dry weight

[jonn r]

all right all you know it alls...

   here is a question for ya

  when we go into dialysis and they weight us and say my dry weight is 81 kg and i come in with 86.5 is they weight gain 5.5 kg or do they this some of it is not only liquid weight....does this make sense to any of you...what i am trying to say is i take a ton of pills everyday and i just don't Sh*t much at all....maybe once in 4 days...they reason i am asking is i have been dropping low on bp during the last hour or so, so is it possible that i am say only gaining 3.5 kg and not 5.5 even thought the scale says that is what it is.....i am not showing ANY signs of retaining water at all.....so come on people plz help

[angela515]

Over time your dry weight can increase, especially if your not exercising. Let them know u think ur dry weight has increased and they should be able to adjust it and adjust how much they take off. At my unti when i was on dialysis, *I* chose how much to take off, not the nurses... Idunno how it is at ur unit, but you should be in charge of how much they remove.

[Bajanne]

Recently I have been losing weight and the nurses were reluctant to bring down my dry weight.  If you have heard anything of my gains, just a few months ago, I had gained 6.2 after a weekend.  The last weekend I went in just 0.7 over, and during the week, once I was -1.0kg.  However the nephro was there yesterday and told them to put my dry weight down to the weight I had come in with the time before.  That was very reasonable to me.
They make the decisions on how much to take off.  I usually let them.

[SpeedFleX]

all right all you know it alls...

   here is a question for ya

  when we go into dialysis and they weight us and say my dry weight is 81 kg and i come in with 86.5 is they weight gain 5.5 kg or do they this some of it is not only liquid weight....does this make sense to any of you...what i am trying to say is i take a ton of pills everyday and i just don't Sh*t much at all....maybe once in 4 days...they reason i am asking is i have been dropping low on bp during the last hour or so, so is it possible that i am say only gaining 3.5 kg and not 5.5 even thought the scale says that is what it is.....i am not showing ANY signs of retaining water at all.....so come on people plz help

Yes they should up u a bit. If your BP is low. Do u feel dizzy or do u get any cramps?? How about your pulse?

[jonn r]

yes i am getting cramps and they start to give me saline and things get better....but i dont think most of you are getting what i am saying...if i have waste in me and its not liquid...will i be up in weight...and if so how would i know how much to take off....

[jbeany]

Jonn, you can set your own goal.  Yes, the solid waste will make a difference.  You know the last time you "went", so if you think that is part of the weight gain from the last session, tell them you want your goal lowered.  After a bit of trial and error, you should be able to get a good estimate if you need to take off 1 kg less, or .5, or whatever works for you.  You may have to argue with them, but stand your ground, and explain to them why you want the leeway in the fluid goals. 

You also might ask for a prescription for something to help your issues along!

[angela515]

Jbeany explained it well. 

[kitkatz]

That time of the month will screw up wieght gain and loss too.

[jonn r]

That time of the month will screw up wieght gain and loss too.

glad i dont have that problem........

[boxman55]

since I started dialysis I have battled the center about my dry weight. I quit smoking and unfortuneatly I gained weight but to convince the techs to increase my dry weight is an ongoing battle. Only you know how you feel and where you are at when you start to cramp. So be a pest and make them listen. The last thing you want all the time is to cramp and then have to have them hit you with saline. Kinda defeats the purpose.  Boxman55

[stauffenberg]

There is now an elaborate device and an equally elaborate procedure by which a patient's real dry weight can be determined by Archimedes' principle, but of course few dialysis centers have such a machine, or the time and training to use it.  So they have to rely on guessing to determine dry weight and make the assumption -- which in the real world and outside of the dialysis world is known by common sense to be insane -- that everyone's dry weight remains the same, day after day, despite variations in food consumption and exercise!

But since edema in the ankles, fingers, and eyelids is a sign of gaining fluid weight, why don't dialysis staff pay more attention to those signs in determining the proportion of dry vs. fluid weight?  Elevated blood pressure is another more reliable sign than total body weight of excess fluid weight. Constipation is itself a sign that the patient is too dry, since fluid is needed to maintain regularity.

