Category: Health & Wellness

Italy and France COVID Cases

I just posted about this about a week ago, and the EU map is already different. The most recent map has a larger portion of France in orange instead of red. Italy is still in the highest positive case rate category, but the graph is still showing a downward trend. For both France and Los Angeles County, the case rate is flattening out, though they are on the opposite sides of the Omicron BA.2 spike.

Live(?) link to the EU case rate map

I am going into the office this Thursday so I can meet in-person with a few people to delegate my responsibilities for the next two plus weeks. It does look like our trip is on; I just need to review all the COVID restrictions for each county once more and see if there is additional paperwork to fill out.

EU Travel Restrictions

https://reopen.europa.eu/static/weekly-map.png

We are about a week away from our trip to Europe, and both Italy and France are in the >300 cases per 100k people per day category. I did research all the travel restrictions currently enforced in Europe, and we can still travel without any COVID tests or quarantine if we are vaccinated. I hope our cheapo CDC white cards are sufficient.

Even though case counts are still high in Italy and France, the number of daily new cases is decreasing. Here are charts for both countries over the past three months.

The big hump for both countries is likely the Omicron BA.2 variant. In Europe, there was not really a break between the BA.1 spike at the beginning of the year, and the second spike. In the US, cases died down quickly but is on the rise again from BA.2.

This is just Los Angeles County so the y-axis scale is totally different. However, you do see an increases in the number of cases while it is clearly decreasing in Italy and France above. I am hoping that cases will continue to drop in Europe during the next week so we will be a bit safer on our trip.

I do feel a bit embarrasses that I am going to a fairly high risk area for vacation, while I am working from home due to the increasing number of cases locally.

Local Hiking

I live right next to Peters Canyon Regional Park. The name sounds more impressive than reality. It is basically a few dirt trails around a small reservoir that is used by hikers, mountain bikers, and horse riders. Anyway, there are several small hills you can climb. If you are out of shape however, it may as well be Mount Everest. My sister has been dragging me out to hike these trails, and the first several times, I failed to climb the “big” hill.

View of park from one of the side streets next to the park

So one afternoon, i decided to try and climb the hill without my sister around. I waited until 6:00 pm since I am more susceptible to skin cancer due to anti-rejection medication. First, I had to walk to the base of the hill, which is about one and a quarter mile so I was tired already. I ended up making it to the top of the hill but had to stop and rest twice as my heart rate jumped up to over 130. Most of the other people did not stop so it was a bit embarrassing, but I was happy I made it.

View from the top overlooking the reservoir

Here is the tracker data from my Apple Watch and Fitness app.

Pretty easy to see where I climb the hill; my heart rate correlates to the altitude

The total round trip was about 2.6 miles, and it took me a bit over an hour. I was super tired, and my legs were giving out by the time I got back home. One reason for all this exercise is to prepare for our upcoming Italy trip. I am hoping that all the tourist areas are flat.

Latest Test Results 5/19/2022

The last set of labs showed high creatinine and potassium. I told my nephrologist I may have been dehydrated, and I have not been too diligent on taking the Lokelma daily. So she gave me another lab order, just for a small subset of tests. Those results came back high as well, so I am now doing a third set of labs. I am still missing a few days of Lokelma since it is a powder you need to mix with water, and you cannot take it within a three-hour window of all the other medications. The creatinine levels were around 1.6. Not terrible but definitely high compared to the normal upper bound of 1.3.

I do not feel I have done anything different, although blood sugar has been harder to control. I am not sure if I am building a tolerance to insulin, or i just need to eat a lot less. I am still on the Natera Prospera DNA test program, but they have not mentioned any signs of kidney rejection.

More Posts…

One of my three readers mentioned the lack of content so I will post more. I actually had a lot of ideas for posts but work was a bit busy so I ended up doing work stuff.

I am working everyday from home again. COVID cases are on the rise, like due to Omicron v2.0 or v2.1. When I decided to start returning to the office in mid-March, there were about 800 cases per day in LA county. Now it is over 3300 per day. Ugh.

Just to reinforce the point, a bunch of people got sick over the weekend. Three out of the six sick coworkers tested positive for COVID.

I am also watching the case trend in Italy and France since we are still planning on going to our European trip in three weeks. It does appear that Omicron v1.0 and v2.0 spikes were closer together, and both countries currently show a decreasing trend.

Back to the Office?

I have worked at my current company for almost eleven years. However, it feels much shorter than that since I have been working from home, both full-time and part-time, for several years. When I first started doing in-clinic hemodialysis, I “unofficially” worked from home two days each week. At the time, my dialysis sessions were from 1:00 pm to 5:00 pm so I worked in the morning during dialysis days, then made up the hours at night or on the weekend, while taking the occasional vacation day. I went back to work in the office full-time while on peritoneal dialysis, then “officially” part-time (30 hours/week) after heart surgery and switching back to in-clinic hemodialysis.

