Tuesday, May 22, 2012

Chest pain and a hospital stay

Starting Friday I noticed pain in my chest, it got increasingly worse throughout the weekend. It was hard to breathe and bending over or changing position made it more difficult to breathe and often resulted in coughing. On Saturday I called the PD (Peritoneal Dialysis) clinic and talked to one of the on call nurses. The nurse I talked to felt that the discomfort was most likely due to an overload of fluid and that I should try to remove the fluid by increasing the dialysis solution (using a higher concentrate of dialysite will draw out more fluid). During Saturday and Sunday I increased the strength of fluid, using 2.5% solution on the cycler at night and during manual exchanges. I successfully pulled off extra fluid but when I woke up Monday morning I noticed the discomfort in my chest was a lot worse and it felt like my lungs hurt. If I bent over even a tiny bit it was painful. I called the PD clinic again and talked to another nurse who told me to go to the ER. When I got there the ER Doctor ordered an EKG, blood work and a chest xray.
What they found was fluid underneath my right lung. I was taken upstairs to have a procedure called a Thoracentesis. I had to sit on the edge of a bed, a Doctor numbed my back with lidocaine and inserted a catheter between my ribs on the right side and then drew out the fluid. The process was relatively simple although highly stressful (when I don't know what to expect I get very nervous... and I really don't like needles!). One of the nurses asked me if I wanted to see the fluid and I said yes... it was a large glass jar similar in size to a quart mason jar and it was 3/4's full... for a total of 900 ml that was extracted from underneath my lung.
The fluid was submitted for tests so that they could figure out where the fluid was coming from. If the fluid is dialysite that means that there is a leak in my diaphragm allowing fluid to get under the lungs. If the fluid was not dialysite, just regular fluid than that would mean I was under fluid 'overload' and we would need to increase my dialysis.
Last night I spent the night in the hospital and this morning my Nephrologist came to visit me. He told me he thinks that the liquid is most likely dialysite that is leaking through a hole in my diaphragm. He said that this happens to only 1% of patients. They are going to keep me on PD (peritoneal dialysis) throughout the day and night (yes, another night in the hospital) and do another chest xray today and tomorrow. If more fluid builds up under the lung that will indicate to my Doctor that it is dialysite. If it is dialysite they will remove me from PD and I will have to switch to doing Hemodialysis. Since my fistula (the vein and artery that were connected in my upper arm to create a large access for doing hemodialysis) is not ready that means they will insert a catheter into the main artery in my chest for hemodialysis until the fistula is ready. The issue with the chest catheter is it has a higher risk of infection due to the fact that it is a direct access to your heart (so any bacteria traveling through it would be lethal). You also can not shower with this type of access.
The Doctor is also scheduling surgery to have my fistula brought closer to the surface of the arm (I have deep veins). Their thinking is while I am in the hospital they might as well get the surgery taken care of. Makes sense to me, although I dislike surgery and don't recover as easily as I wish I would.

I will update again when I know more. In the mean time we are praying for complete healing and I am trusting the Lord to take care of me!

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