Saturday, January 29, 2011

Stability is Sucess

Things I remember saying to patients this week......

"You've grown a lot of different bugs in your urine at various times; look here....I'm seeing Klebsiella, E. coli, Enterococcus, Staph coagulase negative, Serratia. You're an equal opportunity hostess."

"Your kidney function is better this time; not exactly sure why but we don't ask questions when things improve. We just take it."

"Your kidney function is relatively stable, some wobble in the lab results visit to visit but overall stable. Stability is success." **

"Yep, you've got me today. I know you weren't expecting to see me on a Monday but one of our colleagues is out sick and they called me in.'ve got me!"

"I don't think you've got polycystic kidney disease but we need to do a few additional tests to find out for sure."

"Do you have obstructive sleep apnea?"  (the answer was almost always, affirmative....what an epidemic of people with sleep disordered breathing)

"You've got 35 percent kidney function; that sounds awful but I wouldn't expect you to have symptoms at that level. Your kidneys are doing a pretty decent job of regulating your electrolyte, acid-base balance, and fluid balance. But...."

"You use mostly sea salt?  That's basically salt."  (sigh)

"Your kidneys are scarred from diabetes and high blood pressure. Like a scar anywhere on the body it's going to be there forever. We can only hope to slow the process down and prevent further scarring."

"You've got overactive parathyroid glands; that happens to almost everyone with chronic renal failure. Parathyroid glands are in your neck but they have nothing to do with the thyroid which is also in your neck."

"Your dialysis fistula is beautiful, just beautiful."

"We really need to get that tunneled chest catheter out before it gets infected."

"I know you aren't keen on adding any more medication but your blood pressure is dangerously high."

"It's all gravity driven. Totally. During the day your swelling collects in your lower legs as you are upright. At night it layers out in your back and buttocks (or butt, depending on the patient) and your ankles look good when you wake up. The swelling hasn't really gone away, it's just redistributed."

"Do you think you can cut back on your dietary salt intake?  Any room for improvement?"

All in a week's work. Over and over and over again. With twists thrown in at the oddest times, lots of laughs, and empathetic acknowledgments.

** My favorite phrase when I talk to patients with chronic kidney disease who are not yet on dialysis. When their kidney function remains roughly the same, I count that as a win. They always hope for improvement and sometimes we get that but gradually many are accepting what I say about stability being success.

1 comment:

  1. Good post, shows what is part of your day in and out over and over..yes, stable is good.


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