I had blood extracted for a series of tests on 4th March 2013 before seeing the nephrologist the following week. They were Renal Function Test, Liver Function Test, Complete Blood Count, Lipid Profile, Nutritional Anaemia and calcium-phosphate test. It was to be my first time consulting a nephrologist at the University Malaya Medical Centre.
I went to see the nephrologist on 11th march 2013. Serum creatine broke the 300 umol/L threshold to hit 301 umol/L. It was unsettling to see the creatinine slowly creeping up the scale. Dr Wong, the nephrologist, explained that at some point in time in the future, I will need dialysis. I am at a pre-dialysis stage and need to be prepared for it. He explained the two options available to me – peritoneal dialysis or hemodialysis.
For hemodialysis, I need to go to a hemodialysis centre where I will be hooked up to a machine to have the waste product in my blood filtered. Each session lasts about four hours and has to be done thrice weekly. For this method, I have to have to undergo a surgery to create a fistula for blood to be extracted dialysis and then returned.
In peritoneal dialysis, a catheter is used to fill the abdominal cavity with dialysis solution. The solution draws waste from the body using the membrane in the abdomen called peritoneum as a filter. The waste is then drained away through the same catheter. This procedure has to be repeated every six-hourly and can be done anywhere.
A Complete Blood Count was also done to check on my anemia. The figures looked horrible with most of the blood elements tested coming in below the average ranges. Serum calcium-phosphate test show that I am hypocalceamia or low blood calcium concentration. There is no treatment recommended at the moment and I had to go back to see him in another three months which coincides with my appointment at the Rehabilitation Medicine Clinic.
However, Dr Wong suggested that I start on Ketosteril again and gave me two boxes to start off. That supply will last me forty days at two tablets twice daily. I had stopped taking it after I developed itching. I have been taking it for one month now and have not experienced any allergic reaction so far.
My LDL level went up because I stopped taking Lipitor for three months to see if it was causing the urea level to go up. Apparently, it did not as urea level was still high. I have since gone back to 10mg daily. I hope the next blood test will show better results.
Renal and Liver Function tests and Lipid profile done on 4th March 2013.
Yesterday was my scheduled medical check up at UMMC. As I am holding the card issued by the Department of Social Welfare Malaysia for disabled persons, doctor’s consultation, medical tests and medicine are free. These are Detrusitol, Lactulose and other supplements. Those would have cost RM200 per month if I had to pay for them. Apart from that, I am also taking Ketosteril to supplement my low-protein diet and Sangobion for anaemia, both of which the hospital does not provide. One box of 100 Ketosteril tablets costs RM260. I need two boxes per month. That is the minimum. The recommended dosage is 4 boxes. I also bought several other items, namely KY Jelly and one silicon foley catheter, which are cheaper at the UMMC pharmacy than other places. The bill came out to RM1109.20. This is where most of my income from online activities go to. What people say is true – money cannot buy health. Given a choice, I would rather be healthy and happy than wealthy. No, I am not rich either. That makes it doubly painful.
Outside Hospital Pantai Indah, Pandan Indah – 4.15pm.
My kidneys are failing. That is an irrefutable fact. Their condition will only worsen with time. There is no way to determine whether the deterioration will be gradual or sudden. All I can do is to continue to be aware with the dos and don’ts of chronic renal failure and hope that their decline will be arrested.
When I was back in Penang recently, I did not have time to go for my scheduled check-up due this month. Since Wuan is on leave today, we spent almost the whole day at Pandan Indah. In the morning, I got my blood tested and had an ultrasound of my abdomen. In the afternoon, we saw Dr. Lim, the Physician and Nephrologist at Hospital Pantai Indah.
My serum creatinine had risen to 271umol/L from 258umol/U when it was tested in February. Although the calibration of the testing equipment of different laboratories varies, the serum creatinine count still shows an increase. My protein intake has to be further reduced in order not to strain the kidneys further. The three portions of meat that I was allowed is further reduced to two now.
Protein is needed to build, maintain and replace the tissues in the body. Protein provides the body with essential amino acids for such purposes. My low-protein diet, if not properly managed will result in protein depletion. This will cause a host of health problems from anaemia to osteoporosis. Symptoms for both are manifested in my blood tests and rippled finger nails called koilonychia.
Ketosteril was prescribed to supplement my low-protein diet with essential amino acids and Sangobion for my anaemia. Those are expensive drugs. One month’s supply of Ketosteril and Sangobion costs nearly RM600. That is not inclusive of Detrusitol that I am taking to relax my spasmodic bladder which is the cause of my renal failure in the first place. One month’s supply of Detrusitol costs RM170.
To cut down on the expenses for Ketosteril, Dr. Lim has suggested a “drug holiday” where I go without Ketosteril for Saturdays and Sundays. To maintain my protein intake, I have to increase it from 29gms of protein on weekdays to 36gms of protein on weekends. 36gms of protein will allow me three portions of matchbox-sized meat.
This progression is not something that I did not expect. Because of my spinal cord injury, I knew full well that renal failure will be one of the problems that I will have to come face to face with. Nevertheless, the thought that my kidneys may totally fail one day in the future is extremely unsettling. When that day comes, dialysis will be the only solution. That will be an expensive therapy and one that will restrict many aspects of my life. I pray that that day will never come.