Plot Twist: It Was Probably the Tetanus Shot
Friday evening, around 7:00 PM EDT, I was at a recovery meeting when my neck started feeling tight.
Nothing dramatic. Just tight.
Friday is also a dialysis day, so aches, fatigue, and generally feeling like I've been run over by something aren't exactly unfamiliar territory. I had taken some time during the day to sleep and recover, so my first thought was simple:
I probably slept wrong.
Mystery solved.
Or so I thought.
I got home around 8:30 PM. There had been a group conscience/business meeting, I wrote my latest Nextdoor post, and then I hopped onto Zoom with the Fraternity guys.
Basically, a perfectly normal Friday night in my world.
As the Zoom went on, however, things started going downhill.
I was getting achier.
I was getting cold.
And then the thought entered my head:
OMG. Did I pick up ANOTHER flu or virus?
Because apparently my immune system has decided that 2026 is the year we're going to collect illnesses like they're Pokémon.
By around 11:00 PM, I gave up and went to bed.
I'm writing this now at around 6:00 AM EDT after what can generously be described as a terrible night's sleep.
My left arm hurts. I'm achy. I'm pretty sure I have a fever. I feel miserable, and most importantly, I know my body well enough to recognize that this isn't my normal post-dialysis "I've had better days" feeling.
Then, sometime during the night, my brain finally decided to provide one very important piece of information:
Thursday morning, I got a tetanus shot.
Oh.
Yeah.
That.
Mystery possibly solved.
I'm not an anti-vaxxer. I got the original three COVID shots early on, and I've been offered additional boosters since.
But here's the problem:
Every COVID shot made me feel absolutely miserable for almost exactly 36 hours.
Apparently my immune system doesn't quietly process a vaccine.
It holds a staff meeting.
There are committees.
There are breakout sessions.
Someone orders lunch.
And apparently the entire organization needs about 36 hours to discuss what just entered the building.
I understand why it happens. Vaccines are designed to get the immune system ready to recognize and respond to a particular threat. Fever, fatigue, aches, chills, and a sore arm can happen afterward.
Knowing why I feel miserable, however, doesn't make me feel any less miserable.
Which brings me to the vaccine I've been successfully avoiding:
Shingles.
I've been told I should get the shingles vaccine. I'm diabetic. I'm on dialysis. I've had chickenpox. There are plenty of reasons for me to take shingles seriously.
And yet…
I keep putting the vaccine off.
It's not because I think vaccines are bad.
It's because I know the conversation that's going to happen in my head:
Responsible Niel: "You should get the shingles vaccine."
Other Niel: "Remember the COVID shots?"
Responsible Niel: "Yes."
Other Niel: "Remember the tetanus shot?"
Responsible Niel: "Unfortunately."
Other Niel: "Let's revisit this next month."
So here I am, Saturday morning, achy, feverish, sleep-deprived, with a sore arm, writing a blog post at 6:00 AM because apparently sleeping wasn't on the schedule.
The good news?
I probably didn't pick up another random virus.
The bad news?
My immune system appears to be holding another all-hands meeting.
Given how I feel right now, attendance is mandatory.
Proof It Was Time for a New Dialysis Backpack 🎒
Yesterday I purchased a new backpack for dialysis, and today was its first trip to the clinic.
Could I have used my old backpack a little longer? Maybe. But after looking at it, the answer became pretty clear. The seams were ripping, and it was only a matter of time before it failed. It wasn't a case of wanting a new backpack—it was a case of needing one.
My dialysis backpack carries my blanket, pillow, and other essentials three mornings a week. The last thing I want is for the seams to split while I'm walking into or out of the clinic, leaving everything on the ground in the middle of the swampy Lowcountry heat and humidity.
The old backpack served me well, but this is proof that replacing it wasn't an impulse purchase. Sometimes the smartest time to replace something is before it completely falls apart.
Remember This Infographic About My Last Labs?
Remember the infographic I shared about my latest dialysis lab results? I was excited because my pre-dialysis BUN had fallen into the normal range for the first time since I started tracking it in October 2025.
On Mondays, either my nephrologist or a Physician Assistant from the nephrology practice stops by the dialysis clinic to check in on patients. I had a feeling the conversation I had with Clark was coming.
He reviewed my labs—not just the BUN, but the entire panel—and simply said:
"We're going to run them again."
As encouraging as the BUN result was, a few other values were out of whack. My phosphorus was very, very low, along with a couple of other numbers that deserved another look.
