Fast Forward Button

Staples used to have a commercial that featured an “easy” button. Whenever you had a difficult problem, you pressed the easy button and your problem would be solved. I’m looking for a fast forward button. It would be super useful for dialysis sessions and dentist appointments.

I thought about this a lot during the first few weeks of heart surgery recovery. It’s all just a memory now but I had a difficult time right after coming home from the hospital. I was too weak to climb the staircase so I had to sleep in the family room recliner for weeks. Other than dialysis, I spent the entire day sitting in the same recliner, and needed help just to stand up. A fast forward button would have been super useful to bypass all those weeks of suffering. Same thing for dialysis since I’m just sitting there. It would be great if I could just jump to the end of the session instead of staring into space for four hours.

The equivalent is probably taking a nap but I have difficulty falling asleep, especially while sitting. This sucks for long airplane flights. When I traveled to Asia quarterly, I would be awake for the entire 14 hour LAX to Hong Kong flight. Before Cathay Pacific installed on-demand entertainment, you had to watch whatever movie was shown on the few video channels. I wished for a fast forward button there too.

Even now, I sometimes wish I can jump forward in time to post-kidney transplant. Life is not so enjoyable now so I’m okay with skipping the next six months of life and replacing it with some fading memories.

New Headphones

I bought a pair of wireless earbuds for use during dialysis. I had received a pair of Apple AirPods 2 during Christmas and really liked them so I wanted to get a cheaper second pair. I ended up getting a pair of TOZO T10’s from Amazon for ~$32. Much cheaper then the AirPods.

They sound pretty good since they have rubber earpieces that squeeze into your ear canal. The bass is definitely stronger than the AirPods which just sit in your ear opening. Usually when there are multiple earpieces, I use the smallest ones for a better fit. However, I may need to change them since the earbuds keep falling out of my ears. I sat reclined in the dialysis chair for ~30 minutes and both earbuds fell out 5+ times. Apple stuff are usually really expensive but their industrial engineering is top notch. The AirPods hardly ever fall out of my ears, even during exercising.

Also, to get the T10’s to stay in my ear, I have to press pretty hard. Since the rubber earpieces are supposed to seal against your ear canal for noise cancellation, it pushes air in your ears and raises the air pressure. Not comfortable, especially if I’m trying to sleep during dialysis.

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I just read on TOZO’s website that you’re supposed to give the earbuds a quarter turn after inserting them in your ear. I guess I’ll try that first before changing the rubber earpieces.

Pre-Owned Private Jet

Speaking of private jets and expensive toys, I received an email at work form someone selling a 2006 Gulfstream G550. These are pretty large private jets and a 14 year old used one goes for about $15 million.

Interestingly, we (the company, not me) currently owns a Gulfstream G650ER and is in the market for a backup jet. First choice is actually a used G550 for sale by Chevron. I’m not sure how a random jet broker found my contact info… Google search metadata?

Anyway, the operating cost for these are pretty high. This website calculates it to be about $7,000 per hour assuming 400 hours per year. I think we’re looking to use it as a daily shuttle between office sites so ~2,000 hours per year at an estimated cost of ~$10 million.

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Traveling would be so much easier if I was still on dialysis and owned one of these jets. Dialysis at Sea uses Fresenius 2008K home dialysis machines on cruise ships to provide hemodialysis. I wonder if you can install and operate one on a private jet. I guess it depends on how air turbulence compares with ocean swells on a cruise ship. If you’re rich enough to own and operate a G550, you should be able to hire a private nurse for dialysis. You can hook up to the machine prior to take-off and finish dialysis while in the air. If you’re carrying your own machine and supplies, international travel should be feasible. You just need to come back to the jet for dialysis sessions.

There is zero information on the feasibility of getting dialysis while on an airplane flight. All the search results is about taking your home dialysis machine along on trips. I guess most dialysis patients don’t own a private jet.

