Sunday, October 9, 2016

Three Months or 3000 Miles, Routine Clinic Visit 10/3/17

It's that time once again, my quarterly visit to the Heart/Lung Transplant Clinic for labs, x-rays, pulmonary function testing and talking with the Team.  This s the fact that I did make it 3 whole months without a trip to the ER or an unscheduled trip to the Clinic.  I'm pretty happy with that.

A day at the clinic always starts with labs and x-rays.  The labs need to be taken fairly close to 8:00AM, so no matter what time you are scheduled to see the Team, you need to be at the facility around :30 or so. Timing of the labs is important because one of the things they check is the amount of Prograf that is in your system.  To make it a standard measurement, the labs should be drawn close to 11 hours after the last dose.  I don't know if this timing is the same for each team, different teams may have different times for taking the test.  At UTSW, labs and chest x-rays are done in the same area so only one waiting room visit.  Labs then just down the hall for a chest x-ray.

Sometimes we have some time before we need to be in the clinic, so we grab something to eat then head on up to clinic.Clinic begins like most doctor visits, check in with the nurse for weight and vitals.  Next comes pulmonary function testing (PFT's). This is where we had a hiccup. The Team has a new respiratory therapist, and she is changing the protocol for performing PFT's. The old protocol involved breathing in as deeply as you could, then placing the device in your mouth, and blowing.That is the way I've done all but my annuals for well over a decade, and these results are the basis of my personal trend analysis.  The new protocol is more like the annual PFT. Now we begin the test with the device in our mouths, breathe a couple of times, take a deep breath and blow. I don't get as much air during the inhale portion with the spirometer in my mouth.  My results dropped fairly significantly (to me). It really bothered me. I guess it's kind of like buying a new scale and weighing 5 lbs more than your last weigh in.  I know it's just a new baseline that my future tests will be measured against, but still really affected me for a couple of days.  I'm still well over 100% of predicted for healthy lungs, so nothing to really be bothered about.

After PFT's, we usually get to spend some time with my Transplant Coordinator going over what all's been going on in my life since the last visit and making sure I'm still taking all of my meds. This visit my TC was busy and just quickly peeked in to say hi before handing me off to a different nurse.  Then we get time with our Physician Assistant.  This is when we talk about more technical stuff, go over lab results that may be in already, and usually talk about studies I've read or my N-1 experiments. Well.. not this time.  Our PA is on vacation and we had a totally new person that I've never met before, and one who obviously hadn't read my past Dr's notes.  My creatinin levels were a little high this time because I've been slacking a little bit on my water intake. We had to go over little rhymes to help me remember to drink my water, kind of childish.  Then when I mentioned that I had been lifting a little heavier the two days prior to clinic, she told me to not have heavy days and started trying to explain to me how to exercise.  I simply told her no. Kind of caught her by surprise.

The last person we see is a team doctor. This visit we got to see the Director of the Lung Transplant program at UTSW.  I spoke with Dr. Torres about the new protocol for PFT's and we went over x-rays and labs. He listened to my chest and we talked about a couple studies that I've been reading.  When the exam/talk was over, he mentioned that I made him glad that he kept up on all the recent studies.

All in all it was a good visit.  Labs are all spot on with the exception of the creatinine, and we retested that Thursday.  My diet and exercise N-1 experiments seem to be having positive results so far.  The next clinic appointment is in January, and that's the biggie.  That will include several days of scans, x-rays, a colonoscopy, bronchoscopy, more scans and tons of labs. I'm looking forward to those results, been working hard and expect to see some improvement over last Jan's results.

The Heart/Lung Transplant Clinic waiting room.

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