Otto's going to try Nxstage

[lola]

Otto is back at home and everything went really well, he will do D tomorrow. Cherpep he had hiccups for 10 days they tried so many different meds and old wives tales and then they just went away. Otto is hopefully on the road to recovery

[Trouble008]

What's the difference between Nxstage and Baxter cycler?

[Wallyz]

NxStage is home hemo and Baxter is Peritoneal Dialysis

[willieandwinnie]

Amy, 

[okarol]

A friend of ours had a minor throat surgical procedure (for snoring) and ended up hiccuping for 3 weeks! Even in his sleep! They said it was due to the anesthetic used - some people react that way. It finally went away on its own.

Amy, I hope Otto is feeling better - you've all been through so much! 

[lola]

3 weeks OMG Otto would have freaked!!!!!! Thanks for all the Prayers being sent our way If I ever win the lottery I'm paying for a IHD get together 

[lola]

Otto just got done D and his filter looked so weird we're thinking it's from the dye they used yesterday

[willieandwinnie]

lola, what was weird or what color was it? 

[lola]

it was black and clotted looking

[willieandwinnie]

Did Otto get a good run or did you get lots of alarms? When Len had to have his graft cleaned out, the dye they used was purple. I hope tomorrow goes better Amy. Keep us posted. 

[lola]

He had a good run with no alarms, that's why I'm thinking it had something to do with the dye.

[willieandwinnie]

Amy, I'm happy to hear that Otto had a good run but concerned about the clotting issue. Does he get heparin before and during treatment? When Len had his graft done, I believe even the 2nd treatment showed some of the dye in the filter but not a whole lot. Did they tell you what they found, narrowing or clot? Somedays there is too much for us to process. Let us know how todays run goes and please give him a big  .

[lola]

All went well today filter was a little funky today but not as bad as yesterday, thank God we didn't call cause they probably would have made him come in since they think we still have money to suck from us

[lola]

Otto went in today he is felling like and every time he's on D it's worse he also has a low grade fever by the end of each treatment, Dr is a little worried. He's having some more test run as he should not be feeling like this, he says it's just like when he was doing in center. I just want my husband to start to feel better

[okarol]

  lola, hopefully the test will give you some answers. I am sorry Ottos not feeling well. 

[jbeany]

Hope they figure something out soon.   

[monrein]

So sorry Lola.   

[pelagia]

Amy, I found this article about the dialysis membrane causing a low grade fever.  Seems like whatever is causing Otto to feel bad is due to something relating to dialysis itself and something that changed after the transplant.  Could the transplant or the drugs the gave him during the transplant process have made him more sensitive to membranes or that did not bother him in the past?

Chronic renal hemodialysis patient with post-hemodialysis fever caused by hypersensitivity to the hemodialysis membrane: A case report.
http://sciencelinks.jp/j-east/article/200203/000020020301A1028547.php
Low-grade fever is one of the well known complications of chronic hemodialysis therapy. We report the case of a chronic renal hemodialysis patient with post-hemodialysis fever due to dialysis membranes. An 80-year-old woman undergoing hemodialysis for chronic renal failure due to chronic gromerulonephritis had a high-grade fever (39.DEG.C.) after every hemodialysis therapy for about 2 years. In order to discover the origin of the high-grade fever, we administered several drugs and changed some of the hemodialysis conditions. Her high-grade fever was improved only by using a membrane made of Di-acetate (M-170D) and this also relieved her general fatigue. This case led us to conclude that hypersensitivity to the dialysis membrane may be one of the causes of fever of an unknown origin (FUO) after hemodialysis therapy. (author abst.)

[pelagia]

I also found this article which talks about the transition from transplant back to dialysis.  When you think of all that Otto's body has been through and the drug regimes changing, it's easy to imagine that it might take him a bit of time to feel better.  And then there is all the emotional stress piled on top of the physical challenges.  I hope he keeps feeling a little better every day. 

P.S. He is truly lucky to have you by his side! 

