Monday,
2014-06-16
Last
Thursday, 12 June, I went back to the centre learning needling. It supposed to
be a quite day, there was only me and a fellow patient R who came to reduce his
fluid, but the day ended in chaos.
For some
reason after 2 years of self dialysis R recently put on 12kg of excessive
weight than his normal dry one of 88kg, his legs and feet swollen quite badly.
It’s more
than a month now since he noticed his problem and came back to the centre doing
dialysis at least twice a week. R told me his condition hasn’t changed much. If
my memory is correct when I first met him his excess weight was 10kg. The
nurses have arranged quite a few extra doctors’ appointment for him. One day
after dialysis when he visited the specially arranged doctor, he fainted then
and there on the spot.
Nearly 2
months passed, the nurses and doctors are still searching for a remedy. That
morning there was a dietician came talking to him for quite a long while. It
seems his protein level is extremely low even with the supplement he’s taking.
For now at least the level is stabilised.
Every time R
came over, he is hooked up with the best machine available which is a Fresenius
5008 fitted with all the latest bells and whistles, much flashier than the BVM
4008S – the lie detector they used on me.
R had poor
luck again that day, by the time I finished my session of 3 hours and 20
minutes (my bladder wouldn’t last my obligated 4 hours), he had already passed
out on the machine and required oxygen and infused saline which was standard
practice. All the nurses were hovering over him. When I left his eyes were
still firmly shut.
Obviously
again his fluid was removed too fast, on a wrong pace and in a wrong way like
other patients I’ve seen both here in this centre and in a few other units.
That morning
when he was getting on I wanted watch and learn but the nurse manager L gave me
the marching order.
For nearly 2
months the treatment didn’t produce much effects except giving him a few
fainting episodes. Whatever has been done to the man is not working.
R told me in
the past 2 years he always felt fine and wonderful after dialysis, only recent
months his legs and feet became swollen fat. He’s been doing 8 hour sessions at
home alone.
This centre
opens 8 hours a day and 5 days a week. The 8 hours includes time for
preparation, getting patients on and off and shutting down the machine. The
nurses don’t do shift and they too, like everybody else need finishing the day
off and going home to be with their family, as a result the longest a patient
can do here is 6 hour sessions even though they might do 8 hours at home which
is what this centre preaching for, the longer the better.
My theory
for poor R’s situation is this, somehow recently his 8 hour sessions weren’t
adequate enough for him that he accumulated excess fluid in the body, to
counter this, either he needs to increase his hours or the pump speed or
perhaps both, but I have no idea what that will do to his chemical balance.
The F 5008,
what a super machine it is, it even includes a self generating saline function,
perhaps the only room for improvement is to add an oxygen function as well.
Unfortunately, the best machine in the centre did little for him, as I noticed
it is not even linked with a blood pressure monitor to check his blood pressure
and heart beat constantly which would enable the machine taking fluid at a
proper speed and sounding the alarm when is sense danger. I bet when the poor
guy passed out his blood pressure too low and heart beat too slow, perhaps the
heart rate was at 30 – 40 p/m.
In our
dialysis training manual, if we were to do 4 – 5 and half hours, the dialysate
flow Qd should be at 500ml/m, blood flow Qb at 300 or for 5 and half – 8 hours
Qd at 300 and Qb at 225ml/m. Furthermore, if we notice blood pressure running
low, feeling sleepy, or having cramps or headache, we should gave ourselves
saline.
At home
dialysing alone I bet R wouldn’t dare to let himself slip into sleep which
would be extremely dangerous, he would follow instruction, when he felt
drowsiness he would gave himself saline before he reaching the stage of
fainting. But being at the centre, he may put all his trust on the nurses and
lost guard and let himself dose off.
One other
thing I believe was true is that both R and the nurses would all follow the
instruction from the same manual and to the tilt. In the same session they
would be aiming for the same amount of fluid to be removed, one would try doing
it within 8 hours while the other within 6 hours, now you do the math.
The only difference
would be at his home he might have fluid problem in his current condition, but
at least he wasn’t endangering his own life. For poor R, I can’t see the end of
the tunnel just yet, at least in the short term.
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