All About Dialysis: A Patient's Point of View E-Book

Buen Domingo

• Herausgeber: BookRix
• Kategorie: Fachliteratur
• Sprache: Englisch

Veröffentlichungsjahr: 2019

Beschreibung

  This is a compilation of my Coping With ESKD blogs at domingobuen.blogspot.com from March 20, 2014 up to May 7, 2019 in chronological order. This is all about my actual dialysis experiences, writing essays and research work as a dialysis patient at the Hemo Dialysis Unit (HDU) of Gov. Celestino Gallares Memorial Hospital (GCGMH).  This book also include my know-how and achievements in running the Bohol Association of Hemo-Dialysis Patients and Watchers (BOASHEPAWA) as Chairman of the group. I started dialysis on September 29, 2011 and it has been almost eight years since then and I finally realized that it would be easier for me to share my experiences and articles about dialysis if I can print it in a book so that my fellow dialysis patients, doctors, nurses and those people who are interested about caring for their kidneys to avoid kidney disease can read and share it to more people. 

     This book aims to provide information and knowledge about the intricacies of dialysis, what is it all about and what to do and what not to do by the patients. I am not a medical practitioner, but through my personal experiences and continuous research about dialysis, I was able to know the major aspects about dialysis and share it to my co-dialysis patients through my dialysis blogs. This book will also show how I have coped with End Stage Kidney Disease with positive outlook in life, find ways to make my time useful through writing, research and still hopeful and courageous despite a life of pain and uncertainties.

Leseprobe

Buen Domingo

All About Dialysis: A Patient's Point of View

A Personalized Experience in Dialysis

BookRix GmbH & Co. KG81371 Munich

Dialysis Topics

INTRODUCTION   

This is a compilation of my Coping with ESKD blogs at domingobuen.blogspot.com from March 20, 2014 up to May 7, 2019 in chronological order. This is all about my actual dialysis experiences, writing essays and research work as a dialysis patient at the Hemo Dialysis Unit (HDU) of Gov. Celestino Gallares Memorial Hospital (GCGMH).  This book also includes my know-how and achievements in running the Bohol Association of Hemo-Dialysis Patients and Watchers (BOASHEPAWA) as Chairman of the group. I started dialysis on September 29, 2011 and it has been almost eight years since then and I finally realized that it would be easier for me to share my experiences and articles about dialysis if I can print it in a book so that my fellow dialysis patients, doctors, nurses and those people who are interested about caring for their kidneys to avoid kidney disease can read and share it to more people.

I would like to thank my family especially my wife, Belen K. Domingo, for giving me the full support that I need in order for me to achieve my goal of sharing my dialysis knowledge to everyone who are interested about Hemo-Dialysis. I would like also to thank our Nephrologist, Dr. Mayida Ybanez for giving her time and untiring effort to help dialysis patients like us. My gratitude also goes to the doctors and HDU Staff of GCGMH for their sacrifices to fulfill their duties to us and most of all, I would like to thank and acknowledge the efforts of Dr. Mutya Kismet T. Macuno, Medical Center Chief, in providing us a new dialysis center comparable to those in Cebu and Manila. Dr. Macuno was able to provide us dialysis patients with almost free dialysis service through her adept skill in coordination and fund sourcing activity with private and government officials.

This book aims to provide information and knowledge about the intricacies of dialysis, what is it all about and what to do and what not to do by the patients. I am not a medical practitioner, but through my personal experiences and continuous research about dialysis, I was able to know the major aspects about dialysis and share it to my co-dialysis patients through my dialysis blogs. This book will also show how I have coped with End Stage Kidney Disease with positive outlook in life, find ways to make my time useful through writing, research and still hopeful and courageous despite a life of pain and uncertainties.

This book should serve as a guide and I made sure to the best of my ability the accurateness and completeness of the topics in my book. However, due to human limitation, I will not be liable to any untoward incident or injuries, losses or inaccuracy of information that may arise in reading my book.

Chapter I: Dialysis Topics:

 1. The Beginning:

This article is about when my kidney disease began, how it progressed and how it became an End Stage Kidney Disease. It presents how old I am when I was diagnosed and what happened afterwards. This was written on March 4, 2014.

As the pages of my life are turned, it becomes clear to me that every person in this world has his/her: role in life and own story to tell. This is my story. 

