Removing a basal cell

I’ve had a small sore on my right leg for the last four years. With everything else settling down I was finally able to go to the dermatologist and have it checked out. This is about the sixth time I’ve been to the dermatologist to be checked out. This time he took a biopsy and determined it was a basal cell.

When they find a basal cell they bring you into the office and do a procedure where they take off one layer of the sore and put it under a microscope and see if there’s any cells on the edge. If there are basal cells in the cut, they cut little more until they get all of it. This all started at the size of an erasure by the time they decided to do something with it was the size of a nickel. The size that they removed was about the size of a silver dollar. The sizable hole they left behind was too big to be sutured closed. So that means they have to do a skin graft to close the hole.

They took the extra skin from the bottom of my right bicep. They say everybody has extra skin under their biceps. Until the graft took hold I would have to stay off my feet. This would take about 10 days. The biggest problem I had during this time was dialysis. During dialysis they keep a blood pressure cuff on you and take your blood pressure every 30 minutes. They can’t use my left arm because of the fistula, they can’t use my right arm because of the graft,they can’t  use the right leg that’s where they put the graft. So all that was left was my left leg.

My legs are not in the best condition and when they take blood pressure from your legs it is higher than when they take it from your arms. I also usually run a little high in the blood pressure department. After the 10 days they took off the bandages and determined that the graft was growing well. I thought this was going to be great and I was going to be all done and  just let it finish healing but oh no. They are going to be sending out a nurse to change the bandages every couple of days. Then in about two weeks the doctor will take another look and reevaluate at that time. That means I can walk around and still bowl on days as long as I can get my foot with the bandage in a shoe.

Removing the port

Now that the fistula is working properly it’s time to have the port removed. In some cases they do this in the office. In my case no procedure can be done in the office and must be done as an outpatient. So we went to the hospital where they told us they were running about 45 minutes late. If you ever been to the hospital before 45 minutes isn’t bad for waiting. They took me into the back room where they had me put on a gown and go over my medications and medical history. Then the next thing they have to do is start the I.V. in most cases this is done quite quickly. In my case the first nurse tried twice. The next nurse tried once. Then they called in the anesthesiologist he never misses. He tried once the arm and twice in the wrist then he gave up. They thought for a second maybe they would put an iv in my leg. Then they looked at my legs and remembered all the scar tissue and decided not to go there. Then they decided maybe they would go for the neck. Before they could do that the Doctor came in and said we don’t  need the blood tests and really don’t need the IV. Instead he would give me a local and pull it out in the preop room. So he told the anesthesiologist to standby just in case and he did the procedure. The whole procedure took about 10 minutes. Since there is no anesthesia there was no real recovery time. My wife stayed in the room with me while this was going on so as soon as the procedure stop bleeding and they were able to put a little glue on top. I was able to go home.

News of hep c cure

We make plans to go back to the big hospital so they could  check to make sure that the hole from the tooth healed properly. While we were there we stopped by the liver department so they could check me out and tell me of any new information. They had great news of a new cure for hepatitis C. Right now it’s in a study which means  that only certain people can get into. There’s about eight protocols that if you have one of them you won’t qualify. That’s okay. I have all eight. Things like I’ve been treated twice; I’ve had major surgery. I’ve also had major complications from surgery. So for right now though they are giving it to people who are in dialysis but have never been treated for hepatitis C before. If they don’t die or get sicker then they’ll be able to give it to me. If all this works out and they are able to cure my hepatitis C, I will be able to get back on the operating table. I will need a new liver and kidney. I have a good chance of qualifying for these things because I am still young enough and I have AB positive blood. This makes me a universal receiver. So if all goes well by the end of the summer I may be able to start the cure. They said if I get the cure it will lower globulin in my blood system which means I will have an easier time of moving around. Right now it acts like rheumatoid arthritis.

Fistula: still waiting for it to work right

It’s time to try to use the fistula again. We start the same way we started the first time with both 17 needle. Then we’ll go to the 16 needle and finally the 15. Needles are based on resistance just like wires. So the larger the number the smaller the needle and the more resistance. Now my fistula is one third normal skin and two thirds under scar tissue. So far I’ve only been able to get them to stick the scar tissue twice. They only want to stick me into the skin that is thinner. The problem with that is the whole area is only about an inch and a half long. That’s a lot of sticks for such a small area. They say they will stick me wherever the surgeon marks my arm. Right now they been using the fistula for two weeks that’s a total of six sticks. They have missed twice. Every time they miss it makes a bruise about 3″ x 3″ on my bicep. On the two times that they have missed they used one needle in my arm and the other in the port. I was really hoping to get rid of the port so I would stop having this thing sticking out of my chest. Now I am thinking that I’ll try to keep the port in for a while longer. This will give me time for the bruises on my arm to heal a little. This also makes it easier for me to get out of dialysis because when they stick my arm I have to wait 20 minutes for the bleeding to stop. Usually I don’t mind the wait but I still have lots of appointments to make at the center that is 3 1/2 hours away. I have two more appointments at the dialysis center before I make it to the surgeon. When I make it to the surgeon he will make the final decision of where they can and can’t stick me.

