Shower

Aah. First shower since early November last year. That’s about 10 months of wiping down with a towel and washing hair in the sink. It’s amazing what hot water running through your hair feels like. However, it wasn’t as memorable as the first shower after almost two years of hemodialysis back in early 2019. I think I’ve already took that “first” shower when I started this blog so I didn’t mention it here. The vascular surgeon said it was okay to shower 24 hours after removing the catheter. There was still some blood oozing out of the wound when I changed the bandage earlier but I stuck a waterproof bandage on it, and covered it with a thick woven medical tape. I think that kept the opening dry, though without the catheter, infection risk is pretty minimal.

I made a post a few months ago detailing all the scars and catheters in my torso. With the removal of the chest catheter, I think there are no more holes in me. I still need to cover the exit wound for a few more days.

Hopefully that’s the last of installing ports or catheters for me.

Catheter Removal Later Today

So the chest catheter I got during heart surgery is getting removed today. I’ve had it since November 13th, which is about 9 1/2 months. The first chest catheter I had lasted over 20 months. I felt this time the dialysis staff was more insistent on its removal as fast as possible. Maybe they had some infection cases recently?

The nephrologist doing rounds today came pretty late. I was getting the needles removed when he showed up. I told him about the catheter removal, the upcoming CT scan, and gave him an update on the transplant process at UCLA. I think he knows the doctor I spoke to at UCLA; there was a sign of recognition when I mentioned his name. He also lowered my dry weight again to 86.0 kg and said we may even go to 85.0 kg if I’m okay. He agrees that my ankles are swollen and there may be a few extra kg of fluids in me. That could also affect my blood pressure which has been higher recently. Again, the nephrologist is supposed to be responsible for the dialysis patient’s blood pressure, and he seems the least worried out of all my doctors.

One small bit or worry is that the arterial needle site was bleeding during dialysis again. It’s the third time in a row now. Maybe it’s the blood thinner I’m taking but it does coagulate under the medical tape so it’s not leaking out everywhere. I’m just worried that after today, there won’t be any backup access if the fistula blows up or something. I guess they can always put in a third chest catheter but I’m trying to keep actual holes in my chest to a minimum.

Enough, Make It Stop!

Sigh. Occasionally I have days that are hard to get through. Nothing has changed overnight but I just get fed up about everything. Right now, it’s the heart issues and what seems to be too much fluid in me. I know some people have real scary diseases that cannot be managed. My issues are more like a very slow moving train but it’s hitting new stuff on the tracks. It seems like there is an answer to everything that ails me but the totality is overwhelming sometimes.

For several weeks now, I’ve been having more and more trouble breathing while lying down. For awhile, I could get by sleeping on my right but slowly, that’s not working either. It’s 3:40 am and I haven’t slept one bit. I’ve been trying to get the bed into a position that allow me to breath a bit but have not found it. As soon as my head hits the pillow, I’m gasping for air. Plus the pressure on my chest seems to be increasing as well. I’m pretty positive it’s not the heart itself since I walked 15 minutes on the treadmill last night and felt mostly fine, while bending over to pick up laundry winds me.

Then there’s the swelling in my ankles and feet that seems to be persistent. Post heart surgery, I was pretty bloated and it took a few extra dialysis sessions to bet rid of the excess fluid. Since March, it seems the fluid retention has gotten worse even thought my weight has dropped. I think my real weight (without fluids) is even lower since I’ve been eating a lot less, and I still have too much fluids in me. I haven’t come close to the amount of cramping as before on hemodialysis. Maybe I can ask the nurse to pull more fluids out today, or see if I can talk to a nephrologist since it’s Tuesday.

The current situation is that I run out of breath kind of randomly, probably based more on body position than exertion. My doctor friend thinks it may be the chest wall healing and constricting, while my cardiologist thinks it’s musculoskeletal too. I need to call today to set up that CT scan so the thoracic surgeon can see what happened. The excess fluid is just uncomfortable since I can feel the extra pressure as more nephropathy. I think the danger is that the skin will stretch out and crack, and I’ll get several spots where infections can take hold. Infection of the feet for diabetics is bad news.

3:51 am. Maybe I can sneak in a 30 minute nap before leaving for dialysis. Another week of life in paradise…

Ophthalmologist

I went to see my ophthalmologist today, after about 14 months after the last appointment. I’m supposed to see them every year to check for diabetes related eye damage. Since I’ve been keeping my blood sugar under control and lowered my A1C readings, my eyes have been pretty stable, and some of the prior bleeding in the retina has healed.

