Reevaluation

In today's post we will take a break from the article reviews and instead give an update on Mom, followed by the always exciting monthly blog stats at the end. (After a three-month hiatus, the blog's quest for worldwide coverage resumed at a furious pace in February.)

Generally speaking, things are going ok at dialysis. Some days there are no issues, but on other days Mom's arm starts hurting so much that she has to have them stop dialysis before the full four hours have completed. Her hemoglobin was dipping below 9 earlier this year for some reason, and she was feeling a little more anemic as a result of that. But it was back up to 11.2 at the end of February, so hopefully that problem is behind us.

Her new nephrologist changed her medication a little near the end of February. He increased the dosage of Carvedilol from 25 mg daily to 37.5 mg daily, and he also replaced the Amlodopine with Nifedipine.

As I mentioned in the February 7, 2014 post, we were notified in January that Mom might have a chance of being placed on the kidney transplant list again, as a result of the elimination of the "living donor only" category. I went with her to some appointments with the pre-transplant group on Thursday, February 27, to begin her reevaluation.

The first appointment was with a transplant surgeon. As soon as Mom arrived they took her vital signs then sent her back to the waiting area. She told me her blood pressure was 114 over 46, and her pulse was 43. Yikes. Today was the first day she took the Nifedipine instead of Amlodopine, so the Nifedipine is definitely having an effect. She said she felt a little dizzy, so I was a little concerned. We met with the transplant surgeon, Dr. K. He asked some basic health questions and went over what they actually do in a kidney transplant (the basic plumbing connections) and what some of the potential complications are with the surgery itself. He said the typical wait time for a kidney is four years, which was a little depressing because that would mean four more years of dialysis for Mom, while her health would likely deteriorate. We did ask him if he thought Mom would be a candidate for a liver and kidney transplant, and he was rather quick to say no, given her age.

The next appointments were at a different location and we had plenty of time to get there. Mom asked if we could stop somewhere along the way so she cold get something to eat, hoping that would make her feel better. We did that, and she felt a little better but was still not feeling 100% well. I knew one of the next appointments would be with a nephrologist, so we could discuss it at that time.

When they took Mom's vital signs at the next location, they took them with Mom sitting and then standing. Her blood pressure was 115/70 sitting, 115/64 standing. Her pulse was 50 sitting, 48 standing. So things are getting a little better. The nephrologist we met with was Dr. R. That appointment went very well, and she definitely gave us the impression that Mom was a good candidate for a kidney transplant. She was very impressed with how much weight Mom had lost since they last saw her in July of 2012. She said assuming the medical records from Mom's cardiologist and dermatologist do not indicate any problems, she would recommend Mom for a transplant. She also went over some of the possible side effects of the medications people are on after a kidney transplant. Dr. R said most kidney transplant patients say they do not really feel like themselves until about three months after transplant. I got the impression that the most likely long term side effect might be some shakiness, especially in the hands, similar to the early signs of Parkinson's disease. In spite of all the potential side effects, Dr. R said the only patients who have told her they regret getting a kidney transplant have been some who were doing peritoneal or hemodialysis at home before the transplant.

Regarding the four year waiting time that Dr. K had mentioned, Dr. R said that Mom's waiting time started when she was first listed for a transplant, and she is still accruing time although she is not listed as eligible right now. That is obviously good news because it means her wait time has been accruing since August of 2012. So if the typical waiting time for a kidney is four years, she really did not lose anything by being first listed as eligible only for a living donor, and then listed as ineligible since November of last year.

We told Dr. R about Mom starting the Nifedipine today and what effect that was having. She did not seem overly concerned or alarmed and agreed that it was most likely Mom's body adjusting to the medication change. We then met with Mom's transplant coordinator, whom we had both spoken to over the phone before on multiple occasions, so it was good to put a face to a name. She said she would present Mom to the transplant committee after gathering the records from her other doctors, and we should know something within three weeks.

In summary, we came away from these appointments feeling pretty good about Mom's chances of getting a kidney transplant. Since that day, Mom has had a kidney ultrasound and also met with the social worker at the pre-transplant group. We don't have any results from the ultrasound yet, but Mom thinks the appointment with the social worker went well. Then at dialysis on Wednesday of this week Mom was talking to her nephrologist about it, and he looked in her records and saw that Dr. R had submitted her report and recommended Mom for a transplant. Mom's blood pressure has also been fine since that first day she took the Nifedipine, so maybe her current combination of blood pressure medications will keep that under control for awhile.

So right now Mom's doing well, all things considered, and things appear to be moving toward getting Mom on the waiting list for a kidney transplant, this time without the living donor requirement.

Next up: A little disagreement in the medical community.

=====Monthly Blog Status Update=====

As of February 28, 2014:

Total posts: 128 (4 in February)

Total pageviews: 12,200 (~1300 in February)

Email subscribers: 8 (gained 1 in February)

Total number of countries that have viewed the blog: 85

6 new countries viewed the blog in February:

Algeria
Azerbaijan
Bolivia
Croatia
Macau
United Arab Emirates

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