Sunday, June 6, 2010

Kidney Watch Day 18 (renal lesson included)

It has been almost 3 weeks since my last blog and I have had a few request for updates. This is exciting and surprising. Exciting that anyone, including my friends and family, is actually taking the time to read through my lengthy blogs but that they find it interesting enough to want more. The surprise part is easy, I have 5 followers one of which is me, so I don't realize how many people are actually reading this but hi, welcome, leave a comment it makes me happy :). This is going to be more of a medical update, a little boring with all the medical terms, feel free to ask any questions if needed.

Well 3 weeks ago my significant other (I'm 30 years old, boyfriend sounds so immature, I'm not an official fiancĂ©e and partner seems a term for even older couples) had a kidney transplant. I am happy to say that so far so good. No sign of infection or rejection, yay!! However the kidney isn't where we want it to be yet either, he is still on dialysis and getting weekly blood test to see the slight improvements. His last labs showed a creatinine of 7. For all of those who don't know what this means let me give you a slight renal overview. Some of the toxins in your body are call creatinine. When your kidneys are functioning properly they filter your blood and dispose of the creatinine through your urine. When your kidneys are not working properly your creatinine levels in your blood goes up and the toxins poison your body. If these toxins are not removed from your blood by either your kidneys or the process of dialysis you would die. A normal creatinine level is between 0.6-1.2mg/dL, it may be higher or lower do to diet, dehydration, malnutrition, etc. At the Hospital of the University of Pennsylvania once a person creatinine level reaches 3.5 mg/dL they are able to get on the transplant list. Once a person reaches 6.0-7.0 mg/dL they start on dialysis. Kenny was a little over 8.0mg/dL when he started, mostly because the men are stubborn. 9 out of 10 times the men in the clinic would ignore the doctors advice to schedule surgery for port when they reached a high levels, they usually wait until the uremic symptoms begin and end up going to the ER. Dialysis doesn’t improve your creatinine levels, your kidneys work 24 hours a day 7 days a week, a regular patient is usually on dialysis 12hours a week, and that drains their energy right from them. After the treatments Kenny would need a long nap, it helped going to home dialysis but only to a point. Prior to the transplant Kenny’s creatinine level was 12.0. Last Thursday when I worked at Penn I made sure to pull up his labs to see the levels, was very excited to see the 7 so excited that I didn’t look at the rest of the levels. I printed up a copy of the results for our records and placed in my pocket book didn’t even think back to them until the next day.

“Hi babe, I’m in the hospital,” Kenny says when I answered the phone like he is picking up milk at the grocery store. “What’s wrong?!” I can’t bare to think of all the possible issues. “I got a call from the transplant nurse, they reviewed my labs and told me to go straight to the ER.” I went to my pocket book and reached for the lab results which I just reviewed the day before, I was so happy with the creatinine that I didn’t look at anything else. As Kenny explains the call, I look through the results my first instincts is to look at the White Blood Cell Count, an elevated WBC means infection which is really bad, but no is normal, I breathe just realized I was holding my breath. I spot it at the same time Kenny tells me about it on the phone, “my hemoglobin was 7, they want me to have a blood transfusion I think I’m just going to ask for a shot of what they gave me before and check it again on Monday.” I can’t believe I missed a low hgb I use to be the anemia manager, that was my thing…..wait? What did Kenny just say? Wait until Monday?! “Are you crazy?!! You don’t have the luxury to wait until Monday, you need a transfusion now!” Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. A man with no problems has a hemoglobin between 12.0-16.0, at 7.0 Kenny’s heart is working extra hard to keep his body oxygenated, and his brand new fragile kidney isn’t getting the blood supply it needs. The argument didn’t last long, not because I made my reasoning clear but because he said he’ll talk to me later and hung up the phone. I knew that his sister Esther was with him, which was good because she is in the medical field too and I’m sure she too is trying to convince him of the right choice. 45 minutes later when his mom called me to update me on the situation I was steaming, I had spent days in the hospital sleeping in the most uncomfortable reclining chair to make sure he received the best care possible and was even able to have someone remove his IV when I noticed it infiltrated and he isn‘t going to listening to me today. It took every thing in me not to call him an idiot when I spoke to him again. By now, his sister, his mom and me had attacked him; his big issue was the possibility of “catching something” from a blood transfusion, my biggest argument, is that there is a biggest chance of getting something from a transplanted organ and guess what you already did that! When his sister called back an hour later to tell me they were getting him a room I was able to relax. There is a big chance of an allergic reaction when you have a transfusion especially the first time so the hospital will keep you overnight for observation afterwards. Thank God, was all I could think, just one more step to the road of recovery. Tomorrow is another doctor’s appointment and looking forward to hearing good news, better levels and maybe hopefully a fully working kidney. Wish us luck.