The office was very careful due to COVID-19. First you had to call them when you arrive so they can confirm your appointment and collect payment information. I kept saying I’ve reached my out-of-pocket maximum but they wanted to co-pay anyway. Supposedly they will reimburse me if when the insurance double-pays the co-pay. We’ll see…

After I went into the office, they took photos of my retina with a huge special camera made by Nikon. Next, they brought me into a room for medical interview and a preliminary check of my eyesight. Since last year, I have two pairs of glasses: one for reading and one for driving. However, it takes quite a while for my eyes to adapt so for a short period, everything is blurry. I couldn’t read any of the letters they threw up on the wall. Embarrassing. Next they dilated my eyes using some eyedrops. About two hours later, I still can’t see very clearly. Finally, the doctor came in to examine my eyes. My usual doctor is either not in or busy so I got another ophthalmologist, a Korean lady, and everything seemed to go well.

I got referred to a retina specialist again. They made the same referral for three years but kept telling me it wasn’t important. I have so many medical issues that if something isn’t important, it’s not getting looked at. I told her I would call and make an appointment this time.

Perfect Hemogram

I’m not sure what a Hemogram tests for but the dialysis center draws blood for this set of labs during the last week of the month. Here are some results:

Hemogram	7/16/2020	7/30/2020	8/13/2020	8/27/2020
White Blood Cell Count	5 k/uL	4.8 k/uL	4.2 k/uL	4.3 k/uL
Red Blood Cell Count	3.3 M/uL	3.28 M/uL	3.35 M/uL
Hemoglobin	10.7 g/dL	10.4 g/dL	10.7 g/dL
Hematocrit	32.3%	31.3%	32.3%
Mean Corpuscular Volume	97.8 fL	95.6 fl	96.3 fL	95.1 fL
Mean Corpuscular Hemoglobin	32.3 pg	31.7 pg	32 pg	31.5 pg
Mean Corp Hgb Concentration	33 g/dL	33.1 g/dL	33.3 g/dL	33.2 g/dL
Red Cell Distribution Width	14%	14.3%	14.6%	14.8%
Platelet Count	114 k/uL	164 k/uL	148 k/uL	159 k/uL
Mean Platelet Volume	10.1 fL	9.6 fL	9.2 fL	9.5 fL

Maybe not so perfect. The red numbers are results outside of normal range; every red number above was low. I know I get Epogen injections at the dialysis clinic. Evidently it’s for those with anemia or low red blood cell counts. I usually don’t notice since they inject it into the machine and the drugs flow back through the dialysis return line. Weird how the last set of test results just excludes the traditionally low categories. Maybe the results will come later. This is another item that I don’t understand post-transplant. Will I still need to take Epogen or equivalent? Or does the “new” kidney produce hormones to counteract the anemia? Will it work if it’s from a “foreign” kidney?

Treadmill 8/28/2020

Weird. I just walked on the treadmill for about 10 minutes and I feel somewhat okay. I am breathing harder than usual but it’s not as bad as walking across the church parking lot tonight. Maybe I’m walking much faster in real life than on the treadmill? I was walking kind of slow… the treadmill was only going 1.2 mph or 50 minute miles. I usually walk twice as fast. Is that the difference?

It also doesn’t explain the bone movement and sound coming from my sternum. I guess I’ll have to wait until I speak to the thoracic surgery nurse. Musculoskeletal problems don’t sound much better than coronary artery disease.

Breathlessness, Night 2

It’s 11:00 pm and I have try and sleep now, with dialysis in about six hours. I think this problem definitely has something to do with the heart surgery since the keloid on the scar is starting to hurt. I don’t think I’ve experienced this in the nine months since surgery. The chest pressure symptom has always been there in one manner or another, but it’s a lot more pronounced. Over the course of the day today, I tried take a nap several times. Either the shortness of breath gets worse until I have to sit up to breath, or I fall asleep somehow for a hour before waking, still as tired as ever. The cardiologist didn’t call me back yet but usually it takes them two days to reply. I hope I can get some sleep tonight so I don’t have to sleep on the dialysis chair for four hours.

Hypoxemia

I’m learning so much about medical disorders that I can be a doctor soon… just kidding.

