#SilveradoFire

We have another brush fire here in Orange County. A few years ago, our house was evacuated due to the Canyon2 Fire. Today was one of the windiest days this year and of course, a brush fire pops up nearby.

Map shows where the fire started and the current burn area. The orange/peach area is under mandatory evacuation order. My house is just off the map to the north of the “North Tustin” label. It’s pretty crazy how fast the fire spreads when there is 50-70 mph winds.

I got an emergency notification on my phone from the city of Irvine about a mandatory evacuation early this morning. I was actually on my way home from the podiatrist. He removed the stitches in my toe and said to come back in a few weeks. Anyway, since we weren’t being evacuated immediately, I packed up a few things into five duffle bags/backpacks and placed them near the door. I also plugged in my car so I’d have a full charge if the evacuation order came. It’s been 5 hours and it looks like the fire is headed more SSW than East so I think we’re okay for now.

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A few friends texted me about whether my dialysis center is still open. The center is more to the west so it’s not even on the map above. I think the clinic and the hospital complex will be okay. There is no brush anywhere near the hospital. So regardless of what happens, I’ll be going to dialysis at 5:30 am tomorrow.

Hereditary CKD?

I just found out my dad is at stage 3 of chronic kidney disease (CKD). He was showing me his blood test results from the non-stroke visit and his creatinine number was 1.43. The normal range is from 0.7 to 1.3 so it’s a bit high.That translates to a non-African American eGFR of 45. For comparison, my last labs has a creatinine of 9.63 and eGFR of 6. That is with dialysis.

I told him to call his primary doctor to get a referral for a nephrologist. When I found out about my CKD, it was probably in 2014 and my eGFR was ~50. Three years later, it had deteriorated enough that I needed dialysis and a transplant.

When I go to the hospital or see a new doctor, they ask if there is family history of kidney disease. I always answer no since no one I know has kidney disease. Now I’m wondering how much of my kidney failure is hereditary and how much is from bad living.

Crispy Coconut Rolls

I think I’m hooked. My parents bought a few bags of this snack from Costco and I just ate most of one bag this week by myself.

Here is more information, including nutrition, from the manufacturer. Since it’s a sweet snack made from coconut, there’s quite a bit of saturated fat and sugars. I was more worried about potassium and phosphorus. The nutritional information says there is very little potassium, and coconut seems to be okay on phosphorus. I also didn’t see any phosphate compounds on the ingredient list so I’m hoping it won’t spike my labs later next month.

Fistula Update 10/24/2020

Happy to say that the fistula is working great today. The tech didn’t even use the rubber tourniquet; he just asked me to put some pressure on my arm with my finger below the elbow. Needles went in on the first try and flow has been good. No pain… yet. Thursday was like this too but something hurt really bad for a bit when the needles were taken out.

Speaking of flow, my dialysis prescription is four hours at 350 mL/min, which comes out to 84 liters or ~22 gallons (US) total. All through two (relatively) small needles.

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Ugh. With about 30 minutes left in the session, the top of my third toe on my left foot starting hurting from neuropathy. I think it’s the first time that the pain attack started during dialysis. It was bearable but the tech saw me wince a couple of times and thought it was the dialysis needles. I had to explain that my arm is fine but my foot is killing me. Again, I took two Tylenol pills to see if I can head off the pain.

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The sharp pain in my arm happened again. I think tip of the bottom needle is too close to the top (venous) needle so when the tech presses down to control the bleeding post needle removal, he’s also putting pressure near the tip of the needle still in my arm and it hurts a lot. Last time he said he would pull the bottom needle out first but I guess he forgot. The pain went away as soon as he pulled out the second needle.

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Fortunately, the foot neuropathy pain didn’t last that long. I got some lunch on the way home from dialysis, and took a 3 hour nap after eating lunch. The pain went away sometime during the nap. This seems to be the new pattern: more nerve pain attacks but not lasting as long each time. I’m not sure if it’s the Tylenol or the leg shaking (for increased blood flow) or the calf massage that’s reducing the pain duration. It all seems kind of random; I wish there was more a cause-effect to this.

