Wednesday, August 29, 2012

The morning after I don't dialyze

I take most Tuesdays off from dialysis. The swimming pool I go to is closed on Wednesdays. When I don't dialyze, the next morning, I don't swim because my body has a little excess fluid and swimming is a little difficult on these days. Earlier I used to take Sundays off but because of this I used to miss swimming two days of the week. By coinciding my dialysis off day with the swimming off day, I now need to miss swimming only on one day of the week.

I have noticed one other side effect of skipping dialysis. The morning after I don't dialyze, my bones feel stiff. I have no idea why this happens. When I was travelling abroad recently, I was dialyzing only every other day and I found that this stiffness of the bones turned it some very uncomfortable bone pain. It reminded me of the time when I had severe bone pain and it was attributed to the abnormally low Calcium level in my dialysate.

I got quite scared by the end of the trip on this account. I thought the bone pain was back. However, a few nights of long hour dialysis and the bone pain disappeared.

This sort-of ties in to the stiffness I experience on the days after I don't dialyze. What could be the reason? Could it be the Calcium that my body is getting during the night-long dialysis sessions? Is my body missing the Calcium during my nights off?

Another thing that hit me was that I do not take my phosphate supplements when I don't dialyze. Most people on dialysis need phosphate binders because their phosphorus levels are too high. Daily nocturnal dialysis removes a lot of phosphorus and due to this I need to take a phosphorus supplement. When I don't dialyze, I do not take the supplement. I am not worried about too high a phosphorus though. I am more worried about the Potassium because the phosphorus supplement is actually a Sodium and Potassium Phosphate.

Could my phosphorus level be low enough to cause this stiffness? During my trip abroad also I did not take the phosphorus supplement and my nephrologist felt that the phosphorus level might have been low enough to cause the bone pain.

As in most things related to dialysis - more so daily nocturnal dialysis, there is no definite answer to this question. I will have to try different things to check why this might be happening. I should probably take the supplement on the non-dialysis day to see if this helps in abating the symptoms.

Monday, August 20, 2012

I really don't need any studies to tell me whether more frequent dialysis is good for me or not

I keep seeing references to the Frequent Hemodialysis Network study on and off on the internet.

This was a study to study the effects of increasing the frequency of hemodialysis. By looking at the link above, it seems that they did manage to prove that increasing the frequency of hemodialysis does improve heart function that is often impaired in patients on dialysis.

I couldn't care less.

I honestly don't need studies to tell me whether more frequent dialysis is better for me. I have experienced it first hand. I was diagnosed with Left Ventricular Hypertrophy in 2006. My Ejection Fraction (one of the measures of heart function) was 30% which was fairly low. This is a common complication in dialysis patients where the heart function is compromised due to the increased volume of blood in the body (mainly due to the excess fluid in the blood that most dialysis patients have). I was put on some medication for this by the cardiologist. Around the same time, I started daily nocturnal dialysis. After a year when I went back to my cardiologist, the Ejection Fraction had rebounded to 60% which was a perfectly normal value. The cardiologist was surprised and said that they don't normally see such dramatic improvement due to the medication alone. When I told him about my switch to daily nocturnal dialysis, he said it was most likely due to that.

Daily nocturnal home hemodialysis has given me many other benefits. My Restless Legs Syndrome disappeared. My blood pressure control is much better. I need to take Phosphorus supplements (to increase my Phosphorus) where most dialysis patients need to take phosphorus binders (to reduce their Phosphorus)! My blood counts are almost normal. I am on a very small dose of Erythropoietin.

One very important benefit of this dialysis frequency has been practically no diet and fluid restrictions. I eat what I wish and I drink as much fluid as I want. This helps a great deal psychologically as well. I am also able to work full time, exercise and travel. This has been possible only because of the increased frequency. Yes, there are people who do all this even on the regular dialysis regimen of twice or thrice weekly. However, I know myself. I would never be able to take that. I am physically and mentally weaker than them. I need the liberty that comes with increased frequency dialysis.

