Life On Dialysis:

It Isn’t Easy, But It Is Life

By Martha Coville

Dialysis is a physically draining procedure.

“What it is, it’s something you wouldn’t wish on your worst enemy,” said Liz Madison.

Ms Madison, the nurse manager who runs the Nelson Gelfman, MD, Dialysis Unit at Danbury Hospital, is not tossing around clichés. She is speaking in the sympathetic, but unsentimental manner health care workers reserve for truly painful diseases and treatments.

Edina Nakano is one of seven Newtown residents dialyzed at Danbury Hospital. She refuses to define dialysis in such terms. “Nobody likes to go to dialysis,” she said, “but you go because you have to go, because your life depends on it.”

“I’m very optimistic,” the mother of four said. “I take my life as a gift, and you have to live that way.” In fact, she said, “Dialysis actually helped my quality of life.”

Ms Nakano, a diabetic, said that when she started dialysis four years ago, she was “full of water. I had about 70 extra pounds of fluid on me.” She said that because of her diabetes, her doctors had been monitoring her kidneys, and helped her postpone treatment by restricting her diet. “I stayed off protein,” she said.

But the extra fluid weight meant Ms Nakano had trouble walking, even around the house.

Her husband, Dr Yoshizo Nakano, a retired psychiatrist, said, “You know, dialysis saved her, in a way. It gave her mobility, and it have her hope, because she might be able to have a transplant.”

After three or four weeks of treatment, Ms Nakano said the excess fluid had been drained away. She still relies on a powered wheelchair for longer distances, but she a regained a great deal of mobility.

She has not been hit hard by the aftereffects of dialysis, either. Ms Nakano says she has not suffered from the piercing headaches, aching cramps, or cold chills that many patients feel after their treatment is finished. After dialysis, she says, she usually goes home and naps for 30 minutes or an hour. “It does tire you out,” she admits. “There’s no two ways about it.”

‘Nothing Painful Or Scary’

Ms Nakano invited The Bee to visit the Nelson Gelfman, MD, Dialysis Unit, which moved to the new Danbury Hospital Medical Arts Center building in December. The unit is “very untypical in the dialysis treatment community,” according to Ms Madison, because it is owned and run by Danbury Hospital. Most dialysis units are run by private companies operating a chain of clinics. Ms Madison was quick to note that ownership “makes no difference in the quality of care,” but Ms Nakano said it gives her piece of mind to know she is right next to the hospital, should something go wrong. “We’re very lucky here,” she said.

Both Ms Madison and Ms Nakano praised the new building housing the dialysis unit. “This is a huge improvement for our patients,” said Ms Madison. “The old facility was not very modern or aesthetically pleasing; you know, white walls, white floors,” she said. The new building is larger and more efficient, too, she said. “We went from having five chairs for dialysis patients in the old unit to 20 in here. And in the previous place, you kind of had to retrofit the old space to the machine.”

Ms Nakano, reclining in her chair, looked comfortable enough in the new, sunlit unit. “It’s nice and spacious here,” she said. And even though part of the building is under a parking garage, “there’s no noise.”

Her chair, a roomy, cushiony recliner, more like a bed than an armchair, lies in the first of two rows. Curtains, hung from the ceiling, provide the option of privacy, as in shared hospital rooms. Ms Nakano looks around and points out the room’s features. “Each patient has their own TV and heater,” she said.

The tubes connecting her to the dialysis machine were not readily noticeable. They are transparent, and smaller in diameter than drinking straws. The machine itself, the size of a narrow dishwasher, stands to Ms Nakano’s right. A few figures flashed on the screen, and a small tube, the size of a water bottle, hangs to one side.

“I brought all my four grandchildren in here,” Ms Nakano said. “I brought them in one at a time, to show them what it looks like. I said, ‘See, there’s nothing to be frightened of. It doesn’t hurt. There’s nothing painful or scary.’”

An Artificial Kidney

Ms Madison said that dialysis, also called renal replacement therapy, functions as an artificial kidney. The job of the dialysis machine is therefore to “clean” the blood. During dialysis, levels of electrolytes like sodium and potassium are adjusted, and toxins, byproducts of metabolism, are removed from the blood stream, along with excess fluids.

The large machine to Ms Nakano’s right “is really just a safety unit,” Ms Madison said. The real work is performed in the dialysizer, the water bottle-sized tube. It is transparent and looks as though thick paper towels had been folded up, accordion-style, inside it.

They are actually “tiny straws, made of semipermeable fiber,” Ms Madison said. The fibers lay between the blood drawn from the body and solution of electrolytes in ultra purified water, called dialysate, also pumped into the dialysizer. Smaller molecules can flow through the fibers, and as the blood passes through the dialysizer, sodium, potassium, and toxins are drawn off from the blood and into the dialysate solution.

 

‘The Whole Process’

Although dialysis is, as Ms Nakano assured her grandchildren, painless, it can also be brutal. Patients typically undergo three sessions of three or four hours every week. Ms Madison said, “Dialysis replaces round-the-clock kidney function with those three sessions. That means ups and downs of toxin levels. It’s a rollercoaster effect.”

And even though blood flow to and from the body is carefully regulated during dialysis, patients still experience sudden changes in blood pressure as blood leaves and returns to their bodies. Ms Nakano said that her husband brings her to her sessions, and waits until they are over. He does not want Ms Nakano to have to drive home if changes to her blood pressure have made her feel weak or dizzy.

Dialysis patients also complain that their blood cools during treatment. Again, despite how carefully the process is monitored, blood often returns to patients’ bodies a little colder than it left. Bringing the blood back up to body temperature, even if the difference is just fractions of a degree, requires hard work.

Finally, some patients find the effects of dialysis on their quality of life more difficult than others. Working full-time becomes difficult for patients who have sessions scheduled during the work week. Being tethered to the dialysis machine means taking a weeklong vacation is impossible. Other patients resent the dietary restrictions imposed by dialysis.

Dialysis units always include a dietician and a social worker to help patients adjust to the changes dialysis demands. “It really depends on the patient,” Ms Madison said. “Some accommodate very well, and some resist. I always tell patients a lot has to do with their own attitudes. A lot has to do with their support systems, if they don’t have anyone to check up on them. It’s not an easy life, it’s a very difficult life.”

Ms Nakano, still in her dialysis chair, said she is very thankful for the help her family provides. “I have a wonderful family,” she said. “They take care of me, they are my lifeline.” She looks around at the clean, quiet unit. “The whole process,” she said, “just look at it. It’s not so bad.”