2013-05-23

Today's Clinic Visit

Before I tell you all about today's visit to the PD clinic, I want to make sure our readers understand some differences between my posts and Rachel's posts.  I live in the US.  Rachel lives in Canada.  Because of the different types of insurance we have in our respective countries, our procedures will not be the same.  What I have to do will not always be the same as what Rachel has to do.  My US insurance requires certain things in order to comply with Medicare.  The frequency of clinic visits, the lab-drawing schedule, the nephrology appointments and other specifics will probably be different.  But the basics and what actually happens during these procedures will be similar.

Just like any two people who do PD, our stories will have similarities, but won't be exactly the same.  What we hope to show you are examples of how it works for each of us.  And to let you know that your experience might not be just like ours - but you'll have a better idea of what to expect.

On with the post!

Today was what I call a Regular Clinic Visit.  Once a month, I go to the DaVita Dialysis Clinic in town.  On a regular visit, the basics are covered.  A blood draw, a short educational segment (a quiz or a demonstration), review of the previous month's labs, medication review, and an assessment of my general health.  I will be asked if I have any problems or concerns.

Every three months I have what I call a Big Clinic Visit.  During a big visit, I will bring in a sample of the dialysis drain fluid and a sample of my urine.  More tests will be done to determine whether my dialysis prescription (fluid strength, amount, and frequency) is adequate to keep me healthy.  Every six months is the Really Big Clinic Visit.  During that visit, I will have my catheter tubing changed and will meet with the dietician and social worker to discuss any issues I may be having.

Today's regular visit was quick and easy.  Here is an overview:

1.  Arrive at clinic at 1:30pm.  Step on scale, record weight.  Go with PD nurse into clinic office.

2.  Clinic office has a reclining chair, sink, various supplies, IV poles, and pretty much everything associated with PD.  There is a cycler machine set up in there that is used for training purposes.  Reclining chair has been wiped down with sanitizer and covered with clean paper.  It's actually pretty comfy.

2.  PD nurse takes my temperature, blood pressure, and pulse.  Then she listens to my heart - front and back.  Regular breaths and deep breaths.  I give her a copy of the records I keep every day.  (Each morning, I record data from the cycler and information such as my blood pressure and weight.  I note how much fluid was removed during the night, how long the average cycle was, and how much fluid drained initially when I first connected.  The PD nurse collects this every month and I keep records every single day.)

3.  PD nurse reviews last month's labs.  Addresses any concerns.  Today she advised me to increase the amount of protein in my diet.  PD patients lose protein faster than non-PD folks because we are always pulling the good with the bad from our bodies with dialysis.  We discussed my medications (no changes).  We went over my general health, making sure I wasn't showing signs of not getting enough dialysis.  If my dialysis was not sufficient, I would possibly have itchy skin, signs of swelling and water retention.  I don't, so everything was fine.

4.  We do a short educational segment.  She tells me the latest information about a topic related to PD.  Today it was about travel.  I learned what I needed to do in order to travel on PD - what the new requirements are regarding making sure my supplies get to where I'm going.  Then I took a little quiz about it.

5.  PD nurse showed me pictures of her daughter's graduation.  We oohed and aahed about them for a while.  I have had the same PD nurse for about 7 years, so we know a bit about each other and our families.

6.  I was reclined in the chair and the PD nurse took some blood from my right arm.  This will be used to check various lab levels.  I think we (Rachel and I) will post in more detail about labs at another time.  But they're used to see if our medications need adjusting or if our diets are negatively affecting our health. 

7.  The PD nurse and I walked into her administrative office and we scheduled an appointment for next month.  Next month is another Regular Clinic Visit. 

8.  She gave me a hug and I left the clinic at about 2pm.

So, the whole appointment took about half an hour.  We covered everything we needed to cover and had a few minutes to catch up on personal stuff.  The office is friendly, clean, and private.  There are no other PD patients in the room with me during my appointment.  It is one-on-one with the PD nurse.  She hands me a few supplies when I leave.  Things like hand sanitizer, syringes, record-keeping forms.  Whatever I might need. 

And that's it.  Until next month!

Again, what is required by my insurance in the US isn't the same as in Canada.  So, that's my particular experience with a regular visit to the PD clinic.  Questions?  Ask away!

- Rachael M.

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