I'm sure this is a basic question, but so it begins

[bevvy5]

With Greg starting on hemo - I pray every day that it is temporar - after four months on PD, the learning curve starts again.  I'm sure this has been addressed but I can't think of what to search for.

He lost about 12 kilos during his month stay in hospital, from 144 to 132 - yes, he's a large fellow!!  When he started going for regular hemo and was being weighed regularly, he weighed in at about 132 before hemo, and 130 after.  That was set as his "goal weight."  He hasn't been eating much yet and has dropped to about 130 pre hemo weight.  They've reset his goal weight at 128.

Today after hemo, he almost passed out in the elevator coming upstairs.  I had to quickly run and get a chair from our condo, thankfully right next to the elevator and he sat for a few minutes, then made it inside.  His fingers have been cramping all afternoon and he's still pretty wobbly on his feet.

Is this "normal" when starting hemo?  Will it get sorted out once they find where he should be?  Or should we be suggesting that they are being somewhat overzealous with taking off fluid?  I can't believe that almost fainting is the norm.

Thank you very much.

[YLGuy]

I searched "dry weight". Here are some threads about it:

http://ihatedialysis.com/forum/index.php?topic=16791.msg292094#msg292094

http://ihatedialysis.com/forum/index.php?topic=16466.msg287205#msg287205

http://ihatedialysis.com/forum/index.php?topic=15981.0

http://ihatedialysis.com/forum/index.php?topic=15326.0

There are more threads if you do the search

[Rerun]

You need to find your dry weight and yes it comes down to having to crash and then you know..... for a week or two... what your dry weight is.  It is a moving target and if you gain weight or lose weight you need to adjust your dry weight.  You don't want too much fluid on because that is hard on your heart.

Today I challenged my dry weight and my BP dropped, I got the sweats and my feet started cramping.

Then they had to give me 100cc's of fluid so now I have to take that off next time. 

It is an evil roller coaster.

[bevvy5]

Okay, a quick google search reveals that dry weight is the weight after dialysis - I guess that makes sense when you think about it.  I didn't exactly understand that before.

So it sounds like they may have been trying for a dry weight that was too low.  At least we know that it should get better and this is not the expected norm forever.  We'll talk to the nephrologist and nurses on Thursday when he goes back, tell them what happened.  If nothing else, we've learned not to let them take it any lower, at least until we see if he levels out on this one.

Thank you.

[YLGuy]

I am sorry.  I searched dry weight on this site.

[Rerun]

Dry weight is your weight minus any extra fluid.

Crashing is when you find your dry weight and your blood pressure drops or your cramp or pass out or all 3.
NOT Fun.

[jbeany]

Dry weight is, unfortunately, only a guess.  The only realistic way to get to a good dry weight every run is take control yourself.  The weight he ended at today is too low.  Demand that the dry weight they aim for the next run be bumped up - between .3 and .5 kilos would be good.  Then, he has to start paying very close attention to his fluid retention.  If he's showing signs of retention after staying at a regular dry weight for a while, then he's lost real weight and he needs to "challenge" his dry weight.  That can be done slowly - .2 or .3 each run, until the signs of fluid retention at the end of the run go away.  Slow is better - less cramping, crashing and passing out.

Everyone's signs vary a bit - mine showed up in my fingers the most.  Learn to check ankles, etc - wherever he feels the retention the most.

The nurses are supposed to pay attention to all this - but trust me, the more you learn to do yourself, the better the results.

[RichardMEL]

As others have said "Dry Weight" - sometimes also called Ideal Body Weight (IBW) is basically your weight without excess fluid. The idea is to keep you at a stable weight without any fluid retention. The theory is that between dialysis sessions (eg: every one or two days for hemo) 99% of your weight change will be fluid rather than real body weight, that's why you are weighed prior to a D session and after - the prior weight gives them the change from the last session, so the basic assumption is to thus take that amount off (plus a bit more allowing for washback/rinseback). Of course we all know that a person's (real) body weight does fluctuate based on eating patterns, exercise, and other stuff.. so really the dry weight is a guess and you know when it's off from BP crashing, cramping and the like - and this is why it can be so hit and miss unfortunately.

You can get a better idea of how much extra fluid is in you by getting them to run a crit line and doing a BVM (Body Volume Measurement) within the machine which will show the refill rate and thus give a much more accurate idea as to the state of the body's fluid levels - too much being "too wet"(thus the dry weight needs to come down to take off more) or "too dry" and thus you bump the dry weight up/take off less.

Hope that makes some kind of sense.

[aharris2]

I am sorry.  I searched dry weight on this site.

Why sorry, YL? There's lots of good info on dry weight here on IHD!

Bevvy googled??? I cannot believe it...TREASON!!! (just kidding)

Good for you, Bevvy, figuring it out. Yes, passing out and cramping are signs that Greg was too dry. Letting them know at the dialysis unit is the right thing to do. Make sure they pay attention to you and up Greg's target a weight a little (like jbeany says). Hopefully they will pay attention easily. If not, demand, stand your ground, make sure you step it up if necessary (from tech to RN to charge nurse, to Dr, whatever level is necessary).

[bevvy5]

Oh, I have no problem standing my ground, and half an acre of Greg's too.  I have learned through this last month that unless you are informing and looking out for things yourself, things can go off the rails very quickly. 

We've had excellent rapport with the nephrologists on rotation - he's had all of them at least once in the last six weeks.  I'll phone tomorrow and from past experience, they'll make sure that we see whoever is there on Thursday morning so we can voice our concerns.

Thank you all so much for kindly answering my newbie hemo questions.

[Hanify]

Good luck for next time.  Unfortunately as someone already said - there's no easy way to work out what his dry weight shoudl be - they're really not being mean, it's just the way it is.  make sure you tell them befoe he starts the next one about the lift.