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Latest Labs and Other Stuff

August 30, 2008 Leave a comment

I had a visit with the Bariatric doctor (Monday), as well as my bi-weekly labs on Wednesday.

My visit on Monday went well. Of course, I’ve gained weight since last summer. Prior to starting dialysis last August, my weight was 185 lbs; I wasn’t looking so good (my baseline weight after gastric bypass surgery in January 2002 was 240-250 lbs). After a few months of dialysis, I was up to about 205 lbs (my “dry weight” was 93.5 kg). Now, almost 4 months after my transplant surgery, I’m 223 lbs, and seem to have leveled off there. The doctor said that they don’t like to see weight gain like this after gastric bypass, but that mine was acceptable, as long as I didn’t keep gaining. There really wasn’t much else, other than she wanted to check my Vitamin B-12 level, since I get it monthly, and also because the B vitamins are excreted by the kidneys. She also checked my Zinc level (not sure why; probably because of the expected malabsorption after gastric bypass), and my Vitamin D level, since my PTH (parathyroid hormone) was elevated the last time (106). My Vitamin B-12 was 549 (norm 243-894), my Zinc was 66 (norm 60-130), and the Vitamin D is not back yet.

My other labs are still very good. Creatinine is stable at 1.2, my Hemoglobin still climbing with the Procrit (that’s good), and my Prograf level is 8.6 (lower than last time, but still within expected range). I get labs done again in 2 weeks, and I expect that my last dose of Procrit is not far off.

I haven’t done any walking this week, as the area of skin breakdown is just healing. I haven’t worn my AFO’s in a week, but have an appointment on September 8 to get them adjusted. For the meantime, my walking is very tentative, as it wouldn’t take much for one of my feet to drop, causing me to fall flat on my face. With the likelihood of weakened bones from the kidney disease, I don’t need a broken hip or extremity. I’m anxious to get back to walking. For now, I’ve been keeping active by getting the shed in our back yard ready to paint (scraping caulk; what fun!).

Jackie started her new job this week and loves it! Actually, she started it the week before, but that week was orientation, and this week, she actually started in the classroom.  She also contacted a local university, and is planning on taking courses for Special Ed. certification (she has an undergrad in Psychology, and a Master’s in Elementary Ed). It will only be 6 courses, and a 100 hour internship. We’re hoping that at least part of her internship can be done as part of her job, but if it can’t, 100 hours is only about 17 school days (for those of us who have to work 8 hour days, that of course would be 12.5 work days).

I usually don’t discuss politics much, but it’s been an interesting year. I wasn’t thrilled with either presidential candidate, but am still interested in the process and the strategies. Despite the media hoopla (I think I read that he was featured on Time Magazine’s cover 10 times this year, vs 3 for McCain), Obama isn’t that far ahead of McCain. Prior to his speech Thursday evening, the thought amongst some was that he wouldn’t get that much of a bounce out of the convention. Then, his speech was hailed as phenomenol, and I was thinking he might get a decent bounce out of the polls (a speech is nothing more than reading words on a teleprompter; it’s how WELL you do it that sets you apart from others, and he read it well). And then came the news of Sarah Palin being McCain’s running mate. It seems to have energized the Republicans, and worried the mainstream media. We’re in for an interesting ride over the next 2 months…

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Transplant Week 17, Random Stuff

August 25, 2008 Leave a comment

Busy, busy busy, which is why I haven’t posted in a while.  Last week, I had a few hours of overtime at work, and yesterday, I worked a 10 hour shift. We’ll probably have a lull at my full time job for the next 2-3 weeks, but since school is back this week, the kids will once again be sharing their germs, and we’ll start to see more strep and asthma towards the middle to end of September. I’m at a desk still, so I will have minimal exposure, and am not worried.

Nothing to report transplant-wise this week. I haven’t had labs since my last post, although I’m getting some done on Wednesday.

I’m still walking 5 days/week, although not this week. I have some skin breakdown on my right ankle from rubbing against my AFO (“splint” that helps support my ankle and foot when walking, due to problems related to my CMT).  I did put some Duoderm over it, but will have to forego walking for now. I’ll probably just do my recumbent bike for the rest of the week, since I usually don’t wear my AFO’s around the house.

