Types of dialysis and work

[jdsquared]

So, haven’t had to start dialysis YET and am wondering if any specific type is best for my job......I load airplanes for a living. That means I climb in and out of airplanes, up and down equipment and pick up lots of luggage. Was given differing opinions from neph and clinic educator.  Specifically, can’t lift heavy objects because of restrictions associated with PD and HD. Have been leaning toward automated PD. Any suggestions on personal experience?

[Cupcake]

Here's a big vote for PD. Much gentler on the body, preserves any remaining kidney function, fewer diet/fluid restrictions, etc etc. Sure, no soaking in the tub any longer but whatever. I still swim in carefully selected pools.

[jdsquared]

Guess that means no more swimming in lake or ocean 🤔. Haven’t thought of that. I feel clueless

[iolaire]

Guess that means no more swimming in lake or ocean 🤔. Haven’t thought of that. I feel clueless

I’m my pre dialysis training they said ocean swimming was ok with PD because salt water is hygienic. But I went with HD so I never was directly training on PD.

[Cupcake]

"Oceans and privately owned chlorinated pools" are what I was told. I have a system of coiling up the tube and covering with a big sheet of tegaderm and so far so good. I swim twice a week at the gym that is saline and chlorine, but I avoid the therapy pool that has too many old ladies per square inch! So no lakes or hot tubs, and you just have to be careful and picky and do exit site care immediately after removing the tegaderm in case of failure.  I've been tempted to film a YouTube video of how I prepare to swim, but haven't got around to it.

[kristina]

Hello jdsquared,
Before I started dialysis, which will be 4 years ago by the end of this year, I also wondered which access to chose and because I love playing the piano in my spare time as my favourite hobby (if I am not too exhausted from my dialysis-treatments as I am more and more often these days), I chose a tesio-line/chest-catheter. It has served me very well and, touch wood, I had no problem with it so far (touch wood again that it hopefully continues like that).
I was told by medics at the time, that I must be extremely careful about my tesio-line and they also told me that I am never ever allowed to let any water come near it. So I shower every morning up to my hips with a movable shower-head which runs water very gently and softly (I received it from our water-board and they promote it because it also saves water...) and the rest of my body is very carefully cleaned with a flannel. I accept the fact that I never can take a full shower or a bath with my tesio-line.
... I have read here on IHD about a lady who carefully covers her tesio-line-access before showering or even bathing and naturally I asked the medics about it, but they thought that doing this would be too much of a risk, because, as they told me, water can "trickle" unobserved anywhere and so I took their advice and carry on as described above.
The good point about my tesio-line is, that it does not impede my arms and/or hands and that is very important to me.
I have no idea how a tesio-line could or would serve you loading airplanes in your work. I imagine it to be very heavy physical work and hopefully your nephrologist can give you better advice on this. I wish you good luck and hopefully you can carry on remaining pre-dialysis for as long as is possible.
Best wishes from Kristina. .

[lulu836]

Quoted from the National Kidney Foundation web page here:  https://www.kidney.org/atoz/content/hemocatheter

"You can shower or bathe if you have a clear dressing that sticks to your catheter site and the skin around it.  This type of dressing is recommended because it’s water proof, which helps prevent infection.  And because it’s clear, you can see signs of infection.  You should avoid letting the catheter or catheter site go under water during a bath.  This would increase the chance of moisture getting near the catheter site, which can cause infection." 

I rest my case! 


ETA: Here is the whole page   https://www.kidney.org/atoz/content/hemocatheter
        It seems to answer most of the catheter questions that are routinely asked.

[Charlie B53]

Lifting restrictions for a PD Cath will be far more limiting than those on a Hemo Fistula.  Reasoning, abdominal hernia.  While 30 lbs really isn't that much for some people, your recovery period and lifting limitations will take far more than just a few weeks.

If you do decide on PD I seriously suggest you consider a 'Tunneled' cath.  Mine tunneled up and my exit site was left of center chest on a level with my nipples.  No way would I consider repetitious lifting with a belly cath.

[jdsquared]

Did you do manual PD with the tunneled cath?

