11 July 2016

A new--and unexpected--development with my Artificial Graft. I'll get to that in a bit...

Dialysis Weights:

23 Jun 16

Starting Weight:  103.4 kg

Ending Weight:  99.9 Kg

Water Removed:  3.50 Kg

Start BP:  196/121   End BP:  138/83

25 Jun 16

Starting Weight:  102.8 Kg

Ending Weight:  99.3 Kg

Water Removed:  3.50 Kg

Start BP:  187/117   End BP:  122/84

28 Jun 16

Starting Weight:  104.2 Kg

Ending Weight:  100.3 Kg

Water Removed:  3.90 Kg

Start BP:  173/102   End BP:  136/89

30 Jun 16

Starting Weight:  103.0 Kg

Ending Weight:  99.6 Kg

Water Removed:  3.40 Kg

Start BP:  167/105   End BP:  102/70

02 Jul 16

Starting Weight:  102.2 Kg

Ending Weight:  99.2 Kg

Water Removed:  3.00 Kg

Start BP:  160/109   End BP:  123/86

05 Jul 16

Starting Weight:  103.5 Kg

Ending Weight:  100.1 Kg

Water Removed:  3.40 Kg

Start BP:  195/109   End BP:  143/82

07 Jul 16

Starting Weight:  102.0 Kg

Ending Weight:  99.2 Kg

Water Removed:  2.80 Kg

Start BP:  179/107   End BP:  122/75

09 Jul 16

Starting Weight:  101.8 Kg

Ending Weight:  99.7 Kg

Water Removed:  2.10 Kg

Start BP:  164/106   End BP:  110/84

For the most part, my BP's have looked pretty good. That spike of the elevated starting BP's was a mystery. I wasn't doing anything to precipitate the increase--i.e. extra fluid gain--so I have no idea why that jump happened. As it is unusual, I will note any further high starting BP's and discuss it with my Nephrologist.

I crashed once at the very end of treatment on Tuesday, 05 July. My weight loss was normal, as was my Tx. Why I crashed is a total mystery. I stood up to get my final post-D BP reading and began to almost instantly feel dizzy, nauseated, have cold, clammy skin and feel as if I would pass out--all classic S/S's of a crash.

I immediately laid down, called for a nurse and was infused with half a liter of NS (Normal Saline). This eradicated all the symptomology of the crash and within ten minutes I was up and moving around again. As it ended up, I was the 0.50 Kg over my goal (of 99.5 Kg), the same amount I was infused with following my little crash event.

The only factor different that might have contributed to the crash was the fact that I started using my new Artificial Graft that day. However, the treatment was normal and quiet; so just why I crashed is again, unknown.

July 2016 Labs: 

*Albumin (21 Jun): 4.20 g/dL     (+0.40 from 17 May)
  (A measure of Protein in the blood)     NR (Normal Range) 4.0 g/dL or Higher

*Hemoglobin (05 Jul): 11.2 G/dL    (+1.20 from 21 Jun)
  (A Measure of Anemia)

*Ca Corrected (05 Jul): 10.3 mg/dL     (+0.40mg/dL from 07 Jun)
  (A measure of Heart and Bone health)     NR 8.40 to 10.20 mg/dL

*Phosphorous (05 Jul):  5.80 mg/dL    (+1.40 mg/dL from 07 Jun)
  (High Phosphorous affects the health of your Heart and Bones)     NR 3.0 to 5.5 mg/dL

*PTH Intact (21 Jun):  219 pg/mL     (-03pg/mL 17 May)
  (A measure of Vitamin D absorption and bone and tissue health)     NR 150 to 600 pg/mL

*K+ (05 Jul):  5.8 mEq/L    (+0.10 mEq/L from 21 Jun)
  (Proper potassium levels keep your nerves and muscles working well)     NR 3.5 to 5.5 mEq/L

*spKdt/V Dialysis (05 Jul):  1.67     (-0.12 from 07 Jun)
  (A measure of the effectiveness of dialysis and blood filtering.)     NR 1.20 or Higher  

As seen in the numbers above, my labs are not especially good this month. Since I am very good at doing what I should with my renal diet, I do not know why my labs look this bad. As always, I am especially careful with my potassium intake, and with taking my Renvela--the Phosphorous binder. As I've discussed many times previously, the K+ (potassium) will jump around no matter what I do; and, I am always cognizant of my phosphorous intake. Why that one is off is a unknown. The real mystery though is the Calcium Corrected. I have zero clue as to why that is elevated. Hopefully, July will see a reduction in my labs where needed.

Now, the news about my Artificial Graft. I already told you I have begun using the graft this past week (on 05 July). On Saturday, sometime during my dialysis session, I began to have leakage into my arm. I do not know if this was from the needle insertion or maybe a slight infiltration from when the graft was canulated at the start of treatment. However, I DO know that the leakage came from the venous return end of the graft. As a result, I have bruising in my arm that looks like I had a needle infiltration of my old fistula.

Here's a picture taken just now:

     (ScottW's arm contusions following graft leakage on 09 July 2016.) Taken 11 Jul 16.

The contusions (bruising) goes from the base of my thumb to about four inches above my elbow, covering about 2/3's of the arm in that area. Most of it isn't too bad as far as pain. The worst of it is that the arm is purple. Ah well, it's happened before, and will likely happen again.
Luckily, the chest catheter is still emplaced, so I will be using that once again until the arm heals enough.
You may be asking why I didn't know the leakage was happening. That is very simple to answer... I simply had no idea. There was no bump like with a fistula infiltration, no obvious signs at first, and not even any real signs until very late in treatment because I had fallen asleep about two and a half hours into the session, and when I awoke, I noticed my arm felt tight, was moderately painful to move, and only a little bruising was evident. As soon as I saw the bruising I informed my tech. Unfortunately, I awoke just minutes before the end of my dialysis. If I had awoken sooner, the impact of the leakage may have been less, but probably not by much.

Let's see, what else...

My appetite hasn't improved much since my last entry. I am barely eating one decent meal per day, and generally snacking only the rest of the day. Everything is just looking unappetizing. I don't know why; it just is. Even my post-D lunches are not being finished; which is a rarity.

Naturally following a poor appetite, my energy is also decreased--No mystery on this one! However, I will generally push through the lack of energy if I need to. And going hand in hand with these is an increase in sleep. The last couple of weeks I haven't been napping much, but my sleep has been increasing. Last Tuesday, my pre and post-D sleep totaled twenty hours...no kidding. I can't complain about the sleeping. After all, it was because of lots of sleeping that I received my disability judgment in the first place. I just look at it as earning my paycheck!  :o)

The headaches continue. LOTS of TMD involvement, too. How do I know? Because my R jaw is clunking... a lot. This is a major indicator of TMD induced headaches; and has been for going on 31 years.

I think that's about everything for today. If not, I will always add anything on the end of this entry.

...yep...that's it...for now. :o)

Good Health to All!

ScottW