I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: fluffy on July 27, 2008, 04:04:28 AM
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I was just wondering about this. i noticed that right before starting hemodialysis, when i wasnt recieveing adequate dialysis on PD my stae of anxiety and paranoia was fairly high.it went away for the most part. my doctors have commented that my labs arent so great, and the anxiety and stuff is returning. I have to wonder is it the toxins causing this or am i just going crazy. id love to hear from Stauffenberg on this one
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I can't think of anything in the toxins that would make you feel that way. The potassium regulates the heart, the sodium affects your blood pressure, the phosphorus affects your bones. Keep asking questions; we'll figure it out!
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There is a condition known as uremic dementia, also sometimes called dialysis dementia, resulting from the accumulated toxins. Eventually it resolves into increasing somnolence and coma. Long periods of time spent on dialysis also greatly increase the risk of developing Alzheimer's Disease.
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:) thanks for the help on this one you two. hopefully extending my treatment time might stave off the craziness for a little bit. Stauffenberg, how do you know so much about all this stuff? i've read alot ofyour posts and you seem incredibly well informed.
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Anxiety can also be 'panic attacks' , i have been diagnosed with these (renal related) so im told and i also have days where i feel more anxious than others . I think disease drives us all a little crazy!!!!
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My husband, Jack, just spent some time having MRI's and seeing a neurologist because of this.....in the end, they concluded that he was just a little squirrelly from dialysis. Those were the Dr.'s words- squirrelly- he said its just a symptom, and was not dementia,but was very common. even so- It makes pretty worried, we just deal with it. The short term memory loss is tough also.
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I feel it some days more than others. When I am at work I can tell when the toxin crazies have me.
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I feel it some days more than others. When I am at work I can tell when the toxin crazies have me.
blamin' it on the toxins now, are ya' Kit???? >:D
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I feel it some days more than others. When I am at work I can tell when the toxin crazies have me.
blamin' it on the toxins now, are ya' Kit???? >:D
I got to blame something. Wait a minute...Did you just call me crazy?
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not me...not outloud anyway!! :rofl;
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Fluffy, as far as crazy goes, I think that I came this way.
All jokes aside, stress manifests in many ways, and even though labs are great and dialysis is going well, you are living through one of the most stressful times of your life.
Kidney failure effects every aspect of our being, psychological and physical. They are all tied together. So, it may not be the toxins that are doing your head in, but it could be hormones produced by stress, the roller coaster of adrenaline, change in sleep patterns, change in eating habits, blood chemistry or a combination of everything.
As much as we'd like, "normal" will never apply. My best friend says that she knows when my BUN and creatinine are high, because I get bitchy. I just told her to get used to it. (and I do try to be less bitchy) I also notice that I get nervous a lot more than I ever did, but I recognize that as a healthy reaction to the unsettled nature of my life right now. Oh, and I cried all though Wall-e (GREAT MOVIE). So, yeah, I've changed as well since starting dialysis - I guess that I am getting in touch with my sensitive side) I'm going to stop typing now, because I am sounding crazier by the keystroke!!
I too am curious what Stauffenberg will come up with. Maybe a treatise on seratonin production.
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I have no doubt that our craziness/moodiness/depression/etc. is all a combination of physical and emotional changes we suffer through as a result of this new life we lead.
I did talk to my neph about testosterone...little did I know it affects more than just sex drive...thel literature said low testosterone can also be responsible for depression/moodiness, low energy, and a slew of other things. I checked yes to enough of them to begin a testosterone replacement therapy, so I'm hoping that will make me less bitchy and mean...I'm sure my wife hopes the same! But prior to losing my kidneys and adrenals, I had no problem with this, so while I have been depressed over my fate, it does look like there was a chemical reason for some of it as well.
Let's not kid ourselves...we are asking our bodies to do things they weren't meant to do, so there HAS to be ramifications for more than just whether we pee or not.
