Saturday, November 13, 2010

Day over day

-- by Randy

I got in to the hospital later than I planned because there is 6 inches of snow on the ground. I got enough shoveled so that there is so there it is clear around the door so if someone needs to see the dogs they don't have a whole days worth of snow to get through. It's going to take me a couple days to get the drive way done at this rate. Of course it is a pretty snow and probably wont last the week. I only wish it was next weekend.

When I did get to the hospital Holly's bed was elevate a bit she said they had her sitting The therapist wanted to do it yesterday but she was not up to it. She said it felt a bit "wild." She no longer has the finger tip oxygen/heart rate monitor on her finger so that's one less monitor, which is a small progress she still has the stomach tube so that they can remove stomach fluids because she had some nausea in April and with this incision they wanted to avoid any nausea. Also I don't think there is much in terms of peristalsis restarting so this just one other body function that has to be managed as Holly's body re-establishes its self regulation or homeostasis.

About the time I got there a tray of food, really various clear liquids, showed up. Holly hadn't ordered it and tried to send is back but the order was for her. So she elevated the bed a bit more and tried some broth. She did well negotiating the spoon around the stomach tube. Then she put the bed back and went to sleep.

So just as the snow slowly piles up over the day Holly incrementally makes small improvements back to health.

It is amazing how visible the progress is from day to day. Yesterday she was zonked out consistently . Today she is eating a little and a little less zonked.

Friday, November 12, 2010

Very Little Joke

I can't tell this to Holly as she will laugh but imagine a Character from "Mr. Rogers' Neighborhood" . . . Mr. McFeelwell saying "speedy recovery, Miss Holly Speedy recovery."

Thanks for indulging me.

Its a quiet day

As one would expect. Holly had a tough night so today she claims that she's not real exciting. Since I'm not here to be entertained I don't mind. Today her pain is lessened and she is sleeping pretty consistently.

I look around the room at all the monitors and tubes and it is obviously early days in recovery. Last spring each day brought fewer tubes and fewer readouts on the monitors. So we will just wait and I will observe the changes in the room as Holly grows stronger under care.

A couple interesting changes

Randy:

We have noticed a couple of changes in pre-op procedures even in the six months since the transplant. I noticed the first change right away when I went back to spend time with Holly before the operation. She was on the gurney with a white hose attached to her gown and the other end was attached to a heater that looked sounded like an old "soft bonnet" hair dryer, not the bullet shaped missile tops but the bag-over-the-curler type women used to use before blow dryers.

The device is called "Bair Paws" and they were using because studies indicate that warming patients before surgery reduces the risk of infection. It probably also helps them relax and stay comfortable.

The second change is a bar code on the wrist band. This the square type code that advertisers and the post office are using. There are still a lot of questions about name and birth date which may be about confirmation and assessment. It was interesting that at least at one juncture the code was read by a device to register the presence of the band electronically. This is the second day I have noticed that they are using the bar code when collecting additional information. So it seems to be a part of the routine information control.

Holly introduced her own innovation.We were talking and she said "Give me some of that tape." so I gave her some tape from the cart in the prep room and she taped a note to her gown. Every nurse and anesthesiologist said oh a note and Holly let them know that it is reminder for the pathologist to take pictures of, measure and weigh her formerly native kidneys. The last took particular delight. "You've got a point, and you want to get it across."

------Holly, later------

Randy tells me I looked like I'd been through plenty of trauma when they brought me to my room after surgery. Sweating, pale, breathing hard around that stomach tube.

Coming out of everything, I had probably the most physically miserable 48 hours of my life. This time, I had the urinary catheter, an IV, a stomach-emptying tube going into my nose and down my throat, and oxygen. From there, I also had some trouble with pain control -- my own trouble, not the U's. I again had a little pushbutton "pain pump" in my hand to release the IV painkiller, but was either fast asleep or too woozy to give myself enough. So. Pain, dry mouth, dry throat, occasional choking feeling when not getting enough oxygen.

The "last dawdler in the store" thing played against me a little -- on Thursday night, my nurse really, really wanted me to "sit on the side of the bed and dangle." The op had taken some 3-4 hours, probably getting me out of post-op around 6 p.m. And here I was being asked in some hybrid toddler-medical lingo "Do you want to dangle?"

I made clear, I thought, kindly and firmly that no, I had no intentions of dangling anything that evening.

Then, Randy says, I was told I'd be getting blood-pressure lowering meds.
Prior to the operation, my mother said several times on the phone, "I'm glad you're able to stick up for yourself," which I think was her permission not to be the "nice girl" she had fully intended to raise.Permission or not, a certain amount of spirit did serve me well.
Told the name of the med I'd be getting, I said "Why?"
"It's a blood-pressure drug."
"But why?"
"For your blood pressure."
"I'm not asking what it is, I'm asking why you want to give it to me."
It turned out it was because my upper number was all of 1 digit higher than it should be. (And she was not kidding.)

