Dry Weight vs 'Normal' weight gains

[Charlie B53]

I often wonder what is the 'allowable' weight gain between dialysis sessions?

A couple of Mondays I have came in heavy, gaining 2.5 K's.  This bothers me as it seems like those days when Dialysis takes off this much I get more 'tired' and wasted, needing to sleep but the sleep doesn't re-energize me.  I feel washed out until I regain some fluids.

When I began Hemo in December they were taking my weight down far too low.  I virtually quit P'ing and was soo wasted after every session.  Raising my weight, keeping my fluid volume up just enough that there is a small amount of ankle swelling throughout my day I am P'ing regularly and after every dialysis session I am still able to stay up and go about my day.

I am still very hard on myself about my fluids, sucking on an ice cube instead of drinking a glass of water.  When I do get a drink it is only a mouthful instead of a glass.

I have felt like I am cheating, making a single serving glass of Kool-aid, half ice, than taking a couple of hours to drink it.  Raking leaves in the yard, coming in for a half a mouthful, then back outside. Spent the week-end doing leaves I should have done last Fall.  Had maybe THREE glasses of Kool-Aid.  I thought I'd be bad at Monday's weight in.

I came in AT my dry weight.  I was very surprised as the last two Mondays I was 2.5, which was my worst.

So I don't know if I am bragging, or complaining.

The weather is warming, I have those Carona's in the refrigerator.  A cold beer on a hot day after working in the yard can seem like a God sent gift. But I don't know if I can have that much fluid all at once.

[iolaire]

I'm still at a point where I probably could urinate everything I take in, plus I drink 500 ml water each session and eat including an apple which has some weight.  Because of that I'm not yet dealing with swelling. I have variability on my weight,  some days I'll come and be like 400 ml above my "dry weight" and others it will be well over a kilo to 1.5.  (Generally my liquid intake is fairly constant, 2 cups of coffee each day and 500-1000 ml of water, so part of that weight difference has to be food.)  Generally they let me select how much I want to take off but its relative to the dry weight since I know they are trying to hit those targets for their own stats and income.  Some days when I believe I have more food weight in me I will take off less and try to drink less water during the session.

So I can say yes its a struggle, even when you are not putting on tons of weight and are just trying to get at that nice point where they can take off the 1 kg they want to get to for cleaning.

[kristina]

Hello Charlie, I feel for you and know from own experiences, how difficult it can become to really figure our real dry weight.
In my case, I have semi"solved" the problem by cooking and eating exactly the same portion of food every single day,
plus I make absolutely sure to drink exactly the same amount of liquid every single day as well.
That is -of course -  as boring as it sounds, but it helps me quite a bit not to feel too "washed out" after dialysis-treatments.
... I also weigh myself every single morning before taking my shower and then I write my weight into my dialysis-diary.
Doing all this, gives an idea of how much to take off at each treatment.
All that action may sound a bit complicated and long-winded,
but I have done this since starting with dialysis and because of this, I hardly notice the effort any longer.
Writing every day into this little dialysis-diary also helps to keep an eye on my weight, BP
and any changes that come along and it helps a bit to decipher some of those dialysis-mysteries
Take care and best wishes from Kristina.

...

[Michael Murphy]

For me the worst problem if they take me too low my digestive track comes to a screeching halt.  When this happens it takes a strong laxative to break it lose.  Now I follow my weight carefully and don't allow large fluid removal.  For me my cardiologist solved the problem since after the heart attack I have strict instruction to limit fluid removal sine remove too much and it puts too much stress on my heart.

[Charlie B53]

I don't understand IF any fluid removal is necessary for "cleaning".  Granted, there will always be a small amount of blood loss in the lines and filter, despite the 'flush-back', but this should be a minimal amount, barely enough to measure by weight.

So, knowing my 'dry weight' has been set at 106, and I come IN at 106, I went out at 105.3     By the time I got home I was tired, ate, drank, and went to bed.  Just like I did every session before we raise my dry weight to 106. 

