Farewell (Temporarily) to Dialysis

Today's my last day (for the time being, at least) as the designated Dialysis Fellow. At different times of the year, I have different responsibilities. For these past two weeks I've been responsible for all the patients who get admitted to the hospital who are already on dialysis. In some ways, the service is a bit mechanical, in the sense that dialysis is a repetitive process and it doesn't take all that long to get used to ordering it.

However, in another sense, the service offers an incredible variety, too! Patients get admitted with any variety of complaints, both medical, surgical, and even psychiatric. Here's a quick rundown of the patients on my list as I left today:

1. 60ish yo male with severe vascular disease including bilateral leg amputations, just recently diagnosed with end-stage kidney disease after having an infection in his blood.

2. 70ish yo female with amyloidosis (a fascinating disease where you get deposits of protein all over your body) causing both heart and kidney failure who happens to be having some blood in her stools.

3. 30ish yo female, a diabetic who just started dialysis, who came in with a blood sugar so high that it caused her to have a seizure.

4. 80ish yo female on dialysis who keeps on getting admitted because she always accumulates fluid in her lung. We still are trying to figure out why.

5. 60ish yo male on dialysis who also has liver disease and bone marrow suppression who is having fevers while at dialysis. Again, we have no idea why. (see any patterns here?)

6. 30ish yo male, HIV+, who hadn't taken his blood pressure meds and therefore came in with all this fluid in his lungs which had to be dialyzed off.

7. 60ish yo female, diabetes, who came in with chest pain which interestingly turned out to be NOT a heart attack, but rather a pneumonia.

8. 40ish yo female with diabetes and on dialysis who has a blue painful toe which needs to be fixed surgically.

9. 60ish yo male with diabetes and on dialysis who comes in with an ingrown toenail and a nasty infection that will require a few days of iv antibiotics.

10. 50ish yo male with dialysis who comes in with weakness. Could be anything.

11. 60ish yo woman on dialysis who came in with abdominal pain. Turned out to be constipation; her CT scan showed it was packed with stool. Yum.

12. 50ish yo man with diabetes who came in to start dialysis. It was time.

13. 40ish yo woman on dialysis who had a blood clot in her fistula (the means by which one gets dialyzed) who needed a declotting procedure so as to continue dialysis.

14. 50ish yo man on dialysis with essentially the identical story as (13).

15. 50ish yo woman on dialysis who fell and broke her femur.

16. 70ish yo woman on dialysis who came in with a mild heart attack and is getting a bunch of procedures done to her coronary arteries.

I'll stop there. That's a typical day on the Dialysis Service. We're looking forward to this weekend a lot: not only do I have it off, but we are heading to PHILADELPHIA to visit some friends there. I know Sophie's looking forward to it; she's promised to be a good girl during the entire car trip there...

New England Colors

Wonder if Zeus was admiring the beautiful New England fall foliage when he was gazing out our living room window last week?

Or perhaps he was merely focusing on one of our many squirrel neighbors, one of whom chewed through the screen door and ate a few bites of my mom's pumpkin pie (which was surely one of the Thanksgiving highlights according to my nephew Henry).

Shooting Hoops

A series of photos of my nephew Henry shooting hoops with his Dad and uncle Nate.

The Big Ticket

One of my favorite Hellman Thanksgiving Traditions (and this includes my mom's grasshopper pie) is the annual NBA game. Typically this is an Indiana Pacers game, but this year I managed to score tickets to the Boston Celtics-L.A. Lakers game at the Garden!! The atmosphere was quite energetic and I really enjoyed seeing one of my all-time faves Kevin Garnett tear apart the flimsy Laker defense. Boston won (what else is new?) 107-94. Even California governor Arnold Schwartzenegger's presence in the stands was unable to inspire the L.A. team over their arch-rivals.

Happy Thanksgiving 2007!

Happy Thanksgiving--the most important holiday of the year for the Hellman family--to everybody out there!

My parents drove out here all the way from Indianapolis. I liken their travel to Boston to that of the Beverly Hillbillies...after all, they did make the cross-country journey in a jeep filled with pots & pans (for Thanksgiving dinner), a dog (Zeus the samoyed), and a banjo (pictured in photo below, with nearly-two-year-old nephew Henry, who traveled all the way from Phoenix).

Sophie's First Snow

Items:

It's snowing! Well, it snowed for a little while in Boston today at least. Not enough to stop me from biking to/from work though.

