A is for Appetite

Rachael M, here.  I love Rachel's idea for alphabet posts!  Starting off with A today.

Appetite.

When I first started PD, I did manual exchanges at home every day.  Four times a day.  I almost always had about 1500 to 2000 ml of solution in my gut at any given time.  Rarely did I want to eat.

I started manipulating my fills a bit when I figured it out.  Having a full bag on board was making me feel like I had just eaten Thanksgiving dinner.  All day long.  So, for my afternoon exchange, I would cut it down to 1000 ml of solution and I got my appetite back.

Now that I am using the cycler, I get pretty intense exchanges overnight and can go light during the day.  I usually have about 750 ml in me during the day.  And my appetite is good.

Maybe TOO good.

But it's the holiday season.  So, yeah, I'm eating some bad, bad goodies.

Ah well.  I'm happy to be hungry!

Having a low fill volume during the day has allowed me to have a fairly normal eating schedule again.  Walking around all day with a completely full belly can be quite uncomfortable.   One more reason I'm happy about the cycler.  Not only does it take care of the dialysis at night, but I can adjust what I'm carrying during the day.

So, that's A.  I think I know what B will be.  Gotta follow Rachel's lead and talk about Baxter.

Until next time!

Baxter

I love Baxter, I really do.  Their customer support people are wonderful, I have an amazing delivery guy, and really - they are the company that keeps me alive. :)

My issue with Baxter is this:  THE SIZE OF THE FREAKING DIALYSIS MACHINE! Honestly, there is so much amazing technology out there - why do our PD machines weigh 40 pounds?!?! Are you kidding me? How am I supposed to travel with this beast? Oh, and let's not forget the fact that dialysis patients aren't really allowed to lift more than 10-15 pounds - and I have to lug this monster around??

I HATE that travelling is so difficult.  I am going to Calgary for 3 nights (4 days) in December and I've made all the arrangements to have my stuff shipped to the hotel where I'm staying (yay, thanks Baxter!), but oh do I HATE having to carry that damn machine.

So, Baxter, I hope you see this post.  I hope you understand REALLY UNDERSTAND how awful dialysis already is. Having a non-portable machine does not help! So, please, GET TO WORK on something that is small and compact and fits neatly into a backpack. And weighs, like, 3-5 pounds.  Because I'd really like to go to Europe next year and I'm still anti-transplant, I'll be lugging that beast with me - which does not make me happy.

PS - if you have a ton of money, send it to Baxter and tell them to get working on a teeny tiny machine for PD patients.  Please and thanks.

Sooooo the "B" post was a bit of a rant.  I'm not sure what "C" is going to be yet.  "D" has been pretty easy to find topics for, so you might get multiple D posts instead. :)

RachelT

When we read we begin with ABC...

Rachel here - so "writer's block" (I probably mean laziness for myself!!) has lasted almost a year.  Yikes! Sorry about that folks.  I talked to Rachael at the end of the summer about a blogging idea I had to give us some ideas, but I haven't taken the time to put it into action for myself.

Writing consistently simply involves writing consistently, right? :) That's what I'm aiming at for myself. I want to be consistent about blogging and try and improve my style and voice and all that fun writing stuff.  The idea of writing is always so much grander than the practice - or discipline! - of writing.

The plan for giving ourselves writing ideas is to blog through the alphabet.  If I write about "A," Rachael might also write about "A," but she may also carry on to "B."  Pretty simple, but I think it'll work for us.

My first topic is going to be about ANGER.

Anger is OK. Anger is natural.  Throughout your dialysis process - whatever stage you're at - you're likely going to feel downright pissed off.  Go with that.  Let the anger happen and work your way through it.  How you work through it is completely up to you.  You might need to vent to a family member, or you may need to see a counsellor.  You might want to keep your anger to yourself and let it out in a journal, or punch it out onto a pillow. You might walk daily and listen to some hard driving beats.  Find your outlet and then for goodness' sake, use it! If one thing doesn't seem to work for you, try something else. There is no right way, no wrong way to handle your anger.  OK. wait, lemme rephrase that.  Don't beat anyone up.  Don't hurt anyone. If you say words in anger, apologize. Your disease does not give you a free pass to be an asshole, so 'fess up, apologize, and learn from whatever happened.

I haven't had any extreme cases of anger through my dialysis experience, but every once in awhile, I feel mildly pissed off.  Like the other night I was sitting in bed playing Farmville before bed and I kept thinking over and over "I really don't want this to be my life anymore." And the feeling was distinctly pissy.  None of us want this life for ourselves. If I wouldn't have ended up on dialysis, I would have simply worked long enough to save enough money to buy myself a plane ticket out of Canada and gone to Singapore, or even back to Japan. However, this life happened and until I am ready for a transplant, this is the life I'm living. So there's very little I can do about the anger other than remember that I do have outlets and that I can choose my own attitude about the whole thing. So can you.  You can choose to let your anger fester and consume you, or you can treat your mental health with the same respect as your physical health.

