Busy Dialysis Session

Today was a petty eventful day at dialysis. Nothing bad happened but just a lot of stuff came up. Since the one “reliable” tech was still out on medical leave, my nurse just plugged me in using the chest catheter. After about 30 minutes, one of the other senior nurses came by to try her luck. She managed to hit the blood vessel on the first try for both needles, but sadly the arterial one stopped working as soon as she hooked me up to the dialysis machine. I think when I moved my arm to a lower position, it changed the geometry enough that the needle wasn’t getting enough blood flow. The venous needle worked though so they used the catheter to pull blood out, and return it through the fistula. I guess one working needle is better than none.

I also came in at 88.9 kg. which is the least I ever weighted for dialysis. Since the rounding nurse lowered my dry weight to 87.0 kg on Tuesday, it meant we still had to pull about 2 kg of fluids out. I ended up at 86.7 on the way out of dialysis. I also found out that I’m only 5’10” and not 5’11” so any BMI improvements due to weight loss is offset by the shorter height. I can’t win…

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Almost forgot. The dialysis nutritionist came by to give me a phosphorus quiz. I guess they’re doing an education program since I overhear a lot of patients have problems with their phosphorus levels. For the first two years on dialysis, I was usually slightly above the 5.5 mg/dL upper limit. When I was on peritoneal dialysis, that number shot up to 11 since the process wasn’t working. Recently, I’ve been just below the upper limit, and actually got a 4.6 during the last labs on 7/16. If you are consistently high, in the 7-8 range, that may disqualify you from a kidney transplant. How ironic.

Anyway, I got 8/10 on the quiz. Some of the questions were poorly worded but I’ve read a lot online about phosphorus and it’s effects on your body. The nutritionist went over the answers and her spiel anyway. Her voice is really loud so each time she talks to a patient, you can hear her everywhere in the dialysis center. She even pulled out a diagram on how parathyroid hormone is regulated in the body.

*The chart I was shown wasn’t this complicated but it was similar*

DMV Real ID Visit

After my endocrinologist appointment this afternoon, I decided to check out the Santa Ana DMV since I have already filed all the Real ID paperwork online. I got out of the doctor’s office at around 3:30 pm; the DMV office closed at 5:00 pm. When I pulled into the parking lot, there was a huge line plus a lot of people just standing around. The parking lot was surprisingly empty so I parked and walked up to the front door. The long line was for people without appointments, but there was an empty line for appointments only. I know they’re not handing out appointments anymore but my “receipt” for uploading all my Read ID documentation counted as an appointment. I showed the person at the door my receipt and she sent me to a window directly. That person entered my info into the computer, and I was called to a second window while I was still at the first window. I got sent to Window #1 which was way on the other side of the floor where a clerk verified all my documents and took my payment of $37 + credit card fees (CA government is super cheap). I had just switched glasses so my vision was a bit blurry. There was a vision chart hanging inside the office; I was worried that they were going to ask me to read a line. Until my eyes adjusted to the different glasses, I couldn’t read anything on the signboard. She didn’t ask me to read anything. After paying, I was told to go the camera window to take a new photo, then go to Window #25 for a temporary license since mine expires in less than two weeks. All together, I was in five different lines but the entire process took about 45 minutes, which is the shortest time ever spent during a single visit to a DMV office.

*Santa Ana DMV Office. It’s right next to Mos 2, the best Mexican teriyaki chicken place.*

In two weeks, I should have my Read ID driver’s license. Could be useful for domestic air travel if I do that ever again.

I was worried about going in person to the DMV since Santa Ana is such a shit-show for COVID-19 cases. However, with only two weeks until my license expires, I had to go sooner or later. Everyone, including all the visitors, at the DMV was wearing a mask without exception. They also had a bunch of workers with disinfectant bottles spraying and wiping down every surface. They all seemed to be Asian though… weird. I stayed away from everyone; it wasn’t that crowded inside the DMV office.

