Dialysis and surgery – the price of success is vigilance

Well, I’m back, and damn pleased to be here.  Two weeks ago I went to hospital to have my transplant kidney removed.  As anyone following this blog will know that it has been a point of contention for 6-9 months.  I have simply wanted it out. But there seems to be a school of thought that it should not be removed unless it “gives trouble”.

I my opinion, it gave lots of trouble, the result of which was that I felt unwell for the whole period: weak as water at the gym; hardly able to walk long distances, much less jog.  I was a little dizzy a while back and fell and broke my arm.  Then I got AF (an irregular heart beat) then, I had surgery on my fistula to make it more efficient.  But I still felt unwell.

Eventually, the kidney made its statement and swelled up, at last meeting the “giving trouble” criteria.

It was removed two weeks ago in copybook surgery.  As part of the preparation, I had a dialysis session the morning of the surgery, to give me some breathing space after if I needed it.  I must say that I felt better as soon as I emerged from the fog of the anaesthetic.  One small problem: I had acquired the hiccups, about 30 to the minute, day and night. Not pleasant, especially when you are trying to speak, or sleep.

Despite this, I was up and walking the same day, which surprised me as much as anyone.  Thinking I was invincible, I was sent home the next day.  Wrong.

First things first: I had my first BigD session post surgery (a two-day break), which was a relief.

However that night I got a common complication of surgery: pneumonia.  And the AF came back with increased heart rate, high temperatures and some agitation. I was re-admitted the next day for more treatment.

I went to a ward bed, and then as things got worse to Intensive Care, where I stayed for two days.  During this time, I had one four-hour dialysis session. Dialysis is a rare commodity in most ICUs, so they dole it out in meagre portions, and try to manage the fluid intake side of the equation.

However, dialysis fluid balance is not a core concept for ICU staff.  They were told that I should have no more than half a litre a day, so they gave it to me as water-soaked cotton wool wipes, about once an hour.  I was already dried up by the antibiotics, and now reduced to sucking a few drops from cotton wool per hour.  I was so dry I could barely croak: very uncomfortable.

I, like many BigD people know my body very well and understand when I am dry, wet or just right, and I was dry.  Perhaps I am indulging myself, but I don’t think I would have gone over done it if I had access to a small cup of water.  Eventually, I was trusted with a mug of ice, which I must say gave me great relief.

Still, this was a side-show to the main game.  And don’t get me wrong, I have nothing but praise for the hospital.  My family and I don’t think I would have made it without their skill and care. My comments here are primarily about helping you as a member of the BigD club prepare for the rigors of surgery.

Gradually, my temp came down and I returned to the ward.  Another couple of days went by.  I had one more dialysis session and a blood transfusion over this period.  The blood was not available when it would have been most convenient: during the BigD run, so I had it via a drip overnight after the BigD session.

One problem with this: blood that has been cooled has more potassium than blood in the body, so it was also lifting my potassium level.  That is why it is best to dialyse it as it goes in to us BigD types.  However, hospitals are not ideal worlds.  At least I got the blood.

Eventually, I was taken off intravenous antibiotics and allowed to go home.  That was two days ago.  Since then I have had one dialysis session and another booked for both today and tomorrow.  Hopefully things will get back into balance and I will begin to feel normal.

Only one thing still bugs me, the hiccups.  Fortunately, they are stopping for a few hours at a time and returning.  From what I can discover, this may be related to my break in regular BigD, or it could be the result of an internal wound yet to heal from the surgery.  Either way, things are improving.

So there are special difficulties for BigD patients undergoing surgery.  Other procedure and priorities can and will disrupt you BigD regimen and may have added side effects not experienced by people with healthy kidneys.  Be vigilant; understand your surgery and the potential problems, especially for you as a BigD patient; try to organise dialysis ASAP after your surgery.  Keep positive.

ps:  a very big Thank You to the Austin Hospital.  I live to write another day.

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