Don’t hold it in…

Today is World Kidney Day. Well, so what? It is always something-or-other day and it is just one of many trying to raise awareness of many things.

I can put a personal view on looking after your kidneys, though, from the frouhjt experiences of my old man, Neil Grey.

When he was young, my Dad was an indentured apprentice at Parsons, a huge engineering concern in the north east. He was a turbine engineer and started travelling around, building Power Stations. He was working on one down near grays in essex, when he had an industrial accident. I don’t know the details, but he fell off some scaffolding and injured his back. He was in traction in hospital for a long time, but eventually made what was assumed to be a full recovery.

However, many years later, in the course of an investigation for something else, it was found that one of his kidneys was no longer functioning, but that the other had become a super-kidney, taking on the full workload. As he progressed into his fifties, he initially found that his tolerance of a full bladder dropped to the point where he was likely to become incontinent within a few minutes of feeling the urge to go. (The consultant gave him some special cards he was advised to show whenever he was caught short, advising the recepient that the bearer had a medical condition and should be granted access to any facilites due to being in dire need).

Attempts to control the incontinence via medication actually had a detrimental effect- he would not need to go to the loo for days on end. The unintended consequences of this was a back-pressure from the bladder onto the working kidney. The tiny little muscle that relaxes in order to empty the bladder was eventually diagnosed as no longer detecting the signals properly so he was fitted with a catheter and a urine collecting bag. Unfortunately, however, his renal efficiency was now down to a very small percentage and he was permanently tired from all of the toxins in his bloodstream.

At this point, he was introduced to CAPD, Continuous Ambulatory Peritoneal Dialysis, a sort of half-way-house to full blood dialysis. The peritoneum is a layer surrounding most of the internal organs in the abdomen and there is actually a small space within. If you fill that layer with a saline fluid of the right concentration, then the fluid will absorb toxins from the body through the process of osmosis. In practical terms, it is necessary to drain off and replenish the fluid four or five times a day and there is a strict regime of having a bag ready in a warmer so that it is at body temperature when required. It tethers the patient for about twenty minutes as it takes half the time to drain the last solution out and then the new bag is connected to the plumbing and hung on a drip stand. You also have a short pipe sticking out of your tummy and need to ensure a sterile regime for connector cleanliness & replacement.

Now when Neil was on CAPD, he was working in a shop and living above, so fitting a regime around the need to change bags wasn’t overly onerous on him, but if he had worked somewhere else it would have been a lot more difficult with having to have stock and equipment at his workplace (or taking it with him). His previous job as a night mini-cab driver for a Company with no driver facilities whatsoever would have been untenable.

Something we didn’t appreciate when he first started doing CAPD was the quantity of consumables that the NHS would deliver to him and the amount of room it took up. A day’s supply of CAPD bags is about the size (and weight) of the boxes of A4 photocopy paper you see in offices and he would get deliveries of at least twenty of these every couple of weeks.

Now CAPD is only partially effective and as the kidneys continue to deteriorate, there comes the point where it is not quite enough. Eventually, he started to go for an occasional haemo dialysis, for which he was fitted with a substantial canula on one of his arms. Kiyney dialysis machines at the time were quite large but much of the mechanism was to do with pumping the blood smoothly through the machine and returning it to the body. The bit in the middle was the filter unit, where the toxins were trapped and seperated.

Neil would actually return from these sessions invigorated. After feeling like death warmed up beforehand, he would be full of the joys of spring for the rest of the day.

Eventually, Neil went onto full haemo-dialysis. By this time he had given up work due to ill health and was living in sheltered housing with my Mum (who was effectively his full time carer). He gradually developed additional conditions, like Diabetes. Someone with renal failure has to massively curtail their intake of fluids and eat a strict controlled diet. Much of the time he was just too tired and shagged out to do anything at all, even eat.

His post-dialysis day was the best, he felt human again. The day after, he felt ropey. The day after that, he felt seriously rough. So it went, week in, week out.

Eventually, he died in his sleep. The death certificate said heart failure, but at the end of the day nearly everybody dies of heart failure. It was his kidneys that killed him, a long, slow, tedious, monotonous death by chronic illness.

His one piece of advice to me? If you need to go, go, don’t hold it in. When the doctor asks if the waterworks are OK, tell him straight.

The official advice is a bit more wide ranging… (pdf)