The cumulative count for positive COVID cases at all our work sites is now 461, with 414 recovered. That means there are 47 current cases overall. Since the communication email does not break down all the numbers by location, I don’t know how many people are testing positive at my worksite, which has over 5,000 people. I know the positive case count was pretty flat for several months but spiked up again in correlation to the overall trend in California. A couple of coworkers said that people have been coming back onsite more regularly but they will think about staying home more often again.
On a side note, the carpool sticker on my electric car expires in a month and I don’t believe I can renew it anymore. I was thinking of buying a new Tesla Model Y so I can get the sticker again, but now it looks like I’ll be working from home until an effective COVID vaccine is widely available. I’m guessing it will be another 6-12 months, and I can’t plan that far ahead. I’ll keep the old Tesla for now since it still drives fine; I just can’t use the carpool lane by myself anymore starting in 2021.
Speaking of echocardiograms, my cardiologist just posted her notes on the repeat exam to the online patient portal. Again, there were a lot of words and numbers that don’t mean anything to me, but I did see a few important results.
LV ejection fraction is normal, at 57.1 %.
Prior examinations are available and were reviewed for comparison purposes. Compared to the study dated 10/29/2020 there is no longer presence of pleural effusion.
The last echo exam already came back with a LV ejection fraction of ~51% so this test just confirmed the normal results. The most important results is the “no longer presence of pleural effusion.” When the cardiologist told me I had fluid in my lungs, I guess they were telling me I had pleural effusion. It is defined as:
A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excess fluid can impair breathing by limiting the expansion of the lungs.
That’s exactly what happened to me suddenly back in April and lasted for about six months. Initially, we thought it was a symptom of my a-fib condition, and it did improved a bit after the ablation procedure. However, I was still having issues breathing, and a later chest CT scan showed there was still fluid restricting my breathing. With the recent “more aggressive” dialysis, I think we were finally able to remove most, if not all, the excess fluid so I won’t need to physically drain the fluid by other means.
I hope the results were sent to UCLA and they’re satisfied with the updated results. That leaves the colonoscopy as the final hurdle for my kidney transplant. Yay!
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Now that I know what I’m looking for, I found this in the results from the first echo exam:
Incidental Finding: There is a moderate pleural effusion noted in the left lateral region.
Interesting that my cardiologist noted it as an incidental finding, yet it was enough for UCLA to halt the transplant process until the fluid was removed and I was retested. Another peril of having two teams of specialists reviewing your medical results. 😷
My dialysis nutritionist told me to stop losing weight. She said it’s not good to be too skinny for the transplant procedure. I remember the vascular surgeon commenting that I was too fat during the peritoneal dialysis catheter insertion surgery but that worked out okay. Since I’ve always been overweight as far as I can remember, it’s weird to have a medical person tell you you’re too skinny. She told me to eat more meat and protein so that when they remove excess fluid, I don’t lose more “dry” weight.
My nephrologist lowered my weight again to 78.0 kg since that is my latest post-dialysis weight for several days now. We’re removing about 3 liters of fluid per session and I’m trying to drink less so we get the last bit of excess fluid in my lungs and lower legs. I have not heard back regarding results of the last echocardiogram but it should show a lot less fluids in my lungs compared to a month ago.
Tri-tip from Stonefire Grill
I’m trying to eat more, which again, is a weird feeling. I ordered a large meal from Stonefire Grill tonight; my parents are going to pick it up right now. I’m also drinking a protein shake from Nepro or Novasource daily in case I don’t get enough from meals. I also have to start exercising more, otherwise all I’ll gain is fat, which is not good for my “new” heart. Sigh… life is so complicated.
This is my Google Timeline map if you include all the dates tracked. The data starts back in May of 2014 and Google thinks I’ve been to 542 places since then. It gives you a list of the most visited places. My list is: 1) home, 2) work, 3) St. Joseph Hospital, 4) sister’s house in Irvine, and 5) carpool partner’s house. Pretty boring and sad. I know it’s due to dialysis but it sucks to have a hospital to be your #3 most visited place, especially when you’ve only been going there since July, 2017.