-RT

Same old same old stuff and one new kind of stuff

Something I forget to tell people about PD is that it's all about routine.

We do the same things every day.  Day after day.  For as long as we have to.  It's pretty much like breathing after a while.  You don't really think about it, you just do it.

Setting up the machine.  Tearing down the machine.  Then setting up the machine again.

Sometimes I get to the end of a setup and I suddenly snap to attention and realize I've set up the machine without really thinking about it.  It's that repetitive.

Don't panic.  You won't die of boredom.  There are plenty of alarms to go off in the middle of the night to keep you entertained.  Or maybe you'll face the dreaded "my drain line is too short" dilemma when you have to get up during the night to go pee.  Oh - you might also get a weird delivery person.  That shakes things up.

All of this relates to the fact that I haven't posted on here in quite a while.  I honestly felt like I wasn't sure I had anything to say.  But I do.  I'm deep into the routine of PD.  It seems pretty humdrum to me, however, I know there's more to talk about.

Lately I have been wrestling with the issue of food.  I've had some really excellent lab work lately - I mean, it's unusually good.  But it came with some sacrifice.  Yes, the medications do counteract some of the "bad" things we eat.  I still need to do some work on my part, though. 

It's a little bit of a mind game at times.  The PD staff want us to eat plenty of protein.  But frankly, the best stuff with protein is also usually served with bread or pasta.  Or cheese.  I've been skipping the carbs and the dairy now for quite a while.  I would not say it has been easy.  And I have actually been a bit cranky about it.  What I need is to find a balance.  A way to satisfy the cravings without starting a new co-dependent love affair with bread and cheese.

I've learned that my body is a bit on the wheat-intolerant side.  Which is actually a good thing - I mean, if I eat bread I will feel terrible.   So... that's good, right?  Not really.  Bread is delicious.  And it's been a part of my diet my whole life.  I kinda love it.

After reviewing my labs from the last year, I can see spikes in the phosphorus values for the months where I ate with wild abandon.  I have real proof that my diet impacts my health.  But what I'm wondering is how to balance the way the diet impacts my health and the way my diet impacts my happiness.

When I get a good lab report (meaning, when I have a month of eating protein, veggies, fruit, and only rice for carbs), I get praised.  I get told I'm doing this right.  But it's directly related to the sacrifices I make in my diet.  And I think this is a gateway to an eating disorder.

Having to be so aware of every single thing one eats is a delicate issue.  I'm just starting to poke at the surface of this topic.  I'm going to think on it some more and see where this goes.

For the record, my speculation that my dialysis routine is related or could be related to an eating disorder is a very general idea.  It's not a fact.  And I haven't exactly figured out how it all fits together.   I'm just saying that I can sense a real struggle developing in me related to food intake and dialysis labs.  I realize this is unusually personal information, but I felt like sharing these thoughts and maybe they will mean something to you.

Eating well is like being good.  It has it's rewards.  But eating with abandon is just so darned delicious.  I hate to think of food as having a value of being "deserved," yet I can't help but feel there is something deeper - something psychological? - going on here.

Will write more as this issue becomes clearer to me.

Please do not view this as a negative aspect of PD.  It's really more of an issue simply related to anyone with a medical condition.  Weighing the quality of life lived against the quantity of life expected.  I think it deserves some thought.

Hope you are all well.

- Rachael M.

Potassium?!

Potassium is supposed to be the lab value that dialysis patients don't have to worry about. Well, apparently that's wrong because I just finished three doses of Resenium (spelling, will correct later) over 6 hours to bring my potassium levels down. I also got to take Lactulose along with it. If you don't know, Lactulose is a laxative.

I have never spent so much time in my bathroom.

I have never had a problem with constipation, so I'm ticked that my doctor prescribed it, and I didn't really think of it until after I'd chugged the first dose.

It's 2:00am. I finished the last dosage around 1am.  Apparently doctors/clinics don't think patients have lives or jobs when giving these orders. I have to be up in 5 hours to teach, then I have a 2 hour meeting..  Yeah, it's going to be a stellar day today.

That damn phosphorus

I know! It has been way too long since I have written. A little writer's block, a lot of work (3 jobs, the countdown is on to my 3 weeks off at Christmas!!), and really nothing much going on.

