Your kidneys: Beans of stability

The old adage that "You don't know what you have until you've lost it" is applicable in so many facets of our lives. In love, friendship, with work or money. But most people never stop to think about how it might apply to their bodies. Sure we all grow older and as we do some of us may find that we have a little less hair, a bit poorer eyesight or the occasional aches and pains that our younger selves never would have dreamed of. But what if a part of you just stopped working altogether? It's not something most would think about. And thankfully, they really don't have to. But I think it would behoove anyone to stop for a minute and think about what any one part of your body does for you and how totally screwed you would be without it. Obviously without a heart you wouldn't be able to live. Same for your lungs. And because of their very obvious necessity those two organs garner all the glory in the game of keeping you alive.

I think you can see where this is going. I'm here to shill for the often overlooked regulators of so much of our bodies consistency: the kidneys. We all learned in school that the kidneys main functions is to filter our blood and produce urine, the means our body has to get rid of all the bad stuff that you might not even know is in you. But do we really know what that entails. What exactly is it getting rid of? Even I, who have had kidney problems since before I was even born, didn't fully appreciate the importance of the kidneys until I found myself quite literally without any.

Let's look at some of the unpleasantness that the kidneys get rid of for us. The excess sodium that we all take in every day is filtered and sent packing by those magic beans. If they didn't we'd all bloat up like a Macy's balloon. Hypernatremia is the technical term for this eventuality and it can lead to anything from the aforementioned swelling to lethargy all the way to coma.

The kidneys are also in charge of regulating the amount of potassium in the body. Do you know what the main ingredient is in that little lethal cocktail they give inmates on death row? Potassium. An overabundance of the stuff will cause every muscle in your body to completely shut down, including your heart. And as I've mentioned the heart is kind of important if you want to keep from shuffling loose your mortal coil.

How about calcium? Think that stuff is important? Yep. Your kidneys regulate the levels of calcium in your body, as well. Without kidneys you are sure to suffer from what's called hypocalcemia. Because your kidneys no longer work your body lacks sufficient amounts of a vitamin D which helps redirect the calcium in your diet to your bones so you can grow big and strong. Without vitamin D to do that your bones don't get the calcium it needs and we've all seen Sally Fields in enough Boniva commercials to know what that does.

So where does that calcium go? It has to go somewhere, right? Well another job of the kidneys is to keep the levels of phosphorus in your body in check. Too much phosphorus and your body starts to take that calcium and deposit it into your blood vessels and harden them eventually leading to good times like heart attacks. High phosphorus also leads to deposits of said calcium on your skin and the most irritating itching you could possibly imagine. Where does all that phosphorus come from you ask? Rare foods such as milk, cheese, anything with protein in it, chocolate, beer, ice cream, beans or anything with whole grains.

Another important and little known function of the kidney is to regulate your blood pressure. By getting rid of the excess water in your body, your kidneys keep your blood pressure at a constant, normal level. When the kidneys shut down you are unable to get rid of that excess fluid you take in in the form of drinks, soups or really anything that melts. 30-50 ounces a day is the recommended intake of fluid for a dialysis patient. That's roughly one Sonic Route 44 drink a day and that's it. Otherwise your body finds places to put anything more than that you may drink. Places such as in between your cells. Or maybe in your lungs. Eventually you will find yourself unable to breathe and your heart unable to beat because of all that fluid crushing it under it's weight and those extra drinks you had are the reason you are on a ventilator in the hospital.

How do you feel about red blood cells? Kind of important, yeah? Well without functioning kidneys your body doesn't produce enough of the hormone erythropoietin which controls red blood cell production in your body. Without sufficient red blood cells you are prone to anemia which most end stage renal disease patients are. Luckily there is a shot you can take to boost the production of those cells. It's called EPO and it just got Lance Armstrong in a lot of trouble. No entering the Tour de France for me.

So while the heart and lungs get all the glory it's your kidneys that are doing a lot of the heavy lifting to keep your veins from calcifying, your bones from weakening, your blood pressure from shooting through the roof causing you to stroke out and they keep all that fluid you drink/eat from sitting on your lungs and heart keeping them from actually doing the jobs they are so recognized for.

Those inconspicuous beans sitting on your sides are what keep everything else in your body in check. So next time you are getting a check up have the doctor give your kidneys a pass and see how they're doing. Thanks to dialysis, losing your kidneys isn't a death sentence like losing other things. At least not immediately, but it can lead to pain, illness and just general unwellness if they aren't looked after. Keeping your kidneys healthy also keeps one off of dialysis which brings with it it's own set of problems and surprises. Just something to think about.

6 Degrees of Dialysis

I'm making myself write on a regular basis whether I think I have anything to say or not. This will, hopefully, get me into a rhythm. I'm not one for forcing the artistic process. (I'm not calling this blog artistic, it's just that I tend not to write unless I think there's something very pressing on my mind.) And since there is a  tendency for me to judge nothing on my mind as worthy to commit to a blog post, I go weeks then months between writing them. Next thing you know, I haven't written in years and can't remember the password and I just pretend it never happened. So to combat this eventuality I'm gonna pop on here whether I think I have a point to get across or not. Gonna do a stream-of-consciousness thing and see where it leads me.

Maybe that's what this blog will become. Just a place for me to spill my brain out every night before I hit the rack. It wouldn't even have to change the subject of the blog. I'm thinking about dialysis or it's affect on my life about 97% of the time I'm awake. There's actually no part of my life it doesn't touch in some ways. Dialysis is my Kevin Bacon.

To offer another metaphor, dialysis is a dam holding me back from correcting the surprising number of mistakes I made in the first 25 or so years of life. It's not the fault of dialysis that I don't hold any degrees, but it is being on dialysis that prevents me from remedying that by paying back loans currently in default. It's not the fault of dialysis I don't have a career, but being on dialysis prevents me from remedying that by going back to school. You can see where this chain reaction leads. It leads to the day that I hope is coming soon, where I'm in my late 30s, starting over again with a fresh kidney and the mistake of last time to learn from.

When I got the transplant back in 2004 from Jeremy, it was the greatest thing I thought would ever happen to me. And so far it is. But it was also a trap Admiral Akbar wouldn't have seen. For the first time in 25 years I was healthy. Completely healthy. It's hard to describe that to someone who has experienced good health most of their lives, but when I woke up fully from the transplant I felt like a completely new person. Once I walked out of the hospital I was amazed at the difference. I felt like I could do anything. So to that end, I did nothing. Like a jackass I spent the next 5 years doing as little as possible. Enjoying, for the first time, that sweet feeling of good health. Don't get me wrong I worked but at menial jobs. I lived a very fluid life. Worked when I had to, hung out with my friends every other minute of the day. I never saw a day coming where I'd be back on dialysis. Surprisingly and sadly, it was coming much, much sooner than I thought.

