I am amazed!

[tigmonster1968]

Hi all, hope everyone is having a wonderful Memorial Day.  I took my bf (Scott) to dialysis today.  He has had a total of 8 sessions, 3 in the hospital and today was his 5th in center.  The change in how much better he feels is amazing!  He is not running marathons or anything but life before consisted of sleeping, vomiting, no energy, no appetite, nothing.  In this short amount of time his appetite is better, he has some energy back, he has been cooking for three nights in a row now ( former chef) and he sleeps much less and is actually awake and "bored"   I am so happy for him.  I can't wait until we can start HHD.  I hope the fistula works or matures or whatever it's supposed to do correctly.  He did experience some cramping for the first time in his hands and calves during dialysis today, but then came home and ate dinner and then an hour later ate AGAIN lol.   Is the cramping painful?  Is there a reason for it?  Is there a way to avoid it?

[Michael Murphy]

Cramping generally is caused by fluid removal the way to reduce it is fluid control, watch what you drink, the other thing is the centers care givers are not medival torturers so the first thing to do is let the staff know you are cramping,  the cramping is a sign of reaching your dry weight ( the amount you should weigh with excess fluid removed).  The staff has several options when you start to cramp first they should stop or reduce fluid removal, second for severe cramps they will increase saline drip.  Some people swear by coffe,chocolate, or chicken broth in my case stopping fluid removal works.  I also watch for the first sign of cramping in my case I get small micro cramps in my hands.  Generally it gets easier after your fistula matures and you learn to moderate you fluid intake.  In my early years I never thought a drinking problem meant I drinking too much water.

[Charlie B53]

Michael nailed it.  Fluid control is essential to avoiding cramping during treatments.

My limit is 3 liters/kilos, getting close to that point during treatment I break into a swear even though they keep the clinic pretty cool and most everyone, including myself, is covered with a lap blanket, I will start sweating.  Thats' my cue to call the staff and let them know otherwise in a very short time my calves will cramp.

Leg cramps are like those that wake you up at night, they won't go away unless you force yourself to stand up, put weight on the legs and make the muscles stretch back out.  A number of people will make involuntary noises as the pain can get quite terrible.

I carry Lifesavers Mints, both flavors, and Bubblegum in my shirt pocket.  When my mouth and throat dry out too much I'll suck on a Mint, it makes the saliva flow and I feel so much better without gulping water.  I used to be a gulper, never taking a sip but gulping down a glass at a time.  Making that change has been tremendous.  Now when I do need a drink I make a short glass of ice water and take a single mouthful, swallowing only as small as possible so to take as making swallows as possible on that single mouthful.  Then set the glass next to the sink and walk away.   15 to 30 minutes later if I still feel the need I will come back and take one more mouthful.  Many days I can make that one glass of water last me over half the day.  I do have to add more ice so end result I must be drinking more than the one glass.  Good thing I start with a smaller glass instead of a quart jar.  Maybe I should start using one of my insulated glasses.  The VA Hospital has given me one with every admission.  I've been giving them away as I had near a whole shelf full.

Don't forget to figure in the fluids included in foods.  Vegetables can be high, soups , Wow. I haven't had soup in a while.  I miss that.

[GA_DAWG]

Charlie and Michael are dead on the money. One thing to consider is that if he has not been eating well for some time, and has lost weight, the return of his appetite can cause him to gain weight more rapidly than normal. Also, they should have made sure he understands the fluid in foods is a part of his fluid for the day. For example, eating soup subtracts from the amount he can drink, or jello, anything with lots of fluid, including fruits. The cramps are painful, some more than others depending on the amount of fluid removed. Along the lines of what Charlie was saying, if I get woke up by cramps, I take one swallow of water to see if that helps. Another thing he might consider, and it was taught to me early in my sessions by those who had been at it some time, is to be sure and shift his position a bit in the chair if he can. If you sit in one position with your legs locked straight out for four hours, that is enough sometimes to cause cramps.

