emotional after hemo treatment

[WishIKnew]

So, I've only had 4 treatments so far but every time I've had a total melt down within an hour of being done.  Crying, anger, fear, frustration.... I'm a mess for awhile and then I'm just kinda out-of-it for the evening.  Anyone else experience the strong emotional reaction I am experiencing?

Wish
Diane

[willowtreewren]

Diane,

It is reasonable that your blood chemistry is out of whack after a treatment. 

My husband did not experience this, but my heart goes out to you. Keep in mind that it takes a while for your dry weight to be sorted out so they can pull off the correct amount of fluid.

 

Aleta

[WishIKnew]

I expected a physical reaction, not an emotional one,  Guess we just never know what to expect!  It's not horrible, it's just good to know not  to plan anything right after treatment!  Hopefully it will level out and the emotions will stay in check.

[jeannea]

It's probably just your way of experiencing the anger and sadness we feel about ending up on hemo. Some people have years to prepare but you had no time. I had done my yelling and screaming in the hospital when I became conscious and realized I was on hemo. We all have to adjust to the "new normal" and this must be your way. Be kind to yourself for a while and maybe if it doesn't pass in a few weeks get someone to talk to. My therapist makes all the difference.

[okarol]

  I hope things get better.

[greg10]

Be careful.  Emotional lability is a symptom of DDS.  There are ways to minimize DDS with initial treatments of HD.  I hope you feel better soon.

In nephrology, dialysis disequilibrium syndrome, commonly abbreviated DDS, is the occurrence of neurologic signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis.[1]

http://www.medlink.com/medlinkcontent.asp
Emotional lability, labile affect or emotional incontinence refers to a neurologic disorder characterized by involuntary crying.

http://professionals.epilepsy.com/page/renal_dds.html


edited:  The second url didn't link to the specific article, so I have reproduced it here:

Historical note and nomenclature
  Uremia occurs when renal failure results in the systemic retention of nitrogenous and other waste products. Such metabolic derangements may cause dysfunction of various tissue types including those of the central and peripheral nervous systems (Raskin and Fishman 1976a; 1976b). Uremic encephalopathy is diagnosed when renal failure is responsible for alteration of mental status (Fraser and Arieff 1997). In 1962, Kennedy and associates identified dialysis disequilibrium syndrome as a characteristic symptom complex of mental confusion, headache, and muscle twitching following rapid correction of uremia by hemodialysis in patients with chronic renal failure (Kennedy et al 1962). Arieff developed an animal model of the condition by exposing acutely uremic dogs to rapid hemodialysis (Arieff et al 1978). For the first time, in 1972, Alfrey described dialysis dementia in 5 chronically dialyzed patients who developed intermittent speech abnormalities followed by a distinct encephalopathy that was later believed to be a result of aluminum toxicity to the CNS (Alfrey et al 1972; 1976). Peripheral neuropathy as a complication of renal failure was possibly first described in 1863 by Kussmaul (Burn and Bates 1998). In 1971, Dyck and colleagues described uremic neuropathy in detail based on their extensive nerve conduction studies in these patients. Warren and Otieno, in 1975, reported carpal tunnel syndrome in patients on intermittent hemodialysis. In 1954, the team of John Merrill, Hartwell Harrison, and David Hume, headed by Joseph Murray, ushered in the modern era of human organ transplantation.

Clinical manifestations
  Encephalopathy. Uremic encephalopathy generally develops in patients with acute or chronic renal failure when the glomerular filtration rate declines below 10% of normal (Raskin 2001). The clinical features are variable, tend to occur early, are not clearly distinguishable from those of other metabolic encephalopathies, but may respond to hemodialysis (Fraser and Arieff 1997). Features of uremic encephalopathy are characteristic of a metabolic encephalopathy and may include sluggishness, easy fatigability, daytime drowsiness and insomnia, itchiness, inability to sustain attention or to perform complex cognitive tasks, slurred speech, anorexia, nausea and vomiting, restlessness, poor memory, diminished sexual interest, emotional lability, confusion, convulsions, stupor, and preterminal coma (Lockwood 1989; Lacerda et al 2010). The coexistence of features suggestive of depression of neural activity together with those of neural excitation (ie, twitching, agitation, myoclonus, asterixis, seizures) is somewhat distinctive to uremic encephalopathy (Raskin and Fishman 1976a; 1976b). In general, uremic encephalopathy is more severe and fulminating in patients with acute rather than chronic renal failure. Symptoms are promptly relieved following restoration of renal function, as occurs with hemodialysis or after successful renal transplantation (Brouns and De Deyn 2004). Seizures occur in one fourth to one third of patients with uremia (Plum and Posner 1972). The seizures are usually generalized but may also be focal in nature, particularly where there is underlying brain pathology. Seizures are more common in acute (40%) than in chronic renal failure (10%). Asterixis refers to the sudden loss of muscle tone that classically results in a “flapping tremor” but is not specific to uremia. The severity of symptoms tends to parallel the progression of renal dysfunction. Uremic myoclonus is often multifocal and involves the extremities. Uremic myoclonus in humans resembles the reticular reflex form of postanoxic action myoclonus. Research in cats suggests that this phenomenon arises in the brainstem medullary reticular formation. Nonepileptic focal and multifocal myoclonus has been seen in a few uremic patients using gabapentin and in some patients using the related anticonvulsant, pregabalin (Zhang et al 2005). Anatomical involvement of basal ganglia may cause chorea.