25 years was a low end estimate on the expiration date of the new kidney. I had the world in front of me and nothing holding me back. I was gonna enjoy this weird feeling of health for awhile. I enjoyed it for too long it turned out, and after a trip to Las Vegas in January 2008 I went for a routine check up on the old bean and was told that something was wrong and I had to be hospitalized for tests. Those tests gave me the worst news I could imagine. Five years of good health was all I was gonna be given this time. Back to the machine.

Everything I wanted to do, that I thought I had time for down the road was now gonna be that much harder to accomplish. Nobody wants to hire someone who can't be at work 15 hours a week and then might be sick when they are there. And if there's no income then loans that a stupid teenager defaulted on can't be paid back to get back to school. So I cash in on Social Security disability in my 20s and 30s and "live" off that until that elusive second transplant comes around. It's been 5 years now that I've been listed on the UNOS list. I'm Status 1 which I'm pretty sure means I'm in the group best suited for a transplant. The average wait time on the UNOS list is 3-5 years. I can't decide if that's good news or bad. I always tend to lean to bad, but who knows. I have had two false alarms in those five years but beyond that I haven't heard a word from anyone at the hospital. In this case, no news is bad news. It means that nobody anywhere is matching me at all. At least nobody who is dying around here.

 I don't write all this for sympathy, empathy or even judgement or anger. I don't care what you think about what really is at fault for my lot. That's not anger just the truth. I've come to terms with the mistakes I've made in the past.  If I focus too much anger on dialysis to avoid my part in what's happened, that's your opinion but it's what I live. I think I focus appropriate anger on all parties. But this is what streams through my consciousness most nights. As well as, other things related to dialysis. It's not all-consuming but it tries pretty hard to be. Didn't mean to get this serious just three posts back into our relationship, dear reader, but these things happen when I let my brain be in charge of my fingers for awhile. I hope we can still be friends. :)

In which the nothing is said to be something and the something is said to be nothing.

Well the first time back went well. And by went well I mean nobody said it sucked and, on the internet, that is literally the best you can hope for. Not a lot to report on today. I guess I should tell the story of the little medical scare I had this week.

Post-treatment on Monday: While waiting for my ride to pick me up, I ran back inside to let the charge nurse know that it was feeling a little uncomfortable when I took in deep breaths. Like when you go running on a really cold morning. Or so I've heard. That particular pain has happened from time to time, but I have a track record with pulmonary ailments getting out of hand since being on dialysis, so I mentioned it. The PA (Physician's Assistant) happened to be there so she walked on over to get in the game. She's nice enough, seems very eager to do a good job. This must be her first dialysis clinic. So they gave me the once over and she ordered, what I call, a 2-shot. Standard chest x-rays, front and side view. I also showed her the rash that had developed on my back. I thought at first it might have just been cystic phosphorus sores, which I'm prone to, because of  the fact that I usually completely disregard my renal "diet". But the area started developing differently.

THE AUTHOR WILL NOW DIGRESS FOR SEEMINGLY NO REASON

I put the word diet in quotes because I can't, in good conscience, call red meat and rice only a "diet". Not a diet I recognize anyway. For real, I get why there's a regimen. I really do. Too much of any food, with the possible exceptions of said red meat, steamed white rice, and anything made with a "something" substitute it seems, will kill a dialysis patient. I've had my battles in my days. Strawberries.

Nonetheless, for most of my time on the machine, I've taken the view that just having to be there for the 15 hours a week (It can get that high when you add wait times and make allowances for rides picking you up on either end) is really the most I was willing to do. So I'm gonna have all the Italian food, Mexican food, cheeseburgers and fries that I felt comfortable with.

AND HERE THE AUTHOR WILL MAKE SENSE OF HIS DIGRESSION

Once my back started to look like a topographical battle map of the Battle of the Bulge and I itched worse than the mangiest mutt you've ever come across, I decided I'd be the bigger man and start following my diet a tad closer and, more importantly, taking my phosphorus binders when I ate. You see a build up of phosphorus, which is in everything, (I'm serious. Look it up. It's in everything. AND all the best stuff!) draws calcium out of your bones leaving them weaker, as well as, depositing that calcium in your blood vessels and making your skin feel like you've been hugging a kindergarten full of chicken pox patients. How do you avoid this and not starve to death like a Somali, you ask? Phosphorus binders. Take 3 or 4 when you eat a meal. depending on how phosphorus heavy it is, and it will bind to the devilish phosphates in the food and your body will not absorb them in such dangerous levels.

 So to this point all the sores I had, thanks to my reluctance to cut anything from my already sparse diet, had been on my back. Which is why I thought, at first, this disturbance on my back was normal. Normal being relative to me, of course. I had been slipping on my binders a bit lately. But when I saw this new "rash" after a few days wasn't acting the normal way I decided to show the PA. She seemed unconcerned.

The next day I go get the pictures taken and go home thinking nothing of it. It hurt a little less to take those breaths and I have a history of thinking there are things making me feel horrible when there are not. At least nothing out of the normal. Who needs an exotic reason  when I could just chalk it up to the fact that I send my blood to the cleaners 4 times a treatment, 3 days a week? What can I say, I like to be more interesting. Keep people locked in, I guess.

Early evening on Wednesday while laying on the couch not feeling at all right, I get a call from one of the charge nurses at my clinic. I answered and noticed right away she seemed upset to have to deliver whatever news she had for me. She then proceeds to tell me that on one of the x-rays, a "mass" was seen on my right lung. I lost my breath. (No pun intended) I asked her to repeat herself, or at least I think I must have because she did, and I nonchalantly acknowledged the news while recording the number for the pulmonologist, which the nurse was apparently reading to me. "Oh. She's changed offices." What a weird to think at a time like that, I thought.

So I hang up and take a minute to collect myself before my next call. Now I had been given bad medical news before, surely, but nothing like this. Being told I had to go on dialysis was certainly hard to hear. Both times. But not once had death immediately popped in my head the way it had just five minutes ago. Especially untimely death. So at that point I just let myself lose it a touch and I called a very good friend of mine, then my parents, to deliver the news. I wanted to call a few more people but I figured that the least the number of people I told was also the least number of people who had to worry about it. I suppose by that logic I should have just kept the news to myself. But, I think, when a man of any age hears that he may have cancer he just wants to talk to the woman closest to him and/or his mom. So I did both. Because when ill, I can be a baby. Ask around. It's true. Talking to these trusted people helped tremendously.

So the call the next morning, the very first thing in the morning as I did not sleep, was supposed to be to schedule an appointment ASAP to get a second opinion. As it turned out, that second opinion wouldn't be available until Tuesday. Yeah, that wasn't going to sit well with me so I called my dialysis clinic, they got in touch with my nephrologist and he told me to go to the ER and tell them what was going on and they'd get me some answers.

So I did. And the climactic ending to all this waiting and taking stock of a life driven way, way, WAY down the path clearly not intended? They run a CT scan on my chest with contrast and find nothing. As in the contraction of the phrase "not a thing". Zilch. Nothing but air. He didn't even ask me if I had smoked. Maybe he could tell that. But that didn't even seem to bother him. The doctor came in and announced to the relief of all, and confusion of me, that there wasn't a spot, a nodule, or a mass of any kind anywhere near my lungs. Must have been a mistake on the part of whoever read the x-rays originally, or took them.

