Where Does TheTime Go?

I totally missed my self-imposed deadline for posting today’s blog (my goal is to get it online before 10am every day). I worked feverishly on what to write late into the evening yesterday. Words just wouldn’t cooperate. I had a serious case of writer’s block. At least it made me feel like a real writer. Here I was, deadline approaching and I had nothing to offer but muddled phrases and clichés. What is a writer to do?

I was still stuck this morning, so I took a walk around the pond near my house. As I strolled along, I took pictures of the various flowers, birds, and other suburban wildlife that lives there. Shortly after beginning my walk, I received a phone call. As I chatted with my stepson, I barely took notice of the scenery, except to take a picture of a turtle or duck as I went along. After I got off the phone, I realized I’d made it all the way around the lake and was a block from home. Wow…that went fast! Chatting with someone made the walk go by much quicker.

As I walked in the door, it hit me. Write today’s blog about time. Where does our time go? Why do some days seem to pass like an eternity and some zip by in seconds? Does time really speed up as you get older? For me, the answer is yes. Years seem to go by much faster than they used to. I feel more of a sense of urgency to get things done because I am older. I still have a lot of life left, for sure, but not as much as I did ten years ago.

And now it seems my brain has come to a stop again; words are coming more slowly. Time, once again, feels different. It seemed to take no time at all to come up with three paragraphs, and now, it feels slow and clumsy. So before I make a total mess of this, I’ll take my leave. Have a great Thursday!

Why I Enjoy College Football

The college football season is only three months away. I look forward to watching my team, the Alabama Crimson Tide, as they take the field September 1^st. I have been a Bama fan since I was a child; I guess you could say my family strongly persuaded me in that direction. Everyone in my immediate family went to the U of A, including me (well, for one semester anyway). Growing up, my Mom would be in a bad mood the rest of the day if Alabama lost. My grandmother chided my husband recently because he had a blue rope and an orange rope touching (as he was cutting dangerous limbs from her trees). She informed him that those two colors were not allowed together on her property (you have to be an Alabama or Auburn fan to appreciate that one). As much as I enjoy college football, I don’t particularly care for pro football. To me, college ball is more fun and more spirited.

Reasons I enjoy college football more than pro:

• Every year is a different season for college football as seniors graduate and freshmen arrive.
• College players are playing for team pride and possibly a chance to move on to the pros once they graduate. Every game is important.
• College has a much broader variety of mascots than the pros, not to mention exotic mascots like elephants, horned toads, terrapins, and wolverines. There are even teams with man’s best friend as a mascot (bulldogs and huskies).
• In college, your rallying cry can be different from your mascot. For example, Alabama fans yell “Roll Tide!” but their mascot is Big Al, an African elephant. Auburn is even more complicated. Their fans yell “War Eagle!” but they also have a tiger as a mascot. They are known as the Auburn Tigers but at the stadium they have a real golden eagle on the field AND a guy dressed up in a tiger suit (surely there is a good reason for both mascots, and a golden eagle is a safer choice for a live mascot).
• College football fans (especially in the SEC) are some of the most passionate fans in sports. Watching a game live in the stadium is electric.
• During halftime at a college game, you can listen to music played by the team bands.
• College has more bowl games than you can shake a stick at. You practically need a losing season NOT to make it to some bowl game. I used to joke that they were going to add a “Toilet Bowl” so the two worst teams could have a game.
• The variety of bowl games makes watching TV a lot of fun around the holidays and New Years; it seems to add to the festive holiday atmosphere. I only watch the Super Bowl for the commercials (that might have something to do with the fact that the Atlanta Falcons never seem to make it past the playoffs).

In my opinion, college football is hard to beat. Someone pass me the chips, a cold drink, and the remote. It’s going to be another great season. In the meantime, have a happy summer!

The Battle Against Cholesterol – Chapter 6 (The Final Chapter, For Now)

Today will wrap up the mini-series about lipo-apheresis and cholesterol. There are no pictures, so previous warnings won’t be necessary except to say always discuss your medical situation with your doctors.

Kevin discovered in his mid 40s that his cholesterol had risen dramatically. He endured three heart attacks and an 85% blockage. He had a total of six stents installed over the past seven years. After all pharmaceutical avenues were exhausted, Kevin’s doctors enrolled him in lipo-apheresis treatments in an effort to control his cholesterol. The hope was apheresis would prevent any future heart attacks. 

Earlier this year, Kevin’s fistula matured and was ready to be used for the treatments. So far this year, he has had nine successful sessions. Each time he was treated, Kevin and Anthony were able to tweak settings so the treatments were more comfortable and took less time. After the fifth treatment using the fistula, Kevin discovered the lidocaine cream he used to numb his arm was actually causing mild nausea. He was frustrated since he still felt slightly queasy during the treatments. He researched lidocaine cream and did a few experiments by applying the cream when he did not have a treatment. He noticed he felt ill after about 30 minutes. When he washed the cream completely from his arm, the nausea subsided after 15 minutes. Since this discovery, he has stopped using the lidocaine cream. The needles hurt going in, but only for a few seconds.

