Traveling Man

Franklin, Indiana

Our first long trip out of town since dialysis takes us to Franklin, Indiana, about 20 miles south of Indianapolis. Jeannie's son lives here, so we're staying with him. We stopped in the Quad  Cities and picked up Jeannie's other son Matt and his son Jacob. We had a full car, but it was a fun ride from the QC to Franklin.

We're going to check out Super Bowl Village today and tomorrow, taking part in the NFL Experience. This is as close as I'm probably ever going to get to a Super Bow, so I'm looking forward to checking it all out.

Traveling like this meant we had to make arrangements for dialysis. This has always been a scary proposition for me, but it came down to a choice of who or what was going to determine how I live my life. Dialysis has to be a part of the consideration when traveling, but I guess it was time to stop leeting it be the ball and chain that it sometimes feels like.

The decision to travel was made easier since DCI has a clinic in Indianapolis. If I have to go somewhere else for dialysis, I guess I'm glad that it's another DCI. It should be an easier transition.

The clinic here is a 27-chair facility. That makes it similar in size to the one I go to in Omaha. I just checked in with them, and they have me setup for a 4:15 start on Saturday. They may be the same size, but to have a 4pm shift on a Saturday tells me there are a lot of dialysis patients in the area.

Now that I'm working on losing weight, traveling also presents a challenge. Making sure I continue to eat right while we're away from home is always tough. Paul has weight equipment here, so I should be able to do some exercise this weekend, so as long as I can keep my eating in check, traveling shouldn't be a big problem.

So far, I'm down nine pounds in my first three weeks of healthier eating. That works for me!

Once I'm settled into my dialysis chair tomorrow, I will post again.

Losing Weight with Kidney Diease

One of the things Dr. Frock, the nurses, and the dietician told me in my first few months of dialysis was not to try and lose weight. They wanted me to eat well, which I figured would help me weather the three days of dialysis.

Since I'm nothing if not a good patient, I ate well. Every now and again I would do some exercise, but it seemed like every time I got started working out, my fistula would act up,or something out of the blue would flare up. Regular readers here will recall my bout with the UTI. I was on a pretty good workout roll at that time, but the UTI derailed me.

Now, here I am with about 30 pounds of unnecessary weight, ready to get rid of it, and still maintain the kind of health I need to withstand dialysis. I've been working out for the past three weeks. Admittedly, I haven't got myself into a great workout rhythm yet, but I have lost 8.5 pounds, so I'm not doing too bad.

The challenge with losing weight with kidney disease is that food that you know promotes weight loss is a no-no on a renal diet. Wheat bread and wheat pasta are not kidney friendly, too much dairy is a bad thing, and you still have to be reasonable when it comes to hydration. Factor in the three days of dialysis, and I think it's clear that this isn't going to be the easiest thing I've ever done.

I've been down the workout/losing weight path before, so I have an idea of what I need to do. For exercise, I've been following the workout routines that the trainer I worked with a couple years ago gave me to follow. I knew it would pay off to keep those workout sheets!

For diet, I've been keeping one eye on the renal restrictions and adding in some food from Chris Powell's latest book, along with his suggestions for mixing up high carb/low carb days.

I also used Dr. Rob Huizinga's book, "Where Did All the Fat Go?" as a blueprint for the kind of weight loss I wanted to achieve. Dr. H is the main medical guy on the Biggest Loser, and he takes the success he's had with at home contestants and put together a nice road map to follow.

Tomorrow is the first lab work that I've gone through since starting my weight loss program. I"m anxious to see what kind of impact my changes have had. Once I have the results, I'll post them alongside my previous month's numbers.

The Care Conference

One of the things that happens at DCI, and maybe it happens at all clinics, is the Care Conference. This is a brief meeting of the dialysis patient and the social worker, dietician, nurse manager, and in my case, Dr. Frock.

The first meeting happened pretty early on in my dialysis experience. I think it happened within the first month, and then again at six months, and then there was yesterday's conference. There isn't a lot of new ground broken at these meetings, since I see Dr. Frock once a month, and I have regular conversations with the others. It does provide a forum for all the parties to discuss my case at the same time. Since Jeannie only gets her information from me, the conference is a chance for her to hear from everyone directly, which I think is good for understanding.

I had two things I wanted to talk about with the group yesterday. The first item was the length of each dialysis session. Since going to the fistula for my dialysis, I've tacked on an extra 10-15 minutes to the time I'm at the clinic. The extra time is due to waiting for my arm to stop bleeding after the needles are taken out. I usually clot up pretty fast, but by the time someone comes and tapes me down, a nurse listens to me, and I get my blood pressure checked, I'm the last one out the door.

Since I go to work after dialysis, it's important for me to have enough time to get home, eat, and shower before heading in to the office. I've talked with Dr. Frock about cutting 15 minutes off my time, which would at least put me back to the time I had when we were using the catheters. Dr. Frock's answer to this was simply, no. He is not a fan of cutting back on time. He believes his patients should have 12 hours a week of dialysis, and that's it.

So, yesterday I wanted to talk about this with everyone in the room. My blood work is sensational and the number that shows how clean my blood is getting, the KT/V, is also above normal. I thought I had a good case.

Dr. Frock brought it up right away. I told him that I needed at least 15 minutes and maybe even a half hour to be able to get into work to handle my responsibilities there. While I really wanted to sit in the dialysis chair for less time, the bottom line was being able to get out of the clinic at a decent time to allow me to eat, get ready for work, and get to work by noon or so.

To show I was interested in other alternatives, I also mentioned I would be willing to come in earlier, as long as it didn't put stress on the staff and the current on/off schedules of the other patients. It turns out that Janet, the nurse manager, was going to implement an earlier starting time of 5:45 for the first patients. She offered me the 5:45 start for next Tuesday, which should give me an extra 30 minutes. I'd rather have less dialysis time, but 30 minutes is 30 minutes.

My other question was about my Epogen shot, which started up again last Tuesday. I stopped getting the weekly shot because my hemoglobin had gone up to around 12, which is above the range where they issue the shot. Sometime in between the January labs and the follow-up blood draw that happened around the 13th, my hemoglobin dropped, causing the resumption of the Epogen shot.

I learned all of this yesterday. When I needed to hear it was the day I got the shot. Instead, all I heard was that's the way the computer shoots out the instructions, so that's why I got the shot. I don't do well with explanations like that, so I asked Jan, the dietician about it. She showed me how to calculate my hemoglobin, so I would be able to tell from my hematocrit number what was happening.

