tinkll1 (tinkll1) wrote,

First Tuesday in March

The start of another month and rounds at a bunch of clinics around my area, and the usual challenges that you see from an understandably different perspective. I have resolved not to bug my most challenging patients about their intra-dialytic weight gain. They get it, or they don't get it. And a nag, a know-it-all nag, is a pain!
So's the paper work. And the slow reports traveling by turtle from the hospital to the dialysis unit. And the pharmacy phone calls. It's not in their formulary! And, a bit of news from Jim Lehrer. Tennessee is cutting its Medicaid system to the bare bones. And in my wonderful state, Arnold is driving his Hummer, intent to run over any possible benefit for the MediCal patient. How about a restriction on the number of phosphorus binder tablets that a patient can get for a month, even when their phosphorus is still way above target.

So what works? Look for the positive! Blood pressure, controlled. Great! Critline shows no anemia, great! Too early for the potassium and phosphorus returns, the blood is just being drawn. 7 kgs over 3 days! %##@! Are you short of breath?

And that old itch.... normal phosphorus, normal iPTH.... try a cold compress.

6:30 AM to 6 PM. Quitting early. An oriental chicken salad at Mimi's. 90% water by weight.... and, lucky me, I don't have to sweat it.

A transplant for all. A parting wish. I started this stuff a long time ago. Before Medicare. When we told diabetics we were sorry and there wasn't anything we could do, and no places to be had, and no funding, and now they get dialysed, when they need it.

Well, good news for one of 2 patients at my free clinic. Cytoxan, once a month, is holding her membranous lupus nephritis in check. For 6 years. So far. The side effects of the prednisone are almost gone. Cholesterol controlled, BP controlled, and now she goes and gets diabetes, and her glycohemoglobin is 8.6! Target < 6.5.

In 2 weeks, I go to Hawaii to spend a week in luxury brushing up on general internal medicine from 7:30 - 12:30, and trying to hit a tennis ball and not get a heart attack, or gain weight.

Damned dialysis from the other side. There's nothing I'd rather be doing. Hang in there, guys! Damned dialysis! Until a transplant comes along.... hang in there. We're pulling for you!
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