Dialysis from the sharp end of the needle

The work continues

By Bill Peckham

Normally when a blogger complains about ink stained fingers they're saying they've been writing a lot, I can only wish. In my case it's from keeping an HP 45500 flat bed printer up and working.

This summer has been pretty busy at work, often summers are quieter in the tradeshow business but I had one stretch of working 19 days straight, with 60+ hour weeks. At the peak of busyness the routine was wake up, take myself off dialysis, get to work by 8, work 12 hours, get on dialysis, fall asleep, repeat. A few things did get dropped, but minimums were met: the dog was walked and fed (he goes to work with me, so he was working long hours too), the house stayed at a level of tolerable mess and I had clean socks to wear to start each day ... ahh clean socks ... Putting on clean socks in the morning is the best my feet feel all day, from then on they just hurt more and more. 

My feet are the weakest link in this whole operation. By the end of a shift they are throbing. They feel like they're on fire. I think of neuropathy as the nerves being short circuited; my feet don't really hurt I tell myself ... some times it works, some times it doesn't. Instead of feeling like they're being melted by lava, why can't a neuropathy short circuit make the feet feel like they are getting a soapy massage? On the plus side my grip has been getting stronger.

Sometime in the last two years I lost my ability to snap my fingers and by this time last year my ability to grip anything was rapidly deteriorating. I blammed amyloidosis which is commonly seen in people after 20 years with stage 5 CKD, I have 23 years.

Last October when I took on the position of graphics production lead a progression of the amyloidosis in my hands was a major concern. I went bowling for the first time in years in December and couldn't grip a 12 pound ball well enough to keep it out of the gutter. I scored below 100 and for a former league bowler that was hard to take.

Now ten months later my grip strength has improved. I went bowling about a month ago and scored a respectible 150+ in both games. I could grip a standard 16 pound ball. I still can't snap my fingers but my hand strength is greatly improved. I atribute the improvement to work. Working with my hands has reversed the stiffening I was expereincing.

Work is improving my overall fitness too. Standing instead of sitting has its own benefits but I am not just standing. I'm moving. Reaching, stretching, lifting. It's a healthier lifestyle than a desk job. I can feel my body responding to being needed, getting stronger as it gets used. 

I spent a lot of the oughts sitting at a computer. I enjoyed it but it came with a silent price. Working with my hands, making things, comes with silent dividends.

Finish line crossed

By Bill Peckham

I made it to the health insurance finish line, but not until the finish line had moved. After consulting with the Carpenter's Trust of Western Washington I came to understand that there is a whole new system for qualifying for healthcare benefits, which will be an advantage going forward, and now getting initial access is the odd number of 358.05 hours in a three month period ... basically 360; maybe it's just as well I didn't know what I needed at the beginning but as of today I have 364+ hours worked Jan - Mar.

54 hours, about a seventh of that total, was overtime of one kind or another, either hours over eight in a day/forty in a week or working a weekend (a lot were all three: long weekend shifts after a long week). It's the nature of the job that the work load ebbs and flows, so you have to be able to clock the hours when they are there to be worked. One thing is for sure, there is no way I would have been able to get across the health insurance finish line if I had been doing any other type of hemodialysis.

It is only by dialyzing at home, more frequently, while I slept, that I was able to cover all my shifts and earn insurance to supplement my Medicare coverage.

Now it is on to step two, Travel. DSEN will follow my planning for a trip to Argentina. During the trip I will dialyze incenter, in Buenos Aires and near Iguazu Falls (after which I will have dialyzed on six of the seven continents - watch out Antarctica). My Mom is going to go too! We're aiming to go in the second half of August, towards the end of their rainy season, hoping to catch the falls in maximum flow and during what is normally a particularly slow period at work.

The five month countdown begins ... Now.

Week eight entering a lull

By Bill Peckham

I finished last week with over 30 hours, which puts me within 30 hours of my goal but I won't get there this week, it looks like I'll have just one shift. At some point someone is bound to need some signage.

