When Dialysis Abroad Becomes a Risk
A recount of the close calls we experienced while doing dialysis overseas
In previous posts, I have been candid about our personal experience trying dialysis abroad in order to feel a sense of normality and attempt to keep living our lives. We were so impressed with our experience in France that I spent most of my previous posts talking about the positives of our adventure. There were a few times, however, that Andy’s health was put in jeopardy, and we were faced with situations that were difficult to tackle while vacationing abroad. Here are just a few things that happened that weren’t so positive, but better prepared us for any other issues that may arise while partaking in dialysis overseas.
When a Mini Vacation Goes a Bit Off the Road
When we bought our home in France, we bought it with the intention of using it as a home base as we traveled all over Europe during the summer months. Our plans were ground to a complete halt, though, when Andy began to need dialysis treatments, making it very difficult to just pick up and leave as spontaneously as originally planned. This led us to explore our own back yard of Provence a bit more in depth, picking locations within driving distance to visit for long weekend trips. One of our first big weekend away was a visit to the absolutely stunning Gorges du Verdon.
This photo is not edited! The Gorges du Verdon actually looks like this!
The Gorges du Verdon was about two hours away, which was the limit we felt comfortable traveling from Andy’s dialysis clinic. We arrived Friday, late afternoon, and planned to stay until Monday morning, when we’d have to make the drive back home for his weekly treatment that afternoon. Friday evening, all of Saturday and even Sunday afternoon went off without a hitch, visiting the beautiful gorges each day and even heading into a few local towns mentioned as favorite stops for other tourist visiting the region.
Moustiers-Sainte-Marie is a beautiful town not far from the Gorges du Verdon
On our way back from visiting Moustiers-Sainte-Marie, though, we ran into a bit of a problem that we definitely didn’t plan for. The back roads leading to the gorges are small and mostly used by the inhabitants of the tiny villages nestled within the surrounding mountains. Our rental Peugeot, up until that point, didn’t have any issues maneuvering the compact roadways until we were met with a larger SUV who was coming the opposite direction. We slowed down, thinking that we’d gingerly accommodate each other, but the SVU had other ideas, continuing at full speed towards us and edging our tiny Peugeot off the road and into the deep trenches filled with sharp mountain rocks. We paused for a moment, a little shocked by the experience and aggression of the other vehicle who we spotted in the rearview mirror continuing on his way down the mountainous path. After taking a deep breath and a little extra pressure on the gas, we were able to steer ourselves up and out of the ditch and cautiously continued on our way home. At that point we were about a half hour from our Air B and B, but decided to take it slow, not wanting to have a repeat of what had just happened.
We were about five minutes down the road when we started to feel a wobble.
“Is that the road?” Andy asked in a wishful thinking tone.
Not wanting to burst his bubble, I answered with a noncommittal, “I don’t think so, but I could be wrong.”
A small parking lot appeared on the left-hand side of the road, and we pulled over to take a pause and inspect the car further. Opening my car door, my heart sank. It was our literal worst nightmare. The passenger-side front tire was sinking into the gravel… we had a flat tire.
If you are a non-dialysis patient reading this, you’re probably thinking, “why not just change the tire?” There are two reasons for this.
First, when Andy had his fistula created in his arm, that meant his days of lifting anything over 10 pounds was over. Dialysis patients understand that you can’t do absolutely anything with that arm that may jeopardize your fistula.
This leaves A LOT of the heavy lifting of things to me… who is 5’1 and mighty… but not so strong.
Second, we did investigate the car and found that we had a spare tire and some basic tools, but, when we both tried to unscrew the bolts of the original, now flat tire, we were both not strong enough to get them off. We were in quite the pickle!
In the U.S. you would just call roadside assistance or a tow truck no matter what time or day and voilà, within an hour or so be on your merry way. Here in France, however, Sundays are days where many things are notoriously closed in rural areas, especially places like auto body shops or mechanics.
We did call the emergency number for our rental car and was told the we could bring it to a repair shop that was located about 20 minutes away when they opened the next day, Monday, at 10 am. Explaining our situation, we told the person that we’d have to get on the road early Monday morning in order to make it back in time for Andy’s treatment. We also mentioned that we were unable to drive the car anywhere, due to the fact that we couldn’t change the tire.
After a bit of calling around, he was able to find a tow truck to come change the tire for us. Now, the only issue was that the spare tire couldn’t be driven over 50 miles per hour and our route home was all major highways.