Lunch 2/24/2020

There’s usually a fish option for lunch everyday at work. Today, the fish option is halibut. This is my lunch today:

Item	Halibut	Rice	Dinner Roll	Broccoli	Corn	Total
Serving Size	198 g	113 g	37 g	113 g	113 g	574 g
Calories	330	200	90	110	150	880
Total Fat	19 g	9 g	1 g	9 g	7 g	45 g
Saturated Fat	11 g	0.5 g	NA	0.5 g	3.5 g	15.5 g
Trans Fat	0.5 g	0 g	NA	0 g	0 g	0.5 g
Cholesterol	135 mg	0 mg	0 mg	0 mg	15 mg	150 mg
Sodium	470 mg	100 mg	160 mg	125 mg	120 mg	1,020 mg
Total Carbs	2 g	27 g	18 g	7 g	22 g	51 g
Dietary Fiber	1 g	0 g	NA	3 g	3 g	7 g
Total Sugars	0 g	0 g	4 g	2 g	5 g	11 g
Protein	36 g	3 g	3 g	3 g	4 g	49 g
Calcium	46 mg	12 mg	30 mg	50 mg	9 mg	147 mg
Potassium	920 mg	48 mg	NA	331 mg	234 mg	1,533 mg

Total assumes NA = 0

So the full menu item name for the fish is Halibut with Mojo Butter Sauce, and the corn is White Corn with Jerk Butter. The butter part of the menu item probably accounts for the high total fat and saturated fat content.

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The food was mediocre. The fish was a bit dry and not too flavorful even though there’s quite a bit of sodium. I had to find a packet of soy sauce to make it taste better. I also didn’t eat much of the broccoli and corn so it was just fish, rice, and a dinner roll for lunch.

Expedition Yachts

It’s 1:30 am and I’ve been trying to sleep since midnight. The burn in my feet from neuropathy is pretty intense tonight and hard to ignore when trying to sleep.

Another crazy idea I had recently was instead of living in a recreational vehicle (RV), I would buy a yacht, live on the boat, and travel the world. A long time ago I had a coworker that actually lived in Arizona but worked in Irvine. He would fly in Monday morning, get his car from the airport parking lot, and drive to work nearby. Instead of staying at a hotel or apartment, he would sleep in his 45 foot yacht at Balboa Marina for the next few nights, and return to Arizona Thursday evening. He took a few of us out on his boat down to Dana Point and back. It was pretty cool.

I believe my coworker had a sports cruiser so it only had a two decks, was pretty fast, and had terrible range. We probably traveled about 30 miles total and used $300-400 of fuel. The yacht was probably fine to sleep in for a few nights a week, but you couldn’t travel far in it. What I had in mind was to live on the boat long-term, and visit exotic locations worldwide. For that, you need something that has a cruising range of thousands of miles, not hundreds. Since I’m not rich, I can’t afford a superyacht with a full-time crew. The other option available is buying a smaller expedition yacht. I mentioned before that I’ve been watching a lot of yacht videos on YouTube. One brand that stands out is Nordhavn. They make expedition yachts from 41 feet to 148 feet long that can cross oceans. You can get a fairly new 52 foot boat for about $1 million. It’s not cheap, but think of it as buying a house.

On YouTube, there are lots of videos of people making thousand mile trips in Nordhavn boats. They even organized a group trip across the Atlantic Ocean in 2004.

However, unlike buying a RV and driving across the country alone, I don’t think you can operate a expedition yacht by yourself. Each boat in the above video has a multi-person crew. In a RV, if something breaks down, you can always pull over and call for help. If your boat breaks down in the middle of the ocean, you’re on your own. I also think traveling by boat is a 24/7 job so you can’t take 10 hours out each night for dialysis. It’s doable in a RV but not in a boat with 25 foot waves. So if I really want to do this, it will have to wait until after a kidney transplant. Probably need to sell my house too in order to afford a decent boat. It will likely be very expensive to operate a boat, much like owning a private jet, but it would be cool to visit the South Pacific in your own yacht.

This is post #400!

