Apparently you need to highlight this to read it, my apologies.

Below is a letter to my PCP from my kidney doctor, with names, locations and such removed.

Kidney disease. They kind of left that out... like, ever.

Also, I don't eat a lot of salt. I don't eat a lot, period. I am very active, as I am able.

The weight went from 165/170 to 250 in a matter of THREE DAYS, not the course of a year. It has been over a year that I have been fighting to find out WHY. This is all fluid.

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Dear Dr. Xxxx,



I had the pleasure of seeing your patient today for follow up of edema,
weight gain, and chronic kidney disease. As you know, I saw her a few weeks
ago. Since then, the following events have been notable:

5/19: upro/cr 316/439, na 131, cr 1.0, gluc 366

Received echo report from OSH - normal

6/10 saw endo, dc'd actos. Considering metformin. antigad ab's 4.6 (high),
a1c 10.9. vit D 6, using insulin pens and finding that easier

Saw pcp who rx'd vitamin D. LDL 163. rx'd gemfibrozil which she stopped.
Planning to refer to lipid clinic

Had ucx positive for klebsiella. Rx'd cipro.



Renal history and history of edema: patient reports acute onset edema and
SOB on the evening of 5/9/08. She went to the ER and was told it was all in
her head and shortly thereafter was discharged home. SOB improved, and
edema somewhat improved, but since then, she has experienced recurrent
episodes of acute onset edema, as well as steady massive weight gain (170lb
> 250 lb per her report). She has been tried on diuretics, but this led to
increase in bun and creatinine (cr 0.9>1.3) and did not significantly help
her symptoms so it was discontinued. Work up to date has been significant
for the following tests:

- creatinine 0.9 on 3/11/09

- bun low teens > low 20's over past year (20 on 3/11/09)

- urine protein: no microalbumin 7/30/07, 24 hour urine protein 254 on
incomplete collection 3/11/09

- BNP 20

- Tsh 2.7 on 3/6/09, 3.0 on 2/23/09

- Ana positive 1:320 11/5/08, 1: 160 on repeat, then 1:80, then negative.
Esr 47 then 27, c3 169, c4 37.

- Cxr normal 3/11/09

- Ch7 3/11/09: na 137, k 4.3, cl 97, bicarb 31, bun 20, cr 0.92, gluc 146,
ca 9.1, phos 4.5, lft's normal, wbc 11.3, hb 12.8, plt 314.

- Abd ultrasound: liver coarse echogenicity, 24x16x23 mm echogenic lesion,
spleen normal, MRI recommended.

- labs 4/28/09: tsh 1.86, ESR 27, 24 hour urine 129 mmol Na, 1695 mg pro,
pro/cr ratio 1165/845, vol 1455, free cortisol 19.7 (normal). cr 1.13, IFES
no abnormal bands, rf neg, rpr neg, ana pos 1:80, nucleolar pattern, anti
centromere neg, anti histone neg, lyme neg, aldo 1, renin 1.

- labs 5/09: bnp 21 (normal), ds DNA neg, anti scl neg, anti rnp neg,
sjogren's neg, ana neg, c3 and c4 not low



PMHx:

- DM1 onset 1987. on insulin from outset. Retinopathy post laser rx x 2 so
far. A1c's have been 12 for years, though recently 9.5 per her report.

- Asthma

- Fibromyalgia

- Hypothyroidism

- No history hypertension (on diovan for proteinuria/DM)

- 2 LEEP's. ingrown toenails, cyst R thigh removed 6/99. no pregnancies.

- Pyelo 2/98

- C-scope 1.5 years ago normal

- Gastric ulcers

- Emotional lability

- (hospital) records (hosp for F/desat, MRN xxxxxxx, 000-000-0000): 1/23/09
CT: Effusions, several areas of patchy consolidation. Bronchial PNA and
likely also flash pulmonary edema. Irregularly enhancing liver lesions rec
MRI, and fatty infiltrate. Irregular lovulation of R kidney, kidneys
otherwise normal appearing. CT abd noncontrast otherwise unremarkable.



SocHx: no tob, rare ETOH, no drugs. On disability. Schooling: some college.
Lives alone (wi 3 cats), steady boyfriend, supportive family nearby.



