Wednesday, April 19, 2017

Numbness in left hand fingers



Among the two problems that I blogged about a few days back, one of them has been addressed, temporarily at least, by the hyaluronic acid injection I was given a week back. The other problem remains.

The trouble is it does not let me sleep well on my non-dialysis days. Last night, I did not dialyze and this morning I woke up finally at 4 am after having a restless one hour. And here I am blogging at 5 am in the morning after having some Darjeeling tea. My doctor has suggested that I try an ointment for symptomatic relief. Honestly, I don't like the sound of that. Basically it means that there is no permanent solution for this.

For some time, I was like a ball in a tennis match, being thrown from one court to the other court, the neurologist and the vascular surgeon playing the match - "Not a neuro problem", "Not a vascular problem"! Multiple investigations yielded no clue.

When I did not have this problem, I used to sleep till 7 - 7:30 after my non-dialysis nights. That used to feel so good because I could not sleep beyond 5 am on dialysis nights. Now I sleep well till around 5 am on dialysis nights and on non-dialysis nights, I toss and turn, sit up to relieve the numbness and then try to go back to sleep again. After a point I just give up. My watch shows 3 am or 4 am on most such nights.

I have stopped traveling completely due to these two problems. The knee pain was especially debilitating. After I have taken the injection, I am still on the NSAIDs and the doctor said he will withdraw them after a month. I have been given a timeframe of 2 months to a year by different doctors on how long the effect of the injection will last. Sometimes I think, once the pain goes completely (my knee still hurts towards early evening these days), I should travel a bit but due to the hand numbness I am quite wary of traveling. Nights would be quite disturbing since I would not be dialysing at night.

On long term dialysis, it is these additional problems that bother you more than the kidney failure itself. I honestly, don't mind the dialysis these days. I just wish it was the only thing I had to deal with.

Wednesday, April 12, 2017

Hyaluronic Acid Injection for Osteoarthritis in Dialysis Patients: My experience



To address the first problem among the two I mentioned here, I got an injection of Hyaluronic Acid in my left knee yesterday. The thought of getting an injection in the knee can be quite disconcerting even for a dialysis veteran like me who gets daily injections in his left upper arm for dialysis. I had all sorts of questions. Would the needle be put into the bone? How big would the needle be? Would they be giving me a local anesthetic? Would the entire experience be painful?

I was called to the hospital at around 4 in the evening. I reached there promptly. The injection was called Synvisc One. The Orthopedic Doctor was to administer it. He had done this many times and was very confident. He first cleaned the entire left knee with Betadine (Povidone-Iodine solution). He then injected good old Lidocaine. I use this for my dialysis too just before inserting the needles. For this procedure though, he probably inserted a whole lot more than what I do. I couldn't see what was happening because I was asked to lie down and all the action was happening in my knee.

The next step was to put in a needle and position it carefully so that it is in the knee joint. For this he inserted a syringe and then drew the piston. If blood came, the needle was not in the joint. If clear fluid came, then it was in the joint. The first time, only blood came. He then tried repositioning it. Blood again. Every time he drew the piston of the syringe, I felt some pain. It was not unbearable. It was more like a momentary shock. After about three such tries, finally, he got the needle into the joint. He quickly removed the syringe leaving the needle there. He inserted the syringe that was prefilled with the 'miracle juice' as he called it and inserted it into the needle and pushed all the contents into the joint. He removed the syringe with the needle. It was done!

It was a tough task. The Doctor was brilliant with it. To insert a needle into the joint without anything to guide you is like shooting at a target in the dark. He kept assuring me, talking to me and calming me down. I love such doctors.

Yesterday evening, I had a lot of discomfort. The knee joint felt very stiff. I found it difficult to walk. After a while, I became very restless. I couldn't sit still. I tried to distract my mind by watching a movie. The knee wasn't painful at all. It was just discomfort and restlessness. I took a low dose sleeping pill and went to bed.

