Tuesday, April 28, 2009

4/29/09 - The Good News Continues

On Monday, Alyssa went in for her first lab work in almost two weeks, and continuing her upward swing, the results were very good! Hematocrit - 39 and platelet count - 220 which are both within the normal range. Creatinine and BUN are both outside of the norm, but that is to be expected with End Stage Renal Disease (ESRD.)

With her BP lingering around the 100/60 levels, her GP, Dr Salamone has lowered the dosage on another of Alyssa's BP meds. As mentioned before, the goal is to continue to ween her off of as many BP meds as possible. This however, will not be accomplished overnight, it will be a long term project.

As she continues to feel better each day, Alyssa was hoping to go back to work at Bed, Bath and Beyond soon, but Dr Salamone emphatically put an end to that discussion for now. She told Alyssa that among her 2,600 patients, Alyssa was by far the most critically ill over the past three months and that it will take her a while longer to recover and regain her strength. Not what Alyssa wanted to hear, but not surprising news to any of us that have observed her trial and tribulations since January.


Friday, April 24, 2009

4/24/09 - What A Great Trip!

Greetings, we have just returned from the "Land of the Mouse." Limited access to the Internet, and, to be honest, a need to avoid thinking about medical issues, kept me from keeping you up-to-date, but all went extremely well. Alyssa loved her time in the sun and only had a few "bumps in the road" with her peritoneal dialysis treatments. Following is a recap of the week's best activities, but as one who has the attention span of a fruit fly, I'll keep it brief.

We left last Thursday, flying non-stop into Orlando. A connection free flight was a must to eliminate the possibility of getting stuck somewhere without access to her dialysis equipment and supplies. We found out quickly that traveling with a person with special needs is a very challenging proposition. We use to worry about whether we packed enough underwear and socks...now we need to focus on such things as getting dialysis supplies delivered to the hotel, where will they be stored and where do we find access to items such as a scale. The latter was procured during a midnight run to an all night CVS store. But don't worry, we all wore clean socks and underwear every day.

Our first few days were spent with Grandma Deff at her Melbourne Beach winter retreat. It was nice to just relax for a few days with visits to the beach/pool , a little shopping and a great deal of talking with grandma. She has been down here since Alyssa fell ill, so much time was spent filling her in on what Alyssa has been through.

On Saturday we switched our home base to Reunion, Florida, a small town near Disney World, to begin attending Ryan's baseball games at Disney's Wide World of Sports. Trying to avoid Disney's exorbitant prices, I hit the web and found a great deal at the Reunion Inn, a new golf resort, with three courses designed by Arnold Palmer, Jack Nicklaus and Tom Watson. For half the cost of what Disney wanted, we had a three bedroom villa that felt bigger than our house.

We attended all of Ryan's Athena games, with the team going 6-0. Ryan got to pitch in the big stadium, which is the spring training home for the Atlanta Braves. We also did a couple days in the Disney parks. The weather was perfect - warm days and cool nights - providing us with a nice respite from the chilly Rochester temperatures that we had been experiencing.

Alyssa did very well with her PD treatments. She kept in daily contact with her nurses back in Rochester, providing them with updates on her vitals and getting advice on how to handle a few issues that popped-up. Her blood pressure readings remained good throughout the trip, which prompted her doctor to eliminate clonindine from her daily meds.

The best part of the trip though was just watching Alyssa smile and laugh again. She was able to spend a week away from doctors and tests and just able to be old self again. Sun, baseball, Disney, beaches, grandma and her first real shower in three months...all the ingredients for a great week, which is exactly what it was. The only thing missing were brothers Mark and Kyle who stayed back in Rochester for Kyle's games.

We've learned over the last few months that life can be very fragile and as such, you need to make the most of every day. The past seven days were spent with this in mind and will never be forgotten by all of us.

Now back to work...it's time to start looking for a kidney!

Tuesday, April 14, 2009

4/13/09 - PD is Going Great!

