10: Kidney of Fire

Have you ever had a kidney stone?

Renal calculi is another medical term used for this abomination. I'm not using that term loosely, either. If you've ever had a kidney stone, you know abomination doesn't do those little things justice. They are awful!

I think of the line from the film Prometheus. "Big things have small beginnings." Lawrence of Arabia also used this line. The line is tried and true because when you have a small kidney stone that impacts your urinary tract, it's a BIG deal.

I've had two kidney stones in my life. One came in 2016 very unexpectedly. Before that day in October 2016, I had only heard about how bad kidney stones can be. I've had patients with kidney stones who had to work to pass them. I've heard family members express how awful they are when they have experienced them. But none of those observations can prepare you for how bad a kidney stone can be.

Back in 2016, the stone was made more of protein. Protein is not very dense. Therefore, after the initial pain that forced me into the emergency room that night had settled down, the pain was nowhere near as bad. I took Lortab for a few days to help, but the stone was dissolving with the water I was putting into my system. A protein stone is more pliable, so substances like lemon juice being mixed in your water can assist with dissolving it. Eventually, the stone shrunk, so I didn't even feel it pass, but fortunately, it did.

But at the dawn of 2023, that was not the case for that kidney stone. It was January 5, 2023, to be exact, so Happy New Year to me. I had worked out on my new elliptical my wife, and I got each other for Christmas, and completed 55 minutes working out. Remember, I'm always trying to close the rings on my watch, so sometimes you have to do a little extra to get it done. Immediately following the exercise, I used the bathroom. When I did, my urine was amber.

Amber is the color your urine can become for a few reasons. One is dehydration from lack of water. I didn't think I was that dehydrated because I thought I had drunk enough water. But I was convincing myself I needed to step up my water intake. That week had been a little challenging with elimination needs (nice way to say bathroom needs), so I thought maybe I was a bit dehydrated.

The other reason is blood in the urine. My mind did not go to this then because I assumed it was a lack of water. But, the next morning, I quickly discovered the problem with my kidney.

When I used the bathroom upon getting out of bed, my urine was as amber as the night before. It was terrifying to see that urine. I immediately started downing a whole bottle of water in 5 seconds flat. That's when the pain set in.

People have often described kidney stone pain as worse than child labor. Child labor is by far one of the most painful things a person can go through. I had to watch my wife go through it twice with the birth of our children. But despite that, when my wife had a kidney stone herself, years later, she too said the kidney stone was far more painful than delivering either of our children.

So, needless to say, I was brought to my knees right away from this new kidney stone as my wife escorted me to the emergency room to have it treated.

My labs showed gross blood in the urine, which is why it was so dark. The pain made me want to throw up, so I did. I threw up nothing but water because of that whole two bottles of water I drank. I'm not kidding. I downed another one just before the pain set in.

The worst part was the agony of waiting. Because a kidney stone is not emergent, the staff gets to you as quickly as they can in the emergency room. That's just the way it is and part of prioritization. I was in pain, but they got to it as quickly as possible. The problem for me is that, for some reason, this stone hurt worse than the last one. I assumed it must be huge!

The previous stone came in at 5 mm, which put it at almost the full size of the ureter on my left side. But, as I said, it was protein and easily dissolved by water and other agents. So, it passed with very little effort.

This stone in January 2023 came in at a whopping 3 mm. Do huh? It's smaller than the first one? How is that possible? That's impossible! But I searched within my feelings and my medical record later and knew this to be true. This new stone was smaller but much more painful, and there was a reason for that. The stone was made of calcium oxalate. 

Calcium oxalate stones are some of the hardest kidney stones imaginable. They do not break down as easily as protein. What they do, at least in my case, is move around in the ureter as it passes down, scrapping the interior of the ureter along the way. This scrapping was causing the amber urine. Then, because the orifice from the ureter to the bladder narrows, the stone becomes lodged. Once a calcium oxalate stone becomes lodged, no force on earth, in heaven, hell, eternity, or an alternate universe can make that stone move. All you can do is wait for it to pass or have surgery if it won't pass on its own.

Once I had some Morphine and Toradol in my system, the pain subsided, and I could stop rolling around on the floor at the hospital. Yes, you read that right. I was in so much pain at one point in the waiting room that I lay on the floor and did not care. Even once I had a bed, I still had to get up and move in different positions to get some relief until they brought me some medications. It was excruciating!

