Sometime last week my PD nurse called me with the results of the recent kinetics test I had taken.  Ad we suspected, because I am a low transporter, I wasn’t getting adequate dialysis and an extra manual exchange was added for during the day.  This did not disappoint me and because I had been feeling so bad, I was thankful that this would probably make me feel better!  I’ve been doing it for about a week now and I do feel better.  I am no longer dehydrated and my blood pressure is back up (no more feeling like I will faint when I bend over).

When I first began PD, I did all of my manual exchanges in Dick’s office.  I had a nice set up with the 2nd bathroom right there.  When I started using the cycler at night, I moved my table with my supplies into my bedroom (the fluid bags stayed in the office).  Adding a manual exchange didn’t change things up too much.  I did have to take the IV pole into my bedroom but everything else stayed pretty much the same.  Only now I have to walk back and forth to the bathroom to wash my hands – and I get to recline on the bed while doing the exchange.

I had a really long nap this afternoon so I am very alert tonight – which is a good thing since I have to stay up late (for me) to do my last exchange of the day.  I think this is just the way it will have to be on Sunday’s since I can’t get in 2 exchanges before lunch because of church.  I would have to either skip Sunday School, which I love and don’t want to do, or leave early which I don’t want to do either.  So, like today, I will take a nap and make adjustments.

I love online banking.  I was glancing over my accounts this afternoon and noticed the gas station took out $16 twice this morning.  Glad I caught that and can take care of it tomorrow. 

While I napped this afternoon, my hubby was a busy bee all over the house and straightening things up.  He has been a TREMENDOUS help to me these past six weeks.  Yep, I said SIX weeks – that means this Wednesday marks the end of my six week recovery time and I will be able to bend over freely, lift more than 5 pounds (but from now on, I am instructed to never lift more than 25), and I can take a SHOWER.   Yaaaaay! 

My 6 week reign of taking it easy and “just being a queen” (as my PD nurse ordered) is just about over.  Yesterday was 5 weeks since the surgery and I am moving around just great.  I am still planning on being careful not to lift anything heavy but for the most part I am beginning to get back to normal.

We’ve done our chores this morning and we’ve had our school time (with more still to do).  This afternoon we are going to make a bird feeder out of a 2 liter bottle.  I am very sure the little birdies around here will be thankful they won’t have to go looking for food in this frigid cold!

There’s been some talk that fitting in all four exchanges with four hours between each might help me get my sleep schedule straightened out.  It might just be so!  This morning I was still pretty drowsy at 5ish (this is unusual) but I went ahead and got up and started my first exchange of the day.  By the time I was through, cleaned up and restocked my cooler with more fluid bags, it was 6am and I count four hours from the time I finish – so my exchanges today should be 5:15, 10am, 2:30 and 7ish.  That works well for me so I can still go to bed at a decent (for me – heh) hour if I need to.  The later I get started the later I have to stay up.

Tomorrow is our first Friday school of the New Year and the boys are pretty excited about getting back.

On peritoneal dialysis, I do four exchanges a day and they are usually 4 to 6 hours apart.  Some of you have asked what an exchange consists of so I thought I would share it with all of you.  This will be long, so please feel free to skip this post if you are not interested.  An exchange can be broken down in 3 parts:  drain, fill, and dwell.  Here are the steps I take:

Step one -  preparation.  The first thing I do is rinse and dry my hands and then take a paper towel and wet it with a bleach/water solution.  With that I wipe down my prep cart, the fronts and handles of my supply drawers and the IV pole.  After discarding that, I wash my hands normally with soap and water (not the big scrub).  Now, with clean hands, I am ready to lay out my supplies:  4×4 gauze pad, 2 clamps, tape, mini cap and mask.  When the supplies are ready, I put my mask on, set my timer for 3 minutes and do a big scrub on my hands; my nurse says if you don’t scrub for at least 3 minutes, your hands aren’t clean.  I dry my hands, turn off the faucet with a paper towel and throw it away, being careful to not touch the sink or anything else.

