dialysis: “big boy needle”

Another milestone in the dialysis saga today: my nurse used a larger needle for my arterial site and as before a small needle for the vein site of my fistula.  Pump speed was higher,  which leads to better clearances.  They had advised me that the “big boy needles” were coming after some 15 runs of the fistula.  We might be slightly ahead of that.  Apparently my fistula is developing very well.  Not all dialysis patients are that fortunate.  Two of the eight people in my run group have had problems with their new fistulas in the past year.

Victoria Harbour company house

This house dates from 1900-1925 period when my local village was a lumber company boomtown. Today all around the quiet village east of Midland, Ontario, you see this basic house built for company employees and their families. Many remain in the original configuration. Others have had additions and alterations to the rooflines or roofed wrap around porches added.

This is a new and ongoing photographic project I have decided to work on this year.

renal diet and phosphorus

They stress that everyone on hemodialysis is a little different.  Some people have a three hour dialysis run, some four hours.  One element that is common is diet.  The restricted diet is a huge daily struggle.  Dialysis does not remove potassium and phosphorus.  The best thing to do is to avoid foods high in phosphorus.  The other essential thing to do is to take your binder. What is a binder?  Calcium carbonate chemically bonds with phosphorus and that compound can be removed through dialysis.   I take my calcium carbonate in the form of 750mg TUMS. I take five of these with each meal. I keep a bottle of Tums in my car for meals I eat outside of home meals.

My phosphorus is too high. We get our blood taken monthly and the lab checks a number of things.  I had one month when my phosphorus reading was well into the good range but the next month it was back up. The rest of my blood work  is fine.

I originally got a ten page handout on diet and spoke to a nutritionist on several clinic days.  More recently I asked for more information and received a 22 page list of food types including specific products with commonly eaten amounts and the phosphorus amount listed. I have been studying it.  Two unlikely “bad”  foods I will mention here: cottage cheese and yoghurt, both are high in phosphorus.  So they are banished from even once in awhile status.  I will be making further adjustments to my diet with the aim of reducing my phosphorus level.

chair rotation at the dialysis clinic

I always wondered how the nurses at the dialysis clinic decided who sits in which chair and how the rotation works.  There are 8 machines/chairs.  I couldn’t detect any pattern and finally asked about it.  The answer surprised me at first.  The reason why they shift us around is to avoid the possibility of people feeling like a specific chair is their chair.  And the issue is really not within a dialysis shift but to avoid the afternoon people coming in and standing over someone from the morning shift who is just completing their run and glaring and demanding that people hurry up and get out of “their chair”.  After a few ugly moments way back when the satellite clinic opened, the nurses decided to institute a few rules to head off any further conflicts of the humanish kind.  Interesting stuff.

a few thoughts about dialysis

  • home dialysis is an option for many people, however in my case with five cats and one dog, it would be tough to keep things perfectly sterile and hygenic.
  • I find some days the time in the chair, the four hours of the run, almost unbearable, to the point where usually in the third hour I have the urge to yank out the lines and run screaming from the room, but I manage to fight it down and finish the run.
  • the diet is unrelenting, narrow and quite boring, my poor skill as a cook does not help with this problem
  • in one level of understanding, I realize that I am an out patient on life support but I don’t really feel all that sick at all, just trapped in a life necessary trap
  • I have noticed that the other dialysis patients have virtually no interest in talking, few do any reading, one talks on a cellphone, but the rest get by watching the tv sets that are provided in the clinic.
  • it is very difficult but not impossible to change your dialysis schedule to accomodate some special event.  last year I did this once to facilitate staying over for a university reunion, I had to make the request about 7 weeks before the event. I was lucky to get the change.
  • in Ontario, the waiting time for  a cadaverous kidney transplant is about 8 years. in my case I will be 63 years old when my turn may come.

a few more points about dialysis

The waiting room

dialysis waiting room

I spend a few minutes sometimes waiting here prior to a run. luckily the chairs are not that comfortable or I might fall back to sleep.

The evil scale

Before and after each dialysis run we weigh in.  This is the moment of truth when evidence is shown if we kept to our restricted diet and limited fluid intake.

The walk of shame is the title for the walk back to weigh yourself a second time for those mornings when you are not wide awake enough to remember your weight, so the nurse can mark it on your chart. They then make some calculations about the amount of fluid to remove.  Depending on your body weight, this can be up to 3 kg.

Every thirty minutes or sometimes more often, your blood pressure is taken by the dialysis machine.  You wear the blood pressure cuff throughout the run.

The Fistula in Action

fistula in action

The two needles hurt a little, hell, I think they hurt a lot. but once they are in there is no discomfort. The real trick is to keep your arm practically dead still for four hours. A little zen helps. If you don’t have zen the nurses offer to tape your arm down to the cloth covered pillow. After the run and they pull the needles, you must hold gauze over the two holes for about ten minutes, otherwise you leak some blood.

This shot was taken right after needles were inserted and lines connected, but no blood is yet flowing from the left or upper line which is the venal point, the lower one closer to my hand is the arterial flow and it has started.

a few points about dialysis at -12 C

how the front of the hospital looks to me as I walk a little bleary eyed from the road three mornings a week, I am supposed to arrive by 7:20 am, which means getting up around 545 am and that time can go earlier if we have snow, since I need more time to uncover my car and scrape ice off the windshield. I park outside.

it used to be the practice to give dialysis patients a discount on monthly parking fee, we paid $30. However a new policy came into effect and our discount disappeared. The fee is now $60 a month and I along with some other dialysis patients park out on the street in front of the hospital and trudge across the frozen parking lot to the front entrance. Annoying but hardly unbearable.

it is sometimes a little disquietening to see patients in wheel chairs out here smoking.

one day one of our three hour dialysis patients came in to report that a wheel chair patient had fallen out of her chair and was lying on the ground out by the entrance.

Inner  doors main entrance of the hospital

beyond this door is the waiting area for the lab, where we sit and wait to be called in for dialysis

we hang up our coats, take off our winter shoes or boots, and step on the scales to check our walk in weights. The doctor has decided our target or exit weight and the nurses make a calculation on how much fluid to take out of our blood, plus adding in some fluid, and taking in account if we drink water, coffee or tea during the dialysis run

— tomorrow or the next day I will add some more photos and text to take me through a run and the steps needed to get out the door again.

another hat

last night I attended the AGM for the Huronia Chapter of the Ontario Archaelogical Society and I am now the vice-president of the chapter.

We are developing an ambitious set of projects related to the upcoming 400th annniversary of the visit by Samuel de Champlain to Ontario, 1615-2015.

We have our work cut out for us and it should be a lot of fun.

the chapter’s blog lives at: http://historichuronia.blogspot.com/

Spenser is gone….

Robert Parker, the great writer, is dead.  I feel a personal loss. I found out about him a long way back when he was just a few novels into the Spenser series.  I had read my way through Hammett and Chandler and had enjoyed the movie versions of Marlowe and Sam Spade.  Parker revived and extended the hard boiled American privat eye.  He was a tremendous talent.