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.

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).

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"

11 Months Later: The Transplanted Kidney Works Great!

Well, it has now been a little over 11 months (not since I last posted, silly) since I had my kidney transplant. I have to say that everything is going great. I went to my regular post-transplant clinic this week and the doctor said that I am doing great.

My creatinine remains at 1.0. My BUN is still 12.0 (which is good). Sodium, potassium, glucose, phosphorus, and all the other chemicals look great, too. The only thing that is "out of normal" is my magnesium, and it has been slightly low ever since the transplant, so I do not think that they are worried about it too much.

I have my one-year Glofil test scheduled in January. If the results are normal, the doctor said that I will only have to go back for a Glofil every January (which is nice). The Glofil is always at least a half-day appointment, so it will be good from a time management standpoint to not have as many of those.

I had a renal sonogram while I was in the office on Tuesday. The doctor wanted to make sure that my old Polycystic Kidney is not in there causing any problems. The technician obviously could not tell me anything that she saw, but she let me look at the kidney and it looked just as gross as ever. She also showed me the new kidney, which was just perfect looking. It had that great kidney shape, and obviously is doing it's job quite well.

In medication news, I am slowly working down my prednisone dosage. I had been on 10 mg for several months, and since I am almost at my one-year anniversary, I asked (last time) to get on a lower dosage. So, the doctor said to drop my dosage one milligram per month. I am on my third week of 8 mg, so I'll be down to 5 mg by the end of February (I think). I have not started noticing any of the side effects, like always having the "munchies", going away yet. Maybe that won't be noticeable until I have been on 5 mg for a while.

I also saw my cardiologist on Tuesday. She wants to get another echo of my heart to make sure the my mitral valve prolapse is not getting any worse. She said that it still sounds good, but she still wants to take a look to make sure. She also increased my dosage of atenolol (for high blood pressure) from 25 mg a day to 50 mg a day. I just started that, so I don't know the full effects yet. She said it is possible that I will become dizzy, so I am watching out.

Work has been extra-super-crazy for the past month or so. The company is doing a giant software upgrade on some of its internal systems, and I have been deeply involved in End User Acceptance Testing. This is taking several hours a day every day, and has not quite come to an end yet. I am hoping that we will be done before Christmas. I really don't want to keep working on this project next year (for 3 or 6 more months). At that rate, it will be time to upgrade again before this upgrade is completed.

Other than that, not much else is going on. I played my violin in a couple of Christmas concerts, and that was fun. It's been cold and rainy in Texas (but not freezing cold, just 40's cold).

I have that echo on my heart scheduled in the next week or two, so I'll let everyone know what's going on then. Until later, have fun, and enjoy your Christmas!

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).

Three Sticks?

Well, it has been a while since I have posted an update, so I figured that today would be as good of a day as any. I am not going to apologize for the long wait this week, as I am sure that my regular readers (the faithful five) are tired of seeing that!

So, I have been having good dialysis treatments for several months now. There are three (or possibly four) technicians that I let stick me. They are the best technicians at the clinic, and normally do not have too much trouble. They will have to move a needle around a little bit after the treatment starts occasionally, if they did not hit it right down the middle. But, all in all, there have not been too many needle problems.

Last night, however, there was a slight mis-hap. One of the trusted technicians was there to stick me for my treatment. He put in the first needle (the arterial line) and it went in with no problems. He then went for the venous line, and it was a little tricky. He thought he had it in, but it was not pulsing. He opened the line to let it fill with blood, and it filled rather quickly (which was normal). He then went to add heparin to the line, which they always do at the beginning of the treatment. Unfortunately, when he drew the blood in to the heparin needle, he also drew in a clot. So, he swapped out to an empty needle and tried to pull more blood, but could not. He ended up having to remove that line, bandage it up, and put the needle in slightly higher. It hurt a little more going in higher, but that was because it is not an area that normally gets stuck. So, he got me with that needle for the venous stick. They got some new heparin, and all was well. There were no major problems with the rest of the treatment.

The only complaint that they have at the clinic is that my blood pressure and heart rate seem to drop during my treatment. I have had it explained to me that the likely cause is my mitral valve prolapse. My heart rate is irregular, and the machine may not always catch the lighter beats. I think this is why is will register my heart rate as 44 one minute and 88 the next. This problem happens every treatment, but the nurse doesn't seem to have it noted in my chart that it is normal for me. Instead, she worries every week and asks if I am taking too much blood pressure medication.

I guess she did not see in the chart where my blood pressure was up over 150 back in November of 2005. Before we got my medication all worked out, I was having actual heart rate problems. Now, however, I think that everything is fixed, and the machine just doesn't like my heart.

Kala has her test at the end of next week, so I will update everyone as soon as I hear anything. They drew my blood at the clinic yesterday for the monthly (and yearly) tests, so I should have lab results for everyone next week.

Thanks for coming by!

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!!