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.
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.
Waiting for the Call
Three days a week, dialysis keeps me going. It also serves as a constant reminder that I'm waiting for something bigger.
This week, a fellow patient received a kidney transplant after about two years on the waiting list. Hearing that news gives hope to the rest of us still waiting for our turn.
I'm now keeping an overnight backpack ready so that when the call finally comes, I can grab it and head to the hospital.
Watch the full vlog:
https://www.nielflamm.com/videos/esrd