So not only didn't I have cancer, I have a pretty clean bill of health going on in the lung department. That's great news! Hey doc, can you take a look at this "rash" on my back and the one that has recently developed on my chest? Oh that? Looks like shingles.

Fuck. Well that figures. I know I am supposed to think, "Hey the mistake x-ray led me to the ER to have the shingles found in very early stages." And I guess that's one way of looking at it. Another way, the way I usually choose, is that I have something else to deal with on top of the whole dialysis thing. Because that's gotten too easy. I needed a challenge in my life...

So now I'm on very strong ant-viral medicine for a week to try to nip the shingles in the bud hoping they work because my mom just had them and they don't sound awesome. Hopefully they work and I'm just subjected to these two areas of irritation and I can be done with it. I would count myself supremely lucky is that's how it unfolds. I've counted myself "supremely lucky" probably four times in this life and most of those situations have involved meeting a woman. But we'll see. Here's hoping this week goes smoother, yeah?

Don't I know you?

And I'm back! New name, new look, same information nobody asked for! But seriously folks, I am back from my self-imposed blog exile and this time I'm back to do something a tad different that I had been. I will still be blogging on my experiences on dialysis and going through the transplant process but I'm also going to talk about the ancillary and auxiliary parts of my life that dialysis and kidney failure have affected. The reason for the change, honestly, is that just sharing about the experiences of dialysis and the transplant process got very stale and monotonous for me. You go to to dialysis, they hook you up, you sit there for four hours, sometimes you get sick, sometimes you don't. As far as transplant, they see you once, run every test on you and, in my case, never call you again. So, you could see how even a writer as loquacious and rambling as myself could find it hard to summon more than 2 or 3 ways to tell you about those experiences. 

"Broaden your scope, my boy!", I thought to myself. Yes, I do refer to myself as "my boy" from time to time. So broaden my scope I've done. I will now be writing on pretty much anything that inspires me to sit in front of this laptop and bore ya'll with a story or two. After all, the only thing I do is go to dialysis. The reason I don't do anything else? Dialysis. Accordingly, I will use the free time kidney failure has "afforded" me by doing something I know (OK, think) I'm good at: write. I hope you guys enjoy the new direction. Any newbies snooping around here for the first time, feel free to go back and check out the old entries please and let me know what you think. Bye now.

A Close Call

There are very few things in this world that can still put a genuine smile on my face. My niece is a lot of those ways. But when I recieved a phone call at 1:30 am Sunday morning from the hospital saying they've matched me to a kidney I gotta say I was smiling like a fat kid lost in Hershey, PA.

To "get matched" what happens is that a donor kidney comes available and it is run against the database of candidates waiting for a kidney. It matches candidates based on the number of antigens it matches. The human body has 6 antigens, 3 from each parent, and basically they create the antibodies that go out through your body and make sure there's nobody there who shouldn't be there. As long as enough antigens from each person matches, I get that phone call.

So the nurse checked up on my health, told me not to eat and get some rest. One more test to do and that should be back in a few hours. They said they could have me in the OR that night as long as the last test goes well.

The antibody test.

My heart dropped. I've been down this road. This test never goes well for me.

What they do is take your blood/antibodies, mix it with the donors'. Either they get along and a transplant is on or my guys go on a Boondocks Saints-style rampage.

Ideally you wanna have no antibodies in you but we all get sick, so we have some. On a scale of 1-100 ,my last antibody count was 73. What this means is that roughly 3/4 of all donor kidneys will get the Macmanus brothers treatment from Jeremy and my antibodies. Which is what happened this weekend.

So the call back was a huge let down but if there is a plus side to all of this it's that I am rather high up on the transplant list. How was your weekend?

posted from Bloggeroid

The Angry Old Man I've Become

Something has been bothering me recently, and I wonder if anyone else on dialysis has ever had this experience. I've found myself much angrier than usual when I go to dialysis. I'm pissed at the staff, though I try to keep it to myself and I'm pissed at just being there. I know that's probably normal but I don't know why I'm just now experiencing these feelings. I've been on dialysis now for 21 months now. The anger and bitterness should have been something I felt at the outset and then once I accepted things it should have passed. But instead I took everything in stride as I usually try to do with my health and now as soon as I walk into the clinic I'm in a horrible mood. I get angry at those who run the clinic because they are on this rampage of doing things by the book and not ignoring every bit of minutia in their "handbook" about how to administer dialysis, with no thought of the individual needs of the patients. We all don't have the same symptoms/needs as dialysis/ESRD patients. I'm sure my anger is petty and juvenile but it's honest and I really can't do anything about it. I don't want to be angry, I don't want to be bitter about my place but it washes over me like a tidal surge and it just controls me. The second I leave the clinic after my treatment I'm my normal self but for those 4 plus hours I'm in there I'm on the razor's edge and could snap on anyone in there. Anyway, I've had this going on now for a few weeks and I can't do anything about it. I don't like feeling that way, I'm normally a pretty happy guy where my health is concerned. I've dealt with ill health for my entire life and have learned to roll with the punches. The last time I was this angry was after my transplant failed and I was told, as I lay in my hospital bed, that I would need to go back on dialysis as soon as possible which meant guiding a wire into my jugular vein into my heart for emergency dialysis access. That was my 30th birthday, why what did you get for your 30th birthday? Maybe that's it. Maybe I'm just now feeling the cumulative anger I should have felt all these years when I got bad health news. I wish I knew what it was and how to fix it, I know the people at the clinic are just there to do a job and to keep me alive but I really resent them and feel so bitter when I'm in there. Just something I've been thinking about. If any of you reading this have been or are on dialysis currently and have had these feelings I'd love to hear your story and how you dealt with it. It's gotten to the point that I don't even want to go anymore. I said that half jokingly the other day and the nurse practitioner told me that I had to come and that there wasn't an alternative, as if I just got there and didn't know that. I told her, "I don't even care." It's gotten to that point. I'm so angry at dialysis I don't want to go and I don't care what that would mean. I still go, I make myself, but I need to get a grip on these feelings. Sorry for the depressing post y'all. Like I said, the other 20 hours out of the day I'm pretty happy, considering. It's just those 4 that I'm in that building, on that machine. As always, I wish you all good health and much love.

Remember Me?

Hello all. It's been awhile, I know, but I made a promise to myself when I started this blog and that was that I wouldn't just post banality or what was on my mind on a given day every week. I said I'd only post when I had something to say about the subject of this blog and not any other time. So, 2 months since my last post I'm back.