Throwing Up Again

I haven’t vomited for awhile but it came back with a vengeance today. My mom cooked two dishes and chicken soup tonight for dinner. I tried the first dish, stir fried shredded tofu, and it tasted funny. The vegetable dish was odd too so I just drank the soup. It was in a large cup and right when I got to the bottom, my gag reflex kicked in. I ran to the bathroom and the entire bowl of soup came back up. It looked like a lot more coming up than I remembered drinking. That went on for about a minute before the nausea subsided.

Having not eaten anything since breakfast, I quickly ordered a sub from Jersey Mike’s. The one closest to my house wasn’t taking orders since it was almost closing time so I had to drive about 5 miles to another store. I got a turkey sandwich, which is usually pretty safe. Actually, I’m eating it the sub right now and my stomach is still feeling a bit weird.

The store is located in a shopping plaza called Tuskatella Shopping Center. It’s a large strip mall on the corner of Tustin Street and Katella Avenue, hence the name. There are several restaurants in the plaza: Five Guys, Wingstop, Waba Grill, El Pollo Loco, Papa John’s, etc. It was pretty crowded and did not look like we’re in the middle of a pandemic at all. At least almost everyone had a mask on. Are all the anti-mask crazies concentrated in Huntington Beach?

Mail Order Prescriptions

My work health insurance offers a mail order prescription option. The online pharmacy would send me a three month supply of the medication for one co-payment. However, you have to get your doctor to fill out one of their forms and fax it in. I haven’t done this for any of my prescriptions yet since most of them are still changing. Right now I get all my medications from the Sav-On pharmacy located inside the local Albertson’s supermarket. It’s really close but still a pain since all of them refill at different times and I (or my parents) end up going there 5-6 times each month.

I just noticed in the pharmacy app that I can have them ship the medication to me. If I wait 2-3 days, it’s also free. Since these aren’t urgent refills, I asked the pharmacy to ship the latest batch of medications. If this works out, I’ll probably have them ship everything in the future so I can avoid going into the market.

Frozen Dinner

I’m not sure what happened but my parents ended up not making food for me for dinner. Usually they make dinner unless we order out. Anyway, I went downstairs and put the last Marie Calendar’s frozen meal in the microwave. As I mentioned before, this was the beef and broccoli bowl. It looked promising but turned out disappointing.

I’m not sure what type of rice is used in these frozen meals but they come out kind of weird. The rice grains are a bit fatter than what I’m used to and I though it tasted kind of weird. Maybe it’s due to the microwave cooking. The dish was too sweet overall and had a strange taste. Also the beef was a bit tough for me so I would only give it a 2 out of 5 stars. I didn’t finish the bowl; I only ate about 1/2 of it.

Here is the nutritional information on the box:

Nutrition Item	Beef and Broccoli Bowl	Sweet and Sour Chicken	Baked Turkey
Serving Size	335 g	397 g	369 g
Calories	360	550	260
Total Fat	6 g	15 g	6 g
Saturated Fat	1.5 g	2.5 g	3.5 g
Trans Fat	0 g	0 g	0 g
Cholesterol	35 mg	35 mg	45 mg
Sodium	710 mg	1,060 mg	1,040 mg
Total Carbohydrates	57 g	88 g	31 g
Dietary Fiber	4 g	4 g	5 g
Total Sugars	12 g	28 g	6 g
Protein	19 g	17 g	19 g
Vitamin D	0 mcg	0 mcg	0 mcg
Calcium	50 mg	70 mg	30 mg
Iron	1.8 mg	3.5 mg	0.7 mg
Potassium	640 mg	430 mg	750 mg

Nutritional information found on packaging

I’m kind of ambivalent on eating more of these frozen meals. They seem to taste better in the past, whether that’s real of just my imagination. The sweet and sour chicken was not bad, but I probably wouldn’t get the bowl or the turkey again. Maybe I have to try more of them to find a small selection that I do like and stick with that.

Walking 7/28/2020

Weird. My shortness of breath feels worse these couple of days but I was able to walk okay on the treadmill. I just walked about 0.75 miles in a bit under 30 minutes. Not too fast but didn’t run out of breath though. I hooked up my sister’s old iMac in front of the treadmill so I can stream Netflix or files from my video server to make the time pass faster.