It all started when I was about 20 years old when I had my urine examined due to a suspected urinary tract infection. Not only I had an infection but the result showed that my kidneys are leaking proteins which means that something is wrong with my kidneys. The doctor diagnosed it to be a chronic kidney infection and will recur every now and then. My reaction was fear followed by a calming or re-assuring thought that maybe the doctor was not accurate in her diagnosis and all will be well again after I finished taking my medicines. So years have passed by and I did not concentrate on the condition of my kidneys. I continued to live normally except for the occasional bouts of colds and flu with sore throat and frequent stomach discomfort which I associated with hyper-acidity. So I took constant dose of anti-acid medication which I realized now that it had aggravated my kidney disease and the stomach discomfort that troubled me was due to my failing kidneys because I have read that indigestion is one of the symptoms of renal failure. I graduated from college, worked in a government agency and even started my Master's Degree, and then I started to feel pain at the back of my neck with accompanying nausea (feeling or urge to vomit). I felt more of these symptoms after I ate a salty meal. I decided to go to the hospital and had a check-up. My result showed that I have high blood pressure and so the doctor gave me a maintenance drug to control my BP. I was about 25 years old then and again I realize now that the damage to my kidneys at that time was increasing.

I continued with my life as usual, ate whatever food that I want and drunk alcohol occasionally but I continued to take my maintenance medicines on a regular basis. I still experienced symptoms of high blood pressure especially when I over ate or drunk too much alcohol. I did not put much attention to my disease until I had a medical check-up again. I am doing field work for a private bank at that time and I constantly felt body aches and discomfort. This is when my doctor said that my heart was affected by my uncontrolled high BP. I am sicker because of my un-treated kidney disease which is still not pronounced then because the Creatinine (indicates kidney function) level in my blood is in the upper normal. My doctor said that I should eat less fat and more on fish and vegetables. This is the start of my DIE with a T (diet) which I did not follow religiously. One time I felt ill and I was hospitalized in Tagbilaran City. I did not feel well even after I checked out of the hospital so I decided to have a medical check-up at Cebu Doctors Hospital and the Nephrologist advised me to undergo a "workout" (a series of physical and laboratory check-ups). We have to cross the sea to get to Cebu and we don't have a house where we can stay so I decided to be admitted to the hospital while waiting for the results. I thought my stay will only take for a week, but weeks have passed and my Nephrologist prescribed me a medicine for high BP that unfortunately gave me an adverse reaction. My BP shoot up to 200/110 and three doctors stood by my bedside since I was also suffering from Schemic (lack of oxygen) heart disease then. I was lucky, it was not my time to die yet. I got out of the hospital after a month, spending my Christmas and New Year's Eve in a hospital room. The hospital bills? Our office paid the expense since it was part of my benefits.

I religiously took my medicines, followed my diet and had regular check-ups at Cebu Doctors. However, it was not long enough after I was hospitalized and I was back in Cebu Doctors Hospital again due to the effect of my steroid medication which affected the beating of my heart. I was also admitted in St. Lukes and Capitol Medical Center in Manila. When I was in the hospital in Cebu, the doctor said that there will come a time that I will undergo dialysis and I prayed to God if he could give me just six years without dialysis. I monitored my Creatinine once in a while and it was stable at 2.5 to 2.8 and as the years passed by, I thought my kidneys are good and forgot about the medical check-ups. I ate what I want and indulge with alcohol. One day I went out for brisk walking and I had to walk through a steep road, I was not expecting that I would have difficulty in catching my breath but it happened that I almost passed out catching my breath. I am getting old I told myself and didn't take it seriously but as the months passed by it is not only difficulty in breathing that I felt, I also felt nauseous and vomited as if I could spill out my stomach. One night, my mouth was very dry and I am very thirsty. I thought that my blood sugar is high so I decided to have my blood sugar level and Creatinine checked in the laboratory. The result shocked me because my blood sugar level is normal but my Creatinine is 13 which is very high compared to the high normal of 1.7 to 2.0. I immediately contacted a Nephrologist and she advised me to have a Complete Blood Count (CBC). The result showed that my Hemoglobin (helps in distributing oxygen to the cells) is only 6.0 while the normal is 12-14 and I am anemic (low Red Blood Cells count). I realized that my difficulty in catching my breath is due to my anemic condition and my vomiting is about my failing kidneys. My Nephrologist advised me to be admitted as soon as possible. At the hospital where I was admitted, they transfused me with 4 bags of blood and operated on me for my emergency access for dialysis.