In the two months since I've talked to you all last I've joined a gym and started to get into some semblance of good shape. I really like the gym but not really a fan of the money I have to spend on it but nothing worthwhile in this life is free I suppose. Someone has to make money off our lives, right? What would we do without capitalism. Sorry, that's for another blog. Getting in shape has been great, I'm still not eating great but that's something I still can't do. Anyone who is on dialysis will tell you that one of the hardest parts of the experience is the diet. Low potassium, low phosphorus, low sodium, low taste. It's the worst. I'm already a picky eater, ask anyone who's cooked for me, so I already went ahead and cut half of the food in the world out of my diet just from my preferences and now the dietitians are harping on me to go ahead and eliminate the other half. At least the ones that taste good anyway.

No potatoes. Come on I'm half Irish. Really? No dairy, cheese, beans, peanut butter. You're killing me. No soda. Eh. Half the fruits in the world and probably a quarter of the vegetables. So really I'm left with meat. That's it. Meat and bread, but no whole wheat because that's bad too. Meat and bread, nothing on the meat and nothing to season it with.

So that's the diet they are trying to push on me. No thanks. I know it seems petty and immature but no. I'm not doing it. I'll cut back on some of these things, I have no problem with that, but I'm not eliminating anything on that list. It's bad enough I'm on dialysis. It hampers my ability to get a real job, be out in the sun longer than a half an hour, or just live a normal life and now that my kidney function has basically hit rock bottom it's trying to eat into what I eat. I have to draw a line somewhere. OK, I don't have to. I could just be an adult and comply with the rules, but I'm not going to. I've been on the transplant list for a year and a half now, and I know that doesn't seem like very long compared to others who have been on for years, but that's the point. I've been on for a year and a half and haven't even gotten a sniff of a kidney so chances are I'm gonna be on this list for a few more years and in that case I don't think I can give up the few foods I enjoy eating or just the simple freedom of eating whatever the hell I want to.

The intention of this blog wasn't to do this much complaining but clearly this is an issue that really gets to me. I've gotten to a place while on dialysis that I'm sick of it. I'm increasingly less patient with being on the machine every day and more aware every day that I haven't heard from the transplant people in about a year. I'm just coming out of my myopia and realizing that this is gonna be a very long process and that during the process you don't get better you get worse. My kidney function has decreased significantly since I started dialysis and while the washed out feeling afterwards isn't as frequent, I am starting to develop other problems more often. Tachycardia, Brachycardia, a couple bouts with pneumonia. To sum up I'm sick to death of this process.

Since I'm clearly entering a bitter phase about dialysis I will probably be back to blogging more frequently. I think if I don't I may choose to lash out in a different way; getting angry for no reason or even skipping treatments, and neither of those things help anyone. I know this is just a phase and I really am happy with every other aspect of my life, just not the health part. But I guess that's to be expected. And though I'm a little down these days I still wish you, my readers, good health and great love.

Kidneyversary?

That's right, I've made up a word. I've seen it done elsewhere. It actually got someone an A once in college so back off. :) Anyway, I'm temporarily out of my blog hiding hole to pen this thank you note of sorts.

On May 20, 2004 Jeremy Duncan gave me one of his kidneys so that I could be off dialysis and get on with my life and do so healthy. It's been 6 years and I've yet to figure out a proper way to thank him. That's not to say I haven't thanked him. I've done so ad infinitum. But it's still not enough. So I've taken to mentioning his act of heroism and kindness at least once a year on the anniversary of our respective surgeries. I've already mentioned him on Facebook and told friends of today's significance. All that's left to do is to say a little something here so that the entire world can read it.

So thanks again Jeremy. As I wrote on Facebook I hope, one day, someone does something for you that is at least half as nice as what you did for me and I hope that someone is me. Your gift didn't last as long as anyone would have hoped but that doesn't, for an instant, diminish the thoughtful, kind, loving place inside you where the gesture came from. You are a good person, a good friend and a good soul. My friend you have done much more than put a down payment on your spot in Heaven.

Today I am filled with a grateful feeling but also that of remorse. I feel terrible that on this 6th year since the transplant I'm not celebrating a healthy, working kidney. The doctors couldn't give me a reason the kidney ultimately failed so all I can do is bear the responsibility.

Thank you again brother for the gift of time you gave me. 4 good, healthy years I had because of you. Healthier than I'd ever been in my entire life. All the memories, good and bad, that I accrued in that time are all due to you and I'm forever grateful.

Kidney Paired Donation Program

 A new federally funded pilot program has been created to find out if kidney paired donation, which pairs eligible live donors with patients who have a donor that is not medically compatible, can make more transplants possible. They are also studying the feasibility of starting a nationwide KPD program. Below is the story from the UNOS website.



http://www.unos.org/news/newsDetail.asp?id=1344

Questions?

So it seems I'm running out of ideas for what to write about. Well, not ideas but good ideas. So here's what I'm gonna do, what every writer who wants to cash it in does: I'm asking for questions. If any of you have something you want to ask about dialysis, transplant, or anything else related just email or leave it as a comment on this post and I'll do an entry on it. No question is wrong, no question is too personal so go ahead and fire away. If I actually get any questions I'll start answering them at the beginning of March. Hope to hear from all of you.

Happy New Year?

OK, so it's a little late for a "Happy New Year" but it is my first entry of 2010. It had been a pretty quiet start to the new decade, just the way I wanted it, that is until just recently when I woke up on a Sunday to find that my ability to take a breath had been diminished greatly. Not wanting to miss the Cowboys/Vikings game, I waited a few hours to consult anyone. Needless to say, I ended up in the ER and subsequently, Northeast Methodist, with my very own case of pneumonia.

Pneumonia is an accumulation of fluid in your lungs which in turn get infected because it just kind of sits there stagnant. It's a problem that is forever lurking over our collective shoulders. Pneumonia's epidemiology, or prevalence in hemodialysis patients, hasn't been concretely proven but in a study conducted between 1996 and 2001 Medicare tracked over 200,000 cases of pneumonia in dialysis patients. (http://ndt.oxfordjournals.org/cgi/content/short/23/2/680 )

So after 3 days of breathing treatments, IV antibiotics and far too much swabbing, I was released and I've been feeling much better lately. After a year on dialysis I've kind of entered a glide pattern. Nothing really changes too much from treatment to treatment. You have the occasional fluctuation of your dry weight that needs to be corrected but other than that it's pretty standard stuff day in, day out.

I guess if I want this blog to be somewhat educational on the processes of dialysis and not just an unsolicited look into my life, I should explain what a "dry weight" is. Dry weight is simply your weight with as little excess fluid in your body as possible. Basically, in a person with normal kidney function the dry weight would be their weight after they've gone to the bathroom.

Because a failed kidney cannot filter the blood properly one consequence is that excess fluid will build up in the tissues, including the lungs, of a patient. This is called fluid overload and without treatment it can lead to the patient literally drowning in their body. Personally, it's not a great feeling. So in order to assure that this particularly uncomfortable death does not come to any of us, along with having our levels of potassium, phosphorous, urea and creatinine lowered, they also pull off as much excess fluid from the blood as possible.

