Patricia DeFranco 6-3-1935
Kidney Stone Story
November 2015
Mon.,23rd SIUH ER Acute, right flank pain
CT Scan, multiple stones R kidney
morphine x2, with no relief.
Toradol, Flomax, Percoset, with relief.
IV Meropenem 500mg QD.
Tues.24th Cystoscopy under general anesthesia
Dr. Katlowitz Double J stent inserted.
Stones untouched due to infection.
Post anesthesia Blood Pressure 90/40
Transfer to Cardiology CCU over night
Wed.,25th Transfer to floor
IV fluids and continue IV Meropenem
Thur.,26th Tx same as above, starting to cough
small amt. Swelling both feet
Fri., 27th Discharge to home, slight SOB upon exertion
increase in coughing from day before
both feet small amount of swelling
Augmentin 500 mg. PO q 12 hour
Flomax 0.4 mg PO QD
Sat.,28th Marked SOB upon exertion, cough constant,
gross swelling both legs and feet above knees
Dr. Gobran covering for Dr Kiroycheva, says
check creatinine, then start Lasix 40mg. BID
seen by Dr. Roberts @ Annadale Urgicenter
Sun., 29th SOB upon exertion improved
coughing less, swelling of legs decreased
Frequent voiding
Mon.,30th Dr. Makarovskaya SOB improved, swelling
legs decreased. Continue Lasix for fluid overload
Wean from Lasix over next few days.
BMP B-type Natriuretic peptide drawn.
Have bi-lateral venous doppler and echocardiogram.

December 2015
Tues.,1st Venous doppler both legs done @ Annadale Cnt.
Wed.,2nd Quest as per Dr. Kiroycheva blood and urine
Dr. Katlowitz consultation South Ave. will schedule
cystoscope and lithotripsy under general anesthesia.
Fri.,4th As per Katlowitz office Dec.29th Tuesday for surgery
Wed.,9th SIUH pre-admissions Dec. 15th 8:30 am.
718-226-6130
Office visit Dr. Kiroycheva,follow up one month after
stones removed. Appointment Feb. 17th, 2 PM
Fri.11th Echocardiogram done @ Annadale Cnt.
Tues.,15th Pre-admission testing CBC, Chem.7 and U/A done
they will call Dec. 28th with time for OR
Tues.,22nd Dr. Katlowitz office called. Pre-admission urine shows UTI. Wants repeat urine on Dec. 26th.
Dr. Makarovskaya phones in Cipro prescription.
Wed.,23rd Office visit Dr. Makarovskaya for surgical clearance.
Sat.,26th Quest for U/A and urine C+S
Annadale Urgicenter for Flomax refill.
Tues.,29th Stones out, stent in. Discharged to home. Call Dr. Katlowitz for appointment to remove stent.
January 2016
Mon.,4th Dr. Katlowitz office 12:30 PM on Fri. Jan. 8th for
stent removal. Pick up Macrobid @ CVS to start prior
to stent removal.
Fri.,8th Double J stent removed. Continue Macrobid for
3 days. Continue Flomax for 1 week.
Repeat U/A and C+S Quest Tues. Jan.26th, @ 11 am
Renal sonogram @ Regional Radiology Feb. 19th,
Friday, @ 11 am.
See Nephrologist to discuss stone composition and diet. Dr. Kiroycheva, Wed., Feb. 17th @ 2 pm. Have
blood work and urine done before visit.
See Dr. Katlowitz Fri. March 4th, @ 11:30 am.
Wed.,26th U/A and C&S to Quest
February 2016
Mon., 1st Dr. Katlowitz office called. UTI. Start Ampicillin
QID and repeat C&S on Tues., Feb. 9th.
Sun., 7th Finished Ampicillin.
Tue., 9th Quest U/A C+S CBC CMP PO4, Lipid Panel VitD
Wed., 17th Dr. Kiroycheva: do 24 hour urine using Litholink Kit. Discontinue Caltrate and Centrum Silver. Continue Sodium Bicarb 2 times daily. Continue Hair, Skin, and Nails. Return visit Wed. May 18th @ Seaview.
Fri., 19th Regional Radiology Renal Sonogram done.
March 2016
Fri., 4th Dr. Katlowitz Renal Sonogram: No stones Right kidney, Small stone Left (6x1x1). Recommends Renal sonogram in June to monitor stone, 24 hour urine x2,
about 1 week apart to reduce chance of inaccurate result. States he will forward report to Dr. Kiroycheva and Dr. Makarovskaya and either of them can monitor further growth of Left stone.

