Posts Tagged ‘prednisone

28
Jul
17

Five Weeks

I'm officially not anemic anymore!

My creatinine is well below 1!

My GFR is holding at 95! 95!!! Up from 7!

I feel great! My incision has healed up nicely. I'm hardly experiencing any discomfort at all anymore. I'm getting my strength back, walking as much as possible, and going up stairs. I'm drinking, and staying out late, and still have plenty of energy to work five days in the office and go out on the weekends.

I have my life back. I haven't felt this good in years.

I got to taper my steroid dosage back down to 5mg this week. I don't seem to be experiencing much side effects from any of my new meds, except possibly some insomnia from my anti-rejection meds. I've been having a hard time falling asleep and only staying asleep for 4-6 hours most nights. So far, that's enough to keep me highly functional, though not ideal.

I was able to gain back 5lbs pretty quick, but I'm still a bit underweight. Things seem to have plateaued, so I think I'll be stuck here until I can do more physical activity and build some muscle back up.

My twice a week labs are getting pretty tiresome, but maybe those will get reduced at my doctor's appointment in a couple weeks.

Everything's great, and I'm so, so happy.

29
May
17

24 Days

24 Days to my Kidney Transplant Surgery!

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Sorry for the radio silence, but there hasn’t been much to report besides the agonizing wait we’ve been enduring to find out if TK can be my donor during which my condition has continued to slowly deteriorate. Nevertheless, let’s recap what the last couple months have been like.

J and I attended that orientation for dialysis I mentioned when it started to seem like that would be a necessity. We spent a couple hours with a guy old enough to be my dad and a guy old enough to be his dad learning the basics of dialysis I had already taught myself from the internet. What we found out was the timelines for getting on dialysis didn’t really jive with our transplant plans — it takes several weeks to get all the shit together you need to do dialysis if it’s not an emergency. By the time I would have gotten dialysis sorted out, I would have had a new kidney. So, instead, I’ve been “toughing it out”. Seems like I dodged a bullet.

It’s been pretty difficult. Every time I start feeling extra bad I panic that I’ve hit the tipping point and worry I’m going to wind up back in the hospital for weeks. It’s completely insane that I’m still so high-functioning with the shape my body is in right now. All of my important labs have been hovering around the magical number 7, which is kinda funny, but also terrible considering these numbers aren’t supposed to be anywhere near each other.

My GFR, creatinine, and hemoglobin are all hovering around 7.

My GFR would be great if it was anywhere over 50.
Creatinine is supposed to be less than 1.
Hemoglobin should be over 11.

You can see how this is very bad.

Most people are forced onto dialysis with their creatine dips down to 8, they start dying without dialysis when it gets to 6. Most people have to get a blood transfusion when their hemoglobin is less than 10. Mine’s been less than 10 for six months, but a blood transfusion will complicate my transplant so instead I’m just kind of dizzy all the time. My left side constantly hurts, sometimes worse than other times. And I’m so, so tired. But besides that, I don’t feel too rough. A few weeks ago I was feeling really bad for a few days and it seemed like dialysis on the horizon for sure, but then we figured out we didn’t taper my calcium supplements when we tapered my steroids and I was just poisoning myself with calcium. I stopped taking that and felt a lot better. I’m on my last few days of steroids, finally. When I got down to 8mg I started feeling like myself again, mentally. Around 5mg I got my face back, almost. I can tell you that the side effects of chemo and steroids made me feel worse than this kidney failure is making me feel. Nothing’s making me feel as bad as the hypertension was making me feel.

I’m still working full-time, but that’s been getting harder. I haven’t been able to do a full week in the office in weeks, requiring at least one day working from home to rest. Luckily, my company continues to be really awesome and accommodating of that. I spend most of my weekends on the couch, resting, but I try to at least go out for breakfast or see friends when I’m feeling up to it. I’ve been watching a lot of tv.

TK had to go through a whole mess of unpleasantness to find out if she could give me her kidney. And we still have the entire major surgery and weeks of recovery to look forward to! I actually have a ton to look forward to, most of which is food, but also not being tired, dizzy, and in pain all the time. Also, whiskey. And did I mention food? I guess I’ll probably still be in pain for a while, it’ll just be different. And I’ll be allowed to take pain killers again because I’ll have a kidney that works. I’m trying not think too specifically about the actual surgery. J and I were talking about it for a few minutes last night and I nearly fainted, haha. This is one of very few situations where I don’t really want to know how something works or what’s going to happen, I just want it to be over.

