Notes

(1) At the end of one of my last afternoon dialysis sessions, the nurse in charge informed me that my high heart rate at the end of the session was an issue.  She explained that that meant that too much liquid was being removed from my body too quickly, and that that was putting unnecessary strain on my cardiovascular system. The remedy is to have longer sessions to lessen the stress.  Fortunately, I did not have to pursue this issue, since I have transferred to nocturnal dialysis sessions, which are much gentler on the system because they are 6-hour sessions.  I have, however, noticed that my heart rate is still high at the end of the session.  I am not going to pursue the issue now, but wanted to note it for future reference.

(2) Paperwork should be brought to patients' attention at the beginning of a session, not at the end.  At the end of a session, all I am thinking about is getting out of that room.  Again, my personal issue with this has been ameliorated by my moving to the nocturnal dialysis shift.  To be honest, the shift is much better controlled.  Some of that is out of the staff's hands, as nocturnal patients are expected to adhere to a somewhat more restrictive and cooperative set of rules, and that makes them an easier group to manage.

Notes

Continuous Ambulatory Peritoneal Dialysis looks interesting; I would like to see the entire procedure from A to Z.  Is it a do-it-yourself solution?

Dialysate is the solution used to transfer waste materials from the body during dialysis.

Peritoneal dialysis - blood is cleaned inside the body
Hemodialysis - blood is cleaned outside the body

Peritoneum - peritoneal membrane

** PD is looking good. **

Rough Week at K Street Dialysis

I am in a transitional period with my dialysis treatments. I’m in the midst of switching from sharp to dull needles for my sessions at the K Street dialysis center. The dull needles don’t hurt at all; they just feel a little weird when inserted into the fistula blood vessel. I reached this point by technician Sheila’s use of the “buttonhole” technique to stick my arm for three weeks or so. “Buttonholing” means using the same exact spots to insert the two needles for about a dozen consecutive sessions, very much like piercing an ear.  The end result is safer and less painful insertions going forward, and a lesser chance of developing skin keloids -- the arm looks better.

The transition from sharp to dull needles can be messy at times; in my case Monday was the messy day.  Both needle insertions leaked, and I was so uncomfortable as a result that I ended the session early – something that I practically never do.  On Wednesday, the dull needles could not be inserted because my holes had closed up, much like an earring hole does, I guess (I wouldn’t know), and Sheila had to use sharp needles to stick me for my session.  Among other things, I was in what I thought was excruciating pain for the first hour or so, but I have a pretty high tolerance for pain so I toughed it out.

Then came Friday.  All that pain tolerance/tough guy crap went right out the window as I experienced the most excruciating cramps I have ever had in my life toward the end of my session.  I was really uncomfortable for some reason, but couldn’t pinpoint the cause.  The reason started becoming self-evident when I had one short cramp in my calf.  In my case, my hands and feet cramp a little towards the end of each session; if they cramp a lot, it is a sign that too much liquid has been removed too quickly and a saline IV is offered.  Until Friday, I never asked for an IV.  But the top part of my left foot in front of the ankle started cramping and wouldn’t stop for what had to be at least 20 minutes.  I trust that you all know what cramps feel like; I would guess that these were as bad as any you may have experienced.  The worst part was that if I tried to adjust my body my hamstrings and quads threatened to start to cramp up on their own, so I couldn’t move around; I had to sit there and take it.  I was sweating, grimacing, praying, and trying not to make too much noise and scare the other patients.  After what seemed to be an interminable amount of time, the cramps slowly subsided.  I sat there for a good half hour before I even thought about getting up; we then concluded my session and I went home.  Daymn!

Apparently, I gained a couple more pounds over the past couple of weeks, and it all hit the fan during yesterday’s session.  As a result, I had to take one for the team, and found out the hard way that my dry weight (how much I weigh after a dialysis session) needs to be increased yet again, from 104 kilograms to 106 kilograms (about 233 pounds).  I’m still putting on meat and muscle, which is great.  A little advance notice would be appreciated, though!

More change comes next Tuesday evening, when I start a two-week trial period of nocturnal dialysis sessions.  My sessions will now end first thing Monday, Wednesday and Friday mornings.  I’m making the change so I can go back to work on a normal full-week schedule.  I certainly hope that all goes well.

The Weeks.

Getting better takes time.  A lot of time.  I had weeks where the whole week was

Dialysis; recover and rest; dialysis; recover and rest; dialysis; weekend (recover and rest)

for week after week after week.  And I was very happy to do it.

Among other things, this recovery process has taught me patience and persistence.