First Steps

I did something last week I have never ever done in my life that may well change my life. Yes, even this old life. And even though it put things into play that will someday move very quickly, these first steps are going to plod along. I’m going to take you on this journey with me mostly because I don’t want to go and I think those here in my immediate world might need some help keeping me moving along.

Warning, this post actually has some personal information about me that I’ve never shared before. It is not recommended for the squeamish. (Or for those who might have developed any kind of respect for me especially when I reveal what a fraidy-cat I am.)

Last week my nephrologist put in referral paperwork for me to be evaluated for a kidney transplant. And I am terrified.

I’ve worked my entire adult life in health care, mostly in hospitals. I am the most rational human being when somebody asks me for an opinion, a clarification, or some information. But when it comes to me, I’m the biggest wimp in Fraidytown. I hate doctors and nurses and hospitals and medicine and machines whenever I am the focus of their attention. The only good people I see from a hospital bed are the ones who bring me food. Everybody else is an unwelcome visitor. 《Shudder!!!》Now I’m going to have to go through examinations and tests and (arrgghhhh!!!) needles to see if I get to be cut open and have more of my insides swapped out or get sent back to live a life of dialysis with its sharp objects and scary machines.

I hate dialysis. Let me see if I convey how I really feel about dialysis. I hate hate hate hate hate hate hate hate hate hate hate hate hate dialysis. And if one more person tells me “but it’s just a few hours a week” I will stab them with the needles that are thrust into me at each session.

Unlike other long term invasive procedures where an access port might be implanted under the skin to accept the needle used (say for chemotherapy), in dialysis the preferred method of access is your own vein. A surgeon cuts into your arm and brings the vessel from deep within the arm to immediately underneath the skin. Yes it is weird seeing your vein basically sitting on top of your arm and feeling it pulse with your, well, your pulse. Into this vein a dialysis nurse or technician inserts two needles about the diameter of a ball point pen, connects those to a pair of plastic tubes, and attaches those to a machine about the size, and with similar function, of a gasoline pump.

For the next three and a half hours I get to watch my blood zip around the room while it is rid of the crud we ask our kidneys to shed that mine decided to stop shedding. Add in the before and after procedures and repeat a few times a week and that’s why I hate dialysis.

But I also hate surgeries. Let me see if I can convey how much I hate surgeries. You get the idea. I won’t put you through that again. For the first 55 years of my life I had never been in a hospital as a patient. Never a broken bone, never a needed stitch, never even a false alarm brought me close to wearing a hospital gown. Then in less than four years I spent 18 months with my back end uncovered and endured four surgeries, only one of which I didn’t almost die during or shortly after. (True stuff there.) In the last couple years I’ve been back for numerous outpatient procedures and one additional full blown surgery (not death defying (whew!)). Familiarity doesn’t really breed contempt but it sure breeds a hell of a lot of fear.

Every surgery I’ve had has been complicated by a condition I live with that makes decisions for me every day. Seventeen years ago I was diagnosed with Wegener’s Granulomatosis, now known as Granulomatosis with Polyangiitis. We’re not allowed to use the W-word anymore because he was a Nazi. GPA is a rare type of vasculitis that affects less than 3 out of 100,000 people and is fatal without treatment. There is no cure but with various medications the inflammation can be abated. So we have a fatal, rare disease, without a cure, and after years of research somebody figured out the doctor who discovered it was on the wrong side in a war and shouldn’t be “honored” by having a rare, fatal disease, still without a cure, named after him.

GPA primarily affects two major organs, the lungs and (drum roll please) the kidneys. Yes, my kidney disease is not a result of the trauma of the surgeries or the cancer or hard living. It is from the Wegen– oops, from GPA. So in addition to the rest of the pending evaluation, I have to somehow demostrate that my chronic condition will not adversely affect a new (actually a used) kidney. I do that by taking my medicine and having regularly seduced blood work to measure the inflammation markers in my blood. More needles!

So, to make a long story short (I know … too late), I am about to embark on a process that will determine whether I undergo major surgery followed by a lifetime of drugs and tests, or continue with dialysis and a lifetime of big thick needles and multiple times a week treatments and general life interruptus.

And I want you to come along! Now don’t you just feel special?

 

 

 

 

 

Those Who Should Know Better

Ok, you’re going to need a little background for this. At times I’ve written about having kidney disease and going through dialysis. You might recall other times I’ve mentioned some unspecified rare disease. And then once or twice I talked about cancer. So if you sometimes get confused I can understand that. Some of my best friends get confused regarding what’s going on with me. Apparently so are some “experts.”

