5/12/06

10) Of Cannulation & Parathyroid Glands

Thursday

El Milagro: I noticed on the way over here (west side of IH 35 South of Oltorf), driving through Zilker Park, just how brilliant green Austin is after all the rain we¹ve had. It is a perfect afternoon for doing something active outside. So, I breathe in the crisp air deeply for a few minutes while walking across the parking lot of my dialysis center. Kim again did a beautiful job of sticking me (the medical term is cannulation: the process of inserting a cannula, which is a flexible tube inserted to drain or administer fluid, ending with a trocar, a sharp pointed surgical instrument; i.e. needle). Phyllis reminded me of the term, spelled it, and exclaimed, “You’ve been cannulated, Jack” A few minutes later, as I am looking around doing my initial observation, I notice that Moritz is here. I remember to ask him if AB+ is a match for A+ for a kidney. Today we have 12 patients and 7 staff. Moritz is making his ‘rounds¹ like a high priest of the dialysis inquisition, and stops and as he watches me writing this he teases me about not having my laptop; "So, I thought you were the big computer guy. Where¹s your laptop?" to which I make some lame excuse like, "Since my infiltration I am not yet ready to move my arm enough to type but I¹m gonna bring it someday." Moritz and Ron the Nurse and Jennifer the Dietician discuss my recent blood work and Moritz says to put me on a new med for my overactive parathyroid gland. They also discuss my phosphorus still being high and ask if I am taking my binders at each meal, to which I say a confident "Yes!". They nod their heads thoughtfully and move on to their next victim, Jennifer saying over her shoulder, “I’ll be back”. Later Jennifer the dietician returns to more fully explain my para-thyroid situation, saying most of what I have copied below.

Parathyroid Glands*: There are four parathyroid glands which are normally the size and shape of a grain of rice. Occasionally they can be as large as a pea and still be normal. The four parathyroids are shown in this picture as the mustard yellow glands behind the pink thyroid gland. Normal parathyroid glands are the color of spicy yellow mustard. The ONLY purpose of the parathyroid glands is to regulate the calcium level in our bodies within a very narrow range so that the nervous and muscular systems can function properly. This is all they do. They measure the amount of calcium in the blood every minute of every day... and if the calcium levels go down a little bit, the parathyroid glands recognize it and make parathyroid hormone (PTH) which goes to the bones and takes some calcium out (makes a withdrawal from the calcium vault) and puts it into the blood. When the calcium in the blood is high enough, then the parathyroids shut down and stop making PTH. The single major disease of parathyroid glands is overactivity of one or more of the parathyroids which make too much parathyroid hormone causing a potentially serious calcium imbalance (too high calcium in the blood). This is called hyperparathyroidism. ….It is possible for a person to take too much vitamin D so that they absorb too much calcium from their diet and hold on to too much calcium in their kidneys... and their calcium goes high.

After rounds, Moritz was working on the computer for awhile, but then, before he left he completed another sweep of the patients, having brief, more sociable conversations with them as he goes. He has an optimistic bedside manner as he explains medications, encourages people to eat a healthy diet (in Spanish), and kids with those who can. With Mr. Animado Moritz jokes about his coming in late, saying “You don’t work” when he says he is late because of working. As usual, Mr Animado is in good and noisy spirits. Shortly afterwards, I look around and Moritz is gone. Later in the session, Ron the Nurse visits with Mr. Animado, asking him if they can find a better center for him to go to and by the end of the evening, Mr. Animado is transferred to another center. I’m not sure that Mr. Animado wanted that…. it seems the Milagro staff had had it with his coming in late. Maybe there is more to this story; I just report it from my perspective. Obladi Oblada life goes on.


Weighed in at 72.2 Kg and out at 71.4 Kg

*
Norman Endocrine Surgery Clinic (2006) Introduction to parathyroid glands. Retrieved online May 12 from http://www.parathyroid.com/parathyroid.htm

1 comment:

Glen said...

Jack - your optimism continues to be one of your strong suits. You seem like you are adjusting well. Give me a call sometime.