That all changed this weekend when I started noticing lower calf muscle pain.  My first thought was "how much can i keep from my doctor?" (I am a good patient, but not a great patient, especially diet wise. I have unresolved food issues.  I'm currently in therapy, so we'll see how that goes. TMI? OK, moving along. :)

I also thought it was maybe because I hadn't exercised in a week--snow is not my friend. I ordered an exercise bike, so figured the 10 days waiting for that would be OK. Not so, young grasshopper! Not so.  So I've re-added walking to my evening schedule (yes, you're right, the snow has melted).

Here's the main thing that I noticed happening:  if I sat for long periods of time, my legs would be weak/shaky and painful, and I felt like I would have to restart myself--moving was at first painful.  After walking for a couple of minutes, I was fine. Moving at regular speed (lightspeed) and with little to no pain.  However, once I sat again, the whole process would restart. Since one of my jobs is sedentary, I took two days off to keep myself out of that environment and I was able to be at home and up and moving around a lot.  Sit, read for 20 minutes, walk around the house, repeat. Not a bad couple of days off, but a little scary while waiting for the phosphorus to flush out.

The culprit? I should've known right away--yeah, too much phosphorus in my blood, along with some slight malnutrition due to not enough protein. UGH. Ladies & gentlemen, the balance between protein, calcium, phosphorus, etc is a FINE LINE to tread.

So, I started looking up information for low phosphorus foods.  What I really wanted were some numbers I could understand. I never felt like I got that from my clinic.  I was pretty honest with them
when I told them I ate sunflower seeds (which I knew were high in phosphorus). What the clinic
failed to tell me was HOW HIGH.

Yesterday I found this fantastic website that breaks down pretty much ALL foods into ALL their components.  So off I stumble to check out foods I eat regularly: bacon, asparagus (high, but acceptable), sticky rice, various other veggies and meals.  Then I very hesitatingly looked up sunflower seeds. Because once you have the information you need, you have to do something with it, like change. And while I've been changing my diet over the past few months and exercising more, I haven't given up sunflower seeds.  It's been a bit of an addiction.  Not good. And no more.

Let me explain the ideal daily amount of phosphorus allowed a dialysis patient who struggles with phosphorus--some of you lucky buggers don't have this problem.  I am jealous as I love foods with phosphorus in them!

800-1200 mg daily. That's it, that's all folks.  It's a pretty low number. A serving of asparagus comes
in at around 72mg/serving (1 cup). White sticky rice is a paltry 40-ish mg/serving. So far so good.  I'm pretty pleased with myself. But the sunflower seeds.  Oh those traitorous seeds:  1478 mg/1 cup
serving.  So I have been overloading my poor system for a couple of years. That makes me sad, because all someone had to do was make me aware of the numbers.  Not in a pushy way, but just
"Hey, RachelT, here's a booklet on phosphorus levels in foods."  I can react to numbers. Lists saying High Phosphorus Food vs Low Phosphorus Substitutes really do nothing for me because I can see the tangibles.  Obviously I need to see hard data and I need to be allowed to look at it on my own.

So. The sunflower seeds are out. I no longer feel compelled to eat them, because frankly, I have a lot of living left to do and I still have old journals that need to be shredded/destroyed.  I don't want them read after my death. I think about things like that!!

Over the past couple of days, the calf muscle pain has started to abate.  I can get up and walk normally.  I have started to look more seriously at what I'm eating and how much it's costing me in phosphorus.  I have blood work tomorrow and I'm sure the labs for phosphorus will be sky high, and
protein will be quite low.  But that's OK because now I know what I'm doing and what numbers I need.

That handy little website? http://nutritiondata.self.com  Type in the food in the search bar and you'll get a complete breakdown.  Brilliant, helpful website.  I am in love with the person/people who put it together. :)

So it took awhile for me to blog--& included a bit of a health scare to get me back to it--so hopefully I'll be back to posting more regularly. If you think I missed anything, or you have questions, leave them in the comments! Thanks for reading!

RachelT

I am not a doctor, nor do I play one on television

Hi!  Rachael M. here!

It's been a while.  Sometimes life surprises you with issues that seem to eat up all your time, you know?  I've had a lot on my plate lately.  Despite this, I keep trying to find time to tell you about a recent experience.

Before I tell you about it, please know this:  I am not advising anyone to do what I did.  I am not claiming any sort of guarantees.  I am not even suggesting that anyone follow my example.  I just want to tell you what happened to me from my point of view alone.

Okay.  On to the story.

My labs for July were not great.  A few things were in balance, but my Phosphorus has been on the rise for the last couple of months.  I know that a lot of the problem is my lax approach toward the balance between food and binders.  But I just couldn't find a way to regularly keep my Phosphorus in check.  I would eat something high in Phosphorus in a small amount, a few times a day.  And think, "It's barely anything so I don't need to take a binder."  But it adds up.