The shortness of breath is still bothering me quite a bit. It’s especially noticeable when I lie in bed flat on my back. In addition, I can hear the sternum move during each breath. It’s been 9 months since the open heart surgery. The bone should have fused a long time ago but it still feels loose.

Peripheral Neuropathy 7/28/2020

Ugh, I’m tired of writing about this but the attacks are coming in almost daily. I was at my limit when the pain episodes were occurring once a month, but now it’s almost non-stop. The pain from 7/26 subsided this morning but it was enough to prevent me from sleeping that much. As a result, I was super tired during dialysis. I think I fell asleep at 6:00 am and didn’t get up until 8:30 am. That session felt like the fastest ever since I slept through most of it.

Since my feet felt better, I took a short nap at around 1:00 pm and didn’t get up until almost 6:00 pm. But as soon as I got up, another pain site popped up on my left foot, a bit higher up on the insole than the case on 7/23. I said before that I didn’t want more medication since I’m on so many of them now but I’m beginning to change my mind. I can’t stand this anymore. Worse, this probably won’t improve with a kidney transplant since it’s the result of prior uncontrolled diabetes. Even though I have my blood sugar well controlled now, it won’t matter.

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Double ugh. Many websites say to keep well hydrated to avoid or reduce neuropathy. Well, that sucks for dialysis patients, especially when my nephrologist keeps reducing my dry weight. It was reduced to 87.5 kg last Tuesday, and today, it was reduced further to 87.0 kg. I have been leaving the dialysis center at ~87.5 kg lately, the lowest weight for me in recent memory. Is this just coincidence or am I drying out, causing more instances of neuropathic pain?

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This is killing me. The pain switched from the left foot to the toes of the right foot suddenly. The left foot pain was more prolonged but not very painful. The right foot pain now is super painful and spread across the bottom of three toes. Ugh, I can’t stand this anymore.

Raising Cane’s Box Combo

I swear, I must have eaten a whole flock of chickens since I get food from Raising Cane’s so often. The location in Tustin is usually super busy. They marked off two lanes in the driveway for the drive-thru but since I go there around 10:15 am, there is never anyone in line. There was no line today and I got my food in <30 seconds. I still need to go into the store someday to get a club card.

I’ve also got into the habit of eating one (or two) of the chicken fingers as soon as I get it. I ended up parking in the back of the lot and ate two of the chicken fingers. They taste much better when they’re super hot. Usually bu the time I get home, the food has cooled off somewhat, and the fries are starting to turn soggy. It’s also too bad they mostly sell combos. I’m not too big into the toast and coleslaw. Maybe I can just get some chicken fingers à la carte next time. I think it’s $1.39/chicken finger, and $9 w/tax for a box combo. Definitely cheaper if you buy the combo, but only if you eat everything. Since I only ate the chicken and most of the fries, I’m going to try and prorate the nutritional information.

Nutritional Information	Chicken x4	Fries	Total
Calories	560	390	950
Fat Calories	240	170	410
Total Fat	28 g	19 g	47 g
Saturated Fat	4 g	2 g	6 g
Trans Fat	0 g	0 g	0 g
Cholesterol	160 mg	0 mg	160 mg
Sodium	720 mg	310 mg	1,030 mg
Carbohydrates	24 g	49 g	73 g
Sugar	0 g	1 g	1 g
Protein	52 g	5 g	57 g

Raising Cane’s website

Yeah, I think I will just order chicken fingers next time and leave out the fries. There’s probably a lot of extra potassium that I don’t need in the potatoes as well.

As a compromise, there is a Carl’s Jr. across the street from the dialysis center. I sometimes go there to get their $5 meal that includes three chicken tenders, small fries, small drink, and a cookie. It’s not the same taste or quality as Raising Cane’s but if you get it “fresh” as in right after they deep fried the chicken, it’s not too bad. Otherwise, the chicken is usually too dry, and the batter too hard and salty. Carl’s Jr. has much better tasting fries too. The cookie, usually chocolate chip, was terrible.

