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