JSX

I haven’t booked anything for this San Francisco trip I’m planning. With my peripheral neuropathy, having to sit for long time is really uncomfortable. The worst is dialysis since after you sit down, you can’t really get up and move around. I’ve seen patients disconnected during the session so they can use the bathroom, but it’s pretty rare. Also bad would be sitting in an airplane, so that is why I was looking at first-class seats on such a short haul flight. Finally, having to show up early at an airport because you don’t know how long the TSA line will be, then sitting at the gate for hours also sucks. John Wayne airport is great for this because I don’t think I’ve ever waited more than 20 minutes to get through the security checkpoint. For LAX, I’ve seen 10 minutes to an hour and a half for international flights.

*https://liveandletsfly.boardingarea.com/2017/05/05/best-kept-secret-lax/*

Another flight option to the Bay Area from John Wayne is JSX. They have the same owners as JetSuite, a private jet charter company. JSX flies Embraer ERJ135 and ERJ145 jets, which hold 30 passengers. These jets are also flown by American Eagle. JSX advertises their flights as “private-like jet” but they’re really small regional passenger jets. They also have a very small list of destinations. However, JSX has their own terminal and operate as a charter so no TSA checkpoints. I guess that’s the “private-like” part of the experience. You go to their hanger about 15-20 minutes before the flight and just get on the plane. Easy, and less time sitting around with my numb feet.

For my planned trip, JSX flies between John Wayne (Orange County) and Oakland International airports. One way flights are as low as $129, which is $10 cheaper than Alaska Airline first-class seats between John Wayne and San Francisco International. Which is better? First-class seats in an Embraer E175 or a regular seat in an Embraer ERJ-135/145? I think JSX wins because of the ease of check-in and boarding, but they don’t have that many flights. Also, their hanger is away from the main airport terminal with public transplantation. We would have to get an Uber or Lyft to get to/from JSX, whereas BART will go directly to either SFO or OAK. So the new plan would be to fly from SNA to SFO, then take BART to Union Square. When coming home, either take BART to Coliseum Station and Uber to JSX, or ride Uber for the entire trip from Union Square to JSX, then fly JSX from OAK to SNA.

Date	Flight	From	ETD	To	ETA	Price
2/29/2020	AK 3453	SNA	3:00 pm	SFO	4:35 pm	$139*
3/2/2020	XE 332	OAK	7:30 pm	SNA	9:01 pm	$129

*First class. Cheap seats are $69.

YouTube review of JSX

This is probably the closest I’ll get to flying on a real “private” jet. My previous boss had a Gulfstream G500, and my current company owns a Gulfstream G650ER. I haven’t been on either one. The cost for buying and operating a private jet is astronomical. Our G650ER costs about $72 million and we spend a couple $ million each year on operating costs. They are also very expensive to charter or lease. Here is a G650 going for $15,469/hour. If you have 500 friends, you can get a Airbus A380 for $51,564/hour.

*Can’t fly in and out of John Wayne Airport with an A380*

RV Videos

When I was on peritoneal dialysis, I was watching a lot of other types of travel videos. Specifically, I watched videos introducing various recreational vehicles. I was mainly interested in a Class B van so it would be easy to drive everywhere. The thought was that I could retire from work, buy a RV, then travel across US and Canada while living out of the RV. Since I was doing peritoneal dialysis, I could install a PD cycler in the RV, as long as I had enough batteries or shore power to run it all night. I could have the dialysate solution delivered to different places across the country, or come home monthly to pick it up.

I was looking for these specifics features:

Separate shower instead of a wet bath
Solar panels and extra batteries to power the PD cycler overnight
Fits into a “regular” parking spot
Have additional seats in the back with seat belts
Preferably no slide-outs

A lot of Class B campers have wet baths, which reminds me too much of bathrooms in China. So something like this:

Or this:

I’m still not 100% sure why I was thinking of doing this. We never traveled by RV growing up, and most of the places I want to visit are overseas. Traveling by RV is more suited to visiting national parks and campsites; I’m more of an urban traveler, visiting large cities and cultural sites. I think it was the possibility of traveling with the PD cycler so you’re not tied down to one place for dialysis, and not having to carry the machine on airplanes and arranging delivery of dialysate solution.

