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Labs and Today’s Office Visits

Posted Sep 07 2008 8:37pm

I had labs yesterday and office visits with the Transplant Nephrologist and Transplant Surgeon.

My labs are excellent. My Prograf level is within the expected 8-10 range, Hemoglobin is up to 10.6 (up almost 1 gram since starting Procrit 2 weeks ago), creatinine is 1.2, Magnesium is normal (although I’m on 3 doses/day), Platelet count still normal but creeping downward, PTH elevated but lower than before transplant, Iron a little lower but not problematic, and my Lipid panel is excellent; cholesterol is 104.

As for the visit, I first saw the surgeon (Dr. Varma). I did ask about the stent needed for my fistula, and he called in the other surgeon who is the fistula “expert” (Dr. Kotru). He explained that since it still has the “buzz” that can be felt, he would suggest it be left alone. Stenting it would predispose it to clots, and being that I’m not on dialysis, it’s an unnecessary risk. He also gave me the option of having it tied off (”ligated”). I would consider that, but I use it for drawing blood and would prefer to keep it for now. He was fine with that, and further explained that since my fistula is so well developed all the way up to my shoulder, if I did have it ligated, he would need to remove the whole vein. In those with fistulas that are not prominent, this is not necessary. You may remember that the surgeon who did my transplant wanted to eventually ligate it after about a year. I forgot to ask about this, but since Dr. K is the fistula “expert”, I have faith in his opinion (and after all, different doctors have different approaches and opinions). As for the rest of the visit, Dr. Varma was very happy with the way things are going.

The Transplant Nephrologist was also happy with my progress. He ordered the Procrit, and said that I will probably only be on it for a little while longer. He also said my PTH will probably come down over time. I like the way he did the visit; he turned the computer screen towards me so that I could see everything he was typing in. His rationale is that if I had a question, I could ask it right then and there. So many people leave the office with a misconception, and worry needlessly about something, and their perception is not correct. I like this openness. His theory is that he is up front with the patient about everything, and will then at least have a plan on dealing with it, rather than hiding anything.

The nurse managing my Procrit called yesterday. Although my Hemoglobin is coming up, it’s still under 11, so they increased the dose 15% to 11,500 units weekly. I’ll have my hemoglobin checked in 2 weeks again, and my Transferrin Sat/Iron studies in 1 month.

I just have to be careful that I don’t overextend myself. I’m back to work full time, and working my weekend job as well. I feel so much better, and am trying to do a lot. I’ve decided to pace myself and prioritize. This week won’t work with that, as I’m at work until 9 tonight (started at 8:15 today with my appointments and then right to work) and am here from 8am-9pm tomorrow night as well. We have a training both nights, which is why I’m working so long. I did go to bed early last night, knowing what I had ahead of me.

Judging from the way things are at work, there is definitely a full moon coming. I won’t go into specifics, but there is a tension that I can’t describe, and some of the parents in general are more uptight than usual.

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