Tuesday, May 18, 2010

Hello, we have the kidney you ordered.

The day started like any other Monday; woke up, check the weather on the news, get ready for my doctor's appointment, get Tiffany ready for school, gave kisses good bye and out the door. I was very excited to go to my 5th chiropractor appointment. Two weeks ago I went to the office to see if they could do anything with my migraines and daily headaches, after taking X-ray I was happy to know it was not a tumor but the fact that my neck was curve in a reverse form to the point that my nerves were being pinched. I was happy that after my last adjustment I had 2 days headache free. I came into the office and already knew the routine, they placed electrodes and ice on my neck for 15-20 minutes, then ultrasound for 5-7 minutes, then massage (my favorite part)for 10-12 minutes, then adjustment for 15-20 minutes. I had just had my ultrasound and waiting for my massage therapist when my cell phone rang. The caller id showed it was from home and since it wasn't the first time that Kenny had called when he couldn't find an item I just assumed he was looking for something now. "Hi sweetheart, what do you need?" His respond was short and confusing, "They called." I know that I was behind on a loan and keep meaning to call the office to make payment arrangements but the bill collector had started leaving messages at home before I made the first call, I put calling back on my mental to do list. "They who?" I asked pretty sure I knew. "The hospital" he answered. I was lost I didn't owe any money to the hospital and his voice wasn't upset to make me believe someone was hurt, unless...he was in shock. "What did they want?" "They have a match." he said. The impact of his statement hit my chest and stomach at the same time it wasn't something I expected at 10:30 Monday morning, in fact I wasn't sure if I expected it at all this year.

Our relationship started almost 3 years ago; our relationship could fill many pages all by itself so I will try to give a quick review of the beginning. I met him at work, not as a co-worker but as a patient, my patient. I know what you are thinking, bad Ann crossing that patient-health provider relationship line, but to my defense that was not my intention and we were only dating about 2 months before he was on dialysis and no longer directly my patient. When I say he was 'my patient' I don't mean he was one of the office patients and saw one of the doctors, no that isn't it, he was My patient in My clinic. I ran the anemia management clinic in the renal division of the Hospital of the University of Pennsylvania. I educated the patients on anemia in kidney disease, I started them on IV iron and/ or erythropoietin stimulating agents, and I went through the insurance for authorization, I had an Epo clinic, I had over 200 patients in my clinic either at home or coming into the center, I even had an assistant. There are times that I miss having that title that responsibility however that feeling fades fast when I go to work and get my first coo, smile or giggle. Mr. Franks, as I knew him for a while was a renal patient for years and then one day he too became anemic and was sent to my clinic. He came to the Epo clinic every 2 weeks to receive his injection, at times draw blood and review further information. The visits usually lasted 15 mins but as we got to know each other better the visits lasted longer and longer. The visits were twice as long by the 4th month of his ESA care and I like to say our friendship still remained pretty professional. I remember when the change first occurred, when our friendship became something different. It was one of his usual visit, I called Mr. Franks over and discussed his medical problems, as we chatted he mentioned that his investment club was hosting a white party at a local club. For those of you that are not aware of P. Diddy famous white party, this party is when you wear white from head to toe. I smiled and took the invitation and said 'thank you' with no intention of going. He then said the sentence that changed everything, "You can bring your fiancee too, unless you are too busy with wedding plans." The wedding was suppose to take place 2 weeks prior, the relationship ended 8 weeks before then. It was still a sore subject which I didn't talk much about especially not to one of my patients. "No more plans, the wedding is off," my simple respond wasn't good enough for his curiosity, "For the summer?" he prodded. "Forever," I assured. Before I knew what happened Kenny went into his wallet and handed me his card with his personal cell phone number. "He is so stupid, stupid to let you go." he said. 'Let me go?' I thought 'He practically threw me out' "I guess" was all I could say. "If you need anything from me or would like just an ear to talk feel free to call me," he started as I placed the card in my wallet, " and I want to take you to the party, I'll take care of your ticket, you really would have fun and is good to go out, okay?" I couldn't find my words and my mind went blank, I found myself nodding but knowing that I didn't mean it. "Mr. Franks..." I started when I could finally think. "Call me Ken or Kenny please" I stopped and nodded again as he left the examining room and I was in shock. A few nights later I got the courage to call his cell phone and was fortunate enough to get his voice mail; I informed him that I didn't feel ready to be out and think that right now isn't the right time for me but thank him for the offer. Kenny tells me now that that message broke his heart. He continued coming to his 2 week appointments and the message, party or card didn't come up in conversation. He did once ask where is a good place to met nice people our age and we both decided to give the online dating a chance and let each other know how it goes. Six weeks after the voice mail message incident I was working late and reviewing messages sent to me by the doctors. One message had Ken Franks name on it, I retrieved it and saw that it was regarding lab results, nothing urgent and it was 6:30 pm, this could wait until morning I thought to myself and still picked up the phone. I called his home number and was disappointed to hear the answering machine, I left a message and then stated I would try calling him on his other number. I took the card out of my wallet and dialed the cell number. It started ringing and ringing and I felt myself feel down at the thought of leaving another message. After the six ring I had my message speech prepared and was thrown off by the simple hello. "Umm, hello Mr. Franks...Kenny, Hi," Crap Ann Think, " Hi this is Ann calling from the hospital of the university of Penn, renal division, is Kenneth Franks available." Finally, I thought. "Hi Ann, this is Ken," I'm sure he looked at his watch and realized that the office had closed over an hour ago, "working late?" That question lead into a 30 minute conversation none which had anything to do with his lab results and ended after I gave him my personal cell phone number. It wasn't long after that before we became a couple and I didn't tell most of my co-workers until 6 weeks in, and soon after that he started dialysis and was going to the transplant department so no longer was he my patient and our relationship was out in the open and fine with everyone, I think.

