Tuesday, February 2, 2010

The Continuum of Dialyzor Activity in Home Hemodialysis

Dori Schatell of Home Dialysis Central and I were e-mailing about the range of dialyzor activity in Home Hemodialysis and Home Dialysis Training. We noted that the span ranges from 0 to 100 percent activity on the part of the dialyzor.

Take Bill Peckham, for instance. He does his own fistula needle insertions, and handles the entire set-up and treatment without assistance from anyone.

But then, there's my husband Steve. He's probably closer to the other extreme. He's not at what he and I call the "Do-Me" method of Hemodialysis, but he's close. Steve takes his vital signs and weight, calculates the amount of fluid he wants removed, tears tape, and helps me troubleshoot problems.

Why? Well, Steve probably has more "co-morbidities," other conditions that impact his health and treatment. In his case, these include severe peripheral neuropathy, deconditioning after his long recovery from last year's kidney transplant and explantation, labile (unpredictable or variable) diabetes, fistula problems which have required several surgeries to arrive at our currently great access, labile hypertension, and angina!

Is Steve "involved" in his own Home Hemodialysis? Of course he is. Even though he's not up to doing the whole treatment for himself, he most assuredly is involved.

It reminds me of the story Steve tells about ham and eggs:

Q: What's the difference between ham and eggs?

A: The chicken is invested, but the pig is committed!

No matter the details of dialysis Steve performs! He's alert, involved, and 100% committed. And he's at the "sharp end of the needle!"

Every Home Hemodialysis patient and partner has to work out what's practical and possible for them. I think the more involvement, the better. Home Dialysis gives us the opportunity to work within the limitations of our own situations, and make the best of what we have.

Take care. Linda Gromko, MD

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