TREATMENT ­ Prevention is the mainstay of therapy in the DDS, particularly in new dialysis patients who are at highest risk. The initial dialyses should be gentle, but repeated frequently. The aim is a gradual reduction in BUN, which will be protective but may not prevent mild symptoms such as headache and malaise. Slow urea removal can be achieved by one of the following methods: With hemodialysis, therapy can be initiated with two hours of dialysis at a relatively low blood flow rate of 150 to 250 mL/min with a small surface area dialyzer. This regimen, which is repeated daily for three or four days, is different from the standard every other day four-hour regimen at high flow rates. If the patient shows no signs of DDS, the blood flow rate can be increased by 50 mL/min per treatment (up to 300 to 400 mL/min) and the duration of dialysis can be increased in 30 minute increments (up to four or more hours, as necessary for adequate solute removal). Patients who also have marked fluid overload can be treated with ultrafiltration (which removes less urea per unit time) followed by a short period of hemodialysis. The patient can be started on peritoneal dialysis in which the low rate of peritoneal blood flow results in a urea clearance per unit time that is much lower than that with hemodialysis. The DDS has not been reported with continuous peritoneal dialysis. Some physicians recommend prophylactic phenytoin (1000 mg loading dose followed by 300 mg/day until uremia is controlled) and/or the administration of 12.5 g of hypertonic mannitol intravenously every hour of dialysis in high-risk patients with marked azotemia (BUN above 150 to 200 mg/dL [54 to 71 mmol/L]) or an underlying alteration in mental status. Symptoms of DDS are self-limited and usually dissipate within several hours. Severe DDS with seizures can be reversed more rapidly by raising the plasma osmolality with either 5 mL of 23 percent saline or 12.5 g of hypertonic mannitol.

[billybags]

Hope it gets better for you Diane. when my husband was on it temporally he would come home and go to bed for a few hours, he was absolutely jaded. The next day was better.

[jbeany]

Be careful.  Emotional lability is a symptom of DDS.  There are ways to minimize DDS with initial treatments of HD.  I hope you feel better soon.

In nephrology, dialysis disequilibrium syndrome, commonly abbreviated DDS, is the occurrence of neurologic signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis.[1]

http://www.medlink.com/medlinkcontent.asp
Emotional lability, labile affect or emotional incontinence refers to a neurologic disorder characterized by involuntary crying.

http://professionals.epilepsy.com/page/renal_dds.html

Huh, never heard of that - but I suppose it makes sense.  You are going tremendous changes in your blood chemistry in a very short time.  No one is surprised at physical reactions but there's a fine line between physical and emotional anyhow.

With only 4 treatments, hopefully things will level out for you soon! 

[WishIKnew]

Thanks all.  Never heard of DDS.  I don't think my reactions are that severe, but I will tell the nurses tomorrow at treatment and see if there is anything they can do for me.  You all are the best!!!!!!!!!!!!

[kitkatz]

I experienced it after hemodialysis, the family knew to back off me and feed me quick.  You may need a protein pick me up after you get of the machine to help equalize the blood again.

[galvo]

I found that things improved after a while.

[tyefly]

How about going for a long walk,,, or some exercise.....   I often did that when I had to sit for a long time... made me feel alot better.....

[Des]

So, I've only had 4 treatments so far but every time I've had a total melt down within an hour of being done.  Crying, anger, fear, frustration.... I'm a mess for awhile and then I'm just kinda out-of-it for the evening.  Anyone else experience the strong emotional reaction I am experiencing?

Wish
Diane

I am so sorry for you.  I know exactly how you feel. I hope it is just temporarily for you but for me it has been like that for more than a year now. I just can't seem to get used to HD.

