with my company laptop and MS Word as my only friend. I realized that I have not blogged in WAY to long, and that it is time for me to update everyone on what has been going on. Today's post will concern my cardiology appointment from almost a month ago. I'll try to get another post later this week (or early next week) so that I don't have too much information in one post.

I saw my cardiologist back in June for my biannual (two times per year, not every two years) appointment with echocardiogram. They have been watching my mitral valve to make sure that everything is still working properly and that I am not getting worse.

Note: I said "they" because I recently changed cardiologists. The doctor that I had been seeing has "retired" to spend more time with her children. I'm all for this, as a principle, but was not overly excited to lose one of my favorite doctors. So, if she reads today’s blog, then she'll know I liked her. My new cardiologist is at the same practice, and was recommended by the previous one, so I'm not too worried about him. He's just new, and I will have to get used to him.

Now, I will get back to the appointment details. I had my echocardiogram, and it seemed about the same to me as all the others that I have received. However, when the doctor came to tell me the results, he had some bad news. It appears that my ejection fraction (I think) has gone from 60 to 70% down to about 55% (based on visual observation). This is not the best direction for that to go.

The doctor told me that he was slightly more concerned, based on the previous echocardiograms that had been taken. He said that he would like to see me every three months instead of every six months. He said that I still have a "moderately severe" mitral valve prolapse, but with the reduced flow through the valve, he'd like to see more often.

At some point in the future, I will need to have my valve replaced. It's not that time, yet, but the doctor wants to be careful and make sure that I do not suddenly have a major problem because of my mitral valve. So, he is going to watch me a bit more closely. I guess I will just have to wait and see.

Overall, it was a good appointment. The whole reason I was going in to have the echocardiogram every six months was to watch my mitral valve and make sure it was not getting worse. Since it has gotten a little worse, they now want to check me more often. Luckily, the echocardiogram showed what it needed to show, and they are now going to check me more often.

One day, I will need heart surgery to have my mitral valve replaced. I'm not sure what that will involve, but I'm sure it won't be pleasant. On the plus side, I've never had open heart surgery, so that will be new. It's always fun to have something to add to my "List of Surgeries."

That's it for today's post. I will have two more blog posts coming up soon, so stay tuned. Thanks for coming by to read.

Three Years Post-Transplant

Thanks for stopping by, everyone! This week is my three year kidney-versary! I received my donor kidney on January 11, 2007. It's been a wonderful three years.

I had my annual Glofil appointment on Tuesday of this week. For those of you that do not follow me on Twitter or are not friends with me on Facebook, I had a great appointment! I scored an 80.2 on the Glofil this year, which is the same as what I got last year. Now, for a normal person with two kidneys, that would be an 80% kidney function. For a post-transplant kidney patient with only one functioning kidney, it's a really good score (according to the doctors). I'm glad that my kidney is still working well and that my body is still not showing any signs of rejection. Keep praying that it will stay that way for MANY years to come.

My creatinine was 1.0 again. This is really good, since it was 1.4 when I made a short visit to the Emergency Room a week or so ago. For some reason, I passed out and got to go to the ER. I was perfectly fine. The doctors said that it was probably dehydration. My guess is that it was due to being at home for three weeks with our new baby and not being on my normal water drinking schedule. My vacation ended at the end of December, so I'm back to work and back to drinking enough water on a daily basis.

I also had my annual bone density scan at the appointment. Although I did not see the doctor after having the scan, I did as the technician for an unofficial reading of the charts. She said that it looked like the bone density of my hip was the same as last year and the bone density of my spine had improved, slightly.

I did get some bad news in December. My cardiologist, whom I really like, is retiring to spend more time with her family. I told her that it would be fine, as long as she would continue to see me. Even though I am very sad, it's good for her. Her and her husband have several young children, and I hope that they enjoy this extra time that she will have with them. She recommended a new doctor at their practice (who started out as an army doctor) to take over my cardiologist. I will see him in about six months and let you know ...

