Monday, November 3, 2008

How do you determine the exact weight gain?

I'm on nocturnal home hemodialysis. So I start my dialysis usually immediately or shortly after dinner. This means that my weight just before dialysis will always show a little more than what it actually is. This makes it very difficult to know what exactly has been my fluid weight gain between two treatments.

The extra weight that shows up because of the food you just ate is never constant. It depends on what you ate and how much and there is no way to tell the exact amount.

So, you never know how much fluid you need to pull of during a dialysis session.

For example, a few days back, my closing weight after a session was 78 kgs. At night, just before my next dialysis session, my weight was 81 kgs. But I had just had dinner. I usually remove 1 kg to account for dinner. So, I assumed my actual weight was 80 kgs. So, I set the ultrafiltration amount to 2.5 liters (to account for the 500 ml of water that I usually consume during dialysis). So, in effect the nett fluid removal would be 2 kgs.

But, in reality it is never so straightforward. The 1 kg that I assumed is the tricky part. It is very difficult to guage the exact amount.

Yesterday for instance, I assumed the 1 kg and ended up pulling off a lot more fluid. The first half of the day I felt like someone had squeezed me and put me up on a line with hangers to dry. I felt giddy, weak and totally drained. I had to drink a glass of fresh lime water and another glass of Thums Up to even begin to feel better.

Now that's the good part of getting too dry! You get to drink a lot of fluid!

I really wish there was a mechanism to measure the exact amount of extra fluid in the body that was not dependent on the weight. Maybe like measruingt he density of the blood? That should be fairly simple to integrate into the dialysis machine itself. But then, that wouldn't account for the extra fluid in the tissues which could be a significant portion.

Solutions, anybody?

5 comments:

marien said...

Hi Kamal,
Am reading your post again. You asked for a solution. So I offer the one (out of pure love and concern for you) that has been of immense help to me, my family, my friends.What do you tell a man who is suffering from a disease? What words of comfort can I offer? This is it. The words from the Bible, God's own solution to the problems that satan has brought into this world. God didn't bring these diseases. It is our own fallen nature. These are verses of healing that I send out to those I care for. You may not understand them. But miracles happen when we pray in the name of Jesus. And miracles are happening today for different people.Or they may not happen. Finally, it is Jesus who said He is the way, the truth and the life. He is the Redeemer, the unblemished Lamb, the completed sacrifice on the cross, the Healer,Jehovah Jireh, the Provider, the Alpha and the Omega, our resurrected Lord who now sits in heaven interceding for us. This might seem all strange to you. But if you can get a copy of the Bible, read these verses and ponder over them.I am not talking religion here, just showing you a start of a relationship with Jesus, the saviour of mankind.
This is not from man, this is revelation from the Holy Spirit Himself.And I pray that He will help you and you can have that simple faith and complete trust in God who walked on this earth, suffered like us,bled and died for our sins on the cross, and was resurrected on the 3rd day.
So here, my boy, are the verses: Hope you can use them and they will open your eyes of understanding.

1. The thief cometh not, but for to steal, and to kill, and to destroy: I am come that they might have life, and that they might have it more abundantly. ~John 10:10

2. But if the Spirit of him that raised up Jesus from the dead dwell in you, he that raised up Christ from the dead shall also quicken your mortal bodies by this Spirit that dwelleth in you. ~Romans 8:11

3. Likewise the Spirit also helpeth our infirmities: for we know not what we should pray for as we ought: but the Spirit itself maketh intercession for us with groanings which cannot be uttered. ~Romans 8:26

4. But he was wounded for our transgressions, he was bruised for our iniquities: the chastisement of our peace was upon him; and with his stripes we are healed. ~Isaiah 53:5

5. And ye shall serve the Lord your God, and he shall bless thy bread, and thy water; and I will take sickness away from the midst of thee. There shall nothing cast their young, nor be barren, in thy land: the number of thy days I will fulfill. ~Exodus 23:25&26

6. ...If thou wilt diligently hearken to the voice of the Lord thy God, and wilt do that which is right in his sight, and wilt give ear to his commandments, and keep all his statutes, I will put none of these diseases upon thee, which I have brought upon the Egyptians: for I am the Lord that healeth thee. (Jehovah Raphe) ~Exodus 15:26

7. Bless the Lord, O my soul, and forget not all his benefits: Who forgiveth all thine iniquities; who healeth all thy diseases. ~Psalm 103:2&3

8. Behold, I will bring it health and cure, and I will cure them, and will reveal unto them the abundance of peace and truth. ~Jeremiah 33:6

9. Then they cry unto the Lord in their trouble, and he saveth them out of their distresses. He sent his word, and healed them, and delivered them from their destructions. ~Psalm 107:19&20

10. My son, attend to my words; incline thine ear unto my sayings. Let them not depart from thine eyes; keep them in the midst of thine heart. For they are life unto those that find them, and health to all their flesh. ~Proverbs 4:20-22

11. Is any sick among you? let him call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord: And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him. Confess your faults one to another, that ye may be healed. The effectual fervent prayer of a righteous man availeth much. ~James 5:14-16

Then Romans 8 and Isaiah 53, the whole chapters are powerful, especially Isaiah since that's about our Lord's suffering and our healing.
From today, I am going to put you in my prayer list. Please don't take me amiss. I am not forcing anything down your throat. But this is the Good News I have to share with you. Since once upon a time you were my star student!

Kamal Shah said...

Dear ma'am,

Thanks for your concern. But I do not believe that there is a God, Jesus, Ram, Allah etc. who is going to help me or anyone else.

If there was a God, there would not be disease, poverty and suffering in the first place. Because God, if he was powerful and good would not allow these things to exist.

Let me know what is wrong with the above statement.

Really appreciate your concern however.

Kamal

Anu said...

Kamal, this comment probably comes WAY WAY longer than you imagined it might for this post. How about if you use your weight BEFORE dinner as the real weight, and calculate your goal from that? Not that you or someone else would not have got this idea before now...

- Anu
(PS: Been a home PD patient before, now home HD patient. I would be glad to share my home HD training materials with you, especially if you are using NxStage these days).

Kamal D Shah said...

Hi Anu,

Thanks for your comment! That is a good idea but how do you know how much fluid you've consumed after that? For example, it is not only the amount of actual fluid but also the fluid that was part of the solid food at dinner, for example, rice is supposed to be 40% water.

I would love to take a look at your home hemo training material. I don't use the NxStage. I live in India and use a Fresenius 4008S. Can you please send whatever training material you can share to kamalshah20@gmail.com?

Thanks
Kamal

Anu said...

Sure, will be my pleasure!