Well, all that’s is impossible now that I’ve removed the PD catheter since peritoneal dialysis is not an option for me. Home hemodialysis really requires you have a helper in case you screw up and start bleeding out. I doubt it’s possible to do home hemodialysis out of a RV. I could always do RV travel if I get a kidney transplant, but then I would travel by airplane instead of driving a van everywhere.

I also watch a lot of super-yacht and private jet videos but those are definitely out of my budget.

More YouTube Travel/Food Videos

At work today, a coworker asked me what I did all day when I was basically bedridden. I told her I watched a lot of YouTube Travel and Food Videos. Then she asked, “Did you see videos by Mark Wiens?” I guess he’s pretty famous as someone else from my church small group asked me the exact same question. They also made fun of his “I love this” facial reaction.

The other channel I watched a lot is from Mike Chen. I think his claim to fame is how much he eats at AYCE (All You Can Eat) places, especially Chinese Hot Pot and Korean BBQ. I like Mark’s videos a bit more but they’re both pretty good. I guess it’s a pretty good life if your job is traveling and eating. Here is a video that features both of them together eating noodles in Thailand:

I visited Thailand on a “vision” trip back in 2005. It was basically a trip with my church at the time, and the goal was to see if I wanted to move there for one-year as a missionary. We visited major tourist areas like Bangkok and Phuket, but also less well known places like Udon Thani and Koi Yao Yai. I enjoyed the trip but Thailand was too hot and humid, and the food was too spicy for me.

*Beach next to Loh Yak Pier on Koi Yao Yai*

I also visited Taiwan for a few days after Thailand. I remember calling my ex-wife at home from right outside of Sun Yat-sen Memorial Hall in Taipei. It was raining a little bit at the time. This was when she dropped the bomb over the phone, and asked for a divorce from about 7,000 miles away. That’s a story for another time/post.

New Career: Tour Guide

After I had my emergency heart bypass surgery, I was discussing the future with someone from my church small group. His comment was that my previous life was over and I need to think about how to live my second life. For now, I’m going to go back to work but really think about what to do with the rest of my life. 25 years in finance is a long time.

One idea is to find a job closer to home, but several levels below my current position. I’ve been in a director level position for the past 8+ years, which means managing staff that manages other employees. A lot of my time is spent mentoring instead of getting tasks done. Maybe I can take an analyst position nearby and take it easy, but for a lot less pay.

Another idea is to find another career in an entirely different field. I really enjoy putting trips together. On our 2015 family trip to Japan and Taiwan, I spent about three months researching and organizing a detailed itinerary that even included train schedules and restaurant listings. I managed to get it down to two pages and we carried it with us all trip. However, usually when you start a new career at the bottom, you have to work really hard. I don’t mind working hard but I don’t really have a career goal at this point. Also, how do you start with no experience? Do I need to take classes in school again?

I looked at tour operator sites like Abercrombie & Kent and it seems like there are pretty healthy profit margins. Closer to home, I found this tour at Kensington Tours that charges ~$5k/person for six days in Southern California. Assuming they will operate the tour with just two guests, that’s a budget of ~$10k. Let’s break down the itinerary:

Accommodations at Chamberlain West Hollywood: about $400/night for Deluxe suite
Accommodations at Hotel Indigo: about $265/night for King Skyline View room
Day 1: pick up guests at airport
Day 2: 4 hour tour of Los Angeles: the only place that looks like it needs tickets is La Brea Tar Pits ($22/person); not sure if lunch at The Ivy is included; parking at Griffith Observatory is ~$10/hour
Day 3: 9.5 hour trip to Santa Barbara: visits to a bunch of public places so if there are tickets and parking, it’s probably not too expensive; again, not sure if lunch is included; winery tours are probably free; private wine tasting seems to be $35/person
Day 4: 6 hour drive down to San Diego: all the stops in LA are public locations and free
Day 5: 4 hour tour of San Diego: only place that costs money is visiting the USS Midway Museum ($26/person)
Day 6: drop off at airport

If we pay the tour guide $30/hour and we include 10 hours/day, then it’s ~$2k for labor. Accommodations for five nights is ~$2k, and everything else is probably <$1k (transportation, parking, admissions, maybe food). That leaves ~$5k of profit for only two guests (50% margins!). If you have two more guests, just rent a minivan and get another hotel room. The profit margin is even higher with more guests. Of course there are risks, such as sitting around having no customers, but it sure beats working fast food. Maybe even better than working as a finance director.

