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Transplant Athlete
Monday, August 31, 2009
  Bury My Heart On The Blue Ridge

As most readers of this blog know, I hadn't ridden long distances in quite a long time due to the kidney failure. In center dialysis kept me alive (barely) and I never really had the energy to ride. Most of my riding has been around town with the kids. I started dialyzing with the Nxstage System One Home Hemo machine almost two months ago and I've been able to get back on the bike for those long rides I love so much.

Yesterday, I surprised everyone (even myself) by showing up for the "Bury My Heart On The Blue Ridge" century. I've done this ride a couple times in the past. It's got a ton of climbing on it, so it's very challenging. I didn't recognize many faces at the start, just Nick, Gordon, and of course Chuck and Crista. I was able to keep up with the Tandem for about an hour. I debated skipping Chester Gap Rd. Its a little over a mile and a half long and it's very steep. I would lose at least a half hour on the climb, but in the end my legs were feeling pretty good, so I decided to go for it. I got about halfway up when Chuck and Crista came bombing down on the Tandem. It reminded me of a freight train rumbling by. It's been awhile for me, so I was much more conservative on my descent. I rode the brakes most of the way down, I pulled over halfway down to check the rims and they were quite hot.

Rte 522 into Front Royal was mostly downhill, so I was able to make it there pretty quick. From there we headed south on Skyline Drive. After Chester Gap, I felt pretty good on the climb to Dickey Ridge, but I was losing ground to the rest of the group. Maile (sounds like Miley) would pass me, pull over and take some pictures, then pass me again. It was disheartening.

Eventually I caught up to Ed and Mary on their fully loaded tandem. They were on their honeymoon traveling south. It felt good to see them.

Lunch was at the Elk Wallow Wayside on Skyline Drive. I was really suffering trying to get there, my legs were wiped out. After some food and rest, I was ready to go again. I kept up with the tandem and the rest of the group until we hit 211 East. Maile was conservative on the descent, and I got held up for an instant. Maile caught up to me again a few miles down the road after it flattened out. I took a 6 mile shortcut because my legs were screaming "no mas" and took it easy into the final rest stop. My brother-in-law lives on the route about 10 miles from the finish. I pushed hard to make it to his house and then asked him for a ride to the finish.

I got about 87 miles in on a very hard course, so I was happy with that.

 
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Wednesday, August 26, 2009
  Minor Surgery Slows Training

I had some minor Surgery two weeks ago that put a minor crimp in my training. The surgeon told me not to exercise for two weeks, but my Nephrologist gave me the OK to train.

I've switched from easy aerobic rides to higher intensity rides. I'm trying to do longer and longer stretches just below my lactate threshold. I'm also pushing a big gear. I'm hoping that will build some muscle.

It doesn't feel like I'll be ready for the 26th.

 
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Sunday, August 16, 2009
  It's Hard To Believe...

but I'm dialyzing at home now. Today was rough. I placed the arterial line and it felt good, really good, but I wasn't getting any blood flow. After awhile, I figured the line clotted up, so I pulled it and tried placing another one. Of course that one infiltrated. Argh. I took a step back and just relaxed for awhile. I got the arterial placed on the third try.

The venous needle took two sticks to get it right. Once I was hooked up to the machine, my arterial pressure was really high so I fidgeted with it some. Eventually though, the arterial pressures dropped and I was able to crank up the speed on the machine. My treatment time ended up being pretty darn close to 4 hours and with the set-up and early cannulation mistakes, it was a 6 hour affair.

I know, it may not seem worth it right now, but it'll get there. I could draw parallels to my freshman year at Stevens, but I'm wiped. Buenas Noches.

 
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Sunday, August 09, 2009
  Best Pizza Making Website On The Internet

I was born and raised in New Jersey, where good pizza was always within reach. When I moved down to Virginia in 1995, I was immediately disappointed by the quality of the pizza. A friend recommended a place in Baltimore that had great pizza, but eventually, they sold out and the new owners suck at making pizza. I then found a place in Great Falls, the owner was a Jersey Boy like me, but he sold out and the new owner sucks at making pizza.

I've been experimenting with making my own pizza since 1997. I bought the Williams Sonoma Pizza cookbook, but my pizza's were little better than Dominos and they certainly didn't taste as good as the New Jersey Pizzas I grew up with.

A couple months ago, I found a book called The Art Of Pizza Making that brought my pizza's to a whole new level. I'm actually proud of my pizzas now and think they are as good as or better than anything in the Northern Virginia area, but they still don't taste quite right. I found a website that explains pizza making like no other resource. It's Jeff Varasano's New York Pizza Recipe. I'll be using this website for my next batch of pizzas. I just wish I'd found it years ago, it would have saved me a ton of aggravation. So if you are interested in making your own pizzas, check out his site.