Janet apologized for that explanation, gave me a more in depth explanation, and we moved on. It wasn't a big deal, but I do like to know why things are happening to me, and blaming a computer for all of that isn't very comforting. I like facts, especially when it comes to my care.

After getting through my two questions, we talked about my transplant status, and then the dietician and social worker added their comments. Everyone was real positive about my outlook and my health. I think they are all rooting for me to get a kidney, so I can get on with my life.

And that's the care conference. Pretty quick, but it's a nice way for us all to sit down and talk about my case.

And So This is Christmas

One of the things that I keep coming back to, especially during the holidays, is the importance of gratitude. Over the last few days, I've been aware of how I've been feeling lately, and I realized that it has been a very long time since I have felt this good.

I've noticed that I'm not as cold as I had been. It seemed like it wouldn't have to be very cold inside or out to get me to put on a long sleeved shirt. While at work the other day, I actually rolled up my sleeves, which I haven't done in a couple of years.

I also noticed that I'm not falling asleep at night after we eat dinner. This is something that has been a problem for me for several years. Sometimes, it's simply a matter of not getting enough quality sleep, but even when that wasn't an issue, I nod off without any warning. Lately, however, I'm staying up without falling asleep after dinner. It feels good to be more productive during the evening, and even if I don't actually do anything, it's nice to be there for Jeannie and not dozing off all night.

Both of these changes coincide with a recent up tick in my hemoglobin. Since dialysis began, my hemoglobin has been somewhere between 10-11. Good enough for dialysis, but I'm still kind of sluggish at that level. Since the middle of November or so, my hemoglobin has been hovering around 13.5, which is dynamite!

There's been only one downside to this, and I'm not sure yet that I can connect the two things, but I"m getting black and blue marks easier. We noticed the other day that I had black and blue marks in places that don't typically bruise. For example, I've got two bruise marks on my stomach. My stomach? It's the craziest thing. They just appear out of nowhere.

I mentioned this to a nurse at the dialysis clinic the other day, and she told me that it's probably time to drop the dosage of heparin I get during each session. Like I said, I don't know what, if any, relationship there is between the heparin, the increased hemoglobin, and the black and blue marks, but something's going on. And, it's nice to know that for now, the things that are going on are good things!

So, Merry Christmas to everyone out there in the blogosphere. Be sure to take some time to count your blessings today and everyday,

Try This

As I've written several time in this blog, we have a pretty steady routine going with the thrice-weekly dialysis treatments and the every two-month leukemia maintenance treatments. Throw work in to the mix and the once a month trip back to the Quad Cities area to visit family, and we have a pretty full life.

But, just when you think you're dealing with all you can deal with at one time, up pops another little gift. A gift that serves to remind us that we have the capacity to handle much more than we do in our day to day lives.

My reminder was a UTI, and no, that's not the University of Texas International! Okay, there's probably not such a place, but we're only a few days from the start of another college football season.

It's easier to joke about the UTI (seriously, it's a urinary tract infection) today, because I'm taking medicine to get it taken care of. I don't think I could've written with as much jocularity a couple of weeks ago.

I first became acquainted with the UTI on August 14. I was running in the morning, and it seemed like the more I ran, the more it felt like I needed to go to the bathroom. I ended up walking for most of my outing that morning. I hit the bathroom as soon as I got home, and that's when I noticed the lovely burning sensation and a hint of blood in my urine.

Naturally, I did what everyone does in these situations. I went to the internet to get my medical advice. From what I could tell, I didn't have the symptoms for kidney stones, so I went with the UTI. I wasn't freaking out about it, although I didn't care much for the pain I felt each time I used the bathroom. I figured I would call Dr. Frock the next morning and he would be able to prescribe something for me.

What I didn't count on was that Dr. Frock was in Red Oak, Iowa seeing patients. Surely, if I asked the girl that answered the phone in his office to get a message to him, he would call me back, right? Wrong. I didn't hear from him Monday, so when I went to dialysis Tuesday, I asked Angie, my nurse, to give him a call. She reached him right away, and he prescribed Bactrim, once a day for five days. If that didn't do the trick, he wanted me to call a urologist.

I picked up my Bactrim Tuesday and took it as prescribed. The only thing that seemed to get better was that the blood in my urine went away. Otherwise, I still had as much, if not more, pain. So, on Monday, I called the urologist. The soonest I could get an appointment was Friday, so this was going to be a long week of pain.

On Friday I journeyed to the urologist's office, where I got blood drawn from my arm by the nurse, and a surprise prostate exam from the doctor! Dr. Konigsberg prescribed Cipro, twice a day for 10 days. Since starting on this Friday evening, I'm just about pain free.

To be on the safe side, I need to go back in a couple weeks for a follow-up visit, which is going to include a couple procedures. One test will be a CT scan, but the other one is going to be a cystoscopy. He didn't call it that. No, Dr. Konigsberg just told me that they were going to look inside my bladder to make sure everything was okay. Again, using the internet as my source, it sounds like this involves needles going in through places that have never been stuck before. Bogus!

Dr. Frock had tipped me off to this in his monthly visit last week. He said it hurts, but he reassured me I've had worse pain. I'm not sure I buy that!

I'm waiting now for the scheduler to call me to set up the appointment for this day of fun. I expect I'll hear from them today to get a date.

The moral of this story? Don't think it can never get worse, because it always can. At the same time, we're never given anything we can't handle, so like everything that's come before this latest adventure, we make the adjustments and get it taken care of.

The pain associated with the UTI, and the discomfort that follows once you're out of the bathroom, has kept me on the sidelines with my exercise. This afternoon, I'm going to try and work out. If that goes well, I'll run this evening while Jeannie walks. It will feel good to get back to moving again.

Race Day 2011

It's Saturday afternoon, and it's been almost three hours since crossing the finish line at the Bix. I did it! My time was 1 hour and 37 minutes, which was better than last year's time by almost seven minutes. Last year's race was run in cool, rainy weather, but today was a gloriously sunny, warm, and humid day.

There were a couple of firsts for me in this year's race. Obviously, this is my first race with the catheters in my chest. We put some extra gauze under the catheters and we covered the dressing with Saran Wrap. I didn't have any problems keeping that area dry.

The other first, kind of a small thing, but certainly something I didn't do in the last two races, was filling out the medical information on the back of my bib. The bib is where my number is displayed. I figured this would be a good year to start filling in the medical information, just in case. I had a strategy for running this year, but with the heat, I wasn't 100% sure how it would go. I was a little worried.

