And Yet Another Surgery

I’m headed for another medical first for me: 2 surgeries in 1 year.  The first surgery I had this year was when I had my dialysis fistula tied off in April (along with the associated debacle in the hospital several days later).

The previous April, I had surgery on my left foot due to an infection in my foot bone (osteomyelitis) as well as a deep tissue infected from a foot ulcer, and the associated debacle 3 weeks after THAT surgery that put me in to the hospital with Acute Renal Failure from an interaction with my Tacrolimus (I was prescribed Fluconazole for the Candida Parapsilosis in my foot, which caused my Tacrolimus levels to go to 33, leading to ARF).

I just now got back from the Podiatrist, and had the persistent ulcer on my right foot debrided, and given Cipro for the beginning of a cellulitis.  It never really healed well from the cellulitis I had last month, and started “acting up” again over the past week.  He told me I probably have a multiple organism infection, which if not treated, would most certainly become much more problematic, especially given my immunosuppression.

This is all a direct result of my Charcot Marie Tooth peripheral neuropathy.  The muscles in my leg have deteriorated over my 49 years, and although I use a fitted lower leg orthotic, there is a lot of pressure on the outside of my foot, which caused an ulcer.  It will never probably heal well, so my Podiatrist suggested I talk to my Orthopaedic surgeon about reconstructive surgery on my right foot.  I had it done on my left foot last year, and I’ve had no problems at all on the left since my surgery.

I knew this was coming, and although I’m hesistant to do it, I know I need it, and will have it done.

But, there will be 2 conditions I set before having it done (doctors HATE to hear that).

First and foremost, I will insist on a PCA pump, aka Patient Controlled Analgesia.  When I had my left foot done, the Anesthesiologist wouldn’t do a nerve block (rightfully so, being that I have neuropathy).  Thus, I ended up getting “bolus” doses of Morphine and Dilaudid, with much nausea/vomiting and poor pain control.  They did this because they planned on only an overnight stay, but it ended up that I was in for 2 days.  I had PCA for my kidney transplant and gastric bypass, and had excellent control of my pain with little to no nausea.

Second, I will have the Transplant Surgeons consulted while in the hospital to avoid any errors that put my kidney at risk.  They are the ones who manage my Tacrolimus, so they will be the ones to ensure that my kidney is safe.  After my hospitalization this past April when they gave me too high a dose of Vancomycin, I want somebody watching over the meds I get.

So for now, I’m hoping the Cipro helps, and will hopefully get an appointment to see Dr. Cush within the next several weeks.

As for my readers, feel free to contact me via the comments section.  There are people from around the world who read this blog, and I’ve had questions in the past, particularly about BK Virus treatment.  Thanks for reading and following.  I hope someone finds my posts helpful.

Medical Article Scan for August 2008

I know; it’s September. Better late than never…

Anemia of Chronic Disease: An Adaptive Response?  The authors argue that anemia may be beneficial to patients with inflammatory disease, and advocate restraint in treating mild to moderate forms of anemia. This may be proven someday, as they are now finding that too much injected erythropoietin (Procrit, Epogen, etc) can have adverse effects if used to bring hemoglobin up past 12.

CMV Infections Affect More Than Just Patients With Compromised Immune Systems – researchers have discovered that Cytomegalovirus, which is particularly dangerous to those with suppressed immune systems, can also be reactivated in those with normal

Want A Reason To Love Your Lower Belly Fat?….     Fat in the lower abdomen and thighs is rich in adult stem cells.  Maybe they can set up a plan for those having gastric bypass to donate their extra fat after weight loss to cover the cost of cosmetic surgery?

Does Too Much Sun Cause Melanoma? You’ll notice in the past that I’ve had articles on Vitamin D. This article reports that sun can cause the more “benign” skin cancers, but not melanoma, and that we must strike a balance between the need to protect the skin from cancer and the need to get Vitamin D.

Long Term Weight Loss… – study of women which shows that in order to maintain a 10% weight loss, there needed to be 5 days a week of 55 minutes of exercise. On the bright side, small changes throughout the day can be partially substituted, such as moving around more, less TV, etc.

Total Calories More Important Than Dietary Fat In Diabetes Risk – decreased risk of diabetes is linked to weight loss, and not to specific nutrient content. There are other conclusions in this study, such as consumption of soft drinks was associated to unhealthy behaviors and consumption of fruit juices to healthy behaviors “to some extent”.

Stem Cell Scientist Predicts Health Revolution – immature adult stem cells are predicted to be as important a revolution in the 21st century as antibiotics were in the 20th century.

World’s First Transplant of Both Arms – Last month, a surgery team in Germany transplanted bilateral arms onto a 54 year old farmer who lost his in an accident. The 2 things of interest are the actual procedure and what was involved, as well as the hurdles afterwards, such as immunosuppression and the lack of a blood test to catch rejection.

Positive Thinking May Protect Against Breast Cancer – Yet another study affirming feelings of happiness and optimism as providing a “protective role” against disease (in this case, breast cancer).

Restaurant Hygiene

Despite the fact that I’m only 2-1/2 months out from my kidney transplant, I still occasionally eat at restaurants. I’ve always been cognizant of how clean a restaurant is, since I worked in McDonalds while in high school. One of my pet peeves is when a person cleaning a table uses the same rag on the seats as they do on the table (a big no-no at Mickey D’s). However, since my transplant and resulting immunosuppression, I’m even more fanatical about it now.

This past weekend, the 3 of us went to lunch with my wife’s mother and sister. They seated us at a table that obviously was dirty. The hostess noticed it, and put down the napkin-wrapped untensils on the dirty table and told us she would be back to clean it. When she cleaned it, she put the utensils back down ON THE WET TABLE ! (capillary action can wick germs into the napkin and onto the utensils)  I let it get that far to see what she would do, and  when she hadn’t replaced them, I told her of my immune status and asked for clean utensils. Needless to say, I didn’t get a pleasant response. She wasn’t nasty, but I could tell that she was pissed.

2 weeks ago, we went away for the weekend, and when we were waiting for a table at a restaurant, the host picked a cloth up off the floor and WIPED OUR TABLE OFF WITH IT! I mentioned it to the waitress, and of course, got another pissed-off look.

Am I being unreasonable? Even if I DIDN’T have a suppressed immune system, I would still expect that our utensils and napkins not be placed on a dirty table, nor should a rag that was on the floor be used to clean our table off.

Transplant Day 35

Today is the 5 week anniversary of my kidney transplant. Doing better today. Not that yesterday was bad, but urinating was VERY painful after yesterday’s procedure. Today, it’s back to normal. 

My BP is normal today, which proves that BP trends are more accurate than single readings.

Jackie and Kevin put in our air conditioners last evening, so it’s much more tolerable inside today. I feel bad that I’m unable to do heavy lifting or weeding/gardening, but I know it’s for my own good. The heavy lifting restriction is from both the surgery and the fistula. One of the issues last night was that when we turned on the air conditioners, there was a musty smell, which means fungus. So, we sprayed Lysol inside the vent that shoots out the cool air, because fungus in my immune state could be life-threatening.

I posted some interesting articles related to transplants on MyKidney.com.

I also came across a contrarian view to current oil prices (which can be seen here). Time will tell.