So, I decided to try something drastic as an experiment.  On August 1st, I changed my diet completely.  I went 100% gluten-free, dairy-free, and refined sugar-free.  I've always had digestive trouble and a sense of bloating and discomfort after meals.  So I eliminated all of the possible culprits.  The plan was to add one of these elements (gluten, dairy, sugar) back into my diet slowly and see if I had any reactions.  First I had to completely clear my system.

For the entire month of August, I ate absolutely no wheat, dairy, or refined sugar.  

I had labs drawn at the end of August.  My PD nurse called me with the results and told me the amazing news.  Every one of my lab values was within the proper range.  Not too high, not too low.  My labs were the best labs I've had since I started PD.  July's Phosphorus level was up near 7.  August's was in the 4's.  I was able to not only drop my Phosphorus by a couple of points, but get it into a pretty great place.

What happened?  Well, Phosphorus is very high in foods that are bready and cheesy.  Taking those elements out of my diet gave me a much easier method of controlling Phosphorus and taking my binders.  Without gluten and dairy, snacks became things like fruit, popcorn, V8 juice - things that I can graze on that don't require my usual three Phoslo binders.  The Phosphorus going into my body was dramatically reduced.  The other values all fell into line.

As an added bonus, I haven't had the digestive/bloating issues since living without wheat and dairy.

Anyway, that's what happened.  One month of eliminating all gluten, dairy, and refined sugar from my diet knocked my labs into shape.  All the values were within target range without even trying.  I was surprised at how quickly I lost the cravings for bread and cheese.  I got much more creative with meals.  I built my daily menus around animal protein, fruit, vegetables, rice, and oats.  I never felt unsatisfied or hungry.  And I have seen improvements in my complexion.

Again, this is just what I did as an experiment.  But I thought the impact on my lab work was worth sharing.  I am continuing to eat this way (eating "clean" and leaving out the wheat, dairy, and sugar) and will see if it affects my labs again this month.  I have no plans to add the wheat/dairy back to my diet any time soon.  I'll report back when I get this month's results.

If you have any questions about it, let me know!

Quick post - I haven't forgotten!

I'm not sure if it's been a bad case of writer's block, laziness, or busy-ness..but I have been a HORRIBLE blog updater.  I started a new job over the summer and now I'm working two jobs - teaching ESL at the college, and Admin Support in Counselling Services at the university here in town. Needless to say, this first week has been ... BUSY. I'm lucky if I remember to eat. And winding down at night has been my biggest challenge. I get home around 8:30 and my goal is to be in bed and asleep by 10:30. That hasn't happened this week yet, so I need to figure out how I can wind down more effectively so I get a good night's sleep.

Another challenge has been, of course, dialysis. Not really a challenge in that it's been difficult or anything, but I need to be more organized in setting up my machine earlier in the day when I have time at home and I'm not rushing to get to bed. These are the kinks that I need to work out over the next week or so as I settle into this routine.  Right now I'm telling myself that it's for 4 months - until December. I don't NEED to do both jobs, but I am because I want to be completely debt-free by December and this gives me the means to do that.  All part of the hustle. :)

So I've been thinking off and on what I want today's blog post to be about, and I do have to admit, I'm still stumped. At first I was thinking of writing about some things that bug me about Baxter - the PD machine is too heavy. Seriously. Have they looked into that? It's ridiculous to try and travel with that beast. But overall, Baxter takes pretty good care of us.

I then thought about writing about some of the developments I've been hearing/reading about for dialysis patients:  a coffee-cup sized "kidney" being developed in the States, 3D kidneys being "printed" in Japan (sign me up!!)... These developments are exciting for kidney patients and I'm more interested in going through with one of these procedures than I am with an actual transplant. I'll look for those articles and then post them in the next couple of days.

The Kidney March starts tomorrow. It's a 3 day, 100-km walk held to raise money & awareness for kidney disease. Nick Cannon is one of the big celebrity supporters, given his history of kidney problems. He did the walk last year, but wasn't able to do it this year.  A friend of mine is a renal/transplant nurse and she's on a team that's doing their second year. So proud of them! :)

I'll try and sit down this weekend and come up with an actual post instead of just rambling thoughts!
Rachel T

It's Like a Very Bad Hula Dance

Catheter positioning.  I'd like to think that it is an exact science.  I mean, someone is implanting a catheter into my gut so I hope they really know where it's supposed to go.  What I have learned is that catheters are not identical in placement and function.

