Barriers to home dialysis

[stauffenberg]

It was the attitude of the Ancient Stoics that nothing in the objective world is good or bad, but it all depends on whether you want to see it as good or bad.  One of the Stoics, Epictetus, had his arm broken and purportedly was not bothered by the experience, since he had decided he would not let it bother him.  I think there are limits to how far you can take that attitude and still claim to be objectively present in your life, rather than living in the delusional fantasies of a psychotic.  Perhaps because I've been an academic all my life and the goal of academia is to discover what is true and present it with ruthless honesty, I just lack the talent now to turn off my sensitivities when I'm confronted with something it would be better to ignore.

On the one hand you say that Marvin is perpetually an ESRD patient whether he is doing dialysis or not, but then on the other hand you say that you own ESRD.  I don't know how you can be sure that such an enormous intrusion, that is part of your life all the time as you say, is not owning you rather than the other way around.

It was the practice in the days when people were beheaded for capital offenses to hide the executioner's axe under straw so the person about to be decapitated did not have to see it and be further horrified just before dying.  The person knew he was about to die, but actually seeing the instrument of death so near could still be disturbing.  I feel the same way about home hemodialysis.  Even though I was aware every moment of being an ESRD patient as you say Marvin is, I still preferred not to have to see its principal manifestation right in front of my face all the time.

Diseases that are marked by their treatment are usually named in common parlance after the treatment rather than the disease itself, because people recognize that the treatment has become the disease.  Thus we hear "he is confined to a wheelchair," "he's on insulin," "he's in an iron lung," or "he's on dialysis."  Common intuition seems exceptionally insightful here, since it acknowledges that the treatment is not what helps make the patient normal and healthy, but instead what defines him as abnormal and sick.

I think the most appropriate Greek God to symbolize the dialysis experience is not Hercules but Prometheus, who was chained to a rock forever, having to endure the intermittent but never ending visits of an eagle who would eat his exposed liver.

[Adam_W]

Oh, Geeze! I cant take this shit anymore. Not everyone is like you DEAL WITH IT!

[del]

Well I tried to get it back on topic but guess it didn't work  I won't be responding to this thread any more .  In fact I won't even be reading what stauffenberg has to say on the subject.  Seems like he's that only one who has the right opinion and I for one have no time for that. 

Everybody has individual choices.  I think the purpose of this thread was to talk about how difficult it can sometimes be to get home hemo.  It has gone from that to everyone who is on home hemo or on dialysis being told what a horrible life they have. People don't need to hear that!!!  Stauffenberg, you should spend some time with people like my hubby to see what home hemo is really like!!  maybe then you would have a different opinion.   

[Adam_W]

Thanks for trying, Del. I also probably won't be replying anymore. Stauffenberg has the "I'm right and everyone else is wrong" attitude, and like you said, people don't need to hear that. I guess we can't change everyone, and maybe we shouldn't even try. Again, thanks for your efforts.

Adam

[tamara]

Once I got into the routine of home dialysis it was the closest thing to normality I could get at that time.

No more running in and out of hospital for treatment, if I felt tired when I got off, hey I was home in my pj's and I could sleep. People could come around and see me in my own relaxed environment talk about anything we wanted, tv with the sound at the max without complaints, hey I could get on in just my undies if I wanted and hey I did !

It made the whole more experience more personal for me, I was not relying on anyone to put me on take me off, not waiting on a nurse to fix the machine if it was beeping or if I was feeling flat.

In some ways I felt like kidney failure was less in my life even though it was with me at all times, hey you can't escape. I was not exposed to the hospital environment as much, so it actually made me feel less like I had something major that needed to be dealt with, but again each to their own, whats good for the goose, yada yada yada.

My greek god that symbolises my dialysis experience was Prometheus' sister.She chained herself to the rock intermittently but was able to release herself from the rock because she had the knowledge too, and knew what freedom she could obtain by learning too.Since she could release herself from the rock she visited the eagle at his working place and they both discussed how best to treat the "exposed liver". 

[petey]

It was the attitude of the Ancient Stoics that nothing in the objective world is good or bad, but it all depends on whether you want to see it as good or bad.

Exactly -- and Marvin and I chose (and still choose every day) to see it as "good."  We feel pity for those who see it as "bad."

One of the Stoics, Epictetus, had his arm broken and purportedly was not bothered by the experience, since he had decided he would not let it bother him. I think there are limits to how far you can take that attitude and still claim to be objectively present in your life, rather than living in the delusional fantasies of a psychotic.

