Lemons

Sometimes life hands you lemons.....
Sometimes life shoots lemons at the back of your head from a cannon at close range.

I've noticed over the past few months that Nathanial tends to blog about facts and I tend to blog about emotions. I am warning you now, this will be an emotion-filled blog.

I believe in my very first blog about this transplant, I talked about why it was so easy for me to give Nathanial a kidney. I compared it to walking past a drowning person and wanting to save their life. Its natural to want to jump in and save someone you love. Well, now I find myself feeling like I tried to save that drowning person. I ran down to the shore and I tried everything I could to keep him from rushing further down stream. I even got a few injuries myself. And now I find myself standing here empty handed and scared to death ........and he's been taken too far into the rushing water for me to save him. I'm sad and I'm devistated and I'm angry! I'm really angry! I don't even know who I'm angry at, but I'm angry!

I'll tell you about yesterday. Yesterday was our meeting with one of the surgeons and the coordinator in the transplant unit at St. Francis. At first, it was just going to be Nathanial and mom and dad. I wasn't going to be able to attend because I had to work and we found out about the meeting short notice. Then, I had a sick kid yesterday. Having a sick kid sucks. But this did present the opportunity for me to go to the meeting at 1:30. I figured Corynne was old enough to stay by herself for just a couple hours. Especially since this meeting was when they were going to discuss the options we had going forward with Nathanial. What we were told was going to be a meeting to discuss future options and discuss maybe another transplant date to shoot for, turned into, quite possibly, the most devistating doctors appointment I have ever attended.

While sitting in the waiting room, I had the most dreadful feeling come over me that somehow things weren't going to be alright. I know what you're thinking ,'there goes Hilary with her cup half empty logic again!' But that really wasn't the case. It was more of a psycic thing I get. Sometimes when my husband is on his way home, I will open the garage door just as he is rounding the corner, because I can sense that he is near. And even when we were dating I would pick up the phone before it would ring just seconds before he called me. The night of Nathanials huge ordeal a few years ago, (when he lost his kidney function) I did the same thing. I fell asleep knowing something would happen that night. I even called mom before bed and told her I was sleeping with my phone and to call if she needed to, no matter what time. I received a call around 3am that night, if I remember right. It was mom, and Nathanial was not alright. Sometimes I know things. Its probably just womens intuition, but whatever it is, its usually right.

The surgeon that showed up for the meeting wasn't Nathanial's surgeon...he was the one that was supposed to be doing my surgery (removing the kidney). And the coordinator that showed up was also my coordinator instead of Nathanials. Odd. Very odd. The whole family sat on one side of the table .....dad, then mom, then me, then Geoff, then Nathanial was kind of at the head of the table in his wheelchair. The surgeon came in and the coordinator. Sitting opposite us, they looked nervous. My coordinator wasn't making eye contact with me at all. I feel almost as if he were a friend more than the coordinator throughout this whole process and I could tell he was upset about something. The surgeon began by telling the family that the meeting would not be a comfortable one and that he is sorry he has to deliver the news to us. He turned to me and began telling me that in the transplant unit, their main objective is to assure the safety of the organ donor above all else. He said if any little thing indicates that it would be unsafe for me to donate, then they will cancel everything. I understand all of that....they've been telling me that now for weeks. He then proceeded to tell me that due to a blood result they got back from the Mayo clinic indicating that I, too, have Leidens Factor V, they will not allow me to donate my kidney. It would pose too great a risk to go through a surgery like that for something that is not 'fixing' me when I have the Leidens Factor V (that 'V' is a roman numeral for five--Leidens Factor Five). Of course the first thing in my head is that I have been through so many surgeries and I have never had one single complication. But he quickly said 'I know you have had plenty of prior operations and never experienced any complications, but that doesn't mean you won't have any next time. We have to balance the risks and at this time we're not willing to take the risk on you'.

Then without even a hesitation, he turned to Nathanial and began telling him about everything else they found. To fully understand the issue, you must know what Leiden Factor V is. Leiden's is a clotting disorder. It is a mutated gene that is hereditary and it causes abnormal blood clots. Everyone who knows Nathanial knows he has been plagued with blood clots since just after college. One time he had a clot that went all the way from his ankle to the middle of his abdomen. Prior to a sugery a few years ago, Nat had a surgeon that insisted he get a filter surgically installed in him to catch any blood clots from getting to his upper parts....his heart, his lung, his brain, etc. They describe the filter as an umbrella shaped thing that they inserted thru his neck down into a main vein in his chest. Once in place, they 'opened' the umbrella so that it was permanently lodged there in Nathanial's big vein preventing blood clots from getting to the important area's. However, years later, this becomes a problem. The surgeon told Nathanial that the filter is completely clotted and obviously has been for some time. They said that his body has grown new veins around the filter. Those new veins now make Nathanials middle section VERY hard to operate on. Number two issue: Nat's liver is enlarged. They believe the cause is, once again, clotting. Blood is going into the liver, but no blood is coming out...they think. I stress 'they think' because they have to do more tests to exactly determine if that is what is going on. The doctor really danced around that because he wasn't 100% sure that was why the liver was enlarged. Number three issue: Nathanial doesn't have room for a kidney even if they found a new donor now. Between the clot filter, and the large liver, and the old kidneys, and the new veins......Nathanial is just out of room. The surgeon told us that even if they had a good donor at this point, the transplant idea would still be out of question.

There was a lot more talking than just that. I remember bits and pieces of it, but it was really hard to focus at that point. Geoff looked like someone shot his dog. Mom was handing me kleenexes. Dad was wanting more answers. Nathanial was getting out his little notepad of questions he had written down. The doctor told Geoff and I that the kids could also have the Leiden's Factor V and to make sure they were tested before any surgery or if they have any kind of injury. The surgeon also mentioned that there might be a doctor somewhere in Pittsburg that would look at Nathanial more. The surgeon wanted a full run-down of Nathanials medical history and while the family was talking through that, I guess I must have dazed out. Because I don't remember a lot of what all was said. I remember going from angry to just weepy then angry then weepy. I remember looking at Nathanial sitting there asking questions and being so polite. I remember Geoff asking a couple questions about what if they hadn't tested for this. (sidenote: the only reason I was even tested is because Geoff brought it up. None of the doctors thought about testing me prior to ME telling them about Nathanial having it and wondering if I should also be tested).

I excused myself, telling everyone I really needed to be at work. Mark, my coordinator, came over and hugged me on my way out the door. There weren't really any words exchanged. I mean, what can you say? 'Nice try' ? 'Better luck next time' ? Nothing at all is appropriate in a moment like that. Mom and dad and Nathanial were a bit slower than Geoff and I in getting out of the transplant unit. They have Nat's wheelchair and all....and I just kind of bee-lined it for the elevators. Once at the elevators, I just hugged Geoff and cried and cried. I tried to wait until we got outside, but sometimes the tears just turn on and I can't find the off switch.

Nathanial is talking about cashing out his life insurance policy now. And he's making a list of all the things he wants to do before he dies. This has a crippling effect on my mind. I am SO angry that Nathanial has to keep on suffering. I am so spent of worrying about little things, like if he catches a cold or gets the flu. I am exhausted of asking God why Nathanial. Why him.....of all the people in the world. Why him?

I slept okay last night. Until my alarm went off and I sort of came to. I immediately realized everything that had taken place the day before and before I even got out of bed, I had teary, bloodshot eyes. I was hoping to wake up and find out the last two weeks were a bad nightmare. No such luck. I got showered and dressed and packed lunches and saw the kids off. I went to work, but being the cry baby I am, my boss sent me home. I needed to be home I guess. I need to just re-colaberate and pray and digest everything.

So with all that being said, this will be my final blog. There's really no more stories for me to tell. No more drama for me to bring to the table. All my struggles seem so insignificant now with the IV's and the lab. I'm very sorry this didn't end with the happy fairy-tale ending I had dreamed it would. The family will search for any answers we can get for Nathanial. Everyone in our family will be tested to see if they also carry the Leiden's Factor V mutant gene. And no matter what life throws at us next, we will still have our faith.

Love,
Hilary

Not Good News

We talked to the doctors today. One poor fellow had drawn the short stick and had to give us ALL the bad news.

Hilary has Leiden Factor 5, just like me. This means she'll build blood clots easily. This means she cannot donate a kidney to me. It's not all that bad for her. 5% of all caucasions in North America have Leiden Factor 5. Most people never have a problem with it. For Hilary, it means she'll have to be aware and let her doctors know if she has any major surgeries. It also means she'll have to be a little careful that she doesn't lay around too much, keep her legs moving and drink a glass of wine every night(it's a blood thinner). I think she's OK with that.

As for me, I have an enlarged liver. After Thanksgiving, we'll do more tests and see if it's Budd-Chiari Syndrom. If it is, I have to have that taken care of before the kidney. I cannot have a kidney transplant while I have that.

Well, that's about it. Good news is all my bone marrow work came in positive. Later.

Grace and Peace,
-Nat

Gross Long Day

On Friday, I went to dialysis. I always go to dialysis on Fridays, but this day was different. I made a mistake. Normally, before I leave the house for anywhere (which lately means dialysis) I clear out. I go to the bathroom, and I pick my nose clean of all boogers. Yes, yes, I know that's gross. I have a big hole for a nose. I'm self concious about people seeing my nose boogers, especially at dialysis where the nurses get really close and I'm leaning back in a recliner. In fact, I carry a small pocket mirror with me, so I can check out my nose and make sure it's clear.

