Question for those on Hemo...

[tiredandthirsty]

Hi all,

Hope everyone is doing fantastic and continue to do fantastic forever.


I haven't been able to post too much on here since i joined, but i do visit frequently and read a lot.  i find answers to a lot of questions just by searching this forum, so i don't find it necessary to post/create too many threads.  however, i couldn't find an answer for this so i am asking you wise folks to help me if possible.

i have been on in centre hemo since March 28th, and i have not had a whole lot of problems with the grace of God.  however, last friday and yesterday, i started off well, but towards the end i started feeling nauseous.  i didn't throw up but i did feel nauseous for the remainder of the treatment.  the nausea slowly went away after the rinse back (not immediately).  but i have never felt like this in the three months i have been on hemo.  this was the first time. and it was not a good feeling at all.  any ideas/tips/suggestions on what could be happening and what i can do to prevent this? 

Thanks a lot for all your suggestions/tips/advice in advance. 

[Traveller1947]

Hi, t&t!  So good to know that things have been going reasonably well for you.  My first thought about the nausea you've had recently toward the end of treatment, is that they're taking off too much fluid.  It could be that your real weight has increased a bit, so that taking off the usual amount of fluid is actually bringing you below your true weight.  It can't be by much, since rinsing you back helps the nausea.  Here's hoping that this problem can be solved simply by adjusting your dry weight.  All the best to you, as always.

[jbeany]

Traveller has already pointed out the most likely cause.  If it happens again, you can also ask them to give you a bolus of saline right away to see if it helps.  If it happens consistently, then you probably need your dry weight raised.

If upping your dry weight doesn't help, consider if has anything else changed.  Are you getting any new meds while you are hooked up?  Are you wearing different clothes to weigh in?  Has your diet or schedule for eating changed?  Did the center get a new scale? Are they using the same equipment and filters?

[tiredandthirsty]

It could be that your real weight has increased a bit. 

I SO HOPE YOU ARE CORRECT    I need to put some weight back on.  i have gone from 142ish to 118 :-(.

but how can i figure out if this is the case?  this case being my dry weight has increased?

[tiredandthirsty]

If upping your dry weight doesn't help, consider if has anything else changed.  Are you getting any new meds while you are hooked up?  Are you wearing different clothes to weigh in?  Has your diet or schedule for eating changed?  Did the center get a new scale? Are they using the same equipment and filters?

jbeany.  thanks for the response.  i will give you more details based on your questions.  i have not been put on any new meds and i am not getting anything new on the machine either.  just the iron every now and than.  i get epo shots twice a week, but i have been getting that for quite sometime now, about a month at least.  i wear almost the same clothes every treatment (of course a new shirt and underwear hehe).  The centre has not gotten a new scale and i think they are using the same equipment as far as i can tell.  no drastic changes from what i see everytime. 

also the same question to you, how do i figure out if my dry weight has changed/increased?

[del]

Most times your dry weight is figured out through trial and error.  Get the nurses to increase your dry weight gradually to see if it makes a change to the way you feel.

[amanda100wilson]

Yes, I agree with the others.  Low BP caused by taking off too much fluid.

[Bill Peckham]

Two easy ways to check hydration:

• look at the neck veins. When lying down the neck veins should be visible. When standing up they should not be visible. If when lying down they are not visible, you can not see a bulge and the pulse twitch the skin then that suggests that too much fluid was removed. If you can see the veins when standing it suggests you have too much fluid on board.
• look for a lack of elasticity in  the skin tissues.  When you pinch  normal skin, it immediately goes back to its usual position.  If the dialyzor is dehydrated, the skin will  go back to its flat position more slowly. The best places  to test are the forehead, sternum and inner thigh.

Here is a PDF with a longer more technical discussion: http://www.uphs.upenn.edu/renal/important%20pdf%20ii/hd_flluid%20balance%20and%20dry%20weight.pdf

[jbeany]

What they never tell - and everyone needs to know - is that your dry weight is only a guess.  Period.  They don't have a clue.  You are always going to be the best judge of how much real weight you've gained or lost.  Have you been eating more or different foods that might make you gain a little?  Exercised to gain muscle and/or lose fat?  You have to learn your own body's signs of fluid overload and dehydration.  For me, my ankles didn't puff first - my fingers did.  If pinching your inner thigh isn't practical all the time, start seeing how the skin on the back of your hand or arm reacts when you are going in after a weekend compared to when you are leaving after a run that strips you dry.  Get used to the signs and use them to decide on your treatment goals. 
You can set your own fluid removal goals - you may have to get pushy, but it's your treatment and you get to control it!

And remember, while the goal is not to overload you with fluid, carrying an extra 1/2- to 1 liter of fluid for a few days to see if that's the cause of your troubles is NOT going to hurt you.  If raising your weight doesn't fix the nausea, then you have to find a new solution, but you will have eliminated one problem and can move on to the next possible solution.

[mogee]

I use BP to assess my dry weight.  I calculate my dry weight as the weight at which my BP is 115/65.  This method requires you to carefully track your pre and post weights and blood pressures.

[tiredandthirsty]

Thank you all for your wonderful advice and ideas.  i did go into the clinic yesterday and asked them to try and re-gauge my dry weight.  and voila, tomorrow i didn't feel nauseous, washed out or anything.  hopefully this solves the problem.  but yesterday was only the first treatment with the "new dry weight".  i am not sure how many treatments would be needed to "finalize" my new dry weight. 

i will keep you all posted on what's happening.  again, apologies for not reporting in on a regular basis.  i am trying :-)

hope everyone is doing great and continue to do great forever.