By the time Clark reviewed everything, I was already well into my dialysis treatment. That meant it was too late to draw a true pre-dialysis sample and then compare it with a post-dialysis sample.
So, we may repeat the labs on Wednesday to see whether last week's results were an anomaly or the beginning of a new trend.
I'm as curious as you are.
Stay tuned!
Join the discussion on NielFlamm.com.
Monthly Dialysis Labs: A Surprising Number I Haven't Seen Since 2025
Every month during dialysis, I have a full set of lab work done. The nice part? No extra needle stick. The blood is drawn directly through the dialysis tubing while I'm already connected.
The monthly labs help monitor many aspects of living with End Stage Renal Disease (ESRD), including:
Potassium – helps reduce the risk of dangerous heart rhythm problems.
Creatinine – shows how well my kidneys are filtering waste.
Phosphorus – high levels can pull calcium from the bones, while levels that are too low can affect oxygen delivery to muscles and lead to weakness.
Iron
Hemoglobin
Sodium
Chloride
Carbon Dioxide
Total Serum Protein
Albumin
Magnesium
Platelet Count
White Blood Cell Count
The number I paid the closest attention to this month was BUN (Blood Urea Nitrogen).
Here's the simple version. When we eat protein, our bodies break it down, producing ammonia, which is toxic. The liver converts that ammonia into urea. Urea travels through the bloodstream to the kidneys, where healthy kidneys filter it into urine.
With ESRD, that process doesn't work very well, so BUN levels can rise because waste isn't being removed efficiently.
During dialysis, my care team measures BUN before treatment and after treatment to see how effectively the dialysis removes that waste.
When I reviewed my results on Saturday, July 18, something caught my attention.
For the first time, when my monthly labs were tracked starting in October 2025, my pre-dialysis BUN was in the normal (green) range.
Even more interesting, my post-dialysis BUN wasn't dramatically lower. Normally, I'd expect to see a much bigger drop after treatment.
So now I'm left with a few questions:
Are my kidneys somehow recovering a little?
Was this simply an unusually good month?
Did my diet or hydration affect the result?
Or was it just one of those lab quirks that occasionally happens?
The answer is... I don't know.
One lab result doesn't establish a trend, especially with ESRD. But after months of watching these numbers, seeing that green result definitely made me stop and smile.
I'll be watching closely next month to see whether this was the beginning of a trend or simply a one-time surprise.
Either way, I'll keep sharing the journey.
Dialysis Isn’t Just the “Hangover”
When people ask me what dialysis feels like, I often compare it to having a hangover.
Now, before anyone gets confused, I haven’t had an alcoholic beverage in more than 17 years. Recovery has been one of the greatest gifts of my life. But I do remember what a hangover felt like, and it’s one of the closest comparisons I can make.
That foggy feeling.
The fatigue.
The lack of energy.
The difficulty concentrating.
The feeling that my body just isn’t operating at 100%.
For me, dialysis can produce many of those same sensations. It’s as if someone hit the reset button on your body, but the operating system takes hours to fully boot back up.
But there are other reminders of dialysis that don’t get talked about nearly as often.
The photo with this post was taken immediately after one of my dialysis treatments. Those two puncture marks in my arm are where 15-gauge needles were inserted into my graft. During treatment, one needle carries blood from my body to the dialysis machine, where it’s filtered, and the other returns the cleaned blood back to me.
Every treatment.
Three times a week.
Week after week.
The machine isn’t just cleaning my blood. It’s also removing the small amount of excess fluid my kidneys can no longer remove on their own. Even when I carefully manage what I drink between treatments, there’s still fluid that has to come off.
Those needle marks are a reminder that dialysis isn’t just something I do—it’s something my body experiences.
In my case, I have an arteriovenous graft. Some people receive dialysis through an arteriovenous fistula, and depending on the individual, those access sites can become much more pronounced and visibly change over time. Everyone’s journey looks a little different.
When people see someone on dialysis, they often see the few hours spent sitting in a treatment chair.
What they don’t always see is what happens afterward.
The exhaustion.
The soreness.
The arm that reminds me of where two large needles were just inserted.
Planning my life around treatment schedules.
The mental adjustment of knowing I’ll be back in a couple of days to do it all over again.
I don’t write these posts for sympathy.
I write them because, unless you’ve experienced dialysis yourself—or cared for someone who has—it’s difficult to appreciate what life is really like between treatments.
If sharing my experience helps someone better understand what millions of people living with kidney disease go through, then it’s worth sharing.
And if it encourages even one person to consider becoming an organ donor, that’s even better.