469) Like Strands of Spaghetti

July 17, 2021
Saturday

Like Strands of Spaghetti: I mentioned on my HHT Adventure blog recently that my life resembles a pile of spaghetti right now; and that is leading my fuzzy brain to contributing to both my blogs simultaneously.

Related to my kidney, the big news has to do with discussing with the docs taking out my fistula: answering the question, Will taking the fistula decrease my blood pressure on the left side of my body? 

My Kidney Doc (Dr. Baru) and my Cardiologist (Dr. Wozniac) wanted to know(5/25/21).  For some time my BP had been inching up and by May it was running in averages like 159/78; I usually take it once to several times a day.  I am aware of this fistula removal being just ONE of the eight things listed exactly a year ago in post #466!  A noted result of the COVID-19 pandemic's strangle hold on many people's medicinal needs over the last year.

Dr. Baru recommended a vascular surgeon;
Dr. David Nation. We met for a consult on
June 15th and I checked into Seton on the
21st.  Our consult was so "matter of fact" that Dr. Nation helped me to revisualize what the final result would look like and why that was preferable.  I had imagined them cutting all along the top of the fistula, grabbing the vein and pulling it out.  Nation suggests cutting over the "bulb" that pooches out and then closing off the vein just above (see illustration).  He thinks that the rest of the vein up my arm will eventually flatten out.  So, that was our original plan.

There were a number of things I hadn't considered. For a week or more, I couldn't type (part of the reason this post is so late). Another thing I hadn't thought about was/is pain.  Nation had given me about 6 Tylenol w/ codeine, which I started taking when the surgery numbness wore off.... and I FELT pain with this even more than I recall post transplant! For a number of days as the drug wore off I knew it was getting painful about 20 minutes past the 6-hour limit. It helped to put my left arm up above my head during waking hours: at night I had to get up and sit on the couch and say "ouch" every time it slipped down.

Another issue related to my continued kidney adventure and my HHT Adventure  blog (Post #14) is that Dr. Wells prescribed Xifaxan to "prevent... brain problems (decreasing the ammonia high count)  caused by liver disease. The supporting materials from the manufacturer warns patients to use caution when using Xifaxan with Cyclosporine, which I have to take to keep my system from rejecting my transplant. 

I messaged Dr. Baru for his take on all this and on July 22nd he responded: "It should not be a problem. Cyclosporine is metabolized in the liver by... rifaximin has no interaction here. ...To be extremely safe we can measure a cyclosporine level 3 days after the (Xifaxan). Please let me know. 

Dr. Baru reminds me of Dr. Richard Lewis's doctoring.