How to build a laundry room

I’ve just finished the first room in our complete home remodel project. OK, it’s not a real room, it’s a 3-foot by 7-foot laundry room. And I haven’t really finished it yet. But it’s more finished than any other room in the house, so I’m satisfied with my progress.

The house already had a laundry room, but we demolished it and the wall between it and a guest bedroom. The combined rooms will become the new master suite bath. (Yes it will be a large bathroom.)

Meanwhile, we demolished the old master bathroom. Most of it will be converted into a walk-in closet. (Yes, that’s a large walk-in closet. And we’re combining the two reach-in closets in the master bedroom and the guest bedroom to make another walk-in closet. So we will have a pair of walk-in closets, a hers and hers set.)

The end of the old master bathroom, where the bathtub was, will be walled off and converted into the laundry room.

The before and after floor plans are shown below.

Original floor plan with old laundry room and master bathroom highlighted

Proposed floor plan with new smaller laundry room and larger master bathroom highlighted

Demolition

The first step in creating the laundry room was removing the old bathtub. It is cast iron and really heavy. It took four guys to move it down the stairs into the new dining room until I make room for it in the basement (where we will be adding a full bathroom).

At this point, we discovered a problem. The gasket between the shower faucet handle and the tub surround wasn’t sealed properly and one or two drops of water would land on the subfloor every day. In Seattle that means the subfloor would stay wet and was rotted. Also, when the plumber originally installed the drain for the tub, he cut through the joist. Now the floor was sagging. So we had to rip out the ceiling on the first floor underneath the tub, sister the existing joist with a new 2×10” and replace a section of the subfloor.

Framing

You will notice that the new laundry room has a bi-fold door where a wall in the old bathroom was. This is a load bearing wall, so it needed to be replaced with a beam and two columns. Normally, when you do this, you install temporary “crib” walls on both sides of the load bearing wall before removing it. But I cheated. Instead, I used the existing hallway wall as one support and built the new wall for the back of the laundry room and used that as the other temporary support. Then I removed the load bearing wall and installed two 4×4′” columns and a 2.75”x9.75”x7’ glulam beam. (Actually, I hired a framing contractor to do this since it’s too heavy to lift alone.)

Rough-in

The next step was to complete the plumbing, mechanical, and electrical work. The new plumbing includes a hot and cold water outlet box with single handle shut-off valve and  a pair of anti-hammer arresters, washer drain line and trap, and a floor drain and trap with drip valve (to prevent the floor trap from drying out and creating a stink). The mechanical work includes a 1/2” gas line, an in-wall dryer exhaust that vents through the roof, and a room exhaust fan that vents through the roof. This last item was not my choice, it’s required by building code. Electrical work includes two GFCI circuits (one each for washer and dryer), two IC recessed lights, the exhaust fan, and a wall switch.

Walls

Once all rough-in inspections were passed, I filled the wall with R-13 glass fiber insulation for sound control and covered it with 5/8” green wall board held with ceramic coated screws. I followed that with tape, mud, three coats of plaster, primer, and paint.

Laundry room getting a coat of primer. Photo montage by George Taniwaki

Floor

The laundry room has a tile floor. First, I cut a piece of 4×4” pressure-treated lumber to build a curb. I originally wanted to put the curb entirely inside the laundry room so that it would not be visible from the hall. But that would not leave enough room for the dryer and its duct. So I cut notches in the lumber and fit it around the opening. (Note to self, next time make the laundry room at least 35” deep.)

Because the washer and dryer will vibrate a lot, I wanted to add a water-proof isolation membrane between the underlayment and the tile. I used Schluter Ditra and Kerdi-Band. Since the laundry room will rarely (hopefully, never) have running water on the floor, I decided not to slope the floor toward the drain. This also allows me to use larger tile on the floor.

Here’s where I learned (the hard way) that there are several different kinds of mortar. Mortar used to lay bricks tends to have coarse sand in it. Mortar for tile has fine sand. Mortar for tile also contains a small amount of acrylic latex to make it smoother. This is called thin-set mortar. If you add even more acrylic latex (rather than water) when mixing the mortar, it then is called modified thin-set mortar.

You use modified thin-set mortar to apply the membrane to the floor. You use unmodified thin-set mortar to apply the tile to the membrane. (Don’t confuse brick mortar with unmodified thin-set mortar.) You need to use unmodified thin-set mortar because latex-modified mortar requires air to cure and since the membrane and tile are both nonporous, there won’t be enough air contact for the mortar to cure properly.