Today, I have my regular follow up with the Bariatric doctor. Speaking of which, I had started seeing the doctors for Obesity in 1996 or 1997 (back in the Phen-Fen days). One of the doctors who I saw back then left our hospital for a job in Boston. I found out recently that she has written a book on the weigh-loss drug Alli that is now on Amazon.

We ended up not going to the School Board meeting 2 weeks ago.  It was a very hectic day, as I was tired from working 10 hours the day before, and Jackie had to go to see her mother, after she ended up in the Emergency Department for a fall. (she’s OK, but was pretty banged up; broken nose, broken finger, rib injuries, and bruising all over). I don’t think it would have done much good anyway. The only consolation is that the taxpayers are beginning to see how out of control the school board and administration are, and are beginning to confront them on their practices. 

Jackie started her new job at the end of last week (orientation) and will start in the classroom on Wednesday. She’ll be working in a classroom for autistic children at a privately-run school as a para-professional. The position is above that of an aide, but since she isn’t certified in Special Education, she can’t teach at this point. She has been in contact with her alma mater to look into getting certification in Special Ed, and it will only be 6 classes plus an internship. She hopes that her current job will count for at least some of her internship, and possibly even her 3 years as an Alternative Education teacher counting towards it.

I was flipping through the channels last night, and came upon the Olympics. it was the first time I had them on; I’m obviously not a big fan (I’m more likely to watch the Winter Olympics). It got me thinking about my cousin Bernie, who I haven’t seen in a long time (our grandparents’ 50th wedding anniversary party in 1985); my father and his father were brothers. Anyway, the last I knew, he was living in Taiwan. I “Googled” him, and after several different search terms, found that he’s now living in Beijing, and apparently has done well

It looks as though I’ll be building another computer. Kevin wants a new computer for Christmas, so I gave him the option of a manufactured box or a build-your-own. I’ll be watching Newegg over the next few months to pick up components as they go on sale and have free shipping. It’s not necessarily cheaper doing it this way, but the parts you get for the same money as the cost of a manufactured computer are superior.

Labs and Today’s Office Visits

August 13, 2008 2 comments

I had labs yesterday and office visits with the Transplant Nephrologist and Transplant Surgeon.

My labs are excellent. My Prograf level is within the expected 8-10 range, Hemoglobin is up to 10.6 (up almost 1 gram since starting Procrit 2 weeks ago), creatinine is 1.2,  Magnesium is normal (although I’m on 3 doses/day), Platelet count still normal but creeping downward, PTH elevated but lower than before transplant, Iron a little lower but not problematic, and my Lipid panel is excellent; cholesterol is 104.

As for the visit, I first saw the surgeon (Dr. Varma). I did ask about the stent needed for my fistula, and he called in the other surgeon who is the fistula “expert” (Dr. Kotru).  He explained that since it still has the “buzz” that can be felt, he would suggest it be left alone. Stenting it would predispose it to clots, and being that I’m not on dialysis, it’s an unnecessary risk. He also gave me the option of having it tied off (“ligated”). I would consider that, but I use it for drawing blood and would prefer to keep it for now. He was fine with that, and further explained that since my fistula is so well developed all the way up to my shoulder, if I did  have it ligated, he would need to remove the whole vein. In those with fistulas that are not prominent, this is not necessary. You may remember that the surgeon who did my transplant wanted to eventually ligate it after about a year. I forgot to ask about this, but since Dr. K is the fistula “expert”, I have faith in his opinion (and after all, different doctors have different approaches and opinions).  As for the rest of the visit, Dr. Varma was very happy with the way things are going.

The Transplant Nephrologist was also happy with my progress. He ordered the Procrit, and said that I will probably only be on it for a little while longer. He also said my PTH will probably come down over time. I like the way he did the visit; he turned the computer screen towards me so that I could see everything he was typing in. His rationale is that if I had a question, I could ask it right then and there. So many people leave the office with a misconception, and worry needlessly about something, and their perception is not correct. I like this openness. His theory is that he is up front with the patient about everything, and will then at least have a plan on dealing with it, rather than hiding anything.

The nurse managing my Procrit called yesterday. Although my Hemoglobin is coming up, it’s still under 11, so they increased the dose 15% to 11,500 units weekly. I’ll have my hemoglobin checked in 2 weeks again, and my Transferrin Sat/Iron studies in 1 month.