As expected, most of the markers are in Orange County and the South Bay (Torrance) due to work. Here is a zoomed in map:
I’m guessing most of those are restaurants since that category probably has the most variety of destinations that are visited only once or twice. Other clusters in the main map are: 1) San Francisco Bay Area, 2) Portland (Oregon), 3) Tunisia, 4) Japan, and 5) Taiwan. I made several trips to the Bay Area awhile ago and my sister used to live in Portland; I would visit her about once or twice a year. I also went on a two week trip to Tunisia, and my sister’s family an I visited Japan and Taiwan several years ago, before I started dialysis. There are some obvious errors in the data. One marker is for Piedmont Triad airport in Greensboro, North Carolina. I’m 100% certain I’ve never been to that airport. I think it’s when I gave an extra phone to my sister to use in Canada since my plan covers all of North America, and she may have taken it to NC on a business trip while logged into my Google account.
If I had started tracking earlier, there would be even more clusters of markers near: 1) Chengdu, China, 2) Beijing, China, 3) Hong Kong, 4) Singapore, 5) different part of Taiwan, 6) New York City, 8) Mississauga/Oakville/Toronto, 9) Hawaii, and 10) if you go back 20 years, London/Paris/Rome/Florence for my honeymoon. I made this post because I missed traveling. I used to save my boarding passes on airline flights and one year, I collected 56 of them. I have not gone anywhere since starting dialysis because I only have 2-3 days between sessions, and peritoneal dialysis was everyday. Since COVID-19 hit, there has been very little travel so I didn’t miss much in 2020 but I look forward to a return to normalcy post-tranplant.
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My church cell group brothers said we should plan a celebration trip after my transplant. I casually mentioned South Korea since more of them are Korean-American, but that’s unlikely. Maybe we’ll end up at Las Vegas or something. Hopefully the pandemic will be better controlled. I really want to try the Bacchanal Buffet at Caesars Palace. It’s pretty expensive, with prices starting from $79/person; perhaps I can gain back some of the weight I lost over this past year.
My only task for Thanksgiving dinner was to go pick up an apple pie. I pre-ordered the pie from Polly’s Pies in Santa Ana. It was $16 and I was supposed to pick it up today at 10:30 am after dialysis. When I got to the restaurant, there was a huge line out the door with at least 50 people. This was the pre-order line. I don’t know if they even have extra pies for people that didn’t pre-order. Anyway, I got in line with my mask and it took about 30 minutes to get my pie. I see people walking out with 5 or 6 pies. Excuse me, how many people are going to be at your Thanksgiving dinner? We are only meeting with my sister’s family so seven people in total. I’m guess there will be a few block parties and possibly superspreader events. Ugh.
Pie line. I was almost to the front by now. There were probably 40-50 people behind me in line. Inside the restaurant, there were tables with pies piled 5-6 boxes high.
Since our main headquarters is in California, I guess it’s natural that there would be a spike in the number of new COVID-19 cases as well. The cumulative number of cases at our site is now 188, a jump of 10 in the past two days. Again, I’m not sure if the new cases are from infections at work or outside of work, but I’m really glad that I can work from home. My main project these past few months is to evaluate a new software package. I think we’re about to close the deal with a Canadian company. However, due to border restrictions and quarantine, their implementation team can’t visit us onsite so everything has to be done online. I think that will make my job that much harder but there’s really no choice right now.
I found another website with Orange County COVID-19 data but with details by city and better visualization tools. Here is the number of new cases daily from March:
It’s pretty clear from this chart that there is a new wave of infections. If it’s correlated to people’s behavior during a holiday, then we’re in big trouble since Christmas and New Year’s Day is coming up soon. Here is the hospitalization data:
It doesn’t looks as bad yet but maybe there is a lag from when a person is infected to when they symptoms are serious enough for hospitalization. Alternatively, there were more hospitalizations in the first wave because no one was prepared. Now people in higher risk groups are taking more precautions so new infections are from healthier/younger people that tend to have less symptoms. It’s hard to tell without more analysis of the raw data.
Another thing you hear all the time is Los Angeles County people complaining or shaming Orange County for it’s anti-maskers. I think that’s overblown since I see everyone wearing masks. For comparison, here is the number of cases per 100k for Orange County (bar) vs. Los Angeles County (line):
Los Angeles County is at around 3,600 cases per 100k (cumulative) vs. 2,200 per 100k for Orange County.
Not even close. Sure there are more people in Los Angeles County and the population density is higher, but LA’s case rate per capita is almost twice when compared to OC. If you look at the case rates by city, the anti-masker hotspots of Huntington Beach and Newport Beach are doing quite well in comparison to the rest of OC:
I think it’s fine to make sun of the anti-mask “Karens” or OC housewives but that can’t be the primary driver of the increases in cases. Personally, I think it’s due to people getting “quarantine” fever and going out to attend social functions.