Laundry room with waterproof membrane. Photo montage by George Taniwaki

After waiting an hour for the membrane mortar to set, it’s time to lay the tiles. In the picture below, notice the arrangement of tiles around the floor drain. Normally, you want to the tiles to intersect over the hole so that you can use a tile saw to cut a series of notches and nibble away to the edge of the hole. However, that wasn’t possible in the small laundry room. The hole had to be in the center of the tile.

Cutting a large hole in a floor tile is difficult. It requires enormous patience and arm strength if you cut it by hand using a rod saw. I gave up and took the tile to Tile For Less and they cut it for me for $35 using a heavy-duty handheld angle saw. This is another reason (besides fitting the slope) for using small tiles in a shower stall. All of the other tiles in the laundry room have straight cuts or bevel cuts and I was able to make them using my inexpensive ($39 on sale from Harbor Freight Tools) 4”wet tile saw.

When installing tile, always use the little cross-shaped rubber tile spacers. You’ll never get the tiles aligned nicely by eye. Also use the right sized notched trowel when applying the mortar, bigger notches for bigger tiles. And back butter large tiles (like the 12×12 tiles in this project) to ensure good adhesion. Finally, use a dead blow hammer to tap the edges of the tiles to get them all to the same height.

Laundry room with tile. Notice the tile spacers, notched trowel, and dead blow hammer. Photo montage by George Taniwaki

After waiting 20 minutes, I washed the tiles with a sponge to get the stray mortar off. Then I waited a day and applied grout. The local Home Depot carries two kinds of grout, sanded (for use with tiles spaced 1/4” or wider) and unsanded (softer but can fill smaller gaps, used for tiles set under 1/4” apart). All of the grout is pigmented. There are 30 different colors, all with cryptic names like sandstone, fawn, and bone. I didn’t have a tile with me, so I called my wife and asked her to pick up a spare tile from the laundry room and open a web browser compare it to the color swatches on the Home Depot website.

Being an expert on color theory, Windows GDI, LCD display technology, and color management didn’t give me any confidence that this would work. But the alternative would be to compare a tile to the colors printed on the bags of grout. Neither seemed ideal. She picked haystack, a grout color that seemed darker than the darkest color in the tile and I bought a bag of the sanded grout. I mixed it up and used a plastic mud knife and a hard foam pad to apply it.

If you are doing this, wait twenty minutes, then wash off the excess using a scrubbing sponge. Afterwards, a thin haze will appear. Don’t worry. Wait two hours until it hardens, then use a polishing sponge to wipe it off. Wait three days, then seal the tile and grout with a liquid sealant. Touch up the wall paint and you are done.

It turns out the grout color is lighter than we expected. However, it is exactly the same color as the body of the tiles. This made it blend in around the walls and the curb which is actually even better than planned.

Laundry room with wet grout (top), with a coat of haze after washing excess grout (middle), and the finished floor after polishing, sealing, and touch-up painting of walls (bottom). Photo montages by George Taniwaki

Finish

The final step is installing shelving, a clothes rod, and connecting the appliances. The shelf brackets are designed for wire shelves. I snipped off the little hooks that hold the wire shelves so that I could use solid shelves. The shelves are made from 3/4” MDF with white melamine laminate. I cut notches in each shelf to fit around the vertical posts. The clothes rod is hollow and sounded cheap when a hanger would click against it. So I filled the rod with polyurethane spray foam insulation to deaden the sound.

When connecting the dryer vent to the exhaust, use plenty of metal foil tape (not duct tape) to seal the connections. This will keep lint out of the laundry room and reduce the amount of carbon monoxide (assuming you have a gas dryer) released into the house.

Mostly finished laundry room. Photo montage by George Taniwaki

In total, this project took me over 100 hours to complete (everything described above except heavy framing and plumbing) and probably cost over $3,000 in labor (split between the framing team and plumber) and $1,000 in materials. And it still isn’t done. I still need to add tile and grout to the exterior of the curb and I need to build and install custom bi-fold doors. Neither project can be done until I install the floor in the hall. And that project is in the distant future.

 

Likelihood of odd coincidences

Here’s a riddle.

Question: I donated a kidney anonymously on Wednesday, September 29, 2010. This is a rare act. Perhaps 300 people worldwide did it last year. I also write extensively about kidney donation. I was reading Renal & Urology News May 2011 and I saw a story written by a person explaining why he/she donated a kidney to a stranger on Wednesday, September 29, 2010. But it wasn’t written by me. It was a weird experience reading the story about someone who is very similar to me. (I encourage you to read the article.) What are the odds that two people who enjoy writing also donate a kidney anonymously on the same day?

Short answer: Ex post, p=1.

