Hey, I'm Jason. I'm a chronically-ill-super-freedom-loving-medical-self-journalist.
Okay, so I got an intriguing question from a reader (yes, it turns out I have some). It goes …
Do you think someone 87 years old could handle peritoneal dialysis? The 36 year old doctor thinks so but I think it sounds like it’s a bit much for someone that age to handle.
First of all, Jane, thank you for trusting my opinion enough to write – that’s cool. Secondly, please do remember, devoted fans, that I am not a doctor. Or a nurse. Come to think of it, I have never worked at all in any medical profession. I’m better than all of those people. I’m a patient. Everything in this entire blog is opinion-based on experience – not on schooling.
I don’t know the physical and biological aspects of our 87 year old patient (let’s call him “87”). There’s a bunch of scientific discussions for why a patient should or should not attempt peritoneal dialysis, none of which I have any authority, really, to expound upon. So if 87 has trouble healing, for instance, maybe the catheter site would cause trouble. Then there’s efficiency, PD may be more or less efficient depending on the patient’s physical make-up. Hemodialysis, though evil it may be, can offer different solutions for different people. The doctor will know.
Okay, let’s assume 87 is performing his own peritoneal dialysis treatments. There is daily set-up and tear-down of the machine – this takes 30 minutes, more or less. If 87 only dialyzes during the night, then he’ll only have to hook up once before bed and then upon wake up to unhook: the hand-washing and other prep for these procedures can steal a bit more time, but is easy. What concerns me about 87 is the boxes of dialysate solution. Each box contains two bags of solution; each bag is six liters. For those of you stuck in the dark ages of measurement, six liters/kilos equals 13.2 pounds. Anyway, the boxes have 12 liter’s worth of solution, or just under six gallons of milk – if 87 has to carry the box any distance, he’ll need to have the upper body strength. Even carrying one of the bags could be difficult.
Then there’s the number of boxes 87’ll have to store. At my home, my stash of boxes is in our front hallway. It’s the first thing guests see when they walk into the house, which is totally awesome. In my case, I receive 10-30 boxes every two weeks. I could ask my delivery driver to use his fancy mechanical hand truck to bring the boxes upstairs to our bedroom. But then they’re in our bedroom. So I carry my supplies up to my machine each night. I have gotten used to it. Some nights, those boxes seem extra heavy even to me, a young, strongish man. Plus, I’m handsome. But a guy can only write so much in one blog post, so we can talk about me later. For relevance’s sake, let’s just say being handsome has almost zero effect on any kind of dialysis. So far. But I’ve been writing my congressperson, so look out.
And then (back to PD) … there’s the waste bag. The machine fills a waste bag with solution that has passed through the peritoneum each night. Do the math and realize: two solution bags + fluid removed from the body = one waste bag. This waste bag is huge, has no handles and must be carried to a bathtub to empty. It is possible to run the machine’s waste line directly to a toilet or a tub, instead of to this large bag. Current scuttlebutt suggests that it may be all-around safer to do it this way anyway. There are even new products (of course there are) for locking the waste line tubing into place under the toilet seat. If 87 has no access to a drainage receptacle, please do consider the weight of the waste bag.
Peritoneal dialysis is less bothersome than hemodialysis, in my opinion. For instance, if your home is in a rural area, driving three times a week to an HD facility takes a lot of time away from life – by contrast, PD supplies would be driven to you. But PD is not without its difficulties. The problem is: this is still goddamn dialysis. Whatever modality we choose, we still kinda lose.
(Nice, right? With the rhyming and stuff? That’s quality blogging right there.)
Now, if 87 has a reliable partner who is able and trained to do PD, why not? I understand your under-the-breath comment about the young doctor. What the heck does he know, right? Strapping adolescent Porsche driver? Well, young doctors, thank our stars, are becoming more versed and comfortable with PD. They weigh the performance of PD against HD, and likely find that it is overall gentler to the body. There is no blood exchange, nor needles – this not only avoids six 14-gauge needle sticks a week (that’s right, a common size for HD needles is similar to speaker wire) but also lessens the need for plasma and Epo, aka blood replacement therapy. Excess fluid in the body is removed daily instead of, uh, bi-daily. This is a miracle for those of us who have trouble with fluid gain – taking fluid off each night in four or five gentle exchanges almost makes fluid removal unnoticeable.
I want to emphasize that I don’t know anything about your 87 – your 87 could be quite physically capable, maybe this is what that young doctor is thinking. Just remember: if you and 87 decide to go forward with PD, with a partner, the partner will need to be trained and always available during treatments. If 87 decides to take on PD solo, awesome! Keep those hands clean and don’t ignore training – following the rules set down by a PD nurse will eliminate those pesky hospital visits.
Seriously, Jane, thank you for asking my opinion. I hope my thoughts give you direction.