I Have to Begin Dialysis Again After Several Years as a Dialysis Patient. Are There Any Issues or Concerns I Should be Aware of Before I Start Dialysis?

http://www.aakp.org/aakp-library/concerns-before-I-start-dialysis/

Answer: Remarkable strides have been witnessed in the transplantation of solid organs over the past two decades. This is evidenced by the reduction in the incidence of acute rejection one year following the transplant procedure and by the improved long-term overall graft (transplanted organ) survival. Nevertheless, thousands of patients find themselves returning to dialysis yearly as a result of their transplanted kidney having failed. The indications for returning to dialysis would be similar to those that led to the initiation of dialysis after failure of native kidney function (assuming the patient dialyzed pre-transplantation, since a small percentage of patients undergo "preemptive" transplantation - not having been dialyzed before receiving a kidney, usually from a living donor). If the patient had been followed closely by his or her nephrologist, the access for dialysis should have been secured in advance of returning to dialysis, either by placement of a peritoneal dialysis catheter if the patient elects to do peritoneal dialysis, or ensuring there is a working arteriovenous fistula or graft for hemodialysis. The timing for access placement in this setting is similar, once again, to that for native kidney failure, when the creatinine clearance is 20 ml/min or less in non-diabetics and 25 ml/min or less in diabetic patients. This point is usually reached only after the patient has undergone a biopsy at some point to validate that there is very little to no possibility that the transplanted kidney can recover sufficient function with additional or continued immunosuppression.

Obviously, the transition back to dialysis following a failed kidney transplant is fraught with change. The most easily recognizable changes are in lifestyle - following a prescribed diet in terms of limiting salt and water intake, as well as foodstuffs that are rich in potassium and phosphorous, depending upon how much residual kidney function the patient may possess. The anemia that usually abates (lessens) following a successful kidney transplant will likely recur if a transplant fails, so a patient will need to go back on erythropoietin and iron supplements. Phosphorous supplements and multivitamins are also likely to be prescribed. A new "dry weight" will need to be established upon return to dialysis as well.

While new medications are being prescribed that accompany a return to dialysis, other medications that were prescribed for the transplanted kidney are tapered or discontinued. Both the transplanted patient and the dialysis patient are at increased risk for serious infections and certain cancers, the former because of the immunosuppressant drugs and the latter for the immunodeficient state of uremia. Therefore, the patient with the failed kidney transplant who returns to dialysis is best served by having reductions made in their immunosuppressive medications.

Most nephrologists will instruct the patient to discontinue their calcineurin inhibitor (i.e. cyclosporine or tacrolimus)drug outright with no tapering schedule. Should the patient either be on azathioprine, mycophenolate, or sirolimus, these drugs are usually discontinued or tapered off over several months. More importantly, should the patient still be on prednisone or medrol at the time of returning to dialysis, these corticosteroid drugs are tapered off very cautiously, unless there is an overriding medical condition (e.g. lupus), which mandates their continued administration. Should the corticosteroids be discontinued abruptly, the patient may suffer from adrenal insufficiency, resulting in circulatory collapse. The adrenal glands are shut down from producing its own hormones while the patient is taking administered corticosteroids over an extended period of time. Some signs and symptoms that a patient may be experiencing adrenal insufficiency, other than overt hypotension or marked low blood pressure, are continued malaise (lethargy) and fatigue, unexplained low-grade fever, weakness, myalgias (muscle pain) and arthralgias (joint pain) and weight loss from poor appetite.

A major concern of both patient and nephrologist that arises with the discontinuation of the immunosuppressives upon returning to dialysis is the possibility of rejection. The incidence for the need of surgical removal of the kidney, or nephrectomy, has been cited to vary between 20 and 65 percent over the past two decades. The indications for such a removal include pain and graft tenderness, otherwise unexplained fever, blood in the urine (hematuria), and a failure to thrive. Transplant kidneys, which lose function within a year following transplantation, are also usually surgically removed to stave off the possibility of other possible complications arising, such as thrombosis and hemorrhage.

