On the back of the pre-procedure for the colonoscopy, there is a liquid diet guide. I scanned the page thinking that I would embedded it here, but default WordPress does not have a PDF block option, and my scanner only outputs PDFs. Good thing it auto-OCRs the document so I can copy/paste most of it.
Do NOT take any RED, ORANGE or PURPLE colored products
You MAY have BLUE, GREEN, YELLOW & APPLE JUICE color as clear liquids
Ugh, more of the ALL CAPS, bold, and underline style of formatting. Further down the page, they list several FOOD GROUPS:
Fruit Juices
Apple, white grape, white cranberries, pear and pineapple (no pulp)
Beverages
Sodas such as Ginger Ale, Sprite, 7up, Sierra Mist, Mountain Dew, green tea, Gatorade, PowerAde, Propel, Kool Aid, lemonade (Crystal Lite, Country Time Lemonade or Minute Maid) must be strained (NO PULP) and drinking water. NO COFFEE at all
Soup
CLEAR chicken, vegetable broth or bouillon
Desserts/Sweets
Popsicles, frozen juice bars, flavored JELLO, Italian ice, sorbet and hard clear candy (jolly ranchers as an example)
Seasoning
Lemon juice, honey, sugar
The closest item to “food” is probably chicken broth, although I’ve never had it by itself versus as part of a soup or dish. I’m getting some white grape juice and we have some Sprite/7up in the house. Looks like I can’t have any of the dialysis protein drinks. We also have lots of JELLO power so I can make a lot of that, but it’s mainly cherry or strawberry flavored so it’s RED.
I’ll probably just drink water or suck on ice for the next 24 hours.
I sent an email to my endocrinologist with my blood sugar readings for the past 3 days as instructed. There was only one highish reading of 168, and I think that was taken soon after eating some late night snacks. Most of the morning/fasting readings were ~90-100 and post-meal reading were mid-100’s. If we use the CDC guidelines and assuming that my glucose meter is accurate, then 80-130 before meals and <180 two hours after meals is normal. I just want to be normal.
I also sent this screenshot from my glucose meter iOS app. The average over seven days was 117 mg/dL. I hope the readings are sufficient to delay the insulin injections, or at least convince the endocrinologist to order another fructosamine test to verify the first set of results.
While we’re talking about lab results, I also did a lipid panel at the same time. The results were all in the normal range except I have low LDL.
The chart above doesn’t mention triglycerides but the Mayo Clinic defines normal as <150 mg/dL. I’ve been on the highest dose of Crestor (40 mg) for many years so it’s probably the drugs doing the heavy lifting. I do want to talk to one of my doctors to see if they can lower the dosage. I don’t believe I’m experiencing any side effects but it’s always better to cut down on medication if possible.
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Updated: 12/15/2020 6:35 am
Blood glucose reading from last night before bedtime was 103 mg/dL and 84 mg/dL this morning. That’s well within the normal range.
Since I’m sharing too much information already, here’s the actual instructions from the prep sheet:
DAY PRIOR TO PROCEDURE Begin a clear liquid diet from the moment you wake up in the morning Prepare your solution according to the direction on the container and refrigerate Be sure to drink an extra 8oz of clear liquid every hour from 11am to 5pm (Gatorade preferred) to keep hydrated, it can be more than 8 oz. At 6pm begin to drink prep solution 8 oz every 10min until 1/2 of it is consumed Place remainder of the solution into the refrigerator
GAS TABLET 9pm take 2 gas tablets with 8oz clear liquid 10pm take 2 gas tablets with 88oz clear liquid
Continue drinking clear fluid until bedtime/midnight
DO NOT TAKE ANYTHING BY MOUTH AFTER MIDNIGHT Except the morning dose of the prep. Beginning 4 hours before your arrival time drink the remaining solution: 8oz every 10 minutes until solution is gone.
Do take BLOOD PRESSURE and/or HEART MEDICATION the morning or procedure with a SIP of water. all other medications hold until after the procedure.
HAVE NOTHING BY MOUTH 3 HOURS BEFORE YOUR ARRIVAL TIME.
First, as a former “professional” typesetter (I worked at an advertising agency part-time for one year while in school), the formatting (bold/italics/capitalization/spacing) drives me crazy. I think they wanted to highlight certain points but there are only a few lines of instructions. The inconsistent formatting actually makes the page look chaotic and harder to read. Not what you want for a list of medical instuctions.
