432) Transplant Clinic Appointment

April 20, 2012

Friday

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.

431) Adding Cluster Map

April 16, 2012

Sunday

For the first 4 or 5 years I wrote on this blog, I had a Map Widget that tracked the folks who visited my blog... by location and by operating system.  That widget finally went by the wayside and I can't remember if it became a thing I had to pay for or if it just bit the dust.

Today I added another widget for Cluster Map and I am quite excited about it!  So, now, again I can see who visits here and keep track of the locations of my visitors.

As always, thanks for your support and encouragement in my ongoing kidney transplant-related blog. 

430) Meeting with Dr. Bruce

April 9, 2012

Monday

Round Rock:  I drove up to Round Rock with Lizzie to meet with Dr. Bruce and get the consult from him on my earlier procedure.  Even tho we got there at 9 there was a line at his receptionist window and the woman working the window seemed to be taking her time with each person in the line.  I was thinking they should have a take-a-number system or something.  When it was my turn, she checked for my appointment, and gave me a specimen bottle, and I went about the business of filling it, even though I was pretty sure that the consult wasn't going to require that kind of testing contribution.  I wondered how many samples of unused urine they collect in a day.  Also, there were no paper towels in the restroom.  This office is not what I am used to in the way of medical offices, I thought... wondering if I was being to picky, they were just newly moved in, or if this was their usual pattern of behavior.

We waited... and I started reviewing a paper for School Social Work Journal.

An assistant brought us in to a treatment room and went about checking my BP while asking me questions, etc. and, of course, it was high: 160/80.  I complained to Liz after she left the room... "they never give me time to settle in, relax, and get a good reading..." 


Dr. Bruce came in and sat down with a pen and pad and said, "I want to draw you a picture."  He drew and explained that this situation is like a pond that fills with water and then can't drain completely... (which he had said last week too) and this time he added, "so when it can't drain completely cause of the prostate squeezing, bladder stones develop".  OH!


He described that they want to do an operation... I asked about a stent... and he replied that they usually don't do stents for young guys; only older people... and that made me feel young.  We brought up my deal with Medicare and discussed doing this operation in July, after I get back on Medicare.  He thought that was fine; and added that he still has to talk to Dr. Lewis about it all.  


So, I have another appointment with the Transplant Clinic this upcoming Friday... and this saga will continue.  Looks like there'll be a trans-urethral resection of my prostate (TURP) in the summer sometime.

429) No Pain, No Gain is the Only Way I can Positively Reframe...

ALERT: Graphic content intended only for patients who want to know more about these procedures.

April 5, 2012

Thursday

Round Rock:  I drove up to the Round Rock office of Dr. Grady Bruce early... straight from UT after class.  I was scheduled for a cyctometrogram and uroflow study with Tracy, and according to Dr. Lewis, who surprise-called me on my cell phone as I was driving back from Houston last Friday, Dr. Bruce is gonna stop in and see me while I'm there. 

First thing: I have to report to the receptionist that I am no longer on my 36 month post-transplant Medicare and that Liz's insurance is covering this.  She calls and they tell her I am on Medicare and then after some back-and-forth, they tell her this procedure is 100% covered... not even a co-pay.  That pleases me.  However, Dr. Bruce is aw ay "on call" somewhere and won't be back til 6.  But, the 1:00 appointment no-showed so Tracy will be with me shortly.  This I find out in response to my statement to the receptionist that I gotta urinate now and should I go or wait?  Wait.

So, Tracy comes out and brings me back to a room with a barber style chair with stirrups and tells me to go into a adjacent bathroom, strip from the waist down and urinate into a large funnel sitting over a small beaker with a little grey tube leading outa the room and into the treatment room.  I am thinking this is easy.  I pee into the funnel and they somehow measure the "flow" in the little grey tube.  Then we talk about it and that's that. I do so and put on a gown backwards and return to the barber chair room, where Tracy introduces me to Dr. Etsen Cho, who is going to observe and learn from my experience.

Oh.  And, I hear from back somewhere that Dr. Bruce is back from his "on call" and available.  That's good. 

Well... there's a reason they don't tell you to much about cyctometrograms like they do with most "procedures" we patients volunteer for.  You know: they usually have a nurse call and completely explain and give info about the procedure before you go in.  Not in this one.  And, I had been so busy in the last week or so that I hadn't even googled it.