I remember talking to a friend of mine who also does PD on a cycler.  She told me that she was gaining weight, felt bloated, and had significantly low UF (ultra filtration - the amount of actual fluid that is removed during the night) numbers in the morning.  She said she could drain just fine during a manual exchange and didn't think there was a real problem with the catheter itself.

Aha.  Positioning.

The way her catheter fell inside her body when she was in bed and the way she slept curled up in a fetal position were causing her to limit the catheter's ability to drain.  A strange little kink or a specific positioning can slow or even stop the drain of fluids.

We talked about it and I told her what I did.

1.  I accepted the fact that there would be four drains during the night.  And I want to get some good, solid sleep.  So if the first three cycles had low drains, that would be okay. 

2.  I had to set my alarm to wake up when the last drain was scheduled to happen.  Usually a bit before, so I could really encourage the final drain.

3.  That final drain would set the tone for my day.  I didn't want to "trap" a lot of fluid inside my abdomen and feel full, sluggish, bloated, or sore all day.  I wanted it all out so that I could have my final fill and be on my way.  Comfortably.

4.  I wake up a bit before that final drain starts.  I sit up to encourage the drain.  I get up and make the bed.  Start recording my cycler information.  Move around.  All of this movement helps me get a complete final drain. 

My friend said that sometimes it seemed like her catheter drained slow/poorly when she had been sedentary for a while.  I completely agreed.  My usual exercise includes alternating walking with cardio DVDs.  A good amount of movement.  What I have found is that during times when I am unable to exercise (having the flu, for example), I need to encourage that catheter's flow in any way I can.

And yes.  I do mean the very bad hula dance.

Last year I had the flu.  I was on the couch for three weeks.  It was just awful.  And that limited activity seemed to cause my catheter to lie stagnant in my body.  No little movements or exercise-related jostling to keep it moving at all.  Every time I had to do my final morning cycler drain, I had to stand up and gyrate my body to get the fluid to flow.  It was ridiculous.  I'm sure I looked ridiculous.  But there I was, standing next to the bed, looking like a drunk hula dancer.  Just moving around to make sure the drain would be complete.

Is this all in my head?  You might think so.  The fact that I have now talked to two other people who have had to do the Bad Hula on occasion tells me that it very well may be a PD "thing."  Unknown.

Generally speaking, I find I drain much better when I stay as active as I can.  Seems like it encourages things to go very well and keeps my insides limber.  I have no science to back this up.  But if you experience poor UF numbers (when they should be higher) in the morning, try sitting up, standing up, and maybe doing your version of the Bad Hula to get things moving. 

Ah, the ridiculous things we think of on PD.  Keeps it interesting!

- Rachael M.

Self-care

Today I'm going to talk a bit about the importance of self-care.

I think this topic is important for everyone, not just dialysis patients. Stress can be deadly, literally:  http://www.livescience.com/2220-stress-deadly.html

If you don't know how to deal with stress in your life, it's time for you to figure it out. Being on dialysis is one of those big life stressors.  According to the Holmes and Rahe Stress Scale, illness is ranked at #6 on their list. So it's up there with death of a family member and divorce. And it's up to you to do the things that make you happy. And if nothing makes you happy, then find something that does because living as a stressed person is doing you more harm than good.  Plus, you're probably pretty miserable to be around and you want to build a positive support system around yourself.

I am pretty busy during the week with work, volunteering, and other commitments. I try to schedule movies out, dinners, and other social activities during the week because the weekend is for the introverted part of me, when I can read, relax, and rejuvenate--and be alone!  I will catch up on TV programs that I have PVR'd, get lost in a book (right now I'm reading through the Game of Thrones series), do spa stuff for myself, and get outside for some peace and quiet. By the time Monday rolls around, I'm ready to be back at work interacting with people.

So think about what you enjoy. What hobbies do you have? Have you dropped any of your hobbies since starting on dialysis? Why? Can you do something similar to replace that hobby or passion? Is there something you've always wanted to try?

Remember that exercise is one of the best de-stressors out there. It doesn't have to be anything major - but a walk around the block is a good start. Keep your blood flowing and your heart pumping. Keep yourself in shape. Remind yourself that you are ALIVE. If you enjoy something like swimming, figure it out. There are waterproof bandages available in medical supply shops and if your exit site is well-healed, there's no reason you can't swim. Over the winter I usually take an aquajog or aquafit class a couple of times a week. After being in the pool for a couple of hours, I do a quick dressing change in the change room (in a private cubicle) and then go home and shower and do a proper dressing change. In my 8 years of being on dialysis I have never had an infection because I take GOOD care of my exit site - but I also don't let it stop me from doing activities I enjoy. I've done belly dancing, weight lifting, and zumba. Some days it's a bit of a challenge if my blood pressure is low, but then I just take it slow and do what I can. You can, too.