Anyway, I start dialysis around 6:00, by 8:30, I REALLY had to go to the bathroom. I had the nurses unhook me and I waddled as fast as I could to the bathroom. After a long trip to the bathroom, I went back and got plugged into the dialysis machine again. Not long later, I REALLY had to go again. I had only 15 minutes left, so I just quit early.

I had been feeling pretty bad for awhile. It wasn't just frequent trips to the bathroom with massive diarrea, I also had the chills. Normally, if I get the chills, I've got a temperature. Not so this time. So now I've got the chills, diarrea, stomach cramps and I feel like puking. I hadn't eaten anything all day. Every time I took a drink, I had to run to the bathroom. I was sitting at home in the recliner, rocking back and forth, pretty much just being miserable. Any plans I had for the day were shot!

Now, my dad was home, watching me like a hawk. He gets real worried when I start rocking back and forth. After an hour and no progress, he decides it's time to go to the hospital.

My mom has to leave work early, we need her van to drive to the hospital. She has missed SO much work to drive me to doctors and hospitals. Anyway, by now I'm dehydrated. The constant diarrea, along with dialysis has literally drained me. This tends to make my legs cramp. I've got an hour drive to the hospital in Topeka, with diarrea, and leg cramps.

I end up taking an oxycodone for the cramping pain as well as anti diarrea medicine. Things start going a little better. Unfortunately, (fortunately?) by the time we arrive at the hospital, I feel fine. I had been suffering for hours and when we finally arrive where I can get some help...I don't need help any more. This is annoying. Regardless of how I feel, we go inside. They do some lab work and do something I most needed...SALINE!!! I know that requires an IV, but my oxycodone was still working. I got the IV put in and that precious water began flowing through my veins. I felt MUCH better, very quickly.

I guess our bodies are made up of quite a bit of water. Being dehydrated stinks! It feels so bad not to have enough liquid in you, even though you probably don't know why you feel so bad. Anywho, a couple hours later, they let me go home. I feel fine now that the diarrea has stopped and I'm rehydrated.

Despite the long day, it ends up quite a pleasant evening. I even got some sleep that night. :)

Stand Still

The days are dragging by as slowly as possible now that everything is up in the air. Today should have been my day three with no kidney. I should be in a lot of pain today and on a lot of drugs, feasting on hospital food and being forced to walk even though I would rather not. Instead I am still packing the kids' lunches and going to the bank all day. I'm still coming home and letting the puppies out and making dinner and running kids around. I still have this extra kidney. And Nathanial still has none.

Monday, Nat and mom came to town for a bunch of hospital tests to see what all was wrong with him and what all the doctors think they can do. Nathanial described one test as the most painful thing, next to kidney stones, that he has ever lived through. He was in so much pain when he came to our house it made me angry. He kept taking his oxycodone (sp?) and wincing everytime he tried to re-arrange his legs. He didn't sleep at all Monday night. (Although, Mace, our little black puppy, slept quite comfortably next to Nathanial in the guest room!) The next morning Nathanial was scheduled for another test, a cat scan, at a seperate hospital here in town. Conclusively, the doctors think Nathanial has pneumonia....even though he says he feels fine. They also determined his liver is enlarged and they want to find out why. While I am frustrated to not be done with the transplant right now, I am thankful that the doctors are giving Nat the attention he deserves now. Next Monday, the 23rd, the physicians have scheduled another meeting with Nathanial. They said, provided all the tests look okay, they may set a new date for a transplant at that time.

I'm not holding my breath.

In fact, I'm doing the opposite. I painted my nails again (I had all my polish removed for weeks in preparation for surgery). I started taking my Advil Sinus again for my headaches....the nephrologist told me that was hard on my kidneys. I am doing whatever I can to temp Murphy. Murphey's Law and I do this dance often. You see, when I plan and I have things ready to go.....guaranteed something will go wrong. So, when I don't plan, sure enough things happen that should have been planned for. There really is a method to my madness!

Let Down

Well, by now most of you know, the transplant is not going to happen Tuesday.

Its kinda hard to write about this and not be emotional. I mean, we were admitted. We were sent home with our papers and our perscriptions and our 'after care' instructions. When I went back to work after being admitted, everyone from the bank was wearing their little green ribbons for us. I had my list of things I needed to pack for the hospital. The kids' teachers knew what was going on and they were getting the kids homework ready for them to be gone on Tuesday. WE WERE DOWN TO THE LAST MINUTE! ......and then the email came from my coordinator explaining things may be delayed. And then I saw I had a voicemail on my cell phone from Nathanial........I knew it wasn't good news.

Apparently, the doctors here in Wichita didn't fully understand the complications of having Nathanial as a patient. He's not your average kidney patient. He needs infectious disease specialists and blood pathologist specialists and neprologists and a bunch of other 'ists' that I can't even remember. I thought the doctors were acting rather cavalier about him all along. I was concerned that everyone on the transplant team was checking me out to death and not hardly even contacting Nathanial. But then again, I thought maybe it was just because I was so close here in town that they all knew me.

Nathanial will be here in Wichita again tomorrow. He is visiting with a long list of doctors and specialists and he is going to have his bone marrow tested (gag!). And after an exhaustingly stressful day for everyone in the family, I am hoping we have more answers. Its no fun to log onto my facebook and see my time-counter that says "two more days until transplant". It makes me cry. It was no fun to go to church today and have everyone say "oh Hilary, its almost here! We'll all be praying for you Tuesday" and then I have to explain the whole story again. Everytime I explain it, I start crying all over again like a little baby.

And Nathanial, on the other hand, is acting like this is no big deal! I admire his strength and his faith so much. I'm the one whining like the world is going to end on Tuesday and he's all like 'oh well, this is good. They'll fix whatever is going on and THEN we'll do the transplant. No biggie!' He's awesome like that. Its totally normal for him to be awesome like that. And its totally normal for me to cry a lot when things don't go my way. Thats why he deserves to have this kidney. And SOON!!

So please pray! Pray pray pray pray pray. There's a plan here--and none of us know what it is yet--we just have to have faith!! I am believing that this is just going to be a minor setback. I am going to believe that by Christmas Nathanial will have his new kidney. (because I was going to use that as my gift for him this year. lol) I am going to believe that by all these new doctors becoming involved with Nathanial, he will be even healthier than we ever thought! I am going to believe that there will be no more complications and operation kidney transplant will once again resume!!

~ Hil

Delays

Yet more delays. Some of my blood work came back bad, so now I have to run LOTS of tests and meet with specialists on Monday. Until then, the transplant has been delayed.

Oddly enough, one of their suggestions is stopping some medicine I have been taking. There is a possibility that it is causing the blood problems. Stupid medicine. It helps one part of me, but hurts another part of me. :(

Oh well. At least we're still in the end phase of this big project. I'm glad they caught this before the surgery. :)

Being Admitted - by Hilary

Its official. Nathanial and I are admitted to Via Christi St Francis for the transplant. They make this whole process so convienant--they let us use yesterday (Thursday the 12th) to get all our admission paperwork and lab done so that on Tuesday (THE day) we just walk right in and go to it. I have to say, I was starting to get really nervous about this transplant....until yesterday. Yesterday brought such a peace and calmness to me. I don't know why and I don't know how, it just did.

Yesterday I was to be at the imaging center at 6:45 in the morning. It was time for my MRA, magnetic resistance anatomy imaging. I knew this required an IV so I had been literally making myself sick about this day for two weeks. They were going to start and IV drip of some kind of radio-active material and then stick me in the machine so they could see all my insides and map out just exactly how the surgery would take place.

When Geoff and I arrived we had to circle the hospital a few times first to find the imaging center. It was hidden! It was all tucked inside a little C-shaped part of the hospital, but it was a seperate building. I get stressed out when I'm running late, and although this didn't necessarily make me late...it did make me feel like I was late so I got flustered. Upon entering, the desk clerk had me fill out forms releasing my information and consenting to treatment....all that rigamaroo that goes along with doctor visits. Then they asked Geoff if he was going to be in the room with me. What? He has the option!? Last time there was radio-active material in me they wouldn't allow him in the same hall!! So needless to say we were pleasantly surprised he was allowed to go with me!

They guided us to the dressing room and told us that we needed to leave all our things in there. They even made Geoff empty his pockets of his wallet because the room would suck the magnetic stripes right off of his credit cards. ...uh... seriously? We obliged and then I got to put on my little hospital gown. While the gown isn't dripping with sexiness, it sure is comfortable! The nurses guided us to the actual MRA room. It had this giant machine with a tube in the middle and a bed that slid in and out......and then over in the corner was a recliner and some magazines and a little plant. It was actually pretty funny looking because the room itself was so 'medical' and then over in the corner was a little piece of hominess. I immediately began asking which nurse was going to do my IV and with hardly any more questions, they assured me they would just request someone from the IV team to come over from the hospital :) I have determined I must get a look about me once IV's start getting talked about. Maybe its when I go white or when I start shaking uncontrollably, but something sends them the signal that they're going to need help! The nurses said we could do half of the testing before the IV team showed up and then we would stop halfway through for the insertion (gag) of the IV and we would finish up the tests after that.

