Update on in home dialysis

G and I went back to the dialysis center for a appointment. G will go every week for the next few weeks, so they can draw blood to make sure the dialysis is working. Also, they watch him
do an exchange to make sure he is following procedures.

He did well on his following procedures, so that is good. We did find out that he should
not be using the fluid with the highest dextrose concentration all the time, which he has been using. It takes off more fluid, but we were informed overuse can damage the lining of the peritoneum, causing scaring, and therefore causing problems with the exchange, which happens through the peritoneum membrane.

G is still having some trouble getting enough fluid out. I'll write about that some more later.

The good news is he is looking less swollen, so think we are least pretty much back to where he was after starting hemodialysis.

Learning Home Dialysis

G is at this moment doing his 3rd exchange at home.

This morning he forgot to put a clamp on the line to the bag which collects the fluid (from
his stomach), and as there is a "Y" which allows fluid to go from the full bag to the empty
bag, one must put a clamp on the line.

He forgot, and all the new fluid went straight to the empty collection bag, instead of
into his abdomen. But, he just had to get a new bag and try it again.
There is a check list of about 30 steps for the entire procedure, and it's easy to get
confused. Of course like anything, practice, practice, practice.

We think in a few weeks he will be able to go on what is called "the cycler".
It is a machine which pumps the fluid in and out at night while you sleep.
It needs to run about 10 hours, so that will be perfect. G might have
to do 1 exchange during the day, but that would be all. It would give him
much more freedom, and be less work.

Good news...finally

Well, we finally caught a break today.

After a slow start, with some "gunk" coming through the line, the catheter started
flowing well, and the nurse was able to put in and get out a lot of the fluid for
dialysis.

While waiting for the fluid to work (min. 2 hours) we went through training.

G, being G, got 100% on all the quizzes. So even though yesterday was a slow
start, we made up for it today.

Tomorrow we will take some supplies home, so by Sat. G will be doing the dialysis
at home himself. He has been able to do everything for the dialysis, which entails
a lot of very specific steps to avoid contamination. It is SO important to keep
the catheter from getting infected, and G is taking this very seriously, which
I really appreciate.

The majority of the supplies will be delivered directly to our house, or if we are
traveling for more than a few days, we can get them delivered to wherever we
will be.

So, looks like we finally caught a break.

G will go to the dialysis center 2 times a month so they can run tests to see if
he is getting proper dialysis, and also give him Epogen shots which he will need
for production of hemoglobin.

PD catheter exposed - not working well

Yesterday after dialysis G went to have the PD catheter "exposed".

The resident had a little difficulty as it didn't want to come out. Of course, it has been buried
for 2 months, so it probably got a little "attached" (lol).

The Dr. asked us "will they flush out the catheter tomorrow?", and we replied "we don't know...".
It always amazes me that we get asked questions like this...but then it makes me mad that I DON'T know.....because usually I am quite prepared.

So today we went for the PD training. The catheter wouldn't run, so she put some saline in it as there was blood in the catheter line (you could see it), then she tried it some more.

To do the PD dialysis you put fluid into the stomach cavity through the catheter, leave it for a while, and then drain it out. The tech managed to get about 50 cc's in, some drained out, then it stopped.

There are a few possibilities for this problem. In my opinion the most likely one mentioned is that the end of the catheter in the abdomen got twisted and is pointed upward. This would explain why some of the fluid drained out but not all.

There are a couple more possibilities. Anyway, we were sent home with instructions for G to take laxatives, as one of the other possibilities is there is too much pressure on the catheter from the intestines being full. I doubt this is the problem, but it's the easiest one to try and fix.

We will go back tomorrow morning. If it's still not working then they will X-ray it to see if the catheter is in the wrong position.

I am not really surprised by all this. With G, nothing ever goes as it should.

At least the good news is we didn't get the snow and sleet they predicted, so driving around
wasn't that bad.

Great News!

Finally, some good news.

The surgeon was able to place both the catheter in the abdomen for peritoneal dialysis,
and do what he called a "good" fistula in the right arm for hemo dialysis. Both will
probably take about 6 weeks before they can be used.

G will be in the hospital for at least a couple of days, until they get his
blood thinned back to the correct level on coumadin.

At least it appears they are now taking this blood thinning thing as seriously as
they should.

So I feel much better.

And I knew G was feeling better last night, when he called me at 10:00 PM, wanting
me to bring him some food. As I was in the middle of staining some wood in the house,
I declined and suggested he get something from the nurse. They have sandwiches and
fruit cups on the floor.

He phoned back later and said he had.

I am trying to get some projects done inside the house while he was out, as I don't
think the fumes are good for him.

Well, gotta run.

Update on G

For all of you going "enough already, what's up with G?"

Oh, too much to even tell.

Here's the short version. I have made an appointment with the
best surgeon in town to do the special surgery G needs. He will have surgery to allow for peritoneal dialysis, which is done by yourself, at home. But, you need a catheter placed in your stomach area, and then you put in fluids, leave them for some time, and take them out.

They say it mimics the kidneys the best.

But G tried to have the surgery done for this in March 2010, but he had too
much scar tissue in his abdomen from previous exploratory surgery.
However, apparently one can go in from the side, around the organs, to
insert the catheter. It is much more complicated, and a real surgery, not
just outpatient.

The horrible VA surgeon claimed he could do this surgery, so
we couldn't get a referral from the VA, so G will have to pay for the
surgery himself. But, hopefully the surgery will be successful,
and G has Medicare part A, so he will just have to pay for the
surgeon and the anesthesiologist.

But, the first consult appointment I could get is Sept. 1.

That's OK. G really needs to have a sleep study done first, which I just
got scheduled for this Sat. G says he can't sleep on his back, and when he
is in ICU he must, so it's a big problem. G went for 3 days without really sleeping after that last botched surgery, and he was in bad shape. Of course that was
when he lost all that blood and they didn't give him a transfusion.

G's dialysis catheter is running OK, so I think it will work for another month, fingers crossed. He was also told by the dialysis center that another catheter
could be placed in that same site, if this one fails....but as G said "they probably are just saying that to keep me happy"....

Now that my brother is no longer here (may he rest in peace), the house is quiet, G and I can enjoy time together, and needless to say, the stress level is much lower.

Stress is a horrible thing.

Sleep is good.

Think I will take a nap.