While on dialysis I tried to combat the idiocy of the staff by eating exactly the same amount and type of food every single day of my life, which was the only way I could hold the dry weight steady so as to be sure that weight changes really represented excess fluid weight.  But even that control on the situation was not enough, since at different seasons and with different temperatures the body tends to convert more or less food to fat, so weight fluctuates with the time of year.

[angela515]

When dealing with removing fluid from your body it is VERY important YOU take charge on how much is removed each session, NOT the nurse's.

[aharris2]

(alene writing)

Yes John R! The same question came to me and I asked the main nurse in the clinic. She basically told me that I was a f*****g idiot and that the digestive tract always had the same amount of material in it and besides it was a minor contribution to the overall weight picture...blah blah, blah blah, blah blah... Somehow, I don't think that I am the idiot.

As others have said, one must take responsibility for oneself. Tell them what to take you down to and adjust for your own estimate of your digestive tract's contribution. Also, don't be shy about telling your nephrologist to adjust your dry weight.

We have learned this the hard way. Before we understood, the clinic staff let their own errors feed upon each other until Rolando had a fluid overload significant enough to put him in the hospital. After that, we challenged him session after session for three weeks until we hit a reliable dry weight. And, we have never left the target up to the staff again!

[goofynina]

Alene and Rolando, i am sorry to hear what you all had to go through in order for you to take charge and speak out but i am so very glad that is what you are doing now, so many patients just go by what they tell them and sometimes they are actually doing more harm than good.   

[kitkatz]

If I left it up to the staff I would be fluid overloaded every day of my life! I frequently have to challenge my weight gain with taking a little extra off.  The new machines do not pull the fluid weight off as well as the old ones did.  Must be me having to adapt to new stuff.

[RichardMEL]

Clearly the low bp and the cramps are a sign that the dry weight is too low, and the staff should know that and adjust your dry weight higher.

In the later post you ask about putting on 5.5 when maybe you only might have put on 3.5 of fluid... do you keep any track of what fluids you are taking in (and remember that stuff like soup, ice cream, youghurt, custard, etc are also counted as fluid intake) so tell? Sometimes I have been CERTAIN that I have only drunk, say, 1.5lt max, and the scales say 1kg more so I might lower the take off by say 0.5.

The staff are pretty good if you set a reasonable goal. There was only one time they disagreed with me.. I actually wanted to take off a little more than recommended (can't remember why, maybe because a weekend was coming up) and they said "no you shouldn't do that. You might cramp" - well I insisted and said "well it's my choice and my responsibility".... well guess who cramped !! d'oh!! Well, it WAS my fault!!

Given that the gain between sessions can come down to half a kilo or so, certainly the mass of excrement not excreted surely has to count, at least for a little bit. I usually count a little bit off when I go for a #2....

Oh and my unit has one of those "cool" scales for more accurately measuring the amount of fluid. I think it measures body fat or something like that and gives you a percentage value back. They did it after I cramped a few times and determined my dry weight was a bit low... so we bumped it up and I have been cramp free for a couple of months now HOORAY!!!

[jonn r]

well thanks for all the great answers.... i think i am going to ask if they can bump up my dry weight.....maybe 1kg and see what happens.....i hope i don't cramp up tomorrow

[goofynina]

well thanks for all the great answers.... i think i am going to ask if they can bump up my dry weight.....maybe 1kg and see what happens.....i hope i don't cramp up tomorrow

Good Luck John, let us know what they say and how you feel k,   

[AlasdairUK]

If you take off large amounts of fluid your BP will drop as you are pulling more fluid out of the blood stream than the body can replace with the extra fluid in your body that has moved to the tissue. The extra fluid that is in the tissue will cause your left ventricle to pump harder to push the extra fluid round your body and this causes it to become enlarged. So I can understand your unit’s reluctance to increase your dry weight. 3 - 4 % fluid gains of dry weight is normally considered acceptable, 5Kg of 81Kg is 6%

What is your pre dialysis blood pressure? There are devices to determine your true dry weight, but very few units have them for some reason.