April 2016
Wed.,27th 24 hour urine collection completed.

May 2016
Fri., 6th Quest Labs- Blood work and urine done.
Wed.,18th Dr. Kiroycheva: Morning blood sugars low. D/C Januvia. A1C=6
Decrease Glimiperide to QD. Take in morning.
Bicarb. is low.
Increase Bicarb to 2 tabs, Three times a day.
UTI- Amoxicillin 250mg. Q12 times 5 days.
Repeat blood and urine prior to return visit in 6 to 8 weeks.
Repeat 24 hour urine collection, as Litholink rejects sample.
Tues.,24th Saw Dr. Giterman for 1st time. No treatment change.
Wed., 25th Edema both legs.
Thur., 26th Saw Dr. Zhang for edema. Conferred with Dr. Kiroycheva on phone.
Start Lasix 40mg. In morning, Lasix 20mg. At night.
CMP, bilat. Venous doppler to be done. Antiembolitic stockings to be worn.
Sun., 29th Last dose Lasix 20mg. Weaned as daily improvement of swelling occurred.
Tues.,31st CMP drawn Annadale.
Urgicenter visit for eye. Blepharitis.
Start Duricef (Cefadroxil) 500mg.BID x7days.
JUNE 2016
Wed., 1st Telephone Dr. Kiroycheva, read CMP results and decreases dosage Duricef to 500mg. Qd x7days.
Bilat, venous doppler done Annadale.
Thurs., 9th Renal Sonogram Annadale done.
JULY 2016
Wed., 6th Quest Blood and urine done.
Wed., 13th Dr. Kiroycheva: No changes in meds.
Increase glasses water to 7 to 8 daily.
Renal sonogram OK.
Do 24hour urine.
Return Oct. 12th 1:30 pm Rich. Ave. office.
Blood work and urine prior to visit.
SEPT.2016
Tues.,13th Visit Dr. Giterman
No change to meds.
Renewed referral to Nephrology.
Orders lab work
Repeat echocardiogram

Mon.,26th Echocardiogram done.
Flu shot received.
Tues.,27th Quest blood and u/a done.

Wed.,29th Dr. Giterman : “mild dilation of aorta”
To repeat echocardiogram in 6 months.
Decrease Vit. D to once every 2 weeks.
Start Calcitral .5microgram daily

JAN.,2017
Wed.,18th Dr. Kiroycheva: Labs good, BP 170/80
Log blood pressure and start:
Amlodipine Besylate 5mg. Daily (Norvasc)
Decrease Bicarb from 6 tabs daily to 3 tabs daily.
Prophylactic Amoxicillin 2000mg. 1 hour prior to root canal.
May try Melatonin 2mg. as needed for sleep.
Get Renal Sonogram.

Tues.,31st Renal Sono done Regional Radiology Eltingville

FEB.2017
Thurs.,2nd Dr. Gitterman. Renal referral re-newed.
Repeat Echocardiogram in Sept.
Get fasting blood work. Return visit May 4th.

Wed.,8th Fasting blood work done Annadale.

Tues.14th Quest, blood and urine done.

Tues.14th Telephone from Dr. Gitterman:A1C =7.4
Thyroid level elevated, will re-evaluate next apt.
Vit.D level decreased.
Return to taking Vit.D2 50,000 units once weekly.

March2017
Tues.,1st Dr. Kiroycheva. Return in 3 months. Lab work prior to return visit.

April2017
Thurs.,6TH Dr. Carro

May2017
Thurs.,4th Dr. Giterman

Weds.,31 Quest

June2017
Weds.,21st Dr. Kiroycheva

Sept2017
Weds.,27th Dr. Kiroycheva. Potassium elevated. Creatinine up.

