Stayin’ alive

A kidney dialysis/transplant diary

Meanderings

Here it is Sunday morning and I find myself in front of the computer. Basically, it’s killing time I am. Thought maybe I’d let my hands do some meandering and see if I can peel back some of the layers of things on my mind. 

Or not.

I may just wander verbally without peeling anything.

I’m a little worried that my blood is being thinned too much for dialysis. I’m springing a leak far too often for my liking after treatment these days. It seems the choice is thin the blood to the tune of 10 mg of coumidin a day and 15,000 units of heparin per treatment or spend treatment dealing with a machine clotting off because my blood is full of infinitesimal clots only the dialyzor seems to pick up.

What happens when I spring a leak? Well, I bleed at the access points on my left bicep. Generally, it’s the lower or arterial access that springs the leak.

For those of you observing rather than living dialysis, inch and a quarter, large gauge blunt needles are pushed into the two buttonhole access points in my left arm and the blood leaves my body through the attached tubing and goes into the machine where it is cleansed of waste products and fluid in the dialyzor. Once the cleansing is complete, the clean blood is returned to my body through the other access point.

The process takes 4 hours on the machine (15 to 20 minutes to set the machine and patient up not included and take off time not included). When treatment is over and the nurse takes me off the machine, the needles are pulled one at at time. Four by four sterile pads are quickly placed over the opening and plastic clamps applied over and around the bicep to compress and hopefully stem the flow of blood from the access points.

Hold time for the clamps is usually about 10 minutes then the clamps are removed and the access site, with the sterile pad, is taped tightly to the bicep to keep the blood from flowing again. Also, in my case, “tip stops” are added before the initial clamping. They are a little cup-like apparatus on tape. The small cup area is filled, I’ve been told, with some kind of seaweed derivative that promotes clotting.

I’ve been holding for 15 minutes. Ten will stop the bleeding, until I attempt to use my left arm in any way. Once I do, I spring a leak and the blood flows like water. Then it’s try to stop the bleeding again for another 10 minutes or so and hope the combination of more clamping and not using the arm for another half hour to 45 minutes will keep me from bleeding.

One of the problems with that is the need to transfer from the recliners patients sit in during dialysis back to my wheelchair. The recliners are difficult to transfer in to because they are several inches higher than the wheelchair. Getting into them is a literal uphill battle. 

That would seem to make sliding out a breeze, but not exactly so when  other factors come into play: 1. The recliner is also too high for me to have my feet on the floor when my legs are let down. That means I have to push myself to the edge of the recliner, not an easy task using only one arm. 2. The angle of the slide board into the chair approaches 45 degrees and it’s a leap of faith I’ve not been able to take to simply slide without trying to control the speed with an arm and hand on the wheelchair arm.  My left leg is my only remaining leg, so I tend to want to brace with my left arm as well, especially since the transfer involves a partial pivot either by foot or rear end once I’m in the chair. By that time, I’ve sprung a leak.

The last two times, we’ve had me hold for at least 15 minutes and had nursing staff help with the transfer to the chair (helping to control the speed and holding me under the left armpit to keep me from using my left arm. The first time, I still sprung a leak. The second time we transferred me to the chair after removing the tubing from the needles but leaving the needles placed in my arm and then clamping and holding for 15 minutes. Leaving the needles in my arm was a scary thought, but it did seem to work better than removing them first.

I’ve been wondering the past few weeks how I ever managed to do dialysis while I was working full time. I know it takes more time now because I’m unable to drive myself. I leave here about 10 a.m. and return about 4:30 p.m. But it also seems the process tires me more and leaves me with a lingering dull headache. 

A friend tells me I have to remember that I was hospitalized for 2 solid months and that it takes longer than 2 months to regain strength. The headaches are probably partially due to not being able to eat during dialysis. Eating can make you nauseous and must interfere with the effectiveness of treatments.

Of course, the not eating at a normal lunch time can be hard on controlling blood sugars. It seems the dialysis takes priority over the diabetes on that one.  I eat breakfast about 8:30 a.m. and take a couple of graham crackers to eat just before I’m put on the dialysis machine (usually at 11 a.m.). I’m also going to start taking a piece of fruit or something small to snack on at 3:30 or so when I’m off the machine and clamped to stem the blood flow. Supper is usually at 5:30

Dealing with renal and or diabetic diets in a “community living” situation is a topic for another post. It ain’t easy. I am losing some weight, though, very slowly and it’s not simply weight lost because my leg is gone. (grin)

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October 26, 2008 - Posted by | diabetes, dialysis, fistula, health, kidney, renal diet, renal recipes, transplant, weight loss

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