An unneeded scare


PATIENTS undergoing peritoneal dialysis must adhere strictly to every order and advice from the nephrologists and continuous ambulatory peritoneal dialysis (CAPD) nurses, no matter how trivial or mundane they may appear to be. Taking them lightly could lead to dire complications as I discovered earlier this week, much to my consternation and detriment.

Other than being constantly reminded to observe high standards of hygiene when performing dialysis, and keeping to the schedule prescribed, the CAPD team had repeatedly mentioned about moving the bowels once a day. I thought I was doing well as instructed but I was mistaken.

It all happened when I had diarrhoea for four days in a row. I did not make an effort to take the normal medication for keeping my bowels regular, assuming it was sufficient. On top of that, dialysis was pulling out a good volume of fluid from my body. I was finally getting the hang of it. I was happy with the progress.

I went to the hospital on Monday to have a test called the peritoneal equilibration test (PET) to see how fast, or slow, waste is being removed from my blood during dialysis. This would also determine the duration the solution is allowed to dwell in my abdomen, either for a longer or shorter period of time, for it to be most effective.

Later that evening, when I was doing the last dialysis for the day, the waste solution did not drain at the usual rate. It was dripping instead of flowing. Of the 2,000ml that went in, only 400ml came out. Usually, the amount drained is higher than the amount filled as the solution pulls out fluid from the body as well as wastes from the blood.

Two more attempts with different bags of solution yielded similar results. I began to panic. I had two options, either call the nephrology ward for advice as the CAPD clinic was already closed or go to the accident and emergency department to seek treatment.

I decided to call the nephrology ward first for the next course of action. The nurse on duty asked if I was in pain. Because I had none, she advised me to go to the CAPD clinic the next morning. I had a sleepless night worrying if keeping the solution inside me for an extended time would lead to complications.

The X-ray of my abdomen the next morning showed my colon was full of faeces. I was constipated without realising it. The diarrhoea discharged liquid only but the bulk remained inside. Other than feeling bloated, there were no other discernible symptoms pointing towards that. However, it was so bad that the catheter was compressed, pushed upwards and out of place, hence the poor drainage.

The nephrologist preferred more conservative treatment. He advised me to empty my bowels to see if that could solve the problem. Hopefully the catheter would go back to its original position. I was asked to go back for a review in two days if the problem persisted and was prescribed laxatives, stool softeners, and suppositories.

Since I was still producing a fair amount of urine, I was also told to stop dialysis for two days as there was no point trying. The solution still inside me would be slowly absorbed into the body with no adverse side effects. After all, it consisted of dextrose, salt, and other common minerals dissolved in water.

I was worried that if the catheter did not go back to its original position, I would have to undergo more radical procedures including surgery to correct it. If that happened, I might be put under haemodialysis until the problem with the catheter was sorted out. That was a path I was trying to avoid at all costs.

What worried me even more was whether I could transition to automated peritoneal dialysis (APD) next week. The training dates were fixed. Equipment and supplies were slated to be delivered soon. This method uses a machine called a cycler to perform most of the steps that are being done manually in CAPD. The entire process would occur at night while I sleep and would free up my day for other activities.

I took all the medicine prescribed when I got home. Later that evening, after clearing my bowels, the solution started draining and then filling again. It was a great relief to see the solution flowing again.

The volume drained was only 700ml, a far cry from the amount that went in. My body had absorbed almost half of the solution! Subsequent dialysis was like it used to be.

Lesson learnt. Avoid being constipated at all costs. Going regularly does not mean it is clear inside. I have to take laxatives and stool softeners religiously from now on to prevent another occurrence. It was one scare that was not needed. I already have enough drama in my life as it is.

On the brighter side, the cycler, solutions and disposable supplies were delivered last Friday. I am on track to moving on to APD. With this, I hope to be able to get better results for my dialysis. And the best of all is that I may be able to go back to work again.