I thought I would be doing a follow up on staff development tonight but life had other plans. Dale has been on peritoneal dialysis for two years now with no problems. He has been able to work and with a few exceptions live a fairly normal life. The biggest danger for P.D patients is peritonitis because the dialysis access is basically an opening directly into your peritoneal cavity and we thought we had dodged that bullet but it caught up with us tonight. When I got home from work he told me he had had abdominal pain all day and he was doing a dialysis exchange and the fluid was cloudy. Those two symptoms together are pretty much a done deal for peritonitis. I paged his P.D nurse who happened to be on a bus somewhere.  She told me to get him to the emergency room. After bloodwork, x-rays, and a fluid culture plus two I.V.s of super-dooper antibiotics we are home a little after nine. His white count was 17 and I just learned tonight that normal is 8 so ordinarily they would have admitted a patient in his shape. At least he didn’t have to stay over-night. He gets pretty cranky even near hospitals but at least this experience wasn’t too bad. The doctors and nurses listened to us and seemed to accept that we know what we are doing. So often that is NOT the case and other times when he has had to be hospitalized we have had to just dig in our heels and insist that they listen. I’m sure there is a secret file somewhere that flags us as “un-cooperative” but it is hard to argue with two years of success. Dale is the only working P.D. patient in this area and we have gotten good at self-adjusting his dialysis according to how hot the weather gets which means he sweats and loses more fluid and needs more salt or if it is cool and he isn’t moving around too much, changing to a little stronger fluid solution to pull off more fluid. It’s a balancing act and I am proud that we have gotten damn good at keeping all the balls in the air. Hopefully this one round of antibiotics will do the trick. We got our packet of forms to fill out on his medical history and insurance information to send back to Baylor which will be the first step towards kidney transplant so we need to get infection free and as healthy as possible. It was a long day and a longer evening but a little glass of Bailey’s Irish Cream, a couple of cookies, a hot bath, and a good book and all will be well.