Oct.2017
Tues.,24th Quest

Nov.2017
Weds.,8th Dr. Kiroycheva.

Mon.,13th Sonogram bladder and kidney. Regional, Rich. Av

Dec.,2017
Weds.,20th Dr. Kiroycheva.

Thurs.,28th Quest, blood.u/a and C&S.

Fri.,29th Admitted SIUH So.Site.x5days
SOB, New onset A.Fib, Pericardial effusion.
Nasal 02, IV bicarb., Sub Q Heparin QD.
Start:Amiodarone 200mg.QD
Aspirin 81mg. QD

January2018
Weds.,3rd Discharged to home. SOB continues.

Thurs.,4th Awakens with marked edema both feet. SOB. Verbal order Dr. Kiroycheva: Lasix 40mg po this PM.
Continue drinking water as previously instructed.

Jan.,2018
Fri.,5th Verbal order Dr. Kiroycheva:Lasix 20mg po this PM.
Find cardiologist to assess new onset A-Fib. (not on coumadin) repeat echocardiogram.
See Pulmonary Dr. Elsayegh

Tues.,9th Cardiologist Neil Greenberg,SI Heart,501 Seaview Ave,Suite300.States: No Afib at this visit. Lungs clear, pulse 02=95%. .Continue Amiodarone and ASA. Return for Echocardiogram and re-evaluation Jan 23rd.

Weds.,17th SIUH No. Site ER for c/o Right flank pain.
CT scan from lower chest to pubic symphysis w/o contrast done. Percoset po for pain.

Discharge Instructions:Percoset po q 4 hour,
warm compresses to right flank.F/U withUrologist, Get Pulmonary eval with dedicated chestCT scan. Have apt. with Dr.Elsayegh Jan.30th.

Tues.,23rd Dr. Greenberg. EKG, no A-Fib at this time.
Echocardiogram, no fluid noted. BP 140/76
Lungs clear. 24 hour Holter monitor ordered. Return in 3 months, April 26th@11:00 AM.

Jan.,2018
Fri.,26th Dr. Giterman. C/o right shoulder and chest soreness.Crackle heard Right lower lung.
Chest Xray-right pleural effusion.
Ekg-no afib at this time.
Renal Sonogram done.
Albuterol inhaler PRN. See Dr. ElSayegh Tues.Jan. 30Th, pulmonary.

Tues.,30th Chest CT scan w/o contrast done, Annadale.

Tues.,30th Dr. Elsayegh. CT scan chest and chest xray reports reviewed. BP 144/84. Spirometry done.
Request for pleural tap initiated.
Recommends; Lasix, if cleared by Dr. Kiroycheva.
And D/C Albuteral inhaler use.

Tues.,30th 24 hour holter monitor placed Dr. Greenberg.

Weds., 31st Dr. Kiroycheva. Start;
Lasix 40 mg QD each am Lasix 20 mg each pm x 2 days.
Ferrous sulfate (iron) 325 mg two times daily.
Colace or Senna prn.
Will discuss pleural tap with Dr. Elsayegh.
Follow up with Dr. Katlowitz.
Return Dr. Kiroycheva on March 14. Lab work to be done in home (arranged by Kiroycheva’s office)

February 2018
Fri.,9th Dr.Katlowitz reviewed renal sono done on Jan.26th.No intervention is feasible due to other existing problems.

6 small stones Right, 3 small stones Left.
All stones could/should pass without incident.

Except 4x5mm stone lower Right pole.
If obstruction occurs suggests Flomax.
Surgical intervention only if dire circumstance dictates.

Mon.,19th Dr. Elsayegh. Pulse 02=96%. BP 132/80.
Cxray done. Less fluid noted.
Pleural tap for therapeutic purposes only, PRN.
Repeat cxray 4 weeks, March 26th @ 12;30 pm.

March 2018
Tues., 6th Quest blood work done @ home.

Weds., 14th Dr. Kiroycheva.
Calcium low. Restart Calcitrol once daily.
Calcitrol to help absorb calcium.

