Chapter 6: The inevitable Happens
It was a cold winter morning in January 2011. I was in working in my office when I decided to take a break and go for a stroll in the supermarket at the basement of my office building. As I got up from my seat and started to walk, I felt a sharp shooting pain in the center of the chest right below the rib cage. Normally I am able to bear pain to a considerable level. So I kept quiet and went about my walk, hoping that it would go away after some time. Unfortunately it did not. I came back and did what I always do in such cases – looked up on the Internet for a cause for the pain.However after some net surfing I found out that there were just too many reasons for this kind of pain.Hence I tried my best to ignore it for the moment.
Meanwhile day-by-day I felt that I was getting weaker. In fact if I went out in the sun, I would suddenly start feeling dizzy and my head would spin. Even while talking to someone I would suddenly feel a sense of nausea and dizziness. Apart from this there was one more thing that was worrying me and that was that my stomach had bloated up and that was unlike anyone in the family. I have always been lean and so has everyone in my family and it was strange to suddenly develop a potbelly like most middle-aged people.
My folks at home also thought that I looked weak and my sister who was on dialysis said that it must be because of the poor state of my kidneys and the consequential low hemoglobin. She suggested that I start taking the Erythropoietin injections so that my Hemoglobin could improve. She also suggested that I get my fistula made now itself so that I did not have to suffer all the complications of getting a catheter at the last stage as happened in her case. I was not too pleased with her suggestions, and I was upset with her for putting my mind back on kidney failure when I was trying my level best to forget it for the past more than one year.
The next day in office, I kept reading up articles on the net about the symptoms associated with the last stages of kidney failure. I realized I had most of them. I had nausea, loss of appetite, frequent urination at night, swelling in my feet, feeling of tiredness etc. In fact I used to get breathless climbing up to my house on the third floor of our building. Hence with a heavy heart I decided to get my kidney tests done on 25th January 2011. The next day was a national holiday because of 26th January and hence the report was not released as the lab was closed. I went to attend my school alumni meet that happens on this day each year and everyone commented on how I looked very weak. In fact in the dazzling sun, standing in my school grounds I did feel quite dizzy and nauseous. I got back home quickly to rest. When the report came it did not look too good as my Hemoglobin was down to 9.0 compared to 10.9 in my previous report taken way back in August 2009. My Creatinine had risen to 3.72 which I thought over a period of 1.5 years was not much compared to my last report of 3.5. Hence I decided not to panic, but to just try and improve my diet in order to improve my hemoglobin.
Over the next month I ate a special type of fish that increases hemoglobin. I wanted to have Spinach for the same reason, but as my Potassium was high at 5.56 and was above the upper limit of the lab range, I could not take potassium rich Spinach. The whole of February I tried see if I could improve my health with a better diet. But not only did things not get better, they got worse. The shooting pain under the rib cage was still there. I still had poor appetite and I could not have chapattis at all as I felt like vomiting if I had chapattis. So I typically had rice at night. My mother wondered if the increase in rice in my diet was causing the potbelly. Apart from all this I had a strange metallic taste in my mouth that was quite sickening. I read up on the net and saw that one of the end stage renal failure symptoms wasthisammonia like metallic taste in the mouth.
I still wanted to avoid going to a Nephrologist so in the month of March I went to my local General Physician, the South Indian lady about whom I have mentioned earlier. I told her all about my symptoms and how they matched with end stage renal failure symptoms on the net. I also told her how my stomach was swollen. She told me to stop looking up the net and stop worrying all the time. She examined me and also asked me when I had done my ultrasound. I told her it was more than a year back but I really don’t want to go for it since polycystic kidneys had clearly shown up in that and I did not expect any further revelations. After her examination, she concluded that I suffered most likely from an acute Gastritis and that was causing all the problems. She prescribed tablets for Gas and asked me to come back to her after a fortnight. She also asked me to take some iron tablets to help with my anemia. Initially after taking the tablets for gas I felt better in the first 15 days as the chest pain subsided and I had a little better appetite, but after that things again went back to where they were and my weakness, nausea and dizziness continued. In fact the metallic ammonia taste also became stronger and though I had thought that I would avoid going back to the Doctor as far as possible, I was forced to go back to her in the first week of April.
This time she took it quite seriously and ordered immediate blood and urine tests apart from the Ultrasound and told me to come back as soon as I got all the reports. The reports were really bad. My Serum Creatinine had shot up to 4.52 from 3.7 just two months back. My blood urea was up to a high of 99. My potassium levels had further gone up. My PTH had also shot up to 815, where the normal range was only upto 68. Hemoglobin had further come down to 8.9. All this was an eye opener and I realized probably for the first time that I had reached a point of no return. I realized that now there was just no point in hoping against hope that Kidney failure would not happen. I realized that I had to accept fate and do whatever was necessary as directed by the Doctors. No more of running away from reality. Somehow I felt much lighter and better after this as all these years I was scared of reaching this moment and now that the moment had come, I had nothing further to fear. I also felt so much better to accept the facts. I went to my Physician with the reports and she immediately referred me to a well know Nephrologist in a large hospital and asked me to meet him the very next day. In fact she thought that I was crazy that all these days I was always worried about reaching this day and now that the day had come, I was quite cool and relaxed about it and was actually showing signs of relief on getting over with the waiting bit.
The hospital where I went to meet the Nephrologist was the same one where my sister had her final successful fistula surgery after three failed attempts. So she knew the Doctor. So she came along when I went. When we reached the Hospital, we saw that there was a huge queue of people waiting ahead of us. It was surprising to see that so many people are afflicted by kidney ailments. The hospital had a strange system where while the Doctor saw one patient, the next in queue was allowed into the Doctor’s room and waited there. The purpose I presume was that the patients and Doctors keep their conversations brief when they see another patient standing and waiting right behind them.
When we entered the Doctor’s room he immediately recognized my sister and greeted us warmly. He remembered how difficult and complicated it had been to get her fistula surgery done successfully due to her thin veins. He asked her how she was doing and she told him that her dialysis was going fine however we had come as her brother and that was me had now also reached the kidney failure stage. I have rarely seen Doctors react emotionally as they see so many distressful things each day, but he looked so shocked and sad and wondered how in one family we could be undergoing so much suffering. He quickly examined me, checked my reports and came the conclusion that a fistula had to be made in my case immediately and wrote a referral to the same surgeon who had created my sisters fistula. He also told me and my sister to start thinking about and planning for a kidney transplant soon since he was of the view that the less time one spent on dialysis the better it was for the body and for ones longevity and long term health. He also prescribed a lot of medicines for me to reduce the speed at which my kidneys were failing and my Creatinine was rising so that I had time for my fistula to mature before the need for dialysis arose. When I went home and counted, I realized that after today’s prescription the number of medicines per day that I was taking had risen to 20 tablets a day.
In fact after coming back home that day I also felt some of my symptoms worsening. I constantly felt a sensation of pins and needles in my hands and legs. Also at night I was waking up and going at least 6 times to the loo to urinate and that was making it difficult for me to get any proper sleep. In the mornings by 4 am my swollen kidneys would pain so much that I could hardly lie down. In fact even while lying down I was for the past one month finding it difficult to lie down on my sides as my kidneys had swollen up so much that my abdomen had protruded from all sides. I was forced to sleep face up and not sideways. Things were getting more and more difficult to bear.