Greg Collette

Greg Collette

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Sunday, 22 January 2012 01:09

Arranging International Travel Dialysis

I’ve decided to try another trip to China, as part of a business trip.  My last effort ended badly, when I tripped on slippery tiles on a Hong Kong footpath and fell on my fistula.  It scared the hell out of Julie and me, thinking I had a life-threatening injury in a foreign country, at risk of bleeding to death where I fell.  Luckily we were already on the way to a hospital around the corner for dialysis, and more luckily, they found I had bruised but not ruptured the fistula.  All was well, but the doctor suggested we delay our trip to Beijing.  We cut the trip short and came home.

Well, here it is, almost 2 years later and Julie and I are ready to line up again.  This time we plan to go to both China and Europe for a few weeks in April/May.  We will start with a direct flight from Melbourne to Beijing, stay about 5 days, and then fly to London to do some work and catch up with our No. 2 son.  We will probably stay there for about 12 days travelling to Gloucester in the Cotswolds and perhaps Oxford, then Stockholm, back to London and home.

Here’s how we plan and schedule the dialysis I need at each stop.

Arranging dialysis from a distance is like getting a dentist appointment.  The closer the appointment, the less likely you can get one.  So the Number 1 Rule is to start booking early.

Many countries have two kinds of dialysis centres, public and private.  Some are completely separate (like Australian and the UK); others have private chairs in public units (like in China).  Public dialysis is usually free to the citizens of that country, while everyone must pay to use a private unit.  So visitors like me usually book into private units.

However, not always.  Some countries with public health services have signed reciprocal health care agreements, so that their public hospitals will cover any medically necessary treatment which may be required while in that country, including dialysis, at no charge.  Australia has reciprocal health care agreementswith 11 countries: New Zealand, The United Kingdom, The Republic of Ireland, Sweden, Norway, Finland, The Netherlands, Italy, Belgium, Malta, and Slovenia.

In theory, this is great: cost-free dialysis while travelling the world (or a subset of it).  However, the reality is that in most of these countries, the public health system is super-busy all the time, and their dialysis units are usually operating at full capacity.  I have tried to book into public BigD units around the UK before with zero success, so in the past I have used a private unit (The London Clinic) and limited my travel to day trips close to London.

I have had success in other countries in the group: I have dialysed in public units in both Italy and in Ireland.  The dialysis was safe, expert, and free, and both had a delightful local flavour.

I have another option this time.  My local BigD clinic is a Diaverum clinic, a relatively new group, created 4 years ago by spinning off the Gambro Healthcare clinics in Europe.  I have asked my Unit Manager if it is possible to use the Diaverum clinics in Europe.  Hopefully there could be some benefit in doing this.

Though I dialyse 5 days per week in Melbourne, it is quite difficult to do so when travelling, so I will drop back to four or even three days per week (with increased time at each session, as needed).  So, over the next few weeks we will:

  1. Identify possible dialysis units in each country (public first, then if not available, private – Diaverum, then others), in particular a contact name, phone number and email address (Global Dialysisis the best place to start, it is a wonderful resource for BigD travellers)
  2. Choose suitable dates and if possible, approximate times, based on our flight plan
  3. Prepare an email for each unit, listing our proposed dates and times
  4. Send the emails to my Unit Manager
  5. She will send them on under her name, talking the BigD talk with the contact people and eventually confirming the booking dates and times
  6. Once we get tentative confirmation, we book the flights and accommodation
  7. Ask my Unit Manager to make a last check the itinerary, to make sure I am getting enough dialysis – it’s easy to miss a day when arrangements are constantly changing
  8. Arrange some form of travel insurance (again, we will use the Global Dialysis recommended insurer, to get a quote), though I have found useful cover difficult to get in the past.

Steps 5 and 6 tend to be iterative.  First choice days may not be available and they may suggest others.  This usually means we will have to rework our flight and accommodation bookings.  Eventually they will all mesh and we will be ready to go.

Obviously in addition to getting our China visas (no visas are required for the UK or Sweden) and ensuring our passports are valid, I usually get all my meds packaged in blister packs at the local pharmacy.  This is a great service.  It saves me worrying about all those different plastic pill bottles and packs, and helps minimise questions during drug searches (well I think it will, I have never actually been searched for drugs [though I have had a prostate check... at least that what the doc said it was]).  I usually take at least two extra week’s worth of blister packs, just in case I am delayed anywhere.

It is also useful to the take the contact details of other BigD units at each destination, just in case something falls through.

So, the preparation begins.  I’ll let you know how it progresses.