Long answer: Before the two surgeries occur (called ex ante), the joint probability that my surgery (let’s call it event A) occurs on the same day as the other donor (let’s call it event B) is written as P(A ∩ B). We want to break this probability into two parts. First is the probability of my surgery happening on a particular day given that the other person donates the same day. This is written as P(A|B). Similarly, the probability of the other donor’s surgery date given mine is P(B|A) and the joint probability is obtained by multiplying the two together, P(A ∩ B) = P(A|B)*P(B|A).

In this case, I am certain (P>.99) that the date of my surgery was not influenced by the other donor. I was unaware of the existence of the other donor until I saw the story in Renal & Urology News. Thus, we can write P(A|B) = P(A).

Further, I will assume that the other donor’s surgery date was unaffected by my date and so P(B|A) = P(B). Thus, I ignore the possibility that the other donor or his/her surgeons read this blog and selected the donation date to match mine. I will also ignore the possibility of spooky effects like quantum entanglement, ESP, and God’s will forcing the two surgery dates to be identical.

Now we have P(A ∩ B) = P(A|B)*P(B|A) = P(A)*P(B).

Now, I will assume that the surgery dates for both me and the other donor are random and independent. If this is true, then P(B) = P(A). Substituting gives us P(A)*P(B) = P(A)^2.

Actually, this is not quite true. Elective surgeries are not randomly scheduled. For instance, surgeons like everyone else, want their weekends free and dislike scheduling elective surgeries on Saturday or Sunday. Similarly, surgeons like to visit their patients for two days after surgeries, but want to avoid coming in on weekends. Thus, they don’t schedule elective surgeries on Thursdays or Fridays. Finally, emergency care patients who enter the hospital on weekends are often taken into surgery on Monday. Thus, elective surgeries are nearly always scheduled on Tuesdays and Wednesdays. Eliminating the weeks of New Years, Christmas, and Thanksgiving, the Tuesdays after 3-day weekends, and allowing time off for vacations leaves about 90 possible surgery dates each year.

Now, there are about 300 other nondirected donors, so on average over 3 (300/90) nondirected donors will have surgery on the same day. Note however, that it is unlikely that the doctors at my hospital are on vacation the same dates as the doctors at the other donor’s hospital, or have the same holiday schedule, so this estimate isn’t quite right. Further, not all 300 donors like to write. And not all the writers will be English speakers. Now we have a complicated mess.

Yuck. Let’s start over. Instead, let’s look at the probability that an event will occur after we know the outcome, called ex post. It is always either 100% (it happened) or 0% (it didn’t happen). In this case, we know it happened so P=1.

[Update: I clarified the logic. I also changed the wording to indicate that I don't know the gender of the other donor. On initial reading of the story, I thought it was written by a man. Now I think it is a woman. But since the writer is anonymous, I can't be sure. About 60% of anonymous donors are female. (But that doesn't mean there is a 60% chance that I am female.)]

 

What low GFR means for kidney donors

The most common measure of kidney function is called the glomerular filtration rate (GFR). Traditionally, a GFR level of 90 or higher (measured in mL/min/1.73m^2) is considered normal. Kidney disease is categorized in stages from 1 to 5 with each stage defined by a GFR range. Patients with chronic kidney disease (CKD) generally progress though the stages until they reach stage 5. At this point they will require renal replacement therapy, meaning dialysis or a transplant. Details are given in the table below.

Stage	Description	Estimated GFR (mL/min/1.73m2)
0	Normal kidney	>90
1	Slight kidney damage but with normal or increased filtration	>90
2	Mild decrease in kidney function	60-89
3	Moderate decrease in kidney function	30-59
4	Severe decrease in kidney function	15-29
5	Kidney failure (requires replacement therapy)	<15

Traditional definitions of the five stages of kidney disease, they may not apply to kidney donors with one kidney

Patients with stage 4 and stage 5 are much more likely to also have hypertension (chronic high blood pressure) and are more likely to die from a cardiac event (heart failure). About 20% of patients in these categories die each year.

Estimated versus measured GFR

Before looking at the results of studies, let’s define GFR and how it is measured. Glomerular filtration rate is the volume of fluid (in mL) that can be filtered from the renal (kidney) glomerular capillaries per unit time (in min) adjusted for the body surface area (BSA) of the patient (that’s the reason the 1.73m^2 appears in the denominator; it represents the height of the average male of about 5 foot-8 inches).

The most accurate way to measure filtration rate is to use find a chemical that has a steady level in the blood, is completely filtered by the kidneys (arrow 1 in figure below) and is not reabsorbed (2) or secreted (3).

