Getting Ready for Home Dialysis

It’s a big deal. Dialysis is a really big deal. It takes a lot of time, up to 20 hours a week for in-center dialysis, if you count driving and prep time. It is a part-time job that affects the entire rest of your life. You can’t call out sick, you can’t get coverage for your shift, and if you are late, you still have to put in the entire time. There is no leaving early.

Right now, Henning is on a three-day a week schedule: Monday, Wednesday and Friday, 9-12:30. We show up at 8:30 to set up, and we are usually out of there by 1:00pm or so. We are learning how to set-up the home machine, how to run it, deal with the alarms and how to clean-up after. The learning can take months. But the pay-offs to home dialysis are enormous.

First of all, the cons. Doing it at home means we need more room. There is no way the machine and all the supplies would ever fit into this apartment, so Henning is on the list for a bigger one. That means a move, and that adds a level of uncertainty to our lives that is really not needed right now. While I love moving in general, I have still not fully settled in here, and with things up in the air with immigration, I just don’t look forward to doing another major move… but it is inevitable.

Dialyzing at home means it’s all on us. I kind of like the support of in-center dialysis. If the machine alarms, or if it doesn’t turn on, or if it won’t prime… there is not only another machine, there is a person to walk us through the event, and step in if needed. At home, support will be a phone call away, at least. Of course, by then we will be pros… but it is still daunting.

I think that’s it… for cons.

Pros is a much longer list:

*Time!! We can do it on our schedule, more frequently, and for longer. Studies show that the longer and gentler the dialysis, the better outcomes for kidney patients. Also, daily dialysis is so much better than three times a week. You don’t have to read too many articles before you start to freak out about three-day-a-week dialyzing… I don’t recommend that type of reading unless you really are wildly curious or just want to put a damper on your day.

*Travel!! Right now, we are limited to how far we can go between Friday afternoon and Sunday afternoon. Which… is further limited by how he feels, the second day out from his last cleaning. Needless to say, even an overnight trip is draining. We went to a party last month that was an overnight event. The party was fantastic!!! We are glad to have been able to go. But it was quite a drive there, and we had to drive home in a snowstorm. That part was not fun.

We had been pressed to stay longer, wait out the storm… but the deadline of dialysis the next day plus the knowledge that as the day wore on he’d feel less and less well… *shrug* We were glad to just be home. Which is not how we are, historically.

With a portable machine, Henning can travel again! We aren’t that far in the process, but he thinks there is no reason to doubt he would be approved for the smaller machine. The one con is you have to do it longer… but see above… that is not really a bad thing… Plus, you can dialyze at night with the small machine… so… that’s a huge plus both for home AND for travel.

*Space! Since we are forced to get more space… it means we will have more space. I listed the move itself as a con, but having a bigger apartment will be a HUGE pro. Right now, the other chair, the stairclimber, and miscellaneous equipment are stored in the room across the hall, outside the apartment. While not terribly inconvenient, technically he’s not supposed to use it. If our stuff were evicted from that space, we’d be hard pressed to store it inside, and keeping it in the basement storage is just not an option.

Another room and a half (which I believe is what he is approved for) gives us not only space for the dialysis machine and supplies, but also his OTHER equipment and supplies.

ETA: Stairclimber:
THIS:
scalamobil_02

NOT THIS:
stairclimber girl

*Independence. While I listed being on our own as a con from the viewpoint of support, the ability to determine when and how to dialyze is a HUGE pro. It puts control back in Henning’s grasp, and he will not be dependent on the center’s staff, schedule or location.

There is one nurse, who I call Nurse Scabby. She has these huge open sores all over her arms… and I pray every time we go that she is not the one to work with Henning. She also is lax on cleaning the ports EVERY time they are touched (I may have mentioned, these go right to the heart, right??) so she gets on my nerves two ways. I think she should not be allowed to work there… but I am also a raging bitch these days… *shrug*

Also, the center we have transferred to (limited care) is far better with schedule accommodations (surgery seems to always happen on a dialysis day) but it will still be nice to be able to do it at home the night before and after, and not worry about whether he will have TWO two-day gaps in dialysis that week. And it will be nice to not have to get out and drive to the center. I’m lazy. I don’t like getting up early. I do it, but it will be nice not to have to.

*Privacy. I am getting used to the lack of privacy afforded here in Denmark, as opposed to the US. Sort of. I still don’t understand doing intake in the waiting room, or getting information or directions out in the hallway… but I do understand that the system here is overwhelmed… and so I’m getting better at dealing with Henning being partially dressed in full view of God and everyone during exams, at having to answer questions in a room full of strangers, etc. But… the other day I finally lost it.

