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.

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