During the past several months, Kevin also found a disturbing trend in his potassium level (thanks to one of his cardiac rehab nurses). To this day we still don’t have an exact answer for what caused the drop, but the suspicion is one of the newer medications or a combination of the medications. He ended up in the ER at one point because his levels had dropped too low, the supplements kicked in and caused a whipsaw effect. Thankfully he has stabilized and feels much better. The goal is to work with his cardiologist to get off some of the temporary meds he needed as a result of the small blockage from scar tissue around his latest stent.

Kevin has notified his doctors that he would be willing to participate in a study for patients with high cholesterol undergoing lipo-apheresis treatment. Our hope is the treatments will prevent any future heart attacks, and possibly reverse any existing plaque buildup in the arteries. Kevin still goes to his treatments every two weeks, and will continue to do so until medical science can create a drug that doesn’t cause debilitating side effects. We are both grateful for the fact that lipo-apheresis exists. Without it, the future was cloudy. With it, the days ahead are much brighter.

The Battle Against Cholesterol – Chapter 5 (Text Only)

Today’s blog will be a busy one so I’ll get right down to it. If you wish to see the pictures, please go to the “photos” version.

During the previous chapter, Kevin’s hemodialysis catheter was removed to prevent dangerous stimulation of his vagus nerve. His fistula was still new, and wasn’t rising to the surface. We went back to the vascular access office so the doctor could do a quick scan and make sure nothing was blocking the new fistula. From the scans he noticed there were “feeder” veins that were stealing some of the blood flow from the fistula. He was able to close one off with a coil but could not reach the others.

The next week, Kevin met with his vascular surgeon. The doctor had reviewed all the information from the most recent scans and informed Kevin he would need to undergo a CVT (cephalic vein transposition) surgery. Because Kevin had large, muscular arms, the fistula was not going to be able to surface without help. The surgery was scheduled for two weeks out, but Kevin caught a break and took an earlier appointment.

The CVT surgery entailed removing the connection between the artery and vein, lifting the vein up and channeling it through the skin, then reconnecting the artery and vein. The surgeon also cut off other feeder veins that had developed. Kevin would still have to wait another four to six weeks to determine if the fistula was ready for use. Because this surgery was much more invasive, Kevin couldn’t use his arm for the first day after surgery. For the week following the surgery, he had to limit how much he could use the arm and how much weight he could lift. 

While his arm was healing, Kevin continued attending his cardiac rehab sessions. As the month wore on, he began to feel a lot more tired. Cardiac rehab started to become a burden instead of a help. A few weeks later, he called from rehab to tell me he had to stop in the middle of his workout due to chest pain. They did an EKG in the rehab office and a cardiologist came to chat with him. Thankfully they didn’t send Kevin to the ER, but the cardiologist prescribed him anti-angina medication. A week later we met with Kevin’s cardiologist. He suspected Kevin’s beta-blocker could be causing issues, but there might also be more going on. He knew how fast Kevin developed blockages and was worried about the stoppage of the apheresis treatments. He concluded the best option was to send Kevin to the hospital for an exploratory catheterization. If there was a blockage forming, they could take care of it right away. In the meantime the doctor told Kevin to stop attending rehab and take it easy.

The next week we went to the hospital so they could take a look. They prepped Kevin with an IV, fashionable hospital gown, and traction control booties. Since the cath lab was only a short walk away, they let him walk instead of riding on a gurney. I headed to the waiting room, not sure what to expect. A very short time later (less than an hour), they called me back. The cardiac surgeon explained that Kevin didn’t have a typical blockage. He said the stent he placed six month prior had grown a bit of scar tissue and it appeared to be blocking some smaller side arteries. We were both relieved it was only scar tissue and not cholesterol run amok. The doc gave Kevin a prescription for a special nitroglycerin to be used during exercise.

About six weeks after the CVT surgery, Kevin met with his vascular surgeon. He was happy to report that Kevin could begin using the fistula. He felt confident it was mature enough, and he was very happy with the size and how strong it felt. A few days later, Kevin had his first lipo-apheresis treatment in exactly two months. It took a load off our minds knowing he would be back on track for keeping the cholesterol under control.

Since he was now being punctured to do the treatments, Kevin used lidocaine cream on his arm to numb the area. The first treatment using the fistula went very well and Anthony was very pleased with the blood flow. He treated 6,000mL of blood in just over four hours. Kevin experienced some nausea, but we suspected that was the heparin.

Next week, I will wrap up the story with how the treatments have been going since using the fistula, medication reactions, and how we found out lidocaine causes nausea in certain special cases.

The Battle Against Cholesterol – Chapter 5 (Photos Included)

Today’s blog will be a busy one so I’ll get right to it. As always, if you do not wish to see the pictures, please go to the “text only” version.

During the previous chapter, Kevin’s hemodialysis catheter was removed to prevent dangerous stimulation of his vagus nerve. His fistula was still new, and wasn’t rising to the surface. We went back to the vascular access office so the doctor could do a quick scan to make sure nothing was blocking the new fistula. From the scans he noticed there were “feeder” veins that were stealing some of the blood flow from the fistula. He was able to close one off with a coil, but could not reach the others.

Scan showing the feeder veins

Scan after the doctor added the coil to close off one feeder vein. It looks like a tiny fish hook.