The point I am trying to make is for me daily nocturnal dialysis does not need to be proved by a study or a clinical trial to see its benefits. I have literally lived the benefits. I do understand however that many doctors need to see these results before recommending this to their patients. That is the most unfortunate truth that is present in the dialysis world today. Thousands of patients who could benefit from this wonderful modality are being deprived because of the lack of a definitive theoretical recommendation in its favor. Sadly, common sense is not enough!

Wednesday, August 15, 2012

Living in the moment

I was on the cruise having dinner. Across the table was Dinesh feeding his infant-son Raunak. We were to go to a show that was going to start in the theatre in a few minutes. I was hurrying up. To my surprise (and a bit of irritation, might I add!) Dinesh showed no sign of urgency. I saw him happily putting morsel after morsel into the baby's mouth and dealing with the tantrums that generally come with such an exercise. He was savoring the moment.

At that point, it dawned upon me. What was I doing? I was continuously looking into the future. While I was having dinner, I was more worried about getting to the show on time. Once I got into the show, within a few minutes I would start thinking about what we were planning to do after that.

For me, life has become all about the next thing. Which is horrible. Because I am not enjoying what I am doing now. When I am having breakfast, I am thinking about getting to work. When I am in a meeting, I am thinking about what I need to do next. I have realized that I have reached such a stage that whatever it is that I am doing, my mind is actually half focussed on finishing that and then moving on to the next thing.

A similar thing happened when I was with my brother the week after that. He also pointed this out to me. So, it was confirmed that this was true. I needed to change!

Good thing is that I have realized that! Now, I need to do something about it. I have started working on it. I try not to focus on anything but the present.

A couple of days back, I did not wear my watch to work. I wanted to see if that would help. It did. The watch serves as a constant reminder about finishing off your current activity and moving on to the next. When I don't have a watch, it helps me to focus on the current activity without worrying about the the artificial deadline that I have created for myself.

I believe I need to take small steps like these to be able to change. But change, I must. I need to slow down the pace of my mind. I mean this in a good way. Not that I need to do less. I need to do the same things. I just need to do each thing more completely, being fully involved in it. If I am having my cup of tea in the morning, I need to do just that - with mind and body. If I am watching a movie, I need to do just that. If I am in a meeting, I need to be there fully - in mind and body.

Sunday, August 12, 2012

"Dialysis patients are special too"

I found this post on a forum. This was posted by a renal nurse. I only wish more nurses and technicians were like this!

"Renal patients get a bad press by healthcare professionals, and it bothers me.
So just for the 5 mins it takes you to read my thread I want you to imagine you are a hemodialysis patient……………..

You can’t drive to dialysis because you feel so ill after dialysis you might not be able to drive home. So you wait patiently either for a relative who is getting really fed up with driving you there and back 3 times a week, or for transportation who are either too early or too late.

Then you arrive at the dialysis center and have to wait for your dialysis chair-they are always busy at the dialysis center, because they never have enough staff and the patient before you needs his sites holding for longer than 10 mins.

You get weighed and you’ve put on too much, so you have to listen to the lecture of what you must do to not drink so much! For the 100th time. Don’t the staff notice it is over 100 degrees outside

You eventually get to sit in your chair and it takes another 20 mins before you actually start your treatment.

Then the hours begin, there is a television but it doesn’t work well. The patients around you are sleeping or complaining.

The staff are running around and don’t notice you and don’t have time to talk because they are so busy.

You notice that Fred or Alice are not there today, when you ask everybody is secretive because they don’t really want you to know that they have died, because for the last 2 years they have sat next to you.

There might be a bit of drama you can enjoy, but the machines are always alarming and you can’t move your arm in case you pull at the needles stuck in it.

Those 3 4 or 5 hours are so boring and it is so noisy

Then you come off the machine, hold your needle sites weigh yourself and go wait to be picked up.

