Radical Double Nephrectomy Medical Reports

Here are all of the reports from my recent Radical Double Nephrectomy. [I think] I have removed all of my physician names [from the reports] as I do not have their permission to use their names in my blogs.

For those who are interested, these documents are fascinating reading. The pathology report is especially intriguing.

Pre-Op  Page 1   (30 Oct 2013)

 

Pre-Op  Page 2   (30 Oct 2013)

 

Pre-Op  Page 3   (30 Oct 2013)

 

Pre-Op  Page 4   (30 Oct 2013)

 

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Operative Report   Page 1   (15 Nov 2013)

 

 

Operative Report   Page 2   (15 Nov 2013)

 

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Post-Surgical X-ray Report    (15 Nov 2013)

 

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Surgical Pathology Report   (15 Nov 2013)

 

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Post-Op Discharge Summary   Page 1   (19 Nov 2013)

 

 

Post-Op Discharge Summary   Page 2   (19 Nov 2013)

 

 

Post-Op Discharge Summary   Page 3   (19 Nov 2013)

 

 

 

 

 

 

 

31 December 2013

The last day of the year is upon us already.

So, appropriately enough, here is my last entry of 2013, as well...

Dialysis Weights:

19 Dec 13
Starting Weight:  105.1 Kg
Ending Weight:  103.2 Kg
Water Removed:  1.90 Kg

21 Dec 13
Starting Weight:  105.6 Kg
Ending Weight:  103.0 Kg
Water Removed:  2.60Kg
24 Dec 13
Starting Weight:  106.4 Kg
Ending Weight:  103.0 Kg
Water Removed:  3.40 Kg

27 Dec 13
Starting Weight:  107.8 Kg
Ending Weight:  104.8 Kg
Water Removed:  3.00 kg
30 Dec 13
Starting Weight:  109.2 Kg**
Ending Weight:  104.9 Kg
Water Removed:  4.30 Kg
**My December 30th weight is high because of an unfortunate accident I experienced on Christmas night. Long story short--I hit my fistula directly on the top button hole causing massive swelling of the lower arm and LOTS of pain, too.
So, I went to do dialysis on Friday, and after 30 minutes of trying, were finally able to canulate both button holes. Unfortunately, the many attempts at the top button hole resulted in additional swelling and bruising at that site.
On Sunday--an unusual day for dialysis; due to Christmas scheduling--the Techs failed to canulate the top button hole after forty five painfully agonizing minutes. So, I called a stop to the attempts, and I came back in on Monday afternoon (yesterday) so the Head Nurse could work with me to get the canulation.
Anyhow, because of the extra day between treatments, my weight increased 1.5 Kg's higher than it was on Sunday morning (107.6 Kg at the time). Also, because of this, I'll be playing catch-up with my weight for a week or so.

Other than the whole bruised arm thing, my weights remain fairly consistent. I attribute this to my keeping close track of my liquid intake from day to day. Again, I don't know exactly how much I drink every day; rather, I keep a very good approximation. My aim is about one liter of fluids per day.

Back to the dialysis issue...
Yesterday, the Tech initially tried to do a Sharps (a sharp needle, instead of the dull needles that are used for button holes) below the top button hole. However, due top edema, hard tissue and pain, she was unable to get the stick. The Head Nurse was called in. He tried the button hole, but without success. He then used a Sharps even lower on my fistula. Even then it took a bit of fishing around for him to canulate the vein. We'll be using this site for a few treatments to give the button hole a rest, and to allow some of the swelling to reduce. Depending on the condition of the button hole, we will abandon it, or go with the new site. I'll let you know how that ends up.
After he had gotten the stick, the nurse spoke to a doctor about my arm. He was concerned about a possible infection because of the amount of swelling (edema), the hardness of the tissues, and the amount of pain I was experiencing. The doctor prescribed a round of Ansef--an antibiotic--that would be administered in two doses (3 grams yesterday--at the end of Tx--and two grams on Thursday. This should eliminate any infection risk. I'll keep you updated.

