Friday, September 12, 2008

Dialyzing alone revisited

There's been a lot of discussion on the Home Hemo Dialysis forums on Anna Bennett's situation and the issues surrounding dialyzing alone at home. I had written about it a few days back.

I have been following that thread with great interest and concern. It is not a simple decision to dialyze alone. Especially in India. All the people on the thread are talking about the US and Australia which have an entirely different medical system where clinics are responsible for a person's health. Many people are attached to clinics which have a monitoring system that is connected to the dialyzor's home and the entire treatment is being monitored continuously.

Even with these facilities, people are concerned about dialyzing alone.

Again, not all clinics have this facility. And yet, some of the clinics that don't, allow their patients to dialyze alone. The problem is there is not enough data (and there will not be for many more years) to conclusively prove one way or the other that dialyzing alone is safe or not.

Here in India I do not know how many people dialyze at home daily at night. I have a tech coming home and doing everything. That is very safe. But I was dependent on him. The number of hours I dialyzed depended on when he came. I did not like that dependency.

I am now able to start dialysis myslef without help from anyone. The independence is great. The tech does come still. But usually byt the time he comes, I have already started dialysis. I don't know how to get off dialysis at the end of the treatment though. But that is not a problem because I decide that and he is there till morning to help me get off.

But without any monitoring, I sometimes wonder what risks I am taking. I have started dialysis on a couple of occasions without anyone at home. I don't know how wise that was. Even if people are at home, they have absolutely no clue about what to do in an emergency.

Things in India are very different. In the US, I have been told, if there's an emergency, you can get professional help in minutes. In India, I realize that I might be dead and gone before anybody will even react.

The risks however with daily nocturnal dialysis are much less because the dialysis is slow and gentle. But it is not risk free.

I love the independence. I am worried about the risks. Catch 22?

6 comments:

Anonymous said...

Hey Kamal, since you mention about "Emergency" in US, thought i will clarify a few points. I hate the emergency concept in US. Yes, i agree, if someone were on the verge of death, and they arrive at the emergency in an ambulance, they will be taken care of right away. However, for any issue that is not-iminent-death, omg, they make sit for hours and hours together (yes, even if you have a broken arm or foot and are crying with traumatic pain). There are very few doctors on duty at the emergency and, i have hated every trip to it. I was always under the impression that in India (yes, you need to able to afford it) if you can go to a high-profile hospital you can get immediately taken care of, which is not the case here.

Another example of something i hate about the medical system in US, is with regards to wait time for securing an appointment with specialists. OMG, if i want to see a cardiologist or neurolist, i might have to take an appointment two months ahead of time, which has never ever been an issue for me in India.

Bottom line, if you have decent money, nothing can beat India IMO.

Vinay Mantha

Anonymous said...

Yeah, in india having money and not having money is all the difference to living.

while surfing to check the survival rate of dialysis patients specific to india i bumped into Kamal shah 's blog.

Hey, i love the independence u want but starting it without the tech ?......... why this craze?buddy do not take unwanted risk?

anonymous 2

Anonymous said...

America the great leveler.... ?

-Anonymous 3
:P

Anonymous said...

I dont know how its done in the US or other countries. how people without medical insurance are treated or how they have access to the medication.
But here in AP , India we have Arogyasree. There was a post on this.
It does help a lot. It makes a big difference to normal farmers, laborers.. people who do not have an insurance of any sort.
Ive seen lots of cases being treated. They are admitted in to hospitals, they get the best of care and even the medication is free for around 10 days after the operation.
Yes, ofcourse all your past xrays, reports, scans arent accepted. You will have to get ething done all over again.
A small expense there.

See.. not everything is that bad here in India and yes the Govt does function. :)

cheers
Anonymous4? :P

Anonymous said...

Insurance is another headache....ICICI is worst of the lot! But Aryogasree... i havent heard of it. But nice of u mention.

Why is it the blogger makes no replies to the comments at all!

Annonymous2

Kamal Shah said...

Sorry Anonymous 2 for not replying earlier!

I agree it is risky to start dialysis on my own. But compared to the risks associated with regular dialysis in hospital, it is less risky. This is because the dialysis is more gentle on the body due to the slow flow rates.

As far as the insurance schemes go, Arogyasree is great.

I was under the impression that the US is better when it comes to emergency but Vinay Mantha - the first commenter in this thread of comments (not anonymous, btw!)has a different perspective.

Thanks all of you for your thoughts!