Friday, 06 January 2012 02:13

Starting Dialysis

Over the Christmas holiday time both Peter and Armand left comments about their nervousness starting the BigD, Peter for his soon-to-be wife and Armand for himself.

They are not alone. Everyone gets nervous about starting something as dramatic and alien as the BigD: the needles, being a patient, the machine, watching your blood go round and round through the dialysis kidney, the time commitment – it is a big life change.  Also, most people feel very unwell by the time the starts dialysis, so unwell that they can no longer work or play.  Things feel bleak.

But after a few weeks on the BigD, they begin to feel well again – often well enough to start taking their life back.  And once you get used to the routine (which takes about a month), you begin to realise that dialysis itself is no big deal:  you arrive with toxins in your blood, you sit there for three to four hours then you leave with nice clean blood.  Some people like to think of it as a four hour pee.

So what is the real BigD life change?  It’s the time it takes to make it all happen – usually about 15 hours a week.

When I started, my doctor suggested that I think of the BigD as my second job and to make allowances for getting there each session.  But I worked out pretty quickly that I really have no choice but to be there, it’s not some optional hobby.  So now I think of it as my main job, and I think of family time, my for-pay job, the gym, hobby time, movies, etc as things I can do because of my main job.

So now that you are joining the BigD club, the question is not How much of my life do I have to forego?  Rather it’s How will I refashion my life around this new BigD “job”?  Because of BigD, you still have a life.  So you can review it: do I want to keep doing what I did before, or is this my chance to reassess and reprioritise?  Should I negotiate to reduce my work hours?  Or should I start BigD early and work later?  Maybe change the focus to family, fitness or a new work/home mix?

Life with BigD will not be worse, just different.  It’s your choice how different.



Saturday, 24 December 2011 16:22

Holiday time

It’s Christmas Day here in Melbourne!  Time for family, reading books to grand kids (and to me) and hopefully next Tuesday, whipping up enough enthusiasm to clean out the garage.

Have a great Christmas everyone.  We’ll get together again in the New Year.



Its hot today: 32 °C (90 °F), which is normal, because summer started here just over a week ago.  Melbourne has a temperate climate, mostly a comfy 22° (68°F), with the occasional dip and blip as the seasons dictate.  Until yesterday we had delightful spring temperatures of 17°C to 22°C (63°F to 68°F); so it has been a big and a quick change.  But no problem!  I will be acclimatised within a couple of weeks and this will be the new norm.

Things were different before I went onto the BigD. I would have begun complaining about now that it was too hot, and not stopped until autumn arrived with some blessed low temperatures.

Not so now that I am a member of the BigD club.  One of the founding directives of the club is that you don’t drink more than about a litre a day of any fluid.  This includes not only water, coffee, tea, fizzy drinks, beer and whisky, but also watermelon, jelly, porridge, rice pudding and any other high fluid food.  This is because without kidneys or kidney function, the fluid has no way to leave the building.  So it stays in your blood, rests in body fat, ankles, lungs and anywhere else that gravity and body cavities allow.  The result is bloat, which is unsightly, uncomfortable and dangerous.  It becomes difficult to breathe, and the added load on your heart can be – and often is – fatal.

I have always liked to guzzle water (or an icy soft drink –not to mention beer – mmm… er, sorry).   From a young age I loved gulping water direct from the tap: cold, wet and plenty of it.  Perhaps I knew that kind of joy would be denied me later in life, so I drank as much as I could before the kidney bell tolled – who knows.  Anyway, now it’s a litre a day, and has been for so long that it is second nature.  I always reach for the smallest glass, half fill it and leave a little in the bottom when I finish.

Most BigD-ers can tell is they have drunk too much.  I know by my wedding ring, which doubles as a body fluid indicator.  Immediately after dialysis, when I’m at my base weight, my fingers are really thin, with very little flesh.  When I interlace them, I can feel the bones and not much else, and it’s possible for me to gradually slide off my wedding ring.  After a day’s break from dialysis, my hands become fleshier, and it sort of feels normal (softer) when I interlace my fingers. There is no way I could get my ring off.  If I have drunk too much, they become quite plump, and I can barely find my wedding ring.

So why do I like summer?  On a hot day, in the sun or the shade, we sweat.  A lot more than we imagine.  I usually have a drink or two of water or tea in the morning and the same in the afternoon.  In summer, each drink seems to evaporate as you swallow it.  On a really hot day, a drink an hour may not keep up with evaporation.  So guess what?  Guzzle time.  Every few hours through the heat of the day: a whole can of lemonade (Coke, with all that potassium is a bridge too far), or even the odd icy beer.  Just like before this BigD business began.  Bliss.