Teeth

The fistula is on the mend and I am still using the port in my chest. It has finally come time to go to the dentist and get my three teeth out. This will involve me going to the dialysis center at 5:30 AM. Then leaving for a 3 1/2 hour drive to go to the closest dentist that will still work on me. This hopefully will be the last time we will need to use the port my chest.

Once I get to the dentist the first thing they do is hand me a bill. After I pay my bill they will do the work. When I finally get into the dentist chair it goes like any other dentist would do. They numb you up and get to work. After that they go through the medicines and painkillers that I will be taking. Once we look at it, we know that I cannot take any of these medicines for painkillers. Then we talked to the kidney doctors to find out what medicines and painkillers I can take. They allow me to take the amoxicillin but in a smaller dose. This doesn’t last long because I start breaking out in little red dots and I am itching everywhere. So I finally have to change that medicine too.

After they removed my teeth and they tell me that the roots of one of the teeth was long enough to make it to my nasal cavity. This means I will be making a another trip back to the dentist. That’s when they will make sure the hole from my mouth into my nasal cavity has closed up. Now that they’re done the right side of my face is all bruised up. So I get all those great comments like: what does the other guy look like, why do you get her mad and who would you been fighting. Hopefully now that I have waited about a year and a half to get these teeth out everything else will go smoothly for a while.

Still trouble with fistula

Now the hospital had stitched up the fistula and had dialysis treatment I thought it was safe to go back to the dialysis center. On my next treatment I went and had the dialysis done. The only problem that happened was that a golf ball sized lump that appeared. There was also a little blood on the outside of the lump. Dialysis told me not to worry that it would go done in a day.  We let it go for about a day but my arm kept getting tighter. My wife was nervous about my arm and sent me to see my primary physician.  We were given antibiotic just to make sure it did not become infected.  So finally we went to the hospital again to have the doctor look at it. We were sent to the ER room.  She looked at how tight the skin was and before she could look away it started to bleed. She quickly tried to put some gauze on top of it to contain the blood. Once she touched it the stitches gave way and there was blood everywhere. This time it opened up even bigger than the time before. So once again they held above and below and stitched it up. The doctor said enough is enough. Tomorrow we will take you into the operating room and fix it right.  They ended up giving me a hybrid fistula.  This either means I have a fistula with a graft sewn in the middle or I get 50 miles to a gallon.

So once again I stayed in the hospital.(The fourth admit for this glitch in dialysis).  For those of you who have a fistula you know they can’t run an IV in that arm. I’ve also had a lot of other treatments in my right arm. After all these days in the hospital and all the IVs and blood draws they’ve already run my right arm they were running out of space. They put a port in my chest so they could do dialysis treatment there. They were also able to take some blood tests through the port. This was an operation so they had to have an IV so for the third time in two weeks I had to have an IV in my wrist. My right arm was decorated up and down and on both sides with black and blues.

After they did the operation and I was home for a couple of days I tried to go bowling. Right-handed bowler with my fistula in my left arm so I thought I would be okay. During the second game my left arm started to bleed so I grabbed it to put pressure on where it was raining blood and called 911. Once again they took me to the hospital. When the doctor looked at it this time he said it was old blood. I’m not sure with old blood means but it did mean that the stitches didn’t give up or break.

There are a couple of lessons I and my wife learned from this roller coaster ride.  Pay attention if your arm starts to feel or look different.  If you are concerned, have a professional look at it. It could be an abscess or it could be a pseudo aneurysm.   Bleeding from the fistula area is not to be played with.  Call 911 and put pressure on it.  Do not panic.

Trouble with Fistula

After one of my dialysis treatments a bubble formed at the bottom of the fistula. (It was swollen, sore and a little red).  My wife was worried it had gotten infected.  This looked very unusual to us so we went to the emergency clinic to have it checked out. They thought it was an abscess, but were unwilling to open it up because it was right on top of the fistula.  They sent us to our local free standing emergency room.  We would later be very happy that they had made this decision.