Four nights completed on Peritoneal Dialysis and everything is going great - in fact, better than planned. It's been an adjustment for Alyssa, but both her mind and body have adjusted well to being in charge of her dialysis. Her blood pressure readings continue to drop, so today her nephrologist decreased one of her BP meds and plans to do the same with others if she continues this great turnaround. The biggest issue has been getting her to eat more protein, which is a critical element of successful PD. She was sick for so long that the thought of eating any kind of meat just doesn't appeal to her at all. She is now drinking protein shakes to help fill the void.

More good news - her blood labs have continued to improve with every draw, so much so that she will be going back to Rochester General Hospital tomorrow morning to have her PermCath catheter removed! This is a big step as the catheter had been used for both hemodialysis and plasmapheresis treatments. However, both her hematologist and nephrologist are confident that she will not need either of these treatments for the foreseeable future. The risk of infection is the number one concern for patients with catheters, so removing it has always been a priority of her doctors. The one drawback (pun intended) is that all of her blood draws have been through this catheter, so Alyssa will now have to be "poked" once a week for her labs. But removing the catheter will allow her to take a regular shower, eliminate the bandage that shows through all of her clothing and most importantly, she'll be able to swim when she goes to Florida on Thursday. Oceans and chlorinated pools are okay - rivers and lakes are not.

Not all with Project Alyssa is positive today. We've tried to never give up hope that her kidneys would recover, but one of the many lessons that we've learned from this ordeal is that you have to deal with the facts as they are and react accordingly with an aggressive plan of attack.

It's been over three months now since Alyssa went into renal failure. Recovery of kidney after three months is very rare, so today her nephrologist told her that she is now classified as being in End-Stage Renal Disease (ESRD) which is defined as when the kidneys permanently fail to work. She has already shown us a miracle or two with her recovery so far, so we'll never rule out another one, but we will be moving forward.

Never wanting to end on a low-note, the good news is that we will begin the transplant process as soon as we get back from Florida. This is often a long drawn out procedure, so the sooner we begin, the better! We know that Alyssa is "one in a million," but we're confident that there is a match out there for her!

Thursday, April 9, 2009

4/9/09 - Passed with Flying Colors!

Alyssa successfully completed her Automated Peritoneal Dialysis (APD) training on Thursday, so she is now officially on home dialysis and in total control of her dialysis treatments. Yes, it is a scary thought, but as the "Townie" (Rob Schneider) said in the movie Water Boy..."You can do it, you can do it all night long," although we're taking a different slant on this memorable piece of movieology. But that's exactly what APD is - doing your dialysis treatments all night long as you sleep. And, we know that Alyssa can do it!

One last PD lesson for you.
- Automated: automated means that the fluid exchanges are done automatically by a machine called a "Cycler." In APD, the treatment is done at home at night while Alyssa is sleeping. If you remember in yesterday's post, we talked about CAPD, where Alyssa was required to manually perform her treatments , (up to five exchanges per day,) throughout her waking hours. With APD, she will still have five exchanges, but they will all be done by the Cycler as she sleeps.

The steps in APD are

  1. Start the Cycler
  2. Connect the new bags (2)
  3. Connect Alyssa's transfer line (tube from her abdomen) to Cycler
  4. The fluid exchanges are done by the Cycler during the night
  5. Disconnect from the machine in the morning
  6. Have a normal day!
Alyssa will need to perform APD every night and must plan on at least nine hours for all of the exchanges to be completed. There is flexibilty as to when she starts. If she gets home late at night, she will just have stay in bed a little longer the next morning to get her nine hours in - this is beginning to sound more like her life before dialysis.

APD can be performed anywhere that there is electrical power. The dialyisate flows from her body right into a five gallon jug, which can be disposed of down the toilet. It's a very complex procedure that has been brought down to it's most simple and basic level. There are patients on APD that range from new born babies to those in their nineties. As with any procedure of this nature, the number one concern is infection. However, by following the process that they have taught her, Alyssa should do just fine on APD; and we know that she will thrive on her new found independence.

Alyssa - You Can Do It!

