My Failing Kidneys
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.
Tags: Detrusitol 2mg tablet, Ketosteril, low-protein diet, renal diet, Sangobion, Tolterodine 2mg
Dietary Plan
My dietary plan.
Before meeting Jinny at the appointed time yesterday, I went to see the dietician again. Miss Saw, the dietician at the Lam Wah Ee Hospital, explained to me in detail what my 5 daily meals should be like. My ration of three exchanges of protein for the day could be something like one portion for breakfast, one for lunch and one for breakfast or one and one half for lunch and dinner respectively. Meat protein is preferred over soy-based products as it is easier for the body to absorb. It may be difficult initially but I think I can manage eventually. It is just a matter of getting used to and adapting my daily routine around it.
I also decided to collect the Detrusitol SR since I was at the hospital. Mr. Wong, the pharmacist, had already packed them for me and I need not wait in queue to pay. It was all a breeze. The extreme side effects that I experienced could be due to many other factors and that day could be an exception. I have not felt that lousy since. My medication is getting more expensive - RM249 per month. Hopefully, the condition of my kidneys will stabilise at the current levels. It is going to be a drain on my finances should I need even more expensive drugs.
Tags: Detrusitol SR 4mg, low-protein diet, renal diet, Tolterodine SR 4mg
Creatinine Alert
Detrusitol SR 4mg
There was a change in his demeanour from the usual. I thought he was perhaps thinking about his other patients’ problems.
“Have you been taking your Detrusitol?”
I mumbled a soft “Yes.”
“How often do you catheterise?”
“Every four hours.”
“Do you have any problems?”
I told him about the fever prior to the bloggers meet in KL.
“When you have a fever next time, come in for a culture. One day of infection is enough to wipe out your kidneys.”
I could only nod. I had a feeling that what he was to say next would not be good. He went on to say that my creatinine had shot up to 262 umol/l from the 180s. The normal threshold is around 100 umol/l. I was on the way to acute renal failure and he was really not happy with the figures. My kidneys, however, were not swollen, which meant that the intermittent catheterisation and Detrusitol are effective. I have to see the dietician again for my diet to be evaluated and revised. My protein intake of two servings per meal has to be reduced to one and one half. That is like cutting down to 75% from the two matchbox-sized portion of meat that I am allowed now.
“If that doesn’t work, you’ll have to go back to see what Dr. Liong can do for you further,” the dietician said.
This calls for another drastic change in lifestyle and dietary intake patterns. The dietician has also advised me to keep a diet log to track accurately what I have eaten. My medication was also changed. I am now to take one dose of 4mg Detrusitol SR just before bed. A one-month supply costs RM249 and it is supposed to be for the long-term. Detrusitol is prescribed for overactive bladder which may result in a reflux of urine back into the kidneys. I am still digesting this sudden assail of bad news. Hopefully the next review, which has been changed to quarterly from half yearly, will show better results.
Tags: Detrusitol 2mg tablet, Detrusitol SR 4mg, low-protein diet, renal diet, Tolterodine 2mg, Tolterodine SR 4mg