I just have to be careful that I don’t overextend myself. I’m back to work full time, and working my weekend job as well.  I feel so much better, and am trying to do a lot. I’ve decided to pace myself and prioritize. This week won’t work with that, as I’m at work until 9 tonight (started at 8:15 today with my appointments and then right to work) and am  here from 8am-9pm tomorrow night as well. We have a training both nights, which is why I’m working so long.  I did go to bed early last night, knowing what I had ahead of me.

Judging from the way things are at work, there is definitely a full moon coming. I won’t go into specifics, but there is a tension that I can’t describe, and some of the parents in general are more uptight than usual.

Amish Buggy Sunday

August 11, 2008 1 comment

You may have seen me describe a Sunday at work as a (number) Buggy Sunday. Let me explain.

I have a job on the weekends with a nursing agency (different employer than my full time weekday job). It’s in a rural area of Pennsylvania that is an exit off of Interstate 80, and has numerous Amish and Mennonite farms.

On Saturdays, I rarely see any Amish, but on Sunday, that’s a different story.

The Amish, from what I’m told, hold church services in a different home each week. Invariably, I either pass a buggy (or several) on my way to work, or see them going past the house during the day (the house I work at is on a dirt road with farmland surrounding it).

Yes, it’s the 21st century, and there are still people using horses to pull wagons and buggys.

As for the types of buggies, there are 2 basic types; those with a cab, and those that are an open wagon. From what I’m told, the open wagon type are the “courting” buggies. And yes, the Amish DO go parking on dates, usually in a field. My friend lives in Amish country, and jokes that she’s seen these courting buggies rocking in the corn fields (jokes about it, but has actually seen it). She wonders how difficult it is for the male to get the females dress open, as they use straight pins rather than buttons (OUCH!).

To get back on the subject, I categorize each Sunday by the number of Amish buggies I see all day. Usually, it’s a 4 or 5 Buggy Sunday, but I’ve seen 12 to 14 Buggy Sunday’s before.

I originally had this as a page, but decided to convert it to a post. I will refer to this in future posts so that I don’t have to explain it each time.

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Random Stuff

August 10, 2008 Leave a comment

The weekend is almost over; it sure went quick.

We spent yesterday afternoon at Jackie’s sister’s house, having a belated birthday party for my father-in-law. They were on vacation in Florida for his birthday, so that’s why we had it this weekend. We also celebrated her Rottweiler’s birthday, which was yesterday. Since Patti is no longer married, and has no kids, her Rottie (the most gentle dog I’ve ever met) is her child. She had a special birthday cake that is made for dogs (peanut butter and banana, without all the sugar). Everyone except Ed (my father in law) and myself went swimming. It was only in the mid 70’s, so that wasn’t hot enough for me to go in the water.

Jackie and I went to restaurant in my old home-town for supper. They have awesome cheesesteaks, so I had one. Of course, it wasn’t without incident (again). The girl got 2 lids out for the drinks, and of course, she put mine down on the counter (the same counter people lean on, put money on, etc). I asked for a clean one, explaining my situation, and the girl got pissy. So, I just took one without the lid. Had I been alone, I would have gotten my money back and walked out, but I saw her dispense the soda, and was sure that there wasn’t any problem.

I worked a 10 hour shift today, and had to get up at 5am. It’s easy work, but 10 hours is a long day. It was a 4 buggy Sunday today; 3 with enclosed cabs, and 1 open wagon.

My employer has been working for several years on building up to receive “Magnet” status with our nursing department. I’d first like to say that most, if not all credentialing agencies and processes are BS (can you say “JCAHO“?). It’s a big game; the place seeking the credentials has everyone on their “best behavior”, has everything done the way the credentialing agency wants it to be, and once they are gone, everything is back to normal. Healthcare isn’t the only area this is done; I’ve worked for numerous places in high school and college, and it’s done in every industry. Anyway, my employer was seeking this at our campus, and bent over backwards to see that it was successful. They even had scrub tops with our name embroidered on them, and gave them out to all of the nurses on campus. Well, they got orders from every department on campus except for ours. When someone said something, they scurried to get some for us, and we got the leftovers. Fortunately, they had my size, but for the women, they ended up with tops that several had to alter in order for them to not be too big. It’s nothing new, as we are consistently “forgotten”, yet the clinic upstairs is included in everything. I’ve been in the field long enough to not let it bother me, but I keep it stored for later use; there will be a time when our system’s director of nursing will talk to me, and I will let her know.