May resume Vit. D2. Check blood sugar daily.
If greater than 150, resume Glimeperide, but reduce to 2mg. Daily.

Monitor BP. Use Amlodipine Besylate 5mg. For elevated BP instead of Valsartan 80mg.(also known as Diovan).

Return in 6 weeks, blood work to be drawn @ home by Quest. Dr. Kiroycheva’s office will arrange.

If Dr. Giterman orders blood work, ask that he checks Iron. Return April 25th, Weds.

Mon.,26th Dr. Elsayegh. Pulse Ox.=97%. BP 126/80.
Chest X-ray. Pleural Effusion same. No edema feet at this visit. Return in 2 months. June 4th, Monday @12:30.

April 2018
Mon.,23rd Tooth Extraction. Dr.Lydia Lam, oral surgeon.

April 2018
Weds.,25th Dr. Kiroycheva. Reduce Bicarb to 1 tab three times daily.
Resume Amlodipine 5mg.daily.
Notify if systolic BP remains higher than 150. Will increase Amlodipine to 10mg. Daily or switch to Nifedipine if need be.

Discuss complaint of leg weakness with Dr. Giterman. Return 4 weeks. May 23rd., Weds.@ 2.

Thurs.,26th Dr. Greenberg. EKG=no A Fib @this visit. BP= 134/80. No edema feet. Notes weight loss. Continue Amiodarone. Return Aug. 23rd@11.
Ask Dr. Giterman order sed. Rate and liver profile.

May 2018
Mon., 7th DR. Giterman. BP 124/70. Pulse Ox=98%.
Mild SOB upon exertion. Lungs clear.
States review of films, No Chronic Pancreatitis.

Discuss c/o bilateral leg weakness, unsteady gait, and hand tremor. Recommends PT @ home. Will arrange in home blood work. Return visit based upon lab results. Office will call to instruct scheduling return visit.
May 2018
Weds.,23rd Dr. Kiroycheva. Creatinine worse, 4.6.
Phosphorous elevated. Start Renvela 800 mg. three times daily. Also known as Sevelamer Carbonate. Purpose to bind phosphorous.

Recommends AV fistula placement to ready for hemo dialysis. See Dr. Tarantini, vascular surgeon.
Met with Leilani Roperos, dialysis care coordinator.

Start ReQuip 0.25 mg. 1 tab before bed. For c/o restless leg. Also known as Ropinrole HCL.

Please renew referral for renal.

Weds.,30th Vascular Surgeon, Dr Tarantini for vein mapping.

AV fistula placement problematic due to deep and crooked vessel. Would require surgery twice, once to create fistula, second time to bring fistula up to surface for access. Could take between 8 to 13 weeks before fistula could be used.

Discussed graft placement. One surgery to insert graft, could be ready to use in 2 weeks time.

Fistula and graft both under local anesthesia, with sedation. Done Dr. Tarantini’s office.

Dr. Tarantini to confer with Dr. Kiroycheva.
Cardiac clearance required Dr. Greenberg.

Return Tuesday June 26th, @6;45 am. NPO after midnight.
Will discuss meds to be taken prior to surgery with Dr. Kiroycheva at June 20th appointment.

Thurs.,31st Visit Dr. Giterman. He spoke with Dr. Kiroycheva. Both agree PermaCath should be placed as soon as possible. Dr. Giterman explains PermaCath and signs/symptoms of uremia that are present at this time.

Renews renal referral.

Thurs., 31st Dr. Kiroycheva called .States she will discuss PermaCath insertion with Dr. Tarantinini’s office, will also research availability of dialysis spot to get started sooner than later.

PermaCath placement Tuesday, June 12th, 1PM.
@Dr. Tarantini’s office, 2025 Richmond Ave.
NPO after midnight.

JUNE 2018
MON.,4TH Visit Dr. Elsayegh. BP=120/74. Pulse Ox=98%.
Chest Xray, pleural effusion 90% resolved. Return in 3 months,Monday Sept.17 @ 11:00.

Tues.,5th Quest to house for blood work.

Fri., 8th Dr. Kiroycheva called Doreen at home.