Unfortunately, things won’t really be over once the transplant is done. Because an autoimmune disorder is what caused by kidney failure, I’ll still have chronic kidney disease and an autoimmune disorder. It’s possible the same thing that happened to my kidneys could happen to my new kidney. The best I can do is be kind to my kidney and try to catch it earlier this time. Because I’m getting a living donor kidney from a relative, the chances of rejection are lower and I should be able to get a good 15 years out of it, at least. Science, you have 15 years to master 3d printing kidneys–chop chop!

Here’s some weird photos of how things have developed. 

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07
Mar
17

chemo nomo 

I was supposed to have my next chemo treatment today, but I’ve been spared that unpleasantness. We’ve canceled my remaining chemo. It isn’t working. 

Josh called late yesterday to see how I’m feeling. He got my most recent lab results. My creatinine is over 5. My GFR is down to 9. If it gets much lower I’ll have to go on dialysis until we find me a kidney. I’m getting new labs tomorrow to see where we’re at. 

I feel the same–relatively “fine”. My sides/back hurt often, sometimes a lot. I always have a bad taste in my mouth from the wastes my kidneys aren’t filtering. My edema hasn’t gotten any worse. My anemia’s doing its thing. My blood pressure is totally under control. My prednisone dosage is down to 10mg, in a couple weeks we’ll taper it down to 5mg and I’ll hopefully get my face back. 

J is still getting tested to be a donor. We found out today that the tissue typing came back with half our markers matching, which makes sense since we’re half sisters. Next is the cross-match test where we see if my blood tries to attack J’s blood. J’s still undergoing her physical to make sure she’s in tip top shape, but so far so good. 

There doesn’t seem to be much I can do besides continue my diet and stay hydrated and vigilant for worsening symptoms. 

Maybe now my leg hair will grow back. 

J and I watched an ep where Blanche’s sister needed her kidney.

05
Feb
17

There hasn’t been much to report lately — things are pretty stable.

I oscillate between depressed, totally fine, and a little manic every few days. I’m in constant but manageable pain; my knees and ankles, other joints, my left flank, my face. I’m tired pretty much all the time, but rarely to the point that I can’t get out of bed, so I power through. I’ve had bronchitis for two weeks and the coughing has a caused a constant soreness in my ribs and chest.

My main kidney numbers still aren’t getting any better — my creatinine has been going up, it hovers around 2.5 – 4 which is where it was before I checked into the hospital three months ago. Despite that, my GFR is holding steady at around 12-14. I’ve been picking up more subtle symptoms of kidney failure, like bad breath caused by waste build up in my body and cramps in my legs and hands. It’s a total blast. Josh says my other numbers are showing improvement though. My potassium and phosphorous levels are good and my protein filtration is better. I asked if that’s just because I’m limiting stuff in my diet, but he assures me it’s indicative of my kidney function improving. Either way, despite my borderline numbers it sounds like I’m still aways from needing dialysis, so that’s good.

I was supposed to have my transplant evaluation a couple weeks ago, but I had to postpone it because my insurance didn’t approve it in time. The next available slot isn’t until the end of February, which I’m scheduled for and has been approved and I’ve done my blood test for already. Once that’s done, we can start screening potential kidney donors for me. I have some very generous volunteers lined up. No one has anything positive to say about their experience trying to get a kidney transplant. Mine is already not off to a great start. I’d like to get it out of the way before Trump fucks up our healthcare system even more.

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Proof!

My blood pressure is still a little high — 135/90 most of the time. We’ve switched up my meds again; off a beta blocker and back to an ACE inhibitor, but I think it’s making me feel worse so I’m going to talk to Josh about it. Still on the calcium channel blocker. Still on antibiotics. Still taking tons of calcium supplements, vitamin d, and iron. Still on the prednisone, but we’ve tapered my dosage to half what it was when I left the hospital, and I get to taper it to even less over the next month, so maybe I’ll get my face and sunny disposition back soon. I am a little concerned that the boost from the steroids is what’s kept me going the last few weeks and without them I’ll be too tired, but that’s not worth these side effects.

Now that I’ve successfully hacked my diet (seriously, someone in kidney failure should not be eating meat or dairy — it’s really fucking simple, and I can’t believe no one said that) things are better. Sausage D doesn’t happen very often anymore; I keep my feet up as often as possible, so I can wear my normal shoes again. Last time I had chemo I only gained 6 lbs from the fluids and it only took me a few days to lose it. I have chemo again this week, hopefully it goes about the same way.

I’m not too sure what’s up with my anemia. My numbers were trending well, but they dipped a bit last week and right now I am covered in bruises and I’ve been really tired. I’ll get more tests at chemo this week, so I guess we’ll see where things are.