My heart goes out to you and I hope you cope better than myself.

lots of hugs   

[PatDowns]

With all you have experienced lately, both emotionally and physically, going on crying jags after dialysis, especially from a treatment modality you aren't particularly happy about being on, doesn't sound so out of the ordinary.  However, to better help you cope with all you're going through, maybe you should seek some short term counselling.  See if your dialysis social worker can make a referral. 

[lmunchkin]

Jeannea & Pat give good advise!  Diane your reaction is not only expected but very understandable. I say have a good cry and get on with your life. You have been through alot over time and my heart goes out to you, but you must Jump this Hurdle.  After a while, you will see, it is not that bad on D.

And if I recall didnt you do PD? You can do D at home!  Just do In-center for awhile so that you can get to feeling better, then you might look into NxStage. 

Look, I think you will be okay! I mean Lord, look what youv'e been through!  What's not to be emotional about that! Just relax and take it one day at a time, okay?  You are tougher than you think--- this too will pass, Diane!

You are in my thoughts & prayers lady,

lmunchkin   

[MooseMom]

Anger, fear, frustration...I'd say that's a pretty understandable reaction to dialysis.  I haven't been on dialysis yet, but I've experienced many a meltdown, anyway.  I really hope you find ways to cope.  This is all so very hard.  I'm so sorry that hemo has had this effect on you.  Please don't suffer in silence; maybe you should consider speaking to your healthcare team.  Perhaps they have seen this sort of thing before and have some experience in how to help you deal with it.  If you do find something that helps, please do share it with the rest of us!

 

[WishIKnew]

Thanks all!  I spoke to the nurses and techs at my center.  They'd never heard of this kind of reactions. My Dr. had given me a perscription for adavan for as needed and I had never used it.  They suggested I take one when I got home.  So I came home, ate a little dinner, took an adavan and went to bed.  I slept for 12 hours.  If I was a single girl I'd say we found the solutiom, but I cant possible go to bed at 5:00 three nights a week.  I have a family and a life....  Anyway, last night was restful, no tears, no anger, just sleep....

[billybags]

You must have needed the rest Diane, hope it did you good.

[MooseMom]

I'm no psychologist, but in reading all of the posts on this thread, a thought did occur to me.  I am wondering if perhaps your dialysis sessions are serving as an unconscious "trigger" for the pent up feelings that all of the things you've been through certainly must engender.  If everything else in your life was on a pretty even keel and dialysis was "all" you had to deal with, then I'd have to wonder if there is something about the treatments that your body just isn't coping with.  But since there are so many other things in your life that are causing you great concern, I have to suspect that dialysis sessions are merely the last straw, if you see what I mean.  The fact that a very lengthy sleep has helped does make me wonder if your post-treatment emotional upheavels are the result of the cummulative effect of all of the stressors in your life.  Let's face it...you've really been through the wars.

[lcamanini]

I had this same problem for about the first month of treatments. At least in my case I genuinely don't feel that it was pent up feelings or anything like that. I don't know how to describe it but the feelings didn't feel related to anything...they just seemed like random feelings that I couldn't control. They didn't last long for me...maybe an hour or so after treatment. The slightest things could trigger it...I remember one time literally starting to bawl because I was hungry! Sometimes I would feel very sad and others very irritable. My nurses had never heard of that reaction either so they weren't any help, but it went away after about a month.

[lmunchkin]

WIK, are your treatments getting better?  Ive been thinking about you and how things are going.  I got to tell you, with all the krud you been through, I just admire your tenacity!  Most would give up.  You are a tough lady, I tell you what!

Hang in there, and please keep us updated,


lmunchkin       

[WishIKnew]

lmunchkin = yes, the treatments are getting better.   I've started taking half of an ativan as soon as I get home.  Then I eat a little and go to bed.  I sleep a couple of hours and then I'm ok for the rest of the evening.  A little out of it but still able to be with the family, walk the dog, do the dishes, etc.  Things are improving in that area.  Thanks for asking!!!!!

[lmunchkin]

Good to hear!  I got to tell you, I dont have this disease and Im just exhausted all the time.  I seem to be physically & emotionally spent. But I keep going for some unknown reason! lol.   I can only imagine how it must be for you!

Really glad your treatments are better, or should I say, you are handling them better!

lmunchkin     

[rsudock]

Thinking about you Diane! At the kidney walk in Cleveland you entered my mind briefly. I hope you lick this chemo and dialysis stuff!

xo,
R