So that's what the dry weight is, the lowest weight they can get you to by pulling off the extra fluid from your blood. Maybe you ask yourself, "why does he say 'as much as possible'?" And to you I say, good question but this isn't a classroom, keep that to yourself. I say "as much as possible" because there is something called the "dialysis hangover" or "dialysis washout." It is caused by too much fluid being pulled off in one treatment, or can be caused by the fluid being pulled off too quickly.  "Dialysis hangover" is usually characterized by these symptoms, but not necessarily all at once: headaches, nausea, muscle cramps, a drop in blood pressure and fatigue. These complications can resolve within minutes or they could last for a day or so.

 Maintaining your dry weight, while one of the most essential jobs performed by the dialysis treatment, is also the one that will affect the patient the most. There are ways to avoid the "hangover," mostly they involve proper fluid control on the part of we the patient. Basically, knowing your weight, knowing how much fluid you are taking in between treatments and not going over your allotted amount. This sounds easy enough but the recommended fluid intake between treatments for most patients is 32-50 fluid ounces per day, or 64-100 fluid ounces total. 32 fluid ounces is roughly equivalent to a bottle and a half of soda a day. An average person with normal kidney function has a fluid intake of 100 fluid ounces a day. That 32-50 fluid ounces a day doesn't just include water, juice or whatever you drink, it also includes anything liquid you could have. Soup, ice cream, basically any food that is liquid or can melt will count against your daily allotted fluid intake. Now, that 32 ounces a day rule isn't fast and firm. If a patient has residual kidney function that will allow them some wiggle room with their fluids. That's something I have been blessed with for this first year I've been on. I think this latest bout with pneumonia is the death knell for my willy nilly fluid intake.


It's important to know your weight and to weigh yourself regularly at home to make sure you are not gaining too much between treatments. Ideally they would like patients to gain no more than 5% of their dry weight. For me and my 81.5 kilograms that would be a gain of 4 kg in the day and a half between treatments. Not knowing your dry weight, or keeping up with it at home can lead to the fluid overload but it could also lead to the patient just having a little fluid left in the body which, if not caught, can sit there long enough to turn into the pneumonia that lands someone, let's say me, in the hospital.

Dialysis is a partnership. The dialysis nurses and techs are responsible for as much of the patients' care as the patient is. Most dialysis patients know what temperature their dialysis machine should be set to, or how much Heparin, an anti-coagulant, they should get. Knowing these details will ensure that nothing is inadvertently missed by those taking care of you.

Starting with this blog, I'm setting up a new structure. Because dialysis can be the headquarters for tedium, at least from the standpoint of the patient, I'm going to be writing an entry on the first of every month that will cover everything pertinent that happened the month before. It will just assure that I actually come with something interesting for yall to read. I will still write if something particularly emergent occurs and I am moved to write about it immediately. With that I close the book on January 2010, month 13 on dialysis. Until next month, I wish you all good health and great love.

Mortality and Morbidity

It's been a week to remember, or forget, I haven't decided yet. It's funny, in death I've learned a lot about my cousin. He touched so many lives, more than I truly imagined. In reading the messages left to him and the family I've found out things about him, some things I knew others I didn't. He was, to his friends, a source of happiness and humor when they were down. He never had an unkind word for anyone and was always there for his friends. This made me glad to hear. These are things I try to be also and I like to think that maybe that's in our blood. I'm very proud of the man and friend he was. I'm also thankful for the time I had with him and the things I've learned about him this week.

All this death around this week has inevitably gotten me thinking about my own situation. In 2006, 20.1% of American dialysis patients died, either of heart failure or infection. I'm not sure the numbers are much better today. It's not something I've ever really thought about. I've always assumed that I go to dialysis every day and I'll be fine. But that's not necessarily how it works, just how it's supposed to work. I'm not saying that I will ever be one of the 20%, I'm just saying I think it's time to start thinking about it. I've thought a lot about what my legacy would be if something were to happen. It's not a good thought. I mean, I know people would be sad and would mourn and whatnot, but when that's all done what would people remember of me? Hopefully, like Josh, people would remember me as someone who brought humor and comfort to his friends. I'd also like to be remembered as someone who was intelligent and used that intelligence for good (and evil? muah-ha-ha-ha!). I mostly want to be remembered as someone who had a roadblock put in his way and, eventually, got around it and made something of himself.

 Anyway, these are things that I'm sure float through the mind of most dialysis patients at least once. Now is my time. I've never really given a thought to my not being around anymore. But with the sudden passing of a loved one it will inevitably take center stage. So, this will be my last entry concerning the happenings of the past week and my morbid thoughts that followed. The next blog (coming soon?) will get back to regularly scheduled programming. Maybe an episode of The Greatest American Hero, that was a good show. So, until then I sincerely, as always, wish you all good health and great love.

Joshua

Tonight I lost a family member for the first time since I was 12 years old. My youngest cousin Josh and another cousin of ours, Robert were both involved in a car accident up in Ohio. Sadly, Josh didn't make it and I'm praying as hard as I can for Robert. I don't know yet how I'm gonna cope with the idea that "Joshie" isn't around. I've never felt this kind of loss as an adult and it's a more soul crushing feeling than I'd ever imagined. He was 25 years old and had his whole life in front of him and I have lost a part of my soul for ever. Some of my most cherished memories have included him because they have included me hanging with my family. When I lived in Ohio I spent many days off and weekends with Robert and Joshua. One day we were all at my Aunt Barbara and Uncle Danny's house and there was a ton of snow on the ground and the three of us had a snow ball fight that lasted an hour if it lasted a minute. Being from Texas, I hadn't really had a lot of snowball fights and I just remember all the fun we had, and because Josh was the youngest we inevitably ganged up on him. We did that a lot. But he knew we loved him, I even told him so. We picked on him because he was the youngest but we always included him, even if we were made to. :)
   These memories are great and it's important to tell them because it keeps his memory alive. And over time I will talk with relatives and we will tell stories and reminisce but right now all I feel is pain for a lost loved one. Anyway, I just wanted to...I'm not sure what I wanted to do, I kinda just started writing. Anyway, I love you Josh, and you'll be missed very much.

Thanksgiving

Yeah I took a week and a half off. It's not like you all are paying for a subscription. :P

A lot of times, when I'm sitting in the dialysis chair and my calves are cramping or I'm dry heaving, I can't imagine there is a whole lot that I have to be thankful for. But when the season comes around and I really start to think about it, I realize that I have plenty of reasons not to be sullen and "grinch-y." I have a very loving family: my dad George; my mom Jan; my sister Sarah; and the only person I allow to hit me and walk away, my 2-year old niece, Mia. I also have great friends who would do anything for me and they are far too numerous to name but you know who are, and yeah, I'll name you anyway: Justin, Jeremy, Johnny, Kelly, James, Mindy, Laura, and there are more and I'm not just saying that to make myself look popular. I am thankful everyday for yall, I wouldn't be where I am without any of my family or friends.