Fam Hx: mat GM died of kidney failure onset after heart surgery. Mat uncle
kidney stones. Otherwise no renal history. Father had DM and stiff-persons
syndrome



ROS: says ballooned up again June 9th to >260 lb, shiny skin. Went to (hospital). Rx'd lasix 40' for a few weeks and wt came down to 243 and has
hovered there since then. Now on lasix 80'. Cough improved. Walking and
swimming. Says PO intake less secondary to n/v/diarrhea. Believes she has
a low sodium diet. No dysuria. Had hemorrhage in R eye (retina appt
tomorrow). No nsaid use. Chronic DOE (few stairs, not at rest), Chronic
pain - different kinds, throbbing and shooting in bilateral extremities,
also LLQ abd pain. Constant L subchondral (lateral) pain, worse with
valsalva. Acne neck, back and chest past year or so. Intermittent
headaches. Neuropathy hands and feet. Snores a lot and fatigued during the
day. Menstruates regularly. No dysuria, hematuria, urgency. ROS otherwise
negative or noncontributory.



Meds: per logician, is taking diovan. ranitidine prn, albuterol prn, flonase
prn, rare Tylenol, rare advil (not in some time), No herbal or other OTC
meds. Allergies: actos ? contributed to edema. lisinopril > cough, sob and
wheezing, sulfa, cephalasporins, statins, acyclovir, codeine, bactrim.



PE: 104/70, HR 100. wt 243 (from 248 at last visit, 248 prior). Alert and
oriented young woman, obese, in NAD. JVD difficult to assess secondary to
habitus. Lungs CTA bilaterally. H RRR, no MRG apprec. A soft, nontender.
nonpitting edema bilateral LE's, with 1+ pitting bilaterally.



Urine: Sed accidentally omitted today. Prior visit was: WBC's, +bl, rare
dysmorphia, no casts.



Labs: cr 1.18, k 4.2, upro/cr 60/641, microalb 43, ua 2+gluc, no pro, no bl,
no wbc. Ucx negative. Renin 54, aldo 8, wbc 14.9, hb and plt normal. Pth
36, vit D 17.



A/P: 30F, history poorly controlled DM1 with retinopathy, treated
hypothyroidism, fibromyalgia and obesity, following for edema, wt gain from
170>250 lb over the past year, in the context of near-normal creatinine,
minimal proteinuria, and dips positive for blood with relatively benign
sediment.



GFR: cr slightly elevated today 1.2 from baseline of 0.9-1. likely
intravascularly volume depleted. Elevated bun/cr ratio supports this, as
does elevated renin (though these both could also be effect of diovan).
Follow, and if increases further would consider cutting back on diuretics.
Review sediment next visit. Can have dysmorphic hematuria just from
diabetic nephropathy, and as long as creatinine and proteinuria stable
would not necessarily investigate further, but will follow. (flagged endo
and asked to get a ch7 when she is in on sept 10th)



Re: the weight gain and edema, likely multifactorial, endocrine following
and working on diet and insulin dosing. CHF, hypercortisolism, myxedema,
and secondary lymphedema from CTD have all been ruled out. Increased
dietary sodium intake likely playing a role, supported by fact that she had
modestly elevated 24 hour urine sodium on check 4/28/09 and suppressed
renin and aldo then (has since come up on lasix). Has been counseled on low
salt diet/ hidden salt. Classic edema from actos may also have been
contributing. Timing was not suggestive of edema from diovan. Primary
lymphedema hasn't been ruled out yet, though relatively rare. Will defer
to PCP to work up further if they feel indicated.



Re proteinuria: IFES no abnormal bands. Likely from poorly controlled
diabetes for many years (has other sequelae as well - ie: neuropathy,
retinopathy). At goal on diovan. Continue diovan and continue to avoid
nsaids (has been counseled on this).



Re: polydipsia/polyuria, intermittent nature of symptoms consistent with
effect of hyperglycemia. Not an issue on recent urine collection.



Misc: referred for sleep study last visit -scheduled but hasn't happened
yet. Will defer to PCP for MRI to follow up liver lesions.



HCM: recommend pneumovax. Will also need flu vax and H1N1 vax this season
when available.



Thank you for giving me the opportunity to participate in the care of this
patient. I look forward to seeing her back in 6 months, or sooner should
any acute issues arise.



Sincerely,



Xxxxx Xxxxxxxx, M.D.
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I am fairly certain that I am allergic to the pneumonia vaccine. I seem to recall having a pretty bad reaction to it a few years ago.

Not quite sure how I feel about this H1N1 thing. Seems to be jumping the gun a little bit. We don't know much about what I have OR about H1N1...why combine two mystery illnesses?

As for the MRI, I had that repeated a few months ago. I will have to see about getting the report to the new PCP and the kidney doc and see what they think about comparing the two studies.

Okay because my life needs more confusion...