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Saturday, August 08, 2009
  Training For 24 Hours Of Booty

Argh. I'm way behind the 8 ball. I did a 3 hour and 20 minute aerobic ride today and my lower back and neck were killing me. It doesn't feel like I'll be ready in time for the event. I iced the painful bits down, but I'm going to be sore tomorrow. My legs feel wooden, so I should probably just do a short recovery ride tomorrow. I had 5 hours on the bike last week and I've got 9 hours on the bike this week.
 
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Friday, August 07, 2009
  I Will Not Be Helpless

I just read an old article from Dialysis & Transplantation Magazine titled, "Why Home Hemodialysis?" by Jim Curtis, CHT.

Points he made:
1) long interdialytic times (up to 68 hours on the weekend) for in-center patients allow waste to accumulate, then it gets ripped out in a four hour session.
2) A study presented at the 2008 NKF Spring Clinical Meeting found that Standard in-center dialysis leaves patients in a state of kidney failure (CKD Stage 5 - no kidney function), whereas long nightly dialysis leaves patients in a state comparable to CKD Stage 3 (which is like having some kidney function). Obviously, a transplant would leave the body in a state of full kidney function.
3) In-center dialysis encourages "learned helplessness" - everything runs more smoothly if patients show up on time, do what they're told, and leave right after treatment.
4) The center reminds them they are sick, they are around other sick people. According to the article, there is sometimes a waiting list for favorable times and days (apparently, M,W,F mornings are the most requested).
5) There's an ad out lately, I think it's by DaVita that says, "90% of physicians would prefer home dialysis for themselves if they needed dialysis."

I can certainly relate to the first point. I felt like crap after most of my in-center treatments, but after a good nights sleep, I bounced back. I couldn't do dialysis in the morning, my whole day would be spent recovering. It's a very aggressive form of dialysis.

As to point 2, I certainly feel better, I'm not just alive, I'm living. It's not as convenient as a transplant, but I'm getting back to my regular activities.

After seeing point 3 in print, it was no surprise that I didn't really get along back at the center. I need to be in control. I avoid alcohol because I don't like the loss of control. Sailing on larger boats is very hard for me because I don't like the loss of control. I am fine in something small like a Force 5 where I can control the rudder and the sail, but my dad's 17' Islander and later his larger boat got my fight or flight response going. I dislike rafting, but I like kayaking, it's a control issue. I'd also like to point out that it was hard getting answers to questions when dialyzing in-center. You see the doctor once in a blue moon, there are nurses there, but most of your interaction is with technicians, some of whom know little more than how to set up the machine and cannulate a patient (which they do very well).

In an earlier post, when I described my first dialysis experience, I think I mentioned the other patients, who looked like they were one step ahead of the grim reaper. There are patients like that in-center, people being wheeled in on gurneys, in wheelchairs, hobbling in on canes. There's the occasional coughing and vomiting. It's not a very optimistic place.

 
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  Common Sense Weight Loss

A friend of mine (we'll call her Pinkie, yes that makes me the Brain) has been asking me to help her lose weight for a couple months now, but I've declined. I'm not really a coach or trainer, which is why I've said no, but yesterday she stopped in at the house and pleaded with me to help her lose her belly. I took pity on her and said yes.

The first thing we did was check her weight (60.7 Kg) because we need to know where she's starting, in Kilograms (my new scale for dialysis is accurate and in kilos), since she's not fluent in the conversion, she won't obsess over her weight. Second, I had her do some pushups (1) and situps(40), so we'd know where she was starting from.

I'm thinking next, we'll have her record her food choices for a week. My guess is that she's drinking coffee for breakfast and she's skipping lunch (or eating a crappy lunch). Once we see what she's eating, we'll plan some menus for her. We don't want to put her on a starvation diet, we just want to limit some of her caloric intake. Swap out coffee, soda, and juice for water. Make sure that her meals have the proper balance of fat, protein, and carbohydrates so that she'll feel full and get a good meal.

As everyone knows, the secret to weight lose is to make sure that your food intake is below your activity level, so we'll find little ways to help her move more. I think I'm going to recommend that she take a walk around her building during her lunch break (a 30 minute walk will burn about 105 Calories). With her long work hours and young kids at home, it'll be tough to fit in exercise for her during the week, but maybe she'll be able to find some time on the weekends. Of course, taking the kids swimming counts, running around with them at a playground counts, etc. We'll also have her work on building muscle first, because muscle burns fat, For the record, a pound of fat is roughly 3500 calories.