I prayed for six years without dialysis since I was admitted at Cebu Doctors Hospital, that was twenty years ago! God gave me 20 years instead of six years. Praise the Lord almighty!

2. I was Once a Dialysis Rookie:

This is all about: when I started having dialysis, what I have experienced and how I felt as a new patient, my first blood transfusion, my operation on my dialysis access or Fistula and my new “classmates” or fellow dialysis patients. This was written on March 11, 2014.

 Dialysis session at Capitol Dialysis Center in Quezon City with my wife and DOH Assec. Dr. Enrique Tayag

We all had our milestones in life. Sometimes we have experienced them with happiness, sometimes with challenge and pain. What matters most is how we dealt on them. Was it with fear and uncertainty or was it with courage and hope?

One of my fears before was entering a hospital; I just could not stand looking at sick and bloody patients in the emergency room. I do not like a place that exudes pain, suffering and death. When my Nephrologist advised me to be admitted to a hospital, we chose the Regional Hospital in the city that is managed by the government. Upon entering the ER, my nervousness was heightened as I looked on the many patients that are either laid on stretchers or sitting patiently as they wait for their turn to be checked up by the doctor. The room was crowded with nurses (student and registered) and resident doctors busy with their daily routine especially if a new patient is wheeled in from an incoming ambulance. My wife took care of the requirements for admission including my PHILHEATH (government health insurance) requirements so most of the time I was alone and I could not stop thinking of my condition, what will happen to me and my family and the expenses that will be incurred. My brain was overloaded with different images, thoughts and I am confused, nervous and tired. As I am seated and waiting for the doctor, a female nurse approached me and asked me who is my companion and I said that my wife is still outside. The nurse who I learned afterwards is a student nurse informed me that she will insert a Hep Lock (tube where a Catheter (long tube) for IV fluids will be connected) on me. I did not bother to ask her any question and I am quite weak so she tried to insert the Hep Lock on me. She attempted twice until my veins were swollen and the pain has increased so she finally gave up and called a "real" and experienced nurse who effortlessly inserted the Hep Lock at the back of my hand. I realized then that the first nurse was a student who is not supervised by her Clinical Instructor. After a two hour wait, I was checked up by the admitting physician and finally wheeled to a private room. This was my first admission in a government hospital and I am not aware that these things could happen.

I was relieved when I entered my room with air-conditioning, TV, toilet, chairs and a soft cushioned bed. But it was not long enough as I lay down in the comfort of my hospital bed that a surgeon walked into the room and told me that I will be operated upon. I felt nervous again when he asked me where my emergency dialysis access will be placed: in my thigh or wrist or neck. He explained the advantages of an IJ (Intra-Jugular) Catheter in the neck so I decided to choose it. The next day in the hospital was blood transfusion day and this was the first time in my life that another person's blood will run in the veins of my body. At first, I was hesitant and I felt that my body will be violated by a foreign blood but I have no choice. They transfused me with two bags of blood in my room and another two at the Hemo-Dialysis Unit (HDU). The purpose of these transfusions is to increase my Hemoglobin from 6 to 11 because I will not have dialysis if my Hemoglobin is low since I will strain my heart.

The day of the operation came and a rubbery three inch pointed tube was inserted in my neck near my heart. I heard the surgeon said to the assistant nurses in Visayan: " Maayo man ni pero dali ra malata" (this is good but will easily get infected). Oh my Lord! An infection in my neck and near my heart! I was terrified by that thought. There was no complication during the operation. When my access in the neck was done, I was immediately rushed to the HDU at around 7:00 PM where I had my first dialysis. In the HDU, my stretcher was placed beside a dialysis machine. I saw two uniformed nurses and one dialysis technician. These people will become my regular partners in my weekly dialysis. It was my first time to see two tubes from the dialysis machine were connected to my neck and I saw my blood running in those tubes. Not a pleasant sight I tell you. My first dialysis took only two hours, the regular dialysis is four hours.  This first dialysis is to "acquaint" my body to Hemo-Dialysis since after my session, I still felt weak and dizzy. How much more if it is a four hour dialysis. I ate a hearty meal that night and it was the first time that I was able to sleep well.

