There are just so many things....

Whew.....shit is DIFFICULT right now.  Every time I think I'm on an upswing in terms of my health, something happens that crashes it all back to my current hellish reality.

It's 5:07am right now (and on a 2-hr late start for Izzy, no less) and anyone that has met me knows that I'm not a morning person, yet for the last several weeks (maybe even months) I wake up around 4-5 am....sometimes I'm able to go back to sleep, but sometimes not (which is what's happening today).  I've been sleeping with the windows open and I wanted to blame it on the little birdies that wake up around 4:430am, but that doesn't seem fair.  I actually woke up at around 4:15am because of coughing.  I tried to go back to sleep, but my lungs are wheezing so much now that it's impossible.  Physically, it's labored breathing.  It takes work to inhale to get enough oxygen.  Mentally, it's freaking me the hell out because the wheezing and crackling is not getting any better. If anything, it's worse that it's ever been.

Here I am at urgent care Tuesday getting a nebulizer treatment

What is happening to me happens to so many other people (not the coughing and wheezing and lack of sleep).  I am stuck in a vicious cycle of seeing multiple doctors, none of whom are communicating to each other.  There is no one managing my overall care and seeing me as a person.  Here are the number of doctor appointments/trips to Urgent Care/Emergency Room/Hospital admissions that I've had since I started dialysis and the issues they were addressing (or the "diagnoses"):

1/24/17 - regular office visit with PC (just updated meds I was already taking)

• Major depressive disorder, Hypothyroidism, Acute Maxillary Sinusitis (regular office visit) with PCP

1/31/7 - Urgent care (prescribed guaifenesin/codeine cough medicine)

• Acute cough, congestion (nasal)

2/5/17 - Emergency Room (prescribed doxycycline antibiotic for 7 days)

• Upper respiratory infection, pneumonia

2/7/17 - ENT appointment (had a myringotomy performed on left ear)

• Eustachian tube disfunction, acute ethmoidal sinusitis, dizziness

2/7/17 - Emergency Room (subsequent admission to hospital...ambulance ride...yay........)

• pneumonia

2/7-2/10 - hospital

• pneumonia

2/17/17 - hospital follow-up with PCP

• hospital discharge follow-up, pneumonia, recurrent sinusitis, ear pressure, snoring, tinnitus

2/23/17 - CT scan of sinuses

3/1/2017 - Pulmonology in prep for sleep study

• sleep apnea

3/7/2017 - ENT appointment (new doctor - reviewed CT scan and found that sinuses 95% full)

• chronic pansinusitis - referred to allergist

3/14/17 - Allergist

• nasal congestion with rhinorrhea (talked about IGG levels and how IVIG infusion may help)

4/13/17 - Urgent care (prescribed tamiflu and levaquin)

• tested for flu (negative), clinical pneumonia

4/20/17 - Urgent care (prescribed levaquin, but a higher dose)

• another chest x-ray, clinical pneumonia

5/2/17 - IVIG Infusion

5/5/17 - called PCP to prescribe antibiotic over the phone because pneumonia not any better

5/9/17 - Urgent Care (prescribed one-a-day inhaler and nasal spray)

• RAD (reactive airway disease) with wheezing, chronic rhinitis

That's 15 appointments/admissions, and they're all surrounding the same thing.  Why is that??????  What do I have to do to get someone else to see that this is a problem.

And do you know what the worst part is?  I'm not any better...I'd actually say my cough right now is worse than ever.  I've had 2 weeks since the end of January where I wasn't having sinus/lung issues, but I'm sure those two weeks were missed due to dialysis sucking.  Oh yeah, remember that ALL of these appointments are happening either on Tuesdays or Thursdays because I've had dialysis every Monday, Wednesday and Friday since January 25, 2017.  If anyone ever wonders why people on dialysis don't work, this should give you some ideas.

I'm so frustrated.  Since leaving Mayo's care, I have honestly just been scared for my life.  There isn't a single doctor that I see right now that is looking out for my overall care and that terrifies me.  Honestly, I'm scared of dying from a heart attack (from dialysis) or a stroke (from the ridiculously high blood pressure).  I found out during yesterday's visit to Urgent care that my last chest x-ray showed that my heart was enlarged.  I did a little research and found that this happens with dialysis patients and people who have high blood pressure.  The long-term effects are that the heart becomes less and less efficient at pumping blood.  That kind of seems like an essential function, and it doesn't look like there's a whole lot I can do about it except get my blood pressure down.

My blood pressure is a whole different issue.  As a dialysis patient now, any doctor I talk to about blood pressure INSTANTLY thinks it's a fluid-overload thing.  It's ingrained in them and that sucks.  That is the case in most dialysis patients (and me sometimes), but the thing is my blood pressure is astronomical no matter what my weight is.  I can come off that dialysis machine at my dry weight, and my BP will still be 180/113.  Early morning, middle of the day, late at night.....always high.  What's stranger to me is that most people during dialysis have issues with their blood pressure dropping too low.  That's literally only happened to me 4 times so far.    Most people have to put their feet up and recline their chairs to help keep their blood pressure high enough (did you know that lying down is when your BP is the highest??) but not me.  I sit in that damn chair with my legs down and the back upright.  It's probably the LEAST comfortable chair you can imagine.  If I'm lucky I'll get to put my feet up for 1/2 an hour, but then the next BP check will show it jumped right back up and down my legs go (which does great things for the edema around my ankles and feet).  Yesterday, I was having a pretty decent run, BP wise, but then near the end it jumps right back up for no apparent reason as nothing has changed in the physical process at that point.  Then, during rinse back (when they give you back your remaining blood with a saline flush) it goes higher just because of the extra fluid coming back into my body.