I don't think I mentioned that on my most recent appointment wit my PCP (April 27th) my mother had to take me what with the being very swollen and the eye surgery 2 days prior and the still being in pain from the car accident where the airbags didn't deploy.... anyway, some other people also came along because they didn't really have a choice.
The nurse/secretary was NOT happy about this and was rude and nasty and allowed me in for my noon appointment at nearly 2pm (while keeping a 10 month old and a woman with MS waiting with me) The PCP supposedly swabbed me to check for MRSA, but I have not received any results, nor have I been able to get taken off hold to get any answers (this woman is the only person who handles anything, it seems)
So on the 12th of May, I got a piece of mail from a collection agency supposedly about a bill for $34 from the PCP. I had never gotten a bill, nor should I, because I am insured, and disabled. There was no "date of service" on the bill and the agency did not answer, and had a fake v oicemail. Ironically enough, the agency number and the PCP number are only one digit off...hrmmmm....
Anyway, on the 13th of May, I got a hand-addressed envelope from the Dr.;s office and inside was a bright orange paper that said it was a notice of small claims trial to be filed within 30 days if I didn't pay the $34. Let me tell you, I am NOT paying the money. I do not owe it, and I was never sent an actual BILL, so they can spend the well-more-than-34-dollars it will cost them to take my disabled ass to court so I can watch them lose.
I called and had the doctor paged and asked him what was going on, and he stated that he would find out and let me know what was going on tomorrow, which would be today, and given that it is 7:11pm now I am fairly certain he isn't going to do jack shit.
I am going to have to type up a letter and send it certified and get this matter addressed. The whole thing is just ridiculous.

On Tuesday (I think) I get to travel for like 5 hours on public transit to pee in a cup and come back home. Such a good use of my time...

I would really like to know what is going on with the tests that they took while I was at my appointment on the 5th of May. Nothing accute doesn't mean nothing to report. I need to know what is going on and it is my damn right to know what is going on.

I actually left a voicemail with Johns Hopkins Hospital at 12:48am last night/this morning because I am that damn desperate for answers. I left another one today. How would I get to Baltimore if they thought they could actually do something? I have no idea, but I will cross that bridge if and when I ever get to it.

ER again.

I went to the ER again on Saturday night.
The swelling and pain got out of hand. I was up to over 250lbs and felt like my skin was about to pop off. I can't even explain to you how bad the pain was.
I was dropped off at 9pm, taken in back at around 10pm, and told them I had to go to the bathroom so could they please give me a johnny and a cup right away because I knew they would want to do a UA and I couldn't get to the bathroom without a 2nd johnny on. I also asked for a blanket because it was freezing and they didn't give me so much as a SHEET.
Come 11pm, I still had no sheet, no blanket, no johnny, no cup. I was also in a stretcher that was made for someone over 6 feet tall. It was very difficult to get on and off of even with the step stool (the one of which they gave me didn't have the handle bar thing).
I hobbled over to the curtain and said excuse me about 3-5 times and finally someone noticed me and I asked about the johnny, cup, and blankets again and said that it was urgent and that I'd been waiting over an hour already, two if you count the time in the first waiting room. A page was made.

At 11:30pm, I, after sitting on the backless, rolly chair since the initial request because of the height of the stretcher, hobbled over to the curtain again. I said "excuse me" 3 more times and then I said "Hey, excuse me" and then I yelled "HI!" and the girl who had been twiddling her thumbs 3 feet from me and heard everything I said from the first "excuse me" said "Yeah?" and so I said "Johnny. Cup. Now." and she said "Well!" and I said "I've been waiting a long time, ts not like I'm rushing you on the doctor thing, I'm just asking to pee and you've made me wait two hours!" and some other girl came in and asked what was wrong and I told her and she got me set up and I went and came back and asked for blankets again, and got one.

Then I had a student come in, probably around 1am, and talk to me, maybe 1:30, and the nurse started an IV line and got blood after sticking me 3 times. She stuck me a total of about 6 times throughout the night. It was not fun. I had an EKG and a chest x-ray, which I am told were normal. The student measured my ankles.

They left and pretty much left me there listening to the vomiting, screaming, possible-MRSA patient in the curtain next door. Said patient's son kept poking his head in and looking at me, which was creepy enough as it is... and then kepy backing up enough to bump me through the curtain. Talk about scary.

My boyfriend arrived at around 4:30am and the lady in the next curtain, who I'd been putting up with for a couple of hours already, started screaming more and saying that she was going to scream more and more and "I don't care" and at that point, I said "I do" and her son SCREAMED "Shut the fuck up!" so I yelled back "Excuse me but I didn't do anything to you, that was fucking unnecessary!" and of course THEN I get some attention. They came in and said "We've got a very sick woman over here" and I said "I understand that and that's why I have been so patient with her noise and dramatics, but that was unnecessary. I didn't do anything to them." and they moved me to another, single room, with a TV.