I have been experiencing a lot of nausea the past couple of weeks. It usually hits suddenly and is quite intense. I have been trying to combat this sudden onset nausea with a regimen of Tums, followed by Promethazine. This is usually successful. Additionally, since coming home from the hospital, I have been having to eat something every two hours or so. If I don't, the nausea increases to nearly untreatable levels and I am miserable until it declines. So, not much fun there.

Any headaches I get now are entirely TMD related. I can go two or three days between headaches. When I do have one, I pop in my TMD devices at night, and awaken without a headache once again. Ahhhh....life without a 24/7 headache...Love It!!!  :o)

Remember my Phosphorous spike following surgery? Well, after using the new regimen for the binders (Renvela), in just a week and a half I was able to lower my phosphorous by 1.50, going from 8.1 down to 6.6. If I keep that up, my phosphorous levels will be right where I want then to be; in the 4.2-4.8 range.
Speaking of Labs, my next draw should be early next week. I'll post the monthly results when they are available.

That's all for today. However, I will be posting records from my recent hospital stay later this afternoon; so be looking for them.

Have a safe, fun and festive New Years Eve! May 2014 be even better than the year we just finished!

Good Health, and Good Fortune to All!

HAPPY NEW YEAR!!!  :o)

ScottW

Merry Christmas 2013

MERRY CHRISTMAS, Everyone!

May this Christmas day of 2013 find you as blessed as I am!

And may your day be filled to overflowing with family, food gifts and an abundant Spirit of Charity and Goodwill.

MERRY CHRISTMAS!

18 December 2013

I know it's been a bit since my last entry; all I can do is claim tiredness due to post-surgery recovery and dialysis. So let's get going...

Dialysis Weights:

07 Dec 13
Starting Weight:  106.6 Kg
Ending Weight:  103.3 Kg
Water Removed:  3.30 Kg

10 Dec 13
Starting Weight:  107.0 Kg
Ending Weight:  103.3 kg
Water Removed:  3.70 Kg

12 Dec 13
Starting Weight:  105.6 Kg
Ending Weight:  101.1 Kg   (Yeah, you read this one correctly!)
Water Removed:  4.50 Kg

14 Dec 13
Starting Weight:  104.3 Kg
Ending Weight:  103.4 Kg
Water Removed:  0.90 Kg  (This one, too!)

17 Dec 13
Starting Weight:  107.3 Kg
Ending Weight:  103.1 Kg
Water Removed:  4.20 Kg

As I expected, my weights are falling in line with my plan. My voluntary fluid restrictions are definitely helping and are working in my favor. I have NO fluid in my lungs, my heart is clear and I have NO untoward edema anywhere.

Following surgery, my surgeon instructed that I NOT use Heparin during dialysis for six weeks post-surgery. Heparin, a blood thinner, is used to help keep the lines from clotting during dialysis. Unfortunately, Heparin can cause severe internal bleeding in a surgical patient; hence the restriction on its use for a month and a half.
Instead, I am having three things that help my blood to flow smoother...1) A Saline drip at a rate of 100 cc's/hr.  2) Using the dialysis fluid Citrasate 2.5 instead of the regular Dialysate fluid.  3) A Saline Flush of the lines every hour and a half.  
Any additional fluids used in this process is added to my daily goal so that no additional fluids--above my goal loss--is taken.
So, as of this writing, I have five more Tx's to go until I can use the Heparin once more.
The lines still clog occasionally, and when they do, the techs switch out the lines as quickly as they can and get the Tx up and running again within ten minutes or so. Only once have I clotted the lines so badly that all the tubing had to be changed and the machine re-primed. That one set me back about half an hour. But again, this has only happened once.
Now, you may be asking why battling the clotting is so important. Well, the short answer is that keeping the lines flowing smoothly assures that my heart or my lungs (or both) will not be the unfortunate recipient of a nice blood clot, thereby avoiding a heart attack (AMI) or pulmonary embolism. Kinda important!

