chapter 5

Jane was referred to a specialist peritoneal dialysis nurse for intensive training prior to the insertion of a tenckhoff catheter into her abdomen. One end of the tube was going to be on the outside with approximately 6 to 8 inches sticking out. The other end of the tube was going to be placed inside her peritoneum. This was a membrane that protected all of her abdominal organs. Once the tube was in, some special fluid designed for the purpose would be instilled into her peritoneum. The peritoneal membrane would act as a semi permeable membrane and allow solutes to filter from her body into the fluid in a process called diffusion. There was glucose in the special fluid as well. This would act as an osmotic agent to pull water from her body across the membrane and into the fluid. After a period of time, which could be between 1 hour and 6 hours, the fluid with all the poisons in (effluent) would be drained out and then fresh fluid would be instilled to repeat the process once more.
The procedure was so simple in comparison to haemodialysis. Jane practiced using the special bags and tubing and a special apron and got used to handling the equipment without contaminating anything.
Once she had learned how to do a manual exchange, she progressed onto the machine. The nurse put in the programme for her, so all she had to do was set it up, attach herself, then press the green button to start.
She learned how to look after her exit site where the tube came out of her skin. It was important not to pull on it, especially in the beginning. The surgeons were not going to stitch it in place. Instead, there would be a section of the tubing that would be tunnelled just underneath her skin. On this section of the tubing there were two Dacron cuffs. These felt like the loopy side of Velcro. These cuffs would irritate the surrounding tissues and encourage the formation of scar tissue around them. It would be the scar tissue that held the catheter in position.

Jane was nervous about going to theatre. She had to have a session of haemodialysis before she went to make her blood levels safe enough to operate. She had a short spin post operatively too, but then she had her neckline removed.
Her post operative recovery went smoothly. The peritoneal dialysis nurse continued her training until performing the necessary procedures were no longer scary and more like second nature.
It was still daunting the first time she had to do it on her own at home, but she managed. The worst was over.

Jane could not go swimming. She did not have the energy to exercise any more. Having two litres of fluid inside her peritoneum most of the time made her feel heavy and bloated all the time.
Jane had no choice but to change her diet to one that suited her new situation. Her new dialysis treatment meant that she had to eat a high protein diet as there would be some leakage of her own proteins across the peritoneal membrane into the dialysis fluid. She didn’t mind that. She’d eaten lots of protein when she’d been in training anyway. She was supposed to watch the amount of sugar she consumed as well because the fluid inside of her contained lots of sugar and she could absorb some from the fluid.
But Jane thought she could not allow herself to get too depressed about her situation. She did what she could in and around the house and rewarded herself with food treats. It started off with a couple of biscuits with her tea. Then it was a couple of slices of cake. As long as she stayed away from chocolate, coffee and banana and other fresh fruits she would be fine! There was nothing wrong with having Jamaican ginger cake spread Thickly with butter or served with dollops of fresh cream. A traditional Victoria sponge cake was fine with cream or buttercream, and jam. The fruit for the jam had been boiled, so it no longer had the ingredients in it that would make her ill.
On the savoury side, she might be restricted with the vegetables, but she could still eat a thick steak with a rich buttery sauce. She liked a nice cooked breakfast at the weekend. She had to avoid the tomatoes and the mushrooms, but she could still have sausage, bacon, eggs, black pudding, fried bread and a few baked beans. One a weekday, she would have a sausage, bacon or egg sandwich instead. She wasn’t sure if she could have ketchup, but there was nothing in HP that would harm her.

As well as rewarding herself with food and not being able to eat as healthily as she would have liked, Jane liked to consume a lot of food in one sitting. That was probably left over from her training days too.
Even if Jane followed her low potassium, low phosphate, high protein diet to the letter, she would not be able to get enough nutrients into her system. She was prescribed Ensures, or Ensure+. A low volume milk based supplement. She could have up to three of them a day.
As a consequence, in six months, Jane went from being a slim but muscular ten stones, to a flabby fourteen stones.
She could not simply go on a diet like a regular person. Weight loss diets usually involved lots of salads, which she could not have.
Her dietician tried to help, but it was difficult to get the balance right when her sense of taste was affected by the poisons in her bloodstream.