We are learning to use the regular home machine, which is in its own room for training purposes. The smaller, portable machine lives in that room, too. Which is the cause of my meltdown. Henning dialyzes MWF, 9-12:30… every week. It is a regular thing. It is on the schedule. One time, a PD patient (peritoneal dialysis) needed a space for… something… so they asked if they could use part of the room. No big deal. They put up a screen, the patient was in, and out, in a hurry.

However, last week… with no warning or asking… this woman comes in with a burly sort of guy, and starts moving all the equipment around. They wanted to take out the smaller machine. It IS portable… but it’s not like you can sling it over your shoulder. So they started climbing over hoses, moving tubes, pushing Henning’s chair all around. I may have mentioned this, and most people know it… but hey. Dialysis means all the blood is removed from your body, cleaned and pumped back. Over and over again. Which means… those damn tubes are important, ya know?? Don’t f*ck with the tubes… and that is exactly what they were doing. Gah!!!

I was too upset not to have hit the chick, so I sat there making snarky and perhaps inappropriate comments, and generally impeding their progress as much as I dared, once I was certain they weren’t going to disconnect Henning or tip the machine… After they left the room I complained about it to our staff. I said anyone not capable of knowing their schedule three hours in advance (remove the machine prior to Henning’s arrival) or unable to delay it by 30 minutes (Henning only had a half-hour to go) should not have the authority to manage anything. We got an apology. But it still makes me upset to think of it.

So, home dialysis provides far more pros than cons, and we are very much looking forward to it.

The second surgery in a week…

…actually happened.

It was at the other hospital (Herlev, as opposed to Riget), so there was no food or fluid restriction. This surgery was for removing the acute catheter and replacing it with the permanent (still temporary, though) catheter. This one basically goes right to the heart the same as the acute, but not directly into the jugular at the neck. The access is behind the collar-bone and it is far less fragile, and less vulnerable to infection.

The surgery went well, and the doc did a great job at minimizing the amount of scarring and using minimal stitching. Henning complained a bit… the scars make him look like he was attacked by a vampire. Kind of cool… but few will ever see it, due to the doc’s great stitch-work…

So now this catheter is working great. He can even fully shower with it, which is fabulous. I am still leery of it. I can’t quite figure my reaction. I have changed many a bandage in my day, and after working as long as I did in both the nursing home and the hospital, you’d think nothing would throw me. In fact, I can witness anything… but I just can’t get a grip on my reaction to changing the plaster on this catheter. I don’t know if it is because it does go right to his heart, or because it is so vital to his health, or what. But in any case, Henning can do it himself, so it is not a huge deal that I can’t do it without getting cranky or some other inappropriate reaction… but it bothers me that it bothers me… which doesn’t really help at all.

Anyway, the day after the catheter surgery, we picked up my daughters from the airport and had a whirlwind two weeks seeing every sight Denmark has to offer in the winter, that we could get to and from in any given 7-hour day. The girls were astonished that it was only daylight for such a short time… lol

It was a fabulous visit, and too short. But we look forward to them coming this summer. Hopefully by then, we will have this round of endless surgery behind us, and if not dialyzing at home, be very close to that goal. The days will be longer too, and we won’t have to worry about blizzards at the zoo…

2012-12-23 15.47.17

Time to catch up…

… from the Holiday break. I’m still in holiday mode, but the calendar tells me it’s time to get back into the routines of “normal” life. And for us, that means… surgery tomorrow! Not that that is going to be the normal forever, but right now, it seems like it is.

So to catch up from where I left it hanging a few weeks ago… Henning was having surgery twice in one week, and then my teenage daughters were coming for a couple of weeks for the holidays.

Surgery #1 was for his fistula. We arrived a few minutes early and didn’t have a place to hang out, since the room wasn’t ready. While they got the room ready, the nurse gave us coffee. That seems to be the standard here, like you offer guests coffee when they arrive. Not in my house, I forget to even offer water or tell people where the bathroom is… but in YOUR house, I’m sure you are a very gracious host. But I digress…

We didn’t even think about it. It was 6:25am. He drank half of a cup of black coffee… and then… OH NO!!! Turns out, he was not supposed to have any fluids after 6:00am. GAH. The nurse apologized but the damage was done. In my world, when I worked in the hospital, that kind of “ooops” is grounds for some serious reprimands… I doubt it is the case here, but I kind of hope so…

His surgery was to be delayed by one hour. Not that big of a deal, I mean, since when does anything happen on time? In fact, since he wasn’t having general anesthesia, it’s not a big deal. IN FACT, in the OTHER hospital we frequent, there is no food or fluid restriction at all… so it is really just up to the individual anesthesiologist.