My Nephrologist told me that the next dialysis session will already be four hours, "there will be no pain just relax" she said. My four hour dialysis came two days after my first dialysis. That time I sat in a wheelchair from my room to the HDU and then I walked to the dialysis chair. I was not used to sitting for long period of time so I sang tunes in a low voice to kill the time. The dialysis went well and as usual I felt weak and dizzy. At that time I had a little knowledge of what dialysis is. I had to undergo a second surgery and this is about my Fistula (artery and vein joined together, usually in the wrist but some have their Fistula on the upper arm). This is done to make the vein larger so that the nurse can insert the Cannula (dialysis) Needles later after 1 or 1.5 months with regular wrist exercise. My Fistula was done and I was eventually discharged from the hospital after nine days of stay.

Taking a bath with my IJ Catheter in the neck then was a little bit challenging since I have to take good care not to wet it to prevent infection. I have to be aware of the IJ Catheter when I sleep so it will not be pulled and I will not bleed to death.  The HDU of the hospital where I was admitted was full of dialysis patients and many patients are still waiting for their regular dialysis slot so I have to do my dialysis in a different dialysis center. The advice of my Nephrologist is to have regular dialysis of twice a week so that I would not have Edema (too much fluid in the body) and Uremia (too much nitrogenous waste in the body). Luckily I only had dialysis once in the other dialysis center and I got my regular dialysis slot at the HDU of the Regional Hospital in the city.

This is the start of my "class" (dialysis session) and met new "classmates"(fellow dialysis patients) during Monday and Thursday. Before my dialysis, I have to weigh myself for the nurse to estimate my "Dry" Weight (it is the patient's lowest weight that can be possibly achieved after four hours of dialysis where the patient is "Normotensive" or having normal blood pressure). Actually, the "Dry Weight" is only an estimate done by the doctor during the first dialysis and the nurse after the first dialysis based on the patient's chart). After I have taken my weight, the nurse will deduct the previous weight after dialysis to my new weight before dialysis. The difference is the excess body fluid that will be taken by the dialysis machine from my body. Being an estimate, the nurse sometimes could go below the "true" Dry Weight and could result to hypo-tension (due to less blood plasma volume). This is what I experienced before. I am already hooked in the dialysis machine and undergoing dialysis when after 45 minutes I felt queasy, had cold sweat and almost passed out. My blood pressure went down from 100/80 to just 80/60. The nurse and technician reclined my chair so I could lie flat then they flushed my blood with normal saline solution to increase the volume. They took my blood Glucose level to see if I am not Hypo-Glycemic (low blood sugar).

During that life threatening situation I could not do anything so instead of worrying, I just prayed to God and offered everything to Him. Fortunately, my BP went back to a normal value and later that day, I was through with my dialysis.

On previous occasions, I have seen some feverish patients having an infection on their dialysis access and saw them shiver to the bone during dialysis. Their eyes wide open and their body stiff from feeling very cold so the nurse gave them medicine to lessen their shivering and the technician put lighted lamps near their body to provide extra heat. Whenever I see suffering patients, I pray for their comfort and healing. For me, I have maintained my IJ Catheter in my neck without complication or infection for 1.5 months and the day came when my Fistula was ready for dialysis. This was the first time the HDU nurse had inserted the dialysis needles on my vein and I was not comfortable with these big needles inside my vein. I could not describe the pain and I felt heat in my body and to think these needles would be in my vein for four hours! After four dialysis sessions, the nurse advised me to get my IJ Catheter pulled out. Luckily, I did not experience any infection on my access and I did not shiver during dialysis. Again, praise the Lord almighty!

 3. Understanding Hemo-Dialysis:

This is about: the dialysis machine and how it works, the process of dialysis and my initial experiences and insights about dialysis. This was written on June 4, 2014.

As the days, months and years pass by I gradually witness the unfolding of the realities and processes of Hemo-Dialysis. Now I know that the word dialysis came from the Greek words: "dialusis" which means dissolution, "dia" meaning through, and "lysis" means loosening or splitting. Dialysis is done to patients with either acute, chronic and End-Stage renal or kidney failure to remove excess nitrogenous waste, mineral salts and water. There are mainly two types of dialysis: the Hemo (blood) Dialysis and the Peritoneal (abdominal cavity) Dialysis. Hemo-Dialysis involves a dialysis machine and is recommended to patients with considerably healthy heart and liver while those with ailing heart, Peritoneal Dialysis is advised. With my almost three years of experience, I come to understand how the dialysis machine works and how it affects my body. The dialysis machine is a wonderful piece of machinery originally designed by Dr. Willem Kolff, a Dutch physician in 1943. Through the years with constant researches, tests and adjustments it evolved into state of the art machinery which is safer and really suits the need of dialysis patients.

