Tuesday, October 27, 2009
Steve's labs not so good yesterday. His creatinine was 8.0m, phosphorus was 5.4 and potassium was 5.3. Dr Browns nurse called me today and asked how he was feeling. Sometimes good sometimes not so good. She said as long as he is feeling ok and not vomiting it was ok to wait until the 10th to start dialysis. She said it wasn't necessary to do anymore lab work they will do it the morning of surgery for the access for dialysis. At this point his lab work will not be improving. Hopefully he can make it 2 more weeks. Harvest this year sucks. It is not working very well for him. 3 days of rain 1 day in the field. We are trying to avoid crowds and sick people. So he will be as well as possible for the surgery. You probably won't here from me again until surgery day unless he gets sick. Pray for a sucessful surgery and they he avoids the flu.
Wednesday, October 21, 2009
I have to say I got a little excited today, ok maybe more than a little. When I looked at our mail there was an envelope from the University of Kansas Hospital Renal Transplant Program. Of course all kinds of things went through my mind and I ripped it open immediately (it was address to Steve). Nothing about transplant. Small let down. It was a letter informing us about H1N1 (swine flu) based on recommendations from the doctors from American Society for Transplantation and Center of Disease Control.
The vaccine has been approved and some of the first doses are available this month. It was informing Steve to not take the nasal mist form of H1N1 vaccination, it contains live virus. He must wait until a dead-virus vaccine is available in form of injection.
They did recommend he get the regular flu vaccine, which he already has. After transplant it is recommend that the patient never receive a live virus. Which the injection of regular flu is not a live virus. They outlined who is at risk of serious complications for H1N1
Pregnant Woman (Steve doesn't fall into this category)
People between the ages of 6 months and 24 years old(He missed this category to)
People ages 25 to 64 years of age who have chronic health disorders or compromised immune systems ( Steve would fall into this category).
It listed the symptoms of H1N1:
Abrupt fever greater than or equal to 100
Cough, sore throat, runny nose
Aches, chills, fatigue
Diarrhea and vomiting are unusual
It listed some precautions you should take which are the normal:
Stay home when sick, don't go to school or work so not to spread the disease.
At home isolate the patient as much as possible from family member's.
No hugging, kissing or handshakes (Maryville & Conception Parishes have stopped drinking the wine Maryville has also stopped the sign of peace by shaking hands if you choose so).
Get plenty of rest and drink plenty of fluids. (If patient is on a special diet and you would not normally drink the drinks recommended) Steve's fluid intake is somewhat restricted which worries me because of fever, the normal patient would be told to push fluids.
Cover your mouth when coughing, washing hands frequently, etc.,
Do not visit hospitalized or high risk family members or friends.
So the letter was to inform us to take precautions. Which we have been. This is not to be taken lightly. Maryville middle school had 60 students gone yesterday Oct 20th. I think it is just getting started around her. I had a few parents at my work with children who have H1N1. Steve and Blair probably think I am nuts. I bought hand sanitizer, disinfectant wipes, Clorox, etc... Steve just needs to be in a bubble for a while. So if you see us and we don't get too close, hug, kiss, etc, you know why. We have to keep him healthy as possible or he will be in the hospital I am afraid.
The plan is still the same in 3 weeks he is going to do the surgery to have the catheter put in to start dialysis. Hopefully he can avoid the flu. It is going to be a little scary going into the hospital where all the sick people are.
The vaccine has been approved and some of the first doses are available this month. It was informing Steve to not take the nasal mist form of H1N1 vaccination, it contains live virus. He must wait until a dead-virus vaccine is available in form of injection.
They did recommend he get the regular flu vaccine, which he already has. After transplant it is recommend that the patient never receive a live virus. Which the injection of regular flu is not a live virus. They outlined who is at risk of serious complications for H1N1
Pregnant Woman (Steve doesn't fall into this category)
People between the ages of 6 months and 24 years old(He missed this category to)
People ages 25 to 64 years of age who have chronic health disorders or compromised immune systems ( Steve would fall into this category).
It listed the symptoms of H1N1:
Abrupt fever greater than or equal to 100
Cough, sore throat, runny nose
Aches, chills, fatigue
Diarrhea and vomiting are unusual
It listed some precautions you should take which are the normal:
Stay home when sick, don't go to school or work so not to spread the disease.
At home isolate the patient as much as possible from family member's.
No hugging, kissing or handshakes (Maryville & Conception Parishes have stopped drinking the wine Maryville has also stopped the sign of peace by shaking hands if you choose so).
Get plenty of rest and drink plenty of fluids. (If patient is on a special diet and you would not normally drink the drinks recommended) Steve's fluid intake is somewhat restricted which worries me because of fever, the normal patient would be told to push fluids.
Cover your mouth when coughing, washing hands frequently, etc.,
Do not visit hospitalized or high risk family members or friends.
So the letter was to inform us to take precautions. Which we have been. This is not to be taken lightly. Maryville middle school had 60 students gone yesterday Oct 20th. I think it is just getting started around her. I had a few parents at my work with children who have H1N1. Steve and Blair probably think I am nuts. I bought hand sanitizer, disinfectant wipes, Clorox, etc... Steve just needs to be in a bubble for a while. So if you see us and we don't get too close, hug, kiss, etc, you know why. We have to keep him healthy as possible or he will be in the hospital I am afraid.
The plan is still the same in 3 weeks he is going to do the surgery to have the catheter put in to start dialysis. Hopefully he can avoid the flu. It is going to be a little scary going into the hospital where all the sick people are.