I layed on the bed....well, I wouldn't exactly call it a bed.....it was a board with a little bit of cushioning on it. And they strapped me down. The nurses had straps around my hips and my belly and my under-boob-area. My shoulders had to line up just right and then I had to raise my arms above my head. Next they proceeded to explain how I must hold completely still for this test. Even when they pulled me out of the tube for the IV, I must NOT move my torso at all. Great. I don't usually hold still for very long. Geoff and I were then given ear plugs. Apparently the machine is so loud that even Geoff had to wear ear plugs....and he wasn't inside the contraption! They layed a nice warm blanket over my body and then they put warm pillow cases on each of my arms. I was told my arms would be the coldest during the test because they were above my head and they kind of stuck out of the tube. I was strapped (literally) and ready to go!

The giant machine lifted my bed and sucked me into the tube. I'm not clausterphobic in the least bit so this test didn't worry me a bit. I have heard stories of people being scared to death about being put into this tube. Not me, the IV was still the only thing on my mind. Or it was the only thing on my mind.....until the machine turned on. HOLY COW!!!!! The imaging machine was so loud that it sounded like someone was jack-hammering right there in the room!!! No wonder we were given complimentary ear plugs!! I was given a series of breathing commands...'Hilary, take a deep breath and hold it'......okay you can breathe now......'okay, now take a deep breath and hold it again'......etc.

Right about the time I was sort of drifting off into dreamland and really getting relaxed the IV team showed up. They pulled my little bed into the hall and reminded me not to move my torso while they administered the IV. Oh crap.....usually I flop around out of control while getting an IV. If I move my legs around wiggle, it seems to take my mind off the attack of my viens. This was going to be tough. The nurse started doing that slap thing where they slap the back of your hand to 'find a good vein'. THIS IS PURE TORTURE!!! I yanked my hand out of hers and the poor little asian nurse kept saying (in her broken english) 'wat wong wit you?' 'why you don't like?'. Then she would look at Geoff and say "wat wong wit her?" " I didn't do noting yet". I always feel bad afterwards for whatever nurse got chosen to give me my IV. But I went easy on this one.....I had to....because I was tied down and couldn't move my torso. The nurses got me cold rags for my head and they rubbed my feet and I prayed while they did their thing.....and amazingly, the IV went in fairly quickly and painlessly.

Crap! I will have to finish this blog later I guess. Its almost time for me to get to work!

~Hilary

Kidney Song

Dialysis

I've only got three more visits to the Dialysis clinic. I'm going to miss all my friends there. Granted, I won't miss actually being dialyzed. When I first started on Dialysis three years ago, I HATED it! Mom and Dad would go with me, sit next to me and rub my head. I would cry the whole time and shake uncontrollably.

Things are quite a bit different nowadays. I go by myself. I watch TV and talk to people. Shoot, most days I fall asleep while I'm there. I even recently asked to be on dialysis for a longer time. I'm back up to four hours a day, three days a week. I guess you can get used to almost anything. I never would have thought that three years ago.

The human body is an amazing design. It can handle almost anything. The human brain is amazing too. I mean, who was it that first figured out how kidneys worked and what they did for the body? And then, who was the genius that figured out a way to use machines to do the kidneys' job when they shut down? It's crazy!

It's only a week until the transplant. Life is about to change drastically for me. Granted, I think it will be for the better this time. :) This Thursday, Hilary and I go in for the final tests and stuff. Next Tuesday is the surgery.

Only three dialysis left. I'm pumped!

-Nat

My Hero

Before our story wraps up and before I am under the influence of any drugs I feel like my blogging requires a dedication to my hero. While everyone is busy telling me how brave I am and what a great sacrifice I am giving.....while everyone is saying prayers for me and Nathanial and trying to do all they can to help us out during the next couple of weeks.....while everyone hugs me and says 'bless your heart', a silent hero has been standing in the shadows supporting me throughout this entire process.

My hero just cleaned out the guest room last week so that my granny would have a room to sleep in when she comes to stay with us. My hero has been to almost every doctor appointment with me regarding the transplant. My hero put money in all the kids' lunch accounts so I don't have to worry about packing lunches every morning after surgery. My hero has been there to hold my hand and rub my back for all of my tests and proceedures. My hero, well, he's really the reason I'm able to do this. He is my rock.

I'm emotional today. I know the stress is starting to get to me. I keep doing that thing where I think "next week right now I will be....." and then I get weak feeling and anxious. Its dumb, I know. This is the week we have been waiting on for months!! And now, NOW I decide to get weirded out?! It doesn't make sense.

Last night, Geoff just lay beside me in bed listening to me talk about the things I was excited about and the things I was scared about and all the things I laugh about. He rubbed my back and listened, really listened, to all that was on my mind and all that was troubling me so that I could go to sleep. How selfless is that? And then, he cracked a joke about how funny it would be if, when I was coming out of the anesthsia, he put on a white owl mask. (have you seen the trailer for the new movie "The Fourth Kind"? Where people are abducted by aliens and every night they see a white owl outside their window prior to the abduction? FREAKY!!!!) I love how he listens, but then knows just the right time to make me crack up and forget all my troubles. Its hard to find a more genuine soul in this world. Someone who always places your needs before their own. Thank you, Geoff, for being my all. Thank you for being there even when I'm bitchy (and Lord knows, those days are many). Thank you for buying me pudding when I want pudding and for getting me a tanning package because I wanted to be tan for surgery. Thank you for listening to me sing all around the house because I sing like a musical when I'm stressed. Thank you for not throwing out my favorite old pair of green sweat pants that you detest (they're going to be SO comfy after surgery!) And thank you for listening to me and really hearing what I say. I love you.

~Hilary

Footnote: Dad, don't even THINK about getting a white owl mask. I know this is what you are thinking and it would NOT be funny to anyone. This would be like when you and Nathanial came over to watch BlairWitch at my house and left little piles of rocks on my porch in the dark that night after you left.

Why We Need Our Kidneys- Or At Least One Anyway

Most people know that a major function of the kidneys is to remove waste products and extra fluid from the body. The waste and extra junk are removed through urine. The production of urine involves highly complex steps of excretion and reabsorption. This process is necessary to maintain a stable balance of body chemicals. <---- (Can anyone tell I didn't write that? Its copy and pasted from the Nat'l Kidney Foundations website. SSssshhhh. )

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:
*remove waste products from the body
*remove drugs form the body
*balance the body's fluids
*release hormones that regulate blood pressure
*produce an active form of vitamin D that promotes strong, healthy bones
*control the production of red blood cells

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours (un-be-frickin-believ-able!). About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

Okay, class, that concludes todays session of Kidney Function 101. Hope you all learned something valuable!

A Million Things

Now that we have a date, I have a million things to do. I would like to tan (yes, I know that is shallow. But I would really like to not be a pasty white after the surgery. I feel better when I'm tan. So sue me) My granny is coming to stay at my house to look after the kids for a few days post-surgery, so I need to make a spreadsheet for her: how to get to the hospital from the house, what time the buses pick the kids up for school in the morning, how to get to Target and WalMart from my house, what time the kids get out of school......all those little things. The guest room needs cleaned out -my husband actually took care of that one last night for me :) I have a bunch of paperwork to fill out for my leave of absense from the bank. We have to find someone to take care of mom and Nathanial's dogs while they are in Wichita that week at the hospital. ..................the list seems to never end.

So, its my go-to-work-late-day and what do I do? I shop. I bought the t-shirts I've been eyeballing since the day I started testing to be a donor.

http://www.cafepress.com/+kidney+bumper-stickers

Not only did purchase Nat and I the "I'm the Donor" and the "I'm the Recipient" t-shirts, but I got just a little carried away and bought some buttons for everyone's shirts too. I couldn't control myself! There are so many fun sayings on these things!! You should check out their website. They have a tshirt or a bumpersticker for just about everything in the world. But now, I realize how much time I have wasted online and I am going to shut this dang laptop and go do something really productive! PROMISE!!

~Hilary

Dear Kidney,

We need to have a talk. I want you to know I love you very much. And I don't want to upset you in any way. But I need your help. Well, actually, Nathanial needs your help. You see, he's my little brother. And every since the very first day he came home from the hospital, I have felt kind of protective of him.

I remember as a kid, when mom and dad would tuck us into bed and we shared a bedroom. We would still whisper and talk after they went back downstairs. Sometimes we would throw a little stuffed animal back and forth in the dark. We'd laugh when it would accidentally hit one of us. We'd get rowdy and sometimes forget how loud we got when we were supposed to be sleeping. Pretty soon, the hall light would flip on and Dad would come up and yell at us for not going to sleep like we were supposed to. I would always feel bad that Nathanial got yelled at because usually I started it. Another time I remember when Nathanial kept using the word 'damn'. Mom got so mad that he wouldn't stop she finally washed his mouth out with soap! I felt awful that he had to have his mouth washed out with soap, and I immediately ran upstairs and licked the soap myself to see how much he was suffering. And one time at church, when one of the bigger kids was picking on Nathanial, I chased that little bully all over the church kicking and trying to hit him and telling him he'd better not pick on my little brother!! --and I think I scared him off.

Feelings don't change as an adult. When I see someone staring at Nathanial because his nose is gone, I feel rage surge through me and I want to go tell that person off. When I hear a curious little kid ask questions about Nat's nose, it saddens me. The only difference now is that I am an adult and I have to control myself to some extent. I can't chase people down that stare and kick and hit them. I still feel protective. Only now, I feel helpless also.