I take my dialysis solution bag (there is a better name but it escapes me) from the cooler where it is keeping warm with a heating pad and check it (SEAL) for Strength, Expiration, Amount and Leaks and hang it on the IV pole, being careful not to touch the connecting end.

Step two – connect.  This is where I take a 4×4, open it up and tape the outside wrapper part to my thigh.  At this point I have already untaped the end of my catheter so I pull it from my waist band and lay it on the 4×4.  Next I loosen the connecter end of my catheter and grab the connector end of the IV bag, pull the mini cap off my catheter, pull the connector off the IV bag and connect up being very careful not to touch any of the ends where germs might enter my body.

Step three – drain.  Before I drain, I have to flush air from the lines (one from the IV bag and one to the drain bag which is connected to the IV bag); the way I do this is to break the little cannula on the IV bag, count to five and clamp the line, break the cannula to the drain line and then unclamp my roller clamp that is attached to the catheter – this causes the fluids in my abdomen to drain into the drain bag.

It usually takes me about 12 minutes or so to drain and I know I am about empty when I start to feel a tugging inside, comparable to mild cramps (and sometimes not so mild!).  When I am empty, I close the roller clamp on the catheter and take the clamp off the fill line and put it on the drain line. 

Step four – fill.  Now I open the roller clamp again and I am filling back up.  This takes another 12-15 minutes.  When the bag is empty, it is time to disconnect after I take a second clamp and clamp the fill line. Now I am clamped in three places:  fill line, drain line and rollerclamp (catheter).

Step five – disconnect.  During the drain and fill time I have probably been reading our moving my hair out of my face or touching something so I need to use hand sanitizer on my hands.  When they are dry I take a mini cap and open it up and check to make sure there is a betadine sponge inside it and that it is not dried out.  Now I take the unconnect from the catheter, making sure I hold it pointing down towards the 4×4 making sure not to touch it to anything and place a mini cap on it.  Now I am through and can take off the mask.

Step six – dwell.  The dwell time is the how long the fluid is in my abdomen, passing through the peritoneum and collecting the toxins, usually 4 to six hours.

From this point I have various tasks.  The first exchange of the morning I have to take my blood pressure, weight, temperature and blood sugar.  I also have to take the drain bag and hang it over the toilet to drain and then discard.  I also have to clean up the floor because that is where I have thrown the old mini cap, the IV bag outer wrapper and other trash.  They tell you to throw it in the floor because they don’t want you to try and hit the garbage can and chance touching it – all these habits are extremely important since I can get peritonitis if any germs enter my body through the catheter.  We do not want peritonitis!  Now I roll the empty IV bag up and discard it and get a new IV bag for the cooler, rotating the warmer ones around for the next exchange.

Any questions? 

There hasn’t been much new to say lately – just a lot of the same.  I spent everyday but one last week at PD training and I am doing very well; as a matter of fact, I am doing so well that the nurse expects me to be doing it at home by myself by the middle of this week.  Before that happens, one of the doctors will actually come in and observe me doing an exchange and possibly as me some questions – so I am being tested!

This weekend we are doing quite a bit of rearranging.  Dick will be sharing his office with me and that is where I will be doing my exchanges.  We’ve bought a cart and some drawers to hold my supplies (bandages, tapes, clamps, etc.) and a new chair for me to sit in while this all happens.  Today he will put together said chair and cart plus an IV pole that I got on Friday.  It is coming together nicely and I expect to be ready this week.

This week my training sessions will be lasting a little longer and I will also be meeting with the dietitian to get my “orders”.  I had blood work done last week (I was stuck 13 times over the course of 3 days) and the results will let them know what restrictions I will need to follow – such as eat more protein, drink less fluid, etc.  It’s time to get this show on the road.

This Wednesday will mark week 5 since my surgery and they still insist rather strongly that I take it easy – no bending or lifting.  I have done this to the very best of my ability and I only have about 10 more days before I can return to my regular activities.  I can’t tell you how happy I will be when that happens – and a shower?  I will stay in there till the hot water runs cold!!

The boys are loving going to different homes that have been helping me out with childcare.  I am so thankful for the help but you can’t know how hard it is for me to ask people to help in that way – and I still can’t figure out why that is so.