Another aspect of self-care is taking care of yourself mentally. If you're dealing with the grief of being on dialysis (remember, #6 on the list!), then go for counselling. Taking care of your mental health is just as important as your physical health and I think in many ways it makes you stronger. Be willing to make yourself mentally stronger. I was resistant to counselling of any kind for a long time, but a couple of semi-important events convinced me that it would be beneficial for me to take better care of myself mentally. I've always been self-aware, but a little afraid of what some psychologist or counsellor might find while fishing around in my brain. However, it's a good idea to move past that fear and invest in yourself. If you're looking at counselling as a self-care option, talk to the social worker at your clinic. He or she should be able to refer you to someone to work with.

Finally, like I've already said: figure out what makes you happy and do things that you enjoy. Take time for yourself, away from other people. It's OK. And your health will thank you for it!

RachelT

Being prepared

It is really hard to write about disaster preparedness because there is SO MUCH to think about! First, let's get the Zombie Apocalypse preparation out of the way. It's quite easy.

See. Nothing to it. :)

As I mentioned in my previous post, the areas to the north and east of me were heavily flooded. A lot of snow over the winter and heavy rains this spring have resulted in a lot of run off from the mountains. It all combined during one deluge in one day. The people of High River still haven't been allowed back into their town and they're getting angry. A few people managed to sneak into their houses (making their way past police barricades) and were promptly electrocuted when they decided to try and turn the lights on in their still flooded homes.  There's a reason common sense isn't so common anymore.

Anyway, I'm getting a little off-track here! My intention is to talk about disaster preparedness, not other people's lack of common sense! :)

Disaster can strike in many ways: flooding, tornadoes, earthquakes, fire, etc. The flooding that occurred in Calgary and surrounding areas, happened in under 30 minutes but continued on over a couple of days. People had almost no time to gather their things, run to their cars, and escape the area. Now, imagine being on dialysis and trying to gather up the things you need to survive. Not only are you a human trying to survive, you are a person with a chronic illness trying to survive.
Doubly stressful.

First and foremost, you will need your cycler. If I had 15 minutes to leave my home, that is about the only thing other than my computers, changes of clothes, and phone that I would grab. Everything else is replaceable. I would leave the supplies up to Baxter to deal with. They have warehouses full of stuff; I don't need to be hauling it around in an emergency. Same goes for prescriptions. Everything is on file with your pharmacy or doctor's office. They can take care of your prescriptions.

Insurance papers and pictures of your things. I am a bit OCD, so I have pictures of all my stuff in with my insurance papers. This way, if I lose my house to fire or something, I have a record of all my possessions. Possessions are just things, but I pay insurance so they can be replaced in the event of loss.

STAY ORGANIZED. Keep all your important documents in one place. Preferably in a fire-proof lock box. That's in a perfect world. I have all mine in a Rubbermaid container. But it's still easy to grab, and everything is there.

What's your backup plan? Do you have people you can stay with if you need to get out? Do you have an emergency fund so you can pay for a hotel until you are reimbursed? Do you know your area well enough to take alternate routes out?

Do you have an emergency kit with flashlights, batteries, water, canned food, matches, blankets, etc? When I lived in Japan, I had an emergency kit in case of an earthquake. It had clothes, water, shoes, a flashlight, extra batteries, and food in it. It was always beside my door in case I needed to leave in a hurry.

Do you have enough food and water in your house to survive a power outage? If you're in an area that has ice storms (like southern Ontario), do you have a back up generator?
What would you do about your dialysis in case of a power outage (hint: manual exchanges).

My intent is not to create a sense of fear, but instead a sense of awareness that being prepared is better than panicking. Yes, you will still probably panic, but at least you will be prepared and being on dialysis won't be such a big thing for you or others in the event of an emergency. The better prepared you are, the more in control you will feel.

If I missed anything or you can add anything, please do!

RachelT

To share or not to share?

There are people in my life who have known me for many years who do not know that I am a PD patient.  I simply haven't told them.  It never mattered.  My closest friends and family know, of course.  But sometimes I need to get a feel for a person's personality before I share anything related to PD.

Why?  Because of the pity issue.

One thing I have been very protective of since becoming a PD patient is my ability to be viewed as a complete person and just as I am.  I've been disappointed in the past by people who forget to treat me as a friend and instead treat me as a "sick person."