Schematic of function of kidney. Image from Wikipedia

The most common chemical used in GFR measurement is a protein called creatinine. It is a waste product from muscle cells and is produced at a fairly steady rate. As described in a Mar 2008 blog post, a test called the creatinine clearance rate (CCR) can be used to measure the amount of creatinine removed from the blood and excreted in the urine in a 24 hour period. A blood sample is taken to measure the concentration of creatinine in the plasma. These two measurements are used to calculate GFR. Since the concentration in both the urine and plasma are directly measured, this is called measured GFR or mGFR.

Collecting a 24 hour sample of urine is cumbersome and it is hard to get patients to do it correctly. (I’ve done it three times in the past two years while being evaluated as a kidney donor, so I’ve become accustomed to the routine.) To avoid the 24-hour urine collection, doctors estimate the GFR using just the serum concentration. These estimates are based on the person’s age (muscle mass declines with age), gender (women have less muscle mass then men), weight (thin people have less muscle mass), and race (blacks have higher muscle mass than whites). GFR calculated in this way is called estimated GFR or eGFR.

A scary story for donors

After their surgeries, some kidney donors are told they have low GFR, below 80 ml/min/1.73m^2, and thus have chronic kidney disease. A recent paper presented at the 26th Annual Congress Eur. Assoc. Urology reports that one year after undergoing a live donor nephrectomy, more than half of donors will have CKD as defined by the traditional stages. The paper is described in Renal and Urology News Mar 2011.

In the study, a team led by Nilay S. Patel examined data from 3,424 living donors in the United Kingdom who had preoperative and one-year follow-up data available. “The fall in GFR [following donation] has been underestimated to date,” said Dr. Patel. Potential donors should be informed of the risk of renal function decline following donation.

Well, this is rather scary. Is it safe to donate a kidney?

Rising GFR after donation

In the study above, Dr. Patel notes that after the initial decline in GFR, it appears to remain stable for at least five years. Further, donors rarely suffered adverse cardiovascular events or cardiac mortality.

Among the 784 donors with five years of follow-up data available, only 0.4% experienced non-fatal cardiac events and 0.05% died from cardiac events. New-onset hypertension was diagnosed in 10% of donors.

This is reassuring. Let’s take a look at the results from some other recent studies that investigated GFR after kidney donation.

A study of 237 Japanese donors is reported in Clin. Exper. Nephr. Aug 2010. The authors found that the median estimated GFR at the time of donation was 79, meaning that many donors could be considered to have stage 2 kidney disease. After one year, the average decrease in eGFR was down 40% to 48, meaning most (85%) Japanese kidney donors would be considered having stage 3 kidney disease.

This sounds bad. However, data collected over the next four years shows that on average, the eGFR rose by 1 mg/mL/1.73m^2 per year. This upward change was seen regardless of the absolute values of estimated GFR at the time of donation or one year afterwards. This is unexpected because GFR generally declines with age. Thus, among these Japanese kidney donors, low GFR was not a sign that kidney disease will progress.

A Swedish study published in Nephr. Dialy. Transpl. May 2011 (subscription required) and described in Renal and Urology News Mar 2011 confirms that people who donate kidneys experience an increase in estimated GFR for more than a decade after nephrectomy.

The researchers looked at 573 kidney donors who had a mean age of 47 years at the time of donation and with a mean time since donation of 14 years.

The findings suggest that for 30-year old donors, the median estimated GFR increases for 17 years, then remains constant for 8 years, and then declines thereafter. For a 50-year old donor, the median eGFR increases for 13 years and then declines. The gains were less pronounced for measured GFR. The data, developed using multiregression analysis are shown below.

Curves showing median eGFR (left) and median mGFR (right) for a typical 30-year-old donor (black line) and 50-year-old donor (gray line). Graphics from Nephr. Dialy. Transpl.

Difficulty in measuring GFR

Finally, there is some research that indicates that using the standard calculations for measured GFR and estimated GFR is not appropriate for kidney donors and are not reliable ways to determine if they have kidney disease. An article in Clin. J. Amer. Soc. Nephr. Jan 2010 reports that eGFR underestimated actual kidney function while  mGFR overestimated it. The error was larger the older the donor.

Mark Wedel, a retired MD and kidney transplant recipient, provides the following comment on these studies.

“I think the primary question [these studies raise] is whether or not this change is what one would expect [to occur in these donors] after having half their renal mass removed, and secondarily, does that GFR actually increase as the remaining kidney hypertrophies in response to the donation nephrectomy.

“I’m not aware of any serial data on renal mass following nephrectomy. Ideally, I’d like to see a study correlating GFR with renal mass plotted against time [since transplant].”