When Nathanial was hospitalized a few years ago, I felt the most helpless I ever have in my life. There was my little brother...unconscious, feeding tube in his side so he could eat, breathing tube in his neck so he could breath, blood cleaning machine hooked to his veins so he wouldn't poison himself and die. Living by machine. He was mangled looking....his lips and nose were shriveled and black/purple. As were his fingers. As were his ears and the backs of his hands. His legs from the knee down looked like a corpse that had been rotting for some time. His arms were tied to the bed so he wouldn't thrash around and yank out any tubes.

It was literally the most heartbreaking feeling in the world.

And I could do nothing to help him.

Nothing.

I have never cried harder. I have never prayed more.

So, you see, kidney, this is where you come in. Its not that I don't need you....its that he needs you more. This is the one thing that I can do for Nathanial. This is the only thing I can do for my little brother that will help him. This will extend his life for years if it all works well!

Now, you'll have to act like a big kidney and really work hard in Nathanial. But you know its for a good cause. Nathanial will take good care of you and the doctors will check on you all the time to make sure you are enjoying your new home. And I'll still come around! Heck,once you get all settled and make friends with the other organs, I'm sure you'll forget all about me.

So, kidney, please do your best to help! Please, for the whole family and for everyone that loves Nathanial, work your little kidney butt off. Clean his blood like you've always cleaned mine. Help him to be healthy like the rest of us. We're all counting on you!

Love,
Hilary

The Latest Setback

I'm getting more and more impatient by the day. In fact, for a couple of days, I almost forgot entirely about the transplant. Things are moving so slowly now. The hold up seems to be my possible gestational diabetes back in 2000. My doctor wanted to review my pregnancy records. However, my doctors from back then no longer practice (thank goodness) and their records disappeared. My doctor literally couldn't track my medical health any further back than 2004. Finally, this Thursday, my doctor was able to talk to a lady at Newman hospital in Emporia who thought they had my records on microfish. Remember microfish?? She spent most of her Thursday going thru film and printing off page by page anything she could find about me for the transplant center doctors to look at! What a gal!!

Then here is the email I received yesterday regarding what they found in my old records:

Hi Hilary. We discussed your history & lab results this am in our meeting. I explained the story - - Dr. Matt Reed , Dr. John Smith, and Dr. Charles Shield were comfortable with proceeding forward. The group voted that you could be a donor. After the meeting Dr. Mandayam expressed concerns to my manager with this decision. (He was not in the meeting to hear our discussion) He thought we should send you to a diabetes specialist for their opinion. I spoke with him this afternoon and explained the results I was able to find. He asked if we were sending you to a diabetes specialist. I asked why you should go if you never had an elevated glucose. He thinks we should discuss this with the diabetes specialist. I have not received a call back from the KU Med school regarding my message I left yesterday about an appointment. I will page the doctor to discuss your history with him. No appointment with him yet- -hopefully he will give an opinion which agrees with the other physicians to proceed. Mark

Mark Blackmore R.N., B.S.N., C.C.T.C.
Renal Transplant Coordinator
Transplant Institute Via Christi Health

I can't believe the possible gestational diabetes is causing this much havoc! Especially since I passed all the glucose tests with beautiful results that amazed everyone. I fully understand why the doctor is concerned, but everyone else is ready to proceed. Its just this one guy throwing a kink into everything....

So that is where we are. There hasn't been anything exciting to blog about. There hasn't even been anything boring to blog about. There just hasn't been ANYthing to blog about :(
~Hilary

Before/After

Before the transplant happens, both Hilary and I will check into the hospital on a Thursday. I guess there's a lot of last minute work that needs to be done before the transplant. They do the transplants on Tuesdays.

I always have to go in early due to my Leiden Factor 5...my blood clot mutation. Because of that, surgery is more dangerous for me. They have to wean me off of my coumadin (blood thinner pills) and put me on a heparin drip (blood thinner IV).

Apparently, there's a lot of last minute work to be done. They'll have to put in the IV, make me repeat ALL of my vast medical history to them, and I'll lay around for a few days. I'm not sure what else is to be done.

The transplant will happen on a Tuesday. One surgeon will take the kidney out of Hilary, and the other surgeon will put it in me. We'll both be unconcious for this. WHEW!!! Hopefully, they'll knock me out before they insert the cathiter too. ;)

According to the surgeon, there's a 15 minute wait while they bring the kidney over to me. Apparently, as soon as they hook it into me, I start to pee immediately. So, by the time I wake up, I'll have been peeing for awhile.

Hilary and I are both going to request little buttons for morphin pain killer. They wanted to give me epidural, but I don't like that. I prefer the button pain killer, even though the said the epidural reduces pain better.

They say the donor (Hilary) will be in more pain after the surgery. The recipient will be awake, excited, and bouncing all over the place. You see, after the toxins are cleared from my body, I will get all my energy, both mental and physical, back in full swing. I'm excited for that. Hopefully, as soon as they see the kidney works, they'll take the dialysis tubes out of my chest. It would be great if when I woke up from surgery, everything was back to normal. Well, as normal as life can get for me at this point.

They say that both the donor and the recipient usually stay in the hospital for a good 5 days after the transplant. I might have to stay longer, but we'll see. After that, I have a busy schedule. Asides from being in isolation for at least 4 months, I have to visit the doctor a lot.

For the first month, I visit the doctor 3 times a week. For the second month, I visit the doctor 2 times a week. For the third month, I visit the doctor 1 time a week. Then I go back every few months for a biopsy.

Once Hilary is released, I believe she is free and clear to go home and lay around taking LOTS of pain medication and being waited on hand and foot by her children. :) (hint, hint, nudge, nudge)

Well, time is ticking away. It won't be long now.

Grace and Peace,

-Nat

Advanced Meeting

On Tuesday, I had my Advanced Meeting for transplant recipients. It lasted about an hour. My dad and I went to it. I recorded it on my personal little recording device, so my mom could listen to it later on.

We arrived at the hospital by 8:30 because I had a meeting with the wound care people first. They said the same things as usual about my stump. They wanted to try a different bandage this time. That didn't work out so well. It made my stump bleed. >:( We'll never use that stuff again.

Then, we had a bunch of time to kill before the transplant meeting at 12:30, so we went to visit my sister at her bank. I wore a mask everywhere I went that day, so I wouldn't catch anyone's cold. I also carried a little bottle of Purell with me to keep my hands sanitized.

After visiting Hilary, dad was hungry and Hilary suggested a donut place. It took us awhile to find the Donut Whole, but it was worth it. I stayed in the car while dad went inside. Apparently, he couldn't decide what to get, and since he was SO hungry, he bought 3 different donuts so we could try them all out.

I had never had a donut with bacon on it. It was alright. The maple topping covered up the bacon for the most part. I liked the chocolate rice crispie donut best, but dad preffered the triple chocolate donut. Notice a theme? I didn't get any glazed or anything normal because dad went in by himself. The bacon donut was a suggested by Hilary, the other two were dad ideas. My dad LOVES chocolate.

Anyway, then we returned to the hospital and took a nap in the car. We still had lots of time before the meeting. Finally, the meeting time came around and we went inside to attend.

The meeting was hosted by the same lady that did the first meeting I ever went to. She's friendly and really funny. She keeps you awake even when talking about boring stuff. Some of the meeting wasn't relevant for me as it was intended for people who don't have a living donor.

Most of the information was about life AFTER the transplant. We covered the massive amounts of medicine I'll be on, how many times I'll have to come back and meet with people, and the worst part...how many times I will have to come back and get a kidney biopsy.

A kidney biopsy means getting shot. OK, not a normal shot. First you get a normal shot of pain killer to deaden your side. Then, they take a giant version of an ear piercing gun and shoot you in the kidney. It's quick, but hurts. It goes into you and yanks out a little chunk of kidney that they can run tests on. I'm not looking forward to that.

Other than that, I just have to come and talk to them all the time. It means a lot of time in the car driving to and from Wichita. Lots of gas money, and time off work for my mom to drive me.

Well, that's enough for now. Next time I'll blog about the transplant process and what happens immediately before and after. Later! :)

Grace and Peace,
-Nat

My View (By Braden Sullivan, 11yrs)

This whole kidney transplant between my mom and uncle is a very difficult time for me.

My mom is always going to the nephrologist and I can only imagine the stress my uncle is going through. I always feel bad because my mother shows me her little dots from where she gets shots and tells me how scared she was, and I feel like I should have done something. (even though that was clearly impossible since I am always in school when she is getting shot with a long, bloodthirsty, needle) I am very stressed out almost all of the time, even though I don't have to do anything! But it is also VERY relieving, knowing that after this my uncle has many more years to go.

Nathanial (my uncle) is one of the biggest role models in my life. Me and him are like cheese and crackers. Every Wednesday, from when I was little to fourth grade (when we moved to Wichita) he would pick me up and we would have 'guys night'. Nathanial would take me to a movie, or play a board game,or try out a new video game or, well, you get the point. I have memories of Nathanial and I for as far back as I can remember. I have always looked up to him and seen him as not just my uncle, but also my best friend and my hero. I am very excited to find out that he will be around for a while now!

My mom has been there for me since I was, well, a baby. I feel very happy for her, knowing that she has the chance to do a great and honorable thing like donating a kidney. But i also feel bad for her, because on top of normal, everyday stress, she also has to think, "oh no, what if this happens," or, "what if that happens!?" This also stresses me out. But, I will have fun messing with her rib.(which she gets to keep...BLECHKKK!)