That's about it for now. I'm wonderfully healthy, and it looks like my wife is enjoying her new role as a mother. Our baby is happy and healthy (as far as we can tell) and is gaining weight. We are going to have our pediatrician watch her and see if she develops any kidney problems. Hopefully, even if she does, it will be a VERY long time away.

Thanks for all the prayers. I hope everyone enjoyed the post. I'll see if I can put up stuff about my health more often (though, it is difficult from time to time being busy).

Follow-Up From Appointments

I went in for my cardiologist's appointment and ran on the treadmill. I walked/ran for a little more than ten minutes to get my heart rate up over 161. The technician put me on the table and then looked at my heart and the pulmonary vein. She mentioned, during my test, that I was doing really well and that she did not expect to see anything wrong with my heart. The doctor, after reading the test results, told me that my heard and pulmonary vein were working just like they are supposed to be. This is great news! Based on what the doctor told me last time, it's likely that I am just noticing more how my heart and breathing are rather than they are getting worse.

So, there is nothing (else) wrong with my heart. I've still got mitral valve prolapse. My heart still has a moderate to severe prolapse. One day, I will probably need to have a valve replaced, if my heart continues to work the way that it does. But, there are no problems coming my way any time soon.

I also had a nephrology appointment this week. This was my regular quarterly appointment. The doctor was very pleased with the results of my 24-hour urine collection. She said that I had my best results on that test since my transplant. My labs were also great. My cholesterol looked wonderful (HDL was 43.0 and LDL was 69.0). This is great news, saying that my medication is still at the right levels. My creatinine stayed at 1.0 (great news) and they were glad to see me again.

I will be going back in about three months. I'm glad my kidney continues to function just as well. Stay tuned for more news as it comes up. I had a fever last week of 100 (for just a morning). I felt hot, but it was much better by lunch.

My cystoscopy results were great. The urologist called back while Jenny and I were getting her 20-week ultrasound. They said that my urine did not have any signs of cancer. So, that's more good news. I guess the problem that I had had with my urine a couple of weeks ago was all related to my natural polycystic kidney.

Thanks for reading. I'm glad to continue doing well with the transplant.

And remember, you can always follow me on Twitter for updates (other than the blog).

Cardiologist Appointment - June 18

I went and saw my cardiologist on Thursday, June 18, 2009. I realize that it has been almost two weeks now since I went to see her, but that's not my fault. We have been very busy here at home and I have not had the opportunity to make a good blog post.

That's not to say that this blog post will be either informative or humorous, but at least it will exist.

All that being said, my appointment was to have a 2D echo cardiogram done on my heart. This apparently went well, according to the doctor. She said that my results are the same as they were last year, and that she would probably not need to see me for another echo for twelve months. This is always good news (yippie!).

I told her that I had been experiencing some shortness of breath when I walk up stairs. This is not a problem when I walk for a half hour on the treadmill. Even when I am carrying small weights, I still do not have trouble breathing. I only notice the breathing being harder if I am walking up the stairs, or working out in the yard (bending and standing a lot). She told me that it might not be a problem and that I may just be noticing this more since I am exercising and paying more attention to my heart and lungs.

That being said, she told me that she wanted to run some tests. I asked if that meant she would try to kill me, and she chuckled. She asked if I had ever done a stress test before, and I indicated that being the reason I had asked about murder. She laughed again, and told me that we should go ahead and make sure my heart functions correctly when it is actually having to do something (not just when I am laying down on the exam table).

So, on July 10 (which will be my fifth wedding anniversary), I will head back to the cardiologist's office with running shoes and a pair of shorts. There's no way I'm doing this test in smooth soled shoes and khaki pants. That's just crazy. For those of you that don't know, the doctor is going to have me walk on a treadmill that gradually increases in speed and angle of ascent. In layman's terms, they want me to start walking lazily on a park path and work my way up to attempting to run up a large hill. Once I get to the point of nearly passing out, they start a five-minute timer and see how well your heart does.