My strategy worked pretty well. I ran for the first 35 minutes of the race, which included the Brady St. hill, which is an absolute monster right at the start of the race. Going up the hill, the runners, over 20,000, filled the road from curb to curb as far up the hill as you could see. I felt great after going up Brady St. I knew this was going to be a good day.

When I hit 35 minutes, I decided to walk. After climbing one hill, I wasn't too sure I needed to run up another hill, at least not right away. I walked for three minutes and then I started running again. When it was time to climb a hill, I walked. This paid off, because it kept something in my tank for the finish, which is what I wanted. I wanted to finish strong.

I have to say that I felt pretty good for the entire distance. There was a time or two where there was no shade, and that was a bit uncomfortable, but as long as there was shade, and water now and then, the seven miles was manageable.

By the time we got back to the Brady St. hill, beginning our descent back to the finish line, I was running full steam ahead. I was committed to running across the finish line. Once I got to the bottom of the hill, I started looking for Jeannie. I finally found her as I turned the corner and headed down the last 1/8 of a mile to the finish line and the parking lot of the Quad City Times. There I would find water and snacks, so I made sure I finished strong.

I lost a month of training when my fistula got worked on. Looking back, I should've pushed myself a bit harder, because I think it would've helped me run longer during the race. This year I'm feeling like the Bix will be a springboard to continue working out and getting more fit, instead of the culmination of things and then just slipping back into a pattern of little or no activity.

This is my third Bix. the first year I was simply someone with leukemia. Last year, with the leukemia gone from my body following treatment, I was a leukemia survivor. This year, I'm a dialysis patient, running just as well as I did a couple years ago and keeping up with the others around me. Next year, I would love to run as a kidney transplant recipient. That would be great.

Here's a link to the Bix 7 website. http://www.bix7.com/2011/

Cramping My Style

If it's Saturday, and it's early in the morning, it must be a dialysis day. The dialysis experience is generally not too bad. I've mentioned before that anything that can leave me feeling as good as I do is worth a little inconvenience.

Last Saturday I had an experience I haven't had in quite some time. I got leg cramps during treatment. If any readers of this blog are dialysis patients, you have probably had this happen to you too. For me, the cramping is the worst part of the whole deal.

Most days my feet are the first to tighten up. This usually starts around 90 minutes to two hours in. I try to keep my feet and legs moving, to keep them loose, but by the time three hours are in, I have to ask to be turned off. It seems like I very rarely make it through a whole dialysis session without this happening.

As it turned out, last Thursday I was able to get through an entire session without asking to be turned off. A red letter day for sure, because the longer  I can stay on, the better my chance of getting off all the fluid that I put on in between sessions.

Last Saturday, with Thursday's success fresh in my head, I was committed to staying on for the entire four hours. At 2 1/2 hours my feet started cramping. No sweat, I thought. I can tough it out. The cramps in the foot come and go, so I was trying to notice how far apart the cramps were happening. Finally, after 30 minutes of being tough, I realized the cramping wasn't letting up, so I asked to be shut off.

When the machine is turned off, the blood is still getting cleaned, so the transfer is still taking place. The only difference is that no fluid is getting removed. For me, this isn't terrible, because I don't come in to dialysis with a lot of fluid on in the first place.

So, about 10 minutes after being shut off, my left leg cramps. Fortunately, Judi, one of the terrific nurses at the clinic, was standing close by. She came over and pushed on my foot, which helped considerably. Of course, I know my  leg cramps, and I knew it was just a matter of time before it moved. As long as it didn't move up my leg, I knew I would be able to get through this round of cramping.

Of course, at this time of morning, other patients are ready to come off and go home, so it wasn't going to work having Judi continue to stand by me and push on my foot. So, when she went to take another patient off, I pounded my fist into the arm rests every time my cramp reminded me who was in charge. And then the fun started.

I could feel my face getting warm. Not a good sign. I've passed out twice at dialysis, back in my first few weeks of treatment. Each time, the warm face thing was part of the lead-in to passing out. Judi was with someone next to me, so I told her I was feeling warm. That's when she noticed my blood pressure had dropped to 98/65, another sign that I wasn't doing too good.

Even though I had about 15 minutes left to go for my four hours, Judi decided it was time to take me off, get my blood returned, and put an end to this before I went out. All of this business happened over 10 or 15 minutes, but when you can't stand up or do anything to stop the cramping, the time feels like an eternity. I was happy to hear they were taking me off early.

Once they had me off, my blood pressure bounced right back up, so that was a big plus. I was able to stand up and put some weight on my cramp, and that helped too. The cramp went away, but I could feel the knot in my leg. The knot stayed with me for the rest of the day, serving as a reminder that next time I had better ask to be turned off with the first foot cramp. It was a reminder that still resonates this morning as I write this.

My left foot is getting that feeling, as if it's ready to cramp. So far, it's just been teasing me with cramping, but as soon as it starts getting serious, I'm going to be calling out around the world, because there will be cramping in the streets.

An Odds and Ends Day

It's funny how normal days, those days where there's no discussion of transplants, kidney disease, fistulas, or dialysis, feel so good. Yesterday was one of those boring normal days, that I so badly want to return to.

It was my brother-in-law's 75th birthday celebration. Nothing fancy. Just all of us getting together to talk, laugh, and just be together. In the space of almost 3 1/2 hours, it was cool to just be a part of the laughter and the stories that had nothing to do with getting poked with needles or visiting with doctors for the latest pronouncement on my condition.

As I've mentioned before, I think these kind of days help my family get more comfortable with being around me. No one seemed worried that I was going to drop another request for a kidney in the middle of the celebration. That makes it easier for me too.

A thought that I keep coming back to in recent days is how different we are when it comes to dealing with doctors and our medical conditions. A friend of mine shared with me that he learned he has cancer, and although it looks like it was detected early and there are plenty of reasons to be optimistic, he shared with me how difficult it is for him to deal with the doctors.

What can you say about that? I'm certainly no expert on the subject, but I know that I want to live. If that means I have to ask questions over and over until things make sense to me, I'm going to do that. We have to be advocates for ourselves, and hope that comes across to the health care providers, so they understand that they can't bullshit their way through a visit.

Something else I see, especially in the dialysis clinic, are people that won't take care of themselves or take advantage of the resources available to them to help them navigate through something like kidney disease. It sucks to have to come to dialysis, but the payoff after each visit is another day of feeling better. Between dialysis and paying closer attention to what I put in my mouth, I'm feeling better today than I was feeling a year ago at this time. Certainly, I can't be the only one who picks up on the positive things that happens when we take care of ourselves.