Second, my procedure arrival time is 7:00 am on Tuesday, so I moved my dialysis session to Monday (tomorrow) at 5:00 pm to 9:00 pm. I’m afraid the prep solution will cause diarrhea in order to flush out your GI tract so I can’t start taking the solution until after 9:30 pm. I have to push back the prior day schedule by 3+ hours but still get up at 3:00 am Tuesday morning to finish the prep solutions. I think I’m going to take tomorrow off from work, sleep the entire day, and just stay up after dialysis until I’m done with the procedure the next morning. Probably will spend the entire time sitting on the toilet anyway.
Finally, as I mentioned before, that’s a lot of fluid intake. I finished dialysis at 78.4 kg yesterday so I’ll drink until I get to ~80.5 kg since I don’t want more than 3,000 mL of UF at dialysis, especially if it may be a shortened session. Hopefully I will feel well enough after the procedure to pig-out for lunch Tuesday.
It’s not as large as some other patients but under certain lighting, it looks pretty bad. It also gave the techs some problems today. Everything was going well for the first 45 minutes. Then the arterial pressure alarm started screaming. The tech tried to rotate then reposition the needle but it started hurting. She then decided to switch the needle site so the other tech got another needle and jabbed me without lidocaine. Ooooowwwww! Holy sh*t did that hurt a lot. By then my entire arm was in pain, and my blood pressure was dropping fast. Usually they pull all the needles out at the end of the session, but they pulled the unused one now to see if it wold lessen the pain. Not really.
Since I was getting dizzy from the low blood pressure, the nurse came over to give oxygen and stop the UF fluid removal. Now there are three people surrounding my chair, with me in obvious pain. They ended up reclining my chair and giving me some ice for the arm. There was still a lot of pain but it was slowly subsiding. Great, another three hours to go.
It’s now about 8:30 am so I have another 1:20 to go. Arm is better if I don’t move it too much. Since the dialysis chair sucks and my back hurts if I recline too long, I’m sitting up again, but with the oxygen tube still stuck in my nose under the mask.
I’m weirded out by the huge blood pressure drop. I was very lightheaded and my vision started to blur. The tech said it was a natural reaction to stress and pain. I thought it would go up instead. Here is a chart for the first few hours.
The AHA categories are not too useful. I’m always in Hypertension Stage 1 or Stage 2. Even my low reading of 84/50 was recorded as normal even though I was about to pass out.
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It’s now 5:00 pm. The rest of the dialysis session was uneventful. They unhooked me at 10:00 am and I was out by 10:15 am. I took a short nap earlier, but my arm is still hurting a bit, and my right hand is somewhat numb. I am worried about going into dialysis on Monday and having “strangers” try to cannulate my fistula. I hope they don’t screw up.
My endocrinologist called me yesterday afternoon in response to my email message. I had asked her about taking insulin and whether it was permanent. I also asked her about my “normal” readings with the glucose monitor. She agreed that even though the A1C test was inaccurate, this was only one data point for fructosamine, so I should measure my blood sugar more closely for a few days and send her the results. She wanted a reading before each meal, and two hours after each meal. If the numbers are high, then I’ll need to start shooting myself with insulin.
I started last night and so far, everything is pretty low:
Date
Time
mg/dL
12/10/2020
6:01 am
104
12/10/2020
6:36 pm
92
12/10/2020
10:09 pm
97
12/11/2020
8:03 am
85
I’m not exactly sure what the normal range is for a diabetic. I’ve seen a wide range of numbers, but typically 70-130/140. From WebMD:
I typically measure in the mornings before breakfast so it’s like fasting/before meal. It’s almost always below 100. I’m hoping to avoid getting insulin shots since it’s another complication if I ever want to travel after getting a kidney transplant. A lot of places won’t let you bring needles/syringes in, and usually insulin needs to be refrigerated.
A judge has limited Los Angeles County’s outdoor dining ban to three weeks, even as a state order will keep the restrictions in place past Christmas, according to a ruling issued Tuesday.
At a court hearing, the latest to address a pair of challenges to the ban, L.A. County Superior Court Judge James Chalfant said county public health officials must conduct a risk-benefit analysis if they want to extend the ban past its current end date, Dec. 16.