So then I had my boyfriend go and remind them that I am a diabetic and hadn't had ANYTHING to eat or drink at ALL for over 13 hours and could they please fix that. They got me a box lunch and then the nurse came in and started putting something into my up-until-now empty IV line. I asked what it was and she said "pain medicine" and started asking me about allergies. (Mind you, she'd already started administering the drug) I told her and asked again "What IS that?" and she said "Pain medicine. I just told you, did you forget already?" and I said "No, I mean what is it called?" and she said "Oh. Dilaudid." and THEN she checked to make sure I wasn't driving... and then a few seconds later I felt really hot and dizzy and my heart felt like it was goinbg to pop out and I said "Oh my god oh my god what the heck?"and then I needed to lay down more than I was, and then I pretty much was knocked out, and less than 15 minutes later, I was told that even though they admit that I was even MORE swollen than when I came in, that since I wasn't going to die right then and there, I had to leave right then and there.

They told me to follow-up with my PCP, and I called him and I have an appointment for noon on Tuesday. Great. A whole week. More than a week after the ER visit. WHat the hell am I supposed to do? I have a gyn appointment on Thursday. I swear if he thinks I should be admitted, I'm just going to have him do it.

The ER refused to give me copies of my test results. I did officially request them, but they said I have to go through the records department. I know that is a load of crap because I have gotten the results before. They just gave me a bunch of letters and numbers in paragraph form which I am about to try to decipher.

I am so confused.

As previously noted, the allergist had his secretary call to cancel my appointment for today, even though I bent over backwards to make sure he had everything he "needs" after he threw me out without running the tests LAST WEEK when he was supposed to do them.

I showed up today and simply greeted the secretary politely and quietly and said that I wanted all of the records that I had brought in returned to me right then and there, and also the records of the tests he had done, since he had outright refused to tell me the results when they came in while I was in the office a week ago. (He actually claimed that they were not there, but I know that they were because my PCP said they were and teh secretary told me that those were what she brought in while I was in there.)

She said that she was told that all of the results were "normal" (mind you, I had to wait for these records to be faxed over because supposedly when they arrive (even though I had requested them the week before- copies for myself, that is) the doctor scans them into a computer and shreds the paper. Okay, except why didn't he just mail me the paper copy since I wanted them anyway?

Anyway, the results show a few flags for abnormality:
White Blood Count 11.1 Normal is 4.0-11.0 so that is not TOO bad and is certainly lower than I have been... but it is still flagged.
MPV is flagged because it is 12.2 and normal is 9.6-12.0, Carbon Dioxide is 32, normal is 20-31.
Total Bilirubin is 0.2 and normal is 0.3-1.2

Three things that stand out as BIG TIME NOT NORMAL are:
1~ Complement 3, Serum- 169- normal is 79-152
2~ My sedimentation rate is 47, and normal is 0-20.
3~ Anti Nuclear Antibody test was POSITIVE.
These are all a pretty big deal, from what I gather, and not only was I not contacted with the information, I was outright lied to in being told it was not there AND I was refused treatment due to a lack of paperwork that had nothing to do with the tests that (still) need to be done.

Now, moving on to the kidney doctor, I went on March 11th for an appointment, and the doctor said to come off of the Bumex. She said (in front of my mother) that if I was on diuretics that I "would wind up on dialysis and die" so I need to stop immediately. I'd already taken the Bumex for the day, so I stopped the next day. She also said that she wants me to see a colleague of hers at a major hospital and that it is urgent that I do so, but that I need to get some testing done, so she took blood and urine tests and said to come back in a week.

My WBC was 11.3- normal according to this one is 10.3- either way, still high.
Osmolality urine listed at 362 with normal being 500-800.

Now, she didn't mention anything about this to me, she just handed me my results after a very brief appointment in which she poked my ankles a little (without taking off my shoes or socks) and noted that it put me in agony, she noted that I gained weight and swelling while off the diuretic and suggested I go back on one, to which my boyfriend replied "but won't she wind up on dialysis and die from that?" and she said "Well that is why I really don't want her on them.."
but she just said she did... but now she doesn't... but she does... but she won't give me a prescription, and so I remain on nothing.

She had her secretary give me the number for her colleague and I called to try to make an appointment and was told that I couldn't have an appointment til May. I explained that my doctor considered this urgent due to the extremity of the situation and I really couldn't wait that long and that I have records and such and was not even allowed to take the May appointment as a holding spot for just in case, I was told to have the records faxed. I called my nephrologists' office and told them what was going on, I was told that they would call over and get things straightened out and call me back, but of course, I did not get a call and now it is 9pm on a Friday and I will have to wait til Monday.