All and all, I am very excited to see how this turns out. With Every inch of my heart, I want Nathanial to get better. I miss the guys nights, and guy trips, and everything we used to do together. I know that if i couldn't pee, getting a kidney would be at the top of my agenda, so i know how this is exciting for him. I wish him the best of luck in the near future so that everything will go according to plan. I want him to know that I pray for him and my mom everyday so that this will be okay.

Please Sign Here ---->

Today I signed on the dotted line. I signed and initialed and signed and initialed and then the doctors signed and then the coordinator witnessed and then.....the deal was sealed. It was like signing for a mortgage.

And its official.

My kidney will be oh-so-gently placed within Nathanial very very soon.

My day started out very early. Geoff and I had to be at the hospital by 7:30. I had been fasting for 12 hours prior to the appoitment so they could test my blood sugar first thing. yay...more needles. What I didn't realize, was that after the initial blood drawing, they were going to trap Geoff and I in a closet sized windowless room for the next five hours with nothing more than a TV and two chairs. B-O-R-I-N-G! A lab tech explained that I would drink this extremely sugary drink (that tasted like orange soda) and then they would draw my blood an hour after the drinking. And then two hours after drinking. And then three hours after the drinking.....you get the picture. I don't mean to sound like a baby, but I am going to whine just a little. I have been sick the last two days...killer sore throat, headache, body aches...just yuck. So prior to todays visit, because I had to fast, I couldn't take any medicine. Also, this meant no coffee for me this morning. Me feeling sick and not having my morning coffee made for a very unpleasant and uncomfortable morning for me. And my poor husband was trapped in there with me! Not only was he trapped in the small, overly heated room with a grouchy wife, but the lab tech actually thought he was my dad! (Geoff had just a rough of a day as I did, bless his heart)

By 12:45 I was shaky and I needed food and cold medicine badly. The lab tech finished the final draw just in time for me to run down to the cafeteria and get a baked potato before heading back up to the sixth floor of St Francis. I have to admit, I was a little anxious to meet this doctor. I have heard he is quite the stiff, old fashioned type guy that doesn't like to BS. I felt quite the opposite upon meeting him. Dr Shields made Geoff and I feel right at ease. He first went through a flip chart that begun like this: Renal Failure Options. Option #1 Do Nothing = death. (note the picture I took of the lovely flip chart above) We went thru the proceedure and he answered all of the questions Geoff had for him. We told some jokes and I found out that when they remove my bottom rib, they will let me actually keep my bone for a souvineer!! HOW TOTALLY AWESOME IS THAT!?!?!?!!!!! I was a little surprised to find out I wasn't the first one to ask if I could keep my rib bone. I just have to think of a good way keep the bone after I get to take it home. I doubt Geoff will let me mount it and hang it on the wall. I dont think it would look good hanging around neck. Oh, I'll think of something....

After meeting with Dr Shields, we met with the neprologist who is very concerned about my gestational diabetes. Although, my glucose test came back almost perfect (even better than most normal people) he still had his doubts knowing I had gestational diabetes. He recommended that I see a diabetes specialist prior to the surgery so that he can look over my records and make a recommendation. Just between you and me, even if they say I am in a higher risk catagory for diabetes, it won't stop me. I've made it this far with no problems, I'm sure I can skip some sugar and exercise regularly and be just fine the rest of my life. But I understand, from a neprology side of things, why the doctor wants to at least educate me.

Its been a long day. And I'm so glad to be back home! Now I can take my cold medicine and then go watch my daughters concert and then try to get some rest.

Peace Out Bean Sprouts~
Hilary

All the Lose Ends

I don't have much to blog about today, but its been a few days since the last update so I'll fill everyone in. Nathanial is headed to Wichita today (face mask and hand sanitizer in tow so as to avoid swine flu!). He is attending his final 'Advanced Transplant' class in the transplant center at St Francis. The whole family attended one of these classes last year when we first started planning. The class is EXTREMELY uncomfortable. They talk about flank incisions, and they talk about getting a tube shoved in your pee hole, and they talk about the epidural, and they talk about medications after the surgery, and they do their best to really really talk you out of going through with it if you aren't a 100% dedicated. I remember getting grossed out enough that I lost my appetite--and, FYI, it takes a lot of work to make me lose my appetite!! I remember them going over some statistics of survival rates and things like that. They also talked about the financials of the process. So, today's meeting is a follow-up to that original meeting for Nathanial.

I believe Nat also meets with the wound specialist today. For those of you that don't know, back when Nathanial went septic a few years ago, he also lost half of one of his feet. His entire foot had turned a nasty shade of green/black with oozies coming out of it and mom and dad had to make the decision (while Nathanial was still in a coma) to go ahead and remove part of his foot to save the rest. He lost both of his calves and his nose and a few fingertips, but the major thing was his foot. His foot still gives him problems to this day. He had another surgery just a few months ago to shave off a little more of the foot bone and the doctor added some shark cartlidge to help the foot heal better. Apparently, when you don't have kidney function, you don't heal well from other illnesses. For three years, Nathanials foot wouldn't heal from the original surgery. It was very painful for him. He couldn't walk very far or for very long at a time. He had to keep his foot bandaged at all times and change his dressings often. It was all very sad. Then just a few weeks before my wedding is when he had surgery to add the shark cartlidge. We were all very impressed with how quickly he was up and walking after this proceedure. Now he has special little shoes that go around his stub to make him walk better! But back to my original thought--today he follows up with the wound care doctor for his foot. They have to make sure the foot is doing alright before proceeding with the transplant.

I don't have any more tests or meetings until Thursday. Thursday I have to take the entire day off work. So far, I have managed to just take bits and pieces of my work days off for all my tests and meetings. The bank has been really good about working with me on my schedule. This Thursday puts a bit of a kink in things at work because we have several people gone, but no one has given me a hard time about not being here. Everyone at work seems to understand, and even though they don't really know Nathanial, they are all cheering for him. I know its hard on people that aren't part of the family to really wrap their mind around how important this is.

I have been scheduled a glucose tolerance test on Thursday. I guess they don't usually do this test for the donor, but because I had gestational diabetes when I was pregnant with Corynne, they want to make sure I don't have diabetic tendencies now. Then just yesterday I got a phone call telling me that I not only get to meet with the Nephrologist Thursday, but I also get to meet with the Surgeon!!!! So that is HUGE news! On my checklist of things left to do, that completely wraps me up. I am hoping we get to schedule the actual date of the transplant Thursday! We shall see....and when I find out, believe you me, I will blog about it! ~Hilary

Time is tickin' away...

Everything is mostly done. It's only a matter of time before the transplant happens. To be quite honest, I haven't really thought much about it. I get nervous if I think about it too much. You know, going to the hospital, getting poked, pain medicine, etc... I think it's part of my body's natural defenses to shut down thinking about that stuff.

I came upon an insight several years ago when all this medical stuff started happening to me. I would literally make myself sick, worrying about stuff. The more I thought about it, the sicker I got. My stomach couldn't handle it. I would worry myself sick.

After talking to God about it and reading the Word, I learned something. This isn't my life. I have no claim on it. That's a good thing, since all my decisions seem to end up hurting me in the end. So, I turned it over to God. It's sad that I had to be so far down in order to look up.

Every day is a gift from God. I only exist because He wills me to exist. Every heartbeat happens because He desires it to happen. I live simply because He has decided that it is so. I turned my life COMPLETELY over to God that day. I told Him that I was giving up trying to take and claim what never belonged to me. It was up to Him to do with me as He pleased.

I know cognitively that He and He alone knows what is best for me. I had known this for many years, yet I hadn't ever completely given up that desire for control of my life. This was an INCREDIBLY freeing decision. It is amazing the freedom found in releasing control of that which was never mine to begin with.

Since that day, I have been through tremendous times of pain, suffering and near death experiences. I have yet to worry about any of it. It doesn't matter in the slightest what happens to me. I know God has a plan, and I know He will do it no matter what I think about it. I will live here in the shadowlands as long as He desires me to do so. When He says it is time for me to go home, there's nothing I can do to delay it. God IS in control.

I haven't gone home yet. This means that God isn't done with me here in the shadowlands. Apparently, there's something I still have to accomplish here. Don't get me wrong. Times have been hard enough that I have often prayed for death. I longed to be clothed with my "heavenly tent" as Paul put it. But God said, "Not yet." I still have work to do. I'm not completely sure what it is that God wants me to accomplish before I get to go home. It sure would be easier if He would just tell me, and then I could do it. Perhaps not knowing forces me to show more faith in His providence.

Anyway, I tend to ramble on forever. The kidney transplant is coming up soon, and I'm not the slightest bit nervous. I really don't think about it that much. I spend more time planning on what I'll be doing AFTER the operation and my body has more energy. I'm working toward a goal that I believe God has set before me. Something that my particular make up has built me to be able to accomplish. That is what consumes my thoughts and desires. Until next time...

Grace and Peace,
-Nat

Roller Coaster

Yesterday I received a phone call from the transplant center. The call was from Clem, the receptionist, who just called to tell me that our coordinator had made an appointment for me on next Thursday (October 22nd) at 2pm to meet with Dr. Mandayam - the nephrology surgeon!! She told me the meeting was just for me, and that Nathanial was not going to be present, but she said to be sure and bring my husband. Weird, huh?