"A kidney, they have a donor!" I didn't realize how loud I was until I was off the phone and the other patients at the chiropractor office asked about it. I was too excited to care who knew and before I left on my way to Philadelphia most of the office knew the situation. I was a renal nurse for 3 years and heard of these long waits but this was ridiculous. Our first spot at 11:30 am was to the hospital to give blood for a second work up. They informed us that the labs would take about 5 hours and we should go home and Kenny should have a dialysis treatment. He hadn't prepared for a treatment, it took 7 hours for the machine to make the special water, he told this to the transplant coordinator who didn't seem concern, "That will be fine, it will give us enough time." We took the time to go shopping for pajamas, since boxers in the hospital was not a good look, and other essentials. He went home took a shower, packed his bag and got on the dialysis machine. I went with him, I wanted to be there to ask all the medication questions and make sure everything was going to be okay, doctors and nurses do make the worse patients because we are paranoid. At least that is how I felt when I asked for him to call the transplant coordinator back so I can hear about the donors' medical history. Around 7 PM, when Kenny started getting ready for his dialysis treatment, we received another call and were informed that he was definitely a match however it would be a little longer since the family wasn't ready to take the donor(it makes me feel less connected if I refer to him as the donor) off life support. I sat on the bed and was reading a book until I drifted off to sleep. At 11pm I woke up and still no word. We ate dinner making sure we finished before midnight because we were sure the anesthesiologist would delay the surgery if he knew he ate after midnight. I was pacing by midnight, hoping to get a call so he could have his surgery before I had to go to work, I soon realized that it wasn't happening. I was lying in bed when his cell rang, it was 3:30 am Tuesday morning. The kidney was on its way, make your way to the hospital was the coordinators message. At that moment it occurred to me that the donor was not at the Hospital of the University of Penn and that having the job of a transplant coordinator must suck, really 3:30 am, that is a time from the movies and she was wide awake and chipper. We made it to the hospital only to be informed that there were no beds in the transplant unit, because of this he would be sent to the intensive care unit until a bed became available most likely after his surgery. We went to the unit and again waited, the evening shift nurse took his information but didn't know what was next since they didn't have patients that came in for transplant surgeries. An hour later the morning nurse came in to find Kenny and I in the room talking. She looked from him to me and then back at him and simple asked, "Where is the patient?" She too wasn't sure what to do with a 'Walkie-Talkie' the term many nurses gave to patients that were all with it. Soon she knew all the details and started to set him up for surgery, before she could get an IV started the surgeons came it. Dr. P, A, and R went through the procedure step by step, the awful what ifs and side effects, and they were very patient with the crazy nurse girlfriend and her questions. Soon he had the proper charts, signatures and documentations for the procedure and I asked as transport came to get him if he would be changed to a gown. The nurse was mortified that she didn't think of this first and apologized for that and rushed to get him ready. I didn't mind and I could tell Kenny was super nervous because of how slow he answered all the questions so he couldn't think clearly about taking clothes off. He was finally ready and talking to the anesthesiologist about what would happen next, he then escorted me to the surgical waiting room which had TVs, coffee and computers :), along with a board that gave your love ones locations, for the family members to keep entertain while they waited. I gave him a hug and kiss and wished him luck. Ordered the doctors to take care of him and called the family and friends that were awake at 8 am for the update.