The newest name on that list has done a lot this year to end up in the esteemed company she finds herself in, honest and true men every one of them. Even Mindy.  My friend Laura from the great Commonwealth of Virginia has done a lot for me in the short time I've known her. One thing I'm very grateful for, she's thrown some work my way that I can do from home since I have transportation constraints. Greater even than the chance to earn some money, she stepped forward to be tested to be an organ donor for me. Sadly, my antibodies are throwing a party that they are letting very few people into. It's like most parties when I was in college. When her blood cells and mine got together it wasn't a pretty sight. When you've already had one transplant, you have the first donor's antibodies as well. So my antibodies and Jeremy's got together and put a hefty beat down on Laura's blood cells. It's one reason it's so hard to match repeat recipients. But, undeterred, she entered into the Paired Organ Donation program with me and her donation of a kidney to someone else will enable me to get a kidney a lot faster than the traditional way would have. I've mentioned the program before and I have links up to the hospital's website. Links, like this one: http://www.texastransplant.org/kidney/kidney_incompatible.html 

That act means so much to me, more so than I'll be able to capture in this blog. First of all, for the second time I'm having someone step up and offer up a part of themselves to me, so that I can live a normal life. Most people don't get to have one living donor, I'm gonna have two. That just doesn't seem fair to me. I don't really feel I'm worthy of that kind of sacrifice. I didn't feel I was the first time with Jeremy and I certainly feel even less worthy my second time in this rodeo. I am amazed any time someone offers to be a donor. Not that it happens to me a lot, I'm just saying that simply the offer floors me and renders me speechless. To actually go through the process the way Laura has, and do it so enthusiastically, makes me want to be a better human being because I'm clearly not living up to the standard that she is setting.

It's important, especially when you are in a situation like I am, to find things to be thankful for--all year, not just the last month or so. Not only because it's not a good idea to go through life ungrateful, it can be unhealthy, but it's also good to appreciate what you have because there are others out there with so little and they are so happy with their lives. That's another gift Laura has given to me. With the promise of a new kidney, she has given me something very special to be thankful for and with that gift comes an opportunity. An opportunity that I squandered before. To not take life for granted like I did last time and to live up to the high standards that she and Jeremy have set for all of us as people. I wish all of you a belated Happy Thanksgiving, and as always wish you good health and great love.

"For Some Reason We Just Always Hung Out"-Jeremy Duncan

I have now delved into my own psyche and soul significantly enough that I've decided to turn the spotlight outward onto someone else. My donor is known to those readers who are related to me or who know me personally, well mostly. But to any readers out there to whom I am a stranger, my donor is one as well. He's been my friend since 1991 but I had no idea 18 years ago what kind of friend he would turn out to be.

 I met Jeremy Duncan in 6th grade after moving to a new school for the first time since 2nd grade. That was actually a good stretch of time for a military family. Jeremy was just another one of the new kids I didn't bother to try to meet because I was pissed I had to leave my previous school. So when junior high rolled around the next year I eased up a bit and started, trying at least, to make friends. Several of the friends I did make that year I have to this day. Jeremy was one of them. We had gym together as I recall and he lived in my neighborhood. Anyway, I'm not gonna recount the history of our friendship in this entry. Nobody cares to hear it, I'm sure. And frankly, some of ya'll lived through it and don't care. Anyway, the story I do want to tell is the one that got me a new kidney. All of you have heard it or were there but I think you will agree it bears repeating. To me it's like the stories that Jewish families tell over Passover seder, or the Irish tell at wakes after a couple of Jameson's.  Stories that recall times past, loss and gain. Triumph and tragedy. Well this is his triumph story, one of many he has, but the one I will tell over dinners for years.

 In 2003, Jeremy was a 1st Lieutenant in the United States Marine Corps as part of the United States invasion and occupation of Iraq. He lived in Southern California and we didn't see much of each other because his parents had moved off to Indiana sometime before this so he didn't really ever come back to San Antonio. We talked on the phone and on the computer quasi-regularly. I talked to him before he was deployed overseas -- that was February 2003 -- and I told him that I would be starting dialysis any time, which he was sad to hear. That was also the phone call when he told me that he and his wife, Tiffany, would be expecting their first child. That was big news. He was the first one of our group of friends to have a baby. It was a weird idea that any of us would be responsible for a human life. But he's turned out to be an outstanding husband and father, which shouldn't have been such a surprise. We talked a bit more because it would be the last chance to talk before he went off to war, a prospect I was more concerned about than my first time on dialysis, which was just over the horizon. Thankfully, he came back no worse for the wear and he gave me a call soon after his arrival back home to let me know he was home and to see how I was feeling. I had told him that I had started dialysis and that I was slowly adjusting to it, but that it sucked worse than anything I'd ever known. Sucked worse than Godfather III. It was that bad. 

Anyway, then he asked how I would get a new kidney. I explained to him the cadaver donor process of being on a list and essentially waiting for someone with very similar biochemistry to die. Otherwise, I told him, I could in theory get a living person to donate a kidney to me, if we matched blood and tissue types. Unfortunately, the best candidates for such a procedure, my family members, were either not blood type matches or not in a position, health-wise, to donate. That's something I never thought twice about. It never bothered me that everyone in my family was ineligible to donate. I never thought about a living donation because it seemed like way too much to ask of someone. It still does. Jeremy is a naturally curious guy. He likes to know the reason behind everything and how everything works, so when he asked what the process of getting tested to be a donor was, I didn't think he’d actually use the information I gave him. 

 Well, I didn't hear from Jeremy again for a couple months, save for the day his beautiful daughter, Zoe, was born. When I did hear back from him at the end of 2003, he gave me news that I had never in a million years expected to hear. He told me that he had been to a doctor on base and asked about getting tested to be a transplant donor. He needed to know which hospital I was listed at so the blood work could be sent. I was floored. I was almost instantly brought to tears over the gesture and to this day I've never again been that surprised.  So I gave him the hospital’s information and again we didn't talk for a few months. 

 The next time I heard from him, he called to tell me he got a phone call from his doctor informing him that he was a suitable match for me and that he could give me a kidney. He asked what I wanted to do. He was more than willing to do it if I felt OK with it. Again, I was speechless. It was like winning the lottery but having the winnings come out of a loved one’s bank account. All at once I wanted to tell him to get out here now and let's do this, but also I wanted to tell him thanks but no thanks, I couldn't do it. 

 I really mulled over this decision more than I thought I would if and when I ever got a call like this. I was scared for him, he'd never had surgery in his life, and I was scared for me because my best friend was giving me a gift that I could never repay in a million lifetimes and I didn't know what to do with that feeling. It's been over 5 years and the kidney no longer works and I still have those feelings. Even more so because it turned out not to last very long.

