Trending
DEAR DR. ROACH: My daughter, age 44, has had chronic kidney disease since she was 10 years old. She had a renal transplant at 23, then another at 32. The second graft started gradually failing a year back. In January, she was diagnosed with ovarian cancer. This past month, she had a total hysterectomy, along with the removal of malignant tumors and nodules. She has since been on hemodialysis without any output of urine. What are the possibilities with peritoneal dialysis? Will this enable her to have a near-normal life? -- R.S.
ANSWER: Peritoneal dialysis uses the immense lining of the abdominal wall (the peritoneum) to act as a kind of kidney. A special dialysis fluid is instilled into the peritoneal space through a catheter. Excess potassium and acid, along with metabolic toxins that are normally removed by the liver, get diffused into the peritoneum and the dialysis fluid. The fluid is then drained through a second catheter, which removes these unwanted chemicals from the body.
This may be repeated multiple times at night through an automated machine (continuous cycler peritoneal dialysis, or CCPD). It can also be done manually throughout the day (continuous ambulatory peritoneal dialysis, or CAPD). I’ve asked many kidney experts which type of dialysis they’d want if they needed it, and most preferred peritoneal dialysis to hemodialysis. (The only ones who didn’t prefer peritoneal dialysis wanted home-based hemodialysis.)
The main issue for your daughter is the surgical scarring from her ovarian cancer surgery. Scars greatly reduce the amount of peritoneal tissue for fluid to diffuse across and limit the effectiveness of peritoneal dialysis. Furthermore, some women with ovarian cancer have cancer disease within the peritoneum itself, which would make peritoneal dialysis a bad option due to concerns with the cancer treatment and the risk of infection.
Experts recommend a peritoneal catheter via laparoscopic surgery, which would allow the surgeon to see if she’s a good candidate for peritoneal dialysis. Her cancer surgeon and kidney specialist need to discuss this.
DEAR DR. ROACH: My granddaughter, who’s only 18, experiences crashes with her blood pressure. She has to put on compression hose before she even gets out of bed, and she also requires a very strict diet. I know she gets these IV drinks that have something to do with salt. I also know she had a lot of tests done, and a tilt table test showed postural orthostatic tachycardia syndrome (POTS). I’m not sure which medicine they’re giving her; is this something that you can look into? -- R.W.
ANSWER: POTS has been more frequently diagnosed within the past five years, and experts believe that it’s a frequent result of COVID infections, especially in younger women. Different people may have different major symptoms with POTS. For people who have low blood pressure, like your granddaughter, compression stockings as well as plenty of salt and water are the first-line treatments.
A graded exercise program helps many people but can be a problem for some. Medication isn’t always needed, but midodrine and fludrocortisone are sometimes used symptomatically. However, these need to be used with caution. Most people will gradually improve, but there’s a subset of people who may continue to have symptoms for even longer than a year.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved