Dialysis and a week in the kidney ward

I know that all of this will be drearily familiar to many members of the BigD club.  As usual, the trip in hospital switches from boring to unpleasant, to satisfying, to tedious and back again, but the outcome is good.

I started to feel quite unwell last Thursday.  My heart had switched back into Atrial Fibrillation and blood tests at BigD showed raised infection markers.  My nephrologist ordered more tests and blood cultures.  Unfortunately the culture showed some kind of Staph, so he told me to go to the Emergency Department at the Austin, my usual kidney hospital, and he would arrange for me to be booked in.  Julie and my daughter Kathy and I presented ourselves at ED.  Alas, no beds, so I sat on an ED trolley for the night.  Not very comfy, but the medical service was very good.

Assuming the worst, they treated it as Golden Staph, a very nasty and hard-to-treat infection, so while I was on the trolley they started me on vancomycin, the most powerful antibiotic available.  I also had my heart and blood pressure monitored all night. The following morning I was due for BigD, so off I went to the hospital’s dialysis unit for a 4-hour run.  I must say I felt much better after dialysis.

Being infectious I was then admitted to the ward, in a single room with a notice to glove-up at the door.

I have said before that being a renal patient is a long-term proposition. I was last in the Austin about two years ago with pneumonia, and I have been going there since my first transplant in 1995 in the 1920s Ward 4, and my last transplant in 2005, in the flash new Ward 7 North.  Each time I meet old friends (renal nurses, dialysis nurses, specialists, PSAs and others), some that go back at least that far.  It’s a little bit like Cheers, Where Everybody Knows Your Name.  Very comforting.

I went onto a regime of daily blood tests and cultures to better identify the infection.  And being a public hospital, my dialysis regime was changed from 3 hours five times per week to 4 hours every second day. Not a major change, but I really noticed the difference.  I had to watch my diet and fluid intake much more closely, and I felt much less well on each second day, just before dialysis.

But the thing I really disliked was daily blood tests.  On dialysis days, all is fine, because they take the blood from my arterial line.  But on non-dialysis days, they take blood from my non-fistula arm.  That arm has been a pin cushion for years, so the veins hide when the blood nurse comes.  The result is usually lots of near misses and arm like a battleground.

After the second day, to great relief all around, they identified the staph as the much less nasty staph epidermidis.  I was switched from vancomyacin to flucloxacillin (Staphylex).  I began to feel better.

However (just like House!) they wanted to identify the cause of the infection, so I had a range of tests: blood cultures to try and regrow the staph (it never did), CT scans (where they found collections of fluid where my transplanted kidneys used to be – they drained fluid from one of the collections (by poking a needle into it) and found no infection), a bone scan using radioactive dye (which showed the bones squished together in my back, but that was not infection, just the result of a motor bike accident 20 years ago).

By the following Thursday I was feeling pretty well, so the antibiotic was doing its job.  Also, my heart switched back to normal rhythm on the Wednesday, and I started on anticoagulant (clexane) injections until the Warfarin gets to the right level.

Basically, I had recovered, but still no cause identified.  Last Friday I had my last hospital-based dialysis and I was discharged for home treatment.  I am taking the antibiotic orally for 2 weeks and as a final check I am due to have an echocardiogram as an outpatient this week.

It’s not only a pain when you are the one on the trolley, but also for your loved ones.  As usual, Julie and my family and friends were there providing both physical and mental support, with that primal “Is this it?” worry sitting heavily on their shoulders (as it has several times before).  It was great to see them.

We BigD club members are not the robust specimens we used to be, we can fall off the perch quite easily.  Luckily with a little help from some smart and dedicated people, and a loving family, we can climb right back on.

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