I couldn't ask too many questions because she was just relaying the message and didn't really know details. But I have a MILLION questions. Last I knew, we couldn't have our meetings with the surgeons until the last week of October. Then, for no reason at all, I have a meeting next week. And I am to bring my husband - curious.

I have these plethera (sp?) of emotions right now that I can't control at all. I go to bed and I am exhausted to the point of not even being able to keep my eyes open, but then I start thinking about things that are about to happen, and I can't get to sleep. I toss and turn all night long and dream about the surgery. I wake up and immediately google things about the surgery. Then I go to work and think about it all day long, completely ruining my focus behind the desk. I come home and search some more on google. THIS IS CONSUMING MY LIFE!

And its not because I'm nervous, I'm not nervous at all....I'm just anxious. I am ready to do it and get it all over with. I keep coming up with all these 'what if' situations....what if Nathanial's body rejects my kidney? What if I get a kidney infection in my only kidney in a couple years? What if they go in to remove my kidney and find something wrong with it and don't go through with the transplant? What if Nathanial gets sick between now and the transplant? What if, after the surgery, I get a cough and rip out my stitches with every sneeze? --these are the things that make me not sleep, and not focus, and not act like myself.

One minute I'm all giddy and I'm like "Bring it!" and then the next minute I'm thinking about the IV and my legs feel weak and my stomach gets upset. One minute I'm all excited about the thought of 6 weeks relaxing at home to recover, the next minute I'm in a panic about all the sales I'll lose out on at work. One minute I'm wondering why this process takes so long, the next minute I catch myself telling someone that its going so fast! I am a crazy person right now. Literally, a crazy person right now.

I have a plan for this next week. This week I am going to try and act more normal. I am going to quit daydreaming to the point that I don't even hear when the kids ask me a question. I'm going to quit calling my parents house three times a day for no reason. I'm going to do more around the house and quit wasting my time googling. And, by golly, I'm going to sleep!!

Get the Show on the Road

Now comes the hardest part of the whole ordeal for me........ waiting.

I'm done with the bloodwork (for the most part). I'm done with the urine collecting. I'm done with the xrays and the IV's and the radiologist and the therapist. I'm done with the social worker and the EKG. I'm done with the phone calls and the coordinating my schedule and the trips to the hospital. Now all I have to do is wait.

For those of you who don't know me very well, I'll fill you in. I'm not a very patient person. I tend to jump into things head first as quickly as possible. Dad used to have a saying - think first, then act. As often as he would tell me that, somehow I have always ALWAYS done everything in my entire life the opposite. I tend to act first and then think about it (after its too late). While I don't claim this as a very good method, I seem to have survived okay this far in life. I have gotten myself into a few messes.....I once sat our row of hedges on fire as a kid because, without thinking first, I was lighting and throwing fireworks into them. My friend and I once decided on our lunch break to go and get our hands pierced in the little fleshy part between our thumb and forefinger (not very convienant for a banker). I have had the cops call my parents in the middle of the night because I was using their vehicle, and without thinking, I parked it in a towzone while I went and partied. I once moved to Kansas City on a whim, without the financial ability to actually succeed up there, and had to move back only three months later. You get the point. I'm not proud of these things, but I'm drawing a picture here....

So yesterday as I was leaving the psychologist office, I was thinking to myself about how we could just have the surgery tomorrow if we wanted. I mean, all the tests are done. Nathanial is healthy now. WHY ARE WE WAITING?!?!?!? Lets get this show on the road already!

I get that its a process. I get that the doctors want to thoroughly go over my medical records before making the final decision. I get that Nathanial should attend one more of his 'advanced kidney recipient' classes. I get it! But at the same time....every day this is put off is another day things have a chance to go wrong. I don't want to be a debbie downer, but one can't help but think of Nathanials health. If he gets a cold, he'll be put in the hospital and it could delay things for weeks! If he gets an infection, same thing. What if I get H1N1 in the meantime!?

Here is the procession of what is left before surgery:
*my medical records have to arrive in the renal department and Dr Shields has to go over them
*Nathanial has to attend one more 'Advanced Renal Transplant' class (scheduled for October 20th)
*Mark, the coordinator, has to schedule a time that the surgeons can meet with Nathanial and I to decide on the actual date of transplant (I was told this meeting probably wouldn't take place until the last week of October-boo!)

Thats it! See how close we are now! OH man! Everybody please pray for Nathanials health between now and then pleeeeeaaaaaaase! In the meantime, I'm going to keep taking my vitamins and exercising everyday. I'm going to use the hand sanitizer and wash my hands everytime I shake someone's hand at work. I'm going to get plenty of rest and I'm going to eat my veggies. Hope that does the trick!

You Tube

I thought this was a cool video of a sister and brother kidney transplant. Plus, I love Casting Crowns (the background music) Enjoy!

http://www.youtube.com/watch?v=pLco6Ol5mfg

Processes, Processes.....

Yesterday, I had to get up a little early to start my day. Normally, I wouldn't mind so much, but yesterday was Columbus Day. A glorified holiday in the banking world. Its a day that all the bankers and post office workers get the day off, while the rest of the world works. October is the beginning of a series of these little holidays for those who work in a bank. Making this the perfect time of year to be scheduleing so many tests and trips across town to the hospital.

My appointment yesterday was two-fold. I was to turn in my second round of pee jugs (which also means bloodwork-gag!) and I was to have my visit with the social worker. After my last visit with Mark -the renal donor coordinator- he told me I was down to the last few schedulings. He told me I would meet with the social worker, then the psychologist, then Nathanial and I would meet with the surgeon and the nephrologist to schedule THE day.

I wasn't quite sure I needed to meet with a social worker. Actually, I didn't even know what the social worker's role was. Nathanial told me she was a super sweet lady and I would like her. I honestly haven't met one person that works in the renal department that I haven't liked. But, I'm getting off track now. I had to be in the renal department of the hospital by 8am. Driving there takes about 30 minutes during rush hour plus I had to consider parking and walking through the crazy parking garage and getting to the 6th floor. And anyone who knows me knows I HATE being late to anything. I decided to leave the house around 7:15 which meant the kids were on their own for getting on the bus and getting themselves out the door at the right time. That isn't too much of a big deal for them. They have had to do that several times lately due to all of my testing and appointments. On a side note, the kids haven't complained one single time. They are the best little cheerleaders! They always give me extra kisses and hugs in the morning when they know I am having a day faced with needles. And then the first thing out of their mouths when they get home that evening is always "how did the doctors go?". They are just as excited to have Nathanial better as the rest of the family.

I arrived at the hospital at 8:03 according to my car, but I always have my car clock set ten mintues fast to trick myself into always being early. Drives Geoff crazy!! By the time I got up to the renal office to meet with the social worker it was right on the dot, 8 o'clock. Beth Smith, the social worker, came out to greet me. She was a tiny little brown haired lady that imediately made me feel comfortable. She couldn't find an office for us to meet in so we wandered up and down the hall for a few minutes looking for an open space. All the while, my pee jug was splish-sploshing around in my bag. We found an open office and she told me to make myself comfortable. Basically, her job for the day was to give me a sort of interview to deterimine if I really was willing to be Nathanial's donor for all the right reasons.

She asked me questions about financial issues. She asked me questions about my kids feelings about the surgery. She asked me how Geoff felt. She asked me how long I had thought about doing this. She asked me how my employer was going to handle my leave of absense. She asked me who was my support system and who would take care of me after the transplant. She talked with me about what it was that happened to Nathanial to get him to where he is now. She asked me what I would do if it turned out that the transplant didn't work. All these questions and topics were discussed over the course of about an hour. Apparently she approved of my reasons behind why I am doing this for Nathanial, because at the end of the interview she said when the transplant team met and they asked her for her 'yay' or 'nay'on continuing with the procedure as me being the donor, she was going to give me a resounding 'yay'.

YAY! One more obsticle down!

After visiting with the social worker I was sent to the lab. The lady who works the front desk from the lab now knows me by name. 'Hi Hilary', she greeted as I walked (as slowly as I could) through the door of the lab. I sat my bag down and pulled out my pee jug to walk over and give to her. I was sick and tired of hauling that stupid jug around with me everywhere for the last 24 hours so that was at least a good thing! She had me scribble down my height and weight and what time I started and ended collection. Then I had a seat to wait for the BS. BS= blood sucker.

The idea of me getting blood drawn doesn't panic me as much as it did even a few weeks ago. I'm actually very proud of myself for how brave I was yesterday. The BS came to call me to the back room and my stomach didn't even turn like it normally does. The nurse was a very funny guy this time and cracked a lot of jokes. He was young and energetic and very different than the nurses I'm used to. As he was poking around looking for a good vein I mentioned that I was still bruised from the last time they drew blood. He told me he could use a different vein if I wanted him to, but I declined the offer and told him just to use whatever vein was going to be the easiest for him. He said back to me,'do you really mean that? I can use whatever vein is easiest for me? Because my patients tend to get a little uneasy when I tie this rubber strap around their neck." See what I mean? He was funny! ....and if he thought for a second that he was going to use a neck vein of mine to get blood out of he wasn't just funny....he was CRAZY too!!

The blood drawing went well and I was out of the hospital by 10am to go enjoy the rest of my Columbus Day holiday. My next appointment is with a psychologist tomorrow. I guess they don't want to use mentally unstable people's kidneys?? Either way, she is the last person I will see prior to actually scheduling the transplant!! My kidney is anxiously awaiting his new home!