San Francisco Trip (updated)

After almost three years of dialysis, I think I’m ready to take my first trip. I wrote several blog posts about it and spent all yesterday morning researching hotels. I’m going to ask my parents to see if they want to go, then book the trip for February 29th to March 2nd. I can still get $139 first class tickets on Alaska/SkyWest so $834 for plane tickets.

For hotels, it appears that Hilton does not charge a resort fee at their hotels near Union Square. I can get a room with two double beds for ~$180/night including tax at Parc 55. Last time the three of us were in San Francisco, we drove up from LA and it rained the entire time. My main goal this trip is eating dim sum so maybe the weather won’t matter that much.

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Ugh, there are only two first class tickets available for $139 on the flight from SNA to SFO. I probably need to get both seats for my parents and I’ll sit in economy. It’s only 1.5 hour flight.

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I just read this on Reddit. I didn’t know it was even a concern to fly with a chest tunneled catheter. There is a clamp over each tube so it shouldn’t leak blood out of the actual catheter. Maybe the OP is talking about the opening in the chest. Mine was bleeding until about 2-3 weeks ago so I think it’s good. There’s also a BIOPATCH disc on the opening and a large clear bandage covering the entire area.

I’ll probably need to check with my nephrologist before making any reservations. I don’t want any TSA employees thinking that I’m carrying a SIIED or something.

Can I fly with tunneled cath?
byu/skrattadude indialysis

Abercrombie and Kent (updated)

While we’re fantasizing about travel, this seems to be the ultimate in fantasy travel. It’s only $160k per person, double-occupancy. You basically fly on a private Boeing 757 with only 50 seats, and all the attractions and accommodations are amazing.

$160k is a lot of money for 26 days. That comes out to ~$6k per day per person. Since the trip can take 48 guests, the total budget is $7.68 million. I could probably plan a great trip with that much money, though some things, like dinner at Kanazawa Castle may be hard to book for a nobody like me. I wonder how much profit margin they make on each trip.

There are also shorter trips on smaller private jets. It’s still not cheap; you’re looking at ~$35k for 14 days. This makes a lot of sense though. When I planned our Japan/Taiwan trip back in 2015, there was a lot of time allocated to traveling between destinations. It took us most of an entire day to get from Osaka to Taipei on Japan Airlines, and many hours to get from Tokyo Station to Shin-Osaka via the Tokaido Shinkasen. If we had chartered a private jet, then it would have been only a few hours.

This looks like an interesting itinerary. Five countries and only 5.5 hours of flight time between the different cities. You would spend four out of the 14 days transiting on a normal trip. I took a Trafalgar tour many years ago from London to Paris to Rome and we spent almost two days traveling between the cities by ferry and overnight train.

Of course none of this is possible without a kidney transplant. I don’t see a Dialysis in the Air option, though they probably could set up a hemodialysis machine inside a wide-body jet. The patient would have to do dialysis on the jet, probably while parked at an airport, but it will cost a lot for a dedicated nurse and space on the plane for the dialysis machine. Maybe it’s more feasible for peritoneal dialysis patients since all you need is someone to coordinate moving cyclers and supplies to hotel rooms from the private jet. It will be up to the patient to run their nightly dialysis program.