I bought a pulse oximeter several months ago at the start of the COVID-19 lockdown. Since price gougers already hit Amazon by that time, I went and bought it directly from the source on AliExpress. Items are cheaper but you have to be patient; my order for two oximeters took 40 days to get here from China.

*Pulse oximeter. Not the exact one I got but they’re all pretty much the same.*

Normal readings for blood oxygen content is from 95% to 100%. Readings below 90% could mean hypoxemia, or below-normal levels of oxygen in blood. I just measured my oxygen levels and got a 93%. I guess that’s not unexpected since I’m experiencing shortness of breath. I tried breathing deep but it didn’t help very much. Maybe since we’re stuck inside the house with the air conditioner on 24/7, I need to try breathing deep outside.

==========

Ugh, I just went out to the backyard and the reading go worse.

*Maybe it’s due to walking downstairs and using up all the oxygen in my bloodstream?*

Actually, the reading drops down to 80% and comes back up repeatedly. The meter beeps when the oxygen reading drops below 85% so it was beeping constantly. That’s not good. I know things made in China may not be super accurate, but I “tested” everyone in the house when I received them and all were reading 98% to 100%, even me. So something definitely happened in March, probably to my heart as I was recovering from bypass surgery. Whatever it was may have also triggered the a-fib that took forever to fix, and now is making me breath hard.

I hope it’s not serious. I’m tired of hospitals and surgeries. At some point, UCLA transplant center will probably drop me again as a candidate if this continues.

Lab Results 8/13/2020

Here are some recent lab results using the table from a February post:

Test	Normal Range	6/11/2020	7/16/2020	8/13/2020
Albumin	3.6 – 5.1	4.3 g/dL	4.3 g/dL	4.6 g/dL
Calcium	8.6 – 10.3	8.8 mg/dL	8.8 mg/dL	9.4 mg/dL
Potassium	3.5 – 5.5	5.2 mmol/L	5.2 mmol/L	5.4 mmol/L
Phosphorus	3.5 – 5.5	5.9 mg/dL	4.6 mg/dL	5.3 mg/dL
Urea Nitrogen (BUN)	7 – 25	54 mg/dL	39 mg/dL	47 mg/dL
Glucose	65 – 99	82 mg/dL	104 mg/dL	81 mg/dL
Creatinine	0.7 – 1.3	9.74 mg/dL	8.76 mg/dL	9.63 mg/dL
eGFR (non-African American)	> 60	6	6	6
Urea Reduction Ratio (URR)	> 65%	63%	64.1%	68.1%

*1/16/2020 results from Comprehensive Metabolic Panel

So for July and August, all the important renal lab results are within range. Interestingly, the 63% and 64.1% for URR were measured with the chest catheter. For August, they use the fistula and took the blood samples from the dialysis machine. Last week, the nephrologist said that once we figure out the flow and pressure issues, we can “turn up” the machine and get better cleaning. It was already at 68.1% this month. Hopefully they can increase the flow rate and cut down the time. I noticed that out of everyone arriving at 5:30 – 6:00 am at dialysis, I am the last to leave at past 10:00 am.

Serious Shortness of Breath

Wow, it was pretty bad today. I didn’t sleep enough this morning, getting up at around 2:30 am and staying up until dialysis. I tried to sleep during dialysis but it’s difficult with two huge needles in my arm. I also got woken up by nutritionist but that was near the end of the session so probably didn’t matter much.

After charging my car again, I came home at ~11:20 am and started nodding off. I tried to take a nap but was having lots of difficulty breathing. As mentioned before, this was mainly when I was lying down on my back and there were several times when I thought I couldn’t catch my breath. In addition, my sternum was still moving and making noises so it was very uncomfortable. I doubt it’s COVID-19 since I just tested negative and there is no fever. My cardiologist asked about a Lexiscan test last time but I thought symptoms were improving. I guess not. I just sent her a long email asking her what I should do next. So many issues, just one after another…

==========

Situation is about the same for the past four hours. I tried to take another nap but was unsuccessful. it’s almost 10:00 pm now so I’m going to try and go to sleep and see what happens. It’s kind of weird since sometimes I would bend over to pick something up and run out of breath, then go upstairs to my bedroom and feel relatively fine. Shouldn’t I be passing out all the time? Something happened mid-March. I thought it was the a-fib but that’s been fixed for over two months. I’ve also tested negative for COVID-19 four times.

