Freedom to live - peritoneal dialysis

[okarol]

Freedom to live

by: MIKE AVERILL World Scene Writer
3/30/2008  12:00 AM

At-home dialysis gives some patients greater options


Bob Cooley isn't letting dialysis interfere with his favorite pastime of fishing.

If need be, he'll just do it on the boat.

Cooley uses peritoneal dialysis, a treatment where the patient controls the fluid exchange normally done by an artificial kidney with traditional hemodialysis.

"I think it's the only way to go. I can do it out on the lake, a 10-hour flight to Hawaii. You can do it anywhere as long as it's not in a cage full of sick animals," he said.

Cooley, a diabetic, suffered kidney failure that led to a heart attack.

During the attack, he went to the hospital in Okmulgee, where he was flown to the Oklahoma State University Medical Center.

"The next thing I knew, I'm flying into OSU. I remember thinking Stillwater had gotten really big. The lady in the helicopter said 'Stillwater? That's the old osteopathic hospital in Tulsa.' I was kind of lost," he said.

Doctors were able to put a stent in his heart, but his kidneys were shot.

That was about a year and a half ago.

He first started on hemodialysis, a treatment that involves long hours in a dialysis clinic three times a week.

Then he switched to peritoneal dialysis, a treatment that the patient can perform throughout the day, which allows him extra time not spent in a clinic every week.

Another benefit of peritoneal dialysis is it's gentler than other types of treatment, said Beverly Clemmons, home therapies coordinator with Fresenius Medical Care.

"It's a bit gentler because it's done by gravity. They still have a catheter, but it doesn't pull the fluid and toxins out as hard," she said.

After the training period, usually seven to 14 days, patients are on their own, and improper or careless exchanges have their consequences.

"It's important to keep a clean environment and make sure the catheter doesn't get contaminated. And they need to make sure not to break their routine," Clemmons said.

Missing exchanges can lead to sickness, and not keeping things clean can lead to peritonitis -- an inflammation of the peritoneum, a membrane that forms the lining of the abdominal cavity.

"They scared me about peritonitis. I've heard people got it within a month of doing dialysis. I was scared to death of that," he said. "Every time I got a stomach cramp, I thought, 'Oh lord, I hope it's not that.' "

You have to wear a surgical mask -- as does anyone else within 10 or 15 feet -- when doing the exchange.

It might sound complicated, but the freedom makes it worth it, Cooley said.

When he's out at the lake, Cooley makes sure to wash his hands and carries sanitizer lotion.

He frequently goes fishing at Pretty Water Lake in Sapulpa and has hauled in some nice rainbow trout.

"I caught a four-pound rainbow trout out there earlier in the year. I fished all over for trout and never caught one that big," he said.

With all the freedom comes responsibility and the motivation required to make four or five daily exchanges, each taking about 30 minutes.

"There was a time when I first started doing it, I thought, 'Help me God, I don't think I'll last very long doing this,' " Cooley said. "When you're getting used to it, you'll make mistakes. If you don't turn the valve at the right time, it looks like the bag is going to explode."

But with practice, he's become used to the exchange routine.

"Now I can do it with my eyes shut," he said.

Unfortunately, home dialysis isn't an option for everyone, said Lesley Dyer, field program services director for the National Kidney Foundation of Oklahoma.

"When an individual is selecting a treatment modality, several things have to be considered: their health, their social activities and needs, and their support system," she said. "Normally, what a patient chooses is their choice. However, on occasion, their medical condition will pre-empt that choice."

Those who can are greatly benefited, Dyer added.

"I've known people who have kept their jobs for years because they're able to do dialysis in the office," she said. "While dialysis does change their lifestyle somewhat, they're able to continue working and providing for their family at the level they're accustomed to."



Mike Averill 581-8489
mike.averill@tulsaworld.com



About dialysis


Dialysis is a treatment that mimics some of the things done by healthy kidneys.

It’s needed once a person develops endstage kidney failure—usually once 85 percent to 90 percent of kidney function is lost.

Dialysis removes waste, salt and extra water to prevent them from building up in the body, keeps a safe level of certain chemicals in the blood such as potassium, sodium and bicarbonate and helps to control blood pressure.

Types of dialysis


Hemodialysis

Hemodialysis involves an artificial kidney (hemodialyzer) that removes waste, and extra chemicals and fluid from the blood.

To get blood into the kidney, an entrance is made into the blood vessel, usually by minor surgery to the arm or leg.

The time required for hemodialysis depends on how well your kidneys work, how much fluid weight is gained between treatments, how much waste is in the body, body size and type of artificial kidney used.

Usually, each treatment lasts about four hours and is done three times a week, either at a clinic or at home.

Peritoneal dialysis

Peritoneal dialysis involves a surgery where a plastic tube (a catheter) is placed in the abdomen to make an access.

During treatment, the abdominal area is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line the peritoneal cavity, and extra fluid and waste products are drawn out of the blood and into the dialysate.

Types of peritoneal dialysis:

There are two major types of peritoneal dialysis: continuous ambulatory peritoneal dialysis, or CAPD; and continuous cycling peritoneal dialysis, or CCPD.

CAPD is the only dialysis done without a machine. The patient, four or five times a day, fills the peritoneal cavity with dialysate through the catheter and is drained back into the bag about four or five hours later.

CCPD is usually done in the home using a machine called a cycler.

The process is similar to CAPD except that a number of exchanges occur, each lasting about 1 -1/2 hours and occur throughout the night during sleep.

http://www.tulsaworld.com/lifestyle/article.aspx?articleID=20080329_1_D4_hAtho56577

[stauffenberg]

What can be more painful than reading idiotic drivel written about dialysis by people who have never experienced it?  We all know, as this author does not, that both forms of dialysis cripple your lifestyle, and that your only choice is how you would prefer to have your life crippled, not whether you would prefer the 'freedom' of constant fiddling with fluid bags at home for the rest of your life or hemodialysis.

[KT0930]

I'm curious about how he manages to do exchanges "out on the lake" or on a 10-hour flight to Hawaii. I was told not to do it outside, and when I did it inside I had to turn off the heat/AC when connecting, because the airflow could push bacteria, dust, or any number of things into your catheter and cause an infection. You can't control the airflow outside or on a flight...and what about all those people sitting in the same room with you on a plane, not just within 10-15 feet, as the article states.