I remember about two years ago, in March 2020, the COVID-19 pandemic finally hit Los Angeles, and our department was told to go home. At the time, many people thought the pandemic would last a few weeks, perhaps even a few months. Here we are two years later, and the pandemic still rages on. Here are some charts tracking COVID cases in Los Angeles County:

Daily new cases for the last 24 months
Daily new cases for the last 6 months

Given that I have had four Moderna COVID vaccine shots and the latest dosage of Evusheld, plus the sharp decrease in the number of new cases, I feel I can start going back into the office one or two days each week. I did pose this question to my nephrologist, and she was open to the idea, after checking if the Evusheld shots increased my antibodies count. Since most of my meetings are on Tuesdays, I was thinking of driving on Tuesdays/Thursdays to work for now.

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I received an email from work today that we are ending our indoor masking requirement. It is not good news, but one that was expected sooner than later. Since most of the coworkers in my department know my circumstances, I will still wear my KN95 masks while in my cubicle. Let us see how long I can tolerate wearing it for 8-10 hours per day.

Evusheld Shots

I received my two shots this morning. The medication is a combination of two drugs: tixagevimab and cilgavimab. I was given the injections at the St. Joseph hospital cancer infusion center. Other than getting the shots in the butt muscle, it was not any different from a vaccine shot. Maybe it is given at the cancer infusion center because the is the biggest immunocompromised population?

The nurse (male) that administered the shot was very nice and we chatted a bit. It turns out his father has been on dialysis for eight years, so he understands the issues of being an ESRD and post-transplant patient. I made sure that I was getting the new, higher dosage just approved by the FDA. They did keep me for about an hour after the shots to check for any adverse reactions, but all I have so far are slightly sore butt cheeks. The injection is only good for six-months, so they already scheduled my next appointment.

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Usually, prescription drugs come with a medication package insert with a lot of small font text. I have seen this with many of my medications, including insulin pen needles. For Evusheld, the nurse showed me the insert, and it was literally blank except for the words THIS AREA IS INTENTIONALLY LEFT BLANK. I know the medication is new and is being used under emergency approval, but there must be some information. I showed my dad and he asked, “You agreed to take shots with no information?”

Not kidding.

Walking Outside 2/19/2022

I took a quick walk outside this morning, and I mean quick.

It was only fourteen minutes and less than two-thirds of a mile. I went out to walk because my left foot started hurting this morning at 4:00 am. I got up to use the bathroom and when I returned to bed, I felt a slight twitch in my foot. From that, I knew a neuropathy attack was coming but not the intensity. After about six hours, I can defbinitely say it is really bad, like screaming in pain bad. The walk did not do anything to help with the pain, and neither did two Tylenol pills. I have resorted to using a Salonpas patch, and so far it has not helped either.

It is becoming apparent that these nerve pain attacks are happening daily or every other day. I am trying to avoid taking another medication like Gabapentin, but it looks like I have no choice.

From MedlinePlus, possible Gabapentin side effects include:

  • drowsiness
  • tiredness or weakness
  • dizziness
  • headache
  • uncontrollable shaking of a part of your body
  • double or blurred vision
  • unsteadiness
  • anxiety
  • memory problems
  • strange or unusual thoughts
  • unwanted eye movements
  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • dry mouth
  • constipation
  • increased appetite
  • weight gain
  • swelling of the hands, feet, ankles, or lower legs
  • back or joint pain
  • fever
  • runny nose, sneezing, cough, sore throat, or flu-like symptoms
  • ear pain
  • red, itchy eyes (sometimes with swelling or discharge)

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Zero effect from Salonpas so far.

Typically, the only thing that helps with the pain is sleep. I always take Tylenol, but I do not feel is has made any impact. I have also taken some leftover opioids like oxycodone and codeine but any pain relief has been minimal. The best solution is to sleep it off, but I just woke up from bed so not tired yet. Usually the pain would prevent me from sleeping for so long that I just pass out from exhaustion. This is going to be a long, painful day.

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I feel the pain intensity is getting worse after I put on the Salonpas patch.

Peripheral Neuropathy Updated 2/15/2022

My experience with medical issues in the past few years has been, “If you think things are bad, they can only get worse.” I know some problems have gotten better because of surgery, but my peripheral neuropathy has deteriorated in the past year.

