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Posts Tagged ‘Prilosec’

Vacation Week

November 30, 2008 Leave a comment

For my US readers, a belated Happy Thanksgiving.

I had the week off from my full-time job, but was very busy. I had a dentist appointment for a routine cleaning on Monday, I took our 12 year old Springer Spaniel to the vet on Tuesday for her Rabies vaccine, I took Kevin to his yearly check up on Wednesday, chauffered Kevin around in the afternoons…

I also took our 2003 Chevy Malibu to get a new intake manifold gasket on Tuesday. I knew that when the garage called at 11am, the news probably wasn’t good. The bolts holding the rocker arms were shearing off, and the heads needed to be remachined (does that mean anything to you? it only means $$$ to me). Soooo, I had to rent a car for the week (got a good deal from Enterprise), and hopefully, the work will be done by Tuesday. I’m thinking that this will be the last GM car we get, at least the last one with a 3.1 liter engine. GM was well aware of the issues with that, but continued putting in inferior intake manifold gaskets, as well as using the Dexcool that ruined them.

My sister didn’t get the kidney on Tuesday; she didn’t cross match with the donor. The odd thing is that the Transplant Coordinator asked if she had any blood transfusions lately, as she had antibodies (which she apparently didn’t have before).

I had a white knuckle drive to work this morning; snow on Interstate 80, followed by freezing rain over Washingtonville Mountain/PA 54 (“Warshingtonville” as pronounced by the locals). No Amish buggies this morning, but they apparently already were out before me, judging by the numerous patches of horse manure in my lane.

Medically, I went off my Prilosec for the first time since May. I had never taken it prior to transplant, and want to see if I still need it. I initially was on Pepcid in the hospital, went off of it shortly after coming home, had stomach upset, and then went on Prilosec. I notice that I do have more difficulty tolerating certain foods, in that I can’t eat as much, but that’s a GOOD thing. So, I’ll see how it goes.

We didn’t do the Black Friday doorbusters this year, however, we did get 1 good deal. I need a replacement for my Ipod Nano. Nothing fancy, since I only use it on walks, and don’t use it for video or pics. I’ve been looking at a Samsung 4gb MP3 player. It’s a model that I think just came out, and was $99.99 over the summer. Wal Mart in store has it locally for $79.99, and $69.99 online. I saw that Circuit City had it Friday for $59.99, so I ordered it for instore pickup. When I got to the store, they had it for $79.99, so I saved $20 just by ordering online.  I notice today that Wal Mart lowered it another $5, and has it on clearance.  since it’s a Christmas gift from Jackie and Kevin, I won’t open it until Christmas, so I won’t know how good it is until then. I’ve always had good luck with Samsung, so it should be fine.

Transplant Day 25, Appointments

May 28, 2008 5 comments

Feeling better each day. The minor issues I’ve had along the way; edema, arm pain, diarrhea, incisional pain, etc are all but resolved.

My daily vital signs are all good today. I also updated my labs, since they are now finally available to me online.

I had my weekly appointments today, which is why I’m posting later than usual.

They had difficulty drawing my blood today, but with what they had to work with, I’m not surprised. They ended up using “old faithful” (a small vein on the outside of my arm just below my elbow).

The Transplant Nephrologist was in first. His main concern is my anemia, and he is right on top of it. He thanked me for being “proactive”, as I had emailed him over the weekend to explain my ongoing iron situation, and had requested labs to check on it. Since he’s only seen me once since my transplant, I wanted him to know of the ongoing iron problem. He took the time to explain that due to my gastric bypass surgery, I probably malabsorb iron. Iron requires an acid environment (most of my stomach is stapled off, and my “pouch” may not produce enough acid to absorb iron; in addition, my acid secretions are decreased due to the Prilosec), and it also requires the parietal cells in the ileum (portion of the small bowel) as well (my bypass is before the ileum).  The plan is to watch the trend of my iron studies, and if still abnormally low, that I may need monthly IV infusions of iron.

As it turned out, my studies are all normal today, with the exception of my iron binding function, which is minimally below normal. So that is good. My hemoglobin is stable but low, and my hematocrit is fairly stable, although a bit lower than last week. I think that they said that I would need Procrit if the hematocrit goes to 25 or below, so there’s still some room there.  And I’m less concerned, because my hemoglobin is unchanged, so maybe the new kidney is producing erythropoietin now.  Also, he discussed my white blood cell count, which is low. That is due to the Valcyte and CellCept. However, he explained that since my segs were high, I’m more or less protected from viruses, but since I had “Campath Induction” , my T cells were essentially wiped out, making me more susceptible to bacterial infections such as TB.

The Transplant Surgeon was in last, and was very pleased with both my labs and my progress. They did a lab called an Immune Cell Function last week. As it was explained to me, this is a guideline for them to use to determine the amount of my immunosuppression, and it is “right on” where they want it. My phosphorous and magnesium are now both within normal, so I can stop the Magnesium Oxide-yea! My Prograf level (FK-506) is finally normal, so I assume my dose stays the same (this wasn’t back until after my appointment).

I did print out my “daily vital signs” spreadsheet, and the Transplant Nurse told the surgeon I’m “anal”. I agree, however, I also did it to occupy my time as well. But I think that the surgeon is more comfortable with me making sure that I do what I need to do, because he told me that I can come back in 2 weeks, instead of 1 week.

I also asked him about my cystoscopy next week (I’ll be getting my stent out). My concern is that I may get an infection, which will travel to my native kidneys. He said that he would  prefer not to give an antibiotic beforehand, because that promotes resistance. If I had a problem with my heart valve, then yes, he would, but not in this case.

I’m excited about a new blogging opportunity. I will be writing for a website that will have multiple bloggers writing on various aspects of kidney disease. I will be writing as a new transplantee. There are also future plans to expand the site, and I will probably be writing as a medical professional. I will post more details when things are up and running.

Transplant Day 17; Appointments

May 20, 2008 4 comments

Doing well today. Stomach is MUCH better, but I did have diarrhea the past 2 days. Could be from the CellCept (very common) or the Magnesium Oxide. I’m not too worried at this point.

I had my appointments yesterday. Both doctors were pleased with the way things are going.

I first saw the nurse, and she thinks the arm pain is probably from positioning in the OR, and I agree. It is getting better, so that’s fine with me. I took less pain meds yesterday; in fact, I only took them twice from Midnight to bedtime, and only once this morning.

I have to cancel my dental appointment for a cleaning; they don’t want that done until at least 6 months from surgery due to the immunosuppression.

I also addressed the nausea/vomiting, and got a prescription for Prilosec. The Transplant Nephrologist told me to even take it twice daily for several days and then go to once daily.  My stomach is much more settled today.

I do have to drink more; my intake of fluids was about a liter under what I usually take in, and my urine is much more concentrated.
 
I wore my splints again yesterday to my appointments, since I had a lot of walking  (Geisinger is a large campus). By the time I got home, there were ridges in my legs from my socks and splints. In fact, the doctor checked, and I have 4+ pitting edema. That means that when he pressed down on my skin for several seconds (the front of my lower leg), it took more than 4 seconds for the skin to return to shape and the “pit” (depression) to resolve.

The Transplant Nephrologist said that he expects my creatinine to settle in to about 1.4-1.5. It’s still 1.6, but my Prograf levels are higher than normal (intentionally);  once they can lift up on the immunosuppression, and lower the dose, my creatinine will lower. He also said that with a 16 year old’s kidney, it should last the rest of my life! I was thrilled, because the average life of a transplanted kidney is 14 years. I understand that there are things that can change this, but optimistically, it would be great if it lasts me past retirement age.

The next time I hear a co-worker complain about our insurance coverage, I will promptly tell them about my Valcyte. I received a 3 month supply via the mail order pharmacy; my cost was $40, and the cost without the insurance was $4610.00. I’ll be interested to see the cost of my Prograf and CellCept; I sent for 3 month supplies of those (I already know that each will be a $40 co pay, but I don’t know what the retail cost is).

 My labs from yesterday are still not available to me, but the nurse told me my creatinine is stable at 1.6, my phosphorous is lower at 1.5 (the surgeon wasn’t too concerned; I just have to eat more dairy), and my magnesium is lower at 1.2(?). I’ll post them when they are available.

Next week my appointments are on Wednesday, which is the traditional “Transplant Clinic” day. So, I have to get labs “locally” on Thursday, and then again the morning of my appointments; there is a Geisinger clinic within walking distance, which is better for me; that way, Jackie doesn’t have to take off work to drive me to Danville for labs.

Here are my “vitals”. Note that on 5/8, that was the day I came home, and the next day, I didn’t realize that I had to weigh myself until I read through all of the literature they gave me. There is a lot of verbal and written info on discharge, and it’s a bit overwhelming. Also, in my free time, I’m learning Excel, so that is why it’s in spreadsheet format (I figured that now is a good time to learn it, as well as apply what I learned). Note the input and output are tallied at the end of the day, and the BP, Temp, and Weight are done upon awakening.