Rachel and I were talking once about the difference between someone saying, "Hey!  How are you?" and someone tilting their head to the side and gently saying, "Hey... how ARE you?"  It's frustrating when people assume that your need to do dialysis makes you somehow sad all the time and deserving of sympathy.  The option to do PD instead of hemo is a choice that gives me freedom to feel much more "normal" in my daily living.  As soon as I button my pants, my disability is hidden.  And I like it that way.

When I meet people, I need time to get to know them and see how they behave and how/if they gossip about other people in their lives.  If someone is a real talker and loves to share personal information about other people just to sound more interesting, they certainly don't need to know about my private issues. 

My closest friends never bring up PD.  If there's something I want to share with them, I will.  We have so many other things to talk about.  It seems trite to spend our time together to blah blah blah about the PD process.  And it makes me feel like a complete person.  Not a person with issues, unable to take the focus away from myself.

I've met people with various disabilities who just love to talk about their problems.  I understand the frustration and the importance of their concerns, but after a while it gets to be too much.  I really wanted to avoid being that person.  I didn't want my identity to be "the PD girl."  There's got to be more to a person than just their disability.

It's not rooted in shame.  It's rooted in finding appropriate outlets for discussing my issues.  And setting aside time for PD-specific talk with people I love.  And not bringing it to light every single time we meet.  Also, I love the ability to keep my PD to myself and let people get to know me as I am - as a person - before they put any sort of PD label on me.  It makes me stronger and more confident.

Choosing PD over hemo is another way to exert control in my life.  To find privacy when I need it.  To live more closely to my ideals.  And to define myself with my own parameters.

- Rachael M.

upcoming post

http://news.nationalpost.com/2013/06/20/pictures-and-videos-of-massive-flooding-in-canmore-and-southern-alberta/

This is what's been going on in this part of the world over the past week. Therefore, I started thinking about what dialysis/PD patients should do in case of an emergency. I'm planning to post by Friday, but I just wanted to give a heads up on topic and why I haven't posted recently. I am south of Calgary, so wasn't affected in the same way as the people in Calgary, Canmore, High River, and Medicine Hat. Thankfully. But more on that by Friday.

Drain Bags and Dreams

A couple of thoughts are floating around in my brain today.  Just some information that I feel should be here - and if I don't write it, I'm sure I'll forget it.

1.  Something that the training staff/doctors don't tell PD patients is that PD has quirks.  They usually aren't PD patients themselves and have no actual experience with the process.  They don't know what it feels like to have a slow drain, to have to sit up to complete a drain, or to deal with the actual equipment.  Something I think is worth mentioning is the situation of using a drain bag.

Some cycler users run the tubing from the catheter straight into a tub or toilet.  This is a good option for people who have a convenient layout in their homes.  I don't use this method because of the location of the bathroom in relation to the bed.  It would be a tripping hazard for my husband.  Also, I have cats.  And I don't want to tempt them with a tube of bubbling fluid that looks like it would be fun to play with.  So I use a drain bag to collect the dialysis fluid.

A drain bag is exactly what it sounds like.  A big, square, plastic bag.  What happens is that most people who are going to use a drain bag are told to "put it on the floor."  Well.  Let me tell you what kind of nightmare this can create.

All it takes is one clamp that isn't fully closed and the drain bag will leak all of its contents onto that floor.  And if you have carpet in your home, you may be calling a cleaning company or possibly having carpet replaced.  Imagine 10 or more liters of fluid just seeping into your floor.  It's awful.  I've seen posts on various online forums with people asking how to clean up after these accidents.  Remember - the fluid you are removing is very much like urine.  And that's what would spill out all over the floor.  Not pleasant.

I was never advised about this - it's just something I figured out and really think should be shared with anyone who uses a drain bag.  Get a plastic bin from the store (Target, WalMart, etc.) and put the drain bag inside the plastic bin.  Just make that part of your setup routine.  Over the past seven years or so, I have woken up to a plastic bin full of leaked fluid several times.  I've forgotten to close a clamp.  And I can dump the plastic bin into the tub.  And not think about having to clean the carpet.  Which would be a horrible mess.

Save yourself the agony of a possible cleaning crisis and use a plastic bin if you use a drain bag.


2.  A peculiar side effect of starting on the cycler is PD dreams.  Since being on PD, it seems like a few times a month I have quasi-nightmares involving the cycler tubing.  I dream that I am at a party and I'm still connected to my machine.  Or that I have disconnected from my cycler and can't find a cap to close my catheter.

I think this is normal and natural.  We are trained on the specifics of actually doing PD, but not on how to deal with it emotionally.  That burden is left to us to figure out.  I think PD dreams are part of my mind's way of expressing frustration or fear.  When you think about it, it's a little strange being connected to a machine at night.  Sometimes I feel like an astronaut, connected to the ship by a tube and I can only go so far because of my lifeline.