Yesterday's blood pressures

My nephrologist doesn't show enough concern about it.  I can contact her via MyChart, and she's great about responding, but she first talks about dry weight (insert eyeroll here) and then prescribes another BP med.  The thing is that she never checks up after she's prescribed something. I should be seeing her at least every month in clinic, but that hasn't happened.  When you're a dialysis patient, the doctor's come to you, but she can't seem to find the time.  I've seen every other dialysis patient's doctor in my clinic, but I've only seen mine twice.  MyChart is a poor substitute for in-person visits and conversations, so I've got to make some changes.

Today I'm going to start the process of switching to home hemodialysis.  It'll just start with a phone call, but it's a big step.  I've been waiting for a longer period of stability, but after 3 1/2 months of nothing but issues I think it's time.  Everything I've read and heard tells me that doing hemo at home overnight (nocturnal) will provide me the best quality of life.  I'm not sure if that's the route I'll go, but I'm at least going to start the process of figuring it out.  This means I'll have to stick myself with those gigantic needles, which sounds awful, but hell, I climbed out on my roof this spring to help Joacim and I am TERRIFIED of heights.  So I figure if I did that, I can stick myself with gigantic needles.  It's a mind over matter thing, and I think my mind is pretty strong and determined.  This also means I'll have to find another nephrologist, which may be a good thing for me (not all nephrologists take on patients who do home dialysis).

Tomorrow, I have an appointment with my PCP again.  I'm going to convey my concerns to her and ask what she thinks I should do.  She's actually a really great doctor who takes the time to listen, so I'm hoping she has some good suggestions on where to go from here to address the sinus/lung issues. Many may be wondering why I don't go to her every time I'm sick.  I would actually prefer to do that, but she schedules out a month ahead, so there isn't a way for me to see her while I'm in the middle of a sickness.  I go to the Urgent Care clinic where she is (same system so she can see all of the notes) but that's the best I can do.

May 10 2017 - worries from Jenn Trunk on Vimeo.

May 11 2017 - early morning voice from Jenn Trunk on Vimeo.

Part of me is so self-conscious about these videos because I look so worn.  Dialysis is very hard on your body, and on your skin, and it ages you prematurely.  There is a man in my clinic who is technically 2 years older than my dad, but he looks like he could be my grandpa.  But these videos also remind me of where I am at this time.  I often look back on old posts now to see how much has changed.

I posted a few entries last week about my IVIG infusion and arm infiltration (another shit week).  The infiltration sucked.....it's painful and terrifying because I didn't understand what could've caused it.  Luckily, through United Health Care, I have had access to a dialysis nurse case manager, and she explained it perfectly.  Remember me talking about the janky way that the veinous needle was put in by the new tech?  I could feel the tip of the needle, and it's likely that she punctured the other side of my fistula when she cannulated me.  The needle didn't go all the way through or it would've infiltrated immediately, but it was resting on the surface of the inner vein wall.  And 27 minutes in to dialysis, it's likely that my vein moved, causing a vacuum-like effect on the needle against the wall, and then the needle went all the way through causing the infiltration.  You see, THIS is good information to have!  I mean, the explanation I received at my clinic was "well, sometimes it just happens".  Um, no.  THAT'S not a reason....that's an excuse.

This was my arm last Thursday at my extra dialysis session

This is my arm today, 7 days after infiltration

There are a few other issues that are concerning to me as well:

• I can't smell anything (not even my dogs' breath)
• I can't taste anything (not even vinegar)
• I've lost at least 1/4 of my hair, and the texture has completely changed
• My fingernails are brittle and tissue-thin.  I've been getting gel-manicures just to keep them from tearing off of the nail bed, but I may have to stop that soon because taking the gel polish off is causing problems.  I'm not sure what my next options is after that.  This isn't a vanity thing...this is a pain thing.  Imagine all of your fingernails tearing off, leaving your nail bed exposed.  Or having your fingernails break in tiny little places along the side, and then getting snagged on every article of clothing you come into contact with.  Imagine trying to run your fingers through your hair, and getting stuck because your hair gets caught in the cuts of your fingernails.
• I notice than when I'm having more issues with my sinuses then I get migraines during dialysis.  The last 2 runs have produced some whopper headaches, and oddly-enough, the thing that eases them is standing up, which is essentially the last thing anyone with a headache wants to do.  I was getting OK with going to dialysis, but when the headaches come back, I dread it with every fiber of my being.

Going to dialysis now is getting harder, mentally, because the weather here in Minnesota has been PHENOMENAL the last week or so.  Spring is here, and it's glorious.  I'm realizing I have no tolerance for heat anymore, so these few weeks we have here before it gets too warm are important to enjoy.  That's why leaving for dialysis at 1:45pm sucks.  Dialysis sucks.  After dialysis has been sucking too.  It all sucks.

I'm reading Sheryl Sandberg's new book called "Option B:  Facing Adversity, Building Resilience, and Finding Joy".  I'd been hearing her interviews in the media about how little she understood grieving until she lost her husband unexpectedly, and this struck a nerve with me because that's what I'm doing every day....grieving the loss of my other life.  This book isn't wow-ing me right now because it seems to focus on traumatic events rather than chronic things, but I'm not finished yet so I'll reserve final judgement.  I really want to get to the "finding joy" part, because I am really struggling with that.  One of the things she (Sandberg) did was to write down 3 things she was grateful for every day, so I'm attempting to do that to see if it makes a difference in my emotional state.

This was a very long post, but I had a lot to say.  It's 8:15am, and Izzy's still asleep, so I'm going to go enjoy the silence for a little bit more.  Thanks for reading.