maybe I shouldn't have called myself "fearless"! Help?!

[fearless]

I was on PD 8 years.  Just had my first hemo today.  They were unable to remove any fluid at all, and yet my blood pressure went down and I experienced symptoms of too much fluid removal  (dizzy, light-headed).
How will I be able to remove enough fluid?
Simultaneously, I experienced symptoms of too much sodium/fluid (headache bad enough to make me feel nausious-migraine)  I was not given any fluid.
So: no gain, no loss on fluid - but symptoms of both!
Does anybody understand how hemodialysis can put sodium in me (like at beginning of treatment) without it fighting against the desired fluid removal?  I'm very sensitive to sodium and puff up quickly.
Also, I didn't think to ask during treatment, but aren't potassium, phosphorus, calcium checked before and after each treatment?
Anybody know the answer to my questions?  I'm feeling so out-of control after being able to control every little thing myself on PD.  Always able to take of fluid whenever needed.  :-( 
Also, machine clotted and needed some heparin - how do they know how much?  Again, didn't think to ask...it was already done.  Do they check clotting time or just give you some pre-determined amount that they give when the machine clots?
You see, after 8 years of PD, my overall health has declined and i feel a little bit like because I'm new in hemo they might think I actually have a bit more tolerance for all this, but I feel like I don't.
Any advice/ thoughts from anyone?  Thank you so much!

[boswife]

I dont know if 'in center' they do an automatic fluid removal at the start of your session, and then flush that much back  with saline at end of treatment.  That may be part of your issue..   It seems that dr would warn and perscribe differently if he knows your issues....   Im so sorry,,, what awful first outcome for you..

[fearless]

thanks Boswife

I don't know.  I believe they use a saline solution to compensate for the blood that's in the machine, which is then replaced.  But how can any sodium be run into the body without effecting the tendency to retain fluid?

The nurses weren't able to answer my concerns, and i felt as though I wasn't able to make myself understood.  It seems they focus only on total volume, not on the fact that sodium is being added to the body.  So, I came out of dialysis with the same amount of fluid I had when I went in, with more sodium to boot - so how can I help but put on even more fluid? (unless I drink absolutely nothing)

Perhaps I need to find a doctor who can explain what is physiologically happening with the sodium.  She said: we put in the saline, but then we take it back out.  I'm sure she's referring to VOLUME, and not actually putting in and then removing sodium.  Can dialysis even remove sodium (as it removes potassium, phosphorus, etc.)?

Well, as I said, I'm feeling some fear because of not being able to remove any fluid today, even though I know I needed to.  My mind tends to jump into the future, and I'm already thinking: how can this work?!

thanks again

[Restorer]

Blood levels are only checked once a month in most cases. Since it takes several days for the results to come back, it wouldn't make sense to check them before and after every session.

I hadn't really thought about the amount of sodium you're getting with the saline they give you. I thought it was insignificant, but I calculated it just now and it looks like you get about 1800 mg of sodium with 500 ml of saline. Dialysis does remove sodium, but it's not an electrolyte that needs to be watched carefully in kidney failure.

As I've understood it, normal saline is the same concentration as in your blood/body, so it won't make you thirstier. But I may be wrong.

Maybe they calibrate the dialysate with a slightly lower sodium level to counteract what they put in? Your body is sensitive to sodium levels, so changing it too much during dialysis could be problematic - but the dialysis machines do have settings for sodium, and having the wrong sodium profile can cause thirst and/or headaches and/or feeling bad after dialysis.

It's a good idea to ask a nephrologist.

[Bill Peckham]

uhg  sorry the first one was so bad

hmm it sounds like the dialysate sodium could have been too low ... maybe ... here is my thinking

If the dialysate sodium was much lower than your blood sodium then it would have removed sodium from your blood

You're body would have noticed your blood sodium got lower, your body hates when your blood sodium isn't where it likes it, so the one thing it could have done is drawn fluid out of blood stream and into the tissue. By taking fluid out it would increase the sodium concentration of the fluid remaining.

Now your blood stream has a fluid deficit and it wouldn't take much to give you the symptoms you are describing.

Ideally the dialysate sodium level would match the body's preferred sodium level but there is no knowing what the body prefers, so I would want the dialysate to match my sodium level predialysis.

You can still be fearless - when you get knocked down get back up.

[fearless]

thank you one and all for your replies.
I so appreciate the information and your thoughts/observations.  I think that I need to trust that the doctor is going to prescribe appropriate therapy - but that is the hardest thing to do!  The more i learn about how complicated this process is, the more I doubt that my unique physiology (or anyone's for that matter) can be accommodated.  Hopefully the doc will be sensitive to adjusting things depending on the result of the therapy.  But when you're starting out, shouldn't some tests be done before a month has passed?  That seems like a long time if something's screwed up.

Well, people survive it.  So I take hope from you all.  I think a big contributor of my symptoms on that first day was just me having a big huge panic attack.  I know that after I get through a few weeks and I'm still alive i will relax. (I know that sounds really dramatic, but it's just hard for me to trust sometimes - it's not the people, it's the whole deal, ya know?)

Well, thanks again.  Bill Peckham your information was especially illuminating.

and supportive comments are SO appreciated from all

hope I can offer the same for others at some point. 
Perhaps my good PD experience will benefit someone.