[Paul]

What has been said is very true, however if he cannot reduce drinking enough I have found the following help (N.B. "help" not "cure totally"):

If the cramp is in the calf you need your legs dangling down 90 degrees to the thigh, and pointing to the ground. If he  is on a chair thingy, this is easy, if he is on a bed, dangle his legs over the edge. It also helps to raise the head to a sitting position (chair) or as high as possible in a bed.

If the cramp is in the thigh, flatten the foot end chair so the end looks like a bed (if he is in a bed, the foot end will already look like a bed ) then get him to bend his knees upwards (so that, if he had a sheet over him, it would look like a tent).

Massaging the muscle also helps a lot in both cases.

Being warm helps with cramp, if the clinic is cold (or if he feels cold on dialysis) take enough blankets.

Cramp in places other than the legs: No idea, I have been trying to find something for ages (massage and warmth helps a bit).

[Paul]

Adenda: Feet: If in a chair, you need your legs dangling down at 90 degrees like with calf. Then if in a chair put your feet flat against the footboard (or as flat as the cramp will allow) push hard against the footboard as though trying to push the footboard off the end of the chair) (N.B. you may have to lock the footboard or he may succeed in pushing it off). On a bed, ideally, lower legs over the edge of the bed, push on the floor (may have to lower the bed, as nurses/techs tend to set them on high to stop them getting bad backs bending over the patients). If that is not possible, simply do the footboard push (again N.B. you may have to lock the footboard or he may succeed in pushing it off).

[GA_DAWG]

Paul mentioned something it seems they just cannot get through their heads. It is on the days when the room is even colder than the absurdly cold it usually is, that people cramp the most. I know it is hot wearing the PPE, but no amount of AC is going to change it being hot while wearing the impermeable gowns and face shields they must wear.












Sp mod Cas

[Michael Murphy]

The solution for leg cramps would be a strap attached to the chair that ran under your feet that you could push against.  Not as good as standing but I bring a jump rope loop it over my feet and push it seems to help.

[Riki]

Paul mentioned something it seems they just cannot get through their heads. It is on the days when the room is even colder than the absurdly cold it usually is, that people cramp the most. I know it is hot wearing the PPE, but no amount of AC is going to change it being hot while wearing the impermeable gowns and face shields they must wear.

I think that sometimes they forget that, although they are warm even with the AC, that we are also chilled from the inside out.  Our blood is cooled both by the machine, and by the small about of it that is outside our bodies while it is running through the machine.  My blood is artificially cooled by the machine 1C lower than my regular body temp, and though this seems like a small amount, it takes me several hours, even in summer, for me to warm up again after I get home.

[GA_DAWG]

One of the nephs who has patients at our clinic has all of hi patients set at 35.5C, below body temperature. My neph has mine set at 37C which is right at normal body temp, so I can only imagine how cold the ones set lower are. The techs and nurses do not understand that when they have on the impermeable gownss, face shields and gloves, no amount of AC will make it cooler for them. Then when they take those off after everyone is on the machines, they have to go get jackets due to the cold. Add to that, some genius decided the best placement for the AC vents was right over each chair, so it blows directly down in your face.

[Riki]

My machine is set at 35.5C because my bp is always low.  When it was originally done, it was thought that the lower temperature would constrict the blood vessels, making my bp go up.  It hasn't worked, and my bp is sill always low when I'm on the machine.  I've asked that the temp be put up so that dialysis wouldn't be as much of a torture session, but the answer, if I was even given one, has always been no.

[kitkatz]

Get the doctor to change your prescription while on the machine. specifically the temp.

[Simon Dog]

It sounds like you are at an oppressive clinic.    No one has ever given me crap about changing the temp (I like it at 36.7 rather than 37).    There is one RN who thinks I should not touch the machine, but I'm working on that with my MD (he has agreed to help).