Just writing about this has made me thirsty, and I happen to know that there is a small can of lemonade with my name on it in the fridge.  Roll on summer.  Cheers!


Thursday, 24 November 2011 23:04

Dialysis Downtime up in the “air”

Life away from the BigD machine can be pretty good sometimes.  Julie gave me a birthday present in August which was booked out three months ahead – a Boeing 737 Airliner flight simulator.  My trip was for an hour, flying into and from our local airports and then into and from an airport of my choice.

I have flown plane (non-simulated) before.  I learned to fly a Cessna 150 in Albury, about 35 short years ago.  (It is only since I reached my 50s that I have been able to say 30 years of this, 35 years of that.  It gives me a funny (not Ha Ha) feeling, because I always thought that people who said that kind of thing were old.  I don’t feel old; in my head I feel around 25, but with some occasionally useful, occasionally embarrassing experiences.)

Still, I digress.  I learned to fly when I worked for a small defence electronics company in Albury.  It was a private company, owned and run by the founder, Lindsay Knight.  His products were smart target systems for anything that went bang, from pistols and rifles to vehicle mounted guns and tanks.  He had offices in London and South Carolina and travelled everywhere selling.  He had his own plane, a Beechcraft Baron and which he and his pilot flew around the country.  I was writing his technical manuals and I became friendly with Warren, his pilot.  Warren had invented a nifty little device for helping people land small planes safely and he wanted to patent it.  So I helped him write the patent for flying lessons.  The device was a clever design and worked really well, but like many smart inventions, it didn’t get the exposure it needed.

I well remember my first solo flight.  I met Warren at 0630 on a cool autumn morning for my usual half hour lesson.  We did some touch and go circuits and unexpectedly, Warren said: “You’re ready, do a solo circuit.” He jumped out, and deliberately without thinking, I pushed in the throttle lever and took off.  It was surreal, flying in cool, still crystal clear air all alone, the only one responsible for my safe landing.  It was a perfect circuit and a perfect landing.  And I was still on a high when I went home from work that afternoon.

A little after that we had out third child and Julie suggested that no matter how safe it was, I would be more likely to be there for the kids if I stayed on the ground.  And mostly I have done so, apart from a few lessons in an ultralight (something like a lawn mower attached to a sail) a couple of years ago, and a joy flight in a Tiger Moth last year.

Still, I’m very glad I learned to fly when I did.  I can’t fly now, because after the last transplant I lost much of the sight in one eye, and you need two working eyes to be a pilot.

However, I wanted each of our kids to understand the thrill of flying a small plane, so on their 17th birthdays I took each of them to a local flying school and arranged a half-hour flight, where the instructor gave them an introductory lesson.  None of them have taken up flying – yet – but they have at least had a go.

So last Sunday I climbed into the 737 simulator cockpit (with, for the first time, Julie and my daughter Kathy as passengers in the seats behind me).  I had a briefing from the instructor and when I looked up, we were sitting on the tarmac at Melbourne Tullamarine.

On the runway at Tullamarine

I pulled back the throttle, gently touched the rudder pedals and within a minute, we were airborne.  It only took a moment to believe that we were flying, and as we turned for Avalon airport, much of the feel and responses I haven’t felt for so many years came back to me.  It is so much like the real thing my heart was racing and I was sweating to get aligned for the landing.  The first half hour, touching and going at Avalon, Moorabbin and Essendon airports and landing aback a Tullamarine was a great way to get back into groove.

Innsbruck airport between the mountains

For the last half hour, I chose Innsbruck airport in Austria.  It is a difficult airport, located in a river valley with very high snow-capped mountains all on both sides.  Take off involves getting high very quickly while flying left in a gentle arc that follows the valley.

Getting above the snow line

Mountains get very close.  But the 737 is very powerful and the plane lifts easily over the peaks.  Landing is similarly cramped and the runway is short.  But again, the plane design, air brakes, landing gear and flaps make it relatively smooth.  Luckily there was no wind shear or turbulence.   However we did simulate losing one engine.  That was fun.

In fact the whole thing was a real buzz.  It’s over week now since the flight and I am still enjoying it.  Hopefully I can afford a longer flight next year!  Alternatively, I wonder if they can set up a BigD machine in the co-pilot’s chair, so I can benefit on two fronts?

The one hour flight cost A$275.  The simulator is part of the Flight Experience group., with simulators in Australia in Melbourne, Sydney, Brisbane, Adelaide and Perth, and in Hong Kong, Bangkok, Singapore, Kuwait and Europe.


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