Interesting Day at Dialysis: Cardiac shock and chest compressions!

[GraphicBass]

Two weeks ago Tuesday I had an interesting day at dialysis after several months with generally no problems.

Started off normally enough, but about 90 minutes into my treatment I began to feel bed: nausea, lightheadedness, severe hot flashes...not pleasant. We've been trying to get down to my "dry weight", pulling 4 kilos in this session, so I've been expecting some discomfort as we got closer, but this was bad.

But it kept getting worse. Within minutes, the charge nurse noticed my "deer in the headlights" look and came to check on me. She immediately stopped the ultrafiltration and starting squeezing in saline, saying they had pulled too much and needed to get some fluid back in. I would feel better in a moment or two. I looked right at her, agreed that it would be good to feel better. And then I was GONE...right in front of her eyes.

Next thing I know, I was lying flat on my back looking up at four EMTs! They told me they were going to put me on a gurney. I was in no shape to disagree, so I got a nice ambulance ride to the hospital, which was just across the main road (very convenient).

Spent the next 30 hours in the ER undergoing tests to see what happened — the hospital was full, and they were waiting on beds, so I got stashed in one of the treatment rooms. I was lucky, others were left in the hallway or waiting room. My cardiologist, who has followed me for 16 years, was the attending cardiologist in the ER that night — lucky me! So he knew my history very well and watched out for me. Even came back later that night to prod the nurses into keeping a close eye on me.

My wife threw a fit and got a regular bed moved into the room and a real meal, and I spent a comfortable night in the ER with her (well, not so comfortable for her. I had a sleeping pill; she didn't and kept watch on me and the nurses attending me all night — need to buy her a nice dinner out). Then the next morning another round of tests that cleared me of having another heart attack (good!).

Turns out I had an episode of syncope, probably caused by dehydration and excess fluid removal, but also due to my previous history of heart arrythmia. My heart rate dropped to 20 BPI, which is why I passed out. A burly tech lifted me from the chair, still hooked up. They could not hear a heartbeat, hence the shock, followed by chest compressions. One thing they don't tell  you in the TV shows is that those compressions HURT! I'm still sore, sore, sore in my sternum and ribs a week later, and don't wish that on anybody! The pain pills they gave didn't help much, and morphine didn't work. Ouch! Better now, as long as I don't cough too hard or sneeze (double OUCH!)

Since then, I've had two treatments (missed Tuesday due to snow in Atlanta — a rare occurence that shuts the city down) and had no problems. Waiting for a follow-up with the cardiologist to see what can be done to forestall another episode, with would be a beta blocker or a pacemaker, but probably, just need stay a little above my dry weight in the future.

The good news is that the clinic staff reacted FAST! The charge nurse in ex-Army, so she doesn't mess around. They had me on the floor within seconds, checking me over. The other nurses on duty (two) and several techs came RUNNING at full speed, bringing oxygen, the crash cart and whatever else they needed. The other patients tell me they had never seen everyone move as fast as they did that day, including setting up a privacy screen so as to keep from unduly affecting the other patients. Several mentioned to me later they felt good knowing that if they themselves had a problem, the staff would be running to help them.

All in all, I think they reacted well, and the fast action brought me back quickly. I have noticed that in the last few treatments, they've all kept a pretty close eye on me! Can't say I blame them...

So that's my story of my first dialysis crisis. Probably won't be the last, but at least I'm in good hands.

gary

[Stoday]

Wow! GB I've started down that route, but never to the point you got to. Now I know what happens if I'm going and don't get the UF switched off in time.

4 kilos is an awful lot to take off in one session. I won't let them take more than 2.8 kilos off me in one session; I have to catch up on the next.

[galvo]

That's a shocker, Gary. It's great to hear that you are still with us.

Amazingly, I agree with Stoday. No way would I allow 4 kgs to be taken off in one session. At the moment I've got some edema around the ankles and we are reducing my base weight by 0.5 kgs per week. Should be right in 3 weeks.

Hope there is no recurrence.

[rsudock]

thankful they were able to bring you back...I don't like seeing folks crash...it scares me. 

[GraphicBass]

Thanks folks. I agree, 4 kilos now is too much. We did it when I was 35 pounds of fluid over so we could get me some relief. I've been tolerating 4 kilos pretty well, but no more. Last treatment, we took about 1/2 kilo off, which got me down to 104 kilos total weight. Seems anything below 103.3 is the trouble range, so I'm going to stay well away from that.

gary

[Stoday]

104 kilos! Ten years ago I weighed 111 kilos and I thought I was healthy (little did I know...). Enjoyed eating caviar, smoking Montecristos and drinking old clarets.

I got ill and now I weigh 77 lkilos. 

Anyway, it sounds like you've found your dry weight. It happened much the same with me, except I never crashed right out as you did. At that point I still had somewhat swollen ankles, but the swelling reduced over a couple of weeks whilst I kept to 77kg.

