My life with dialysis and kidney disease
dialysis
Everything’s Fine
Dec 19th
But we’re being taken off early tonight due to a broken water pipe (or something along those lines).
I only bring this up because I was planning on writing a bit about things on my mind the last bit of treatment, but now that bit won’t come.
I’ll try to make it up on Wednesday though, and perhaps by then my thoughts will be coherent.
Wow, I’m Published!
Dec 16th
I mentioned a few weeks back doing an interview for a member of the dialysis_support listserv doing an article for a publication (at least I think I did).
Well I walked into my clinic today to find the published – printed copy sitting there for me to see (complete with crummy picture).
My first reaction? "Cool!"
My second reaction? "I thought things in quotes were exactly what you said, not paraphrased….. I’m confused."
What’s the deal? I’m not saying I didn’t say the things I said … but I didn’t say them exactly as they are quoted. The context of how I intended some things to come across also seems to have been lost in some instances.
Overall after reading it I kept wondering if someone in my clinic would read it and get the wrong idea – thinking I was against the clinic or somehow unhappy with my time there.
To be clear, I really value the people at the clinic – both doctors and medical staff (almost certainly a few of them will be reading this now that this blog’s URL has been "published"). *smiles*
Seriously though. It’s important to me that the doctors and techs and nurses working on me know they are valued, and appreciated. It’s also important to me that they know the things I mentioned in the article are all in all fairly accurate.
I do feel there are issues that are not adequately addressed, and I think it is the patients who potentially suffer.
In the article I mentioned more "customer service" issues – and a few bad sticks. That’s pretty much out of the question for now due to self cannulation (at least the blame-game is over for now). But there are constant issues with sanitary protocol, techs working the floor who have seemingly no idea what they’re doing, and so on.
What is so difficult to understand about infection control?
If you have latex gloves on and go to shut off another machine that’s alarming, you are risking cross-contamination. What is so hard to understand about that? You need to wash your hands and put on new gloves.
When you’re taking a patient off, you don’t run to another part of the clinic to grab something you forgot – touching who knows what along the way – then come back and continue working on the patient with the same set of gloves.
Even if the science told us there was no significant risk of infection or cross contamination (which isn’t the case, as research indicates this is a big deal), wouldn’t they pretend to be paranoid about it just to make us feel better as patients? Is the problem that not enough patients say "whoa…. do you mind putting on some new gloves after blowing your nose?"
Well, while I’m sitting here writing this I just talked with a technician about some of these issues.
I know that at least some level of this education exists. But I can’t help but think that you have to have someone working the floor whose job it is to encourage and educate techs as they begin.
Good habits have to be formed, and it needs to be done in a constructive manner which promotes forward thinking and problem solving on the tech’s part, rather than "oh great, here comes my nagging boss again."
Perhaps with time these things will improve. Time, and a corporate structure that is concerned about more than how their business is being run from a financial standpoint.
Moments I Hate
Dec 7th
Right now is a moment I don’t like while at dialysis: watching another patient have a rough time.
This has happened quite a few times over the years I’ve been here, and never gets easier. Right now it appears that this poor woman is having a heart attack. Unfortunately, neither she nor her husband speak much English, so nobody really has any idea what’s happening. The ambulance will come, and take her away, and hopefully the paramedic on this rig won’t be deaf like the last time.
The last time, one of my long time dialysis friends was having a heart attack right next to me in his dialysis chair, and a deaf medic showed up. I couldn’t believe it. I thought it was great that he was working in the field, and that he was able to do his job and help people. What I couldn’t believe was that he was the leader of the rig, and was paired up with an EMT, rather than another paramedic.
He didn’t understand the patient asking for his nitro, and heard him saying he couldn’t take nitro. He then relayed to the firemen and EMT on site that the patient couldn’t take nitro — while the patient keeps yelling for his nitro. It was ridiculous.
I can only imagine what will happen if the same medic shows up with this poor lady who can’t even tell him what’s wrong in English.