My first post-surgery labs were pretty much as everyone expected:

*Albumin (21 Nov):  3.70 g/dL (-0.70 g/dL from 22 Oct)
  (A measure of Protein in the blood)     NR (Normal Range) 4.0 g/dL or Higher

*Hemoglobin (03 Dec):  8.60 g/dL  (-2.90 g/dL from 05 Nov)
  (A Measure of Anemia)

*Ca Corrected (03 Dec): 9.20 mg/dL (-0.50 mg/dL from 05 Nov)
  (A measure of Heart and Bone health)     NR 8.40 to 10.20 mg/dL

*Phosphorous (07 Dec):  8.10 mg/dL (+3.30 mg/dL from 05 Nov)
  (High Phosphorous affects the health of your Heart and Bones)     NR 3.0 to 5.5 mg/dL

*PTH Intact (21 Nov):  157 pg/mL  (+15 pg/mL from 22 Oct)
  (A measure of Vitamin D absorption and bone and tissue health)     NR 150 to 600 pg/mL

*K+ (21 Nov):  4.3 mEq/L (+0.10 mEq/L from 22 Oct)
  (Proper potassium levels keep your nerves and muscles working well)     NR 3.5 to 5.5 mEq/L

*spKdt/V Dialysis (03 Dec): 1.39   (+0.06 from 05 Nov)
  (A measure of the effectiveness of dialysis and blood filtering.)     NR 1.20 or Higher

The Hemoglobin drop and the Phosphorous spike are both to be expected following surgery. The real surprise was the K+ (potassium). This normally spikes after a nephrectomy, but it me, it stayed level. Even the surgeon was surprised by this one.
For the phosphorous, I am now taking 3 Renvela Binders with every meal (up from one), and one binder with any snacks (up from none). Plus, I am being more cautious than ever with phosphorous intake. Between the two, we should be seeing a drop in that phosphorous number very quickly.
As to the Hemoglobin drop, this will simply take time to rebuild within my body. The Epo shots and my daily intake of the dialysis vitamin will take care of this one.

So how am I doing at this point?

-Well, I am only wearing the abdominal binder when I go out of the house. Another couple of weeks and I should be comfortable enough to stop wearing this at all.
-My energy is still lousy. (Not unexpected.)
-Most of the scabs on my new scars are gone. (The scars really don't look too bad when they aren't red and swollen!)
-My body continues to adjust to not having kidneys.
  I finally had a normal BM (bowel movement) about a week ago. As of now, my BM's range from normal to soft. (At least I'm no longer sitting on the toilet ten plus times a day!)
  -There is still abdominal pain bilaterally which flares up if I over-do things.
  -My sleep is not consistent. It's not bad dreams...I'm just having a hard time staying asleep; which, of course, leaves me tired all the time.
  -The neuropathy in my feet is still present. I had hoped this would go away once the kidneys were out--and it still may once all the swelling from surgery is gone. I continue to see my chiropractor to help this.
  -The weirdest thing I have to report is that whenever I have a BM, my urethra tries to push out the now non-existent urine via the normal peristalsis motion--which is a normal function of the body. Since no fluid is expelled, I am left with those waves of peristalsis within the urethra. It just feels weird and is something I wasn't expecting.
  -My stomach is having an issue with going from hungry to painful hunger pangs within just a couple of minutes. This impacts my ability to eat normally, and is an unexpected adjustment to my daily routine. I can ignore the pangs to a degree; but have to either eat--and be miserable while doing so--or take a regimen of Promethazine (anti-emetic) and Tums to combat the inevitable nausea.

All in all, I am very pleased with my progress post-surgery. Healing simply takes time. Add in the gunk that was systemically in my body due to my kidneys, and that time frame will
further expand the recovery time.

I told you before that I have the pathology report from the surgery, and I am going to put that on here, along with a couple of other things. I have a technical issue on my end that is keeping me from getting this done. As soon as I have it worked out, I'll get those things posted.

Until then, have a great week! Keep your countenance bright, and remember those who have less this Christmas season.

Good Health to All!

ScottW

06 December 2013 (Part 2)

As stated in the first part of this post-Op blog, the first day was a blur, but the second day was far better.

In the late morning a Physical Therapist came in and informed me that I would be walking. After reviewing the proper way to get up (and back down), I was assisted to my feet and we began a short walk into the hallway. Walking certainly didn't feel good, but I have been through far worse; so from my perspective, it was relatively easy. In all that day, I took three walks; each one with increasing distance.

On that second day I finally got to see my abdomen when the nurse came in to change the bandages. The first thing I noticed was that I had five new holes in me. Two from the Lap sites, the actual incision, and two holes from which drain tubes extruded. My abdomen will never be the same...not that it's been much to look at since two previous surgeries years ago. Anyhow, here are two pics of how my belly looks following the nephrectomy:


Following my Radical Double Nephrectomy on 15 Nov 13, you can easily see the surgical incision and the two Laproscopic Inserton sites. The drainage ports (not visible here) are just above the pelvis on either side.


 

A Close-up of the incision, showing the staples used to close the site.
 

The surgeon came in that day to explain how everything went. In short, the surgery went better than expected. There were no issues removing the kidneys, the hernia was significant, but was also accomplished with little issue. In all, the nephrectomy was a huge success!

On that second day I was not allowed to eat; chewing on ice instead for both food and water (yippee!). The two drains were emptied several times. The first time both were full of a purplish, nasty-looking fluid. As the drains were progressively emptied, the fluid went from that purplish to a normal crimson red. The drains tubes were for any left over gunk from the kidneys to have a way to exit my body. I don't know if this is a standard Tx, so be sure to ask your surgeon if these will be placed in your procedure.

The rest of the second day was unremarkable as things went in a continuous round between sleeping, walking, dressing changes (and drains emptied), vitals, deep breathing exercises, etc. I also had my first in-hospital dialysis Tx that evening. Everything went well, and the session lasted my usual four hours.

Sunday (two days post-Op) was another day of the same. Aside from a few visitors, the day was pretty much the same as Saturday.

Monday was definitely better. I was walking around unaccompanied, my deep breathing exercises were way beyond normal, the O2 I was on was finally DC'd, my pain meds were reduced [due to my progress], and the surgeon took me off ALL HBP meds! No more Atenolol or Gemfibrozil--Woo-Hoo!  :o) That's another 27 pills every week that I DON'T have to ingest!
Also on Monday, the drain tubes were getting very little out anymore, so the decision was made to Extubate them (take them out). I asked the nurse if this would hurt, and was told it would just feel weird. Well, as the first tube (on my L, I believe) was removed, the foot of tubing inside of me came out with both pain and a really weird sensation. Luckily, the removal was quick, and the sensations only lasted about five seconds. Once the L was done, the nurse move moved around the bed and extubated the R tube. When she was done, the holes were small enough that they would close on their own, so no dressing or anything was needed on either site.
I also had my second in-hospital dialysis Tx on Monday evening. This session also went well; aside from the lines clotting because I can't yet use Heparin to thin the blood.
You see, Heparin cannot be used post-Op due to the high risk of internal bleeding at the surgical site(s). So, a saline drip is used [during dialysis] to compensate. In spite of the saline drip, the dialysis tubing will often clot anyhow, and all the lines will then need to be changed and flushed to avoid it happening again.

That evening my feet began to have that intense neuropathy feeling, but with greater intensity than I've ever felt it before. Basically, both of my feet felt as if they were on fire. The sensation was so intense that I got almost no sleep that night. The nurse had no answer, nor did the docs, so I just put up with it and planned on seeing my Chiropractor as soon as I could.

Tuesday (four days post-Op) was the day I'd be going home. Thank goodness, too! I was bored to death, the bed was uncomfortable and I knew that I'd done as much healing at the hospital as I could. Time to go home. After speaking with the Surgeon, the Respiratory Therapist, the Physical Therapist, the Nutritionist and the Staff Nephrologist, I was given the OK to go home.

My time at the Intermountain Medical Center was great! The entire staff, from the surgeons on down to the nurses aids was absolutely the finest hospital staff I have ever been around! I cannot say enough praises about my experience in that facility. What a phenomenal decision it was to have the nephrectomy there! I also learned that the staff I had will be the same ones I will have when I get my transplant. They are specifically trained for transplant and associated patients; which is why they were so darned awesome during my stay. When my transplant occurs, I'll be on the same floor, as well.

Anyhow, before going home I had my bandages changed, and a fresh abdominal wrap was put on me.

