Fluid Balancing

No – NOT like ‘balancing plates’. ( Thankfully. As my general balancing abilities prevented me ever managing to stay upright on rollerskates, ‘Damp’ would become a Permanent Feature ).

As it transpires, this relates to the amounts of fluid taken in versus given out by an organism. ( In this case, DJ. One of his Essential Needs That Arrived Unexpectedly And Started All This. Caused by a fundamental mechanical drainage problem which reached and passed the state of no return, and a longstanding slightly impaired renal function).

Fluid Balancing tends to mean lots of tempting, cajoling and measuring to achieve the minimum intake requirement of two litres each day. And a fair bit of Ingenuity to make it a tolerable requirement for DJ. And good humour. And a basic ‘O Grade’ in addition.

Tuesday was a Fairly Good Day. By 3pm we’d already reached 1875 mls.

(It may not seem like much of an achievement to you – but believe me !)

That’s the ‘Input’ part of the equation. Easy to talk about. As DJ has difficulty tolerating anything around his body that he wasn’t born with, then the ‘Output’ is perhaps a little more ticklish to consider. Many people will tolerate (I use this word carefully) a tube which is inserted into the appropriate orifice and left in place (known as an ‘indwelling urinary catheter’) to drain into a collection bag which is hidden under clothing. This is then changed every few months by a professional such as the district nurse, with care and hope to avoid infection. If someone really will not tolerate this method, their ‘waterworks’ can alternatively be managed by gently slipping a simple catheter in as and when necessary – and then taking it out again. Needs a clean and careful technique, but it is really not difficult. As this is most usually done by the person for themselves, it is called ‘Intermittent Self-Catheterisation’ (ISC).

But The System remains doubtful that anyone would/could wish to do this for themself, and is absolutely convinced that no-one could possibly consider doing such a thing for someone else. That this method is commonplace for many people with spinal injuries (for example), does not seem transferable to care of the elderly so far as the system is concerned. Former colleagues of ChickPea suggested this management approach might be possible for DJ, were she willing to do it for him. Given that her job had required doing far more horrible things to ill people, she was willing to give it a try – so long as DJ was in agreement. He was. And TH. He was too. But The System ? – Took a bit of convincing, I can tell you ! (Not the nurses – they were great – very supportive and encouraging, and taught her over the next 3 days, and we got DJ home within the week – after a month in hospital of very difficult ‘person-management’ for both DJ and the staff concerned – and not just a few bruises, either).

Anyway – that’s how we do the ‘Output’ bit, usually about 3 times throughout the 24-hr day, measuring of amounts being necessary, adding up the day’s production and then comparing this with the day’s ‘Input’.

Now. For DJ to stay elsewhere requires they have staff who can do this technique. Does it seem obvious to you ? (Try telling the Social Worker……there’s several stories involved, but maybe another time…….). Anyway – the end result of this is that there are very VERY few of the ‘Respite’ facilities hereabouts which can cope with ISC. And because of the (dis)organized expertise of the Social Work system, there is apparently no database involved for listing the ‘Respite’ premises with such skill. Oh No. Each place has to be phoned, and asked.

Our experience of this is that if the Social Worker actually manages to arrange a Respite bed it will be somewhere that is not able to cope with either DJ's stage of ‘dementia’ or ‘ISC’. She assumes the district nurses will pop in and do the necessary, 3x/day for 7 days (or whatever). ! This thought causes apoplexy for the district nurses. (And for TH and ChickPea). Now that we are wise to this, ChickPea finds it most successful to track a place down herself, and get SW agreement thereafter…..

And I think – after 18 months of searching for a place to stick with – we may have found it. And that is where DJ is staying for Respite this time. And they even phoned yesterday morning to tell us that he had fallen on the floor during the night (what – only once ? – a miracle !), and that his fluid output at his late session was as good as we could hope. (Somewhat more reassuring than a previous place who had put him into hospital without telling us…….. they’d mis-copied our telephone contact details from the printed sheet we’d given them………).

DJ appears to be in the safest of available hands. We live in hope.