Date   Input Output BP Temp Wt (kg) Wt (lbs)
5/8/2008   1040 775        
5/9/2008   3320 2575 134/64 98.6    
5/10/2008   3080 2300 132/64 98.5 100 220
5/11/2008   3280 2950 132/72 98.1 99.0909 218
5/12/2008   2740 2900 138/70 98 99.0909 218
5/13/2008   2680 2485 138/78 97.7 99.5 219
5/14/2008   2740 3375 132/80 96.5 99.5 219
5/15/2008   3160 3000 138/80 97.7 99.8 219.5
5/16/2008   3590 3800 132/82 97.9 99.0909 218
5/17/2008   2960 3375 138/78 97.8 99.3182 218.5
5/18/2008   2320 3500 132/68 97.7 97.2727 214
5/19/2008   2800 2275 128/70 97 96.3636 212
5/20/2008       122/62 97.8 95.4545 210

 

Transplant Day 16

May 19, 2008 2 comments

Another rough day stomach-wise yesterday. I started Prilosec on Saturday night, and felt better. I was still ok Sunday morning, but by supper, my stomach didn’t feel right. No vomiting, but it was unsettled. We went out to eat, and all I had was a small salad and bowl of soup (since I didn’t eat much, I figured that my total sodium for the day was still within limits). I felt yucky for most of the night, but held off on taking the Prilosec until 10pm. That way, it would still be working today through at least early evening. I felt much better within an hour.

My total intake yesterday was down for both liquids and solids, but my urine output was still good.  Total ins: 2320 cc; total outs: 3500 cc. Today, my wt is down 2 lbs to 212 (maybe some of the extra fluid is finally coming off), BP 128/70 (MUCH better), and temp 97.0.

Being that I have my appointments today, I had to hold off on taking my evening Prograf until 12:30 this morning; the labs have to be drawn 12 hours after the last dose. Instead of relying on my alarm, I stayed up. I’ll be back on track with my dosing schedule by tomorrow.

The arm pain is better overall, but still occurs mainly at night, when my arm is still. That’s on my list for today to discuss with the doctor.

Yesterday, I forgot my phone when we went to pick Kevin up at Jackie’s parents house (about 1 hour away). When I realized it, I panicked. But then I remembered that I’m not waiting for “the call” from the transplant nurse!

Anyway, I had a voice mail when I got home. It was from our family doctor, to check to see if Jackie and I were doing OK. I called him back, and had a nice conversation; he asked if there was anything I needed. How many people are lucky enough to have a doctor like this?

My WordPress blog surpassed 1000 views yesterday! Not sure where my LiveJournal is at, as they do not offer those stats to bloggers (hence one of the reasons for the move). The 2 things I DO like about LJ over WordPress is that LJ has a friends page that keeps you up to date on their entries, as well as the ability to limit a post to “friends only”, thus keeping it private.

I’ll post either this evening or tomorrow about my appointments today.

 

Transplant Day 15

May 18, 2008 6 comments

The main issues since yesterday’s post are arm pain and nausea/vomiting, but from a kidney-standpoint, everything is great.

Today’s vitals: BP 132/68, Temp 97.7, Wt 214, and yesterday’s ins 2960, and outs were 3375.  BP yesterday was 138/78, and wt was 4 lbs higher.

The reason for the changes probably have to do with my stomach. I vomited 3 times yesterday, and hardly ate much at all. Remembering back to my last appointment, the doctor had stopped my Pepcid, because he prefers to use Prilosec (they are from 2 different classes of drugs; Pepcid is an H2 antagonist and Prilosec is a PPI). He said that if I had stomach problems, he would Rx Prilosec. So, last night I picked up some over the counter Prilosec, and away went my stomach problems! I’ve actually had nausea for the past few days, and not coincidentally, it started 2 days after stopping the Pepcid. So I obviously need something. I’ll get a prescription at my appointment tomorrow.

As for the lower BP; not sure if that is from losing weight or the Magnesium kicking in.

My arm continues to hurt, but mainly when I wake up; it wasn’t too bad during the day. Tylenol #3 helps, so I do take that at night.

We had family over for a cookout yesterday. It was a little chilly, but the rain held off until it was over. Our dogs had a blast; especially Digger. Kevin was playing catch with my sister-in-law’s boyfriend’s son, and Digger thought they were playing with him. If one of them didn’t catch the ball, Digger was right there to scoop it up, and proudly ran around the yard with it in his mouth! Chester, despite his arthritis and rotundness, would bark when the ball was thrown, and make a half-hearted attempt to chase it.

Before we got Chester, he lived at the home I work at on weekends (I do private homecare on the side). It’s not unusual for there to be several Amish buggies go by on a Sunday. Chester would run parallel to the buggy as it went down the road, and barked at it the whole way. I’m surprised that the horses were never spooked!

Tomorrow, I have labs at 12:30, so I have to postpone my evening Prograf dose to 12:30 am, so that it is taken 12 hours prior to blood work. After that, I have an appointment with the Transplant Nurse and Surgeon, and then on to the Transplant Nephrologist.