Week 7 - 330 in sight

By Bill Peckham

Even with missing work Monday and Tuesday to attend the Annual Dialysis Conference, I finished the week with 36 hours - leaving me with fewer than 60 hours left to reach my initial goal. (My actual count remaining is now 57 hours, I must have over counted my hours by one last week). Between travel, dialysis and work I really needed a day off and I finally got one yesterday.

I slept in and then spent most of Sunday doing laundry and cleaning the house. Laundry and house cleaning are about at the bottom of my to do list but eventually it has to be done. Two months down, one to go and then 6 or 8 years until I can retire.

Quick update on week 6

Bill Peckham

I'm in Phoenix attending the Annual Dialysis Conference. I've had two treatments overnight in my hotel room; this morning I slept in after getting off dialysis. Tomorrow I am going to participate on a panel, led by Mark Neumann of NN&I, my contribution will be to discuss the Bundle from a patent's point of view (if you have access to AJKD I have an editorial posted ahead of the print edition that covers the same topic: The 2011 ESRD Prospective Payment System: Perspectives of a Home Dialysis Patient Advocate (only $30 for non subscribers - wow DSEN is a great value!)). 

Last week I finished the work week a day early with 28 hours, leaving me only 92 hours left to reach my initial goal. I've enjoyed being back at work, but it is humbling because so much can go wrong just making a simple sign. No one wants to send a flawed sign to show site and I had a couple shows in a row where I had no mistakes called to my attention, but then over the last two weeks I've had a few goofs that were entirely my fault and were identified by show management after they were installed.

It's one thing dealing with a temperamental printer and hiccups in quality, few people ever get to see those mistakes and waste of material. It's another thing entirely when an incorrect sign gets through to show site where show management notices the problem. I'm sure I'm the only one outside of show management that noticed this partial suboptimal fix to the pictured ADC Exhibit Hall hours sign - I extend my sympathies to the sign maker. 

Week five, vacation in sight

By Bill Peckham

Another 38 hours, very much on track to 330, as I prepare for five days off to attend the Annual Dialysis Conference in Phoenix. I've managed to live blog the Saturday program the last two years - 2009; 2010 - I'll try to do it again. I'm on a panel on Tuesday to talk about the bundle, so I'll have Saturday, Sunday and Monday to enjoy the conference.

Usually I like to write when I'm traveling so hopefully the blogging will pick up. A lot of the fun of these conferences is having the chance to see people in person and not just through email. I expect the Rogue River Rafters Reunion to be a highlight.

Week four, past the half way mark

By Bill Peckham

It was good week, 27.5 hours brings my total to 172, leaving 158 hours to clock by the end of March. I'm definitely on pace to reach my goal but I also am in no way ready to declare victory. I can feel each of those 172 hours in my arthritic hands, particularly my left one, and the twinge I've developed along the left side of my lower back. I can count the nicks on my hands and fingers. The wear and tear is about what I expected but it's also a reminder that I'm relying on a body that has seen better days.

This last week all the graphics from the auto show made their way back to the shop where I spent a couple hours cutting them down so they could be thrown away. Dozens of signs, signs that took hours to make, sliced down to ~ 2' x 3' chunks.

Saving signs to use them again is the exception. Most often designs change - show colors, themes, change year to year, and the details of the show change, who's speaking, when and where change, so the signs can only be used once. The vast majority of signage Triumph made for the car show were one time use and until recently one time use signs would have been thrown away at show site. Not anymore, these days most convention centers want to limit their garbage so they expect the tradeshow contractor to leave no trace. This means all the signage comes back to the shop for disposal and so now I am the one who must destroy them.

There is no doubt a lesson in this, something about the transitory nature of existence, still it's a shame to have to be the one to do the cutting.

Week Three, on track to 330

By Bill Peckham

I finished the week with 44 hours, which puts me at 140.75 for the month. Considering my first shift was on the 10th, January turned out well. There are several events going on that required signs but by far Portland International Auto Show is the largest. Anytime an event takes over a convention center - in this case Portland's - and attracts large crowds, signs will be needed to get people where they want to go.