Comparing donors to patients

I have drawn two graphs below to represent the change in GFR for two people. On the left is GFR data plotted for a hypothetical 40-year-old woman. Her GFR declines for two years going from 98 to 78 before she is diagnosed as having kidney disease. At this point, which we will call year 0, she has stage 2 kidney disease. Over the following four years her GFR continues to decline and reaches 40 in year 4 meaning she is now at stage 3. If the trend continues we can expect her to reach stage 5 eventually.

On the right is GFR data plotted for another hypothetical 40-year-old woman. Her GFR is relatively flat for two years until she donates a kidney. At her first medical examination after her donation, the lab test show her GFR is 66. We will call this year 0. Her GFR is lower than the 78 level that was used to diagnose the woman in the paragraph above as having stage 2 kidney disease. Should she be concerned? Maybe, maybe not. Let’s see what happens over then next four years. In the case I have illustrated, her annual GFR test results are 76, 83, 88 and  86. These GFR values are still below normal and lower than her pre-nephrectomy values. However, they are trending upward rather than downward. Saying this woman has stage 2 or stage 1 kidney disease doesn’t seem accurate or useful in describing her situation.

This does not mean you can ignore the lab results. However, it means you need to look at the trend as well as the absolute value when evaluating GFR results after a kidney donation.

Note that the same analysis holds true for the kidney transplant recipient as well. Checking to see if GFR is trending upward or downward can play an important role in deciding if the transplant is successful.

  

Change in GFR for a hypothetical kidney patient (left) and a hypothetical kidney donor (right) both show below normal kidney function, but only the one on the left should be considered kidney disease. Graphics by George Taniwaki

 

Paris scam artists

Sue and I visited Paris recently and had a wonderful time (see a Mar 2011 blog post about my visit to the Musée Carnavalet.).

One thing that we found disconcerting was the prevalence of scam artists around the city. Unfortunately, although we took lots of pictures of the city, we failed to take any of these people.

The door blocking musicians

Our first experience with a scam artist was riding the train from the airport to the city center. At a stop after the airport, a young man, who from his complexion I assume to be North African, stepped on the train with a portable amplifier/synthesizer. He blocked the exit door of the train and began singing. When the train pulled to the next stop, he stopped singing and held a tip cup as people moved on or off the train. When the train started moving again, he started singing again. We saw musicians nearly every day while riding the Metro. Unlike the U.S. the musicians were always on the trains, never in the stations. Also, unlike the street musicians I see in the U.S., these people were uniformly untalented.

The school for the deaf

Our second experience occurred a few minutes later as we exited the airport train at Gare du Nord. It is a beautiful building. In front of the station are throngs of teenage girls, all of them deaf (or so they mime), and all of them with long dark hair and brown eyes. I presume they are also North African. They each have a clipboard with note, in English, asking for a donation for their school. They are very persistent, like flies at a picnic. We saw these deaf girls outside all the Metro stations nearest tourist sites and near the Eiffel Tower.

The found ring

Apparently, lots of men drop their gold wedding bands on the ground near museums in Paris. Luckily, there is always a nice gentleman who speaks broken English who will pick it up and ask you if it is yours. When you say “no”, he will ask if you want to buy it and then point to the 14K mark inside the band. Too bad the ring is made of brass. A version of this scam involving a woman is described here.

The woven bracelet

After walking past the hoard of deaf girls at the upper station for the Montmartre funicular , I started walking down the steps. On the way down, I encountered a group of young men who surround me. They are all black, possibly immigrants from West Africa. One of them places a string loop around my wrist and begins weaving it. I get bored with his spiel and move on. The weaver yells down the hill and a second group of young men surround me again and repeat the process. I’m intrigued, but am in a hurry and break away from them. Naturally, they are disappointed that I didn’t stick around to buy a souvenir of my visit to the Basilique du Sacré-Cœur.

Trinket dealers

As you walk toward the Eiffel Tower, there are many people selling souvenirs and toys. There are some selling identical Eiffel Tower key chains (always 12 for 5 Euros) and Eiffel Tower replicas (in several sizes up to a foot tall). Others sell identical wind-up fuzzy dogs. And a final group sells wooden trains with carved letters that you can use to spell your name, or “P-A-R-I-S” or “E-I-F-F-E-L T-O-W-E-R.” Nearly all of the vendors were young men and appeared to be either black or North African.

What’s going on?

I thought it was odd that so many scam artists would use identical techniques. Here are a few ideas that popped into my head.