While on dialysis, there were many times when I thought the numbness and pain was getting worse. Looking back, the neuropathy now appears rather stable. I would get attacks every few weeks, and the intensity did not fluctuate that much. Even the everyday numbness seemed constant. After transplant surgery, my blood sugar has been difficult to control, which likely increased the overall level of neuropathy. Most nights, one or both feet would be so numb that I could barely move them.

More alarmingly, the frequency of pain attacks has definitely increased. Another attack just started about 15 minutes ago, and it is the fourth or fifth one in the past seven days. Each time it happens, I basically lose a night of sleep due to the constant pain. The intensity has increased too. Right now, each pain attack would leave my entire lower leg numb for about ten seconds, and this repeats every 30 to 45 seconds. The only remedy is to stay awake until you are so tired that you collapse from fatigue, and hopefully the attacks end when you wake up. Sometimes the pain would just start up again for several hours.

What really drives me crazy is there does not appear to be any immediate drivers to each attack. Sure, the long-term cause is chronic diabetes. The excess sugar in the bloodstream causes nerve damage, and the pain is from dead or injured nerve endings. However, the attacks are totally random. This time, I was tired after dinner, so I took a short nap. I was able to fall asleep, but the sudden foot pain woke me up after about an hour. Sometimes, I would be just sitting, either reading a book or browsing the web and the pain would suddenly appear. Frustrating.

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I may as well connect to the office and do some work since I am unable to sleep from the pain. There is a large meeting tomorrow today (12:39 am) and I need to provide many slides. I sent out three emails over the past week reminding my team of the deadlines, but only about 1/3 of the analysts responded. It is an inconvenient situation as I outrank everyone, both in title and seniority, but none of them actually report to me. It is going to look stupid for everyone if our slides are only half complete for the meeting tomorrow…

COVID Antibodies Test Update (updated)

My nephrologist just called me and said my results, though positive for antibodies, are relatively low compared to her other transplant patients. Typically, they are well over 150 after three or four vaccine shots, but my result was ~31. She is going to send in a referral to St. Joseph hospital cancer center to see if they will give me one of the few doses they have. Hopefully they will give me the shot since I am pretty much a regular customer, like Norm in Cheers.

You can tell how old I am by that reference.

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Updated: 2/15/2022 1:30pm

Got a call this morning from the St. Joseph hospital infusion center (did not know this was a thing). They wanted to schedule me for the Evusheld shot. That means my nephrologist was able to get one for me. Every bit helps. The appointment is in a few weeks. I will get both shots, one in each butt cheek, and they will also hold me for an hour to watch for adverse reactions. I think I will finally feel somewhat protected from COVID after these set of shots.

COVID Antibodies

Test results came back, and I have antibodies! Specifically, this is the SARS COV 2 AB (IFF) SPIKE, SEMI QN test from Quest Diagnostics.

My nephrologist already told me that the number is not indicative of the level of protection, and all the material from Quest says the same thing. However, I still take it as good news that I have some protection against COVID. I still need to take all preventative measures like before, such as wearing masks indoors and social distancing. Good to know that at least one of the four Moderna shots had some effect.

Double Doctor’s Appointments

I had two doctor’s appointments yesterday morning. It was not planned, so fortunately they were at separate times. The first appointment was with my endocrinologist. My blood sugar has been slightly lower recently, but there is a lot of variability in the readings. She mentioned that I may have brittle diabetes, which is harder to control. The linked webpage does say that it is rare and typically found in type 1 diabetic s however. I may also have experienced rebound hyperglycemia that would raise my morning blood sugar readings even though I did not eat anything overnight. In the end, she just increased my insulin prescription again, and sent another referral for a CGM (continuous glucose monitoring) meter.

I was done at about 9:15 am but the next appointment was at 10:20 am. I sat in the parking lot checking my phone instead of driving home since I would be heading out right away again. The next appointment was with my nephrologist. She said my lab results were fine but asked me to take some vitamin D supplements since my level was low. We also talked about COVID vaccine, antibodies, and Evusheld availability.

At my previous appointment with UCLA transplant center, they said I should get Evusheld shots, but since I am not a high-risk patient, they do not have enough doses to offer it to me. My nephrologist said St. Joseph hospital only received 40 doses, and the transplant doctor is restricting access to only his patients. One of her other patients told her that UCI received 600 doses for some reason; their transplant program is not that large either. Anyway, her plan for me is to get an antibody test (I did that this morning). If I have zero antibodies after four Moderna shots, she will try and make a case for me to receive Evusheld at St. Joseph. If that is not possible, she will then refer me to UCI to try and get shots from there. I have not had an antibody test before so it will be interesting to see if I do have antibodies.

Lab Visit 2/4/2022

I went to get blood drawn for labs this past Thursday. It was not planned, but my next nephrologist and endocrinologist appointments are both scheduled for next Thursday. This is good because I can get both sets of labs done with one trip.