You can check out the PIAS Facebook page for photos from the show. Plenty of good looking cars to see but what I was looking for was the signage Triumph produced. PIAS provided me with a lot of work so I'm glad to see the good crowds.

140 hours in January leaves me needing 190 in February and March. Needing 95 hours a month is a flash from the past - when I started in the union the number of hours for benefits was 275 in a three month period. It was a good month but I know I won't have 140 hours every month. With PIAS open, demand for signage is down to the point that I have a three day weekend and, what looks to be less than 20 hours of work to do by Friday.

That's the nature of the business. One week you need to keep the printers going overtime just trying to catch up with what's needed NOW on a show floor; the next week the work is for a show days away, allowing production to proceed at a more relaxed pace. 

On the other hand I also know that the nature of the business is such that this lull could evaporate in the blink of an email.

Week two, seven days of work

By Bill Peckham

My comment to Week One was wrong, the pay period is Sunday to Saturday, which means 36 hours for week one but those Sunday hours last week count towards this week's total of 60.5 (today's hours will count to next week). I can see down the road not wanting to work this many hours but right now I want them and I'm keeping up. I always think of overtime as going towards travel, the old formula was four hours of overtime to one day of travel. These days, I need to budget more for accommodations (I'm feeling my years) so now the formula should probably be five to one, thus I had 20 hours of OT so I have four days of travel banked.

My body has definately aged - !shock! Those first few shifts left me stiff and sore but it  is getting easier. I started off the year and through the first week of working dialyzing in the evenings without heparin. A long story short, I slipped and fell on New Year's Eve day (I was sober), landing on my backside, which left an immense bruise and required the change in dialysis modality: shorter, faster, heparinless. Dialyzing in the evening, after working all day, is a hard schedule to maintain, there isn't any margin for something to take longer than expected, and something always takes longer than expected.

For the last couple of treatments I have been back to overnight, extended runs while I sleep, which is much easier on the schedule. Without having to fit in dialysis right after work, I now can address my current scheduling challenge: making time in the work week for iron repletion at the clinic and my monthly doctor's appointment. If I could just teleport from place to place it would be much less of a problem.

Week One

By Bill Peckham

There are eleven weeks, including this week, between now and the end of March. Eleven weeks for me to clock the 330 hours I need to earn insurance. This week I clocked 36 hours, which is ahead of the 30 hour a week average required. It was a good start: 294 to go.

I could have had the full forty hour week but I lost a couple hours by taking a long lunch on Tuesday so I could attend a meeting of NKC's Foundation. I've been volunteering on the Foundation board since December 1997 but I've missed the last couple of meetings because of work, so on Tuesday when we had a little lull in graphics production I clocked out for an extended lunch so I could attend.

The other two hours I came up short was mostly because I got on the clock late, or we went to China Pavillion for lunch, which takes 45 minutes instead of the allotted 30. China Pavilion's unsalty egg flower soup is worth the 15 minutes, but the other part of it, getting in late, isn't ideal. However, I need to stop for coffee, traffic in the early morning dark rain of Seattle's January is unpredictable, and once I arrive the first thing I do is walk the dog along the river and rather than be five minutes late I'll take some time and clock in at 8:15. 

 This is the lower reach of the Green River after it has transitioned into the Duwamish. The tides effect this section of the river causing the water level to go up and down through the day. Over the eleven years I've been visiting the river with the dog I've seen salmon jumping, cormorants, eagles and osprey fishing (and many people in waders doing the same). If it isn't raining too hard I like to take a little time, while the dog takes care of business, to stand by the river. Walking the dog and just looking at the river for a few minutes is my preferred way to start the day and spend my morning and afternoon work breaks.

In the spring, summer and fall, when the sun is shining, it can be hard to drag yourself back into the windowless production area, but even this time of year, in the rain and cold, a river walk is a good way to break up the day. You never know what you'll see.