How this retired Navy Commander reclaimed his life with home dialysis
When his creatinine levels reached an alarming level of 5.5, 73-year-old retired Navy Commander Dattatreya Toke had no option but to undergo dialysis. Suffering from Chronic Kidney Disorder (CKD) — a progressive and irreversible condition that can at best be slowed down — for over three years and treated by doctors at the Indian Naval Hospital Ship (INHS), Asvini, Mumbai, he realised that time was not on his side. And that dialysis was his best bet at lengthening it. But he didn’t want to waste the value of his borrowed time by traveling to and from dialysis, spending hours in the hospital or undergoing the treatment. So, he decided to do the next best thing, go for a home dialysis machine. And take up the serious business of running it like a DIY (do-it-yourself) project.
However, like the naval commander he used to be, he treated his recovery like a mission that had to be accomplished. He got a tube permanently inserted this year through the abdomen to allow a fluid called dialysate to be emptied and replaced every day and cleanse his body of toxins. He underwent training by doctors at INHS to operate the home dialysis unit. Today Commander Toke has returned to his normal life, stepping out daily for morning walks, driving his car and working up a better appetite for not just food but life itself.
KIDNEY DAMAGE CREPT UP ON HIM DESPITE AN ACTIVE LIFE POST-RETIREMENT
A marine electrical and control engineer, Commander Toke headed the electrical department of a naval cruiser and retired in 1989. He joined a private firm dealing with optical fibres and travelled extensively worldwide between 1997 and 2011. “It was sometime in 2012 that I began complaining of recurrent health issues, including those related to blood sugar and hypertension,” says he, admitting he did a fair share of smoking. “However, they did not deter me from my physical activity and routines as I started studying Sanskrit and got engrossed in developing solar energy projects. My mind was alive and well,” he adds.
In November 2019, Commander Toke had symptoms of fatigue and sleepiness all the time, disrupting his normal rhythms at work. Investigations showed high levels of creatinine. The sudden turn of events and a course correction of his life made him very irritable and depressed. “It was psychologically a very disturbing phase in my life,” he says. While his wife Jayashree handled him like a child, a trip to the US earlier this year to visit his daughter compelled him to face his changed reality and deal with it. “My creatinine levels had shot up so high that my daughter had to escort me back to India,” he recalls. “Both my daughters and wife played a very supportive role and convinced me to go for dialysis,” he says.
He was also guided by his treating doctor, Surgeon Commander Vineet Behera of the INHS Asvini, to go for home dialysis instead of visiting a hospital at least twice a week.
HOW PERITONEAL DIALYSIS WORKED FOR HIM
Peritoneal Dialysis (PD) collects waste from the blood by washing the empty space in the abdomen (peritoneal cavity). It can be done easily from home with the access tube inserted through your abdomen. Once you put sterile PD fluid (dialysate) into your belly, it stays there, or dwells as they say, for a few hours. Meanwhile, you can go about your daily activity as the fluid absorbs waste. Then after a certain period of time, you can drain out the used fluid and refill fresh fluid. This process is called an exchange.
Basically, PD uses the inner lining of your belly (peritoneum) as a filter to clean your blood. A surgeon places a tube, as narrow as a straw, through the wall of your belly or chest (it is called presternal catheter). It is through this tube that you have to fill your belly with sterile fluid.
Most people use a cycler for PD—a machine that will fill your belly with the fluid and empty it out. Cycler PD is most often done at night while you sleep. If you can do the PD steps yourself and lift the fluid bags, you don’t need support.
There are two ways to do PD. If you choose to do it by hand, then you have to change fluids at breakfast, lunch, dinner and bedtime. Each session takes about 20 or 30 minutes. This is called continuous ambulatory (walking around) PD, or CAPD.
KEEPING UP WITH THE CLOCK
“Surgeon Behera and Askhata Wagh trained me and my family members with patience and perseverance and I am really grateful to them,” says Commander Toke. “Initially, the process of dialysis at home can be overwhelming as fluid insertion takes place post-dinner and the liquid has to stay in the peritoneal cavity in the stomach for a good 12 hours before draining it before breakfast. Equipment like a fluid bag stand and others have to be disinfected and even the clothes kept in the autoclave have to be sterilised. It requires thorough sanitisation of equipment and I cannot afford to allow any infection,” the Commander says.
STRAPPED, BUT LIFE IS BEAUTIFUL
Once he grew comfortable with a stable set-up at home, Commander Toke even made a day trip from Mumbai to Pune to test his abilities. A stickler for discipline, he ensured he went through the dialysis process after reaching home at 10 pm. Now that he is practised, doctors have given him emergency medication as a stand-by in case of a viral infection. He has also been asked to report at the hospital in such a scenario. “I am now convinced that dialysis is not all that difficult as it is considered to be. It can be made simple and carried out from within the confines of your home,” he says as he shares chores with his wife and resumes his daily routine with a new-found enthusiasm.