The lab visit took longer than usual. It took them almost 20 minutes to combine both sets of lab orders into one list. The phlebotomist ended up drawing ten rubes of blood plus a urine test. The blood stopped flowing freely by the eight tube so she had to press my vein and move the needle around to fill the final two tubes. Still not as bad as the 22+ tubes I had to give for transplant evaluation labs.

I already received some results back. The two items I was worried about were hemoglobin A1C and creatinine. My A1C came back at 7.5% which says I am diabetic, and correlates to an average blood glucose of 169. I was hoping it would be lower, but still an improvement over the 8.0% number from four months ago. My creatinine level was 1.34 mg/dL. This is slightly high, but both my nephrologist and UCLA transplant center were fine with results as high as 1.5. My potassium and calcium were also borderline high, but everything else seems fine.

Mother Of All Neuropathy Pain

I can’t take this anymore.

When the whole peripheral neuropathy pain thing started many years ago, it was coming about once a month, and would go away after about 24 hours. Recently however, pain attacks are happening about every other day. There were about three episodes, but I was able to take some Tylenol and sleep them off.

Not tonight.

I am in the middle of a huge attack. It started about two hours ago and the pain intensity has drastically increased. In addition, instead of a short burst of pain each time, attack is about three seconds of excruciating pain. I have taken the usual Tylenol, used a wand massager for an hour, and walked around the first floor of my house to no avail. I am also short of breath and sweaty from shaking my leg during each attach, as it seems to help dissipate the pain. My back is also hurting for some reason; not sure how that is related.

I see my endocrinologist in about two weeks. I am ready to ask for any medication that will relieve these neuropathy pain attacks. They were bearable when only happening once a month, but I do not think I can handle every other day. If the frequency increases further to daily occurrences, then I will be in pain 24/7.

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Ugh. I just went ahead and took 5 mg of Oxycodone that was prescribed for post-transplant pain. I never took the medication after surgery since it was easily tolerable. I believe I have taken the pain medication three times in the past for neuropathy pain, but it was unclear how effective it was. At this point I do not even care. Every little bit of pain relief is welcome.

Walking Outside 1/29/2022

Not good.

I finally went outside for a walk. It has been a long time since I walked outdoors instead of using the treadmill in the garage. It definitely felt much harder than before. My legs were numb and sore after the first few blocks, and I was running out of breath near the middle of the walk. I was surprised that the pace was fairly high (for me); it felt much slower during the walk. My heart rate also increased more than before where I would only hit low-80’s. This must be from all the recent weight gain, and not walking consistently for the past few months.

I walked a mile on the treadmill last week and it did not feel this tiring. I hope some of the tiredness is from the Moderna vaccine shot on Thursday, but I need to walk more consistently, especially if we are still going to Europe in June.

4th COVID Vaccine Shot

I received my 4th COVID-19 vaccine shot yesterday. After my last appointment with them, UCLA transplant clinic put a reminder in my records to schedule the booster. Since their clinics are all extremely far away, I ended up going to my local Albertsons pharmacy and got the shot there. I did call to make sure they were offering the fourth vaccine shot, but everything was fine. I even had the CDC page ready on my phone in case they asked.

Like the other three Moderna shots I have received already, I did/do not have any reactions or side-effects so far, other than a slightly sore arm. I was hoping for a bigger reaction as it may indicate the presence of antibodies.

At least the number of cases is decreasing in Orange County.

https://occovid.com/cases

Sudden Neuropathy Pain

I was just sitting here eating lunch when I was hit with a sudden jolt of pain. This time it is in my left foot insole, right under the bone to the big toe. These painful nerve attacks are happening every few days instead of weeks and months.

Now I have to call in to a meeting with my manager. This sucks.

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My boss did not show up to the meeting. I did have to talk to another manager while my foot was hurting every 30 seconds.

The Next COVID Crisis… is Here

I just posted about this three weeks ago. At the time, I was still hoping that this next wave/spike/whatever could still be contained. No chance of that now.

https://occovid.com/cases

If you look at the previous chart for Orange County from the December 9th post, the latest “spike” was only about one-half of the case count from last year. However, that is no longer the case. The new case rate is now higher than it has ever been. I just had an appointment with my nephrologist, and she said the hospitals are getting full again, and that I should stay home for the next two weeks. Here is a chart for total US and world new cases:

https://www.nytimes.com/interactive/2021/us/covid-cases.html

https://www.nytimes.com/interactive/2021/world/covid-cases.html

1.4 million new cases for the first day of 2022. Looks like this year will not be any better than last year. In the US, with all the New Year’s Eve parties last night, the numbers will get even worse over the next few weeks.