Dentist Appointment 8/24/2020

Holy crap! I think that was the mother of all dentist appointments I just went to today. I got there at 9:00 am and got out after 12 noon. I then had to take something to the guy making my crowns and have him do some color matching. All together it took over 3.5 hours. Today, the dentist prepped my upper teeth for a bunch of crowns. I think there are six temporary crowns in my mouth right now. All to be replaced with permanent crowns in about two weeks. I’m not sure what all this costs. I think I paid $4000 a few weeks ago and about $800 today. This is in addition to >$10k earlier in the year.

Since so much work was being done today, my gums took a beating. The anesthesia was waring off near the end of my appointment and my gums were throbbing in pain. After I got home, I quickly popped two Tylenol + codeine pills and now I feel pretty good. The downside is I only have two more pills left so hopefully no more long dentist appointments. I do have some leftover Percocet from the heart surgery, and my mom has some Tylenol + hydrocodone. I can use those if the pain becomes unbearable.

==========

My dentist worked in the same company as me before he became a dentist. I left that company 9 years ago but still keep in touch with a few ex-coworkers. Coincidentally, the old sales VP was in the dentist’s office as I was checking out. My dentist asked if I wanted to say hi. I know of the VP and were in a few meetings together but I don’t think he remembers me, especially after 9 years so I declined. Small world.

==========

It’s 10:30 pm and all I’ve ate today are some pieces of watermelon and a cup of decaf tea. The temporarily capped teeth are feeling better but still throbbing a bit. I was going to eat something but it was either too sticky or hard. I’ll probably go grab a protein shake, drink it and go to sleep. Looking forward to having the nurse remove the couple of sutures in my arm. The incision point has been itchy all day.

Thinner (updated)

As I was brushing my teeth tonight before bed, the word thinner popped into my head. I know I’ve talked a lot about my weight loss. If this had been anytime within the last 30 years, I would have been very happy. However, I’m fluctuating between annoyed and concerned right now. I’ve kind of flattened out at ~88 kg lately but here’s the chart from Fitbit again, updated for today.

*I had to move the chart manually and hold it while getting a screenshot, so the app didn’t reformat the y-axis.*

Thinner was a book by Stephen King. I think I read it a long time ago. I’ve actually read many Stephen King novels until I read It. I read it right before I started college at UCLA, and it scared the crap out of me. They also made a movie based on the book but I don’t believe I ever saw it. Basically a lawyer runs over a Gypsy and the justice system covers for him so he’s found not guilty. The Gypsy’s father curses the lawyer by touching his face and whispering, “Thinner.”

My situation is not a curse but nevertheless, I’ve been losing a lot of weight. Looking at my ankles, I probably still have too much fluids in me so the weight loss may be more dramatic than shown. From right after the surgery in November 2019 to now, I lost ~20 kg or ~45 pounds. As someone who has been overweight to slightly obese his entire adult life, this should be great news. I thought when it happened, I would be losing fat. Instead, I think I’m losing muscle mass as my arms and thighs have definitely shrunk over time. Now I really feel like a shrinking old man.

==========

Updated: 8/24/2020 11:00 pm

Since I skipped all my meals today to to a long dentist appointment, I just weighed in at 86.6 kg. I believe the lowest I’ve weighted at home was 86.5 kg so I’m almost there again. It would be a very light dip at the end of the chart if I were to update it. I’m a bit hungry but not too bad. I think I’ll just grab a protein shake. Maybe I’ll feel better enough tomorrow to eat some solid food.

Sternum Noises

Sigh. Looks like another problem.

For heart surgery, the surgeon cut through my sternum to open up my chest and ribcage so they can have access to my heart. After surgery, they bind the sternum together with wire so the bone will fuse back together. All good, right?

However, since mid-March, I’ve had some shortness of breath, especially when lying flat on my back or walking up stairs. I thought it was related to my a-fib condition but it has continued after my cardiac ablation procedure. I thought it was getting better but now it seems worse. There is definitely a clicking sound and feeling of bone grinding at the base of the sternum when I’m flat on my back. It’s kind of freaky feeling. I didn’t experience this early on during heart surgery recovery when the bones should be moving. Not sure why it’s happening 9 months after surgery. Not even sure who I should contact… my cardiologist or the thoracic surgical nurse?