This is what happens when I have idle time to think about stuff. I need some more hobbies! Maybe I just need some more normal days like I had yesterday. Those sure are nice.

Frightening the Family

As anyone who goes through an experience with any kind of illness will tell you, it is critical to have a good support system surrounding you. I have that, and it has made this whole process much easier to go through.

I've written before about my wife, but it goes without saying that without her in this with me, I would be floundering.

My family has been great too, but it's clearer to me now that all of this stuff is a bit frightening to them. I send out updates to everyone as things happen, because we're scattered all over the place. E-mail updates seemed to make the most sense.

I usually hear from a few people with every update. Words of encouragement usually, but sometimes they have more questions too, so I like being able to answer those for them.

When the whole transplant thing became more realistic, and I was writing about this to them, the replies became a little less frequent. Admittedly, I may have caused this, because in each of the updates I was explaining how "easy" it was to donate, and in each of the transplant updates, I encouraged them to get tested to see if we would be a match.

I know how big of a request it is to ask a family member to donate a kidney. My mistake in all of this has been to discuss it in a way that makes it sound like it's a walk in the park. Part of that comes from us getting more comfortable with the whole transplant process, to the extent that it really doesn't seem like a big deal. The other reason I took such a positive approach to explaining the process, was that I didn't want to make it sound like some crazy out of this world thing that looks like a last resort.

So, along the way, I feel like I did the very thing I was trying to avoid. I've since sent out an update that was supposed to help people feel more at ease with saying no, because I don't want anyone feeling guilty about not wanting to donate, or not being comfortable with the whole donation idea.

The other thing I noticed in my updates and during those times when we would be gathered together for a birthday celebration or something was that my kidneys always seemed to be the center of the conversations I was having. There I was, letting the kidney disease become the thing that defined me to my family.

With all that in mind, I was absolutely ecstatic when we got together with family on Friday, and my kidneys never came up. It felt like a breath of fresh air, and it showed everyone that I wasn't going to follow them around and nag them about whether or not they wanted to get tested. Maybe it was a missed opportunity to recruit, but there will be other times for that, and maybe, the space will encourage some to ask more questions. We'll see.

The Working Life

I haven't written much about my work, so I thought I would spend a little time writing about how work works.

The day I crashed back in September, I was sitting at my desk, working along on my list of things to do for the day. I left before saying too much to anyone other than those in offices close by. I heard from my immediate supervisor later in the evening or first thing next morning. Her position was not to worry about anything and focus on getting better.

When dialysis became a definite thing, the first thing I worried about was how this would play at work. I am fortunate in that I can do my work anywhere there's an internet connection, so I knew I had options. My only worry was how those options would be viewed by my boss and my co-workers.

When I went back to work on the Monday after my crash, everyone was glad to see me. Once I got my dialysis schedule, I thought we settled into a pretty good routine. I told the President of our company that I planned on taking work with me to dialysis, because I wanted to be productive. I asked my supervisor for work that I could do while at dialysis, but I never got any response to that. So, being the self-directed guy that I am, I started looking at my daily work and looking at what I could take with me to dialysis.

I've been working 2-3 hours each dialysis day, generally, ever since. I like it, because it makes the time go by quicker in the chair, and it keeps me up to date on my work. I get an internet connection through my cell phone, and armed with a laptop, I can keep up with my work and when I need to access my desktop at work, I can do that too.

As I said, I think the President of our company is happy with me being able to continue to be productive. I haven't missed any deadlines with my work, and I'm able to help people as I always did. So, while most of my fellow dialysis patients sleep or watch TV, I plow through my work.

Does this mean everything is rosy at work? Optimist that I am, I know that the people who are important to my work are fine with what's happening. In fact, I can only think of one person who has struggled with my new schedule and work habits. I had to remind this person that I would be happy to switch places with them, if they thought I was living a life of ease.

There's no question that my kidney problems have caused a lot of people to make adjustments at work, but I guarantee you that no one on my job has had to make the adjustments that Jeannie and I have had to make in all of this. Between the two fights I've had to take on with my health, I've discovered that people and situations that used to make me nervous or anxious, don't have the same impact on me.

When I feel a little fear rising up inside of me, I quickly review what I've been through, and what I have to look forward to going through, and the fears tend to subside. I'm lucky to work where 99% of my co-workers are supportive and appreciative of my willingness to keep moving forward. Looking at that percentage just now, serves as another reminder to me that one person who swims against the current isn't worth the stress or worry that they try to cause.

How about those of you out there fighting the good fight with your kidney issues? Are some of you able to continue to work? I feel so lucky to work at the kind of job where I'm able to work remotely, and just as lucky to have a company that gives me the ability to do that.

Work gives me a sense of purpose, and once we established a good routine with the dialysis and the other visits to doctors and hospitals, the work gets done like it always did. I"m actually looking to do more, which is very exciting.

So, while I wait for the news that someone is willing to get tested and donate a kidney, I'm going to keep doing my work. As the saying goes, "those that matter don't mind, and those that mind don't matter."

It took a lot to happen before I got my head around this, but life is definitely too short.

Fistula Follow-up

I had my follow-up appointment with Dr. Feldhaus on Thursday afternoon. He was pleased with how everything sounded, and as I went through my list of questions with him, I got a better explanation of what he actually did last week during surgery.

First, it turned out that my fistula wasn't completely trashed. He was able to clear the clot and open the fistula up. In doing that, however, he had to cut away an area where the vein and artery are joined together. Rather than stretch the two so tightly to join them, Dr. Feldhaus used a small piece of graft material to join the vein and artery together. This allowed the rest of my fistula to work as before.

I found this to be great news, because I thought that my fistula was doing really well, at least before it was infiltrated. Which brought me to the last question on my list for Dr. Feldhaus.

Was my fistula damaged by a careless tech, or was it still not developed? He didn't beat around the bush with his answer. He said he and his fellow surgeons see this kind of thing all the time. Now, he didn't think anyone deliberately did anything to my arm, but he did tell me he hears stories all the time about this kind of thing happening, and he sees the results.

I go back to see Dr. Feldhaus in a month. Hopefully by that time, the last little bit of swelling will be gone, and he will give the okay for the clinic to begin using my arm again for dialysis. Ultimately, that's the thing that matters most to me. Starting back with my fistula means we're getting closer to removing the catheter.