It is now 1 PM and not happy that the family waiting area doesn't have a bed. I received one update an hour ago telling me that he went under with no problems and the surgery is going as predicted. I will probably be here another hour or two before I see him, and praying for no complications, along with many of our family and friends. Thanks for all the support and looking forward to keep you all update on our good news.

Monday, May 10, 2010

Mother's bond

Mother’s day is a day to acknowledge the self sacrifice that I have made to devote more time to my child and offer her better things in her life, the love and affection that I provided regardless of the preschooler’s mood swings, the disciplining that I give to assure she becomes a good person and makes better choices even though it would mean I would be the devil for a short period of time. My Mother’s day was a grand event, not only was I able to spend the day with my daughter but also my mother and my boyfriend. The celebration for me started a few weeks ago when my boyfriend bought me a blender/food processor combo. I wanted a food processor for the longest time to ‘sneak in’ veggies into our regular meals. The four green beans and two broccoli crowns that I forced Tiffany to choke down each dinner time was not enough to provide the much needed vitamins to a growing child. I figured not only will mixing in the veggies to our regular food be better for her but also for me, because in reality even though I ate my cup of vegetables I didn’t do well mixing it with fried pork chops and white rice. My choices must improve as well. I also hadn’t seen my brand new beautiful blender, which I had used twice since I got it at the bridal shower (long story, will get to that in a future entry), in over a year. So the first gift was totally awesome. My next gift, given to me a few days prior to Mother’s day was a wonderful new camera, a Sony Cyber-Shot with 14.1 mega pixels, and compared to my 6 mega pixels camera is a huge advancement with great new play options, and I can’t wait to figure them all out. On Mother’s day we started the day out with breakfast at Gilchirst which makes the best blueberry pancakes ever! My mom took Tiffany to my aunt for an afternoon BBQ while I stayed with Kenny to pick up groceries for our dinner plans. That evening my mom, Tiffany, Kenny and I enjoyed a wonderful lasagna, salad, garlic bread and later on strawberry short cake. My mom surprised me with a new GPS navigator; the old one was stolen almost 2 years ago in the Philadelphia Zoo, I still find glass in my car at times. And finally Kenny gave me a card which brought a tear to my eye, especially since last year he didn’t give a gift because Tiffany had made me something at school. The difference a year makes. It made me truly appreciate all I had and I thanked God for getting me to where I was, just thinking that not only was I a mom, but I also felt like a mom, I had that bond, that strong heart felt bond which I didn’t always have and feared that I wasn’t going to have it.

I wanted that bond the moment I knew that she would no longer be my niece but my daughter. I wanted that closeness where you can sense when they are in trouble, when you can heal the wounds with just a kiss, the sensation that your life is greater because you have this being that you created and mold to be the best person you can help it to be. But honestly 2 years ago, it wasn’t there. I loved her, not just because she was family, but because she would be mine to raise and her life was in my hands to assure her safety, her growth, to fulfill her every need it was all my responsibility. At first, I was scared, scared of “messing up” I hadn’t had 9 months to prepare myself mentally for the transition from single adult to motherhood. I had a few months to prepare my work schedule, my home situation, to childproof my home for a preschooler. To look around the grocery store to find out where the PB and J was, the chicken nuggets, the character cereal. To hid the R rated movies, to place the knives in the top shelves, to convert the computer room into a princess palace, to find the right soaps, hair ties, and a bed. The time came when I had this little person living with me and I worked on the hugs and kisses, and the transition from aunt to mom. Then I learned I wasn’t ready for other things. I wasn’t prepared for the first meltdown at the store, or the first sleepless night with the fever; I wasn’t ready for the stomach bug, or hold down a screaming child for blood work. I wasn’t ready to change timeout spots depending on the chore I was doing at that moment and escorting her back to bed 20+ times during the night until she slept in her own bed. The fear slowly faded, the bond grew, and one day she stopped calling me Titi and started calling me Mommy, that day was over a year ago and it continues. The bond grew and with time, I earned her trust and love and she had my heart. Soon I learned that even though they had a head start most moms are still nervous of “messing up“ and don‘t feel prepared. They do it…we do it because the love, the bond, is so strong and great that it is as satisfying to met their needs as it is to met your own. That bond , that special mother bond that makes you smile to hear them laugh and feel proud when they say ‘please and thank you’, that melts your heart when they say I love you, and have tears in your eyes when they cry. I can honestly say that I have that now, the power to kiss away the hurt, hug away the pain, love her more than I could ever imagine loving another being, I have that bond because I too, am a mom.