Maybe you won't experience the strange PD dreams, but if you do, just know you are not alone.

- Rachael M.

starting PD

I’ve been thinking about this post all week. I want to make this post simple and clear, not overloaded with information.

Rachael spoke previously about the idea of Why PD? Our answer is always Why not?? It’s so much easier on the body than hemo and really gives you a sense of control over your health and welfare.

For this post I want to talk a little more about the process of starting on PD. Your clinic likely offers an orientation when you start on dialysis and presens  all types of therapy to you. You can do at home hemo, in clinic hemo, and PD.  They will of course say that a transplant is the optimal form of therapy, but is it really? We all know what the waiting lists are like and you might even know what it’s like to want a living donor, but are too hesitant to ask family and friends to donate because it is a BIG DEAL.

That’ll be another post for another day! J

I decided very quickly that I wanted to switch from hemo to PD. At first, I hadn’t been interested in doing anything other than what I was doing because I was still adjusting to the idea of being on dialysis and adjusting my life to that whole process. However, I got a job working nights and dragging myself to the dialysis clinic after working all night and sitting on a machine for 3 hours was REALLY unappealing. Thus, my decision was made to switch to PD.

I was working a week on-week off rotation and the surgeon booked me in for catheter placement surgery on the Tuesday of my week off. In my naivete I thought a week of recovery would be more than enough. HAHAHA. It wasn’t.

The catheter surgery is a day surgery procedure. I checked in to the hospital in the morning, the surgery happened at about 1pm and I was home by 5. My only instructions were to keep an eye on the catheter site for bleeding through the bandages and to NOT MOVE AROUND.

Unfortunately, the catheter site wouldn’t stop bleeding, so I drove myself in to emerg and a surgical resident did a little bit of restitching on the catheter to close the site a little tighter. That helped and I began the healing process. I have a REALLY hard time sitting still, so my healing time was perhaps a little longer than normal. I ended up taking an extra week off work because I still couldn’t move around freely. It didn’t hurt, it was just tender and prone to bleeding (because I kept moving around).

I still continued to do hemo while the catheter site healed. I think it took about a month before I started on PD. In that time I also did the PD training – a full day of instruction and practice using the cycler, setting up bags, learning about alarms and proper care & treatment. The training was excellent and the only problem I had was the nurse yelling at me because she was used to training elderly patients with bad hearing. I did tell her that she didn't need to yell, and that helped. J

One bad/disappointing/frustrating moment while all this was going on – and hopefully this reminds nurses out there how important it is to be encouraging. One nurse had the gall to tell me that PD didn’t usually work on patients because the catheter floated up inside the peritoneal cavity instead of staying lower down like it should. She told me that I shouldn't get my hopes up. Boy, was I pissed off. So, nurses, even if you think that, keep your mouths shut. Please and thanks. J

The worst part for me, and I've had people agree and disagree with me here, was the flushing of the line once the healing was well underway and I was ready to start PD on my own at home. PAIN. Oh my heavens. Pain. I have tattoos and and those didn't hurt AT ALL. Getting the line flushed was pain and nausea all rolled into one. I’m not sure if it was the temperature of the solution or what. I just wanted to curl into a ball and cry. Oh wait, I did.

I’d like to tell you why the line flush is important or necessary, but I’m not remembering why. It might have to do with the healing of the catheter, or the solution that’s put into the tubing during the surgery. I can definitely ask and get back to you. I just remember that it was not pleasant. Like I said before, though, I’ve talked to people who have had no pain during the flushing process. So there is hope that yours will be pain free, too!

I first started out doing manual exchanges 4 times a day. The exchanges take about 20 minutes and I would do them in my kitchen and do dishes or read while draining and filling. After a couple of months of that, I was able to switch over to the cycler as I had the right type of peritoneal membrane for the cycler. There are four types of perintoneal membrane, with two of those types being right to use the cycler. You’ll want to speak more to your nephrologist or PD nurse about that.

To wrap up, switching to PD was the best decision for me. It is easy, I have more energy, and I feel –almost- like a normal person. I like that I can hook myself up at night, go to sleep, and be done in the morning. I like that I can control the machine and set it up for MY schedule. I’m not at the whim of a clinic and a clinic schedule. I don’t have to worry that I’ll get a nurse who is in a hurry, overworked, distracted, or just in general pissy while poking me with needles. I like that there are no needles, period.

Don’t get stuck thinking that your form of therapy is your only choice because your doctor chose it for you. Be the manager of your care and fight for your care, your comfort, your health, and your body.

 Coming up: why I'm on PD and why I'm not pursuing a transplant (yet).

RachelT