Doubleheader Day

No more butchering song lyrics, at least not with this post!

I'm in dialysis earlier than normal today, because it's doubleheader day. Once I finish with dialysis, I go home for a few minutes and then it's off to Bergan for some repair work on my fistula. Regular readers will remember that my fistula was infiltrated by one of the techs a few weeks back. Well, today, after a couple of reschedules, Dr. Feldhaus is going to go in and either clear the clots and widen the fistula, or he will place a graft in my arm to replace the fistula. I don't know that I have a preference for what he does. I just want to get back to using my arm for dialysis instead of the catheters.

Doubleheader day means that I didn't enjoy a slice of bread before going to dialysis as I usually do. It also means that I can't enjoy any ice chips while I'm in the chair. To prepare for this afternoon's event, I have to be empty.

Since it's Thursday, I'm hoping the UNMC transplant team will discuss my case today, and that Dr. Morris will be in the room for the conversation. That should give me the final answer on whether or not I'll be able to proceed with the transplant.

Before signing off this morning, I'm curious about something.

It's easy to assume that the things we're going through in life are unique to us. The reality, at least the reality I've encountered over the years, is that many of us go through the same experiences in our lifetime. With that in mind, how many of you reading this blog are going through kidney issues? I can tell you that sharing the experience, and realizing that there are others dealing with the same questions and concerns, helps make the whole thing a little easier to handle.

Thanks in advance for sharing!

Maintenance

I'm hooked up and receiving my maintenance treatment of Rituxan.. We met with the Nurse Practioner and Dr. Tarantolo this morning. Dr. T gave us some more thoughts on how the CLL would behave with the anti-rejection meds from a transplant.

He believes that one of the drugs I'll get will suppress the CLL. I believe he was talking about Ropamune. He agreed there are risks associated with the transplant, but he thought those were of a low probability. He's going to call Dr. Tim Call at the Mayo Clinic, a doctor who specializes in CLL, to see if he has access to any data on CLL patients getting kidney transplants.

The benadryl is kicking in. It's all a part of the pre-med cocktail I get before the Rituxan begins to flow. I'm plenty relaxed now, making spelling errors to beat the band! My typing is about a step or two behind my thoughts.

Ethel is taking care of me this morning. She just brought over some wipes that they use to remove adhesive marks left on the skin. She wiped off my left arm and then left me a wipe to use on my right arm.

While waiting for Dr. Tarantolo this morning, I was thinking about our appointments before treatment and all the kidney issues. He used to ask me what concerts I would be going to, and we would talk about those.  Since dialysis began, we really haven't done much in the way of traveling or taking in any concerts.  It may not be fair to blame all of this inactivity on dialysis, there's no question that it changes things.

We may be stopping treatments soon too. Since the treatments aren't doing anything positive for my kidneys, and that was the main reason Dr. T started me on treatments, he may just go back to monitoring my situation. That would be great!

Monday's PET scan was clean as a whistle, so that's more good news! Now, all we need is the phone call from Holly at UNMC. Let's get moving on the transplant!

The Waiting is the Hardest Part

With apologies to Tom Petty, there's no question that the waiting can make a person crazy. Although work is busy, there just seems to be enough time to go have this crazy conversation with myself. Is a transplant the right thing to do? Am I trading away a longer life with dialysis for a potentially shorter life with a new kidney?

Sitting here and writing this now, I feel like I know the right answer to this dilemma. There's nothing that says I would experience what the two cases in France experienced. Those two people were older, and I don't know how severe their CLL was when it made its comeback. I'm healthy and getting healthier. That has to be something in my favor, right?

There are no guarantees. There are so many things that could happen that are out of my control which could cut my life short, none of which would have nothing to do with my current health situation. All I can do is keep a handle on the things I can control and make sure I'm giving myself every chance to succeed. That's something I used to tell my high school bowlers. The stakes are higher in this case, but that's still a true statement.

I'm fortunate to have people around me who are willing to lay it all out for me. I tend to maybe dwell on the positives too much, when I should be paying closer attention to the risks. I've always thought of myself as a bit of a coward, so I think all of this must be causing me to evolve.

Tomorrow is my appointment with Dr. Tarantolo. I'm looking forward to hearing his take on this. I should also get a call from Holly tomorrow too. It's going to be a big news day.

Kidney Transplant Evaluation - Day 2

The second day of evaluations was interesting. Generally speaking it was a more positive day than our first day. Not that day one wasn't a positive experience, but as they say, you remember the negative sometimes more than you do the positive. The words from Dr. Morris are still lurking in the back of my mind, but I'm getting a better handle on that now too.

One of the things Dr. Morris kept trying to get across to me was that transplant is not a cure. I remembered that yesterday, and I fully agree with that. When I get a new kidney, I'm still going to be a guy with IGA nephropathy. A new kidney won't change that. But, I'll be a lot smarter about this, having gone through what I've gone through since September. If they put a new kidney in me, I will care for that thing so well, I will get the maximum life it has to offer me.

So, armed with that attitude, Jeannie and I arrived at UNMC around 7:15am, and checked in for my ultrasound. We ended up in the wrong place, but while I was there I was able to get my second lab done. It was a good mistake and I was glad to get that out of the way right away. We were guided down to the right place for the ultrasound, so we ended up being there on time.

The ultrasound was no big deal, but I was glad that the gel was warm and not cold. It's the little things! The tech doing the ultrasound was chatty, and she explained what was happening on the monitor. The grainy black and white image was hard for me to focus on, but she was happy with the pictures she got.

Since I had to fast before this test, and I had to eat before 9am to prepare for the afternoon's stress test, we headed up to the cafeteria to eat breakfast. From there is was on to two consultations.

The first was with a nutritional person. Her name was Meghan, and she must have been an intern. She told us she was hoping to get a job after her UNMC experience ended. She had lots of good things to say about my lab results.They were the best she had seen that week, and it was her opinion that I was in good shape for a transplant.

Our next stop was with a staff psychiatrist. Dr. Keim and I talked for about an hour, and I was able to share my thoughts on Wednesday conversation with Dr. Morris. We talked on a variety of topics, and when we were finished she told me that she would speak in favor of the transplant when everyone got together to discuss my case next week.

My final stop for the day was the Heart Center. I had an echo-cardiogram and then a stress test. This was wild. The stress test is medically induce with a couple different drugs. First off, they got my heart beating so loud it felt like it was going to jump out of my chest. Then they added another drug that made my heart race like an Indy race car. The pictures they got were pretty awesome. At least they were to me.