The next week, Kevin met with his vascular surgeon. The doctor had reviewed all the information from the most recent scans and informed Kevin he would need to undergo a CVT (cephalic vein transposition) surgery. Because Kevin had large, muscular arms, the fistula was not going to be able to surface without help. The surgery was scheduled for two weeks out, but Kevin caught a break and took an earlier appointment.

The CVT surgery entailed temporarily removing the connection between the artery and vein, lifting the vein up and channeling it through the skin, then reconnecting the artery and vein. The surgeon also cut off other feeder veins that had developed. Kevin would still have to wait another four to six weeks to determine if the fistula was ready for use. Because this surgery was much more invasive, Kevin couldn’t use his arm for the first day after. For the week following the surgery, he had to limit how much he could use the arm and how much weight he could lift. These pictures show the progression of his recovery:

About five hours after surgery

The following day

Four days after surgery

One week later

While his arm was healing, Kevin continued attending his cardiac rehab sessions. As the month wore on, he began to feel increasingly tired. Rehab started to become a burden instead of a help. A few weeks later, he called from rehab to tell me he had to stop in the middle of his workout due to chest pain. They did an EKG in the rehab office and a cardiologist came to check on him. They didn’t send Kevin to the ER, but the doctor prescribed him anti-angina medication. A week later we met with Kevin’s cardiologist. He suspected Kevin’s beta-blocker could be causing issues, but there might also be more going on. He knew how fast Kevin developed blockages and was worried about the stoppage of the apheresis treatments. He concluded the best option was to send Kevin to the hospital for an exploratory catheterization. If there was a blockage forming, they could take care of it right away. In the meantime the doctor told Kevin to stop attending rehab and take it easy.

The next week we went to the hospital so they could take a look. They prepped Kevin with an IV, fashionable hospital gown, and traction control booties. Since the cath lab was only a short distance, they let him walk instead of riding on a gurney. I headed to the waiting room, not sure what to expect. A very short time later (less than an hour), they called me back. The cardiac surgeon explained that Kevin didn’t have a typical blockage. He said the stent he placed six month prior had grown a bit of scar tissue and it appeared to be blocking some smaller side arteries. We were both relieved it was only scar tissue and not cholesterol run amok. The doc gave Kevin a prescription for a special nitroglycerin to be used during exercise. He advised Kevin it was okay to engage in light exercise and he should meet with his cardiologist to discuss when to resume rehab.

The following week (about six weeks after the CVT surgery), Kevin met with his vascular surgeon. He was happy to report that Kevin could begin using the fistula. He felt confident it was mature enough, and he was very happy with the size and how strong it felt. A few days later, Kevin had his first lipo-apheresis treatment in exactly two months. It took a load off our minds knowing he would be back on track for keeping the cholesterol under control. Kevin was also able to resume cardiac rehab and get back into a normal routine.

The lipo-apheresis treatments were slightly different using the fistula. Because he was being punctured with 17 gauge needles,  Kevin used lidocaine cream on his arm to numb the area. The first treatment using the fistula went very well, and Anthony was very pleased with the blood flow. He treated 6,000mL of blood in just over four hours. Kevin experienced some nausea, but we suspected that was the heparin. Here’s what the process looked like with the fistula:

The plastic wrap keeps the lidocaine cream in place so it can numb the area

First needle is in

Both needles are in and lines are hooked to the machine

Kevin is able to work during the treatment

A closer view of the machine (you can see the three filters in front)

Next week, I will wrap up the story with how the treatments have been going since using the fistula, medication reactions, and how we found out lidocaine causes nausea in special cases.

The Battle Against Cholesterol – Chapter 4 (Text Only)

Thank you for joining me again in this on-going story of cholesterol and lipo-apheresis. As you may remember from the previous chapters, Kevin went through the process of getting a hemodialysis catheter installed and had his first lipo-apheresis treatment. In today’s blog I will discuss the fistula surgery and what happened when the first cath clogged. If you would like to see the fistula pictures, see the "photos included" version. Also, Kevin’s experiences are unique; always discuss medical procedures and all medications with your doctor.

Kevin was settling into a routine of dealing with the cath, but he was looking forward to getting the fistula done. The vein mapping and scans revealed he had great potential for a successful fistula since the diameter of his vein was almost 5mm (7mm is the target for a fully mature fistula). It also had the potential for being viable for many years since Kevin was strong, healthy, and it would only be used every other week. When Kevin made the appointment for the surgery, he was told it would be at least three weeks out since the surgeon was totally booked. Kevin accepted the date and told the scheduling coordinator to call if they had an earlier opening.

As luck would have it, Kevin received a call a few days later asking if he could take an opening the following day (he gladly accepted). It meant I had to miss my cousin’s wedding, but I was happy we would be one step closer to getting rid of the cath. The day of the surgery went well; the hospital was running ahead of schedule (how often does that happen?) and the procedure only took 45 minutes. We went home a half hour later when they were sure Kevin wouldn’t bleed to death (that’s pretty important). I did have a scare when we were headed home since the tiny blood spot on the bandage was increasing in diameter. 