The patient who returns to dialysis following a failed kidney transplant needs to play an active role in his or her own healthcare. He or she needs to follow the prescribed diet and medications, stay physically active and keep whatever appointments may have been made for cancer screening examinations (e.g. colonoscopy, mammography, etc.) and coronary disease testing. They also need to report any symptoms to their dialysis team that may be related to their failed kidney transplant mentioned above. Lastly, they should seek out relisting on their local organ procurement organization waiting list or identify any possible living donor to their dialysis healthcare team.

Question answered by Ken Bodziak, MD. Dr. Bodziak is an Assistant Professor of Medicine in the Division of Nephrology at University Hospitals of Cleveland. He was previously at Beaumont Hospital in Royal Oak, MI, where he participated in the renal transplant program as a transplant nephrologist.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in the March 2002 issue of aakpRENALIFE, Vol. 17, No. 5.

[kitkatz]

Amy, I found this article about the dialysis membrane causing a low grade fever.  Seems like whatever is causing Otto to feel bad is due to something relating to dialysis itself and something that changed after the transplant.  Could the transplant or the drugs the gave him during the transplant process have made him more sensitive to membranes or that did not bother him in the past?

Chronic renal hemodialysis patient with post-hemodialysis fever caused by hypersensitivity to the hemodialysis membrane: A case report.
http://sciencelinks.jp/j-east/article/200203/000020020301A1028547.php
Low-grade fever is one of the well known complications of chronic hemodialysis therapy. We report the case of a chronic renal hemodialysis patient with post-hemodialysis fever due to dialysis membranes. An 80-year-old woman undergoing hemodialysis for chronic renal failure due to chronic gromerulonephritis had a high-grade fever (39.DEG.C.) after every hemodialysis therapy for about 2 years. In order to discover the origin of the high-grade fever, we administered several drugs and changed some of the hemodialysis conditions. Her high-grade fever was improved only by using a membrane made of Di-acetate (M-170D) and this also relieved her general fatigue. This case led us to conclude that hypersensitivity to the dialysis membrane may be one of the causes of fever of an unknown origin (FUO) after hemodialysis therapy. (author abst.)

The same thing happened to me for six months in 1995. I was allergic to dialyzer membrane. They changed the dialyzer. I am now known as a pain in the butt, because they have to special order my dialyzers.

[petey]

When Marvin's transplanted kidney quit working effectively (dropped below 15%), all his anti-rejection meds were stopped immediately and he returned to dialysis (perm cath for access).  He was also on steroids, but they were discontinued on a gradual basis (taper down); he was completely off the steroids a month after dialysis resumed.  He kept the transplanted kidney (though it wasn't working) for 15 months after he went back on dialysis.  Then, it was determined, the kidney was swollen and trapping blood and not letting it return to his system.  When the transplanted kidney was removed, Marvin felt better immediately.  The surgeon told me (after removing it) that it was almost twice the size as when it was transplanted and should have been causing him MAJOR pain (Marvin described only "discomfort").  Even after 15 months of NO anti-rejection meds, Marvin didn't reject the kidney (and probably would have kept it longer had it not started swelling).  I've often wondered how he kept it so long with no Cellcept and Prograf (his anti-rejection regime).

[willieandwinnie]

Amy, we just wanted to let you and Otto know we are thinking of you. 

[lola]

Well so far blood culture are not showing anything, waiting for other stuff there running. Today they called to say his phosphorus level is 9.2 and said he needs to be taking his phoslo, HELLO if he eats he does. Otto is ready to throw wall-e out the window.  Otto is still on some transplant meds only because he still has his old kidney that still works at like 5% or something like that. They stopped his cellcept when he was in the Hospital.

[lola]

Otto's pure flow went  he's suppose to get a new one in the morning, although he'd rather just trow the whole thing out the window. He's going to see his transplant Dr Thursday and then his Neph again Tuesday. I'm so sick of him feeling like this, I just want my husband back this sucks soooooo bad.

[kimcanada]

Lola, hang in there , I am praying for a speedy recovery for Otto, damn kidneys 

Lola    Otto