The doctor that was supervising all of this said that I passed the test. I wasn't worried about that, I guess, but you never know, right? He guided the nurse through injecting the medicine that would slow down my heart, and within about10 minutes or so, my heart rate was back to normal. One of the side affects of all of this was a really bad case of dry mouth. The nurse warned me about this before we started, and she didn't undersell. I had to slam down the water during the rest of the day to finally feel normal.

I noticed this morning I came into dialysis a little bit heavier than normal, but as I write this I can see that most of it was water, and it's coming off just fine.

So now, we wait. The transplant team meets next Thursday to determine if I will be eligible to be placed on the transplant list. I'm hopeful, but given how the conversations went with the doctor and the surgeon, I have to be open to the possibility that they will make me wait.

To pass the time next week, I will get to focus on a Monday PET scan and then a maintenance treatment for the CLL on Friday. In between, I'll have plenty of work to catch up on. It should be a fast week.

Kidney Transplant Evaluation - Day 1

Yesterday was my first day of transplant evaluations. It was a long day, with plenty of ups and downs. I was really looking forward to getting started with the evaluation process, but by the time we wrapped up yesterday afternoon, I wasn't so sure.

The day started out fine. I had a 7:30am appointment to get my blood drawn, get an EKG, and get a chest x-ray. These three things weren't any big deal. I'm in good shape, so I wasn't worried about the outcomes for any of the three tests. I got a kick out of how much blood was drawn. When the girl started on the 10th vial, I was sure there wasn't going to be anymore blood left in me. Turns out there were a couple three more vials left in me. I don't ever remember having that much blood drawn at one time.

Once all three of these tests were finished, Jeannie and I headed to the cafeteria. I had to fast before this blood draw, so I hadn't eaten anything since 9pm the night before. The cafeteria had great food, and I was thinking that this was a good thing. Eventually, Jeannie's going to be eating several meals from here, so I was hoping the food was good.

After we ate, we headed down to our next set of appointments, both related to finance. Our first appointment was with the Pharmacy Financial Counselor to go over the medicines that I would be taking post-transplant and the financial impact that would have. Fortunately, thanks to a good insurance plan, the financial impact will be practically non-existent. This was the perfect lead-in for our next appointment, with another financial counselor, this time to talk about the costs for the transplant and the testing I was going through.

Again, thanks to a good insurance plan, the transplant was not going to be a financial hardship for us. The same is true for any donor that wants to get tested, and if eligible, give me their kidney. All of that is covered too. We were both on cloud nine after hearing both assessments of our insurance situation. I've mentioned this in previous posts, but we are truly blessed with how well the insurance is working out for me.

The two financial discussions were quick. So quick, we ended up with almost 90 minutes to kill before our next appointment. Thinking we would be going without much downtime, I didn't bring anything to read, so I went and tracked down a newspaper from the gift shop.

We were scheduled to join three other families in a conference room to watch a 45-minute video on the transplant process. It was an interesting video, but as it turned out, we watched it over the weekend. I came across the links to the video on the UNMC website a week or so ago, so Jeannie and I watched them over the weekend. It didn't hurt to see them a second time, so we each made some notes with questions to ask the transplant team when we met up with them in the afternoon.

Here's the link to the page with the video: http://www.nebraskamed.com/transplant/kidney/info/process/transplant_evaluation.asp

After lunch we met up with the transplant coordinator. She is an absolute bundle of positive energy. She's doing the perfect job for her personality, and I said again that I couldn't believe how great this was all going. We saw the Nurse Practitioner next, and she asked some more medical history questions, and we had a long chat about my CLL. She was great with us, but she expressed concern about the effects of a transplant on my CLL. Her questions were fair, I answered them the best that I could, and when she was finished, she said she was sure I would have no problem getting a kidney.

The transplant coordinator came back in; Holly is her name, by the way, and we talked some more about how we would get notified when a kidney was available, how the transplant list worked, and when I would be placed on the list. Then, we got our first less than positive visit. We met Dr. Morris.

Dr. Morris came in to see us after finishing a transplant. It was my first meeting with him, so I don't know much about him, but he was pretty blunt with us, which left me a little bit shaken. He wanted me to be able to make an informed consent when it came time to agree with the transplant. So, he hit us with all the negatives related to my transplant candidacy.

The anti-rejection drugs will weaken my immune system, which could lead to a re-occurrence of the CLL. He threw out a scenario where I may not live three years with my transplanted kidney. If that happened, it would not have been a good decision to give up dialysis for something that would kill me. The concern is that a transplanted patient has a higher risk of developing tumors and infections following the transplant. Bad as dialysis is on our lifestyle, it won't kill me.

"CLL is CLL," he said to me, when I tried to explain that the degree or severity of my CLL was such that we thought I would be a good candidate. This comment got under my skin. He lost me after that, which fortunately was near the end of our chat. When he left, Holly came back into the room, and we talked about what had just happened. Looking back on it today, I can't help but think that she was playing good cop to the bad cop played by Dr. Morris.

In the middle of our conversation, Dr. Miles came in to visit. He would be the last person for us to talk with on this first day. I went right to it, recapping what Dr. Morris had said, and how I thought it was hard to imagine him saying "CLL is CLL." I asked Dr. Miles if he believed that there was no degree to this type of disease.

He agreed that there was, but he maintained that the transplant, especially with a cadaver kidney, could cause problems. I told him that I thought that between him and Dr. Tarantolo there should be enough brain power to come up with a plan for how to deal with any post-transplant issues. He agreed with that too. Things were looking up. I don't have a problem with exploring both sides of an issue, as long as we truly explore both sides.

Dr. Miles asked some more questions and then we were done. The first day of evaluations was in the books. I go back tomorrow for round two. More tests and two face to face meetings. I have to go back on the 22nd for one more meeting that couldn't get scheduled during these two days of evaluations. Once that is done, the transplant team will meet to go over my case again and then a final decision will be made to put me on the transplant list or have me wait.

I need to work on seeing if someone will feel inspired to donate a kidney, but I'm going to wait until I hear for certain that I will be eligible.

Getting Fit

Controlling my weight with diet changes worked good for a time. It just wasn't enough, and even though I had dropped quite a bit of weight, I wouldn't have said I was healthy. As I mentioned in the last post, we had two guys from Progressive Fitness come in and talk to us about doing training at our office. In that moment, I decided this was exactly what I needed to finish what I had started.