I am scheduled for another echocardiogram this morning. UCLA Transplant Center requested it after my previous one since there appeared to be fluid in my lungs. After running the Crit-Line monitor during dialysis for the past two weeks, I think we took out a lot of excess fluid so hopefully UCLA will be satisfied with the results.
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It’s 11:00 am and I’m back home. The echo scan tool about 20 minutes. This time, I was looking at the machine and saw most of the scan results. Since it’s an ultrasound, the pictures were blurry but you can see the heart muscles and valves pretty clearly. The tech had to freeze frame and trace out several heart cavities on the screen; I guess that’s how they determine volumes. It was pretty weird looking a moving images of your own heart. The worst part of the exam was that the room was pretty cold and you have to remove your shirt. I was shivering for the first few minutes until he covered me with a small towel. I can’t interpret anything from the screen so I have to wait for my cardiologist to call me back.
I had a weird dream this morning. I haven’t had that many dreams recently since my sleep times are so short. I usually fall asleep before midnight and wake up at 2:30 am. This time however, I felt like I was dreaming and awake at the same time. I remember I was talking to an unknown person about my ex-wife, except I wasn’t divorced (so I must be dreaming). The room in the dream was very similar to my current bedroom, which added to the illusion. In the last part of the dream, I was wondering why I haven’t spoken to my “wife” for a long time. When I woke up, I was looking for my ex-wife until I remembered I’ve been divorced for 14 years. Still, I was surprised at the emotional jolt I got when reality kicked in. I read stories about people with Alzheimer’s Disease or dementia who forgot that their spouse has passed away. When they find out, it’s as if they heard for the first time and you can see the grief and despair in their face. I guess this morning’s dream was like that but probably less intense. It was the brief mixing of the dream and reality that confused me.
This is the new case rate for all of California. It seems like the increase is even worse than the second wave during June/July. We haven’t seen an increase in deaths, but that likely lags the number of infections. Here is the number of deaths for California:
For Orange County, the pattern is similar. The relevant data and charts can be found here. The only noticeable thing for me is the re-closing of restaurant indoor seating. It’s also confusing where all the new cases are coming from. Are people having huge parties recently? I read that there are a lot of anti-maskers in OC but I don’t see any where I am.
I’m a bit confused on what is going on with my fluid balance. I thought that I was losing weight but retaining fluids so my weight is fairly constant. Once we started removing more fluid during dialysis, my weight should drop more. My nephrologist thinks there a couple of liters of excess fluid by looking at my lower legs. After a week of using the Crit-Line monitor, my lower legs look pretty “normal” but my weight haven’t changed that much. My scale at home says I’m about 81.0 kg now, which is pretty consistent over the past several weeks.
YTD weight. I’ve been around 80 kg since October but blood pressure is much lower during the last week.
From what the nurse showed me, there’s several “buckets” of fluid: in cells, between cells, and in the bloodstream. I found this chart online:
I’m not sure what my percentages are but we’re trying to remove more fluid than what is moving to the first area or blood plasma. I was told that during dialysis, as we remove fluid, it’s constantly being replaced by fluid in and between cells. It seems to make a difference how fast fluid is removed during dialysis, though I can’t understand why. Here is the Crit-Line graph from Thursday:
Initially, nothing much was happening. After an hour, the chart started to show a decrease in blood volume % change. It seems the flow rate between the different fluid buckets in the body is not constant either. Even though we didn’t change the setting after the marker, the chart values change constantly. Blood pressure is much improved as well, which supports the conclusion that fluid in the bloodstream is lower than before when my blood pressure was up to 180’s. I didn’t caputre Saturday’s chart but the blue wedge was much larger as we removed 3,200 mL of fluid and I ended at 78.4 kg. The only questions is what is different since my weight is about the same. Either I gained non-fluid weight (unlikely) or fluid is being retained in the cells but the absence of edema says otherwise. Very confusing.
Hopefully this time next year I will still be alive from my bypasses, and have received a kidney transplant so life can go back to normal.
Normal = does not suck
Remember I was two weeks out of the hospital, not really mobile, and in the dark about a lot of health related things. A year later, things are better but still no transplant. Life is still kind of sucky but I’m not dead yet. Interpolating from some discreet data points, probably 35-40% of dialysis patients die after 3 1/2 years. Again, that’s probably skewed towards older patients but it’s depressing to think about.
