Chapter 3: My first serious health problems
In Dec 2006 I was forced to shift my office temporarily to a floor above my residence, as there was a sealing drive against commercial establishments operating from houses especially on main roads. I was unable to get a commercial place at short notice and any commercial space that was available had increased their rates substantially on account of the sudden demand. It did cause a lot of stress. I am not sure if it had any direct effect on my health. My blood test reports, especially of Creatinine though normal and within the labs range at least till mid 2007, did see a slight increase and it inched closer to the upper end of the normal range. I asked the lab folks if they had any patients who were beyond the range, and they replied in the affirmative. Beyond that they said nothing and I did not try to find out either.
The down side of working out of home during this period was that I had little by way of exercise as even the trip to and from office was just a climb up and down a flight of stairs. However, I still continued with a half hour routine each morning of exercising in my room. I did some pushups, some spot jogging, some stretching exercises and weights with dumbbells. This routine had continued since my college days although the time that I gave to it had gradually reduced.
Work wise I faced no problems by shifting our office to a floor above my residence as the middle and senior level hiring that my firm did, our interviews were mostly telephonic and rarely face-to-face. In fact it actually saved on costs, as I was not paying any rentals now since I was operating from a self owned property instead of a rented one. However, I soon faced some major health issues. It was late one evening in July 2007, I was sitting in my drawing room watching television when I happened to press my finger against my left ankle. Immediately there was a shooting pain and within minutes the pain was unbearable and my ankle had swollen and become red. My elder sister rushed me to the nearest hospital where in the emergency OPD they examined the ankle and by a physical examination they concluded that there was no fracture. The Doctor on duty wrapped a Crepe Bandage and gave some painkillers. He suggested that I come and get an X-Ray done the next day as the department had closed for the day, to rule out any hairline fracture. In case of a fracture he said, I could go for a plaster cast or just use the Crepe Bandage and rest for a fortnight. The next day I got the X-Ray done and also met the Head of Orthopedics. He saw the X-ray and ruled out a fracture, but after careful examination of my ankle came to the conclusion that it was most likely a ligament tear. He told me to wear the crepe bandage for a fortnight and rest so that the tear could heal on its own. However when he looked at my medical file and saw that my hemoglobin was a little lower than normal he was concerned. It was 11 in my last annual blood test, which I had undertaken just a fortnight back. I then told him about my underlying condition of ADPKD. He then wondered if my leg injury could have some correlation with my kidney condition and referred me to a Nephrologist in the same hospital.
Around that time my elder sister was also regularly visiting the same Nephrologist in this hospital. Actually some years after the detection of ADPKD in my comprehensive health checkup, I had shared the details with my family. I have two elder sisters. The eldest one is married and has two sons, while the one elder to me is not married and stays with my mother and me. Both my sisters had got themselves screened for ADPKD and it was found that both suffered from the same genetic condition. However my eldest sister had normal kidney parameters, the sister elder to me was showing signs of kidney malfunction with higher than normal Creatinine levels and had started visiting a nephrologist. In fact the hospital had recently set up a nephrology department and she was the Nephrologists first patient. A former army Doctor, this Nephrologist had also worked in AIIMS and had considerable experience. Hence I decided to meet him as well.
So the week after my meeting with the orthopedic, my sister took me along and introduced me to this Nephrologist. He was a friendly old gentleman who examined me and wrote a whole host of blood tests. When the results of the tests came I was worried to see that for the first time my Serum Creatinine reading was at 1.7 which was above the lab range, although the other parameters were still more or less normal except for hemoglobin which had come down further to around 10.9. He wondered if because of my kidney condition I was suffering from Gout, and if he needed to prescribe more tests for checking on that. I was already a little distressed with my kidney test results that I wanted to avoid any more tests and I told the Doctor that my leg was fine now and there was no need to do any further tests. In Gout, the Uric acid levels in the blood rise and crystals of uric acid accumulate near the ankle or toe leading to inflammation. I did read up on it on the net, but I was too worried to get a detailed check up, as I did not want to add to the list of medical conditions that I needed to worry about.
I had suspended my daily exercise schedule for a fortnight in order to rest my injured leg. However once I started feeling normal I resumed my routine activity including spot jogging. Unfortunately within a week, while I was at work and was climbing down the stairs I again felt the shooting pain in my left ankle. I came down to my room and my office boy decided to get some warm water to dip my feet in to alleviate the pain. It was not of much help. It was later when I read up on the Internet, I realized that I should have put a cold compress with ice for more effective results. My ankle had swollen up quite a bit and it was so painful that I just could not move or put any weight on that leg. I called up the Orthopedic who had seen me earlier and he said that I could put back the crepe bandage, use a cold pack of ice on the swollen area and come and see him when he was in the hospital next after a couple of days. I soon realized that this would be impossible as by the next day, I was barely able to hop across in one leg upto the bath. I called the Orthopedic back to check if he did home visits but he refused. So I was pretty much on my own till I got better enough to move.
I decided to continue my office work from my bedroom and not go to the office upstairs. Since I did not a have a Wi-Fi Internet modem, I got LAN cabling done till my room and moved my computer table into my room. No amount of rest helped and my swollen ankle remained as it is for the next few weeks and I wondered if my leg would ever be normal again. It was a month and a half later that I saw an advert insert in our paper where this clinic had put an ad saying that it was conducting free sessions of Pulse Electromagnetic Therapy that was supposed to cure among other things, non-healing sports injuries and swollen legs and feet. Initially I was hesitant, but by evening I decided I must give it a try if I want to ever get moving and I called on the numbers given in the leaflet. The caller mentioned that their free session was over, but I could come over to their office and get a checkup done the next day. For the treatment they said they could come home and do it, but I needed to manage and come over at least once to their clinic in Kailash Colony for a detailed checkup first.
So I asked my elder sister to take me there the very next day. I had to wear slippers since my feet were swollen and there was no way that I could wear my shoes. Once there, they checked something called the Ankle Brachial Pressure Index. Based on the readings, they decided on the dosage of the Pulse Electromagnetic Therapy. The first session was a half hour sample session and I immediately felt a huge relief and my ankle pain reduced quite a bit. I was thrilled. My sister who was also suffering from pain and swelling in the legs due to malfunctioning kidneys decided to try out the half hour trial session. Over the years, due to poor kidney function, she had developed dark spots around her ankles and somehow after this session these spots spread across the entire leg. She was quite alarmed and we wondered if this treatment was harmful for a kidney patient. The clinic folks quickly contacted their principals abroad and they were informed that this treatment was actually contraindicated for kidney patients. Hence we decided against any more sessions for my sister, but in my case they felt since the kidneys were functioning fairly normally they could go ahead with the treatment. I heaved a sigh of relief since I wanted to get my ankle back to normal so that I could walk normally again. They said they would send their technician to my house for the treatment each day for a week to ten days till my leg was fine and it would cost around 500 bucks per visit. I agreed and from the very next day the half hour sessions started. The electromagnetic therapy as such did not cause any sensation or feeling in the body, but because it was supposed to increase blood circulation to the affected area and thus induce quick healing, it did cause a slight rise in blood pressure after the treatment session, though this was minor. Within ten days as promised, my swelling and pain had gone and I could walk normally. I started attending my office back in my office room upstairs after a gap of around two months. This had been my first ever break in my life due to any medical reason.
I realized that the electromagnetic therapy would have been useful whether it was a ligament tear or Gout. In the first case the improved blood circulation would have healed the tear, and in the latter case, it would have removed uric acid crystal accumulation. However, later I was to realize that this therapy might have been one of the factors that could have aggravated my kidney function decline by probably putting pressure on my weakened kidneys.
Although I was back in office, I soon realized that I was not as normal as before. The left leg had become weak and I could no longer wear my heavy soled shoes as it immediately caused pain. It so happened, that I had a physiotherapist in the recruitment team working in my office. She had decided to change careers after finishing her course in Physiotherapy from a leading University in Delhi. She suggested, that my ankle muscles might have weakened due to the long bed rest and I needed to do strengthening exercises. She got a device to measure my ankle movement and saw that it was restricted and prescribed daily exercises. After a few days when my left leg still remained weak she suggested I meet her professor who practiced Physiotherapy in the hospital attached to the University. I decided to go and meet him. He was a very knowledgeable and was a very good physiotherapist. He agreed to come home and visit me and treat my leg to regain its strength.
The professor suggested that I try out an ultrasound therapy on the affected area of the leg apart from doing some physiotherapy exercises in order to strengthen the weakened muscles. He said this therapy had no negative side effects and basically caused the affected tissues, ligaments and tendons to vibrate at a very high frequency helping in cell repair. The therapy along with the exercises that he made me do, helped tremendously in regaining strength in the leg and the weakness in my ankle diminished. I continued with his treatment for a fortnight and felt a huge improvement. Although he did say that it would take some years for the weakness to completely go away.
Meanwhile I renewed my visits to the Nephrologist my sister had introduced me to. He asked me to get my tests done monthly and by now he had put me on a lot of medication to control not just my BP, but also my calcium levels, iron levels, and phosphorous levels. Though all of them were normal, they were closer to the upper limits of the range specified in the lab reports, and the Doctor wanted to prevent them from deteriorating further and moving out of range. However in my next monthly tests in January 2008, I was not too pleased to see that my Serum Creatinine had moved up to 2. I asked my Nephrologist if it would remain stable at 2 or did he expect it to increase further. He did not answer my question directly but took a pen and paper to draw a graph. He showed me by drawing that graph that once the Creatinine had crossed the upper end of the lab range, it meant the kidney function was already at 50% of normal kidney function. He then drew a downward line on the graph to indicate the decline in kidney function over time to show that it would be within 3 years by when I could expect to suffer a complete kidney failure. I got a sinking feeling on hearing this and I actually felt angry with the Doctor for sharing such a disappointing prognosis. I knew it would be difficult for me now to keep this out of my mind. I then asked him about my sister’s condition and by when she would have to undergo dialysis and he said that currently her kidney function was at about 25% and by the time it was around 10 – 15%, the need for dialysis will arise.