I wrote this in response to a new patient's questions on the Home Dialysis Central Discussion Group:

I started in center then tried PD which works for many many folks. The catheter insertion is a relatively simply procedure which is often done without invasive anesthetics. I believe I had a couple of Verseds and then some lidocaine on the site. I don't know of anyone who likes a catheter sticking out of their belly or neck, or a bulging vein on their arm or leg in the case of a fistula or graft. What you will find though is that these become your life line. Literally as in they keep you alive. Dialysis patients are some of the most resilient folks I know. We have to endure much change, but the successful patients embrace the changes realizing that the alternative is death. For a number of reasons, primarily relating to me not making any urine, PD didn't end up working for me. After my second kidney transplant (the first was from my wife) failed due to FSGS I found myself back in center. I read about NxStage and found a center an hour away.  

On the same thread, another poster had concern with doing nocturnal home hemodialysis so added this:

After two years of sitting in the chair doing short term I knew there was a better way. Also, following the good information you get at Dori Schatell's sites and others, I realized as I think you and your wife do too, how much better my dialysis and my outcome will be with longer and slower dialysis (just like my BBQ). I have found now doing nocturnal for seven years is that my body just doesn't toss and turn when I'm on nocturnal dialysis. On the nights off, I'm all over the bed. It is the same principal that keep you from falling out of the bed. There is a subliminal recognition of your position. I also secure my needles well. I've never had a needle dislodge. Recently though because my graft is getting older I did experience a slow leak that was not detected by wetness monitor. While I generally do my dialysis by myself, that night, my wife leapt into action and everything turned out all right. My ten year old walked in and saw the mess and immediately walked out. Having been on dialysis since my fifteen year old son was one, my kids have seen a lot, but to them it is just part of life with their dad.

And additional concern of the poster was what impact a PD catheter might have on one's love life.  To which I added:

Shy fellow that I am Dori, I'll just say that I didn't have much libido on in center or PD. It wasn't until I got on NxStage, five years after I started on dialysis, that the urge returned to near pre ESRD levels. And, once it returned I was pretty darn happy, my wife needed a bit of convincing though (taking care of a sickly dude for five years can take a toll on a healthy person's desires). I was so happy, that I sent an email to Jeff Burbank, founder and CEO of NxStage telling him that I thought NxStage was better than Viagra. A few years latter I ended up writing an article about this for a Finnish Company which was introducing the new technology to Findland.

For all of you who donate blood, thank you.  If you have ever wondered who receives it, well I got a pint of Mid-Michigan's finest last night.  The graft in my left bicep that I use for daily at home hemodialysis is like a garden hose.  A garden hose that sits under a steel rake that keeps getting stepped on. The act of puncturing the the hose repeatedly flattens it and makes the holes larger.  Those larger holes allow the water to come out faster.

It has been Shocktober at our house.  Instead of water coming out of the hose, I have had blood coming out of the worn out holes in my graft and down my arm.  Sure, I try to work up the hose where there are no holes, but puncturing virgin skin hurts.  Human nature to is to avoid pain.  To do that is to puncture where the scar tissue is; where the graft is flatter and has more holes.  As the blood comes out of the large holes it is under pressure and it takes more gauze and more pressure from me holding the gauze to stop the flow so that it can clot.  This can get to be a bit messy–Dexter messy.

I'm thankful that when needed my family steps up to hand me more gauze or help change the pads I use to protect the tray table that I use.  I feel terrible that my fifteen year old son has to sometimes help and wonder what impact it has on him emotionally.  But, he doesn't flinch and is just there to do whatever needs to be done.  Incredible.  My wife shares most of the burden with me.  Again, my guilt is heavy that she has to see me like this, but, she too doesn't question and gets elbow deep in to it.

This time we had this happen too many times in a row and before I knew it my moderate anemia plunged.  When you lose blood you lose the building block of blood, iron.    Without iron no matter how much Erythropoetin (yes, the stuff Lance used to increase oxygen carrying blood cells) I inject into my belly, the blood count just can't increase.  Kidneys normally make the protein that works with blood marrow to create red blood cells.  Without kidneys then it is very difficult for your body to produce red blood cells.  When you spill too many of those precious oxygen carrying nuggets on the table you are in for a world of hurt.  It is difficult to breath let alone climb the stairs.  Sleeping becomes your day.  The kind of sleep that doesn't replenish.

Because of your generosity, I was got up this morning and made a nice breakfast for my family.  A pint of blood generally increases hemoglobin by a point.  That point has made a tremendous difference today with little labored breathing and little coughing.  I'll probably have to sit on the couch and watch football the rest of this beautiful fall day, but I'll call it a success if I don't take a nap.

Thank you for donating blood.  It has made a difference in my life for me and my family today.