Mom, Dad, Cathy, Tim, and Henry are coming in for Thanksgiving, which I'm incredibly excited about.

I just dropped altogether too much money on Celtics-Lakers basketball tickets for Friday night, so hopefully it will be a good game.

I gave my presentation on starfruit-induced delirium in a patient with chronic kidney disease today. Nice to have one less thing to think about.

Sophie's first tooth is coming in!

Walden Pond

For the better part of the day I was having major flashbacks to my 11th grade English class with Momma Oberg (I can't even remember her first name anymore, she was always and will remain "Momma Oberg" in my mind), as we read a fair amount of famed American author and transcendentalist Henry David Thoreau. You see, Claire, Sophie and I visited Thoreau's Walden Pond, which is only about 30 minutes or so outside of Boston. It was quite pretty, though I think we missed the peak fall colors by about 2 weeks. Some photos from our day:

Sophie insisted on driving us there.

Still some nice patches of beautiful New England colors to be found.Words of wisdom from the man himself.
Site of Thoreau's former log cabin (Claire is standing on where the chimney used to be).

Pretty colors...
It's cold out! As proof you could see ice in the process of forming on one of the smaller ponds.

Sophie happy to warm up at a coffee shop in nearby Concord, MA.

My Secret Weapon

Long time since I've rapped at 'ya, to steal a line from one of my main amigos Jim Anchower.

It's time I unleash my "secret weapon" for my Nephrology fellowship: it's my father. A nephrologist himself, my father is my own personal repository of kidney-related information at any hour. Well, not any hour. But often I will run a case by my Dad before I present it to my attending so I can look all smart and all. Also, the other night my Dad gave me some advice about a patient who chugged a bunch of antifreeze (which contains ethylene glycol, a compound which needs to be emergently dialyzed off) which prevented me from having to take a trip into the hospital at 2 in the morning. And there was much rejoicing.

Looking forward to my "weekend off" (it's in quotes because although I have Saturday off, I am covering the dialysis unit Sunday from 7am-noon and then can get called in anytime after 5pm). Awesomeness.

Camera's Fixed!

Hot damn! Our Canon Power Shot digital camera is back from the shop and eager to get back to work. More blog fodder hopefully in the weeks to come.

Here we are with our family friends from Duluth the Leffs, as we went out to dinner last night in the Beacon Hill neighborhood.

I'm on call for the weekend. At about the halfway mark so far, here's to hoping I get more than three hours of pager-free, uninterrupted sleep tonight!

1st Transplant

The first successful kidney transplant was performed by physician Joseph Murray in 1954 at Brigham Hospital (where I am now!) The transplant was performed between identical twins, the Herrick brothers (shown in picture) which is important because it means that there was no chance of organ rejection, given that the genetic background between the donor and the recipient was the same.

Nowadays we can do transplants between most individuals provided their blood types match and they don't have pre-formed antibodies against the potential donor kidney. The only hitch is that we have to give toxic medications which suppress the immune system, tricking the body into accepting this foreign piece of tissue and allowing it to function as a replacement kidney. Most of the time this works, but from time to time the body still "rejects" the organ when it doesn't. Today for instance I met somebody who is on his 3rd kidney transplant already because he had already rejected the first two!

Slow News Week

As you may have gleaned from the overall paucity of blog entries over the past few weeks, I'm kinda busy. Yesterday evening on-call I was served up two tasty nephrology treats which kept me in the hospital 'til late: one a patient with the highest sodium level I had ever seen (183mmol/Liter, for those of you keeping score at home), and another a patient with a fascinating disease called thrombotic thrombocytopenia purpura (TTP), which requires repeated plasma exchange, a technique somewhat related to dialysis in which you basically have the entire liquid portion of your blood emptied from your body and then replaced with other people's donated plasma. Also relevant to me, it is also a technique which requires the presence of the renal fellow, even when it gets performed at 11pm. At least it's not dull!

Organizing Photos

I've just spent the better part of my Saturday morning organizing photos....all I have to say is that the developers of iPhoto (the program on Macs used for photo organization) are not going to be on my Christmas card list this year.

On the plus side: I've got the weekend off. I plan to spent the remainder of today deciding whether to root for the Indianapolis Colts or the New England Patriots in tomorrow's mega-football game and perhaps reading about kidney transplants since it's raining and gloomy outside.