I hate it

[hurlock1]

I am a 60 y/o 314lb male.  I'm sick of having to be on for 5 hr. It's for reasons that I have a bad lower back and at about after 3 hr. I have to go potty really bad. They said that after a while i would quit having to go. I don't know whether i'll like that or not. It's torture! Do thet get more money the longer I stay on? After about 3 mo., they asked me politely if I could go for 5 hr. This was about a year ago and i was still on the cathator and my pump pressure was about 325. I'm using the fistula now and my pressures are at 500+. I don't like to complain, but I've about had it.

[BigSky]

Actually they get paid less money the longer each session you run.

The length of time you run each session depends largely on your Kt/V.

Recommended at least 1.4 for most with 1.7 for diabetics.

[dwcrawford]

what in the world does that mean?  will I have to learn to "speak" metric?

If I lose weight before I  start will it cut down on my time...?  He is planning 4 hours...  that's too much.  I'm 6'1" and 220 pounds...  fat huh?

[BigSky]

Explanation of Kt/V and URR

http://kidney.niddk.nih.gov/Kudiseases/pubs/hemodialysisdose/

[David13]

I don't know the details, but part of the reason for your long run may be related to your size.  The larger you are, generally the more dialysis it will take to clear the toxins from your system. 

Also, you might want to ask how your recent labs have been looking.  If they increased how long you run when you still had a catheter and a low pump speed, your values may have improved since you starting using your fistula.  It certainly wouldn't hurt to ask! 

[twirl]

what in the world does that mean?  will I have to learn to "speak" metric?

If I lose weight before I  start will it cut down on my time...?  He is planning 4 hours...  that's too much.  I'm 6'1" and 220 pounds...  fat huh?

fat?   my husband is 6ft 3 inches and he weighs 216 and he is not fat

a patient I know had to stay on 5 hours and she lost about 120 lbs and she started staying on
for about 4 hours then her brother gave her a kidney

I used to have to go to the restroom about 2 hours in the treatment
and the techs hated to let me go
and it will slow way down
then you have to be more careful with your fluid intake
and now she is free

[jbeany]

Hurlock, they can take you off temporarily to let you go to the bathroom.  There's no reason you should be in discomfort for the last two hours of your session!  Demand that they left you off to go.  (And yes, some patients stop peeing when they start dialysis.  Some don't.  Some keep doing it for years.  Making you hold it until your function stops is idiotic!)  If they bitch that much, they can at least bring you a jug to pee in!

You need to get informed about your lab results.  What are your clearances now?  If your URR or KT/V (some centers used one or the other, some use both - they are both just a measure of how well the toxins are being cleared out of you during your dialysis sessions) are high enough with your new fistula, you should be able to have your time knocked down if you really want it shorter.  Personally, I'm fighting for more dialysis, not less, but if you are that physically uncomfortable with that long of a run, talk to the doc about lessening your time if the lab results are good enough.

what in the world does that mean?  will I have to learn to "speak" metric?

If I lose weight before I  start will it cut down on my time...?  He is planning 4 hours...  that's too much.  I'm 6'1" and 220 pounds...  fat huh?

That's hardly fat for someone 6-1, dan. Most centers start everyone at set time, and then adjust after the clearances are checked.  My center starts everyone at 4 hours, regardless of size.  I'm still on 4 hours, only because I demanded to stay there even though my clearances are much higher than they require.  (URR is supposed to be at least 65%.  Mine is 81%, which is really quite good for in-center.)  I feel better the more dialysis I get, so I'm sticking with my 4 hours.

[dwcrawford]

There is so much that I don't understand...he says they will initially check your blood stats weekly and then every two week once you stable.  Also he see each patient once time per  week once that go to the center.  I guess he will explain everything to me then.  But I  am still reading.  I could stand to lose 20 pounds.  That might help.

[paul.karen]

Can or do they take a blood sample while your dialyising?
Or do you have to get that done seperate.

[dwcrawford]

You tell me... surely lif they are draiining your blood they could use a little bit to test rather than stick you again..  Anyway, I'll probably let me know in a couple of weeks.   lol
Do the vampires hang around the centers to get any spilled blood?

[G-Ma]

Many patients get taken off to use the restroom, my clearances are very good, all my numbers are and they offered to lower my time from 4 hours but I declined.  I want to continue feeling as good as I do.  Could you try a foam type cushion to use in the chair...I see several patients carrying those and using them. I am overweight for my height or I'm undertall, not sure which and that's a struggle I am working on now.  Good luck.

