Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jun 2003 13:15 Post subject: Educational Questions, Part 46.
To our Readers and Posters,<
>The best defense in any fight against a disease is education. <
>This column of questions and answers is an attempt in that direction. Anyone is welcome to ask questions. <
><
>What I want to reiterate again is that my answers to your questions DO NOT and SHOULD NEVER take the place of your Dr.'s advice. I am not a Dr. and my answers are based on my many years of experience in the dialysis field. What works for one patient may not work for another. EVERY Patient needs to schedule and attend regular visits with your Dr. in their office.<
><
>This column is for dialysis and dialysis related questions. Please be aware that clinics and companies, machines, policies and procedures vary from place to place. <
><
>I hope that we can help in furthering your dialysis education.
>Thank you!<
>Founding RN <
><
>P.S. I work full time so I may not be able to answer your questions right away. But I will get to them ASAP! <
>
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jefelex
Joined: 03 Jul 2003
Posts: 2
PostPosted: 03 Jul 2003 14:47 Post subject: Re: Educational Questions, Part 46.
Slightly off topic (sorry, founding RN!) <
><
>Hi! I'm not a nurse, I'm a bio-med technician who looks after the maintenance of the dialysis machines and other equipment in our clinic. <
><
>A few years ago I wrote a simple computer program the will help you work out your KT/V or URR if you know your blood results, and your nurse is not assisting you with these calculations. it's completely free, has no advertizments or viruses, and is not part of an e-mail address harvesting scam. <
><
>It's only a grey and white MSDOS based program, but it will run on virtually any computer. I'd be pleased to send it to you if you want it. Just send a message to my e-mail box and I'll attach the program as a reply to your message. Just be sure to include some or all of this message and I'll be sure to know what you're emailing to me about. Also, be sure to include the letters ktv in the subject line of your message, or my message filter may bounce it back to you. (I hate spam mail as well!!) <
> <
>
>
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Jul 2003 02:22 Post subject: jefelex
You are welcome to send me your program if you wish at my e-mail address. Would you be willing to provide this to any patients who might want it also?<
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jane
Joined: 30 May 2003
Posts: 3
PostPosted: 19 Jul 2003 02:15 Post subject: stroke
Are strokes common on dialysis?
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jane
Joined: 30 May 2003
Posts: 3
PostPosted: 19 Jul 2003 02:20 Post subject: high pulse
My pulse goes very high at the end of tx. The next to last pylse might be about 105 and then the very last pulse with standing bp goes to 120-145. What causes this? Is it normal as long aas it goes down after tx? My staff talks like I'm the only patient with a pulse like this.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 19 Jul 2003 11:55 Post subject: Jane
Strokes are not common on dialysis.<
><
>Your high pulse may be your body telling you that you have gotten too dry. Aim for a slightly higer weight to come off, say 0.5 kilo and see how your pulse is. In my expereince, this is usually your body's way of saying that you have gained a bit of actual weight. If your pulse stays up no matter what, then you may need to see a cardiologist to rule out any other problems.
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patient
Joined: 30 Oct 2002
Posts: 137
PostPosted: 24 Jul 2003 12:18 Post subject: Archives
I have wanted to search the education board archives. Does DEO still plan to add them?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 24 Jul 2003 23:02 Post subject: Archives
The educational topics were mixed in with the regular topics so it should all be together. The columns are titled the same as here, Educational Questions, Part --. Have fun!
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Ellie
Joined: 26 Jul 2003
Posts: 2
PostPosted: 26 Jul 2003 12:41 Post subject: hgb
My hgb this month is 12. I've read where others say they feel well because theirs is 13 something. What determines hgb and is there anything that can be done to get it higher?
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Jason
Joined: 26 Jul 2003
Posts: 12
PostPosted: 26 Jul 2003 12:46 Post subject: access
If an access is going out what are the signs? Does it always show up in the ap or vp? How soon should a patient be seen by a surgeon if the access is having problems?
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Chrissy
Joined: 26 Jul 2003
Posts: 1
PostPosted: 26 Jul 2003 12:51 Post subject: surgeon
How do you find a good vascular surgeon? A tech told me that he knew of a surgeon I should not go to. He said he butchered the arms of so many patients with their access surgeries. He said I should go to a bigger city if I wanted to find a good surgeon.
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Jasmine
Joined: 26 Jul 2003
Posts: 1
PostPosted: 26 Jul 2003 13:02 Post subject: sodium
I try to keep my sodium low, but its almost impossible to keep it to 2000 mgs a day as everything has sodium in it. My bp is not high. Does that mean I am keeping my sodium low enough?
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Jacob
Joined: 26 Jul 2003
Posts: 1
PostPosted: 26 Jul 2003 13:07 Post subject: high arterial
How do you straighten the needle out if the ap is high?
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achey
Joined: 26 Jul 2003
Posts: 1
PostPosted: 26 Jul 2003 13:11 Post subject: bones and muscles
My labs are great, but I have achey bones and muscles. Is this caused by kidney disease or something else?