1. These people are all copying each other because these particular scams have proven to be the money makers. You wouldn’t want to copy a scam that is inefficient.
2. The prevalence of North African and West African immigrants in these scams indicates how hard it is for these people to find regular employment in the French economy. Discrimination forces immigrants and their descendants to live in the margins of society.
3. The tolerance of the French police to these scammers, who prey on tourists and ply their trade in busy public places in broad daylight, indicates a tacit admission by the government that there are no other jobs for these people and to restrict their activities could lead to violent social unrest. Recall the riots in Clichy-sous-Bois and other banlieues in 2005.
4. Some scams, like the musicians are probably independently operated. But others, like the sales of identical toys, and the soliciting for the deaf girl school, indicate that someone may be controlling access to the goods, the forms, and maybe even the prime street locations. These may be pyramid schemes in which the vendors are paying a cut to someone above. These street scam artists may be victimizing tourists. But they may be victims themselves.
5. The girls with the clipboards ask you to complete the “donation” form because this is an easy way for the scam operator to ensure each girl reaches her quota and ensure she isn’t stealing any of the funds.

 

Musée Carnavalet

There’s a museum on every street corner in Paris. I’m exaggerating, but it sure feels that way. On Sunday, I took a walking tour of the Marais district of Paris and made a stop at the Musée Carnavalet. Despite the crowded streets, there were only a few visitors in the museum; apparently most people in the Marais district were busy shopping or eating.

The Carnavalet Museum features artwork and furniture that covers the history of Paris. It is housed in two old mansions connected by a corridor on the second floor. Each mansion has a courtyard with a garden, although at this time of year the gardens weren’t on display. The museum is free and photography is allowed.

A rare prerevolutionary statue of Louis XVI in entry courtyard. Photo by George Taniwaki

Each room covers a single time period, but the rooms are not in chronological order. The labels are in French only. It’s all quite confusing unless you bring a guidebook with you. I used Rick Steves’ Paris 2011.

Just for fun, I took a few panorama shots using my iPhone. They are stitched together using Autostitch, an app featured in a Feb 2010 blog post.

90 degree panorama of first floor staircase. Photo by George Taniwaki

180 degree panorama of mural above staircase. Photo by George Taniwaki

I’ll say one thing about France. There sure were a lot of wars there from 1789 to 1945.

 

World faces novelty eyeglass crisis

In 1991, two Seattle musicians designed and patented the first novelty eyeglasses with lenses fitted inside the circles of the two numeral “9”s. It was a brilliant idea and one that lasted because every year since then has had two adjacent 9s or two adjacent 0s in it. That is, until 2010, which still almost works. But this upcoming year, 2011, begins a drought of double circles that will last until 2016.

But it turns out, the two inventors, Richard Sciafani and Peter Cicero, exited the market in 2008 (Seattle Times Dec 2008) because low-priced knock-offs (from a country that must not be named) have made the business unprofitable. Their company Brainstorm Novelties still exists though.

Richard Sciafani (left) and Peter Cicero. Photo from Seattle Times

The New Year eyewear fashion fad received attention from the Wall St. J. Dec 2010, complete with examples of how some designers have solved the 2011 single circle problem.

Oh well, hope you have your party favors, hats, firecrackers, and plastic champagne glasses ready. Happy New Year!

 

Post-surgical follow-up

It’s one and a half weeks after surgery and I’m scheduled for a follow-up visit at the Univ. Washington Medical Center. This will be my thirteenth visit, and first post-surgical visit, to the hospital related to my kidney donation. (I’ve become a volunteer at the hospital, so I’ll continue coming here, just not as a donor/patient.)

I’m not supposed to drive yet. But my wife, Sue, is out-of-town, and it would be inconvenient for me to take a taxi. Besides, I’m been driving for short errands since last Thursday and have already gone back at work (and driving to commute) last Friday, only nine days after surgery.

As always, my visit starts with a blood draw for a CBC and serum creatinine tests and a urine sample for protein and assay. The tests are ordered stat so that results are ready for my appointment with the surgeon, Dr. Ramasamy Bakthavatsalam.

At my appointment, Dr. Baktha takes a look at my incision and asks me if there has been any bleeding (no) or any pus (no). He asks me if I’m taking any oxycodone (no) or acetaminophen (yes, 500mg 3x a day). He tells me that my incision is healing nicely. He advises me to start kneading the incision 2x a day to prevent my muscles from getting hard and lumpy. That sounds like good advice. I certainly want to look my best the next time I wear a revealing swimsuit.

****

Next I meet with the transplant coordinator, Kami Sneddon. She gives me a thank you card signed by the staff at the Puget Sound Blood Center HLA lab. She also provides me with a slew of goodies. She gives me a pullover sweatshirt embroidered with “Got 2 Give 1 I’m a Living Kidney Donor”, two green ribbon lapel pins, and a UWMC Living Kidney Donor license plate frame. What great swag!