Abdominal Wrap used following Nephrectomy, Nov 2013

The abdominal wrap is used to stabilize the abdomen for greater patient comfort, as well as to hold any bandages in place. I would have to use this 24/7 for one week, then I could remove it at home, sleeping without it--if comfortable--after that. However, any time I go out, I must wear the wrap for at least six weeks. Once home, I opted to wear a regular undershirt under the wrap to reduce chaffing on my skin which, by the time I was home, was already happening in several places on my chest, back and sides.

Back to going home...
The paperwork took some time to navigate all the needed channels, but once given the go-ahead, the nurse removed my IV, went over after-care instructions with me, gave me some backup supplies, and I was then discharged. Only four days post-Op and I was going home!

Once home it certainly wasn't a picnic, but at least I wasn't bored, and I could eat whatever I wanted...BONUS!  :o)

In the time since returning home I have been to dialysis seven times. Here are all the weights:

21 Nov 13
Starting Weight:  107.5 Kg
Ending Weight:  104.7 kg
Water Removed:  2.80 Kg

23 Nov 13
Starting Weight:  107.7 kg
Ending Weight:  104.7 Kg
Water Removed:  3.00 Kg

*Thanksgiving Schedule
25 Nov 13
Starting Weight:  107.0 Kg
Ending Weight:  104.2 Kg
Water Removed:  2.80 Kg
27 Nov 13
Starting Weight:  107.1 kg
Ending Weight:  103.7 Kg
Water Removed:  3.40 Kg
30 Nov 13
Starting Weight:  108.9 Kg
Ending Weight:  105.0 Kg
Water Removed:  3.90 Kg

03 Dec 13
Starting Weight:  107.9 Kg
Ending Weight:  103.7 kg
Water Removed:  4.20 kg

05 Dec 13
Starting Weight:  106.2 Kg
Ending Weight:  103.4 Kg
Water Removed:  2.80 Kg
Now that I have no kidneys, retaining water is a HUGE issue. Though I haven't yet been told to do so, I have voluntarily reduced my fluid intake to about 36 oz per day; or, about one kilogram. I can eat any solid foods I want--well, within the dialysis diet--but I must watch the fluids. So, I've actually been measuring fluids, finding out what one cup of pebble ice equals in water (about 5 oz's), and keeping track of my intake throughout the day. It's really not hard to do; but I have weight goals that I intend on meeting with each subsequent dialysis Tx.
Like I've stated before, I want to be as healthy as I can be going into my transplant so that I have the very best chance coming out the other side to live a long, happy life. All it takes is self-discipline and making the decision to do what needs to be done every day.
I must choose what is more important--my long-term health--or--a temporary desire to eat whatever I want and drink as much as I want; and to take my meds, follow doctor instructions, etc. Hmmm...
...I choose my long-term health. For me, it really IS as simple as that. And it's a no-brainer, if you ask me!
If you are going through anything similar, I strongly encourage you to ask yourself, 'what it is that you want at the end of all of this?' Be honest with yourself. If you choose to continue living a lifestyle that is detrimental to you, then so be it. There are natural consequences to such a decision, which you must live with. That's fine; it's your choice.

However, if you choose to be healthier, then decide what it is you must do to achieve that and then go do it! Attitude, eating habits, fluid intake, Rx dosing, physician instructions, etc...do what you've got to do.
(Alright...enough of the soap box lecture...)

At dialysis I am still going four hours per Tx. This may yet change; but as long as I control my fluids, and my labs come back looking good, the time-on may not change at all. I will keep you updated.
Now that my kidneys are gone, I am getting injections (via-IV) of Epoetin with each Tx. Epo, as it's called, is a naturally occurring glycoprotein hormone that helps the body to regulate production of Red Blood Cells and Hemoglobin. The kidneys produce this hormone; so without it, cascading anemia is a real threat and will cause major issues if not addressed.
Also, I will continue to do the saline drip with each Tx for about six weeks post-Op. This has already resulted in a number of clotted lines; but if the lines are flushed about every hour and a half, clotting is reduced.

My first time back at dialysis--about six-days post-Op, I have a number of patients and techs all tell me how much better I look. Here's a pic of me I just took:

Three weeks post-surgery. 06 Dec 13

I saw my surgeon yesterday and had the staples removed. There are now just steri-strips over the incision and lap sites. These will remain in place for about a week. Once they start falling off I can just peel off the ones that are ready. Unless something untoward happens, I won't see my surgeon again until I get the transplant. 
My surgeon also enthusiastically told me how good I look, and that I seem to be doing "far better that expected." (I'll certainly take that news!)

