JWR Adds: Peritoneal dialysis at home should only be
considered a “last resort” measure, when there is no other care available. In
my estimation, the safest course for anyone who is on a kidney dialysis regimen
is to strategically relocate to a region that already has a capable,
well-established dialysis center with at least thee seats and that is in an
electrical power exporting region where the local power utility already has
plans in place for “islanding” their power, in the event of a grid collapse. I
described one such area (Farmington, New Mexico), in my novel Survivors. There are
several other such regions, mainly in the Pacific Northwest and in the Inland
Northwest. For further details, see my article: Islands in the Darkness: Some Local
Power Utilities Have Prepared to Go It Alone. – JWR
The power-grid goes down
two hours before you are scheduled to begin your next round of hemodialysis at
a clinic thirty-five miles away. Using the Ham radio, you discover through your
III Percent communications network that all power is down across the southern
sector. There is little hope of it being restored in the foreseeable future.
The clinic should have a back-up generator in place, so (other than an
inconvenience) your treatment should go ahead as planned. You lock the place
down, turn on the alarms, and then you and the wife head for the clinic. As
usual, when you leave you can’t shake the feeling of vulnerability, knowing
that the security of the homestead rests with Macs– an eleven year-old Labrador
that is racked with arthritis so bad that he seldom moves from his favorite
spot under the corner of the porch.
As you maneuver your way
down the hill, straddling the gullies caused by a recent downpour, you began to
question the rationality of your situation. Can you really survive a down-grid
scenario with renal failure? What happens if you arrive at the clinic to find
they have no back-up power? What happens if the roads are blocked or the clinic
is under attack by roving thugs looking to cash in on prescription drugs?
Questions, one after another, began to tumble through your mind; answers,
however, prove more elusive than the dust before yesterday’s rain. By the time
you make it to the blacktop, you realize that what you don’t know could be just
enough to kill you.
Those who suffer from
kidney failure must deal with these questions every day, praying for no
interruptions in their circumstances, and hoping to survive until a donor is
located and a transplant successfully performed; at least that is the case for
those whom transplant is even an option. According to the National Kidney
Foundation, of the 99,000 Americans on the kidney transplant list, fewer than
17,000 people receive one each year. Every day, 14 people die while waiting for
a kidney. Of course, there are no guarantees, especially when considering the
many obstacles encountered during this trying time (and the risks inherent with
dialysis). Fortunately, there are answers to many of these questions through an
alternative dialysis treatment– peritoneal dialysis (PD). PD provides patients
an opportunity (and the flexibility) to perform dialysis, regardless of
location or the need of electricity. This can mean the difference between life
and death in a down-grid scenario.
My knowledge of this
treatment came about through the personal experience of a dear friend that I
will refer to as Sniper1. Like me, he is retired, middle-aged, and doing
everything he can to prepare his family for the eventual collapse of society.
Regrettably, he was diagnosed in January 2013 with chronic renal failure. His
kidneys had shut down and toxins were building up in his bloodstream. After
numerous tests (which almost cost his life) Sniper1 was placed on a
hemodialysis regimen three times weekly (lasting four hours, each). He would
usually leave the house before sunrise to make the thirty-five mile trip to the
clinic. There, he would use his walker to slowly move to the check-in desk,
answer a litany of questions, fill out forms, and then spend about an hour in
the waiting room before being called back for treatment. He would then be
weighed and his ports connected to the hemodialysis machine. Approximately
three hours later at the end of his treatment, he was usually so tired and weak
that he required assistance back to the car for his return trip home. Due to
the side effects of hemodialysis, such as: cramps, nausea, vomiting, and
weakness, he was not able to drive himself back from treatment. This required
either his wife, daughters, or close friends to chauffer him the seventy miles
round trip, three times a week. He would spend roughly thirty-six hours with
these painful side-effects, slowly and painfully regaining some strength, and
then repeat the cycle again.
I watched as my friend’s
condition deteriorated, becoming progressively worse with each passing day, but
there was always hope in Sniper1’s eyes. He would force a feeble smile and say,
“Red Flint, we’re gonna buy us a mountaintop in West Virginia some day when we
win the lottery and I get to feeling better.” I would wholeheartedly agree,
anything to keep him in good spirits. We would discuss plans for our bunker and
spend hours exchanging ideas on scriptural issues and doctrines. As far as he
was concerned, this kidney failure was just another bump in the road, like the
rest of his life had been; he would get through it just like he had Vietnam and
everything else since then. He was determined to leave this world at the last
possible second, as Sniper1 is a true survivalist.