She also tells me that my blood and urine results are normal. My WBC is 5.3, which means it is now “normal”. Well, that really means it’s high. (For more on my low WBC, see this Jun 2010 post.)

****

My final appointment for today is with Paige Kayihan, the living donor social worker. She’s concerned that I am overexerting myself and should have rescheduled my appointment to later in the week so that Sue could drive me. She asks me why I didn’t (I’m fine, really). She asks me how I’m doing (the surgeon says I’m progressing well, and I feel pretty good).

I do say though that reflecting on my experience, even though I was in a lot of discomfort in the hospital, having all those people doting over me and telling me what a wonderful thing I did was nice. It was sort of a letdown to go home and have to do more on my own. I tell her that I’m thinking I about donating my other kidney. She laughs. But how does she know I’m joking?

(Of course I’m joking. I know I can’t donate my other kidney. I would have to donate a lobe of my liver or lung instead. OK, now I’m really joking.)

****

The next day, after Sue gets home, she takes a picture of me with my new gear (see below). In my hands is one of my kidney pillows. I had it signed by all the nurses, therapists, housekeepers, food service staff, doctors, and phlebotomists who visited me in my hospital room.

And check out the mustache and beard. I couldn’t shave (or bathe) while in the hospital, and was too woozy to safely shave after I got home. After a week, Sue told me she liked my new look, so I kept it. I haven’t had facial hair since I got out of college. Almost nobody at work mentioned it. Maybe they didn’t notice it. But more likely they were just too polite to say anything.

The new me, now with facial hair. Photo by Susan Wolcott

 

Kidney jewelry

My wife pointed me to a listing on Etsy for a kidney-shaped pendant. How cute.

PKD awareness pendant. Image from Etsy

 

Surgery and recovery

It is still dark outside when my wife Sue and I leave home to go to the surgery pavilion at the University of Washington Medical Center. My check-in time is 6:15am and we left home at 5:30. We have both overestimate the amount of traffic on the 520 bridge this early in the morning. (There is almost none and even though I’m going 65 mph, it seems that what few cars there are, are all passing us.) We get to the hospital easily before 6am.

The receptionist pulls out my yellow chart. She takes the forms she needs and hands the rest back to me. I ask her if I’m scheduled for laparoscopic surgery or open surgery. She looks at a timesheet and states that it says I am scheduled for laparoscopic but the surgeon will confirm. I’m still hopeful about it. She has me fill out some additional forms and puts a wrist band on me. Sue and I take our seats and wait.

****

I am not a happy camper. I haven’t had anything to eat in over 24 hours or anything to drink since 11 pm last night. I’m also still feeling the effects of the bottle of magnesium citrate I drank yesterday afternoon and so have to take a trip to the restroom.

****

After about an hour in the waiting room, I hear my name called. An attendant ushers us to a pre-operation room. A nurse explains that I can put my clothes and valuables in a garment bag and put on a gown, elastic calf compression socks, and non-slip booties. After I get into the gurney, she starts up a hot air blower that inflates a disposable air blanket. The flimsy blanket is surprisingly warm and comfy while the blower is almost silent.

I have to urinate, so I get up and find a nurse who directs me. But I can’t go, apparently there’s nothing left in me. Slightly embarrassed I get back in my gurney.

Suddenly the room becomes a hive of activity where a steady stream of people enter to check on me and my chart. First, a new nurse takes my vital signs, my BP is 128/90, which is really high for me. Then the first nurse returns to check my wrist band. She asks me to spell my name and give my birthdate. She then takes a sheet from my chart. She asks me to describe in my own words if I know what procedure I’m about to receive. I say, “donor nephrectomy, right side, possibly using laparoscopic method.” But then I say, “Actually, those aren’t my words, they’re the surgeon’s.”

A phlebotomist takes some more sheets from my chart and takes several vials of blood. An anesthesiologist, who is not the same doctor who interviewed me two days ago, comes in to discusses my case. An anesthesiology nurse enters and inserts an IV catheter line in my left wrist. Some confusion develops because the anesthesiologist says he was told the surgery was laparoscopic and if I am undergoing open surgery I should get either an epidural or spinal. The circulating perioperative nurse enters and reviews my chart.

Anesthesiologist, anesthesiology nurse, and circulating OR nurse holding the all important chart. Photo by Susan Wolcott

The surgical resident appears and marks my right flank with his initials. He doesn’t know whether the surgery will be open or laparoscopic either. He tells the anesthesiology nurse to stop my IV until he has a chance to confirm with the surgeon, because I need to be coherent when the actual procedure is explained to me. He grabs the chart and leaves. A couple of minutes later he returns and says the IV can start because I’ve already signed the consent form for open surgery.

