Reassess

So, when we were discharged a week ago, Dr. Jetton said that she would see us for our regular clinic appointment and we’d reassess. I tried to pretend I hadn’t heard her.

Wednesday, at our regular clinic appt, everything looked OK. He had gained a bit of weight, not much, but some. His hemoglobin was 8.4 or something, which is atrocious, but it’s up. But his BUN was 77. That’s pretty high, and the general cutoff for dialysis in our clinic is 70. Yeah.

There was a lot of hemming and hawing and worried looking around, but after I pointed out Wally’s birthday is Sunday, we ultimately decided to take a sort of Band-Aid approach. We upped his intake more, and cut out his supplemental protein. (BUN is a byproduct of breaking down protein. You can lower it by essentially diluting it with more liquid, and you can lower it by restricting protein.) The goal is to keep him healthy enough to last another week so we get past Wally’s birthday.

The original plan was to just plan on an admit next Wednesday and get started. In the PICU. (I’m not going to lie, I’m nervous about the PICU. First, it seems like a very sad place. Second, it’s all new nurses, new routines, new rules, new procedures. I am comfortable on the peds floor, and I’m at least quite familiar with the NICU. PICU is all new.) But I emailed Dr. Jetton last night and asked if she thought it would be reasonable to reassess first again, rather than just automatically admit. If his BUN remains high, despite our efforts, then we will know (I will know) for certain that it’s his kidney finally crapping out.

But if his BUN is lowered, then I’m going to wonder if the problem is just that he’s on an inadequate amount of fluid intake and he was actually just dehydrated. So if his BUN is lower, we will try more fluid and adding the protein back in and giving it another week.  Sigh. We’ll see.

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