In the other situation, the guy didn’t get his nitro until he was at the hospital ….. That’s a bad thing.
The problem here and now is, nobody knows what’s really going on with this poor woman. She’s feeling chest pain, but has anyone found out if perhaps she is just cramping?
The medics are here now, and getting ready to transport her, though I’m not sure anyone has yet heard from her exactly what’s wrong.
I pray she is alright, and I pray she is indeed not suffering a heart attack right now.
I’ve been around long enough to have more than a few patients pass away. It never gets easy, and I hope that won’t be the case with this poor woman, bless her soul. Hopefully she’ll run into someone at the hospital who speaks enough Spanish to find out if she is suffering indigestion, or heart failure.
Today I Did Both
Dec 7th
Well today was the day.
I decided today that I was going to do both needle sticks myself today, and I did. I was a little worried at first about doing the venous stick, because it is typically the stick that the techs have trouble with. That, and it is one I usually "feel" more than the arterial stick, which I rarely feel at all.
Well, I lined up on the arterial stick, and slid it right in.
After the arterial stick was taped up, I took a deep breath, and advanced the other needle.
It slid right in, and while I did feel it, I didn’t feel it the same way I usually do. I think it’s true what they say about self cannulation - you’re paying so much attention to cannulating that needle, that you don’t feel the pain of it. While I still felt it, it was a much different feeling, and not painful in the way it usually is.
The stick was fine, and I am now officially self-cannulating. What a feeling to know I can put myself on. I suddenly have less fear about traveling, and treatment in general.
I don’t have a lot of bad sticks, but when I do have one, I seem to remember it for a long time. I have now at least removed the variable that is most responsible for this: the person sticking. Now if there is a problem, I am the only one to blame.
Next stop: Buttonhole Technique
Today I Finally Did It
Dec 2nd
I’ve been reading now for awhile about self cannulation (sticking yourself at treatment). I’ve been trying to build up the courage to do it for over a year now, but just haven’t seriously followed through on it. Well after reading recently on the dialysis_support group about buttonhole technique, and the advantages of "one sticker" on a fistula, I decided that it was time to seriously think about beginning to stick myself. There is only one PCT (Patient Care Technician) at our clinic that I trust to stick me. Others do it because he is not always there, but still, there is only one who has always done a good job. There are two others who are also good, but always cause more pain, or hematoma later.
After traveling around a bit and having experience in other clinics, I’ve realized how GREAT the techs are at our clinic. This has been my thinking for a long time. If only I could stick myself, I wouldn’t have to worry about "bad" sticks anymore. Or, at least I would have nobody to blame but myself.
It’s a bit tricky though, to psyche yourself up to sticking a 15 gauge needle into your own arm. It’s not like an insulin shot or something similar that’s sub-cutaneous, this is an intravenous stick, and has to be fairly precise and controlled. Not to mention I have about 900 sticks on my fistula already, so I’ve developed a pretty thick layer of scar tissue in some areas (feels sometimes like you need a hammer to get the needle through).
Well today was the day. As I drove into the clinic today I decided that I was going to really seriously think about probably maybe actually sticking myself today. I don’t think I actually believed it until I was in the chair. I spoke with my tech about it, and he told me the same things I had read: insert the needle at a 25 degree angle until you see a "flash" of blood in the tube, then level the needle out and advance it (slowly) into the vein.
So I basically just grabbed the needle, got in a position where I could "work" comfortably, and then shoved that sucker in there…. nice and slow.
I have to tell you, there was absolutely no pain, and no problem.
I’m sort of happy now that I know I can do it. This means that while traveling I can stick myself and no longer worry about who the heck is doing it.
I can also seriously consider establishing buttonhole sites, which from what I have read is healthier in the long term for the fistula. Before establishing buttonhole, or "constant" sites, I will need to get more comfortable with sticking myself, but I am still excited to know that I at least have the ability to stick myself. Even if I don’t pursue buttonhole sites, I will have removed the variable of "who".
It really was quite a walk in the park, and I would offer encouragement to anyone thinking about pursuing this.