As far as I can tell from the one time I did this for my transplant testing, if you live to hear the timer beep, then your heart functions correctly. Last time, I obviously passed, and I expect to pass again. I may ask to see if they can start my incline a bit higher so it doesn't take nearly fourteen minutes to complete! That's about how long I was on the treadmill the last time. But, of course, as a man I can do it. (Here, you can imagine me with my chest stuck out, facial hair gleaming, and muscles bulging inside my shirt).

That's about it, healthwise. You will notice that I updated the links on the right-hand side of my page (for those of you using my style sheet and visiting on line). I changed the link from our now-defunct adoption blog to our new hot "family" blog. It's called 'Journey Through Parenthood' and can be reached at http://journeythroughparenthood.blogspot.com/. I think that's the longest name Jenny could get (sorry about that). Update your RSS readers, bookmarks, or that little scrap of paper next to your monitor (yes, I know you have one).

Nothing eles from me at this time. If you just can't get enough of Nathan, you can always follow me on Twitter. If you are not familiar with Twitter, just imagine what awesome would smell like, mix in some Internet, and add a dash of real-time updates. Oh yeah!

See you next time (probably after July 10).

Not About Kidneys: But Still Important

Hi, it's Nathan. I know that it has been a while, but not too many exciting things have been happening (medically speaking) to me. However, I do have a major announcement. Now, normally, this blog will NOT contain information that does not pertain to my health. But, for today, we are going to deviate.

Jenny and I are pregnant, and will be having a baby in mid-December (2009)!

Below is the story that is posted on our other blog. This blog was originally going to be about our adoption process, since the doctors told me that my chances were very close to zero for ever fathering a child naturally (ha, showed them!). Though we are not stopping our pursuit of adoption, it will be on hold (per the agency) until after the birth of our child. The following paragraphs were written by Jenny:

When Nathan and I decided to pursue adoption we did so because the doctors told us we had a VERY small chance of becoming pregnant naturally. They recommended procedures that involved lots of doctor manipulation. We did not have peace about going down that road so we chose adoption. However we saw no point in going back on birth control. We said if I ever got pregnant it would be because God wanted it to happen. We are excited to announce that God decided that a pregnancy IS in His plan for us! I am 14 weeks pregnant, due December 16. Everything looks great so far, the sonogram showed a good strong heart beat. I also had a first trimester screening for Downs Syndrome and Trisomy 18 and all those results came back normal.

After finding out I was pregnant one of the first things we talked about was how we felt this affected our adoption process. Nathan and I both feel that God has still placed a desire in our hearts to be adoptive parents. We believe that God is in control of timing and don’t even feel a need to put ourselves on hold or anything. We realize this means we have the possibility of having 2 babies very close together. =) We know God will work our all those details though. I’m going to call our agency this week and let them know what’s going on. Once the baby is born we plan to create an additional page to add to our scrapbook.

Here are some things you can pray for:

• Healthy pregnancy
• Healthy baby
• God’s perfect timing on our adoption
• Continue to pray for our birth mother

Since this blog will no longer be solely focused on adoption I think I’m going to change the blog’s web address. So be on the look out in the next few days for a post giving the new address. You will want to make sure you update all your bookmarks to the new address once it is in place. We are still on an adoption journey, and this pregnancy is now a part of that journey.

Thanks for taking a few minutes to read something non-kidney (at least so far) related. If you would like to follow developments on this story, you can always visit http://nmccart-adoption.blogspot.com/ for details. Please note that this link will soon change, but I will be sure to update it in the side bar (to your right and my left, as I am behind your screen looking at you).

This is truly a miracle, and we continue to trust God for his best in our lives. As you all (may or may not) remember, my Polycystic Kidney Disease is most likely the autosomal dominant type. This means that there is a 50% chance of the gene being passed on to any of my children. Given that both my sister and I have PKD, it is probably not the autosoal recessive version (the more deadly at a young age). We will have to see, as time goes on, what we decide about testing and kidney disease and things of that nature.

For now, we appreciate any and all prayers. I will be blogging later this week on my cardiologist appointment this Thursday.

See you soon!

Magnetic Resonance Angiography of My Head

Today, I had an MRA, or magnetic resonance angiogram, done of my head. For those of you that did not know, my mom died last month from complications after a burst brain aneurysm.

