432) Transplant Clinic Appointment

April 20, 2012

South Austin Med Center:  I arrived at 7:30 am for my lab work and Hattie the lab tech reported that my regular tech, Peggy, has quit and moved back home to east Texas.  So, Hattie does my draw and then I head straight up to NAMC for clinic.  

NAMC: My first time to register without my Medicare 36 month post transplant status... now only on Liz's insurance... I have my checkbook in case there is a co-pay... but the woman who registers me hardly gives the change a glance as she types away and clears me for another clinic visit.

Since I am almost an hour early, I head to the cafeteria for coffee and grading a few papers before the appointment... and a person from the transplant center finds me and directs me back to the NAMC lab cause part of my earlier lab work wasn't done correctly.

By my appointment time I am situated in the clinic and Maxine tries to take a slower, longer time getting my BP; to no avail, it is still 174/80. Even though we all know I have "white coat hypertension" and Maxine usually takes it right after I sit down and while she is asking me questions, it has been worrying me that it seems to be creeping up over time.  I did mention it to Dr. Lewis several visits ago and he only seems moderately concerned.  Maxine runs me through all the usual questions for the form and I spend some time describing my recent bouts of hives: how they come on in the middle of the night, what they look like, how I decided to wait til after my Dr. Bruce referrals to call Dr. Krienke back about what to do next, and all about how I have been dealing with them over the last few weeks.

Patty, my new transplant coordinator, comes in with another new nurse (Pat) to discuss what Maxine has just written down and I repeat the whole story again, with the nurses talking about various ways to wash my sheets in Dreft and/or food alergies, etc.  Patty also asks about my BP monitoring and I admit that I haven't been tracking it as closely recently because of my neglectful nature and just having been focused on other things in my daily routine.  She makes me promise to get back on the schedule of checking it daily!

Finally Dr. Lewis comes in and asks me how my urination is going: pain? trouble starting? trouble ending?... to which I answer that all is as good as it was before the bladder stone and he replies about his talk with Dr. Bruce and how we should do the surgery and it is okay to wait til July and how he wants to know if it becomes any problem.

He continues that my cholesterol is doing so good that he wants me to drop my Crestor to 1/2 ever other day.  Creatinine is at 1.4 and every thing else looks good.  I tell him about my hives with the disclaimer that he shouldn't have to worry about that with all the important kidney and prostate stuff, and he counters with that I should leave it to him what he worries about.  

He wants to know all about the hives and suggests that I work through Dr. Krienke to get an appt with a dermatologist, or let them find one (although he admits that he doesn't personally know a good one to refer me to... and adding that HE will be studying up on hive himself in relation to this).  His recommendations are 1) get an appointment in the morning so there is at least a chance that I will have them when I go in; 2) Chart when I have them, including what I ate the night before; 3) Take pictures of them to show the dermatologist, and 4) Have the dermatologist send him the results.  He concluded that if they aren't caused by something external in the environment, then they are caused by something internal... and he wants to know about anything going on internally!

He wants to see me in 3 months... and then he leaves as usual, with a handshake and stating that the nurses will be back with appt info, etc.   About 4 minutes later he pops in again and says, "Your to number on your BP is too high.  I am adding another BP med and I want you to chart it and come in in one month with your chart... no blood work"  "Okay", I reply.  So, when the nurses come back in with my appointments, I find that he has added Labetalol, 100 mg, 2X a day.  Patti says I can take it along with my Lisinopril and if my BP gets too low (<110) then back off a little.

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