Two Good Months and a Can of Coke

Second month in a row, every number on my labs came back inside the range. The doctors are pleased. And the first thing my brain did with that information was suggest a can of Coke.

Not a dinner out. Not a trip. A can of Coke. Two months of the phosphorus number finally sitting where my doctors want it, and the prize my head picked out is a drink with phosphoric acid on the label. I'd like to say I laughed. What I actually did was stand there looking at the can for a while, thinking: I can afford this now. I'm free.

I don't know what did it

That's the part I want to be honest about, because it matters for what comes next.

Four things changed this summer, roughly at once:

• I've been lifting two or three times a week. The gym when I get there, dumbbells at home when I don't.
• My dry weight went up. My dialysis team changed it; I didn't.
• Since the weight was changed, I've been less thirsty and, oddly, less hungry. The total amount I eat in a day seems to have gone down without me deciding anything. Purely my observation. I have no idea whether it's physiology or coincidence.
• I've been logging what I eat in renalee, the app I built.

Which of the four moved the number? No idea. Maybe all of them. Maybe none, and it's just a good stretch. Two data points is two data points.

Where the tension went

When the phosphorus was high, there was a constant tension. Where is it now. What did I eat that pushed it up. How do I bring it down. Every meal was a small negotiation.

Then the results came back good, and the tension stopped. And I noticed something I didn't expect: the tension was doing work. It was the thing standing between me and the Coke.

Good labs are a bank statement. They tell you the account was fine last month and nothing about what you're about to spend. My head reads the statement, sees a positive balance, and proposes spending it before I've finished reading.

It's an easy trap to fall into, because labs are delayed feedback. Whatever I eat tonight doesn't show up in a number tonight. For a while, everything still looks fine. There's a gap between the thing I did and the number that shows it, and that gap is very good at convincing me the thing had no cost.

That gap is one of the reasons I built the app in the first place. I can't watch my labs in real time. I can at least keep a rough estimate of what went in, in my pocket.

The disease didn't read the results. Nothing about the last two months means the next two are free.

The cheat meal

If I take the binders when I'm supposed to, watch what I eat, lift twice a week, and the phosphorus comes back fine, my head doesn't say: stop. It says: you've earned a cheat meal. Which sounds reasonable, and that's what makes it work. On a Saturday evening, with the results in front of me, one earned exception is the most natural thing in the world.

And it's never just Coke. The Coke is the visible part. The rest is quieter: a workout that slides to tomorrow, the app I don't open because I "more or less know" what I ate, the optimistic estimate instead of the honest one. Good results loosen everything at once, not one thing.

I've been through this loop before. Things get bad. I get disciplined. The numbers improve. The tension goes. I relax. Nothing dramatic. The exceptions just stop being exceptions, and eventually the lab sheet reminds me the disease was there the whole time.

What I do with a good result

Not much. The gym result comes from going back on Thursday, not from having gone on Tuesday. Same with this.

I'd like to report that the battle was won. I didn't buy the Coke. I bought a Dr Pepper. Different can, same trick.

Observation continues.

I'm a dialysis patient, not a clinician. My targets, phosphorus, potassium, dry weight, all of it, are set by my nephrologist and my dialysis team, and yours are set by yours. This is what happened in my head this month, not a recommendation for anyone else.