Hi Dr.Agar…having solved one problem, now I have another that has been on-going for nearly the duration of my dialysis of 11 months. When I get off the machine I have trouble breathing, with a very mild pain in the center of my chest and every part of my body hurts like I have been run over by a bus. This continues for 2 hours before it eases up but then the next day I have no energy to do anything. I have been to emergency twice…had every test and they can’t find anything wrong.The point being that I just don’t feel well after my treatment.

Dear Needled88

It is difficult to know what to answer here as there are so many possibilities. To have even a bulls-roar chance (an OZ expression, sorry) of answering sensibly, I would have to know a heap of very personal, detailed stuff about you …

What follows is a list of just some of the questions I would need to know the answers to if I were your nephrologist and I was trying to answer (sensibly) about potential causes and/or solutions to your problem.

I would need to know, at the very least …

Your age?

Your underlying ‘type’ of kidney disease?

The ‘vintage’ of your Chronic Kidney Disease (CKD) … ‘vintage’ is a term now used to describe both the length of time - ususally years - you have been exposed to (a) CKD3 and beyond to (b) dialysis and the years and modalities and exposures to those modalities)?

Your other-health record (eg: do you have a history of heart or lung disease, or smoking)?

If you are diabetic?

What is your dialysis prescription … short? long? in-between?

Your ‘kidney’ … high or low flux?

You flows and pressures (blood flow, venous and arterial pressures)?

Your blood pressure control - good? bad? and what ‘happens’ to your BP during dialysis?

How many hours a run and times a week are you on the machine?

What is your access type … and is it a catheter … or have you had catheters in the past (and if so … where) as this could be, for example, a sign of a central vein stenosis.

What is your mean interdialytic weight gain?

Your usual UFR?

What membrane are you on … polysulphone, etc … or, god-forbid, cellulosic?

Have you had a CXR … what did it show?

An ECG … usually unhelpful … but have you had one?

What does your echo show … much more useful … and what is your diastolic function like?

What pills are you taking … are there any BP of cardiac-impacting medications?

Do you sleep on dialysis?

Do you dialyse flat or sitting?

This is NOT and exhaustive list … but, Needled88, you see, to answer those sort of questions here is almost impossible as there are so many possibly things that might impact on you, your symptom and the correct cause and solution for it.

It is why (and a good example of the reasons why) I sometimes have to say … this is s problem I dounbt I can fairly answer here without a huge data-bank of knowledge about you that I just dont have … hence, (note my comments in the reply post to Sinead yesterday in her thread) this is why I sometimes have to ‘cop out’ and say - this has to be one for your own on-the-ground advisors who know all the information well and who can find out the cause … and a solution … and make no mistake, there is likely to be one …

So, sorry, but … for this one? … its back to your team I think.

John Agar