Define weight gain ? fluid or muscle

[jessup]

Dad and I had a conversation the other day and I didn't know the answer so..........
When we were at renal we asked the nurse .............
and guess what -  he didn't know how to explain it to Dad either so
 here is the question/statement that Dad made/asked

What's the point of me eating all this food to put on weight when
as soon as I go to dialysis they take the weight off.

I tried to explain that dialysis takes off fluid not muscle
However he said " if I weigh 68.9 kg when I go to dialysis the nurse/machine will take off 1.9 kg + .5kg (wash back) so I reach my dry weight of 67 kg"
Dad then asked "how do they know what is fluid weight and what is muscle weight"

It is worth noting that Dad is now eating a lot better and more frequently  and muscles (puny but noticeable) are developing in his legs and arms - he exercises a lot in the pool - now the saggy skin is not so saggy after losing so much weight in the past 6 months.  He sticks to his water restriction (i litre / day)

I hope that this makes sense - and if this is posted in the wrong section please move moderators.
Waiting in anticipation for some help and words of wisdom IHD family

[nursewratchet]

Say your Dad's weight is 69. kg.  If he has a poor appetite, barely eating, and they don't lower the dry weight, then he will still be 69 kg, and be filling up with fluid. They would take off whatever to get him to 69 kg.  Meanwhile, lungs would be overloaded. He will end up in Hospital. 

If his appetite is great, and his weight is 69 kg, and they don't adjust the dry weight, and try to get him to 69 kg, he will cramp, get dizzy, nauseas, lightheaded.  He would not have much fluid, and his BP would bottom out.  He would end up in Hospital. 

They dry weight gets adjusted constantly, so any time the appetite changes, or if there is diarrhea, or vomiting always tell the nurse. The nurse can tell the difference by the assessment, which should always be done before he starts a treatment, or has his goal set. She can tell by listening to his heart, Lungs, and checking his lower legs for swelling.  Also, if he is short of breath, or coughing, he is probably needing to have his weight adjusted.   There is fluid, and real weight. Big difference.  Great that he is eating and exercising.

[jessup]

 
they never listen to his heart or lungs nor take his temperature - not in 6 months of dialysis
they just read the folder to check what his dry weight is and then set the machine to take off the weight difference !!! ah ah ah

we  (Dad and I ) always tell them (nurses) when he has diah...(sh#&s ) vomiting dizziness etc. but they don't adjust buggar all.
they always decide to take him to his dry weight which is 67 kg no matter what
And before you suggest it - the bloody neph - my Dad does not get to make appt. with him (check my previous posts please)

[nursewratchet]

You can certainly tell them you want less wait off.  Shame on them for not doing an assessment.  It's required here, I must say I'm shocked to hear of some of the "missed" stuff at some clinics.  Even if it wasn't required, I don't know how else to check on a patient before a treatment.  Is he cramping and such?  Ask them to take off less fluid, they may make you sign an AMA (against medical advice), which is fine, because it will have to have a reason, to which you can write down that the nurse didn't assess his weight, heart, or lung sounds.  That's horrible.   

[RichardMEL]

Jessup my unit never do anything like that either. It is just go by the dry weight however absolutely I can (and sometimes do) request more (or less) off as I feel it. They might ask for my reasons why but usually they are pretty good about it. I don't usually modify it though unless I notice that I may be feeling like a cramp or crash is coming on (thus too much fluid being taken off) or say over the course of some sessions my BP is too low (or high) which could indicate a shift in "real" body weight (as opposed to fluid).

The general thought is that over a 1 or 2 day break 90% of your body's change will be in fluid gain as muscle/body weight do not tend to fluctuate so rapidly. This is why they go off the IDW.

You should be able to get them to do a "water percentage" test I think it is. When I did it they use a special set of scales and it measures the % of fluid in you somehow (black magic?) and they can thus tell if you are too wet or too dry which can thus give a better measure of working out a more ideal dry weight.

The real issue is though that if he feels bad during or after a dialysis session, has the symptoms of fluid overload (or being too dry) like cramp, or feeling faint etc, or the BP is too low they may need to raise the dry weight.

It is a pity the staff do not seem to listen to your dad because he should be the master of his own body. The staff at my unit are great and we work as a team. They will make changes in consultation/conjuction with me - either if they notice something, or I do and we work it out together so that we're all happy. I like that I have a measure of control of my own treatment but also feel that the staff trust me enough to help.

[Gramapat]

I always tell them how much to take off.  They check my lungs, heart and take my temp at the beginning and end of each session.  I don't gain fluid in my legs ever.  I can tell by looking at my hands whether I've gained any fluid or not.  Lately even if I have a little fluid, if they take off more than 2 - even 2.1 - I get sick and vomit.  They marked that in my chart.

It is your dad's body and he has every right to tell them how much he wants them to take off.  Sounds like he (or you) will have to be his own health advocate and demand what he knows is right!

[qwerty]

You can certainly tell them you want less wait off.  Shame on them for not doing an assessment.  It's required here, I must say I'm shocked to hear of some of the "missed" stuff at some clinics.  Even if it wasn't required, I don't know how else to check on a patient before a treatment.  Is he cramping and such?  Ask them to take off less fluid, they may make you sign an AMA (against medical advice), which is fine, because it will have to have a reason, to which you can write down that the nurse didn't assess his weight, heart, or lung sounds.  That's horrible.   

I'm with you on this one? I cant imagine not assessing my patients!!! Time factor is no excuse to forgo such an important aspect of dialysis or in any medical situation for that matter. I've been to places that didnt do them but it wasnt because they werent required it was out of pure laziness and I would definitely be bringing it to someones attention! Also see if the clinic allows the PCT's to determine the fluid removal this may be another reason if they arent qualified to make this determination.

[nursewratchet]

That is BASIC Dialysis!!!  You have to do a pre, and a post assessment. Anything less is unsafe.  PERIOD!  My techs can check for fluid, but a nurse has to do an assessment as well.  Both listen to heart and lung, and check for edema.  Every Time.

[Jess21]

I've been at 3 centers..only 1 checked my legs for fluid retention every time.  The rest just do temp and weight.