I called the nurse when I got home and she assured me that was normal to see. As long as the entire dressing wasn’t covered in blood, Kevin was good to go. Later that day I felt Kevin’s wrist. It was like he had a tiny motor inside…it was very strange! We removed the bandage the next day and saw the incision covered with the suture bandage. What we didn’t see was a huge, bulging vein in his wrist and lower arm like the medical literature portrayed. It turns out it takes a few weeks (at least 8) for the fistula to get to a point where it is mature enough to use. It has to be a certain diameter (7mm is the target) and it has to be strong enough to tolerate being punctured by the 17 gauge apheresis needles. The surgeon also told Kevin that if the fistula didn’t come to the surface, he would need to do an additional surgery, possibly two. We were hoping that wouldn’t be necessary.

A few days after the fistula surgery, Kevin went for his second lipo-apheresis treatment. This time it took about 7 hours. We had food with us, but not enough to last all day. The cath developed a small clot on one side, so Anthony had to use extra heparin just to get a minimal flow. It was a slow, painful treatment for Kevin. By the end of the day he was queasy and in pain from the cath being manipulated.  After a discussion with the doctor, Anthony scheduled us to come back in a few days so he could inject more heparin in the cath to prevent a total blockage.

Three days later we were back at the dialysis center for the heparin injection. Anthony could barely get any flow on the “slow” side and could not get any blood to pull out, so he called the nepherologist. She advised Kevin to go to the vascular access center for further analysis and troubleshooting. As luck would have it, they had an opening that afternoon. We rushed across town to get there in time. The nurse finally took us back, and she had Kevin fill out more forms. The amount of forms and paperwork seemed strange since we expected they could do a quick flush to get the existing cath flowing again. Instead they informed him it would be totally replaced (now all the paperwork made sense). We were both crushed. Kevin wanted the darn thing out. To have it replaced was a huge setback mentally and physically.

After waiting anxiously for about an hour, I was called back to recovery. Instead of Kevin sitting up and looking alert, he was laying on his side. His legs were twitching and he was not lucid. I couldn’t get coherent responses when I asked him what was bothering him. I asked the nurses to get the doctor; this seemed very wrong. The doctor told me he injected a dose of Phenergan directly into the cath to quell Kevin’s nausea. Unfortunately it resulted in an allergic reaction. It took over an hour for Kevin to recover enough to leave the office. The traffic was terrible (6:00 on a Friday evening…not a surprise), so we decided to eat a quick bite before going home. Kevin was agitated and confused throughout the meal. (The next day he remarked that he never remembered eating his food and was confused by the sight of an empty plate.) It took until noon the following day for all of Kevin’s symptoms to abate. We marked Phenergan as an allergy on his med sheet.

A few days later, we went to the dialysis center so one of the nurses could give Kevin a heparin injection in the new cath to prevent clotting. This would be the routine (a heparin injection) every 4 or 5 days as long as Kevin has the cath. Under normal circumstances, people use these types of hemodialysis catheters for kidney dialysis. Those patients are going to the center every day or every other day for treatment, so the cath never has a chance to clog. Because Kevin went every other week, the chance for clotting was much greater since heparin breaks down after a few days. He went to the center the day before his third lipo-apheresis treatment to make sure the new cath was still flowing properly. Anthony was able to inject the heparin, and when he tested the flow, it was much better than the previous cath. Kevin met with his doctor and let her know this cath was more painful than the previous one. She examined it and realized one set of wing stitches broke. This allowed the tube to twist in on the other set of stitches causing irritation. The doc snipped the second set of stitches (giving Kevin immediate relief) and told us to keep a small Band-Aid over the tube to prevent it from moving too much.

The following day, Kevin went for his third apheresis treatment. The new cath was flowing much better, and Anthony pushed the machine to a higher flow rate. Suddenly Kevin became extremely sick as the machine kicked into a higher speed. Throughout the treatment he could not shake the nausea. Thankfully the treatment was quick. Anthony was able to treat 6,000mL of blood, the highest volume so far. 

Determined to find out why he became so sick and why he had a constant, low-level “car-sick” feeling, Kevin did some research. He discovered that the cath was most likely stimulating his vasovagal response. A few nights later Kevin was lying down and realized his motion sickness was much worse. He rolled onto his right side and felt very uncomfortable. He rolled onto his left side and started to feel his heart slow down and had difficulty breathing. He sat up and the symptoms abated. He called the nepherologist the next day and explained what he experienced. She told Kevin to go to the vascular access center to have the cath removed immediately since it was now endangering his health.

We were very happy to see the cath removed. The nurses were very nice and allowed me to watch the removal. As they pumped the bed up so they could work on him, Kevin started getting nauseated again. They waited until he felt stable to start the process. One of the senior nurses injected lidocaine into the skin where the cath tube exited. She waited until the area was numb and proceeded to break the adhesions. Once it was loose, she pulled the entire cath out in one smooth motion. I could see in Kevin’s face that he instantly felt better. Just to test, the nurse raised and lowered the bed; Kevin felt no nausea.

The good news was Kevin didn’t have to put up with the cath anymore (he celebrated by taking his first real shower in over a month). The bad news was he had to suspend his apheresis treatments until the fistula was ready to use. In tomorrow’s blog I’ll talk about the second fistula surgery, why it took nearly two months to resume the treatments, and the scare we had while waiting. 