Not only is he a
survivalist, he is a realist and fully understands the urgency of his
situation. The side effects of the hemodialysis treatment were taking a
physical toll on his body and the long drives were putting a strain on his
finances in addition to causing an excessive burden on his family. Even in his
frail condition, he began to research alternative methods of kidney dialysis.
The last thing he wanted was to be dependent on the electrical grid. One
alternative method–peritoneal dialysis– sounded promising. He spent many hours
researching the pros and cons of this procedure.
Sniper1 believed he
could reduce many of these additional health problems by changing from
hemodialysis to peritoneal dialysis and improve his quality of life in the
process. More importantly, he wanted to be able to survive without the use of
electricity. His doctor agreed that he was a good candidate for peritoneal
dialysis and suggested he start the new treatment. The port in his chest was
removed, and a small catheter was inserted into the peritoneal cavity in his
abdomen. He was required to attend classes on how to perform the procedure
safely. Once he was cleared and certified as proficient, items required for the
treatment and the dialysate were shipped to his residence.
Unlike hemodialysis,
which requires the patient’s blood be cleansed through a machine, peritoneal
dialysis involves a change of fluids by force of gravity.
www.rch.org.au- A
single-dose flexible bag, containing dextrose solution, is hung on an IV pole,
and a small tube from the solution is connected to the catheter on the
patient’s abdomen. The peritoneal dialysis solution is instilled into the
peritoneal cavity. Through the process of osmosis, excess water and toxins in
the bloodstream are pulled into the solution through the semi-permeable
membrane of the peritoneum. The length of “dwell time” of the solution in the
peritoneal cavity is determined by the doctor. Afterwards, the solution is
drained from the patient. Normally, the fluid is drained and solution is
instilled at the same setting; this takes approximately thirty minutes for both
procedures and is usually performed four times each twenty-four hour period.
Patients are encouraged
to stockpile three months’ supply of dialysate. This is shipped to the
patient’s home via UPS or FedEx. Some facilities will allow a far longer
supply, if requested. The main concern is not to exceed shelf life. Storage is
the primary problem to overcome when requesting a large order.
Though there are
numerous advantages of peritoneal dialysis, there are precautions and warnings
associated with this procedure. Like all medical procedures there are risks
involved that could prove fatal, if proper procedures are not followed. The
greatest risk with peritoneal dialysis is infection. Every facet of this
procedure must be performed in an extremely sanitary environment, and all
tubes, catheter, and connections must be sterilized. Even something as small as
a dust mite can result in peritonitis; infection, if not treated properly, can
be fatal. Infection of the peritoneum has been described as a pain worse than
death. Sanitation cannot be overstated while performing this procedure.
Patients who are using
peritoneal dialysis should have routine evaluations to determine if accurate
hematologic factors and electrolyte blood levels are being maintained. This
osmosis process can cause a significant loss of water-soluble vitamins,
protein, and amino acids; replacement therapy may be required if levels are
determined to be too low. It is also extremely important to maintain a proper
fluid balance between treatments to prevent over- or under-hydration. Failure
to maintain a proper balance can result in shock and/or heart failure.
Sniper1 has been on
peritoneal dialysis now approximately a year and is enjoying a far better
quality of life than he did while on hemodialysis. He still suffers from
neuropathy in both feet and requires the use of a four-pronged cane sometimes
to keep from losing his balance. He can perform many tasks now that were
impossible while on hemodialysis, such as mowing the yard or working in his
garden. He is certainly not up to pre-renal failure abilities, but he can
perform roughly 70% of his normal daily routine.
It is still unclear as
to why his anti-immune system failed, leading to this life-threatening
condition. Sniper1 is presently on the waiting list for transplant and is being
tested continually to monitor whether he is a viable candidate. He may or may
not receive this operation; his white blood cell count is still too high, indicating
an anti-immune deficiency reaction. If fate dictates no improvement, he will be
required to continue peritoneal dialysis indefinitely.
Can Sniper1 or a reader
of Survival Blog really survive a down-grid scenario with renal failure? The
answer to this question is a resounding YES! There’s no need to worry about a
blackout, whether the clinic has a backup power source, if the roads are
blocked, or if thugs are on the prowl. This life-saving procedure can be
performed in the comfort of one’s home, while reading the latest edition of
Field & Stream, or The Patriot.
I write this so that
other readers of SurvivalBlog know that there are alternate solutions to their
health issues in a worse-case scenario. I, like everyone else in Sniper1’s
family and my own, was completely unaware that peritoneal dialysis even
existed. I have now seen its capabilities first hand and am duly impressed.
From the Survival Blog
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