So, I'll keep you updated on her progress. Anybody that wants to follow along and lose a little weight is welcome to write your goals in the comments.

 
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Thursday, August 06, 2009
  Monty Python Moment...

Yesterday, as I was taking myself off the dialysis machine, I reached for the sharp end of the needle, but changed my mind and reached for the other end. A piece of tape in my hand snagged the butterfly (the "wings" just behind the needle) and yanked the needle out. A small stream of blood squirted out. It was warm and wet and I instantly got gauze on it.

I met with the Surgeon on Tuesday and he said "No Buttonhole" needles, so I'm back on sharps. Which is fine by me, I was having trouble placing the buttonhole correctly, and I got the distinct impression the nurses were going to keep me at the clinic training longer because I couldn't place them. I probably could have gone home the second week, if we hadn't messed around with buttonhole needles.

For those who don't know, a "buttonhole" or "constant site cannulation" is formed by using sharps in the same exact spot for about 7 days. The sharp needle eventually creates a "scar tunnel", then the patient switches to buttonhole needles which are dull. These buttonhole needles slide down the scar tunnel and push a flap open on the vein. The problem is you need to place the needle in the exact same spot, at the exact same angle over and over again, which is hard to replicate when you are just starting to self-cannulate. My surgeon feels that buttonhole weakens the vein in that spot and then if he needs to go in and repair it, there is nothing to sew to, so he must attach a graft to bypass the weak area. Also, he feels that if something goes wrong during use of the buttonhole, it won't clot properly (because the area is weak) and there is nothing there to stop the blood from rushing down the scar tunnel and out my body. He says it's very dangerous.

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Tuesday, August 04, 2009
  Eat More Raisins

Back in 2007, I joined a gym and worked my tail off and I didn't really see much of a benefit. I was seeing minimal strength gains, and I certainly wasn't getting any faster on the bike. Lately, I feel like I've been putting on a lot of muscle mass for a little bit of work. I'm only riding about 5 hours per week right now, but my legs feel like they are getting larger and more defined.

No, I haven't started doping, but I did have an epiphany last night as I was happily spinning away on my trainer. I had opened up the bible and was flipping through the pages to see if their was any guidance I could use in my training when I found this: (and I quoteth):
"It's apparent that as we grow older muscle mass is lost...Nitrogen, an essential component of muscle protein, is given up by the body at a faster rate than it can be taken in...This is due to a gradual change in kidney function that comes with aging, ultimately producing an acidic state in the blood. Essentially we are peeing off our muscles as we pass the half-century mark in life...Also with a net loss of nitrogen, new muscle cannot be formed."
The Cyclist's Training Bible by Joe Friel, 2003

This didn't really register with me before, after all, I'm only 37. Lightbulb. My mom's kidney did pass the half century mark; for her sake, I'll leave out how long ago that was, but suffice it to say, I should have been eating more raisins, spinach, etc. to bring my blood alkalinity back into balance. I'm eating a lot of Calcium (Tums) as phosphate binders and that is probably helping me build mass now.

 
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Sunday, August 02, 2009
  NXSTAGE System One

During training, I'm only dialyzing 5 days per week, which means my WEEKENDS are free. WAHOOO. I haven't had a free weekend in awhile. My parents were down last week to help out, so I sent my kids back with them to NJ. I rode my Litespeed on a trainer Saturday morning (I used a heart rate monitor to get the most from the workout) and ABL and I drove up to NJ with TGL later that day. We drove straight to the boardwalk in Seaside Heights.

I have a love hate relationship with Seaside Heights. I love the smell of the salt air, the smell of sausage & peppers cooking on the grill at Midway, and the taste of pizza at 3 Brothers, eating ice cream from Kohrs. I dislike the crowds especially when they're smoking heavily. We sometimes go down to the Boards in the off-season, although the rides, games, and most of the restaurants are closed, it's so much nicer in my opinion without all the people. Q ended up in the ocean, even though the beaches were closed, while RJ went on rides.

We were hoping to go to the waterpark today, but the weather report called for scattered thunderstorms. My parents took the kids to a beach on the bay instead.

We stopped in Perryville, MD to do a little shopping, then picked up our babysitter in Woodbine. So, today was a long day.

 
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I've gone through kidney failure twice. The first time in 2000, my mother donated a kidney; and again in 2008, I'm on dialysis waiting for a breakthrough in immuno-suppression medicines before seeking a new kidney.

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Warning Signs for Kidney Disease:

  • High Blood Pressure
  • Burning or Difficulty when Urinating
  • Frequent Urination at Night
  • Blood in your urine
  • Cola or tea colored urine
  • Swellig of the eyes, ankles, or feet
  • Lower back pain unrelated to physical activity


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