The Battle Against Cholesterol – Chapter 4 (Photos Included)

Thank you for joining me again in this on-going story of cholesterol and lipo-apheresis. As you may remember from the previous chapters, Kevin went through the process of getting a hemodialysis catheter installed and had his first lipo-apheresis treatment. In today’s blog I will discuss the fistula surgery and what happened when the first cath clogged. If you prefer not to see the pictures in the blog, there is a “text only” version. Also, Kevin’s experiences are unique; always discuss medical procedures and all medications with your doctor.

Kevin was settling into a routine of dealing with the cath, but he was looking forward to getting the fistula done. The vein mapping and scans revealed he had great potential for a successful fistula since the diameter of his vein was almost 5mm (7mm is the target for a fully mature fistula). When Kevin made the appointment for the surgery, he was told it would be at least three weeks out since the surgeon was totally booked. Kevin accepted the date and told the scheduling coordinator to call if they had an earlier opening.

As luck would have it, Kevin received a call a few days later about an opening, and he was able to get in the next day. It meant I had to miss my cousin’s wedding, but I was happy we would be one step closer to getting rid of the cath. The day of the surgery went well; the hospital was running ahead of schedule (how often does that happen?) and the procedure was a quick 45 minutes. We went home a half hour later when they were sure Kevin wouldn’t bleed to death (that’s pretty important). I did have a scare when we were headed home; this is what his bandage looked like:

I was nervous by the increasing diameter of the blood spot. I called the nurse and she assured me that was normal. As long as the entire dressing wasn’t covered in blood, Kevin was good to go. Later that day I touched Kevin’s wrist. It was like he had a tiny motor inside…it was very strange! We removed the bandage the next day and saw the incision covered with the suture bandage (there were no stitches):

Several days later it looked like this:

What we didn’t see was a huge, bulging vein in his wrist and lower arm like the medical literature portrayed. We wouldn't see anything like that for some time since it takes a few weeks (at least 8) for the fistula to enlarge. It has to be a certain diameter (7mm is the target) and it has to be strong enough to tolerate being punctured by the 17 gauge apheresis needles. The surgeon also told Kevin that if the fistula didn’t come to the surface, he would need to do an additional surgery, possibly two. We were hoping that wouldn’t be necessary.

A few days after the fistula surgery, Kevin went for his second lipo-apheresis treatment. This time it took about 7 hours. We had food with us but not enough to last all day. The cath developed a small clot on one side, so Anthony had to use extra heparin just to get a minimal flow. It was a slow, painful treatment for Kevin. By the end of the day he was queasy and in pain from the cath being manipulated.  After a discussion with the doctor, Anthony scheduled us to come back in a few days so he could inject more heparin in the cath to prevent a total blockage.

Three days later we were back at the dialysis center for the heparin injection. Anthony could barely get any flow on the “slow” side and could not get any blood to pull out, so he called the nepherologist. She advised Kevin to go to the vascular access center for further analysis and troubleshooting. They had an opening that afternoon, so we rushed across town to get there in time. The nurse finally took us back, and she had Kevin fill out more forms. The amount of paperwork seemed strange since we expected they could do a quick flush to get the existing cath flowing again. Instead they informed us it would be totally replaced (now all the paperwork made sense). We were both crushed. Kevin wanted the darn thing out. The need for a new cath was a huge setback mentally and physically.

After waiting anxiously for about an hour, I was called back to recovery. Instead of Kevin sitting up and looking alert, he was laying on his side. His legs were twitching and he was not lucid. I couldn’t get coherent responses when I asked him what was bothering him. I asked the nurses to get the doctor; this seemed very wrong. The doctor told me he injected a dose of Phenergan directly into the cath to quell Kevin’s nausea. Unfortunately it resulted in an allergic reaction. It took over an hour for Kevin to recover so he could walk out on his own. The traffic was terrible (6:00 on a Friday evening…not a surprise), so we decided to eat a quick bite before going home. Kevin was agitated and confused throughout the meal. (The next day he remarked that he never remembered eating his food and was confused by the sight of an empty plate.) It took until noon the following day for all of Kevin’s symptoms to subside. We marked Phenergan as an allergy on his med sheet.

A few days later, we went to the dialysis center so one of the nurses could give Kevin a heparin injection in the new cath to prevent clotting. This would be the routine (a heparin injection) every 4 or 5 days as long as Kevin has the cath. Under normal circumstances, people use these types of hemodialysis catheters for kidney dialysis. Those patients are going to the center every day or every other day for treatment, so the cath never has a chance to clog. Because Kevin went every other week, the chance for clotting was much greater since heparin breaks down after a few days. He went to the center the day before his third lipo-apheresis treatment to make sure the new cath was still flowing properly. Anthony was able to inject the heparin, and when he tested the flow, it was much better than the previous cath. Kevin met with his doctor and let her know this cath was more painful than the previous one. She examined it and realized one set of wing stitches broke. This allowed the tube to twist into the other set of stitches causing irritation. The doc snipped the second set of stitches (giving Kevin immediate relief) and told us to keep a small Band-Aid over the tube to prevent it from moving around.