[RichardMEL]

You tell me... surely lif they are draiining your blood they could use a little bit to test rather than stick you again..  Anyway, I'll probably let me know in a couple of weeks.   lol
Do the vampires hang around the centers to get any spilled blood?

Yes, thats' the way it works. They take blood from the line, or if doing monthly bloods they usually take it "fresh" when they stick you - prior to connecting up (so there's no dialysis in the way). One of the few things that is "painless" in terms of the dialysis treatment another is giving stuff like EPO or aranesp since they stick it in the line rather than your arm. sweet!

[hurlock1]

It could be that I just want what I want, to be only there for 4 hr.  I can't go behind the screens. Embarrassment, shy bladder, whatever. I went AMA at 4 hr yesterday, I had told them that before dialysis because I my grandson was having a birthday party. After dialysis I was wiped! I mean. . . So I was a ghost at the party. While I was writing the original letter, I was talking to the people at the clinic; the head nurse, the nurses, the techs, etc., and they said that they would look at the results of my recent 24 hr urine and get back with me. I want what I want when I want it. If I get off to go to the bathroom, I feel like there's only 30 min to go so I might as well get off and go home. There's is a TV that doubles as a computer and game machine. And I have a portable DVD Player, and have netflix, so I have plenty to do to keep me from being bored. It's that last 30 min of dialysis that are excruciating! I was only on for four hr yesterday and the last 30 minutes were as excruciating as the last 30 minutes of a 5 hr. treatment. I think that I think to much.

[RichardMEL]

Quite frankly the only one you're doing disservice to is yourself. More dialysis is better no matter who you are - and if it was determined that you specifically should have the 5 hours it's for your own health you know. Cutting 20% of that might not seem like much but you're doing yourself no favours in that equation. Trust me, I have done 5 hour sessions for the past nearly 3 years, so I *know* how it feels, but every time I see people get off earlier than me, or whatever, I think of the simple mantra "no pain, no gain"

[petey]

When Marvin was in-center, he always had one of the longest "runs" (time on machine) of all the patients there.  While his kt/v held at an "okay" level, the doc said he had to have more time because of his size (at that time, Marv was about 225 lbs., and he's six feet tall).  When he left the center (July 2007) to start home hemo, his run time was 4 hours, 45 minutes.  With time before for weighing, bps, etc., and time after for holding his site, it made for some very, very long M, W, and F's for Marvin.

Now that Marvin's on home hemo, his "run" time is between 2.5 and 3 hours (depending on fluid gain between treatments).  But, now he does run six days a week instead of the three he was running in-center.  Home hemo has done so much for Marvin, like making his appetite come back, and he's put on some pounds.  He's at about 260 lbs. now.  He said that if he were still in-center at this weight, they'd probably put him on when they left for the day and make him run at 450 bfr all night long!  When Marvin first started dialysis, there was this one guy there who weighed about 400 pounds, and his run time was six hours.  I don't know how that poor fella lasted that long.

Luckily (? if you can call it lucky?), Marvin doesn't urinate any more, so he doesn't need to disconnect to go to the bathroom.  There were times, however, when he was in-center when he needed to go to the bathroom (#2 -- he has such a sensitive stomach).  The nurses hated to disconnect and tried to convince him to wait.  But, Marvin would insist that he needed to come off, and the nurses soon learned when he said he had to go, he had to go!  It's unimaginable that they would force you to be so uncomfortable.  I suggest you DEMAND to be disconnected to go to the restroom; there's no sense in your being miserable (any more than you have to be in the first place).

Even though I know the procedure to disconnect Marvin for a bathroom break, he hasn't had to go a single time when he's been on the machine since we started home hemo (almost 2 years).

[hurlock1]

The caretakers never discourage me from getting off to go to the bathroom. They always encourage me to get off and come back. All of the caregivers are friendly and supportive, and seem genuinely concerned at the center were I go. I need to just thank God for my good fortune as to the kind of treatment I receive at the center and quit thinking that they are trying to get me to do anything for profit

[justatech]

The reason behind the increase of treatment times is based mostly on your monthly labs and tthe clearances you receive from your dialyzer, the size of the dialyzer etc.  Especially since your a bigger guy, a 4 hour run and probably on an F-180 dialyzer, that was not cleaning your blood well enough. What is your URR? And weight gains, that also has a lot to do with treatment time.  If you want to increase your chances of getting back to a 4 hour run, then watch your fluids (32oz/daily max), stay away from the high potassium foods, eats lots of protein and take your binders. Show that you can actually abide by the "recommondations" and then talk to your Dr.