No Pressure....

 I'm pretty sure that most of you are already aware that dialysis is not a fun game.  But in case you weren't completely convinced of this:

Part of homeostasis is the management of blood pressure.  Normal is a range, with 120/70 typically being a happy number.   My dad's pressure typically ran 90/50ish, and it never bothered him at all (although given the number of times he traumatized his body with power tools, this blood pressure frequently traumatized his ER team). I often tell patients that there is no such thing as blood pressure that is too low unless it is causing symptoms. 

High blood pressure is one of the top three reasons that people end up on dialysis.  Keeping blood pressure under control is a huge part of the dialysis regimen. Abnormally (symptomatic) low blood pressure is typically triggered by blood loss, dehydration, other fluid shifts or autonomic dysfunction (a sadly increasingly common issue in Long Covid patients). 

Dialysis is all about shifting fluids and electrolytes from on place to another.  So symptomatic hypotension (low pressure) is a common occurrence. When hemodialysis is being done at a center, there are people there to immediately respond to this issue. They can add fluid, or reposition the patient to improve the pressure issues. 

Oh, yes.  And hypotension symptoms? Sweating. Nausea. Loss of consciousness (syncope is the fancy medical term for fainting). 

Babygirl is doing her hemodialysis at home, unsupervised and frequently alone. Hypotension is an issue for her on a fairly regular basis. Her chair is designed with a bar above her head that can be grabbed as soon as symptoms appear.  Pulling the bar immediately tips the chair into Trendelenburg position - rapidly taking her from sitting in a normal recliner to almost upside down. Usually this is followed by about 10 minutes of retching and vomiting as her system struggles to pull out of the hypotension. 

Whild all this is going on she is supposed to decide whether to add additional fluid (which is, of course, not preferred when you are in the process of mechanically REMOVING the excess fluid from your body, or whether to terminate dialysis early (also not preferred for obvious reasons), or whether to just ride it out. This brings up the question: How long should you hover on the brink of consciousness trying to make this type of decision?

Thus far she has not lost consciousness during any of these episodes.  She has had to terminate her sessions early a few times, usually 30-45 minutes off of a four-hour session, which means that she has lost about 15% of the time needed to clean toxins out of her blood. 

And to add a bit of heart-stopping silliness to this entire story, Babygirl is SHORT.  Her chair is a one-size-fits-most contraption. That bar she has to grab to go upside down has got to be grabbed AGAIN to get her right side up.  The challenge is to reach above your head to the BACK of the chair, grab the bar with ONE hand (since the other has needles sticking out of your arteries), pull the bar and attempt a sit-up WITH YOUR ARM ABOVE YOUR HEAD from a head-down-toes-up position. The leverage is all wrong for her body size, and she ends up staying upside down longer than she needs to, and from that position she cannot easily reach the buttons that allow her to power down the machine. She looks a bit like a hooked fish during this process. I've been there to rescue her a few times, but I'm not always home.

This situation terrifies me more than a little. 

I've given it some thought.  I'm working on adding a strap to the bar so she can pull it from the front of the chair. This means that she will have to be mindful to place the strap within reach before she sets up.

We'll see how it goes.

DeeDee