Before a patient undergoes dialysis, the bloodline (long tube where blood flows) and dialyzer (this is the filter where the blood passes through and cleaned while in contact with the dialyzate or dializing solution) are primed or cleaned with Normal Saline Solution (NSS) or "suero" in Tagalog to clean and make it sure that it passes the conditions that are set by the machine. Then while priming, the patient is prepared by sitting him/her on a "lazy boy chair" or laid comfortably on a cushioned bed whichever his/her choice. The nurse take the blood pressure of the patient to determine if dialysis will push through or not (patients with very high or low blood pressure cannot be dialyzed until his/her BP normalizes or comes back within acceptable range). If the BP is okay, the nurse inserts the Cannula (dialysis) needles. Other dialysis centers have local anesthesia to dull the pain of insertion of big needles in the vein or Fistula (artery and vein joined together to make the vein larger to make it possible to insert the needles for dialysis). For new patients that do not have a Fistula, their dialysis access is either through the neck, wrist and thigh. This has less pain compared to venous insertions of needles. After the needles are inserted and the machine is ready for dialysis, the patient is "hooked" or connected to the dialysis machine. First, the Cannula needle which is inserted into the artery or Fistula is connected to the bloodline and blood rushes within the tube into the dialyzer, filling it and into the other end of the bloodline where the venous Cannula needle is connected and blood is returned to the body. Blood flow is accomplished by a rotating external mechanical pump which squeezes the tube of the bloodline forcing blood through the tube. The faster the pump rotates, the faster the flow of blood and the more the blood is cleaned; but at the initial phase of dialysis the normal flow rate should be 180 ml or cc per minute or lower depending on the condition of the patient's health and his/her dialysis access if the flow of blood in the vein is strong or weak. Then a regular or low dose of Heparin (an anti-coagulant to prevent blood clot) is injected into the bloodline. If the patient is bleeding due to her period or other wound, no Heparin is injected and clotting is prevented by regular flushing with Normal Saline Solution (NSS). After the patient is connected to the machine, it is advisable for the nurse to take a second reading of the patient's BP to see if it is still normal. Some patients experience hypo-tension after they are hooked on the machine due to the amount of blood circulating outside the patient’s body which is about 237 ml or cc.  If the patient’s BP is still normal, dialysis continues for two or four hours depending on the recommendation of the doctor. Dialysis period for first timers is only two hours to acquaint the patient’s body to Hemo-Dialysis.

The dialysis machine is a complex machine that combines modern computing and medical science into one. The machine “knows” if the pH (acidity or alkalinity), concentration, amount and temperature of the dialyzate (dialyzing solution) are not right by sounding an alarm. The dialyzate is composed of an acid and base or electrolytes that are separately contained in one gallon plastic containers. The one with the red cap is the acid and the one with the blue cap is the bicarbonate or base. In solution they contain physiological (in equilibrium or equal quantity in the dialysate and the patient’s blood, these electrolytes are consistent with the normal functioning of the patient) amounts of Potassium, Calcium, Glucose, Sodium and other minerals and water. The machine also monitors the arterial and venous pressure of the blood in the bloodline. If the pressure is either too high or too low, the machine automatically sounds an alarm or even stops the blood flow if necessary. It can also detect air bubbles in the blood line and blood leak in the dialyzer and will also sound the alarm. During power interruption or brownouts, the machine automatically draws power from its own Uninterrupted Power Supply (UPS) and will sound an alarm.

