How Peritoneal Dialysis Works



This is me at my 'station' in my room doing a manual exchange

I just wanted to try and give a more detailed explanation of how the dialysis process works.

There are two common types of dialysis. The one most people seem familiar with is hemodialysis. If you know someone who has dialysis three times a week in center, this is hemodialysis.  Hemodialysis can also be done at home, but more often it is done in center. This type of dialysis involves creating a fistula in the forearm (a surgeon takes a vein and an artery and sews them together to create a large access vein for the dialysis needles).

The peritoneal dialysis process uses the peritoneum in the abdomen as a membrane across which fluids and dissolved substances (such as electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (CCPD - Continuous Cycling Peritoneal Dialysis) or via regular exchanges throughout the day (CAPD - continuous ambulatory peritoneal dialysis). The primary complication of PD is infection due to the presence of a permanent tube in the abdomen.

The training process for peritoneal dialysis was stressful as there is high risk of infection if you don't use a proper sterile process. In order to do an exchange a patient needs to wash their hands for 30 seconds, put on a mask before removing the cap from the catheter, and use hand sanitizer. You also have to remove any pets from the area and close any windows (and turn off any air vents if the air is blowing).

Then you connect the the catheter to a manual exchange bag, drain the fluid that is currently inside, refill with new fluid and then disconnect the catheter. The whole process takes about 45-60 minutes.

After a week of training on the manual exchanges (CAPD) I was trained on how to use the cycler. I now hook up to this machine every night before bed time, usually about 10pm. It does an initial fluid drain, and fill, then it does three more exchanges while I sleep. The machine stops at about 7:30 am the next morning. During the day I do one manual exchange, usually sometime between 4pm-6pm.

Curriculum Shopping In The Antique Mall

Whoever heard of curriculum shopping in an antique mall? "Great idea, why didn't I think of that?" you might say. Well, I thought of it first! Lol.
Actually, I went out to breakfast this morning with my mom and sister as Lydia turned 36 today ("Happy Birthday Lydia!") and someone suggested going to the antique store a few blocks over. As we were browsing slowly through the booths and aisles I came across a stack of Popular Science magazines. I realized those would make a great supplement to any history or science curriculum. So as we continued through the store I kept my eyes peeled for anything else that could be a resource. There were many great items I had to pass on due to price... really I can't afford to pay $20 for a math book from 1930. There were soooo many old fun reading books, such as the Bobbsy Twins, Little Peppers and many many more I just couldn't afford. I did however write down the titles of some amazing books I saw in the hopes of finding them online or in a thrift store. We went to two different antique stores, one in Milton and one in Puyallup and spent over three hours browsing. It was a lot of fun.
I bought three different copies of Mechanix Illustrated, they were published in 1968 and one copy of Build It from 1959. Build It has great illustrations on different building products. One of the magazines had a great article about what they expected the future to be like in 40 years (the article was published in 1968). I bought a copy of Life magazine, it was a special edition 1969 To The Moon and Back. A few older reading books and.... a cabbage patch doll and a dress pattern. Why the doll? I'm weird like that, perhaps because I was never allowed to have one when I was a kid. Plus it was only $9.00! Hehe.
I also found a neat magazine that is a bit newer, its called The Good Old Days and you can visit their website here. Fun reading!

I hope to do more antique shopping in the future!

A sun shiny weekend.

We were blessed with a beautiful weekend! In the Seattle area we go a long long time without seeing the sun so when it does come out to play, life seems more wonderful. We spent most of Saturday at my mothers garden. Although technically it is our garden now also. She is renting 4 spots at large community garden and we are helping to weed and plant. This will help us out this year as I don't know that I will get my own garden planted in our small backyard. Last year we had a pretty decent garden using seven raised beds. I followed the square foot gardening book and we really did end up with a lot of produce for the space. Unfortunately we need to add some good top soil to the beds and without a truck of our own to do it, I'm not sure it will happen. Also... I really don't have the energy.

The other neat thing about the community garden we visited is that they have two huge chicken coops with two different groups of chickens. The boys really enjoyed looking at the Rhode Island Reds, and the white chickens with the bare bottoms (molting)! My favorite was a handsome black rooster and his two beautiful black hens. I haven't researched yet, but I'd love to find out the breed because some day... I want some of those!

Hopefully next time we go to the garden I will remember the camera!