But finally, I got some meds, and they prescribed pain meds, Lortab and Toradol, along with Flomax, to help get the stone out of my system. After that trip of despair to the emergency room, I went home to suffer through 5 more days of pain trying to pass this stone before my follow-up appointment. 

Each day, unfortunately, the pain never improved. This lack of pain relief was vastly different from the previous stone. Eventually, with the stone in 2016, I had no pain at all. This stone was evil! The stone kept lodging in my ureter, right at the passageway that would send it out of my body for good. A couple of times, while straining urine, I saw a speck of dark pieces in the strainer. I thought This is just the tip of the iceberg. I'm ready to sink the Titanic. Heck, let's blow up the Titanic at this point!

Finally, the last of those 5 days came, and out came the full stone. I held that stone at my fingertips, looking at it like David in the picture. It felt rock solid between my fingers. No crumbling or anything, and protrusions were visible on one side. It looked almost like an insect. It was ghastly and awful, and I couldn't wait to trash that thing. Immediately the pain ceased, and all was well again. I was so relieved the pain was over from that awful stone. Then the blood clots came.

I never had blood clots from my first stone. Like I said, it wasn't as dense. This one scrapped the interior lining of my ureter all the way down and plowed through the orifice from my ureter to my bladder. It caused damage that led to blood pooling up in those areas. The result was a bunch of clots on the lining of my ureter that had to come out with the urine. At one point, the bottom of the toilet was filled with leftover clots. That was intense too. The clots didn't hurt, but just passing them was insane. All I could think was What has this tiny stone done to my kidney? 

A few weeks later, I returned for my follow-up scan to see if my kidney had returned to normal size because the build-up of fluid made it swell, and everything was back as it should have been. It was such a relief. I actually cried when I was alone in the patient room waiting.

So, what does this have to do with my sugar concerns and dieting?

Well, do you know what can cause calcium oxalate stones? This link will tell you more, but dehydration and chocolate and nuts are a big culprit.

You see, coming out of the Christmas holidays, I had been eating a few things that were not good for me. After getting my last A1c of 5.8, which wasn't horrible, I decided to enjoy some things through the holidays and pick back up on dieting with the new year. That's not uncommon for anyone, so I was no different in this case. But I was indulging in some really delicious stuff.

For one, my mom makes the best roasted pecans. They are to die for. Now, pecans are lower in oxalate, but not in the amounts I was eating. I was eating roasted pecans like they were going out of style. On top of that, I had started just munching on peanuts as a whole, buying a big box of peanuts at the store whenever it suited me. Indulging in peanut butter sandwiches. I was going nuts for nuts.

Then I added in chocolate! I was eating a ton of Milk Duds and other chocolates, from leftover Halloween candy to Christmas candies. Don't forget chocolate chip cookies! But the last part was the dehydration. By this point, I had slipped back into drinking more diet soft drinks than water. I love the taste of Diet Wild Cherry Pepsi or Pepsi Cherry Zero. I love the taste of those so much. But they contain more carbonation, which can be dehydrating. Combine that with 3-4 days of irregular stools, bingo, and kidney stone from Hades!

The dehydration caused by the loose stools and lack of water was probably the single biggest factor for the stone, but the overabundance of chocolate and peanuts didn't help. What had happened was after receiving my A1c result, I just wanted to have some fun through the holidays. It cost me pretty well by January 5, 2023.

So, over the last 8 months since, I've drank almost nothing but water the whole year. I had a few times of diet drinks coming back into the mold, but I've just adopted the habit of drinking water now. I've also cut way back on chocolate, and nuts have been cut out almost completely except on rare occasions. I don't want another kidney stone, but those food items are also fattening. Chocolate and nuts contain a lot of calories, especially if you eat them in bulk, like I was doing during Christmas. You can't do that when you're trying to maintain a balance in your diet. You especially can't do it when you have sugar control issues.

Now, it is not to say you can't indulge occasionally. Anything in moderation is not bad, but I was not moderating it. I opened my mouth wide and poured a whole bag of pecans into it in one sitting. Put it in perspective, my mom, during the holidays, made my dad and I the same size tin of roasted pecans, with the same amount of pecans for each. My tin of pecans was gone in 2 hours. My dad's tin of pecans was gone in 2 weeks. Yeah, that's a little bit overindulging, to say the least.

