PD Training - Day 1

My PD training began the next Tuesday - I was to show up at the PD unit at 8am sharp. Amma and I got there at 8:15am *Indian Standard Time, heheh* Anyway, the nurse doing my training was very nice about it and didn't mind that we were late.

We started off with the usual round of signing documents - luckily I'd signed most of them back when I had my first flush, so that made up for my tardiness that started the day. There were basically three strengths of dialysis fluid - 1.5%, 2.5% and 4.25% dextrose (or the yellow, green and red stoppers at the end of the tubes). Yellow pulled the least fluid from the body, and red the most - like the goldilocks story, there was one that was just right. We used the green bags that day.

The fluid has to be at close to body temperature when it goes in, otherwise the results are extremely uncomfortable cramps, and inefficient dialysing (too hot OR too cold). In the PD unit, they had these multiple-bag warmers, but out in the real world, I would need a microwave at home and use a warming pad to heat the dialysate at work. I would also need to fill out a daily log of the bags I used, my weight, temperature and blood pressure after the first exchange of the day, which had to be turned in at the end of the month.

Then it was time to do my first full exchange. The nurse showed me the exact process, then I had to do it again - 5 more times that day! After the first one, she always had me do them by myself, because after all, I had to get used to doing them by myself. At the end of exchange #1, I felt b-l-o-a-t-e-d. Only to be expected, after all, because I had 2 litres of fluid sloshing around in my belly.

Now I truly learned what it was like to be a (smallish) snake that had just swallowed a (largish) goat whole. But I didn't get the full effect of it because I was sitting. I was really really uncomfortable for the 30 minutes between the first and second exchange. At the second exchange, I got increasingly comfortable while the fluid drained, but by the time the fill bag was empty (i.e., the next lot of fluid was in me), I felt the same as before.

Then the nurse declared that it was time to break for lunch. Amma was pretty much famished by that time, but I hadn't felt the least twinge of hunger (and I told the nurse so). She said that was the fluid pushing on my stomach, which dulled the pangs thoroughly,so the next time and until my body adjusted to the extra fluid, I would have to fill only1.5 litres, because I needed to be able to eat. Glory be!

In the exhuberance of the thought of only 1.5 litres of fluid to be filled, I ate 4 whole idlis (a bit less than my usual of 4 regular + a few little ones). Big BIG mistake. Right there I came face to face with the undeniable fact - I simply couldn't eat as much as I had always eaten, at any one sitting! I would have to do 6 small meals a day instead of 2-3 big ones (as I had been wont to do).

Exchange #3: When I had finished draining, I was finally able to breathe freely again. Unfortunately, I had to do the fill part of the exchange, and even though it was "only"1.5 litres, because I'd had a full breakfast I was back to bloated snake again. The irony of it - now I could eat all my fave foods, but I didn't WANT to eat anything. GAH!

Exchanges #4 went pretty tamely... Except that at the end of #4, I was feeling VERY lightheaded and woozy. My blood pressure had dropped quite dramatically, because of all the extra fluid that had drained out with the dialysate. So it was feet up and head down - amazing what that doctor's office chair can do - it can recline just enough to put your feet up, or it can recline flat and beyond until you're practically upside down. Amazing. So the nurse matter-of-factly said that I should use the yellow bag at home that night, instead of the green.

"At home? Tonight? *gulp*." I was supposed to do one final exchange at bedtime, all by my lonesome. Without the nurse along to hold my hand.

I would have to change my feeding habits of the past 7 years too - for such a long time I'd been watching my protein and potassium (making sure not to have too much); now those instructions were overturned. Instead of a paltry 38gms of protein a day, I now had to eat up to 100gms, at least, each and every day. And the potassium restriction was also gone - I could eat potatoes again! YAY! And then the other shoe dropped - because the dialysate essentially worked by exchanging dextrose molecules for whatever was in my blood - I had to eat a low-carb diet. Potatoes = major carb, therefore that had to be fairly limited, still. :(

After I'd had a little nap, we were ready to leave. I stood up, and learnt a whole new meaning of discomfort - my whole abdominal area ached like I'd been doing continuous pull-ups and crunches for the past 5 hours. The nurse said it was probably because my abdominal muscles were also trying to compensate for the weight and volume of the fluid.

We left the PD unit at about 2:30pm, finally - got home at 3:00pm. On the dot at 2pm, CMR had called to find out what I was doing. So soon's we got going, I called her from the car, and let her know that I would be online at about 3:15pm. That was what she had been waiting for, because she had to leave early that day, and she wanted to debrief me on the happenings and emergencies of the day. Which she did, in detail. So soon's I got home I had to log in to work even though ALL I wanted to do was take a looong nap. Then it was 4 hours of intense work. By 7pm I was POOPED!

The PD unit had loaded us down with solution bags, face masks and clamps so I would have everything I needed for the home exchange. I already had the antibacterial soap and waterless hand cleanser at home. As soon as I was done with work, Amma and I had to set up my little Dialysis Corner, upstairs in my bedroom. We took the rocking chair upstairs and set it up as the core around which to add all the other stuff. Moved all the little lightweight stools upstairs, at least until we knew how many I would need. We found that I needed a total of 3, so the others have come back down.