Patient stories: Angel Velez
Angel Velez, age 64, has been on dialysis for almost 4 years—since May 2001. For most of that time, he went to a local dialysis center 3 times a week for hemodialysis. But, in July 2004, Angel started doing CAPD at home.
Watching and waiting
The onset of kidney failure was slow but relentless for Angel. A diabetic for 30 years, he began to experience health problems as a result of his disease. He gradually lost his vision, and was forced to give up his business operating a snack truck in his hometown of San Juan, Puerto Rico. Then, his kidneys began to fail. "He was going to the nephrologist for 2 years before he needed to start dialysis," related Angel's wife, Rose. About 18 months before his kidneys failed, his doctor said it was "time to start setting up for dialysis." So, Angel went to the surgeon to have a fistula created.
"We watched his progress every month," noted Rose. "We got lab reports, did 24-hour urine collections, and we went to the dialysis center and the hospital to see what hemodialysis would be like." Because they were so prepared, Angel never really experienced any symptoms of kidney failure and started dialysis earlier than many people. "We didn't want to wait for a crisis," explained Rose, "so we went by the lab reports, not the symptoms."
Starting at the center
Angel and Rose were not interested in home dialysis at first. They thought there was "too much involved," and were a little intimidated by the idea. Besides, the dialysis clinic was close to their home, and the staff there was terrific. "It seemed like it would be convenient," clarified Rose. "Just go over there and they handle everything for you."
Angel chose the 4-8 pm shift so he could go in for his treatment and then come home and go right to sleep. "The treatment really does drain you," Rose observed. But aside from being tired after dialysis sessions, Angel did pretty well for three years. He didn't like the needles, and had a problem with his fistula once, but he felt pretty good.
Need for a change
Then, Angel developed liver problems. His abdomen began to fill with fluid on the days between dialysis treatments. His belly would swell, and he was even getting fluid in his lungs. To remove the fluid, Angel went the gastroenterologist twice a week; the doctor would put a large needle put into his belly to draw the excess fluid out.
Week in and week out, this process took a toll on Angel. He lost his appetite—and 30 pounds. "He was down to 98 pounds," reports Rose. "He felt terrible and looked terrible, too. He hardly had the strength to walk."
Then, the gastroenterologist suggested that Angel try CAPD. Rose quickly followed up on the idea and made an appointment with a surgeon to place the PD catheter. Husband and wife attended 2 weeks of PD training in July 2004.
Because Angel cannot see well enough, Rose took on the task of doing his exchanges. "You have to keep your mind on what you're doing," Rose commented, "but it is not hard to learn."
Seeing progress
The switch to CAPD is working exceptionally well for Angel. "People who saw Angel six months ago can't believe the progress he's made since July," claims Rose. Angel has gained 30 pounds, and has started to take an interest in life again. "Before, he was resigned to dying," recalls Rose, "but lately he is feeling better and is joining into our family life a little more. The other day he even laughed!"
The PD nurses have been very helpful and encouraging, too. "They told him they wanted to see him get out of his wheelchair and walk in for his appointments," said Rose. And, he did! With the help of a cane, Angel can now walk into the dialysis center on his own.
According to Rose, even the nephrologists are amazed at Angel's progress. "They tell him he's one for the history books," Rose points out, "because he's doing so well in spite of the liver problems."
Comfortable routine
After several months at home, Rose and Angel have fit the four daily CAPD exchanges into a comfortable routine. They have a separate room for exchanges so all the supplies are handy and it is easier to keep the area clean. When the door to the room is closed, it means Rose is helping Angel with an exchange, and "grandchildren and other family members know they shouldn't disturb us."
Rose has worked out a schedule that is convenient for both her and Angel, and she has developed a few little time-saving techniques. She likes the fact that the CAPD exchanges can be done on with some time flexibility so she can run errands, like taking her granddaughter to karate classes.
Angel is feeling well enough these days to lend a hand, too. "He wasn't too cooperative in the beginning," Rose remembered, "but now he feels better and he helps with some of the prep, the blood pressure monitor, and clamping." She and Angel are getting so good at doing exchanges that they are thinking about doing a little traveling. "You don't have to take all the boxes with you," said Rose, "you can have your supplies shipped to the place you want to visit."
Worth a try
Both Rose and Angel have come to appreciate the benefits of doing PD at home. "It gives you a lot of flexibility," Rose describes, "so you have more time to do other things." Rose and Angel also like the fact that with CAPD, Angel can eat more of the foods he likes. "The other diet was very limited," Rose complained. "Everything was 'no.' now he can eat more of the things he wants."
Although they didn't want to "do it themselves" at first, Rose has changed her mind about home dialysis. "It's a good option, and people should try it," she asserts. She believes home dialysis makes good sense, especially for young people and people who work. "If you can do it, give it a try!"