I had said in the last post that I needed to make changes to my diet, and the kidney stone made me do just that. Following the kidney stone debacle, I was back in action, trying to get my diet in a place that would lower my A1c again. My goal was to be at least at 5.6 or lower by May. The new year had begun, 2023 was one I was looking forward to, and my goal was to get things under complete control if possible. I was now heading that way.

So tune in next time for 10: Swamp Rabbits, Grants, and Graduations, OH MY!

10: The 5.8 Syndrome

Journeying into the Fall of 2022, I continued working through the tenure track process and all the stress that ensued with that experience. Of course, with that stress, I started stressing about other things. For instance, what will my A1c do this time?

The first thought that went through my mind was, here we go again.

I've since decided to label this year as The 5.8 Syndrome!

From November 19, 2021, to November 18, 2022, the 5.8 Syndrome seemed appropriate. Thrown in the middle of all that was that my A1c had been 5.6 in May 2022. But that didn't seem to matter. Once again, my focus shifted back to the "woes me" mentality because I sometimes felt I wasn't eating that great due to stress from navigating the tenure track. Additionally, my weight was creeping up again.

By May 2022, I weighed 210 lbs. When I went in for my check-up in November 2022, I weighed 216 lbs. In November 2021, I weighed 202 lbs. So, I gained 14 lbs in one year!

Egads!!!!

In August 2021, I also weighed 202 lbs which had me down by 29.6 lbs from where I began in April 2021. In November 2022, I was only down 15.6 lbs from where I started.

Obviously, my diet had changed since August 2021. But my activity had not. From March 2021 to November 2022, I walked or ran EVERY SINGLE DAY. The only exceptions were when I had some heart concerns that became nothing and when I had COVID. Clearly, I wouldn't have exercised during those few days. Otherwise, you would have found me walking or running in my neighborhood, at the AnMed Health North Campus track, in downtown Columbia, all over Clemson, Greenville, Pigeon Forge, Surfside Beach, and pretty much everywhere I could do those activities. Remember, since March 2021, by November 2022, I had run in 8 5Ks or 1-mile races too. All that running leading up to the races certainly put on one other thing...muscle. Muscle weighs more than fat; what happened over the past year is I had replaced fat with muscle. This was noticeable in my clothing because I still wore the stuff I had after losing weight.

But it is hard to see muscle sometimes. For instance, you tend to look at your arms more when you think about muscles. I don't have the most muscular arms, but I'm working on it. However, when I looked at my legs, that was, and still is, a very different story. I have muscles and veins bulging all over my legs, meaning I have built them up with the exercise regimen. That's a good thing.

What that translated to is my A1c wasn't changing much in November. Despite my stress eating or concerns with my diet, my exercise routine was stout and helped me maintain things. I needed to tweak things diet-wise to get where I wanted to be.

When I got the result of 5.8 again, I didn't freak out this time like I had the year before. I didn't like it and was disappointed, but a friend helped me put things in perspective right away. They basically told me, "You're doing great, Jason." 

In fact, I was doing good. My other blood work showed the following:

11/21/2022 (Expected values in parentheses)

Glucose 108 (74-106)

BUN 15 (7-18)

Creatinine 0.970 (0.60-1.30)

GFRaa >60

GFRc >60

Calcium 8.8 (8.5-10.1)

Sodium 140 (136-145)

Potassium 5.0 (3.5-5.1)

Chloride 104 (98-107)

CO2 29.9 (21-32)

Anion Gap 11.1 (9-15)

Besides the 5.8 A1c, my blood sugar was the only other lab elevated that day. I was up slightly for whatever reason, but it was still going well everywhere else.

As suggested here, I just needed to adjust my diet and work on things. Little did I know, though, something would assist me right away with diet modifications. Believe me, though, this is not a method you would want to use at all. But I, unfortunately, had to endure the pain it brought me.

I'm talking about...a kidney stone.

Tune in next time for the next segment, 10: Kidney of Fire.

10: Fall 2022

 

Ah, Fall! My favorite time of year. Seeing autumn come makes me think of cooler temperatures, milder climates, multicolored leaves, less grass cutting, school is back in, football, Halloween, World Series, bonfires, and paving the way to Christmas time.

I love this time of year. I always start decorating for fall as soon as September hits, not September 21st, but September 1st. That is the start of the fall season for me. The true, most wonderful time of the year, at least for me.