Transportation is late, so by the time you get home you’ve been gone 6 hours. Now it is time for a nap.

The next day of your life you spend recovering from dialysis treatment and the day after that the cycle begins again………………..

I cannot imagine how horrible it must be to spend up to 7 hours which includes travelling and waiting time, to be tied to a chair and have dialysis.

We complain if we have to sit in a car for a couple of hours when we are travelling to somewhere nice.

Just imagine for a second that every other day for the rest of your life you have to sit in a chair and travel for 4 hours.

They have lost complete control of their life and if they don't dialyze then they die.

Then to add insult to injury they have to have needles stuck in their arm 3 times a week, they cannot eat what they want, they cannot drink what they want and they have to be talked down to every treatment by nurses who half the time do not even try to understand what they are going through.

I have had the privilege of working with ESRD patients for many years and the amount of unruly patients I have looked after is almost zero! I have found if you listen to them, that is all they want. They are frightened and angry, plus they look around the dialysis unit and what do they see?

They see 20 other people tied to a chair, in various stages of deterioration. Doesn’t seem like they have a lot to look forward to.

Oh and most of them are labeled 'non-compliant' words which are frequently used to describe patients who eat the wrong food, drink too much and miss dialysis sometimes.

Half the time they are on dialysis because we have decided they didn't look after their BP or their diabetes.

I wish I was so perfect that I could say I do everything I am supposed to do all the time.

If we as health care professionals actually took time to meet the patients face to face and listened to what they have to say instead of telling them what to do, maybe just maybe we could actually reduce the 'unruly' patient.

23 years as a RN-13 years in renal nursing has taught me that healthcare professionals are very dismissive of pts who have renal disorders.
I honestly think we are frightened of them because we do not really understand the renal system. We are only human after all and we tend to shy away from conditions which seem complicated.
Looking after the chronic renal patient is unique and many friendships have been forged over the years. A deep sadness and loss is felt by the staff who have looked after them for so long.
There is so much to be gained by looking after chronically ill patients, I just don’t want us to forget how important they are by labeling them."

Friday, August 10, 2012

Yes, we can

For me, this trip to the US and Canada has opened up a whole new world of possibilities. Before I actually did the trip, I never really thought it would happen. I never really thought I could do it. But now that it is done, it doesn't seem so difficult after all.

There were many obstacles - the visas, dialysis, costs and many other smaller ones as well. I proved to myself that everything can be resolved. Provided I have the will to do so. I was very keen to go on this trip. I badly wanted to do a cruise. I badly wanted to see the Niagara Falls. Dialysis was probably the biggest obstacle mentally. How would I manage the dialysis? In the need it all turned out all right.

There are differences in the way dialysis is done in the US from how it is done in India. Obviously. What would you expect?

For example, in the US they generally use much higher blood flow rates than we do in India. They also use bigger needles (15 gauge as opposed to the 16 gauge we use here). They also have differences in the starting and closing techniques though this does not affect us as much. One difference in the closing method is they use a 'closed' method of closing where the bloodlines are not disconnected from the needles until the blood has been completely returned. This seems to be a better method of closing. The only problem is about 500 ml of saline is pushed into the body towards the end which means you need to adjust for that in the UF goal.

Some tips for people on dialysis visiting the US:

- Start planning as early as possible. Dialysis bookings take time. They need to accommodate you into their schedules. They need a lot of paperwork to be sent.

- Book your flights after your dialysis sessions have been booked. Some cities operate only some shifts. If you plan a flight on the same day as dialysis, then you may need to adjust your flight timings based on the dialysis slot you are able to get. Also, often a lot of flights are available. Dialysis availability is not so easy.

- Carry your needles if you are used to 16 gauge. I carried my 16 gauge buttonhole needles and I was allowed to use them everywhere.

- Carry xylocaine (lidocaine) if you cannot do without it. Many units don't use this. Carry some insulin syringes to inject it as well.

