Bob's Blog 2-6-16: What, Me Worry?

Bob Here.

How often in our lives do we have one of those moments when we say to ourselves, "Gee, if only I had known that earlier?"

You know, like the time you drove around for an hour with your 'Check Engine' light on and ended up with your prized vehicle burning down to a cinder on the side of the road? You end up thinking, gee, if only I had known that's what would happen I would have either taken it to a service station or seen if I could get a good buy on a fire extinguisher.

Not that I know anyone that has happened to. <Ahem>

One of those epiphanies struck me recently when it occurred to me that we worry too much about things that we either a) cannot change, or b) don't really matter anyway.

You have to admit that most of the things that give us pause in this world are not truly worth worrying about.

Even for a home hemodialysis patient, whose appropriate responses to problems that arise during setup and treatment can range from spitting out the occasional curse word to making sure their will is up to date.

Now, I'll have to admit that when I first started at home, the process was a little nerve wracking. I was so uptight while setting up the machine, that if you snuck up behind me and tapped me on the shoulder, you would have had to peel me off the ceiling shortly thereafter.

I remember our training nurse trying to reassure us that doing treatments at home was not equivalent to buying a one-way ticket to that big dialysis center in the sky.

"Don't worry too much," she had said. "There are enough safeguards in the machine to keep you from doing any real damage."

I didn't know whether to laugh or start shopping for burial plots.

Of course, as one moves along in life (read: gets old), you experience many instances of worrisome circumstances. And with the wisdom of age, we start to realize that there really aren't that many that could be classified as "meltdown worthy."

I noticed a change during last year's brutal winter in New Hampshire where we have chosen to go to pasture after working in industry for 35 years.

We had made our primary residence in Texas before moving up north. And even though we're both from the Northeast, we adopted the very Southern practice of completely freaking out when the slightest bit of freezing precipitation was in the weather forecast.

Now, my friends in the Dallas area can correct me if I'm wrong, but I found that as little as an inch of frozen precip can paralyze the entire metroplex.

Now, in fairness, Texas doesn't have the snow removal equipment that exists in the North, so a little snow or sleet tends to wreck a lot more havoc.

All it took was for one of the weather prognosticators to say something as innocent as "Oh, and we may get a stray snow flurry tomorrow," and people would be scurrying like rats to their nearest grocery store to stock up on bread, water, and as many canned foods they could carry without herniating themselves carrying them out to their cars.

All of which would be kind of funny, except, of course, for the fact that I was one of the rats.

But oh how things have changed. This is our third winter in New Hampshire and we had a doozy last year. We accumulated 120 inches of snow in about five weeks time.

So now, the meteorologist can predict getting a decent amount of snow, say 8-10 inches, and I'll be like, "Huh. Might take me five minutes longer to get to the gym." And the wife will say, "Huh. Good day to go get my hair and nails done."

What a difference.

There are many aspects of dialysis which have caused agita over the years that have triggered similar changes in perspective as we gain more experience and as our nerves in general have calmed with the accumulation of years.

(Isn't it great the way I avoid saying that, "We're getting old?")

Just the other day, we were setting up for treatment, minding our own business, and the micron chip leading to the dialysate dispenser started leaking all over the place. The word, "leaking" doesn't really do the situation justice.

Unless, of course, you consider Niagra Falls to be "just a little leak coming over the hill."

Now, I'm certainly no stranger to leaks on dialysis, many of which came at my own hand.

When we were in training for treating at home, I accidently opened the wrong clamp during a trial setup.

"Oh crap," I said before proceeding to panic and close two of the clamps that weren't leaking and opening another wrong one which made the original spill even worse.

To make a long (and wet) story short, after cleaning up the flood, I looked sheepishly at our training nurse.

"Does this mean we're disqualified from the home program?" I asked.

She just rolled her eyes. "No, but I think I will up our flood insurance coverage for the rest of your training period."

To show you how far we've progressed, when the tidal-wave sized leak started pouring out of the chip this past week, we were both very calm. The wife just turned the Pureflow off. We both realized that we couldn't use the batch and we said to each other at the same time, "Bags it is."

(The pre-mixed dialysate bags are the alternative to using the Pureflow.)

So now, my attitude toward accidently causing a deluge is simply:

"What, me worry?"

(With all due respect to Alfred E. Neuman.)

Probably the most worrisome step in executing a home treatment (or any treatment, for that matter) is cannulation.

For you lucky non-dialysis patients, cannulation involves the placing of your needles, or, in the vernacular, "Getting stuck."

All hemodialysis patients know that one of the keys to having a good treatment is the proper insertion of the needles into your blood vessel, a fistula in my case. All you non-patients need to know is that having to do so is one of the many reasons you don't ever want to go on dialysis if you can possibly avoid it.

When I first started in-center treatments, I admit, I worried aplenty about which attendant or nurse was going to put my needles in. Truth be told, there is a wide range in quality of "sticking ability."

Early on, when my fistula hadn't yet matured properly, I got to go through the less-than-joyful occurrence of "infiltration" where an inexperienced attendant put one of my needles right through the vessel and out the other side.

Now, I won't lie, the pain was substantial. But I didn't know any better, so we proceeded with the treatment.

The net effect of infiltration is that blood, fluid, water, dialysate and everything short of the kitchen sink flows into your tissue instead of traveling along its merry way into your vessel where it belongs.

I was looking down at my arm with concern. The attendant must have noticed because he called over, "Is everything okay?"

I said, "Well, if my arm gets any bigger, we'll be able to enter it as a float in the Thanksgiving Day Parade."

He rushed over, saw the swelling in my arm, avoided fainting, and said, "Holy Crap!" and shut the machine down.

Obviously that incident did nothing to ease my concern about "getting stuck" properly going forward.

But now as a home patient, lucky me, I get to self-cannulate, or put my own needles in.

Now, if anybody had suggested such a thing when I first started, I would have done about anything to get out of it. Maybe act crazy, so they wouldn't think I was capable.

I could have said something like, "Sorry, the voices in my head say I can't do that."

But treating at home has its advantages, so I agreed to give it a shot.

I use "buttonholes" which mean I put the needles in the same place for every treatment. It's generally an easier process, except for the fact that buttonholes can stop working.

So, back to the agita.

When I first started at home and I had trouble getting a needle in, the freaking out process would begin anew.

My initial tendency was to apply a principle that I had used frequently in my mostly-unfortunate endeavors into DIY home repair:

"When in doubt, use force."

I would end up pushing as hard as I could and, although occasionally successful, in general the only breakthrough I achieved was setting a new high for systolic blood pressure.

But now, being the sage, experienced dialysis guy that I am, I know that, in general, if you calmly back the needle out, re-excavate the entry point, and try again, you can have a high rate of success without having to notify an emergency medical team.

So, my attitude towards self-cannulation is now similar to when I hear that we're going to have a blizzard or when something I do causes a waterfall from my dialysis machine.

"What, me worry?"

Thanks for reading. Take care.