Health

Friday 22 August 2014

Driving Home Dialysis

The great outdoors: Jan in his home/hospital

I use four bags of dialysis fluid a day

You could say that Dutch sculptor Jan Ploeg has an unusual lifestyle. He lives for much of the year in a customised Volkswagen van with its own bed and desktop, on a meadow just above the high water line on the Co Clare coast,

He gets his water from a nearby well, stores his food on shelves made from plastic water bottles cut in half, cooks his meals in an outdoor stone kitchen that he built himself and swims for hours with Dusty, the local dolphin every day. But there's more.

Jan has chronic kidney disease and, since last January, has had to have dialysis. Most people have dialysis in hospital. But, unwilling to disrupt his tranquil lifestyle with exhausting trips to hospital several times a week, Jan opted to carry out dialysis on himself – in his van.

Jan is one of the 13pc or so of dialysis patients who opt for home dialysis.

His methods may be unorthodox, but, as his consultant nephrologist David Lappin admits, they work. As part of his daily Peritoneal Dialysis routine, the 64-year-old from Groningen in North Holland, uses four bags of dialysis fluid. These must be warmed beforehand – not easy if you're living in a converted van, but somehow, Jan makes it work.

In summer, he hangs the bags in the window of his van at Famore, near Lisdoonvarna, where they warm in the sun. He puts them between hot water bottles, on the van heater or in a basin of hot water in colder weather.

Jan, who has been on the transplant list for some 28 months, performs Peritoneal Dialysis every four hours as part of his daily routine, successfully combining activities like working on his computer while conducting his dialysis – and has never had an infection.

Peritoneal Dialysis involves exchanging fluid into and out of the abdomen four times a day – in the other kind, haemodialysis, blood is circulated through a machine which purifies it.

The Dutchman loves his life in Ireland – he visited the country for the first time in 1992 when he travelled to Dingle to swim with Funghi. After that he holidayed here every year, before moving to Ireland permanently in 2004.

"Up to about three years ago I'd swim for four or five hours a day, but now, since I am on dialysis, I swim for two to three hours a day, though not in December because of my kidneys. I am susceptible to the cold," says Jan, who is divorced with an adult daughter, Anne Linde, who lives in Holland.

These days he swims from March to mid-November and continues to work with wood, though nowadays, giving his self-sufficient lifestyle, his work is more practical than decorative – he recently made a wooden mono-fin, which he uses during his swims with Dusty, along with a water- wing, which he also made from wood.

Despite his condition, he copes well with the cold Irish weather – partly through being highly active and very organised.

"In the day I'm working in the meadow when I am not swimming. In the evenings I wrap myself in a few sleeping bags with a lot of hot water bottles and when it gets very cold I will let the engine run." During the winter he rents an apartment, but he's back in the van come April or May.

Jan's journey to living in Ireland began more than 20 years ago when, after suffering from depression for many years, he heard about the potential healing effects of swimming with a famous Kerry dolphin. "In 1990 I met Horace Dobbs who founded the International Dolphin Watch – we met in Tenerife. Horace told me about the healing effects on depression of dolphins and advised me to go to Dingle." Two years later he swam with Fungi for the first time.

"It was fantastic. I found a being that I felt I had connected with and that I could share my love of swimming and water with. It was the whole social aspect of it too because there were lots of people who swam with Fungi at that time." Jan enjoyed the experience so much he continued to visit Dingle every summer until 2004, when he inherited some money from his father and moved to Ireland to live.

'Since the late 1980s I had been told that my kidneys were deteriorating and in 2010 I was told I was going to need dialysis. Then in January 2012 I was put on dialysis. I was given the option of home or hospital dialysis." He chose the home option, he says, because it would have meant a 120-km round trip to the hospital in Galway three days a week. "I can't afford to drive on my disability allowance of €190 a week so I'd have had to be collected. This would have meant spending a whole day travelling to and from hospital and getting treatment three days a week."

"It would take away half of my life and I wouldn't be able to plan anything that would take longer than a day," he says. He makes regular trips to Holland to visit his mother and his daughter, and this would not have been possible if he was receiving hospital-based dialysis.

"The home-based dialysis involves the delivery of fluid and equipment every fortnight. I have to have dialysis for up to an hour every four hours in the daytime. At night I have a different type of fluid which lasts for eight hours.

"I use a total of four bags of dialysis fluid per day. If I don't warm the bags I'll get two litres of cold fluid in my belly which in turn causes an excruciating pain in my shoulder – it's something to do with the nerves according to the doctor."

Somehow, Jan's unorthodox method has worked. "If you have little money and a lot of energy you'll find a way," he says. He's fit and healthy – he goes rock running when the weather is dry and eats a lot of sea spinach which grows on the border of the meadow:

"I call it the 'diamond edition' of spinach. It's very good for you, very healthy and very plentiful."

And while he may live in a van in a field in the middle of nowhere, he's in contact with people all over the world through his website about swimming with dolphins, jnploeg.nl.

"I have broadband – I have an aerial which I mount on a stick or on a plank on my roof. It's weighed down with two five litre bottles of water so that it won't blow away in the wind and I have perfect reception! Jan has also recently built a sailcloth tent which acts as a workshop.

"I love living in the van. I only live in the apartment in wintertime because of the dialysis. I'd stay in the van otherwise. The meadow is the most beautiful place in the world; it's in the middle of nature and I learn new things all the time – recently I found that when they're hungry, the seagulls pick up sea-urchins, fly high above the rocks then drop them so that their shells crack, enabling the gulls to eat the meat inside.

"I'm living proof that you can have dialysis at home and be independent and mobile. This summer Dusty was swimming in Doolin, about 16 km away from where I live, and I was able to travel there and do my dialysis in the van – simple! The system is very clever and very easy to learn. It's very logical and straightforward."

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