Wednesday, April 8, 2009

4/8/09 - Great Start!

Day one of Peritoneal Dialysis (PD) training is done, and in the books; and like the Red Sox, it's an opening day victory! Alyssa easily and successfully went through four exchanges of CAPD: Continuous Ambulatory Peritoneal Dialysis today, which is step one in her move from hemodialysis to PD. CAPD is the manual method of performing PD, where the solution exchanges are done manually at home, normally with four exchanges daily, seven days a week, by the patient.

  • C- continuous: dialysis solution is always inside the “belly” cleansing the blood in a continuous manner.
  • A- ambulatory: ambulatory means that between exchanges, you can move about freely and continue normal activities like going for a drive, walking, studying, sleeping or purse shopping.
  • P- peritoneal: this type of dialysis makes use of the peritoneal membrane that covers the peritoneal cavity in order to cleanse the blood of waste products and water.
  • D- dialysis: dialysis is the process of removing all wastes and excess water from the blood, in PD using the peritoneal membrane as a filter.
The process itself is very simple, with gravity pushing the new fluid into Alyssa's peritoneal cavity and the cleansed fluid out. Following are the steps that she follows for each of her four daily exchanges:
  • Step 1) Attach the new bag
  • Step 2) Drain: this means letting the solution go from the peritoneal cavity (by gravity) to the so-called drain bag, which takes 15-20 minutes
  • Step 3) Flush: this is when the system is ‘flushed’ with unused solution for approximately 10 seconds. This ensures Alyssa is made clear of bacteria that may have entered the system when the new bag was connected
  • Step 4) Fill: filling the peritoneal cavity with the new solution. This normally takes less than 10 minutes
  • Step 5) Dwell time: this is when the dialysis solution is inside the peritoneal cavity between exchanges.

For Alyssa, CAPD will only be used as a back-up to APD (Automated Peritoneal Dialysis) where exchanges are done automatically by a cycler machine as Alyssa sleeps. But that's tomorrow's lesson, so back to CAPD. It's important for her to know how to perform CAPD as it will need to be used if we experience any loss of power, and we all know how often that can occur in upstate NY. Alyssa will use CAPD through Friday morning, then switch to APD on Friday night.

She did two exchanges during training then two more on her own at home this afternoon and tonight. The critical aspect of each exchange is to maintain a sterile environment around the tube that has been implanted into her abdomen. A dropped line while she is connecting or disconnecting from the solution bag could cause her a trip to the hospital; so not surprisingly, her hands were a little shaky today, but true to the task. Tomorrow she learns APD.

...and by the way, BP and blood labs continue to be great - I never get sick of saying that!


Monday, April 6, 2009

4/6/09 - Lab Results

Good lab results again today so no need for plasmapheresis treatment this afternoon. Let the good times roll!

Sunday, April 5, 2009

4/5/09 - Peri What?

...and that magical roll just continues on and on. Another great day for BP and only a slight bout of nausea. Alyssa hasn't had a single reading over 130 for a week now! Removing this issue should help make her Peritoneal Dialysis training go much easier this week. Keep those toes and fingers crossed!

mentioned Peritoneal Dialysis many times, but haven't really explained how it differs from the more traditional Hemodialysis that Alyssa has been receiving since falling ill; and more importantly, how it should benefit her. So let's get stared with Dialysis 101.

Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure - acute and chronic. Alyssa has acute renal failure which typically has an abrupt onset, but is potentially reversible. Chronic renal failure progresses slowly, over at least three months, and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

Healthy kidneys clean your blood by removing excess fluid, minerals and toxins. They also make hormones that keep your bones strong and your blood healthy. As your kidneys fail, harmful toxins build up in your body, your blood pressure may rise, and your body may not make enough red blood cells. When this happens, you need dialysis treatments to replace the function of your failed kidneys. Dialysis removes substances such as water, salts, and waste products (from the body’s normal metabolism), which build up in patients with failing kidneys.

There are two primary forms of dialysis treatments available.

