Does anyone do a 3 on - one off schedule?

[silverhead]

Sharon's blood work has been "in the green" for so long, thankfully, and we have been on NxStage for about 3 months, she was really showing marked overall improvement, has been able to do more limited walking (usually needs the wheelchair when going anywhere), but lately has no energy again and it crossed my mind that she might benefit from a schedule of 3 on- 1 off, instead of 6 on 1 off. what are your thoughts?
Tom

[livecam]

I haven't heard of such a schedule. Generally speaking the more dialysis the better. Since her energy level is low how is her hemoglobin doing?

[goofynina]

That would be something i would definetly talk to my neph about.   Have you guys ever just went and did your own schedule?  I know Epoman would dialyze when he wanted to, he would skip a day (sometimes) not often but he said he still felt good.  I have skipped a day (twice) and nothing major happend, i wont make it a habit but i know it is possible only cuz i have done it.  I think it would be up the you as the patient and how you feel. 

[silverhead]

I am drawing blood tomorrow for the hemo test, will know in a few days, she hasn't had a procrit shot in some time, her hemo was borderline for it, so we will see soon, just was wondering if she might benefit from a 3 on schedule over the 6 on, 1 off she is on now, it certainly looks as if she loses a small but significant amount of blood each session due to incomplete rinse back each night, lots of blood in the filter and venous lines are still quite pink, I know it's not a lot, but does add up in time.......

[jbeany]

I've done a 3-1 schedule since the beginning. I like the rotating days off and never wasting any of the batch.  Switching to fewer days would depend on her Kt/V, though - is it high enough on 6 days to consider 5?   It's not always a 5-day week, actually.  One week out of the month works out to 6 days.  I'd think her hemoglobin is the more likely culprit if she's wearing out too fast.
 If you aren't happy with the rinseback, you can always up the amount of saline used to flush the lines.

[Don]

Tom

I do dialysis 6 days a week. my daily KTV is about .53. Weekly is over 2.3.   When my butt begins to drag I look at my Iron level. It had been really low. I get a bag a week until my levels come up - what I have noticed is I have more energy and my appetite is the best it's been in months.........

Don

[silverhead]

Don, how do you get your Iron on the NxStage?
Tom

[Don]

Tom

I have to go into the center. The drip usually takes about 45 min to an hour. But I sure feel better - the only shots Linda gives me is a epo shot on Saturdays.

Don

[skyedogrocks]

Rob does NxStage 5 days a week.  His kt/v is over 2 so he is able to do this.  He fits Nxstage into his schedule.  His week is Monday - Sunday and manages 5 days in that week.  Some days he may do 3 in a row, some 2 in a row.  That's the beauty of it, fitting it into your schedule. 

If she is feeling blah, definitely have her hemo & iron levels checked.  Rob was feeling that way about a month ago and his hemo & iron levels were very low.  He was put in 22,500 units of Epo a week and a weekly dose of Venipher for his iron.  Within a month his hemo was actually too high, so they took him off of epo and just the weekly dose of Venipher.  He just had his labs done the other day, so we will see how his hemo is doing.  Whenever he feels tired or not himself, it is usually his hemo/iron levels being too low.

Definitely talk to your Nurse about modifing your schedue.

[cev]

We do 3 on 1 off and have been for about 6 months.  It works well for Richard, he feels good and if necessary we will do 4 on 1 off 2 on to fit into an outing we want to do.  We are a little flexible with his schedule but try not to be off 2 days in a row. difinately have the Hgb checked, it could be too low.  I am surprised she is not on a regular schedule of epo, just thought everyone was.  If her rinseback is not good check with your nurse and see if you can increase the heparin or additional rinse back or both.  That little bit of blood in the line does make a difference

[silverhead]

I called our Nurses and told them that I believed Sharon was low on Iron and probably need an Iron Infusion and some EPO, they checked her records and sure enough, the last check on Hgb was in July and it was at 17, they want it over 25, they apologized on the over site and said to bring her right in and they would start to correct it right away, we did that and also took further blood for testing, I'm sure she will perk up pretty soon after this.
I have increased her rinse back to 300, from 250, it helps a lot and the lines are much clearer now, Another thing we have discovered is that the bad headache she was experiencing near the end of treatment has gone away since I lowered the Dyalisate temp in the Pureflow unit one notch (was at 13, now at 12), she needs extra blankets now as she is really cold during treatment, but the trade-off is worth it to her......
Tom

[goofynina]

Good for you Silverhead, i am glad things are finally looking up for the both of you (even if it took YOU having to tell THEM what the problem is) sheeesh, Good job amigo 

[del]

My husband does 3 on 1 off then 2 on 1 off so that it works out to 5 nights a week. He is doing really well with this. Bloodwork is great.  He does 7 hours each night.  It really depends on the person and what they feel good with.

[MEG]

Yes, my hubby still has some residual kidney function and his clearances have been good.  He often feels better when he has had a day off so the Neph and our center Nurse approved a 3 on and 1 off schedule for him. We use a pureflow batch and then we have a day off.  It gets a little complicated when we have to do labs cause labs have to be done after a day off and our labs want things done on their schedule so we sometimes have to adjust for that. 

[boclark54]

Does everyone do labs after a day off ?

[jbeany]

No - I do mine every Sunday, unless it's a day off, then I do them on Monday.  With a 3-1 schedule, the day off is never the same.

[mark j]

I also do 3 on 1 off but its subject to change depending on my schedule.  When I was on 20 ltrs. it worked out better 3 treatments and then an off day to make distalate, about 3 months ago they upped my ltrs to 25.  So now I use Sak 003 which makes a 50 ltr batch and i get 2 treatments out of that.