I enjoy commenting on Home Dialysis Central's Facebook Page.   Recently a young man posted about how he wasn't looking forward to going on dialysis and that he was scared.  Below was my response.

Jefferson you should be scared, life as you knew it both before you got sick and after will change completely. The unknown is difficult to comprehend. But my friend, let me tell you I have been through every type of dialysis and two failed transplants and have raised my fourteen year old son and ten year old daughter with my wife of 25 years at me side. I am still on dialysis with no chance of a successful transplant in my future. Every day that I hook up to dialysis I give myself the gift of life. A life that I choose to live the way I want. I've been doing this since 2001. Without dialysis there would be no choice for me. With dialysis every day is a new opportunity. It will suck until you take ownership. Learn to cannulate yourself early in your treatment - stick those big needles in your arm. Pay attention to how your machine is set up and how it runs. Don't just watch tv during your runs. Watch a little, but read or play a game too. Learn to ride the roller coaster of anemia. When your too tired don't beat yourself up or feel guilty. If managed it will pass and you'll have energy again. When you have energy do something. It will take time but always remember that you are the captain, your doc is your first mate and the rest are your staff - all working together for your optimum health. Jefferson, I love your name, I had a friend with the same name in high school. You will win at this, take the lumps as they come and remember that it always gets better because you believe in yourself.

Help us to achieve $100,000 for the National Kidney Foundation - I need your help.

A little something different this year for The Riverdudes National Kidney Foundation of MI fundraising team. This year I dialyzed in my camper and helped Jacob's Boy Scout Troop at camp and could not attend the Walk.  I have also been spending a lot of time finishing up my first memoir, A Chocolate Dog Tale, and looking for a publisher.

A young Gen X couple falls in love in high school, gets married after college and finds their well planned life crashing on the shoals of a sea of obstacles as they try to achieve parenthood. With the urging of Andria’s Grandpa, she and Erich adopt a Chocolate Labrador Retriever puppy to try to bring joy back into their lives.  The bread loving Amos puts the three on the path of many adventures as they find themselves on, in and around numerous Michigan rivers. 

Together we have raised $78,000 and we can't stop now. Please once again donate $100 or what you can to the NKFM through my secure site.

Thank you for all your support and look for A Chocolate Dog Tale at your favorite book store soon. 

Peace, Erich

“A young Gen X couple falls in love in high school, gets married after college then finds their well planned life crashing on the shoals of a sea of obstacles as they try to achieve  parenthood.  With the urging of Andria’s Grandpa, she and Erich adopt a Chocolate Labrador Retriever puppy to try to bring joy back into our lives.   A Chocolate Dog Tale, Ditschman’s first memoir, takes the reader on adventures never far from the rivers he loves.  In part, Tale is an ode to Michigan’s rivers, the history that forms around them and and the connectedness to place that they provide.  But Tale never departs far from the star of this story, Amos, the lovable Chocolate Labrador Retriever who’s passion for lakes and bread often keep Andria and Erich’s minds off their pain and filled with thoughts of how to retrieve their wayward bread loving Retriever.  Ditschman brings humor and honesty to the telling of the incredible relationship that can quite unexpectedly form between pets and their humans.  Follow Erich and Andria as they quietly address the frustrations of infertility and adoption while inadvertently expanding their family along the way.  With a cast of characters that are easy to recognize in our own families, Tale will make you laugh out loud, bite your nails in suspense and struggle to hold back tears as you follow the three through their life together.” #achocolatedogtale

Last night was a very successful paddle with the Boy Scouts on the Red Cedar River and Grand River in downtown Lansing, MI.  I'm a little sore and tired today, but that is just my body reminding me that I had a great time yesterday.

You can see more photos at the Troop/Crew 180 website.

Find time to get outside and paddle.

Tonight I'm leading Troop 180 Boy Scouts on a short (one and half hours give or take) canoe trip in preparation for a longer trip on the Rifle River in northern Michigan later this month. We'll hop in the Red Cedar, the river famously referred to in MSU's fight song, and paddle to the confluence with the Grand River. Will follow that into downtown Lansing, Michigan's Capital of Michigan and hop out just before the northern dam in Old Town. We have been blessed with a number of rainless days and the rivers have coming down from the April highs. The weather forecast is excellent.

I wanted to take my son's kayak and follow the route this past weekend just to make sure it is not to obstructed. Unfortunately, my anemia was such that it probably wasn't a good idea to take two paddles (trips) so close together. Instead, I've saved up my strength for a wonderful paddle tonight.

So, here is the take away - not being strong enough to do things like you used to, is not a reason to give them up all together. You need to make adjustments, lower expectations, ensure that you are still confident and will be safe, and hop into your boat and paddle away. Just because you are on dialysis you shouldn't give up the things you love.

Paddle on.