There are NO limits as to how far we can take this attitude and still be objectively present in our lives.  Those who dwell constantly on their misfortunes, bad luck, ill health, etc., to us, are robbing themselves of that very thing -- life.  We are not delusional fantasy-laden psychotics; rather, we are survivors.  It is this attitude that will help us survive, and it makes life so much sweeter when you have a positive attitude.

On the one hand you say that Marvin is perpetually an ESRD patient whether he is doing dialysis or not, but then on the other hand you say that you own ESRD. I don't know how you can be sure that such an enormous intrusion, that is part of your life all the time as you say, is not owning you rather than the other way around.

My dear Stauffenberg, you've missed the point!  Yes, Marvin is perpetually an ESRD patient (as are you and many others).  But, we "own" his disease because we try to find the good in it and in dialysis (and there is good in dialysis -- at least there is to us).  If we spend all of our time hating this disease and its subsequent treatments and constantly spreading macabre and horrific opinions of it, we would not have time to enjoy the very life that has been extended by the treatments.  I say we own ESRD because we REFUSE to let it defeat us.  We do not let ourselves become mired down in the intrusions, the discomforts, and the absolute necessity of it; we chose, instead, to treat it as a part of Marvin's survival.  Take it in stride and go with it!

It was the practice in the days when people were beheaded for capital offenses to hide the executioner's axe under straw so the person about to be decapitated did not have to see it and be further horrified just before dying. The person knew he was about to die, but actually seeing the instrument of death so near could still be disturbing. I feel the same way about home hemodialysis. Even though I was aware every moment of being an ESRD patient as you say Marvin is, I still preferred not to have to see its principal manifestation right in front of my face all the time.

We differ again (imagine that!).  If I were to be sentenced to such a punishment, I would WANT to see the axe.  Weird?  Maybe.  But, I am not a coward and I am not afraid to face my fate -- whatever it may be.  But, we're talking about a punishment in this instance.  For us, Marvin's ESRD and dialysis is not a punishment; he did nothing to deserve this.

I think the most appropriate Greek God to symbolize the dialysis experience is not Hercules but Prometheus, who was chained to a rock forever, having to endure the intermittent but never ending visits of an eagle who would eat his exposed liver.

Let's discuss your choice for the Greek god who symbolizes the dialysis experience TO YOU -- Prometheus.    Prometheus was, if you recall, chained to the rock forever having to endure the daily eating of his liver by a vulture (some stories say eagle) -- only to have it regenerate at night and eaten again the next day, over and over again -- because he was being PUNISHED by Zeus for giving fire to man.  While Prometheus can be your epitome god of the dialysis experience, he's definitely not ours!  We would not pick a sufferer who was being punished for his disobedience to be our role model.  This dialysis experience is not a punishment for Marvin (it may be for you -- but it's NOT for him).  We would, rather, pick a god who symbolized strength and courage; yes, that's our role model.  Also, wasn't there a story somewhere in Greek mythology where Hercules (our choice) shot and killed the vulture -- or eagle -- that was hounding Prometheus (your choice)?  Hmmmmmm, very interesting analogy, my academic friend -- very interesting indeed.

[jbeany]

Oh, Geeze! I cant take this shit anymore. Not everyone is like you DEAL WITH IT!

Adam, this is how he deals with it.

[stauffenberg]

It is bizarre how everyone jumps to the totally unsubstantiated conclusion that I was ever at any time saying that MY experience with home hemodialysis somehow HAD to be everyone else's.  Show me where I ever said that!  I simply said that in considering the costs and benefits of home hemodialysis, the potentially negative psychological factors, which I noted in my own experience of home hemodialysis, should be weighed in the balance against the undoubted health benefits of that option.  Until you try it for yourself, you can't know how you will react, so you have to consider the possibility that your reaction will be like mine. For me the psychological costs outweighed the benefits, for others the balance could well be different. I also don't see how my discussion of my own psychological barriers to home hemodialysis were somehow, as many have asserted, "off topic" for a discussion entitled "barriers to home dialysis."

[petey]

It is bizarre how everyone jumps to the totally unsubstantiated conclusion that I was ever at any time saying that MY experience with home hemodialysis somehow HAD to be everyone else's. Show me where I ever said that! I simply said that in considering the costs and benefits of home hemodialysis, the potentially negative psychological factors, which I noted in my own experience of home hemodialysis, should be weighed in the balance against the undoubted health benefits of that option. Until you try it for yourself, you can't know how you will react, so you have to consider the possibility that your reaction will be like mine. For me the psychological costs outweighed the benefits, for others the balance could well be different. I also don't see how my discussion of my own psychological barriers to home hemodialysis were somehow, as many have asserted, "off topic" for a discussion entitled "barriers to home dialysis."