I met with Matt on their first visit to our offices. We talked about the fitness goals I had, and I think I expressed myself pretty well. I knew what I wanted in terms of a goal weight, and I knew generally that I wanted to feel healthier, which I know is what everyone says,but I had an idea in my head of what healthy was.

So armed with my goals, we setup a plan where I would workout with Matt once a week and then I would spend the other 4-5 days of the week working out on my own. Matt told me later that this was not typically how they did things, but I convinced him that I was motivated to do the work on my own. All I needed was guidance on the best exercises to do for the goals I set for myself. And, I needed to be accountable to someone. This was perfect for me.

Matt turned out to be a great trainer for me. He motivated me to keep going and he wasn't afraid to push me to work harder when he was with me each week. He had a plan for me, and we followed it. He started on developing my core strength first, which got me to be better at balancing myself for the off-balance stuff we did every week. As my core strength came together, we did more muscle/strength training. All the while, mixing up the exercises so my body was kept off guard. THis was critical to the success we had.

When the dust and sweat settled, I had lost close to 40 pounds during the time we trained together. I didn't drop the weight in Biggest Loser numbers, but I had a steady 1-2 pound loss each week. I had some moments where I would plateau or maybe not get in all the workouts I needed for the week, but generally speaking, it was easy to lose the weight and get stronger.

Easy sounds strange, and I feel a little odd using that word to describe what it took to lose the weight and the inches off my body. Going through the workouts wasn't always easy. Matt pushed me as my body got into the routine of working out. I started running about halfway through our time together. That was something I didn't know I could do without hurting my knees, but it turned out to be something I really enjoy.

At some point I want to be able to do for others what Matt did for me. I would love to do personal training. The kidney issue has held me back some on this goal, but I think it's something I can get done. And, it's something I think I would be good at.

During the treatments for the CLL I wasn't able to workout like I had become accustomed to. Once the treatments were finished, I got back into the routine again. Now with dialysis three days a week, I've had to modify my workout schedule again, but I've got a routine that works for me. I'm back to running again, and I'm getting ready to run my third Bix, a 7-mile race held in the Quad Cities. I've got almost two months to get ready, and I'm already further along in my preparation than I was a year ago at this time.

It never occurred to me that CLL and kidney disease was going to stop me from exercising. I've made some modifications, but I'm going to keep pushing. I"m sure the exercise has contributed to how well I've been able to weather the treatments and the dialysis.

Attitude Test

I believe we are always tested. It could be in our work, it could be at home, or it could be with our health. I've always believed that how we face our challenges matter more than the challenges themselves. To date, I feel like I've handled the health tests pretty well. Certainly better than some of the other tests I've faced!

Dialysis with the catheter was fairly uncomplicated, and the adjustments I needed to make with the catheter hanging from my chest weren't the end of the world. Back in December I had a fistula placed. This was a pretty cool experience, and in the weeks following the placement, it was quite the show and tell item with my friends and family!

The fistula is a merging of an artery with a vein.That merger created a buzz within my arm that people are either fascinated by or uncomfortable with. As it developed, the buzzing was more prominent, a good sign that it was strong and going to be great for dialysis when the time came to tap into it. The official term for this buzzing is "the thrill."

Once I cleared all the checks from the surgeon who placed it for me, we were ready to give it a whirl. The staff at the clinic were looking forward to using it too. It was the beginning of the process of getting the catheters removed.

They start you out slow, with a small needle, and gradually work their way up to a bigger needle. All the while, the fistula is still maturing. The plan would be that once I used each needle three times in a row with no drama, I could move to the next size needle. Three more times with no drama, and we move up to the big boy needle. Running good with the big boy needle means make an appointment with the surgeon, because the catheter is on its way out.

Well, as we know, things don't always go as we plan them. The first time the tech tried to access the fistula it infiltrated. That's bad, because it means the needle went through the fistula. My first clue that something was wrong that day was the tech saying, "oh crap." Trust me, this is not something you want to hear from someone sticking a needle into you. In less than the time it took to say "oh crap," my arm swelled up, giving me an arm like Popeye! This wasn't good.

With that, I was hooked up to the catheters. The debut of my fistula was not going to be on this day. The nurses and techs were all nice and supportive. "This happens" is what they all said. Initially, I was down about what happened, but I had to trust the expertise of the people around me, so I accepted that this kind of thing truly did happen, and went to work on getting the swelling down on my arm.

It took almost a month before the selling and bruising cleared up enough for the second attempt. On that second attempt, a different tech tapped into my fistula. Eureka! It worked. I was back in business.

I made it through the small needle with no problems for my required three times. It was time to graduate to the medium size needle. This move was also successful, so three more turns at the trough with the medium needle, and I would graduate to the big boy needle.

The first time with the big boy needle wasn't very productive. There was no infiltration, but there was also no blood. I knew I had blood in me, but I wasn't getting poked in the right part of the fistula to do the deed. So, back to the medium size needles for a few more times. The medium needle continued to work just fine.

One of the techs thought that maybe things would go better if I had a fistula gram to make sure everything with my fistula was fine. The main thing was to make sure it hadn't narrowed or clotted. So, I got my appointment for a Friday afternoon and had my fistula examined. The fistula got great reviews from the surgeon who looked me over, and I was sent on my way, confident that the next time they tried to use the big boy needle, everything would go well.

It did. I cruised through my three swings with the big boy needle. I may have even gone a few extra times just for good measure. Finally, I got the okay to make my appointment to have the catheter removed. May 25 was going to be independence day.

I came into dialysis on May 10 excited about the possibilities of washing my hair in the shower without a cape and a towel draped over my shirt to keep the catheter dry. I settled in to my chair, anticipating another smooth day of dialysis. The first needle went in just fine. As the tech was getting ready to start the second needle, some of the other staff were talking with one of the other patients across the way.

There was some laughter, and one of the other techs said something to the tech that was working on my arm, and as the second needle was going in just fine, the tech's ears perked up and she gave one more push into my arm with the needle and I felt it happen.

It was a sting in a place where there isn't supposed to be any pain. I looked down and saw the area around the needle start to swell. Another infiltration. There was no "oh crap" this time. I don't remember what, if anything, was said. All I knew was that my goal of getting the catheter removed was fading into the sunset. I looked at my arm, and I was pleased to see the swelling wasn't as bad as it was the first time this happened.