One problem at a time. First is another dental appointment Monday. Then a video call with UCLA Transplant Center medical director Friday. Then an appointment with the ophthalmologist Monday. I guess then I can call my cardiologist about the sternum and maybe do a Lexiscan since I’m not breathing right. Ugh.

Quarantine @Home

So the rules from St. Joseph Hospital are:

Stay home
Do not go to work, school, or public areas
Limit the number of people in your home; do not allow visitors
Separate yourself (at least six feet away) from others in your home
If you are unable to stay six feet away from other in your home, everyone should wear a mask or a cloth face cover over your mouth and nose

The paper the first nurse handed me on Monday had these points 1) highlighted, 2) circled with a pen, and 3) had large hand-drawn arrows pointing to them. I think she was being super passive-aggressive because I complained about the long home quarantine when they did nothing of the sort the last two times I had procedures done at the hospital. Instead of telling me that things have gotten worse in Orange County hence the new procedures, she said that it’s always been like this when it definitely is not true. The nurse that actually took the swab today was more laid back. After the test he said the hospital will contact me if the test is positive, but come Friday anyway since it won’t change anything.

*Felt like they stuck the entire swab up my nose and into my throat.*

At home, I mostly sat at my desk in the office. My mom was in the same room on her computer but several feet away so close enough. I cooked my own dinner and brought it to the office to eat instead of joining my parents at the dining room table. Also, they did not leave the house today so chances of getting sick from them, if it hasn’t happened already, is pretty low.

A-fib Again?

At every dialysis session, the nurse usually listens to my lungs and heart. One of the fears for dialysis patients is not clearing enough fluid, which can build up in the lungs causing pneumonia. When she listened this morning, she said my heart beat was irregular. Ugh, words I did not want to hear. With so many health issues, once you think you treated something, you want it to go away. I listed to my fistula and I can hear the skipped beat. Crap.

Since they successfully stuck needles in my arm today, I could not listen through my fistula. I just checked now (9:00 pm) and everything sounds fine. Fitbit said heart rate is 62 bpm. Hopefully it was very temporary and my heart fixed the rhythm by itself.

COVID-19 Testing 8/18/2020

Since I’m supposed to be quarantined after taking the COVID-19 test, I decide to get lunch first after dialysis, then go get tested. I was deciding whether or not to get a breakfast burrito but ended up at Raising Cane’s again. I got the Box Combo, which has four chicken fingers. For some reason, the box had five chicken fingers instead. It’s like I won the lottery!

I then drove back to the ER parking lot to get tested. I was afraid it would be busy but there was no one in line. I pulled up and had to wait about five minutes; I think the nurses were on break. Since I registered yesterday, it was quick. A nurse checked my ID and stuck a swab up my nose for five seconds, then I was done. He also said they will let me know if the test came back positive, but it won’t affect the procedure on Friday.

*The COVID-19 drive-thru test station at St. Joseph Hospital*

Now I got to keep away from my parents at home for a few days.

COVID-19 Test @ER (updated)

Off I go to the St. Joseph Hospital ER to get a COVID-19 test for Friday’s fistulagram. My dialysis nurse was surprised that the test is administered in the ER, as if they don’t have enough to do. At St. Jude Hospital last time, they had me go to a testing lab onsite for the test, and no quarantine afterwards. Maybe the pandemic got a lot worse after early June.

To go to the ER, there is only valet parking (yay Orange County) so I have to pay for that. Also they’d better not charge me $5,714 for the test. I think that’s what my last visit to the ER cost and it turned out to be nothing.

Also I hope there is no line this early on a Monday morning.

==========

Update: 8:00 am

Ugh. I’m back after about 45 minutes and it was a huge waste of time. First, the test wasn’t in the ER, just the parking lot of the ER. They have a drive through tent set up for you to get swabbed. Because it looked like a last minute setup, there weren’t any markings in the lanes so it too me awhile to figure out where to go based on the vague directions from the parking attendant. Also, the nurse at the drive thru said they’re testing for Thursday’s procedures today. I guess the test takes three days to come back? Once I’m tested, I have to quarantine myself, even from family members. All this is news to me based on the conversation I had with the surgeon’s nurse.