COVID-19 in Orange County per The New York Times

Here is a chart for number of cases in Orange County from The New York Times on Google. It looks somewhat different than the data shown by the Orange County Department of Health. I zoomed in to show May to July.

I think both are showing a downward trend in the past few weeks but the data points seem completely different. Yet, both websites show the exact same number of cumulative confirmed cases as 34,646. How can the totals be the same when individual days are totally off? For example, I’ll pick a random date of July 15, 2020. OC Department of Health shows 555 cases, while NYT shows 911. That’s a huge difference. Who is right and why is the other source so different?

Ding Tai Fung Dinner

Someone from my parents’ church bought food from Ding Tai Fung (DTF) for us so they went to their house to pick it up. The food included two orders of xiaolongbao, two orders of potstickers, and three cups of chicken soup. My mom re-steamed the xiaolongbao to heat it up, and we microwaved the rest. It was okay. I’m not a big fan of DTF, especially how expensive the food is. Our dinner was probably over $60. It was nicely packaged for take-out though. They even included little containers of shredded ginger and packages of black vinegar.

*Ding Tai Fung at South Coast Plaza in Costa Mesa*

The friends ordered from the South Coast Plaza location. I’ve never been to that location before. I’ve only eaten at the one in Seattle, and the flagship store in Taipei 101 in Taiwan.

*Line at entrance of Ding Tai Fung at Taipei 101. This was back in 2015.*

I looked online and there doesn’t seem to be any nutritional information published. Typical for a Chinese restaurant. I ate about half dozen of the xiaolongbao, four potstickers, and drank only the soup; the chicken meat was super dry and tough. Probably wasn’t supposed to eat the chicken meat anyway.

*FAQ section of Ding Tai Fung’s website*

Reddit r/dialysis

There seems to be more and more messages of despair and hopelessness on the r/dialysis subreddit. Before, it was mostly people asking more experienced dialysis patients for advice, but recently, there seems to be a lot of posts where the OP is talking about stopping dialysis or committing suicide.

I think the combination of going to dialysis and the recent COVID-19 outbreak has really stressed out a lot of patients. Admittedly, dialysis was already a pain-in-the-ass, having to go to the clinic three times a week. However, the pandemic adds a whole new level of risk to everything plus social isolation. My social worker kept stressing the importance of continuing to work if possible, and maintaining my support groups. Well, now I’m working from home everyday, I don’t get to see my co-workers. I have co-worker I’ve known for 9 to 20 years, and they do act as social support sometimes. My cell group at church hasn’t met in person since March, though we “meet” weekly on Zoom. It helps, but nothing like sharing a meal with friends. I can see how this environment can get super depressing really quickly.

I’m not sure the public knows the fear and isolation affecting dialysis patients now. Since nobody seems to know for sure, the fear is that any exposure to the coronavirus will kill you so you stay away from everyone and everything. I still get take-out food but the places I visit are either curbside pickup or drive-thru. I go to the supermarket/pharmacy on rare occasions but always with a mask and lots of sanitizer. Even with a vaccine coming out soon, I think life for dialysis (and other seriously ill) patients have permanently changed for the worse.

More Marie Calendar’s Frozen Meals

For lunch, I had another Marie Calendar’s frozen meals, this time it was the sweet and sour chicken. This one got 3.5 stars on their website and again, that’s a pretty fair score. It was a bit better than the turkey breast I had last time. Again, I had to mix the chicken + sauce with the rice halfway through the heating cycle but the batter on the chicken wasn’t too soggy and the taste was decent.

Here is the nutritional information from the box.