For the record, it all started about 15 years ago when I was diagnosed with Wegener’s Granulomatosis. Wegener’s is an autoimmune vasculitis that affects the smallest of blood vessels and the organs they occupy – most notably the kidneys, lungs, liver, and sinuses, in my case the kidneys. There is no cure but it can sometimes be controlled with combinations of chemotherapy, immunosuppressant, and steroid medications.

After 10 years of treatment with methotrexate and prednisone, the working parts of my body decided they wanted some attention and got together to vote on who would revolt. My bladder either won or lost depending on your point of view and grew cancer.  One year and four operations later I was pronounced cancer, and bladder, free and the proud owner of rebuilt body parts fashioned from other body parts that to this point had done not much more than the jobs they were originally intended.

In the process of trying to create a recoverable environment for my post-operatively rebuilt body I had to replace the drug therapy that was so far managing to keep the ravages of the Wegener’s at bay but now not such a good choice in a body now equally desperate to keep other cancers at the same bay. While that search was underway the dastardly disease took advantage of the temporary unprotected kidneys and put them into a (hopefully but who are we kidding) temporary shut down and put me in a chair at the local dialysis clinic.

And that’s how I came to be an unplanned early retiree with a handicap placard hanging from my rear view mirror. But “who are those who should know better?” you asked. Good question.  Why, the health care “experts” of course. I’m allowed to speak of them with disdain because I was a health care expert for close to 40 years before my unplanned early retirement. And those years included years when experts in health care were the ones educated in and actually providing health care.

Recently I had to complete some paperwork for the government’s end stage kidney disease program including what led me to be on dialysis. As in the past I check “other” after not finding in among the pages of pre-selected options and entered Wegener’s. It was rejected because there is no such condition in their database of diseases. Since I have it know for sure there is but I also know for sure it’s also known by another name, Granulomatosis with Polyangiitis, I questioned the explanation. Even if you’re being paid by the letter you have to agree that Wegener’s is an easier fit for a government form. And that’s why I had always fit it. So I called the help number for some help and asked what I had done wrong. I was told we’re not allowed to call it Wegener’s anymore because that doctor who discovered it “was a Nazi you know.” So all traces of his name have been removed and it is disallowed from official use. I wouldn’t have minded if at least they would have matched the funds it took to rename everything for “official use” with perhaps some official research.

But those are government people who are used to doing stupid things. Or things stupidly. But…there actually are others who should know even better even. Those are ones who bring me my tri-weekly adventures in artificial kidney function replacement. Or dialysis if you prefer,although personally I don’t prefer dialysis.

At the corner kidney clinic they posted a new “let’s raise everyone’s spirit” poster. On it is a classic pie chart with the legend, “ONLY 7%!” It goes on to explain that “You spend only 7% of your week in dialysis. The other 148 hours are yours to do the things you like!” Really. That sounds like something that someone who doesn’t know what dialysis does to a body wrote. Not a national organization responsible for 290,000 dialysis patients. (Source: that company’s website). That 7 percent might account for the time that you are actually having your blood circulate through the machine taking up the 10 square feet next to your chair. Not the time it takes for a nurse to do a pre-dialysis assessment and then physically connect you to the machine by way of two needles about the size and diameter of a Bic pen stuck into your arm. Not the time for a nurse to physically remove you from the machine by withdrawing the Bic pen like needles from your arm, for the bleeding one would expect for two holes the size of Bic pens in your arm to stop bleeding, and then to go through a post-dialysis assessment (all about another hour). Not the time it takes to get to and from the dialysis clinic (roughly another hour for me). Not the time it takes to physically recover from the actual process (in my case 10 to 12 hours).

So if we consider the time to get on dialysis, get off dialysis, go to dialysis, and recover from dialysis I actually have 10 hours a week to do what I like. I like to sleep about 8 hours a night and I like to eat at least 2 meals a day so I’m down to around 33 hours a week I can call my own. Almost a whole day and a half! I wonder if they would notice if I would “edit” their poster at the clinic.

PieChartHD

My revised pie chart

Well now you know who those are who should know better. A government who is more concerned with what to call diseases than what to do with the people who actually have the disease and the people who are supposed to be minimizing the effect of a disease on the body but are clueless about how to minimize the effect of the disease on the person.

Boy I feel bad for the poor soul who I might run in to today and says “Hey, how ya doing?” I might actually tell him.