The best thing I love about fall is running. In high school, running in the cooler autumn temps allowed my lungs to expand as much as possible to take in plenty of oxygen and run as fast as I could for 3.1 miles. My favorite course was always the Furman Invitational. The race was typically in mid-October, allowing for a nice crisp chill in the air on the race mornings. The course was on the golf course mostly, so almost completely flat with beautiful grass and landscapes. Every time I ran that race, I did a personal record of some kind. I just loved it!

But each race in high school was met with uncertainty where you had to show your capabilities. That was not unlike the Fall 2022 semester for me, as I was starting a new course for my career - as a researcher.

Having accepted a position on tenure track, I knew the next year would be busy trying to navigate the rigor and needs of research. But I was up to the challenge. I will admit, though, this added a layer of stress after finishing the dissertation. I replaced one stress with another stress.

Stress plays a huge factor in sugar control too. For one, if you are stressed, you are prone to eat and eat comfort foods. But much like the Fall of 2021, I still did well trying to balance things out. COVID helped some. My weight dropped by almost 8 pounds during COVID. However, I knew I would put that weight back on once I felt back to full strength. I didn't lose that weight initially like the year before; it was due to sickness.

Amazingly, my sugars never got out of control during COVID and remained steady in the 80-100 range thereafter. I wasn't checking my sugars nearly as often now, given a reprieve by my provider to save my fingers from needle sticks. I was checking my sugars twice a week now. Only one time during the fall did my sugar reading reach 100 during those checks. The stress of trying to write grants, manuscripts for publications, and submit abstracts was tough, but it wasn't quite as bad as the dissertation phase had been. This difference was largely because I was now working with a team of researchers.

Having gone to my first Prisma Health, Health Science Center (HSC) Mixer, I found myself working with a group as passionate about virtual reality (VR) as I am. The HSC Mixers are an opportunity for researchers to mingle and share ideas in the hopes of applying for seed grants offered by Prisma Health. When I planned to attend, I wanted to meet some people to start thinking of ideas so that I might apply for a seed grant the next fall in 2023. With it already being mid-September and the due date for the letters of intent was mid-October, I didn't think I could get a grant submission in time for fall 2022.

I was wrong.

That's the thing about being a novice. You don't really know anything until you actually do something. All your schooling really leads to entry-level. I felt like the doctor in the first episode of Scrubs.  It's also a lot like running cross country. You never knew what the courses might be like sometimes, although the coaches tried to prepare you. You still had to run the race. There was always something in the path you had to navigate around, obstacles even. But ultimately, you figured out the course and successfully completed the race without injury. The same rules applied here with grant writing and doing research. However, I was forewarned before the start of the semester. At orientation, President Jim Clements made it clear to all of the newest faculty and researchers of Clemson University that the best time to start doing your research for tenure track is NOW. Don't delay. So, when opportunity knocked that day at the HSC Mixer, I jumped on the train and never looked back.

This was the same philosophy I took with my diabetic concerns from March 31, 2021. I knew this was the only way to handle things, and I would be remiss if I didn't try. When you're faced with new challenges, all you can do is adapt and figure out ways to succeed. Much like Spring 2021, the Fall semester of 2022 was uncharted territory for me. How did I fair? Well, just like any race, steady as she goes, doing the best I could.

That effort would soon open the door for me to things I hadn't even considered before finishing my PhD. A new team. New affiliations. New opportunities. It was truly amazing, all the while still trying to maintain control of my sugars as I had the previous year and a half. How would the results end up this time?

Tune in for the next segment, 10: The 5.8 Syndrome.

 

10: COVID

 

Have you ever had COVID-19? I know we have all lived through the era of COVID, but there are those out there that can say they have never contracted the virus. However, if you've ever had COVID, then you know for certain it is a big deal.

Now, COVID affects everyone differently; it is a confusing virus. I've seen people who were considered high risk for mortality with COVID come through the virus as if nothing happened, and then I've seen people that were perfectly healthy before contracting COVID succumb to it. The virus makes absolutely no sense in that regard, but one thing is for certain if you get COVID, any variant of it, you better take it seriously.

For me, in the summer of 2022, that became the first time I ever contracted COVID during the pandemic. I was fortunate the variant I got was a lesser version of COVID, the latest Omicron variant for that year. I heard about many people's struggles with other earlier variants, but I never wanted to experience those. But even the variant I got was enough to knock me backward.