Tracy invites me to sit in the chair and sets about catheterizing my penis!  Oh. And, Oww! And "This stings!"  Tracy asks me to breathe in through my nose, out thru my mouth... slowly... as she continues to try to run this catheter up my penis, through the prostate-squeezed urethra and into the upper part of the bladder.  She is explaining to Etsen how she will try another size (?) or something while I am trying to breathe thru the pain of each of her attempts.  No pain for the time it takes her to re-adjust her tools.  That's nice and I breathe better. She apologizes for the pain... and we are off on it again.  I breathe they way she suggests, harder and more forceful... she pushes that thing up there... and I am conscious of clenching my teeth so hard I worry I'll break one... and I can feel tears rolling outa the sides of my eyes and back down my face towards my ears.  This is tough! 


She pulls the catheter back out and says something like, "It's just to small an opening... I can't get it through... will have to get Dr. Bruce in to try."  I breathe / sigh / relax.  The women leave the room and I lay back and visualize how I can dissociate when they resume this procedure.  


Tracy and Etsen return and we are talking about my years on dialysis, the kidney transplant, my teaching at UT, ..Macs versus PC's, and how this whole thing started:  I thought I had a urinary tract infection and went to Dr. Krienke, who did a culture that showed it was not an infection and then about calling the Transplant Center when the painful urination continued... and about the hosptialization and yada yada yada.  

Dr. Bruce finally comes in as I am finishing with Dr. Krienke and his referral to Dr. Floyd for me and Bruce says Floyd is part of his practice... and comments that I must have had my share of experiences with doctors... He sets about asking Tracy some technical questions and expertly inserts the catheter again (more of the same pain) while saying "We have some tricks..." and in it goes, with him concluding, "I think it's in... it's not getting shoved back out..." and I am breathing out and sensing that even though it is somewhat uncomfortable it is not painful at this point and I know I can handle it from here on out!


He says that now Tracy will continue the flow test and he will study the results, call Dr. Lewis, and meet with me as soon as he can to fill me in too.  Tracy brings out the funnel and jar contraption and sets in front of my chair.  I have these tubes up my penis and she describes that at some point I will either sit and urinate or stand up in front of the funnel and urinate into it, while the machine measures the "flow" and pressures on my urethra and my sphincter.  Tracy continues; explaining to Etsen what she will be seeing on the graphic display and instructing me on what will be happening too.  

Long story short: They fill my bladder with a solution and want to know when I first can feel the cool liquid in there; then when I first feel like I want to urinate but wouldn't normally go to the bathroom; then when I begin to think I might want to go to the bathroom; and then when I it is time to go to the bathroom; and "Now I want you to wait til you can't wait anymore..." Tracy concludes.  We talk some more about trivial stuff (her going to UTA, marriage and family counseling, respecting our elders, etc.) while I continue to hold it as long as I can.  She tells me that if I feel that I cannot urinate with two women in the room, I can ask them to leave right at the last moment.  I am wondering how this all will happen and envisioning if indeed I will be jumping up to pee and yelling for them to get out... don't imagine that will happen when the time comes.


We talk and just enjoy our visit until I can't hold it any more... and I stand up, holding my tubes and all, and relieve myself over the funnel ("Ahhh") as the women watch the measurement graphs charting my performance!  What a scene!  With all those tubes up there I have to concentrate to ensure it all goes into the funnel.  Then Tracy asks how that is like usual and I (without even thinking of that absurdity of that question) report that I didn't feel like the flow was a forceful as usual when I feel this kind of urgency to urinate.  I add that I think the tubes up there may have impacted the normalcy of my gushing flow... or something to that effect.  Tracy considers that and nods that that reflection might have some merit... also saying to Etsen that my flow seemed, on the graphing display, to be less than a normal flow.  I, in my mind, agreed... and yet the part of me that is happy this is over doesn't really care at this point about the findings.  I just don't want them to say, "We gotta do it again..." 


Tracy concludes that we are done for now.  She simply slides them tubes out and I get dressed.   As a kind of debriefing gesture, I ask Etsen if her name means anything special in her culture (she is from Camaroon) and she replies that it means 'hut' and was her grandmother's name.  Tracy comments that she loves ethnic names and we are all smiles as we say our goodbyes.  "What a day" I think to myself as I drive away towards the south.