 Obviously, I called him back and said "yes, let's do this" and 2 months later he was in San Antonio getting his final work up and the rest is history. The news media "somehow got wind" of the story and we were briefly local celebrities. We even did a CNN interview (which is posted on my first entry "Pilot") and one on The Morning Show on CBS with Harry Smith. One tidbit that never ended up on TV or in print was about the moments before we were both wheeled into surgery. If you've ever had any kind of surgery, which he hadn't, you know they usually give you an injection that they call "a margarita." It's a powerful sedative to relax you as they are wheeling you in and putting you on the table, basically doing everything before they put the mask on you and telling you to count back from 100. I, frankly, love the "margarita" and look forward to it every time I have surgery. Well, on this occasion I must have been abnormally nervous because when they injected the sedative I immediately began to dry heave. Just for a second, but it was long enough for Jeremy to see. He was literally right next to me in another gurney. He saw me wretch and he lost it. He was saying, "don't give me that! I don't want what you gave him!" I had recovered and started laughing at his outburst. The nurse calmed him down and they gave him the "margarita" and he instantly became Cheech Marin. We were laughing over the dumbest stuff and he was telling me things like, "man I'm so stoned." It was hilarious. 

 Not nearly as hilarious as when they rolled me into post-op, and a still drugged up Jeremy blurted out, "Hey, that guy has my kidney!" I don't remember it, but I heard about it later. Everyone thought it was hilarious. I would have, too.

 Well, that's the story of my first transplant. To this day, I'm still amazed at Jeremy's sacrifice and even though it didn't last as long as everyone wanted it to, I'm still thankful every day for his gift. I am still awed that he would do this for me, but the God's honest truth is that Jeremy is the kind of person who would have done it for a stranger. Anyway, I don't want this to get overly sappy so I will just say that he is a great friend, a great person and I thank God that we had gym together in 7th grade.

 The point of this story was not only to let the blogosphere know what kind of person Jeremy Duncan is, it's also to point out that any of you reading this can be a donor. It doesn't have to be a kidney necessarily, it can be as simple as blood plasma. Blood and tissue donations are sorely needed all over the country. 45 minutes of your time could save the lives of up to 7 people. I leave you with that thought and, as always, wish you good health and great love. I also wish for all of you at least one Jeremy Duncan in your life.

The Crackpot and These Women

So another installment is in high demand apparently. And by high demand I mean 1 or 2 people are asking me to write a new one soon. I had a great weekend, real laid back and low key and dialysis really didn't give me any problems or ideas on Monday. It was in and out, as it were.

 So, what should I write about? That is the question that is plaguing me. 

Time.

 You know, I don't ever think about getting a new kidney. I don't. But what I do think about is what I'm going to do with it. It's like when you were a kid and you knew, at least I did, that you were gonna get a check from your grandparents for your birthday. So in the weeks or days leading up to your birthday you never thought about the check that you knew was coming, but rather what you were gonna spend grandma’s and grandpa’s money on.

 That's what it's like, at least for me personally, being on the transplant list. It's not if, it's when, and it's not even when as much as it's after that you think about.

 When I got my first kidney I was told it would be 20-25 years until I would start back down the transplant road again. That was probably the worst thing anyone could have told me. I was 26 years old and I had at least 20 years of health in front of me. And if this "health" thing is anything like what I was feeling the first day out of the hospital, I could really enjoy it. I had never, literally never, felt so good in my life.

 However, the knowledge that I had 20 years to feel like this before it was gone was telling me to enjoy life now. "Make these 20 years the most fun of your life." That's what I was hearing in my head. My brain was telling me to go out and spend kidney money I didn't have. Which I did. I should have at least tried to go back to school, I belong in school and it's my goal for the future to get back and NEVER leave. I will get every degree they can offer, then turn around and teach those subjects.

 So in lieu of going to school I...

 Yeah, I'm sitting here racking my brain and I can't think of anything I did with my life, and kidney, in the 4 years of good health that I had. I mean I did some things; I went to Vegas, I got engaged and subsequently unengaged, I worked crappy minimum wage jobs. But I didn't do anything. I assumed, which I do a lot, that I had time. I would have time for school, I'd have time to graduate and get a good job, meet someone and start a family.

I was wrong. I did not have that time. But I did have enough time to do something, if not everything. But I floated on the cloud of good health and just went where it took me. If I had known I only had 4 years before I'd be back in hospitals and 5 years before I was back on dialysis, I would have done things so much differently.

But you can't see into the future and you shouldn't spend too much time on the past. The present is what you must see because it's fading so fast.

 Just remember that time is a fluid thing. It flows past you before you know it, so enjoy what you have now. Enjoy what life has given you and don't waste it. You never know when the river of time will end in a fall. As always, I wish you, my readers, good health and great love. And time.

Sgt. David M. Nessley, Sr. USMC

When I get down on myself, which is a lot, I try to remember those who have it worse than I do. I wish it were harder but there are many out there worse off than I am. I think of the nurse at my clinic who is on chemo, all the people who don't qualify for a transplant and have to be on dialysis the rest of their lives, or the people who need a heart and don't have the possibility of something like dialysis that can keep them going until that life-saving transplant. Most of all, though, I think about my grandpa. I’d rather stay on dialysis the rest of my life than go through what he has to go through. My grandpa has dementia and hardly remembers who any of us are anymore. I saw him last year and I was told that it might be the last time I see him because he was getting bad. For some reason, in my brain, I couldn't accept that. Now I realize that, while I had some good moments with my grandfather last year, I didn't take the appropriate amount of time to tell him how I felt about him. Whether he would have processed it or not, and he likely wouldn't have, I still wish I had told him what he meant to me. My other 2 grandparents died when I was a kid and they both went suddenly so I didn't get the opportunity I probably lost last summer.

I wanted to tell my grandpa, who was a Marine Sergeant in World War II and a Bronze Star winner for bravery, that he was one of my heroes. But I’m not the one who has it worse in this story -- my grandfather does. He is a perfectly healthy human being who eats, sleeps, and lives in a world he increasingly forgets about. That’s a kind of hell that I've never experienced even in all my years of hospitals, surgeries, and organ failures.

I've lost my grandfather and that's sad for me, but what's worse is that I've lost him while he is still alive. Being hooked to a machine 12 hours out of the week is really small potatoes when it's stacked up against things like that. There's no machine that's gonna make him remember his son, daughter, grandkids, or friends.

In the grand scheme of things, I'll get a new kidney and move on with my life. But there will still be 10s of thousands left behind on dialysis and I think about that a lot and remember that things can always be worse. I kind of think of it in prison terms: There will always be someone who has been on dialysis 1 day longer than I have and that person has it worse than I do.

There is good news for today's blog. Mr. Moreno, an older gentlemen who had been treated at my clinic for quite a long time, got his kidney on Wednesday, 11 November. I sincerely hope everything works out for him and that I don't see him return -- at least not as a patient.

I swear life is not normally this dreary on dialysis. It may not seem that way from reading these posts. It's certainly not the end of the world. And that's kind of the point of this entry I suppose. Dialysis isn't the end of the world at all, it's just a bump along the way. I've never met anyone who has let dialysis define who they are. Those who are able (and they are usually the ones who've been on a good deal of time and have adapted to it) go to work as many hours as they can, coach their kids’ Little League games, and even nurse others. These people are mothers, fathers, uncles, grandmothers, etc. What they are not are dialysis patients, at least not to their families and friends.