Finally, the surgeon shows up. Dr. Bakthavatsalam asks me how I am and checks my right flank. He confirms that he will be performing open surgery. He says that is better than starting with laparoscopic and then switching to open if he cannot reach the renal artery using the robot.

He tells the anesthesiologist that I won’t be needing an epidural or spinal. Everything is ready, so I am wheeled into the OR. It is a large white room filled with people, bright lights, and equipment. I turn my head to see what’s on the other side of the room and then, nothing.

****

When I awaken, I am in a gurney and being lifted into a bed in a private room. It is just after 4 pm. Over seven hours have passed since my last conscious thought. I vaguely recall being wheeled into this room from the post-anesthesia care unit. But maybe I’m just imagining that since logically I know that’s where I must have been. I have no memory of leaving the operating room or ever being in the PACU.

I feel drowsy, disoriented, and very weak. It hurts to breathe or move. A nurse checks my wrist band, asks for my name and birthdate, and then introduces herself. She asks me to rate my pain on a scale of 1 to 10. I say 7. She says I can administer morphine using the PCA pump. The pump is calibrated to provide a 0.5 mg dose into my IV catheter when I push the button. There is no background dosage, so if I don’t press the button, I won’t get any pain relief. She tells me to err on the side of pressing the button too often rather than holding back. I can’t OD because the device has a timer set so that the button is locked out for six minutes after each dose (for a maximum dosage of 5 mg/hr or 120 mg/day). A blinking light tells me that pressing the button will cause the pump to switch on.

I press the button. The blinking light goes out. I hear a beep followed by the pump whirr, but don’t feel any better. This is going to be a long evening.

 

How I feel on the day of my donation

Well, this is the day. It’s 5:00am. I’m leaving in a few minutes to check in at the surgical pavilion at the University of Washington Medical Center to have my kidney removed (right donor nephrectomy). It’s the culmination of three years of waiting to find a program and a hospital to accept my offer of a kidney. I slept fine last night (except having to get up twice to go to the bathroom), but I’m a still a bit tired and a bit nervous.

****

Over the past several months, a lot of people have asked me how it feels to be a potential kidney donor. They want to know if I’m getting excited or if I’m scared. Some of the people asking me that are also donors themselves. In July, Angela Stimpson, who has a wonderful kidney donor blog called OK Solo, asked me if I was excited. My response to her then follows.

“…Anyway, I’m not excited yet. I guess part of it is because I’m not an excitable kind of guy. Another part is that I’ve been waiting so long that I’ve had time to read, think, watch YouTube videos, and write about what I’m doing. So most of the mystery is gone. And another part is that it seems so passive. It’s not like getting ready for a vacation, climbing Mt. Rainier, or running a marathon. There isn’t any planning or training involved. And once my big day arrives, the first thing that will happen is they’ll knock me out, so there won’t be anything to see or remember. (Too bad I can’t just have a local, just so I can stay awake and watch… Or maybe not, since I might ask too many questions and distract the surgeon.)

“I’m sure I won’t sleep well the day before my surgery, but other than that, I don’t expect much of an adrenaline rush. But afterwards, if I get to meet the recipient, that will be pretty emotional.

“Hoping you the best with your donor surgery (which with any luck will happen before mine)…”

[Incidentally, Ms Stimpson’s donor surgery was Sep 21, so it did happen before mine.]

Image from OK Solo

And I dug up another email exchange. This one with Cara Yesawich who donated a kidney on Apr 25 and has a lovely blog called Simply Cara. In early June (when my donor surgery was scheduled for Jun 29), she asked if I was getting excited yet. My response:

“Eh, no excitement yet. But I still have 3-1/2 weeks left to go.”

Photo from Simply Cara

Actually, maybe it’s a good thing that I don’t get too emotional. My original donor surgery was cancelled less than a week before the scheduled date. It would have been a lot tougher on me psychologically if I was heavily invested in completing it on that specific day. And if I was the nervous or superstitious type, maybe I would have taken it as an omen and cancelled the whole thing. Instead, I took it somewhat in stride and picked a new donor surgery date three months later.

****

Well, time to go. If you never see another post from me again, you’ll know why. Just kidding. (Though I guess it’s true. And not just today for me. It’s true every day and for every person you know, including yourself.) Life is precious and ephemeral. So do stuff now that makes it worthwhile. Don’t wait and regret what could have been.