I can’t remember what happened last year but we probably didn’t do anything for Thanksgiving. I don’t remember bringing my walker to my sister’s house. This year, I’m a lot more mobile and pretty much 90% recovered from the bypass surgery. We typically meet at my sister’s house during Thanksgiving since their house is bigger and they have a nicer kitchen. We either have a traditional American Thanksgiving dinner with turkey, ham, and side dishes, or go full Chinese and have Taiwanese hot pot. I think we’re having turkey this year as my sister asked me to bring an apple pie from somewhere.
We use an electric hot plate instead of the chimney pot
This year is also different because of COVID-19. Orange County is a shitshow and in the midst of a third wave of infections.The CDC released some recommendations on having a safe Thanksgiving but it seems like people are still going to travel. I guess we’re not 100% safe either since we’re two households. I’ll probably wear a mask this time; typically we don’t masks when we meet up with my sister’s family.
I’m not sure what’s happening but I have been really tired for the past week. Maybe it has to do with the higher ultrafiltration rate that started this past Tuesday. I’ve been pretty good with fluid control so typically we only have to pull 2 liters of fluid out. This week however, we’ve been pulling 3+ liters each session. I haven’t cramped yet but I am super tired after each session. For example, I was done at 10:00 am today. I then went to Raising Cane’s to get some lunch (4 chicken fingers) then got home at around 11:15 am. I took a nap immediately and didn’t get up until 6:30 pm. Even with such a long nap, I’m still really tired and will probably go back to bed now, even though it’s only 7:45 pm. Tomorrow is Sunday so I’ll probably be in bed the entire day.
I remember being super anxious post-heart surgery. At the time, I was just starting to recover, and didn’t know what was happening with my potential kidney transplant. Little did I know that 2020 was going to get a lot worse. I was freaking out because I thought it would take a long time to get back on the transplant list. I was also dreading dialysis a lot more than before. Yet here we are twelve months later and I’m still on hemodialysis. The long awaited kidney transplant is closer but not guaranteed yet.
I’m a bit worried about losing a lot of weight this year. I was probably around 235 pounds pre surgery and now I’m about 175. That’s a loss of 60 pounds. It’s weird looking at myself in the mirror. I look really skinny in the upper half of my torso. You can really see my collarbone and my upper arms have stretch marks where I lost a lot of fat and muscle. There are so many complications with dialysis and kidney failure that I don’t know what is normal anymore. I woke up at 2:00 am again this morning after going to bed at 11:00 pm. I probably fell back asleep at around 4:30 am then woke up at 8:30 am again. Now I’m tired so I’ll probably nap until the next event on my work calendar at 2:30 pm. I can’t imaging how life would be like if I had to drive into work everyday. Probably falling asleep at my desk all the time.
I guess I’m trying to say that humans are pretty adaptable. I thought I would go crazy if I had to continue dialysis for another year but we’re past that anniversary. I also thought I could not stand locked up at home and was super glad to get back to work in February. Then COVID-19 hit and bam, I’m stuck at home for the next nine months with no end in sight. I’m trying not to plan too far ahead with regards to the kidney transplant since a lot of things could still happen. One of the things I wanted to do post-transplant was to travel again but that looks like it’s not going to happen soon.
Governor Newsome has issued a curfew for all California counties that are in the “purple” tier, which includes most counties including Orange County. The curfew prohibits non-essential activities from 10:00 pm through 5:00 am.
It’s all purple
So I’m not sure how this will help. Are all the infection transmissions happening during that time? Are people meeting up and not practicing social distancing after 10:00 pm? Just not sure why he chose that period when typically no one is out. Also, who is going to enforce this? Local police? Do they have enough resources to stop every car and pedestrian to see what they’re doing out? Madness…
For as long as I could remember, I would take showers everyday or every other day. While I was married, this was often at night since my ex-wife didn’t want me in bed if I was “dirty.” After the divorce, I usually took a shower in the morning before going to work. However, once I got the first chest catheter put in, all that changed. The main risk to a chest catheter is an infection. Since the catheter goes directly to the heart, any bacterial infection in the heart is serious and hard to treat. So for two years, I did not take any showers or baths. There were waterproof bandages that can be used to cover the catheter site, but I’m risk adverse so I avoided getting the area wet. I did not get an infection using the chest catheter for two years. But for two years, there were lots of towel baths and shampoos in the bathroom sink. I think it also got me into a habit of not showering regularly.