[rcjordan]

I'm on home HD for almost 5 months now and am slowly regaining stamina and strength. Before surgery, I could handle 60# sacks of concrete for landscape retention wall-building all day long. Now I can handle about 30# max for maybe a half-dozen times.  My stamina for staying on a small project is pretty good, I can do light construction projects for 5 or 6 hours now.

We do my sessions 4 evenings a week and that helps free up some daylight working hours.

[PrimeTimer]

Interesting...when I was young I use to work for an airline and for a short while, even down on the tarmac as a baggage handler. I understand the kind of lifting you do. Might be okay with a fistula in your arm. Would have to be careful not to bump it. If you belong to a union, I'd suggest talking to your union steward before approaching your manager about this. Perhaps they can arrange your dialysis schedule around your work schedule. There are laws that state that they are to offer you reasonable accommodations. My husband's boss has been great about it, hopefully yours will be too. For instance, do dialysis late in the day so that you can go home and rest afterward opposed to dialysis in the morning and then going to a physical job. Or what about the possibility of working indoors as a ticket agent? In either case, so long as you feel up to it I would definitely continue working. Staying mobile and fit will be good for your overall health. My own husband has reaped rewards of that. And this is just my own personal opinion but I would think keeping a PD catheter clean and bacteria-free in your work environment would be harder to deal with than a fistula for hemo. Follow your good attitude and let us know if we can be of any help. Sounds like you got a good head on your shoulders and ready to start your dialysis life. Go for it. We'll be here...

[Charlie B53]

Did you do manual PD with the tunneled cath?

The only difference with a 'tunneled' PD cath is the actual position of the exit site.  Treatments, schedules,, are all exactly the same as iif you had a belly cath.

Some people are reallly bothered having a belly cath.  Having that length of hose hanging near the belt-line can be awkward.

Many of my T-shirt I have cut a small slot inside the pocket so I could thread the cath through, coil it a bit and have it all safely tucked into that pocket all day.

I did manual exchanges, 4 times every day for over my first year before getting my Cycler.  The Cycler in some ways was a Gos-send as I had no more interruptions to my days, all exchanges done during the night mostly while sleeping in bed.

The drawback to the Cycler is I had to get started very early in the evenings, get connected, then STAY connected until almost 7 the next morning.  It felt like being tied down.

My Nurse didn't approved, BUT....being a smoker, and I don't smoke in the house, I would cap off during dwells, go out in my garage so I could smoke.  Make sure to be back and connected before the machine wants to start again or you WILL hear what the alarm sounds like.  It will tell you if  you are late.

Switching from PD to Hemo I did notice that I dropped about another 10 pounds of water weight.  For my size I didn't think that was a significant amount.

[jdsquared]

I like the idea of cycler. It’s at home. Wouldn’t qualify for home HD, no training partner.
Literature about cycler states 6 days per week, 8 hours per session. That realistic?
Another concern with HD is firtula protection. I guess I could make some adaptive device, maybe modify a soccer shin guard to put on my arm to protect from smacking it at work

[jdsquared]

Sorry, 7 days a week

[iolaire]

Another concern with HD is firtula protection. I guess I could make some adaptive device, maybe modify a soccer shin guard to put on my arm to protect from smacking it at work

The fistula is fairly tough, but I do think a guard would be good in the type of environment you work in. I believe that one of our members bought some sort of cover to wear well on his motorcycle?

I felt by the morning after treatments the fistula was fairly well healed and didn't worry about it too much. I could see you starting work early and doing an afternoon/evening treatment, go home and get sleep and do your work in the AM. I was not badly effected by dialysis but I did feel sort of out of it like I had a cold the days I did a morning treatment and went to work. 

I do think that regardless you should get a fistula as soon as possible so it can heal and grow prior to needing it - assuming the vascular surgeon is ok with the fistula and your work.  Given the work you do it should grow nice and large making it easy to stick the needles in and ready to use when you need it be that the start of dialysis or should you be forced to move from the catheter options.  That also gives you time to find another surgeon for a second opinion should the first not be willing to say you could work with the fistula.

I have no expense with catheters but I do wonder if there would be challenges keeping it sanitary at work.  I sweat even under the fistula bandages - would you sweat with a taped up catheter on your chest working outside in the heat?  If so would that increase the risk of bugs getting to the line and causing bad infections?