About 8:00am, they wheeled him down the hall. And promptly brought him back. They had gotten as far as the nurse’s station. Apparently, the anesthesiologist freaked out over the half-cup of black coffee, and wanted to wait another hour.

About 9:30am, they took him out AGAIN… and by 10:15 he was back in the room, bleeding from the needle stick, but that’s it. Apparently, there was an emergency and the anesthesiologist was called away AS HE WAS ADMINISTERING THE BLOCK TO HENNING’S SHOULDER. Yup, the needle was in, the team was ready, and the dude just left. I hope he went to go save a life, because otherwise… well… I don’t think Denmark can (apparently) afford to lose so precious of a resource, but I really hope he gets hit by a bus some day soon…

So we waited. And waited. And waited….

This is Henning, bored.
2012-12-12 13.51.47

Except for the half-cup of black coffee, Henning had had nothing to eat or drink since the night before. The nurse had no info for us, nothing. Finally, the nurse came in and said the vascular surgeon (Johnny… I can’t get over the first name usage here) was scheduled to go home at 3:00pm (Must be nice, work 8-3 AS A DOCTOR. That’s better than banker’s hours… ) so they would know by 2:45pm if Henning was having surgery or not. Nice.

As you may imagine, the answer was not. But since this is an important surgery for Henning, they rescheduled us pretty quick. Sometime in January… they’d let us know. Double nice.

 

Schedules and other oddities

We are not organized people. It’s not that we lack the capacity to maintain a schedule. We both have the knowledge. Henning has his teaching/conference schedule and his private practice, both of which need time management. I used to be a manager in many incarnations of my varied careers. I like to walk into chaos, and organize it. I’m really good at lists, plans, etc. HOWEVER… when it comes to private life, neither of us like the idea of having that time scheduled. It’s not that we lack the skill… just the will.

But that has all changed.

With dialysis three times a week at four hours a pop (MWF), doctor’s appointments, and of course, social engagements, on top of our regularly scheduled activities… we are getting into the swing of having a pretty rigid, detailed schedule… which is good, considering the weeks ahead. This coming week, for example, has two (yes, TWO) surgeries and… my kids are coming for the Christmas holiday. So… if any of you are wondering what we will be up to in the coming days, here’s a preview.

Today is a dialysis day, so that means 4 hours in the morning – which, really, goes until about 1pm… so saying morning is kind of silly. Dialysis is really the equivalent of adding a part-time job to the schedule. Today is also Henning’s last day with his long-term PT (she is moving to the mainland), so that got fit in right after dialysis. He also has an appt. this afternoon, so that means a full day of driving around, after the big D.

Henning is having surgery on his fistula Wednesday. This is minor surgery to tie off some veins near the site to force the fistula to mature faster. While this is a one-day, in-and-out visit, it takes up a lot of time because we have to do the admission paperwork 24 hours in advance. Plus, because the surgery is on Wednesday, that means rescheduling dialysis. Our regular unit at Herlev Hospital seems accommodating, but since the surgery is at Riget Hospital, he’ll dialyze there. In this case, he will dialyze on Tuesday afternoon, as they didn’t have a Wednesday spot available.. So that means two trips to the Kingdom (Riget Hospital) on Tuesday, and one on Wednesday.

He is then having surgery on Friday to insert a permanent catheter behind his collar-bone. The one in his neck is working great, but it is not a long-term solution. It is more vulnerable, and, honestly, a pain in the… well… you get it. Since we don’t know how long it will take for the fistula to mature, this is a better, longer-term option.

Again, this requires the paperwork to be done 24 hours in advance, but since this surgery is in our unit at Herlev, it is closer. Making daily trips is not such a big deal.  Also, again, the surgery is on a dialysis day, but since this is our unit, it is easier to re-schedule the dialysis… we hope.

And to top off a week of busy, busy, busy, my kids are coming this Saturday (yes, the day after surgery #2) to spend two weeks with us. We have a tentative schedule full of trips to the city, museums, Tivoli Gardens, Sweden to visit Henning’s dad… it’s NUTS!! (But in a good way) The girls are well prepared to suspend any and all activities depending on how Henning is feeling, or if something unexpected comes up. But regardless we will be pretty busy. We also have a trip to Immigration planned. It is that time… fingers crossed.

I think we may come up for air sometime in January…

 

This a great post!! Greg is always a wealth of information!!!