I refused this help, too, even more firmly. When it's an existential struggle just to stay awake for someone to take your vitals, it shouldn't be too surprising if your BP is up. (We may also have been having a dangling debate while the nurse was taking my blood pressure.)

After two more offers to help me sit on the side of the bed, the nurse grumbled, "Well, it's my job to encourage you to sit up and move, and so I'll keep on doing it."

Still, I didn't hear another thing about "dangling" that day.

Thursday, November 11, 2010

New post

Holly officially is not able to blog today so it's my turn.

Holly had her native kidneys removed today. She went into surgery at 12:50 and she should be in recovery soon. The surgeon was pleased with the "boring" surgery.

Just to start catching everybody up, after her transplant Holly has been enjoying life and having a great summer. She has been gardening, with gloves and a big hat, mostly. (Skin cancer is now one of our threats, as immunosuppression makes you less able to fight that, too.) Grooming dogs, painting a new bedstead and doing other projects as well as work have kept her happily busy. The transplanted kidney issues resolved and she recovered from the surgical restrictions. As the summer progressed she acclimated to her medications and her new routine associated with this new life.

It has been the plan to remove the native kidneys as soon as Holly was recovered enough handle another surgery. Her native kidneys were enlarged by the cysts caused by the PKD. She was experiencing quite a bit of pain from them and they were affecting her appearance and causing other complications. We will have more details about the native kidneys as these posts continue.

My admiration and gratitude to Dr. Dunn and the transplant team at the University of Minnesota Medical center. Thanks to Cheryl for stopping by to pass the time this afternoon. Thanks to Bethel University and the ITS Help Desk team for picking up the slack while I'm gone to take care of Holly. My gratitude is not just for the events around this particular surgery but for the improvement in Holly's life since this spring.

I will have a few days here to go into more details.

Randy

--------Holly, later--------

I actually slept most of the night before the operation, thanks mainly to a double-headed rush to get things done at work and at home to prepare for weeks off. Plus, I think I'd been getting gradually more depressed as the weeks got closer. Delaying the operation due to a bad bladder infection and ER visit in late October didn't help much.

I went into this operation with a dread I've hardly felt since I was afraid to leave home to go to camp. Figuring between a "We'll just hook up this organ with the bladder and a blood supply" operation and "We'll slice you open from breastbone to below your navel, take out half the organs you can name in your abdomen, and juggle the rest for awhile before closing up," I banked on being in at least 60 percent more pain than I'd been during the transplant.

In a rough calculation of incision inches vs. weeks off, I came up with 7" TX and 3 weeks off, and prepared everyone at the newspaper office for a 9-10" incision with the removal and at least a month off.

What did help was taking the Tuesday prior to surgery off. I was able to finish painting the bedstead that would help this recovery -- wouldn't be crawling off a mattress on the floor. I then took the dogs outside -- this was a sunny day in the mid-60s -- and trimmed their coats and claws and played with them barefoot on the front lawn. Something about those perfect afternoon hours reminded me this was why I was going through surgery -- to have more days like this.

Surgery was scheduled for noon Nov. 11. I never knew surgeons, who usually want you to check in at 4 a.m., even worked that late.

My surgeon checked in and said she probably wouldn't have to take my spleen along with all the other organs -- that's a huge relief, as your spleen is something of a last-ditch defense against infection. She also predicted cheerfully "When these are out you'll look so svelte!" The stinker. She knew this was good news all around the whole time.

As Randy waited in the little kiosk with me and people occasionally popped in to hook up IVs, quiz me about anesthesia or confirm what was being removed, I thought of something. "I probably won't feel like going to Cheryl's parents' for Thanksgiving, but I bet you could go on your own," I suggested.

"Oh no. I'm not going to that," he shot back. Randy's the gregarious half of our couple and he really likes the whole Jahnke family, so this instant rejection surprised me. I looked at him in bemusement.

"I need to be home," he told me sternly. "You need a lot of supervision."

The idea that, like a puppy, you can't leave me home unsupervised for a couple hours cracked us both up. And that helped, too, as the pre-op area emptied of both patients and staff.

I was certainly the last customer in the shop and they seemed quite ready to get rid of me! This time, as they wheeled me through the halls (I'd insisted on being awake this time, so as not to miss so much) Randy didn't have any time to get emotional at the "goodbye corner." They whisked me right through it, and I barely had time to grab his hand for a split second.

About all I was able to observe in the OR was that there were, as in an old movie, mint-green glazed tiles on the walls. Also, I thought, the giant light hanging over me had better be well-secured. "The chandelier! The chandelier!" About this time, the group decided they'd had enough of the awake Holly, and I agreed to a push of the "relaxing shot" into my IV. I had time, as my ears began to go tinny, to announce, "It's working!" although I'm sure a few seconds later they could have seen that for themselves.

Monday, September 20, 2010

Another view of 'the twins'

Ever since I first met my surgeon and informed her blithely "I'd also like to have my native kidneys taken out," we seem to have been on either side of a line in the sand, protocol-wise.

