Thursday, April 4, 2013

That Cretin Creatinine - A Detective Story

Let's start with the good news: it's very unlikely my kidneys are failing.

Of course, I never really thought I had kidney failure... except maybe for a brief couple of hours between my first creatinine test and my second. Have I mentioned that the Internet is a scary place for medical information?

The problem is, nowhere on all the wonderful places where one might surf does one find a site that says, "It's probably nothing. Go have a glass of wine and calm down." That's what your doctor says. Except the last part. He usually says, "It's probably nothing.... but let's run a gajillion tests just to rule out all the somethings that it probably isn't"

Maybe some context would be helpful here.

About two years ago, I was in the midst of following up on a couple things that I had brought to the attention of my doctor. The first one, which was probably nothing, was a swollen lymph node that was eventually diagnosed as follicular lymphoma. The second was some swelling in my lower right leg. That was probably nothing, too, but my track record with nothing wasn't that impressive. So after blood work - normal and an ultrasound to rule out a blood clot -- ruled out, we were left with essentially nothing.

My leg was never really bothering me, but it was just kind of there, a little swollen, and noticeable. Sort of like my lymph node. Two years later and my lymph nod is no longer "swollen" -- thank you rituxan and chemo, but here's my leg returning to its less-than-normal status.

This time round, I have a few more variables in the mix.  For one, I've been doing the whole standing desk thing for three months. Not eight hours a day, but enough hours to probably have an impact. And then there's the chemo.

I reached out to Dr. L who, checked my recent scans and also noted that I had mentioned this problem two years ago when I first saw her. She didn't suspect it was lymphoma related and while I would have preferred to see her than my primary care physician, for a variety of reasons including proximity. I set up an appointment with my PCP.

I have to say up front that I like my PCP well enough. We're not hanging out on the links together, but he's a nice enough guy, thorough and smart. He is, after all, the one that had me do tests on that pesky swollen lymph node that was probably nothing. The problem is, after two years of care at Dana-Farber, the bar is set pretty high. So after checking in with a not un-friendly desk person, I waited.

Eventually a nurse came out and asked if I had filled out any paperwork? No, I hadn't. She looked confused. She came back with paperwork -- a health questionnaire that I started to fill out. She reappeared and asked if I was here for a physical. Um, no, and I started to explain. OH, she says, that's why I didn't have paperwork. She had just assumed that because I was being seen in a time slot that's usually reserved for physicals that this must be why I'm here. Um, no.

If you're wondering, yes, it is the same nurse who believes that "they" have already discovered a cure for cancer but are keeping it to themselves. After we have that awkward conversation, nurse leads to doctor, doctor leads to lab tests (and yes, another ultrasound). Lab tests lead to slightly elevated levels of creatinine.

Huh? About 10 minutes after I saw the tests online, I get a call from a nurse saying that my PCP wants to run the test again. Okay. In the meantime, it's time for me to figure out what the hell creatinine is. And why mine is slightly elevated. I do some reading. I convince myself that I am beginning to have kidney failure, even though my kidneys feel just fine. I do some more reading, trying to find why it might be elevated. I'm now certain that my kidneys are failing... or I have pre-eclampsia, which only applies to pregnant women. I read some more. I know that "Creatinine is a breakdown product of creatine, which is an important part of muscle" but I haven't started any giant muscle building program. I finally hit upon this nugget: among the things that can elevate creatinine levels are strenuous exercise, high levels of red meat, caffeine.

My bloodwork was done on Monday around 3 pm. What happened in the 48 hours prior? Well, ran about 3.5 miles at 6 pm on Saturday. Ran about 5 miles at 11 am Sunday. Had leftover brisket (mmmm) for lunch on Sunday and Monday. Oh, and I didn't sleep well on Sunday so had an extra cup of coffee on Monday around noon. Strenuous exercise. Red meat. Caffeine. My kidneys visibly relaxed.

When they retested me on Wednesday morning, just to be safe, I had them prick the other arm. Wednesday afternoon, I got the results: as I suspected, creatinine levels were back to normal.

I celebrated with a nice brisk run this morning (after my coffee, of course). And resigned myself to the fact that my veins, like their owner, are just older and more tired than they used to be.