- Know your blood flow rate, UF goal and how much heparin you are used to. Find out from your dialysis center. Though these things will be asked as part of your prescription, you may need to fine tune some of this based on how you are feeling.

- Plan to carry a blanket and pillow to the center. They don't provide this and centers can get quite cold.

- Carry cash with you for the payment. They don't accept credit cards, cheques or any other form of payment. They do accept money orders but it is difficult to get money orders once you're there.

I definitely think we, on dialysis, can do international travel. In fact, if anything, it would be easier for people who are not used to daily, nocturnal dialysis to do this since the dialysis dose is the same. I was not used to in-center four hour sessions so I had a little difficulty adjusting. However, for those used to this, it should really be a cakewalk.

Travel gives us a change. It gives us something to look forward to. Apart from all the fun we have on the trip, it also reinforces to us that we are normal but for dialysis. Dialysis really need not restrict us from doing what we want to do. All it takes is a little determination and willingness to do it.

I feel so liberated after this trip. I am already starting to think about my next destination. Switzerland perhaps? :-)

Thursday, August 9, 2012

New York diary

My flight from Toronto to New York's La Guardia airport was to take off on Wednesday the 1st of August at 2:30 in the afternoon. I got to know that it was delayed by an hour as I waited at the airport after checking in. I killed time by snacking and checking email. We boarded the aircraft and waited endlessly for the flight to take off. No luck. Almost half an hour passed after everyone had boarded and they completed the safety demo.

The captain then came online and announced that there were thunderstorms in the La Guardia airport because of which they could not land there. We would need to wait for about half an hour before we got any further information! Ok, I am not surprised!

After another forty five minutes, the captain came on again and announced that they had decided to get everyone off the plane as they were not sure if the flight would take off or not. Oh crap!

I had to reach New Jersey that evening. I had a flight to India the next day!

I checked with my relatives in Toronto and New Jersey about alternatives. In another half hour or so, there was an announcement that they were re-boarding the flight and that they would be taking off. So, we got on to the flight again and the flight did take off!

I later learnt that around the same time, there was a very specific bomb threat in the San Antonio International Airport in Texas and that they had evacuated that whole airport. Of course, I will never know if this was related to that but my gut feels it was.

Times Square

My cousin Rajul and her family picked me up from the airport and we drove straightaway to Times Square. I had only one day in the place and that was what I was advised to see.

The whole area was buzzing with activity. There are so many huge buildings, you can barely see the top. Most buildings have these signboards that have video ads playing continuously. And there are people. A large number of people. People going here. People going there. In the middle of the street there is an impromptu show going on. There is a guy wearing little, donning a cowboy hat playing a guitar who has inscribed on his undies "The Naked Cowboy"! There is someone who is dressed up like the Statue of Liberty. Then there's Minnie Mouse.


We took some pictures and then had dinner at a joint there and then headed towards New Jersey. On the way we saw the New York skyline from across the Hudson river. We saw the Empire State Building and we also saw the Freedom Tower structure that is coming up at Ground Zero. I thought it quite amazing that the structure was already up! We got home close to midnight and I had a good sleep after a long day!

New Jersey

The next morning, I was dropped off at the dialysis center by Pratik, Rajul's husband. This part of the city was very scenic much like some of the other cities I had seen and very different from the part of New York that I saw the previous night.

Home sweet home

I took the 11:05 p.m. flight that evening to India. It was mixed feelings all the way. On the one hand I was sad that the trip was coming to an end. On the other hand, I hated in-center dialysis so much that I was actually feeling happy to be going back home for the simple reason that I could dialyse at home. At my convenience. At my will. Yes, it was good to be back home!

