(update 6/26/16: See the comments for more thoughts about cramping)
Aside from the fact that it is excruciatingly painful, it is an indication that something is wrong during dialysis. Too much fluid is being removed or fluid is being removed too quickly. I’ve had my leg cramp so hard I thought it was going to break a bone and brought me to tears.
You get cramps when the muscles don’t have enough fluid for their proper operation. Some people get cramps in major muscles like their legs or in muscles furthest away from their heart, like feet. I even had cramps in my hands that caused me too look like I’m awkwardly signing “Live long and Prosper” to Captain Kirk. All kidding aside, it is very painful and feels like torture. I’ve seen many patients brought to screaming from the pain. And, it is an indication something is amiss in dialysis.
If you are cramping often, talk with the technician about the rate of flow and the amount of fluid being removed. If they don’t seem to have an understanding of the problem and offer some relief, talk with the nurse. Then, if you aren’t getting a reasonable response, speak with the doctor. Perhaps your “dry weight” (your weight after dialysis) needs to be increased because you’re taking off too much fluid or you’re taking it off too quickly. Perhaps you need to explore adding an additional session that week so you don’t have to remove too much fluid in just three sessions and a fourth will help. My center will sometimes have a chair available on Saturday and I come in for a fourth session. I have had to do it during the holidays when eating and drinking too much is often my failing. Ask and discuss it with the nurse. Some centers don’t have that opportunity though because they are at capacity. But at least explore the option. However, with some work on your part it shouldn’t be necessary.
Make sure you are part of the fluid removal calculation. When you come into dialysis, you weigh in. The amount of fluid to be removed is your weight before dialysis minus your dry weight. Too often the tech just does a quick calculation and doesn’t review it with you but enters that information into the machine and off you go. Some patients don’t know how much is being taken off. Don’t let that happen. Engage. Ask the tech how much is being taken off. Check their math, so to speak. Be observant and discover your limit. My tech, Bobby, pointed out that I can only tolerate a maximum fluid removal of 5.5 liters. If I exceed 5.5, I’ll start cramping. For example, if I am six liters over my dry weight, he told me to just do 5.5 or less and be careful with my fluid before the next treatment and take off the rest in the next treatment. Don’t exceed 5.5 liters in the four hour treatment. Great advice. (See my blog about Fluid Control . You have to limit your fluid intake between sessions for your own good!
If the cramping comes before the last hour and your dry weight is correct, it may be the rate of flow. Too much fluid is being removed from the blood too quickly. Again, speak with the tech, nurse, or doctor about reducing the flow rate or, another option, extending the treatment time. As much as I dislike sitting in that chair for any longer than necessary, adding another fifteen to thirty minutes could mean less fluid has to be removed as quickly and you benefit by avoiding cramping.
If cramping occurs, one method of immediate relief is to add saline to your blood increasing the volume of fluid in your blood. This really isn’t doing you much good. You should be removing fluid, not adding it. Also, saline adds salt (sodium) and makes you thirsty for more fluid! It’s counter-productive. Another method is to have the tech stop the fluid removal for a few minutes (perhaps 10 of 15 minutes). Your blood continues to be cleaned but no fluid is being removed. This is a better option. Engage the tech when you start feeling cramps coming on. Learn to sense when they are beginning and take immediate action to avoid them.
Again, cramping is not good. It’s an indication something is wrong. Some centers and technicians don’t understand this. They act as if it’s just part of the treatment “experience”. No it isn’t! It should never (or rarely) be happening. I went through a couple years of frequent cramping at such a center. Where I am now, they don’t allow cramping and do whatever they can to make it nonexistent. The dialysis goes better and I don’t have to endure any pain. I do my best to manage my fluid and they do their best to help me avoid cramping.
(In another posting, I will discuss Blood Pressure and Dialysis. As fluid is removed or is removed too quickly, your blood pressure will drop. This is more likely than cramping for me! But that’s for another blog.)
If you have some experience and can offer some advice, please feel free to comment.