I ran that day with one needle and one catheter line. I got ice for my arm right away, so I was hopeful the swelling would subside. When I came back fro my Thursday appointment, I thought the swelling had gone down enough to try again. The nurse agreed, so she tried again. The lower needle worked fine,but nothing was happening with the top needle. My arm started to swell again. Time for more ice.

Now I was angry. Not at the nurse. No, I was convinced that the infiltration that happened on my earlier visit that week was caused by operator error. I was sure that the tech that day was distracted by all the fun happening away from my chair. A little more focus and maybe I wouldn't be getting my arm iced.

I shared my frustration with the Nurse Manager, and she did what she was supposed to do. She stood up for her tech. I expected that, but I mostly just wanted to be heard. Despite having the opportunity to vent, I still couldn't let it go. I was back in the chair the next day (my wife and I were going out of town for the weekend), running with both catheters. My anger continued to build as the techs continued to tell me that my fistula probably wasn't developed enough for the bigger needle. Really? The two weeks of running fine don't count for anything? Was it a fluke that I was running well all that time? I couldn't get my head around that at all.

It didn't take long for my body to pick up on all of this anger, and my reward for this really positive outlook I was carrying around, was to get sick. More good news! As I write this entry, I'm still coughing a bit, but I think I"ll be better on Monday. I'm done being angry, although writing about this again has stirred up some of those earlier feelings. These things happen is the way I've got to face this.

One of the nurses thinks my fistula is clotted. That sounds bad, but that can be corrected. I see the surgeon next week, and I'm thinking now he will be making another appointment to get in there and correct the problem. I'm not overly excited about this, but it's better than waiting for my arm to come around on its own, when it's looking like it won't.

So, as another day of dialysis winds down, I'm looking forward to the resolution of this latest drama. The quality of my dialysis has been great since using the fistula. If I can't tolerate the big needle, which is possible, I should be able to do just as well with the medium sized needle. If that's the case, I'll be making that appointment for removing the catheter sometime in July.

I'm crossing my fingers. In the meantime, I have some other cool stuff happening in June that will help me re-focus.

More Lines About My Lifeline

My first post about my wife described the practical side of her contributions to my life. Those are certainly important, but not nearly as important as the emotional support she has provided since all of this drama began.

Jeannie likes to tell people about how much my positive outlook helps me get through the challenges we have faced so far, and the ones that are sure to be coming around the bend. The truth is my positive outlook is a result of the love and support that Jeannie continues to give me every day.

Believe me there have been times when it's been tough to put on a smiley face. In those moments when it's just the two of us, and the enormity of what's taken place in the last couple of years washes over us, it's easy to fall apart. I've crumbled many times, and Jeannie has been there to pick me back up. She's had her moments too, when she has felt sorry for me and all the tests and procedures I've gone through, and the lifestyle changes my conditions have brought upon us both. In those moments, I've had to be strong and remind her that somewhere there are others who are going through the same thing, maybe to a more worse degree or without the support of someone who loves them unconditionally.

It's one thing to declare our love in sickness and in health when we recite our wedding vows, but no one expects that declaration to be tested so early in a marriage. It's something one generally associates with growing old. Well, our test came early. I think we'll pass this test with flying colors and be able to grow old together.

My Lifeline

Since beginning this blog, I completed the paperwork for a kidney transplant and will start the evaluation process in June. Before I get started writing about this process, I need to write a couple hundred words about my wife.

Jeannie and I have been married for two years. I told her about the leukemia when we were dating. Other than some doctor visits, leukemia wasn't something that interfered with our life. She may have been thinking that some day I would need treatment, but it wasn't something we talked about.

I introduced her to Dr. Tarantolo when our conversations turned to treatment. As much as I had already come to respect Dr. T through our visits, my admiration and respect grew after observing how he was with Jeannie when they first met. I introduced them during one of my regular Thursday visits, and he immediately turned to her and gave her the rundown of my condition, what he thought about my prognosis, and why he thought it was time for treatment. He was reassuring and confident, and by the time we were finished talking, Jeannie had a better understanding of my situation, and she felt better about the treatment I was preparing for.

To say that Jeannie was supportive and helpful during my initial treatments would be an understatement. She was with me for the first couple of treatments, to make sure I was doing okay and to make sure I got home safely. She made lunch for us to eat during treatments and made friends with all the nurses. She even baked cookies for the nurses during the holidays.

The Rituxan, easy as it was to tolerate, still sapped a lot of my strength from me. Saturdays were usually pretty good days, but on Sundays I was pretty much a couch potato. I didn't have the energy to help much with the daily household duties, so Jeannie picked up the slack there, doing my work on top of the many things she does on a daily basis. By the time Wednesday would roll around, I would feel a bit more normal. Thursdays were the best, and then it would be time for another Friday treatment.


We celebrated our first wedding anniversary with the leukemia reduced to next to nothing. Our lives got back to something resembling a normal routine.

The kidney problems appeared out of left field. Neither one of us were prepared for what my kidneys were going to put us through. After my second kidney biopsy, we met with a dietician who set us up with some dietary ideas that would be more kidney friendly for me. That was all Jeannie needed to dig in and learn more about renal diet needs and get started on making some changes to what we ate.

Jeannie is a great cook. There isn't anything that she can't put together. I was never worried about her ability to adapt to the needs of a renal diet. She wasn't as confident, probably because she was cooking in a way that was different than she had cooked before. To her credit, she hung in there, signed up to receive renal recipes on-line, and started modifying some of her tried and true recipes to adapt them to the renal way.

Since the September train wreck, our lives have changed drastically. Everything we do has to line up with my dialysis schedule, doctor appointments, and Rituxan maintenance treatments. In other words, we don't do much. This has probably been the hardest thing for her. We used to drive back to see her Mom, her son Matt, and the grandkids, Jacob and Olivia, 2-3 times each month. That all changed with my kidneys.

Our trips back to visit have been cut back to once a month, which I know is not what she signed up for when she said yes to my marriage proposal! I feel bad sometimes that my condition has caused such a change in how we are living. She hasn't flinched a bit, and even though it's been tough to accept some of these lifestyle changes, I am so blessed to be with someone willing to do what it takes to make it all work out.

I can't imagine going through all of this myself. I get great compliments from Jan, the dietician at the dialysis clinic, for the way I've been able to do so great with my renal diet and how well all my lab work has turned out. I can't take any of the credit for that. Jeannie deserves all the credit for going above and beyond the call to make sure I have food that is good for me and my situation. I'm truly the luckiest man in the world.

As we prepare for the possibilities on the road to a kidney transplant, I know it will all be fine because Jeannie is right there with me.