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Being on dialysis causes the accumulated toxins to affect the pituitary-gonadal axis, meaning that your pituitary gland, often called the 'master gland' because of its role in directing how the other glands of the body function, fails to stimulate the testes to produce a normal amount of testosterone. Dialysis patients can eventually experience hypogonadism, in which the size of the testicles eventually shrinks. On a scale where normal testosterone levels vary between 10 and 34, my testosterone level at the end of more than eight years of dialysis was only 2.
Unfortunately, doctors are extremely cautious about prescribing testosterone, even for males with extremely low levels, because all they can think of is "Why create potential problems with prostate cancer for a patient who is too sick anyway to expect to have a sex life?" Although the best research shows that testosterone only increases the risk of death from prostate cancer if there are already cancerous tumors present, but does not increase the chance of new tumors forming, few clinicians seem aware of this fact.
In practice this means that the average male dialysis patient has to wait for a renal transplant to correct this problem.
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im terrified of cancer, but considering that it takes a while to get a transplant id love to get some testosterone therapy, cause according to the endocrinologist my pituitary is kinda messed up. imcurrently waiting on a mri to confirm that tho. thanks for the ideas everyone :)
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I've had spells with the anxiety attacks. Lorazepam (Ativan) knocks it out.
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Hubby's been on diaysis for 11 years and it hasn't affected his sex life!!! Actually with the home hemo it's better than ever. :rofl; :yahoo; He did have a bad time when pd stoped working and toxins started to build up. I thought he was losing his mind. He saw insects coming out of the electrical plug ins, huge birds in the sky that weren't there and people on the side of the road when there was nobody!! It was very frightening. After he started hemo that all stopped. he has had panic attacks and trouble with anxiety. Think it goes with renal failure or any chronic disease.
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Everyone hear seems well informed- but I guess you would be if it were happening to you. So here are my :twocents;. Yes, some people have anxiety/panic attacks with dialysis. And yes, others seem to have a build of toxins (uremia) which can cause "dialysis dementia". I think it is pretty cool that you are picking up on the way you feel when your labs are out-of-wack. So here is the big kicker- would you be willing to do a little more time, say 15 minutes with each treatment? Most patients would be kicking me at this point...
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they had me on 4 sessions a week, that was godawful,but i wouldnt mind extending my treatments by half an hour even,i could handle that.my lifes miserable as it is and another half hour wont bother me much, maybe i'll ask them about it
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I have had a similar experience - when I first started (before diagnosis) I was experiencing an odd mental state. Also if I miss a treatment, cut my time or on my long stretch between treatments (sometimes) I get meaner and I do things I would not usually do. Strange but true.
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Most dialysis centers would also be kicking you. It's referred to as "cattle call" dialysis. Get 'em in and get 'em out. And the next patients complain about the long waiting time. Another advantage for home hemo.
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Even an extra 15 or 30 mins a treatment can make a big difference!!
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i wouldnt say i get meaner, no meaner than usual at least. but i'll sit and worry about nothing for hours and get generally paranoid. i've since learned the joys of benadryl (cant worry wehn im passed out!)
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Not to lecture all, but that is why you should stay on the machine your full time. They say cutting your treatment even 15 minutes a month can cut your life expectancy by years!! I know I know....you don't want to hear it!
Fluff, I curious to what your kt/v (called: k t over v) is. I think for hemo the goal is 1.8 (I think) at least. Kt/v is your dialysis adequacy (are running long enough).
PS. I hope you don't think I am being condescending, I truly am just trying to help!
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Not to lecture all, but that is why you should stay on the machine your full time. They say cutting your treatment even 15 minutes a month can cut your life expectancy by years!! I know I know....you don't want to hear it!
No IUNurse that is one of the reasons IHD founder Epoman created this site - so that all impacted by Dialysis could speak their minds on this issue without censure - so feel free to speak your mind
That said - I HATE DIALYSIS ! :sir ken;
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A problem with the 'cattle-call' system of dialysis used at some for-profit dialysis centers in the US is that in order to maximize profit by squeezing as many patients as possible into the limited number of dialysis stations each day, some units hold all patients to a single dialysis length, sometimes as low as 3 hours per session. This is in contrast to the system in countries with socialized medicine, where the length of dialysis sessions is tailored to the needs of each patient, and patients are even allowed to request additional time despite having 'adequate' kt/v levels at their current time.