Cardiologist: Lexiscan® Explained

I had a phone call with my cardiologist today. I thought it was supposed to be a Zoom call but we just talked on the phone. She was very cheerful; I guess that’s a good trait for a cardiologist since her patients all have some heart issues.

She explained the results of the Lexiscan test to me. Basically they were looking for defects or damage to my heart, and also to see if it is reversible. The results showed that I do have some heart tissue damage (infarction), but it’s not reversible. I probably suffered one or more heart attacks prior to the bypass surgery. That was corroborated by my high troponin test results days prior to the surgery showing heart muscle damage. However, she also said that there’s nothing in the test that would rule me out for a kidney transplant. There is some elevated risk, but since I did not have a stroke before, and the bypass surgery basically “rebuilt” my heart, I should be fine for transplant. Of course, the final decision is up to the surgical team at UCLA, but she will send her findings in to them. She also said the chest CT scan indicated I had probably up to 500 mL of fluids in my right lung, but dialysis should be able to take care of that. I think we’ve taken care of that already since my breathing is near normal as my nephrologist dropped my dry weight to 80.0 kg. Finally, she was agreeable for me to stop taking my blood thinner a week prior to the transplant surgery without the need to switch to coumadin/Warfarin. Yay for small victories!

Finally, I made the initial consultation to see a doctor about colon cancer screening. That is (hopefully) the last test I need to take to be cleared for transplant. My sister is already cleared as a donor so I’m finally hopeful that a live donor kidney transplant may actually happen.

2020 Elections

I completed my ballot and will drop it in the mailbox as I leave for dialysis later this morning. I’ve always voted by mail in the past so this is nothing new. I don’t know what Trump is complaining about.

The only vote I’ll disclose is that I voted no on Proposition 23; that’s probably very clear from this post.

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OK, I voted Libertarian for president. It’s like four years ago; both the major party candidates suck, and my vote for president doesn’t count anyway in California.

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One more. No on Proposition 16. If that makes me a torch bearing white supremacist according to the Democrats, so be it. Fight me.

Missed Appointment

Of all the medical appointments I’ve had since the heart surgery, I have not missed any. That is also including my 3x/week dialysis treatments. At some point however, I was going to miss something. Well, today I missed my dental cleaning appointment. I was eating lunch, waiting for a 2:30 pm work call, when the dentist office called me at 2:15 pm. Turned out I had an appointment at 2:00 pm but for some reason, I thought it was tomorrow. I apologized profusely and we rescheduled for two weeks later. Ugh. I even marked the date/time correctly in Google Calendar but must have read the date wrong.

For context, I have the following appointments coming up:

Cardiologist: 10/22
Podiatrist: 10/26
Dentist (again): 11/2
UCLA Transplant Social Worker: 11/9
Endocrinologist: December something
Nurse appointment for shingles vaccine

I also got my referral to see a specialist for a colonoscopy. No date has been scheduled yet but I’m going to make it ASAP.

Fluid Control

I had difficulty sleeping last night due breathing issues again. Without weighing myself, I knew that I was going to be overweight at dialysis this morning. I ended up weighing 83.5 kg, which is not that high, but it is 4.3 kg above my ending weight on Saturday. That’s probably too much. I’m really only given about 1,000 mL of fluid intake per day. Over the three day break, I shouldn’t gain more than 3.0 kg. All this is from drinking too much fluids. I had a few cups from the fountain at work Sunday plus a bottle of orange juice. I also got a Box Combo at Raising Cane’s, which comes with a 22 oz. drink. There were also several dinners where my parents gave me some of their soft drink.

The tech and I decided to remove 3,300 mL of fluids today, which include the saline flush-back to make sure any blood in the dialysis machine is returned to me. The nephrologist doing rounds decided that my weight was low enough so we’re keeping it at 80.0 kg, but we’ll try for 79.0 kg on Thursday. I think the fluid balance is very sensitive since having an extra one to two liters of fluid can affect my breathing. On the flip side, my ankles have been cramping slightly over the weekend. That usually means that we’ve pulled out all the excess fluids. Who knows…

Scam Emails

I’ve been getting a lot of scam or phishing emails lately. Almost one email per day from “Amazon”, “Paypal”, or “Apple Store” asking me to log in and verify my password. Some of the fake emails are pretty good, but then there’s this gem:

Greetings From Amazon.

