Kidney Punch

"I'm going to put your oxygen in," Renee calmed in a not-too-syrupy, but just-syrupy-enough, heads-up voice while she directed the clear tubes to Cam's nostrils. 

He was moaning continuously and trying but not trying to arch his back.

His oxygen absorption rate had dropped to 79 when Nurse Brandy called for reinforcement from the dialysis Charge Nurse Renee.  Now absorption was flickering in the low 80's. Below 90 causes a nurse to stand at attention. Ideal absorption rate is 100%.

Who knows what other numbers where on the heart monitor? Not me. I couldn't take my eyes off him now. 

What should I do? Just keep rubbing his legs?

I'd never seen him in pain like this before.

The nurses worked. Quickly and calmly. They weren't shooing me away, so I tentatively massaged his legs and murmured reassuring words. 

I'm so glad we're still here.  Here, as in Wake Forest, where we're familiar with procedures and the dialysis staff is familiar with Cam. That thought of gratitude actually played through my mind as a complete sentence -- in the hospital even. And the other: I've never seen him like this before.

What I was seeing that I had never seen before was the distinct pain and discomfort of an allergic reaction to dialysis.

I know. Who knew?

I'll try to simplify what I understand of what transpired by using this diagram from Wikipedia, since I can't find the pictures I’ve taken of our machines:

But first, the machine is not larger than a person, as the diagram here might have you think.  The ones we're used to stand a bit less than 5 feet. And the diagram’s parts are hugely disproportionate -- we’ll presume that the artist is providing detail shots -- plus, the big screen at the top has been left off. But, honestly, the only numbers on the screen that I understand anyway are the ones on the count-down timer.

Okay. So an allergic reaction happens because of the dialyzer, which looks like a small vacuum filter. Brandy approved of that observation, by the way. Except that the filter tube is filled with fibers that are way more sophisticated than the fibers in my vacuum's filter.

The filter does the work of -- you guessed it -- filtering the blood for impurities, accomplishing a lot of the work of a kidney. Toxins and urea get filtered away from the patient, while the important blood cells go back to the patient's body.

A patient can have an allergy to the type of fibers used in the filter, or the way that the fibers are sterilized.

According to Brandy, an allergic reaction can happen on the first session or the tenth -- but it usually happens at the beginning of the session. This was Cam’s 15^th session in three weeks, but it did happen in the first twenty minutes.

Allergic signs Cam had:

•  A sudden HOT “mask” across his eyes that grew into a hot flush through his face and then the body. Cam asked for blankets to be removed and that I fan him.
• Extreme pain in the lower back, which he likened to someone hitting him with a baseball bat.
• Temperature jump – in his case, to 100.7
• As mentioned above, oxygen absorption drop.
• I’m pretty sure blood pressure dropped, but also mentioned above was the fact that I wasn’t reading monitor numbers – my job was to love and comfort.
• The flush through the body gives way to chills. Cam was shaking uncontrollably and eagerly received additional layers of heated blankets.

The nurses removed him from the dialysis machine and waited for his symptoms to subside before changing his filter to a pricier type that doesn’t clean as quickly but is also unlikely to cause a reaction. 

The whole episode was probably about fifteen minutes from inception to the time he began to recover, but I'm sure it seemed much, much longer to Cam.

Brandy also suggested that he might have been having mini reactions for awhile, but that they were small enough to go unnoticed.  He did in fact, have an awful, full-body flush that was hugely disconcerting to him some time around treatment #7 . . .

And the reaction may solve one of the mysteries about why he’s had continued nausea to the point of vomiting four different times in the past week . . . something his surgeon told us yesterday morning should NOT be occurring.

So far today, no vomiting.

As Cam says about the tiniest of good news: I’ll take it.