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Not to lecture all, but that is why you should stay on the machine your full time. They say cutting your treatment even 15 minutes a month can cut your life expectancy by years!! I know I know....you don't want to hear it!
No IUNurse that is one of the reasons IHD founder Epoman created this site - so that all impacted by Dialysis could speak their minds on this issue without censure - so feel free to speak your mind
That said - I HATE DIALYSIS ! :sir ken;
yep Epoman liked strong opinions!!
But not ALL people get off early- my husband only does if there is a problem with his fistula or his machine, I have asked him to ask if he can increase his time a bit- if his Neph says so-they will do it. I hope it helps. Last month he watched the 5 hour Pride and Prejudice A&E movie- this month we watched it again, he could not remember watching it, and even after watching it twice- he doesn't remember the first time. ( I wondered if it was a man thing- that was such a girlie movie maybe his brain suppressed the horror of it LOL)
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They say cutting your treatment even 15 minutes a month can cut your life expectancy by years!!
IU Nurse, please cite the data that you are quoting this from, as there has been much discussion about the QALY study I am curious how you substantiate "years".
And as far as your Kt/v guidelines, how do you arrive at your calculations? As Kt/v is also a very controversial measurement especially when dealing with home hemo. What formula does your clinic use when calculating Home Hemodialysis via Nxstage on a varied schedule? You will find that this has also been discussed at length here on IHD.
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Sorry it took so long to reply. I will pull the info at work and get back to you on the reference I made to shortening dialysis time. As far as kt/v goes, I am sad to say that I'm not sure how they calculate it as I just draw it. I guess you are as good as you feel.
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Just to join in and throw my :twocents; in, I know that when my kidney finally decided it was done and I got REALLY sick, three weeks no eating stuck in the hospital for one and a half weeks sick, I was going crazy. Emotional and mental mess. Since then I have settled out, but I still had wicked back anxiety. I was hoping it would get better on its own, kinda like it has always done before. But for months I wasnt sleeping, I was getting really back anxiety attacks, my social anxiety disorder would "flare" at the weirdest times, and I was really really moody with people at the oddest moments. I dont like to say I gave up, but I was tired, so I talked to my doctor and she/they put me on the low dose of paxil to help.
ANYWAY! Ive found that the toxins do have a profound affect, but that there also may be an underlying reason you feel nuts. (Im not calling you nuts btw. lol. Ive been there, I feel ya.)
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im actually quite nuts, but i've found music to be a great outlet for that :) did you find the paxil helped with the anxiety? did it have any nasty side effects?
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The only thing I'm finding is that I'm having trouble finding words and am making really stupid mistakes at work that I've never made before and on a fairly consistent basis. I hate that.
Funny you mentioned "Pride and Prejudice". One of the girl's I work with has a son in Austin. He was on a business trip and the airplane was loaded and sat on the runway for hours. A plane full of men and they showed "Pride and Prejudice" to pass time. He wanted them to just take a gun and shoot him. :banghead;
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kt/v is:
K= dialyzer clearance of urea
T= time on the machine
V=volume of fluid in the body
Many experts don't consider it a good measurement of the efficiently although there is a relationship to URR. I don't think most nephrologists really understand it.
BTW, lorazepam (Ativan) is really great for anxiety. It can be habit forming but, hell, so is dialysis.
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flip you are smart
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kt/v is:
K= dialyzer clearance of urea
T= time on the machine
V=volume of fluid in the body
Many experts don't consider it a good measurement of the efficiently although there is a relationship to URR. I don't think most nephrologists really understand it.
Wow! I did not know that that is a way to look at KTV, is that true or did you make that up, flip? Sorry if that is a stupid question............
