The perils of drinking too much on holiday

A couple of years ago, this would have been a post about drinking too much booze in the airport lounge, on the plane and then with dinner on the first day of a new travel adventure but now things are a bit different. The danger now is drinking too much of anything, including water – a habit we are usually encouraged to take up in hot climates.

The problem is that with an eGFR function of just 15, the flow of blood through C’s kidneys is only 15ml per minute. Compare that to my healthy rate of 100ml per minute and you can start to see the issue.

For people without CKD, the kidneys can process excess fluid quickly out to the bladder as urine but with a significantly reduced kidney function, that fluid has nowhere to go.

But what about sweating? I hear you ask – excess water can leave that way, surely? Well yes, that’s usually an option in the heat and getting red faced and sweaty whilst trekking round Roman ruins was certainly my body’s way of dealing with the heat. But with CKD, the complications of reduced kidney function also interferes with other signals so patients can have an unquenchable thirst as well as a reduction in sweating.

The result? A confusion of signals and actions from the body leading to swollen ankles, puffy fingers and painful joints as a fluid traffic jam builds up in the body. The solution is to carefully monitor and control fluids into the body and not always believe signals like thirst. But it’s easier said than done and we are still working out causes and solutions to C’s retinue of symptoms.

Like many things it becomes a careful balance of enjoying a beer on a boat trip or an Aperol Spritz by the pool and just sipping water throughout the day rather than guzzling cocktails and 2litre bottles of water in rotation like we used to. Yes things have to change but being rigid and too restrictive takes the joy out of anything and what would be the point then in a holiday?

We don’t know when we will get a trip like this again so for now we are enjoying it and taking the time to plan all the adventures we will have post transplant. And there will be plenty of them – with lots of cocktails.

Testing, Testing….

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Last week I had my second round of tests to check my suitability as a kidney donor.  The first round had been some simple blood tests and a chat with the transplant nurse back when I put myself forward to check my blood and tissue types, but this next round really stepped things up.  Here’s how my day went:

08:00. Arrived at the Medical Investigation Unit (MIU) at St Heliers.  I was weighed; my height measured and blood pressure checked and an initial blood sample taken before the main part of the test commenced. This involved an “contrast agent” called Iohexol being administered via a cannula.  I have fortunately never needed to have a cannula before so today was the today I discovered the veins in my arm are shy so mine was fitted to the back of my hand. It wasn’t in for long as first the Iohexol was administered and then the line flushed through.  After a short wait back in the waiting room to make sure there was no adverse reaction, I was free to go for the rest of my tests.

09:30. Over to the renal unit to see the Counselor.  This was a one to one chat so she could understand my reasons for wanting to donate; make sure I felt supported and that at any time I could change my mind and that was OK.  The main purpose of the chat is to make sure the donor is not being coerced or paid to donate and I think I made it clear I was doing this for all the right reasons. (not money!)

10:20. I headed over the the ECG clinic.  There was quite a queue here and as time ticked by I knew I would not be back in time to the MIU for my next timed blood test.  A quick word with the receptionist and she assured me it was fine to head on over to my other appointment and then come back when I was ready.

10:50. Back in MIU, a second cannula fitted to my other arm.  Once again, shy veins in my arm meant I had to have it in the back of my hand.  I really felt this one go in, but once in and taped down I got used to it.  Two lots of blood taken and I was done.

11:00. Out of MIU and over to Ultrasound.  A quick squidge of cold gel, some prodding around my tummy with the ultrasound probe and I am declared “Normal”.  This is good news on many levels, the main one being it means I have two kidneys – one for me and one spare, hurrah!

11:30. Across the hall from Ultrasound was the X-Ray dept where I went next for a chest x-ray.  Another nice quick and simple procedure with minimal waiting.  The trickiest part was getting the gown on and off – you’d think they would have come up with something better than all those little ties by now?!

11:45. Back over to MIU for my next timed blood test.  The cannula works well and the two vials of blood are taken in no time.  One more test left…

11:50. Back in ECG and this time no queue and I’m seen very quickly.  Some sensors are attached to my skin and the test begins. On the screen I can see my heart beating away and after a few minutes it’s all done.  The test looks “normal” but will need full analysis along with all my other results.  I found it amusing that as advanced as the machine was, it sill produced a paper output that I had to walk over to the Renal Unit on the other side of the hospital, but it helped kill some time.

12:40. Back in the MIU for the final blood sample to be taken to complete the five hour Iohexol test that will be the true indicator of my suitability.

Kidney function is measured as GFR and normal for a female adult is between 120 and 90 with 99 being average.  If mine is below 90, then they will not allow me to donate.  Hopefully, this will be another test where I will be “normal”… time will tell.

And that was the end of the day.  I fully expected to have lots of time waiting around, getting lost, being told I was in the wrong place/wrong time, but it all went like clock work.  I cannot praise the NHS staff enough. I felt well looked after and valued – it really is a world class service when working well.