The following day, Kevin went for his third apheresis treatment. The new cath was flowing much better, and Anthony pushed the machine to a higher flow rate. Suddenly Kevin became extremely sick as the machine's speed increased. Throughout the treatment he could not shake the nausea. Thankfully the treatment was quick. Anthony was able to treat 6,000mL of blood, the highest volume so far. 

Determined to find out why he became so sick and why he had a constant, low-level “car-sick” feeling, Kevin did some research. He discovered that the cath was most likely stimulating his vasovagal response. A few nights later Kevin was lying down and realized his motion sickness was much worse. He rolled onto his right side and felt very uncomfortable. He rolled onto his left side and started to feel his heart slow down and had difficulty breathing. He sat up and the symptoms abated. He called the nepherologist the next day and explained what he experienced. She told Kevin to go to the vascular access center to have the cath removed immediately since it was now endangering his health.

We were very happy to see the cath removed. The nurses were very nice and allowed me to watch the removal. As they pumped the bed up so they could work on him, Kevin started getting very queasy. They waited until he felt stable to start the process. One of the senior nurses injected lidocaine into the skin where the cath tube exited. She waited until the area was numb and proceeded to break the adhesions. Once it was loose, she pulled the entire cath out in one smooth motion. I could see in Kevin’s face that he instantly felt better. Just to test, the nurse raised and lowered the bed; Kevin felt no nausea.

The good news was Kevin didn’t have to put up with the cath anymore (he celebrated by taking his first complete shower in over a month). The bad news was he had to suspend his lipo-apheresis treatments until the fistula was ready to use. In tomorrow’s blog I’ll talk about the second fistula surgery, why it took nearly two months to resume the treatments, and the scare we had while waiting.

The Battle Against Cholesterol – Chapter 3 (Text Only)

Welcome to the third chapter of the lipo-apheresis story. In today’s blog, I’ll cover vein mapping and what life was like when Kevin had a hemodialysis catheter. Note: This is the text only version. If you are interested in seeing the pictures, you can look at the "photos included" version.

In order for Kevin to start his lipo-apheresis treatments as soon as possible, his doctors sent him to a vascular access office so he could get a hemodialysis catheter installed. This allowed the lipo-apheresis machine access to a significantly larger blood flow than could be achieved with regular needles into a typical vein. Normally this type of access is used for kidney dialysis patients. In Kevin’s case, it was the best way to jump start the treatments while waiting for the fistula to be created, which would take three months and two surgeries to complete. (A fistula is the joining of an artery to a vein in order to create a “super-vein” for use with kidney dialysis or lipo-apheresis.)

The first step to prepare for the fistula surgery was a vein scan and mapping. Doctors at the vascular access office used ultrasound and x-rays to measure the size of the largest vein in Kevin’s left arm. The nurses and doctors were kind enough to allow me into the surgical suite to watch the process. 

After the vein mapping, the information was sent to a highly specialized vascular surgeon, and Kevin was scheduled for the fistula surgery. In the meantime, Kevin’s lipo-apheresis treatments began about a week after the chest catheter was installed.

We weren’t sure what to expect for the first treatment. We showed up at the dialysis center at 8:30 where we met Anthony, the lipo-apheresis technician. His warm and friendly personality put us at ease. It took Anthony about 15 minutes to hook Kevin up, start the machine, and then treatment was underway. 

The catheter tubes are hooked to an arterial intake line and a venous return line. The blood is pumped from the body, into the machine, through the specialized lipo-scrubbing filters (where the magic happens: LDL and triglycerides remain trapped in the filter). The fat from the blood is sent into a collection bucket and the clean blood is mixed with saline and Lactated Ringer's solution, then warmed and sent back into the Kevin. Heparin is used to prevent the catheter and other lines in the machine from forming blood clots. The first treatment took over four hours and we neglected to bring any food. By the time we headed home, we were both starving and Kevin was very tired.

In the days and weeks following its installation, we learned a lot about taking care of a hemodialysis catheter. Because the catheter tubes go directly into the jugular and down to the heart, keeping the area free from dirt and deadly microbes was critical. The doctors and nurses warned us many times how easily caths can become infected. I used a combination of alcohol swabs, peroxide, and pre-soaked betadine sticks. After each cleaning, I put a fresh gauze pad on the exit point and over the stabilization wings. The trick was finding fresh skin to affix the tape; after a few weeks the entire area was irritated from constant application and removal of medical tape.

Things we took for granted changed after Kevin had the cath installed. Taking a shower was now a two-person job. We have a hand-held attachment in our shower, which allowed us to control the water. Getting tap water on the cath site was a big no-no. There are clear plastic bandages to protect the catheter to make showering easier, but we chose not to use them. Kevin had to wash his face and hair in the sink. We kept a heavy towel on his shoulder to protect the cath from any incidental splashes. It wasn’t fun, but we got it down to a science. Having a very short haircut made it a little easier.

Even though the cath was no picnic, it was worth the hassle. The first lipo-apheresis treatment was a huge success. Initially it wore him out; it took about a day or two for Kevin to bounce back. Once he started feeling better, he REALLY felt better! We started to notice small changes like his toes were turning pink and were warm to the touch. Kevin also mentioned he had more feeling in his toes and a lot more energy overall. It seemed to make sense; now that his blood was normal viscosity, blood flow was vastly improved. When he exercised, his output was much higher than it had been in previous months.

