Clinic visits are a regular part of the routine, much like regular blood work. When I first started on PD, I would have clinic visits every 3 months and the routine was very similar to what Rachael described here: Rachael M's clinic visit. However, because I am a healthy dialysis patient, my nephrologist switched me to every 6 months (ok, HE didn't switch me, I negotiated for that) :) And right now I'm almost at the 9 month point since my last appointment (scheduling conflicts, bad patient, etc). I also only go in roughly every 3 months for lab work. Mainly because I despise having my blood drawn.
So, I'm going to do a brief comparison of clinic visits.
1. Arrive at clinic, refuse to step on the scale and give them my weight from home (which I will possibly lie about. I used to lie all the time, but now I don't - mainly because I lost a bunch of weight and am now OK with the truth) :)
2. PD nurse checks blood pressure while inside I freak out because guaranteed it's going to be elevated. Play images of Hawaii in my head to force myself to relax.
3. Go through chart with PD nurse, making any updates on medications, or noting any questions I have. I check through my labs with the nurse to see if anything is of concern. Usually told to increase my protein intake and that my phosphorus levels need to come down. Of course they do, I eat sunflower seeds all the time. I know why the phosphorus is high.
3.5. Refuse to see the dietician. I know what my food issues are. I know what I need to or should change.
4. Because I go in every 6 months, it'll be time for a catheter change. This is NOT the whole catheter - just so you don't think that you need surgery every six months! You don't. They change the tube at the end. The PD nurse will do this while we wait for the nephrologist to show up. It takes about 15 minutes - the nurse will wash and glove up and then take off the dressing over the catheter (ouch), switch out the tubing, and redo the dressing. I leave them to it and then change the dressing as soon as I get home because it's never done the way I like it. But that's OK, because they can't learn every patient's personal preferences for how their dressing is done.
5. Wait for the doctor.
6. Still waiting.
7. My rock star doctor hustles in - he's the only nephrologist in the whole region - so the man is BUSY. And he is a bit of a rock star. He's got spiky hair, he's in a rock band, he's overall an awesome guy.
8. We argue over my blood pressure. I refuse to change any or increase any medications (if I can do it through diet, I'll try - HAHAHAHHAHAHAHA). We talk AGAIN about why I don't want a transplant. He asks to see me again in 3 months, I say 9, we agree on 6 and he goes on his merry way, telling me to take care.
9. The PD nurse comes back in and checks the instructions and we book an appointment for 6 months down the road. She hands me a bag with any supplies I've requested that Baxter doesn't supply, and I leave.
The whole appointment takes about an hour. I'm not a non-compliant patient, but I believe very much in being the one in control. I know what my lab values should be and what they all mean. I am not hesitant in saying no to medication. I do not lie to my doctor, but I am the one living with this. He can understand to a point, but he would also like to see me with a transplant. To me, right now, a transplant doesn't make sense. Or rather, the benefits do not outweigh the risks. When I get to that point, then I will move forward with a transplant, but I'm not there yet.
I think that'll be a good future topic: the benefits of PD versus hemodialysis and transplant.
Any questions or comments, feel free!
RachelT
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