[GraphicBass]

Hah -- Let's see, in US reckoning, 77 kilos is about 169 pounds, which is what I weighed in high school 37 years and 6 inches shorter ago. I think if I was at that weight now I'd float away!  104 is about 228 pounds. I'd like to lose real weight (not fluid) to about 200, which is a good weight for me (tall and large-boned am I). Have to get rid of all that "brown fat" in my belly that has accumulated, but I'm working on that now that I feel generally better.

gary

[Bruno]

I've looked over my old charts and I was 115.7 in October last year and my IW now is 109.6 in January 2011. Through the first month I discovered 2kg in a session was my limit and one of the first things I did when I got home was to schedule it so that I never had 2 successive days off dx. I just couldn't handle 2 days of fluid...hang on, that's not right, I could handle 2 days of fluid...what I couldn't handle was trying to get 2 days of fluid off in one session.
At one time I thought that with my bulk I'd be able to take 2 kg off easily, after all percentage wise it's minor compared with someone who is, say, 79 kg..but folks, that's just not true. I've had so much trouble from misguessing my IW or trying to take a little too much off that I now err on the side of caution.
The problem is, of course, that your IW can shift around, I reckon by as much as .5 kg and forecasting it at the beginning of a session is pretty much a dark science in my view.
But I've never had it as bad as Bassy unless you count the time I passed out at home after my triple by pass and frightened s**t out of everybody except me (I was blissfully unconscious).
But that was the wrong medication.

[huldafolk]

Dry weight is I figure a fairy tale .  How do you judge how much of your increase in weight at any one time is due to fluid or food/waste material in your GI tract.  I have been fooled many times when I don't think that I had much extra to eat, but at dialysis you can't get close to your desired dry weight /or even an adjusted weight for the overload of food. In these cases I get headache and loss of hearing and blood pressure crash. UF off early and sometimes a trip to the ER. At the start of D , the RN asks how much do I want to take off today, and then quickly do a calculation to get you down to your dry weight.  Even if it is a ridiculously high number ,they ask if you want to take it all off.  I don't know about the rest of you, but if I was to go for some of the numbers that they suggest,I would be DEAD.

[GraphicBass]

Even after the short time I've been on dialysis, I've discovered that what you write is true, huldafolk. This week I took control of how much is pulled off, and hopefully, will avoid another trip to the ER. The techs and nurses are conscientious, but I'm the one living in my body and know how I feel, what I've eaten and drunk, etc. It took a bit of time to "calibrate" this to actual treatment parameters, but I'm feeling much better with less taken off each time.

gary

[okarol]

Jeeez it's scary that they are taking off that much fluid. I hope your pain goes and you're better soon. 

[GraphicBass]

Yup, although I didn't know it at the time. I was very overloaded and there was pressure to get that fluid off as quickly as possible.

Now that I'm down, and feeling better, we'll back off.

Sternum is not painful, and I see the cardiologist on Wednesday to review what happened and determine what to do next. I saw my primary and nephrologist both today; they each think I need a pacemaker.

A month full of doctors....

gary

[Brightsky69]

Scary stuff

[Kay]

 Hi GraphicBass,  That episode sounded really scary -  especially for your poor wife!  I have never heard of anyone having 4 kilos pulled off - far too much!  Hope you get back to where you were before all this trauma -  night night!

[tyefly]

Unfortunately I have seen people in clinic who take of 4 and 5 k on session.... every session....  they cramp and deal with it but they still bring in potato chips and eat while do D......  I use to cramp when I first when it center  when I would have to just take 2.5 off......   

  scary.... very scary.....   

[GraphicBass]

I did those amounts just to get my initial fluid overload under control, so I think I'm now there. I'm gaining about .6-1.1 kilos per day, so I can go easier on the UF.

The wife is calm, but stressed. She checks my pulse during the night to make sure I'm "still here"! I am very sorry to have inflicted this on her, despite promises "...in sickness and in health." She's gone beyond the call of vows with my health over the 30 years we've been married and I appreciate it. She handles it, and I help by being in absolute compliance with doctor's instructions — after research ad asking questions (momma didn't raise no fool!) so as to not actively help my conditions along.

I've seen those folks who come in 4, 5 or even 6 kilos over. I don't know how they can stand 4 hour sessions of cramping and the exhaustion afterwards, when it's really rather easy to control diet and fluid (or so I've found; but I've been on our own modified cardiac/diabetes.renal diet for years and am used to it). There's nothing I hate more than nausea and I will make any diet change or add any restriction to avoid feeling like that.

g

[Ang]

the problem with taking 3 and 4 kilos off 3 times a week for  extended periods (months and years ) is that it does damage to your heart.

yep like most, guilty as charged

[Kay]

Hi GraphicBass,
Have you thought about CAPD - my husband did just three months on HD - I found the whole process quite alarming -especially as he had just come from the intensive care unit. CAPD is really gentle  - we do it together - so spend 30 minutes uninterrupted time, four times a day - we are still a little paranoid about the aseptic techniques needed  - but he takes off about 1.250kg daily and initial blood results are very promising. We will now push for transplant  - I hope to donate as a swap or using the antibody technique so he can take any kidney - as  we are not a match.
Tell your wife I really sympathise with her!!
All the best,
Kay

[Des]

I am VERY happy to hear that it turned out ok.

I have had 2 of thos experiences myself in the last 10 months..... It seems that the dry-weight thing can really stuff up a person's health if they get that wrong.

 

[MooseMom]

Oh god, I hate hearing stories like these!  It must have been so frightening for everyone involved.  I hope that's the last time that happens to you.

And good for you for being compliant!  That's a generous thing to do for your wife.  The patients who are not compliant don't really understand how that affects the people who love them.