I'd already revealed myself as a nephrectomy advocate, so she had to take on the role of dissuading me from this course. If only 1 out of 20 patients has a nephrectomy -- and my pain hadn't begun yet -- it was unlikely she'd be doing one on me.

Thus, through poking and prodding my abdomen (which, from ribs down to hipbones at any longitude bounces right back like a couple of leather bags full of water) she determined my kidneys are only "moderately large," and has said several times "Your kidneys really aren't that large. I don't know why they'd be causing you all this trouble."

With the onset of pain and the MRI results, she agreed to remove them, but still didn't sound particularly convinced.

However, at my pre-op meeting, Randy and I were briefed by a specialist we'd never met before. My surgeon runs late on a regular basis, between operating, teaching, doing research, meeting with committees that do everything from hiring to reviewing transplant candidates, and last but not least keeping clinical appointments.

The new guy, with a pronouced Georgia accent, was catching up with my history on the computer, when he saw I had PKD. "Hey! Did you have any imaging done? I love looking at polycystic kidneys!"

I admitted I had an MRI somewhere, and he found it. "Wow! These are huge!" he enthused.

Startled by this new viewpoint but still tentative, Randy offered that we referred to them as "the twins."

"Oh, these are bigger than babies," the doc said. "I've sired babies, and these are bigger than that."

Not only was the horsy reference delightful, the confirmation of what I'd always thought was encouraging.

We then delved further into his Southern past. "You know rugby balls?" he asked. (We both nodded, even though we have only a sketchy idea of what a rugby game looks like, much less the ball.) "Well, these are the size of rugby balls," he said.

Looking up "regulation rugby ball" and converting centimeters to inches yields some startling statistics. All I can say is I'm ready for them to bounce on out of here.

Thursday, September 2, 2010

The most unwelcome question

We were on vacation at my parents' cottage -- "heaven," as people who've been there call it -- and were escaping from a noonday June sun on the beach by driving to the nearest town to shop.

The cottage is a place where outside worries just don't penetrate. We have no daily papers and no TV. One summer, we noticed the neighbor's flag was at half-staff one morning, and thought, "Oh, that's too bad -- the World War II veteran who lives there must have died." But when we went into town to post some mail, the Post Office flag was at half-staff, too. When I asked the woman behind the counter why, she looked at me like I'd fallen off Mars and snapped "President Reagan died!"

So, with only trivial issues on the agenda, such as "Will it be sunny again tomorrow?" and "What should we have for dinner tonight?" I was miles away from thinking about my health problems. I was completely unprepared when a woman smiled sympathetically at me and said "I can't imagine what it would be like to be pregnant in this heat."

She seemed kind, and I had been in a sunny mood until then, so I just smiled back and said "I'm not pregnant," and let the shock and the oh-I'm-so-sorrys fall where they might.

Thankfully, back home in Minnesota, I'm generally surrounded by people who, as Garrison Keillor has portrayed them, are almost too cautious to pry into how you take your coffee. That's just as I like it in any case -- I just don't think whether or not I have a passenger on board is a passing stranger's business.

I can certainly appreciate the fact I don't look "normal". Out of curiosity, I recently tried to calculate my pants size on a store's Web site. Thighs: size 10 or 12. Hips: size 10 or 12. Waist: size 24. Even at that, I had to do some extrapolation to arrive at the waist size -- it was literally off the chart.

So, yes, I am bizarrely shaped, suggesting pregnancy, a serious beer addiction or, of course, being one of the roughly 300,000 women in the U.S. with PKD.

I've run into such well-meaning strangers a few times before, as have others. One woman told me she had to start wearing maternity clothes at age 48. And, at that, her primary physician's nurse exclaimed excitedly on seeing her, "Oh! How many months are you pregnant?"

I'm sorry, really? At 48? You're holding her medical chart with "PKD" all over it in your hand?

For me, it's embarrassing, humiliating and maddening in varied proportions. My first thoughts are of snapping back in a way that would prevent this person from asking that question ever again.

But I don't. Counting blessings again, I'm fortunate in not wanting to have children. There are women out there -- apparently in less-introverted regions -- who have PKD, huge kidneys and risk pregnancy reminiscences and belly rubs every time they leave the house. "I started getting an enlarged abdomen about 5 or 6 years ago when I was in the throes of infertility treatments," one wrote on a forum. "Imagine being infertile and desperately trying to have a baby and being asked all the time "when are you due?" I remember replying 'Never! I will never be due because I can't have kids!' and bursting into tears."

Are there many people left out there besides older, nosy relatives who haven't heard "Don't ask a woman if she's pregnant unless you actually see another human being coming out of her"? (May I add: in that rare case, you might as well save your breath for calling 911.)

My husband says it's about people wanting to share the experience by proxy. Whatever the motivation, these thrill-seekers should be warned that there are a few of us ringers out here who, depending on the day, may share more than the experience you expect with you.