There I was in July 2022, riding high after completing my Ph.D. and fresh off signing a new contract to work on tenure track at Clemson. For both of those reasons and with it being my 20th wedding anniversary with Leslie, I wanted to take my family someplace fun to celebrate. We headed to Wilderness at the Smokies and specifically spent a lot of time at their new waterpark Soaky Mountain. We had a blast that week riding all the newest attractions and living it up in celebratory style.

Once we got home, though, Leslie told me her throat was scratchy. She also said she was starting to ache all over. All I could think was, oh boy! So, we tested her with an at-home kit, and the result was positive.

I assumed it would be a matter of time before I had COVID myself, after having avoided the virus for nearly 2 and 1/2 years. By the next evening, even after having tested negative at Urgent Care, just to be sure, my throat began to get scratchy as well. By the next day, I was full-blown COVID. 

If you've had COVID, you can probably relate to the descriptions I'll post next. I just felt blah. It was like having the flu at first, although it had been a long time since I had it. I never had a fever the whole time, but the blah feeling and achiness all over was awful. Then came the weakness and tiredness. I was so lethargic the first day. I still attended some virtual meetings online, but I couldn't tell you a thing about those meetings those couple of days when the virus took hold. Fortunately, the meetings were early-stage developmental types, so more robust meetings followed.

I could move around fine. Oxygen levels were fine. I was just incredibly tired. Then the sore throat began. That was the worst part for me. In the past, I've had horrible sore throats, especially with stuff like the Flu. So, this made a lot of sense that COVID attacked my throat the worst. It felt like I was swallowing razor blades every time I tried to swallow. It was so painful. But if that was the worst that happened to me, considering other's worse experiences, I'd take it!

One day after the meetings and feeling tired and weak, I started feeling slightly better. I thought maybe I could go for a walk. Boy, was that a mistake. Number one, it was mid-August by then and hot as fire outside. I decided to go in the middle of the day and walk for 30 minutes around my driveway. I figured this would be a good way to start back. The exercise ring on my watch will only close when I put enough effort into exercising to register on the device. With walking, it takes a brisk pace, 20 minutes or less per mile. That day, it took me 50 minutes to make the 30-minute exercise ring close during an outdoor walk. On top of that, I went in immediately following and showered. When I got out of the shower and dried off, I was still sweating like I had finished walking. It was awful. Even my food that day for lunch just felt like it was growing in my mouth. I didn't have to be anywhere the next day, so I stayed in bed most of the day. The day after that, I finally started feeling like myself again, with still a subsiding sore throat.

During COVID, I watched what my blood sugar did before and after. The day before I tested positive, my blood sugar check was 90, so normal. A few days later, when COVID was starting to simmer down, and I was off quarantine, my blood sugar was 93 and normal again. But during the height of COVID, my blood sugar fasting was 107. Now that's not incredibly high, but it was higher than I was accustomed to when not eating anything. Sick days as a diabetic can be challenging sometimes, so you have to watch your intake, stay hydrated, and prevent concerns related to sugar issues. Like I said though, 107 wasn't horrible, but clearly higher than the days leading up and following.

After having COVID, for me, it was only flu-like symptoms. But it showed me how detrimental this virus could have been. Before COVID, I got both Pfizer shots and 1 booster in the fall of 2021. The only ill effect I ever had from the shots was some mild tachycardia and feeling tired, but the day after that, I was perfectly fine. What the shots did for me was prevent COVID from getting into my lungs. I had no congestion in my lungs. My oxygen saturation was perfectly fine the whole time. No other ill effects took place. Therefore, I received the next booster shot in the fall of 2022 and will always get boosters as needed for as long as recommended.

COVID is a big deal. You're going to see a lot of things out there about COVID, both positive and negative. Although I had what you might consider a mild case of COVID, other people have not been so fortunate over the last three years. Some have developed conditions that never go away because of COVID. Some have lost limbs because of COVID. Unfortunately, some have died because of COVID. The other thing I have seen is people getting repeated infections with COVID, which causes more issues each time. I eventually got COVID again, recently, at the time of this blog. That bout with COVID will be the discussion in a later post.

You need to decide for yourself what is best for you, just like I did. 

The CDC does offer great resources if you want to look into COVID and the vaccines more. I'll include that link here. Otherwise, I encourage you to do your own homework and research to determine the best way to handle COVID for you and your family.

Because I hate to say it, folks, COVID is here to stay.

Tune in next time for 10: Fall 2022.