Blood work from Tuesday;Creatinine level dangerously high. She discussed with Dr. Tarantini. They will disregard need for cardio clearance from Dr. Greenberg. Will proceed with PermaCath insertion on Tues., June 12th.

Also, blood sugar level way too LOW. Discontinue use of Glimeperide immediately.

Tues.,12th PermaCath inserted under local anesthesia, with mild sedation @Verrazano Vascular, 2025 Richmond Ave. Procedure tolerated well.

Post-op instructions. Tylenol for pain as needed, ice for swelling as needed.

Do NOT change dressing, will be done by dialysis staff. Do NOT get dressing wet.

Call office if severe swelling occurs.

JUNE 2018
Weds., 13th Start HD (hemodialysis)@ 800 Castleton Ave., DCI, The Carol Molinaro Center.

Meeting with Social Worker Alexa Priola.
Physical exam done by Esther, resident Physician Assistant.

Dialysis session initiated by Abraham, RN.
Session tolerated without incident.

Dialysis schedule, MON.,WEDS., and FRI.

Keep fluid intake to 1 Liter per day, include tea and coffee in the total.

NO dark Cola drinks.(high in phospherous)

Limit dairy intake.

Fri.,15th Second HD. Blood pressure dropped during session. Length of session reduced.

Will proceed with future sessions slowly.

Aranesp 10 mcg. IV given to stimulate red blood cell production to treat anemia caused by kidney failure.

JUNE 2018
Thurs.21st Called Dr. Tarantini’s office to cancel Fistula appointment for Tues. 26th.
Spoke with Michelle,she says to call to re- schedule when ready. Advises against making appointment for end of September in the event you choose to go forward with fistula sooner than end of September.

JULY
Fri.,13th Hepatitis Vaccine given at HD.

Mon.,16th Tooth out during HD, while eating muffin.
Saw Dr. Diamondstein in afternoon. Mold taken for making a “flipper”.

Wants remaining portion of tooth to be extracted by oral surgeon.
Instructs to make return visit immediately after tooth extracted to fit and place flipper.

Tues.31st Consult with Dr. Lam @256-C Mason Ave., SI Oral & Maxillofacial Surgery.

Return for extraction, under local anesthesia on Tues., Aug. 14th @ 8;30 AM.
Eat breakfast, take Amiodarone before appointment as well as Amoxicillin one hour prior to appointment.

See Dr. Diamondstein for flipper @ 2PM Aug.14th.
AUGUST 2018
Weds., 1st Spoke with Leilani Roperos, RN,the care coordinator @1550 Richmond Ave to discuss transfer to that site.
She will contact Alexa @ Castleton Ave to inform her of possible transfer based upon availability at Richmond Ave site.

Mon., 6th Social Worker, Alexa Priola called to update available slots at 1550 Richmond Ave.
If any are suitable, call and let her know and she will put transfer in motion.

MON.,WEDS., and FRI @ 2;30PM or
Tues.,THURS., and SAT. @ 10;30 or10;45 AM

Both of the above slots covered by Dr. Pepe.

Tues. 7th Spoke with Jill @ Dr. Diamondstein’s office.
She questioned him about coming in several hours after tooth extraction for flipper to be placed. He said yes, come in @ 2PM, Aug. 14th, and he will put flipper in.

Tues.,14th 8:30 AM Tooth extraction with Dr. Lam,done without incident.256-C Mason Ave.

2 PM Dr. Diamondstein for insertion of flipper.
Return for adjustment if uncomfortable after several days.

August 2018
Thurs.,23rd Visit Cardiologist, Dr. Greenberg. EKG, No A- Fib @ this time. BP=130/80, lungs are clear.
137 lbs.

Questioned him about Amiodarone. He recommends staying on Amiodarone indefinitely , as he feels A-Fib will return upon the discontinuance of Amiodarone.

For cardio clearance for Fistula creation, he requests lab work to be done within 30 days.

Return visit January 10, 2019, Thursday.

Mon.27th Called Vascular Surgeon, Dr. Tarantini, appointment made for Fistula creation.

Tuesday, Sept.18th, 7 AM @2025 Richmond Ave. Local Anesthesia with sedation.