Once the patient is connected to the machine, the nurse checks for the arterial and venous pressure readings if they are not high or too low and then record them in the patient's chart. The nurse also checks if air bubbles are trapped properly in the air trap of the bloodline. If everything is okay, the nurse monitors the patient’s BP every hour or as needed. Dialysis or cleaning the patient’s blood is accomplished by the dialyzer and the dialyzate. The blood flow into the dialyzer downward while the dialyzate in the opposite direction. Through the process of diffusion (movement of molecules in a solution is from higher concentration to lower concentration) the nitrogenous waste and excess mineral salts in the patient’s blood are drawn out through the semi-permeable membrane of the dialyzer into the dialyzate. The faster the flow of blood and dialyzate, the blood is more cleaned. Now, the question is: why do the blood and other proteins in the blood are not drawn out into the dializate together with the waste? That is because the dialyzer is made up of fine fibers and openings in the membrane are so small that it limits the passage of larger particles of blood such as RBC, WBC, proteins. Thus, it prevents blood loss that may result to hypo-tension. Another question that arises is how does excess water from the patient’s blood taken out from the body through the dialyzer? This is accomplished by the process of Ultra Filtration (UF). The pressure in the dialyzate compartment is lowered and water molecules flow through the dializer membrane into the dialyzate (dializing solution). The dialysis machine can be set at the prescribed volume of water to be taken from the patient’s body at a specific time period by increasing or decreasing the pressure. Too much water taken from the body could result to painful cramps, temporary hearing loss and hypo-tension. My practice is when I feel that my toes are twitching or my leg muscle starts to contract or there is pressure in my ear, it is a sign that excess water has been taken from my body and I would instruct the nurse to limit the remaining volume of water to be taken to just 20 ml while cleaning of my blood continues. The normal practice of nurses is to flush the bloodline with NSS if the patient has low blood pressure. When the prescribed time of dialysis is reached, the nurse terminates the dialysis session by returning the patient’s blood in the bloodline and injects Erythropoietin Intra-Venous (into the bloodline)  or Subcutaneous (below the skin) depending on the patient’s decision. Swimming in pools or sea water in beaches is discouraged for Hemo-Dialysis patients to prevent infections through the punctured wound in the skin where the needles were inserted.

During my first year in dialysis I experienced high blood pressure. Even with the hypertensive drugs prescribed by the physician at the Regional Hospital, my BP is not lower than 150/90. During dialysis, my BP will shoot up to 200/110 and I would feel pain at the back of my neck and I experienced severe headache. I would take sub-lingual dose of Clonidine or Catapres and my BP will go down near normal values. As a result of my hypertensive condition, water entered the cavity of my left lung and found it hard to breathe especially when walking or lying flat while I slept. I was diagnosed as having Pneumonia and enlargement of the heart. When I went to Manila for a vacation, I had my dialysis in the Capitol Dialysis Center near the Capitol Medical Center where my daughter is a pediatric staff nurse. I had bouts of hypertension and cramps during dialysis so their physician prescribed me oral maintenance dose of Catapres (Clonidine) 75 mg 3 times per day aside from my maintenance medicine of Olmesartan 40 mg. once a day and Amlodipine 5 two times per day. I took Clonidine 75 mg. only two times per day since I monitored regularly my BP with my digital BP reader. To my amazement my BP returned to normal value and the water has left my lungs. Now I take the Clonidine 75 mg once a day or every other day.

I have learned that it is very important for the patient to fully understand what dialysis is all about and he/she should observe what are the factors affecting his/her body functions. The number one factor is fluid control especially for end-stage patients whose urine output is low or very low. This is also the cause of water in the lungs if there is too much water in the blood. This also affects the heart since the volume of blood is above normal values. Excess water is also deposited in the abdominal cavity and the legs. The patient should stick close to his/her diet especially avoiding salty foods that can cause water retention. Too much intake of animal protein will significantly increase the nitrogenous wastes in the blood and will cause Uremia that can affect the patient’s heart and brain. During this condition, the body compensates by triggering the patient to vomit constantly until his/her Esophagus is so irritated that he/she vomits blood. Excess intake of animal protein also causes the dark pigmentation in the skin of the patient. Intake of food rich in uric acid or purines causes painful gout and arthritis.

Phosphorous in the blood is also removed by dialysis but the bulk of it is located in the tissues and almost all the food that we eat contain some phosphorous. With damaged kidneys, excess Phosphorus is not efficiently removed through urination so there is a danger of build-up of Phosphorous in the blood which is dangerous. This mineral will bind with Calcium in the blood and will deplete the Calcium that causes Hypo-Calcemia that can result to weakening of the bones and Osteoporosis. To counteract this, the patient should take at most 1500 mg of Calcium Carbonate per day depending on the Calcium level to replenish the Calcium in the blood. Calcium also binds with phosphorous in the food taken in by the patient and excess phosphorous will not enter the bloodstream and instead will go through the digestive tract and excreted with the other bodily wastes. Other phosphate binder such as Sevelamer is very expensive but very effective if taken in the right dose and timing. Monthly monitoring of the chemistry and uric acid content of the blood is recommended aside from other monthly laboratory tests.