Stauffenberg, dear, I didn't imply that your experience with HHD was what everyone else's would be like.  Through your words, I fully understand that your experience with HHD was not pleasant and not the best modality FOR YOU.  However, your words and descriptions of HHD are strong, caustic, and dismal.  For the ones who are new to dialysis, pre-dialysis, or inexperienced in HHD, I wanted them to know that your experience isn't like many others' experiences.  I wanted them to see "the other side of the coin."  Let me also use some of your words and say to the newbies, "Until you try it for yourself, you can't know how you will react, so you have to consider the possibility that your reaction will be like MARVIN'S" (which has been wonderful, refreshing, revitalizing, promising, optimistic, happy, etc.).

Like you, Stauffenberg, I don't think we've gotten off topic, either.  In fact, I think all of your posts serve as the root of one of the major "barriers to home dialysis" -- the negativity of one bad experience overshadowing the heartening, encouraging experience of many others.  For every one Stauffenberg out there who has tried HHD and didn't like it, there are thousands of Marvins who tried it and loved it!

[mark m]

I like to look at the positives of home hemo.

In center I saw a rat run across the floor, I have yet to see one in my room.

True story, cheers.

-Mark.

[Zach]

It is bizarre ...

Yes, bizarre pronouncements may produce bizarre reactions.

Cassius was right:
"The fault, dear Brutus, is not in our stars, but in ourselves."

[flip]

That's why I went to the center, Mark.....to get away from the rats
 

[stauffenberg]

Or again, Zach, the same theme appears in 'Hamlet': "There is nothing good or bad, but thinking makes it so."

[monrein]

The impression I have here in Canada is that home hemo is recognized quite well by the nephs and is presented routinely as a viable option for patients capable of managing it.  Could be because it saves money for our medical system in addition to being more comfortable for many patients.  When I was on home hemo, some 28 years ago, it was truly the best choice for me as I lived 60 miles from the nearest hospital that did dialysis and the winter conditions in Nova Scotia on that particular stretch of road were often awful.  I felt pretty comfortable with my set-up in the big kitchen of the house we rented and used to pass some of the time (5 hour runs then) by having small dinner parties while I was hooked up.  Gruesome to some people I'm sure but we had many good times and one of my current potential donors lives in France now but attended many of those feasts.  I also used to do extra private tutoring for some of my more motivated students during the first two hours of each run.  After that I felt too fuzzy to be bothered trying to be clear.
I also had a machine up at our cottage because that was where we spent the summers and I would have many visitors in during my runs.  They'd visit with me, play scrabble or whatever, go for a swim in the lake, visit some more, barbeque and so on.  Not as good for me obviously as being a "regular" person but certainly way way better and much more fun than going to a hospital or other centre at some distance away.  These were two entirely separate provincial systems that provided home hemo for me but both were readily offered when I started on dialysis.

The one thing that makes me hesitate this time around about home dialysis is the fact that my husband would need to be here and would so be tied down with me.  He isn't concerned about this but I am and since the self-care unit is close to me and is nice I think I prefer that for now.  I actually wouldn't be nervous about going solo but not sure how the medical people would feel about that. I am talking to them however about going to 5 days a week most likely 2 1/2 hour runs to minimize the ups and downs.  Another option is 5 nights per week nocturnal at the hospital downtown.  Not as convenient for me but still not bad.

[Hemodoc]

Thank you for the update Monrein.

Yes, Canada and the rest of the modernized nations are way ahead of America.  We developed the first chronic dialysis treatments after the Scribner shunt with most of those patients in the 1960's at home.  Home dialysis is often called "new" therapy which it is not.  We further developed the fistula and yet today have only 30% of our patients with this lifesaving access.  America has not kept up with its own innovations.  Sadly, we do this with many of our technologies.

I am looking forward to home dialysis since my wife and I are already doing most of our own care in center right now.  As long as my access holds out, dialysis is not a burden compared to the alternative.  In fact, I continue to marvel that it is as safe and effective as it is despite my tainted impression of dialysis as a practicing physician.  Dialysis and dialysis patients seen in the hospitals with the many complications negatively impact the larger number of dialysis patients who are taking care of themselves with exercise, diet and daily dialysis and are doing remarkably well.