Your Amazon account where placed on hold and all pending order.
We took this action the billing information you provided did not match the information on file with the card issuer.

To resolve this issue, please verify now with the billing name, address, and telephone number registered to your payment card. If you recently moved, you may need to update this information with the card issuer.

Verify Account

If you are unable to complete the verification process within 24hours, all pending orders will be cancelled. You will not be able to access your account until this process has been completed. We ask that you not open new account as any new order you place may be delayed.

We hope to see you again soon

Amazon.com

C’mon. Fake email is not believable if there are typos and strange grammar. I think the scammers should at least hire a good translator or editor to fix the wording. I thought I was getting scammed by Google Translate or something. I’ve been tagging them as phishing emails in Outlook.com since they’re coming to my hotmail.com account. Hopefully Microsoft is doing something with all these reports.

Why the increase? Maybe all these people lost their minimum wage job in India or Russia or wherever and now turning to phishing scams to make money?

Fistula Bruising

This is what my arm looked like last night:

The purple spots near the elbow are bruises. It looks a bit worse this morning, but they still jabbed me in the same spot. I was instructed to put an ice pack on my arm today, then use a warm compress tomorrow to prevent the vein from hardening. I think this is from the screw up on Tuesday where the needle infiltrated the blood vessel and caused some internal bleeding. Fortunately, it just looks ugly and doesn’t hurt that much.

Also, the chaplain intern showed up today after disappearing for seven months. I’m not sure if he is still in school, or interning full-time. Unfortunately, his English didn’t get any better so I only got ~50% of our 10 minute conversation. It was difficult because I had to ask him to repeat a lot, and I don’t think he understood everything I said. Instead of asking me to repeat however, he just has a puzzled look, then keeps going with the conversation. He said he will be back to the clinic twice a week so maybe he’s making up for lost time.

Santa Ana Supercharger

Since I’m heading into work tomorrow and it’s about 42 miles one-way, I was going to charge up my car at the Supercharger. The battery is currently at about 45% full which should get me there and back. However, I went to get some lunch first and got lazy. Since I was denied yesterday, I went to Raising Cane’s and just got some chicken fingers. I’m not getting combo anymore since I don’t eat the bread and coleslaw, and I shouldn’t be eating fries (potatoes) and getting a large fountain drink. I ended up eating all six chicken fingers in the parking lot. They are so much better hot right out of the fryer. Once they cool in the box, the breading gets soggy. If the restaurant was open for seating, I would probably order one or two chicken fingers at a time so I would always get hot/fresh ones.

The usage at the Santa Ana Supercharger is very inconsistent. Before COVID-19, it would be always crowded during the day. The usage totally dropped off after the pandemic lockdown but hasn’t really recovered yet. I thought most people would be driving again but most of the time, there are several open charger spots. Today, it was about half-full, which means probably sharing a circuit and have slower charging speeds. After eating my chicken fingers, I drove home and will charge up my car overnight.

Podiatrist Visit

Just got home from the podiatrist. Since my cut is at the bottom of my foot, he prefers to leave stitches in for about three weeks. So basically nothing happened today, although he did say it was healing nicely. I have to go back in about another 10 days to have him remove the stitches. He also said I could wear regular shoes if I could get my foot in.

Since I didn’t eat before the appointment, I thought I would go get some lunch. I tried going to Raising Cane’s as I haven’t been there for a week. Even at 2:30 pm in the afternoon, the drive-thru line was totally full and backed on to the main road. I didn’t feel comfortable waiting while blocking traffic, so I kept on driving. It looked like the line would take 20+ minutes as well. On the way home, I tried pulling into a nearby In-N-Out. This one is super busy too, and they keep changing how the drive-thru line is configured. There appeared to be lots of cars in line, and I didn’t even know where the line starts. Defeated, I drove across the street to Carl’s Jr. and got a Famous Star burger. Not the best meal you can get for $5 but I was getting hungry. Where did all these people come from on a Friday afternoon? Late lunch? Early dinner?