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OK, they are ridiculously expensive. I looked at one of their Tailor Made custom tours of Nice and Monaco. For four days, it’s ~$5k double occupancy, so about ~$10k for two people. The hotel listed in the itinerary, Hôtel La Pérouse, is only $210/night in May for an Economy room; even if you book a Deluxe room, it’s ~$750/night, breakfast included. If you go to all the places listed in the trip itinerary, the total cost of admissions is <€60. Other than the hotel breakfasts, there are no other meals included. Add local transportation, airport transfers, and the cost for a private guide for a few days, it’s still way less than $10k. I guess there’s some value in coming up with the itinerary. A friend planned her Europe trip by copying itineraries from Rick Steve’s website, or you can just use a travel agent.

Next Seven Days

This is the last week before my planned return to work. I have never stopped working for so long since I started working full-time. I’m actually anxious because it feels like I’m starting a new job, plus I have two surgeries on Friday. This is my schedule for the last seven days of medical leave:

Date	Events
Thursday, January 30th	dialysis; acupuncture; church small group; go to dentist’s house to remove temporary crowns for surgery
Friday, January 31st	surgery at 9:30 am; check-in at 7:30 am
Saturday, February 1st	dialysis; rest
Sunday, February 2nd	rest
Monday, February 3rd	rest
Tuesday, February 4th	rest; therapist appointment (maybe); ~~acupuncture (maybe)~~
Wednesday, February 5th	first day of work again (maybe)

At some point, I have to restart cardiac rehab as well but that will depend on what the surgeon says. I can probably walk and work out my right arm pretty soon but I don’t know how long I have to rest my left arm.

Again, I’m basing my non-exercise recovery schedule according to the PD installation surgery. That was on a Thursday, also with general anesthesia. I took Friday off work, and returned the following Monday. The catheter removal should be similar to the earlier surgery, and the fistula surgery seems to be a more minor surgery. I guess I’ll find out in 36 hours.

Lakers Game (updated)

This doesn’t have much to do with dialysis or cardiac recovery but I’m going to the Lakers-Clippers game this Wednesday night at the Staples Center. One of our vendors from work gave us some tickets, maybe even in one of the luxury boxes. It will be the first Lakers game after Kobe Bryant’s death yesterday. I am pretty sure there will be some sort of memorial program before the game since Kobe was such a huge part of Lakers history for 20 years.

I sometimes feel sorry for myself, especially when sitting in the dialysis chair, but I’m usually surrounded by really sick people. And when something like Kobe’s accident happens, I realize even with all my illnesses, I’m still alive and have a chance at a productive future. I know it’s hard to compare lives but Kobe was an inspiration to millions of people and father to four kids. He’s had a huge impact to our society. Whereas I’m just some random anonymous guy that hasn’t really done much with his life. How do you measure fairness in life?

I don’t know where I’m going with this post. However, often I am reminded of the Book of Ecclesiastes:

Surely the fate of human beings is like that of the animals; the same fate awaits them both: As one dies, so dies the other. All have the same breath; humans have no advantage over animals. Everything is meaningless. All go to the same place; all come from dust, and to dust all return.
Ecclesiastes 3:19-20 (NIV)

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Oops. The game is actually on Tuesday night (1/28/2020), and it’s been ~~cancelled~~ postponed. They didn’t mention when the game will be replayed and I don’t know if we will get tickets for that game as well. Since I screwed up the date, I had scheduled a dentist appointment and an acupuncturist appointment for Tuesday so I would have had to miss the game if it wasn’t postponed.

Dialysis Blood Pressure 1/23/2020 (updated)

The three medication combo is definitely working. The first few readings are:

Time	Systolic	Diastolic	Pulse	Notes
9:10 am	145	88		Standing
9:18 am	151	83	61	Sitting/legs up
9:48 am	141	82	60	Sitting/legs up

Without all the meds, I was getting numbers like ~190/110 sitting. The NIFEdipine should last a few hours but one or both of the other medications will start getting dialyzed out of my bloodstream and the blood pressure will slowly increase.