“The county should be prevented from continuing the restaurant closure order indefinitely.” Chalfant said in the decision.
So the judge ruled that the county health officials made the decision to shut down outdoor dining cannot last forever, and asked them to provide a cost-benefit analysis on the closure. I guess he had the same questions I did regarding the scientific basis behind the shut down. Supposedly only 5-10% of the recent COVID cases can be traced back to a restaurant. Where are the majority of the new cases coming from?
All this is moot since the county order was superseded by a state closure level, and the judge’s ruling only applies to LA County. However, it’s good to see someone else asking for scientific proof before making policy decisions that affect millions of people.
Well, that was much easier than previous tests. Instead of jamming the swab into my brain, they just swabbed the inside of my nostrils for 10 seconds on each side. It was super fast and didn’t hurt at all. Still, the drive there and back took ~45 minutes.
I do have to complain about the test site however. They set up a large, drive-thru tent in the parking lot. The issue was that there were confusing signs everywhere. I believe there was another testing site for another insurance company (Optum) in the same parking lot. That site is not operating but they left all the traffic cones and signs in place. Each of the entrances to the parking lot had an Exit Only sign, and the only sign with clear directions was facing away from the street; you can only see it if you turn in to the parking lot while ignoring the exit signs. I got to the parking lot ten minutes early for my 9:30 am appointment and was still five minutes late to the tent.
They also gave me an instruction sheet that contains a section called Self-isolation Instructions. There is one bullet that says:
If you have other medical appointments, schedule them for before your test or for after your scheduled surgical procedure.
Since they scheduled the test so early, I still have three dialysis sessions to attend before my procedure, and there’s no way I can skip them, especially when I’m supposed to guzzle all that fluid beforehand. The other points on the list are not as bad as the directions I received post-COVID test for my cardiac ablation procedure.
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With the bad results from the fructosamine test, now I’m more worried the colonoscopy. Each new test seems to bring more bad news. 😫
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I just realized that my dashcam captured me gettin lost in the parking lot. If I can figure out how to embed videos in WordPress posts, I’ll include it later.
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And that’s a no. I have to upgrade to WordPress Premium to be able to upload my own videos. I can always upload videos to my YouTube account then embed them in my post, but then I would lose the little bit of anonymity that I still have on this blog.
Each time I see a new doctor, we find something else wrong healthwise. In this case, I thought my diabetes was pretty well controlled, but I guess not. My endocrinologist says that the regular hemoglobin A1C test is not accurate for dialysis patients so she ordered a fructosamine test. This basically tell us what my blood glucose levels are over the past 2-3 weeks. She also claims that most diabetes medicine are not effective for dialysis patients so I may have to use insulin if the test result is high.
Well, the test result came back and they’re high. My number was 479 µmol/L, while the reference range is 200-285. This translates to an A1C number between 8-9, which is clearly in the diabetes range. The strange thing is that my daily glucose number are still lowish: it was 89 this morning. How am I supposed to monitor my blood sugar if none of the regular tests are accurate?
Sigh. Maybe she can wait a few months to see if I get my kidney transplant and come off dialysis.
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F*ck. The endocrinologist office just called and it’s imperative that I start taking insulin shots as soon as possible before the transplant. I’m so disappointed. Don’t these doctors talk to each other? They’re all part of the same hospital/medical group. I’ve been on diabetes medication forever and dialysis for 3.5 years. No one, not my primary doctor, nephrologist, or nutritionist ever said that there was a secret test I need to take because everything else is inaccurate. If the fructosamine test is accurate, then I’ve spent the last three years thinking my A1C was ~5 to 6% when in actuality it was ~9%. WTF? And if it was that high, how was I getting hypoglycemia that was bad enough to require a trip to the ER?
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I’m so tired. I think it’s even more discouraging when you think you’ve made good progress by watching what you eat and exercising regularly, but then find out your lab results were all a lie. How can all these doctors and nurses tell me “good job on controlling your diabetes” when this fructosamine test says otherwise, and it’s bad enough that I have to get daily insulin shots?!