After I got my PD catheter and had the chest catheter removed, I started taking showers again. I did notice that I didn’t jump back into the 1 or 2 day shower schedule; I was taking showers less often than before. It’s like that wasn’t part of my daily anymore and taking a shower became an extra chore. When the second chest catheter was put in, I stopped taking showers again until it was removed in September. The additional 10 months didn’t help my personal hygiene habit at all. Now I’m taking showers again, but the schedule is more like weekly than daily. Kinda gross, but again, it’s not part of my daily routine anymore. I think I have to set reminder alarms for showers so I can pick up that habit again.
Pretty sure I’ll run into this problem again post-transplant while the incision heals.
My sleep schedule is all messed up. I’m still going to bed at 11:00 pm-ish but waking up at 2:00 am almost every night. On workdays (MWF), that’s okay since I can try going back to sleep, then sleep in since I rarely have early meetings/calls. For dialysis days, I have to get up at 4:20 am so I usually end up not sleeping. I try to make it up during dialysis but having the blood pressure cuff go off every 30 minutes is not good for sleeping. However, due to dialysis, I’m always tired. I typically sleep for a few hours after dialysis, then do a bit of work, followed by another nap after dinner. Today, I slept in until 9:30 am, then had a bunch of work calls, and took another nap from 2:00 pm until now (~6:00 pm). Yet I am still very tired and will likely fall asleep right after dinner but wake up at 2:00 am again.
I guess I’m lucky to be able to work from home. Otherwise, I’m gonig to fall asleep driving to/from work again.
We had dinner from Stonefire Grill last night. It’s the first time I’ve eaten there. I was getting food for someone in my church cell group that just had a baby. They provided a list of restaurants and I chose Stonefire Grill. Since I was getting their dinner, I just placed a second order for my family. It’s a “typical” American restaurant and the food was pretty good. I ordered the 1/2 chicken-1/2 rib meal that comes with salad and breadsticks. I also got some mashed potatoes and a huge carrot cake for dessert.
Half lemon garlic chicken
The nutritional information is a huge PDF file found here.
Menu Item
Calories
Total Fat
Sat. Fat
Sodium
Carbs
Protein
Baby Back Ribs (half)
420
23 g
8.5 g
610 mg
14 g
35 g
Lemon Garlic Chicken (half)
700
53 g
10.5 g
1170 mg
7 g
48 g
Garlic Mashed Potatoes (medium)
180
8 g
1 g
380 mg
23 g
5 g
Breadsticks (each)
200
9 g
4 g
420 mg
20 g
8 g
Carrot Cake (full portion)
680
37.5 g
14.5 g
445 mg
85 g
5 g
Couple of observations. I’m surprised at the sodium content of the 1/2 lemon garlic chicken. I thought it was kind of bland and needed a to of the lemon garlic sauce to give it flavor. My dad mentioned that the ribs were kind of fatty so it’s surprising that there’s more fat in the chicken than in the ribs. Our meal came out to ~$35 and there was a lot of leftover. I ate most of the salad since that can’t keep once you mixed the dressing.
I was replying to a Reddit post on r/dialysis, and for some reason, I started counting the number of surgical procedures I had related to dialysis. Here’s the list:
First chest HD catheter in (July 2017)
PD catheter in (April 2019)
First chest HD catheter out (June 2019)
Second chest HD catheter in (November 2019)
PD catheter out + fistula in (January 2020)
Fistulagram (August 2020)
Second chest HD catheter out (September 2020)
All of these were outpatient procedures, except for putting in the second chest catheter. I was already in the hospital for my heart surgery, otherwise it would have been done in a few hours total. All together, I was under full anesthesia for only two items on the list that included the peritoneal dialysis catheter. The last one is best. A physician assistant didn’t know I was on a blood thinner so he just cut some sutures and yanked the chest catheter out. Blood spurted out of the chest opening and he freaked out a bit.
I bought one of these from Amazon yesterday. It’s supposed to be delivered today.
List price on the Omron site is $90 but they’re available for $70 retail. We already have lots of blood pressure monitors at home, from a manual mercury sphygmomanometer, to a Bluetooth connected wrist device. All in, this is probably the sixth blood pressure monitor but I really wanted something without the vacuum tubing and that can connect to my phone. I’ve never been able to get a good/accurate measurement on the wrist device so I let my mom have it and purchased the Omron Evolve instead. I need to start tracking my blood pressure more consistently so hopefully the Bluetooth connectivity will make it easier.
Life with chronic diseases 