Pressure Relief

In our previous episode, Mom's nephrologist, Dr. N, had taken her off of one medication for heart palpitations and prescribed two additional blood pressure medications, bringing the number of blood pressure medications she is on up to five as of November 8. And in the ongoing quest to determine the cause of her high calcium, he scheduled her for a CT scan of her chest, abdomen and pelvic region on Tuesday, November 12.

Dr. N went over the results of the CT scan with Mom while she was at dialysis on Friday, November 15. He said there is an abnormality in her chest cavity, but it might be due to the talc pleurodesis surgery she had in July of last year. Dr. N called the surgeon, Dr. J, and Dr. J suggested that Mom have a biopsy done to determine if the abnormality is due to the surgery or something else. (I suppose it could be the talc material or the scar tissue.) Dr. N also wants to have x-rays taken of Mom's legs. Hooray, more tests and procedures . . .

Speaking of high calcium, the upper limit of the normal range is 10. So anything above that can be considered high. Here is a chart of her corrected calcium going back to February of this year:

(That chart may run off the edge of the page when viewed on the blog, but the next smaller size was too small to read easily.)

There is not really a clear trend in that chart, but her calcium was definitely above normal for four months starting in July of this year, and it was still at the upper end of the normal range with the most recent reading in November. Maybe the calcium level is just something that fluctuates with some dialysis patients, and Mom's calcium happens to be high or almost high anyway. If that is true, then there may not really be any underlying cause that needs to be addressed. We will see what happens over the next few months.

On November 15 Dr. N also increased the dosages on two of Mom's new blood pressure medications. That is probably a routine occurrence when starting a patient on a new blood pressure medication, to start at a low dosage and then increase it if necessary based on how the patient responds. Mom had a follow-up appointment with her internist, Dr. M, on Tuesday, November 19. Dr. M said Mom's blood pressure was headed in the right direction, and Mom is not yet taking the maximum recommended dosage of the blood pressure medication, so that's good. A few days before that appointment, however, Mom's pulse was around 150 bpm when she got up in the morning, and it stayed that way until late in the morning. Dr. N has taken her off the medication she had been taking quite awhile for heart palpitations, so hopefully that elevated pulse will not be a recurring issue. I know we will all rest a little easier once this blood pressure is under control.

Next up: Back to the article reviews.