Since I’m getting the related COVID test tomorrow, I went over the pre-procedure preparation instructions. On the day before the procedure, I can only have a clear liquid diet, and they want me to drink 8 oz of Gatorade every hour from 11:00 am to 5:00 pm. First, that’s about 1.5 liters of fluid that I have to get rid of through dialysis, and Gatorade is high in electrolytes like potassium and phosphorus. I also have to mix 4 liters of the Golytely solution and drink 1/2 of it that night and 1/2 of it starting at 3:00 am the next morning. All together, I’m supposed to drink ~6 liters of fluids in the 12 hour before the procedure. They must not have considered fluid restrictions for dialysis patients in their instructions. Multiple people said the Golytely is to flush your digestive tract so none of it should be absorbed. That still leaves about 2 liters of extra fluid. I guess I have to stop drinking right after dialysis on Saturday and hopefully the rescheduled Monday session will be able to remove enough excess fluids. Having fluids in your chest cavity and not being able to breathe sucked.
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From this paper, it appears that the incident rate for colorectal cancer in Asian males is 37.8 per 100,000 people. That’s not very much at all but I haven’t had the greatest luck with health issues.
In preparation for my colonoscopy procedure next Tuesday, the surgical center is requiring me to get a COVID test tomorrow. That means I have to “quarantine” myself at home afterwards for an entire week. They also made the appointment pretty far away in Santa Ana, near the IKEA store. That’s a 30 minute drive from my house and may take longer since the appointment is at 9:30 am. Seriously, it’s a drive through test site so I’ll be there for under 3 minutes but will spend an hour commuting. I hope its the saliva test and not the jam-a-swab-up-your-nose test.
Since I have to go to dialysis, I don’t know how effective my “quarantine” will be. I typically don’t go anywhere else anyway so I don’t anticipate any changes to my routine.
Apparently, Medicare increased it’s premiums for next year. I only found out after received a billing statement for January 2021. For December, I paid $462.70 for Part B. That has increased to $504.90. Since my work insurance won’t pay for dialysis anymore, I have to continue to pay for Medicare. At this point, I believe Medicare will pay 80% of transplant costs, and Blue Shield will pick up the remaining 20%, hopefully. Because I sold some stock this year, and the proceeds go on my W2 statement, my premiums will likely increase again to the highest tier right after I file my taxes.
Weird. I just noticed that almost all my doctors are female and Asian.
Speciality
Gender
Ethnicity
Primary Care
Female
Asian (Vietnamese?)
Nephrologist
Female
Asian (Chinese)
Cardiologist
Female
Asian (Indian)
Endocrinologist
Femaie
Asian (Indonesian)
Podiatrist
Male
Caucasian
For my podiatrist, I was referred to another doctor but she was booked solid so I scheduled a meeting with a different doctor. The original referral was to another Asian (Chinese) podiatrist. Also, my original primary care doctor, who just quit her practice, is also Chinese. I didn’t choose any of these doctors specifically. They were either referred by other doctors, or randomly assigned when I called their medical group office.
This is probably due to the Asian parent effect. All Asian parents want their child(ren) to become doctors or dentists or engineers. That’s why you see such so many Asians in those majors in college, and it skews the demographics when they all graduate and get jobs. I remember engineering school was probably >2/3 Asian students.
My blood pressure is still pretty volatile, like a risky stock price. I took the exact same medication as I did last Saturday: one NIFEdipine ER the night before and skipping the other two medications in the morning. I probably weighed about a kilogram more so maybe there’s more fluid in the bloodstream. Here’s what I recorded from the dialysis machine:
Time
Systolic
Diastolic
BPM
Notes
5:34 am
138
71
61
5:40 am
138
69
59
6:12 am
144
78
61
6:41 am
141
74
61
7:11 am
158
79
60
7:42 am
148
83
65
8:11 am
149
85
65
8:41 am
129
80
67
9:11 am
160
90
64
9:45 am
125
77
69
standing
The readings appear to be 10-15 points higher (systolic) versus Saturday. The head nephrologist was rounding today and he looked at my readings but had no comments. I think the numbers are still high but everyone else at the clinic seems to be fine with the results.
The blood pressure readings also vary a lot depending on how I am sitting. Usually the last reading is taken while standing since your blood pressure drops when you stand. If it’s <100, then they won’t let you leave, especially if you drive. There was a huge 35 point drop from the 9:11 am reading. Your blood pressure is also higher if you are reclined or lying down. I forgot to record how I was sitting at each of the readings so that could account for some of the variability.
