Something with my dialysis treatment went terribly wrong last Friday. Half-way through the session, I started to get leg cramps. All sorts of cramps are common for dialysis patients, but not for me—I haven’t had cramps for years; I’m close to obsessive-compulsive in managing my fluid intake. For the last few months, though, I’ve had intermittent leg cramps. My cramps are especially strange. You’d expect that I’d cramp in my calves or my thighs, but no, I cramp in my shins. Shins. How weird is that?
On Friday I immediately recognized cramps coming on and asked the technician to stop the ultrafiltration and give me a shot of saline.
Ultrafiltration is the osmotic process by which fluids are removed from the bloodstream. Too much fluid in the body results in higher blood pressure and other complications.
At the same time I started cramping, I became severely disoriented, weak, and nauseous. But I didn’t crash, and retained consciousness.
After about a half-hour I asked that the ultrafiltration resume and I finished my treatment. I came off 0.8 kilogram above my dry weight, which is quite rare for me. My disorientation, weakness, and nausea became increasingly severe throughout the last half of the session. I somehow managed to drive myself home—the dumbest thing I’ve done in a while; when the nurse asked me if I was okay to drive, my response was, “of course.” Once in the car, it took me a full three minutes of intense concentration to remember where I was going—home—and how to get there.
My disorientation, weakness, and nausea continued throughout Friday night and Saturday morning my wife called my primary care physician, a partner of whom instructed her to get me to the emergency room. If I couldn’t manage it myself, it was a call to 911 and an ambulance. Not wanting to pay the ambulance bill, I got myself to the car and Karen drove me to Saint Joseph’s Hospital.
In Saint Joe’s emergency room, technicians drew blood samples—a lot of blood samples, ran an electrocardiogram, and started an intravenous drip. Oh no, bad idea. I’m already almost a kilo heavy and I’ll have to pull all this extra fluid on Monday. The initial blood work showed nothing but relatively high potassium (under 6.0). I explained that I hadn’t eaten breakfast and had a banana Friday night after dialysis. They remained unconvinced and drew more blood.
Bad news. The blood work still showed nothing and I still felt horrible. I had to be admitted. My hopes for a quick emergency room in-and-out were gone.
I’m wheeled to my room and what’s the first thing they do? Start an intravenous drip with an even bigger bag of saline and draw yet more blood. And a heart monitor. My primary care physician’s partner comes to do an examination and orders a chest x-ray. Several times with the blood draws throughout the day Saturday and Saturday night. And yet another big bag of saline for the IV drip Saturday night.
Sunday morning I’m feeling marginally better—I’m more frustrated than disoriented, but still pretty weak and nauseous. By noon I’m on the mend and my primary care physician’s partner is in to see me again and agrees to release me as soon as someone from my nephrologist’s practice sees me.
About 2 PM one of my nephrologist’s partners comes to do an examination, lectures me (nicely) about getting a transplant, and declares me okay. I’m free.
First thing I do when I get home is hit the shower—I haven’t had a bath since Friday morning and I’m one of those old farts who needs one every day to feel human. Second thing I do is hit the scale. Please, please, please no more than 211; okay I’ll take 212, but please no more. 206. What? How did I manage to lose three pounds. I only missed one meal over the course of the weekend and all that IV fluid… what happened. Next morning I weighed 204. Yikes—a 5-6 pound drop. Was my body mightily fighting something off and actually won for a change? Who knows.
I went to my scheduled dialysis session on Monday and pulled one kilo of fluid, had the usual diarrhea after the treatment—my nephrologist’s partner attributes it to dialysis being an unnatural act—did some work, and went to bed.
One positive thing that came out of this ordeal was that I really like my nephrologist’s partner. She’s frank and listens. And she’s an internist as well as a nephrologist. Karen’s been on me to see an internist.
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