The Hemoglobin level in the blood will indicate if the patient is advisable to have blood transfusion. A Hemoglobin level of seven or lower is already critical and the patient is not advised to have dialysis unless he/she can have blood transfusion during dialysis. At very low level of Hemoglobin, the patient can strain his/her heart during dialysis since it is the Hemoglobin together with iron that helps distribute oxygen in the body cells. My practice is if my Hemoglobin level is below 10, I would inject 4,000 units of Erythropoietin Alpha twice or three times per week to elevate my Hemoglobin back to 10 or 11. Too much Erythropoietin could cause high blood pressure due to the thickening of the blood. At a Hemoglobin value of 10.8 to 11 or more, the dose of Erythropoietin is at once a week. Blood transfusion is discouraged by the physician unless it is really needed by the patient to prevent Hepatitis infection. Erythropoietin should be combined with a daily dose of Ferrous Gluconate or other organic iron supplements to be effective.

Dialysis patients should not eat too much fat in their diet since it could contain Cholesterol that blocks arteries and veins resulting to stroke and heart attack. So it is also advisable to regularly monitor the Cholesterol level in the patient’s blood. Too much fat also causes fatty liver which could affect its function. Remember that without the kidneys, it is the liver that performs the function of breaking down harmful chemicals and substances that are supposed to be excreted by the kidneys. Drinking alcohol is also not advisable since it can harm the liver.

If the above practices are followed religiously, I can vouch for the efficiency of dialysis of at least twice a week and the survival period of the patient can be prolonged to a maximum of twenty years!

Headaches and high blood pressure during dialysis especially of new patients can also be caused by Dialysis Disequilibrium Syndrome (DDS). In theory, DDS results when the blood waste, Blood Urea Nitrogen (BUN) level in the patient’s blood is abruptly or drastically brought down by aggressive Hemo-Dialysis (fast blood flow rate). My practice now is I would start my dialysis at a blood flow rate of 180 ml per minute and after one half to one hour my blood flow rate should be 250 ml per minute for two to three hours. At the fourth hour of my dialysis my blood flow rate should be lowered to 200 ml per minute. One half hour before I am through with my dialysis, my blood flow rate should be back at 180 ml per minute. This would allow the gradual removal of nitrogenous waste in my blood at the same time allowing my heart to cope up easily with my dialysis. My maximum blood flow rate is only 250 ml per minute because of my heart condition which is already enlarged but is not yet failing. Other patients can tolerate a blood flow rate of more than 300 ml per minute.

The Blood Urea Nitrogen (BUN) shoots up when the patient has eaten a large amount of animal protein for two or three or more days. Three times or more dialysis per week is recommended for patients with very high level of BUN and suffering from Uremia and this is also true for diabetic patients. Most patients have two times dialysis per week due to the high cost of dialysis especially in private hospitals and dialysis centers. The ideal frequency of dialysis is three times or more per week.

I hope that I could learn more from the processes of Hemo-Dialysis so I can share more learning with other dialysis patients. God willing, I can accomplish this task. We praise and thank you Lord God almighty!

 4. Dos and Don’ts of a Dialysis Patient:

    This article deals on the things that a dialysis patient should do and not to do to avoid further complication of his disease. I have written this on major categories such as: fluid intake, Phosphorus, Potassium and so on for the patient to easily understand the subject in focus. This was written on June 28, 2014.

Fluid Intake:

The first thing that a dialysis patient should not do is to drink too much water especially when his/her urine output is low or very low because this could cause Edema (swelling) of the legs and other body parts. The worst that a dialysis patient can get from drinking too much water is Pulmonary Edema wherein water could enter the lung cavity resulting to difficulty in breathing and high blood pressure. If the situation becomes serious the lung could not anymore function properly and the last resort for the doctor is Intubation (putting a tube in the trachea of the patient to facilitate breathing with the help of a manual/mechanical pump). Too much water volume of the blood strain the heart as it tries to pump the excess water and it could result to enlargement of the heart or heart failure. The question is how much water is too much? For dialysis patients with low or very low urine output they should drink not more than one liter per day or preferably less.