Hemodialysis (HD), is where the blood is cleaned outside the body and then returned to the body. This treatment, done in a hospital, or a dialysis clinic, is normally done 3 times a week, with each session taking about 4 hours. In HD, a machine and a filter are required, as well as a system to get the blood out of the body, and return the cleaned blood to the patient. In most patients, access to the blood is done by inserting two needles into blood vessels on the forearm. Alyssa's access is currently through her Permcatheter that is also used for her plasmapheresis treatments. But this is not a long term solution due to infection risks that are inherit with this type of catheter. Those awful needles are looming in Alyssa's future!

Peritoneal Dialysis - Continuous Cyclic Peritoneal Dialysis (CCPD) is the form of PD that Alyssa will receive. Through the use of a machine called a cycler, dialysate fluid will be instilled through a soft, hollow tube, that has been surgically placed into Alyssa's lower abdomen near the navel. The solution will remain in the cavity for several hours. During this time, waste products and excess fluid pass from the blood into the peritoneal cavity. After the completed dwell time (period the dialysis solution is in the abdomen), the solution will be drained from the cavity. This process is called an exchange. The process is repeated again three to four times per night. In theory, Alyssa will sleep through the whole process as the cycler automatically controls all the various steps. In Alyssa's case, she will need to perform CCPD every night for approximately eight hours per night.

Why switch from Hemodialysis to PD? For Alyssa there are many advantages...since she doesn't have to go to a dialysis center for treatment, CCPD gives her more control. She can do treatments at home, at work or on trips. It allows her to have a normal work schedule. It's much gentler on her body as the process is done over eight hours versus three. But, the biggest reason for Alyssa - NO NEEDLES!

She is very excited to make the change this week! We'll keep you posted as to her progress.

Saturday, April 4, 2009

4/4/09 - Catching-up

Things have been rather mellow with Lyss, so I took a couple days off myself; but news continues to be positive. Alyssa has flown through two dialysis treatments and almost a week now of great blood pressure readings. We still aren't sure what's caused this big change, but we're enjoying every minute of it. The icing on the cake is that her ongoing nausea has been on hiatus. She's still not eating the way we'd like, but her appetite is slowly returning and she's becoming more of a "player" at the dinner table.

Next week is going to be a big one for Alyssa. On Monday, she returns to Rochester General for the all important blood labs. Monday will also mark two weeks between plasmapheresis treatments and satisfactory labs will allow her extend this streak. On Tuesday she will have what we hope will be her last hemodialysis treatment as she is scheduled to begin her peritoneal dialysis training on Wednesday. Daily sessions will take place for the rest of the week. If all goes as expected, dialysis will become a nighttime activity undertaken from the comfort of her own bed.

Tomorrow we'll provide you with a short tutorial on peritoneal dialysis.

Wednesday, April 1, 2009

4/1/09 - No Jokes Here

This is no April Fool's Day Joke...Alyssa has had great blood pressure levels now for 4 days running. Nary a reading above 120! I'm afraid to even say it so as to not jinx her. We are assuming that her new wonder drug, Tekturna, has caused what we call The Tekturnaround. This relatively new-to-the-market drug wasn't even available in the hospital - I had to go to Wegmans to get it filled for her. The addition of Tekturna is the only significant change that has been made in the last week, so all hail the miracle drug...may it's powers rein forever!

While it's a little early to start talking about decreasing her other BP medications, this what we ultimately would like to do as there are some nasty side-effects from some, including nausea and exhaustion. She seldom eats now and continues to sleep a vast majority of the day - two symptoms that we would love to see go away!

Other good and important news - Alyssa will begin peritoneal dialysis training on 4/7. If all goes well, that will also be the date for her last hemodialysis treatment. The peritoneal team is pushing this up so that Alyssa can go to Florida in mid-April for some much needed R&R. It is also hoped that she will tolerate peritoneal dialysis much better than she has the hemodialysis as it is much easier on the body. And, she does it at home, so no need to drive to Irondequoit anymore! YES!