Wednesday, August 8, 2012

The Niagara Falls

From Las Vegas I flew down to Toronto. There are a bunch of things you can do in Toronto. However, my visit to Toronto was with only one motive - The Niagara Falls. I had seen pictures of my parents' trip to the place and had been mesmerized since then by the majesty of the falls. When I started planning my trip, there were two things that were absolute must-dos - the cruise and the Niagara Falls. So, I had one complete day in Toronto and the Niagara Falls it would be!

I stayed with Leslie Uncle and Glynis Aunty who stay in Mississauga, which is very close to Toronto. They picked me up from the airport and straightaway took me to the local Saravana Bhavan where we had a great thali. The next morning we headed out at around 10:30 to the falls.

We got to the falls in about an hour and a half. As we arrived, we were driving down the road by the falls and making our way towards the parking lot. The falls were slightly visible from the road itself. I tried not to make visual contact with the falls until we were ready. I looked away. I did not want to take a small glimpse and then have to do something else. I wanted to take it in completely.

After getting off the car, I walked towards the falls and then managed to get a vantage point. I then started taking in the whole scene. It was absolutely breathtaking! I learnt later that at peak flows, about 5.7 million liters of water flow down the falls every second! 

The whole thing was so spectacular! This humungous quantity of water falling down this great height and then flowing off is only to be seen to be believed! The water roars as it falls down and you can hear the roar from quite far. It was difficult to take my eyes off the falls for a while.

I then went down an elevator to a tunnel that has three outlets. Two of them allow you to see from the sides at the base of the falls. The other outlet has a balcony where you can actually go very close to the base of the falls and feel the water! This was one of the most exhilarating experiences of my life. It was difficult to capture on camera as well because of the water that is spraying on you continuously from the falls!

After having my fill, I went back up and then we went for the famous Maid of the Mist ride. On this ride, they take you in a boat past the American falls and then right up to the Canadian falls. This was also just too good.

The visit to the Niagara Falls was probably the highlight of my entire trip! I leave you with a video I took of the falls:

Tuesday, August 7, 2012

Vegas diary

I had heard so much about Vegas. When I was planning my trip, I posted a question to my friends on Facebook about which place I should visit in the US if I had to pick just one? Most of my Indian friends said Vegas. "Vegas, Kamal. Trust me on this", said Vinay.

So, I finally included Las Vegas in my itinerary. Honestly, I had half a mind to drop it. Dori had said, "The last time I went to Vegas I didn't even bother to leave the hotel!" I am not a huge fan of casinos and big buildings and all that stuff. I wondered what I would do in Vegas. But then my parents and brothers also insisted I go to Vegas.

Start gambling at the airport itself

You obviously know that Vegas is famous for gambling. The funny thing though is that there are gambling stations at the airport itself. So, people who go to Vegas to satisfy their gambling itch don't even need to wait till they get to the casino. They can start as soon as they land. Or gamble right up to the time they board the aircraft while leaving!

A check-in queue!

When we arrived at our hotel, to my shock I saw that there was a huge line of about 50-60 people at the reception waiting to check in to the hotel. This was a first! A check-in queue at a hotel? WTF! Once we were checked in, we went to our room. Our room at the Wynn was just too good. It was on the twenty second floor and had a floor-to-ceiling glass on one side so that you could see the whole city from your room.

Casino hopping

We headed out the next day to see the famous casino-hotels in the city. We saw the Venetian, Caesar's Palace, Palazzo etc. All magnificent structures. I was most impressed with the Venetian. They have a mini-Venice there complete with the waterways, gondolas and streets which have an artificial sky above which fools you into thinking for a moment that you are under the real sky!

David Copperfield

We were advised to catch one of the Cirque-du-soleil shows but we couldn't get tickets. So, we decided to go to the David Copperfield show at the MGM Grand. This show was really amazing. The final act involved picking thirteen people from the audience at random. Ten of them were put in a huge cage and three were made to guard the three sides of the cage - the front was visible to the audience. The cage was then covered with a sheet and then after a couple of seconds, the sheet was removed. The cage  was empty! The ten people were found standing among the audience!