America is the country with the barriers to dialysis since we have forgotten our own history of dialysis in this nation.  Perhaps soon, the access to daily home hemo will be a true reality here in the US and the impact on cost savings will likewise be substantial.

[del]

monrein is it posible for you to do nocturnal at home. I know a couple of people (in Canada) who do it alone.  One did it completely alone but he is now transplanted. Another lady I know does it herself - hubby doesn't help at all.  There are many times during the summer when her husband and sons go camping and she stays alone and does nocturnal.  She is hooked to a monitoring system though.  She uses a perm cath.  I can see a problem doing it alone if you are usisg needles.

Stauffenberg the reason I said to try to get things back on topic was the fact that whatever was said positive about home hemo you always came back with a negative of why it wasn't good.   That's fine but you don't have to down the treatments so much and imply that life on dialysis is hideous. It isn't for most people. New people need to listen to all sides of the discussion of the treatment.  Home hemo dialysis has changed so much over the years. The main barrier I think to home hemo dialysis is the attitude people have towards it because of the way dialysis used to be.  People who were on dialysis years ago were usually very sick.  For the most part they aren't now because of new drugs and kidneys.  The long ,slow treatment of nocturnal dialysis has really made a difference in the lives of people who chose that option.

[monrein]

Yes Del I would for sure consider all options available to me and nocturnal sounds good.  I'm not a fan of the permacath, much preferring the fistula and I actually would not object to doing needles even to sleep.  Also that would tie my husband down less as he's always home at night and if he went to the cottage he'd go when I could go too or I'd stay alone occasionally.

Right now, we're in the process of testing 4 potential donors for a transplant and I have 4 back-ups in the wings.  (Just received my last serious offer from a family friend at a party on Saturday). They do them in batches of four at a time here.  My neph wanted me to do about 6 months of dialysis in order to stabilize some medication issues and they prefer not to train me for home hemo if I was going to be on for less than a year.  If the transplant option fades away and dialysis becomes more long term then I'll think about rearranging the house etc. to do home hemo.  For the moment though, the self care clinic is a very good option.  It's close, somewhat flexible, nice staff, I set up, do my needles but they clean up and take care of all equipment etc.  Can't complain.

[stauffenberg]

I have never seen any statistics on how many people refuse home hemodialysis when they hear about what it entails rather than proceed with that option, nor have I ever seen any statistics about how many people withdraw from home hemodialysis, as I did, rather than continue with it after starting.  So I don't think we can simply assume that positive views of it among patients constitute the 'vast majority' of responses to it as many people posting comments take for granted.

Monrein raises a good point about home hemodialysis, which is the added burden this places on the helper, who is usually the spouse.  If you accept that there is some moral duty to try to contain the impact of a tragedy like renal failure, you also have to question whether this additional extension of that tragedy to your home dialysis helper is something you can live with.  Almost everyone I knew at my dialysis unit who was doing home dialysis had a helper who was either not employed or was employed only part-time.  But since my helper, my wife, was the head of a major federal government department, she had to be at work every day from 8 AM to 7:30 PM, and having to help with home dialysis on top of that seemed to me to be a cruel burden to impose on her, since the added work left her totally exhausted.

[petey]

Monrein raises a good point about home hemodialysis, which is the added burden this places on the helper, who is usually the spouse. If you accept that there is some moral duty to try to contain the impact of a tragedy like renal failure, you also have to question whether this additional extension of that tragedy to your home dialysis helper is something you can live with. Almost everyone I knew at my dialysis unit who was doing home dialysis had a helper who was either not employed or was employed only part-time. But since my helper, my wife, was the head of a major federal government department, she had to be at work every day from 8 AM to 7:30 PM, and having to help with home dialysis on top of that seemed to me to be a cruel burden to impose on her, since the added work left her totally exhausted.

Once again, it is a matter of perspective.  I am Marvin's home hemo "helper" (though I choose the word "partner" to define my role).  I am employed full-time; I am a high school English teacher.  I leave for work at around 7 a.m., and I usually am home by 4 p.m.   After work, I have various "jobs" to do: cook supper, wash clothes, tidy up the house, grade papers, plan lessons, tend to one very precious dog, and assist Marvin with his 6x week home hemo treatments.  Additionally, Marvin and I both volunteer in our community (youth baseball program) where we both give generously 15-20 hours a week of our time so the children in our community have an excellent recreational program and facility in which to play baseball; we do not have any children of our own.  There are also certain days when I have "extracurricular" work at school -- ballgame duty, prom duty, faculty meetings, graduation practice, etc.