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patientwife
Joined: 18 Jul 2003
Posts: 47
PostPosted: 26 Jul 2003 17:46 Post subject: IV Iron
How does IV iron affect labs? <
><
>At some time I was told that IV iron needed to be discontinued 10 days prior to drawing blood for monthly labs. Does this apply to Iron Dextran, Venofer and Ferrelecit alike?<
><
>Lab's reference ranges re this communication are:<
>Retic HGB(CHr) - 25.4 - 31.8; Iron - 45 - 160; UIBC - 110 - 370; TSAT - 20 - 55; Ferritin - 22 - 322.<
><
>Ferritin value for blood collected 03-18-03 was 120. <
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>My husband completed an eight-treatment course of IV iron on 04-17-03. Blood was collected for monthly labs on 04-22-03. Results were Retic HGB (CHr) = 35.2; Iron = 54; UIBC = 132; and TSAT = 29. (HGB = 13.7; HCT = 43.0; HGBX3 = 41.1).<
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>On 05-03-03 my husband began a trial of oral iron, Anemagen Caps, 1 daily. Blood was collected for monthly labs on 05-20-03. Results were Retic HGB (CHr) = 34.7; Iron = 49; UIBC = 127; and TSAT - 28. (HGB = 14.3; HCT = 41.8; HGBX3 = 42.9).<
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>My husband continued ortal iron trial during June and nephrologist had indicated that assessment/decision re use of oral iron would be made following monthly labs. However, on 06-12-03 my husband was administered IV iron (Ferrlecit 125mg). Blood was collected for monthly labs on 06-17-03. Results were Retic HGB (CHr) = 39.2; Iron = 106; UIBC = 93; TSAT = 53; and Ferritin = 321. (HGB = 14.3; HCT = 43.9; HGBX3 = 42.9).<
><
>Why would oral iron have been administered on 06-12-03? Would the one-time IV administration on 06-12-03 have affected the labs for blood collected on 06-17-03?<
>Would the IV administration in April have accounted for increased values in June?<
><
>Your help
is appreciated. <
> <
><
>
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Ellie
Joined: 26 Jul 2003
Posts: 2
PostPosted: 27 Jul 2003 11:55 Post subject: hgb Reply with quote Edit/Delete this post Delete this post View IP address of poster
The amount of EPO given helps determine how high your hgb is along with adequate Iron stores in your blood. If you were given more EPO then it would go higher. But Medicare will not pay for EPO if your hgb is higher than 12 so don't get your hopes up. This is because the companies use the DOQI Guidelines as their standards, just as Medicare uses them also for reinbursment. <
>Yes, most people do feel better with a higher hgb because it is closer to what they had before renal failure struck.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jul 2003 11:59 Post subject: Jason
Yes, it usually shows up in the venous pressures and a surgeon should be seen if your venous pressures are consitantly higher than normal for you. If you don't see a surgeon, you risk clotting your access.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jul 2003 12:04 Post subject: Chrissy
Ask around, ask patients and staff, and don't leave out your Dr. While it is true that many small towns have a limited choice of vascular surgeons, you just might find a good one anywhere. <
><
>It is true that in a bigger city you will have more choices. Ask around and observe to how many patients are having multiple visits to a surgeon. If they are going alot, then that may not be a good choice. Also be aware of infections. If patients going to certain surgeons have increased infections, it may be wise to keep looking.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jul 2003 12:10 Post subject: Jasmine
You are doing the best you can and it is hard enough to do. Consult with your dietician on this one and go over what you are doing with them and maybe they can give you a few helpful tips or suggestions. Sodium can be removed in dialysis so if you do get too much, something can be done about it.<
>Some people just have naturally low BP's. I would worry more about your low BP as if it gets too low, you risk clotting your access or passing out. If this is a problem, then do see your Dr. and ask what you can do about it.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jul 2003 12:12 Post subject: Jacob
Once that needle is in, it really can not be straightened. sometimes by just pulling the needle back just a fraction can help. Otherwise a second needle may need to be placed in a different area. <
><
>If high pressures are a continuing problem, then you do need to see a surgeon as your risk of clotting off your access is increased.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jul 2003 12:14 Post subject: Achey
It could be from renal failure but then it could be from age related problems. Do consult your Dr. about it to get to the bottom of what is causing your aches and pains.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 27 Jul 2003 12:27 Post subject: Patientwife
There is on-going discussion about how labs for Iron should be drawn when a series is being given. From what you have posted, it sounds like your company/ unit is one of those who wants the series done before it draws the labs. That is fine. This would apply to all kinds of IV Iron that is given.<
><
>Oral Iron has long been considered of little use to an ESRD patient due to the fact that they are unable to absorb it and utilize it very well. The fact that your husband recieved another dose of IV Iron says that the oral did not do as well as they thought it might. Yes, the one time dose might have affected the result of the oral trial. To see how much, a blood sample should have been drawn before the one time dose of IV Iron was given. Keep an eye on this trial as this could scew the results if they do not aknowledge the IV given. You may want to mention to the Dr. who is doing the study that your husband recieved that 1 IV Iron does and when. he may not be aware of what happend. <
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>Depending on how fast your husband utilized the IV Iron given, the series would show up in his labs for a several months and affect those labs drawn later. Yes, the April series could still show up in June. <
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