In tomorrow’s blog, I’ll share what happened when the cath developed a partial clog and photos after Kevin’s fistula surgery. I’ll also reveal why Kevin had to stop his treatments and wait for the fistula to mature.

The Battle Against Cholesterol – Chapter 3 (Photos Included)

Welcome to the third chapter of the lipo-apheresis story. In today’s blog, I’ll cover vein mapping and what life was like when Kevin had a hemodialysis catheter. Also my previous warning is still applicable: if you are bothered by the site of scars or wounds, you can read the “text only” version.

In order for Kevin to start his lipo-apheresis treatments as soon as possible, his doctors sent him to a vascular access office so he could get a hemodialysis catheter installed. This allowed the lipo-apheresis machine access to a significantly larger blood flow than could be achieved with regular needles into a typical vein. Normally this type of access is used for kidney dialysis patients. In Kevin’s case, it was the best way to jump start the treatments while waiting for the fistula to be created, which would take three months and two surgeries to complete. (A fistula is the joining of an artery to a vein in order to create a “super-vein” for use with kidney dialysis or lipo-apheresis.)

The first step to prepare for the fistula surgery was a vein scan and mapping. Doctors at the vascular access office used ultrasound and x-rays to measure the size of the largest vein in Kevin’s left arm. The nurses and doctors were kind enough to allow me into the surgical suite to watch the process. Here are a few images from the scan:

The doctor uses an ultrasound machine first to determine the diameter of the target vein.

Next is the x-ray part of the mapping. You can see Kevin’s bones, but the dye isn’t in place to see the vein.

Dye is injected. There’s the vein!

After the vein mapping, the information was sent to a highly specialized vascular surgeon, and Kevin was scheduled for the fistula surgery. In the meantime, Kevin’s lipo-apheresis treatments began about a week after the chest catheter was installed.

We weren’t sure what to expect for the first treatment. We showed up at the dialysis center at 8:30 where we met Anthony, the lipo-apheresis technician. His warm and friendly personality put us at ease. It took Anthony about 15 minutes to hook Kevin up, start the machine, and then treatment was underway. Here’s what it looked like:

Kevin receiving his first treatment

The catheter tubes are hooked to an arterial intake line and a venous return line. The blood is pumped from the body, into the machine, through the specialized lipo-scrubbing filters (where the magic happens: LDL and triglycerides remain trapped in the filter). The fat from the blood is sent into a collection bucket and the clean blood is mixed with saline and Lactated Ringer's solution, then warmed and sent back into the Kevin. Heparin is used to prevent the catheter and other lines in the machine from forming blood clots. The first treatment took over four hours and we neglected to bring any food. By the time we headed home, we were both starving and Kevin was very tired.

In the days and weeks following its installation, we learned a lot about taking care of a hemodialysis catheter. Because the catheter tubes go directly into the jugular and down to the heart, keeping the area free from dirt and deadly microbes was critical. The doctors and nurses warned us many times how easily caths can become infected. I used a combination of alcohol swabs, peroxide, and pre-soaked betadine sticks. After each cleaning, I put a fresh gauze pad on the exit point and over the stabilization wings. The trick was finding fresh skin to affix the tape; after a few weeks the entire area was irritated from constant application and removal of medical tape.

It was crucial to clean around the site regularly.

After cleaning, gauze was applied to keep the cath clean and protected.

Things we took for granted changed after Kevin had the cath installed. Taking a shower was now a two-person job. We have a hand-held attachment in our shower, which allowed us to control the water. Getting tap water on the cath site was a big no-no. There are clear plastic bandages to protect the catheter to make showering easier, but we chose not to use them. Kevin had to wash his face and hair in the sink. We kept a heavy towel on his shoulder to protect the cath from any incidental splashes. It wasn’t fun, but we got it down to a science. Having a very short haircut made it a little easier.

Even though the cath was no picnic, it was worth the hassle. The first lipo-apheresis treatment was a huge success. Initially it wore him out; it took about a day or two for Kevin to bounce back. Once he started feeling better, he REALLY felt better! We started to notice small changes like his toes were turning pink and were warm to the touch. Kevin also mentioned he had more feeling in his toes and a lot more energy overall. It seemed to make sense; now that his blood was normal viscosity, blood flow was vastly improved. When he exercised, his output was much higher than it had been in previous months.

In tomorrow’s blog, I’ll share what happened when the cath developed a partial clog and photos after Kevin’s fistula surgery. I’ll also reveal why Kevin had to stop his treatments and wait for the fistula to mature.

The Battle Against Cholesterol – Chapter 2 (Text Only)

If you tuned in to yesterday’s blog, you learned a bit about my husband who has been undergoing lipo-apheresis treatments since last year in order to combat familial hyperlipidemia. During today’s blog, I will continue to tell the story of how he got into the treatments, and what he had to endure to get them started. Keep in mind I am NOT a medical professional, so anything you read in my blog needs to be discussed with your doctor. 