Besides being tired and in pain and my face being totally swollen all the time, I’m basically fine I guess. Work is going to stop being so crazy now that it’s not January anymore, so hopefully I can spend some time looking into alternative treatments to manage my symptoms. I also really need to make an eye appointment because my eyes are fucked up and I don’t know if it’s because of the meds or just strain or both, but I feel like I’m going blind half the time and it’s hurting my head. I’ve been trying to exercise more — walking around, taking the stairs a bit, but it really wears me out and hurts my legs, so I’m not sure what to do about that. I had to jog about half a block to catch my bus home the other day and my legs were really close to collapsing under me. But, my heart felt good!

I’m over this you guys.

02
Jan
17

Research Mode

Things have been a little rough, but I’m turning them around.

As it turns out, going through the Stages of Grief on steroids during the holidays with your family around is the recipe for a horrible nightmare.

Or at least pretty serious depression. But who can tell, with the steroids?

But, the holidays are over now and I’ve reached Acceptance (again, for now) and I go back to work tomorrow and I’m feeling a lot better. For now. Until my next mood swing. Or spot of bad news.

I’ve done a lot of research into my disease this week. It started as research into an alternative diagnosis, spurred on by a few things:

  1. Everyone keeps talking about how “very unique” my case is.
  2. IgA Nephropathy is a very dissatisfying diagnosis — cause is unknown and it’s a bit of a catch-all.
  3. IgAN is not a something I want to have — it has no cure, known treatments are basically 50/50, and it could recur even if I get a kidney transplant.

So, I went hunting for a new diagnosis. It seemed promising at first. All of the American scholarship around kidney disease is typical American bullshit — focuses exclusively on old white guys with kidney disease, skewing all of our data. In America, we don’t even really bother screening for kidney problems until it’s way too late, lest we give people an opportunity to actually adjust their lifestyle and not kill themselves with sodium overload and a high-protein diet. It’s so fucking stupid. In Asia, they screen young people regularly for early signs of kidney problems, which tons of people have, so they change their diet and repair their kidneys and live longer without chronic kidney disease. The fact is we’ve just accepted that the kidneys degenerate over someone’s lifespan and have decided to not really do anything about it and then just blame it on high blood pressure or diabetes when it becomes a problem when people are 70. The problem I’m having is something has caused my kidneys to degenerate extremely fast 40 years early and no one call tell me what that is, which is exceptionally frustrating. I didn’t suffer an injury to my kidney, I’m not diabetic, and it’s unlikely I had high blood pressure before my kidneys were damaged. So what caused this?

I went looking for cases of kidney disease in other young people in other parts of the world. I was able to dig up that dehydration is most certainly a factor — kidney disease is killing young farm workers in Central America and India at alarmingly high rates. Unfortunately, I have about as much in common with young farm workers as I do with someone who’s 70, so this information is of limited use to me. I did discover that what’s happened to me is starting to happen to more young Americans, and also younger people in urban India. There’s certainly a lifestyle component, but that alone doesn’t explain what’s happened to me — otherwise everyone my age would be in kidney failure. High blood pressure is a red herring. It comes with the kidney failure. If I had HBP long enough to cause kidney damage I would see damage in other organs as well, which I don’t.

I live a substantially healthier lifestyle than the average person my age, so the only thing that actually makes sense is that something totally stupid and random like igAN would happen to me. I’ve been doing a lot of things right since college — my vegetarian diet is already lower protein than most people’s and much closer to the recommended. I had already been making efforts to reduce sodium. I was already avoiding things like transfats and high-fructose corn syrup and refined sugars and other additives and flavorings and things that aren’t actually F O O D. I made all of these changes 7-8 years ago. The only thing I could have really done better is eat less cheese. I could have been exercising more, but I walk a fucking ton, more than enough to keep healthy. Healthier than average. Healthy enough to avoid fucking major organ failure. I’ve already been drinking less alcohol the last few years than I was before. I’ve limited my coffee to one strong one a day (most days) for the last five years. I’M A HEALTHY FUCKING PERSON. Which I’ve had confirmed, aside from my kidneys, all of other organs are in tip-top shape, including my heart and my liver which are now at the greatest risk. My blood sugar is great. My cholesterol is normal. It’s really frustrating to be googling lifestyle changes to help my kidneys and find a list of shit I’ve already been doing for 8 years. Salt being bad for you is not fucking news to me. I guess I’ll eat less cheese and chocolate. I’ve already cut out alcohol and caffeine.

So, I took the long way around, but ended up validating the igAN diagnosis.