Ugh again. What a huge pain in the ass. I live with my parents and they do all the cooking. Now they have to stay six feet away from me or wear a mask inside. I understand the need to contain COVID-19 but it seems the hospital is putting all the burden on the patients. I know they have a faster test. Why not have the patients tested before the procedure so you know they’re not infected, and save people from three days of quarantine? I need to go to the hospital two hours before my procedure and most of the time it’s just sitting in pre-op waiting for the next nurse. They can easily swab me right in the beginning and have timely test results before the procedure. Instead, they are depending on my parents to stay away from me in the same house? Which is more reliable? Are the fast tests more expensive? It’s not like the hospital is paying for anything. It’s all charged to one insurance or another.

Anyway, to avoid an extra day of home quarantine, I’m waiting to do the test tomorrow instead. They did register me today in order to save time for tomorrow. I’m guessing the lines will be much longer at 10:00 am after dialysis then at 7:30 am in the morning. Seriously, even if they can’t do the one hour test, surely there is an overnight test or something. It’s as if the hospital is making things easier on themselves by making things harder for all their patients.

#700

700th post. During Divorce Care group meeting yesterday, someone mentioned they kept a journal of their healing process and it was very helpful. I guess this blog is similar. Originally I though it would be about peritoneal dialysis since there was so much to learn and do each night at home. Sometimes I would get home all tired, yet need to spend 30 minutes cleaning and connecting myself to the PD machine. Then the entire process took up close to 12 hours each day; half my life was dedicated to keeping me alive. Anyway, the blog helped.

Then I got emergency heart surgery and also switched back to hemodialysis. It was even more frustrating so this blog became an outlet. It didn’t matter that anyone I knew actually read the blog, just writing stuff down and venting was therapeutic.

So here we are, post #700. Again, a lot of the posts are pretty mundane: I walked this far, I weigh this much, no sleep again, and my foot hurts. I guess part of it shows that even with all these medical issues, I’m trying to live as normal as possible. Even with the pandemic and fear of serious harm/death, I still need to go to dialysis, get food or groceries, and breath “fresh” air once in awhile.

Actually, the weirdest part of this whole experience is dealing with mortality. I guess all these health issues puts me at higher risk of something more serious, and bad things happen on dialysis. I don’t know if other 50-year olds think about death but it’s hard to ignore for me. Some of it is watching fellow dialysis patients disappear from the clinic, and some of it is reading about complications from kidney failure, heart bypass surgery, diabetes, high blood pressure, and now COVID-19. I don’t have any brilliant thoughts or conclusions; I guess I’m still processing all this vs. how life was like 5-10 years ago.

Dental Appointment 8/14/2020

First day of year 53 was spent at the dentist. He wanted to crown the remaining upper teeth anyway so me losing part of the front tooth just hurried the process along. He prepped the front two tooth for crowns which means grinding them down then putting on temporary crowns until the permanent ones are ready. For both crowns and prep, they charged me $3,996. However, since I have dental insurance, even though I used up all my funds for this year, the adjusted price should have been $1,732 so I have a large credit on my account. This is the same with medical costs and insurance. Even though I’m paying myself, the price can vary wildly. If I didn’t have dental insurance, the I would have paid $2,265 more for the exact same service + crowns. That’s more than double. Plus usually people without insurance are those without good jobs so they double can’t afford dental work.

Anyway, due to the fistulagram quarantine next week, I can’t go back to the dentist until the following Monday. Instead of two temporary crowns, I have one large one covering the two front tooth. Weird but okay for a few weeks, though I can’t chew using the front until the permanent crowns are in.

Hungry…

Ugh, my stomach is growling. As I mentioned in the previous post, I skipped breakfast and lunch, and only had about half of what my mom made for dinner. It’s a local Malaysian dish call laksa and it has a lot of spices. The flavor pack came straight from her hometown in Malaysia.

I’m afraid of drinking a pre-made protein shake (Nepro, Ensure, etc.) since the last two gave me diarrhea. Don’t want that to show up during dialysis. It’s monthly labs day so no disturbing the dialysis cleaning process. I have Honey & Bunches of Oats (HBO) cereal from Costco but I’m afraid that will mess up my chipped tooth some more.

Man, life is so complicated. Not sure what I’m going to eat for breakfast in a few hours so that I don’t pass out during dialysis. I may also need to skip my typical post-dialysis take-out lunch since I have to rush home to get on a work call. I picked a bad time to go “part-time” and lose part of my salary while seemingly doing the same amount of work.