*How come nothing ever looks like the promotional photos?*

Neuropathy Pain Again

I’m not sure what is happening but another pain attack just started on my left foot, kind of under the 4th toe joint. This is the third painful attack in three days; I don’t think I’ve ever experienced this before. Once again, it’s super painful but the duration is longer than normal so the pain actually builds intensity. I’m popping Tylenol pills like candy at this point, hoping I can head off the eventual increase in pain intensity that lasts 24+ hours.

Aaarrrggg! Another stab of pain just hit and it felt like it lasted over five seconds. Usually the pain subsides until the next attack but this time, the pain is so intense that it lingers on so that spot is in constant pain. I’m not sure what to do. I’m afraid to massage the spot too hard since the last two times I got a blood blister. Unlike a kidney transplant, I don’t think there is any way to mitigate this. It’s sad, but I can’t remember back to when I was not living with this numbness and pain.

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Fortunately, I was able to fall asleep pretty quickly and the pain was gone when I woke up at 3:30 am (still can’t sleep the night).

Beef Stroganoff Again

My mom must have really liked the Costco Beef Stroganoff since she told me to heat up the other half of the package for dinner tonight. We also finished the salad package from yesterday so we had the exact two items for dinner as we did yesterday. She also thought we wouldn’t have enough noodles left in the package so she cooked some Chinese noodles and ate that with the sauce instead.

I managed to save the packaging so here is the nutritional information for the Beef Stroganoff:

Nutritional Item	Beef Stroganoff	% DV
Serving Size	5 oz
Calories	250
Calories from Fat	130
Total Fat	14 g	22%
Saturated Fat	7 g	35%
Trans Fat	0 g
Cholesterol	60 mg	20%
Sodium	400 mg	17%
Total Carbohydrates	17 g	6%
Dietary Fiber	1 g	4%
Sugars	2 g
Protein	12 g
Vitamin A		0%
Vitamin C		0%
Calcium		4%
Iron		10%

Packaging

The ingredient list is a mile long however.

UCLA Voice Mail (updated)

I received a call yesterday from the UCLA Kidney Transplant Center. For some reason, the caller ID said “Anonymous” but I didn’t see the call either. Anyway, they wanted to verify my email address and send me a Financial survey form. I filled one of these out several years ago. I am already on Medicare which pays for either all of the transplant fees or only 80%. Maybe they want to be sure that I can pay the 20%? I have work insurance through Blue Shield that should pick up any charges not paid by Medicare.

UCLA also wanted me to call Blue Shield to update my coordination of benefits file. This was the huge mess-up from earlier this year where Blue Shield had the wrong cut-over date and thought it was secondary payer when they were supposed to be primary. I thought this was already taken care of but I called to check just in case. Maybe when UCLA calls me back they can clarify.

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Update: 10/21/2020 10:00 am

So UCLA didn’t call me back but the person that called did send me a form via email. The form was a sign-able PDF. It asked for my monthly salary (including stock awards?) and checking/savings account balances. When I completed the form, I digitally signed it and sent the form back to UCLA. Today, I got another email that said they could not accept digital signatures and I had to sign the form with a pen… old school style. Not a problem, but why did they send me a digital signature form if they can’t accept it? Fortunately, they do accept a scanned PDF form. I thought I had to find a stamp and envelope to mail the actual paper form.

Bloody Footprints Again

Sigh, I have terrible luck. Since I couldn’t sleep, after typing the previous post, I decided to cut my toenails. This is always risky since I can’t feel anything if I cut too deep. Of course, that’s what I did on two toes on my right foot. Coincidentally, the worst one was the same toe that I cut badly last week. Anyway, I didn’t notice that I was bleeding again. The blood from the toenail seeped into the gauze and soaked it completely, and I managed to leave a trail of bloody footprints on the carpet again.

At this point, it was 4:30 and I had 45 minutes to get ready for dialysis. I woke up my parents and then tried to apply pressure on my toenail to stop the bleeding. I was successful for one of the toes but the other one would not stop bleeding after 20 minutes. I was planning to call the dialysis center to tell them I would be late when a combination of raising my foot and using antibacterial gel to finally stop the bleeding. I quickly stuck a bunch of band-aids, gauze, and tape on my foot to protect the various cuts, and my dad drove me to dialysis.