[Paul]

I am on HD and the lifting restrictions are a bastard. So many minor things are difficult when protecting a fistula arm. For example shopping: I have to use a trolly even if only buying a few items, because a basket becomes too heavy to carry with my fistula arm, and some items are too heavy to lift alone with my fistula arm, so I have to keep putting the basket down to fill it. If it were not also for the fact that I have a walking stick and don't walk well, I'd feel I looked stupid walking up to the till with a trolly and only three items in it.

As to lifting luggage: unless it is one case at a time, with a handle, I think a fistula would cost you your job. I am trying to pack all my belongings to move out (landlord's insistence) and he is getting very angry as he cannot believe how long it is taking (because I can only use one arm for heavy stuff), if it were a job of work, I would probably been fired by now.

If I were able to do so I would have gone with PD, but for other medical reasons I could not. I now really wish PD would have been a viable option for me.

[PrimeTimer]

I agree with iolaire; a fistula takes a couple months to mature before it can be used so getting one before you actually need it may be wise. Otherwise, if you wait til the last minute and end up crashing in the ER, they'll probably insert a chest or neck catheter in you until a fistula or catheter for PD can mature/heal enough for use. By the way, I realize not all employers are the same but my husband still gets paid while on dialysis. His boss has been great about letting him take the time off to go to his treatments.   

I am including a couple links about a pro bodybuilder who is on dialysis. Apparently he was doing "nocturnal" but don't know if that means hemo or pd. Just thought it was interesting that he was able to continue "lifting". Unfortunately, the second link is about him going to prison over the illegal sale of steroids. In no way do I condone that but still, the idea that he continued life as a bodybuilder while on dialysis is impressive. Hopefully this isn't fake news...if it is well, sorry about that.

Bodybuilder Don Long

https://www.bodybuilding.com/fun/drobson269.htm

http://spacecoastdaily.com/2018/07/pro-bodybuilder-don-long-sentenced-to-prison-for-conspiracy-to-illegally-distribute-anabolic-steroids/

[MooseMom]

That's SUCH and interesting story about Don Long, so thanks for posting that, PT!

Like you, I also wonder just what this "new type of dialysis" actually was.  I guess we're talking about 2003; which "new" method was introduced around that time?

[jdsquared]

Well, PD is out because of weight restriction of 25 lb. I go meet with vascular surgeon soon.  Hopefully, I will be allowed to eventually lift more so I can keeep this job. Guess I’ll find out soon!

[Indajen]

That's SUCH and interesting story about Don Long, so thanks for posting that, PT!

Like you, I also wonder just what this "new type of dialysis" actually was.  I guess we're talking about 2003; which "new" method was introduced around that time?

The article says "After his failed transplant Don was put on a new course of dialysis, a more efficient nocturnal method where he could live more in accordance with a bodybuilding lifestyle."

This sounds like APD on a cycler.

[Michael Murphy]

Remember in the US employers are required to to make reasonable accommodations for employees with disabilities.  Plus if your working check your disability coverage,  I took the cheaper plan which gave me 60 % of my pay till I am 69.  I should have paid the extra money for the 70 % plan.  My ex employer now pays the difference between my Social Security and the 60% amount of my last paycheck.

[jdsquared]

Two months in and time for an update. I had a PD cath placed  before Christmas and went back to work about a month later. While taking it very easy the first week, I’ve slowly gotten back into the job. I will say that I move a little slower but haven had any major problems.  Only real change is I’ve gone to a four day work week because of the time I am losing to dialysis. On a five day week, I seem to have too little time for family
I was extremely worried about restrictions from neph and surgeon but after talking with me both agreed that getting back to a semi normal life was an important milestone.
Just remember everyone, take it a day at a time

[Cupcake]

Thanks for the update. Glad things are working out!

[iolaire]

Thank you for coming back to give an update, these types of stories help others. 

[PrimeTimer]

Certainly sounds like you are off to a good start, jdsquared! Hope it continues for you. Thanks for the update. I think it's important for people to know what works or doesn't work for some. The only way to know is to share info like you did.