Wednesday, April 28, 2010

Where did the time go?

The very first blog entry has to be the most difficult, because I don't know if I write it as if I was talking to a friend, talking to myself, or writing a section that can possibly come together to make a story. At times I dream of becoming a writer and making up stories mixed in with my lives true stories however the fact that English is my second language and my writing style is usually more of a run on sentence than a story I never put that dream in a reality column. But for this blog, at least today, I will write as though I am writing one heck of a story and go from there.

This is the first Wednesday I had off in so long I wasn't sure what to do with myself. As I do most mornings I woke up logged on to the computer and answered a few emails; instinctively I opened a second tab and logged on to my facebook account where I checked if any of my friends had posted any new news, any birthdays, or new pictures. Played a round of Family Feud and turned off the monitor when I heard the footsteps coming down the stairs. "Good morning Princess" I said before I saw her, it made her smile to know that I could sense her a mile away. "Good morning mommy," she said. Looked at me puzzled in my sweat pants and t-shirt, "You aren't going to work today?" She's five but very observant, not much you could get pass her. "I'm off today but you do have school." Took me less than 20 minutes to get ready for school. We came to the kitchen where she fed the cats and I looked in the fridge for the starts of breakfast. Took out the gallon of milk and her annoyance was obvious. "Cereal again?! I can have cereal at school." "Well then," I said as I put away the milk, "You will." Surprisingly the cereal battle didn't cause an argument; in the car we chatted about summer and summer camp and class field trips. She sang songs that played in the radio which at times made me twitch because I knew my little one should not be singing about getting 'tipsy' even if she didn't know what it meant. With a kiss and hug I dropped her off at her preschool were her teacher had started pouring cereal bowls for some of the other children there. Decided to stop at the supermarket to pick up bacon, eggs, pancake mix and other necessaries. Found the store wonderfully calm on a Wednesday morning and wish it would me like this on Monday evenings too, my usual shopping day. Bought enough breakfast, lunch and dinner items for a house full of people, even though is just Tiffany, the two cats, me and my boyfriend who visits on the weekends. Came home and put away the groceries and back online as I ate my breakfast. An hour later the lights flickered and the monitor went black; along with all the lights that were on and the radio in the background. I went outside and "played" with the outlet box with no luck. Decided that it was a sign from God to get off the computer and do some work around the house before the day escaped. I found it very frustrating that I couldn't do a load of laundry or run the dishwasher. When I started washing the dishes by hands found it even more frustrating that the garbage disposal wouldn't turn on to let bits of food drain. I ended up organizing the kitchen cabinets. Something I wanted to do for a long time but never found the time. An hour and a half later; when I put the last can in the covers the radio and lights turned back on. "hoorah!" I thought and decided to start a blog, so this is why I'm here.

During that 90 minutes of complete silence I found myself wondering how my life has become what it has become. Many thoughts came into my head about different paths and decisions that I have made through out my life and not knowing how these decisions have got me here. I thought about my regrets, my "what-ifs" and mostly my current goals and desires. 12 years ago I would have never imagined me being a single mom of a 5 year old, living two towns from where I graduated high school, only 20 minutes from my mom's home and still working on my bachelor's degree. However the paths that got me here involved losing a child, breaking off an engagement 2 months before the wedding, moving to and from the city and promising my dying uncle that I would make sure his little girl was taken care off. Even know as I reread my sentences and rethink my journey I swear I made it up. The last 12 years, which involved stupidity, heartbreak, betrayal, joys, love, and death all seem like a very nicely woven together novel, the kind that I like to read to see the heroines overcome their struggles and win at the end; except for this time I don't know what the end has planned and I don't know if there is a win or a losing side, just a being the best person I know I can be and go from there. Wishing for the best, I guess. Well this is my start on recording and improving my life's journey.