I have NEVER felt that my serving as Marvin's home hemo partner is a "cruel burden" or any kind of imposition on me or my time.  When we ventured into this modality of treatment last summer, we went into it -- just as we have with every other endeavor in the past 22 years -- as a TEAM.  He does his part, and I do mine.  Together, we might quite an impressive duo.  Marvin does everything he can to help me; while I am at school every day, he does as much "housework" as he is physically able to do.  He has become quite a good cook, an expert at sorting, washing, and folding clothes, and a whiz at dusting, straightening, and "picking up" around the house.  I do the "heavy" (physically challenging) housework that he is not able to do (however, with his regained strength, energy, and stamina now that he's on home hemo, the list of things he can't do is dwindling).  Also, Marvin has his machine totally "set up" and ready to go when I get home.  I walk in the door, put my bookbag down, give Marv a kiss, pat the dog on the head, wash my hands, and cannulate Marvin's access.  (Please note:  Marvin IS NOT allowed to grade papers -- his spelling is atrocious and his grammar skills, severely lacking.  However, he would certainly try to do this if he thought it would help me.)

Whatever "burden" of time and energy there may be to me as Marvin's home hemo partner is no burden at all.  I would gladly do more for this most precious husband of mine.  If he needed to run for eight hours a day on home hemo, I would find a way to make it work for him.  If he needed my last breath or my remaining kidney, I would give it to him right now.  With all that's good in a marrige, home hemo is another case of "give and take."  Sometimes I give more, and sometimes I take more.  It all evens out, and it all works for the good of both (Marvin is healthier on home hemo -- statistics or not -- and I am better because he's healthier).  Marvin is lucky to have me as his home hemo partner; he knows that and appreciates that.  I am lucky that I get one more day to spend with this truly inspiring, wonderful man.  There is no cost too high for me to pay to make his life easier, better, and happier.

[Adam_W]

I know I posted earlier that I would no longer respond to this thread, but Stauffenberg brought up an interesting comment regarding the partner/helper. I think for a lot of people, the helper issue is a very big barrier to home hemo. A lot of people, like Marvin, have very good, willing, and able partners. When I trained for home hemo a little over a year ago, my dad trained with me, even though I did everything myself. I'm going to be moving soon, and I'm going to be living alone. I'm capable and confident to continue home hemodialysis completely alone, but my doctor and the centre won't let me. That, along with some access issues is why I had to switch to PD. I'd much rather do home hemo because I think it's a superior treatment compared with PD (PD is very good, however), but if it was ever discovered that I was continuing to do home hemodialysis without a partner, they would boot me out of the home dialysis program completely, and I would be thrown back in-centre, where I would probably get depressed again, and possibly end up stopping dialysis period. Other people may want to do home hemo, but they don't have a partner at all, or their spouse or whoever their "partner" may be might not want to be responsible for some or all of the patient's treatment. That is especially and issue for patients who are not able to do 100% of the dialysis themselves and HAVE to have a partner. So yes, the partner issue can be a huge barrier to home dialysis.

Adam

[petey]

Adam, I understand that some dialysis folks do not have partners to help.  And I can see how that could be a barrier to home dialysis.  Marvin could not do this alone (even if his center allowed it solo -- which it doesn't).  Marvin cannot cannulate himself -- he just can't look when the needles are going in, and he never has been able to.  So, this set-up works perfectly for us; others must find another way.  I justed wanted Monrein to understand that not all partners/situations are like Stauffenberg's.  Monrein, have you seriously talked to your husband about this?  Maybe he wants to do this, maybe it wouldn't be too much on him, maybe he wouldn't see it as a "burden."

[flip]

I know what you mean, Adam. I'm sure I could do mine without a helper but they won't let me.

[del]

I definitely do not find it any burden to be my husband's partner with his dialysis and it has nothing to do with my moral duties. Everything we do we do together anyway and we enjoy each others company. I am a grade 2 teacher.  I live almost next door to the school!!!  I leave for work about 8 a.m and get home about 4 ish (often bringing work home with me to do in the night).  It takes about 30 -45 minutes each night to get the machine and needles ready.  Most of that time we spend chatting waiting for the machine to do all the tests and go through recirculation.  Takes me probably 10 minutes to set up the machine - put lines on etc.  and it takes hubby about 5 mins to do the needles.  To actually get the needles put in and machine up and running about 5 or 10 minutes.  It takes probably 5 minutes for disconnect in the morning.  I put the machine in vinegar before I pull his needles and by the time the needles are out it is time to put the machine in heat disinfect. By the time I shower the temp is high enough to turn off the RO.  Hubby strips the lines off the machine when he gets up.  The time it actually takes in the day is less than an hr for set up and everything.  he usually sleeps the whole 7 hrs he is on.  The rest of our day we have for ourselves from about 7 in the morning until 11 or 11:30 at night.  Only maintenance is once a week disinfect the RO.  Takes about a minute to put the wand in the RO and the RO does the rest automatically. Have to Javex the dialysis machine once a week.  I do this on Sunday instead of a heat disinfect.  