I had a stroke back in early 2005. With that, and with my mom's death, my neurologist recommended that I have an MRA done of my head. I had that done at the clinic today. The neurologist also wants me to get my homocystine levels checked to make sure my medications are still working. In addition, I saw my cardiologist earlier this week and she wants me to have my choloestrol checked. So, I'm going to get blood work done at LabCorp on Friday.

I do not know when I will be getting results. I am going to call the neurologist tomorrow and see if they need me to bring my films in or of they received their own copies from the clinic.

I'll post again when I know more. My health is good, overall. I have not had any problems or neurological symptoms. Both my cardiologist and neurologist said that I am doing well. My yearly EKG was perfectly normal.

Cold

I'm guessing you read the title of this post prior to actually reading the post itself. If so, you may be wondering how I could be cold, in Dallas, in June. Well, I'm not! In fact, for the most part, it's pretty warm. The problem I'm having is "a cold." That's right, I only managed to go 17 months after my kidney transplant before I managed to get sick.

I woke up the last week of May on a Tuesday with a runny nose and a slightly sore throat. I didn't have fever or any other problems, so I was guessing that one of the many things I'm allergic to (see previous post for details) had attacked me in my sleep (that, or Jenny did). By Friday, I had started coughing and producing some of that lovely yellow phlegm that everyone enjoys so much. At that point, I decided it was not just allergies, so I quit taking Benadryl, started taking Mucinex, and called my family doctor for an appointment. I saw her the next Monday, and she gave me an antibiotic and said to try that for ten days. I kept taking the Mucinex (to get stuff out of my chest) and the antibiotic (to kill anything that might try to live in my lungs) for the ten days. That ended last Wednesday, and I was coughing still. I called the nephrologist on Friday (yesterday) and came in for a chest x-ray. Everything is fine in the x-ray, but he wants me to get some blood work on Monday. He also prescribed a cough syrup with codeine to help me. I started taking that today, Saturday, and I think it helps a little.

Wow, that was a long paragraph. This one will be short, to help balance.

That was much better. Let's see, I also saw my cardiologist this week for my regular six-month check-up. She did an echo cardiogram, and said that my mitral valve prolapse is still moderately severe (no change since last time). She said that since I had no change, I would not need an echo in six months, but that I should still come back at that time to see her again. She said she would only do another echo earlier if I had strange trouble breathing.

She also told me that a friend of mine that I met while on dialysis is currently seeing her for her pre-transplant cardiac workup. As a doctor, she did not actually mention this lady's name, but from her description, I was able to figure out who she was referencing. Apparently, this unnamed patient had mentioned that I had a blog and that I had mentioned my cardiologist on it. So, here I am, mentioning her again. I assured her that I've never said anything bad about her, mostly because I really like her and think she does a great job. In fact, if anyone were to ever ask me for a doctor to go see, I'd recommend her. She's very knowledgeable, and always seems to remember at least one non-medical thing that we talked about at our last appointment.

You might think that this isn't special, but let me give you my perspective on things. I saw the nephrologist at dialysis every week, and he barely had time to say hello before he was at the next patient. There was no conversation, and no feeling that he cared how I was doing. Yet, my cardiologist, who I see only once every six months, is able to remember things that I told her that are not medically-related, in addition to being quite friendly and seems to care about my health.

So, long post - but I'm supposed to keep taking the cough suppressant until Friday. If I am still coughing at that time, I have to call the transplant nephrologist back and get seen again. Hopefully it won't be a problem that long.

And, Jenny tells me to have everyone look at the links on the right-hand side of the page. I put one up, today, that links to my adoption story blog. Read it if you like. Or don't, I can't make you (or stop you).

Have a great weekend!!

toDwI'ma' qoS yItIvqu'

Welcome everyone once again to my blog. I know, I don't post for six weeks, then I get on here twice in almost no time at all. What's the world coming to?