“Perhaps there will be less people on the road since it’s a Sunday,” I reasoned. “I think we should cut our weekend short and slowly and safely drive home today and avoid the rush hour traffic of Monday.”
It was disheartening, trying to live like normal vacationers, but we were swiftly brought back to reality when encountering something as simple as a flat tire. Under normal circumstances, a flat tire is a pain, but wouldn’t have the power to derail a whole trip. Missing a treatment after being off for two days, however, wasn’t an option and so, our two-hour trip home took about 3 and a half as we inched further and further north into the tippy top of Provence. We were, of course, disappointed, but so thankful that the situation wasn’t any worse and we were able to find a solution that kept Andy safe.
No Liquids for 48 Hours!
I can’t stress how incredible Andy’s dialysis clinic is in France and have devoted a few posts to the wonderful staff, practices, and the health care system as a whole. To say it is complete night and day from our experience with the clinic here in the U.S. is an absolute understatement. I will say, however, that we have taken two trips within the U.S. in the past few months and the clinics he visited in Orlando, Florida and New Orleans, Louisiana were magnificent, leaving us to wonder if it really is just the ones around Pittsburgh that leave so much to be desired.
The clinic in France is so meticulous and thorough that, when our next hiccup happened, I actually didn’t believe him when he told me.
It was a Friday afternoon when he arrived home from his treatment and handed me a card.
“Something happened today at dialysis,” he started. I was used to him coming home and saying that in Pittsburgh, as the laundry list of shenanigans continued to grow at that clinic, but when he said it in France, I knew it must be something big. I looked down at the card and noticed it was contact for a specific department in the Avignon emergency room.
“What’s going on?” I questioned, not really sure if I wanted to hear the response.
“I’m not really sure how it happened,” he started, “but whoever set up my machine today didn’t do it accurately and I went through the whole treatment without actually taking anything off,” he said, clearly unsure of what to do now.
By “taking anything off” he meant fluid. Dialysis patients lose the ability to produce urine, which is how many toxins and fluid are removed from your system. By going to the treatments, the patients are essentially removing the fluid left in their system from drinking or eating foods high in water content and also cleaning their blood of toxins. With a whole weekend ahead of us, Andy was instructed to not drink anything…. for 48 hours. He was also told that, if he started to have trouble breathing, he must go directly to Avignon since it was the weekend, and the clinic would be closed.
“That’s it?” I shook my head in disbelief, surprised that they’d send him home in such a state.
“That’s it,” he confirmed. “Because it’s the last shift before the weekend and they don’t open until Monday, nothing can really be done.”
Now, I am fully aware that this accident could have happened anywhere and at any time, but in regard to the situation, it very much felt as if we were just waiting for the other shoe to drop. What was meant to be a relaxing weekend away from his weekly treatments brought them to the forefront of both of our minds. I immediately canceled all of our plans for that weekend.
The Dentelles de Montmirail
The long hike we had planned to take scaling the Dentelles de Montmirail would be miserable if he got thirsty and couldn't quench his thirst. I also canceled our dinner reservations. Cooking at home, you are able to modify recipes for the dialysis patient, cutting down the salt and finding alternatives to forbidden ingredients. Not wanting to roll the dice with someone else’s cooking, I opted to make some simple grilled veggies and chicken over rice.
As Monday morning rolled around, I woke up to the smell of coffee. Since he hadn’t touched any liquid the whole weekend, he was rewarding himself with a big cup of coffee before heading off to treatment.
This situation could have easily spiraled out of control, but fortunately it just left us on edge for the weekend. While it wouldn't have been an ideal situation to deal with in our home country, being two people who were still figuring out all of the terms for dialysis in French, we weren’t looking forward to the possibility of the hour drive to the ER and having to try to explain the situation in cobbled together French.
One thing that did happen over the weekend that took us by surprise was that one of his nurses from his clinic texted him to check in. In all the time that he has been sent home from his clinic in Pittsburgh after a major flub on their behalf, not once was he ever called and checked in on. The quick message just reaffirmed that the whole process in France is more patient centered than back home.
If there is one thing I would like you to take away from this post, it is that travel is possible, even on dialysis. Above were just two examples of hiccups that we experienced while Andy was on dialysis abroad. If anything, they do show us it’s not all sunshine and honey, but it is doable! Make sure you plan ahead for the unexpected and just be prepared for anything, which is good advice to heed whether you’re on dialysis or not.
If you are inspired to travel abroad despite your treatments, please take a look at my post on dialysis abroad to spotlight some of the differences between dialysis in the U.S. and in France.
Safe Travels!
-Rachel