Remember, when times are bad and you think you have it worse than someone else, take a look around because chances are someone in your vicinity is going through something just as tough, if not tougher than you are. This is one truth that I have learned on dialysis. I've also learned that I was far too self absorbed to see this truth when I was 25 and started dialysis the first time. With age comes wisdom. As always I wish you, my readers, good health and great love.

5 Votes Down

While sitting in the waiting room yesterday waiting to be called back for my treatment, I noticed an older man and his wife, waiting. The social worker,  Beth, came out from the back with her clipboard and called them back. That's when I noticed the man's temporary Hickman catheter in his jugular; this guy was new to dialysis. I overheard him saying as they went back that whatever caused him to be on dialysis had come on suddenly over the weekend. Then the trio's voices trailed off indistinctly and I was left there to wonder:.  "What is taking these people so long to bring me back."

Witnessing this scene made me think back to my very first day of dialysis, not in a hospital, but here in this very clinic. Dialysis in the hospital, to me, was just another room to go to, and another needle; it was just going through the motions of a hospital stay. In an outpatient dialysis clinic, it's a different creature. My first day in the clinic was one of the few times I was actually a little scared -- at least at first. When you walk in there for the first time, you are hit with the sound, first. In a hospital, where I started it my dialysis treatments, you may have had one other patient in the room with you but when you enter the outpatient clinic. you are bombarded with the noise of 20-30 other people on their treatments. There are people moaning, talking, laughing. At my clinic, you can hear an old woman scream when her needles are put in. Those kinds of sounds greeted me my first day as I timidly sat my 120- pound self in the chair and listened as the head nurse was talking to me, making sure I was OK. I was not OK. For one thing, I was cold. They keep dialysis clinics ridiculously cold. I assume it's for the machines but man, it's uncomfortable. Here's another key difference between the hospital and an outpatient clinic: In a hospital setting, if you are cold they will offer you a blanket, usually a heated blanket. In an outpatient clinic you better bring your own gear or you are out of luck. I was not aware of this distinction my first day. It was March and starting to feel very nice outside. South Texas Spring was here and I was in short sleeves and shorts, which led me to freeze my ass off for the entirety of that first treatment. 

Back to the sounds of the clinic: phones ringing, patients chatting, patients moaning and calling for relief, patients crying or exclaiming with every needle stick. All of these invaded my brain and really made me long to be back in the hospital. Eventually, I was able to shake these sounds with the help of the TV, which back then provided basic cable, and with the help of the terrific staff at the facility. Well, before I knew it that first treatment was over and I got in my car and drove off, not sure if I'd be driving back on Wednesday. Of course I did. It took me a week or so to get into the groove of this new world, but now it's very much second nature to me.

When I saw that old man in the waiting room, I wondered if any of those thoughts were going through his head. Of course, he had a wife who seemed very comforting and supportive. That will go a long way toward easing his transition into our world. I think, for the most part, the patients who have someone at home do much better in the long run.

Enough for now. As always, I ask you to remember the 104,900 people on transplant waiting lists. Until next time, I wish all my readers good health and great love.

But for one little girl...

One thing someone with an organ failing them thinks a lot about is what they would/will do once they were healthy. I find myself doing it a lot, especially when I see that little girl in the picture. That's my niece Mia.  She's 2 and when I was in the hospital last year and they told me that my transplant was beyond repair and that I would need to go back on dialysis and be re-listed for a transplant I was never more ready to end it all. That sounds horrible to say but after knowing 5 years of health, the only 5 years of real health I'd ever known, I didn't want to go back to what lay ahead. I had seen too much good stuff to go back. Well, obviously I didn't end it, and the first thing I thought of when the shrink asked why I didn't really want to die was that little girl. I want to get a new kidney, and make something of myself that makes that little girl proud of her uncle. So for a lot of those 3 1/2 hours that I'm watching free cable I'm thinking about the future. I try not to think about exactly HOW FAR into the future it may be, but I look to the future for a time when I'm not tied to a machine to keep me from being poisoned by the food I eat, and from drowning in the liquids I drink. Anyway, I thought I'd share that story of a time at the outset of all this when I was not prepared to go on. I'm sure it happens to more than a fair share of those of us in organ failure. Thanks Mia. Your uncle owes you a lot.

Post Hoc, Ergo Propter Hoc

Monday night, the first treatment of the week. I hope the weekly blood work comes back fine, as it thankfully has been doing so far. My phosphorus has been the only thing showing up a little high from time to time. I am lucky in that I don't have a whole lot of dietary restrictions yet because my blood work is always so good. Unfortunately, I've been through the renal diet in the past and I truly feel for those patients who have to be on it. Diabetics have it twice as bad. Every time I've been hospitalized and put on the "renal diet" I've been stuck with baked, skinless chicken and rice almost every night, and a bagel with cream cheese, with 1 scrambled egg substitute every morning. Num Num! I like to eat so, to me, this is the part of dialysis/kidney disease that I find difficult to deal with. Hopefully, I will get a new kidney before the dietary restrictions have to be thrust upon me again. (For a good idea of what the renal diet is, and isn't, click on the link above.)

 Speaking of getting a new kidney, I had a close call last month. As well as being listed with UNOS, I am in a program at Methodist Transplant and Specialty Hospital here in San Antonio called the Paired Donor Program. Essentially, here's how it breaks down: 1) I have a friend or family member who wants to donate but can't because of tissue or blood type incompatibilities, in this episode being played by Laura Williamson McCafferty. 2) The hospital matches us with another pair that is in the program but are incompatible with each other. 3) If all the tests come back positive, Laura gives her kidney to the other recipient who needs one and that person’s friend/family member gives me theirs. A kind of swap meet for kidneys. http://www.texastransplant.org/kidney/kidney_incompatible.html

Well, I got a call last month saying that a 60 year old couple was an initial match and would I be down if the further testing came out positive. I'm not one to really look a gift horse in the mouth so I said yes, though I did have some reservations about it. Yeah, the nurse said that they were good to go otherwise they wouldn't be in the program, which is true, the program at Methodist has strict parameters and guidelines to ensure the best matches possible. But still, a 60 year old kidney, I would be waiting for it to give out again because it's old. Well, in the end my antibodies went to town on the 60 year old's and the transplant was a no go. I had to wait a weekend to find out and it was pretty tough to find out on Monday that I would have to wait some more. But then I thought about the thousands who were going to dialysis that Monday and were in their fourth or fifth year of going, and I remembered how lucky I am to have never had to have gone that long. Yet.

 Well that's it for Monday, turns out I won't get my blood results this week due to some malfunction that happened tonight with the machines. Oh well, mine haven't changed that much lately. If any of yall have any questions about the Paired Donor Program or the renal diet feel free to ask. Leave a comment and I'll get back. Until next time I wish you all good health and great love.