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Dialysis and Blood Sugar

Prior to starting dialysis my blood sugar levels where controlled perfectly well by diet. My A1C for the last 3 months was 5.9 which is in the normal range. Then I started dialysis.... since then my blood sugar levels are no longer controlled and my fasting sugars in the morning are high, in the 140-180 range.
Peritoneal Dialysis puts dextrose into the abdominal cavity, dextrose has glucose. The liquid works itself around (but not into) all the organs and depending on each body, the membrane absorbs the glucose differently. Generally though a days worth of dialysis treatments adds 400-800 calories. If you have tried to lose weight, or struggled with weight loss and/or diabetes, you will know that is not a good thing. Take a person that is already struggling to lose weight and pack on an extra 400-800 calories, plus throw their blood sugar out of wack and its not good.
Eventually I will just be put on medications for diabetes, because of the glucose in the dialysite solution that is pulling toxins out of my body. Win some you lose some, I guess?

The Waiting Game

My first week on Dialysis has come and gone. I can honestly say that it is a relief to be at this point. Previously it was just a waiting game, waiting for insurance, waiting for surgery, waiting for dialysis to begin. I am still waiting... waiting for transplant... which I am told can be a 3-5 year wait in the state of Washington for a non-living donor (a person that has passed away and signed their donor card or agreed to donation). However its a different sort of wait and in the mean time there will eventually be some relief from the symptoms of ESRD as the toxins are continually pulled out of my body via dialysis. I must say though that Dialysis is not a cure, it does help to remove toxins from the body but it does NOT prevent the kidneys from further damage.

Since my name was just sent in for referral I have a potentially long road ahead. In order to be officially on the list I have to meet with a transplant team and go through various tests prior to being approved for transplant. The process is the same for everyone but the results depend on the overall health of the individual.

I think it is important to spread the word regarding kidney failure and the need for living donors. When I was leaving the Northwest Kidney Center PD unit today I saw a boy about 10 yrs old who looked very sick. Children are not allowed in the PD unit... unless they are kidney patients. My heart really went out to him and I will probably never know his story, but spreading the word about the need for kidney donation may help save a life.

Please consider being a donor whether it be for someone you know or a complete stranger.
Give the gift of life!

Surgery #3 and a week of Dialysis Training

Tuesday: On March 27th I went in for a scheduled outpatient (same day) surgery. This was just a minor procedure, they cut a thin slit in my abdomen to externalize the buried catheter that was placed two weeks prior. This process was really a breeze as they gave me local anesthesia, I fell asleep, stayed asleep during the entire procedure and woke up alert and ready to go home. This was very unlike the two surgeries earlier in the month with heavy anesthesia that left me groggy and ended up in two overnight hospital stays.

Wednesday: Wednesday my husband and I went to the Northwest Kidney Center Peritoneal Dialysis training center in downtown Seattle to start my training. The training lasted five hours and pretty much consisted of my sitting in a chair, listening to a nurse explain proper procedures on doing PD at home. There is quite a process including cleaning the prep area, washing hands, using hand sanitizer, making sure all windows are closed, removing any animals from the area and basically following every step precisely to avoid risk of infection. If I skip a step or make a mistake like touching the open catheter (which is a direct line to my stomache when open) I am at high risk of infection which can lead to having to switch to hemodialysis (depending on the severity of the infection).

Thursday: Thursday morning I received my first months worth of dialysis supplies. These were delivered by Baxter (a medical supply company) in a large Penske trunk and filled *two* pallets, consisting of *72* boxes. I am told that after the first delivery on average I will get about 30 boxes a month. We will see.... we spread the boxes from the first pallet around the house into every empty nook and crany we could find and the second pallet is sitting under the carport with a tarp covering it!
Thursdays training was more hands on and I actually ended up doing a full day worth of dialysis exchanges (four exchanges when done manually). The first few times I had the fluid in my abdomen I didn't feel anything other than just a full sensation. But the last three times it has been pretty uncomfortable for the first 30-60 minutes. The solution is causing my heartburn to go out of control so I have to start taking a second prilosec a day to combat that. Also the fluid can cause a feeling of a 'stitch' or pain in my side and sometimes I feel pain moving up through my back and then eventually it just dissipates... it almost feels like the pain starts low, moves up through my stomache, my back, my limbs and then is gone.

Friday: Training on Friday was once again from 11am to 4 pm. This time we met with the nurse first, went over a few things and then I met with the dietician. The dietician went over my lab work from what was drawn on Wednesday and told me that so far all my numbers are looking good. She also explained how when a patient is on Peritoneal dialysis, they have to increase their potassium and protein intake. This information was a little confusing at first because when someones kidneys are failing (prior to dialysis) you have to go on a low protein and low potassium diet. This is because the kidneys can not process the protein when they aren't functioning properly. Once on peritoneal dialysis (it is different with hemodialysis) the dextrose/dialysite strips protein from your body so you have to compensate with a high protein diet. This is ok with me. I am happy to be able to eat high protein again and loving eating my bananas and oranges!