You might have noticed the title of today's post. I've been brushing up a little bit on the Klingon language, and discovered how one might wish a speaker of Klingon a Merry Christmas. You would say, toDwI'ma' qoS yItIvqu' or literally ''Our-savior's birthday you-enjoy!''). Why do I know this? Well, I think if you've been reading the blog up to this point, that answer is quite obvious.

Here's the latest news from the cardiologist: my mitral valve prolapse continue to be "moderate to severe," as it was six months ago. She said that she was pleased, and I will have to come back in six months to have another echo cardiogram and let her see if it stays the same. She also asked if I had noticed any more palpitations, but it had only been two days since I had last seen her, so I had to tell her no. I had mentioned at my last appointment that I noticed my irregular heartbeat about once a month or so, but it is not too bad (just noticeable).

Well, that's about it for me for this week. I hope everyone enjoys their Christmas and any time off of work that they might receive. I've got a picture (not all that great, but what do you want) of my Christmas tree for everyone to enjoy!



Until next time, remember the words of the Christmas cow, "Looooooooooow"

Post-Transplant Glofil #3

Good Morning! (And, if I don't see you, good afternoon, good evening, and good night).

Tuesday, the 17th, was my 6-months Post-Transplant Glofil appointment. As always, if you are unfamiliar with the Glofil test, you can read about it in a previous post here: http://nmccart.blogspot.com/2007/02/upcoming-first-post-transplant-glofil.html

My score this time was 76.3. That is down from the last two scores. On 2/22, I got 86.1 and on 5/14, I got 82.0. I spoke with the nurse at Dallas Transplant Institute this morning, and she said that this is not a problem. Since my creatinine is stable and my urine output is stable, then there are no worries. Speaking of that, they ran labs on Tuesday as well, and my creatinine remains at 1.0 (which is wonderful). The next Glofil comes 9 months after my transplant date, which should be around October 11, 2007.

And ... while we are talking about lab reports ... the only problem the doctor pointed out on my lab report was that my triglycerides are pretty high. The acceptable range is 32.0 to 238.0 mg/dL. On 6/19, my triglycerides were at 175.0. But, yesterday, my triglycerides were up to 281.0. The cardiologist had previously complained that my triglycerides were too high, so now I need to work with the two doctors to get on some medication to get that down. The transplant doctor suggested that I might could take Fish Oil supplements, if the cardiologist will approve. I am going to send my lab reports to the cardiologist to see what dosage of fish oil that they suggest in my case.

The only thing left to schedule for the transplant clinic will be a Bone Density test. It seems that they cannot do the bone density and the Glofil at the same time, due to the Glofil using a radioactive dye that would interfere with the bone density. The bone density test is pretty quick, so I will see if I can get one scheduled for some morning soon (they want it done this month).

So, that's all for today. Maybe I'll find out what the cardiologist wants so I can get my cholesterol down. Have a great day!

Couple of Quick Updates

Hey everyone!

It's been over a week, and it seems I have had nothing to say.

Our church had Vacation Bible School this week, and Jenny and I participated by being "park security." We had the event at a local water park. The only problem was the torrential downpour that occurred on Tuesday and Wednesday, which reduced us to two days of VBS instead of four. But, I think the program was a success overall.

In kidney news, I think all is going well. I am trying to keep myself well-hydrated. I stopped taking Nexium this week, and I do not think there have been any negative side effects. That will save me several dollars a month, so I am glad to be off another medication. I think the next medication I get to cut out is the Bactrim, but I won't know until after my next clinic visit in the middle of July.

Speaking of clinic visits, I still need to schedule another Glofil test. This will be my "six months post-transplant" workup, so it should be a good one. I am going to try and set that for the same day as my clinic, so I don't have to go down to the office twice.

I also need to remember to call my cardiologist next month and see if they have any other options for lowering my triglycerides other than the "tricor" that they wanted to put me on. The nephrologist said no because it could raise creatinine. I guess I'll have to make that call next week, too.

That's about it for today. Nothing much, but I am still doing well, so that's always good news! Enjoy your weekend.