Big D and Me

Manny (not his real name) started BigD about two months ago.  And contrary to common experience, he feels just as lousy as when he started: weak, tired, generally unwell and incapable of doing much at all.  These are classic symptoms of insufficient dialysis, where not enough toxins are being removed by the membrane filter.

Why?  Like all new BigD members, his fistula was soft and fragile and initially couldn’t handle blood pump speeds higher than about 200 milliLitres per minute (mL/min).  But rather than his fistula gradually maturing over time to become capable of faster blood flows, it had some kind of blockage (maybe it was clotted or had a narrowing that impeded the blood flow).  So staff couldn’t get the blood pump speed past the 200 mL/min mark, which is not really enough dialysis to make a difference.

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So then… Wedding Bells!!

Ok, so there were no bells. Or rice, or even birdseed, for that matter. But the bathroom walls had been scrubbed!!!

When I pulled up in front of the apartment Wednesday, there was a van blocking the space I wanted. Being the meek, mild, complacent soul I am, I gestured for him (the driver- I have no idea of the van’s gender) to move. He did, and I pulled into the space. As we got out of the car, I noticed he was a flower deliveryman. Nice. Someone was getting flowers! I felt a little bad as I had basically forced him out of the space, so now he had farther to walk with two very large floral packages. A little bad. A very little…

… until he showed up at our door.

They were for us!!! LOL Oh well. He laughed, I laughed, we all laughed. It makes a fun story.  And the flowers are gorgeous!!!

We had about 30 minutes after all was said and done to get ready for our wedding ceremony. Neither of us had showered, neither of us had our clothing ready… it was madness. But we looked good. At least I think we looked good. I haven’t seen the pictures, yet…

Henrik arrived, and we discussed walking to City Hall, but in the end opted to drive. I think the fact that we seriously considered walking, even though it really is quite a short distance, speaks volumes for our state of mind. We met Bente and her husband (also Henrik) at City Hall, and by the time we had all finished greeting each other and went inside, they were ready for us.

I had forgotten something blue, though. I was a bit distressed. I had my grandmother’s pearls, new earrings, my daughter’s bracelet… but nothing blue. So Henning drew a heart on my arm, in blue pen. I was ready.

We were all joking around, it was far from a serious occasion. Henrik the first (Henning’s dear friend) took LOTS of pictures, and Henrik the second (Bente’s husband) sat at HIS friend’s council seat. The ceremony was lovely, and brief. It was about 10 minutes long, and that was because the officer read a 6 minute long poem. But it was, really, very sweet. And appropriate. I managed to say “Yes,” where appropriate, and just like that, we were married!

We all returned to the apartment for fish (provided by Henrik the first), caviar (provided by Henning’s dad) and Champaign. We read lovely cards filled with heartfelt sentiments, and opened our wonderful gifts. We ate and drank and hugged each other. The afternoon was full of love and good wishes. It was truly amazing. And short.

Henning’s dad drove us back to the hospital, where, slightly buzzed, and as tired as I can ever remember being in my life, we waited for our room to be ready. The staff were full of congratulations, in English! And then… dialysis.

After all the drama, I don’t know what I expected, but it went textbook smoothly. Everything worked, the machine worked, the access worked, no alarms sounded… it was entirely uneventful. Except, the nurse has an American husband, so her English was better than excellent, and we discussed American Thanksgiving (which, I may not yet have mentioned… we were having in two days. We were celebrating it belatedly because, a month earlier, Henning had been scheduled to teach ON Thanksgiving…it had since become a wedding celebration as well… so we were planning on a house full of guests… in two days), so THAT was a little unexpected, but the process was blessedly dull.

We returned home, and basically collapsed. Henning’s parents were staying through the weekend, so we had houseguests, but they took care of us. They got take-away, did dishes, cooked for us, bought pastries and rolls, it was very sweet and very appreciated. We needed the pampering, honestly.

It would have been perfect, but after a couple of hours of real sleep, the first real, deep sleep either of us had in… well, you know the story… the phone rang. At 11:30pm. It was kind of like when the fire alarm bell goes off… it was that loud and unexpected, and we were both quite shaken. I would like to say it was someone who had simply forgotten the time and wanted to wish us well on our wedding day, but alas… it was not. I may have mentioned the reason we started this blog? Well… some people refuse to accept that Henning is not available to the curious world 24/7.  After fielding some   comments about his forgetting to inform them of what was going on, with no congratulatory wishes forthcoming, I might add (it WAS our wedding night, after all…), we tried to go back to sleep. We tried, but to no avail. *sigh*

And finally…

It continued…

… with admission to the hospital.