Nutrition Item	Sweet and Sour Chicken	Baked Turkey
Serving Size	397 g	369 g
Calories	550	260
Total Fat	15 g	6 g
Saturated Fat	2.5 g	3.5 g
Trans Fat	0 g	0 g
Cholesterol	35 mg	45 mg
Sodium	1,060 mg	1,040 mg
Total Carbohydrates	88 g	31 g
Dietary Fiber	4 g	5 g
Total Sugars	28 g	6 g
Protein	17 g	19 g
Vitamin D	0 mcg	0 mcg
Calcium	70 mg	30 mg
Iron	3.5 mg	0.7 mg
Potassium	430 mg	750 mg

Nutritional information found on packaging

I included the information from the previous frozen meal for comparison. First, I thought the sweet and sour chicken tasted a lot saltier since the turkey breast was not that flavorful. However, the sodium content was pretty similar. There was a lot more sugars, probably due to the “sweet” part of the sauce. I left a lot of sauce behind since it was so sweet. That probably contributed to the calories and the total carbs number since both chicken and turkey are pretty lean. Finally, the potassium levels in the turkey breast was likely due to the mashed potatoes. Rice doesn’t have that much potassium compared to potatoes. Lots of carbs though.

This leaves me with one more meal in the freezer. I bought three of them last time since Albertson’s were selling them for $10/3. The last one is a beef and broccoli bowl, which got 4.0 stars on their website. Maybe it will actually taste “good” instead of just okay.

Walking 7/26/2020

I went outside for a short walk just now. I walked only 0.3 miles at a pace of 30’13”. It’s pretty slow but I made it around the small block without having to pause. The last time I went outside to walk the same short path, I had to sit down twice to catch my breath. I guess it’s an improvement.

Foot is still hurting from the neuropathy though. It was okay when I was walking but I was concentrating on not passing out. I already took two Tylenol tablets for 1000 mg of acetaminophen but it doesn’t seem to have any effect. I still have some codeine that I’ve saving for when I need to visit the dentist again.

Peripheral Neuropathy 7/26/2020 (updated)

Ugh, the last episode ended only two days ago and it’s starting up again in the other foot. I can feel the stabbing pain now on the insole of my right foot. Seriously, the pain just stopped two days ago in my left foot and it’s back already. I thought I was lucky that that pain stayed away for many weeks. I want to go out and walk for a bit but the blister in my right foot and this low level shortness-of-breath is making things difficult.

Speaking of the blister, it was still bleeding/leaking this morning, I’ve been using about four layers of gauze but it’s seeping through all of that every 8-10 hours. I want to switch to an island dressing that is adhesive but not too absorbent (Telfa), but worried that the fluids will leak out everything in my socks/shoes.

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Updated: 7/27/2020

Crap! It looks like my left foot is acting up too, even while the pain is getting worse in my right foot. This is my worst case scenario, that both feet are experiencing neuropathy pain at the same time. It even appears that there are two pain sites in my left foot so I’m really getting three sharp jabs instead of just one. Great!

I just took two more Tylenol pills. I don’t think there is any way i can sleep tonight. Since all the pain sites are pretty recent, the pain intensity is just going to get worse.

Quarantine Haircut

I’ve been going to the same hairdresser (he’s too expensive to be a “barber”) for the past ~20 years. His salon is in Irvine so the rent is probably not cheap, and currently he charges $25 for a haircut, and it comes with a scalp-massage shampoo. The last cut I got was in February. I usually go every 3-4 months and have him cut it short. When hair salons were open for a few weeks, I didn’t go back to get a haircut and now we’re all shut down again.

When we were growing up, my dad used to cut my hair. He recently bought a pair of hair clippers and still has some barber scissors from before. Today, he sat me down and spent about 15-20 minutes cutting my hair. It came out ok. Not as short as my guy would cut but since I don’t have much hair anyway, you couldn’t mess up that much.

Saturate OC

I’ve been a Christian for almost 30 years and have attended and served in many churches. These people on the beach seem totally crazy to me. I really don’t understand their reasoning or justification for doing this. We’re in the middle of a super infectious pandemic where people are dying daily. I’m willing to bet that these idiots are one of the main reasons the pandemic is out-of-control in Orange County.