Clinic and Cardiology Updates

Welcome to Wednesday! It's been a little over a week since I have sent out an update, so I figured I had let enough time elapse. I have a couple things to cover, so the post won't just be fluff.

I had a cardiologist check-up last week. The doctor said that I seemed fine and that she wanted some blood work (to check my cholesterol) and to get an echo of my heart to check on my mitral valve prolapse.

I had the echo cardiogram done on Monday afternoon. The technician was not able to tell me anything (of course). The doctor called on Tuesday to let me know that my prolapse looked about the same as it had six months ago, and I will need to get another echo in six more months. That was what I had hoped for, since it had gotten worse between the last two echoes I had had done. But there was not change on the latest echo (Monday) so I am in good shape for another six months. That means no valve replacement surgery for me (yet).

I also had my post-transplant follow-up clinic appointment on Tuesday (yesterday). My creatinine is still at 1.0, which is great!! The other numbers in my lab report all looked about normal, so that's good news, too. In fact, the doctor said that I was doing so well that I do not have to come back for a whole month! That's wonderful, since it means less time out of work to go to the doctor to hear that I am doing well. I'm also glad that the new kidney is working well enough to keep me out of the hospital or out of the doctor's office.

Coming up next will be another Glofil and another bone density scan. Those are both scheduled at the six-month after transplant mark. So, come July 11, I will need to get that on the books. I guess I should go ahead and schedule the Glofil soon, since I already have a doctor's visit set up for July. That will keep me from having to go down there twice.

That's it for today! Stay tuned next time for more fun kidney information (or not fun, I guess it depends on what you enjoy).

Welcome to 2007

Good morning everyone, and welcome to 2007. I realize that it has now been 2007 for at least 48 hours in most time zones, but I am still here to wish you welcome. Thank you for coming by (from all over the world) to read my little blog. Allow me to introduce myself, for the new readers.

My name is Nathan. I am 28 years old and live in Texas. I was diagnosed with Polycystic Kidney Disease in 1998, at the age of 20, while in college. According to http://www.pkdcure.org/, polycystic kidney disease is: "the most common genetic, life threatening disease affecting more than 600,000 Americans and an estimated 12.5 million people worldwide - regardless of sex, age, race or ethnic origin. In fact, PKD affects more people than cystic fibrosis, muscular dystrophy, hemophilia, Down syndrome and sickle cell anemia — combined."

My kidney disease, which is supposed to be genetic, was not discovered until I went to the hospital with a kidney stone. In making sure that I was healthy, the doctors discovered that I had multiple cysts growing on my kidneys. I was told that my kidneys would eventually fail due to this disease, and that I should watch my blood pressure and get regular check-ups with a nephrologist (which is a fancy word for kidney doctor).

I followed up with a nephrologist and a cardiologist on a regular basis. My blood pressure was kept mostly under control. The cardiologist found that I have mitral valve prolapse, and that was monitored closely as well. My kidney function was tested after I moved to Texas, and it was around 25 or 30% of normal (which is not good). I was told that in several years, after my function had decreased under 10%, that I would have to start dialysis.

In February of 2005, I had a minor stroke. The cause was undetermined, though I tend to blame my kidneys. I fully recovered, and the neurologist put me on a blood thinner as a precaution to prevent further strokes. I was sick quite a bit after that, just not feeling 100%. At the end of May, I got some kind of infection in my left kidney. The cysts were bleeding into each other. I went to the hospital and got several blood transfusions, but the blood was all getting trapped in my left kidney. After about a week, the kidney had grown to a gigantic size. (See this post for details: http://nmccart.blogspot.com/2005/08/photos-of-kidney.html). Basically, they had to cut out my kidney, and it weighed 15 pounds when removed.

So, needless to say, my kidney function declined rapidly. By the next time it was checked, I was under 10% function. I had an AV Fistula placed in my lower left arm, and I was scheduled to begin dialysis. I started my treatments in the hospital at the end of July in 2005. That fistula never quite worked as well as it should have, and it eventually stopped functioning at all. So, after several minor surgeries on my arm, I finally got a new fistula in my upper left arm (above the elbow). It is quite twisty, which isn't so great for sticking giant needles into, but it has an excellent flow rate and helps me get a great dialysis treatment.

