I just got home after today’s dialysis session. Due to New Year’s Day being on Friday, the weekend schedule was shifted back one day. As I mentioned before, my weight was pretty high. Even after removing my thick jacket (but leaving my shoes on), the scale said 83.5 kg. I usually take 0.5 kg off for miscellaneous clothing but I cheated a bit more and told the tech I weighed 82.5 kg. That means I had to cheat at the end weigh-in too. Even at that weight, the tech decided that we would remove 3,800 mL of fluids, probably the most they’ve tried during one session.

Right at the beginning, there was a problem. The arterial needle didn’t go in that smoothly, and it hurt really bad. The venous needle was a bit better but there was a dull pain in my arm that wouldn’t go away. After about 30 minutes, the tech decides to move the needle since the pressure was wrong, and it hurt a lot worse. He ended up removing the arterial needle and jabbed me further up the arm. Initially, he missed the vein, but was able to hit in with a second needle. He jokingly said he was praying. Not sure how much of it was serious.

I started getting dizzy around the two hour mark. Both my feet were super numb for some reason but I tried to lie flat in the chair to raise my blood pressure. I guess it worked okay since I was averaging 140/80, even as the machine eventually pulled out 3,732 mL of fluids. When I stood up at the very end for the final blood pressure reading, I almost fell over, and the reading was 85/50. Not good. I took a few sips of water, waited five minutes, and tried again. This time it was 104/70 (or something) so good enough. Walking out, I was still pretty dizzy but felt better once I sat down in my car. The weight reading was 80.1 kg, which was 83.5 kg – 3.7 kg + a few sips of water. I ended up telling the tech that I weighed 79.2 kg so I have to watch what I eat/drink for the next few days. Of course, I was starving and stopped by Raising Cane’s to get four chicken fingers a la carte. No drinks. I ate them while driving home. They were super hot (temperature) and tasted awesome. I think I should get a job there after retiring from my real job. I leave you with a chicken finger video.

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Ugh, so tired. I think I woke up for a bit at 2:00 pm but I slept until almost 7:00 pm. Meanwhile, two of the dialysis needle insertion points are still bleeding, visible through the band-aids. I’ve gone through four of them already.

Ugh, I’m so dead for tomorrow. I just weighed myself and I’m at 83.2 kg without much clothing. With clothes and shoes, less my 0.5 kg adjustment, I’ll probably come in at 84.0 kg. I was below 80 kg on Thursday so I’m way over my last weight, and dry weight is still 78.2 kg. I heard a tech bitch at another patient Thursday for being 4.5 kg over, with talk of ER visits and ventilators. If I’m ~6 kg over, they are going to freak out and schedule additional sessions.

I’m not even sure what happened. I measured myself at 82.1 kg this morning, a bit high but manageable. I had some coffee (~300 mL) and an egg sandwich for breakfast. I even skipped lunch. I don’t think I ate or drink anything else, except for a few Korean crackers at lunchtime. Don’t know why the scale read 1.1 kg gain. My mom made beef curry over rice for dinner. There’s no way I can eat that: rice and curry sauce is mostly water. She also baked some Costco mini-eggrolls so I had a few of those so I wouldn’t starve. I really think the dialysisi center went too low with my dry weight but they’re hesitant to raise it after lowering ti consistently over the last few months. Not sure what I’m going to do. If I think I can be disciplined over the next few sessions, I can “cheat” and do a bigger adjustment before/after so it looks like a gradual decrease over time. Of course, the problem gets worse if I keep gaining fluid weight. I guess I can always take off my sweatshirt and sh9es and another 0.5 kg for the remaining clothes. That will lower the baseline but that also means taking longer at weigh-ins going forward.

Today was a super eventful day at dialysis. Maybe it was because it was a Sunday when the clinic is hot typically open. I mentioned previously that I had problems sleeping this morning so I was already exhausted when I got to the clinic. Also, I thought I was going to be very overweight so I skipped breakfast. Finally, my morning blood pressure was satisfactory at 143/80/60 so I also skipped all my morning medications, including the Tradjenta as I was not eating.

I was having problems staying awake during the 15 minute drive to the dialysis center. Not a good start. My regular tech was still out on vacation so another MWF tech poked me. Even with lidocaine, it hurt a lot going in and kept hurting for about 15 minutes. She probably hit a nerve by sticking the needle almost straight down initially. My blood pressure was pretty normal at this point at 158/78/65. but over the next two hours, it rose steadily until it hit 174/91/63 at about 7:40 am. Thinking that it was going to keep rising, I took all my morning meds, including the blood thinners and Tradjenta. Within about five minutes, the next reading was 123/73/68. The elapsed time was too short fo the meds to take effect so the 174 number was wrong?

From that point, my blood pressure started dropping more until I was feeling kind of nauseas and lightheaded. My BP got as low as 103/58/64 before I asked the tech to turn off the UF. For the next 15 minutes, we kept manually measuring my BP until a 98/60/65 popped up, but both readings before and after were in the 140’s/150’s. Again, I don’t know if the BP meter is accurate but having the number swing 50 points down then up didn’t feel good. At the same time, I think my blood sugar was crashing too since I didn’t eat anything for breakfast and I also only ate a small dinner the previous day, worried about being too much over my “dry” weight. I ended up drinking a small can of Sierra Mist and taking a few glucose pills to try and put some fluids and sugars back. Even though they took me off 15 minutes early, I sat in the chair after the session to recover and didn’t leave until 10:15 am. I was even more tired at that point but starving so I went to get lunch, ate it in the parking lot, and drove home to sleep. I just woke up at around 2:30 pm, still very tired, but feeling a lot better.