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Here are the rest of the blood pressure reading from today:

Time	Systolic	Diastolic	Pulse	Notes
10:18 am	156	88	61	Sitting/legs up
10:48 am	149	82	61	Sitting/legs up
11:18 am	156	86	60	Sitting/legs up
11:48 am	157	89	61	Sitting/legs up
12:18 pm	164	90	65	Sitting/legs down
12:59 pm	132	28	64	Standing

Lab Results 1/16/2020, Part II (updated)

More bad news. Each month, the dialysis clinic tests for dialysis clearance or adequacy. For hemodialysis, there are two measurements: Kt/V and URR (Urea Reduction Ratio).

Test	Limit	Prior Month	This Month
Kt/V	>1.2	1.199	1.0 something
URR	>65%	64.7%	60.6%

For some reason, both numbers have gotten worse. They are drawing blood today to retest. I did not provide a 24 hour urine collection this month but since last month’s 50 mL did not contribute anything to the clearance, I don’t think it will matters this month either.

Depending on the restest, they may ask to increase the dialysis time to four hours per session since they can’t increase the flow rate anymore.

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Whew! I just saw the updated test results. It only shows the URR value and it’s 65.0%. I think that meets the minimum requirements. The Kt/V is a calculated number. Since I cleared with a URR of 64.7%, the updated results should yield a satisfactory Kt/V value too.

The super low number was when I was just to switched back to hemodialysis. It’s the result of inadequate peritoneal dialysis. I don’t know about all the other dips in prior results; I wasn’t asked to do more dialysis at the time. Maybe there is large variability day-to-day in dialysis effectiveness.

Blood Pressure Medication Instructions

After talking with my nephrologist Tuesday, she changed the timing of my blood pressure medications. So previously, I would take:

Time	Dialysis Day	Non-dialysis Day
Morning	Olmesartan 20 mg	Olmesartan 20 mg Metoprolol 25 mg
After Dialysis	Metoprolol 25 mg
Evening	Olmesartan 20 mg Metoprolol 25 mg	Olmesartan 20 mg Metoprolol 25 mg
Night	NIFEdipine ER 30 mg	NIFEdipine ER 30 mg

Now, I think I need to take:

Time	Dialysis Day	Non-dialysis Day
Morning	Olmesartan 20 mg Metoprolol 25 mg NIFEdipine 10 mg	Olmesartan 20 mg Metoprolol 25 mg
Evening	Olmesartan 20 mg Metoprolol 25 mg	Olmesartan 20 mg Metoprolol 25 mg
Night	NIFEdipine ER 30 mg	NIFEdipine ER 30 mg

I believe the logic is that something is getting dialyzed out, but my blood pressure becomes too high during the session if I wait to take all the morning medicaion after dialysis. The 10 mg of NIFEdipine is probably there to offset other medications being dialyzed and we know that works well. They also didn’t want to move the NIFEdipine ER to the morning in case I get hypotension during dialysis. I still need to figure out how to time the 10 mg of NIFEdipine so the blood pressure is not to high during cardiac rehab either.

I also spoke to the cardiology nurse practitioner today. She mentioned that usually they defer to the nephrologist for dialysis patients since nephrologists are more familiar with how medications interact with dialysis. She did say that my prescription dosages are all quite low so there may be room to increase the dosage if necessary. Let see if the new medication schedule works any better than the previous schedule.

Claim Jumper Nutritional Information

The PDF I linked to earlier with Claim Jumper’s menu and nutritional information is gone. The link just returns a 404 page. I wonder why they took the page down. I’m going to have to rely on a third party page for their nutritional information.

About seven people showed up for dinner. It’s mainly people that show up each year. It’s still pretty amazing that we still meet every year; I left the company about 20 years ago. Anyway, I was considering the following menu items:

Menu Item	Calories	Saturated Fat	Cholesterol	Sodium	Carbs
Chicken Pot Pie	2,120	30 g	260 mg	3,550 mg	170 g
Meatloaf & Mashed Potatoes	1,180	31 g	328 mg	3,303 mg	83 g
Fish & Chips	1,115	7 g	89 mg	5,358 mg	148 g
Widow Maker Burger	1,565	26 g	177 mg	3,973 mg	126 g
Southern Fried Chicken	1,130	18 g	203 mg	3,175 mg	106 g
Spaghetti & Meatballs	1,450	25 g	163 mg	3,140 mg	111 g
Asian Grilled Chicken Salad	585	3 g	62 mg	1,946 mg	48 g