So, from a health standpoint, I am maintained by dialysis and watched carefully by a hand-picked team of doctors (all of whom I have acquired in the past five years). Once I had a fully failed kidney, I started looking in to the possibility of a transplant. Every doctor that I saw said that I was an excellent candidate, since I was only 28 and was relatively healthy, minus the horrible kidney disease. They recommended that I look in to transplantation as an option. I completed the paperwork and had my transplant orientation in December of 2005.

I had several people immediately volunteer as a possible donor. My father volunteered to be tested for me first. Unfortunately, he was not a good match. After he was denied, a friend of mine named Josh stepped into the volunteer booth. He, too, was denied the opportunity to have a vital organ removed and given away. Next, a lady in our church, Kala, asked if she could be tested. She had heard of my plight through my mother-in-law and wanted to see if she could donate a kidney to help me out. So far, all of her tests have been positive. The transplant committee has conditionally approved her, and she has one final test on January 18. Once we get the results of that test, she should be fully approved to be my kidney donor.

I am hoping that we will be ready to have the transplant in February of 2007 (this year!). It has been a long, difficult journey so far, but I am ready for the next turn.

You may be asking yourself, "Self, what can I do to help Nathan? It seems like he is a wonderful person with a great sense of humor. In fact, I would probably be his friend if I met him in person. He seems, oh wait, I was asking myself a question. Self, how can I help Nathan out?"

I am glad you asked that (and thanks for saying all of those nice things about me). As a Christian, I think that the most help that anyone can give is prayer. Pray for my health, and pray that Kala's tests will continue to go well so that she can donate her kidney. You can also send me e-mail or leave comments on my blog. The comments route is the more public choice, and works well, depending on what you want to say. If you have questions for me, or want to know more, then you can always e-mail me. I try to read and reply to all of my e-mail, it just takes a while to do so.

Well, now you have an idea of who I am and where I am going. I hope that this post will be a good start to 2007. Keep reading, and come back to find out when I get my transplant and what all wonderful things that they will then get to do to me to help me keep the new kidney!

(For those of you that are not new, thank you for reading this year-end recap. You may have also noticed that I updated the format on the blog page. Blogger recently upgraded their system, so I got a new look to the blog. I hope you like it.)

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!!

400 ml/min

It’s been another week, so it’s time for a blog update. I got an instant message from a friend today telling me that they hadn’t seen any blog updates in a while, so this is for you (thanks for the prompting).

The last you heard from me was on Wednesday the 16th. I’ve had two more treatments since then, and they both went well. I got two sticks on Thursday and two sticks on Saturday, and the machine was able to run at 400 ml/min on both days. 400 is the speed that is preferred. It is as fast as they dialysis center prefers to go, and gives you the best possible treatment. The faster your blood can be pulled, then the more blood that can be processed in four hours (that makes sense, right?).

Thank you to everyone that has been praying for good sticks and good treatments. Please keep it up. I would love to have a couple of good weeks in a row (for starters). And, I’d like to see my next flow rate test be just as high as the first one (they take an average to set your baseline).

I saw my cardiologist on Friday. She said that I am doing well, and she wants to see my lipid results to see I still need to be taking Lipitor. She also swapped my beta blocker for a different beta blocker, hoping to change some of the side effects. She said that as long as my blood pressure and heart rate stay in the “healthy” range, then I shouldn’t need to change my medication again soon. The only problem would be if my blood pressure drops again and my heart rate goes up. Then she would have to recommend a more invasive procedure. I did not have her explain as I hope that my current medication will continue to keep my numbers in check.

So, I have a treatment this afternoon, and I have been fasting all day for my lipid panel. Jenny is going to bring me dinner, so that will work out. I just hope that they are able to get a good stick without having the needle primed with saline to start. I’ll have to tell the technician to stick, draw blood, flush with saline, and to then stick the second needle. I think that will work and should satisfy any problems that I might have with clotting. I haven’t seen any clotting during the last two treatments, which is always nice.

