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!

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!