Our church is not a participant in this. Sadly, I recognize some of the church “partners” on their website (Rock Harbor, Harvest). Our church did open up pretty quickly on Memorial Day weekend but shut down again per the governor’s orders. Do these people think they’re being oppressed or something? Can’t they worship from home? People are going to get sick and die from this. Do they think God is going to protect them from their own stupidity? Ugh, normal people are now going to blame Christians for spreading the virus. I’m Chinese and Christian… I guess that’s two strikes for me.

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There are countless news stories about some COVID-19 denier getting sick, almost die, and then warn people to be careful and practice social distancing. Is that what it’s going to take to stop these idiots? Having family members or themselves get sick and possibly die? I wonder if they will get vaccinated once an effective vaccine is found.

Take-Out Lunch

I usually get take-out lunch to eat at home after dialysis. The session usually ends a bit after 10:00 am so by the time I get food and get home, it’s usually almost 11:00 am. My list of food/restaurants is not that large:

Box Combo from Raising Cane’s ($9)
Charbroiled Chicken Shish Kabob from Panini Kabob Grill ($15)
Club Sub from Jersey Mike’s ($10)
Breakfast Burrito with Bacon from Johnie’s Jr. Burgers ($7)
Teriyaki Chicken Combo Plate from Mos 2 in Santa Ana (no website) ($9)

I’ve ordered from some other restaurants as well but these are the ones I go to the most. They also have to be open by 10:00 am; some restaurants don’t open for lunch until 11:30 am and I’m too lazy to go home first then come out again. A lot of times I end up skipping lunch altogether. I guess if I was willing to drive further, there are a lot of food choices. There are several dim-sum take-out places in Garden Grove that I want to try.

Today I had the chicken kabob for lunch. It was a lot of food but I didn’t have lunch or dinner yesterday so I was pretty hungry. I wish I could get some of the meat juice to go on the rice. Usually when we order the family meal, there’s some juice at the bottom of the meat tray. Otherwise, the basmati rice is too dry.

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Dang it! I just found out that Raising Cane’s has a frequent visitor club where you get points for free meals. However, you have to go into the restaurant to get a membership; you can’t sign up online. I’ve never been inside the restaurant, especially now. I’ve always ordered from the drive-thru line. I must have eaten there over 50 times by now. <sad face>

Fistula Update 7/25/2020

I’m disappointed that no one at the dialysis center wanted to try to stick me today. The one tech that have been successful is still out. Usually the techs lay out the fistula needles on my chair. They didn’t even do that today; they only prepped supplies needed to connect me with the catheter. I thought at least someone would try to stick me since it can be done. I guess I’m using the catheter for the next week and a half.

Meeting An Old Friend

I went out about 5 pm today to meet up with an old friend at a local Corner Bakery. He was there with his wife and some other people, but they all left when I arrived so it was just the two of us. We sat outside and talked for an hour. Even though there wasn’t six feet separation, it was pretty windy so I thought the three feet distance was sufficient. We both had surgical masks but took them off so it was easier to talk.

I met this friend during undergraduate orientation about 35 years ago. We also ended up in grad school together right afterwards. He then became a missionary and spent the next ~30 years in China and Thailand. I think they’re moving back to America for good. His eldest child got married and moved to this area so he was here to help them get settled.

It’s interesting to meet someone you’ve known for so long but haven’t seen in several years. Of course he wanted a health update, which took forever. Maybe I should have directed him to this blog instead.

Transplant Update

I just got a text from my sister saying that UCLA transplant center has received all the files and the image CD, and the donor committee will meet on Monday, August 3rd. It’s strange that the quality of the next 10-15 years of my life will depend on a few people meeting in a conference room in Westwood.

Life was already pretty depressing before but now it’s even worse with COVID-19. Not just because everything is shut down, but the uncertainty of symptoms if infected is actually pretty scary. Most people are asymptomatic or show mild symptoms, but you see news stories of normally healthy people die just days after being infected. If you can’t assess risk, then the smart thing to do is to be more cautious. I actually think there will be more of an infection risk post-transplant surgery due to all the drugs but I got to do it… these dialysis sessions is killing me slowly.