Until next time~
Hilary

Liquid

In my last post, I told you all about the Renal diet. Some of you may have been wondering, what about water? My body cannot get rid of water. Dialysis takes off some of the excess water, but not all. Let me tell you a story.

When I was young, I didn't drink much water. Shoot, I didn't drink much of anything. When I was in college, some things happened that changed all that. No, it wasn't my 21st birthday. It was kidney stones. Ah, yes, kidney stones.

My father had a kidney stone several years earlier. I remember he was in a lot of pain, rolling around on the floor. I thought that I would NEVER have a kidney stone. I actually drank water. Dad didn't drink water. As the urologist would later explain to me, it's not so much what you drink, but how much you drink.

I ended up with kidney stones two different times. Once I got hit by one while at the Rennaissance (spelling?) Festival. I'm pretty sure I freaked out Toby and my brother, who had to pull over to the side of the highway and call an ambulance. I was on the grass, on all fours, weaving back and forth and puking constantly. A quick trip to a local hospital and an IV with lots of saline, and I felt much better.

Later, I got another kidney stone. This one I couldn't pass. I had a surgery, sort of. They knocked me out and then blasted my kidneys with sound waves in order to break up the stones, so they would be small enough to pass. They stuck an incredibly long, flexible straw up Mr. Happy in order to keep the passage way open when I passed the stones. That was awkward. For the next couple of weeks, Mr. Happy had a couple little strings hanging out the end of him. Why strings you ask? So when the tube needed removed, they could do it quickly. I go to the doctor. I stand over a trash can and drop my drawers. The doctor wraps his finger around the little strings and yanks!!! AAAAAAAAAHHHHHHHHHH!!!!!!!!!

Needless to say; after a couple of experiences like this, I started drinking a lot of liquids. Any of you who are familiar with my medical history will wonder how this compares to other things. Well, here it is. KIDNEY STONES ARE THE MOST PAINFUL THING I HAVE EVER EXPERIENCED. That's right. I'd rather have gone through all the other things if I could have avoided kidney stones. Shoot, the last kidney stone I had, not even massive amounts of morphin could lessen the pain.

Anyway, I forced myself to drink lots of liquids. I carried a big mug of water around with me to track how much fluid intake I had in a given day. I set goals and I drank constantly. Then, my kidneys shut down.

Now, my body can't get rid of water, so I 'm restricted to a small amount of fluid each day. That's right, after training for years to drink a lot, suddenly, I can't drink hardly anything. My nephrologist (kidney doctor) keeps wondering why I have such a hard time stopping myself from drinking too much.

I am restricted to 32 ounces a day. That may seem like a lot to some people at first, but try counting your liquid intake in a day. I bet it comes up to more than that. You see it's liquid intake. Not just what you drink. Soups, fruits and vegetables. Anything with liquid in it has to be calculated. This really throws off more eating options for me.

When it's cold and rainy and it's a perfect soup day...not for me. When it's the middle of summer and I'm outside burning up; a nice, cold, tall glass of water is out of the question. The worst part is winter. When it gets cold outside, my body dries out. I am constantly thirsty, but I can't drink very much. I have itchy, dry skin and constant chapped lips, but I can't do anything about it. I have to stay partially dehydrated.

Have you ever been seriously dehydrated? I have. It hurts. Your whole body just doesn't feel right. You hurt all over and can't figure out what's wrong. Luckily, it's happened to me enough that I know how to fix it. A quick trip to the ER and they stick an IV in my arm and shoot me full of saline. After about half an hour of fluid, I'm feeling decent again.

OK. I've gone on long enough for this post. I'll write again later.

Grace and Peace,
-Nat

Going Green

Typically, when you hear someone say they are 'going green' it means they are going to start using earth friendly methods for everyday activities. They plan on changing their old light bulbs for energy efficient ones. They are going to ride their bike more and use their car less. And, if they aren't already, they are going to start recycling. How fitting is it then, that the kidney donor ribbon is green?

Today as I was leaving the renal transplant floor of St Francis, I noticed a cute little quilt on the wall that somebody had sewn for the department. The quilt had different sorts of green material all stitched together to make a green "donor" ribbon. It occured to me that there are probably a large number of people out there who don't know what it means when they see someone wearing a green ribbon. We all know the yellow ribbon is for our troops. And the pink ribbon is for breast cancer. And we all remember red ribbon week at school to keep kids off drugs. But I'll bet few realize that when they see a green ribbon, it is in support of kidney donation.

Yesterday at mom's, as we were all sitting around eating lunch, she pulled out her little spool of green ribbon. Mom wanted us all to make little ribbons out of the spool and safety pin them to our shirts. What a GREAT idea!! We all wore our ribbons around the rest of the day. I have to say, it gives me a kind of proud feeling to own a green ribbon. I plan to wear my little green ribbon to death over the course of the next few months. I plan to get a green ribbon t-shirt. And I plan to get a green ribbon magnet for my car. I truly plan on Going Green.

MORE Gathering....

This is Nathanial while on dialysis. Every Monday, Wednesday, and Friday he has to go to the hospital and do this for 3 or 4 hours. I can't tell much about the experience, but I had these pictures to share. Those tubes coming down his chest are the lines they hook the machine up to that dialysizes him. Blood is going out one side and going back in the other side. Apparently, having your blood taken out makes you extremely cold. He always has to have blankets with him and he has to dress warm. I believe he even takes warm fuzzy hats and mittens sometimes too, but I'll leave it up to him to describe the dialysis experience with you. I'm going to write a little about my day now.

This morning I woke up to my dog heaving. He was getting ready to vomit on my bed so I grabbed him and sat him on the floor to finish doing what he had started. Sick. Well, lovely to wake up to that on a Sunday morning! I asked the pups if they needed to potty and they jumped around all excited to run out into the cold for a few minutes. They're weird like that. Usually, my routine is to get up, turn off the house alarm, let the puppies out, and then I come in and go potty myself. Today I am doing more of the pee collecting for Dr. Shields. So after letting the puppies out, I had to get my tray and my jug before proceding. This threw my whole routine off!

I believe this is my last round of the pee collecting. Of course, if the doctor wants me to do it again, I will do it again. Whatever it takes. I hear this doctor of ours isn't one to mess with. If he says do it, we better do it. Period.

Today I have a lot going on, so today may be more difficult with the jug hauling. (I feel like inserting a bad joke here about how I'm used to carrying around big jugs) First we have church, then we are headed on a little road trip to Emporia to see my mom. Her birthday was Friday. I will need to call mom on the way and ask her to clear a spot in the fridge for my pee jugs. I'm sure she won't mind. Hopefully by next month right now, she is clearing room in the fridge to save jugs of Nathanials pee!

You have died of Dysentary

I'm not going to die of dysentary. I'm much more likely to die of dehydration or hunger. I promised in my last blog that I would write next about the Renal diet. I suppose you could call it a 'diet', I do lose weight. Mostly because I can't eat anything that tastes good.



All people on dialysis have to be on a Renal diet plan, though the extremes of the diet vary greatly from person to person. Basically, if you can't pee, your body fills up with toxins normally urinated out of your body. Dialysis attempts to remove both the toxins and the excess water, but it cannot do it all. So, you are to avoid certain foods that are high in these toxins.



There are LOTS of different toxins out there in LOTS of different food items. Shoot, even things that are good to eat for normal people end up being bad for dialysis people. The biggest toxin, and the one I struggle with the most, is Phosphorus. Phosphorus is found in ALL food. There is no way to avoid it, so I have to take special pills called 'phosphate binders' with every meal or snack.



As I'm eating, I take a chewable phosphate binder that removes the phosphate from the food I ate and turns it immediately into poop. That's right, poop. My body will then discharge the phosphates the next time I go to the bathroom. Which is usually some time in the next five minutes. That is why I can't go out to eat any more. My pills send me to the bathroom usually before I'm even done eating the meal.



There are lots of high phosphate foods. These are the foods I'm not supposed to eat very much of. This hurts, because I LOVE these foods. Here's a short list: Nuts, Beans, Okra, Chocolate, Pancakes, Biscuits, Waffles, etc... Then the big one...dairy products. That's right, all forms of dairy are high in phosphorus. Milk, Cheese, Ice Cream, etc... I LOVE drinking milk. I used to drink it every day. I LOVE ice cream. I used to eat it all the time. Don't even get me started on cheese. Cheese goes with EVERYTHING. Cheese goes ON everything. Cheese goes IN everything. Cheese makes up a major portion of my diet!



There is another toxin I struggle with: Potassium. This is something that's good for normies (what I call normal people). When I was younger, I used to seek out high potassium food and drink because it helped me avoid leg cramps. I used to get HORRIBLE leg cramps, so bananas and milk (that's right, it's high in phosphorus AND potassium), All Sport and other potassium high stuff was a constant in my life. Now, I'm supposed to avoid them.



This makes it MORE difficult to find appropriate food and drink. I LOVE fruit juices, but all forms of citrus are high in potassium. Orange, Grapefruit, Cranberry, etc... And it gets worse. That's right, even worse than having to avoid cheese. There are two food items that are super high in potassium that I love to eat and are in most every dish I eat: Potatoes and Tomatoes. Both these items show up as ingredients in almost every meal I've ever eaten. These are constant staples in my diet. They're cheap, diverse, and we even grow them in our backyard garden!



