ESRD. End Stage Renal Disease. Huge volumes of information are available regarding kidney disease at all stages, but ESRD implies a kidney patient must face tough decisions regarding his or her treatment. Most materials are very direct in the approach to kidney disease, i.e. "dialyze or die." However, there are options for necessary dialysis, including a kidney transplant.
Hundreds on kidney patients live and are treated in the Middle Tennessee area. Near 60 of those are treated at Dialysis Clinic, Inc. in Shelbyville.
The DCI on-profit treatment centers number at least 230 clinics in 28 states.
The Jackson family still operates these clinics, which owe their success at treating kidney patients and aiding transplant donors.
Digitally efficient machines monitor blood pressure, can be set to pump blood at certain rates of exchange, i.e., so many milliliters of blood per minute and includes advanced filtering with dialyzer units for each individual.
The actual dialyzer is removed for cleaning at the end of each session and trashed, or in some instances sent for cleaning to be reused by the same individual. The filtering process removes waste and water from the blood of the patient, performing as natural kidneys would.
More than six years ago, my family physician sent me to a nephrologist as my blood tests reflected possible kidney issues. After several years of monitoring my condition, the doctor suggested, "You know? I expect you will need dialysis eventually."
I was flabbergasted... how could this be possible? I dismissed the fact that my brother spent ten years on dialysis before receiving a donor kidney. In denial and suppressed anger, I sought the opinion of another nephrologist. During approximately two years of visits to the new doctor, (Dr. Oladapo Omitowoju) the exact same diagnosis was repeated to me as before.
I laughed in continued disbelief. How and why had my kidneys failed? Answer: Hypertension; fluctuating blood pressure, long-term.
A one-time diagnosis of diabetes was put aside, blood sugar levels, normal, and the nephrologist tripled the dosage of my blood pressure medicine. My kidneys functioned at 14-16%. Later: 8% and in a few more months, 4%. Dr. O. announced, "It is time. You can begin hemodialysis Friday."
Driving home, unable to think clearly, I concentrated on what Dr. O. had said. My condition was likely genetic. I could live for many years on dialysis. We discussed all the options in treatment and he arranged with surgeon Dr. William Russell to create a fistula in my left forearm. That did not succeed, as my veins are too fragile.
So, Dr. Russell installed a graft in my left upper arm, a plastic tube over a vessel that allows for the insertion of two needles. Blood out, blood in, through tubes attached to the hemodialysis machine. Because I slept through that surgery I became more calm and accepted that my life was changing.
An afternoon on the dialysis machine for me can be at any one of 23 stations at DCI. Ten to 23 patients and myself are plugged into the dialysis machines for several hours during any of three shifts on a Monday, Wednesday and Friday.
One of five nurses, four certified technicians, the interns and assistants welcome us to the clinic directed by Faye Chavez, RN, Nurse Manager.
We weigh in, wash our hands and access sites and are directed to our heated chairs and digital machines for the day's session.
May is my fourth month on hemodialysis at DCI.
The large clinic on the second floor of the Russell Plaza Building is beautifully designed and decorated in comforting colors of blue, green and white. The floors, counter tops and all surfaces shine. Television sets hang above all 23 stations. Florescent lighting is recessed in the ceiling and large windows on three sides allow us to view the woods and fields in the surrounding area. The view is beautiful, especially on a sunny day.
Nutritionist, Emma Montgomery, RD, LDN, with social worker, Rene Brothers, LAPSW, and the Clinic Director, Faye Chavez are all at work when patients arrive. The Clinic opens at 5:30 a.m. and those last to leave depart late in the evening. The RN's, Logie Fuerte, Haydee Rivera, Ted Labayo, and Maria Belinda Enriquez are scheduled per shift with alternating late evening duty during the week.
The CCHT group (clinical technicians) all share the same alternating schedule. Those individuals include: Chauneuell Green, Jennifer Johnson, Lanisa Crosslin, and Diana Aldridge. Jason Gentry is the Bio-Med Technician, and Beverly Waddell is the Unit Office Clerk. Beverly is the first to greet patients at the office window when we arrive at DCI.
I am scheduled to dialyze from 2 to 6 p.m. Monday, Wednesday and Friday, but am often called to come in early when a station is available. The drive from home to the Clinic is 16 miles one way. The 90 miles per week can be deducted as medical-related expense on income tax filings.
Travel to and from the clinic is the only expense not covered by insurance. Medicare covers other charges and DCI is a non-profit medical service. Average cost of treatment per patient, per session is normally more than $1,000.
Hemodialysis is not easy or comfortable initially, but one becomes accustomed to the process, and we beginners are treated with compassion and understanding by all the staff. Conceding to the time necessary each week is challenging if one is usually busy with work, childcare, or other endeavors.
Driving back and forth in bad weather is equally challenging. But the real challenge for me was facing those two large needles inserted into my upper arm, through the graft there installed for precisely the purpose of filtering or cleaning my blood.
Once plugged into the tubes that circulate the blood through the dialyzer, a patient's blood pressure is monitored every half hour. Heartbeat and body temperature are measured, speed of circulation is set for milliliters per minute, ankles and legs checked for swelling. (Many patients are diabetic and have lost kidney function as a result.)
One marvelous invention is a numbing cream, which applied a couple hours before a session does keep the patient from feeling the pain of those large, needle sticks. I am a strong advocate of this pain-relieving cream applied to my upper arm.
Initially, one begins with small needles at a pump rate of 175 to 300 ml per minute, and that is gradually increased to a rate of 400 ml per minute with larger needles. Time on the machine is a standard four hours per session.
A graft is a surgically implanted tube in the arm that covers a large vein. The tube allows or accommodates the two-needle placement for blood in, blood out. There are other kinds of access. One is a port in the chest or another, a port in the belly for peritoneal access. Another solution to ESRD (end stage renal disease) is a kidney transplant. Thousands of individuals await transplants. Currently, I do not qualify because I have not yet been on dialysis for two to five years, nor were any of those who offered me a kidney qualified to be donors.
So I and thousands of others will continue dialysis for the remainder of our lives. Some disqualifying instances for potential donors include being a childbearing age female, being obese or very elderly, or having once been a cancer patient. Without dialysis, I would die and soon. That explains most of the emotional, mental, psychological adjustment every patient faces. One irony is the fact that many kidney conditions are genetic and entire families can be subject to these choices for treatment for life.
One can lose two to five pounds in one session on the machine.
Therefore, the necessity for weighing in and out at every session, and for the patient's limiting liquid and sodium intake between sessions is extremely important. Blood chemistry is monitored monthly and discussed with the patient by the nutritionist. Patients learn all about foods high or low in sodium, potassium, phosphorous, and readings include blood number measurements of albumin, creatine, hematocrit, vitamin D and more. Believe me: at DCI, in the atmosphere of face masks, white coats and blue latex gloves, with bleach and vinegar as cleaning fluids, nothing goes unnoticed, unrecorded, unmeasured or unmentioned!
There are several DCI Clnics in the middle-Tennessee area, including Murfreesboro and Nashville. DCI social worker Rene Brothers, can arrange for patients to dialyze elsewhere, even as far as out-of-state or in another country. But that, I am not quite ready to do. However, Missouri and California are on my bucket list for trips outside Tennessee, even if I must taxi myself to a clinic three days during a week-long visit.
Thanks to Dr. Kolff and Dr. Johnson, I will not only survive, but can lead an active, productive and happy life. We thousands of kidney patients and our families owe deep gratitude to the many non-profits who so generously provide this costly, life-saving service. Thank you, DCI, Shelbyville!