Monday, April 22

Taking home dialysis one step at a time


ONE month after I underwent a four-day intensive training on continuous ambulatory peritoneal dialysis (CAPD) and then started to do it at home, I moved on to a three-day intensive training on automated peritoneal dialysis (APD) in the middle of this week.

This is a process where a machine, also known as a cycler, takes over most of the manual steps between the first and last exchanges in CAPD. During this process, I am hooked up to the cycler for five continuous exchanges over a period of 10 hours at night while I am sleeping or resting.

APD frees up my day and gives me more freedom to stay out longer. I do not have to rush back home to do an exchange every six hours. I also can go about doing my chores at home while hooked up to the cycler. I am hooked up as I am typing this article. I can do anything as long as I am within the length of the tube I am attached to.

As for CAPD, I depend on my wife to help me in doing the manual exchanges. My limited hand function means I lack fine motor skills to manipulate clamps and valves. I also have trouble lifting and hanging the solutions on the IV pole. Each bag weighs 2kg.

My wife is working full-time. As it takes 10 hours from the time she leaves for work until she steps back into the house, we were unable to keep to the schedule on weekdays. By the time she got home to help me with the exchange, my body had absorbed some of the solution. This is not ideal as dialysis is supposed to pull out water from my body apart from waste from my blood.

On top of that, there is the fear the pressure of carrying the solution inside me at all times may trigger autonomic hyperreflexia due to my spinal cord injury. This condition can be fatal if not treated immediately. The doctors and CAPD nurses felt that APD could prevent this. Likewise, APD could give better results considering the constraints we have in keeping to the dialysis schedule.

The APD training was done at home in the bedroom. Since the time when I started CAPD, it was cleared of all unnecessary furniture. Loose items were packed into containers to prevent dust from settling on them. The floor was mopped every day. Curtains and bedsheets were changed every week for the same purpose.

These are necessary steps to reduce the possibility of contamination, which could lead to infection. Repeated infections could damage the peritoneal membrane and cause scarring and thickening. When this happens, peritoneal dialysis may not work anymore and I have to shift to haemodialysis.

Three days in a row, Sazila, the APD nurse from Baxter came to train my wife and me on the proper techniques on using the cycler. I am using an APD cycler from that company. She was very patient as she guided us, taking great pains in making sure we got each step right from the beginning until the end.

There are pros and cons between APD and CAPD. When on APD, apart from not having to do four exchanges a day, my peritoneal cavity is empty during the day. I do not have to carry 2,000ml of solution in me at all times like in CAPD.

I have very limited upper body strength. Each time I sit up, transfer to and from the wheelchair, and while pushing the wheelchair, I exert pressure on my abdominal muscles. I found it uncomfortable with that amount of solution inside me. It severely restricted my mobility and independence. I have no such problem with APD.

However, there are also disadvantages with APD. One of them is no more late nights. I have to be home by seven in the evenings to prepare for dialysis in order to be unhooked from the cycler and get to work on time the next morning. I need to have dinner, empty my bowels, bathe, and brush my teeth before beginning dialysis.

There are more steps to remember when doing APD as compared to CAPD. In fact, there are too many to memorise. Luckily we were given printed step-by-step instructions to follow. Nothing should go wrong if we strictly adhered to them. I call them APD for Dummies. Just before she left after the completion of APD training, Sazila reminded us to do it slowly and follow the instructions one step at a time.

Machines can break down. Power can go out. These are the drawbacks of being dependent on the cycler. During those times, I have to fall back on CAPD. That was why Roslena, the CAPD staff nurse, wanted us to be familiar with doing manual dialysis for one month first before moving on to APD. I am glad she had the foresight to prepare us for these contingencies.

Regardless of the advantages or disadvantages, I am thankful peritoneal dialysis is keeping me healthy. I am also thankful to all the doctors, nurses, dieticians, and everyone else involved in this process. I may not be the model patient but rest assured I am doing the best I can to follow their instructions. Their goal is to keep my health complication-free as long as possible. So is mine.

As I conclude this article, I have also successfully completed my first overnight dialysis session using the cycler. It was incident-free. I spent half of the time writing and the other half sleeping. This is the beauty of being able to do dialysis at home. I can still be productive at the same time.

The amount of water pulled out from my body through APD is good. Tests later will tell if sufficient waste is being drawn out as well. I will worry about that when the time comes. The only thing I want to do now is to nail down the timing for me to go back to work again.