I just paid my auto registration for next year. I purchased my car on December 20, 2016, so the car is almost four years old. Unfortunately, the auto registration fee in California for my car has not gone down year-over-year, though I’m certain I’ve lost more then 50% of the car’s value due to depreciation.
Year
Registration
2017
$554
2018
$515
2019
$621
2020
$577
2021
$544
In 2019, I believe the California legislature added $100 to the renewal fees for electric cars so I’m paying almost the same fees in year 5 as when I bought the car. Even with such high registration fees, our DMV and road conditions still suck.
Boom! The update from yesterday had an increase of another 13 cases. My work site is up to 232 cumulative cases so far. For a long time, there weren’t any new cases but the number has exploded along with the rest of California. People are still going to work since we’re classified as an essential business. At least the company has given everyone an extra 10 sick days if you are affected by COVID. Let’s hope one of the several approved vaccines actually work and can slow or halt the growth in infection cases.
Due to the spike in COVID-19 cases, parts of California are being ordered into lockdown again. I believe the criteria is >15% ICU availability and is evaluated by region. Orange County is part of the Southern California region, and the total ICU availability is 10.9%. At the state level, total ICU availability appears to be 14.2% from covid19.ca.gov.
Since March, I’ve been working from home exclusively, and have basically not met with anyone outside my immediately family. I’ve not eaten out, even with outdoor seating, but relied on home cooked meals and take-out. I also wear a mask during the few times I have to go indoor to buy food or groceries. I have a lot of risk factors for COVID-19 so I’m being super careful.
However, I do have some issues with the above order. First, how did they determine the 15% threshold? Why not 10%? Maybe 15% is too lenient and we should be shutting down at 25%. Also, why did they group the statistics by arbitrary regions instead of by county? Orange County is being ordered to shut down since the Southern California region is at 10.9%, but the county is only at 18%.
For sure 18% is a bad number, but if you’re going to make up rules that affect the livelihood and lives of millions of people, should it be more rigorous? Why not enforce the order at the county level when the data is readily available? I’m very lucky that my job is not really impacted by the pandemic so far since we’re an essential manufacturer, and revenues are from long-term contracts that have not been affected so far. I would hate to be a restaurant owner. After 9 months of shut down orders, they have to again decide between closing and going out of business, or staying open and risk losing their business license. Also, what is causing the current spike in cases? Is it from people eating at outdoor seating at restaurants? I’m actually curious since I don’t go anywhere.
Finally, governor Gavin Newsome was caught attending a dinner party with lots of people apparently not wearing masks. When asked about it later, he claimed the party was outdoors but there are some photos and witnesses that seems to suggest otherwise. So not only did the governor violate his own order, but also lied about it afterwards.
The witness also claimed no one at the party was wearing masks, which would seem to violate the state’s guidance that individuals at gatherings wear face coverings at all times when not actively eating or drinking.
Politico reported on Tuesday that top California Medical Association officials were also present at the birthday party.
On Monday, Newsom said he will try to set a better example going forward.
“I made a bad mistake,” he said at a press conference. “I should have stood up and … drove back to my house. The spirit of what I’m preaching all the time was contradicted. I need to preach and practice, not just preach.”
It’s hard to make sacrifices when the actual governor and medical people don’t follow their own rules and recommendations. It appears that the state is forcing restaurant owners to choose between bankruptcy and losing their business license. Likewise, Newsome had to choose whether to go to a dinner party or not, and he chose to go. There doesn’t not seem to be any consequences for the governor “making a bad mistake.” Maybe he should “lose his job” for violating health orders then lying to the pubic about it.
This whole situation sucks and handled poorly by government at all levels.
I’m hosting a demo of the software we are planning to buy. This is hopefully the last “demo” before we sign the contract. Currently there are 17 people online; hopefully Webex will be stable since we need our CFO’s approval to buy the software. He is on the call, along with all his direct reports, and it’s the first time they have seen a demo of the software. We’re hoping no one will have an issue with our choice and we can move on and start implementing the new software.
