Just had a conversation with my not-too-bright SIL. Seems her diabetes-related kidney failure has finally caught up with her (after being told that dialysis is now a requirement rather than a treatment option, instead of setting up appointments, she began researching how she can arrange to buy a home dialysis system to use in her apartment. FTR, the kibosh was put on that idea, tout de suite, but she still made no move to get herself dialyzed).
She called us today to inquire after my wife’s broken shoulder, and told me that she’s been laid up with what she’s calling “a cellulitis”. To my understanding, cellulitis is a condition of the skin, and is not normally spoken of with an indefinite article, as though it had singular and plural forms. Anyway, the way she described it, the fluid that her kidneys were no longer processing began to exude through the skin in her leg. It evidently caused her a great deal of trouble, and she was finally compelled to accept a fistula in her shoulder, in preparation for dialysis which she says will commence next Monday. Her explanation for the delay is that because she screened positive for hepatitis (she did not indicate which strain), she has to have some kind of hepatitis test (I dunno – liver function? -kd99).
Does anyone have any idea wtf she’s talking about? Because I have very little confidence that she does.
TIA
ETA: I suspect that she actually may have been dialyzed when she went to the ER, although she says not.
Edema is common with people in kidney failure - not cellulitis. I know sometimes my ankles and feet will swell up, making it uncomfortable to move around, but that’s exactly what I must do in order to get rid of it. And they don’t screen for hepatitis prior to fistula placement or dialysis.
A shoulder port is usually the location for dialysis in an emergency situation - my nephrologist called it the “No Joke” placement. It’s not a fistula (the redirection of veins), it’s a regular port as they give medication/do chemo on other people. A fistula takes time to develop - I had mine done at the end of May and it’s almost matured enough now for dialysis (if needed).
Cellulitis usually refers to an infection of the skin. Although not often life-threatening or even terribly serious, cellulitis can be a major problem in certain people, who have, for example, diabetes, kidney failure, or any other underlying condition which renders the body less able to fight off infections.
In terms of the fluid leaking, I imagine she’s talking about fluid ‘transudating’ (oozing or leaking) out from her skin since that can indeed happen when there’s so much pressure in the veins from there being too much fluid inside them (e.g. if your kidneys aren’t working to excrete fluid properly) that the fluid literally leaks out and/or when the protein level in the bloodstream is very low. This latter cause is due to the fact that the protein, actually albumin, normally acts like a sponge to hold fluid in the blood vessels. If there’s not enough sponges, there’s nothing to hold the water in. Diabetic kidney disease often leads to a decline in the blood protein (albumin) level.
Impaired kidney function (with an inability to properly excrete fluid) when coupled with low protein in the blood is a recipe for edema and/or for fluid actually leaking out through the skin.
In any case, if fluid is leaking out from the skin, you can imagine that germs can probably go the other direction - from the skin surface into deeper territory. When you add on diabetes and/or kidney failure, two diseases that impair the ability to fight off infection, you’ve got a perfect set-up for cellulitis, i.e. skin infection.
We usually call it “weeping edema”. It’s gross. It also tends to itch like the dickens when the skin is stretched that far, which can lead to people scratching and with a surprisingly little amount of pressure, breaking the too-taught skin. Then infection sets in those little tears and cellulitis and…not so good stuff.
You may want to tell her that while home dialysis is a great option for some people, they simply will not cooperate to set it up for a “non-compliant” patient. She’s going to have to play nice for a little bit before they’ll even consider it (and even then, it may not be a safe option for her condition.) While it’s not really all that hard to do, it’s a big responsibility, and they will not take the risk if she won’t cooperate with the easy stuff.
The only time I see home dialysis (I’m a home health nurse) is with the really motivated, cooperative patients or with those who are about to die and can’t safely be taken to outpatient dialysis. This is a real shame. It’s estimated that at least 20% of the people in the US getting dialysis could do home hemodialysis, but less than 1% actually do. Worse, only 12% and 34% are even told that home hemodialysis and peritoneal dialysis (respectively) are even an option. https://www.aakp.org/education/resourcelibrary/dialysis-resources/item/is-home-dialysis-an-option-for-you-should-it-be.html