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That is true but, remember, urea clearance is not necessarliy a good indicator of toxin removal.
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i'm on home hemo and they (Davita)want my kt/v at 2.0. If it drops below 2.0 they raise my dialysate by.5 liters.
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Many consider a kt/v of 1.2 adequate and roughly the equalivent of a URR of 63.
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i tried ativan and it didnt do much, but that was probably the doseage. Clonazepam is pretty good and xanax is awesome, but it has the unfortunate side effect of being really damn addictive , messing with my moods and making me black out so i stopped that one
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One of the other issues is that many dialysis patients show symptoms of PTSD, separate from other forms of dementia. You have had surgery, a sudden change in health and financial status, you relationships have changed, and your identity has been shifted radically. Ithink we should be working both on CBT and EMDR for dialysis patients, in stead of or in support of the SSRI therapy that many of us are using.
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Yes, and renal social workers ought to be providing or linking patients to those therapies but it's not going to happen because of money. It's cheaper (and more enriching to the drug companies) to go with anti-depressants.
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There's another T-shirt idea there: Dialysis is habit forming!
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I'm wondering if my mom could be experiencing a reaction to the toxic buildup. Having gone as far as insulin shock she may still have levemir in her system as it is long acting besides. Her numbers have not changed though.
Sounds like a great tshirt kitkatz!
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We have a Gentleman in our unit who has been on dialysis for 13 years. and he is a real character talks loudly and abruptly. he cant remember any of the nurses names and calls them darling. and having a conversation with him is so painful. his speech is slurred and he kinda nods of mid sentence.
I was wondering if it is from the toxins, or is the poor man suffering from Alzheimer's?
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aaawwww how old is the poor man?
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well he said he is 63. but apparently he said that last year and the year before. :)
and when he weighs him self before dialysis they need to keep an eye on him. he cant remember what he weighed and will just give a random number for his weight. he is really a nice guy and completely harmless. all the patients and staff call him the "mayor" of unit.
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aaaawwww (as they say here in the good ole' south) :) bless his heart :)
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I don't know if uremic toxins or dialysis can change your basic personality or logical reasoning, but it does tend to do all kinds of things that you wouldn't suspect. In the days before I was hospitalized for really bad uremia when I caught a bug, one of the things that happened to me was my left eye (my good one) stopped responding properly to bright light. Going from sunny outdoors to indoors, it would take 3 or 4 minutes to dilate to where it should've been - in the meantime, I had a staticky donut-shaped spot in front of my eye that kept me from seeing anything in detail that wasn't directly in front of my gaze, or in my peripheral vision. When I finally adjusted to the darker light, going outside, my eye wouldn't constrict again for a good 4 or 5 minutes, and looking at anything in direct sunlight was like an overexposed photo, with a bright corona effect.
Not to mention the terrible joint pain (phosphorus 13+) and later the shortness of breath and dizziness.
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There's another T-shirt idea there: Dialysis is habit forming!
I loved that, too!!
Have an AWESOME Sunday!!
Kelly :)
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Sorry for the long reply on the paxil, I have been off my feet, literally. My hip got infected and all that. I havent really noticed and side effects from the Paxil, and I am on a low dose so that may make a difference but I dunno. I know that it has helped me sleep, Im not getting anxious all the time, Im not down about sitting in that chair for 12+ hours a week. Its rather nice. Granted, reading anything on paxil will scare the crap outta ya, but if its done correctly and safely its all good. I havent had any problems.
I would also like to mention that meds was my last option. Ive been dealing with my medical stuff my entire 22 years of living and it tends to wear on the mind, emotions, and control. I tried therapy and my social anxiety improved alot, which I am very happy for. But my random general anxiety... I needed more help, you cant fix something no one can find the cause of. (just my :twocents; and personal experience.)
I almost hate to admit it but I love Ativan. the only problem is I cant take it! My stomach doesnt really agree with it, and when I need it the most, at dialysis, I drive myself home (usually) afterwards... generally not safe to be sedated and driving.