There is one particular thing I'm supposed to eat LOTS of...protein. Protein helps your body heal, so anyone who is sick or in the hospital is supposed to eat lots of protein to keep their albumin levels high. But, there's a problem. All proteins (that is meat, fish, eggs) are also high in phosphorus. It's a catch 22. Darned if you do, darned if you don't.



So, that's how the Renal diet works. It's incredibly annoying and stops you from eating most stuff that tastes good. I've never gotten a good report on my toxin levels because if one gets low (phosphorus) then the albumin is low too.



Good. Bad. It doesn't matter. I know that the build up of these toxins will end up killing me, but sometimes I just want to eat some cheesey mashed potatoes! :)



Grace and Peace,

-Nat

Urine My Heart, Urine My Soul

My mom is worried sick. When we met with the nephrologist and the kidney donor coordinator a couple of weeks ago, she was teary almost the entire meeting. I don't blame her....as a mother myself, I know worrying about your children comsumes 90% of your life. I can't fathom if two of my three kids were going to be having major surgery, in the same month, on the same day, at the same time!! My mom doesn't handle stress well anyway. My dad is the calm one in moments of stress. He just acts goofy and tells bad jokes :) But he keeps my mom grounded and calm-er when they're together. Unfortunately, I just found out my dad is getting ready to leave for about a month for work......which means he will be gone when Nathanial and I have surgery.

I don't know how this will work out exactly for my mom. I'm very worried for her on that day. She will have my three kids to keep her company in the waiting room. She'll have Kristian, my youngest brother, to keep her company. She'll have my husband there with her. And I'm sure she'll have my granny Doris also. But she won't have my dad....her rock.

I know my dad, and I know dad will make every effort to make it for part of the day somehow. His job sends him all over the country and when he's on a 'mission' he can't just call in for a personal day. Even when his excuse is that his daughter AND his son are both going to be having major surgery that day. I know it will kill him not being there as well. Do you really think he will be focused on work that day? Hardly. Fortunately, I don't think dad will be too far away for this mission. I just hope they go easy on dad that day and let him leave a little early or something.

You know, really, when it all comes down to it, its really my parents fault that Nathanial and I will both be in surgery at the same time. They only have themselves to blame. Mom and dad are the ones that ALWAYS made me share with my brothers when we were younger. All the time as a child I was told to share. Share, share, share. Sometimes I even had to share dumb things like my Barbies! I would whine about how the Barbies were mine and they were in my room so why should I have to share with Kristian when he came in and wanted to play. (yes-Kristian used to want to play Barbies with me!) We would have to share our toys in the playroom..... and share the Nintendo...... and share our snacks.... and share our blankets when we would camp in the tent in the backyard. Mom and dad bred us to share. So when I hear someone make a remark on how brave I am, all I can say is "my dad always told me to share".

~Hilary

End Stage Renal Disease

For this blog, I thought it would be prudent to explain exactly what End Stage Renal Disease is like. It's kind of a scary name, End Stage Renal Disease. It's called End Stage because it's a disease that will kill you quickly if you don't do something about it. It will "End you". I've known a few people with End Stage Renal Disease who decided that they have lived long enough. All their affairs are in order, so they quit dialyzing. They die within one week.

Basically, End Stage Renal Disease means that your kidneys no longer function. Your kidneys are filters. When you drink liquids, the liquids pass through your kidneys where all the bad stuff is removed and sent to your bladder to be shot out of your body the next time you pee. People with End Stage Renal Disease can't pee. Since their kidneys shut down, all the bad toxins from the liquids, as well as the excess water, build up inside the body. If nothing is done about this, you will die. Isn't it neat the way God designed the body. All this stuff we find gross like peeing, pooping, farting, are actually your body's way to removing bad stuff. If you don't do it, you die.

Dialysis is what you do to survive. They take these big machines and hook them up to your body. There are several ways to do this. I have tubes sticking out of my chest. One tube is where they remove the blood and the other is where they put it back. Three times a week, over the course of several hours, the machine pulls blood out of my body, puts it through a filter and attempts to remove harmful toxins and excess water. Then, they put the blood back into my body through the other tube. Every time I go to dialysis, I lose about 6 pounds.

Unfortunately, dialysis is man's attempt on God's design and; therefore, doesn't work perfectly. All the toxins will never be completely removed from my body, so I am adversely affected. Over the past three years, you may have noticed many changes in me. These are almost all due to the kidney failure. Yeah, I went through lots of other stuff too, but the kidney failure has affected me far more than any other thing.

The build up of toxins in your body affects you physically, emotionally and mentally. Basically, toxins slow everything down. Physically, I have no energy. I sleep all the time, and don't do much of anything. Even menial tasks seem insurmountable.

Emotionally, I feel nonchalant, lazy, unmotivated. I get depressed easily. Sometimes I cry for no stinkin' reason. That's annoying! I'll just be sitting there, watching TV and all of a sudden, tears well up in my eyes! I'm thinking, 'what the heck! I have no reason to cry, but I am.' I'm not a big fan of that part.

Mentally, I have no energy. I can't keep thoughts in my head. I walk into a room and forget why I went there. I can't remember people's names or where I know them from. I still get ideas for youth ministry and my business, but I can't develop them. They don't have a hold on my brain any more. Being one of those uber thinkers, this is probably the most annoying aspect of this disease. I used to think all the time. I used to have a hard time shutting off my brain at night so I could fall asleep. Now, I can't keep thoughts in my head. I have to write everything I need to do down on paper, just so I remember to do it. Even simple things like eating a meal and brushing my teeth go on my to-do list.

Well, this blog is long enough now. Next time, I'll talk about diet. That's right. People with End Stage Renal Disease can't have a normal diet. Until next time, thanks for reading...

Grace and Peace,
-Nat

Planning Ahead

I found this very detailed picture that shows how the surgery happens. Isn't it great?! ...and kind of revolting, all at the same time? I have been googling nephrectomies (the official term of a kidney transplant). I'm just fine googling nephrectomy unless I push the 'images' button at the top of the page. There are some pretty graphic pictures you can find on the internet!! Dang! I found this one picture of a cat before and after picture blog. The cat had kidney disease. After the cat died, the owner took a picture of his diseased kidneys laying next to his little grave. What the heck!?

I have a reason behind my googling. I have to decide what kind of nephrectomy I want. Apparently I get a variety of surgeries from which to choose. The three main choices are the Open Procedure, Laparoscopic or the Hand-Assisted Laparoscopic. I have decided to rule out the hand-assisted option. For some reason, the thought of them cutting a hand-sized hole along my pubic bone for them to stick their hand up into during surgery just doesn't appeal to me. I invision laying on the operating table with the doctors arm INSIDE my body and it gives me the heebie-jeebies. I bet the doctors make jokes about it. I bet they stick their arm up in there and then pretend they're getting sucked in....and they jump around and say "oh no! Its got me!" for a good laugh. While that would make me laugh if I were a nurse in the room, being the patient makes it not so alluring.

I have to really weigh the pro's and con's of the other two choices. This reminds me of last week's episode of The Office, where Jim kept making Pro and Con lists. My mom always did this to make decisions when I was growing up. I think thats where I got if from. So below I have listed the Pro's and Con's of each option.

OPEN NEPHRECTOMY PRO'S

• 
  
  long-term international record of safety


• 
  
  potentially fewer abdominal complications


• 
  
  shorter operative time


• 
  
  earlier kidney function in the recipient (very important)

DISADVANTAGES OF OPEN NEPHRECTOMY

• 
  
  possibly more severe pain after surgery


• 
  
  6-8 weeks of recovery before feeling back to normal


• 
  
  larger surgical scars

ADVANTAGES OF LAPRO

• 
  
  possibly less post-op pain


• 
  
  minimal scarring


• 
  
  return to normal activity sooner


• 
  
  shorter hospital stay


• 
  
  magnified view during surgery

DISADVANTAGES OF LAPRO

• 
  
  slower kidney function for the recipient (very important)


• 
  
  longer surgery time


• 
  
  higher risk of damage to the kidney


• 
  
  slower return of bowel function


• 
  
  longer anesthesia time

Knowing all sides of the story will help everyone understand why I have ultimately chosen to have open surgery. The idea that the kidney will function faster in Nathanial during an open surgery is the biggest factor in my decision. Geoff and I have discussed this a lot. I keep making him read articles and lay in bed at night and talk to me about it. I'm sure Geoff is more than anxious for this to be over with! I was told that in an open surgery (which only lasts a couple of hours, by the way!) the kidney is taken out, rinsed immediatly with saline, and then they begin re-attaching the veins in the recipient within 5 or 6 minutes. And the kidney will begin functioning IMMEDIATELY upon being placed in the patient!! Think of this: Nathanial will have kidney function before they are even starting to sew him up if we go with the open nephrectomy. How awesome is that!? With the laparoscopic version, the surgery is far more problematic for the recipient. First off, the surgery is done through little holes with tiny little scissors and tiny little lasers all through a camera. This makes the surgery quite a bit more lenghthy...5 or 6 hours!! Secondly, they have to capture the kidney in a little baggie after cutting the veins and ureatha all of it and then pull the kidney through an incision. This places extra stress on the kidney and the kidney had more 'dead time' before being placed in the recipient. That, in turn, makes the kidney slower to function. It all makes perfect sense! And, with lapro, there is still a chance they will have to change their mind and do a full open surgery.

So, with all that being said, I'm sure everyone will agree with my decision of the open nephrectomy.