So what's left?
Well, a few more weeks of healing, is all. My surgeon told me to call Mayra, my Transplant Coordinator, at the end of December to report how I'm doing. The Transplant Committee will then decide to place me on the Active List, or not. I'm hoping for placement as soon as possible!
After that, I'll get a letter from UNOS (United Network of Organ Sharing), the national entity that oversees organ placement/matching, stating my status and provide other info. Then, it's a waiting game.

So what's changed since the surgery?

First--and foremost--my Four Year-Long Headache is GONE! (Finally!)

--That overwhelming flu-like feeling is GONE!

--All the back pain from the cystic kidneys is GONE!

--My Energy Level is already Increased!

--My Skin Color/Tone is Better!

--My Mental Clarity is Increasing!

--My dreams are better and better! (No more bad dreams, so far.)

--That goop that was circulating throughout my body is GONE!

Not bad results at three weeks post-Op!  I think pretty much anyone would be ecstatic with these results...I know that I am!

I know I've probably missed a few things, but I've spent a few hours writing this up and am done! I'm tired, my abdomen is sore (from sitting up constantly) and I'll be going now.

I did pick up the surgical and pathology reports yesterday--no pics, sorry!--and I'll put them on my next blog.

As always, if you have any questions or comments, please let me know. I'll respond as soon as I can.

Until the next time...

Good Health to All!

ScottW

02 December 2013

I am finally feeling up to writing my surgery report for you. The medical records I want have not yet arrived; but as soon as I have them, I will share those with you as well. For now, let's just go with the things I recall...

My surgery time actually got bumped due to a transplant that came up. Instead of an 0800a time, it was at 1200p. I arrived at IMC (Intermountain Medical Center) at 10A, did the final Registration paperwork, and was taken back to pre-Op, where I changed into the hospital gown, Full-Leg Compression Socks (for post-op clot prevention), got an IV placed, turned in my Living Will to a Hospital Legal Rep, and then awaited transport to the OR.

 

Ready and Awaiting IV in Pre-Op (15 Nov 2015)



Heading to see the Anesthesiologist...and the OR. (15 Nov 2013)



 



Outside the Operating Room, I met with the Anesthesiologist. We discussed Rx allergies and what he was going to do once I was inside the OR. After that, I was wheeled into the OR, transferred to the OR table, positioned and then heard the Anesthesiologist say he had injected my IV line and then I was out.

I drifted in and out post-surgery for hours. Apparently, I awoke enough once to tell my wife, "Not as bad as the back surgery." This is referring to the horrific pain I woke to following my L5/S1 hardware fusion back in 2000. My wife was a wreck for days after seeing the intolerable pain I was in. So, with my brief message about a low pain level, she was able to relax and didn't worry about me so much.

Although I don't remember giving that message, I do remember waking up every so often, but sleeping solidly once again. At about 930p, I finally was able to stay awake enough to remember things. The most prevalent memory was pain. I was being given Fentanil, but it was doing very little. I asked about Morphine, since it always works best on me--and I'm not allergic to it! The answer I received resulted in a big, "Ahh, got it!"
You see, Morphine is metabolized in the kidneys and, seeing that both kidneys were now gone, the drug would have zero effect in reducing pain.

However, with the inability of the Fentanil to do the job, that drug was DC'd (discontinued) in favor of IV Dilaudid. It still wasn't great, but it reduced the pain enough for me to be comfortable. This Rx was used until I went home.

The first night post-surgery was a very long night. Not only was I not able to sleep much, but there was a steady stream of medical personnel coming in all night, as well. Labs, Vitals, Respiratory Therapy, Meds, Nurses, Nurses Aides, etc...it really did seem non-stop. With everything going on, I literally got about an hour of sleep from 930p through about 11a the next morning. I was exhausted, to say the least.

On day 1 post-OP I was up and walking.

---Alright...that's all for this entry. I've already fallen asleep twice, so I'd best be going.
I'll write more on Wednesday.


                                    ***************End, Part One***************

ScottW