Looking forward to doing it all again on Tuesday.

Yup. It’s Christmas but the dialysis never stops. Well, the clinic is taking tomorrow off so the next two days get pushed out. My next session is now on Sunday instead of Saturday.

Due to the holidays, several of the dialysis center staff took days off. The tech that normally cannulates me is off for a few days so I thought the other tech would stick me today; they usually are assigned in pairs. However, the “substitute” was another staff member that normally just refilled supplies, such as saline, tubing kit, dialyzer filters, and blankets. He also sets up the dialysis machines for their cleaning cycles between patients. I’ve seen him since my first day at the dialysis center but I’ve never seen him work on a patient.

So, I was a bit surprised when he came over to hook me up to the machine. I was a bit worried at first since most techs have problems getting a clean insertions. He also used the top two insertion points; typically we use the bottom one (closest to wrist). I decided to let him try and it worked out great. He was a bit slower than the other techs but worked very carefully. The insertions did not hurt at all and was fine throughout the entire session. Even when he took out the needles at the end, it didn’t hurt at all. Often I get a weird pain sensation when the needles are pulled out.

However, I still felt like crap at the end of the session. I’m still not getting enough sleep and for me, it’s hard to sleep during dialysis. I also came in heavy again; not sure if it’s fluid or eating more. We only removed 3,000 mL of fluid today though I was about 4.0 kg over last session’s weight. I did get some cramps in my ankles earlier today so I don’t know if my dry weight is set to low now.

Due to the colonoscopy, I asked to moved my dialysis treatment from tomorrow morning to tonight. I was supposed to get there at 5:00 pm but I got a call at 4:00 pm informing me that my machine was ready. I got there at 4:30 pm and a unfamiliar tech led me to the chair. I was a bit worried since we just had problems with my fistula Saturday, but he was able to cannulate the needles fine. Since they had to fit me into their schedule, I was only dialyzed for 3 1/2 hours, which was fine by me. Since the nephrologists come around on Mondays and Tuesdays, I saw the same doctor again. He said my phosphorus levels were really high at 7.7. Last month, the reading was 6.2 so something is weird. I’m eating mostly the same things and taking the binder. The only thing I can think of is the deli meat from the club subs I’m getting from Jersey Mike’s. They don’t publish the phosphorus content of their ingredients so maybe they are using one with high phosphorus levels.

The patient to the left of me came in 10 minutes after me. He saw my work-logo’ed clothing and asked if we were hiring. I told him to go online and look but automatically assumed that he was after a factory job. He didn’t look like a salaried office worker, but I probably don’t either. I think I made an assumption based on his race and age, even though I just took a class online a few weeks ago. Not good. He later had pretty severe leg cramps and was still groaning and moaning when I left.

On the right side was an Indian-looking woman. She appeared to be a fairly new patient and just came back from the hospital due to pneumonia. As the doctor talked to her, it turned out she had an infection with her chest catheter, and they had to set up an antibiotic IV for her. So far, I’ve avoided any access infection while on dialysis so I don’t know how it feels, but I heard it sucks big time. She seemed to be in a bit of pain; I hope she gets better.

I left dialysis at 77.9 kg and won’t be back until Thursday morning. My ending standing blood pressure was pretty low at 103/something. I’m counting on all the colonoscopy flush to come out and that I don’t absorb 4 liters of fluids.

I’m a bit confused on what is going on with my fluid balance. I thought that I was losing weight but retaining fluids so my weight is fairly constant. Once we started removing more fluid during dialysis, my weight should drop more. My nephrologist thinks there a couple of liters of excess fluid by looking at my lower legs. After a week of using the Crit-Line monitor, my lower legs look pretty “normal” but my weight haven’t changed that much. My scale at home says I’m about 81.0 kg now, which is pretty consistent over the past several weeks.

From what the nurse showed me, there’s several “buckets” of fluid: in cells, between cells, and in the bloodstream. I found this chart online:

I’m not sure what my percentages are but we’re trying to remove more fluid than what is moving to the first area or blood plasma. I was told that during dialysis, as we remove fluid, it’s constantly being replaced by fluid in and between cells. It seems to make a difference how fast fluid is removed during dialysis, though I can’t understand why. Here is the Crit-Line graph from Thursday:

Initially, nothing much was happening. After an hour, the chart started to show a decrease in blood volume % change. It seems the flow rate between the different fluid buckets in the body is not constant either. Even though we didn’t change the setting after the marker, the chart values change constantly. Blood pressure is much improved as well, which supports the conclusion that fluid in the bloodstream is lower than before when my blood pressure was up to 180’s. I didn’t caputre Saturday’s chart but the blue wedge was much larger as we removed 3,200 mL of fluid and I ended at 78.4 kg. The only questions is what is different since my weight is about the same. Either I gained non-fluid weight (unlikely) or fluid is being retained in the cells but the absence of edema says otherwise. Very confusing.