It’s not almost noon and there’s no blood on the bandages yet. I’ll need to remove everything to see if the bleeding truly has stopped. It will be an interesting discussion with the podiatrist tomorrow.

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Since my dad picked me up from dialysis, I didn’t get a chance to get some take-out lunch. I was planning to go to Raising Cane’s again but we just went home after dialysis. I ended up toasting some bread and eating PB&J sandwiches for lunch.

No Sleep 10/15/2020

It’s 3:38 am and I didn’t sleep at all last night/this morning. I also did not talk a nap all day yesterday since I was busy will work calls. I’m not quite sure what the problem is this time. Breathing was a bit more difficult lying down so my fluid balance is off again? Whatever the cause, I’m really tired from not sleeping well for the past two days.

I read somewhere that peripheral neuropathy was affected by fluids, and dehydration will cause the numbness to get worse. Maybe my new lower dry weight has something to do with increased numbness. Last night, I actually tried to go to sleep at around 9:00 pm since my right foot was experiencing neuropathy pain attacks. I even took some Tylenol PM to try and get some sleep but the constant numbness kept me awake until now. Fortunately, the pain attacks went away so I don’t have to deal with that during dialysis.

Since I have to get up in 45 minutes anyway, it’s pointless to try and fall asleep so I guess I’ll just stay up and prepare for dialysis.

Costco Dinner

For dinner tonight, we had an all Costco menu. I heated up the packaged Beef Stroganoff and mixed up the Asian Cashew Chopped Salad we bought a few days ago.

The serving count for each was pretty high: 8 for the beef and 7 for the salad, so I only prepared half of each package. I was also worried that my parents wouldn’t like the Stroganoff so I didn’t want to heat up everything. It turned out it tasted kind of like the IKEA meatballs and we ate everything I prepared. That means I have enough left over for another meal later in the week.

iPhone 11 Pricing

I’m a bit upset with my mom. In late August, she started complaining about her phone again. At the time, she had an old iPhone 6S+ and wanted to replace it with an iPhone 11. I told her that Apple usually introduced new phones in the Fall so let’s wait a bit. It turned out Apple introduced new iPod and iWatch models, but no iPhone 12. Again I told her that the introduction will be in October, and prices on the iPhone 11 will drop. For some reason, my sister convinced her that prices won’t change so she wanted to replace the phone right away. A few weeks ago, I ordered her a red 64 GB iPhone 11 for $699 and picked it up from the Apple Store.

Guess what? Apple introduced the iPhone 12 today and the iPhone 11 model I just purchased two weeks ago is now $599. I told everyone it’s typical Apple behavior to keep the top model at the same price point but drop the prices on older models. Well, I hope my Apple stock does better with the $100 extra revenue.

Fistula Update 10/13/2020

Not off to a good start today. The tech that usually sticks me messed up this morning. Something happened to the return line needle after being connected to the machine. Pressure was too high or something. He tried moving the needle around a lot but to no avail, and the insertion site started to swell. I think that’s bad. He then went to the original lower site since swelling usually means the blood vessel was blown at that site. He asked me if I wanted lidocaine or just to stick it. I said, “Just stick it.” Holy shit, wrong answer. I guess I’ve always had lidocaine before needle insertion since it hurt like hell without it. The third site did work even though it hurt a lot at the beginning, and now we’re running at 350 mL/min again.

*Here is my arm with three huge needles stuck in it. You can see the large bump on the top one that’s not being used.*

Also, I skipped breakfast since I thought it was lab day. Turns out it’s not today so I kinda fasted for no reason. At least my blood pressure is somewhat normal today. Last reading was 133/74/56 sitting down. Three hours and twenty minutes to go.

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Ugh. Arm is hurting more than usual. Don’t know if it was the “no lidocaine” needle jab, or something else. I can’t tell where the pain is coming from since my arm gets cold and numb during dialysis as the blood flow is diverted away from my wrist/hand by the fistula. I’m going to try and sleep to hopefully pass the time faster.