If we continue with this software vendor, there’s a slight issue when we come to implementation. Due to the pandemic, there’s not much business travel going on, so their consultants will have to help us over the phone instead of in-person. Even worse, it’s a Canadian company so even if they travel to our office, they will have problems returning to Canada afterwards.
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For anyone that has set up meeting at a large company, it was almost impossible to find a free slot for everyone with only a few days notice. I don’t want to try and setup another meeting for all these people again.
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We just had a call to inform the second place vendor that we’re going with another solution. It was a weird call, kind of like breaking up with a boyfriend or girlfriend. We were trying to say “Hey, it’s not you. We just prefer something a bit different.” This one was a bit harder since we did a lot of demos with them. I had to reject a lot of other vendors but since there was less time invested, it was a bit easier. I’m glad I don’t work in Purchasing since it appears that this is a regular part of their work.
Maybe it’s because the Apple Watch is still a novelty, but I’ve walked four three days in a row since I picked it up from the Apple Store. I decided to take the local park route, even though I think Orange County is supposed to go into lockdown mode again. There were still some people in the park, most were walking their dogs. I did see a group of teenagers sitting around a picnic table without a mask in sight. Here is the Apple Fitness data:
For music, I started the 30 min Hip Hop Fun Walk in the Peloton app. The problem was that Apple Fitness tracked both sets of data, so two workouts showed up on the summary. I don’t know how it counts the two sets of data so I deleted the Peloton one. Since it’s all integrated, the next time I use the Peloton app, I don’t need to start tracking on the Apple Watch as well. Also, the green or Exercise ring on the Apple Watch moved a lot after the walk. This walk was a bit slower than the walk around the mall from yesterday. Not sure why that walk didn’t count towards the Exercise amount tracked.
Since it was dark out, I clipped a small flashlight to my hoodie so it would illuminate the ground around me. It’s really for cars to see me since I walk on the street and some areas are pretty dark. I bought one of these from Amazon so I’ll try it out tomorrow.
Another thing my dad and I did this afternoon was to put up the LED lights I bought. It took us about an hour to nail plastic wire holders on the wooden eaves of the house to hold the plastic tube housing. The string of lights is battery powered so we installed that on the inside of the garage where we can turn on/off and control the lighting program with a remote. It was barely visible during the day, but it turned out okay when viewed at night.
It’s not very impressive but it’s the first set up outdoor lights that we’ve put up for Christmas, ever. You can’t tell from the photo but the lights alternate colors and blink on and off. Not bad for our first attempt. I’m thinking I’ll just leave the LED light strip up all year, and only turn it on during December. Each year, I’ll spend another $20 and put up a new light strip on the house somewhere. Eventually we’ll go all out like our neighbor:
Since the charge in my car battery was pretty low, the charging display said it would take an hour to charge to 90%. I was on one of the “urban” chargers that only outputs about 50 kW or ~165 miles/hour. I spent about 20 minutes eating lunch in my car, then decided to go for a walk. I ended up walking around the outside of Santa Ana Main Place. I was going to walk inside too since the mall was open but I forgot to bring a mask from the car so I stayed outside. I felt a little conspicuous without a mask so I walked pretty quickly to avoid any contact or confrontations. Most everyone else I saw had a mask on but they were all headed inside the mall. I ended up walking 0.84 miles at a pace of 19’40”, which is better than 3 miles/hour. It didn’t feel like I was walking that fast.
After getting home and taking a nap, I decided to take another walk around the block. On the Apple Watch, it tracks your daily fitness with three rings: Move, Exercise, and Stand. The idea is to “close your rings” each day by moving and standing enough. I’m fine with those two circles/measures, but the Exercise ring is supposed to track activity at or above a brisk walk. The only issue is the definition of brisk walk. Evidently, 3 miles an hour is not brisk enough since the Exercise ring hardly moved after my round-the-mall walk. On the second walk, I tried to walk at a faster pace but failed. I ended up walking 0.71 miles at a pace of 20’39”. Here is what the rings look like right now:
At the top of the screen, you can see that I’m doing pretty good with the red and blue rings, but I can’t get the green ring (Exercise) to move with consistency. Maybe “brisk walk” actually means “running” or something. From the Move chart, you can see when I got up and went to dialysis at 4:30 am, had lunch and first walk, then went for a second walk before dinner.
Life with chronic diseases 