It is your decision as to what dry weight and how much fluid comes off during your treatment, but keep in mind the effects on the heart with your fluid gains.

[RichardMEL]

and of course try to be careful with the fluid intake...

[jonn r]

so today i goto that PLACE and i ask if i can raise my dry weight to 82.5 because i don't think that my dry weight is right....one reason is that i started my dialysis right after i was in the hospital for a week ... and for the reason i said before just not going to the bathroom more then twice a week..... so the nurse says OK  what do you want to start at today i ask what do i weigh now 87.0 -1 kg for shoes that 86 kg. so if i go by the dry weight they have thats a 5. kg gain. and i know that its not a real weight for me so they only take off 3.5 once we start at 82.5...then the Dr comes in and asks why I WANT TO RAISE MY DRY WEIGHT....and then i explain it to him......and he tells me i am wrong...now don't get me wrong i understand that he is a lot smarter then me when it comes to this stuff....but i know my body and i know i did not gain that much weight like the scale says....plus there is two scales in the place and one says one weight and the other is diffrent..then he tells me well he does not want to raise my dry weight and tells me to dry sinacot and something else for a week and see what happens....so the bottom line is what you mite ask.........MORE DAMM PILLS....

[goofynina]

John, i am sorry things just dont seem to be going your way, it is amazing how different Nephrologists seem to be, i know my dry weight had to be increased weekly due to my weight gain which was due to my fluid intake.  I hope you find what makes you comfortable soon, if not, you may just have to stop being Mr. Nice Guy and let 'em have it, ya know what i'm saying?    Hang in there my friend, hopefully it will get better soon. 

[aharris2]

John R,

So, what weight did they take you down to today? How did you feel? You now have two data points - the day when they took you down to 81 kg (your bp dropped and you cramped), and today when I am guessing they took you to 82.5? If so, how did you feel? If you felt great, go for 82 next time. And...and... more later after you let us know how things went today.

Doctors need to be handled with diplomacy, but again we'll talk more. Rolando's dry weight is 83.0 but we are currently targeting 79 because of digestive issues. Over time, we have requested targets appropriate to Rolando's digestive health - either above or below as he gains or loses real weight. All this without requesting a change in dry weight. Again, more later.

Goofy, Rolando was just beginning his 14th month of dialysis and we were still unsure... but ending up in the hospital will definitely make a person assertive!

[BigSky]

Gonna sound like a broken record,

Get put on a crit line.  It will tell if too much fluid is coming off and if your dry weight did go up.

[RichardMEL]

You know what I find annoying about the story? The doc says "*I* don't want to raise *your* dry weight" - I mean sorry but there's something about that that bugs me. I reckon, within reason, the medical stuff should listen to YOU.. specially as you get more experience yourself you will know what you can tollerate and you can't. Sure, medical professionals like the doc know a lot of things we don't and I grant that, but I would hope that they didn't just cut you down and say no way.

Just today I took off more than usual but I explained to the nurse why - I wanted another cup of tea near the end of my session because I have this horrid cold and I feel like crap, and hot tea helps. So that was cool.. we took off 2.9 instead of 2.7 and it was all fine because I knew what I could handle, and we discussed it...

I think I would be pretty annoying if I had a doc telling me THEY didn't want to change MY dry weight when it's MY body and I reckon I should have as much say than them. I mean sure if I came in and said I don't want to take any fluid off or i gave some kind of crazy demand well sure.. tell me off, but I don't think John was very unreasonable with what he wanted.

Incidently down here my doc doesn't do anything with my dry weight or any of the day to day dialysis stuff. He's more interested in the labs and how I am feeling. he leaves all the dry weight stuff etc to the nurses in the unit.

Well just my thought for what little it's worth.