Late last year, Kevin was enrolled in a treatment called lipo-apheresis. Once every other week a machine pulls his blood through very specific filters that remove all LDL and triglyceride components. He suffers from familial hyperlipidemia that led to three heart attacks (four interventions total) resulting in six stents. Kevin’s cholesterol levels have often been immeasurable because the serum is too turbid. In the past, his doctors put him on a variety of medications and diets. The diets didn’t work and the medication (statins and fibrates) left him unable to function. 

Cholesterol is necessary for certain functions inside our body (it is involved in cell membrane creation and repair among other things). The foods we consume give us about 20% of our cholesterol (called dietary cholesterol). The other 80% is produced in our bodies, predominantly by the liver. When we have too much and the body can’t metabolize the excess, it can lead to clogged blood vessels, heart attack, or stroke. This is why it is important to have your levels tested regularly, especially if anyone in your immediate family knows they have high cholesterol.

Despite the fact that Kevin is in great shape and follows a healthy diet, his cholesterol cannot be controlled without medical intervention. This is the frustrating part of familial hyperlipidemia. In order for Kevin to start his lipo-apheresis treatments, he first had to get a hemodialysis catheter installed in his chest. This pair of tubes goes through the neck, into the jugular and straight into the heart. The external part of the tube is channeled under the skin and the access ports come out just above the breast line (to make it easier to manage the dangling tubes). If you would like to see the pictures, go to the "photos included" version.

The process of getting the catheter into Kevin was a bit brutal. We went to the vascular access center on a Friday morning and the nurse took us into an office to discuss what would happen. Kevin had to fill out an endless barrage of forms. He points out that the paperwork must equal the body weight of the patient before they can be discharged. As the nurse goes over the whole procedure, we wonder what we’re getting into. This sounds pretty involved, but we’re thankful it is only temporary until the fistula can be created.

 

An hour after they wheeled Kevin into the surgical suite, I am called back to the recovery area. He had a huge dressing on his chest and neck and he was still woozy from the sedative. The doctor explains to me that Kevin will be sore since they had to jam the tubing through his very strong neck muscles. We are scheduled to come back on Monday to get the dressing changed and to do the vein mapping in preparation for the fistula.

Tomorrow, I will discuss the vein mapping and fistula surgery, and Kevin’s first lipo-apheresis treatment. I will also explain what it was like to take care of someone with a chest catheter installed. 

The Battle Against Cholesterol – Chapter 2 (Photos Included)

If you tuned in to yesterday’s blog, you learned a bit about my husband who has been undergoing lipo-apheresis treatments since last year to combat familial hyperlipidemia. In today’s blog, I will continue to tell the story of how he got into the treatments, and what he had to endure to get them started. I will also issue a couple of warnings. First, I am NOT a medical professional, so anything you read in my blog needs to be discussed with your doctor. Second, I will be including photos in this and future blogs so if you get woozy looking at scars or incisions, please view the "text only" version.  

Late last year, Kevin was enrolled in a treatment called lipo-apheresis. Once every other week a machine pulls his blood through very specific filters that remove all LDL and triglyceride components. He suffers from familial hyperlipidemia that led to three heart attacks (four interventions total) resulting in six stents. Kevin’s cholesterol levels have often been immeasurable because the serum is too turbid. In the past, his doctors put him on a variety of medications and diets. The diets didn’t work and the medication (statins and fibrates) left him unable to function. 

Cholesterol is necessary for certain functions inside our body (it is involved in cell membrane creation and repair among other things). The foods we consume give us about 20% of our cholesterol (called dietary cholesterol). The other 80% is produced in our bodies, predominantly by the liver. When we have too much and the body can’t metabolize the excess, it can lead to clogged blood vessels, heart attack, or stroke. This is why it is important to have your levels tested regularly, especially if anyone in your immediate family knows they have high cholesterol.

Despite the fact that Kevin is in great shape and follows a healthy diet, his cholesterol cannot be controlled without medical intervention. This is the frustrating part of familial hyperlipidemia. In order for Kevin to start his lipo-apheresis treatments, he first had to get a hemodialysis catheter installed in his chest. This pair of tubes goes through the neck, into the jugular and straight into the heart. The external part of the tube is channeled under the skin and the access ports come out just above the breast line (to make it easier to manage the dangling tubes). It looks like this:

The process of getting the catheter into Kevin was a bit brutal. We went to the vascular access center on a Friday morning and the nurse took us into an office to discuss what would happen. Kevin had to fill out an endless barrage of forms. He points out that the paperwork must equal the body weight of the patient before they can be discharged. As the nurse goes over the whole procedure, we wonder what we’re getting into. This sounds pretty involved, but we’re thankful it is only temporary until the fistula can be created.

An hour after they wheeled Kevin into the surgical suite, I am called back to the recovery area. He had a huge dressing on his chest and neck, and he was still woozy from the sedative. The doctor explained to me that Kevin will be sore since they had to jam the tubing through his very strong neck muscles. They schedule us to come back the following Monday to get the dressing changed and to do the vein mapping in preparation for the fistula.

Here is what the dressing looked like (the huge compression bandage on his neck had already been removed):

Tomorrow, I will discuss the vein mapping and fistula surgery, and Kevin’s first lipo-apheresis treatment. I will also explain what was involved to care of someone with a chest catheter.