Dialysis Risk — More is Less (sometimes)

Tuesday 2014-04-22 

Lately I feel sort of like a secret agent often doing things clandestine way. As I’m more familiar with the machine, my supervisor’s hawk eye was lax a little, though she still pricks up her keen ears not missing anything.

When they changed my treatment, initially I did suffer mental anguish and physical misery, I experienced headache, nausea, lethargy, insomnia, cramps, urinary infection, constipation, aching limbs, toes and ankles (totally washed out in other words).

Gradually I am allowed handling the machine on my own. Some changes have to be made to survive. The 1^st thing was to reduce the Qd pump rate (dialyser pump) to 300 ml/minute instead of the ordered 500. The trick is the Qd number doesn’t appear on the screen unless a series of buttons were pushed even then it disappears all on its own.

A while back starting on 28 Oct 2013 when I was taking perindopril to reduce my blood pressure, what it did was increased my heart beat. With a racing heart I couldn’t survive blood pump rate (Qb) 250 ml/minute and Qd 500 which are the standard rates for dialysis patients, I did Qb rate at 200 for a while. With 3 hours of dialysis I was afraid it wasn’t giving me sufficient clearance, so I increased to do 3 and half hours which is the limit for my bladder. I knew the above combination was alright for me, as I couldn’t change the blood pump rate when it appears constantly on the screen, and I survive poorly 250 Qb rate and 500 Qd rate combinations for 4 hours, the only thing I could maneuver was the Qd rate which hide inside the machine.  On screen I was doing 4 hours at 250 Qb, very normal indeed.

This change made huge difference to my life, I could at last breathe again, l was once again felt more like a human being than a miserable zombie, no longer felt so washed out and groggy, even my bowel became happier, I don’t want the nurses noticing my physical improvement, so after 3 hours of dialysis which is when the washed out feeling started, my beloved other half often remind me that I need to appear somewhat tired than I actually feel.

The second thing changed was the heparin dose, instead of taking on 6000 units for 5 hours at the very beginning and later 1000 units bolus and 500 hourly rate, I am now only taking on 1500—2000 units for 4 hours. If when bolus given was been watched I simply take on a little extra or else I may skip bolus altogether and the last hour heparin may also be stopped. With the amount of extra saline I’m receiving these days (about 300ml during each session) the dialyser is always white.

As for catheter lock, I’m given 25000 units and both my lumens are 1.9cc. Recently I’m using Tego to reduce infection risk which add extra 0.1cc, I was told to use 2.0cc to include the length of Tego which I found the end of lumen often clotted with blood, I’m now giving myself 2.1cc for arterial line and 2.05 for venous line. So far, they haven’t clotted again. The worst thing could happen to me is I might take on 750 units extra heparin, that’s the price to pay for safety. The sad thing is when I go home I was told for some reason I have to use Claxine instead of heparin which will be a bit of nuisance for me. I’d better enjoy while heparin still in use.

Beside these changes there are other things to manipulate such as sodium level and machine temperature to suit body ones, etc.

The last couple of sessions coincide with public holiday when the manager who has keen observance and sharp senses, and always sees everything and hears everything takes her days off. I was liberated, her foot soldiers only very involved with their own affairs, I even managed reducing dialysis hours a little. The fact is every bit of less dialysis I receive (to a point), the more beneficial to my wellbeing. With only 2 sessions of less hours (roughly 3 and half hours), my walking has already improved, the pain has reduced, although still hasn’t recovered to what I was before I enter this training unit, the change is obvious.

When these changes were made, my beloved other half was maneuvering the machine while I took on watch, we feel like a couple of spies doing thing under cover. By the way, at the end of sessions we need to set the machine back to order in case being checked, or simply turn the machine off and on again, letting it forget what it had been.