AND everyone spoke to us in English. The doctor who admitted Henning gave us all the information we asked for, and then asked (often) if we had any more questions, and left us with the assurance that she was available if we thought of something to ask later.  She was being shadowed by a medical student, so for his sake as well as ours, she was very detailed and specific.

All the questions about the acute catheter vs. permanent catheter were answered. His fistula (as you likely remember) is still too young/weak to bear the pressure of dialysis. He has a consult next week, bu there is no way to know how long it will be before they can operate, or how long after that until the fistula is viable. Because the acute catheter is not a good option for long-term use, but also because we could not wait the three-plus weeks for the permanent catheter (different team, different surgery schedule), we all agreed for him to have the acute catheter placed as soon as possible (some time that night), and still be placed on the schedule for the permanent catheter. More surgery, but also immediate access for dialysis, which would take place the next day, hopefully first thing in the morning, but for sure within 24 hours.

I drove home (yes, I drove!) to supply us for at least one, maybe two days in the hospital. If I stayed with him, Henning was allowed to stay in the Patient Hotel (sub-acute and way less “institutional” than a traditional room). Of course I was staying. Duh.

Anyone who has been reading my facebook posts the last week knows this, but when I came home, it was to an immaculate space. Bente had scrubbed the entire apartment in anticipation of our wedding celebration (because the next day, we were getting married… nothing like excellent timing), and the place was literally shining. I really did cry, then.

By the time I’d returned to the hospital, Henning was checked into the Patient Hotel, and our room was ready. It was lovely. We had two beds that we were able to push together. They made sure we ate, that we knew who was on staff for the evening, that we had extra blankets and pillows… they were wonderful.  After the experiences we’d had for the past few weeks, it was like finding an oasis.

We had an amazing dinner, and were able to finally relax, somewhat. We watched movies and read until they called Henning for surgery. I had only intended to follow him to the ward, but due to a combination of miscommunication between the porter and the surgical nurse, and (I am SURE – the language barrier), I was suited up in cap and gown and stood in a corner to observe the entire thing.

I was sure the phone would ring in the middle of the procedure, as I had not even thought of turning it off until the doc was well under way, and when I shifted position to check it, everyone stopped to make sure I was ok, so I just left it alone… Yikes!!!

I won’t go into all the details here, but it was fascinating. I have watched my oldest daughter have surgery, so I was somewhat prepared to watch someone I love get cut into. Somewhat. I also had a small career on the telemetry floor of a hospital as a phlebotomist and nursing assistant, so I know I have no fear of blood, guts, or other bodily excretions, and was in no danger of passing out or otherwise disrupting the operation. But…  it was still disturbing, as much as it was fascinating.

The procedure took about 20 minutes, and that was including the doc being interrupted by a phone call, and a visitor. I have a skit written in my head depicting the whole thing that I’m sure would be worthy of Saturday Night Live… but I digress.

Henning was then taken to X-Ray to make sure the catheter was properly placed. There was a fun moment (that I missed because the room was too small for all of us and the bed) when the tech asked if Henning would please stand up for the X-Ray, and Henning delayed for a moment after saying, “No,” before giving his explanation. I wish I had been there for that moment… 😀 Oh, and the catheter WAS properly placed.

After an hour or so of observation, we were allowed to go back to the Patient Hotel and (finally, maybe?) sleep. Have I mentioned how much sleep we have had at this point? Right, none. Neither of us had slept through the night in weeks… and had not more than an hour at a time in days. We soon discovered that the two beds were not quite the same height, and the taller one had a slight wooden lip that my elbow honed in on right away, but otherwise, it was very nice. But we didn’t sleep. We dozed, there was some snoring… but neither of us was able to let go enough, to relax enough, to really sleep.

The next morning, I grabbed food from the fabulous buffet provided, and we settled in to wait for the call to come to dialysis. We had quite a few OTHER calls, because people wanted to know what was going on, but no call from the dialysis ward. Henning’s dad had come to town, so we called him to ask him to chill the wine… I have mentioned that now we are well into our WEDDING DAY, right? No? Well, the days were running together at that point… so…

Finally the call from the dialysis ward came. They were unable to get us in first thing, but if we came in at 3pm… Henning asked them to call back in 5 minutes while we had a discussion.

The wedding was scheduled for 1pm. We had people coming over, some from quite far, and some (like his dad) had already arrived. Could we do the wedding, AND the party, in TWO hours?? Or … the other option was to wait until the next day for dialysis. When they called back, we took the 3pm slot. Or maybe… we could push it to between 3pm and 4pm… ? 🙂 When they found out why we needed more time, they complied readily.

So then….