We live a little over 100 km away from the closest dialysis unit so this was a really good option for us.  Winter was always an issue with driving. The roads were never done well after it snowed.  Plus after 6 years driving to the unit 3 days a week it was home hemo or move!!!  Right now if we were to move closer to the center we would still want home hemo.

[monrein]

Many factors go into choosing the right treatment modality and those factors are different for each of us.  Undoubtedly some find that home hemo doesn't suit them and the same can be said for PD or in-center or any modality.  Choice is the key.  Situations differ also depending on the ages of those involved, their jobs, other responsibilities and very importantly the nature of the relationship between patient and "helper" or partner.  You all know the old saying "One man's cruel burden is another man's inspiration and pleasure".

A decision, about something such as home hemo and requiring varying degrees of cooperation between two people, would need to be a joint one and like many decisions made in a marriage would not automatically be viewed as a burden.  In my case my husband would far rather help me dialyze actually than help me in my garden, which he would likely turn into an ornamental tennis court if he had to have anything to do with it.  My husband always grew up with a cottage and so always wanted one.  We bought ours in 1974 and now have two.  Now, let's talk about BURDENS.  Anyone care to guess which partner has over the course of this marriage done the most work, maintenance etc just so one person could be where they feel their most comfortable?  Oh, while we're at it, I've gone on 11 major white water canoe trips including one to the Arctic because my husband prefers sleeping on the ground to a really good quality bed.  The one very scary bear attack used up my life's supply of adrenaline, not to mention the fact that Lee was born blind in one eye so his depth perception is suspect at best so I had to get very good at "reading" rapids and especially ledges or drops.  I might have chosen to spend all that money spent on going as far into the bush as possible on a world-class spa.  He'd rather stick hot nails in his eyes than have someone mess with his toes.

However, chores, burdens, impositions, inconveniences, travails, hmmm, compromises...whatever we want to call them...entered into willingly, mutually and non-coercively are not usually experienced as horrible.  If any arrangement ever becomes too onerous, that's where the possibility of alternate options comes in and something else can be chosen.  (Seriously considering selling a cottage on this end but it won't be easy giving up such a beloved burden.)  It must also be said that every modality has pros and cons, just like most things in life (even chocolate) and its always a matter of which column runs longer than the other at any given point in time.

We on this site perhaps do not represent the entire spectrum of the ESRD population but there are quite a few of us here with a wide range of experiences.  We could always ask the question "Have you ever tried home hemo?  Was it good for you?  Did you quit because you preferred something else?  If you have never tried it what would your fears/concerns/hesitations be?  Would you like it to be available to you?  Would you do it if you could pay an outside helper and get a tax deduction?"  From the posts I've read home hemo seems to suit quite a few really really well. (For heavens sake, Flip would consider marrying a nurse so HE could do it.  Stauff would rather stick hot nails into every last inch of his body).  Not statistics, but still informed opinions and therefore valid and helpful in my book.

[del]

Monrein, nocturnal dialysis is so new that apparently there has not reallty been any long term studies done on it. I have visited a lot of sites on the internet dealling with nocturnal dialysis. They are just going by what the people who are on it are saying right now.  You are right monrein what treatment works for one does not necessarily work for another.  I very rarely talk about the awful experience hubby had with PD because I don't want to scare anybody from trying it.  Some people do PD for years without any problems and love it.  Hubby does not want a transplant because he is scared of some of the side effects of the drugs.  That is his choice. He sometimes talks about having to hook up to a machine all the time but he says what's the good to complain.  It's not going to do any good. Just accept each day and deal with it as best he can. His way of dealing with it is keeping busy.  he always has several projects on the go!!  He would really like a portable machine though so that we could travel a bit more.  That will probably come in time.  If I was in his situation I might very well choose a transplant.  People have to choose what works best for them.  They just need to be educated to all of the options so they can make an informed choice.