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A disease of the kidney, specifically a form of glomerulonephritis: an inflammation of the glomeruli of the kidney.

“Very rarely (5% each), the presenting history is:

The proteinuria and cutaneous edema characteristic of nephrotic syndrome are my two main kidney disease symptoms — they’re the ones I had leading up to my hospital stay and the ones I still have now that my kidney function hasn’t improved. Plus the hypertension and anemia I presented with, but don’t have anymore. My anemia is nearly cured, maybe, and my hypertension is managed with meds for now. I get other kidney symptoms; flank pain, so far only on my left side, as punishment for not following my diet well enough and straining my kidneys; and still fatigue. Everything else I’m dealing with is side effects from treatments, or issues related to my pH/electrolyte/nutritional imbalances due to kidney failure, which are mostly managed with meds. For example, my calcium absorption is all fucked up, plus the steroids are actively trying to wreck all my bones. I’m at risk for hypocalcemia, so I’m taking a ton of calcium supplements everyday, but if my eating schedule gets weird, or I forget to take them, or I take them to close to food or other meds that block absorption, I don’t get enough calcium, and I get tremors (which could also be from the steroids, or just fatigue), or if I do this badly for over a day, I get cramps in my hands and feet. My left hand, in particular, making it really hard to use. So, it’s a fun trade off. I can eat cheese and insure I get enough calcium, but I’ll know I’m straining my kidneys when my back/side starts fucking killing me; or I can not eat cheese (be miserable) and be hyper-vigilant about my calcium absorption otherwise my left hand freaks out while I’m trying to drive somewhere.

Now that I’ve settled into my diagnosis, shitty as it is, I feel more proactive again. I’ve doubled down on research into my disease. Josh has thrown all the available conventional treatments at me already, and there’s basically only a 50% chance they’ll have any positive effect. The best case really just postpones the inevitable — Stage 5 kidney failure. Stage 5 means dialysis and kidney transplant if I want to live, so postponing that is good. My numbers are already technically Stage 5 numbers, but I’m still symptomatic of Stage 4, which is good, but not comforting in the slightest. Finding a living donor kidney and setting up my Backup Plan is still Priority 1. (Has been difficult to get any traction during the holidays — the transplant program office has been closed for non-emergencies.) Transplant comes with a ton of new bullshit and it won’t cure my igAN, so I’m probably looking at immunosuppressants for the rest of life, which is really really depressing. So we’re just going to not think about that now because there’s nothing we can do about it and it launches me into a pit of despair which I already cried about for like five straight days.

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What I can do something about is my diet, which I’ve been led astray on a bit. I should definitely continue being vegetarian. A low-potassium vegetable-based diet is the best thing for my kidneys, not to mention the rest of my body. There’s too much protein and phosphorous in most dairy, so I’ll be limiting those more strictly as well. This makes me feel better. Onions, red bell peppers, garlic, parsley, and apples are my kidney superfoods and I’m going to eat them everyday. Over the Christmas weekend I ate way too much cheese and chocolate and I super paid the price for it — I had persistent flank pain for days, some of the worst fatigue since the first few days after leaving the hospital, headaches (not migraines), and just the most depressive fucking mood. First I blamed what I assumed (hoped?) was low blood levels from my chemo nadir, but labs came back and my blood levels were up, so that wasn’t it. Then I ate just vegetables for two days and felt better. Vegetables are the best.

Because my blood levels were so good the other day I didn’t get my hormone boost, so now we’re experimenting to see if they go down without it or if I’m not anemic anymore. The phrasing the nurse practitioner used was “it’s a little risky — hopefully in a week we don’t see you circling the drain“. That seemed a little indelicate, for someone I had just met, even by my standards. But anyway, it’s almost a week later and I still feel pretty good. I have chemo next week, so we’ll find out then. It took me a week to lose the 8lbs I gained from chemo last time, so looking forward to that again. Right now I’m down to 123lbs, which is nearly what I was before I went into the hospital, so normal. I’m still Staypuft from the prednisone, but less Sausage D in general. I’m not due to see Josh for another 3 weeks, but I think I need to get him on the phone sooner, because we should be tapering my prednisone sooner than that if we can. I finally had my follow-up with my PCP last week. Last time I saw her was the day we met and she immediately identified I was in kidney failure and threw me at Josh, so obviously a lot has happened since then. I was still in a pretty fucked up emotional state when I saw her. She offered to refer me to a therapist.

I get a week of normalcy this week, which I’ll need because work is going to be crazy. Getting through it with my prednisone mood swings is probably all I can fit on my plate.

 

 

 




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