What happens in Vegas...

There's something about the city that catches on. The vibrant atmosphere can be infectious. So, yours truly also well, kind of, you know.... well, we'll just leave it at that. For the great master Confucius say, "What happen in Vegas, stay in Vegas!" 

Monday, August 6, 2012

California diary

I took a flight to Los Angeles from Vancouver on the 22nd of July. My brother picked me up from the airport. Almost the whole of that week was going to be spent in different parts of the state of California. California, despite being a state belonging to a country, has an economy that is larger than all but eight countries in the world!


My brother and I had dinner on the night of my arrival with an uncle who's been in Los Angeles for decades now. He took us to BJ's Restaurant and Brewhouse, a very cool place. There, as my brother and he chatted about how Kobe Bryant might or might not retire in two years from now and how it might or might not affect his team's chances at something (I forget what), we dug into the most innovative and tasty method of serving soup. We ordered a Tuscan Tomato Bisque and a Broccoli Cheddar. They bake bread in the shape of a bowl and serve the soup in that freshly baked bread-bowl. So, you basically take a spoon and scoop out some soup along with the bread that forms the bowl! Heavenly! Here's a pic:

Transformers @ Universal

The next day we decided to go to Universal Studios. As we reached the place, we found that there was a huge crowd of cars waiting to get in. My brother found that strange for a weekday. We thought it was no point going as there would be long queues and we would need to wait for hours to get our turn at most of the rides. So, we headed out to Malibu beach and returned the next day early in the morning to the place. This time we got in quickly and headed straight for the new Transformers ride that my brother was raving about. It was truly amazing. It was like a 4D experience. They make you sit in a small car like enclosure and then it is almost like you are inside a scene from a movie. You actually feel the jerks and the movement while you are right there sitting in the car! This has to be experienced and words cannot really do justice to the experience.

We did some more rides and the studio tour all of which were really great. 

At the entrance of Universal Studios

Yosemite or Yashomathi?

We flew into San Jose that evening and hung out with family. The next day we visited Stanford University and the Apple campus. We also went over to have ice cream at the famous Ghirardelli Square.

Stanford University

Apple's famous 1, Infinite Loop address

Ghirardelli Square

The next day Obul, Krishna, my brother Karan and I drove over to Yosemite National Park, which an aunt of mine insists on calling 'Yashomathi' in probably the worst ever 'desi' murder of an American name! It is a beautiful place. It is unbelievably huge and can take you hours to simply drive from one end to the other. It has huge sheets of rock, many creeks and waterfalls and a lot of natural beauty. The weather was fairly hot that day and all of us decided to jump into a creek that had ice-cold water which was spectacularly clear.

A creek at Yosemite

We stayed the night there and after visiting some of the spots there returned the next evening. 


That night, my friend Krishna took me to Chipotle, a mexican food chain. I had some very tasty Tacos. My brother Karan loves Chipotle as well and insists that they add something to the food that gets you hooked to them forever. I couldn't agree more! We followed up with some frozen yoghurt at (I forget the name of the place, grrrr!). Apparently, in the US many people are hugely loyal to yoghurt companies as well. They have their favorites and insist that their favorite is really the best. Now, where did I hear something similar?

Sunday, August 5, 2012

Vancouver diary

We got off the cruise on 22nd of July at Vancouver. Dinesh was to drop me off at the airport before heading back to Seattle. We had a few hours in between though. We thought we would go around Vancouver and have lunch before going to the airport.

Discipline, discipline is the thing!

One thing that struck me as we drove around the city was that the hedges in all the houses were all trimmed so perfectly! Every single house had the hedges in a perfect straight line. It was almost as if it was from a picture. On checking I learnt that this was imposed mostly by the local authorities who penalized people who did not maintain their lawns and hedges in a neat manner!