At the emergency room they did a sonogram of it to make sure the fistula had not clotted.  While they were scanning it, the pressure caused it to open up a small hole.  My wife mentioned the small drip coming from the site and we were told to just watch it while they waited for lab results.  Luckily my wife noticed that the drip had made a large spot on the hospital gown.  This got me a trip to the hospital. That’s where the vascular surgeon stitched it up. Since this is like an artery rupture there was no time to anesthetize the area. So they just grabbed above the rip and below the rip; applied pressure and stitched it up. This took about 3 stitches.  The surgeon didn’t feel there was much to worry about and there really wasn’t that much blood loss so no transfusion was needed. They kept me in the hospital for three days. During this time they did dialysis and made sure the stitches were in good shape. (First admit to hospital for this glitch in dialysis).

I went back to the dialysis center to have them do it the next time it was due but they weren’t sure whether they could do it or not.  I had to go back to the hospital; be admitted for one day and had my dialysis done by the hospital. (Second admit to the hospital for this glitch in dialysis).

Going back to the dialysis center to try again and they had a problem finding a location to stick the needles. After they infiltrated the top needle they asked me to come back the next day. Then they took out the bottom needle and  it started to bleed so they applied more pressure. They applied so much pressure they ripped my stitches out. Then they had to call the ambulance to to come and get me to the hospital. That’s when I found out that most ambulances only have two people in it. One to drive in the other to monitor vitals. They needed a third person to hold the artery so I wouldn’t bleed out. So once the ambulance got there they called the fire rescue. Once the fire truck was there that gave them the third person to hold the artery. So the four of us rode in the ambulance while the fire truck escorted us to the hospital. That’s where the rescue worker handed me off to the ER nurse and she held my arm until the doctor came in. Then once again someone grabbed hold the top of the tear and the bottom of the tear and he stitched up the now larger tear. He said the fistula still had a thrill so it should be okay. I was admitted to the hospital for three days with the hospital did my dialysis treatment. I usually get dialysis three times a week but during these times I was only receiving it twice a week. That’s because one of the dialysis days fell on the day they stitched me and my levels did not become dangerously high.  (Third admit to the hospital for this glitch in dialysis).

At this time, we were only half way through this roller coaster but we didn’t know this. It would have been nice to know but  that would have taken a really good crystal ball.

My timeline in pictures.

250 lbs  2008

250 lbs 2008

2009 after brain surgery
2009 after brain surgery

2010  121lbs

2010 121lbs

2013  190lbs on dialysis

2013 190lbs on dialysis

 

 

MY pills

Some of the new sites I have joined have asked me what pills I take.  So I will try to give you a list of how, what and how often.

Synthroid  once daily either 150mg or 100 mg depending on the day. This is three pills or two depending on the dosage and this is for my thyroid.

Keppra  twice daily  500mg unless it is dialysis day then I have to take one after dialysis.  2 or three pills a day and this is to control my seizures.

For my blood pressure I take a couple of pills.  Toprol XL 50 mg each morning.  Clonidine .2mg three times a day. Finally Norvasc 5 mg daily unless it is dialysis day then it is 10mg.  So that is 5 pills.

My anti-rejection drug is Cyclosporine which is twice daily at 50mg.  This is 4 pills.

For my joints I take two types of pills.  Plaqenil 400mg daily and Medrol img daily.  This is four pills.

The vitamins I take are Vitamin B12 (1000 mcg daily), Zinc sulfate (220 mg daily), Vitamin C (500 mg daily) and Vitamin D (400iu daily).  This is 3 pills and 2 gummies daily.

And to make sure that all this will pass I take 100 mg docusate sodium daily. This is one pill.

This makes up a GRAND total of  21 pills and 2 gummies on the light days and 23 pills and 2 gummies on the heavy days.

Now there are those special days, when I have to go to the dermatologist or the dentist and I have to take 500 mg of amoxicillin, so add 1 more pill.

 

 

 

 

 

The Teeth

This week, after a 4 1/2 month wait, I was finally able to get in to the dentist at Shands Hospital. This was only the initial visit so all they did was look at my teeth. For that I had to pay $156. The answer they came up with is to wait for weeks then at that time I will take a blood test. If my platelets are above 50 they will extract the three teeth. I will have to stay in town overnight to make sure it’s not bleeding. The other option is that my platelets are below 50. If this happens I will have to cancel the appointment. Then make arrangements to be admitted to the hospital. This will mean that they will extract the teeth and keep me for 48 hours of observation. The only real problem I have with either one of these options is what to do with dialysis. If the numbers above 50 I will go into dialysis at 5 AM and get out by 9:30 AM. Then I’ll drive for four hours to get to the hospital where my appointment will be at 3 PM. If the numbers below 50, I will leave it up to the hospital to do my dialysis. Either way my wife will need to  take off work. Thankfully for us, her workplace is very accommodating for our needs. We will not know what days she shall have to take off until after the blood test. Hopefully Quest lab will be prompt in their delivery of the results. This still seems to be to be a lot of trouble just to remove three teeth.