Thursday, August 7, 2008

Six years of normalcy - Peritoneal Dialysis Part 4

In December 2004, a few friends and I planned a trip to Mahabalipuram in South India at a beach resort. We reached on Christmas night. The next morning, the tsunami struck (you can find a more elaborate account of this here).

My catheter and exit site were completely in the filthy water that the tsunami brought with it. I took strong antibiotics immediately and for the next few days. There was no immediate problem.

A few months after this incident, one morning, while cleaning my exit site, I noticed some puss around it. My exit site was infected.

I quickly called the Baxter Clinical Coordinator, Venkatramana. He came over and examined the exit site. I went over to Dr. Girish Narayen and he put me on antibiotics and I was asked to do the exit site dressing twice daily. We also sent the puss to the lab for a culture.

I had no fistula at this point. Dr. Girish Narayen suggested that I get a fistula made in case we needed to do hemodialysis at some point. I thought that would be an overkill. I mean, why would I ever need to go back to hemodialysis? This was a small infection and we could take care of it. But I went with Dr. Narayen's advice.

Dr. P. C. Gupta, an amazing person first and then an excellent vascular surgeon was to do the fistula. I was wheeled into the Operation Theatre (OT) for a surgery that was expected to take about an hour at most. I was awake during the surgery. Dr. Gupta and his assistant surgeon were working on the fistula on my upper left arm. I was following their conversation and after about an hour, the conversation sounded like they were about to wind up. However, the conversation suddenly became a little worried and they sounded a little perplexed.

I was wondering what the hell was going on. After a few minutes Dr. Gupta said, "Mr. Shah, there is a small problem. The vein seems to be blocked and we're not getting a good flow. We will need to connect this to another vein and this may take some more time." There was nothing more I could say apart from "Ok doctor."

What was supposed to take one hour finally took about three and half hours. My family outside the OT were by now panicking. What was going on? When the surgery was finally completed, they were told about what had to be done. So, I finally got a new fistula which, at that point, seemed totally unnecessary to me. I could not have been more wrong.

The exit site puss culture identified the bacteria as the dreaded pseudomonas aeruginosa.

I had attended a medical conference on Peritoneal Dialysis about a year back sponsored by Baxter. Usually such conferences are attended by doctors and technicians. But I knew one of the senior executives in Baxter, Harish Natarajan. He offered to allow me to attend to learn more about what's new in the PD world. I had attended a session on infections and I remember the speaker mentioning that infections due to the pseudomonas family of bacteria are hard to eliminate completely.

The exit site infection was however controlled within a few days. But unfortunately, that was not the last I had heard from the deadly pseudomonas.

A few weeks later I developed a tunnel infection. The tunnel is the path the PD catheter takes from outside below your skin finally to the peritoneum. An area of my skin above the tunnel had become red and swollen. Sure signs of an infection. I took oral antibiotics again and it looked like the infection was cleared.

The doctors however decided to reposition the catheter because of the recurrent nature of the pseudomonas bacteria. So, I underwent a surgery where the catheter was repositioned. The peritoneal end of the catheter was in the peritoneum itself. Only the outer end of the catheter was repositioned to take another path.

To no avail.

The tunnel infection recurred. The pseudomonas devils had still not given up.

Part 5

No comments: