Hi Tired and Confused. This IS a very sad situation. I’m concerned that it sounds as if he’s feeling much worse recently. Has anything changed with his treatments?
-- Different fluid level to remove?
-- Different meds?
-- Different dialyzer brand or even size?
-- What is his hemoglobin (red blood cell) level? Anemia, a low red blood cell count, can cause severe fatigue.
-- His albumin (protein) level? Low levels of protein can also cause fatigue.
-- Will the doctor check his carnitine level? (Carnitine is depleted, over time, by dialysis and low levels can cause fatigue).
Ask for a referral to a hematologist (blood specialist) about the dropping platelet count. Problems with his access (stenosis, or narrowing) could also cause the bleeding--this should be checked with a flow study of his fistula or graft.
You say your dad is in a rural area, but have you checked our database to see if any home treatment options are offered nearby? You can find that here: http://www.homedialysis.org/locate/. This site is Home Dialysis Central--because research shows (and we have seen with many, many people) that MORE dialysis, longer and/or more frequent treatments--give people more energy, a better appetite, and help people who would otherwise fail on standard in-center treatment.
Keep in mind that a home treatment doesn't have to be right around the corner. Training can take from 1-6 weeks, depending on the type of home treatment, and then he would only have to go to the clinic once a month for follow up visits. So, it can be as far away as he is willing to drive once a month.
Your dad still sounds like he's pretty spry. ANY type of home treatment (or in-center nocturnal, though I tend to doubt that they have that) could make him feel better.
If home is not an option, see if he can do longer treatments in the center. He might not want more of what’s making him feel bad, but longer treatments are more gentle and easier on the heart, and might help him more than he knows.