Monday, October 5, 2009
Disappointment
Steve had the appointment with Dr. Lukens today. As Dr. Brown suspected there is something wrong with the fistula(access in the arm for dialysis). The only way to find the problem is to inject dye which they don't want to do because it could take whats left of the kidney function which is not much. Contrast dye for any test is hard for kidneys to get rid of. Dr Lukens suspects there is two issues the first being where the graft was done where the artery and the vein come together, about 1 to 2 inches from the wrist on the inside of the arm. The other issue he believes is that there are branches coming off the main blood supply which is not that uncommon. If it is what he suspects there are a couple of things that can be done. If the vein has narrowed they can angioplasty it like they do on heart patients and make the narrow places wider. They can also tie the branches off depending on how many there are (there would be an incision for every place that needs to be tied off). They just won't know for sure without using the dye.
So, the next plan of action is the 2nd week of November he will be admitted to the hospital, have the catheter put in his next(another dialysis access), he will get dialysis 1 or 2 days and while in the hopital they will do the dye to find the problem with the fistula. Steve picked the 2nd week of November. They will work on getting the fistula fixed and he will have to use the other access for dialysis. If something happens between now and November and he gets sick they will do an emergency procedure and put the catheter in his neck. The doctor says some of his older patients like the catheter access because they do not like getting stuck all the time. The risk of infection is higher.
Pray for what is left of the kidney to last 5 more weeks.
He went to the field when we got back from the doctors appointment. Pray for good weather.
Christy
Steve had the appointment with Dr. Lukens today. As Dr. Brown suspected there is something wrong with the fistula(access in the arm for dialysis). The only way to find the problem is to inject dye which they don't want to do because it could take whats left of the kidney function which is not much. Contrast dye for any test is hard for kidneys to get rid of. Dr Lukens suspects there is two issues the first being where the graft was done where the artery and the vein come together, about 1 to 2 inches from the wrist on the inside of the arm. The other issue he believes is that there are branches coming off the main blood supply which is not that uncommon. If it is what he suspects there are a couple of things that can be done. If the vein has narrowed they can angioplasty it like they do on heart patients and make the narrow places wider. They can also tie the branches off depending on how many there are (there would be an incision for every place that needs to be tied off). They just won't know for sure without using the dye.
So, the next plan of action is the 2nd week of November he will be admitted to the hospital, have the catheter put in his next(another dialysis access), he will get dialysis 1 or 2 days and while in the hopital they will do the dye to find the problem with the fistula. Steve picked the 2nd week of November. They will work on getting the fistula fixed and he will have to use the other access for dialysis. If something happens between now and November and he gets sick they will do an emergency procedure and put the catheter in his neck. The doctor says some of his older patients like the catheter access because they do not like getting stuck all the time. The risk of infection is higher.
Pray for what is left of the kidney to last 5 more weeks.
He went to the field when we got back from the doctors appointment. Pray for good weather.
Christy
Thursday, October 1, 2009
We saw Dr. Brown yesterday. Regular check up. Creatinine, potassium and phosphorus were pretty much the same. We mentioned to her about him being sick on Sunday and having blurry vision. She thinks it is possible that his blurry vision could be from being very fatigued. She said if it happens again to let her know and she would set us up with an optimalogist. Blurry vision is not usually due to kidney failure. Steve did admit that he is nauseous about every day but it usually goes away. So after talking with her for an hour she suggested that he start dialysis at the center 2 times a week for a couple hours to make him feel better and get him through harvest. He said no!
We talked about his fistula(access for dialysis) in his arm. She looked at it and had some concerns. She thinks it may now be too deep or narrowed off. We are going to see the vascular surgeon on Monday that did the surgery and see what he thinks. It may be smaller veins are branching off taking some of the blood supply and they would have to tie them off to get the main supply back to the large vein or if it is too deep they may be able to bring it back to the surface. They usually check it with dye but since his kidney is only working 9% they don't want to risk using the dye. They may do an ultrasound with a Doppler. Guess we will know Monday.
Dr. Brown called me later the same day after we had seen her that morning. She said she had been thinking about his case all day. She really feels that he should start dialysis 2 times a week now before he gets really sick. If he gets sick and has to go to the hospital depending on what his levels are they would just put a port in his neck and start dialysis. There is always a chance this could be critical and she doesn't want that. She would like to start the training next week but you have to do the training on the patient. I told her I would let him know that she called and we are to call her Monday after his appointment with the vascular surgeon to let her know what he has decided. Guess what he said? NO I am not planning on dialysis until after harvest unless I get sick. Stubborn!!!!! Does anyone know if this attitude came from the Meyer side or the Schmitz side??? Guess I will have to take my own action. I am telling his sisters.
Later Christy
We talked about his fistula(access for dialysis) in his arm. She looked at it and had some concerns. She thinks it may now be too deep or narrowed off. We are going to see the vascular surgeon on Monday that did the surgery and see what he thinks. It may be smaller veins are branching off taking some of the blood supply and they would have to tie them off to get the main supply back to the large vein or if it is too deep they may be able to bring it back to the surface. They usually check it with dye but since his kidney is only working 9% they don't want to risk using the dye. They may do an ultrasound with a Doppler. Guess we will know Monday.
Dr. Brown called me later the same day after we had seen her that morning. She said she had been thinking about his case all day. She really feels that he should start dialysis 2 times a week now before he gets really sick. If he gets sick and has to go to the hospital depending on what his levels are they would just put a port in his neck and start dialysis. There is always a chance this could be critical and she doesn't want that. She would like to start the training next week but you have to do the training on the patient. I told her I would let him know that she called and we are to call her Monday after his appointment with the vascular surgeon to let her know what he has decided. Guess what he said? NO I am not planning on dialysis until after harvest unless I get sick. Stubborn!!!!! Does anyone know if this attitude came from the Meyer side or the Schmitz side??? Guess I will have to take my own action. I am telling his sisters.
Later Christy
Subscribe to:
Comments (Atom)