Categories: Random

Transplant Week 14, Labs, Other Stuff

August 8, 2008 2 comments

I’m almost 14 weeks since my transplant, and everything is going well.

I had labs this week, and my creatinine is boringly still normal (I’m NOT complaining). It’s up slightly, but that’s either just normal variation, or maybe from my Prograf being a little elevated.

Lab highlights: Prograf is 10.8, and they want it between 8-10 at this point; hemoglobin is coming up, and is now 10.2, a week after starting Procrit; and my iron studies are all normal. In addition, my CMV continues to be negative. They had decreased my Valcyte several weeks ago (the anti-viral med to prevent CMV), so it’s obviously working despite the lower dose. And, they decreased my Prograf by 1mg/day to 3mg in am and 3mg in PM.

I’ve been walking consistently. I did miss Wednesday because I had ankle pain. This was due to my orthotic splint rubbing, which was a result of new shoes. I’m wearing my old shoes for now, and gradually breaking the new ones in. I’m now to the point where I can keep a fairly good speed going up the large incline, and not getting as short of breath with it.
I renewed by CPR this week. We take the American Heart Association course, and I like this for 2 reasons. The “book part” we do online, which means we can do different sections at different times, and when we are done, we print off the certificate, make an appointment for the “hands on” portion, and finish up with that. The 2nd reason is that it’s good for 2 years, while American Red Cross is good for 1 year. I’ve taken CPR now since 1986, and pretty much can breeze right through at this point. I’ve done CPR on a handful of patients; fortunately, it’s all been in the hospital/clinic, so I always had an Ambu bag to ventilate, and never had to do true mouth-to-mouth (I’ve had friends that have done it this way, and usually the person on the receiving end vomits, so you have to clear the mouth out and resume artificial respirations; yuck!). The only problem I have is that they keep making these minor changes which end up being confusing. No more 5 compressions to 1 ventilation with 2 man Adult CPR; it’s now 30 and 2. And instead of compressing the chest of an infant 1/2″-1″, it’s now 1/3 the depth of the chest. It’s enough to make you crazy. When you are in the actual situation, and the adrenaline is pumping, you don’t COUNT; you just do it. Another recent change is that on an infant, you can use both thumbs to do compressions, with the rest of the hands encircling the chest. Newsflash: we did that back in the late 80’s/early 90’s when I worked in the hospital. I guess they figured out that it is a good way of doing it; that is, until they change it again in 2 years!

Try not to be too jealous, but gas at the supermarket around the corner from our house was $3.45 this morning on my way to work! As of now, oil is down to $115.38/barrel, down $4.64 from yesterday.

Not much planned for the weekend. I’m working Sunday, and on Monday, we’ll be going to the school board meeting.

Yesterday, I was in a fast-food drive-thru, and saw a rather odd police car: a Pennsylvania State Police Dodge Magnum (I found a pic on the internet, but can’t hotlink to it).

Whenever you feel as though there are insurmountable obstacles, or feeling that your life is tough, read this.

To Speed, or Not To Speed?

August 6, 2008 Leave a comment

I travel I-80 to work everyday, and see people speeding on a regular basis. And, it’s not unusual to see a State Trooper speeding without lights or siren, only to be seen further ahead,  either getting off the exit to presumably go back to the barracks, or parked in the median with the radar gun out.  Not what I call a justifiable situation in which to speed.

I just read a story of a father who was pulled over on May 12 for speeding. In fact, he was doing 90 MPH in a 65 MPH zone. This is illegal.  However,  his REASON for speeding clouds up the issue a bit.

His son had a stroke which left him partially paralyzed and in kidney failure. On May 12, they received a call that a kidney was available, but that the person it was offered to was not able to go through the surgery, and if they rushed to the hospital, he could have the surgery. Since the kidney was apparently already harvested, time was of the essence.

The father, who was a long-time truck driver, phoned his local sheriff, and asked for advice. They told him to use his headlights and hazard lights, and if pulled over, to explain the situation.

A sheriff in another county pulled him over, but didn’t buy the explanation.  As it turns out, they didn’t arrive to the hospital in time, and he didn’t receive the kidney.

Yes, speeding is illegal, but if he didn’t speed, the son wouldn’t get the kidney.

Personally,  it took 7 calls before I got my kidney. I’m fortunate, in that I live 30 minutes from my transplant center. If I were in this father’s situation, I would have done the same thing as he did.

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