I really wanted to get the Chicken Pot Pie or the Fish & Chips but those are crazy fat and sodium numbers. A Eating Right for Your Heart page recommends a daily sodium limit of 2,300 mg or only 1,500 mg if you have high blood pressure. The cardiac rehab program recommends 1,500-2,000 mg of sodium and <15 g of saturated fat. The only menu item I considered that meets those guidelines is the Asian Grilled Chicken Salad so I got that. It was pretty good but I’m basically at my sodium limit with one dish.

*That looks delicious! It will probably give me another heart attack but yum!*

We sat there with the menu for quite a long time since we were waiting for a few more people. I was trying to justify to myself that this was a rare occasion and I don’t eat out every night. However, I think it’s just like exercising. I can justify sitting out for one day, which then becomes two days, and so on. Eating unhealthy for one night probably won’t kill me (literally), but I’ll probably use the same excuse many times and risk more heart disease.

Return To Work, Part II

I got an email from our external leave of absence management company. The rep said he got my medical release form but there is a problem with the return date. I think both my nephrologist and I got the dates mixed up. We though that 1/31/2020 was the leave end date and not the first day back to work. Why would we pick a Friday to return to work? On the medical release form, we put 2/3/2020 as the return date which does not match the original leave request form.

Anyway, he wanted me to have my doctor fill out the entire leave request form just to extend my leave for one day. It’s hard enough seeing my nephrologist during dialysis sessions, much less making multiple trips to her office just to get a form filled out. After several emails, the rep said if I take a PTO day for 1/31/2020, that’s an internal work issue and it won’t affect my leave status. Good. I was going to take a vacation day for 1/31/2020 anyway. That way I can leave my nephrologist out of it.

So I guess I’m going back to work very soon. Since the additional surgery will be on 1/31/2020, I’ll keep taking vacation days until I feel well enough to actually return to work.

Cardiac Rehab 1/22/2020

I went to rehab around 8:30 am this morning. I had another appointment in the same building at 10:15 am so I tried to time it so that when I finish rehab, I would have a few minutes to change then go to the next appointment. However, when I got to rehab, it was pretty full with patients, and they wouldn’t let me start exercising because my blood pressure was too high. It started at ~ 180/100. After “resting” and retaking it several times, we got a 163/90-something so they let me exercise, but only at 1.5 mph on the treadmill. They have three blood pressure monitors and I think one of them reads high. Anyway, I walked for 30 minutes and only completed 0.75 miles.

After rehab, my appointment was with the cardiology nurse practitioner. They measure my blood pressure again at their office and it was 144/80-something. The nurse measured it again manually (with a stethoscope) and it was lower than the rehab readings. Either the rehab’s monitors all read high, or the two medications I took in the morning took a long time to kick in. In the future, I think I will sneak in a 10 mg capsule of NIFEdipine before rehab so that they will be happy with the blood pressure readings.

Return To Work

My nephrologist signed a Medical Release for me today so I can return to work on 2/3/2020. They probably wanted a release from my cardiologist but the form just said “doctor” and my nephrologist is very helpful with forms.

I have my PD catheter/fistula surgery scheduled for Friday, 1/31/2020. I looked through my work calendar to see what happened when the PD catheter was put in last April. I had the surgery on a Thursday and was back to work on Monday. Since both these surgeries seem less complex than putting in the PD catheter, I think the weekend is sufficient for recovery. Otherwise I can take a few days of vacation.

FMLA only guarantees a 12-week medical leave. I started my leave on 11/11/2019 and 12-weeks ends on 1/31/2020. It’s probably easier to end my leave then take vacation instead of getting more paperwork to extend my leave. There’s probably no extra pay anyway without even more paperwork for EDD and our disability insurance company.