So why did she take off .7 if NO removal is necessary for cleaning?

We will have a talk tomorrow.

Now, as to my fluid intake, I drink when I feel I really NEED to.  The rest of the time I seriously limit myself to only a mouthful, or a glass of ice.  I will not let myself become dehydrated.  I watch for that carefully.  If I even suspect I am getting a bit too 'dry' I will immediately go get a big coffee mug of chicken broth to give me a pound of water plus the salt necessary to keep that water within my system.

I sweat freely.  I am a goodly sized 'Guy' and I get out in the yard and try to stay busy.  With the little breeze I don't notice any 'sweat' but I know I am losing water at a pretty fair rate.  Which for this past week end has to have been the reason I didn't have any weight 'gain'.  This could very easily happen again with warmer weather coming.  I try to stay active as otherwise I would turn into a couch potato, or worse, a slug.

I may have to learn to start stepping on the scale again.  I used to, morning and night while on PD.  Blood pressures also.  I stopped doing all that when I started going 'In-Clinic' because they do everything.  How quickly I got soft.


Now, as for how much fluid I can have daily, I don't know.  I drink when I fell I really need to

[iolaire]

I don't understand IF any fluid removal is necessary for "cleaning".  Granted, there will always be a small amount of blood loss in the lines and filter, despite the 'flush-back', but this should be a minimal amount, barely enough to measure by weight.

My center has said that 1000 is the minimum for cleaning, that's 500 mil removed and 500 that will be added back as rinse back. Other centers are fine removing 500 (the rinse back).  It might be machine dependent.

I guess I've accepted in and thought that they might need some water being pulled out off the blood to help pull the nasty's out of the blood.

More modern machines abroad will actually insert extra water into the blood and remove it via the filter.  Again that seems to indicate that it helps filtering process to have water. (I think those machines also do away with dry weight calculations since they just try to get the blood water ratio to the right point, rather than target some random weight  - obviously people who are retaining water still need to take it off.)  I think one time they told me my estimated water removal was too low by something like 300 mil...

Similar discussions here:
http://ihatedialysis.com/forum/index.php?topic=14692.0

[Charlie B53]

Talked with the Tech.  She told me that she saw my Outgoing Weight and was surprised to see how much the machine had taken off, that she had set it for NO removal other than the rinse back.  I can't bitch too much, she did what she was supposed to do.

Someone needs to build a different chair.   One with a scale.  Sort of like the newer hospital beds with a built in scale.  Then the Dialysis machine could be plugged in and 'see' just how much water weigh is being pulled off AS IT HAPPENS.

I don't doubt this will eventually come about.  This industry like may others will slowly evolve, hopefully making little improvements along the way.

The Guy next to me today and I were laughing about how we could build a 'sun screen' on the arm holding the TV so it could shade us from the bright lights.   It really wouldn't be that difficult.

I have been thinking about making another addition to my ditty bag.  One of the recliner 'vibrator' pads we have at home.  We have two.  One is even bigger, with vibrators in the calf area.  I might have to switch my kitchen plastic bag that holds my pillow and Blankie to one of the 55 gallon bags.  Big enough I can stuff that biga$$ recliner cushion into it!

[smartcookie]

Just get a roller suitcase!  That would be hilarious to drag into dialysis! 

[GA_DAWG]

For me, we only put in the machine for what I have gained, and add only .1 for the rinse. The techs, the ones who have been there a while, say some people give up fluid easily and if they add for the rinse, it leaves them too low. While you are building the sunscreen, how about coming up with one that would shield from the AC vent that blows down over every chair.

[Simon Dog]

More modern machines abroad will actually insert extra water into the blood and remove it via the filter.

This is referred to as hemo diafiltration.   I don't know if it is still underway, but Davita was testing in on a few patients in the US.

Interesting, the NxStage system was originally intended as a diafiltration machine, but coming up with a system to provide the replacement fluid proved insurmouontable, so it was reengineered as a conventional (sort of) hemo machine.