Please continue to pray for:

• good, easy sticks for each treatment (only two sticks is preferred)


• that the machine can continue to run at 400 ml/min each treatment


• that my lipid panel will have good results

Thanks for coming by to read! It’s short because it’s full of good news

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!

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.

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!

March 2006 Lab Report

Hey there everyone. It is Friday afternoon, and I have decided to update my blog and let everyone know how I am doing. Things have been going decently this week. I have felt well every day (except this morning, when I felt a little ill). I have had good dialysis treatments and the technicians have not injured my arm in a while.

I went to the cardiologist’s office on Wednesday and had a nurse take my blood pressure. I also gave her a chart from my last two weeks at dialysis. The machine takes my blood pressure every half hour, so I have a fairly complete record. Since I have been experiencing a little bit of dizziness and some occasional near-blacking out (right after I stand up, not while driving or anything), the doctor said I should try and even out my meds. So now, instead of taking one 200 mg Toprol XL once a day, I am supposed to take one 100 mg Toprol XL twice a day (once in the AM and once in the PM). I started that yesterday, so there has not been a chance for any changes yet. Give it a week and I’ll see.

I have been enjoying my new dry weight of 69.0 kg (which is about 151 lbs). I had been having more cramps at home between treatments, and those are much fewer now. It is not any fun to be awakened in the middle of the night when your foot feels like it is trying to escape from the bottom of your leg. I had one last night and it was not enjoyable. I am hoping that we can figure out my proper weight and I’ll get back to feeling normal again.

As the title of my post suggests, I got my March lab reports back yesterday. The dietician is once again pleased with my report. All of my charts fell within the accepted ranges. I am pleased because my phosphorus went back down ½ a point. So, without further ado, here are the March labs:

• ALBUMIN: 4.6 (goal is 3.8 to 4.5)


• eKdrt/V: 1.47 (goal is greater than or equal to 1.2)1.47 is down a little from last month, but still is good.What this means is that my eKdrt/V is adequate, so I am receiving enough dialysis.


• enPCR: 0.59 (goal is greater than or equal to 0.8)This says that my protein catabolic rate (protein intake) is low. It recommends that I eat more fish, seafood, chicken, turkey, lean red meat, lean fresh port, eggs, or cottage cheese. The dietician says that has always been low because my one kidney still makes urine and passes some of that out of my blood stream.


• POTASSIUM: 4.3 (goal is 3.5 to 6.0)My potassium level is normal which means that I am doing a good job with the potassium in my diet (and the 3K solution at dialysis helps, too).


• CORRECTED CALCIUM: 9.0 (goal is 8.4 to 9.5)My corrected calcium is normal.


• PHOSPHORUS: 4.5 (goal is 3.5 to 5.5)My phosphorus was 5.5 last month, so this is exciting. This means that my phosphorus is normal and that I am doing a great job limiting high phosphorus foods and taking my binders with my meals and snacks.


• HEMOGLOBIN: 12.9 (goal is 11 to 12)Hemoglobin levels show how anemic I am, so this is always nice to be high (so I have some energy)


• AVERAGE FLUID WEIGHT GAIN: 1.86 kg or 2.7% (goal is 3 – 5% of dry weight)This is acceptable, and it feels good to me.

I again did not get my full lab report. Maybe I will be able to get a hold of it Saturday (and the one from February). I’d like to see my BUN, creatinine, and URR (all of which I was told are important).

Please continue to pray for my health. The longer a patient is on dialysis, the worse it is for them (overall). They say that you best chances for a transplant to work is if you can get one with as little dialysis as possible. Please pray for the donors and for the transplant office that all of the appointments and schedules will work out right. And, please pray for healing. If God chooses to heal me rather than to use a transplant, I will be VERY excited. I know that we do not get to pick the way that God chooses to deal with our requests, but I would like to pray for healing. I know that it is possible and that God will do what He knows is best for His glory in this situation. Thank you all for coming by to read and for offering your prayers with me. I really do appreciate it.

See you next week!