Sleep was quite disturbed. I kept waking up due to the restlessness and discomfort in the knee. I had a final stretch of good sleep though and woke up feeling refreshed and much better than last night.

Overall, I think the entire experience of taking the injection was not painful. I would call it 'discomfort'.

The Doctor said the injection would take 4-6 weeks to kick in. I hope this resolves this knee pain, at least for a year.

Sunday, April 2, 2017

The one additional feature I wish dialysis machines had



Dr. John Agar asked all the patients on the Home Hemodialysis group on Facebook a few weeks back, what additional features we would like on hemodialysis machines? I don't remember the exact words and I don't even remember what I answered.

Thinking about it now, I feel that if there was an accurate way for hemodialysis machines to determine how much above my dry weight I actually was, I think it would make my life a lot easier.

Dry weight is the weight of a dialysis patient assuming there is no excess fluid in the body. Since the kidneys of a dialysis patient do not work, excess fluid and toxins that healthy kidneys remove, start accumulating in the body leading to various complications. These are removed during the dialysis treatment.

While toxins are removed automatically based on the concentration gradient between the blood and a fluid called dialysate and we usually do not 'set' the amount of these toxins to be removed, the fluid is removed based on a machine setting. You basically 'set' the machine to remove a certain amount of fluid. If you're a good boy or girl, this is typically under 1 to 2 litres. If, on the other hand, you're like me, a non-compliant patient, this could be up to 5 litres sometimes!

Now the tricky part is figuring out how much to remove? Apart from the additional fluid, the patient's weight might have risen or fallen due to various other factors - exercise, nutrition, just after a meal etc. For us nocturnal patients, the last one of these is typically the culprit. Your weight may be off depending on how light or heavy your dinner was and how long after dinner did you check your weight to determine your fluid removal goal.

Due to this, I have often tried to remove too much or too little fluid leading to all kinds of issues.

If the hemodialysis machine could automatically detect the amount of excess fluid and advise me to remove a certain amount, I could either accept or ignore that advice. The technology I think is already available. I have seen a machine some time back that used Bioimpedance to determine the amount of excess fluid in the body. It wasn't accurate enough though.

By improving the accuracy and integrating this technology into the hemodialysis machines, I am sure many patients would be saved from complications such as cramps, hypotension and breathlessness due to wrongly setting fluid removal goals during hemodialysis treatments.

Saturday, April 1, 2017

Wah re marketing!

I happened to taste Cranberry Juice from Real at my brother's house one day. I really liked the taste. I promptly bought a one litre pack a few days later and kept it in my refrigerator to sip whenever I felt like some. A few weeks after that pack got over, I went to the supermarket and happened to see a Real Cranberry Juice packet on the shelf there.

I picked it up and checked the ingredients.


If you look at it carefully, you realise that the main ingredient is water, next is sugar and in third place is Cranberry Juice concentrate. Also only 2% of the contents are actual cranberry juice! What kind of gimmick is this? Only 2%!

My eyes then fell on a packet of Tropicana Cranberry Juice. I picked that up and checked the ingredients. I thought this might be better as they have all this '100%' campaign going on.


I was in for a huge shock. Water and sugar were first and second on expected lines. However, Red Grape Juice was third and Concentrated Apple Juice was fourth! Concentrated Cranberry juice was fifth and was only a measly 0.5%!

Who allows this kind of nonsense? Aren't the regulatory authorities supposed to check such fraudulent practices? How can something that has more grape and apple juice than cranberry juice be sold as Cranberry Juice?

I had a problem with the Real product as well because that contained only 2% Cranberry Juice. and here was the Tropicana version that really took the cake!

We all need to learn to read the ingredients of what we buy from stores. I read somewhere that we should never buy anything that has more than three ingredients. While that would be really difficult to practice, at least reading the ingredients of products would give us a lot of information on what we are actually buying.