Saturday and Tuesday

So, I have been chronicling my experiences with extra sticks recently. It seems my fistula is not working the way that I would prefer it to. Last week, I had 4 sticks on Tuesday and 3 sticks on Thursday (just to bring you up to speed).

On Saturday, I was lucky and only had to be stuck with two needles. This seemed to be a good thing, since they wanted to run an “access flow” check on my fistula. This is a quarterly test that they run at the dialysis clinic to see how well the blood is flowing inside your fistula. They tell me that a rate over 400 ml/min is preferred for an AV Fistula. My previous fistula never scored much over 300, and it eventually died. I was hoping for a better score with this one. Unfortunately, there was a problem, and they couldn’t run the test on Saturday. I guess one of the needles was not quite in the right place, because it kind of leaked a little bit the rest of the night. They stopped the bleeding, but I don’t think it was quite right.

On Tuesday, they had to use three needles before they could get me. Keep in mind that the same technician has been sticking me for about 7 straight treatments at this point. But, the needles went in and we were ready to try the access flow again. This time, it ran just fine, and the machine reported an access flow around 640 ml/min (or close to that). That is a wonderful number. I am very thankful that my fistula is flowing well, even if it is not sticking well. The extra needle this week was due to clotting again.

I received my monthly lab reports on Tuesday as well. Here they go:

Albumin: Protein in the blood that helps fight infections and aids in healing

August 2006 - 4.5 (goal is 3.8 to 4.5)

Your albumin (blood protein) is normal

enPCR: Protein Catabolic Rate; suggest if I am eating enough fish, chicken, beef, and other protein foods to meet my daily needs

August 2006 - 0.59 (goal is greater than or equal to 0.8)

Your protein catabolic rate (protein intake) is low

The dietician suggested that I try eating eggs for breakfast, so I will.

eKdrt/V: Tells how well my dialysis treatment is working and if I am receiving enough dialysis to clean my blood

August 2006 - 1.26 (goal is greater than or equal to 1.2) – this is up a tiny bit from last month

Your eKdrt/V is in the goal range.

Potassium: A mineral needed for normal heart rhythm and muscle function. High potassium can make my heart stop!

August 2006 - 3.8 (goal is 3.5 to 6)

Your potassium level is normal

Corrected Calcium: A mineral needed for healthy bones and muscles

August 2006 – 9.4 (goal is 8.4 to 9.5)

Your corrected calcium is normal

Phosphorus: A mineral needed for healthy bones. High phosphorus can damage my heart and blood vessels by making them stiff, and can weaken my bones.

August 2006 – 2.9 (goal is 3.5 to 5.5)

Your phosphorus is low.

This is the lowest I’ve ever seen my phosphorus. The dietician said it is still within normal range as long as it is above 2.5.

Hemoblobin

August 2006 – 9.6 (goal is 11 to 12)

Your hemoglobin is low. This is called anemia. You may need your EPO or iron changed.

The dietician did raise my EPO levels.

There was also a new chart showing my average fluid weight gains for the last six months. My overall average was less than 3.0 liters per month. The weekend fluid gains were between 3.0 and 3.5 liters on a monthly basis. This was well within my goal of staying under 3.5 liters (since that is about all my body can tolerate having removed in one treatment).

I hope the new format of the lab report wasn’t too confusing. If you have any questions, please feel free to comment or e-mail. I have to go now. Jenny hasn’t seen much of me all week and is jealous of my blog getting all this attention.

4 Needles, and then 3

I am here at dialysis tonight, and I have a few minutes, so I think I”m going to update my blog. It is Thursday, August 10, and I have been to two treatments since I wrote to you last. Let me tell you how it's going.

Tuesday night, it took four sticks to get my treatment started. The technician, who does a great job, got the first needle in with no problems. She stuck it easily, and got “the flash” right away. But, because they were drawing labs that night, she did not dilute the line with saline. She spent about five minutes trying to get in the next needle, and it ended up that the area was clotted. She had to pull the needle out and find a new location. She spent another five minutes or so looking for a spot, and finally got a replacement needle in place. Unfortunately, by this time, the first needle that was inserted had become clotted. So, she had to remove it and find a new location. She went ahead and drew my labs, and then put in saline to dilute the line so it would not get clotted, too. The fourth needle was successful, and we were able to do the treatment. The machine ran at 300 for a while, but they had to turn it down to 270 after an hour or so.

So, now let me bring you to Thursday. Tonight was only three needles. The first went in easily, and was diluted with saline right away. The second needle went in easily, but pulled a clot. I think there must be several clots hiding under my skin just waiting to get out on a nice friendly dialysis needle. So, it only took about 30 minutes to get me ready, and then we got started. The machine was started at 300, and we bumped it up to 350 after an hour. It has been running successfully at 350 for about an hour now, which is great. If the stick goes well on Saturday, then I will go to 400 (which is the fastest that they like to run the machine). 400 ml/min helps you get the best possible treatment available.

They drew labs on Tuesday, so I should have the report next week. I think I have been doing well on my diet, so I want to see if all of my numbers are in range. The one that causes me the most problems is the phosphorus. Last month, it was a little low. So, maybe this month, I will be back in the middle of the range.

I had a friend ask me about Josh. He is the guy that has volunteered to be tested as a kidney donor for me. As of today, I have not heard anything new. It took about two weeks after my dad was called before he got his packet of test information. So, I am guessing that they are processing a pile of paper work for Josh, and that he will have his packet in the next week or so. I'm looking forward to his test results.

Please pray that God will prepare the kidney that he has for me, from whomever it may come. Pray that Josh's testing will go quickly and easily. And, please pray that my fistula will behave and not have so many clots (that require re-sticks).

I've got 45 minutes left on the machine. I'm going to watch “Who Wants to be a Superhero?” on the SciFi channel. So, you guys have a good night, and I'll give you more information as I get it!

Three Sticks

Well, I had a few more sticks than I would have preferred this weekend. I normally go to dialysis every Tuesday, Thursday, and Saturday evening from 4:30 – 8:30 pm (or there about). Unfortunately, I had a minor problem this most recent weekend. I went in for my normal treatment on Thursday, the 3rd. I arrived at the clinic around 4:15pm (which is normal for me) and headed over to my chair for dialysis. I requested my usual technician (who has had several good sticks with my new upper arm fistula). She had some trouble getting in the first needle, though that is not unusual. It finally flashed (which is what dialysis people call it when the blood pulses in the needle). So, she taped the needle down and began working on the other side.

The second needle was a bit more of a problem. She poked around, but it seemed that all she was able to find was a sticky mess of clotted blood. So, she thought she would try a third location. This was not altogether pleasant, but I wanted to have dialysis, so I let her continue to look for a spot to stick my fistula. Sadly, by the time this needle was properly placed (and only barely at that), the first needle had become clotted. By this time, it was about 5:30. I told them that I would just prefer to go home and come back to try again tomorrow. They charge nurse scheduled me for a 4:30 appointment on Friday afternoon and I went home to ice my arm. It did not bruise, though it still is sore today (Monday).

So, I had 3 needles on Thursday, but they just didn’t work. I went in on Friday, and had a different technician. She tried an entirely new area of my fistula and was able to get the needle to flash right away. Since the area was new, there was not any fear of coming up with clots. She is still using the same place on the lower half of the fistula, so it is at least a little more scarred over (which makes the needle stick slightly less noticeable). The treatment ran Friday night at about 250 ml/min to start, and then up to 300 ml/min for the rest of the treatment (I think).

I came back for dialysis again on Saturday (even though I had only gained about 1.5 kilos). The same technician from Thursday was there again, so she stuck me again. She put the needles in about the same places as she had used on Friday night, and they both stuck. The upper needle gave her a little trouble, and she had to move it around inside the fistula a little bit to get it right down the middle of the lane. The treatment on Saturday ran at 300 ml/min for the entire time, which is better. The best treatment that they give at our clinic runs at 400 ml/min using the 15-gauge needles. So, I just have to let my fistula grow its way up to 400 ml/min, and I should be okay. That, and I need the fistula to start accepting needles better.

Here are some prayer requests for this week, if you don’t mind:

• Pray for my friend Josh. He has volunteered to have his kidney tested as a possible donor. He has also told me that he’d be willing to go in for an experimental treatment. You can read about that here: http://abcnews.go.com/WNT/Health/story?id=2243837&page=1


• Pray for the technicians at dialysis. Please pray that they will be able to find two good spots on my fistula to stick in the needles.


• Pray that in addition to the good sticking, that we will be able to run the machine at 400 ml/min for an optimal treatment.

I’m hoping for two good weeks worth of treatments in a row. Thank you for coming by to read today. If you look over the ABC news article, don’t panic. I have not talked to any doctors about this, and I do not even know if they are testing it in the Dallas area. If they are, I will talk to the transplant team and see if they would recommend something like that for me. I know I would enjoy the possibility of no drugs (and keeping the kidney longer).