Stanley Park

We went over to the beautiful Stanley Park which is one of the largest urban parks in North America. We drove around a bit and then went to take a train ride in a small area of the park which focusses on the Sasquatch. The ride is mainly for kids but adults join in as well. There is a story that is narrated on the public address system about the Sasquatch. As the train goes along, there are people enacting small scenes from the story. Pavithra wondered whether they did that again and again the whole day! What a boring job!

A scene from the Sasquatch story

As we left Stanley Park, we took this bridge to get to the rest of the city

Lunch at Saravanaa Bhavan!

During the cruise we did get good food. It was mostly bland stuff though. Pizza, pasta, salads, bread, dessert etc. There was very limited Indian food. For lunch and dinner there would mostly be plain rice and a dal with some papad. For breakfast there would be one Indian dish like upma or poori bhaji and so on.

Though I really like this kind of food, the moment I got to know that there was a Saravanaa Bhavan in Vancouver, I had this inexplicable craving for South Indian food. I got Dinesh to take me there. They had a buffet which was amazing. Poori, curry, sambar, rasam, dal, dosa, idli chutney, papad, pickles and payasam. We had a sumptuous lunch. I loved it absolutely!

At Saravanaa Bhavan, Vancouver

Wednesday, August 1, 2012

Dialysis in the middle of an ocean

During my seven night cruise, I got three dialysis sessions. Monday, Wednesday and Saturday. The sessions were all four hours each. The company that facilitates this is called Dialysis at Sea. They take up a couple of rooms in the medical facility of a cruise ship and they pay the cruise fees of a nephrologist and the necessary dialysis nurses and technicians who are supposed to administer the treatments to the patients.

The dialysis sessions are done only on three days. That is, the days are all fixed. So, during our cruise, ALL patients got their dialysis sessions on Monday, Wednesday and Friday. These are basically the days when the ship is completely at sea and is not docked at any port. They had four dialysis machines and that meant they could dialyze four patients at a time. They had three shifts. I had chosen the last shift - at around 1:30 p.m.

The idea is to get you good enough dialysis so that you can take the cruise. They do not offer nocturnal dialysis which meant I had to watch my fluid intake and diet.

The nurses and technicians were quite good. They knew all the basic stuff and could take care of complications. They were very well trained. The nephrologist would visit us every session, do a basic review and adjust any dialysis parameters if needed.

I generally use 16 gauge buttonhole needles. They did not have 16 gauge but had 15 gauge needles. Luckily I had carried my needles with me and used those. I inject a little lidocaine (xylocaine) in my sites just before cannulating to reduce the pain. Though they had lidocaine they did not have the needles necessary to administer it. Luckily I had taken the syringes I use to administer the lidocaine as well. I used this.

The dialysis sessions were all uneventful. The weight gain was never too much and the fluid could all be pulled off quite comfortably. I guess I was too busy having a good time to think of fluids!

I managed to get only a little sleep during the sessions. The rest of the time I blogged using my iPad, heard some music or chatted with the nurse.

On Friday night however, I felt a little sick. It was a mixture of nausea and fever. I took a Dolo (Paracetamol 650 mg) and a Zofer 4 mg tablet. This helped me feel better.  It was probably the two day gap. I had never given such a long gap in my dialysis in a long time. The next morning also I felt nauseous and took a Zofer again. After a while I felt better. I then got my dialysis on Saturday and felt much better.

All in all, I think it was ok. I would have definitely liked to have access to daily, nocturnal dialysis on the ship but this was a good compromise. The trouble is you lose out on about 5 hours of your day which could have been spent having fun. And then of course, there is the issue of the aggressive dialysis compared to the gentle dialysis I am used to. This dialysis did make me feel kind-of zoned out after the session which did not allow me to stay up that late in the night.

Dialysis at Sea is doing a great job with this. They have made cruising possible for folks on dialysis. This would not have been possible without them. Yes, the charges are a bit high but at least it is possible! Here is a picture of me on dialysis aboard the Celebrity Century: