Thursday, December 25, 2008

Prayers Tonight

Mels brother Tim moved to Dallas a few months ago. Tim has chronic kidney disease (technically IgA nephropathy), as a result of an infection inducing acute renal failure 10 years ago; which has left him with about 40% function of his kidneys.

Since he's moved to Dallas, he's had a problem receiving proper treatment. Tim has atypical drug reactions, and it took him and his doctors years to understand what worked for him and what didn't.

Unfortunately, many doctors seem to believe that their pronouncements are infallible dictats from god, subject to no disagreement, or even the actual reality of the patient in front of them. Thus, his nephrologist in Dallas has decided that it's not that the treatments are wrong, it's that Tim is not complying with instructions.

Tim is many things, some good some not; but what he most definitely is, is absolutely anal about following his treatment regimen.

It was NOT following proper treatment that killed his kidneys in the first place; and only through diligent adherence to his regimen did he not only survive, but improve his kidney function from around 20% to around 40%.

Yesterday, Tim went to the emergency room in Dallas with his blood pressure spiking to 200/120. Elevated blood pressure is one of many side effects of Tims treatment regimen; but that is dangerously high.

While there, his nephrologist insisted that the reason Tims blood pressure was through the roof, was because he was non-compliant, and that he didn't need any other treatment but to get back on his regimen.

Tim fired his nephrologist in Dallas yesterday and got on a plane this afternoon.

This was mostly because he is a stubborn idiot. I'm sure he can find a good nephrologist in Dallas, and flying with his blood pressure like that is dangerous and stupid... but he's here.

Mel picked him up about three hours ago, and they went straight to the hospital where he's been recieving treatment for years.

He was just admitted with a hypertensive emergency. It's a recurrence of acute renal failure, complicated by acute hypertension; with his blood pressure at 245/145.

The conventional treatment (SNP and Clonidine) isn't bringing his blood pressure down, and they're worried about trying anything else because of his atypical reactions, and his kidneys .

Because his BP is so high, they have to worry about ischemia, and because of his severely reduced kidney function they have to be VERY careful about what drugs to administer(captopril for example, another typical emergency hypertension treatment, could kill him). They're starting him on a slow Labetalol IV to try and bring his BP down over about 8 hours.

His old nephrologist will be seeing him in the morning.